NR 546 Week 4 Exam V2 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
4 Exam) | Chamberlain University
1. A 28-year-old patient is prescribed Fluoxetine for Major Depressive Disorder. The patient
asks why this medication only needs to be taken once daily compared to other
antidepressants. What is the most accurate pharmacological explanation?
A. Fluoxetine has a high affinity for the dopamine transporter.
B. Fluoxetine undergoes rapid first-pass metabolism in the liver.
C. Fluoxetine and its active metabolite norfluoxetine have exceptionally long half-lives.
D. Fluoxetine is an irreversible inhibitor of Monoamine Oxidase.
Correct Answer: C
Explanation: Fluoxetine stands out among SSRIs due to its long half-life of approximately
2-3 days, while its metabolite norfluoxetine lasts up to 2 weeks. This pharmacological
profile reduces the severity of discontinuation symptoms if a dose is missed. It also
necessitates a longer washout period when switching to an MAOI compared to other
antidepressants.
2. Which side effect is a primary concern for patients taking Venlafaxine (Effexor XR) at
dosages exceeding 225 mg per day?
A. Dose-dependent increase in blood pressure
,B. Significant weight loss and anorexia
C. Acute renal failure
D. Priapism
Correct Answer: A
Explanation: Venlafaxine acts as an SSRI at lower doses but increases norepinephrine
reuptake inhibition at higher doses. This increased noradrenergic activity can lead to
sustained elevations in diastolic blood pressure. Regular blood pressure monitoring is
mandatory for patients on high-dose SNRI therapy to prevent cardiovascular
complications.
3. A PMHNP is considering Bupropion for a patient with depression and a history of nicotine
dependence. Which condition would contraindicate the use of this medication?
A. Hypothyroidism
B. Seasonal Affective Disorder
C. Generalized Anxiety Disorder
D. Anorexia Nervosa or Bulimia
Correct Answer: D
Explanation: Bupropion is strictly contraindicated in patients with a history of eating
disorders such as anorexia or bulimia due to an increased risk of seizures. The medication
lowers the seizure threshold significantly in these populations, likely due to electrolyte
, imbalances associated with purging behaviors. Clinicians must screen for current or past
eating disorder symptoms before initiating NDRI therapy.
4. When switching a patient from a Selective Serotonin Reuptake Inhibitor (SSRI) to a
Monoamine Oxidase Inhibitor (MAOI), how long must the ‘washout’ period be for most
SSRIs?
A. 24 hours
B. 7 days
C. 14 days
D. 30 days
Correct Answer: C
Explanation: A 14-day washout period is required to ensure that the SSRI is completely
cleared from the system before starting an MAOI. This period prevents the development of
Serotonin Syndrome, a potentially fatal condition caused by excessive synaptic serotonin.
Note that Fluoxetine requires an even longer washout of 5 weeks due to its unique half-life.
5. A patient presents with ‘electric shock’ sensations, dizziness, and irritability after abruptly
stopping Paroxetine. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Relapse of Major Depressive Disorder
C. Antidepressant Discontinuation Syndrome
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
4 Exam) | Chamberlain University
1. A 28-year-old patient is prescribed Fluoxetine for Major Depressive Disorder. The patient
asks why this medication only needs to be taken once daily compared to other
antidepressants. What is the most accurate pharmacological explanation?
A. Fluoxetine has a high affinity for the dopamine transporter.
B. Fluoxetine undergoes rapid first-pass metabolism in the liver.
C. Fluoxetine and its active metabolite norfluoxetine have exceptionally long half-lives.
D. Fluoxetine is an irreversible inhibitor of Monoamine Oxidase.
Correct Answer: C
Explanation: Fluoxetine stands out among SSRIs due to its long half-life of approximately
2-3 days, while its metabolite norfluoxetine lasts up to 2 weeks. This pharmacological
profile reduces the severity of discontinuation symptoms if a dose is missed. It also
necessitates a longer washout period when switching to an MAOI compared to other
antidepressants.
2. Which side effect is a primary concern for patients taking Venlafaxine (Effexor XR) at
dosages exceeding 225 mg per day?
A. Dose-dependent increase in blood pressure
,B. Significant weight loss and anorexia
C. Acute renal failure
D. Priapism
Correct Answer: A
Explanation: Venlafaxine acts as an SSRI at lower doses but increases norepinephrine
reuptake inhibition at higher doses. This increased noradrenergic activity can lead to
sustained elevations in diastolic blood pressure. Regular blood pressure monitoring is
mandatory for patients on high-dose SNRI therapy to prevent cardiovascular
complications.
3. A PMHNP is considering Bupropion for a patient with depression and a history of nicotine
dependence. Which condition would contraindicate the use of this medication?
A. Hypothyroidism
B. Seasonal Affective Disorder
C. Generalized Anxiety Disorder
D. Anorexia Nervosa or Bulimia
Correct Answer: D
Explanation: Bupropion is strictly contraindicated in patients with a history of eating
disorders such as anorexia or bulimia due to an increased risk of seizures. The medication
lowers the seizure threshold significantly in these populations, likely due to electrolyte
, imbalances associated with purging behaviors. Clinicians must screen for current or past
eating disorder symptoms before initiating NDRI therapy.
4. When switching a patient from a Selective Serotonin Reuptake Inhibitor (SSRI) to a
Monoamine Oxidase Inhibitor (MAOI), how long must the ‘washout’ period be for most
SSRIs?
A. 24 hours
B. 7 days
C. 14 days
D. 30 days
Correct Answer: C
Explanation: A 14-day washout period is required to ensure that the SSRI is completely
cleared from the system before starting an MAOI. This period prevents the development of
Serotonin Syndrome, a potentially fatal condition caused by excessive synaptic serotonin.
Note that Fluoxetine requires an even longer washout of 5 weeks due to its unique half-life.
5. A patient presents with ‘electric shock’ sensations, dizziness, and irritability after abruptly
stopping Paroxetine. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Relapse of Major Depressive Disorder
C. Antidepressant Discontinuation Syndrome
