NR546 Final Exam Advanced Pharmacology:
Psychopharmacology for the PMHNP Tested
Questions with Revised Answers + Guarantee Latest
2026/2027
Question 1.
A psychiatric medication undergoes extensive first-pass metabolism. The clinical
consequence is that:
A. The drug bypasses the liver entirely when taken orally
B. Only a fraction of the oral dose reaches systemic circulation, often requiring higher oral than
parenteral doses
C. All of the dose reaches the bloodstream unchanged after oral administration
D. The drug must always be given rectally to work
Correct Answer: B
Rationale:
Portal circulation delivers oral drugs directly to hepatic enzymes, so first-pass metabolism
degrades a portion before it reaches the blood, raising oral dose requirements. The drug does
not bypass the liver orally, full bioavailability is false, and rectal dosing is not a general rule .
Question 2.
A client takes a new antidepressant with a half-life of 30 hours. Approximately how long
until steady-state plasma levels are reached?
A. About 5 to 7 days, since steady state requires roughly five half-lives
B. About 60 hours, since two half-lives suffice
C. About 30 minutes after the first dose
D. About 3 months regardless of half-life
Correct Answer: A
Rationale:
,Steady state is achieved after approximately five half-lives, so five times 30 hours equals 150
hours, about six days. Two half-lives, minutes, and months all misapply the steady-state rule .
Question 3.
A client who smokes two packs daily takes a medication metabolized by CYP1A2. After
smoking cessation, the nurse anticipates that:
A. Plasma levels will rise as the loss of CYP1A2 induction slows metabolism, requiring dose
reduction
B. Plasma levels will fall because smoking protects the drug
C. No change in levels occurs since smoking affects only the lungs
D. The drug must be switched to a parenteral form immediately
Correct Answer: A
Rationale:
Polycyclic aromatic hydrocarbons in smoke induce CYP1A2; cessation removes the induction,
slowing clearance and raising levels of drugs such as olanzapine, clozapine, and theophylline.
Smoking does not lower or ignore drug levels, and the route is irrelevant .
Question 4.
A client with CYP2D6 poor metabolizer genotype takes nortriptyline and develops marked
side effects at a standard dose. The best explanation is:
A. The client has developed a sudden allergy to the medication
B. Poor metabolizers clear drugs faster than extensive metabolizers
C. Genotype has no influence on medication response
D. Reduced enzyme activity slows clearance, so the drug and active metabolites accumulate
Correct Answer: D
Rationale:
CYP2D6 poor metabolizers lack efficient enzyme function, so tricyclics and many psychotropics
accumulate, raising toxicity risk at standard doses. Allergy, faster clearance, and genotype
irrelevance are incorrect .
, Question 5.
A full agonist at a receptor is best described as a drug that:
A. Binds the receptor and produces the maximal possible intrinsic response
B. Binds the receptor and produces a submaximal response even at full occupancy
C. Binds but does not activate the receptor
D. Blocks the receptor without producing any response
Correct Answer: A
Rationale:
A full agonist binds the receptor and produces the maximal possible intrinsic response. A partial
agonist produces a submaximal response even at full occupancy. An antagonist binds but does
not activate the receptor .
Question 6.
Which enzyme system is inhibited by fluoxetine and paroxetine, potentially increasing the
levels of TCAs and certain antipsychotics?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Correct Answer: B
Rationale:
Fluoxetine and paroxetine are potent inhibitors of CYP2D6, which can lead to increased plasma
levels of drugs metabolized by this enzyme, including tricyclic antidepressants and certain
antipsychotics, increasing the risk of toxicity .
Question 7.
A 45-year-old patient with generalized anxiety disorder has been taking lorazepam 2 mg
three times daily for 8 months. The patient expresses a desire to discontinue the
medication due to concerns about dependence. The nurse practitioner develops a
tapering plan. Which tapering strategy is most consistent with current evidence-based
guidelines?
Psychopharmacology for the PMHNP Tested
Questions with Revised Answers + Guarantee Latest
2026/2027
Question 1.
A psychiatric medication undergoes extensive first-pass metabolism. The clinical
consequence is that:
A. The drug bypasses the liver entirely when taken orally
B. Only a fraction of the oral dose reaches systemic circulation, often requiring higher oral than
parenteral doses
C. All of the dose reaches the bloodstream unchanged after oral administration
D. The drug must always be given rectally to work
Correct Answer: B
Rationale:
Portal circulation delivers oral drugs directly to hepatic enzymes, so first-pass metabolism
degrades a portion before it reaches the blood, raising oral dose requirements. The drug does
not bypass the liver orally, full bioavailability is false, and rectal dosing is not a general rule .
Question 2.
A client takes a new antidepressant with a half-life of 30 hours. Approximately how long
until steady-state plasma levels are reached?
A. About 5 to 7 days, since steady state requires roughly five half-lives
B. About 60 hours, since two half-lives suffice
C. About 30 minutes after the first dose
D. About 3 months regardless of half-life
Correct Answer: A
Rationale:
,Steady state is achieved after approximately five half-lives, so five times 30 hours equals 150
hours, about six days. Two half-lives, minutes, and months all misapply the steady-state rule .
Question 3.
A client who smokes two packs daily takes a medication metabolized by CYP1A2. After
smoking cessation, the nurse anticipates that:
A. Plasma levels will rise as the loss of CYP1A2 induction slows metabolism, requiring dose
reduction
B. Plasma levels will fall because smoking protects the drug
C. No change in levels occurs since smoking affects only the lungs
D. The drug must be switched to a parenteral form immediately
Correct Answer: A
Rationale:
Polycyclic aromatic hydrocarbons in smoke induce CYP1A2; cessation removes the induction,
slowing clearance and raising levels of drugs such as olanzapine, clozapine, and theophylline.
Smoking does not lower or ignore drug levels, and the route is irrelevant .
Question 4.
A client with CYP2D6 poor metabolizer genotype takes nortriptyline and develops marked
side effects at a standard dose. The best explanation is:
A. The client has developed a sudden allergy to the medication
B. Poor metabolizers clear drugs faster than extensive metabolizers
C. Genotype has no influence on medication response
D. Reduced enzyme activity slows clearance, so the drug and active metabolites accumulate
Correct Answer: D
Rationale:
CYP2D6 poor metabolizers lack efficient enzyme function, so tricyclics and many psychotropics
accumulate, raising toxicity risk at standard doses. Allergy, faster clearance, and genotype
irrelevance are incorrect .
, Question 5.
A full agonist at a receptor is best described as a drug that:
A. Binds the receptor and produces the maximal possible intrinsic response
B. Binds the receptor and produces a submaximal response even at full occupancy
C. Binds but does not activate the receptor
D. Blocks the receptor without producing any response
Correct Answer: A
Rationale:
A full agonist binds the receptor and produces the maximal possible intrinsic response. A partial
agonist produces a submaximal response even at full occupancy. An antagonist binds but does
not activate the receptor .
Question 6.
Which enzyme system is inhibited by fluoxetine and paroxetine, potentially increasing the
levels of TCAs and certain antipsychotics?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Correct Answer: B
Rationale:
Fluoxetine and paroxetine are potent inhibitors of CYP2D6, which can lead to increased plasma
levels of drugs metabolized by this enzyme, including tricyclic antidepressants and certain
antipsychotics, increasing the risk of toxicity .
Question 7.
A 45-year-old patient with generalized anxiety disorder has been taking lorazepam 2 mg
three times daily for 8 months. The patient expresses a desire to discontinue the
medication due to concerns about dependence. The nurse practitioner develops a
tapering plan. Which tapering strategy is most consistent with current evidence-based
guidelines?
