NSG 552 Exam 4 V2 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 4) | Wilkes
1. A 9-year-old patient diagnosed with ADHD is prescribed Methylphenidate (Ritalin). Which
mechanism of action best describes how this medication manages symptoms?
A. Antagonism of dopamine receptors in the prefrontal cortex
B. Stimulation of GABA receptors to reduce neuronal excitability
C. Inhibition of the reuptake of norepinephrine and dopamine
D. Selective inhibition of serotonin reuptake in the synaptic cleft
Correct Answer: C
Explanation: Methylphenidate works by blocking the transport of dopamine and
norepinephrine back into the presynaptic neuron. This increases the availability of these
neurotransmitters in the synaptic space, particularly in the prefrontal cortex. Improved
neurotransmission in these areas helps enhance focus, attention, and impulse control in
pediatric patients.
2. When prescribing Atomoxetine (Strattera) for a pediatric patient, the PMHNP must
monitor for which rare but serious adverse effect?
A. Severe liver injury
B. Stevens-Johnson Syndrome
,C. Agranulocytosis
D. Acute renal failure
Correct Answer: A
Explanation: Atomoxetine has a black box warning regarding potential severe liver injury
in some patients. Clinicians should educate families to watch for signs such as jaundice,
dark urine, or upper right quadrant pain. Although rare, hepatotoxicity is a critical safety
concern that distinguishes it from stimulant medications.
3. An 82-year-old patient with Alzheimer’s disease is started on Donepezil (Aricept). What is
the primary pharmacological action of this drug?
A. NMDA receptor antagonism
B. Beta-adrenergic stimulation
C. Dopamine D2 receptor blockade
D. Reversible inhibition of acetylcholinesterase
Correct Answer: D
Explanation: Donepezil is a cholinesterase inhibitor that prevents the breakdown of
acetylcholine in the synaptic cleft. This leads to increased cholinergic activity, which is
hypothesized to compensate for the loss of functioning cholinergic neurons. It is primarily
used to treat mild to moderate stages of dementia.
, 4. A patient with Alcohol Use Disorder is prescribed Disulfiram (Antabuse). The patient must
be educated that the reaction between alcohol and Disulfiram is caused by the accumulation
of:
A. Acetic acid
B. Acetaldehyde
C. Ethanolamine
D. Methanol
Correct Answer: B
Explanation: Disulfiram inhibits the enzyme aldehyde dehydrogenase, which is
responsible for breaking down acetaldehyde. When alcohol is consumed, acetaldehyde
levels rise significantly, leading to unpleasant symptoms like flushing, nausea, and
tachycardia. This serves as a psychological deterrent for patients attempting to maintain
abstinence.
5. A 75-year-old female presents with insomnia. According to the Beers Criteria, which of the
following medications should be avoided in this patient?
A. Ramelteon (Rozerem)
B. Zolpidem (Ambien)
C. Trazodone
D. Melatonin
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 4) | Wilkes
1. A 9-year-old patient diagnosed with ADHD is prescribed Methylphenidate (Ritalin). Which
mechanism of action best describes how this medication manages symptoms?
A. Antagonism of dopamine receptors in the prefrontal cortex
B. Stimulation of GABA receptors to reduce neuronal excitability
C. Inhibition of the reuptake of norepinephrine and dopamine
D. Selective inhibition of serotonin reuptake in the synaptic cleft
Correct Answer: C
Explanation: Methylphenidate works by blocking the transport of dopamine and
norepinephrine back into the presynaptic neuron. This increases the availability of these
neurotransmitters in the synaptic space, particularly in the prefrontal cortex. Improved
neurotransmission in these areas helps enhance focus, attention, and impulse control in
pediatric patients.
2. When prescribing Atomoxetine (Strattera) for a pediatric patient, the PMHNP must
monitor for which rare but serious adverse effect?
A. Severe liver injury
B. Stevens-Johnson Syndrome
,C. Agranulocytosis
D. Acute renal failure
Correct Answer: A
Explanation: Atomoxetine has a black box warning regarding potential severe liver injury
in some patients. Clinicians should educate families to watch for signs such as jaundice,
dark urine, or upper right quadrant pain. Although rare, hepatotoxicity is a critical safety
concern that distinguishes it from stimulant medications.
3. An 82-year-old patient with Alzheimer’s disease is started on Donepezil (Aricept). What is
the primary pharmacological action of this drug?
A. NMDA receptor antagonism
B. Beta-adrenergic stimulation
C. Dopamine D2 receptor blockade
D. Reversible inhibition of acetylcholinesterase
Correct Answer: D
Explanation: Donepezil is a cholinesterase inhibitor that prevents the breakdown of
acetylcholine in the synaptic cleft. This leads to increased cholinergic activity, which is
hypothesized to compensate for the loss of functioning cholinergic neurons. It is primarily
used to treat mild to moderate stages of dementia.
, 4. A patient with Alcohol Use Disorder is prescribed Disulfiram (Antabuse). The patient must
be educated that the reaction between alcohol and Disulfiram is caused by the accumulation
of:
A. Acetic acid
B. Acetaldehyde
C. Ethanolamine
D. Methanol
Correct Answer: B
Explanation: Disulfiram inhibits the enzyme aldehyde dehydrogenase, which is
responsible for breaking down acetaldehyde. When alcohol is consumed, acetaldehyde
levels rise significantly, leading to unpleasant symptoms like flushing, nausea, and
tachycardia. This serves as a psychological deterrent for patients attempting to maintain
abstinence.
5. A 75-year-old female presents with insomnia. According to the Beers Criteria, which of the
following medications should be avoided in this patient?
A. Ramelteon (Rozerem)
B. Zolpidem (Ambien)
C. Trazodone
D. Melatonin
