,NURS 5359 Exam 1 – Antipsychotic Medications | 200 Questions with
Accurate Answers and Rationales
SECTION 1: GENERAL CONCEPTS AND MECHANISMS (Questions 1–25)
1. Which neurotransmitter is primarily implicated in the therapeutic effects of antipsychotic
medications?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. GABA
Answer: B
Rationale: Antipsychotics primarily work by blocking dopamine D2 receptors in the mesolimbic pathway,
reducing positive symptoms of psychosis.
2. The dopamine hypothesis of schizophrenia proposes that positive symptoms are related to:
A. Dopamine deficiency in the mesocortical pathway
B. Dopamine excess in the mesolimbic pathway
C. Serotonin excess in the brainstem
D. GABA deficiency in the cortex
Answer: B
Rationale: Positive symptoms (hallucinations, delusions) are linked to excessive dopamine activity in the
mesolimbic pathway.
3. Which antipsychotic is classified as a first-generation (typical) antipsychotic?
A. Risperidone
B. Olanzapine
C. Haloperidol
D. Quetiapine
Answer: C
Rationale: Haloperidol is a butyrophenone typical antipsychotic. The others are atypicals.
4. Which receptor blockade is most associated with extrapyramidal symptoms (EPS)?
A. Serotonin 5-HT2A
B. Dopamine D2 in the nigrostriatal pathway
C. Histamine H1
D. Muscarinic acetylcholine
Answer: B
Rationale: Blockade of D2 receptors in the nigrostriatal pathway causes EPS.
5. Atypical antipsychotics have a lower risk of EPS because they:
A. Block more D2 receptors
B. Block serotonin 5-HT2A and dopamine D2 with fast dissociation
C. Have no dopamine blockade
D. Increase dopamine release
,Answer: B
Rationale: Atypicals have higher 5-HT2A/D2 affinity ratios and fast dissociation from D2 receptors,
reducing EPS.
6. Which antipsychotic is most likely to cause agranulocytosis?
A. Haloperidol
B. Clozapine
C. Risperidone
D. Aripiprazole
Answer: B
Rationale: Clozapine carries a black box warning for severe neutropenia/agranulocytosis; requires
regular ANC monitoring.
7. The black box warning for all antipsychotics in elderly patients with dementia-related psychosis is:
A. Increased risk of falls
B. Increased risk of death (mostly cardiovascular or infectious)
C. Increased risk of diabetes
D. Increased risk of seizures
Answer: B
Rationale: All antipsychotics carry a boxed warning for increased mortality in elderly patients with
dementia-related psychosis.
8. Which antipsychotic is available as a long-acting injectable (LAI)?
A. Haloperidol decanoate
B. Clozapine
C. Quetiapine
D. Olanzapine (oral only)
Answer: A
Rationale: Haloperidol decanoate is a long-acting injectable. Olanzapine also has an LAI (Zyprexa
Relprevv), but the question asks “which is available” – haloperidol decanoate is correct.
9. Which laboratory test is mandatory before starting clozapine?
A. Liver function tests
B. Absolute neutrophil count (ANC)
C. Serum creatinine
D. Thyroid function
Answer: B
Rationale: Baseline ANC is required, and weekly monitoring for 6 months, then biweekly, then monthly.
10. Which side effect is most characteristic of typical antipsychotics?
A. Weight gain
B. Metabolic syndrome
C. Extrapyramidal symptoms
D. Hyperprolactinemia (less common)
Answer: C
Rationale: Typical antipsychotics commonly cause EPS due to strong D2 blockade.
, 11. Which atypical antipsychotic is most associated with weight gain and metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Answer: C
Rationale: Olanzapine has the highest risk of weight gain and metabolic disturbances among atypicals.
12. Which antipsychotic has the lowest risk of metabolic side effects?
A. Olanzapine
B. Clozapine
C. Ziprasidone
D. Quetiapine
Answer: C
Rationale: Ziprasidone is relatively weight-neutral and has lower metabolic risk.
13. Which medication is used to treat acute dystonia from antipsychotics?
A. Benztropine
B. Propranolol
C. Valbenazine
D. Lithium
Answer: A
Rationale: Benztropine (anticholinergic) or diphenhydramine is used for acute dystonia.
14. Tardive dyskinesia is characterized by:
A. Involuntary repetitive movements (lip smacking, tongue protrusion)
B. Muscle rigidity and fever
C. Tremor at rest
D. Akathisia
Answer: A
Rationale: Tardive dyskinesia involves involuntary choreoathetoid movements, often of the face and
tongue.
15. Which medication is approved for tardive dyskinesia?
A. Valbenazine
B. Haloperidol
C. Benztropine
D. Propranolol
Answer: A
Rationale: Valbenazine and deutetrabenazine are VMAT2 inhibitors approved for TD.
16. Neuroleptic malignant syndrome (NMS) is characterized by:
A. Hyperthermia, muscle rigidity, autonomic instability, altered mental status
B. Hypothermia, flaccidity, bradycardia
C. Hypertension, tachycardia, diarrhea
D. Weight gain, hyperglycemia
Accurate Answers and Rationales
SECTION 1: GENERAL CONCEPTS AND MECHANISMS (Questions 1–25)
1. Which neurotransmitter is primarily implicated in the therapeutic effects of antipsychotic
medications?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. GABA
Answer: B
Rationale: Antipsychotics primarily work by blocking dopamine D2 receptors in the mesolimbic pathway,
reducing positive symptoms of psychosis.
2. The dopamine hypothesis of schizophrenia proposes that positive symptoms are related to:
A. Dopamine deficiency in the mesocortical pathway
B. Dopamine excess in the mesolimbic pathway
C. Serotonin excess in the brainstem
D. GABA deficiency in the cortex
Answer: B
Rationale: Positive symptoms (hallucinations, delusions) are linked to excessive dopamine activity in the
mesolimbic pathway.
3. Which antipsychotic is classified as a first-generation (typical) antipsychotic?
A. Risperidone
B. Olanzapine
C. Haloperidol
D. Quetiapine
Answer: C
Rationale: Haloperidol is a butyrophenone typical antipsychotic. The others are atypicals.
4. Which receptor blockade is most associated with extrapyramidal symptoms (EPS)?
A. Serotonin 5-HT2A
B. Dopamine D2 in the nigrostriatal pathway
C. Histamine H1
D. Muscarinic acetylcholine
Answer: B
Rationale: Blockade of D2 receptors in the nigrostriatal pathway causes EPS.
5. Atypical antipsychotics have a lower risk of EPS because they:
A. Block more D2 receptors
B. Block serotonin 5-HT2A and dopamine D2 with fast dissociation
C. Have no dopamine blockade
D. Increase dopamine release
,Answer: B
Rationale: Atypicals have higher 5-HT2A/D2 affinity ratios and fast dissociation from D2 receptors,
reducing EPS.
6. Which antipsychotic is most likely to cause agranulocytosis?
A. Haloperidol
B. Clozapine
C. Risperidone
D. Aripiprazole
Answer: B
Rationale: Clozapine carries a black box warning for severe neutropenia/agranulocytosis; requires
regular ANC monitoring.
7. The black box warning for all antipsychotics in elderly patients with dementia-related psychosis is:
A. Increased risk of falls
B. Increased risk of death (mostly cardiovascular or infectious)
C. Increased risk of diabetes
D. Increased risk of seizures
Answer: B
Rationale: All antipsychotics carry a boxed warning for increased mortality in elderly patients with
dementia-related psychosis.
8. Which antipsychotic is available as a long-acting injectable (LAI)?
A. Haloperidol decanoate
B. Clozapine
C. Quetiapine
D. Olanzapine (oral only)
Answer: A
Rationale: Haloperidol decanoate is a long-acting injectable. Olanzapine also has an LAI (Zyprexa
Relprevv), but the question asks “which is available” – haloperidol decanoate is correct.
9. Which laboratory test is mandatory before starting clozapine?
A. Liver function tests
B. Absolute neutrophil count (ANC)
C. Serum creatinine
D. Thyroid function
Answer: B
Rationale: Baseline ANC is required, and weekly monitoring for 6 months, then biweekly, then monthly.
10. Which side effect is most characteristic of typical antipsychotics?
A. Weight gain
B. Metabolic syndrome
C. Extrapyramidal symptoms
D. Hyperprolactinemia (less common)
Answer: C
Rationale: Typical antipsychotics commonly cause EPS due to strong D2 blockade.
, 11. Which atypical antipsychotic is most associated with weight gain and metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Answer: C
Rationale: Olanzapine has the highest risk of weight gain and metabolic disturbances among atypicals.
12. Which antipsychotic has the lowest risk of metabolic side effects?
A. Olanzapine
B. Clozapine
C. Ziprasidone
D. Quetiapine
Answer: C
Rationale: Ziprasidone is relatively weight-neutral and has lower metabolic risk.
13. Which medication is used to treat acute dystonia from antipsychotics?
A. Benztropine
B. Propranolol
C. Valbenazine
D. Lithium
Answer: A
Rationale: Benztropine (anticholinergic) or diphenhydramine is used for acute dystonia.
14. Tardive dyskinesia is characterized by:
A. Involuntary repetitive movements (lip smacking, tongue protrusion)
B. Muscle rigidity and fever
C. Tremor at rest
D. Akathisia
Answer: A
Rationale: Tardive dyskinesia involves involuntary choreoathetoid movements, often of the face and
tongue.
15. Which medication is approved for tardive dyskinesia?
A. Valbenazine
B. Haloperidol
C. Benztropine
D. Propranolol
Answer: A
Rationale: Valbenazine and deutetrabenazine are VMAT2 inhibitors approved for TD.
16. Neuroleptic malignant syndrome (NMS) is characterized by:
A. Hyperthermia, muscle rigidity, autonomic instability, altered mental status
B. Hypothermia, flaccidity, bradycardia
C. Hypertension, tachycardia, diarrhea
D. Weight gain, hyperglycemia
