NR 546 ADVANCED PHARMACOLOGY: PSYCHOPHARMACOLOGY FOR THE
PMHNP FINAL EXAM COMPLETE TEST BANK|QUESTIONS WITH VERIFIED
ANSWERS & DETAILED RATIONALES WEEKS 5–8 | CHAMBERLAIN UNIVERSITY |
2026/2027 UPDATE
1. A patient with major depressive disorder and a history of bulimia nervosa is being considered for
bupropion. What is the most important concern?
A) It may worsen depression
B) It lowers the seizure threshold
C) It causes weight gain
D) It is ineffective for depression
Answer: B
Rationale:
Bupropion is contraindicated in patients with eating disorders because electrolyte imbalances and
malnutrition lower the seizure threshold, increasing the risk of bupropion-induced seizures.
2. A PMHNP is initiating escitalopram for a patient with generalized anxiety disorder. What is the
most appropriate starting dose?
A) 5 mg daily
B) 10 mg daily
C) 20 mg daily
D) 40 mg daily
Answer: B
Rationale:
Escitalopram is typically started at 10 mg daily for anxiety or depression, with a maximum of 20 mg daily.
Starting at 5 mg may be considered in sensitive patients, but 10 mg is standard.
3. A patient on venlafaxine reports new-onset elevated blood pressure. What is the most appropriate
action?
A) Continue and recheck in 3 months
B) Reduce the dose or switch to a different agent
,C) Add an antihypertensive without changing venlafaxine
D) Double the dose to stabilize mood
Answer: B
Rationale:
Venlafaxine causes dose-dependent hypertension. If blood pressure rises, the dose should be reduced or the
medication switched, with close monitoring.
4. A patient on lithium reports a coarse hand tremor, vomiting, and confusion. What is the priority
nursing action?
A) Hold lithium and notify the provider immediately
B) Administer the next dose
C) Encourage fluids
D) Reassure the patient
Answer: A
Rationale:
Coarse tremor, vomiting, and confusion indicate lithium toxicity. Lithium should be held, the provider
notified, and serum levels checked emergently.
5. A patient on clozapine has an ANC of 1,200/µL. What is the appropriate action?
A) Continue clozapine and recheck in 1 week
B) Hold clozapine and notify the provider
C) Increase the dose
D) Add filgrastim and continue
Answer: B
Rationale:
An ANC below 1,500/µL requires holding clozapine and notifying the provider. Severe neutropenia (ANC
<500) may require discontinuation and specialist involvement.
6. Which medication is a first-line treatment for obsessive-compulsive disorder?
A) Sertraline
B) Bupropion
C) Venlafaxine
D) Mirtazapine
2
,Answer: A
Rationale:
Sertraline is an SSRI and first-line for OCD. Bupropion is not effective for OCD, and SNRIs like venlafaxine are
second-line.
7. A patient on fluoxetine is switching to phenelzine. How long must the fluoxetine be discontinued
before starting phenelzine?
A) 3 days
B) 7 days
C) 14 days
D) 5 weeks
Answer: D
Rationale:
Fluoxetine has a long half-life and active metabolite; a 5-week washout is required before starting an MAOI
to prevent serotonin syndrome.
8. A patient on haloperidol develops acute muscle spasms of the neck and eyes. What is the
appropriate treatment?
A) Benztropine
B) Propranolol
C) Valbenazine
D) Dantrolene
Answer: A
Rationale:
Acute dystonia is treated with anticholinergics like benztropine or diphenhydramine. Propranolol treats
akathisia, and dantrolene treats NMS.
9. Which lab value is most important to monitor in a patient taking valproate?
A) Serum glucose
B) Platelet count
C) Thyroid function
D) Serum calcium
Answer: B
3
, Rationale:
Valproate can cause thrombocytopenia and hepatotoxicity. Platelet count and liver function tests should be
monitored regularly.
10. A patient on risperidone reports breast enlargement and galactorrhea. Which mechanism
explains this?
A) Serotonin reuptake inhibition
B) Dopamine D2 blockade increasing prolactin
C) Histamine H1 blockade
D) Alpha-1 adrenergic blockade
Answer: B
Rationale:
Risperidone blocks D2 receptors in the tuberoinfundibular pathway, increasing prolactin levels and causing
gynecomastia and galactorrhea.
11. Which benzodiazepine is safest for a patient with hepatic impairment?
A) Diazepam
B) Chlordiazepoxide
C) Lorazepam
D) Clorazepate
Answer: C
Rationale:
Lorazepam undergoes glucuronidation and does not require hepatic oxidation, making it safer in liver
disease.
12. A patient on buprenorphine for opioid use disorder asks about respiratory depression risk. What
is the best response?
A) It has no risk of respiratory depression
B) It has a ceiling effect that lowers risk
C) It causes more respiratory depression than methadone
D) It always requires intubation
Answer: B
4
PMHNP FINAL EXAM COMPLETE TEST BANK|QUESTIONS WITH VERIFIED
ANSWERS & DETAILED RATIONALES WEEKS 5–8 | CHAMBERLAIN UNIVERSITY |
2026/2027 UPDATE
1. A patient with major depressive disorder and a history of bulimia nervosa is being considered for
bupropion. What is the most important concern?
A) It may worsen depression
B) It lowers the seizure threshold
C) It causes weight gain
D) It is ineffective for depression
Answer: B
Rationale:
Bupropion is contraindicated in patients with eating disorders because electrolyte imbalances and
malnutrition lower the seizure threshold, increasing the risk of bupropion-induced seizures.
2. A PMHNP is initiating escitalopram for a patient with generalized anxiety disorder. What is the
most appropriate starting dose?
A) 5 mg daily
B) 10 mg daily
C) 20 mg daily
D) 40 mg daily
Answer: B
Rationale:
Escitalopram is typically started at 10 mg daily for anxiety or depression, with a maximum of 20 mg daily.
Starting at 5 mg may be considered in sensitive patients, but 10 mg is standard.
3. A patient on venlafaxine reports new-onset elevated blood pressure. What is the most appropriate
action?
A) Continue and recheck in 3 months
B) Reduce the dose or switch to a different agent
,C) Add an antihypertensive without changing venlafaxine
D) Double the dose to stabilize mood
Answer: B
Rationale:
Venlafaxine causes dose-dependent hypertension. If blood pressure rises, the dose should be reduced or the
medication switched, with close monitoring.
4. A patient on lithium reports a coarse hand tremor, vomiting, and confusion. What is the priority
nursing action?
A) Hold lithium and notify the provider immediately
B) Administer the next dose
C) Encourage fluids
D) Reassure the patient
Answer: A
Rationale:
Coarse tremor, vomiting, and confusion indicate lithium toxicity. Lithium should be held, the provider
notified, and serum levels checked emergently.
5. A patient on clozapine has an ANC of 1,200/µL. What is the appropriate action?
A) Continue clozapine and recheck in 1 week
B) Hold clozapine and notify the provider
C) Increase the dose
D) Add filgrastim and continue
Answer: B
Rationale:
An ANC below 1,500/µL requires holding clozapine and notifying the provider. Severe neutropenia (ANC
<500) may require discontinuation and specialist involvement.
6. Which medication is a first-line treatment for obsessive-compulsive disorder?
A) Sertraline
B) Bupropion
C) Venlafaxine
D) Mirtazapine
2
,Answer: A
Rationale:
Sertraline is an SSRI and first-line for OCD. Bupropion is not effective for OCD, and SNRIs like venlafaxine are
second-line.
7. A patient on fluoxetine is switching to phenelzine. How long must the fluoxetine be discontinued
before starting phenelzine?
A) 3 days
B) 7 days
C) 14 days
D) 5 weeks
Answer: D
Rationale:
Fluoxetine has a long half-life and active metabolite; a 5-week washout is required before starting an MAOI
to prevent serotonin syndrome.
8. A patient on haloperidol develops acute muscle spasms of the neck and eyes. What is the
appropriate treatment?
A) Benztropine
B) Propranolol
C) Valbenazine
D) Dantrolene
Answer: A
Rationale:
Acute dystonia is treated with anticholinergics like benztropine or diphenhydramine. Propranolol treats
akathisia, and dantrolene treats NMS.
9. Which lab value is most important to monitor in a patient taking valproate?
A) Serum glucose
B) Platelet count
C) Thyroid function
D) Serum calcium
Answer: B
3
, Rationale:
Valproate can cause thrombocytopenia and hepatotoxicity. Platelet count and liver function tests should be
monitored regularly.
10. A patient on risperidone reports breast enlargement and galactorrhea. Which mechanism
explains this?
A) Serotonin reuptake inhibition
B) Dopamine D2 blockade increasing prolactin
C) Histamine H1 blockade
D) Alpha-1 adrenergic blockade
Answer: B
Rationale:
Risperidone blocks D2 receptors in the tuberoinfundibular pathway, increasing prolactin levels and causing
gynecomastia and galactorrhea.
11. Which benzodiazepine is safest for a patient with hepatic impairment?
A) Diazepam
B) Chlordiazepoxide
C) Lorazepam
D) Clorazepate
Answer: C
Rationale:
Lorazepam undergoes glucuronidation and does not require hepatic oxidation, making it safer in liver
disease.
12. A patient on buprenorphine for opioid use disorder asks about respiratory depression risk. What
is the best response?
A) It has no risk of respiratory depression
B) It has a ceiling effect that lowers risk
C) It causes more respiratory depression than methadone
D) It always requires intubation
Answer: B
4
