Wilkes NSG 552 Exam 1 Psychopharmacology EXAM
Exam Coverage
• Foundations of psychopharmacology, including pharmacokinetics, pharmacodynamics,
therapeutic response, and medication safety principles.
• Neurotransmitter systems involving dopamine, serotonin, norepinephrine, glutamate, GABA,
acetylcholine, and their psychiatric relevance.
• Neuroanatomy and dopamine pathways, including mesolimbic, mesocortical, nigrostriatal, and
tuberoinfundibular pathways.
• Cytochrome P450 metabolism, enzyme induction and inhibition, half-life, steady state,
bioavailability, and clinically important interactions.
• Antipsychotic pharmacology, including first-generation and second-generation agents,
receptor actions, indications, and monitoring.
• Extrapyramidal symptoms, tardive dyskinesia, akathisia, dystonia, pseudoparkinsonism,
neuroleptic malignant syndrome, and treatment approaches.
• Antidepressant pharmacology, including SSRIs, SNRIs, bupropion, mirtazapine, trazodone,
TCAs, MAOIs, and newer multimodal agents.
• Serotonin syndrome, antidepressant discontinuation, hypertensive reactions, overdose risks,
sexual adverse effects, and patient counseling.
• Mood-stabilizing pharmacology, including lithium, valproate, carbamazepine, and lamotrigine,
with emphasis on toxicity and laboratory monitoring.
• Clinical prescribing principles, adherence, treatment response, adverse-effect management,
special precautions, and evidence-based medication selection.
,1. A patient taking trazodone develops a prolonged painful erection and seeks urgent
evaluation. Which adverse effect is classically associated with this medication?
A. Priapism
B. Agranulocytosis
C. Severe hyperprolactinemia in all patients
D. Tardive dyskinesia
Answer: A
Rationale: Priapism is a rare but important adverse effect of trazodone and requires urgent
medical evaluation because prolonged ischemia can cause tissue injury.
2. A patient with treatment-resistant schizophrenia is being considered for clozapine. Which
serious adverse effect requires ongoing blood monitoring?
A. Mild dry mouth
B. Severe neutropenia or agranulocytosis
C. Transient headache
D. Increased appetite alone
Answer: B
Rationale: Clozapine can cause severe neutropenia or agranulocytosis, so appropriate
blood-count monitoring is required to reduce the risk of serious infection.
3. In an advanced-practice nursing assessment, the nurse practitioner wants to select the
explanation that is most consistent with psychopharmacology. when comparing two
medications by their receptor actions and resulting clinical effects rather than their absorption or
elimination, which concept is being assessed?
,A. Pharmacokinetics
B. Bioavailability
C. Pharmacodynamics
D. Clearance
Answer: C
Rationale: Receptor action and the resulting biologic response are pharmacodynamic
concepts. Pharmacokinetics instead addresses how drug concentrations change in the body.
This interpretation is clinically useful because it links the medication's mechanism with the
patient's observable response and guides appropriate monitoring.
4. During a psychiatric medication review, the patient asks which pharmacologic principle most
directly explains the finding described. why are medication washout periods important when
switching between an MAOI and another serotonergic antidepressant?
A. Washout periods prevent all weight gain
B. They eliminate the need for blood pressure monitoring
C. They increase CYP induction
D. The combination can produce serious toxicity, including serotonin syndrome
Answer: D
Rationale: MAO inhibition persists beyond the last dose for some agents. Inadequate
separation from serotonergic medications can produce severe serotonin toxicity. This
interpretation is clinically useful because it links the medication's mechanism with the patient's
observable response and guides appropriate monitoring.
, 5. A patient taking a dopamine-blocking antipsychotic develops severe rigidity, hyperthermia,
altered mental status, and autonomic instability. Which emergency is most likely?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Tardive dyskinesia
D. Acute dystonia
Answer: A
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction to
dopamine blockade characterized by severe rigidity, hyperthermia, altered mental status, and
autonomic instability.
6. In a clinical decision-making encounter, the patient asks which pharmacologic principle most
directly explains the finding described. a patient taking a typical antipsychotic develops rigidity
and tremor. Which neurotransmitter pathway is most directly affected by the medication's
therapeutic mechanism and this adverse effect?
A. Only acetylcholine pathways
B. Dopaminergic pathways
C. Only glutamate pathways
D. Only GABA pathways
Answer: B
Rationale: Typical antipsychotics primarily block dopamine receptors. Their clinical and
adverse effects reflect dopamine signaling across several pathways. This interpretation is
clinically useful because it links the medication's mechanism with the patient's observable
Exam Coverage
• Foundations of psychopharmacology, including pharmacokinetics, pharmacodynamics,
therapeutic response, and medication safety principles.
• Neurotransmitter systems involving dopamine, serotonin, norepinephrine, glutamate, GABA,
acetylcholine, and their psychiatric relevance.
• Neuroanatomy and dopamine pathways, including mesolimbic, mesocortical, nigrostriatal, and
tuberoinfundibular pathways.
• Cytochrome P450 metabolism, enzyme induction and inhibition, half-life, steady state,
bioavailability, and clinically important interactions.
• Antipsychotic pharmacology, including first-generation and second-generation agents,
receptor actions, indications, and monitoring.
• Extrapyramidal symptoms, tardive dyskinesia, akathisia, dystonia, pseudoparkinsonism,
neuroleptic malignant syndrome, and treatment approaches.
• Antidepressant pharmacology, including SSRIs, SNRIs, bupropion, mirtazapine, trazodone,
TCAs, MAOIs, and newer multimodal agents.
• Serotonin syndrome, antidepressant discontinuation, hypertensive reactions, overdose risks,
sexual adverse effects, and patient counseling.
• Mood-stabilizing pharmacology, including lithium, valproate, carbamazepine, and lamotrigine,
with emphasis on toxicity and laboratory monitoring.
• Clinical prescribing principles, adherence, treatment response, adverse-effect management,
special precautions, and evidence-based medication selection.
,1. A patient taking trazodone develops a prolonged painful erection and seeks urgent
evaluation. Which adverse effect is classically associated with this medication?
A. Priapism
B. Agranulocytosis
C. Severe hyperprolactinemia in all patients
D. Tardive dyskinesia
Answer: A
Rationale: Priapism is a rare but important adverse effect of trazodone and requires urgent
medical evaluation because prolonged ischemia can cause tissue injury.
2. A patient with treatment-resistant schizophrenia is being considered for clozapine. Which
serious adverse effect requires ongoing blood monitoring?
A. Mild dry mouth
B. Severe neutropenia or agranulocytosis
C. Transient headache
D. Increased appetite alone
Answer: B
Rationale: Clozapine can cause severe neutropenia or agranulocytosis, so appropriate
blood-count monitoring is required to reduce the risk of serious infection.
3. In an advanced-practice nursing assessment, the nurse practitioner wants to select the
explanation that is most consistent with psychopharmacology. when comparing two
medications by their receptor actions and resulting clinical effects rather than their absorption or
elimination, which concept is being assessed?
,A. Pharmacokinetics
B. Bioavailability
C. Pharmacodynamics
D. Clearance
Answer: C
Rationale: Receptor action and the resulting biologic response are pharmacodynamic
concepts. Pharmacokinetics instead addresses how drug concentrations change in the body.
This interpretation is clinically useful because it links the medication's mechanism with the
patient's observable response and guides appropriate monitoring.
4. During a psychiatric medication review, the patient asks which pharmacologic principle most
directly explains the finding described. why are medication washout periods important when
switching between an MAOI and another serotonergic antidepressant?
A. Washout periods prevent all weight gain
B. They eliminate the need for blood pressure monitoring
C. They increase CYP induction
D. The combination can produce serious toxicity, including serotonin syndrome
Answer: D
Rationale: MAO inhibition persists beyond the last dose for some agents. Inadequate
separation from serotonergic medications can produce severe serotonin toxicity. This
interpretation is clinically useful because it links the medication's mechanism with the patient's
observable response and guides appropriate monitoring.
, 5. A patient taking a dopamine-blocking antipsychotic develops severe rigidity, hyperthermia,
altered mental status, and autonomic instability. Which emergency is most likely?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Tardive dyskinesia
D. Acute dystonia
Answer: A
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction to
dopamine blockade characterized by severe rigidity, hyperthermia, altered mental status, and
autonomic instability.
6. In a clinical decision-making encounter, the patient asks which pharmacologic principle most
directly explains the finding described. a patient taking a typical antipsychotic develops rigidity
and tremor. Which neurotransmitter pathway is most directly affected by the medication's
therapeutic mechanism and this adverse effect?
A. Only acetylcholine pathways
B. Dopaminergic pathways
C. Only glutamate pathways
D. Only GABA pathways
Answer: B
Rationale: Typical antipsychotics primarily block dopamine receptors. Their clinical and
adverse effects reflect dopamine signaling across several pathways. This interpretation is
clinically useful because it links the medication's mechanism with the patient's observable
