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 PMHNP is initiating pharmacotherapy for a patient with major
depressive disorder. Which medication is considered first-line due to its
favorable safety profile?
A) Phenelzine
B) Sertraline
C) Amitriptyline
D) Tranylcypromine
Answer: B
Rationale: SSRIs are first-line for MDD due to efficacy, tolerability, and safety in
overdose compared to TCAs and MAOIs.
2. A patient on fluoxetine reports feeling agitated, diaphoretic, and has
hyperreflexia and clonus. Which condition should the PMHNP suspect?
A) Neuroleptic malignant syndrome
B) Serotonin syndrome
C) Anticholinergic toxicity
,D) Malignant hyperthermia
Answer: B
Rationale: Serotonin syndrome presents with mental status changes, autonomic
instability, and neuromuscular abnormalities (clonus, hyperreflexia).
3. Which laboratory test should be monitored regularly in a patient taking
lithium?
A) Liver function tests
B) Serum lithium level, renal function, and thyroid function
C) CBC with differential
D) Lipid panel
Answer: B
Rationale: Lithium affects kidneys and thyroid; therapeutic level is 0.6-1.2 mEq/L.
Monitor renal and thyroid function every 6 months.
4. A patient on clozapine reports a sore throat and fever. Which action should
the PMHNP take first?
A) Administer acetaminophen
B) Order an immediate CBC with differential
C) Reassure the patient
D) Increase the clozapine dose
Answer: B
2
,Rationale: Sore throat and fever may indicate agranulocytosis; clozapine requires
regular ANC monitoring (weekly for 6 months).
5. A patient with bipolar disorder is started on lamotrigine. Which instruction
is most important to include in patient education?
A) “Take with food to prevent nausea.”
B) “Report any rash immediately, as it may be serious.”
C) “You can stop the medication when you feel better.”
D) “Avoid sunlight during treatment.”
Answer: B
Rationale: Lamotrigine carries a risk of Stevens-Johnson syndrome; slow titration
reduces risk. Any rash warrants immediate evaluation.
6. Which medication is FDA-approved for treatment-resistant depression
when combined with an oral antidepressant?
A) Quetiapine
B) Esketamine (Spravato)
C) Lurasidone
D) Aripiprazole
Answer: B
Rationale: Esketamine is an NMDA antagonist approved for treatment-resistant
depression; administered intranasally under supervision.
3
, 7. A patient on haloperidol develops a stiff neck, tongue protrusion, and
oculogyric crisis. Which medication should the PMHNP administer?
A) Benztropine
B) Benztropine or diphenhydramine
C) Propranolol
D) Lorazepam
Answer: B
Rationale: Acute dystonia is treated with anticholinergic medications (benztropine
or diphenhydramine) IM or IV.
8. A patient with schizophrenia is prescribed risperidone. Which adverse
effect should the PMHNP monitor?
A) Agranulocytosis
B) Hyperprolactinemia
C) Nephrotoxicity
D) Cardiomyopathy
Answer: B
Rationale: Risperidone commonly elevates prolactin, causing galactorrhea,
gynecomastia, and sexual dysfunction.
9. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement indicates understanding?
4
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 PMHNP is initiating pharmacotherapy for a patient with major
depressive disorder. Which medication is considered first-line due to its
favorable safety profile?
A) Phenelzine
B) Sertraline
C) Amitriptyline
D) Tranylcypromine
Answer: B
Rationale: SSRIs are first-line for MDD due to efficacy, tolerability, and safety in
overdose compared to TCAs and MAOIs.
2. A patient on fluoxetine reports feeling agitated, diaphoretic, and has
hyperreflexia and clonus. Which condition should the PMHNP suspect?
A) Neuroleptic malignant syndrome
B) Serotonin syndrome
C) Anticholinergic toxicity
,D) Malignant hyperthermia
Answer: B
Rationale: Serotonin syndrome presents with mental status changes, autonomic
instability, and neuromuscular abnormalities (clonus, hyperreflexia).
3. Which laboratory test should be monitored regularly in a patient taking
lithium?
A) Liver function tests
B) Serum lithium level, renal function, and thyroid function
C) CBC with differential
D) Lipid panel
Answer: B
Rationale: Lithium affects kidneys and thyroid; therapeutic level is 0.6-1.2 mEq/L.
Monitor renal and thyroid function every 6 months.
4. A patient on clozapine reports a sore throat and fever. Which action should
the PMHNP take first?
A) Administer acetaminophen
B) Order an immediate CBC with differential
C) Reassure the patient
D) Increase the clozapine dose
Answer: B
2
,Rationale: Sore throat and fever may indicate agranulocytosis; clozapine requires
regular ANC monitoring (weekly for 6 months).
5. A patient with bipolar disorder is started on lamotrigine. Which instruction
is most important to include in patient education?
A) “Take with food to prevent nausea.”
B) “Report any rash immediately, as it may be serious.”
C) “You can stop the medication when you feel better.”
D) “Avoid sunlight during treatment.”
Answer: B
Rationale: Lamotrigine carries a risk of Stevens-Johnson syndrome; slow titration
reduces risk. Any rash warrants immediate evaluation.
6. Which medication is FDA-approved for treatment-resistant depression
when combined with an oral antidepressant?
A) Quetiapine
B) Esketamine (Spravato)
C) Lurasidone
D) Aripiprazole
Answer: B
Rationale: Esketamine is an NMDA antagonist approved for treatment-resistant
depression; administered intranasally under supervision.
3
, 7. A patient on haloperidol develops a stiff neck, tongue protrusion, and
oculogyric crisis. Which medication should the PMHNP administer?
A) Benztropine
B) Benztropine or diphenhydramine
C) Propranolol
D) Lorazepam
Answer: B
Rationale: Acute dystonia is treated with anticholinergic medications (benztropine
or diphenhydramine) IM or IV.
8. A patient with schizophrenia is prescribed risperidone. Which adverse
effect should the PMHNP monitor?
A) Agranulocytosis
B) Hyperprolactinemia
C) Nephrotoxicity
D) Cardiomyopathy
Answer: B
Rationale: Risperidone commonly elevates prolactin, causing galactorrhea,
gynecomastia, and sexual dysfunction.
9. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement indicates understanding?
4
