NURS 5359 Psychopharmacology
Exam 4 Questions and Answers| Updated| Pass Guaranteed
1. What is the primary mechanism of action of methylphenidate?
A. Directly stimulates postsynaptic dopamine D2 receptors
B. Blocks reuptake of dopamine and norepinephrine by inhibiting the dopamine
(DAT) and norepinephrine (NET) transporters
C. Inhibits monoamine oxidase irreversibly
D. Enhances GABA-A receptor chloride conductance
Answer: B. Blocks reuptake of dopamine and norepinephrine by inhibiting the
dopamine (DAT) and norepinephrine (NET) transporters
Rationale: Methylphenidate increases synaptic dopamine and norepinephrine,
particularly in the prefrontal cortex, improving attention, working memory and
impulse control.
2. How do amphetamines differ mechanistically from methylphenidate?
A. Amphetamines also promote release of dopamine and norepinephrine by
reversing transporter flow (and VMAT2 effects), in addition to blocking
reuptake
B. Amphetamines act only as serotonin antagonists
C. Amphetamines are NMDA antagonists
D. Amphetamines work only by blocking monoamine oxidase
Answer: A. Amphetamines also promote release of dopamine and
norepinephrine by reversing transporter flow (and VMAT2 effects), in addition
to blocking reuptake
Rationale: Amphetamines enter the presynaptic neuron, disrupt vesicular storage
and cause non-exocytotic release of catecholamines. Methylphenidate mainly
blocks reuptake.
Page 1
,3. Which brain region and neurotransmitters are most associated with the
therapeutic effect of ADHD medications?
A. Hippocampus; acetylcholine
B. Raphe nuclei; serotonin only
C. Cerebellum; GABA
D. Prefrontal cortex; dopamine and norepinephrine
Answer: D. Prefrontal cortex; dopamine and norepinephrine
Rationale: ADHD involves reduced catecholamine signaling in prefrontal networks
governing executive function and attention.
4. What is first-line pharmacotherapy for ADHD in school-aged children,
adolescents and adults?
A. Atomoxetine
B. Clonidine
C. A CNS stimulant (methylphenidate or amphetamine)
D. Bupropion
Answer: C. A CNS stimulant (methylphenidate or amphetamine)
Rationale: Stimulants have the largest effect sizes (about 70 to 80% response).
Non-stimulants are used when stimulants are ineffective, not tolerated or
contraindicated.
5. According to AAP guidance, what is first-line treatment for a 4-year-old with
ADHD?
A. Amphetamine salts
B. Evidence-based parent training in behavior management
C. Atomoxetine
D. Guanfacine
Page 2
,Answer: B. Evidence-based parent training in behavior management
Rationale: For ages 4 to 5, behavioral therapy comes first. Methylphenidate may
be considered if behavioral interventions fail and symptoms are moderate to
severe.
6. Under the Controlled Substances Act, how are amphetamine and
methylphenidate classified?
A. Schedule II
B. Schedule IV
C. Schedule III
D. Not controlled
Answer: A. Schedule II
Rationale: Schedule II drugs have high abuse potential. Prescriptions require a
new prescription each time (no refills) and strict tracking, and the PDMP should
be checked.
7. What is the current boxed warning for CNS stimulants?
A. Hepatic failure
B. Increased suicidality in all adults
C. Agranulocytosis
D. High potential for abuse and misuse, which can lead to substance use
disorder, overdose and death
Answer: D. High potential for abuse and misuse, which can lead to substance
use disorder, overdose and death
Rationale: Prescribers must assess abuse risk before prescribing, educate patients
and monitor for misuse and diversion throughout therapy.
Page 3
, 8. Which adverse effects are most common with stimulants?
A. Weight gain and sedation
B. Hypotension and bradycardia
C. Decreased appetite, insomnia, headache, abdominal pain, irritability, and
increased heart rate and blood pressure
D. Constipation and urinary retention
Answer: C. Decreased appetite, insomnia, headache, abdominal pain, irritability,
and increased heart rate and blood pressure
Rationale: Stimulants cause sympathomimetic effects. Appetite suppression and
sleep problems are the leading reasons for discontinuation.
9. A 9-year-old on methylphenidate has poor appetite and has lost weight.
Which strategy is most appropriate?
A. Stop all medication permanently without evaluation
B. Give medication with or right after breakfast, offer calorie-dense meals when
the drug wears off, and monitor height and weight on growth charts
C. Add a second stimulant
D. Give the drug on an empty stomach and skip meals
Answer: B. Give medication with or right after breakfast, offer calorie-dense
meals when the drug wears off, and monitor height and weight on growth
charts
Rationale: Appetite effects peak midday. Strategies include a hearty breakfast
and evening snacks, and consider dose adjustment or a drug holiday. Growth
should be plotted regularly.
Page 4
Exam 4 Questions and Answers| Updated| Pass Guaranteed
1. What is the primary mechanism of action of methylphenidate?
A. Directly stimulates postsynaptic dopamine D2 receptors
B. Blocks reuptake of dopamine and norepinephrine by inhibiting the dopamine
(DAT) and norepinephrine (NET) transporters
C. Inhibits monoamine oxidase irreversibly
D. Enhances GABA-A receptor chloride conductance
Answer: B. Blocks reuptake of dopamine and norepinephrine by inhibiting the
dopamine (DAT) and norepinephrine (NET) transporters
Rationale: Methylphenidate increases synaptic dopamine and norepinephrine,
particularly in the prefrontal cortex, improving attention, working memory and
impulse control.
2. How do amphetamines differ mechanistically from methylphenidate?
A. Amphetamines also promote release of dopamine and norepinephrine by
reversing transporter flow (and VMAT2 effects), in addition to blocking
reuptake
B. Amphetamines act only as serotonin antagonists
C. Amphetamines are NMDA antagonists
D. Amphetamines work only by blocking monoamine oxidase
Answer: A. Amphetamines also promote release of dopamine and
norepinephrine by reversing transporter flow (and VMAT2 effects), in addition
to blocking reuptake
Rationale: Amphetamines enter the presynaptic neuron, disrupt vesicular storage
and cause non-exocytotic release of catecholamines. Methylphenidate mainly
blocks reuptake.
Page 1
,3. Which brain region and neurotransmitters are most associated with the
therapeutic effect of ADHD medications?
A. Hippocampus; acetylcholine
B. Raphe nuclei; serotonin only
C. Cerebellum; GABA
D. Prefrontal cortex; dopamine and norepinephrine
Answer: D. Prefrontal cortex; dopamine and norepinephrine
Rationale: ADHD involves reduced catecholamine signaling in prefrontal networks
governing executive function and attention.
4. What is first-line pharmacotherapy for ADHD in school-aged children,
adolescents and adults?
A. Atomoxetine
B. Clonidine
C. A CNS stimulant (methylphenidate or amphetamine)
D. Bupropion
Answer: C. A CNS stimulant (methylphenidate or amphetamine)
Rationale: Stimulants have the largest effect sizes (about 70 to 80% response).
Non-stimulants are used when stimulants are ineffective, not tolerated or
contraindicated.
5. According to AAP guidance, what is first-line treatment for a 4-year-old with
ADHD?
A. Amphetamine salts
B. Evidence-based parent training in behavior management
C. Atomoxetine
D. Guanfacine
Page 2
,Answer: B. Evidence-based parent training in behavior management
Rationale: For ages 4 to 5, behavioral therapy comes first. Methylphenidate may
be considered if behavioral interventions fail and symptoms are moderate to
severe.
6. Under the Controlled Substances Act, how are amphetamine and
methylphenidate classified?
A. Schedule II
B. Schedule IV
C. Schedule III
D. Not controlled
Answer: A. Schedule II
Rationale: Schedule II drugs have high abuse potential. Prescriptions require a
new prescription each time (no refills) and strict tracking, and the PDMP should
be checked.
7. What is the current boxed warning for CNS stimulants?
A. Hepatic failure
B. Increased suicidality in all adults
C. Agranulocytosis
D. High potential for abuse and misuse, which can lead to substance use
disorder, overdose and death
Answer: D. High potential for abuse and misuse, which can lead to substance
use disorder, overdose and death
Rationale: Prescribers must assess abuse risk before prescribing, educate patients
and monitor for misuse and diversion throughout therapy.
Page 3
, 8. Which adverse effects are most common with stimulants?
A. Weight gain and sedation
B. Hypotension and bradycardia
C. Decreased appetite, insomnia, headache, abdominal pain, irritability, and
increased heart rate and blood pressure
D. Constipation and urinary retention
Answer: C. Decreased appetite, insomnia, headache, abdominal pain, irritability,
and increased heart rate and blood pressure
Rationale: Stimulants cause sympathomimetic effects. Appetite suppression and
sleep problems are the leading reasons for discontinuation.
9. A 9-year-old on methylphenidate has poor appetite and has lost weight.
Which strategy is most appropriate?
A. Stop all medication permanently without evaluation
B. Give medication with or right after breakfast, offer calorie-dense meals when
the drug wears off, and monitor height and weight on growth charts
C. Add a second stimulant
D. Give the drug on an empty stomach and skip meals
Answer: B. Give medication with or right after breakfast, offer calorie-dense
meals when the drug wears off, and monitor height and weight on growth
charts
Rationale: Appetite effects peak midday. Strategies include a hearty breakfast
and evening snacks, and consider dose adjustment or a drug holiday. Growth
should be plotted regularly.
Page 4
