NURS 5334 PHARMACOLOGY EXAM 1 REVIEW:
ANTIPSYCHOTICS, MOOD STABILIZERS, AND
ANTIDEPRESSANTS (NURS 5334)
1. What is the primary mechanism of action of typical antipsychotics
like haloperidol?
A. Serotonin reuptake inhibition
B. Dopamine D2 receptor antagonism
C. GABA receptor agonism
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: Typical antipsychotics primarily exert their therapeutic effects
by blocking dopamine D2 receptors in the mesolimbic pathway.
2. A patient taking risperidone develops galactorrhea and
amenorrhea. Which receptor blockade is most likely responsible for
these symptoms?
A. Serotonin 5HT2A
B. Histamine H1
C. Dopamine D2 in the tuberoinfundibular pathway
D. Alpha-1 adrenergic
Correct Answer: C
Rationale: Blockade of D2 receptors in the tuberoinfundibular pathway
disinhibits prolactin release, leading to hyperprolactinemia and
associated symptoms like galactorrhea and amenorrhea.
3. Which atypical antipsychotic requires regular monitoring of
absolute neutrophil count (ANC) due to the risk of agranulocytosis?
,A. Quetiapine
B. Olanzapine
C. Clozapine
D. Aripiprazole
Correct Answer: C
Rationale: Clozapine carries a black box warning for severe
neutropenia/agranulocytosis, requiring strict ANC monitoring through a
REMS program.
4. A patient on lithium therapy reports coarse hand tremors, vomiting,
and confusion. What is the priority nursing action?
A. Administer the next scheduled dose
B. Hold the medication and notify the provider immediately
C. Encourage increased fluid intake
D. Reassure the patient that these are common side effects
Correct Answer: B
Rationale: These symptoms indicate lithium toxicity. The medication
must be held, and the provider notified immediately for evaluation of
serum lithium levels.
5. What is the significance of avoiding strong CYP3A4 inducers when
prescribing Lurasidone?
A. They enhance the effects of Lurasidone
B. They decrease the effectiveness of Lurasidone by increasing its
metabolism
C. They increase the risk of tardive dyskinesia
D. They have no significant impact on Lurasidone
Correct Answer: B
Rationale: Strong CYP3A4 inducers (like carbamazepine) increase the
,metabolism of Lurasidone, significantly reducing its plasma
concentration and therapeutic efficacy.
6. Which food item must patients taking monoamine oxidase
inhibitors (MAOIs) avoid to prevent a hypertensive crisis?
A. Leafy green vegetables
B. Aged cheese and cured meats
C. Citrus fruits
D. Whole grains
Correct Answer: B
Rationale: Aged cheese and cured meats contain high levels of
tyramine. MAOIs inhibit the breakdown of tyramine, which can lead to
a severe hypertensive crisis.
7. A patient experiencing acute dystonia after receiving an
antipsychotic is most likely to be treated with which medication?
A. Benztropine
B. Propranolol
C. Valproic acid
D. Lithium
Correct Answer: A
Rationale: Benztropine is an anticholinergic medication used to rapidly
reverse acute dystonic reactions caused by antipsychotic-induced
dopamine blockade.
8. Which atypical antipsychotic is most associated with significant
weight gain and metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
, D. Lurasidone
Correct Answer: C
Rationale: Olanzapine is highly associated with weight gain,
hyperglycemia, and dyslipidemia compared to other atypical
antipsychotics.
9. What is the therapeutic serum range for lithium in the maintenance
treatment of bipolar disorder?
A. 0.1 - 0.4 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.5 mEq/L
D. 3.0 - 4.0 mEq/L
Correct Answer: B
Rationale: The therapeutic range for lithium is narrow, typically 0.6 to
1.2 mEq/L for maintenance therapy.
10. A patient prescribed sertraline reports experiencing sexual
dysfunction. What is the most appropriate nursing intervention?
A. Tell the patient to stop taking the medication immediately
B. Reassure the patient that this is a common side effect and encourage
them to discuss options with their provider
C. Double the dose to counteract the side effect
D. Switch the patient to an MAOI without consulting the provider
Correct Answer: B
Rationale: Sexual dysfunction is a common SSRI side effect. The nurse
should validate the patient's experience and encourage them to discuss
potential solutions (dose reduction, switching, or adding bupropion)
with the prescriber.
ANTIPSYCHOTICS, MOOD STABILIZERS, AND
ANTIDEPRESSANTS (NURS 5334)
1. What is the primary mechanism of action of typical antipsychotics
like haloperidol?
A. Serotonin reuptake inhibition
B. Dopamine D2 receptor antagonism
C. GABA receptor agonism
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: Typical antipsychotics primarily exert their therapeutic effects
by blocking dopamine D2 receptors in the mesolimbic pathway.
2. A patient taking risperidone develops galactorrhea and
amenorrhea. Which receptor blockade is most likely responsible for
these symptoms?
A. Serotonin 5HT2A
B. Histamine H1
C. Dopamine D2 in the tuberoinfundibular pathway
D. Alpha-1 adrenergic
Correct Answer: C
Rationale: Blockade of D2 receptors in the tuberoinfundibular pathway
disinhibits prolactin release, leading to hyperprolactinemia and
associated symptoms like galactorrhea and amenorrhea.
3. Which atypical antipsychotic requires regular monitoring of
absolute neutrophil count (ANC) due to the risk of agranulocytosis?
,A. Quetiapine
B. Olanzapine
C. Clozapine
D. Aripiprazole
Correct Answer: C
Rationale: Clozapine carries a black box warning for severe
neutropenia/agranulocytosis, requiring strict ANC monitoring through a
REMS program.
4. A patient on lithium therapy reports coarse hand tremors, vomiting,
and confusion. What is the priority nursing action?
A. Administer the next scheduled dose
B. Hold the medication and notify the provider immediately
C. Encourage increased fluid intake
D. Reassure the patient that these are common side effects
Correct Answer: B
Rationale: These symptoms indicate lithium toxicity. The medication
must be held, and the provider notified immediately for evaluation of
serum lithium levels.
5. What is the significance of avoiding strong CYP3A4 inducers when
prescribing Lurasidone?
A. They enhance the effects of Lurasidone
B. They decrease the effectiveness of Lurasidone by increasing its
metabolism
C. They increase the risk of tardive dyskinesia
D. They have no significant impact on Lurasidone
Correct Answer: B
Rationale: Strong CYP3A4 inducers (like carbamazepine) increase the
,metabolism of Lurasidone, significantly reducing its plasma
concentration and therapeutic efficacy.
6. Which food item must patients taking monoamine oxidase
inhibitors (MAOIs) avoid to prevent a hypertensive crisis?
A. Leafy green vegetables
B. Aged cheese and cured meats
C. Citrus fruits
D. Whole grains
Correct Answer: B
Rationale: Aged cheese and cured meats contain high levels of
tyramine. MAOIs inhibit the breakdown of tyramine, which can lead to
a severe hypertensive crisis.
7. A patient experiencing acute dystonia after receiving an
antipsychotic is most likely to be treated with which medication?
A. Benztropine
B. Propranolol
C. Valproic acid
D. Lithium
Correct Answer: A
Rationale: Benztropine is an anticholinergic medication used to rapidly
reverse acute dystonic reactions caused by antipsychotic-induced
dopamine blockade.
8. Which atypical antipsychotic is most associated with significant
weight gain and metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
, D. Lurasidone
Correct Answer: C
Rationale: Olanzapine is highly associated with weight gain,
hyperglycemia, and dyslipidemia compared to other atypical
antipsychotics.
9. What is the therapeutic serum range for lithium in the maintenance
treatment of bipolar disorder?
A. 0.1 - 0.4 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.5 mEq/L
D. 3.0 - 4.0 mEq/L
Correct Answer: B
Rationale: The therapeutic range for lithium is narrow, typically 0.6 to
1.2 mEq/L for maintenance therapy.
10. A patient prescribed sertraline reports experiencing sexual
dysfunction. What is the most appropriate nursing intervention?
A. Tell the patient to stop taking the medication immediately
B. Reassure the patient that this is a common side effect and encourage
them to discuss options with their provider
C. Double the dose to counteract the side effect
D. Switch the patient to an MAOI without consulting the provider
Correct Answer: B
Rationale: Sexual dysfunction is a common SSRI side effect. The nurse
should validate the patient's experience and encourage them to discuss
potential solutions (dose reduction, switching, or adding bupropion)
with the prescriber.
