NURS 5359 (Advanced Psychopharmacology) Exam 4
| Questions and Correct Answers plus Rationale | New
Update 2026-2027 | Graded A+
1. Which of the following best describes the primary mechanism of action of
donepezil in Alzheimer's disease?
A) Inhibition of acetylcholinesterase, increasing acetylcholine availability
B) Antagonism of NMDA receptors, reducing glutamate excitotoxicity
C) Selective serotonin reuptake inhibition, improving mood
D) Blockade of dopamine D2 receptors, reducing psychosis
Correct Answer: Inhibition of acetylcholinesterase, increasing acetylcholine
availability
Rationale: Donepezil is a centrally acting acetylcholinesterase inhibitor that
increases acetylcholine levels in the brain, which temporarily improves cognitive
symptoms in mild to moderate Alzheimer's disease. It does not act on NMDA
receptors, serotonin reuptake, or dopamine receptors. This mechanism is distinct
from memantine, which is an NMDA receptor antagonist.
2. What is the primary function of memantine in the treatment of moderate
to severe Alzheimer's disease?
A) Blocking NMDA receptors to reduce glutamate excitotoxicity
B) Inhibiting acetylcholinesterase to increase acetylcholine
C) Enhancing GABA activity to reduce anxiety
D) Blocking dopamine receptors to reduce psychosis
Correct Answer: Blocking NMDA receptors to reduce glutamate excitotoxicity
Rationale: Memantine is an NMDA receptor antagonist that modulates glutamate
activity, reducing excitotoxicity that contributes to neuronal damage in
,Alzheimer's disease. It is often used in combination with acetylcholinesterase
inhibitors. It does not inhibit acetylcholinesterase, enhance GABA, or block
dopamine receptors.
3. Which acetylcholinesterase inhibitor is associated with a dual mechanism of
action involving both acetylcholinesterase inhibition and nicotinic receptor
modulation?
A) Donepezil
B) Rivastigmine
C) Galantamine
D) Memantine
Correct Answer: Galantamine
Rationale: Galantamine has a dual mechanism: it inhibits acetylcholinesterase and
also modulates nicotinic acetylcholine receptors, which may enhance cognitive
effects. Donepezil and rivastigmine are pure acetylcholinesterase inhibitors.
Memantine is an NMDA receptor antagonist. This unique mechanism
distinguishes galantamine from other cholinesterase inhibitors.
4. Which finding is most consistent with vascular dementia?
A) Stepwise decline following cerebrovascular events with better-preserved verbal
memory
B) Insidious onset with prominent short-term memory loss and personality
changes
C) Visual hallucinations, parkinsonism, and cognitive fluctuations
D) Early behavioral changes with preserved memory and executive function
Correct Answer: Stepwise decline following cerebrovascular events with better-
preserved verbal memory
Rationale: Vascular dementia is characterized by a stepwise decline that follows
strokes or cerebrovascular events. Verbal memory is often better preserved than
in Alzheimer's disease, while processing speed and executive functions are more
,prominently affected. Visual hallucinations and parkinsonism suggest Lewy body
dementia.
5. Which finding is most consistent with Lewy body dementia?
A) Visual hallucinations, spontaneous parkinsonism, and cognitive fluctuations
B) Stepwise decline following cerebrovascular events
C) Insidious onset with prominent short-term memory loss
D) Early behavioral changes with preserved memory
Correct Answer: Visual hallucinations, spontaneous parkinsonism, and cognitive
fluctuations
Rationale: Lewy body dementia is characterized by visual hallucinations,
spontaneous parkinsonism, and cognitive fluctuations. Memory impairment may
be less severe than in Alzheimer's disease, with visuospatial and executive deficits
more prominent. This presentation is distinct from vascular dementia and
frontotemporal degeneration.
6. Which finding is most consistent with frontotemporal degeneration?
A) Early behavioral changes and personality changes with preserved memory
B) Visual hallucinations and parkinsonism
C) Stepwise decline following strokes
D) Prominent short-term memory loss with disorientation
Correct Answer: Early behavioral changes and personality changes with preserved
memory
Rationale: Frontotemporal degeneration is characterized by early behavioral and
personality changes, with memory relatively preserved compared to Alzheimer's
disease. It often presents with disinhibition, apathy, and impaired executive
function. This pattern is distinct from the memory-predominant presentation of
Alzheimer's disease.
7. What is the primary mechanism of action of rivastigmine?
A) Inhibition of both acetylcholinesterase and butyrylcholinesterase
, B) NMDA receptor antagonism
C) Selective serotonin reuptake inhibition
D) Dopamine D2 receptor blockade
Correct Answer: Inhibition of both acetylcholinesterase and butyrylcholinesterase
Rationale: Rivastigmine inhibits both acetylcholinesterase and
butyrylcholinesterase, which may provide broader cholinergic enhancement. It is
available in oral and transdermal forms. Donepezil and galantamine primarily
inhibit acetylcholinesterase. Memantine acts on NMDA receptors.
8. Which medication is a non-stimulant approved for ADHD that works by
selectively inhibiting norepinephrine reuptake?
A) Atomoxetine
B) Methylphenidate
C) Amphetamine
D) Lisdexamfetamine
Correct Answer: Atomoxetine
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI)
approved for ADHD. It is a non-stimulant option that may be preferred in patients
with substance use disorders or those who cannot tolerate stimulants. It may take
several weeks to achieve full effect, unlike stimulants.
9. What is the primary mechanism of action of methylphenidate?
A) Blocking dopamine and norepinephrine reuptake
B) Enhancing GABA activity
C) Inhibiting serotonin reuptake
D) Blocking dopamine receptors
Correct Answer: Blocking dopamine and norepinephrine reuptake
Rationale: Methylphenidate is a stimulant that blocks the reuptake of dopamine
and norepinephrine, increasing their availability in the synapse. It is used for
| Questions and Correct Answers plus Rationale | New
Update 2026-2027 | Graded A+
1. Which of the following best describes the primary mechanism of action of
donepezil in Alzheimer's disease?
A) Inhibition of acetylcholinesterase, increasing acetylcholine availability
B) Antagonism of NMDA receptors, reducing glutamate excitotoxicity
C) Selective serotonin reuptake inhibition, improving mood
D) Blockade of dopamine D2 receptors, reducing psychosis
Correct Answer: Inhibition of acetylcholinesterase, increasing acetylcholine
availability
Rationale: Donepezil is a centrally acting acetylcholinesterase inhibitor that
increases acetylcholine levels in the brain, which temporarily improves cognitive
symptoms in mild to moderate Alzheimer's disease. It does not act on NMDA
receptors, serotonin reuptake, or dopamine receptors. This mechanism is distinct
from memantine, which is an NMDA receptor antagonist.
2. What is the primary function of memantine in the treatment of moderate
to severe Alzheimer's disease?
A) Blocking NMDA receptors to reduce glutamate excitotoxicity
B) Inhibiting acetylcholinesterase to increase acetylcholine
C) Enhancing GABA activity to reduce anxiety
D) Blocking dopamine receptors to reduce psychosis
Correct Answer: Blocking NMDA receptors to reduce glutamate excitotoxicity
Rationale: Memantine is an NMDA receptor antagonist that modulates glutamate
activity, reducing excitotoxicity that contributes to neuronal damage in
,Alzheimer's disease. It is often used in combination with acetylcholinesterase
inhibitors. It does not inhibit acetylcholinesterase, enhance GABA, or block
dopamine receptors.
3. Which acetylcholinesterase inhibitor is associated with a dual mechanism of
action involving both acetylcholinesterase inhibition and nicotinic receptor
modulation?
A) Donepezil
B) Rivastigmine
C) Galantamine
D) Memantine
Correct Answer: Galantamine
Rationale: Galantamine has a dual mechanism: it inhibits acetylcholinesterase and
also modulates nicotinic acetylcholine receptors, which may enhance cognitive
effects. Donepezil and rivastigmine are pure acetylcholinesterase inhibitors.
Memantine is an NMDA receptor antagonist. This unique mechanism
distinguishes galantamine from other cholinesterase inhibitors.
4. Which finding is most consistent with vascular dementia?
A) Stepwise decline following cerebrovascular events with better-preserved verbal
memory
B) Insidious onset with prominent short-term memory loss and personality
changes
C) Visual hallucinations, parkinsonism, and cognitive fluctuations
D) Early behavioral changes with preserved memory and executive function
Correct Answer: Stepwise decline following cerebrovascular events with better-
preserved verbal memory
Rationale: Vascular dementia is characterized by a stepwise decline that follows
strokes or cerebrovascular events. Verbal memory is often better preserved than
in Alzheimer's disease, while processing speed and executive functions are more
,prominently affected. Visual hallucinations and parkinsonism suggest Lewy body
dementia.
5. Which finding is most consistent with Lewy body dementia?
A) Visual hallucinations, spontaneous parkinsonism, and cognitive fluctuations
B) Stepwise decline following cerebrovascular events
C) Insidious onset with prominent short-term memory loss
D) Early behavioral changes with preserved memory
Correct Answer: Visual hallucinations, spontaneous parkinsonism, and cognitive
fluctuations
Rationale: Lewy body dementia is characterized by visual hallucinations,
spontaneous parkinsonism, and cognitive fluctuations. Memory impairment may
be less severe than in Alzheimer's disease, with visuospatial and executive deficits
more prominent. This presentation is distinct from vascular dementia and
frontotemporal degeneration.
6. Which finding is most consistent with frontotemporal degeneration?
A) Early behavioral changes and personality changes with preserved memory
B) Visual hallucinations and parkinsonism
C) Stepwise decline following strokes
D) Prominent short-term memory loss with disorientation
Correct Answer: Early behavioral changes and personality changes with preserved
memory
Rationale: Frontotemporal degeneration is characterized by early behavioral and
personality changes, with memory relatively preserved compared to Alzheimer's
disease. It often presents with disinhibition, apathy, and impaired executive
function. This pattern is distinct from the memory-predominant presentation of
Alzheimer's disease.
7. What is the primary mechanism of action of rivastigmine?
A) Inhibition of both acetylcholinesterase and butyrylcholinesterase
, B) NMDA receptor antagonism
C) Selective serotonin reuptake inhibition
D) Dopamine D2 receptor blockade
Correct Answer: Inhibition of both acetylcholinesterase and butyrylcholinesterase
Rationale: Rivastigmine inhibits both acetylcholinesterase and
butyrylcholinesterase, which may provide broader cholinergic enhancement. It is
available in oral and transdermal forms. Donepezil and galantamine primarily
inhibit acetylcholinesterase. Memantine acts on NMDA receptors.
8. Which medication is a non-stimulant approved for ADHD that works by
selectively inhibiting norepinephrine reuptake?
A) Atomoxetine
B) Methylphenidate
C) Amphetamine
D) Lisdexamfetamine
Correct Answer: Atomoxetine
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI)
approved for ADHD. It is a non-stimulant option that may be preferred in patients
with substance use disorders or those who cannot tolerate stimulants. It may take
several weeks to achieve full effect, unlike stimulants.
9. What is the primary mechanism of action of methylphenidate?
A) Blocking dopamine and norepinephrine reuptake
B) Enhancing GABA activity
C) Inhibiting serotonin reuptake
D) Blocking dopamine receptors
Correct Answer: Blocking dopamine and norepinephrine reuptake
Rationale: Methylphenidate is a stimulant that blocks the reuptake of dopamine
and norepinephrine, increasing their availability in the synapse. It is used for
