NRNP 6675 EXAM
1. Which neurotransmitter system is the primary target of selective serotonin
reuptake inhibitors (SSRIs)?
A. GABA
B. Acetylcholine
C. Serotonin
D. Dopamine
Answer: C. Serotonin
Rationale: SSRIs block the serotonin transporter (SERT), increasing synaptic
serotonin. Effects on other systems are minimal, which explains their favorable
side-effect profile.
2. A patient on sertraline develops agitation, tremor, hyperreflexia, diaphoresis
and fever after linezolid is added. What is the most likely diagnosis?
A. Anticholinergic toxicity
B. Serotonin syndrome
C. Lithium toxicity
D. Neuroleptic malignant syndrome
Answer: B. Serotonin syndrome
Rationale: Linezolid is a weak MAOI; combined with an SSRI it can cause serotonin
syndrome (hyperreflexia, clonus, autonomic instability). NMS causes rigidity and
bradyreflexia.
3. Which laboratory test is required before starting carbamazepine in patients of
Asian ancestry?
A. Serum lithium level
B. HLA-B*1502 genotype
C. CYP2D6 phenotype only
D. Thyroid antibodies
Answer: B. HLA-B*1502 genotype
Rationale: HLA-B*1502 is associated with Stevens-Johnson syndrome and toxic
epidermal necrolysis with carbamazepine.
,4. Which is the therapeutic serum lithium range for acute mania?
A. 0.2 to 0.4 mEq/L
B. 0.8 to 1.2 mEq/L
C. 1.8 to 2.5 mEq/L
D. 2.5 to 3.5 mEq/L
Answer: B. 0.8 to 1.2 mEq/L
Rationale: Acute mania is treated at 0.8 to 1.2 mEq/L; maintenance is typically 0.6 to
0.8 mEq/L. Levels above 1.5 are associated with toxicity.
5. Which medication increases serum lithium levels by reducing renal
clearance?
A. Acetazolamide
B. Hydrochlorothiazide
C. Caffeine
D. Furosemide only
Answer: B. Hydrochlorothiazide
Rationale: Thiazide diuretics, ACE inhibitors, ARBs and NSAIDs reduce lithium
clearance. Caffeine and acetazolamide increase excretion.
6. Which atypical antipsychotic carries the highest risk of agranulocytosis and
requires a REMS program?
A. Clozapine
B. Olanzapine
C. Risperidone
D. Aripiprazole
Answer: A. Clozapine
Rationale: Clozapine can cause severe neutropenia and requires absolute neutrophil
count monitoring through the Clozapine REMS.
7. Which antipsychotic is most associated with metabolic syndrome and weight
gain?
A. Lurasidone
B. Aripiprazole
C. Ziprasidone
D. Olanzapine
Answer: D. Olanzapine
Rationale: Olanzapine and clozapine have the highest metabolic risk. Ziprasidone,
lurasidone and aripiprazole are weight-neutral to low risk.
,8. A patient on haloperidol develops fever, lead-pipe rigidity, altered mental
status and elevated creatine kinase. What is the priority action?
A. Start an SSRI
B. Discontinue the antipsychotic and provide supportive care
C. Increase the haloperidol dose
D. Add a second antipsychotic
Answer: B. Discontinue the antipsychotic and provide supportive care
Rationale: These findings indicate neuroleptic malignant syndrome, a medical
emergency. Stop the offending agent; give fluids, cooling, and consider dantrolene or
bromocriptine.
9. Which agent is first-line for treating acute dystonia caused by an
antipsychotic?
A. Lorazepam alone
B. Propranolol
C. Valbenazine
D. Benztropine
Answer: D. Benztropine
Rationale: Anticholinergics such as benztropine or diphenhydramine rapidly relieve
acute dystonic reactions.
10. Which medication is FDA-approved to treat tardive dyskinesia?
A. Haloperidol
B. Amantadine
C. Benztropine
D. Valbenazine
Answer: D. Valbenazine
Rationale: Valbenazine and deutetrabenazine are VMAT2 inhibitors approved for
tardive dyskinesia. Anticholinergics may worsen it.
11. Which antidepressant has the highest risk of seizures at higher doses and is
contraindicated in bulimia?
A. Escitalopram
B. Sertraline
C. Mirtazapine
D. Bupropion
Answer: D. Bupropion
Rationale: Bupropion lowers the seizure threshold, especially in eating disorders,
alcohol withdrawal and high doses.
, 12. Which antidepressant is most likely to cause weight gain and sedation due
to histamine blockade?
A. Bupropion
B. Venlafaxine
C. Fluoxetine
D. Mirtazapine
Answer: D. Mirtazapine
Rationale: Mirtazapine's H1 antagonism produces sedation and increased appetite,
useful in depressed patients with insomnia and poor appetite.
13. Which antidepressant class requires a tyramine-restricted diet?
A. Atypical antidepressants
B. SNRIs
C. SSRIs
D. Monoamine oxidase inhibitors
Answer: D. Monoamine oxidase inhibitors
Rationale: MAOIs prevent tyramine breakdown; ingestion of aged cheese or cured
meats can cause hypertensive crisis.
14. What is the minimum washout period after stopping fluoxetine before
starting an MAOI?
A. 2 days
B. 1 week
C. 5 weeks
D. 24 hours
Answer: C. 5 weeks
Rationale: Fluoxetine and its active metabolite have long half-lives, so a 5-week
washout is needed to avoid serotonin syndrome.
15. Which SNRI is most likely to cause dose-dependent elevations in blood
pressure?
A. Duloxetine
B. Venlafaxine
C. Sertraline
D. Mirtazapine
Answer: B. Venlafaxine
Rationale: Venlafaxine increases noradrenergic activity at higher doses, so blood
pressure should be monitored.
1. Which neurotransmitter system is the primary target of selective serotonin
reuptake inhibitors (SSRIs)?
A. GABA
B. Acetylcholine
C. Serotonin
D. Dopamine
Answer: C. Serotonin
Rationale: SSRIs block the serotonin transporter (SERT), increasing synaptic
serotonin. Effects on other systems are minimal, which explains their favorable
side-effect profile.
2. A patient on sertraline develops agitation, tremor, hyperreflexia, diaphoresis
and fever after linezolid is added. What is the most likely diagnosis?
A. Anticholinergic toxicity
B. Serotonin syndrome
C. Lithium toxicity
D. Neuroleptic malignant syndrome
Answer: B. Serotonin syndrome
Rationale: Linezolid is a weak MAOI; combined with an SSRI it can cause serotonin
syndrome (hyperreflexia, clonus, autonomic instability). NMS causes rigidity and
bradyreflexia.
3. Which laboratory test is required before starting carbamazepine in patients of
Asian ancestry?
A. Serum lithium level
B. HLA-B*1502 genotype
C. CYP2D6 phenotype only
D. Thyroid antibodies
Answer: B. HLA-B*1502 genotype
Rationale: HLA-B*1502 is associated with Stevens-Johnson syndrome and toxic
epidermal necrolysis with carbamazepine.
,4. Which is the therapeutic serum lithium range for acute mania?
A. 0.2 to 0.4 mEq/L
B. 0.8 to 1.2 mEq/L
C. 1.8 to 2.5 mEq/L
D. 2.5 to 3.5 mEq/L
Answer: B. 0.8 to 1.2 mEq/L
Rationale: Acute mania is treated at 0.8 to 1.2 mEq/L; maintenance is typically 0.6 to
0.8 mEq/L. Levels above 1.5 are associated with toxicity.
5. Which medication increases serum lithium levels by reducing renal
clearance?
A. Acetazolamide
B. Hydrochlorothiazide
C. Caffeine
D. Furosemide only
Answer: B. Hydrochlorothiazide
Rationale: Thiazide diuretics, ACE inhibitors, ARBs and NSAIDs reduce lithium
clearance. Caffeine and acetazolamide increase excretion.
6. Which atypical antipsychotic carries the highest risk of agranulocytosis and
requires a REMS program?
A. Clozapine
B. Olanzapine
C. Risperidone
D. Aripiprazole
Answer: A. Clozapine
Rationale: Clozapine can cause severe neutropenia and requires absolute neutrophil
count monitoring through the Clozapine REMS.
7. Which antipsychotic is most associated with metabolic syndrome and weight
gain?
A. Lurasidone
B. Aripiprazole
C. Ziprasidone
D. Olanzapine
Answer: D. Olanzapine
Rationale: Olanzapine and clozapine have the highest metabolic risk. Ziprasidone,
lurasidone and aripiprazole are weight-neutral to low risk.
,8. A patient on haloperidol develops fever, lead-pipe rigidity, altered mental
status and elevated creatine kinase. What is the priority action?
A. Start an SSRI
B. Discontinue the antipsychotic and provide supportive care
C. Increase the haloperidol dose
D. Add a second antipsychotic
Answer: B. Discontinue the antipsychotic and provide supportive care
Rationale: These findings indicate neuroleptic malignant syndrome, a medical
emergency. Stop the offending agent; give fluids, cooling, and consider dantrolene or
bromocriptine.
9. Which agent is first-line for treating acute dystonia caused by an
antipsychotic?
A. Lorazepam alone
B. Propranolol
C. Valbenazine
D. Benztropine
Answer: D. Benztropine
Rationale: Anticholinergics such as benztropine or diphenhydramine rapidly relieve
acute dystonic reactions.
10. Which medication is FDA-approved to treat tardive dyskinesia?
A. Haloperidol
B. Amantadine
C. Benztropine
D. Valbenazine
Answer: D. Valbenazine
Rationale: Valbenazine and deutetrabenazine are VMAT2 inhibitors approved for
tardive dyskinesia. Anticholinergics may worsen it.
11. Which antidepressant has the highest risk of seizures at higher doses and is
contraindicated in bulimia?
A. Escitalopram
B. Sertraline
C. Mirtazapine
D. Bupropion
Answer: D. Bupropion
Rationale: Bupropion lowers the seizure threshold, especially in eating disorders,
alcohol withdrawal and high doses.
, 12. Which antidepressant is most likely to cause weight gain and sedation due
to histamine blockade?
A. Bupropion
B. Venlafaxine
C. Fluoxetine
D. Mirtazapine
Answer: D. Mirtazapine
Rationale: Mirtazapine's H1 antagonism produces sedation and increased appetite,
useful in depressed patients with insomnia and poor appetite.
13. Which antidepressant class requires a tyramine-restricted diet?
A. Atypical antidepressants
B. SNRIs
C. SSRIs
D. Monoamine oxidase inhibitors
Answer: D. Monoamine oxidase inhibitors
Rationale: MAOIs prevent tyramine breakdown; ingestion of aged cheese or cured
meats can cause hypertensive crisis.
14. What is the minimum washout period after stopping fluoxetine before
starting an MAOI?
A. 2 days
B. 1 week
C. 5 weeks
D. 24 hours
Answer: C. 5 weeks
Rationale: Fluoxetine and its active metabolite have long half-lives, so a 5-week
washout is needed to avoid serotonin syndrome.
15. Which SNRI is most likely to cause dose-dependent elevations in blood
pressure?
A. Duloxetine
B. Venlafaxine
C. Sertraline
D. Mirtazapine
Answer: B. Venlafaxine
Rationale: Venlafaxine increases noradrenergic activity at higher doses, so blood
pressure should be monitored.
