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NRNP 6665 Final Exam – Practice Questions with Verified Answers
Section 1: Psychopharmacology & Pharmacokinetics (Questions 1–20)
1. A patient is started on a new psychotropic medication. The PMHNP explains that steady
state is typically reached after approximately how many half-lives?
A. 2 half-lives
B. 3 half-lives
C. 5 half-lives
D. 7 half-lives
Answer: C – 5 half-lives
Rationale: Steady state is achieved when the amount of drug administered equals the
amount eliminated. This typically takes about five half-lives, reaching approximately 97% of
steady-state concentration .
2. Carbamazepine (Tegretol) is unique among mood stabilizers because it:
A. Has no significant drug interactions
B. Induces its own metabolism over time
C. Does not require serum level monitoring
D. Has a shorter half-life than other mood stabilizers
Answer: B – Induces its own metabolism over time
Rationale: Carbamazepine is a known enzyme inducer that induces its own metabolism
(auto-induction), lowering serum levels over the first several weeks and requiring follow-up
level checks .
3. Fluoxetine (Prozac) has a significantly longer washout period than other SSRIs primarily
because:
A. It has a shorter half-life than other SSRIs
B. Its active metabolite has an extremely long half-life
C. It is not metabolized by the liver
D. It has poor oral bioavailability
Answer: B – Its active metabolite has an extremely long half-life
Rationale: Fluoxetine's active metabolite, norfluoxetine, has a half-life of 7–15 days,
requiring a 5-week washout before starting an MAOI to prevent serotonin syndrome .
4. The PMHNP is managing a patient on lithium. Lithium typically reaches steady state
after:
A. 3 half-lives
B. 5 half-lives
C. 14 days
D. 30 days
, 2
Answer: B – 5 half-lives
Rationale: Lithium follows standard pharmacokinetic principles, reaching steady state after
approximately five half-lives. With a half-life of ~24 hours, steady state is achieved in about 5
days .
5. When treating geriatric patients with psychotherapeutic drugs, the PMHNP must
consider that:
A. Elderly persons metabolize drugs more rapidly
B. Elderly persons may be more susceptible to adverse effects
C. Elderly persons require higher starting doses
D. Elderly persons excrete drugs more rapidly
Answer: B – Elderly persons may be more susceptible to adverse effects
Rationale: Older adults have reduced hepatic metabolism and renal excretion, meaning they
metabolize and excrete drugs more slowly and are more prone to adverse effects and
toxicity. This supports the principle "start low, go slow" .
6. Which antipsychotic medication has the greatest tendency to increase appetite and
body weight?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Haloperidol
Answer: C – Olanzapine
Rationale: Olanzapine is associated with significant weight gain and metabolic effects, more
so than ziprasidone, aripiprazole, or haloperidol .
7. A patient on lithium develops polyuria, polydipsia, and a urine osmolality of 150
mOsm/kg. Which intervention is most appropriate?
A. Increase lithium dose
B. Switch to amiloride
C. Add hydrochlorothiazide
D. Discontinue lithium abruptly
Answer: B – Switch to amiloride
Rationale: Lithium-induced nephrogenic diabetes insipidus is treated by switching to
amiloride, which blocks lithium entry into renal tubular cells. Thiazides may worsen lithium
levels .
8. Which statement accurately reflects the FDA boxed warning for all antidepressants
regarding suicidality?
A. Risk is highest in adults over 65
B. Risk is limited to the first week of treatment
, 3
C. Risk is highest in patients under 25, especially during initiation
D. Risk is equivalent across all age groups
Answer: C – Risk is highest in patients under 25, especially during initiation
Rationale: The boxed warning highlights increased suicidality in patients under 25,
particularly early in treatment .
9. A patient on lithium presents with coarse tremors, ataxia, and confusion. Serum lithium
level is 2.1 mEq/L. Which intervention is the immediate priority?
A. Administer activated charcoal
B. Initiate hemodialysis
C. Administer sodium polystyrene sulfonate
D. Increase fluid intake and monitor
Answer: B – Initiate hemodialysis
Rationale: Lithium toxicity with severe neurological symptoms and levels >2.0 mEq/L
warrants hemodialysis to rapidly reduce serum levels. Activated charcoal does not bind
lithium .
10. Ketamine therapy requires immediate monitoring of which parameter after infusion?
A. Serum electrolytes and renal function
B. Blood pressure and heart rate
C. Liver function tests
D. Thyroid stimulating hormone
Answer: B – Blood pressure and heart rate
Rationale: Ketamine can cause transient hypertension and tachycardia, requiring immediate
hemodynamic monitoring .
11. Which factor most strongly predicts the development of tardive dyskinesia in patients
receiving long-term antipsychotic therapy?
A. Cumulative antipsychotic dose and duration of treatment
B. Concurrent use of anticholinergic agents
C. History of substance use disorder
D. Family history of Parkinson's disease
Answer: A – Cumulative antipsychotic dose and duration of treatment
Rationale: Tardive dyskinesia risk correlates with cumulative antipsychotic exposure,
especially with first-generation agents .
12. Which genetic polymorphism most significantly affects clopidogrel activation and is
relevant when co-prescribed with SSRIs?
A. CYP2D6
B. CYP2C19
NRNP 6665 Final Exam – Practice Questions with Verified Answers
Section 1: Psychopharmacology & Pharmacokinetics (Questions 1–20)
1. A patient is started on a new psychotropic medication. The PMHNP explains that steady
state is typically reached after approximately how many half-lives?
A. 2 half-lives
B. 3 half-lives
C. 5 half-lives
D. 7 half-lives
Answer: C – 5 half-lives
Rationale: Steady state is achieved when the amount of drug administered equals the
amount eliminated. This typically takes about five half-lives, reaching approximately 97% of
steady-state concentration .
2. Carbamazepine (Tegretol) is unique among mood stabilizers because it:
A. Has no significant drug interactions
B. Induces its own metabolism over time
C. Does not require serum level monitoring
D. Has a shorter half-life than other mood stabilizers
Answer: B – Induces its own metabolism over time
Rationale: Carbamazepine is a known enzyme inducer that induces its own metabolism
(auto-induction), lowering serum levels over the first several weeks and requiring follow-up
level checks .
3. Fluoxetine (Prozac) has a significantly longer washout period than other SSRIs primarily
because:
A. It has a shorter half-life than other SSRIs
B. Its active metabolite has an extremely long half-life
C. It is not metabolized by the liver
D. It has poor oral bioavailability
Answer: B – Its active metabolite has an extremely long half-life
Rationale: Fluoxetine's active metabolite, norfluoxetine, has a half-life of 7–15 days,
requiring a 5-week washout before starting an MAOI to prevent serotonin syndrome .
4. The PMHNP is managing a patient on lithium. Lithium typically reaches steady state
after:
A. 3 half-lives
B. 5 half-lives
C. 14 days
D. 30 days
, 2
Answer: B – 5 half-lives
Rationale: Lithium follows standard pharmacokinetic principles, reaching steady state after
approximately five half-lives. With a half-life of ~24 hours, steady state is achieved in about 5
days .
5. When treating geriatric patients with psychotherapeutic drugs, the PMHNP must
consider that:
A. Elderly persons metabolize drugs more rapidly
B. Elderly persons may be more susceptible to adverse effects
C. Elderly persons require higher starting doses
D. Elderly persons excrete drugs more rapidly
Answer: B – Elderly persons may be more susceptible to adverse effects
Rationale: Older adults have reduced hepatic metabolism and renal excretion, meaning they
metabolize and excrete drugs more slowly and are more prone to adverse effects and
toxicity. This supports the principle "start low, go slow" .
6. Which antipsychotic medication has the greatest tendency to increase appetite and
body weight?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Haloperidol
Answer: C – Olanzapine
Rationale: Olanzapine is associated with significant weight gain and metabolic effects, more
so than ziprasidone, aripiprazole, or haloperidol .
7. A patient on lithium develops polyuria, polydipsia, and a urine osmolality of 150
mOsm/kg. Which intervention is most appropriate?
A. Increase lithium dose
B. Switch to amiloride
C. Add hydrochlorothiazide
D. Discontinue lithium abruptly
Answer: B – Switch to amiloride
Rationale: Lithium-induced nephrogenic diabetes insipidus is treated by switching to
amiloride, which blocks lithium entry into renal tubular cells. Thiazides may worsen lithium
levels .
8. Which statement accurately reflects the FDA boxed warning for all antidepressants
regarding suicidality?
A. Risk is highest in adults over 65
B. Risk is limited to the first week of treatment
, 3
C. Risk is highest in patients under 25, especially during initiation
D. Risk is equivalent across all age groups
Answer: C – Risk is highest in patients under 25, especially during initiation
Rationale: The boxed warning highlights increased suicidality in patients under 25,
particularly early in treatment .
9. A patient on lithium presents with coarse tremors, ataxia, and confusion. Serum lithium
level is 2.1 mEq/L. Which intervention is the immediate priority?
A. Administer activated charcoal
B. Initiate hemodialysis
C. Administer sodium polystyrene sulfonate
D. Increase fluid intake and monitor
Answer: B – Initiate hemodialysis
Rationale: Lithium toxicity with severe neurological symptoms and levels >2.0 mEq/L
warrants hemodialysis to rapidly reduce serum levels. Activated charcoal does not bind
lithium .
10. Ketamine therapy requires immediate monitoring of which parameter after infusion?
A. Serum electrolytes and renal function
B. Blood pressure and heart rate
C. Liver function tests
D. Thyroid stimulating hormone
Answer: B – Blood pressure and heart rate
Rationale: Ketamine can cause transient hypertension and tachycardia, requiring immediate
hemodynamic monitoring .
11. Which factor most strongly predicts the development of tardive dyskinesia in patients
receiving long-term antipsychotic therapy?
A. Cumulative antipsychotic dose and duration of treatment
B. Concurrent use of anticholinergic agents
C. History of substance use disorder
D. Family history of Parkinson's disease
Answer: A – Cumulative antipsychotic dose and duration of treatment
Rationale: Tardive dyskinesia risk correlates with cumulative antipsychotic exposure,
especially with first-generation agents .
12. Which genetic polymorphism most significantly affects clopidogrel activation and is
relevant when co-prescribed with SSRIs?
A. CYP2D6
B. CYP2C19
