NR546 Midterm Exam – Advanced
Psychopharmacology for the PMHNP
Questions and Answers Updated
2026/2027 Version | Verified Answers
1. What should the PMHNP consider when prescribing chemical restraints? -
ANSWER ✅ -allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical
restraint
-state regulations regarding chemical restrains must be reviewed
2. Are the PMHNP and other staff liable if the client has an allergic reaction or
adverse side effects to the drugs used for chemical restraint? - ANSWER ✅
No.
The client has been court-ordered to take the prescribed medications and the
standing order for chemical restraints is approved. The PMHNP and other
staff are not liable if the patient has an allergic reaction or adverse side
effects.
3. How does reviewing the genetic makeup of a client help guide the PMHNP
in selecting medication for clients? - ANSWER ✅ -Genetic testing can
assist by providing more information on how clients may respond to certain
psychotropic medications
-provides information on how a client may break down and metabolize
medications based on the cytochrome P450 system.
4. area of the brain thought to be responsible for the positive symptoms of
schizophrenia is the ____________. one of the neuronal pathways known to
, be affected here is the ___________ from the _____________ and the
_____________. - ANSWER ✅ limbic system, mesolimbic pathway,
ventral tegmental area (VTA), nucleus accumbens
5. schizophrenia: the dopamine theory - ANSWER ✅ suggests that in the
mesolimbic pathway, neurons from the VTA (ventral tegmental area) release
higher than normal levels of dopamine into the synaptic cleft at the NAC
(nucleus accumbens).
-More dopamine binds to the D2 dopamine receptors in the NAC. This is
thought to be the cause of positive symptoms
6. Schizophrenia: dopamine and mesocortical system - ANSWER ✅ area of
the brain thought to be responsible for negative symptoms of schizophrenia,
prefrontal cortex
-mesocortical pathway goes from the VTA (ventral tegmental area) to the
PFC (prefrontal cortex)
-dysregulation of dopamine between these two areas of the brain results in
the negative and cognitive symptoms
7. Dopamine pathway: mesolimbic - ANSWER ✅ location: Ventral tegmental
area (VTA) within midbreain to the nucleus accumbens (NA) in the limbic
system
function: regulates emotional behaviors & associated with reward,
motivation, pleasure
8. symptoms: overactivation causes (+) symptoms and may be a downstream
consequence of prefrontal cortex dysfunction & glutamate activity in the
hippocampus
,9. Dopamine pathway: mesocortical - ANSWER ✅ location: ventral tegmental
area (VTA) to the prefrontal cortex (PFC). Specifically affecting dorsolateral
prefrontal cortex (DLPFC) & ventromedial prefrontal cortex (VMPFC)
10.function: regulates cognition, executive function, emotions, affect.
DLPFC-cognitive, (-) symptoms
VMPFC-affective & (-) symptoms
symptoms: hypoactivation of pathway may cause (-), cognitive, & affective
symptoms
11.dopamine pathway: nigrostriatal - ANSWER ✅ location: projects from
substantia nigra (in midbrain) to basal ganglia (striatum & globus pallidus)
function: part of extrapyramidal nervous system, controls posture &
voluntary motor movements
symptoms: imbalance of pathways causes movement disorders. Common
disorders-parkinson's and tremor.
Low dopamine in basal ganglia-akathisia & dystonia.
Hyperactivation of pathway-tics, dyskinesias, chorea.
Chronic blockade of D2 pathway-tardive dyskinesia.
12.dopamine pathway: tuberinfundibular - ANSWER ✅ location: projects from
hypothalamus to anterior pituitary gland
function: dopamine inhibits prolactin release from pituitary
, symptoms: disruption of pathway causes prolactin level to rise resulting in
gynecomastia & galactorrhea.
Females-amenorrhea
Both may get sexual dysfunction
13.neurobiological factors that contribute to psychosis and schizophrnia -
ANSWER ✅ -genetics
-neuroanatomy
-neural networks
-neural signaling
14.neuroanatomy: symptoms associated with mesocortical and ventromedial
prefrontal cortex - ANSWER ✅ negative and affective symptoms
15.neuroanatomy: symptoms associated with dorsolateral - ANSWER ✅
cognitive symptoms
16.neuroanatomy: symptoms associated with orbitofrontal and connections to
amygdala - ANSWER ✅ aggressive, impulsive symptoms
17.Worst toxin for someone who has at risk genes for schizophrenia -
ANSWER ✅ marijuana
18.Medications to treat psychosis are classified as either: - ANSWER ✅ first
generation antipsychotics (FGAs) or second- generation antipsychotics
(SGAs)
19.Antipsychotics are prescribed based on their: - ANSWER ✅ -
pharmacological properties
Psychopharmacology for the PMHNP
Questions and Answers Updated
2026/2027 Version | Verified Answers
1. What should the PMHNP consider when prescribing chemical restraints? -
ANSWER ✅ -allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical
restraint
-state regulations regarding chemical restrains must be reviewed
2. Are the PMHNP and other staff liable if the client has an allergic reaction or
adverse side effects to the drugs used for chemical restraint? - ANSWER ✅
No.
The client has been court-ordered to take the prescribed medications and the
standing order for chemical restraints is approved. The PMHNP and other
staff are not liable if the patient has an allergic reaction or adverse side
effects.
3. How does reviewing the genetic makeup of a client help guide the PMHNP
in selecting medication for clients? - ANSWER ✅ -Genetic testing can
assist by providing more information on how clients may respond to certain
psychotropic medications
-provides information on how a client may break down and metabolize
medications based on the cytochrome P450 system.
4. area of the brain thought to be responsible for the positive symptoms of
schizophrenia is the ____________. one of the neuronal pathways known to
, be affected here is the ___________ from the _____________ and the
_____________. - ANSWER ✅ limbic system, mesolimbic pathway,
ventral tegmental area (VTA), nucleus accumbens
5. schizophrenia: the dopamine theory - ANSWER ✅ suggests that in the
mesolimbic pathway, neurons from the VTA (ventral tegmental area) release
higher than normal levels of dopamine into the synaptic cleft at the NAC
(nucleus accumbens).
-More dopamine binds to the D2 dopamine receptors in the NAC. This is
thought to be the cause of positive symptoms
6. Schizophrenia: dopamine and mesocortical system - ANSWER ✅ area of
the brain thought to be responsible for negative symptoms of schizophrenia,
prefrontal cortex
-mesocortical pathway goes from the VTA (ventral tegmental area) to the
PFC (prefrontal cortex)
-dysregulation of dopamine between these two areas of the brain results in
the negative and cognitive symptoms
7. Dopamine pathway: mesolimbic - ANSWER ✅ location: Ventral tegmental
area (VTA) within midbreain to the nucleus accumbens (NA) in the limbic
system
function: regulates emotional behaviors & associated with reward,
motivation, pleasure
8. symptoms: overactivation causes (+) symptoms and may be a downstream
consequence of prefrontal cortex dysfunction & glutamate activity in the
hippocampus
,9. Dopamine pathway: mesocortical - ANSWER ✅ location: ventral tegmental
area (VTA) to the prefrontal cortex (PFC). Specifically affecting dorsolateral
prefrontal cortex (DLPFC) & ventromedial prefrontal cortex (VMPFC)
10.function: regulates cognition, executive function, emotions, affect.
DLPFC-cognitive, (-) symptoms
VMPFC-affective & (-) symptoms
symptoms: hypoactivation of pathway may cause (-), cognitive, & affective
symptoms
11.dopamine pathway: nigrostriatal - ANSWER ✅ location: projects from
substantia nigra (in midbrain) to basal ganglia (striatum & globus pallidus)
function: part of extrapyramidal nervous system, controls posture &
voluntary motor movements
symptoms: imbalance of pathways causes movement disorders. Common
disorders-parkinson's and tremor.
Low dopamine in basal ganglia-akathisia & dystonia.
Hyperactivation of pathway-tics, dyskinesias, chorea.
Chronic blockade of D2 pathway-tardive dyskinesia.
12.dopamine pathway: tuberinfundibular - ANSWER ✅ location: projects from
hypothalamus to anterior pituitary gland
function: dopamine inhibits prolactin release from pituitary
, symptoms: disruption of pathway causes prolactin level to rise resulting in
gynecomastia & galactorrhea.
Females-amenorrhea
Both may get sexual dysfunction
13.neurobiological factors that contribute to psychosis and schizophrnia -
ANSWER ✅ -genetics
-neuroanatomy
-neural networks
-neural signaling
14.neuroanatomy: symptoms associated with mesocortical and ventromedial
prefrontal cortex - ANSWER ✅ negative and affective symptoms
15.neuroanatomy: symptoms associated with dorsolateral - ANSWER ✅
cognitive symptoms
16.neuroanatomy: symptoms associated with orbitofrontal and connections to
amygdala - ANSWER ✅ aggressive, impulsive symptoms
17.Worst toxin for someone who has at risk genes for schizophrenia -
ANSWER ✅ marijuana
18.Medications to treat psychosis are classified as either: - ANSWER ✅ first
generation antipsychotics (FGAs) or second- generation antipsychotics
(SGAs)
19.Antipsychotics are prescribed based on their: - ANSWER ✅ -
pharmacological properties
