NR 546 Final Exam Actual Exam V3 | NR 546 Advanced
Psychopharmacology for the PMHNP (NR546 Final Exam) [PDF] |
Chamberlain University
1. A 32-year-old female patient with treatment-resistant depression is prescribed an MAOI.
Which of the following statements should be included in her education regarding the risk of a
hypertensive crisis?
A. You can safely consume aged cheeses as long as you limit the portion size.
B. You may take over-the-counter decongestants for cold symptoms without concern.
C. The medication will immediately lower your blood pressure regardless of your diet.
D. Avoid foods high in tyramine, such as cured meats, sauerkraut, and draft beers.
Answer: D
Rationale: Hypertensive crisis is a major risk when patients on MAOIs consume foods high
in tyramine, which acts as a sympathomimetic amine. This occurs because the inhibition of
MAO-A prevents the breakdown of tyramine in the gut, leading to massive norepinephrine
release. Patients must be strictly educated to avoid cured meats, aged cheeses, and certain
fermented products to ensure safety.
2. Which lab value is the most critical to monitor before and during treatment with Clozapine
(Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum Creatinine
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a black box warning for severe neutropenia or
agranulocytosis, which can be life-threatening. The Clozapine REMS program mandates
regular monitoring of the Absolute Neutrophil Count (ANC) to ensure patient safety.
Practitioners must verify that ANC levels are within the acceptable range before the
pharmacy can dispense the medication.
3. A 24-year-old male is started on Risperidone for schizophrenia. He presents with new-
onset breast enlargement and nipple discharge. Which mechanism explains this adverse
effect?
A. Serotonin 2A receptor blockade in the mesocortical pathway
B. Histamine H1 receptor blockade in the hypothalamus
,C. Dopamine D2 receptor blockade in the tuberoinfundibular pathway
D. Alpha-1 adrenergic blockade in the peripheral nervous system
Answer: C
Rationale: Risperidone causes hyperprolactinemia by blocking dopamine D2 receptors in
the tuberoinfundibular pathway. Dopamine normally inhibits prolactin release; when it is
blocked, prolactin levels rise, leading to gynecomastia and galactorrhea. This side effect is
common with first-generation antipsychotics and Risperidone among the second-
generation agents.
4. A patient with Bipolar I Disorder is stable on Lithium. Which of the following medications,
if added for pain, would most likely increase the risk of Lithium toxicity?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Gabapentin
Answer: A
Rationale: NSAIDs like Ibuprofen reduce renal blood flow and inhibit prostaglandins,
which can lead to decreased renal clearance of Lithium. This interaction significantly
increases the risk of Lithium toxicity, which manifests as tremors, ataxia, and confusion.
Patients on Lithium should generally use Acetaminophen or Aspirin for mild pain as they
have less impact on Lithium levels.
5. What is the primary reason for a slow titration schedule when initiating Lamotrigine
(Lamictal)?
A. To minimize gastrointestinal upset and nausea
B. To prevent the development of Stevens-Johnson Syndrome (SJS)
C. To avoid immediate weight gain and metabolic syndrome
D. To allow the patient to develop tolerance to sedation
Answer: B
Rationale: Lamotrigine must be titrated slowly to reduce the risk of life-threatening
rashes, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Rapid
escalation of dosing is a major risk factor for these serious dermatological reactions. If a
patient misses more than five days of their medication, the titration schedule must usually
be restarted from the beginning.
, 6. A 45-year-old patient with depression and chronic neuropathic pain would benefit most
from which antidepressant class?
A. SNRI (Serotonin-Norepinephrine Reuptake Inhibitors)
B. SSRI (Selective Serotonin Reuptake Inhibitors)
C. SMS (Serotonin Modulators and Stimulators)
D. SARI (Serotonin Antagonist and Reuptake Inhibitors)
Answer: A
Rationale: SNRIs, such as Duloxetine and Venlafaxine, are effective for both depression
and chronic pain conditions. The inhibition of norepinephrine reuptake enhances the
descending inhibitory pain pathways in the spinal cord. This dual action makes SNRIs a
preferred choice for patients presenting with comorbid physical pain symptoms.
7. Which of the following is a symptom of Neuroleptic Malignant Syndrome (NMS) that
distinguishes it from Serotonin Syndrome?
A. Muscle ‘lead-pipe’ rigidity
B. Altered mental status
C. Hyperthermia
D. Tachycardia
Answer: A
Rationale: NMS is characterized by ‘lead-pipe’ muscle rigidity, whereas Serotonin
Syndrome is more typically associated with hyperreflexia and myoclonus. Both conditions
involve fever and autonomic instability, but the neuromuscular exam is key for
differentiation. NMS is an idiosyncratic reaction to dopamine antagonists, while Serotonin
Syndrome results from excess serotonin.
8. A PMHNP is considering starting a patient on Valproate (Depakote). Which patient
characteristic is a relative contraindication for this medication?
A. A 22-year-old female of childbearing age without effective contraception
B. A 50-year-old male with a history of hypertension
C. A 30-year-old patient with stable Asthma
D. A 65-year-old patient with mild osteoarthritis
Answer: A
Rationale: Valproate is highly teratogenic, specifically associated with neural tube defects
like spina bifida. In females of childbearing age, it should be avoided unless other
Psychopharmacology for the PMHNP (NR546 Final Exam) [PDF] |
Chamberlain University
1. A 32-year-old female patient with treatment-resistant depression is prescribed an MAOI.
Which of the following statements should be included in her education regarding the risk of a
hypertensive crisis?
A. You can safely consume aged cheeses as long as you limit the portion size.
B. You may take over-the-counter decongestants for cold symptoms without concern.
C. The medication will immediately lower your blood pressure regardless of your diet.
D. Avoid foods high in tyramine, such as cured meats, sauerkraut, and draft beers.
Answer: D
Rationale: Hypertensive crisis is a major risk when patients on MAOIs consume foods high
in tyramine, which acts as a sympathomimetic amine. This occurs because the inhibition of
MAO-A prevents the breakdown of tyramine in the gut, leading to massive norepinephrine
release. Patients must be strictly educated to avoid cured meats, aged cheeses, and certain
fermented products to ensure safety.
2. Which lab value is the most critical to monitor before and during treatment with Clozapine
(Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum Creatinine
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a black box warning for severe neutropenia or
agranulocytosis, which can be life-threatening. The Clozapine REMS program mandates
regular monitoring of the Absolute Neutrophil Count (ANC) to ensure patient safety.
Practitioners must verify that ANC levels are within the acceptable range before the
pharmacy can dispense the medication.
3. A 24-year-old male is started on Risperidone for schizophrenia. He presents with new-
onset breast enlargement and nipple discharge. Which mechanism explains this adverse
effect?
A. Serotonin 2A receptor blockade in the mesocortical pathway
B. Histamine H1 receptor blockade in the hypothalamus
,C. Dopamine D2 receptor blockade in the tuberoinfundibular pathway
D. Alpha-1 adrenergic blockade in the peripheral nervous system
Answer: C
Rationale: Risperidone causes hyperprolactinemia by blocking dopamine D2 receptors in
the tuberoinfundibular pathway. Dopamine normally inhibits prolactin release; when it is
blocked, prolactin levels rise, leading to gynecomastia and galactorrhea. This side effect is
common with first-generation antipsychotics and Risperidone among the second-
generation agents.
4. A patient with Bipolar I Disorder is stable on Lithium. Which of the following medications,
if added for pain, would most likely increase the risk of Lithium toxicity?
A. Ibuprofen
B. Acetaminophen
C. Aspirin
D. Gabapentin
Answer: A
Rationale: NSAIDs like Ibuprofen reduce renal blood flow and inhibit prostaglandins,
which can lead to decreased renal clearance of Lithium. This interaction significantly
increases the risk of Lithium toxicity, which manifests as tremors, ataxia, and confusion.
Patients on Lithium should generally use Acetaminophen or Aspirin for mild pain as they
have less impact on Lithium levels.
5. What is the primary reason for a slow titration schedule when initiating Lamotrigine
(Lamictal)?
A. To minimize gastrointestinal upset and nausea
B. To prevent the development of Stevens-Johnson Syndrome (SJS)
C. To avoid immediate weight gain and metabolic syndrome
D. To allow the patient to develop tolerance to sedation
Answer: B
Rationale: Lamotrigine must be titrated slowly to reduce the risk of life-threatening
rashes, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Rapid
escalation of dosing is a major risk factor for these serious dermatological reactions. If a
patient misses more than five days of their medication, the titration schedule must usually
be restarted from the beginning.
, 6. A 45-year-old patient with depression and chronic neuropathic pain would benefit most
from which antidepressant class?
A. SNRI (Serotonin-Norepinephrine Reuptake Inhibitors)
B. SSRI (Selective Serotonin Reuptake Inhibitors)
C. SMS (Serotonin Modulators and Stimulators)
D. SARI (Serotonin Antagonist and Reuptake Inhibitors)
Answer: A
Rationale: SNRIs, such as Duloxetine and Venlafaxine, are effective for both depression
and chronic pain conditions. The inhibition of norepinephrine reuptake enhances the
descending inhibitory pain pathways in the spinal cord. This dual action makes SNRIs a
preferred choice for patients presenting with comorbid physical pain symptoms.
7. Which of the following is a symptom of Neuroleptic Malignant Syndrome (NMS) that
distinguishes it from Serotonin Syndrome?
A. Muscle ‘lead-pipe’ rigidity
B. Altered mental status
C. Hyperthermia
D. Tachycardia
Answer: A
Rationale: NMS is characterized by ‘lead-pipe’ muscle rigidity, whereas Serotonin
Syndrome is more typically associated with hyperreflexia and myoclonus. Both conditions
involve fever and autonomic instability, but the neuromuscular exam is key for
differentiation. NMS is an idiosyncratic reaction to dopamine antagonists, while Serotonin
Syndrome results from excess serotonin.
8. A PMHNP is considering starting a patient on Valproate (Depakote). Which patient
characteristic is a relative contraindication for this medication?
A. A 22-year-old female of childbearing age without effective contraception
B. A 50-year-old male with a history of hypertension
C. A 30-year-old patient with stable Asthma
D. A 65-year-old patient with mild osteoarthritis
Answer: A
Rationale: Valproate is highly teratogenic, specifically associated with neural tube defects
like spina bifida. In females of childbearing age, it should be avoided unless other
