NR 546 Exam 1 Actual Exam V2 | NR 546 Advanced
Psychopharmacology for the PMHNP (NR546 Exam 1) [PDF] |
Chamberlain University
1. A 32-year-old patient with schizophrenia is experiencing auditory hallucinations. Which
dopamine pathway is primarily associated with these positive symptoms?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: D
Rationale: The mesolimbic dopamine pathway projects from the ventral tegmental area to
the nucleus accumbens. Hyperactivity in this specific pathway is theorized to cause positive
symptoms of psychosis, such as hallucinations and delusions. Antipsychotic medications
work by blocking D2 receptors in this pathway to reduce these symptoms.
2. A patient stabilized on Olanzapine 20mg daily for several months abruptly stops smoking
cigarettes. What is the most likely clinical outcome regarding their medication?
A. Decreased drug efficacy due to induction of CYP1A2
B. Increased risk of extrapyramidal symptoms due to increased serum levels
C. No change in drug metabolism
D. Increased risk of serotonin syndrome
Answer: B
Rationale: Polycyclic aromatic hydrocarbons in cigarette smoke induce the CYP1A2
enzyme, which metabolizes Olanzapine and Clozapine. When a patient stops smoking, the
induction ceases, leading to higher serum levels of the medication. This increase in
concentration can lead to toxicity or an increase in side effects such as sedation or
movement disorders.
3. A medication has a half-life of 24 hours. If a patient starts a daily dosing regimen,
approximately how long will it take for the drug to reach steady-state plasma concentrations?
A. 24 hours
B. 3 days
C. 5 days
,D. 2 weeks
Answer: C
Rationale: Steady state is generally reached after approximately 4 to 5 half-lives of a drug
have passed. Given a 24-hour half-life, five days represents the time needed to reach a point
where drug elimination equals drug intake. This timeframe is critical for PMHNPs to
remember when evaluating the full therapeutic effect of a new dosage.
4. Which neurotransmitter is considered the primary inhibitory neurotransmitter in the
central nervous system?
A. Glutamate
B. GABA
C. Acetylcholine
D. Norepinephrine
Answer: B
Rationale: Gamma-aminobutyric acid (GABA) is the chief inhibitory neurotransmitter in
the mammalian central nervous system. It acts by reducing neuronal excitability
throughout the nervous system by binding to GABA-A and GABA-B receptors. In contrast,
glutamate is the primary excitatory neurotransmitter, maintaining the balance of brain
activity.
5. A patient is prescribed a medication that acts as a partial agonist at the D2 receptor. How
does this medication behave in the presence of high endogenous dopamine levels?
A. It acts as a pure agonist, increasing dopamine signaling further
B. It behaves like an antagonist, lowering the overall dopamine activity
C. It has no effect on the receptor when dopamine is present
D. It irreversibly binds and destroys the receptor
Answer: B
Rationale: A partial agonist has an intrinsic activity that is lower than that of a full agonist
but higher than that of an antagonist. In areas of high neurotransmitter concentration, it
competes for the receptor and results in a net decrease in signal, effectively acting as an
antagonist. In areas of low neurotransmitter concentration, it provides a low level of
stimulation, acting as an agonist.
6. A PMHNP is considering starting Lithium for a patient with Bipolar I disorder. Which of the
following lab values is most critical to evaluate prior to initiation?
A. Liver function tests (AST/ALT)
B. Platelet count
, C. Serum amylase
D. Serum Creatinine and GFR
Answer: D
Rationale: Lithium is almost exclusively excreted by the kidneys and is not metabolized by
the liver. Patients with impaired renal function are at a significantly higher risk for lithium
toxicity due to decreased clearance. Therefore, baseline and periodic monitoring of serum
creatinine and glomerular filtration rate (GFR) are essential for safe prescribing.
7. Which CYP450 enzyme is responsible for the metabolism of approximately 25% of all
psychiatric medications, including many SSRIs and antipsychotics, despite making up a small
percentage of total hepatic enzymes?
A. CYP3A4
B. CYP1A2
C. CYP2D6
D. CYP2C19
Answer: C
Rationale: CYP2D6 is a major metabolic pathway for many psychotropic drugs, including
venlafaxine, fluoxetine, and risperidone. Significant genetic polymorphism exists within
this enzyme, leading to phenotypes categorized as poor, intermediate, extensive, or ultra-
rapid metabolizers. Identifying these differences is crucial for avoiding adverse drug
reactions or treatment failure.
8. A patient taking Phenelzine (an MAOI) consumes a large amount of aged cheese and wine.
They present to the ER with a headache and a blood pressure of 210/120. This is caused by an
accumulation of:
A. Serotonin
B. Dopamine
C. Tryptophan
D. Tyramine
Answer: D
Rationale: Monoamine oxidase (MAO) is responsible for breaking down tyramine in the
gut; when MAO is inhibited, dietary tyramine enters the systemic circulation. Tyramine
causes a massive release of norepinephrine from sympathetic nerve terminals, leading to a
hypertensive crisis. Patients on MAOIs must strictly follow a low-tyramine diet to prevent
this potentially fatal interaction.
Psychopharmacology for the PMHNP (NR546 Exam 1) [PDF] |
Chamberlain University
1. A 32-year-old patient with schizophrenia is experiencing auditory hallucinations. Which
dopamine pathway is primarily associated with these positive symptoms?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: D
Rationale: The mesolimbic dopamine pathway projects from the ventral tegmental area to
the nucleus accumbens. Hyperactivity in this specific pathway is theorized to cause positive
symptoms of psychosis, such as hallucinations and delusions. Antipsychotic medications
work by blocking D2 receptors in this pathway to reduce these symptoms.
2. A patient stabilized on Olanzapine 20mg daily for several months abruptly stops smoking
cigarettes. What is the most likely clinical outcome regarding their medication?
A. Decreased drug efficacy due to induction of CYP1A2
B. Increased risk of extrapyramidal symptoms due to increased serum levels
C. No change in drug metabolism
D. Increased risk of serotonin syndrome
Answer: B
Rationale: Polycyclic aromatic hydrocarbons in cigarette smoke induce the CYP1A2
enzyme, which metabolizes Olanzapine and Clozapine. When a patient stops smoking, the
induction ceases, leading to higher serum levels of the medication. This increase in
concentration can lead to toxicity or an increase in side effects such as sedation or
movement disorders.
3. A medication has a half-life of 24 hours. If a patient starts a daily dosing regimen,
approximately how long will it take for the drug to reach steady-state plasma concentrations?
A. 24 hours
B. 3 days
C. 5 days
,D. 2 weeks
Answer: C
Rationale: Steady state is generally reached after approximately 4 to 5 half-lives of a drug
have passed. Given a 24-hour half-life, five days represents the time needed to reach a point
where drug elimination equals drug intake. This timeframe is critical for PMHNPs to
remember when evaluating the full therapeutic effect of a new dosage.
4. Which neurotransmitter is considered the primary inhibitory neurotransmitter in the
central nervous system?
A. Glutamate
B. GABA
C. Acetylcholine
D. Norepinephrine
Answer: B
Rationale: Gamma-aminobutyric acid (GABA) is the chief inhibitory neurotransmitter in
the mammalian central nervous system. It acts by reducing neuronal excitability
throughout the nervous system by binding to GABA-A and GABA-B receptors. In contrast,
glutamate is the primary excitatory neurotransmitter, maintaining the balance of brain
activity.
5. A patient is prescribed a medication that acts as a partial agonist at the D2 receptor. How
does this medication behave in the presence of high endogenous dopamine levels?
A. It acts as a pure agonist, increasing dopamine signaling further
B. It behaves like an antagonist, lowering the overall dopamine activity
C. It has no effect on the receptor when dopamine is present
D. It irreversibly binds and destroys the receptor
Answer: B
Rationale: A partial agonist has an intrinsic activity that is lower than that of a full agonist
but higher than that of an antagonist. In areas of high neurotransmitter concentration, it
competes for the receptor and results in a net decrease in signal, effectively acting as an
antagonist. In areas of low neurotransmitter concentration, it provides a low level of
stimulation, acting as an agonist.
6. A PMHNP is considering starting Lithium for a patient with Bipolar I disorder. Which of the
following lab values is most critical to evaluate prior to initiation?
A. Liver function tests (AST/ALT)
B. Platelet count
, C. Serum amylase
D. Serum Creatinine and GFR
Answer: D
Rationale: Lithium is almost exclusively excreted by the kidneys and is not metabolized by
the liver. Patients with impaired renal function are at a significantly higher risk for lithium
toxicity due to decreased clearance. Therefore, baseline and periodic monitoring of serum
creatinine and glomerular filtration rate (GFR) are essential for safe prescribing.
7. Which CYP450 enzyme is responsible for the metabolism of approximately 25% of all
psychiatric medications, including many SSRIs and antipsychotics, despite making up a small
percentage of total hepatic enzymes?
A. CYP3A4
B. CYP1A2
C. CYP2D6
D. CYP2C19
Answer: C
Rationale: CYP2D6 is a major metabolic pathway for many psychotropic drugs, including
venlafaxine, fluoxetine, and risperidone. Significant genetic polymorphism exists within
this enzyme, leading to phenotypes categorized as poor, intermediate, extensive, or ultra-
rapid metabolizers. Identifying these differences is crucial for avoiding adverse drug
reactions or treatment failure.
8. A patient taking Phenelzine (an MAOI) consumes a large amount of aged cheese and wine.
They present to the ER with a headache and a blood pressure of 210/120. This is caused by an
accumulation of:
A. Serotonin
B. Dopamine
C. Tryptophan
D. Tyramine
Answer: D
Rationale: Monoamine oxidase (MAO) is responsible for breaking down tyramine in the
gut; when MAO is inhibited, dietary tyramine enters the systemic circulation. Tyramine
causes a massive release of norepinephrine from sympathetic nerve terminals, leading to a
hypertensive crisis. Patients on MAOIs must strictly follow a low-tyramine diet to prevent
this potentially fatal interaction.
