NURS 6630 Midterm Exam: Psychopharmacologic Approaches to
Treatment of Psychopathology
latest update 2024-2025 Walden University
Question 1
During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the
PMHNP’s best response is:
A. “Psychiatric medications only affect brain receptors, but we monitor overall health.”
B. “Heart conditions are completely separate from psychiatric symptoms.”
C. “Your medical history is required by clinic policy before starting therapy.”
D. “Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for
comorbidities such as type 2 diabetes.”
ANSWER ■: D — “Anxiety can cause cortisol levels to increase and when this happens frequently it
puts you at risk for comorbidities such as type 2 diabetes.”
Rationale: Chronic elevations in stress hormones such as cortisol and sympathetic nervous system
activation link psychiatric conditions like anxiety with physical comorbidities, including metabolic
syndrome, cardiovascular disease, and type 2 diabetes.
Page 1
,Question 2
During gene expression, what must occur prior to a gene being expressed?
A. Transcription factor must bind to the regulatory region within the cell’s nucleus.
B. Translation of mRNA into protein must occur in the cytoplasm.
C. Ribosomal RNA must bind directly to the DNA double helix.
D. Epigenetic silencing must deactivate the promoter sequence.
ANSWER ■: A — Transcription factor must bind to the regulatory region within the cell’s nucleus.
Rationale: Gene expression begins in the cell nucleus where transcription factors bind to specific
regulatory regions of DNA (promoters/enhancers), activating RNA polymerase to transcribe DNA into
messenger RNA (mRNA).
Question 3
The PMHNP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This
client has begun to develop a common side effect of this medication. What is this side effect?
A. Weight gain
B. Agranulocytosis
C. Sedation
D. Tardive dyskinesia
ANSWER ■: D — Tardive dyskinesia
Rationale: Chronic blockade of dopamine D2 receptors in the nigrostriatal pathway leads to receptor
up-regulation and hypersensitivity, resulting in extrapyramidal symptoms including tardive dyskinesia.
Page 2
, Question 4
After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible
effect?
A. Severe hypotension and bradycardia
B. Respiratory depression and sedation
C. Acute hepatic necrosis
D. Precipitated withdrawal symptoms and seizures
ANSWER ■: D — Precipitated withdrawal symptoms and seizures
Rationale: Flumazenil is a competitive GABA-A receptor antagonist that reverses benzodiazepine effects.
In benzodiazepine-dependent individuals or mixed overdoses (especially with TCAs), rapid reversal can
precipitate acute withdrawal and seizures.
Question 5
A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder.
What does the PMHNP understand about this patient?
A. The patient has mild hepatic dysfunction.
B. The patient is pregnant.
C. The patient has severe renal impairment.
D. The patient is a CYP2D6 ultra-rapid metabolizer.
ANSWER ■: C — The patient has severe renal impairment.
Rationale: Desvenlafaxine is primarily eliminated by the kidneys. In patients with severe renal impairment
(eGFR < 30 mL/min), clearance is significantly reduced, necessitating dosage reduction to 50 mg every
other day.
Page 3
Treatment of Psychopathology
latest update 2024-2025 Walden University
Question 1
During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the
PMHNP’s best response is:
A. “Psychiatric medications only affect brain receptors, but we monitor overall health.”
B. “Heart conditions are completely separate from psychiatric symptoms.”
C. “Your medical history is required by clinic policy before starting therapy.”
D. “Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for
comorbidities such as type 2 diabetes.”
ANSWER ■: D — “Anxiety can cause cortisol levels to increase and when this happens frequently it
puts you at risk for comorbidities such as type 2 diabetes.”
Rationale: Chronic elevations in stress hormones such as cortisol and sympathetic nervous system
activation link psychiatric conditions like anxiety with physical comorbidities, including metabolic
syndrome, cardiovascular disease, and type 2 diabetes.
Page 1
,Question 2
During gene expression, what must occur prior to a gene being expressed?
A. Transcription factor must bind to the regulatory region within the cell’s nucleus.
B. Translation of mRNA into protein must occur in the cytoplasm.
C. Ribosomal RNA must bind directly to the DNA double helix.
D. Epigenetic silencing must deactivate the promoter sequence.
ANSWER ■: A — Transcription factor must bind to the regulatory region within the cell’s nucleus.
Rationale: Gene expression begins in the cell nucleus where transcription factors bind to specific
regulatory regions of DNA (promoters/enhancers), activating RNA polymerase to transcribe DNA into
messenger RNA (mRNA).
Question 3
The PMHNP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This
client has begun to develop a common side effect of this medication. What is this side effect?
A. Weight gain
B. Agranulocytosis
C. Sedation
D. Tardive dyskinesia
ANSWER ■: D — Tardive dyskinesia
Rationale: Chronic blockade of dopamine D2 receptors in the nigrostriatal pathway leads to receptor
up-regulation and hypersensitivity, resulting in extrapyramidal symptoms including tardive dyskinesia.
Page 2
, Question 4
After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible
effect?
A. Severe hypotension and bradycardia
B. Respiratory depression and sedation
C. Acute hepatic necrosis
D. Precipitated withdrawal symptoms and seizures
ANSWER ■: D — Precipitated withdrawal symptoms and seizures
Rationale: Flumazenil is a competitive GABA-A receptor antagonist that reverses benzodiazepine effects.
In benzodiazepine-dependent individuals or mixed overdoses (especially with TCAs), rapid reversal can
precipitate acute withdrawal and seizures.
Question 5
A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder.
What does the PMHNP understand about this patient?
A. The patient has mild hepatic dysfunction.
B. The patient is pregnant.
C. The patient has severe renal impairment.
D. The patient is a CYP2D6 ultra-rapid metabolizer.
ANSWER ■: C — The patient has severe renal impairment.
Rationale: Desvenlafaxine is primarily eliminated by the kidneys. In patients with severe renal impairment
(eGFR < 30 mL/min), clearance is significantly reduced, necessitating dosage reduction to 50 mg every
other day.
Page 3
