NRNP 6635 FINAL EXAM STUDY GUIDE 2026/2027 – ADVANCED
PSYCHOPHARMACOLOGY FOR PMHNP | 100+ QUESTIONS &
ANSWERS WITH RATIONALES
1.
A 32-year-old patient presents with persistent low mood, anhedonia, poor
concentration, and insomnia for the past six weeks. The PMHNP considers
starting an SSRI.
Which of the following neurotransmitter systems is primarily targeted by
SSRIs to produce antidepressant effects?
A. Dopamine and acetylcholine
B. Serotonin reuptake inhibition
C. GABA receptor enhancement
D. Histamine blockade
Answer: B – Serotonin reuptake inhibition
Rationale: SSRIs selectively block serotonin reuptake transporters,
increasing serotonin levels in the synaptic cleft. Options A and C relate to
dopaminergic and GABAergic activity, not primary SSRI mechanisms.
Option D explains sedation, not antidepressant action.
2.
A patient taking fluoxetine begins treatment with linezolid for pneumonia
and develops confusion, tremors, and diaphoresis.
What should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
,C. Hypertensive crisis
D. Anticholinergic toxicity
Answer: B – Serotonin syndrome
Rationale: Combining serotonergic drugs (like SSRIs and MAO inhibitors
such as linezolid) raises serotonin dangerously, causing agitation,
hyperreflexia, and hyperthermia. NMS involves dopamine blockade;
hypertensive crisis occurs with tyramine and MAOIs; anticholinergic
toxicity presents with dry skin and mydriasis.
3.
All antidepressants carry which FDA black-box warning that the PMHNP
must discuss before prescribing?
A. Risk of mania in bipolar disorder
B. Increased risk of suicidal thoughts in youth
C. Increased seizure threshold
D. Cardiovascular events in older adults
Answer: B – Increased risk of suicidal thoughts in youth
Rationale: Studies show a transient increase in suicidal ideation in
individuals under 25 at treatment initiation. PMHNPs must monitor closely
and educate families. Options A and C are important adverse effects but not
black-box warnings.
4.
Which antipsychotic requires baseline and routine absolute neutrophil count
(ANC) monitoring due to agranulocytosis risk?
A. Risperidone
B. Clozapine
C. Quetiapine
D. Ziprasidone
,Answer: B – Clozapine
Rationale: Clozapine uniquely risks agranulocytosis, mandating strict ANC
monitoring. Though effective for treatment-resistant schizophrenia, safety
surveillance is essential. The other atypicals rarely cause severe neutropenia.
5.
A 29-year-old woman with bipolar II disorder gains 10 kg after starting
olanzapine. Which mood stabilizer is least likely to cause further weight
gain?
A. Valproate
B. Lithium
C. Lamotrigine
D. Carbamazepine
Answer: C – Lamotrigine
Rationale: Lamotrigine has minimal metabolic side effects and is ideal for
bipolar depression prevention. Valproate and olanzapine cause marked
weight gain; lithium and carbamazepine can contribute modestly.
6.
A patient on an MAOI eats aged cheese and develops severe headache and
hypertension. What explains this reaction?
A. Dopamine depletion
B. Tyramine-induced hypertensive crisis
C. Serotonin deficiency
D. GABAergic inhibition
Answer: B – Tyramine-induced hypertensive crisis
Rationale: MAOIs prevent tyramine breakdown; dietary tyramine triggers
massive norepinephrine release, leading to hypertensive crisis.
, 7.
A male patient on paroxetine reports decreased libido and anorgasmia.
Which medication may improve depressive symptoms while alleviating
sexual side effects?
A. Bupropion
B. Sertraline
C. Duloxetine
D. Citalopram
Answer: A – Bupropion
Rationale: Bupropion increases norepinephrine and dopamine with minimal
sexual dysfunction risk. SSRIs (options B–D) commonly cause sexual side
effects.
8.
What is the primary mechanism by which benzodiazepines reduce anxiety?
A. Block NMDA receptors
B. Enhance GABA-A receptor activity
C. Inhibit serotonin reuptake
D. Increase norepinephrine release
Answer: B – Enhance GABA-A receptor activity
Rationale: Benzodiazepines potentiate GABA, the brain’s main inhibitory
neurotransmitter, producing anxiolytic and sedative effects.
9.
A 36-year-old with generalized anxiety disorder has failed multiple trials of
SSRIs. The PMHNP considers buspirone.
Which characteristic makes buspirone distinct from benzodiazepines?
PSYCHOPHARMACOLOGY FOR PMHNP | 100+ QUESTIONS &
ANSWERS WITH RATIONALES
1.
A 32-year-old patient presents with persistent low mood, anhedonia, poor
concentration, and insomnia for the past six weeks. The PMHNP considers
starting an SSRI.
Which of the following neurotransmitter systems is primarily targeted by
SSRIs to produce antidepressant effects?
A. Dopamine and acetylcholine
B. Serotonin reuptake inhibition
C. GABA receptor enhancement
D. Histamine blockade
Answer: B – Serotonin reuptake inhibition
Rationale: SSRIs selectively block serotonin reuptake transporters,
increasing serotonin levels in the synaptic cleft. Options A and C relate to
dopaminergic and GABAergic activity, not primary SSRI mechanisms.
Option D explains sedation, not antidepressant action.
2.
A patient taking fluoxetine begins treatment with linezolid for pneumonia
and develops confusion, tremors, and diaphoresis.
What should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
,C. Hypertensive crisis
D. Anticholinergic toxicity
Answer: B – Serotonin syndrome
Rationale: Combining serotonergic drugs (like SSRIs and MAO inhibitors
such as linezolid) raises serotonin dangerously, causing agitation,
hyperreflexia, and hyperthermia. NMS involves dopamine blockade;
hypertensive crisis occurs with tyramine and MAOIs; anticholinergic
toxicity presents with dry skin and mydriasis.
3.
All antidepressants carry which FDA black-box warning that the PMHNP
must discuss before prescribing?
A. Risk of mania in bipolar disorder
B. Increased risk of suicidal thoughts in youth
C. Increased seizure threshold
D. Cardiovascular events in older adults
Answer: B – Increased risk of suicidal thoughts in youth
Rationale: Studies show a transient increase in suicidal ideation in
individuals under 25 at treatment initiation. PMHNPs must monitor closely
and educate families. Options A and C are important adverse effects but not
black-box warnings.
4.
Which antipsychotic requires baseline and routine absolute neutrophil count
(ANC) monitoring due to agranulocytosis risk?
A. Risperidone
B. Clozapine
C. Quetiapine
D. Ziprasidone
,Answer: B – Clozapine
Rationale: Clozapine uniquely risks agranulocytosis, mandating strict ANC
monitoring. Though effective for treatment-resistant schizophrenia, safety
surveillance is essential. The other atypicals rarely cause severe neutropenia.
5.
A 29-year-old woman with bipolar II disorder gains 10 kg after starting
olanzapine. Which mood stabilizer is least likely to cause further weight
gain?
A. Valproate
B. Lithium
C. Lamotrigine
D. Carbamazepine
Answer: C – Lamotrigine
Rationale: Lamotrigine has minimal metabolic side effects and is ideal for
bipolar depression prevention. Valproate and olanzapine cause marked
weight gain; lithium and carbamazepine can contribute modestly.
6.
A patient on an MAOI eats aged cheese and develops severe headache and
hypertension. What explains this reaction?
A. Dopamine depletion
B. Tyramine-induced hypertensive crisis
C. Serotonin deficiency
D. GABAergic inhibition
Answer: B – Tyramine-induced hypertensive crisis
Rationale: MAOIs prevent tyramine breakdown; dietary tyramine triggers
massive norepinephrine release, leading to hypertensive crisis.
, 7.
A male patient on paroxetine reports decreased libido and anorgasmia.
Which medication may improve depressive symptoms while alleviating
sexual side effects?
A. Bupropion
B. Sertraline
C. Duloxetine
D. Citalopram
Answer: A – Bupropion
Rationale: Bupropion increases norepinephrine and dopamine with minimal
sexual dysfunction risk. SSRIs (options B–D) commonly cause sexual side
effects.
8.
What is the primary mechanism by which benzodiazepines reduce anxiety?
A. Block NMDA receptors
B. Enhance GABA-A receptor activity
C. Inhibit serotonin reuptake
D. Increase norepinephrine release
Answer: B – Enhance GABA-A receptor activity
Rationale: Benzodiazepines potentiate GABA, the brain’s main inhibitory
neurotransmitter, producing anxiolytic and sedative effects.
9.
A 36-year-old with generalized anxiety disorder has failed multiple trials of
SSRIs. The PMHNP considers buspirone.
Which characteristic makes buspirone distinct from benzodiazepines?
