NR 546 Final Exam – Advanced Psychopharmacology
for the PMHNP – (2026) Actual Questions & Answers
(Chamberlain) 100% Guarantee Pass
Question 1. A 45-year-old female presents with major depressive disorder. She reports
a history of poor adherence to daily medications due to a busy work schedule. Which
antidepressant should the PMHNP consider first?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Venlafaxine
Correct Answer: B
Rationale: Fluoxetine has a long half-life (4–6 days) and an active metabolite, making
missed doses less impactful for patients with adherence difficulties . Paroxetine has a
short half-life and withdrawal risk. Sertraline and venlafaxine have shorter half-lives than
fluoxetine.
Question 2. A 28-year-old male is prescribed an SSRI for depression. Which of the
following is the FDA black box warning associated with SSRIs in adolescents and young
adults under 25?
A. QT prolongation
B. Suicidal ideation
C. Hypertensive crisis
D. Manic episodes
,Correct Answer: B
Rationale: SSRIs carry an FDA black box warning for increased risk of suicidal thinking
and behavior in children, adolescents, and young adults under 25 . This requires careful
monitoring, especially during the first few weeks of treatment and after dose changes.
Question 3. A patient on multiple serotonergic medications develops hyperthermia,
agitation, tremor, and clonus. This presentation is most consistent with which condition?
A. Anticholinergic toxicity
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Hypertensive crisis
Correct Answer: B
Rationale: Serotonin syndrome is a life-threatening condition caused by excessive
serotonergic activity, often from combining SSRIs with other serotonergic agents .
Symptoms include hyperthermia, agitation, tremor, clonus, and autonomic instability.
Question 4. Before prescribing an SSRI, the PMHNP should screen the patient for which
condition to prevent adverse outcomes?
A. Cardiac arrhythmias
B. Bipolar disorder
C. Electrolyte imbalances
D. Liver disease
,Correct Answer: B
Rationale: SSRIs can precipitate mania or hypomania in patients with undiagnosed
bipolar disorder . Screening for bipolar disorder and history of suicidal ideation is
essential before initiating SSRI therapy.
Question 5. Which SSRI has the least CYP450 interactions and is considered safest in
polypharmacy?
A. Fluoxetine
B. Escitalopram
C. Paroxetine
D. Fluvoxamine
Correct Answer: B
Rationale: Escitalopram has minimal CYP450 inhibition, making it the SSRI with the
fewest drug-drug interactions . Fluoxetine and paroxetine are potent CYP2D6 inhibitors.
Fluvoxamine is a potent CYP1A2 and CYP2C19 inhibitor.
Question 6. A patient with major depressive disorder is switched from paroxetine to
fluoxetine. The PMHNP should educate the patient about what potential risk?
A. Immediate therapeutic effect
B. Discontinuation syndrome
C. Hypertensive crisis
D. Weight gain
, Correct Answer: B
Rationale: Paroxetine has a short half-life and no active metabolites, making it most
associated with discontinuation syndrome when stopped abruptly . Fluoxetine's long
half-life makes it protective against withdrawal symptoms.
Question 7. A patient is prescribed lithium for bipolar disorder. Which of the following
increases lithium levels and risk of toxicity?
A. Caffeine
B. NSAIDs
C. Theophylline
D. High sodium intake
Correct Answer: B
Rationale: NSAIDs, ACE inhibitors, and diuretics reduce renal clearance of lithium,
increasing serum levels and toxicity risk . Caffeine and theophylline increase lithium
clearance. Sodium restriction and dehydration also increase lithium levels.
Question 8. A patient on lithium develops tremor, nausea, and diarrhea. The PMHNP
should suspect which of the following?
A. Hyponatremia
B. Lithium toxicity
C. Hypothyroidism
D. Dehydration
for the PMHNP – (2026) Actual Questions & Answers
(Chamberlain) 100% Guarantee Pass
Question 1. A 45-year-old female presents with major depressive disorder. She reports
a history of poor adherence to daily medications due to a busy work schedule. Which
antidepressant should the PMHNP consider first?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Venlafaxine
Correct Answer: B
Rationale: Fluoxetine has a long half-life (4–6 days) and an active metabolite, making
missed doses less impactful for patients with adherence difficulties . Paroxetine has a
short half-life and withdrawal risk. Sertraline and venlafaxine have shorter half-lives than
fluoxetine.
Question 2. A 28-year-old male is prescribed an SSRI for depression. Which of the
following is the FDA black box warning associated with SSRIs in adolescents and young
adults under 25?
A. QT prolongation
B. Suicidal ideation
C. Hypertensive crisis
D. Manic episodes
,Correct Answer: B
Rationale: SSRIs carry an FDA black box warning for increased risk of suicidal thinking
and behavior in children, adolescents, and young adults under 25 . This requires careful
monitoring, especially during the first few weeks of treatment and after dose changes.
Question 3. A patient on multiple serotonergic medications develops hyperthermia,
agitation, tremor, and clonus. This presentation is most consistent with which condition?
A. Anticholinergic toxicity
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Hypertensive crisis
Correct Answer: B
Rationale: Serotonin syndrome is a life-threatening condition caused by excessive
serotonergic activity, often from combining SSRIs with other serotonergic agents .
Symptoms include hyperthermia, agitation, tremor, clonus, and autonomic instability.
Question 4. Before prescribing an SSRI, the PMHNP should screen the patient for which
condition to prevent adverse outcomes?
A. Cardiac arrhythmias
B. Bipolar disorder
C. Electrolyte imbalances
D. Liver disease
,Correct Answer: B
Rationale: SSRIs can precipitate mania or hypomania in patients with undiagnosed
bipolar disorder . Screening for bipolar disorder and history of suicidal ideation is
essential before initiating SSRI therapy.
Question 5. Which SSRI has the least CYP450 interactions and is considered safest in
polypharmacy?
A. Fluoxetine
B. Escitalopram
C. Paroxetine
D. Fluvoxamine
Correct Answer: B
Rationale: Escitalopram has minimal CYP450 inhibition, making it the SSRI with the
fewest drug-drug interactions . Fluoxetine and paroxetine are potent CYP2D6 inhibitors.
Fluvoxamine is a potent CYP1A2 and CYP2C19 inhibitor.
Question 6. A patient with major depressive disorder is switched from paroxetine to
fluoxetine. The PMHNP should educate the patient about what potential risk?
A. Immediate therapeutic effect
B. Discontinuation syndrome
C. Hypertensive crisis
D. Weight gain
, Correct Answer: B
Rationale: Paroxetine has a short half-life and no active metabolites, making it most
associated with discontinuation syndrome when stopped abruptly . Fluoxetine's long
half-life makes it protective against withdrawal symptoms.
Question 7. A patient is prescribed lithium for bipolar disorder. Which of the following
increases lithium levels and risk of toxicity?
A. Caffeine
B. NSAIDs
C. Theophylline
D. High sodium intake
Correct Answer: B
Rationale: NSAIDs, ACE inhibitors, and diuretics reduce renal clearance of lithium,
increasing serum levels and toxicity risk . Caffeine and theophylline increase lithium
clearance. Sodium restriction and dehydration also increase lithium levels.
Question 8. A patient on lithium develops tremor, nausea, and diarrhea. The PMHNP
should suspect which of the following?
A. Hyponatremia
B. Lithium toxicity
C. Hypothyroidism
D. Dehydration
