NURS 6630 FINAL EXAM
PSYCHOPHARMACOLOGIC APPROACHES TO
TREATMENT OF PSYCHOPATHOLOGY ALL
QUESTIONS AND VERIFIED ANSWERS
ALREADY A GRADED|NEW AND REVISED
1. A 45-year-old patient with major depressive disorder has failed
trials of two SSRIs and one SNRI. Which medication is MOST
appropriate as a next-line treatment?
A. Increase the current SNRI dose
B. Add a benzodiazepine
C. Consider a trial of an MAOI or atypical antipsychotic
augmentation
D. Discontinue all medications
Rationale: After multiple antidepressant failures, guidelines
recommend MAOIs or atypical antipsychotic augmentation (e.g.,
aripiprazole, quetiapine). Increasing dose or adding benzodiazepines is
not standard; discontinuation is not appropriate.
2. A patient with schizophrenia develops severe extrapyramidal
symptoms on haloperidol. The prescriber switches to clozapine. The
primary advantage of clozapine in this situation is:
A. Higher D₂ receptor affinity
B. Lower risk of EPS due to lower D₂ occupancy and 5-HT₂A
antagonism
C. Faster onset of action
D. No need for monitoring
Rationale: Clozapine has low D₂ receptor occupancy and high 5-HT₂A
antagonism, resulting in minimal EPS. It does not have higher D₂
affinity, faster onset, or require no monitoring.
,3. A 30-year-old patient with bipolar I disorder is being discharged
on lithium. Which patient education point is MOST critical
regarding lithium therapy?
A. Take with food to avoid nausea
B. Maintain consistent sodium and fluid intake; avoid dehydration
C. Avoid sunlight exposure
D. Take on an empty stomach
Rationale: Lithium levels are affected by sodium and fluid balance;
dehydration can increase lithium levels to toxicity. Food intake is less
critical; sunlight avoidance is not required.
4. A patient on clozapine develops fever, tachycardia, and lethargy.
Laboratory results show absolute neutrophil count (ANC) of
350/mm³. The MOST appropriate action is:
A. Continue clozapine and monitor ANC weekly
B. Discontinue clozapine immediately and initiate G-CSF
C. Reduce clozapine dose by 50%
D. Add lithium to increase neutrophil count
Rationale: ANC < 500/mm³ indicates severe
neutropenia/agranulocytosis; clozapine must be stopped immediately.
G-CSF is indicated. Continuing or reducing dose is unsafe; lithium
does not treat agranulocytosis.
5. A 60-year-old patient with generalized anxiety disorder and
hypertension is started on buspirone. Which statement about
buspirone is TRUE?
A. It has immediate anxiolytic effects
B. It does not cause dependence, withdrawal, or sedation
C. It acts primarily on GABA receptors
,D. It is a benzodiazepine
Rationale: Buspirone is a non-sedating, non-benzodiazepine anxiolytic
with no dependence or withdrawal. It has delayed onset and acts on 5-
HT₁A receptors.
6. A patient with Parkinson's disease develops psychosis. Which
antipsychotic is MOST appropriate due to its minimal
extrapyramidal side effects?
A. Haloperidol
B. Quetiapine
C. Risperidone
D. Aripiprazole
Rationale: Quetiapine is often preferred in Parkinson's disease
psychosis due to its low D₂ receptor occupancy and minimal EPS.
Haloperidol has high EPS risk; risperidone and aripiprazole also have
EPS risk at therapeutic doses.
7. A patient with treatment-resistant depression is started on
tranylcypromine. Which dietary restriction is MOST important to
communicate?
A. Low-sodium diet
B. Avoidance of tyramine-rich foods (aged cheese, cured meats,
fermented foods)
C. Low-carbohydrate diet
D. Avoidance of caffeine
Rationale: MAOIs inhibit tyramine breakdown, leading to
hypertensive crisis. Tyramine-rich foods include aged cheese, cured
meats, and fermented foods. Sodium, carbohydrate, and caffeine
restrictions are not specific to MAOI therapy.
, 8. A 25-year-old patient with ADHD and a history of substance use
disorder is started on a non-stimulant medication. The MOST
appropriate choice is:
A. Methylphenidate
B. Dextroamphetamine
C. Atomoxetine
D. Lisdexamfetamine
Rationale: Atomoxetine is a non-stimulant, selective norepinephrine
reuptake inhibitor with no abuse potential. Methylphenidate,
dextroamphetamine, and lisdexamfetamine are stimulants with abuse
potential.
9. A patient with bipolar I disorder is started on valproic acid.
Which monitoring parameter is ESSENTIAL during therapy?
A. Serum creatinine
B. Liver function tests and complete blood count
C. Thyroid function tests
D. Fasting blood glucose
Rationale: Valproic acid can cause hepatotoxicity and
thrombocytopenia. Liver function tests and CBC must be monitored.
Renal function, thyroid function, and glucose are not primary
monitoring parameters for valproate.
10. A patient with schizophrenia develops tardive dyskinesia. The
involuntary movements are MOST likely due to:
A. Serotonin receptor hypersensitivity
B. Dopamine receptor supersensitivity
C. Norepinephrine receptor blockade
D. Histamine receptor blockade
Rationale: Tardive dyskinesia is caused by dopamine receptor
PSYCHOPHARMACOLOGIC APPROACHES TO
TREATMENT OF PSYCHOPATHOLOGY ALL
QUESTIONS AND VERIFIED ANSWERS
ALREADY A GRADED|NEW AND REVISED
1. A 45-year-old patient with major depressive disorder has failed
trials of two SSRIs and one SNRI. Which medication is MOST
appropriate as a next-line treatment?
A. Increase the current SNRI dose
B. Add a benzodiazepine
C. Consider a trial of an MAOI or atypical antipsychotic
augmentation
D. Discontinue all medications
Rationale: After multiple antidepressant failures, guidelines
recommend MAOIs or atypical antipsychotic augmentation (e.g.,
aripiprazole, quetiapine). Increasing dose or adding benzodiazepines is
not standard; discontinuation is not appropriate.
2. A patient with schizophrenia develops severe extrapyramidal
symptoms on haloperidol. The prescriber switches to clozapine. The
primary advantage of clozapine in this situation is:
A. Higher D₂ receptor affinity
B. Lower risk of EPS due to lower D₂ occupancy and 5-HT₂A
antagonism
C. Faster onset of action
D. No need for monitoring
Rationale: Clozapine has low D₂ receptor occupancy and high 5-HT₂A
antagonism, resulting in minimal EPS. It does not have higher D₂
affinity, faster onset, or require no monitoring.
,3. A 30-year-old patient with bipolar I disorder is being discharged
on lithium. Which patient education point is MOST critical
regarding lithium therapy?
A. Take with food to avoid nausea
B. Maintain consistent sodium and fluid intake; avoid dehydration
C. Avoid sunlight exposure
D. Take on an empty stomach
Rationale: Lithium levels are affected by sodium and fluid balance;
dehydration can increase lithium levels to toxicity. Food intake is less
critical; sunlight avoidance is not required.
4. A patient on clozapine develops fever, tachycardia, and lethargy.
Laboratory results show absolute neutrophil count (ANC) of
350/mm³. The MOST appropriate action is:
A. Continue clozapine and monitor ANC weekly
B. Discontinue clozapine immediately and initiate G-CSF
C. Reduce clozapine dose by 50%
D. Add lithium to increase neutrophil count
Rationale: ANC < 500/mm³ indicates severe
neutropenia/agranulocytosis; clozapine must be stopped immediately.
G-CSF is indicated. Continuing or reducing dose is unsafe; lithium
does not treat agranulocytosis.
5. A 60-year-old patient with generalized anxiety disorder and
hypertension is started on buspirone. Which statement about
buspirone is TRUE?
A. It has immediate anxiolytic effects
B. It does not cause dependence, withdrawal, or sedation
C. It acts primarily on GABA receptors
,D. It is a benzodiazepine
Rationale: Buspirone is a non-sedating, non-benzodiazepine anxiolytic
with no dependence or withdrawal. It has delayed onset and acts on 5-
HT₁A receptors.
6. A patient with Parkinson's disease develops psychosis. Which
antipsychotic is MOST appropriate due to its minimal
extrapyramidal side effects?
A. Haloperidol
B. Quetiapine
C. Risperidone
D. Aripiprazole
Rationale: Quetiapine is often preferred in Parkinson's disease
psychosis due to its low D₂ receptor occupancy and minimal EPS.
Haloperidol has high EPS risk; risperidone and aripiprazole also have
EPS risk at therapeutic doses.
7. A patient with treatment-resistant depression is started on
tranylcypromine. Which dietary restriction is MOST important to
communicate?
A. Low-sodium diet
B. Avoidance of tyramine-rich foods (aged cheese, cured meats,
fermented foods)
C. Low-carbohydrate diet
D. Avoidance of caffeine
Rationale: MAOIs inhibit tyramine breakdown, leading to
hypertensive crisis. Tyramine-rich foods include aged cheese, cured
meats, and fermented foods. Sodium, carbohydrate, and caffeine
restrictions are not specific to MAOI therapy.
, 8. A 25-year-old patient with ADHD and a history of substance use
disorder is started on a non-stimulant medication. The MOST
appropriate choice is:
A. Methylphenidate
B. Dextroamphetamine
C. Atomoxetine
D. Lisdexamfetamine
Rationale: Atomoxetine is a non-stimulant, selective norepinephrine
reuptake inhibitor with no abuse potential. Methylphenidate,
dextroamphetamine, and lisdexamfetamine are stimulants with abuse
potential.
9. A patient with bipolar I disorder is started on valproic acid.
Which monitoring parameter is ESSENTIAL during therapy?
A. Serum creatinine
B. Liver function tests and complete blood count
C. Thyroid function tests
D. Fasting blood glucose
Rationale: Valproic acid can cause hepatotoxicity and
thrombocytopenia. Liver function tests and CBC must be monitored.
Renal function, thyroid function, and glucose are not primary
monitoring parameters for valproate.
10. A patient with schizophrenia develops tardive dyskinesia. The
involuntary movements are MOST likely due to:
A. Serotonin receptor hypersensitivity
B. Dopamine receptor supersensitivity
C. Norepinephrine receptor blockade
D. Histamine receptor blockade
Rationale: Tardive dyskinesia is caused by dopamine receptor
