NSG552 EXAM 2 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales
Psychopharmacology Grade A 100% Correct
Pass Guaranteed - A+ Graded
SECTION 1: ANTIDEPRESSANTS (Questions 1-20)
Q1: A patient with major depressive disorder is started on sertraline. The patient calls the office 3
days later reporting nausea and headache. What is the most appropriate nursing response?
A. Discontinue the medication immediately
B. Reassure the patient that these side effects are often temporary and may improve with time.
[CORRECT]
C. Double the dose to overcome the side effects
D. Switch to a different antidepressant
Correct Answer: B
Rationale: SSRIs commonly cause GI side effects (nausea) and headache initially due to
increased serotonin in the gut and CNS, but these often improve within 1-2 weeks as the body
adapts. Reassuring the patient and encouraging them to continue with supportive care is
appropriate (B). Discontinuing (A) or switching (D) is premature after only 3 days. Doubling the
dose (C) would likely worsen side effects.
Q2: A 45-year-old patient with depression and comorbid neuropathic pain is started on
duloxetine. Which side effect should the nurse specifically monitor for at higher doses?
A. Hypotension
B. Hypertension [CORRECT]
C. Bradycardia
D. Hypoglycemia
Correct Answer: B
,Rationale: Duloxetine is an SNRI that inhibits norepinephrine reuptake in addition to serotonin.
At doses above 60 mg/day, the noradrenergic effects can cause dose-related increases in blood
pressure (B). While other side effects occur, hypertension is specifically associated with higher
doses of SNRIs like venlafaxine and duloxetine due to increased sympathetic tone.
Q3: A patient has been taking phenelzine for treatment-resistant depression. The patient presents
to the emergency department with severe headache, stiff neck, sweating, and blood pressure of
210/120 mmHg after eating at a restaurant. Which dietary component is most likely responsible?
A. Fresh mozzarella cheese
B. Aged cheddar cheese [CORRECT]
C. Fresh green beans
D. Vanilla ice cream
Correct Answer: B
Rationale: MAOIs like phenelzine inhibit the breakdown of tyramine, which can accumulate and
cause hypertensive crisis. Aged, fermented, or cured foods contain high tyramine levels,
including aged cheeses (cheddar, blue, Swiss), cured meats, and some wines/beers (B). Fresh
cheeses (A) and most fresh foods (C, D) are generally safe in moderation.
Q4: A patient with depression and smoking cessation goals is started on bupropion XL. Which
patient history would contraindicate the use of this medication?
A. History of hypertension
B. History of seizure disorder [CORRECT]
C. History of asthma
D. History of osteoarthritis
Correct Answer: B
Rationale: Bupropion is contraindicated in patients with seizure disorders or conditions that
lower seizure threshold (eating disorders, abrupt alcohol/benzodiazepine withdrawal) due to
dose-related seizure risk (B). It lowers the seizure threshold by inhibiting dopamine and
norepinephrine reuptake. Hypertension (A), asthma (C), and osteoarthritis (D) are not
contraindications.
Q5: A patient with depression, insomnia, and poor appetite is prescribed mirtazapine 15 mg at
bedtime. Which side effect should the nurse anticipate and counsel the patient about?
A. Insomnia and weight loss
B. Sedation and weight gain [CORRECT]
, C. Sexual dysfunction and diarrhea
D. Hypertension and tachycardia
Correct Answer: B
Rationale: Mirtazapine is a NaSSA (noradrenergic and specific serotonergic antidepressant) that
antagonizes 5-HT2 and H1 receptors, causing sedation (helpful for insomnia) and appetite
stimulation/weight gain (B). At lower doses (7.5-15 mg), antihistamine effects predominate
causing more sedation. This profile is beneficial for patients with insomnia and poor appetite but
requires counseling about weight monitoring.
Q6: A patient has been taking fluoxetine 20 mg daily for 6 weeks with partial response. The
PMHNP decides to increase the dose. When should the next therapeutic assessment occur?
A. 1 week
B. 2-4 weeks [CORRECT]
C. 3 months
D. 6 months
Correct Answer: B
Rationale: After dose adjustments, antidepressants require 2-4 weeks to achieve new steady-state
therapeutic effects (B). Fluoxetine has a long half-life (and active metabolite norfluoxetine), but
clinical response still requires time for receptor adaptations and neuroplasticity changes. Earlier
assessment (A) is premature, while longer intervals (C, D) delay optimization of treatment.
Q7: A patient taking amitriptyline for depression presents with dry mouth, constipation, and
blurred vision. Which mechanism explains these side effects?
A. Alpha-1 adrenergic blockade
B. Histamine H1 blockade
C. Muscarinic acetylcholine receptor blockade [CORRECT]
D. Dopamine D2 blockade
Correct Answer: C
Rationale: TCAs like amitriptyline have potent anticholinergic (antimuscarinic) effects due to
blockade of muscarinic acetylcholine receptors, causing the classic triad of dry mouth,
constipation, and blurred vision (C), along with urinary retention and cognitive effects. These
side effects limit TCA tolerability, particularly in older adults.
Complete Questions and Verified Answers
with Detailed Rationales
Psychopharmacology Grade A 100% Correct
Pass Guaranteed - A+ Graded
SECTION 1: ANTIDEPRESSANTS (Questions 1-20)
Q1: A patient with major depressive disorder is started on sertraline. The patient calls the office 3
days later reporting nausea and headache. What is the most appropriate nursing response?
A. Discontinue the medication immediately
B. Reassure the patient that these side effects are often temporary and may improve with time.
[CORRECT]
C. Double the dose to overcome the side effects
D. Switch to a different antidepressant
Correct Answer: B
Rationale: SSRIs commonly cause GI side effects (nausea) and headache initially due to
increased serotonin in the gut and CNS, but these often improve within 1-2 weeks as the body
adapts. Reassuring the patient and encouraging them to continue with supportive care is
appropriate (B). Discontinuing (A) or switching (D) is premature after only 3 days. Doubling the
dose (C) would likely worsen side effects.
Q2: A 45-year-old patient with depression and comorbid neuropathic pain is started on
duloxetine. Which side effect should the nurse specifically monitor for at higher doses?
A. Hypotension
B. Hypertension [CORRECT]
C. Bradycardia
D. Hypoglycemia
Correct Answer: B
,Rationale: Duloxetine is an SNRI that inhibits norepinephrine reuptake in addition to serotonin.
At doses above 60 mg/day, the noradrenergic effects can cause dose-related increases in blood
pressure (B). While other side effects occur, hypertension is specifically associated with higher
doses of SNRIs like venlafaxine and duloxetine due to increased sympathetic tone.
Q3: A patient has been taking phenelzine for treatment-resistant depression. The patient presents
to the emergency department with severe headache, stiff neck, sweating, and blood pressure of
210/120 mmHg after eating at a restaurant. Which dietary component is most likely responsible?
A. Fresh mozzarella cheese
B. Aged cheddar cheese [CORRECT]
C. Fresh green beans
D. Vanilla ice cream
Correct Answer: B
Rationale: MAOIs like phenelzine inhibit the breakdown of tyramine, which can accumulate and
cause hypertensive crisis. Aged, fermented, or cured foods contain high tyramine levels,
including aged cheeses (cheddar, blue, Swiss), cured meats, and some wines/beers (B). Fresh
cheeses (A) and most fresh foods (C, D) are generally safe in moderation.
Q4: A patient with depression and smoking cessation goals is started on bupropion XL. Which
patient history would contraindicate the use of this medication?
A. History of hypertension
B. History of seizure disorder [CORRECT]
C. History of asthma
D. History of osteoarthritis
Correct Answer: B
Rationale: Bupropion is contraindicated in patients with seizure disorders or conditions that
lower seizure threshold (eating disorders, abrupt alcohol/benzodiazepine withdrawal) due to
dose-related seizure risk (B). It lowers the seizure threshold by inhibiting dopamine and
norepinephrine reuptake. Hypertension (A), asthma (C), and osteoarthritis (D) are not
contraindications.
Q5: A patient with depression, insomnia, and poor appetite is prescribed mirtazapine 15 mg at
bedtime. Which side effect should the nurse anticipate and counsel the patient about?
A. Insomnia and weight loss
B. Sedation and weight gain [CORRECT]
, C. Sexual dysfunction and diarrhea
D. Hypertension and tachycardia
Correct Answer: B
Rationale: Mirtazapine is a NaSSA (noradrenergic and specific serotonergic antidepressant) that
antagonizes 5-HT2 and H1 receptors, causing sedation (helpful for insomnia) and appetite
stimulation/weight gain (B). At lower doses (7.5-15 mg), antihistamine effects predominate
causing more sedation. This profile is beneficial for patients with insomnia and poor appetite but
requires counseling about weight monitoring.
Q6: A patient has been taking fluoxetine 20 mg daily for 6 weeks with partial response. The
PMHNP decides to increase the dose. When should the next therapeutic assessment occur?
A. 1 week
B. 2-4 weeks [CORRECT]
C. 3 months
D. 6 months
Correct Answer: B
Rationale: After dose adjustments, antidepressants require 2-4 weeks to achieve new steady-state
therapeutic effects (B). Fluoxetine has a long half-life (and active metabolite norfluoxetine), but
clinical response still requires time for receptor adaptations and neuroplasticity changes. Earlier
assessment (A) is premature, while longer intervals (C, D) delay optimization of treatment.
Q7: A patient taking amitriptyline for depression presents with dry mouth, constipation, and
blurred vision. Which mechanism explains these side effects?
A. Alpha-1 adrenergic blockade
B. Histamine H1 blockade
C. Muscarinic acetylcholine receptor blockade [CORRECT]
D. Dopamine D2 blockade
Correct Answer: C
Rationale: TCAs like amitriptyline have potent anticholinergic (antimuscarinic) effects due to
blockade of muscarinic acetylcholine receptors, causing the classic triad of dry mouth,
constipation, and blurred vision (C), along with urinary retention and cognitive effects. These
side effects limit TCA tolerability, particularly in older adults.
