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
serotonergic activation, but these typically improve within 1-2 weeks as the body adapts.
Reassuring the patient and encouraging continued use with follow-up is appropriate.
Discontinuing (A) or switching (D) is premature at 3 days. Doubling the dose (C) would likely
worsen side effects.
Q2: A patient on fluoxetine develops agitation, confusion, myoclonus, hyperreflexia, and
diaphoresis after starting tramadol for pain. This represents:
A. Opioid overdose
B. Serotonin syndrome [CORRECT]
C. Neuroleptic malignant syndrome
D. Withdrawal reaction
,Correct Answer: B
Rationale: Serotonin syndrome results from excessive serotonergic activity, commonly when
SSRIs are combined with other serotonergic agents like tramadol. The triad includes mental
status changes (confusion, agitation), autonomic instability (diaphoresis, tachycardia,
hypertension), and neuromuscular abnormalities (myoclonus, hyperreflexia, tremor) (B). NMS
(C) presents with rigidity and fever without myoclonus.
Q3: A patient with depression and neuropathic pain is started on duloxetine. What is the
mechanism of action?
A. Selective serotonin reuptake inhibition only
B. Serotonin and norepinephrine reuptake inhibition [CORRECT]
C. Dopamine and norepinephrine reuptake inhibition
D. Monoamine oxidase inhibition
Correct Answer: B
Rationale: Duloxetine is an SNRI that inhibits both serotonin and norepinephrine reuptake. The
norepinephrine component provides efficacy for neuropathic pain and fibromyalgia, unlike
SSRIs which only inhibit serotonin reuptake (B).
Q4: A patient with treatment-resistant depression is considering phenelzine. Which dietary
instruction is essential?
A. Avoid all dairy products
B. Avoid tyramine-containing foods (aged cheeses, cured meats, wine) [CORRECT]
C. Increase caffeine intake
D. Take with grapefruit juice
Correct Answer: B
Rationale: MAOIs like phenelzine inhibit MAO-A, preventing breakdown of tyramine.
Tyramine-rich foods (aged cheeses, cured meats, fermented products, wine, beer) can cause
hypertensive crisis with severe headache, hypertension, and potential stroke. Strict dietary
restrictions are essential (B).
Q5: A patient on paroxetine wants to discontinue the medication. The nurse practitioner should:
A. Stop the medication immediately
B. Taper gradually over several weeks to months [CORRECT]
C. Switch to fluoxetine for 1 week then stop
, D. Double the dose for 1 week then stop
Correct Answer: B
Rationale: Paroxetine has a short half-life and potent cholinergic rebound, causing significant
discontinuation syndrome (dizziness, electric shock sensations, insomnia, irritability). Gradual
tapering over weeks to months is necessary. Some evidence supports switching to fluoxetine
(longer half-life) then tapering, but gradual taper of paroxetine itself is standard (B).
Q6: A patient with depression and sexual dysfunction on an SSRI is switched to bupropion. What
is the expected outcome?
A. Worsening of sexual dysfunction
B. Improvement in sexual dysfunction and possible weight loss [CORRECT]
C. Increased sedation
D. Development of EPS
Correct Answer: B
Rationale: Bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor) with minimal
serotonergic effects, resulting in lower rates of sexual dysfunction and weight gain compared to
SSRIs. It may cause weight loss and improved sexual function, making it a good option for
patients with SSRI-induced sexual side effects (B).
Q7: A patient with depression, insomnia, and poor appetite is started on mirtazapine. What side
effects should be monitored?
A. Insomnia and weight loss
B. Sedation and weight gain [CORRECT]
C. Sexual dysfunction and tremor
D. Hypertension and tachycardia
Correct Answer: B
Rationale: Mirtazapine is a NaSSA (noradrenergic and specific serotonergic antidepressant) that
blocks 5-HT2 and 5-HT3 receptors and alpha-2 adrenergic receptors. It is highly sedating (H1
antagonism) and causes significant appetite stimulation and weight gain, making it useful for
patients with insomnia and poor appetite, but these effects must be monitored (B).
Q8: A patient with depression and cardiac disease requires an antidepressant with minimal
cardiac effects. The best choice is:
A. Amitriptyline
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
serotonergic activation, but these typically improve within 1-2 weeks as the body adapts.
Reassuring the patient and encouraging continued use with follow-up is appropriate.
Discontinuing (A) or switching (D) is premature at 3 days. Doubling the dose (C) would likely
worsen side effects.
Q2: A patient on fluoxetine develops agitation, confusion, myoclonus, hyperreflexia, and
diaphoresis after starting tramadol for pain. This represents:
A. Opioid overdose
B. Serotonin syndrome [CORRECT]
C. Neuroleptic malignant syndrome
D. Withdrawal reaction
,Correct Answer: B
Rationale: Serotonin syndrome results from excessive serotonergic activity, commonly when
SSRIs are combined with other serotonergic agents like tramadol. The triad includes mental
status changes (confusion, agitation), autonomic instability (diaphoresis, tachycardia,
hypertension), and neuromuscular abnormalities (myoclonus, hyperreflexia, tremor) (B). NMS
(C) presents with rigidity and fever without myoclonus.
Q3: A patient with depression and neuropathic pain is started on duloxetine. What is the
mechanism of action?
A. Selective serotonin reuptake inhibition only
B. Serotonin and norepinephrine reuptake inhibition [CORRECT]
C. Dopamine and norepinephrine reuptake inhibition
D. Monoamine oxidase inhibition
Correct Answer: B
Rationale: Duloxetine is an SNRI that inhibits both serotonin and norepinephrine reuptake. The
norepinephrine component provides efficacy for neuropathic pain and fibromyalgia, unlike
SSRIs which only inhibit serotonin reuptake (B).
Q4: A patient with treatment-resistant depression is considering phenelzine. Which dietary
instruction is essential?
A. Avoid all dairy products
B. Avoid tyramine-containing foods (aged cheeses, cured meats, wine) [CORRECT]
C. Increase caffeine intake
D. Take with grapefruit juice
Correct Answer: B
Rationale: MAOIs like phenelzine inhibit MAO-A, preventing breakdown of tyramine.
Tyramine-rich foods (aged cheeses, cured meats, fermented products, wine, beer) can cause
hypertensive crisis with severe headache, hypertension, and potential stroke. Strict dietary
restrictions are essential (B).
Q5: A patient on paroxetine wants to discontinue the medication. The nurse practitioner should:
A. Stop the medication immediately
B. Taper gradually over several weeks to months [CORRECT]
C. Switch to fluoxetine for 1 week then stop
, D. Double the dose for 1 week then stop
Correct Answer: B
Rationale: Paroxetine has a short half-life and potent cholinergic rebound, causing significant
discontinuation syndrome (dizziness, electric shock sensations, insomnia, irritability). Gradual
tapering over weeks to months is necessary. Some evidence supports switching to fluoxetine
(longer half-life) then tapering, but gradual taper of paroxetine itself is standard (B).
Q6: A patient with depression and sexual dysfunction on an SSRI is switched to bupropion. What
is the expected outcome?
A. Worsening of sexual dysfunction
B. Improvement in sexual dysfunction and possible weight loss [CORRECT]
C. Increased sedation
D. Development of EPS
Correct Answer: B
Rationale: Bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor) with minimal
serotonergic effects, resulting in lower rates of sexual dysfunction and weight gain compared to
SSRIs. It may cause weight loss and improved sexual function, making it a good option for
patients with SSRI-induced sexual side effects (B).
Q7: A patient with depression, insomnia, and poor appetite is started on mirtazapine. What side
effects should be monitored?
A. Insomnia and weight loss
B. Sedation and weight gain [CORRECT]
C. Sexual dysfunction and tremor
D. Hypertension and tachycardia
Correct Answer: B
Rationale: Mirtazapine is a NaSSA (noradrenergic and specific serotonergic antidepressant) that
blocks 5-HT2 and 5-HT3 receptors and alpha-2 adrenergic receptors. It is highly sedating (H1
antagonism) and causes significant appetite stimulation and weight gain, making it useful for
patients with insomnia and poor appetite, but these effects must be monitored (B).
Q8: A patient with depression and cardiac disease requires an antidepressant with minimal
cardiac effects. The best choice is:
A. Amitriptyline
