NR546 Week 4 Midterm Exam 2026 |
Psychopharmacology for PMHNP Examplify
Proctored Questions & Verified Answers
• This is a question practice exam for NR546 Week 4 Midterm —
Psychopharmacology for PMHNP — covering all major testable topics with verified
answers and EXPERT RATIONALE to reinforce clinical reasoning.
• Use this material by attempting each question first before reading the correct
answer and EXPERT RATIONALE, spacing your review across multiple sessions for
optimal retention.
1. A patient with major depressive disorder (MDD) is started on fluoxetine.
Which mechanism best explains its antidepressant effect?
A. Blocks dopamine reuptake in the nucleus accumbens
B. Inhibits monoamine oxidase A and B
C. Blocks norepinephrine and serotonin reuptake equally
D. Inhibits reuptake of serotonin at the presynaptic terminal
E. Antagonizes serotonin 2A receptors postsynaptically
Correct Answer: D. Inhibits reuptake of serotonin at the presynaptic
terminal
EXPERT RATIONALE: Fluoxetine is a selective serotonin reuptake inhibitor
(SSRI). It works by blocking the serotonin transporter (SERT) at the presynaptic
terminal, increasing serotonin availability in the synapse. It does not inhibit MAO or
equally block norepinephrine.
2. Which of the following SSRIs has the longest half-life and is least likely to
cause discontinuation syndrome?
A. Paroxetine
B. Sertraline
C. Citalopram
,D. Fluoxetine
E. Fluvoxamine
Correct Answer: D. Fluoxetine
EXPERT RATIONALE: Fluoxetine has a half-life of 1–6 days and its active
metabolite norfluoxetine has a half-life of 4–16 days, providing a self-tapering effect
that minimizes discontinuation syndrome compared to other SSRIs.
3. A PMHNP is managing a patient on phenelzine who requests a
decongestant for a cold. Which response is most appropriate?
A. Prescribe pseudoephedrine at a low dose
B. Prescribe oxymetazoline nasal spray safely
C. Avoid all sympathomimetics due to risk of hypertensive crisis
D. Switch phenelzine to an SSRI before prescribing the decongestant
E. Recommend diphenhydramine as a safe alternative
Correct Answer: C. Avoid all sympathomimetics due to risk of hypertensive
crisis
EXPERT RATIONALE: Phenelzine is a monoamine oxidase inhibitor (MAOI).
Combining MAOIs with sympathomimetics such as pseudoephedrine can
precipitate a life-threatening hypertensive crisis due to excess catecholamine
release.
4. Which of the following best describes the mechanism of bupropion?
A. Serotonin reuptake inhibition only
B. Norepinephrine and dopamine reuptake inhibition
C. Serotonin and norepinephrine reuptake inhibition
D. Monoamine oxidase inhibition
,E. Serotonin 1A partial agonism
Correct Answer: B. Norepinephrine and dopamine reuptake inhibition
EXPERT RATIONALE: Bupropion is classified as an NDRI (norepinephrine-
dopamine reuptake inhibitor). It has no significant serotonergic activity, which is
why it does not cause sexual dysfunction or weight gain typical of SSRIs.
5. A patient on lithium presents with coarse tremor, confusion, and polyuria.
Lithium level is 2.4 mEq/L. What is the priority intervention?
A. Reduce lithium dose by half
B. Add propranolol for tremor management
C. Discontinue lithium and initiate hydration
D. Switch to valproate immediately
E. Administer activated charcoal
Correct Answer: C. Discontinue lithium and initiate hydration
EXPERT RATIONALE: A lithium level above 2.0 mEq/L indicates severe toxicity.
Symptoms such as coarse tremor, confusion, and polyuria confirm toxicity.
Immediate discontinuation and IV hydration to enhance renal clearance are the
priority interventions.
6. Clozapine is indicated for which of the following conditions?
A. First-episode psychosis in an antipsychotic-naive patient
B. Treatment-resistant schizophrenia and suicidality reduction
C. Bipolar I disorder as a mood stabilizer
D. Major depressive disorder with psychotic features
E. Generalized anxiety disorder refractory to SSRIs
, Correct Answer: B. Treatment-resistant schizophrenia and suicidality
reduction
EXPERT RATIONALE: Clozapine is FDA-approved for treatment-resistant
schizophrenia and for reducing suicidal behavior in patients with schizophrenia or
schizoaffective disorder. Its use requires REMS enrollment due to risk of
agranulocytosis.
7. Which antipsychotic is most associated with causing hyperprolactinemia?
A. Quetiapine
B. Clozapine
C. Aripiprazole
D. Risperidone
E. Olanzapine
Correct Answer: D. Risperidone
EXPERT RATIONALE: Risperidone strongly blocks D2 receptors in the
tuberoinfundibular pathway, inhibiting the normal dopamine suppression of
prolactin, leading to significant hyperprolactinemia compared to other atypical
antipsychotics.
8. Which of the following is the most serious adverse effect requiring
monitoring with clozapine use?
A. Weight gain
B. QTc prolongation
C. Agranulocytosis
D. Tardive dyskinesia
E. Hyperprolactinemia
Psychopharmacology for PMHNP Examplify
Proctored Questions & Verified Answers
• This is a question practice exam for NR546 Week 4 Midterm —
Psychopharmacology for PMHNP — covering all major testable topics with verified
answers and EXPERT RATIONALE to reinforce clinical reasoning.
• Use this material by attempting each question first before reading the correct
answer and EXPERT RATIONALE, spacing your review across multiple sessions for
optimal retention.
1. A patient with major depressive disorder (MDD) is started on fluoxetine.
Which mechanism best explains its antidepressant effect?
A. Blocks dopamine reuptake in the nucleus accumbens
B. Inhibits monoamine oxidase A and B
C. Blocks norepinephrine and serotonin reuptake equally
D. Inhibits reuptake of serotonin at the presynaptic terminal
E. Antagonizes serotonin 2A receptors postsynaptically
Correct Answer: D. Inhibits reuptake of serotonin at the presynaptic
terminal
EXPERT RATIONALE: Fluoxetine is a selective serotonin reuptake inhibitor
(SSRI). It works by blocking the serotonin transporter (SERT) at the presynaptic
terminal, increasing serotonin availability in the synapse. It does not inhibit MAO or
equally block norepinephrine.
2. Which of the following SSRIs has the longest half-life and is least likely to
cause discontinuation syndrome?
A. Paroxetine
B. Sertraline
C. Citalopram
,D. Fluoxetine
E. Fluvoxamine
Correct Answer: D. Fluoxetine
EXPERT RATIONALE: Fluoxetine has a half-life of 1–6 days and its active
metabolite norfluoxetine has a half-life of 4–16 days, providing a self-tapering effect
that minimizes discontinuation syndrome compared to other SSRIs.
3. A PMHNP is managing a patient on phenelzine who requests a
decongestant for a cold. Which response is most appropriate?
A. Prescribe pseudoephedrine at a low dose
B. Prescribe oxymetazoline nasal spray safely
C. Avoid all sympathomimetics due to risk of hypertensive crisis
D. Switch phenelzine to an SSRI before prescribing the decongestant
E. Recommend diphenhydramine as a safe alternative
Correct Answer: C. Avoid all sympathomimetics due to risk of hypertensive
crisis
EXPERT RATIONALE: Phenelzine is a monoamine oxidase inhibitor (MAOI).
Combining MAOIs with sympathomimetics such as pseudoephedrine can
precipitate a life-threatening hypertensive crisis due to excess catecholamine
release.
4. Which of the following best describes the mechanism of bupropion?
A. Serotonin reuptake inhibition only
B. Norepinephrine and dopamine reuptake inhibition
C. Serotonin and norepinephrine reuptake inhibition
D. Monoamine oxidase inhibition
,E. Serotonin 1A partial agonism
Correct Answer: B. Norepinephrine and dopamine reuptake inhibition
EXPERT RATIONALE: Bupropion is classified as an NDRI (norepinephrine-
dopamine reuptake inhibitor). It has no significant serotonergic activity, which is
why it does not cause sexual dysfunction or weight gain typical of SSRIs.
5. A patient on lithium presents with coarse tremor, confusion, and polyuria.
Lithium level is 2.4 mEq/L. What is the priority intervention?
A. Reduce lithium dose by half
B. Add propranolol for tremor management
C. Discontinue lithium and initiate hydration
D. Switch to valproate immediately
E. Administer activated charcoal
Correct Answer: C. Discontinue lithium and initiate hydration
EXPERT RATIONALE: A lithium level above 2.0 mEq/L indicates severe toxicity.
Symptoms such as coarse tremor, confusion, and polyuria confirm toxicity.
Immediate discontinuation and IV hydration to enhance renal clearance are the
priority interventions.
6. Clozapine is indicated for which of the following conditions?
A. First-episode psychosis in an antipsychotic-naive patient
B. Treatment-resistant schizophrenia and suicidality reduction
C. Bipolar I disorder as a mood stabilizer
D. Major depressive disorder with psychotic features
E. Generalized anxiety disorder refractory to SSRIs
, Correct Answer: B. Treatment-resistant schizophrenia and suicidality
reduction
EXPERT RATIONALE: Clozapine is FDA-approved for treatment-resistant
schizophrenia and for reducing suicidal behavior in patients with schizophrenia or
schizoaffective disorder. Its use requires REMS enrollment due to risk of
agranulocytosis.
7. Which antipsychotic is most associated with causing hyperprolactinemia?
A. Quetiapine
B. Clozapine
C. Aripiprazole
D. Risperidone
E. Olanzapine
Correct Answer: D. Risperidone
EXPERT RATIONALE: Risperidone strongly blocks D2 receptors in the
tuberoinfundibular pathway, inhibiting the normal dopamine suppression of
prolactin, leading to significant hyperprolactinemia compared to other atypical
antipsychotics.
8. Which of the following is the most serious adverse effect requiring
monitoring with clozapine use?
A. Weight gain
B. QTc prolongation
C. Agranulocytosis
D. Tardive dyskinesia
E. Hyperprolactinemia
