NR546 Week 8 Final Exam | Advanced Psychopharmacology for
PMHNP | 75 Practice Questions with Answers & Rationales |
Chamberlain 2026
Updated for 2026. This comprehensive practice exam covers the NR546 Advanced
Psychopharmacology for the PMHNP Week 8 Final Exam at Chamberlain University.
The final exam covers content from Weeks 5-8, focusing on medications for mood
disorders, substance use disorders, and other advanced psychopharmacology topics .
Exam Quick Facts
Feature Details
Course NR546 Advanced Psychopharmacology for the PMHNP
Institution Chamberlain University
Exam Week 8 Final Exam (Weeks 5-8 Content)
Format Multiple Choice, Matching, Examplify Online Proctored
Number of 75+
Questions
Topics Mood Disorders, Substance Use Disorders, Antidepressants,
Mood Stabilizers, Antipsychotics
Question 1
A 45-year-old patient with major depressive disorder has been taking fluoxetine 40 mg daily
for 8 weeks with partial response. The patient reports excessive sweating, insomnia, and
sexual dysfunction. Which is the most appropriate next step in managing this patient's
medication regimen?
A) Add bupropion 150 mg daily to augment antidepressant effects
B) Increase fluoxetine to 60 mg daily to achieve full remission
C) Switch to phenelzine to address treatment resistance
D) Add trazodone 50 mg at bedtime for sleep disturbance
,Answer: A
Bupropion is an effective augmentation strategy for SSRIs like fluoxetine, particularly when
patients experience SSRI-induced sexual dysfunction and incomplete response.
Bupropion's dopaminergic and noradrenergic properties complement serotonergic activity
without exacerbating sexual side effects. Increasing fluoxetine would likely worsen side
effects without proportional benefit .
Question 2
Which cytochrome P450 enzyme is primarily responsible for the metabolism of fluvoxamine,
and what clinical significance does this have?
A) CYP2D6; requires dose adjustment in poor metabolizers
B) CYP1A2; significant inhibition of theophylline and caffeine metabolism
C) CYP3A4; increased risk of drug interactions with statins
D) CYP2C19; affects proton pump inhibitor metabolism
Answer: B
Fluvoxamine is a potent inhibitor of CYP1A2, which leads to clinically significant increases
in theophylline and caffeine levels, potentially causing toxicity. While fluvoxamine does
affect other CYP enzymes, CYP1A2 inhibition is its most clinically relevant interaction .
Question 3
A 28-year-old male with schizophrenia has been non-adherent to oral antipsychotics. He is
currently experiencing auditory hallucinations and paranoid delusions. Which long-acting
injectable antipsychotic would be most appropriate for this patient?
A) Haloperidol decanoate
B) Aripiprazole monohydrate
C) Olanzapine pamoate
D) Risperidone microspheres
Answer: B
Aripiprazole monohydrate is available as a once-monthly long-acting injectable with a
favorable metabolic profile compared to other LAIs. For a patient with adherence issues, an
,LAI is indicated. Aripiprazole's partial D2 agonist activity provides efficacy with lower risk of
extrapyramidal symptoms and metabolic disturbances .
Question 4
A 72-year-old patient with Alzheimer's disease is started on donepezil 5 mg daily. One week
later, the family reports the patient is experiencing vivid nightmares, muscle cramps, and
bradycardia. What is the most appropriate action?
A) Increase donepezil to 10 mg daily
B) Discontinue donepezil and start rivastigmine patch
C) Reduce donepezil to 2.5 mg daily
D) Add memantine 10 mg twice daily
Answer: C
Reducing donepezil to 2.5 mg daily addresses cholinergic side effects while maintaining
some therapeutic benefit in an elderly patient. Donepezil's cholinergic effects can cause
nightmares, muscle cramps, and bradycardia, particularly in older adults. Starting at a lower
dose and titrating more slowly is appropriate .
Question 5
A 56-year-old male with a history of alcohol use disorder is being treated for generalized
anxiety disorder. Which medication should be avoided due to the risk of severe
hepatotoxicity in this population?
A) Buspirone
B) Duloxetine
C) Hydroxyzine
D) Alprazolam
Answer: B
Duloxetine carries a risk of hepatotoxicity and should be used with caution in patients with a
history of alcohol use disorder due to potential hepatic enzyme induction and increased risk
of liver injury. Buspirone, hydroxyzine, and benzodiazepines do not have the same hepatic
risk profile .
, Question 6
A 38-year-old female with panic disorder has been taking clonazepam 0.5 mg three times
daily for 6 months. She wishes to discontinue the medication. Which is the most appropriate
tapering strategy?
A) Reduce by 0.25 mg every 2 weeks
B) Switch to alprazolam for easier tapering
C) Abruptly discontinue and monitor for withdrawal
D) Reduce by 0.125 mg every week
Answer: D
A slow, gradual taper of 0.125 mg (25% reduction) per week is recommended for
benzodiazepine discontinuation to minimize withdrawal symptoms and rebound anxiety.
Benzodiazepine withdrawal can be severe and potentially dangerous. Abrupt
discontinuation is contraindicated due to the risk of seizures and severe withdrawal
symptoms .
Question 7
Which of the following is a characteristic feature of serotonin syndrome that distinguishes it
from neuroleptic malignant syndrome?
A) Lead-pipe rigidity and bradykinesia
B) Hyperthermia and elevated creatine kinase
C) Clonus and hyperreflexia
D) Autonomic instability and altered mental status
Answer: C
Clonus and hyperreflexia are hallmark features of serotonin syndrome that are not typically
seen in neuroleptic malignant syndrome. While both conditions involve autonomic instability
and altered mental status, the presence of neuromuscular excitability (clonus, hyperreflexia,
tremor) is characteristic of serotonin toxicity. NMS more commonly presents with lead-pipe
rigidity and bradykinesia .
Question 8
PMHNP | 75 Practice Questions with Answers & Rationales |
Chamberlain 2026
Updated for 2026. This comprehensive practice exam covers the NR546 Advanced
Psychopharmacology for the PMHNP Week 8 Final Exam at Chamberlain University.
The final exam covers content from Weeks 5-8, focusing on medications for mood
disorders, substance use disorders, and other advanced psychopharmacology topics .
Exam Quick Facts
Feature Details
Course NR546 Advanced Psychopharmacology for the PMHNP
Institution Chamberlain University
Exam Week 8 Final Exam (Weeks 5-8 Content)
Format Multiple Choice, Matching, Examplify Online Proctored
Number of 75+
Questions
Topics Mood Disorders, Substance Use Disorders, Antidepressants,
Mood Stabilizers, Antipsychotics
Question 1
A 45-year-old patient with major depressive disorder has been taking fluoxetine 40 mg daily
for 8 weeks with partial response. The patient reports excessive sweating, insomnia, and
sexual dysfunction. Which is the most appropriate next step in managing this patient's
medication regimen?
A) Add bupropion 150 mg daily to augment antidepressant effects
B) Increase fluoxetine to 60 mg daily to achieve full remission
C) Switch to phenelzine to address treatment resistance
D) Add trazodone 50 mg at bedtime for sleep disturbance
,Answer: A
Bupropion is an effective augmentation strategy for SSRIs like fluoxetine, particularly when
patients experience SSRI-induced sexual dysfunction and incomplete response.
Bupropion's dopaminergic and noradrenergic properties complement serotonergic activity
without exacerbating sexual side effects. Increasing fluoxetine would likely worsen side
effects without proportional benefit .
Question 2
Which cytochrome P450 enzyme is primarily responsible for the metabolism of fluvoxamine,
and what clinical significance does this have?
A) CYP2D6; requires dose adjustment in poor metabolizers
B) CYP1A2; significant inhibition of theophylline and caffeine metabolism
C) CYP3A4; increased risk of drug interactions with statins
D) CYP2C19; affects proton pump inhibitor metabolism
Answer: B
Fluvoxamine is a potent inhibitor of CYP1A2, which leads to clinically significant increases
in theophylline and caffeine levels, potentially causing toxicity. While fluvoxamine does
affect other CYP enzymes, CYP1A2 inhibition is its most clinically relevant interaction .
Question 3
A 28-year-old male with schizophrenia has been non-adherent to oral antipsychotics. He is
currently experiencing auditory hallucinations and paranoid delusions. Which long-acting
injectable antipsychotic would be most appropriate for this patient?
A) Haloperidol decanoate
B) Aripiprazole monohydrate
C) Olanzapine pamoate
D) Risperidone microspheres
Answer: B
Aripiprazole monohydrate is available as a once-monthly long-acting injectable with a
favorable metabolic profile compared to other LAIs. For a patient with adherence issues, an
,LAI is indicated. Aripiprazole's partial D2 agonist activity provides efficacy with lower risk of
extrapyramidal symptoms and metabolic disturbances .
Question 4
A 72-year-old patient with Alzheimer's disease is started on donepezil 5 mg daily. One week
later, the family reports the patient is experiencing vivid nightmares, muscle cramps, and
bradycardia. What is the most appropriate action?
A) Increase donepezil to 10 mg daily
B) Discontinue donepezil and start rivastigmine patch
C) Reduce donepezil to 2.5 mg daily
D) Add memantine 10 mg twice daily
Answer: C
Reducing donepezil to 2.5 mg daily addresses cholinergic side effects while maintaining
some therapeutic benefit in an elderly patient. Donepezil's cholinergic effects can cause
nightmares, muscle cramps, and bradycardia, particularly in older adults. Starting at a lower
dose and titrating more slowly is appropriate .
Question 5
A 56-year-old male with a history of alcohol use disorder is being treated for generalized
anxiety disorder. Which medication should be avoided due to the risk of severe
hepatotoxicity in this population?
A) Buspirone
B) Duloxetine
C) Hydroxyzine
D) Alprazolam
Answer: B
Duloxetine carries a risk of hepatotoxicity and should be used with caution in patients with a
history of alcohol use disorder due to potential hepatic enzyme induction and increased risk
of liver injury. Buspirone, hydroxyzine, and benzodiazepines do not have the same hepatic
risk profile .
, Question 6
A 38-year-old female with panic disorder has been taking clonazepam 0.5 mg three times
daily for 6 months. She wishes to discontinue the medication. Which is the most appropriate
tapering strategy?
A) Reduce by 0.25 mg every 2 weeks
B) Switch to alprazolam for easier tapering
C) Abruptly discontinue and monitor for withdrawal
D) Reduce by 0.125 mg every week
Answer: D
A slow, gradual taper of 0.125 mg (25% reduction) per week is recommended for
benzodiazepine discontinuation to minimize withdrawal symptoms and rebound anxiety.
Benzodiazepine withdrawal can be severe and potentially dangerous. Abrupt
discontinuation is contraindicated due to the risk of seizures and severe withdrawal
symptoms .
Question 7
Which of the following is a characteristic feature of serotonin syndrome that distinguishes it
from neuroleptic malignant syndrome?
A) Lead-pipe rigidity and bradykinesia
B) Hyperthermia and elevated creatine kinase
C) Clonus and hyperreflexia
D) Autonomic instability and altered mental status
Answer: C
Clonus and hyperreflexia are hallmark features of serotonin syndrome that are not typically
seen in neuroleptic malignant syndrome. While both conditions involve autonomic instability
and altered mental status, the presence of neuromuscular excitability (clonus, hyperreflexia,
tremor) is characteristic of serotonin toxicity. NMS more commonly presents with lead-pipe
rigidity and bradykinesia .
Question 8
