NSG 552 Final Exam V2 | NSG 552
Psychopharmacology | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG552
Final Exam 2026)
1. A patient with Major Depressive Disorder is started on Fluoxetine. Which mechanism of
action best describes how this medication increases synaptic serotonin?
A. Direct stimulation of post-synaptic receptors
B. Increasing the synthesis of Tryptophan
C. Inhibition of the Serotonin Transporter (SERT)
D. Inhibition of Monoamine Oxidase
Answer: C
Rationale: Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) that works by
inhibiting the SERT protein. By blocking the reuptake of serotonin into the presynaptic
neuron, it increases the concentration of the neurotransmitter in the synaptic cleft. This
prolonged presence of serotonin leads to greater receptor occupancy and subsequent
therapeutic effects.
2. When prescribing Clozapine (Clozaril), the Psychiatric-Mental Health Nurse Practitioner
(PMHNP) must monitor the Absolute Neutrophil Count (ANC). What is the primary clinical
reason for this requirement?
A. Risk of hemolytic anemia
,B. Risk of life-threatening agranulocytosis
C. Risk of severe thrombocytopenia
D. Risk of elevated liver enzymes
Answer: B
Rationale: Clozapine carries a significant risk of agranulocytosis, a severe drop in white
blood cell counts that can lead to fatal infections. Due to this risk, the drug is managed
under a strict REMS program requiring regular blood draws. The PMHNP must verify the
ANC levels before dispensing new prescriptions to ensure patient safety.
3. A 24-year-old male is diagnosed with Bipolar I Disorder and started on Lithium. Which of
the following lab values would be most concerning regarding potential Lithium toxicity?
A. Serum Lithium level of 0.8 mEq/L
B. Serum Lithium level of 1.6 mEq/L
C. Serum Lithium level of 1.2 mEq/L
D. Serum Lithium level of 0.4 mEq/L
Answer: B
Rationale: The therapeutic range for Lithium is typically 0.6 to 1.2 mEq/L, with levels
above 1.5 mEq/L considered toxic. At a level of 1.6 mEq/L, the patient is at risk for
symptoms such as tremors, ataxia, and confusion. Management requires immediate
, discontinuation of the drug and hydration to prevent further neurological or renal
complications.
4. Which antidepressant medication is contraindicated in patients with a history of seizure
disorders or eating disorders?
A. Sertraline
B. Mirtazapine
C. Bupropion
D. Duloxetine
Answer: C
Rationale: Bupropion is known to lower the seizure threshold, especially in patients with
pre-existing risks. It is specifically contraindicated in patients with bulimia or anorexia
nervosa due to the higher incidence of seizures in these populations. The PMHNP must
screen for these conditions thoroughly before initiating treatment.
5. A patient taking Haloperidol presents with high fever, muscle rigidity, and autonomic
instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Acute Dystonic Reaction
D. Neuroleptic Malignant Syndrome (NMS)
Psychopharmacology | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG552
Final Exam 2026)
1. A patient with Major Depressive Disorder is started on Fluoxetine. Which mechanism of
action best describes how this medication increases synaptic serotonin?
A. Direct stimulation of post-synaptic receptors
B. Increasing the synthesis of Tryptophan
C. Inhibition of the Serotonin Transporter (SERT)
D. Inhibition of Monoamine Oxidase
Answer: C
Rationale: Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) that works by
inhibiting the SERT protein. By blocking the reuptake of serotonin into the presynaptic
neuron, it increases the concentration of the neurotransmitter in the synaptic cleft. This
prolonged presence of serotonin leads to greater receptor occupancy and subsequent
therapeutic effects.
2. When prescribing Clozapine (Clozaril), the Psychiatric-Mental Health Nurse Practitioner
(PMHNP) must monitor the Absolute Neutrophil Count (ANC). What is the primary clinical
reason for this requirement?
A. Risk of hemolytic anemia
,B. Risk of life-threatening agranulocytosis
C. Risk of severe thrombocytopenia
D. Risk of elevated liver enzymes
Answer: B
Rationale: Clozapine carries a significant risk of agranulocytosis, a severe drop in white
blood cell counts that can lead to fatal infections. Due to this risk, the drug is managed
under a strict REMS program requiring regular blood draws. The PMHNP must verify the
ANC levels before dispensing new prescriptions to ensure patient safety.
3. A 24-year-old male is diagnosed with Bipolar I Disorder and started on Lithium. Which of
the following lab values would be most concerning regarding potential Lithium toxicity?
A. Serum Lithium level of 0.8 mEq/L
B. Serum Lithium level of 1.6 mEq/L
C. Serum Lithium level of 1.2 mEq/L
D. Serum Lithium level of 0.4 mEq/L
Answer: B
Rationale: The therapeutic range for Lithium is typically 0.6 to 1.2 mEq/L, with levels
above 1.5 mEq/L considered toxic. At a level of 1.6 mEq/L, the patient is at risk for
symptoms such as tremors, ataxia, and confusion. Management requires immediate
, discontinuation of the drug and hydration to prevent further neurological or renal
complications.
4. Which antidepressant medication is contraindicated in patients with a history of seizure
disorders or eating disorders?
A. Sertraline
B. Mirtazapine
C. Bupropion
D. Duloxetine
Answer: C
Rationale: Bupropion is known to lower the seizure threshold, especially in patients with
pre-existing risks. It is specifically contraindicated in patients with bulimia or anorexia
nervosa due to the higher incidence of seizures in these populations. The PMHNP must
screen for these conditions thoroughly before initiating treatment.
5. A patient taking Haloperidol presents with high fever, muscle rigidity, and autonomic
instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Acute Dystonic Reaction
D. Neuroleptic Malignant Syndrome (NMS)
