NURS 660 Exam 4 V1 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 4 2026)
1. A 68-year-old patient with Alzheimer’s disease is being considered for Donepezil. Which of
the following is a primary side effect that the PMHNP should monitor?
A. Hypertension
B. Bradycardia
C. Constipation
D. Tachycardia
Answer: B
Rationale: Donepezil is a cholinesterase inhibitor that increases vagal tone. This
pharmacological action can result in bradycardia and potentially syncope in elderly
patients. The PMHNP must assess the patient for underlying cardiac conduction delays
before starting treatment.
2. When treating a patient for Alcohol Use Disorder, which medication is contraindicated in a
patient with acute hepatitis?
A. Acamprosate
,B. Topiramate
C. Gabapentin
D. Naltrexone
Answer: D
Rationale: Naltrexone is primarily metabolized in the liver and has a potential for
hepatotoxicity at high doses. It is contraindicated in patients with acute hepatitis or liver
failure. Acamprosate would be a safer alternative for patients with hepatic impairment as it
is renally excreted.
3. A 10-year-old child diagnosed with ADHD is starting Methylphenidate. What physical
monitoring parameters are essential for this patient?
A. Liver enzymes
B. Renal function tests
C. Hearing acuity
D. Weight and height
Answer: D
Rationale: Stimulants like methylphenidate are known to cause appetite suppression
which can lead to growth deceleration. It is standard practice to monitor height and weight
on a growth chart at each visit. If growth is significantly impacted, a drug holiday may be
considered.
, 4. Which medication used for the treatment of Alzheimer’s disease acts as an NMDA receptor
antagonist?
A. Rivastigmine
B. Galantamine
C. Donepezil
D. Memantine
Answer: D
Rationale: Memantine works by regulating the activity of glutamate, a chemical messenger
involved in information processing. It acts as a non-competitive NMDA receptor antagonist
to prevent excitotoxicity. This mechanism is distinct from cholinesterase inhibitors like
Donepezil and Rivastigmine.
5. A patient with Opioid Use Disorder (OUD) is seeking a medication that provides a ‘ceiling
effect’ on respiratory depression. Which medication is most appropriate?
A. Buprenorphine
B. Oxycodone
C. Methadone
D. Morphine
Answer: A
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 4 2026)
1. A 68-year-old patient with Alzheimer’s disease is being considered for Donepezil. Which of
the following is a primary side effect that the PMHNP should monitor?
A. Hypertension
B. Bradycardia
C. Constipation
D. Tachycardia
Answer: B
Rationale: Donepezil is a cholinesterase inhibitor that increases vagal tone. This
pharmacological action can result in bradycardia and potentially syncope in elderly
patients. The PMHNP must assess the patient for underlying cardiac conduction delays
before starting treatment.
2. When treating a patient for Alcohol Use Disorder, which medication is contraindicated in a
patient with acute hepatitis?
A. Acamprosate
,B. Topiramate
C. Gabapentin
D. Naltrexone
Answer: D
Rationale: Naltrexone is primarily metabolized in the liver and has a potential for
hepatotoxicity at high doses. It is contraindicated in patients with acute hepatitis or liver
failure. Acamprosate would be a safer alternative for patients with hepatic impairment as it
is renally excreted.
3. A 10-year-old child diagnosed with ADHD is starting Methylphenidate. What physical
monitoring parameters are essential for this patient?
A. Liver enzymes
B. Renal function tests
C. Hearing acuity
D. Weight and height
Answer: D
Rationale: Stimulants like methylphenidate are known to cause appetite suppression
which can lead to growth deceleration. It is standard practice to monitor height and weight
on a growth chart at each visit. If growth is significantly impacted, a drug holiday may be
considered.
, 4. Which medication used for the treatment of Alzheimer’s disease acts as an NMDA receptor
antagonist?
A. Rivastigmine
B. Galantamine
C. Donepezil
D. Memantine
Answer: D
Rationale: Memantine works by regulating the activity of glutamate, a chemical messenger
involved in information processing. It acts as a non-competitive NMDA receptor antagonist
to prevent excitotoxicity. This mechanism is distinct from cholinesterase inhibitors like
Donepezil and Rivastigmine.
5. A patient with Opioid Use Disorder (OUD) is seeking a medication that provides a ‘ceiling
effect’ on respiratory depression. Which medication is most appropriate?
A. Buprenorphine
B. Oxycodone
C. Methadone
D. Morphine
Answer: A
