NR 546 Exam 3 V2 | NR 546 Advanced
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
3)
1. A 10-year-old male is prescribed Methylphenidate (Ritalin) for ADHD. Which mechanism of
action accurately describes how this medication manages symptoms?
A. It acts as a selective norepinephrine reuptake inhibitor only.
B. It serves as a partial agonist at the D2 receptor site.
C. It increases the release of serotonin in the synaptic cleft.
D. It blocks the reuptake of dopamine and norepinephrine into the presynaptic neuron.
Answer: D
Rationale: Methylphenidate functions by inhibiting the transporters responsible for the
reuptake of dopamine and norepinephrine. This increases the concentration of these
neurotransmitters in the extraneuronal space, specifically within the prefrontal cortex. By
enhancing these levels, it helps improve attention, focus, and impulse control in patients
with ADHD.
2. When initiating Atomoxetine (Strattera) for a pediatric patient, which black box warning
must the Advanced Practice Psychiatric Nurse discuss with the family?
A. Potential for increased suicidal ideation in children and adolescents.
,B. Risk of severe hepatotoxicity and liver failure.
C. Risk of sudden cardiac death in patients with structural heart defects.
D. Possibility of developing Stevens-Johnson Syndrome.
Answer: A
Rationale: Atomoxetine carries a specific black box warning regarding the increased risk
of suicidal ideation in pediatric populations. While hepatotoxicity is a potential adverse
effect, it is not the primary black box warning associated with psychiatric risk in this age
group. Clinicians must monitor for changes in behavior, agitation, or signs of suicidality
during the initial months of treatment.
3. A patient with Alcohol Use Disorder is prescribed Acamprosate (Campral). What is the
primary contraindication for this medication?
A. History of Severe Depression.
B. History of Opioid Use Disorder.
C. Mild to Moderate Hepatic Impairment.
D. Severe Renal Impairment (CrCl < 30 mL/min).
Answer: D
Rationale: Acamprosate is primarily excreted by the kidneys and is strictly
contraindicated in patients with a creatinine clearance of less than 30 mL/min. Unlike
Naltrexone, it does not undergo significant hepatic metabolism, making it safer for patients
,with liver disease. This medication helps maintain abstinence by modulating the glutamate
and GABA neurotransmitter systems.
4. A patient presents to the ED with pinpoint pupils, respiratory depression, and bradycardia.
Which medication is the priority for emergency reversal?
A. Flumazenil
B. Buprenorphine
C. Naloxone
D. Methadone
Answer: C
Rationale: The patient is exhibiting the classic triad of opioid overdose: miosis, respiratory
depression, and CNS depression. Naloxone is a competitive opioid antagonist that rapidly
displaces opioids from the receptors to restore respiratory drive. Because Naloxone has a
short half-life, multiple doses or a continuous infusion may be necessary if the offending
opioid is long-acting.
5. Which neurotransmitter system is the primary target of Suvorexant (Belsomra) for the
treatment of insomnia?
A. GABA-A receptor modulation
B. Orexin receptor antagonism
C. Histamine-1 receptor antagonism
, D. Melatonin MT1/MT2 agonism
Answer: B
Rationale: Suvorexant is a dual orexin receptor antagonist (DORA) that works by blocking
the wake-promoting neuropeptides orexin A and orexin B. By inhibiting the ‘wake’ signals
in the brain, it facilitates the transition to sleep rather than simply sedating the CNS. This
mechanism differs significantly from benzodiazepines and ‘Z-drugs’ that target GABA
receptors.
6. A patient is starting Disulfiram (Antabuse). Which education point is critical for the
patient’s safety?
A. Wait at least 12 hours after the last drink before the first dose.
B. The medication can be started while the patient still has alcohol in their system.
C. It should only be taken when the patient feels an urge to drink.
D. Mouthwash and hand sanitizer containing alcohol are safe to use.
Answer: A
Rationale: Disulfiram causes an accumulation of acetaldehyde if alcohol is consumed,
leading to severe physical distress. Patients must be alcohol-free for at least 12 hours
before starting the medication to avoid a premature reaction. They must also be warned
that even hidden sources of alcohol, like certain hygiene products or sauces, can trigger the
reaction for up to two weeks after stopping the drug.
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
3)
1. A 10-year-old male is prescribed Methylphenidate (Ritalin) for ADHD. Which mechanism of
action accurately describes how this medication manages symptoms?
A. It acts as a selective norepinephrine reuptake inhibitor only.
B. It serves as a partial agonist at the D2 receptor site.
C. It increases the release of serotonin in the synaptic cleft.
D. It blocks the reuptake of dopamine and norepinephrine into the presynaptic neuron.
Answer: D
Rationale: Methylphenidate functions by inhibiting the transporters responsible for the
reuptake of dopamine and norepinephrine. This increases the concentration of these
neurotransmitters in the extraneuronal space, specifically within the prefrontal cortex. By
enhancing these levels, it helps improve attention, focus, and impulse control in patients
with ADHD.
2. When initiating Atomoxetine (Strattera) for a pediatric patient, which black box warning
must the Advanced Practice Psychiatric Nurse discuss with the family?
A. Potential for increased suicidal ideation in children and adolescents.
,B. Risk of severe hepatotoxicity and liver failure.
C. Risk of sudden cardiac death in patients with structural heart defects.
D. Possibility of developing Stevens-Johnson Syndrome.
Answer: A
Rationale: Atomoxetine carries a specific black box warning regarding the increased risk
of suicidal ideation in pediatric populations. While hepatotoxicity is a potential adverse
effect, it is not the primary black box warning associated with psychiatric risk in this age
group. Clinicians must monitor for changes in behavior, agitation, or signs of suicidality
during the initial months of treatment.
3. A patient with Alcohol Use Disorder is prescribed Acamprosate (Campral). What is the
primary contraindication for this medication?
A. History of Severe Depression.
B. History of Opioid Use Disorder.
C. Mild to Moderate Hepatic Impairment.
D. Severe Renal Impairment (CrCl < 30 mL/min).
Answer: D
Rationale: Acamprosate is primarily excreted by the kidneys and is strictly
contraindicated in patients with a creatinine clearance of less than 30 mL/min. Unlike
Naltrexone, it does not undergo significant hepatic metabolism, making it safer for patients
,with liver disease. This medication helps maintain abstinence by modulating the glutamate
and GABA neurotransmitter systems.
4. A patient presents to the ED with pinpoint pupils, respiratory depression, and bradycardia.
Which medication is the priority for emergency reversal?
A. Flumazenil
B. Buprenorphine
C. Naloxone
D. Methadone
Answer: C
Rationale: The patient is exhibiting the classic triad of opioid overdose: miosis, respiratory
depression, and CNS depression. Naloxone is a competitive opioid antagonist that rapidly
displaces opioids from the receptors to restore respiratory drive. Because Naloxone has a
short half-life, multiple doses or a continuous infusion may be necessary if the offending
opioid is long-acting.
5. Which neurotransmitter system is the primary target of Suvorexant (Belsomra) for the
treatment of insomnia?
A. GABA-A receptor modulation
B. Orexin receptor antagonism
C. Histamine-1 receptor antagonism
, D. Melatonin MT1/MT2 agonism
Answer: B
Rationale: Suvorexant is a dual orexin receptor antagonist (DORA) that works by blocking
the wake-promoting neuropeptides orexin A and orexin B. By inhibiting the ‘wake’ signals
in the brain, it facilitates the transition to sleep rather than simply sedating the CNS. This
mechanism differs significantly from benzodiazepines and ‘Z-drugs’ that target GABA
receptors.
6. A patient is starting Disulfiram (Antabuse). Which education point is critical for the
patient’s safety?
A. Wait at least 12 hours after the last drink before the first dose.
B. The medication can be started while the patient still has alcohol in their system.
C. It should only be taken when the patient feels an urge to drink.
D. Mouthwash and hand sanitizer containing alcohol are safe to use.
Answer: A
Rationale: Disulfiram causes an accumulation of acetaldehyde if alcohol is consumed,
leading to severe physical distress. Patients must be alcohol-free for at least 12 hours
before starting the medication to avoid a premature reaction. They must also be warned
that even hidden sources of alcohol, like certain hygiene products or sauces, can trigger the
reaction for up to two weeks after stopping the drug.
