Western Governors University
MRAHPOHCYSP · 543D
WGU
◆ ◆
College of Health Professions — Psychiatric-Mental Health Nurse
D345
Practitioner
A NEW KIND OF U
EST. 1997
D345 Psychopharmacology — Comprehensive
Examination
G E R I AT R I C PSYC H O P H A R M ACO LO G Y, S U BSTA N C E US E D I S O R D E RS , T R D ,
P R E S C R I B I N G P R I N C I P L E S & S A F E TY
INSTITUTION Western Governors University PROGRAM MSN — Psychiatric-Mental Health
Nurse Practitioner
COURSE CODE D345 — Psychopharmacology COURSE TITLE Advanced Psychopharmacology
Across the Lifespan
ACADEMIC YEAR EXAM TITLE D345 Psychopharmacology —
Comprehensive Examination
TOTAL QUESTIONS 175 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans geriatric psychopharmacology, substance use disorders, treatment-resistant depression,
prescribing principles, and medication safety.
▸ Questions reflect D345 OA and psychopharmacology board examination content.
▸ Correct answers and clinical rationales appear below each question for comprehensive test preparation.
▸ Questions have been randomized to promote active recall and simulate authentic testing conditions.
, SECTION I — D345 PSYCHOPHARMACOLOGY
Questions 1 – 175
COMPREHENSIVE PRACTICE EXAMINATION
1. Should antipsychotics routinely be used for delirium?
A. Yes, for all patients with delirium regardless of severity
B. No — reserve for severe agitation threatening safety
C. Yes, as first-line treatment before attempting nonpharmacologic interventions
D. No — antipsychotics are contraindicated in all forms of delirium
CORRECT ANSWER B — No — reserve for severe agitation threatening safety
RATIONALE Antipsychotics are not first-line for delirium. The primary treatment is
identification and correction of the underlying cause (infection, medication
toxicity, metabolic disturbance, etc.) combined with nonpharmacologic
interventions (reorientation, family presence, normalizing sleep-wake cycles,
minimizing sensory deprivation). Antipsychotics should be reserved for severe
agitation that threatens patient or staff safety, and when used, should be at the
lowest effective dose for the shortest duration. Routine use increases mortality
risk in elderly patients and may worsen delirium in some cases.
2. Which antipsychotic is commonly used for severe delirium-related agitation?
A. Olanzapine
B. Haloperidol
C. Clozapine
D. Risperidone
CORRECT ANSWER B — Haloperidol
RATIONALE Haloperidol is frequently used for severe delirium-related agitation due to its
minimal anticholinergic effects, minimal cardiovascular effects, and availability in
multiple formulations (oral, IM, IV). Anticholinergic medications worsen delirium,
making haloperidol's clean anticholinergic profile advantageous. Olanzapine and
risperidone have greater metabolic and anticholinergic burdens. Clozapine is not
used for acute delirium management. Despite haloperidol's common use, it
should still be reserved for severe agitation and used at the lowest effective dose
with close monitoring for QT prolongation and extrapyramidal symptoms.
,3. Which antipsychotic should generally be avoided in Parkinson's disease psychosis?
A. Quetiapine
B. Haloperidol
C. Clozapine
D. Pimavanserin
CORRECT ANSWER B — Haloperidol
RATIONALE Haloperidol and other high-potency D2 antagonists worsen the motor symptoms
of Parkinson's disease — increasing rigidity, bradykinesia, tremor, and risk of falls.
In Parkinson's disease psychosis, medications with minimal dopamine blockade
are preferred: pimavanserin (FDA-approved, selective 5-HT2A inverse agonist) is
first-line, and clozapine or quetiapine may be used off-label due to their relatively
low EPS risk. Haloperidol's strong D2 antagonism directly counteracts the
dopaminergic deficiency underlying Parkinson's motor symptoms and can cause
significant functional decline.
4. What antipsychotic is FDA-approved for Parkinson's disease psychosis?
A. Risperidone
B. Pimavanserin
C. Olanzapine
D. Haloperidol
CORRECT ANSWER B — Pimavanserin
RATIONALE Pimavanserin (Nuplazid) is the only medication with FDA approval specifically for
Parkinson's disease psychosis. Its mechanism — selective serotonin 5-HT2A
inverse agonism with minimal dopamine blockade — uniquely addresses
psychosis without worsening motor symptoms. This is a breakthrough in
managing this common and debilitating complication of Parkinson's disease.
Clozapine is effective but requires ANC monitoring. Quetiapine is commonly used
off-label but has less robust evidence. All other antipsychotics carry significant
risk of worsening Parkinson's motor symptoms due to D2 antagonism.
, 5. What is pimavanserin's mechanism of action?
A. D2 receptor antagonism
B. Selective serotonin 5-HT2A inverse agonism
C. Dopamine partial agonism
D. NMDA receptor antagonism
CORRECT ANSWER B — Selective serotonin 5-HT2A inverse agonism
RATIONALE Pimavanserin is a selective serotonin 5-HT2A receptor inverse agonist — it binds
to 5-HT2A receptors and produces the opposite effect of an agonist, reducing
constitutive receptor activity. This mechanism addresses psychosis without
meaningful dopamine D2 receptor blockade, which is why it does not worsen
Parkinson's motor symptoms. This represents a novel approach to antipsychotic
treatment — targeting the serotonin system rather than dopamine. The minimal
dopamine blockade is the key to its safety in Parkinson's disease, where
dopaminergic function is already compromised.
6. Which antipsychotic may also be used in Parkinson's disease psychosis due to minimal
worsening of motor symptoms?
A. Haloperidol
B. Clozapine
C. Risperidone
D. Aripiprazole
CORRECT ANSWER B — Clozapine
RATIONALE Clozapine is effective for psychosis in Parkinson's disease with minimal worsening
of motor symptoms due to its relatively low D2 occupancy and complex receptor
profile. Multiple controlled studies have demonstrated efficacy at very low doses
(6.25-50 mg/day) — far below doses used for schizophrenia. However, clozapine's
use is limited by the required ANC monitoring (risk of agranulocytosis), weekly
blood draws during the first 6 months, and side effects including sedation,
sialorrhea, and metabolic effects. Quetiapine is more commonly used in practice
despite weaker evidence because it does not require hematologic monitoring.
MRAHPOHCYSP · 543D
WGU
◆ ◆
College of Health Professions — Psychiatric-Mental Health Nurse
D345
Practitioner
A NEW KIND OF U
EST. 1997
D345 Psychopharmacology — Comprehensive
Examination
G E R I AT R I C PSYC H O P H A R M ACO LO G Y, S U BSTA N C E US E D I S O R D E RS , T R D ,
P R E S C R I B I N G P R I N C I P L E S & S A F E TY
INSTITUTION Western Governors University PROGRAM MSN — Psychiatric-Mental Health
Nurse Practitioner
COURSE CODE D345 — Psychopharmacology COURSE TITLE Advanced Psychopharmacology
Across the Lifespan
ACADEMIC YEAR EXAM TITLE D345 Psychopharmacology —
Comprehensive Examination
TOTAL QUESTIONS 175 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans geriatric psychopharmacology, substance use disorders, treatment-resistant depression,
prescribing principles, and medication safety.
▸ Questions reflect D345 OA and psychopharmacology board examination content.
▸ Correct answers and clinical rationales appear below each question for comprehensive test preparation.
▸ Questions have been randomized to promote active recall and simulate authentic testing conditions.
, SECTION I — D345 PSYCHOPHARMACOLOGY
Questions 1 – 175
COMPREHENSIVE PRACTICE EXAMINATION
1. Should antipsychotics routinely be used for delirium?
A. Yes, for all patients with delirium regardless of severity
B. No — reserve for severe agitation threatening safety
C. Yes, as first-line treatment before attempting nonpharmacologic interventions
D. No — antipsychotics are contraindicated in all forms of delirium
CORRECT ANSWER B — No — reserve for severe agitation threatening safety
RATIONALE Antipsychotics are not first-line for delirium. The primary treatment is
identification and correction of the underlying cause (infection, medication
toxicity, metabolic disturbance, etc.) combined with nonpharmacologic
interventions (reorientation, family presence, normalizing sleep-wake cycles,
minimizing sensory deprivation). Antipsychotics should be reserved for severe
agitation that threatens patient or staff safety, and when used, should be at the
lowest effective dose for the shortest duration. Routine use increases mortality
risk in elderly patients and may worsen delirium in some cases.
2. Which antipsychotic is commonly used for severe delirium-related agitation?
A. Olanzapine
B. Haloperidol
C. Clozapine
D. Risperidone
CORRECT ANSWER B — Haloperidol
RATIONALE Haloperidol is frequently used for severe delirium-related agitation due to its
minimal anticholinergic effects, minimal cardiovascular effects, and availability in
multiple formulations (oral, IM, IV). Anticholinergic medications worsen delirium,
making haloperidol's clean anticholinergic profile advantageous. Olanzapine and
risperidone have greater metabolic and anticholinergic burdens. Clozapine is not
used for acute delirium management. Despite haloperidol's common use, it
should still be reserved for severe agitation and used at the lowest effective dose
with close monitoring for QT prolongation and extrapyramidal symptoms.
,3. Which antipsychotic should generally be avoided in Parkinson's disease psychosis?
A. Quetiapine
B. Haloperidol
C. Clozapine
D. Pimavanserin
CORRECT ANSWER B — Haloperidol
RATIONALE Haloperidol and other high-potency D2 antagonists worsen the motor symptoms
of Parkinson's disease — increasing rigidity, bradykinesia, tremor, and risk of falls.
In Parkinson's disease psychosis, medications with minimal dopamine blockade
are preferred: pimavanserin (FDA-approved, selective 5-HT2A inverse agonist) is
first-line, and clozapine or quetiapine may be used off-label due to their relatively
low EPS risk. Haloperidol's strong D2 antagonism directly counteracts the
dopaminergic deficiency underlying Parkinson's motor symptoms and can cause
significant functional decline.
4. What antipsychotic is FDA-approved for Parkinson's disease psychosis?
A. Risperidone
B. Pimavanserin
C. Olanzapine
D. Haloperidol
CORRECT ANSWER B — Pimavanserin
RATIONALE Pimavanserin (Nuplazid) is the only medication with FDA approval specifically for
Parkinson's disease psychosis. Its mechanism — selective serotonin 5-HT2A
inverse agonism with minimal dopamine blockade — uniquely addresses
psychosis without worsening motor symptoms. This is a breakthrough in
managing this common and debilitating complication of Parkinson's disease.
Clozapine is effective but requires ANC monitoring. Quetiapine is commonly used
off-label but has less robust evidence. All other antipsychotics carry significant
risk of worsening Parkinson's motor symptoms due to D2 antagonism.
, 5. What is pimavanserin's mechanism of action?
A. D2 receptor antagonism
B. Selective serotonin 5-HT2A inverse agonism
C. Dopamine partial agonism
D. NMDA receptor antagonism
CORRECT ANSWER B — Selective serotonin 5-HT2A inverse agonism
RATIONALE Pimavanserin is a selective serotonin 5-HT2A receptor inverse agonist — it binds
to 5-HT2A receptors and produces the opposite effect of an agonist, reducing
constitutive receptor activity. This mechanism addresses psychosis without
meaningful dopamine D2 receptor blockade, which is why it does not worsen
Parkinson's motor symptoms. This represents a novel approach to antipsychotic
treatment — targeting the serotonin system rather than dopamine. The minimal
dopamine blockade is the key to its safety in Parkinson's disease, where
dopaminergic function is already compromised.
6. Which antipsychotic may also be used in Parkinson's disease psychosis due to minimal
worsening of motor symptoms?
A. Haloperidol
B. Clozapine
C. Risperidone
D. Aripiprazole
CORRECT ANSWER B — Clozapine
RATIONALE Clozapine is effective for psychosis in Parkinson's disease with minimal worsening
of motor symptoms due to its relatively low D2 occupancy and complex receptor
profile. Multiple controlled studies have demonstrated efficacy at very low doses
(6.25-50 mg/day) — far below doses used for schizophrenia. However, clozapine's
use is limited by the required ANC monitoring (risk of agranulocytosis), weekly
blood draws during the first 6 months, and side effects including sedation,
sialorrhea, and metabolic effects. Quetiapine is more commonly used in practice
despite weaker evidence because it does not require hematologic monitoring.
