NR 546
FINAL EXAM
Actual Questions & Answers with Rationales
WEEKS 5 – 8 COVERED
(Advanced Psychopharmacology for the PMHNP)
Chamberlain
What You Will Get:
➢100+ Questions with correct answers.
➢Detailed rationales included.
➢Final exam review questions.
➢Study points for quick revision.
,Table of Contents
NR 546 FINAL EXAM ............................................................. 2
NR 546 FINAL EXAM REVIEW QS ........................................ 40
NR 546 FINAL EXAM STUDY POINTS ................................... 50
NR 546 FINAL EXAM
1. When treating a patient for major depression disorder which medication would
the PMHNP consider first?
A. Depakote
B. Selegiline
C. Escitalopram
D. Isocarboxazid
Correct Answer: C. Escitalopram
Rationale: Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is
considered first-line pharmacotherapy for major depressive disorder (MDD) due to its
favorable efficacy and safety profile. Depakote is a mood stabilizer used primarily for
bipolar disorder and seizure disorders. Selegiline and isocarboxazid are monoamine
oxidase inhibitors (MAOIs), which are reserved for treatment-resistant depression due
to dietary restrictions and side effect profiles.
2. Which of the following medication should be considered for a patient
diagnosed with major depressive disorder who reports "always forgetting to take
my pills"?
A. Mirtazapine
B. Fluvoxamine
C. Fluoxetine
D. Carbamazepine
Correct Answer: C. Fluoxetine
,Rationale: Fluoxetine has a long half-life (24–72 hours) and an active metabolite
(norfluoxetine) with a half-life of 4–16 days, making it more forgiving if doses are missed
occasionally. This pharmacokinetic profile is advantageous for patients with adherence
challenges. Mirtazapine and fluvoxamine have shorter half-lives, and carbamazepine is
not indicated for depression.
3. Which of the following medication has a black box warning of a life-threatening
skin rash?
A. Lithium
B. Lamotrigine
C. Lurasidone
D. Lorazepam
Correct Answer: B. Lamotrigine
Rationale: Lamotrigine carries an FDA black box warning for serious rash, including
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be
life-threatening. The risk is highest during the initial titration period. Slow dose titration
significantly reduces this risk.
4. Which medication is considered the best tolerated SSRI?
A. Venlafaxine
B. Bupropion
C. Sertraline
D. Escitalopram
Correct Answer: D. Escitalopram
Rationale: Escitalopram is often cited as the best-tolerated SSRI due to its high
selectivity for the serotonin transporter (SERT) with minimal effects on other receptors
(e.g., muscarinic, histaminic, or adrenergic). This selectivity results in fewer
anticholinergic, sedating, and cardiovascular side effects compared to other
antidepressants.
5. During a 4-week follow up appointment, Rashida, who is prescribed Sertraline
25 mg qAM reports slight improvement in depression symptoms and tolerating
medication well. Which of the following should the PMHNP do?
, A. Increase Sertraline dose
B. Switch to an SNRI
C. Switch to a different SSRI
D. Add Trazodone qHS for sleep
Correct Answer: A. Increase Sertraline dose
Rationale: Sertraline 25 mg is a subtherapeutic starting dose for most adults with MDD.
The usual therapeutic range is 50–200 mg daily. Since Rashida is tolerating the
medication well with slight improvement, the appropriate next step is to titrate upward to
a therapeutic dose rather than switching agents or adding adjunctive medications
prematurely.
6. Which medication should be avoided for the 66-year patient diagnosed with
major depressive disorder and anxiety with a reported fall 3 months ago?
A. Citalopram
B. Sertraline
C. Paroxetine
D. Aripiprazole
Correct Answer: C. Paroxetine
Rationale: Paroxetine has significant anticholinergic properties compared to other
SSRIs, contributing to sedation, orthostatic hypotension, and cognitive impairment,
which increase fall risk in elderly patients. The Beers Criteria recommends avoiding
highly anticholinergic medications in older adults. Sertraline and citalopram are
preferred in this population.
7. A patient reports upset stomach and diarrhea 3 days after taking new
prescription of sertraline. Which of the following is the most appropriate
response from the PMHNP?
A. "Start doubling the dose of sertraline and your symptoms will begin to ease up"
B. "Most side effects subside after 4–5 days. Your body is getting adjusted to the
increased serotonin levels"
C. "Stop taking it immediately and go to the local emergency"
D. "You must take Sertraline with food, otherwise you will continue to experience GI
distress"
Correct Answer: B. "Most side effects subside after 4–5 days. Your body is
getting adjusted to the increased serotonin levels"
FINAL EXAM
Actual Questions & Answers with Rationales
WEEKS 5 – 8 COVERED
(Advanced Psychopharmacology for the PMHNP)
Chamberlain
What You Will Get:
➢100+ Questions with correct answers.
➢Detailed rationales included.
➢Final exam review questions.
➢Study points for quick revision.
,Table of Contents
NR 546 FINAL EXAM ............................................................. 2
NR 546 FINAL EXAM REVIEW QS ........................................ 40
NR 546 FINAL EXAM STUDY POINTS ................................... 50
NR 546 FINAL EXAM
1. When treating a patient for major depression disorder which medication would
the PMHNP consider first?
A. Depakote
B. Selegiline
C. Escitalopram
D. Isocarboxazid
Correct Answer: C. Escitalopram
Rationale: Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is
considered first-line pharmacotherapy for major depressive disorder (MDD) due to its
favorable efficacy and safety profile. Depakote is a mood stabilizer used primarily for
bipolar disorder and seizure disorders. Selegiline and isocarboxazid are monoamine
oxidase inhibitors (MAOIs), which are reserved for treatment-resistant depression due
to dietary restrictions and side effect profiles.
2. Which of the following medication should be considered for a patient
diagnosed with major depressive disorder who reports "always forgetting to take
my pills"?
A. Mirtazapine
B. Fluvoxamine
C. Fluoxetine
D. Carbamazepine
Correct Answer: C. Fluoxetine
,Rationale: Fluoxetine has a long half-life (24–72 hours) and an active metabolite
(norfluoxetine) with a half-life of 4–16 days, making it more forgiving if doses are missed
occasionally. This pharmacokinetic profile is advantageous for patients with adherence
challenges. Mirtazapine and fluvoxamine have shorter half-lives, and carbamazepine is
not indicated for depression.
3. Which of the following medication has a black box warning of a life-threatening
skin rash?
A. Lithium
B. Lamotrigine
C. Lurasidone
D. Lorazepam
Correct Answer: B. Lamotrigine
Rationale: Lamotrigine carries an FDA black box warning for serious rash, including
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be
life-threatening. The risk is highest during the initial titration period. Slow dose titration
significantly reduces this risk.
4. Which medication is considered the best tolerated SSRI?
A. Venlafaxine
B. Bupropion
C. Sertraline
D. Escitalopram
Correct Answer: D. Escitalopram
Rationale: Escitalopram is often cited as the best-tolerated SSRI due to its high
selectivity for the serotonin transporter (SERT) with minimal effects on other receptors
(e.g., muscarinic, histaminic, or adrenergic). This selectivity results in fewer
anticholinergic, sedating, and cardiovascular side effects compared to other
antidepressants.
5. During a 4-week follow up appointment, Rashida, who is prescribed Sertraline
25 mg qAM reports slight improvement in depression symptoms and tolerating
medication well. Which of the following should the PMHNP do?
, A. Increase Sertraline dose
B. Switch to an SNRI
C. Switch to a different SSRI
D. Add Trazodone qHS for sleep
Correct Answer: A. Increase Sertraline dose
Rationale: Sertraline 25 mg is a subtherapeutic starting dose for most adults with MDD.
The usual therapeutic range is 50–200 mg daily. Since Rashida is tolerating the
medication well with slight improvement, the appropriate next step is to titrate upward to
a therapeutic dose rather than switching agents or adding adjunctive medications
prematurely.
6. Which medication should be avoided for the 66-year patient diagnosed with
major depressive disorder and anxiety with a reported fall 3 months ago?
A. Citalopram
B. Sertraline
C. Paroxetine
D. Aripiprazole
Correct Answer: C. Paroxetine
Rationale: Paroxetine has significant anticholinergic properties compared to other
SSRIs, contributing to sedation, orthostatic hypotension, and cognitive impairment,
which increase fall risk in elderly patients. The Beers Criteria recommends avoiding
highly anticholinergic medications in older adults. Sertraline and citalopram are
preferred in this population.
7. A patient reports upset stomach and diarrhea 3 days after taking new
prescription of sertraline. Which of the following is the most appropriate
response from the PMHNP?
A. "Start doubling the dose of sertraline and your symptoms will begin to ease up"
B. "Most side effects subside after 4–5 days. Your body is getting adjusted to the
increased serotonin levels"
C. "Stop taking it immediately and go to the local emergency"
D. "You must take Sertraline with food, otherwise you will continue to experience GI
distress"
Correct Answer: B. "Most side effects subside after 4–5 days. Your body is
getting adjusted to the increased serotonin levels"
