CHAMBERL AIN COLLEGE OF NURSING
School of Nursing · NR 546
NR 546 — Psychopharmacology
Academic Year: 2026/2027
Final Exam · Comprehensive Question Bank
Question 1
Which of the following medication should never be given at the same time as an
MAOI?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Benzodiazepines
D. Atypical Antipsychotics
CORRECT ANSWER: A. Selective Serotonin Reuptake Inhibitors (SSRIs)
RATIONALE:
SSRIs such as fluoxetine, sertraline, paroxetine, citalopram, or escitalopram should never be
given at the same time as an MAOI due to the risk of serotonin syndrome, which presents
with tremor, sweating, hyperthermia, and agitation. A washout period is required when
switching between these medications.
, Question 2
Which SSRI is considered the best tolerated with the fewest CYP-mediated drug
interactions?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Escitalopram
CORRECT ANSWER: D. Escitalopram
RATIONALE:
Escitalopram (Lexapro) is considered the best-tolerated SSRI with the fewest CYP-mediated
drug interactions. It has a clean pharmacological profile with minimal inhibition of CYP450
enzymes, making it a safer choice for patients on multiple medications.
Question 3
Which medication is associated with risk of priapism?
A. Fluoxetine
B. Trazodone
C. Bupropion
D. Mirtazapine
CORRECT ANSWER: B. Trazodone
RATIONALE:
Trazodone is associated with the risk of priapism, a prolonged and painful erection lasting
more than 4 hours. This is a rare but serious side effect that requires immediate medical
attention. Patients should be educated about this risk when prescribed trazodone.
, Question 4
A client returns for follow-up appointment and reports that all mental health
symptoms have improved except the sleep difficulties. The client is having difficulty
falling asleep and staying asleep. Which serotonergic medication is commonly
prescribed at low doses as an adjunct for insomnia?
A. Trazodone
B. Fluoxetine
C. Bupropion
D. Venlafaxine
CORRECT ANSWER: A. Trazodone
RATIONALE:
Trazodone is commonly prescribed at low doses (25-100 mg) as an adjunct for insomnia
due to its sedating properties. It is a serotonin antagonist and reuptake inhibitor (SARI) that
promotes sleep without the risk of dependence associated with benzodiazepines.
Question 5
A client who takes Sertraline 100 mg daily was recently prescribed cyclobenzaprine
(Flexeril) for a whiplash injury by the primary care provider. She presents to the clinic
with the following complaints: tremors, restlessness, and tachycardia. Symptoms are
indicative of which of the following concerns?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Extrapyramidal symptoms
D. Tardive dyskinesia
CORRECT ANSWER: A. Serotonin syndrome
RATIONALE:
The combination of sertraline (an SSRI) and cyclobenzaprine (a muscle relaxant with
serotonergic properties) can lead to serotonin syndrome. Symptoms include tremors,
restlessness, tachycardia, hyperthermia, and diaphoresis. This is a potentially life-
threatening condition requiring immediate intervention.
, Question 6
Atrophy of which two brain areas can lead to overactivity of the HPA axis?
A. Hippocampus and Amygdala
B. Prefrontal cortex and Thalamus
C. Basal ganglia and Cerebellum
D. Hypothalamus and Pituitary
CORRECT ANSWER: A. Hippocampus and Amygdala
RATIONALE:
Atrophy of the hippocampus and amygdala can lead to overactivity of the HPA
(hypothalamic-pituitary-adrenal) axis. This is associated with chronic stress and depression,
as these structures normally exert inhibitory control over the HPA axis. Their dysfunction
results in elevated cortisol levels.
Question 7
Which statement best describes the Monoamine Hypothesis of Depression?
A. Depression is due to a deficiency of monoamine neurotransmitters
B. Depression is due to an excess of monoamine neurotransmitters
C. Depression is caused by genetic mutations
D. Depression is a result of environmental factors only
CORRECT ANSWER:
A. Depression is due to a deficiency of monoamine neurotransmitters
RATIONALE:
The Monoamine Hypothesis of Depression proposes that depression is caused by a
deficiency of monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) in
the brain. This is supported by the mechanism of action of antidepressants, which increase
monoamine levels.
School of Nursing · NR 546
NR 546 — Psychopharmacology
Academic Year: 2026/2027
Final Exam · Comprehensive Question Bank
Question 1
Which of the following medication should never be given at the same time as an
MAOI?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Benzodiazepines
D. Atypical Antipsychotics
CORRECT ANSWER: A. Selective Serotonin Reuptake Inhibitors (SSRIs)
RATIONALE:
SSRIs such as fluoxetine, sertraline, paroxetine, citalopram, or escitalopram should never be
given at the same time as an MAOI due to the risk of serotonin syndrome, which presents
with tremor, sweating, hyperthermia, and agitation. A washout period is required when
switching between these medications.
, Question 2
Which SSRI is considered the best tolerated with the fewest CYP-mediated drug
interactions?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Escitalopram
CORRECT ANSWER: D. Escitalopram
RATIONALE:
Escitalopram (Lexapro) is considered the best-tolerated SSRI with the fewest CYP-mediated
drug interactions. It has a clean pharmacological profile with minimal inhibition of CYP450
enzymes, making it a safer choice for patients on multiple medications.
Question 3
Which medication is associated with risk of priapism?
A. Fluoxetine
B. Trazodone
C. Bupropion
D. Mirtazapine
CORRECT ANSWER: B. Trazodone
RATIONALE:
Trazodone is associated with the risk of priapism, a prolonged and painful erection lasting
more than 4 hours. This is a rare but serious side effect that requires immediate medical
attention. Patients should be educated about this risk when prescribed trazodone.
, Question 4
A client returns for follow-up appointment and reports that all mental health
symptoms have improved except the sleep difficulties. The client is having difficulty
falling asleep and staying asleep. Which serotonergic medication is commonly
prescribed at low doses as an adjunct for insomnia?
A. Trazodone
B. Fluoxetine
C. Bupropion
D. Venlafaxine
CORRECT ANSWER: A. Trazodone
RATIONALE:
Trazodone is commonly prescribed at low doses (25-100 mg) as an adjunct for insomnia
due to its sedating properties. It is a serotonin antagonist and reuptake inhibitor (SARI) that
promotes sleep without the risk of dependence associated with benzodiazepines.
Question 5
A client who takes Sertraline 100 mg daily was recently prescribed cyclobenzaprine
(Flexeril) for a whiplash injury by the primary care provider. She presents to the clinic
with the following complaints: tremors, restlessness, and tachycardia. Symptoms are
indicative of which of the following concerns?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Extrapyramidal symptoms
D. Tardive dyskinesia
CORRECT ANSWER: A. Serotonin syndrome
RATIONALE:
The combination of sertraline (an SSRI) and cyclobenzaprine (a muscle relaxant with
serotonergic properties) can lead to serotonin syndrome. Symptoms include tremors,
restlessness, tachycardia, hyperthermia, and diaphoresis. This is a potentially life-
threatening condition requiring immediate intervention.
, Question 6
Atrophy of which two brain areas can lead to overactivity of the HPA axis?
A. Hippocampus and Amygdala
B. Prefrontal cortex and Thalamus
C. Basal ganglia and Cerebellum
D. Hypothalamus and Pituitary
CORRECT ANSWER: A. Hippocampus and Amygdala
RATIONALE:
Atrophy of the hippocampus and amygdala can lead to overactivity of the HPA
(hypothalamic-pituitary-adrenal) axis. This is associated with chronic stress and depression,
as these structures normally exert inhibitory control over the HPA axis. Their dysfunction
results in elevated cortisol levels.
Question 7
Which statement best describes the Monoamine Hypothesis of Depression?
A. Depression is due to a deficiency of monoamine neurotransmitters
B. Depression is due to an excess of monoamine neurotransmitters
C. Depression is caused by genetic mutations
D. Depression is a result of environmental factors only
CORRECT ANSWER:
A. Depression is due to a deficiency of monoamine neurotransmitters
RATIONALE:
The Monoamine Hypothesis of Depression proposes that depression is caused by a
deficiency of monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) in
the brain. This is supported by the mechanism of action of antidepressants, which increase
monoamine levels.
