NR 546 Week 10 Exam V2 | NR 546
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A patient with schizophrenia is started on Clozapine (Clozaril) after failing two other
antipsychotic trials. Which laboratory value is most critical for the PMHNP to monitor to
prevent life-threatening complications?
A. Blood Urea Nitrogen (BUN)
B. Aspartate Aminotransferase (AST)
C. Serum Albumin
D. Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine is associated with a risk of severe neutropenia, which can lead to life-
threatening infections. The Risk Evaluation and Mitigation Strategy (REMS) program
requires mandatory monitoring of the Absolute Neutrophil Count (ANC) rather than the
total White Blood Cell (WBC) count. If the ANC falls below specific thresholds, the
medication must be interrupted or discontinued to protect the patient’s immune system.
,2. A 32-year-old female patient is prescribed Lithium for Bipolar I Disorder. She mentions she
is planning to become pregnant. What is the most significant fetal risk associated with
Lithium use during the first trimester?
A. Neural tube defects
B. Ebstein’s anomaly
C. Fetal Hydantoin Syndrome
D. Cleft lip and palate
Answer: B
Rationale: Lithium exposure in utero, particularly during the first trimester, is classically
associated with Ebstein’s anomaly, a rare cardiac malformation of the tricuspid valve.
While the absolute risk is lower than previously thought, it remains significantly higher
than in the general population. The PMHNP must discuss the risks and benefits of
continuing Lithium versus switching to a different mood stabilizer before conception
occurs.
3. Which mechanism of action characterizes Second-Generation Antipsychotics (SGAs) and
contributes to their lower risk of Extrapyramidal Symptoms (EPS) compared to First-
Generation Antipsychotics?
A. Pure D2 receptor antagonism
B. Serotonin-Dopamine Antagonism (5HT2A and D2)
C. GABA-A receptor modulation
,D. NMDA receptor blockade
Answer: B
Rationale: Second-Generation Antipsychotics (SGAs) are defined by their ability to
antagonize both Dopamine D2 receptors and Serotonin 5HT2A receptors. The 5HT2A
antagonism increases dopamine release in the nigrostriatal pathway, which helps mitigate
the motor side effects caused by D2 blockade. This pharmacological profile allows for
effective treatment of psychosis with a reduced incidence of tardive dyskinesia and acute
dystonia.
4. A patient taking Phenelzine (Nardil) for treatment-resistant depression arrives at the
emergency department with a severe headache, palpitations, and a blood pressure of
210/120 mmHg. Which dietary indiscretion most likely caused this event?
A. Eating fresh strawberries
B. Drinking orange juice
C. Consuming aged cheddar cheese
D. Eating grilled chicken breast
Answer: C
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that prevents the
breakdown of tyramine in the gut. When high-tyramine foods like aged cheese, cured
meats, or draft beer are consumed, tyramine enters the systemic circulation and triggers a
massive release of norepinephrine. This results in a hypertensive crisis, which is a medical
, emergency characterized by dangerously high blood pressure and potential neurological
damage.
5. The PMHNP is considering starting a patient on Atomoxetine (Strattera) for ADHD. What is
the primary mechanism of action for this non-stimulant medication?
A. Agonism of Alpha-2A adrenergic receptors
B. Inhibition of the Norepinephrine Transporter (NET)
C. Blockade of Dopamine receptors
D. Stimulation of GABA release
Answer: B
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) that works
by blocking the Norepinephrine Transporter (NET). By increasing norepinephrine levels in
the prefrontal cortex, it improves attention and impulse control without the high abuse
potential associated with stimulants. It is a preferred option for patients with a history of
substance use disorders or those who do not tolerate stimulants well.
6. A patient is diagnosed with Bulimia Nervosa and Major Depressive Disorder. Which
antidepressant is strictly contraindicated due to an increased risk of seizures in this
population?
A. Sertraline (Zoloft)
B. Bupropion (Wellbutrin)
C. Fluoxetine (Prozac)
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A patient with schizophrenia is started on Clozapine (Clozaril) after failing two other
antipsychotic trials. Which laboratory value is most critical for the PMHNP to monitor to
prevent life-threatening complications?
A. Blood Urea Nitrogen (BUN)
B. Aspartate Aminotransferase (AST)
C. Serum Albumin
D. Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine is associated with a risk of severe neutropenia, which can lead to life-
threatening infections. The Risk Evaluation and Mitigation Strategy (REMS) program
requires mandatory monitoring of the Absolute Neutrophil Count (ANC) rather than the
total White Blood Cell (WBC) count. If the ANC falls below specific thresholds, the
medication must be interrupted or discontinued to protect the patient’s immune system.
,2. A 32-year-old female patient is prescribed Lithium for Bipolar I Disorder. She mentions she
is planning to become pregnant. What is the most significant fetal risk associated with
Lithium use during the first trimester?
A. Neural tube defects
B. Ebstein’s anomaly
C. Fetal Hydantoin Syndrome
D. Cleft lip and palate
Answer: B
Rationale: Lithium exposure in utero, particularly during the first trimester, is classically
associated with Ebstein’s anomaly, a rare cardiac malformation of the tricuspid valve.
While the absolute risk is lower than previously thought, it remains significantly higher
than in the general population. The PMHNP must discuss the risks and benefits of
continuing Lithium versus switching to a different mood stabilizer before conception
occurs.
3. Which mechanism of action characterizes Second-Generation Antipsychotics (SGAs) and
contributes to their lower risk of Extrapyramidal Symptoms (EPS) compared to First-
Generation Antipsychotics?
A. Pure D2 receptor antagonism
B. Serotonin-Dopamine Antagonism (5HT2A and D2)
C. GABA-A receptor modulation
,D. NMDA receptor blockade
Answer: B
Rationale: Second-Generation Antipsychotics (SGAs) are defined by their ability to
antagonize both Dopamine D2 receptors and Serotonin 5HT2A receptors. The 5HT2A
antagonism increases dopamine release in the nigrostriatal pathway, which helps mitigate
the motor side effects caused by D2 blockade. This pharmacological profile allows for
effective treatment of psychosis with a reduced incidence of tardive dyskinesia and acute
dystonia.
4. A patient taking Phenelzine (Nardil) for treatment-resistant depression arrives at the
emergency department with a severe headache, palpitations, and a blood pressure of
210/120 mmHg. Which dietary indiscretion most likely caused this event?
A. Eating fresh strawberries
B. Drinking orange juice
C. Consuming aged cheddar cheese
D. Eating grilled chicken breast
Answer: C
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that prevents the
breakdown of tyramine in the gut. When high-tyramine foods like aged cheese, cured
meats, or draft beer are consumed, tyramine enters the systemic circulation and triggers a
massive release of norepinephrine. This results in a hypertensive crisis, which is a medical
, emergency characterized by dangerously high blood pressure and potential neurological
damage.
5. The PMHNP is considering starting a patient on Atomoxetine (Strattera) for ADHD. What is
the primary mechanism of action for this non-stimulant medication?
A. Agonism of Alpha-2A adrenergic receptors
B. Inhibition of the Norepinephrine Transporter (NET)
C. Blockade of Dopamine receptors
D. Stimulation of GABA release
Answer: B
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) that works
by blocking the Norepinephrine Transporter (NET). By increasing norepinephrine levels in
the prefrontal cortex, it improves attention and impulse control without the high abuse
potential associated with stimulants. It is a preferred option for patients with a history of
substance use disorders or those who do not tolerate stimulants well.
6. A patient is diagnosed with Bulimia Nervosa and Major Depressive Disorder. Which
antidepressant is strictly contraindicated due to an increased risk of seizures in this
population?
A. Sertraline (Zoloft)
B. Bupropion (Wellbutrin)
C. Fluoxetine (Prozac)
