NR 546 Week 10 Exam V3 | NR 546
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A 28-year-old male with a history of Opioid Use Disorder (OUD) is seeking medication-
assisted treatment. He has been opioid-free for 10 days. Which medication is the most
appropriate to initiate to prevent relapse by blocking the rewarding effects of opioids?
A. Naltrexone
B. Buprenorphine
C. Methadone
D. Naloxone
Answer: A
Rationale: Naltrexone is a full mu-opioid receptor antagonist that effectively blocks the
euphoric effects of opioids. It is indicated for the prevention of relapse to opioid
dependence following opioid detoxification. To avoid precipitated withdrawal, patients
must be opioid-free for at least 7 to 10 days before starting therapy.
,2. When treating a 9-year-old child for ADHD, which medication is considered a first-line
stimulant treatment that works primarily by blocking both the dopamine transporter (DAT)
and the norepinephrine transporter (NET)?
A. Guanfacine
B. Atomoxetine
C. Methylphenidate
D. Clonidine
Answer: C
Rationale: Methylphenidate is a first-line stimulant that works by inhibiting the reuptake
of dopamine and norepinephrine by blocking DAT and NET. This increases the availability
of these neurotransmitters in the synaptic cleft, particularly in the prefrontal cortex. It is
one of the most commonly prescribed treatments for ADHD across the lifespan due to its
efficacy and safety profile.
3. A 72-year-old patient with Alzheimer’s dementia is experiencing significant agitation.
According to the Beers Criteria and FDA warnings, what is the primary concern regarding the
use of atypical antipsychotics in this population?
A. Increased risk of urinary retention
B. Reduced efficacy of cholinesterase inhibitors
C. Increased risk of mortality and stroke
D. Severe hepatotoxicity
,Answer: C
Rationale: The FDA has issued a boxed warning for all antipsychotic medications used in
elderly patients with dementia-related psychosis due to an increased risk of death. Most of
these deaths are cardiovascular or infectious in nature, such as heart failure or pneumonia.
Clinical guidelines recommend using non-pharmacological interventions first and only
using antipsychotics when symptoms are severe or distressing.
4. Which mechanism of action distinguishes Lisdexamfetamine (Vyvanse) from other
amphetamine-based stimulants?
A. It is a prodrug converted in the red blood cells.
B. It directly releases dopamine from the vesicles.
C. It acts as a selective alpha-2A agonist.
D. It is a transdermal formulation bypassing the liver.
Answer: A
Rationale: Lisdexamfetamine is a prodrug where l-lysine is covalently bonded to d-
amphetamine. The drug is inactive until it is cleaved by enzymes in the red blood cells,
which results in a gradual release of the active stimulant. This design is intended to provide
a longer duration of effect and potentially lower the abuse potential compared to
immediate-release stimulants.
, 5. An adult patient with Alcohol Use Disorder (AUD) who is currently abstinent and wishes to
reduce cravings is being considered for Acamprosate. Which laboratory assessment is most
critical before starting this medication?
A. Liver function tests (LFTs)
B. Complete Blood Count (CBC)
C. Renal function (eGFR/Creatinine)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Rationale: Acamprosate is primarily excreted unchanged by the kidneys and is
contraindicated in patients with severe renal impairment (CrCl < 30 mL/min). For patients
with moderate renal impairment (CrCl 30-50 mL/min), a dose reduction is required. Unlike
naltrexone or disulfiram, acamprosate does not undergo significant hepatic metabolism,
making it a safer choice for patients with liver disease.
6. A PMHNP is treating a patient for Narcolepsy. Which medication, known for being a wake-
promoting agent with a lower risk of peripheral side effects compared to traditional
stimulants, is appropriate?
A. Modafinil
B. Alprazolam
C. Prazosin
D. Zolpidem
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A 28-year-old male with a history of Opioid Use Disorder (OUD) is seeking medication-
assisted treatment. He has been opioid-free for 10 days. Which medication is the most
appropriate to initiate to prevent relapse by blocking the rewarding effects of opioids?
A. Naltrexone
B. Buprenorphine
C. Methadone
D. Naloxone
Answer: A
Rationale: Naltrexone is a full mu-opioid receptor antagonist that effectively blocks the
euphoric effects of opioids. It is indicated for the prevention of relapse to opioid
dependence following opioid detoxification. To avoid precipitated withdrawal, patients
must be opioid-free for at least 7 to 10 days before starting therapy.
,2. When treating a 9-year-old child for ADHD, which medication is considered a first-line
stimulant treatment that works primarily by blocking both the dopamine transporter (DAT)
and the norepinephrine transporter (NET)?
A. Guanfacine
B. Atomoxetine
C. Methylphenidate
D. Clonidine
Answer: C
Rationale: Methylphenidate is a first-line stimulant that works by inhibiting the reuptake
of dopamine and norepinephrine by blocking DAT and NET. This increases the availability
of these neurotransmitters in the synaptic cleft, particularly in the prefrontal cortex. It is
one of the most commonly prescribed treatments for ADHD across the lifespan due to its
efficacy and safety profile.
3. A 72-year-old patient with Alzheimer’s dementia is experiencing significant agitation.
According to the Beers Criteria and FDA warnings, what is the primary concern regarding the
use of atypical antipsychotics in this population?
A. Increased risk of urinary retention
B. Reduced efficacy of cholinesterase inhibitors
C. Increased risk of mortality and stroke
D. Severe hepatotoxicity
,Answer: C
Rationale: The FDA has issued a boxed warning for all antipsychotic medications used in
elderly patients with dementia-related psychosis due to an increased risk of death. Most of
these deaths are cardiovascular or infectious in nature, such as heart failure or pneumonia.
Clinical guidelines recommend using non-pharmacological interventions first and only
using antipsychotics when symptoms are severe or distressing.
4. Which mechanism of action distinguishes Lisdexamfetamine (Vyvanse) from other
amphetamine-based stimulants?
A. It is a prodrug converted in the red blood cells.
B. It directly releases dopamine from the vesicles.
C. It acts as a selective alpha-2A agonist.
D. It is a transdermal formulation bypassing the liver.
Answer: A
Rationale: Lisdexamfetamine is a prodrug where l-lysine is covalently bonded to d-
amphetamine. The drug is inactive until it is cleaved by enzymes in the red blood cells,
which results in a gradual release of the active stimulant. This design is intended to provide
a longer duration of effect and potentially lower the abuse potential compared to
immediate-release stimulants.
, 5. An adult patient with Alcohol Use Disorder (AUD) who is currently abstinent and wishes to
reduce cravings is being considered for Acamprosate. Which laboratory assessment is most
critical before starting this medication?
A. Liver function tests (LFTs)
B. Complete Blood Count (CBC)
C. Renal function (eGFR/Creatinine)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Rationale: Acamprosate is primarily excreted unchanged by the kidneys and is
contraindicated in patients with severe renal impairment (CrCl < 30 mL/min). For patients
with moderate renal impairment (CrCl 30-50 mL/min), a dose reduction is required. Unlike
naltrexone or disulfiram, acamprosate does not undergo significant hepatic metabolism,
making it a safer choice for patients with liver disease.
6. A PMHNP is treating a patient for Narcolepsy. Which medication, known for being a wake-
promoting agent with a lower risk of peripheral side effects compared to traditional
stimulants, is appropriate?
A. Modafinil
B. Alprazolam
C. Prazosin
D. Zolpidem
