NR 546 Week 10 Exam V1 | NR 546
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A 28-year-old female patient is prescribed Sertraline for Major Depressive Disorder. Which
mechanism of action best describes how this medication exerts its primary effect?
A. Antagonism of the 5-HT2A receptor
B. Inhibition of the norepinephrine transporter (NET)
C. Agonism of the GABAA receptor
D. Inhibition of the serotonin transporter (SERT)
Answer: D
Rationale: Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI) that primarily
functions by inhibiting the serotonin transporter (SERT). By blocking the reuptake of
serotonin into the presynaptic neuron, it increases the concentration of serotonin in the
synaptic cleft. This sustained increase in serotonin levels is associated with the
amelioration of depressive symptoms over several weeks.
2. When initiating Lithium carbonate for a patient with Bipolar I Disorder, which laboratory
test is most critical to monitor due to the risk of toxicity?
A. Liver function tests (LFTs)
,B. Complete blood count (CBC) with differential
C. Lipid profile
D. Serum creatinine and BUN
Answer: D
Rationale: Lithium is excreted almost entirely by the kidneys, making renal function
monitoring essential for patient safety. Elevated serum creatinine or decreased glomerular
filtration rate (GFR) can lead to reduced clearance and subsequent lithium toxicity. Patients
should also have their thyroid function and electrolyte levels monitored periodically during
long-term therapy.
3. A patient taking Haloperidol presents with high fever, muscle rigidity, and autonomic
instability. Which life-threatening condition should the PMHNP suspect?
A. Serotonin Syndrome
B. Acute Dystonia
C. Tardive Dyskinesia
D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Rationale: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal reaction
to dopamine antagonists, particularly first-generation antipsychotics like Haloperidol. Key
clinical features include lead-pipe muscle rigidity, hyperpyrexia, and altered mental status.
,Immediate discontinuation of the offending agent and supportive care in an intensive care
setting are mandatory.
4. Which of the following medications is considered a first-line treatment for Generalized
Anxiety Disorder (GAD) due to its lack of addictive potential compared to benzodiazepines?
A. Alprazolam
B. Buspirone
C. Diazepam
D. Lorazepam
Answer: B
Rationale: Buspirone is a partial agonist at the 5-HT1A receptor and is effective for the
long-term management of GAD. Unlike benzodiazepines, it does not carry a risk of physical
dependence or withdrawal symptoms upon discontinuation. However, patients must be
informed that it may take 2 to 4 weeks of consistent dosing to achieve full therapeutic
benefit.
5. A PMHNP is considering Clozapine for a patient with treatment-resistant schizophrenia.
Which baseline lab value is required by the FDA REMS program before starting the
medication?
A. Hemoglobin A1c
B. Absolute Neutrophil Count (ANC)
C. Platelet count
, D. Serum potassium
Answer: B
Rationale: Clozapine is associated with a risk of severe neutropenia and agranulocytosis,
necessitating strict monitoring of the Absolute Neutrophil Count (ANC). Before initiation,
the ANC must be 1500/mm3 or higher in the general population. The FDA Risk Evaluation
and Mitigation Strategy (REMS) program requires regular ongoing ANC reporting to ensure
patient safety.
6. Which antidepressant is most likely to cause hypertensive crisis if the patient consumes
foods high in tyramine, such as aged cheese or red wine?
A. Fluoxetine
B. Venlafaxine
C. Phenelzine
D. Bupropion
Answer: C
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
breakdown of dietary tyramine. High levels of tyramine can cause a massive release of
norepinephrine, leading to severe vasoconstriction and a dangerous spike in blood
pressure. Patients on MAOIs must strictly adhere to a low-tyramine diet to avoid this
potentially fatal interaction.
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A 28-year-old female patient is prescribed Sertraline for Major Depressive Disorder. Which
mechanism of action best describes how this medication exerts its primary effect?
A. Antagonism of the 5-HT2A receptor
B. Inhibition of the norepinephrine transporter (NET)
C. Agonism of the GABAA receptor
D. Inhibition of the serotonin transporter (SERT)
Answer: D
Rationale: Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI) that primarily
functions by inhibiting the serotonin transporter (SERT). By blocking the reuptake of
serotonin into the presynaptic neuron, it increases the concentration of serotonin in the
synaptic cleft. This sustained increase in serotonin levels is associated with the
amelioration of depressive symptoms over several weeks.
2. When initiating Lithium carbonate for a patient with Bipolar I Disorder, which laboratory
test is most critical to monitor due to the risk of toxicity?
A. Liver function tests (LFTs)
,B. Complete blood count (CBC) with differential
C. Lipid profile
D. Serum creatinine and BUN
Answer: D
Rationale: Lithium is excreted almost entirely by the kidneys, making renal function
monitoring essential for patient safety. Elevated serum creatinine or decreased glomerular
filtration rate (GFR) can lead to reduced clearance and subsequent lithium toxicity. Patients
should also have their thyroid function and electrolyte levels monitored periodically during
long-term therapy.
3. A patient taking Haloperidol presents with high fever, muscle rigidity, and autonomic
instability. Which life-threatening condition should the PMHNP suspect?
A. Serotonin Syndrome
B. Acute Dystonia
C. Tardive Dyskinesia
D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Rationale: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal reaction
to dopamine antagonists, particularly first-generation antipsychotics like Haloperidol. Key
clinical features include lead-pipe muscle rigidity, hyperpyrexia, and altered mental status.
,Immediate discontinuation of the offending agent and supportive care in an intensive care
setting are mandatory.
4. Which of the following medications is considered a first-line treatment for Generalized
Anxiety Disorder (GAD) due to its lack of addictive potential compared to benzodiazepines?
A. Alprazolam
B. Buspirone
C. Diazepam
D. Lorazepam
Answer: B
Rationale: Buspirone is a partial agonist at the 5-HT1A receptor and is effective for the
long-term management of GAD. Unlike benzodiazepines, it does not carry a risk of physical
dependence or withdrawal symptoms upon discontinuation. However, patients must be
informed that it may take 2 to 4 weeks of consistent dosing to achieve full therapeutic
benefit.
5. A PMHNP is considering Clozapine for a patient with treatment-resistant schizophrenia.
Which baseline lab value is required by the FDA REMS program before starting the
medication?
A. Hemoglobin A1c
B. Absolute Neutrophil Count (ANC)
C. Platelet count
, D. Serum potassium
Answer: B
Rationale: Clozapine is associated with a risk of severe neutropenia and agranulocytosis,
necessitating strict monitoring of the Absolute Neutrophil Count (ANC). Before initiation,
the ANC must be 1500/mm3 or higher in the general population. The FDA Risk Evaluation
and Mitigation Strategy (REMS) program requires regular ongoing ANC reporting to ensure
patient safety.
6. Which antidepressant is most likely to cause hypertensive crisis if the patient consumes
foods high in tyramine, such as aged cheese or red wine?
A. Fluoxetine
B. Venlafaxine
C. Phenelzine
D. Bupropion
Answer: C
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
breakdown of dietary tyramine. High levels of tyramine can cause a massive release of
norepinephrine, leading to severe vasoconstriction and a dangerous spike in blood
pressure. Patients on MAOIs must strictly adhere to a low-tyramine diet to avoid this
potentially fatal interaction.
