NSG552 / NSG 552 Exam 2 (Latest 2026/2027)
Psychopharmacology | Grade A Questions and Verified Answers | 100% Correct
Wilkes University - Advanced Practice Psychiatric Nursing Education
Section 1: Antidepressant Pharmacology
Q1: A 28-year-old patient with major depressive disorder is started on fluoxetine (Prozac) 20 mg daily. The patient
asks the nurse practitioner when they can expect to notice improvement in mood. What is the most appropriate
response?
A. Improvement in mood typically occurs within 24-48 hours of starting the medication
B. Therapeutic effects usually begin within 1-2 weeks, with full effects at 4-6 weeks **[CORRECT]**
C. Fluoxetine requires 8-12 weeks before any therapeutic benefit is observed
D. The medication works immediately, but the patient may not perceive the change for several months
Correct Answer: B
Rationale: SSRIs like fluoxetine require 1-4 weeks for initial therapeutic effects and 4-6 weeks for full effect due to downstream
neuroadaptations including receptor desensitization and BDNF upregulation, not the immediate synaptic serotonin increase. Choice A
is incorrect because 24-48 hours is too early for mood improvement, though side effects may appear. Choice C overestimates the
timeframe, as some benefit is usually seen by 2 weeks. Choice D is incorrect because while the pharmacologic action begins
immediately, therapeutic mood effects require neuroadaptive changes over weeks (Wilkes NSG 552 Psychopharmacology curriculum).
Q2: A patient taking sertraline (Zoloft) 100 mg daily for generalized anxiety disorder reports sexual dysfunction
including decreased libido and difficulty achieving orgasm. The nurse practitioner is considering switching to an
alternative antidepressant. Which medication would be the most appropriate choice to minimize sexual side effects?
A. Paroxetine (Paxil)
B. Venlafaxine (Effexor XR)
C. Bupropion (Wellbutrin) **[CORRECT]**
D. Escitalopram (Lexapro)
Correct Answer: C
Rationale: Bupropion is a dopamine and norepinephrine reuptake inhibitor (DNRI) with minimal serotonergic activity, making it the
antidepressant with the lowest risk of sexual dysfunction. Choice A (paroxetine) is incorrect because it has the highest rate of sexual
dysfunction among SSRIs due to potent anticholinergic properties. Choice B (venlafaxine) is incorrect because as an SNRI it has
significant serotonergic activity and similar sexual side effect rates to SSRIs. Choice D (escitalopram) would not resolve the problem as
it is another SSRI with comparable sexual side effects (Wilkes NSG 552 Psychopharmacology).
Q3: A 35-year-old woman with depression is prescribed citalopram (Celexa). What is the maximum
FDA-recommended daily dose for this medication due to the risk of QTc prolongation?
A. 20 mg/day
B. 40 mg/day **[CORRECT]**
C. 60 mg/day
D. 80 mg/day
Correct Answer: B
Rationale: The FDA recommends a maximum citalopram dose of 40 mg/day (20 mg/day in patients over 60, hepatic impairment, or
CYP2C19 poor metabolizers) due to dose-dependent QTc prolongation, which increases the risk of torsades de pointes. Choice A is
incorrect because 20 mg is the standard starting dose, not the maximum. Choice C is incorrect because 60 mg/day was the original
maximum but was reduced by the FDA in 2011 due to cardiac safety concerns. Choice D is incorrect because 80 mg/day significantly
increases QTc prolongation risk and is contraindicated (Wilkes NSG 552).
,Q4: A patient who has been taking paroxetine (Paxil) 40 mg daily for 2 years wishes to discontinue the medication.
The nurse practitioner instructs the patient to taper gradually. Which of the following symptoms is most
characteristic of SSRI discontinuation syndrome?
A. Tremor and tachycardia
B. Dizziness, paresthesias described as electric shock sensations (brain zaps), and nausea **[CORRECT]**
C. Hypertensive crisis and fever
D. Seizures and hallucinations
Correct Answer: B
Rationale: SSRI discontinuation syndrome is characterized by dizziness, nausea, paresthesias (electric shock sensations or brain zaps),
insomnia, dysphoria, and irritability. Paroxetine has the highest risk due to its short half-life and anticholinergic activity. Choice A
describes more typical benzodiazepine or alcohol withdrawal. Choice C describes hypertensive crisis associated with MAOI-tyramine
interactions. Choice D is more consistent with alcohol or benzodiazepine withdrawal seizures rather than SSRI discontinuation (Wilkes
NSG 552).
Q5: A psychiatric nurse practitioner is considering prescribing an MAOI for a patient with treatment-resistant
atypical depression. The patient is educated about dietary restrictions. Which food should the patient be specifically
instructed to avoid?
A. Fresh green leafy vegetables
B. Aged cheeses and cured meats **[CORRECT]**
C. Chicken breast and rice
D. Fresh citrus fruits
Correct Answer: B
Rationale: MAOIs irreversibly inhibit monoamine oxidase, which normally metabolizes tyramine. Ingesting tyramine-rich foods (aged
cheeses, cured meats, fermented products, red wine, beer, fava beans) can cause a hypertensive crisis due to unmetabolized tyramine
displacing norepinephrine from nerve terminals. Choice A is incorrect because fresh vegetables are low in tyramine. Choice C is
incorrect because fresh poultry and rice are not tyramine-rich. Choice D is incorrect because fresh fruits are safe with MAOIs (Wilkes
NSG 552).
Q6: A patient presents with symptoms of serotonin syndrome including agitation, diaphoresis, tremor,
hyperreflexia, and hyperthermia. The nurse practitioner reviews the medication profile. Which combination of
medications is most likely responsible for this potentially life-threatening condition?
A. Bupropion and lithium
B. Sertraline and tramadol **[CORRECT]**
C. Mirtazapine and propranolol
D. Venlafaxine and gabapentin
Correct Answer: B
Rationale: Serotonin syndrome results from excessive serotonergic activity. The combination of an SSRI (sertraline) with tramadol
(which has weak serotonin reuptake inhibition and MAO inhibition properties) significantly increases serotonin syndrome risk. Choice
A is less likely because bupropion has minimal serotonergic activity. Choice C is incorrect because neither mirtazapine nor propranolol
is strongly serotonergic in combination. Choice D is incorrect because gabapentin does not affect serotonergic pathways (Wilkes NSG
552).
Q7: A 42-year-old patient with major depressive disorder is started on venlafaxine (Effexor XR). At higher doses
(above 150 mg/day), the nurse practitioner should monitor for which dose-dependent adverse effect that
differentiates SNRIs from SSRIs?
A. QTc prolongation
B. Sustained hypertension **[CORRECT]**
C. Agranulocytosis
D. Tardive dyskinesia
Correct Answer: B
, Rationale: Venlafaxine has dose-dependent norepinephrine reuptake inhibition that becomes clinically significant above 150 mg/day,
which can cause sustained hypertension requiring blood pressure monitoring. This differentiates SNRIs from SSRIs, which do not
typically affect blood pressure. Choice A is more associated with TCAs and citalopram. Choice C is associated with clozapine and
carbamazepine. Choice D is associated with antipsychotics, not antidepressants (Wilkes NSG 552).
Q8: A 25-year-old patient with a history of seizure disorder presents with depression. Which antidepressant is
contraindicated in this patient due to seizure risk?
A. Sertraline (Zoloft)
B. Fluoxetine (Prozac)
C. Bupropion (Wellbutrin) **[CORRECT]**
D. Mirtazapine (Remeron)
Correct Answer: C
Rationale: Bupropion lowers the seizure threshold in a dose-dependent manner and is contraindicated in patients with seizure
disorders, eating disorders (bulimia/anorexia), and those undergoing abrupt alcohol or benzodiazepine discontinuation. The seizure
risk is approximately 0.1% at doses up to 300 mg/day but increases significantly at higher doses. Choices A, B, and D are incorrect
because SSRIs and mirtazapine are not contraindicated in seizure disorders and may be safely used (Wilkes NSG 552).
Q9: A nurse practitioner is prescribing duloxetine (Cymbalta) for a patient with major depressive disorder and
comorbid diabetic peripheral neuropathy. What is the rationale for choosing this specific medication?
A. Duloxetine is the only antidepressant approved for neuropathic pain
B. Duloxetine has dual serotonin and norepinephrine reuptake inhibition effective for both MDD and neuropathic pain
**[CORRECT]**
C. Duloxetine has minimal drug interactions compared to other antidepressants
D. Duloxetine does not require dose adjustment in patients with renal impairment
Correct Answer: B
Rationale: Duloxetine is an SNRI with balanced serotonin and norepinephrine reuptake inhibition at therapeutic doses, making it
effective for both MDD and neuropathic pain conditions including diabetic peripheral neuropathy and fibromyalgia. Choice A is
incorrect because other medications (venlafaxine, TCAs) also treat neuropathic pain. Choice C is incorrect because duloxetine has
significant CYP1A2 and CYP2D6 interactions. Choice D is incorrect because duloxetine requires dose adjustment or is contraindicated
in severe renal impairment (CrCl < 30 mL/min) (Wilkes NSG 552).
Q10: A patient with depression who is taking fluoxetine (Prozac) 60 mg daily needs to be switched to phenelzine
(Nardil), an MAOI. How long must the nurse practitioner wait after discontinuing fluoxetine before starting the
MAOI?
A. 5 days
B. 14 days
C. 5 weeks **[CORRECT]**
D. 2 weeks after the last dose of phenelzine
Correct Answer: C
Rationale: Fluoxetine has an extremely long half-life (1-3 days for the parent drug, 4-16 days for its active metabolite norfluoxetine),
requiring a 5-week washout period before starting an MAOI to prevent serotonin syndrome. This is the longest washout of any SSRI.
Choice A (5 days) is far too short and would cause serotonin syndrome. Choice B (14 days) is the standard washout for most SSRIs
(sertraline, citalopram, escitalopram) but not fluoxetine. Choice D is backwards and would also be dangerous (Wilkes NSG 552).
Q11: A patient taking amitriptyline (Elavil) 150 mg at bedtime for depression and neuropathic pain reports dry
mouth, constipation, blurred vision, and urinary hesitancy. The nurse practitioner recognizes these side effects as
resulting from which pharmacologic property of TCAs?
A. Norepinephrine reuptake inhibition
B. Anticholinergic (muscarinic receptor blockade) **[CORRECT]**
C. Alpha-1 adrenergic antagonism
Psychopharmacology | Grade A Questions and Verified Answers | 100% Correct
Wilkes University - Advanced Practice Psychiatric Nursing Education
Section 1: Antidepressant Pharmacology
Q1: A 28-year-old patient with major depressive disorder is started on fluoxetine (Prozac) 20 mg daily. The patient
asks the nurse practitioner when they can expect to notice improvement in mood. What is the most appropriate
response?
A. Improvement in mood typically occurs within 24-48 hours of starting the medication
B. Therapeutic effects usually begin within 1-2 weeks, with full effects at 4-6 weeks **[CORRECT]**
C. Fluoxetine requires 8-12 weeks before any therapeutic benefit is observed
D. The medication works immediately, but the patient may not perceive the change for several months
Correct Answer: B
Rationale: SSRIs like fluoxetine require 1-4 weeks for initial therapeutic effects and 4-6 weeks for full effect due to downstream
neuroadaptations including receptor desensitization and BDNF upregulation, not the immediate synaptic serotonin increase. Choice A
is incorrect because 24-48 hours is too early for mood improvement, though side effects may appear. Choice C overestimates the
timeframe, as some benefit is usually seen by 2 weeks. Choice D is incorrect because while the pharmacologic action begins
immediately, therapeutic mood effects require neuroadaptive changes over weeks (Wilkes NSG 552 Psychopharmacology curriculum).
Q2: A patient taking sertraline (Zoloft) 100 mg daily for generalized anxiety disorder reports sexual dysfunction
including decreased libido and difficulty achieving orgasm. The nurse practitioner is considering switching to an
alternative antidepressant. Which medication would be the most appropriate choice to minimize sexual side effects?
A. Paroxetine (Paxil)
B. Venlafaxine (Effexor XR)
C. Bupropion (Wellbutrin) **[CORRECT]**
D. Escitalopram (Lexapro)
Correct Answer: C
Rationale: Bupropion is a dopamine and norepinephrine reuptake inhibitor (DNRI) with minimal serotonergic activity, making it the
antidepressant with the lowest risk of sexual dysfunction. Choice A (paroxetine) is incorrect because it has the highest rate of sexual
dysfunction among SSRIs due to potent anticholinergic properties. Choice B (venlafaxine) is incorrect because as an SNRI it has
significant serotonergic activity and similar sexual side effect rates to SSRIs. Choice D (escitalopram) would not resolve the problem as
it is another SSRI with comparable sexual side effects (Wilkes NSG 552 Psychopharmacology).
Q3: A 35-year-old woman with depression is prescribed citalopram (Celexa). What is the maximum
FDA-recommended daily dose for this medication due to the risk of QTc prolongation?
A. 20 mg/day
B. 40 mg/day **[CORRECT]**
C. 60 mg/day
D. 80 mg/day
Correct Answer: B
Rationale: The FDA recommends a maximum citalopram dose of 40 mg/day (20 mg/day in patients over 60, hepatic impairment, or
CYP2C19 poor metabolizers) due to dose-dependent QTc prolongation, which increases the risk of torsades de pointes. Choice A is
incorrect because 20 mg is the standard starting dose, not the maximum. Choice C is incorrect because 60 mg/day was the original
maximum but was reduced by the FDA in 2011 due to cardiac safety concerns. Choice D is incorrect because 80 mg/day significantly
increases QTc prolongation risk and is contraindicated (Wilkes NSG 552).
,Q4: A patient who has been taking paroxetine (Paxil) 40 mg daily for 2 years wishes to discontinue the medication.
The nurse practitioner instructs the patient to taper gradually. Which of the following symptoms is most
characteristic of SSRI discontinuation syndrome?
A. Tremor and tachycardia
B. Dizziness, paresthesias described as electric shock sensations (brain zaps), and nausea **[CORRECT]**
C. Hypertensive crisis and fever
D. Seizures and hallucinations
Correct Answer: B
Rationale: SSRI discontinuation syndrome is characterized by dizziness, nausea, paresthesias (electric shock sensations or brain zaps),
insomnia, dysphoria, and irritability. Paroxetine has the highest risk due to its short half-life and anticholinergic activity. Choice A
describes more typical benzodiazepine or alcohol withdrawal. Choice C describes hypertensive crisis associated with MAOI-tyramine
interactions. Choice D is more consistent with alcohol or benzodiazepine withdrawal seizures rather than SSRI discontinuation (Wilkes
NSG 552).
Q5: A psychiatric nurse practitioner is considering prescribing an MAOI for a patient with treatment-resistant
atypical depression. The patient is educated about dietary restrictions. Which food should the patient be specifically
instructed to avoid?
A. Fresh green leafy vegetables
B. Aged cheeses and cured meats **[CORRECT]**
C. Chicken breast and rice
D. Fresh citrus fruits
Correct Answer: B
Rationale: MAOIs irreversibly inhibit monoamine oxidase, which normally metabolizes tyramine. Ingesting tyramine-rich foods (aged
cheeses, cured meats, fermented products, red wine, beer, fava beans) can cause a hypertensive crisis due to unmetabolized tyramine
displacing norepinephrine from nerve terminals. Choice A is incorrect because fresh vegetables are low in tyramine. Choice C is
incorrect because fresh poultry and rice are not tyramine-rich. Choice D is incorrect because fresh fruits are safe with MAOIs (Wilkes
NSG 552).
Q6: A patient presents with symptoms of serotonin syndrome including agitation, diaphoresis, tremor,
hyperreflexia, and hyperthermia. The nurse practitioner reviews the medication profile. Which combination of
medications is most likely responsible for this potentially life-threatening condition?
A. Bupropion and lithium
B. Sertraline and tramadol **[CORRECT]**
C. Mirtazapine and propranolol
D. Venlafaxine and gabapentin
Correct Answer: B
Rationale: Serotonin syndrome results from excessive serotonergic activity. The combination of an SSRI (sertraline) with tramadol
(which has weak serotonin reuptake inhibition and MAO inhibition properties) significantly increases serotonin syndrome risk. Choice
A is less likely because bupropion has minimal serotonergic activity. Choice C is incorrect because neither mirtazapine nor propranolol
is strongly serotonergic in combination. Choice D is incorrect because gabapentin does not affect serotonergic pathways (Wilkes NSG
552).
Q7: A 42-year-old patient with major depressive disorder is started on venlafaxine (Effexor XR). At higher doses
(above 150 mg/day), the nurse practitioner should monitor for which dose-dependent adverse effect that
differentiates SNRIs from SSRIs?
A. QTc prolongation
B. Sustained hypertension **[CORRECT]**
C. Agranulocytosis
D. Tardive dyskinesia
Correct Answer: B
, Rationale: Venlafaxine has dose-dependent norepinephrine reuptake inhibition that becomes clinically significant above 150 mg/day,
which can cause sustained hypertension requiring blood pressure monitoring. This differentiates SNRIs from SSRIs, which do not
typically affect blood pressure. Choice A is more associated with TCAs and citalopram. Choice C is associated with clozapine and
carbamazepine. Choice D is associated with antipsychotics, not antidepressants (Wilkes NSG 552).
Q8: A 25-year-old patient with a history of seizure disorder presents with depression. Which antidepressant is
contraindicated in this patient due to seizure risk?
A. Sertraline (Zoloft)
B. Fluoxetine (Prozac)
C. Bupropion (Wellbutrin) **[CORRECT]**
D. Mirtazapine (Remeron)
Correct Answer: C
Rationale: Bupropion lowers the seizure threshold in a dose-dependent manner and is contraindicated in patients with seizure
disorders, eating disorders (bulimia/anorexia), and those undergoing abrupt alcohol or benzodiazepine discontinuation. The seizure
risk is approximately 0.1% at doses up to 300 mg/day but increases significantly at higher doses. Choices A, B, and D are incorrect
because SSRIs and mirtazapine are not contraindicated in seizure disorders and may be safely used (Wilkes NSG 552).
Q9: A nurse practitioner is prescribing duloxetine (Cymbalta) for a patient with major depressive disorder and
comorbid diabetic peripheral neuropathy. What is the rationale for choosing this specific medication?
A. Duloxetine is the only antidepressant approved for neuropathic pain
B. Duloxetine has dual serotonin and norepinephrine reuptake inhibition effective for both MDD and neuropathic pain
**[CORRECT]**
C. Duloxetine has minimal drug interactions compared to other antidepressants
D. Duloxetine does not require dose adjustment in patients with renal impairment
Correct Answer: B
Rationale: Duloxetine is an SNRI with balanced serotonin and norepinephrine reuptake inhibition at therapeutic doses, making it
effective for both MDD and neuropathic pain conditions including diabetic peripheral neuropathy and fibromyalgia. Choice A is
incorrect because other medications (venlafaxine, TCAs) also treat neuropathic pain. Choice C is incorrect because duloxetine has
significant CYP1A2 and CYP2D6 interactions. Choice D is incorrect because duloxetine requires dose adjustment or is contraindicated
in severe renal impairment (CrCl < 30 mL/min) (Wilkes NSG 552).
Q10: A patient with depression who is taking fluoxetine (Prozac) 60 mg daily needs to be switched to phenelzine
(Nardil), an MAOI. How long must the nurse practitioner wait after discontinuing fluoxetine before starting the
MAOI?
A. 5 days
B. 14 days
C. 5 weeks **[CORRECT]**
D. 2 weeks after the last dose of phenelzine
Correct Answer: C
Rationale: Fluoxetine has an extremely long half-life (1-3 days for the parent drug, 4-16 days for its active metabolite norfluoxetine),
requiring a 5-week washout period before starting an MAOI to prevent serotonin syndrome. This is the longest washout of any SSRI.
Choice A (5 days) is far too short and would cause serotonin syndrome. Choice B (14 days) is the standard washout for most SSRIs
(sertraline, citalopram, escitalopram) but not fluoxetine. Choice D is backwards and would also be dangerous (Wilkes NSG 552).
Q11: A patient taking amitriptyline (Elavil) 150 mg at bedtime for depression and neuropathic pain reports dry
mouth, constipation, blurred vision, and urinary hesitancy. The nurse practitioner recognizes these side effects as
resulting from which pharmacologic property of TCAs?
A. Norepinephrine reuptake inhibition
B. Anticholinergic (muscarinic receptor blockade) **[CORRECT]**
C. Alpha-1 adrenergic antagonism
