WILKES UNIVERSITY · 2026-2027
NSG 552 Exam 2
Psychopharmacology — Comprehensive 100-Question Practice
Examination with Verified Answers aligned with Wilkes
University Advanced Practice Psychopharmacology Curriculum
Course: NSG 552 · Psychopharmacology
Questions: 100 · Sections: 6
Focus: Antidepressants, Mood Stabilizers, Antipsychotics, Anxiolytics, Pharmacokinetics
,NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026-2027 Page 1
Section 1: Antidepressant Pharmacology (SSRIs, SNRIs, TCAs,
MAOIs, Atypical)
Q1: A 34-year-old woman with major depressive disorder is started on
fluoxetine 20 mg daily. She asks the nurse practitioner how the medication
works in the brain. Which response best explains the mechanism of action of
SSRIs?
A. It inhibits the reuptake of serotonin at the presynaptic membrane,
increasing serotonin availability in the synaptic cleft. [CORRECT]
B. It blocks norepinephrine and dopamine transporters, increasing synaptic
levels of both neurotransmitters.
C. It acts as a reversible inhibitor of monoamine oxidase type A, preventing
serotonin metabolism.
D. It antagonizes 5-HT2A receptors while partially agonizing 5-HT1A
receptors to modulate serotonin transmission.
Correct Answer: A
Rationale: Selective serotonin reuptake inhibitors (SSRIs) selectively block the serotonin
transporter (SERT), increasing serotonin concentration in the synaptic cleft and enhancing
serotonergic neurotransmission. This mechanism is foundational to the antidepressant
pharmacology unit in the Wilkes NSG 552 curriculum and underlies the therapeutic effects
across multiple psychiatric disorders.
Q2: A 55-year-old patient with depression is prescribed paroxetine 20 mg
daily. She is also taking tamoxifen for breast cancer. The nurse practitioner
recognizes that paroxetine is a strong CYP2D6 inhibitor. What is the clinical
significance of this interaction?
A. Tamoxifen efficacy is reduced because CYP2D6 is needed to convert
tamoxifen to its active metabolite endoxifen. [CORRECT]
B. Tamoxifen toxicity increases due to inhibited metabolism and higher active
metabolite levels.
C. Paroxetine efficacy is reduced due to induction of its own metabolism by
tamoxifen.
D. The combination increases the risk of serotonin syndrome due to additive
serotonergic effects.
Correct Answer: A
Rationale: Paroxetine and fluoxetine are potent CYP2D6 inhibitors that block the
conversion of tamoxifen to its active metabolite endoxifen, potentially reducing the
Aligned with Wilkes University NSG 552 Advanced Practice Psychopharmacology
100 Questions
Curriculum
| 6 Sections For Educational Use Only
,NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026-2027 Page 2
anticancer efficacy of tamoxifen. The Wilkes NSG 552 curriculum emphasizes assessing
CYP450 interactions before prescribing SSRIs, particularly in patients on tamoxifen or
other prodrugs requiring CYP2D6 activation.
Q3: A 72-year-old woman with major depressive disorder has been taking
citalopram 40 mg daily for 6 months. Her recent ECG shows a QTc interval of
485 ms. What is the most appropriate action by the nurse practitioner?
A. Continue the current dose and recheck the ECG in 3 months.
B. Reduce the citalopram dose to 20 mg daily and recheck the ECG in 2
weeks. [CORRECT]
C. Switch to escitalopram 20 mg daily because it does not prolong the QTc
interval.
D. Add a beta-blocker to prevent arrhythmias and continue citalopram at the
current dose.
Correct Answer: B
Rationale: The FDA recommends a maximum citalopram dose of 40 mg daily in adults and
20 mg daily in patients over age 60 or those with hepatic impairment, due to dose-dependent
QTc prolongation and risk of torsades de pointes. A QTc above 480 ms warrants immediate
dose reduction, as highlighted in the antidepressant safety module of the Wilkes NSG 552
curriculum.
Q4: A 40-year-old patient with treatment-resistant depression has been on
fluoxetine 60 mg daily for 2 years. The nurse practitioner decides to switch the
patient to phenelzine, an MAOI. How long must the patient wait after
stopping fluoxetine before starting phenelzine?
A. 2 weeks, which is the standard washout period for most SSRIs.
B. 5 weeks due to the long half-life of fluoxetine and its active metabolite
norfluoxetine. [CORRECT]
C. 14 days because fluoxetine and phenelzine can be started immediately after
one another.
D. 7 days, which is sufficient for fluoxetine clearance from the body.
Correct Answer: B
Rationale: Fluoxetine has a long half-life of 2-4 days, and its active metabolite norfluoxetine
has a half-life of 7-15 days, requiring a washout period of at least 5 weeks before starting an
MAOI to prevent serotonin syndrome. The Wilkes NSG 552 psychopharmacology
curriculum identifies fluoxetine as the SSRI requiring the longest washout due to its
extended elimination kinetics.
Aligned with Wilkes University NSG 552 Advanced Practice Psychopharmacology
100 Questions
Curriculum
| 6 Sections For Educational Use Only
, NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026-2027 Page 3
Q5: A 45-year-old man presents to the emergency department with agitation,
diaphoresis, hyperreflexia, fever of 39.2 C, and tremor. His wife reports he
takes sertraline 200 mg daily and recently started taking tramadol for chronic
back pain. The nurse practitioner suspects serotonin syndrome. What is the
priority intervention?
A. Administer a beta-blocker for tachycardia and monitor vital signs.
B. Discontinue the serotonergic agents, provide supportive care, and
consider cyproheptadine. [CORRECT]
C. Administer dantrolene sodium for suspected neuroleptic malignant
syndrome.
D. Increase the sertraline dose to stabilize serotonin levels and add a
benzodiazepine.
Correct Answer: B
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excess
serotonergic activity, often from combining SSRIs with other serotonergic agents such as
tramadol, linezolid, or triptans. Treatment involves immediate discontinuation of
serotonergic agents, supportive care, and consideration of cyproheptadine, an
antiserotonergic agent, as covered in the Wilkes NSG 552 antidepressant safety unit.
Q6: A 29-year-old woman ran out of her sertraline prescription 5 days ago
and has not taken her medication. She reports feeling electric shock sensations
in her head that occur multiple times per day, along with dizziness and
nausea. The nurse practitioner recognizes these symptoms as:
A. Serotonin syndrome resulting from abrupt discontinuation of sertraline.
B. Antidepressant discontinuation syndrome, commonly referred to as
brain zaps. [CORRECT]
C. Neuroleptic malignant syndrome caused by dopamine receptor
hypersensitivity.
D. Hypomanic switching secondary to rapid serotonergic withdrawal.
Correct Answer: B
Rationale: Brain zaps are a hallmark symptom of antidepressant discontinuation syndrome,
described as brief electric shock sensations in the head, and occur more frequently with
short-half-life SSRIs like paroxetine and sertraline. The Wilkes NSG 552 curriculum
emphasizes educating patients to taper SSRIs gradually rather than stop abruptly to prevent
these distressing discontinuation symptoms.
Aligned with Wilkes University NSG 552 Advanced Practice Psychopharmacology
100 Questions
Curriculum
| 6 Sections For Educational Use Only
NSG 552 Exam 2
Psychopharmacology — Comprehensive 100-Question Practice
Examination with Verified Answers aligned with Wilkes
University Advanced Practice Psychopharmacology Curriculum
Course: NSG 552 · Psychopharmacology
Questions: 100 · Sections: 6
Focus: Antidepressants, Mood Stabilizers, Antipsychotics, Anxiolytics, Pharmacokinetics
,NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026-2027 Page 1
Section 1: Antidepressant Pharmacology (SSRIs, SNRIs, TCAs,
MAOIs, Atypical)
Q1: A 34-year-old woman with major depressive disorder is started on
fluoxetine 20 mg daily. She asks the nurse practitioner how the medication
works in the brain. Which response best explains the mechanism of action of
SSRIs?
A. It inhibits the reuptake of serotonin at the presynaptic membrane,
increasing serotonin availability in the synaptic cleft. [CORRECT]
B. It blocks norepinephrine and dopamine transporters, increasing synaptic
levels of both neurotransmitters.
C. It acts as a reversible inhibitor of monoamine oxidase type A, preventing
serotonin metabolism.
D. It antagonizes 5-HT2A receptors while partially agonizing 5-HT1A
receptors to modulate serotonin transmission.
Correct Answer: A
Rationale: Selective serotonin reuptake inhibitors (SSRIs) selectively block the serotonin
transporter (SERT), increasing serotonin concentration in the synaptic cleft and enhancing
serotonergic neurotransmission. This mechanism is foundational to the antidepressant
pharmacology unit in the Wilkes NSG 552 curriculum and underlies the therapeutic effects
across multiple psychiatric disorders.
Q2: A 55-year-old patient with depression is prescribed paroxetine 20 mg
daily. She is also taking tamoxifen for breast cancer. The nurse practitioner
recognizes that paroxetine is a strong CYP2D6 inhibitor. What is the clinical
significance of this interaction?
A. Tamoxifen efficacy is reduced because CYP2D6 is needed to convert
tamoxifen to its active metabolite endoxifen. [CORRECT]
B. Tamoxifen toxicity increases due to inhibited metabolism and higher active
metabolite levels.
C. Paroxetine efficacy is reduced due to induction of its own metabolism by
tamoxifen.
D. The combination increases the risk of serotonin syndrome due to additive
serotonergic effects.
Correct Answer: A
Rationale: Paroxetine and fluoxetine are potent CYP2D6 inhibitors that block the
conversion of tamoxifen to its active metabolite endoxifen, potentially reducing the
Aligned with Wilkes University NSG 552 Advanced Practice Psychopharmacology
100 Questions
Curriculum
| 6 Sections For Educational Use Only
,NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026-2027 Page 2
anticancer efficacy of tamoxifen. The Wilkes NSG 552 curriculum emphasizes assessing
CYP450 interactions before prescribing SSRIs, particularly in patients on tamoxifen or
other prodrugs requiring CYP2D6 activation.
Q3: A 72-year-old woman with major depressive disorder has been taking
citalopram 40 mg daily for 6 months. Her recent ECG shows a QTc interval of
485 ms. What is the most appropriate action by the nurse practitioner?
A. Continue the current dose and recheck the ECG in 3 months.
B. Reduce the citalopram dose to 20 mg daily and recheck the ECG in 2
weeks. [CORRECT]
C. Switch to escitalopram 20 mg daily because it does not prolong the QTc
interval.
D. Add a beta-blocker to prevent arrhythmias and continue citalopram at the
current dose.
Correct Answer: B
Rationale: The FDA recommends a maximum citalopram dose of 40 mg daily in adults and
20 mg daily in patients over age 60 or those with hepatic impairment, due to dose-dependent
QTc prolongation and risk of torsades de pointes. A QTc above 480 ms warrants immediate
dose reduction, as highlighted in the antidepressant safety module of the Wilkes NSG 552
curriculum.
Q4: A 40-year-old patient with treatment-resistant depression has been on
fluoxetine 60 mg daily for 2 years. The nurse practitioner decides to switch the
patient to phenelzine, an MAOI. How long must the patient wait after
stopping fluoxetine before starting phenelzine?
A. 2 weeks, which is the standard washout period for most SSRIs.
B. 5 weeks due to the long half-life of fluoxetine and its active metabolite
norfluoxetine. [CORRECT]
C. 14 days because fluoxetine and phenelzine can be started immediately after
one another.
D. 7 days, which is sufficient for fluoxetine clearance from the body.
Correct Answer: B
Rationale: Fluoxetine has a long half-life of 2-4 days, and its active metabolite norfluoxetine
has a half-life of 7-15 days, requiring a washout period of at least 5 weeks before starting an
MAOI to prevent serotonin syndrome. The Wilkes NSG 552 psychopharmacology
curriculum identifies fluoxetine as the SSRI requiring the longest washout due to its
extended elimination kinetics.
Aligned with Wilkes University NSG 552 Advanced Practice Psychopharmacology
100 Questions
Curriculum
| 6 Sections For Educational Use Only
, NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026-2027 Page 3
Q5: A 45-year-old man presents to the emergency department with agitation,
diaphoresis, hyperreflexia, fever of 39.2 C, and tremor. His wife reports he
takes sertraline 200 mg daily and recently started taking tramadol for chronic
back pain. The nurse practitioner suspects serotonin syndrome. What is the
priority intervention?
A. Administer a beta-blocker for tachycardia and monitor vital signs.
B. Discontinue the serotonergic agents, provide supportive care, and
consider cyproheptadine. [CORRECT]
C. Administer dantrolene sodium for suspected neuroleptic malignant
syndrome.
D. Increase the sertraline dose to stabilize serotonin levels and add a
benzodiazepine.
Correct Answer: B
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excess
serotonergic activity, often from combining SSRIs with other serotonergic agents such as
tramadol, linezolid, or triptans. Treatment involves immediate discontinuation of
serotonergic agents, supportive care, and consideration of cyproheptadine, an
antiserotonergic agent, as covered in the Wilkes NSG 552 antidepressant safety unit.
Q6: A 29-year-old woman ran out of her sertraline prescription 5 days ago
and has not taken her medication. She reports feeling electric shock sensations
in her head that occur multiple times per day, along with dizziness and
nausea. The nurse practitioner recognizes these symptoms as:
A. Serotonin syndrome resulting from abrupt discontinuation of sertraline.
B. Antidepressant discontinuation syndrome, commonly referred to as
brain zaps. [CORRECT]
C. Neuroleptic malignant syndrome caused by dopamine receptor
hypersensitivity.
D. Hypomanic switching secondary to rapid serotonergic withdrawal.
Correct Answer: B
Rationale: Brain zaps are a hallmark symptom of antidepressant discontinuation syndrome,
described as brief electric shock sensations in the head, and occur more frequently with
short-half-life SSRIs like paroxetine and sertraline. The Wilkes NSG 552 curriculum
emphasizes educating patients to taper SSRIs gradually rather than stop abruptly to prevent
these distressing discontinuation symptoms.
Aligned with Wilkes University NSG 552 Advanced Practice Psychopharmacology
100 Questions
Curriculum
| 6 Sections For Educational Use Only
