NSG 552
W
N SIGLMultiple-Choice
5K
5 2E S
Comprehensive
100
C URRICULUM
UMN 2I V
EXA
antidepressants
Latest
· EP R
(SSRIs,
S IHTOYP H·2A R2covering
SQuestions
YC
Examination
SNRIs, TCAs, MAOIs,
Edition
M0AC
2 6O-L 2O G0Y2 7
Psychopharmacology
atypicals), mood stabilizers (lithium,
anticonvulsants), antipsychotics (typical and
Exam 2
atypical), anxiolytics and sedative-hypnotics,
pharmacokinetics and drug interactions, special
populations, and integrated clinical scenarios with
prioritization.
,NSG 552 / NSG552: Psychopharmacology Exam 2 (Latest 2026/2027) Wilkes University
NSG 552 / NSG552: Psychopharmacology Exam 2
Latest Edition | Wilkes University | 100 Multiple-Choice Questions
Section 1: Antidepressants (SSRIs, SNRIs, TCAs, MAOIs, and Atypicals)
(Questions 1-30)
Q1: A PMHNP is teaching a patient about initiating sertraline (Zoloft) for major depressive disorder.
Which statement by the patient indicates understanding of the medication?
A. I should expect to feel significant improvement in my mood within the first 3 days of taking this
medication.
B. It may take 4 to 6 weeks before I notice the full therapeutic effect of this medication.
[CORRECT]
C. I can stop taking this medication as soon as I start feeling better.
D. This medication will cause immediate drowsiness that will persist throughout treatment.
Correct Answer: B
Rationale: SSRIs such as sertraline typically require 4 to 6 weeks to achieve full therapeutic effect, although some
patients may notice partial improvement earlier. The delayed onset is due to downstream neuroadaptive changes
including receptor desensitization and increased BDNF expression. Patients should be counseled to continue the
medication even if they do not feel immediate improvement. Abrupt discontinuation can lead to discontinuation
syndrome. Unlike sedating antidepressants such as mirtazapine, sertraline is more likely to cause initial insomnia or
activation than drowsiness.
Q2: A patient taking fluoxetine (Prozac) reports experiencing visual hallucinations, muscle rigidity,
diaphoresis, and a temperature of 40.2 degrees C (104.4 degrees F). Which condition should the PMHNP
suspect?
A. Serotonin syndrome [CORRECT]
B. Neuroleptic malignant syndrome (NMS)
C. Malignant hyperthermia
D. Anticholinergic toxicity
Correct Answer: A
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity,
most commonly from drug interactions (e.g., combining an SSRI with an MAOI or tramadol). Classic symptoms
include the triad of mental status changes (agitation, hallucinations, coma), autonomic instability (hyperthermia,
diaphoresis, tachycardia, hypertension), and neuromuscular excitability (clonus, rigidity, hyperreflexia). NMS is
associated with antipsychotics and presents with lead-pipe rigidity rather than clonus. Malignant hyperthermia is
triggered by anesthetic agents. Anticholinergic toxicity presents with dry skin, not diaphoresis.
Q3: A patient prescribed phenelzine (Nardil), an MAOI, asks which foods must be avoided. Which
response by the nurse is most appropriate?
A. You should avoid all fresh fruits and vegetables to prevent interactions.
B. You must avoid foods that are high in vitamin K such as leafy green vegetables.
C. You should avoid all dairy products and wheat-based foods.
Page 1
,NSG 552 / NSG552: Psychopharmacology Exam 2 (Latest 2026/2027) Wilkes University
D. You must avoid tyramine-rich foods such as aged cheeses, cured meats, and fermented
products. [CORRECT]
Correct Answer: D
Rationale: MAOIs block the enzyme monoamine oxidase, which normally breaks down tyramine in the gut. When
tyramine is not metabolized, it causes displacement of norepinephrine from nerve terminals, leading to a potentially
fatal hypertensive crisis. Foods high in tyramine include aged cheeses (cheddar, Swiss, blue), cured or smoked meats
(salami, pepperoni), fermented products (sauerkraut, soy sauce, tap beer), and certain wines (Chianti). Fresh fruits,
vegetables, dairy, and wheat products are not restricted. Vitamin K avoidance is relevant for warfarin therapy, not
MAOIs.
Q4: A PMHNP is considering prescribing venlafaxine (Effexor XR) for a patient with depression and
comorbid neuropathic pain. What is the primary pharmacological rationale for this choice?
A. Venlafaxine selectively inhibits serotonin reuptake, which addresses both conditions.
B. Venlafaxine has strong dopamine reuptake inhibition that provides pain relief.
C. Venlafaxine inhibits both serotonin and norepinephrine reuptake at higher doses, providing
analgesic effects. [CORRECT]
D. Venlafaxine is a sodium channel blocker that reduces neuropathic pain signals.
Correct Answer: C
Rationale: Venlafaxine is an SNRI that at lower doses (less than 150 mg/day) primarily inhibits serotonin reuptake,
but at higher doses (150 mg/day and above) also significantly inhibits norepinephrine reuptake. The dual action on
both serotonin and norepinephrine is thought to provide additional analgesic benefits for neuropathic pain, similar
to duloxetine. Venlafaxine does not have clinically significant dopamine reuptake inhibition at therapeutic doses, nor
is it a sodium channel blocker. The SNRI class is considered first-line for depression with comorbid chronic pain
conditions.
Q5: A patient who has been taking amitriptyline (Elavil) for depression presents to the emergency
department with a heart rate of 120 bpm, dilated pupils, dry mouth, urinary retention, and confusion. The
PMHNP recognizes these findings as consistent with which toxicity?
A. Serotonin toxicity
B. Beta-blocker overdose
C. Anticholinergic toxicity [CORRECT]
D. Opioid toxicity
Correct Answer: C
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with strong anticholinergic properties. Anticholinergic
toxicity presents with the classic mnemonic "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a
hatter" - reflecting hyperthermia, mydriasis with blurred vision, dry mucous membranes, flushed skin, and delirium
or confusion. Additional findings include tachycardia, urinary retention, and decreased bowel sounds. TCAs also
have cardiac sodium channel blocking effects, which can lead to wide QRS complexes and arrhythmias. Treatment
includes physostigmine in severe cases and sodium bicarbonate for cardiac toxicity.
Q6: A PMHNP is discussing the black box warning for antidepressants with a patient who is 24 years old.
Which statement accurately reflects the content of this warning?
A. All antidepressants carry an increased risk of suicidal ideation and behavior in children,
adolescents, and young adults up to age 25. [CORRECT]
B. Only SSRIs carry an increased risk of suicidal ideation in patients over 65 years old.
C. The warning applies only to MAOIs and TCAs, not to newer agents.
Page 2
, NSG 552 / NSG552: Psychopharmacology Exam 2 (Latest 2026/2027) Wilkes University
D. Antidepressants are contraindicated in all patients under the age of 30.
Correct Answer: A
Rationale: Since 2004, the FDA has required a black box warning on all antidepressant medications regarding the
increased risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (up to age
24) during initial treatment and dose adjustments. This warning applies to all antidepressant classes including SSRIs,
SNRIs, TCAs, MAOIs, and atypicals. The risk does not mean antidepressants should be avoided in young adults, but
rather that close monitoring is essential during the first 1 to 2 months of treatment and during dose changes. In
adults over 65, some antidepressants may actually reduce suicide risk.
Q7: A patient with depression is prescribed bupropion (Wellbutrin XL). Which pre-existing condition
would be a contraindication to this medication?
A. Type 2 diabetes mellitus
B. Hypertension controlled with lisinopril
C. A history of seizure disorder or eating disorder with seizures [CORRECT]
D. Hypothyroidism treated with levothyroxine
Correct Answer: C
Rationale: Bupropion is contraindicated in patients with a known seizure disorder, a history of seizures, or a
diagnosis of bulimia or anorexia nervosa (which carry an increased seizure risk). Bupropion lowers the seizure
threshold in a dose-dependent manner, with risk increasing significantly above 450 mg/day. The immediate-release
formulation carries a higher seizure risk than the sustained-release or extended-release formulations. Bupropion is
actually a preferred antidepressant in patients with depression and comorbid concerns about sexual dysfunction or
weight gain, as it has a favorable profile in both areas compared to SSRIs.
Q8: A patient taking citalopram (Celexa) has a routine ECG that reveals a QTc interval of 520 ms. What
is the most appropriate action by the PMHNP?
A. Continue the current dose and monitor the QTc interval in 3 months.
B. Increase the dose of citalopram to achieve better antidepressant efficacy.
C. Add a beta-blocker to counteract the QTc prolongation.
D. Reduce the dose of citalopram to 20 mg/day or switch to an alternative antidepressant.
[CORRECT]
Correct Answer: D
Rationale: Citalopram causes dose-dependent QTc prolongation, and the FDA has issued specific warnings: the
maximum recommended dose is 40 mg/day (20 mg/day in patients over 60, those with hepatic impairment, or those
who are CYP2C19 poor metabolizers). A QTc interval exceeding 500 ms significantly increases the risk of torsades
de pointes, a potentially fatal ventricular arrhythmia. The appropriate action is to reduce the dose or switch to an
alternative antidepressant with less effect on cardiac conduction (such as sertraline or bupropion). Adding a
beta-blocker does not adequately address the underlying QTc prolongation risk.
Q9: A patient who has been taking paroxetine (Paxil) 40 mg daily for 2 years wishes to discontinue the
medication. The PMHNP explains the risk of antidepressant discontinuation syndrome. Which symptom
is most commonly associated with this syndrome?
A. Seizures
B. Hypertensive crisis
C. Visual hallucinations and delirium
D. Flu-like symptoms, dizziness, nausea, and electric shock sensations (brain zaps) [CORRECT]
Correct Answer: D
Page 3
W
N SIGLMultiple-Choice
5K
5 2E S
Comprehensive
100
C URRICULUM
UMN 2I V
EXA
antidepressants
Latest
· EP R
(SSRIs,
S IHTOYP H·2A R2covering
SQuestions
YC
Examination
SNRIs, TCAs, MAOIs,
Edition
M0AC
2 6O-L 2O G0Y2 7
Psychopharmacology
atypicals), mood stabilizers (lithium,
anticonvulsants), antipsychotics (typical and
Exam 2
atypical), anxiolytics and sedative-hypnotics,
pharmacokinetics and drug interactions, special
populations, and integrated clinical scenarios with
prioritization.
,NSG 552 / NSG552: Psychopharmacology Exam 2 (Latest 2026/2027) Wilkes University
NSG 552 / NSG552: Psychopharmacology Exam 2
Latest Edition | Wilkes University | 100 Multiple-Choice Questions
Section 1: Antidepressants (SSRIs, SNRIs, TCAs, MAOIs, and Atypicals)
(Questions 1-30)
Q1: A PMHNP is teaching a patient about initiating sertraline (Zoloft) for major depressive disorder.
Which statement by the patient indicates understanding of the medication?
A. I should expect to feel significant improvement in my mood within the first 3 days of taking this
medication.
B. It may take 4 to 6 weeks before I notice the full therapeutic effect of this medication.
[CORRECT]
C. I can stop taking this medication as soon as I start feeling better.
D. This medication will cause immediate drowsiness that will persist throughout treatment.
Correct Answer: B
Rationale: SSRIs such as sertraline typically require 4 to 6 weeks to achieve full therapeutic effect, although some
patients may notice partial improvement earlier. The delayed onset is due to downstream neuroadaptive changes
including receptor desensitization and increased BDNF expression. Patients should be counseled to continue the
medication even if they do not feel immediate improvement. Abrupt discontinuation can lead to discontinuation
syndrome. Unlike sedating antidepressants such as mirtazapine, sertraline is more likely to cause initial insomnia or
activation than drowsiness.
Q2: A patient taking fluoxetine (Prozac) reports experiencing visual hallucinations, muscle rigidity,
diaphoresis, and a temperature of 40.2 degrees C (104.4 degrees F). Which condition should the PMHNP
suspect?
A. Serotonin syndrome [CORRECT]
B. Neuroleptic malignant syndrome (NMS)
C. Malignant hyperthermia
D. Anticholinergic toxicity
Correct Answer: A
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity,
most commonly from drug interactions (e.g., combining an SSRI with an MAOI or tramadol). Classic symptoms
include the triad of mental status changes (agitation, hallucinations, coma), autonomic instability (hyperthermia,
diaphoresis, tachycardia, hypertension), and neuromuscular excitability (clonus, rigidity, hyperreflexia). NMS is
associated with antipsychotics and presents with lead-pipe rigidity rather than clonus. Malignant hyperthermia is
triggered by anesthetic agents. Anticholinergic toxicity presents with dry skin, not diaphoresis.
Q3: A patient prescribed phenelzine (Nardil), an MAOI, asks which foods must be avoided. Which
response by the nurse is most appropriate?
A. You should avoid all fresh fruits and vegetables to prevent interactions.
B. You must avoid foods that are high in vitamin K such as leafy green vegetables.
C. You should avoid all dairy products and wheat-based foods.
Page 1
,NSG 552 / NSG552: Psychopharmacology Exam 2 (Latest 2026/2027) Wilkes University
D. You must avoid tyramine-rich foods such as aged cheeses, cured meats, and fermented
products. [CORRECT]
Correct Answer: D
Rationale: MAOIs block the enzyme monoamine oxidase, which normally breaks down tyramine in the gut. When
tyramine is not metabolized, it causes displacement of norepinephrine from nerve terminals, leading to a potentially
fatal hypertensive crisis. Foods high in tyramine include aged cheeses (cheddar, Swiss, blue), cured or smoked meats
(salami, pepperoni), fermented products (sauerkraut, soy sauce, tap beer), and certain wines (Chianti). Fresh fruits,
vegetables, dairy, and wheat products are not restricted. Vitamin K avoidance is relevant for warfarin therapy, not
MAOIs.
Q4: A PMHNP is considering prescribing venlafaxine (Effexor XR) for a patient with depression and
comorbid neuropathic pain. What is the primary pharmacological rationale for this choice?
A. Venlafaxine selectively inhibits serotonin reuptake, which addresses both conditions.
B. Venlafaxine has strong dopamine reuptake inhibition that provides pain relief.
C. Venlafaxine inhibits both serotonin and norepinephrine reuptake at higher doses, providing
analgesic effects. [CORRECT]
D. Venlafaxine is a sodium channel blocker that reduces neuropathic pain signals.
Correct Answer: C
Rationale: Venlafaxine is an SNRI that at lower doses (less than 150 mg/day) primarily inhibits serotonin reuptake,
but at higher doses (150 mg/day and above) also significantly inhibits norepinephrine reuptake. The dual action on
both serotonin and norepinephrine is thought to provide additional analgesic benefits for neuropathic pain, similar
to duloxetine. Venlafaxine does not have clinically significant dopamine reuptake inhibition at therapeutic doses, nor
is it a sodium channel blocker. The SNRI class is considered first-line for depression with comorbid chronic pain
conditions.
Q5: A patient who has been taking amitriptyline (Elavil) for depression presents to the emergency
department with a heart rate of 120 bpm, dilated pupils, dry mouth, urinary retention, and confusion. The
PMHNP recognizes these findings as consistent with which toxicity?
A. Serotonin toxicity
B. Beta-blocker overdose
C. Anticholinergic toxicity [CORRECT]
D. Opioid toxicity
Correct Answer: C
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with strong anticholinergic properties. Anticholinergic
toxicity presents with the classic mnemonic "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a
hatter" - reflecting hyperthermia, mydriasis with blurred vision, dry mucous membranes, flushed skin, and delirium
or confusion. Additional findings include tachycardia, urinary retention, and decreased bowel sounds. TCAs also
have cardiac sodium channel blocking effects, which can lead to wide QRS complexes and arrhythmias. Treatment
includes physostigmine in severe cases and sodium bicarbonate for cardiac toxicity.
Q6: A PMHNP is discussing the black box warning for antidepressants with a patient who is 24 years old.
Which statement accurately reflects the content of this warning?
A. All antidepressants carry an increased risk of suicidal ideation and behavior in children,
adolescents, and young adults up to age 25. [CORRECT]
B. Only SSRIs carry an increased risk of suicidal ideation in patients over 65 years old.
C. The warning applies only to MAOIs and TCAs, not to newer agents.
Page 2
, NSG 552 / NSG552: Psychopharmacology Exam 2 (Latest 2026/2027) Wilkes University
D. Antidepressants are contraindicated in all patients under the age of 30.
Correct Answer: A
Rationale: Since 2004, the FDA has required a black box warning on all antidepressant medications regarding the
increased risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (up to age
24) during initial treatment and dose adjustments. This warning applies to all antidepressant classes including SSRIs,
SNRIs, TCAs, MAOIs, and atypicals. The risk does not mean antidepressants should be avoided in young adults, but
rather that close monitoring is essential during the first 1 to 2 months of treatment and during dose changes. In
adults over 65, some antidepressants may actually reduce suicide risk.
Q7: A patient with depression is prescribed bupropion (Wellbutrin XL). Which pre-existing condition
would be a contraindication to this medication?
A. Type 2 diabetes mellitus
B. Hypertension controlled with lisinopril
C. A history of seizure disorder or eating disorder with seizures [CORRECT]
D. Hypothyroidism treated with levothyroxine
Correct Answer: C
Rationale: Bupropion is contraindicated in patients with a known seizure disorder, a history of seizures, or a
diagnosis of bulimia or anorexia nervosa (which carry an increased seizure risk). Bupropion lowers the seizure
threshold in a dose-dependent manner, with risk increasing significantly above 450 mg/day. The immediate-release
formulation carries a higher seizure risk than the sustained-release or extended-release formulations. Bupropion is
actually a preferred antidepressant in patients with depression and comorbid concerns about sexual dysfunction or
weight gain, as it has a favorable profile in both areas compared to SSRIs.
Q8: A patient taking citalopram (Celexa) has a routine ECG that reveals a QTc interval of 520 ms. What
is the most appropriate action by the PMHNP?
A. Continue the current dose and monitor the QTc interval in 3 months.
B. Increase the dose of citalopram to achieve better antidepressant efficacy.
C. Add a beta-blocker to counteract the QTc prolongation.
D. Reduce the dose of citalopram to 20 mg/day or switch to an alternative antidepressant.
[CORRECT]
Correct Answer: D
Rationale: Citalopram causes dose-dependent QTc prolongation, and the FDA has issued specific warnings: the
maximum recommended dose is 40 mg/day (20 mg/day in patients over 60, those with hepatic impairment, or those
who are CYP2C19 poor metabolizers). A QTc interval exceeding 500 ms significantly increases the risk of torsades
de pointes, a potentially fatal ventricular arrhythmia. The appropriate action is to reduce the dose or switch to an
alternative antidepressant with less effect on cardiac conduction (such as sertraline or bupropion). Adding a
beta-blocker does not adequately address the underlying QTc prolongation risk.
Q9: A patient who has been taking paroxetine (Paxil) 40 mg daily for 2 years wishes to discontinue the
medication. The PMHNP explains the risk of antidepressant discontinuation syndrome. Which symptom
is most commonly associated with this syndrome?
A. Seizures
B. Hypertensive crisis
C. Visual hallucinations and delirium
D. Flu-like symptoms, dizziness, nausea, and electric shock sensations (brain zaps) [CORRECT]
Correct Answer: D
Page 3
