NSG 552 / NSG 552 Exam 2 (Latest )
Psychopharmacology | Grade A Questions and Verified Answers | 100% Correct
Wilkes University - Nesbitt School of Pharmacy
Advanced Practice Psychiatric Nursing Education
100 Questions | 6 Sections | Comprehensive Rationales
Total Questions 100 (Multiple Choice, A-D)
6 Sections (Antidepressants, Mood Stabilizers, Antipsychotics, Anxiolytics,
Sections
Pharmacokinetics, Clinical Scenarios)
Cognitive Levels 20% Recall | 55% Application | 25% Analysis
Format 70% Scenario-based | 20% Direct Recall | 10% Clinical Judgment
Section 1: Antidepressant Pharmacology (SSRIs, SNRIs, TCAs, MAOIs,
Atypical)
Q1: A 28-year-old patient with major depressive disorder (MDD) is prescribed fluoxetine (Prozac). The
psychiatric-mental health nurse practitioner explains the mechanism of action. Which statement best
describes how fluoxetine exerts its therapeutic effect?
A. Blocks the reuptake of serotonin and norepinephrine at the synaptic cleft
B. Blocks the reuptake of serotonin at the synaptic cleft, increasing serotonergic neurotransmission
[CORRECT]
C. Inhibits monoamine oxidase enzymes, increasing synaptic monoamine levels
D. Acts as a partial agonist at the 5-HT1A receptor while inhibiting serotonin reuptake
Correct Answer: B
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that selectively blocks the reuptake of serotonin at the
synaptic cleft, thereby increasing serotonergic neurotransmission. Option A describes SNRIs, not SSRIs. Option C describes
MAOIs. Option D describes vilazodone, which has dual mechanisms (SRI + 5-HT1A partial agonism). Fluoxetine is also a potent
CYP2D6 inhibitor, which is clinically significant for drug interactions. Per Wilkes University NSG 552 curriculum,
understanding the distinct mechanisms of each antidepressant class is foundational to prescribing.
Q2: A 35-year-old woman with obsessive-compulsive disorder (OCD) is started on fluvoxamine (Luvox).
She reports that her roommate takes sertraline for depression. The nurse practitioner should explain that
fluvoxamine has a unique role among SSRIs. Which of the following is most accurate regarding
fluvoxamine?
A. It is the only SSRI FDA-approved for OCD in adults
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,NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026/2027 Grade A Questions and Verified Answers
B. It is a potent CYP1A2 inhibitor that requires careful attention to drug interactions [CORRECT]
C. It has a significantly longer half-life than other SSRIs, requiring a 5-6 week washout
D. It is preferred in pregnancy due to its favorable reproductive safety profile
Correct Answer: B
Rationale: Fluvoxamine is a potent CYP1A2 inhibitor, which distinguishes it from other SSRIs and has significant drug
interaction implications. CYP1A2 metabolizes clozapine, olanzapine, and theophylline, so fluvoxamine can dramatically increase
levels of these medications. Option A is incorrect because multiple SSRIs (fluoxetine, sertraline, paroxetine, fluvoxamine) are
FDA-approved for OCD. Option C describes fluoxetine, which has a very long half-life due to its active metabolite norfluoxetine.
Option D is incorrect; sertraline is generally the preferred SSRI in pregnancy. Per Wilkes NSG 552, CYP450 enzyme interactions
are a critical prescribing competency.
Q3: A psychiatric nurse practitioner is considering citalopram (Celexa) for a 50-year-old patient with
MDD and mild renal impairment. What is the most important prescribing consideration for this patient?
A. The maximum recommended dose is 20 mg/day due to renal impairment
B. The maximum recommended dose is 40 mg/day (60 mg/day only in young healthy patients) due to QTc
prolongation risk [CORRECT]
C. Citalopram should be avoided entirely in patients over age 40
D. Citalopram requires weekly CBC monitoring due to risk of agranulocytosis
Correct Answer: B
Rationale: Citalopram has a well-documented risk of dose-dependent QTc prolongation. The FDA recommends a maximum dose
of 40 mg/day in most patients, with 20 mg/day in patients who are elderly, have hepatic impairment, or are taking concurrent
CYP2C19 inhibitors. The 60 mg/day dose is no longer recommended. This is a critical safety consideration that distinguishes
citalopram from other SSRIs like escitalopram, which has a more favorable cardiac profile. Per Wilkes NSG 552, knowledge of
dose limits and QTc risk is essential for safe prescribing.
Q4: A 22-year-old college student with panic disorder has been taking paroxetine (Paxil) for 6 months and
wishes to discontinue due to sexual dysfunction side effects. The nurse practitioner plans a tapering
schedule. Which statement is most accurate regarding paroxetine discontinuation?
A. Paroxetine can be stopped abruptly since it has a long half-life
B. Paroxetine has a short half-life and is associated with a higher risk of discontinuation syndrome
including dizziness, paresthesias (brain zaps), nausea, and dysphoria [CORRECT]
C. Discontinuation syndrome only occurs with SSRIs that have strong CYP2D6 inhibition
D. Paroxetine discontinuation syndrome is best managed by switching directly to an MAOI
Correct Answer: B
Rationale: Paroxetine has a relatively short half-life and is the SSRI most associated with antidepressant discontinuation
syndrome due to its anticholinergic properties and short half-life. Symptoms include dizziness, nausea, paresthesias (brain zaps),
insomnia, and dysphoria. Gradual tapering over weeks is recommended. Option A is incorrect because paroxetine has one of the
shortest half-lives among SSRIs. Option C is factually wrong; discontinuation syndrome relates to half-life, not CYP inhibition.
Option D is dangerous because switching directly to an MAOI without adequate washout risks serotonin syndrome. Per Wilkes
NSG 552, understanding discontinuation syndromes and safe tapering protocols is a core clinical competency.
Q5: A 30-year-old patient with MDD is prescribed sertraline (Zoloft). The nurse practitioner educates the
patient about the FDA black box warning. Which of the following statements accurately reflects the black
box warning for SSRIs?
A. SSRIs carry a black box warning for increased risk of suicidal ideation and behavior in children,
adolescents, and young adults (up to age 24) [CORRECT]
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,NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026/2027 Grade A Questions and Verified Answers
B. SSRIs carry a black box warning for increased risk of completed suicide in all age groups
C. The black box warning applies only to children under age 12
D. The black box warning was removed by the FDA in 2020 due to new evidence
Correct Answer: A
Rationale: SSRIs carry an FDA black box warning for increased risk of suicidal ideation and behavior in children, adolescents,
and young adults up to age 24. Patients in these age groups should be monitored closely, especially during the first 1-2 months of
treatment and during dose adjustments. The warning does not state increased risk of completed suicide (Option B), is not limited
to children under 12 (Option C), and has not been removed (Option D). This warning is a fundamental prescribing consideration
taught in the Wilkes NSG 552 psychopharmacology curriculum and is essential knowledge for advanced practice psychiatric
nurses.
Q6: A 40-year-old patient taking fluoxetine (Prozac) 60 mg daily for treatment-resistant depression is
being considered for a switch to phenelzine (Nardil), an MAOI. How long must the nurse practitioner wait
after stopping fluoxetine before initiating phenelzine?
A. 5 days
B. 14 days
C. 5 weeks [CORRECT]
D. 7 days
Correct Answer: C
Rationale: Due to its long half-life and the long half-life of its active metabolite norfluoxetine (4-16 days), fluoxetine requires a
5-week washout period before starting an MAOI. This is significantly longer than the standard 14-day washout required for most
other SSRIs (which is already longer than the 2-week washout for non-serotonergic drugs). Initiating an MAOI too soon after an
SSRI risks life-threatening serotonin syndrome. This is a critical drug interaction safety point emphasized throughout the Wilkes
NSG 552 psychopharmacology curriculum.
Q7: A 45-year-old woman with GAD and comorbid MDD is prescribed escitalopram (Lexapro). She asks
why this medication was chosen over citalopram, which her friend takes. What is the most accurate
response?
A. Escitalopram is the S-enantiomer of citalopram and has a lower risk of QTc prolongation at
therapeutic doses [CORRECT]
B. Escitalopram has a dual mechanism affecting both serotonin and norepinephrine
C. Escitalopram is significantly more effective than citalopram for all patients
D. Escitalopram does not cause sexual dysfunction, unlike citalopram
Correct Answer: A
Rationale: Escitalopram is the S-enantiomer of citalopram and is the active stereoisomer responsible for the antidepressant
effect. It has a more favorable cardiac safety profile than citalopram, with less QTc prolongation at therapeutic doses. The
maximum dose of escitalopram is 20 mg/day, compared to the restricted 40 mg/day maximum for citalopram. Both are SSRIs
with similar efficacy and side effect profiles, including sexual dysfunction. Option B describes SNRIs. Option C is an
overstatement; studies show modest differences. Option D is incorrect because both cause sexual dysfunction. Per Wilkes NSG
552, understanding stereochemistry and its clinical implications is part of advanced pharmacology education.
Q8: A 25-year-old patient with premenstrual dysphoric disorder (PMDD) is being treated
pharmacologically. Which SSRI has FDA approval for continuous daily dosing for PMDD and can also be
dosed intermittently (luteal phase only)?
A. Sertraline (Zoloft) [CORRECT]
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, NSG 552 Exam 2 | Psychopharmacology | Wilkes University 2026/2027 Grade A Questions and Verified Answers
B. Paroxetine (Paxil)
C. Fluoxetine (Prozac)
D. Fluvoxamine (Luvox)
Correct Answer: A
Rationale: Sertraline is FDA-approved for PMDD and is unique in that it can be dosed continuously or intermittently (luteal
phase only, starting 14 days before menses). Fluoxetine is also approved for PMDD but for continuous daily dosing. This
intermittent dosing option is clinically valuable as it reduces total medication exposure. Per Wilkes NSG 552, knowledge of
FDA-approved indications and flexible dosing strategies for specific SSRIs is important for evidence-based prescribing in
women's mental health.
Q9: A nurse practitioner is reviewing a patient's medication list and notes the patient takes St. John's
Wort for mood and was recently prescribed sertraline. What is the most critical concern regarding this
combination?
A. Reduced efficacy of sertraline due to CYP induction
B. Increased risk of serotonin syndrome due to additive serotonergic effects [CORRECT]
C. Increased risk of QTc prolongation
D. Increased risk of lithium toxicity
Correct Answer: B
Rationale: St. John's Wort has serotonergic activity and, when combined with SSRIs, significantly increases the risk of serotonin
syndrome, a potentially life-threatening condition characterized by hyperthermia, autonomic instability, clonus, and altered
mental status. St. John's Wort also induces CYP3A4 and CYP2C9, which can reduce levels of other medications, but the serotonin
syndrome risk is the most critical immediate concern. Per Wilkes NSG 552, identifying serotonergic drug combinations that
increase serotonin syndrome risk is a fundamental safety competency. Other dangerous combinations include SSRI + MAOI,
SSRI + tramadol, and SSRI + linezolid.
Q10: A 38-year-old patient with social anxiety disorder (SAD) is started on paroxetine (Paxil). The nurse
practitioner should counsel the patient about which unique side effect concern associated with paroxetine
compared to other SSRIs?
A. Paroxetine has the highest rate of sexual dysfunction among SSRIs due to strong anticholinergic
properties [CORRECT]
B. Paroxetine is more likely to cause weight loss than other SSRIs
C. Paroxetine has a significantly lower risk of discontinuation syndrome
D. Paroxetine does not inhibit any CYP450 enzymes
Correct Answer: A
Rationale: Paroxetine is considered the SSRI with the highest rate of sexual dysfunction, which is attributed to its potent
anticholinergic properties and strong CYP2D6 inhibition. Paroxetine is also the most anticholinergic SSRI, contributing to
additional side effects such as dry mouth, constipation, and sedation. Unlike other SSRIs, paroxetine tends to cause weight gain
rather than weight loss or neutrality. It also has the highest risk of discontinuation syndrome among SSRIs due to its short
half-life and anticholinergic properties. Per Wilkes NSG 552, differentiating SSRI side effect profiles is critical for medication
selection and patient education.
Q11: A 50-year-old patient with MDD, diabetic neuropathy, and generalized anxiety disorder is being
evaluated for pharmacotherapy. Which medication would address all three conditions?
A. Fluoxetine (Prozac)
B. Duloxetine (Cymbalta) [CORRECT]
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