NSG 552 Psychopharmacology
Examination 1
Complete Guide with Verified Answers
Wilkes University Passan School of Nursing
2026-2027 Curriculum | Advanced Practice Psychiatric Nursing
75 Questions | 100% Correct Answers | Comprehensive Rationales
Cognitive Levels 25% Recall | 55% Application | 20% Analysis
Format 70% Scenario-based | 20% Direct Recall | 10% NGN-Style
6 Sections: Neurobiology, Pharmacokinetics, Antidepressants, Mood
Sections
Stabilizers, Clinical Applications, NGN Scenarios
,Section 1: Neurobiology and Neurotransmission
Q1: A psychiatric NP is explaining synaptic transmission to a nursing student. Which sequence correctly
describes the process of neurotransmission at the synapse?
A. Neurotransmitter release -> action potential -> receptor binding -> reuptake
B. Action potential -> neurotransmitter release -> receptor binding -> postsynaptic response -> reuptake or
enzymatic degradation [CORRECT]
C. Receptor binding -> action potential -> neurotransmitter release -> enzymatic degradation
D. Postsynaptic response -> neurotransmitter release -> receptor binding -> action potential
Correct Answer: B
Rationale: Correct synaptic transmission sequence: action potential travels down the axon, triggering calcium influx
and vesicular neurotransmitter release into the synaptic cleft. Neurotransmitter binds to postsynaptic receptors,
generating a response. Signal termination occurs through reuptake (SERT, DAT, NET) or enzymatic degradation
(MAO, COMT). All other options present physiologically impossible or reversed sequences.
Q2: Which neurotransmitter is synthesized from tryptophan and originates from the raphe nuclei, projecting to
the cortex, limbic system, and hypothalamus?
A. Dopamine
B. Norepinephrine
C. Serotonin (5-HT) [CORRECT]
D. Gamma-aminobutyric acid (GABA)
Correct Answer: C
Rationale: Serotonin (5-HT) is synthesized from tryptophan via tryptophan hydroxylase and aromatic L-amino acid
decarboxylase. Cell bodies are in the raphe nuclei, projecting to cortex, limbic system, and hypothalamus. It regulates
mood, sleep, appetite, pain, aggression, and sexual behavior. Dopamine is from tyrosine. Norepinephrine is from
dopamine. GABA is from glutamate.
Q3: A patient with Parkinson's disease exhibits tremor, bradykinesia, and rigidity. Degeneration of which
dopaminergic pathway is responsible?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway [CORRECT]
D. Tuberoinfundibular pathway
Correct Answer: C
Rationale: The nigrostriatal pathway (substantia nigra to striatum) controls motor planning and execution. Its
degeneration causes Parkinson's motor symptoms. The mesolimbic (VTA to nucleus accumbens) mediates reward,
implicated in psychosis and addiction. The mesocortical (VTA to prefrontal cortex) mediates cognition. The
tuberoinfundibular (hypothalamus to pituitary) inhibits prolactin.
Q4: Which receptor type is a ligand-gated ion channel that is the primary target of benzodiazepines?
A. GABA-A receptor [CORRECT]
B. GABA-B receptor
C. 5-HT2A receptor
D. Muscarinic acetylcholine receptor
, Correct Answer: A
Rationale: GABA-A is an ionotropic (ligand-gated ion channel) receptor. When GABA binds, chloride influx
hyperpolarizes the neuron. Benzodiazepines are positive allosteric modulators at GABA-A, enhancing GABA's
inhibitory effect. GABA-B is metabotropic (G-protein coupled). 5-HT2A and muscarinic receptors are also
metabotropic, not ionotropic.
Q5: Blockade of D2 receptors in which pathway is most associated with extrapyramidal symptoms (EPS)?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway [CORRECT]
D. Mesocortical pathway
Correct Answer: C
Rationale: D2 blockade in the nigrostriatal pathway disrupts dopaminergic motor regulation, causing EPS: acute
dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia. Mesolimbic D2 blockade is therapeutic (reduces
positive symptoms). Tuberoinfundibular D2 blockade causes hyperprolactinemia. Mesocortical D2 blockade may
worsen negative symptoms.
Q6: Norepinephrine is synthesized from dopamine through which enzyme, and originates primarily from
which brain structure?
A. Tryptophan hydroxylase; raphe nuclei
B. Dopamine beta-hydroxylase; locus coeruleus [CORRECT]
C. Monoamine oxidase (MAO); substantia nigra
D. Catechol-O-methyltransferase (COMT); VTA
Correct Answer: B
Rationale: NE is synthesized from dopamine via dopamine beta-hydroxylase (DBH) within synaptic vesicles.
Noradrenergic cell bodies are in the locus coeruleus, projecting to cortex, limbic system, and hypothalamus. NE
regulates arousal, attention, mood, and fight-or-flight via alpha-1, alpha-2, beta-1, and beta-2 receptors.
Q7: Overactivation of which glutamate receptor subtype is most associated with neuronal excitotoxicity?
A. AMPA receptor
B. Kainate receptor
C. NMDA receptor [CORRECT]
D. Metabotropic glutamate receptor 1
Correct Answer: C
Rationale: NMDA receptors are highly calcium-permeable. Excessive activation causes pathologic calcium influx,
triggering excitotoxic cascades: free radicals, mitochondrial dysfunction, and apoptosis. This is implicated in stroke,
TBI, and neurodegenerative diseases. Normal NMDA activation is essential for learning and memory (LTP). AMPA
and kainate are primarily sodium-permeable. Metabotropic receptors are G-protein coupled.
Q8: A medication acting as a partial agonist at the 5-HT1A receptor would most likely produce which effect?
A. Increased prolactin secretion
B. Anxiolysis and antidepressant effects [CORRECT]
C. Extrapyramidal symptoms
D. Sedation and muscle relaxation
Correct Answer: B
Examination 1
Complete Guide with Verified Answers
Wilkes University Passan School of Nursing
2026-2027 Curriculum | Advanced Practice Psychiatric Nursing
75 Questions | 100% Correct Answers | Comprehensive Rationales
Cognitive Levels 25% Recall | 55% Application | 20% Analysis
Format 70% Scenario-based | 20% Direct Recall | 10% NGN-Style
6 Sections: Neurobiology, Pharmacokinetics, Antidepressants, Mood
Sections
Stabilizers, Clinical Applications, NGN Scenarios
,Section 1: Neurobiology and Neurotransmission
Q1: A psychiatric NP is explaining synaptic transmission to a nursing student. Which sequence correctly
describes the process of neurotransmission at the synapse?
A. Neurotransmitter release -> action potential -> receptor binding -> reuptake
B. Action potential -> neurotransmitter release -> receptor binding -> postsynaptic response -> reuptake or
enzymatic degradation [CORRECT]
C. Receptor binding -> action potential -> neurotransmitter release -> enzymatic degradation
D. Postsynaptic response -> neurotransmitter release -> receptor binding -> action potential
Correct Answer: B
Rationale: Correct synaptic transmission sequence: action potential travels down the axon, triggering calcium influx
and vesicular neurotransmitter release into the synaptic cleft. Neurotransmitter binds to postsynaptic receptors,
generating a response. Signal termination occurs through reuptake (SERT, DAT, NET) or enzymatic degradation
(MAO, COMT). All other options present physiologically impossible or reversed sequences.
Q2: Which neurotransmitter is synthesized from tryptophan and originates from the raphe nuclei, projecting to
the cortex, limbic system, and hypothalamus?
A. Dopamine
B. Norepinephrine
C. Serotonin (5-HT) [CORRECT]
D. Gamma-aminobutyric acid (GABA)
Correct Answer: C
Rationale: Serotonin (5-HT) is synthesized from tryptophan via tryptophan hydroxylase and aromatic L-amino acid
decarboxylase. Cell bodies are in the raphe nuclei, projecting to cortex, limbic system, and hypothalamus. It regulates
mood, sleep, appetite, pain, aggression, and sexual behavior. Dopamine is from tyrosine. Norepinephrine is from
dopamine. GABA is from glutamate.
Q3: A patient with Parkinson's disease exhibits tremor, bradykinesia, and rigidity. Degeneration of which
dopaminergic pathway is responsible?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway [CORRECT]
D. Tuberoinfundibular pathway
Correct Answer: C
Rationale: The nigrostriatal pathway (substantia nigra to striatum) controls motor planning and execution. Its
degeneration causes Parkinson's motor symptoms. The mesolimbic (VTA to nucleus accumbens) mediates reward,
implicated in psychosis and addiction. The mesocortical (VTA to prefrontal cortex) mediates cognition. The
tuberoinfundibular (hypothalamus to pituitary) inhibits prolactin.
Q4: Which receptor type is a ligand-gated ion channel that is the primary target of benzodiazepines?
A. GABA-A receptor [CORRECT]
B. GABA-B receptor
C. 5-HT2A receptor
D. Muscarinic acetylcholine receptor
, Correct Answer: A
Rationale: GABA-A is an ionotropic (ligand-gated ion channel) receptor. When GABA binds, chloride influx
hyperpolarizes the neuron. Benzodiazepines are positive allosteric modulators at GABA-A, enhancing GABA's
inhibitory effect. GABA-B is metabotropic (G-protein coupled). 5-HT2A and muscarinic receptors are also
metabotropic, not ionotropic.
Q5: Blockade of D2 receptors in which pathway is most associated with extrapyramidal symptoms (EPS)?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway [CORRECT]
D. Mesocortical pathway
Correct Answer: C
Rationale: D2 blockade in the nigrostriatal pathway disrupts dopaminergic motor regulation, causing EPS: acute
dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia. Mesolimbic D2 blockade is therapeutic (reduces
positive symptoms). Tuberoinfundibular D2 blockade causes hyperprolactinemia. Mesocortical D2 blockade may
worsen negative symptoms.
Q6: Norepinephrine is synthesized from dopamine through which enzyme, and originates primarily from
which brain structure?
A. Tryptophan hydroxylase; raphe nuclei
B. Dopamine beta-hydroxylase; locus coeruleus [CORRECT]
C. Monoamine oxidase (MAO); substantia nigra
D. Catechol-O-methyltransferase (COMT); VTA
Correct Answer: B
Rationale: NE is synthesized from dopamine via dopamine beta-hydroxylase (DBH) within synaptic vesicles.
Noradrenergic cell bodies are in the locus coeruleus, projecting to cortex, limbic system, and hypothalamus. NE
regulates arousal, attention, mood, and fight-or-flight via alpha-1, alpha-2, beta-1, and beta-2 receptors.
Q7: Overactivation of which glutamate receptor subtype is most associated with neuronal excitotoxicity?
A. AMPA receptor
B. Kainate receptor
C. NMDA receptor [CORRECT]
D. Metabotropic glutamate receptor 1
Correct Answer: C
Rationale: NMDA receptors are highly calcium-permeable. Excessive activation causes pathologic calcium influx,
triggering excitotoxic cascades: free radicals, mitochondrial dysfunction, and apoptosis. This is implicated in stroke,
TBI, and neurodegenerative diseases. Normal NMDA activation is essential for learning and memory (LTP). AMPA
and kainate are primarily sodium-permeable. Metabotropic receptors are G-protein coupled.
Q8: A medication acting as a partial agonist at the 5-HT1A receptor would most likely produce which effect?
A. Increased prolactin secretion
B. Anxiolysis and antidepressant effects [CORRECT]
C. Extrapyramidal symptoms
D. Sedation and muscle relaxation
Correct Answer: B
