NSG 552 Psychopharmacology Exam 2
Wilkes Actual 2026/2027 – Complete
Questions with Detailed Rationales |
100% Verified Answers – Pass
Guaranteed – A+ Graded INSTANT
DOWNLOAD
1. A patient with major depressive disorder has been on fluoxetine 20
mg daily for 6 weeks with minimal response. The provider considers
increasing the dose. Which CYP450 enzyme is primarily responsible for
fluoxetine metabolism, and what is a critical consideration when
increasing the dose?
A) CYP2D6; fluoxetine is a potent inhibitor, so dose increases may lead to
disproportionately higher levels
B) CYP3A4; fluoxetine is an inducer, so higher doses are usually required
C) CYP1A2; fluoxetine metabolism is rapid, so dose increases are safe
D) CYP2C9; fluoxetine has no significant drug interactions
Answer: A
Rationale: Fluoxetine and its active metabolite norfluoxetine are potent
CYP2D6 inhibitors. In patients who are poor metabolizers or taking other
CYP2D6 substrates, dose increases can lead to toxicity.
2. A 45-year-old patient with generalized anxiety disorder is started on
buspirone. The patient returns after 1 week stating, "This medication
isn't working at all." What is the most appropriate response?
A) "Buspirone can take 2–4 weeks to reach full efficacy; it is not a PRN
,medication."
B) "We should increase your dose immediately."
C) "Buspirone is not effective for GAD; we should switch to a
benzodiazepine."
D) "You should take it on an empty stomach for better absorption."
Answer: A
Rationale: Buspirone has a delayed onset of action (2–4 weeks) and is
ineffective as a PRN agent. Patients must be educated about this to prevent
premature discontinuation.
3. A patient on citalopram 40 mg daily for depression develops new-
onset QTc prolongation on an ECG. What is the most appropriate next
step?
A) Reduce citalopram to 20 mg daily
B) Add a potassium supplement
C) Switch to escitalopram at an equivalent dose
D) Obtain a baseline ECG before any changes
Answer: C
Rationale: The FDA warns that citalopram doses above 40 mg (20 mg in
elderly or hepatic impairment) cause dose-dependent QTc prolongation.
Escitalopram has a lower risk of QTc prolongation at therapeutic doses.
4. A patient abruptly stops paroxetine after 2 years of use. Which
symptom cluster is most consistent with antidepressant
discontinuation syndrome?
A) "Brain zaps," dizziness, nausea, and insomnia
B) Hypertensive crisis, diaphoresis, and tachycardia
,C) Muscle rigidity, hyperthermia, and confusion
D) Sedation, weight gain, and dry mouth
Answer: A
Rationale: Abrupt SSRI discontinuation (especially paroxetine and
venlafaxine) causes "brain zaps," flu-like symptoms, nausea, and insomnia
due to the sudden drop in synaptic serotonin.
5. Which benzodiazepine is safest for a patient with severe hepatic
cirrhosis requiring PRN anxiety management?
A) Diazepam
B) Lorazepam
C) Alprazolam
D) Chlordiazepoxide
Answer: B
Rationale: Lorazepam, oxazepam, and temazepam (the "OTL" drugs)
undergo glucuronidation outside the liver, making them safest in hepatic
impairment.
6. A patient with bipolar disorder on lithium maintenance presents
with tremor, nausea, and confusion. Serum lithium level is 1.8 mEq/L.
What is the priority intervention?
A) Hold lithium and check level again in 24 hours
B) Administer activated charcoal
C) Discontinue lithium and start hemodialysis
D) Increase fluid intake to 3 L/day
Answer: A
Rationale: Lithium levels >1.5 mEq/L indicate toxicity. Mild-to-moderate
, toxicity (1.5–2.5) is managed by holding the drug, rechecking levels, and
ensuring hydration. Hemodialysis is reserved for severe toxicity (>2.5) or
renal failure.
7. A patient on clozapine has an absolute neutrophil count (ANC) of
1100/mm³. What is the appropriate action per REMS guidelines?
A) Continue clozapine with weekly ANC monitoring
B) Hold clozapine and restart when ANC >1500
C) Discontinue clozapine permanently
D) Reduce clozapine dose by 50%
Answer: B
Rationale: Clozapine can be continued if ANC ≥1200/mm³. If ANC falls
between 1000–1199, it is held and restarted when ANC >1500. Permanent
discontinuation occurs if ANC drops below 500.
8. Which antidepressant is most likely to cause a false-positive urine
amphetamine screen?
A) Sertraline
B) Bupropion
C) Venlafaxine
D) Mirtazapine
Answer: B
Rationale: Bupropion is structurally similar to amphetamines and can
cross-react on immunoassay screens, causing false-positive results.
Wilkes Actual 2026/2027 – Complete
Questions with Detailed Rationales |
100% Verified Answers – Pass
Guaranteed – A+ Graded INSTANT
DOWNLOAD
1. A patient with major depressive disorder has been on fluoxetine 20
mg daily for 6 weeks with minimal response. The provider considers
increasing the dose. Which CYP450 enzyme is primarily responsible for
fluoxetine metabolism, and what is a critical consideration when
increasing the dose?
A) CYP2D6; fluoxetine is a potent inhibitor, so dose increases may lead to
disproportionately higher levels
B) CYP3A4; fluoxetine is an inducer, so higher doses are usually required
C) CYP1A2; fluoxetine metabolism is rapid, so dose increases are safe
D) CYP2C9; fluoxetine has no significant drug interactions
Answer: A
Rationale: Fluoxetine and its active metabolite norfluoxetine are potent
CYP2D6 inhibitors. In patients who are poor metabolizers or taking other
CYP2D6 substrates, dose increases can lead to toxicity.
2. A 45-year-old patient with generalized anxiety disorder is started on
buspirone. The patient returns after 1 week stating, "This medication
isn't working at all." What is the most appropriate response?
A) "Buspirone can take 2–4 weeks to reach full efficacy; it is not a PRN
,medication."
B) "We should increase your dose immediately."
C) "Buspirone is not effective for GAD; we should switch to a
benzodiazepine."
D) "You should take it on an empty stomach for better absorption."
Answer: A
Rationale: Buspirone has a delayed onset of action (2–4 weeks) and is
ineffective as a PRN agent. Patients must be educated about this to prevent
premature discontinuation.
3. A patient on citalopram 40 mg daily for depression develops new-
onset QTc prolongation on an ECG. What is the most appropriate next
step?
A) Reduce citalopram to 20 mg daily
B) Add a potassium supplement
C) Switch to escitalopram at an equivalent dose
D) Obtain a baseline ECG before any changes
Answer: C
Rationale: The FDA warns that citalopram doses above 40 mg (20 mg in
elderly or hepatic impairment) cause dose-dependent QTc prolongation.
Escitalopram has a lower risk of QTc prolongation at therapeutic doses.
4. A patient abruptly stops paroxetine after 2 years of use. Which
symptom cluster is most consistent with antidepressant
discontinuation syndrome?
A) "Brain zaps," dizziness, nausea, and insomnia
B) Hypertensive crisis, diaphoresis, and tachycardia
,C) Muscle rigidity, hyperthermia, and confusion
D) Sedation, weight gain, and dry mouth
Answer: A
Rationale: Abrupt SSRI discontinuation (especially paroxetine and
venlafaxine) causes "brain zaps," flu-like symptoms, nausea, and insomnia
due to the sudden drop in synaptic serotonin.
5. Which benzodiazepine is safest for a patient with severe hepatic
cirrhosis requiring PRN anxiety management?
A) Diazepam
B) Lorazepam
C) Alprazolam
D) Chlordiazepoxide
Answer: B
Rationale: Lorazepam, oxazepam, and temazepam (the "OTL" drugs)
undergo glucuronidation outside the liver, making them safest in hepatic
impairment.
6. A patient with bipolar disorder on lithium maintenance presents
with tremor, nausea, and confusion. Serum lithium level is 1.8 mEq/L.
What is the priority intervention?
A) Hold lithium and check level again in 24 hours
B) Administer activated charcoal
C) Discontinue lithium and start hemodialysis
D) Increase fluid intake to 3 L/day
Answer: A
Rationale: Lithium levels >1.5 mEq/L indicate toxicity. Mild-to-moderate
, toxicity (1.5–2.5) is managed by holding the drug, rechecking levels, and
ensuring hydration. Hemodialysis is reserved for severe toxicity (>2.5) or
renal failure.
7. A patient on clozapine has an absolute neutrophil count (ANC) of
1100/mm³. What is the appropriate action per REMS guidelines?
A) Continue clozapine with weekly ANC monitoring
B) Hold clozapine and restart when ANC >1500
C) Discontinue clozapine permanently
D) Reduce clozapine dose by 50%
Answer: B
Rationale: Clozapine can be continued if ANC ≥1200/mm³. If ANC falls
between 1000–1199, it is held and restarted when ANC >1500. Permanent
discontinuation occurs if ANC drops below 500.
8. Which antidepressant is most likely to cause a false-positive urine
amphetamine screen?
A) Sertraline
B) Bupropion
C) Venlafaxine
D) Mirtazapine
Answer: B
Rationale: Bupropion is structurally similar to amphetamines and can
cross-react on immunoassay screens, causing false-positive results.
