NR 546 PSYCHOPHARMACOLOGY
ADVANCED EXAM PREP QUESTIONS
AND ANSWERS
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia when overactive?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: Overactivity in the mesolimbic pathway is associated with
positive symptoms such as delusions and hallucinations. Conversely, underactivity in the
mesocortical pathway is linked to negative symptoms.
2. A patient taking an SSRI and Sumatriptan presents with hyperreflexia, agitation, and
diaphoresis. What is the most likely diagnosis?
A. Serotonin Syndrome
,B. Neuroleptic Malignant Syndrome
C. Anticholinergic Toxicity
D. Hypertensive Crisis
Answer: A
Conceptual Explanation: Serotonin syndrome results from excess serotonin; symptoms
include neuromuscular irritability (hyperreflexia, clonus) and autonomic instability.
Sumatriptan and SSRIs both increase serotonin activity.
3. Which lab value must be monitored most closely for a patient prescribed Clozapine?
A. Serum Creatinine
B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis. Strict
monitoring of the Absolute Neutrophil Count (ANC) is required via the REMS program.
4. A patient on Lithium reports increased thirst, frequent urination, and coarse hand tremors.
Her level is 1.8 mEq/L. What is the priority action?
A. Increase fluid intake and continue the dose
B. Hold the dose and evaluate for toxicity
, C. Add a beta-blocker for the tremor
D. Switch the patient to Valproate immediately
Answer: B
Conceptual Explanation: A lithium level of 1.8 mEq/L is above the therapeutic range
(typically 0.6-1.2 mEq/L). Coarse tremors and polyuria are signs of toxicity; the dose
should be held.
5. What is the mechanism of action of Bupropion?
A. Selective Serotonin Reuptake Inhibitor
B. Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)
C. Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)
D. Monoamine Oxidase Inhibitor
Answer: C
Conceptual Explanation: Bupropion inhibits the reuptake of norepinephrine and
dopamine, making it unique among antidepressants as it lacks significant serotonin
activity.
6. Which medication is most appropriate for a patient with ADHD and a history of substance
abuse?
A. Methylphenidate
B. Lisdexamfetamine
ADVANCED EXAM PREP QUESTIONS
AND ANSWERS
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia when overactive?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: Overactivity in the mesolimbic pathway is associated with
positive symptoms such as delusions and hallucinations. Conversely, underactivity in the
mesocortical pathway is linked to negative symptoms.
2. A patient taking an SSRI and Sumatriptan presents with hyperreflexia, agitation, and
diaphoresis. What is the most likely diagnosis?
A. Serotonin Syndrome
,B. Neuroleptic Malignant Syndrome
C. Anticholinergic Toxicity
D. Hypertensive Crisis
Answer: A
Conceptual Explanation: Serotonin syndrome results from excess serotonin; symptoms
include neuromuscular irritability (hyperreflexia, clonus) and autonomic instability.
Sumatriptan and SSRIs both increase serotonin activity.
3. Which lab value must be monitored most closely for a patient prescribed Clozapine?
A. Serum Creatinine
B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis. Strict
monitoring of the Absolute Neutrophil Count (ANC) is required via the REMS program.
4. A patient on Lithium reports increased thirst, frequent urination, and coarse hand tremors.
Her level is 1.8 mEq/L. What is the priority action?
A. Increase fluid intake and continue the dose
B. Hold the dose and evaluate for toxicity
, C. Add a beta-blocker for the tremor
D. Switch the patient to Valproate immediately
Answer: B
Conceptual Explanation: A lithium level of 1.8 mEq/L is above the therapeutic range
(typically 0.6-1.2 mEq/L). Coarse tremors and polyuria are signs of toxicity; the dose
should be held.
5. What is the mechanism of action of Bupropion?
A. Selective Serotonin Reuptake Inhibitor
B. Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)
C. Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)
D. Monoamine Oxidase Inhibitor
Answer: C
Conceptual Explanation: Bupropion inhibits the reuptake of norepinephrine and
dopamine, making it unique among antidepressants as it lacks significant serotonin
activity.
6. Which medication is most appropriate for a patient with ADHD and a history of substance
abuse?
A. Methylphenidate
B. Lisdexamfetamine
