Nr 546 Final Exam Study Guide 2026 | Advanced Psychopharmacology Pmhnp Q&A

NR 546 FINAL EXAM STUDY GUIDE 2026 |
ADVANCED PSYCHOPHARMACOLOGY
PMHNP Q&A
NR 546 FINAL EXAM STUDY GUIDE 2026

ADVANCED PSYCHOPHARMACOLOGY PMHNP Q&A



DOCUMENT OVERVIEW

• Comprehensive Question Study Guide: Designed to thoroughly prepare PMHNP
students for the NR 546 Final Exam covering all major pharmacological principles,
drug classifications, mechanisms of action, clinical applications, and advanced
therapeutic strategies in psychopharmacology.

• Strategic Study Tool: Features well-spaced multiple-choice questions with
detailed rationales to reinforce critical thinking, evidence-based practice, and
clinical decision-making skills essential for safe and effective prescribing in
psychiatric and mental health practice.




QUESTIONS AND ANSWERS



QUESTION 1: A 35-year-old patient with major depressive disorder has been
on sertraline 100 mg daily for 8 weeks without adequate response. The
PMHNP considers augmentation therapy. Which of the following is considered
a first-line augmentation strategy for SSRI non-response?

A) Adding an MAOI immediately without tapering the SSRI

B) Switching to a different SSRI at a lower dose

C) Augmenting with low-dose aripiprazole

D) Adding herbal supplements such as St. John's Wort

E) Discontinuing the SSRI and starting bupropion monotherapy

,___________________________________________________________

CORRECT ANSWER: C) Augmenting with low-dose aripiprazole

RATIONALE: Augmentation with low-dose aripiprazole (typically 2-5 mg daily) is an
FDA-approved and evidence-based first-line augmentation strategy for SSRI non-
response in major depressive disorder. Multiple randomized controlled trials
demonstrate significant efficacy when aripiprazole is added to an SSRI that has
been given an adequate trial (minimum 4-6 weeks at therapeutic dose). This
approach maintains the SSRI while targeting dopamine D2 receptors, providing
synergistic antidepressant effects. Option A is dangerous due to serotonin
syndrome risk. Option B typically fails if the first SSRI was adequately dosed. Option
D may interact with SSRIs and has limited evidence. Option E abandons a partially
effective medication without adequate optimization.




QUESTION 2: Which neurotransmitter system is primarily affected by tricyclic
antidepressants (TCAs)?

A) Predominantly serotonin with minimal norepinephrine effects

B) Both norepinephrine and serotonin through reuptake inhibition, plus
anticholinergic effects

C) GABA and glutamate exclusively

D) Dopamine and acetylcholine only

E) Histamine and substance P exclusively

___________________________________________________________

CORRECT ANSWER: B) Both norepinephrine and serotonin through reuptake
inhibition, plus anticholinergic effects

RATIONALE: Tricyclic antidepressants work by blocking the reuptake of both
norepinephrine and serotonin at presynaptic terminals, leading to increased
concentrations of these neurotransmitters in the synaptic cleft. Additionally, TCAs

,have significant anticholinergic properties due to blockade of muscarinic cholinergic
receptors, which accounts for many of their side effects (dry mouth, urinary
retention, constipation, tachycardia). They also have significant cardiotoxicity and
are less commonly used as first-line agents. The dual action on both monoamines
distinguishes them from SSRIs. Options A, C, D, and E do not accurately represent
the primary mechanisms of action of TCAs.




QUESTION 3: A 28-year-old patient with generalized anxiety disorder has been
prescribed buspirone 15 mg three times daily. What is the primary
mechanism of action of buspirone?

A) GABA-A receptor agonism

B) 5-HT1A receptor partial agonism

C) Benzodiazepine receptor binding

D) Norepinephrine reuptake inhibition

E) Acetylcholinesterase inhibition

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CORRECT ANSWER: B) 5-HT1A receptor partial agonism

RATIONALE: Buspirone is an azapirone anxiolytic that works as a partial agonist at
serotonin 5-HT1A receptors, both presynaptically and postsynaptically. This
mechanism is distinct from benzodiazepines and does not involve GABA-A receptor
binding. Buspirone has minimal abuse potential, does not cause sedation, has no
muscle relaxant properties, and shows less interaction with alcohol compared to
benzodiazepines. It is particularly useful in patients with substance use disorder
history or those requiring alertness. The delayed onset of action (2-4 weeks)
requires patient education about the need for patience during treatment initiation.
Options A, C, D, and E represent mechanisms of other classes of anxiolytics but not
buspirone.

, QUESTION 4: A 42-year-old patient with bipolar I disorder currently taking
lithium 900 mg daily presents with tremor, muscle weakness, and confusion.
Laboratory results show lithium level of 2.1 mEq/L. What is the immediate
nursing intervention?

A) Increase lithium dose to achieve therapeutic levels

B) Hold lithium immediately and assess for dehydration and renal function

C) Continue current dose and monitor closely for 24 hours

D) Add a beta-blocker to manage tremor symptoms

E) Switch to valproic acid without tapering lithium

___________________________________________________________

CORRECT ANSWER: B) Hold lithium immediately and assess for dehydration
and renal function

RATIONALE: The patient is presenting with classic signs of lithium toxicity. The
therapeutic range for lithium is 0.5-1.2 mEq/L for maintenance, and levels above 1.5
mEq/L are considered toxic. A level of 2.1 mEq/L confirms acute lithium toxicity
requiring immediate intervention. The PMHNP must discontinue lithium, check
renal function and hydration status, and monitor electrolytes. Mild dehydration
from any cause (vomiting, diarrhea, excessive sweating, decreased fluid intake) can
precipitate toxicity. Treatment involves IV hydration, and in severe cases,
hemodialysis may be necessary. Options A and C would worsen the toxic state.
Option D addresses symptoms without addressing the underlying problem. Option
E abandons the therapeutic agent without proper management of acute toxicity.




QUESTION 5: Which selective serotonin reuptake inhibitor (SSRI) has the
longest half-life and is therefore safest in terms of discontinuation syndrome
risk?