NSG 552
EXAM 2
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
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➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
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Get the Complete PDF After Purchase
NSG 552 EXAM 2 - PSYCHOPHARMACOLOGY
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 552 Exam 2 .................................................... 2
NSG 552 Exam 2 Study Guide ............................. 45
NSG 552 Exam 2
Question 1 [Case-Based Scenario]
A 22-year-old female with Anorexia Nervosa is admitted to an inpatient
psychiatric unit. She reports severe anxiety before meals and refuses to eat
due to intense fear of weight gain. The psychiatrist considers pharmacologic
intervention. Which medication is most appropriate to administer as a pre-
meal anxiolytic to decrease anticipatory anxiety?
• A. Fluoxetine 20 mg daily
• B. Lorazepam 0.5 mg PRN before meals
• C. Olanzapine 5 mg daily
• D. Buspirone 10 mg BID
Correct Answer: B. Lorazepam 0.5 mg PRN before meals
Rationale: Lorazepam is a short-acting benzodiazepine commonly used as a pre-
meal anxiolytic in Anorexia Nervosa to reduce anticipatory anxiety. It has a rapid
onset and can be given PRN. SSRIs like fluoxetine take weeks to work and are not
appropriate for acute anxiety. Olanzapine is used for severe preoccupation with
weight and food, not acute anxiety. Buspirone has a slow onset and is not useful for
PRN anxiety relief.
,Question 2 [Select All That Apply (SATA)]
A 19-year-old female with Anorexia Nervosa has been hospitalized for severe
malnutrition and obsessive preoccupation with food and body weight. Her
BMI is 14.2. The treatment team is considering pharmacologic options. Select
all that apply regarding appropriate medication management for this patient.
• A. Olanzapine may be prescribed to reduce severe preoccupation with weight
and food
• B. Fluoxetine is FDA-approved for Anorexia Nervosa
• C. A pre-meal benzodiazepine such as lorazepam may reduce anticipatory
anxiety
• D. Bupropion is contraindicated due to seizure risk in malnourished patients
• E. Mirtazapine is first-line for weight restoration in Anorexia Nervosa
Correct Answer: A, C, D
Rationale: Olanzapine (A) is used off-label for severe preoccupation with weight
and food in Anorexia Nervosa. A pre-meal benzodiazepine like lorazepam (C) can
help with anticipatory anxiety. Bupropion (D) is contraindicated in eating disorders
due to increased seizure risk, especially in malnourished patients. Fluoxetine (B) is
NOT FDA-approved for Anorexia Nervosa—it is approved for Bulimia Nervosa.
Mirtazapine (E) is not first-line for weight restoration, though it may be used
adjunctively.
Question 3 [Single Best Answer]
Which of the following medications is FDA-approved for the treatment of
Bulimia Nervosa?
• A. Sertraline (Zoloft)
• B. Fluoxetine (Prozac)
• C. Venlafaxine (Effexor)
• D. Bupropion (Wellbutrin)
Correct Answer: B. Fluoxetine (Prozac)
Rationale: Fluoxetine (Prozac) is the only FDA-approved medication for Bulimia
Nervosa. It is typically prescribed at higher doses (60 mg/day). Bupropion is
contraindicated in eating disorders due to seizure risk.
,Question 4 [Case-Based Scenario]
A 28-year-old male presents with recurrent episodes of binge eating followed
by purging behaviors. He reports feelings of shame and guilt. His vital signs
are stable, and his BMI is within normal range. Which combination represents
the most evidence-based treatment approach?
• A. Fluoxetine monotherapy only
• B. CBT-E plus fluoxetine
• C. Olanzapine plus dietary counseling
• D. Bupropion plus interpersonal therapy
Correct Answer: B. CBT-E plus fluoxetine
Rationale: The gold standard treatment for Bulimia Nervosa is Cognitive Behavioral
Therapy (CBT-E) combined with fluoxetine, the FDA-approved medication. CBT
addresses the behavioral and cognitive components, while fluoxetine targets
depressive and obsessive symptoms. Olanzapine is not indicated for bulimia.
Bupropion is contraindicated.
Question 5 [Single Best Answer]
What is the first-line treatment for Binge Eating Disorder (BED)?
• A. Lisdexamfetamine (Vyvanse)
• B. Cognitive Behavioral Therapy (CBT-E/CBT-BED)
• C. Fluoxetine (Prozac)
• D. Orlistat (Alli)
Correct Answer: B. Cognitive Behavioral Therapy (CBT-E/CBT-BED)
Rationale: CBT-E/CBT-BED is the first-line treatment for Binge Eating Disorder.
While lisdexamfetamine is FDA-approved for BED, psychotherapy remains the
initial treatment of choice. Medications are considered when psychotherapy alone is
insufficient.
Question 6 [Single Best Answer]
Which stimulant medication is FDA-approved for the treatment of Binge
Eating Disorder?
,• A. Methylphenidate (Ritalin)
• B. Amphetamine salts (Adderall)
• C. Lisdexamfetamine (Vyvanse)
• D. Modafinil (Provigil)
Correct Answer: C. Lisdexamfetamine (Vyvanse)
Rationale: Lisdexamfetamine (Vyvanse) is the only stimulant FDA-approved for
Binge Eating Disorder. It is thought to work by reducing impulsivity and binge
episodes through dopamine and norepinephrine reuptake inhibition.
Question 7 [Clinical Reasoning]
A 35-year-old female with Binge Eating Disorder and obesity is interested in
pharmacologic treatment to aid weight loss. The provider discusses Orlistat.
What is the mechanism of action of this medication?
• A. Serotonin reuptake inhibition
• B. Dopamine and norepinephrine reuptake inhibition
• C. Inhibition of pancreatic lipase, decreasing fat absorption
• D. Melatonin receptor agonism
Correct Answer: C. Inhibition of pancreatic lipase, decreasing fat absorption
Rationale: Orlistat works by inhibiting pancreatic lipase in the GI tract, which
decreases the amount of dietary fat absorbed. This leads to reduced caloric intake
and weight loss. Side effects include steatorrhea and fat-soluble vitamin deficiencies.
Question 8 [Select All That Apply (SATA)]
A 24-year-old female with Anorexia Nervosa is being discharged from
inpatient treatment. The nurse is providing medication education. Select all
that apply regarding safe medication practices in this population.
• A. Bupropion should be avoided due to seizure risk in malnourished patients
• B. Olanzapine may help reduce obsessive thoughts about food and weight
• C. Fluoxetine is FDA-approved for Anorexia Nervosa maintenance
• D. Pre-meal lorazepam may be used for anticipatory anxiety
• E. Mirtazapine is contraindicated in all patients with Anorexia Nervosa
, NSG 552 Exam 2 Study Guide
1. Anxiety Disorders
First-Line Treatment
SSRI for chronic anxiety, GAD, panic disorder
GAD: 1st line = SSRI (escitalopram, paroxetine); 2nd line = buspirone, SNRI
(Cymbalta, venlafaxine). Can consider short-term use of benzos or augmentation
with buspirone.
Panic Disorder: 1st line = SSRI or SNRI (fluoxetine, paroxetine, sertraline,
venlafaxine). 2nd line = TCA (clomipramine, imipramine). Use benzos with caution,
short-term until other meds reach therapeutic efficacy. FDA approved for panic
disorder: alprazolam (Xanax).
Social Phobia: CBT + SSRI or SNRI. Benzos can be used as scheduled or PRN. Beta
blockers such as atenolol (50-100mg) and propranolol (20-40mg) 1 hour before
performance or public speaking.
OCD: Meds + CBT. 1st line = SSRI at high doses (sertraline, fluoxetine, fluvoxamine,
paroxetine). FDA approved for OCD: fluvoxamine. 2nd line = SNRI (venlafaxine).
TCA: clomipramine (only TCA effective for OCD). Can augment with atypical
antipsychotic in severe cases. ECT in debilitating cases.
,Specific Phobias: CBT with exposure.
Agoraphobia: Anxiety disorder where a person feels intense fear or panic in
situations where escape might be difficult or help might not be available. Treated
with CBT and SSRI.
Illness Anxiety Disorder: SSRI may be helpful for comorbid anxiety and depressive
symptoms.
Medical Conditions That May Precipitate Anxiety
Endocrine: Hyperthyroidism, hypothyroidism, pheochromocytoma, Cushing's,
Addison's, menopause, diabetes
Cardiac: Acute coronary syndrome, arrhythmia, CHF, hypertension, mitral valve
prolapse
Neurological: Epilepsy, stroke, Meniere's, multiple sclerosis, migraine, encephalitis,
early dementia
Respiratory: Asthma, COPD, pulmonary embolism, pneumonia
Metabolic: Porphyria, diabetes
Neurobiology of Anxiety
Norepinephrine: Made in the locus coeruleus; mediates fight or flight responses.
NE hyperactivity causes hypervigilance, increased arousal, panic, and exaggerated
stress responses.
GABA: Primary inhibitory neurotransmitter that induces calmness and relaxation.
Activating Antidepressants (Can Result in Anxiety, Agitation, Restlessness)
• Bupropion
• Fluoxetine
• Venlafaxine
, 2. Benzodiazepines
Mechanism of Action
Enhance activity of GABA at GABA-A receptor. Work as positive allosteric
modulators, bind to specific receptor site and increase receptor's affinity for GABA
→ increased chloride ion influx into neurons leading to hyperpolarization and
decreased neuronal excitability.
Benefits Compared to Antidepressants
• Rapid onset of action
• Effective
• Well-tolerated
Clinical Concerns When Prescribing
• Potential for abuse & addiction
• Patient becomes physically dependent and builds tolerance
• Known limitations: rebound insomnia
• Dependence, tolerance, withdrawal, respiratory depression, misuse
Effects in Elderly Population
• Increased fall risk
• Hip fracture risk
• Confusion
• Cognitive impairment
• Paradoxical agitation
Benzodiazepines for Liver Disorders / Alcohol Use Disorders
OTL = Lorazepam, Oxazepam, Temazepam = not metabolized by liver (bypass liver
metabolism).
When to Administer in Anxiety Patients
• Panic attacks
• Useful in the initial weeks of SSRI/SNRI initiation to rapidly reduce anxiety
• Short-term use for acute relief or bridging while SSRIs/SNRIs take effect
• Initial treatment for panic attacks
Withdrawal / Clinical Manifestations
Similar to ETOH withdrawal:
• Insomnia
• Anxiety
• Hand tremors
• Irritability
• Anorexia
EXAM 2
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 552 EXAM 2 - PSYCHOPHARMACOLOGY
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 552 Exam 2 .................................................... 2
NSG 552 Exam 2 Study Guide ............................. 45
NSG 552 Exam 2
Question 1 [Case-Based Scenario]
A 22-year-old female with Anorexia Nervosa is admitted to an inpatient
psychiatric unit. She reports severe anxiety before meals and refuses to eat
due to intense fear of weight gain. The psychiatrist considers pharmacologic
intervention. Which medication is most appropriate to administer as a pre-
meal anxiolytic to decrease anticipatory anxiety?
• A. Fluoxetine 20 mg daily
• B. Lorazepam 0.5 mg PRN before meals
• C. Olanzapine 5 mg daily
• D. Buspirone 10 mg BID
Correct Answer: B. Lorazepam 0.5 mg PRN before meals
Rationale: Lorazepam is a short-acting benzodiazepine commonly used as a pre-
meal anxiolytic in Anorexia Nervosa to reduce anticipatory anxiety. It has a rapid
onset and can be given PRN. SSRIs like fluoxetine take weeks to work and are not
appropriate for acute anxiety. Olanzapine is used for severe preoccupation with
weight and food, not acute anxiety. Buspirone has a slow onset and is not useful for
PRN anxiety relief.
,Question 2 [Select All That Apply (SATA)]
A 19-year-old female with Anorexia Nervosa has been hospitalized for severe
malnutrition and obsessive preoccupation with food and body weight. Her
BMI is 14.2. The treatment team is considering pharmacologic options. Select
all that apply regarding appropriate medication management for this patient.
• A. Olanzapine may be prescribed to reduce severe preoccupation with weight
and food
• B. Fluoxetine is FDA-approved for Anorexia Nervosa
• C. A pre-meal benzodiazepine such as lorazepam may reduce anticipatory
anxiety
• D. Bupropion is contraindicated due to seizure risk in malnourished patients
• E. Mirtazapine is first-line for weight restoration in Anorexia Nervosa
Correct Answer: A, C, D
Rationale: Olanzapine (A) is used off-label for severe preoccupation with weight
and food in Anorexia Nervosa. A pre-meal benzodiazepine like lorazepam (C) can
help with anticipatory anxiety. Bupropion (D) is contraindicated in eating disorders
due to increased seizure risk, especially in malnourished patients. Fluoxetine (B) is
NOT FDA-approved for Anorexia Nervosa—it is approved for Bulimia Nervosa.
Mirtazapine (E) is not first-line for weight restoration, though it may be used
adjunctively.
Question 3 [Single Best Answer]
Which of the following medications is FDA-approved for the treatment of
Bulimia Nervosa?
• A. Sertraline (Zoloft)
• B. Fluoxetine (Prozac)
• C. Venlafaxine (Effexor)
• D. Bupropion (Wellbutrin)
Correct Answer: B. Fluoxetine (Prozac)
Rationale: Fluoxetine (Prozac) is the only FDA-approved medication for Bulimia
Nervosa. It is typically prescribed at higher doses (60 mg/day). Bupropion is
contraindicated in eating disorders due to seizure risk.
,Question 4 [Case-Based Scenario]
A 28-year-old male presents with recurrent episodes of binge eating followed
by purging behaviors. He reports feelings of shame and guilt. His vital signs
are stable, and his BMI is within normal range. Which combination represents
the most evidence-based treatment approach?
• A. Fluoxetine monotherapy only
• B. CBT-E plus fluoxetine
• C. Olanzapine plus dietary counseling
• D. Bupropion plus interpersonal therapy
Correct Answer: B. CBT-E plus fluoxetine
Rationale: The gold standard treatment for Bulimia Nervosa is Cognitive Behavioral
Therapy (CBT-E) combined with fluoxetine, the FDA-approved medication. CBT
addresses the behavioral and cognitive components, while fluoxetine targets
depressive and obsessive symptoms. Olanzapine is not indicated for bulimia.
Bupropion is contraindicated.
Question 5 [Single Best Answer]
What is the first-line treatment for Binge Eating Disorder (BED)?
• A. Lisdexamfetamine (Vyvanse)
• B. Cognitive Behavioral Therapy (CBT-E/CBT-BED)
• C. Fluoxetine (Prozac)
• D. Orlistat (Alli)
Correct Answer: B. Cognitive Behavioral Therapy (CBT-E/CBT-BED)
Rationale: CBT-E/CBT-BED is the first-line treatment for Binge Eating Disorder.
While lisdexamfetamine is FDA-approved for BED, psychotherapy remains the
initial treatment of choice. Medications are considered when psychotherapy alone is
insufficient.
Question 6 [Single Best Answer]
Which stimulant medication is FDA-approved for the treatment of Binge
Eating Disorder?
,• A. Methylphenidate (Ritalin)
• B. Amphetamine salts (Adderall)
• C. Lisdexamfetamine (Vyvanse)
• D. Modafinil (Provigil)
Correct Answer: C. Lisdexamfetamine (Vyvanse)
Rationale: Lisdexamfetamine (Vyvanse) is the only stimulant FDA-approved for
Binge Eating Disorder. It is thought to work by reducing impulsivity and binge
episodes through dopamine and norepinephrine reuptake inhibition.
Question 7 [Clinical Reasoning]
A 35-year-old female with Binge Eating Disorder and obesity is interested in
pharmacologic treatment to aid weight loss. The provider discusses Orlistat.
What is the mechanism of action of this medication?
• A. Serotonin reuptake inhibition
• B. Dopamine and norepinephrine reuptake inhibition
• C. Inhibition of pancreatic lipase, decreasing fat absorption
• D. Melatonin receptor agonism
Correct Answer: C. Inhibition of pancreatic lipase, decreasing fat absorption
Rationale: Orlistat works by inhibiting pancreatic lipase in the GI tract, which
decreases the amount of dietary fat absorbed. This leads to reduced caloric intake
and weight loss. Side effects include steatorrhea and fat-soluble vitamin deficiencies.
Question 8 [Select All That Apply (SATA)]
A 24-year-old female with Anorexia Nervosa is being discharged from
inpatient treatment. The nurse is providing medication education. Select all
that apply regarding safe medication practices in this population.
• A. Bupropion should be avoided due to seizure risk in malnourished patients
• B. Olanzapine may help reduce obsessive thoughts about food and weight
• C. Fluoxetine is FDA-approved for Anorexia Nervosa maintenance
• D. Pre-meal lorazepam may be used for anticipatory anxiety
• E. Mirtazapine is contraindicated in all patients with Anorexia Nervosa
, NSG 552 Exam 2 Study Guide
1. Anxiety Disorders
First-Line Treatment
SSRI for chronic anxiety, GAD, panic disorder
GAD: 1st line = SSRI (escitalopram, paroxetine); 2nd line = buspirone, SNRI
(Cymbalta, venlafaxine). Can consider short-term use of benzos or augmentation
with buspirone.
Panic Disorder: 1st line = SSRI or SNRI (fluoxetine, paroxetine, sertraline,
venlafaxine). 2nd line = TCA (clomipramine, imipramine). Use benzos with caution,
short-term until other meds reach therapeutic efficacy. FDA approved for panic
disorder: alprazolam (Xanax).
Social Phobia: CBT + SSRI or SNRI. Benzos can be used as scheduled or PRN. Beta
blockers such as atenolol (50-100mg) and propranolol (20-40mg) 1 hour before
performance or public speaking.
OCD: Meds + CBT. 1st line = SSRI at high doses (sertraline, fluoxetine, fluvoxamine,
paroxetine). FDA approved for OCD: fluvoxamine. 2nd line = SNRI (venlafaxine).
TCA: clomipramine (only TCA effective for OCD). Can augment with atypical
antipsychotic in severe cases. ECT in debilitating cases.
,Specific Phobias: CBT with exposure.
Agoraphobia: Anxiety disorder where a person feels intense fear or panic in
situations where escape might be difficult or help might not be available. Treated
with CBT and SSRI.
Illness Anxiety Disorder: SSRI may be helpful for comorbid anxiety and depressive
symptoms.
Medical Conditions That May Precipitate Anxiety
Endocrine: Hyperthyroidism, hypothyroidism, pheochromocytoma, Cushing's,
Addison's, menopause, diabetes
Cardiac: Acute coronary syndrome, arrhythmia, CHF, hypertension, mitral valve
prolapse
Neurological: Epilepsy, stroke, Meniere's, multiple sclerosis, migraine, encephalitis,
early dementia
Respiratory: Asthma, COPD, pulmonary embolism, pneumonia
Metabolic: Porphyria, diabetes
Neurobiology of Anxiety
Norepinephrine: Made in the locus coeruleus; mediates fight or flight responses.
NE hyperactivity causes hypervigilance, increased arousal, panic, and exaggerated
stress responses.
GABA: Primary inhibitory neurotransmitter that induces calmness and relaxation.
Activating Antidepressants (Can Result in Anxiety, Agitation, Restlessness)
• Bupropion
• Fluoxetine
• Venlafaxine
, 2. Benzodiazepines
Mechanism of Action
Enhance activity of GABA at GABA-A receptor. Work as positive allosteric
modulators, bind to specific receptor site and increase receptor's affinity for GABA
→ increased chloride ion influx into neurons leading to hyperpolarization and
decreased neuronal excitability.
Benefits Compared to Antidepressants
• Rapid onset of action
• Effective
• Well-tolerated
Clinical Concerns When Prescribing
• Potential for abuse & addiction
• Patient becomes physically dependent and builds tolerance
• Known limitations: rebound insomnia
• Dependence, tolerance, withdrawal, respiratory depression, misuse
Effects in Elderly Population
• Increased fall risk
• Hip fracture risk
• Confusion
• Cognitive impairment
• Paradoxical agitation
Benzodiazepines for Liver Disorders / Alcohol Use Disorders
OTL = Lorazepam, Oxazepam, Temazepam = not metabolized by liver (bypass liver
metabolism).
When to Administer in Anxiety Patients
• Panic attacks
• Useful in the initial weeks of SSRI/SNRI initiation to rapidly reduce anxiety
• Short-term use for acute relief or bridging while SSRIs/SNRIs take effect
• Initial treatment for panic attacks
Withdrawal / Clinical Manifestations
Similar to ETOH withdrawal:
• Insomnia
• Anxiety
• Hand tremors
• Irritability
• Anorexia
