NR 568 Final Exam Prep Questions 1-250 (New Unique Set - No
Repetition from Previous) | Advanced Practice Psychiatric Nursing
Psychopharmacology Test Bank
Accelerate your psychiatric-mental health nurse practitioner board preparation with this
brand-new, completely unique set of practice questions 1 through 200 for the NR 568
final exam. This comprehensive test bank features 100% verified correct answers and
detailed, evidence-based rationales with zero repetition from previous study materials,
focusing heavily on advanced clinical decision-making. It is an indispensable resource
for graduate nursing students looking to master neurobiology, psychotropic prescribing
guidelines across the lifespan, and drug-receptor mechanics to secure an A+ grade.
Question 1
A 55-year-old patient with treatment-resistant depression is started on phenelzine
(Nardil). After 3 weeks, the patient reports a severe headache, palpitations, and nausea.
Which food is most likely responsible for this adverse reaction?
A) Grapefruit juice
B) Avocado
C) Soy sauce
D) Aged cheese
Correct Answer: D
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Consumption of
tyramine-rich foods such as aged cheese, cured meats, and fermented products can
precipitate a hypertensive crisis. Tyramine displaces norepinephrine from presynaptic
vesicles, causing a massive release of catecholamines. This can lead to severe headache,
hypertension, palpitations, and nausea, which can be fatal. Grapefruit juice affects CYP3A4
metabolism, soy sauce contains moderate tyramine, and avocado contains low tyramine,
but aged cheese has the highest tyramine content .
,Question 2
A 62-year-old patient with Parkinson's disease is prescribed carbidopa/levodopa. Which
vitamin supplement should be avoided due to interference with levodopa absorption?
A) Vitamin C
B) Vitamin B6 (pyridoxine)
C) Vitamin D
D) Vitamin E
Correct Answer: B
Rationale: Pyridoxine (vitamin B6) is a cofactor for aromatic L-amino acid decarboxylase
(AADC), the enzyme that converts levodopa to dopamine in the periphery. High doses of
vitamin B6 can increase peripheral conversion of levodopa to dopamine, reducing the
amount of levodopa that reaches the brain and diminishing therapeutic efficacy. This is
why carbidopa is added to levodopa—carbidopa inhibits peripheral AADC, preventing this
effect. The carbidopa in combination products blocks this interaction, but high-dose B6
supplements should still be avoided .
Question 3
A 45-year-old patient with schizophrenia has been on fluphenazine decanoate for 8
years and now presents with involuntary choreoathetoid movements of the tongue and
lips. Which medication is FDA-approved for treating this condition?
A) Benztropine
B) Diphenhydramine
C) Valbenazine
D) Propranolol
Correct Answer: C
Rationale: The patient is presenting with tardive dyskinesia, a late-onset movement
disorder associated with prolonged antipsychotic use. Valbenazine and deutetrabenazine
are VMAT2 inhibitors that are FDA-approved for the treatment of tardive dyskinesia.
Benztropine and diphenhydramine are used for acute EPS (dystonia, parkinsonism), not
,tardive dyskinesia. Propranolol is used for akathisia. VMAT2 inhibitors reduce dopamine
release, which helps suppress the hyperkinetic movements .
Question 4
A 30-year-old patient with bipolar II disorder is started on lamotrigine. The PMHNP
recommends a slow titration schedule. What is the primary reason for this slow titration?
A) To minimize gastrointestinal side effects
B) To reduce the risk of Stevens-Johnson syndrome
C) To prevent weight gain
D) To avoid sedation
Correct Answer: B
Rationale: Lamotrigine carries a black box warning for serious skin rashes, including
Stevens-Johnson syndrome and toxic epidermal necrolysis. Slow titration is essential to
minimize this risk. The standard titration is 25 mg daily for 2 weeks, then 50 mg daily for
2 weeks, then 100 mg daily, with further increases as tolerated. Valproate inhibits
lamotrigine metabolism, requiring even slower titration (25 mg every other day). Stevens-
Johnson syndrome is a life-threatening dermatologic emergency that requires immediate
discontinuation .
Question 5
A patient with generalized anxiety disorder has been on alprazolam 1 mg TID for 6
months. The PMHNP plans to discontinue the medication. Which of the following is the
most appropriate approach?
A) Abruptly stop the medication
B) Cross-taper to a longer-acting benzodiazepine and slowly taper
C) Switch to buspirone immediately
D) Add fluoxetine and stop alprazolam
, Correct Answer: B
Rationale: Alprazolam has a short half-life and is associated with significant withdrawal
symptoms, including rebound anxiety, seizures, and insomnia. The safest approach is to
convert to a longer-acting benzodiazepine (such as clonazepam or diazepam) and then
slowly taper the dose over weeks to months. Abrupt discontinuation can cause life-
threatening withdrawal seizures. Switching to buspirone (C) may be part of the plan, but
cross-tapering is the standard approach to minimize withdrawal .
Question 6
A 72-year-old patient with Alzheimer's disease is started on memantine. What is the
mechanism of action of memantine?
A) Cholinesterase inhibition
B) NMDA receptor antagonist
C) Dopamine receptor agonist
D) Acetylcholine release enhancer
Correct Answer: B
Rationale: Memantine is an NMDA receptor antagonist that modulates glutamate
activity. It is thought to protect neurons from excitotoxicity due to excessive glutamate. It is
approved for moderate to severe Alzheimer's disease, often in combination with a
cholinesterase inhibitor (donepezil, rivastigmine, galantamine). Donepezil (A) is a
cholinesterase inhibitor. Memantine is not a dopamine agonist (C) or acetylcholine release
enhancer (D) .
Question 7
A 28-year-old patient with ADHD and a history of substance use disorder is prescribed a
non-stimulant medication. Which medication is most appropriate?
Repetition from Previous) | Advanced Practice Psychiatric Nursing
Psychopharmacology Test Bank
Accelerate your psychiatric-mental health nurse practitioner board preparation with this
brand-new, completely unique set of practice questions 1 through 200 for the NR 568
final exam. This comprehensive test bank features 100% verified correct answers and
detailed, evidence-based rationales with zero repetition from previous study materials,
focusing heavily on advanced clinical decision-making. It is an indispensable resource
for graduate nursing students looking to master neurobiology, psychotropic prescribing
guidelines across the lifespan, and drug-receptor mechanics to secure an A+ grade.
Question 1
A 55-year-old patient with treatment-resistant depression is started on phenelzine
(Nardil). After 3 weeks, the patient reports a severe headache, palpitations, and nausea.
Which food is most likely responsible for this adverse reaction?
A) Grapefruit juice
B) Avocado
C) Soy sauce
D) Aged cheese
Correct Answer: D
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Consumption of
tyramine-rich foods such as aged cheese, cured meats, and fermented products can
precipitate a hypertensive crisis. Tyramine displaces norepinephrine from presynaptic
vesicles, causing a massive release of catecholamines. This can lead to severe headache,
hypertension, palpitations, and nausea, which can be fatal. Grapefruit juice affects CYP3A4
metabolism, soy sauce contains moderate tyramine, and avocado contains low tyramine,
but aged cheese has the highest tyramine content .
,Question 2
A 62-year-old patient with Parkinson's disease is prescribed carbidopa/levodopa. Which
vitamin supplement should be avoided due to interference with levodopa absorption?
A) Vitamin C
B) Vitamin B6 (pyridoxine)
C) Vitamin D
D) Vitamin E
Correct Answer: B
Rationale: Pyridoxine (vitamin B6) is a cofactor for aromatic L-amino acid decarboxylase
(AADC), the enzyme that converts levodopa to dopamine in the periphery. High doses of
vitamin B6 can increase peripheral conversion of levodopa to dopamine, reducing the
amount of levodopa that reaches the brain and diminishing therapeutic efficacy. This is
why carbidopa is added to levodopa—carbidopa inhibits peripheral AADC, preventing this
effect. The carbidopa in combination products blocks this interaction, but high-dose B6
supplements should still be avoided .
Question 3
A 45-year-old patient with schizophrenia has been on fluphenazine decanoate for 8
years and now presents with involuntary choreoathetoid movements of the tongue and
lips. Which medication is FDA-approved for treating this condition?
A) Benztropine
B) Diphenhydramine
C) Valbenazine
D) Propranolol
Correct Answer: C
Rationale: The patient is presenting with tardive dyskinesia, a late-onset movement
disorder associated with prolonged antipsychotic use. Valbenazine and deutetrabenazine
are VMAT2 inhibitors that are FDA-approved for the treatment of tardive dyskinesia.
Benztropine and diphenhydramine are used for acute EPS (dystonia, parkinsonism), not
,tardive dyskinesia. Propranolol is used for akathisia. VMAT2 inhibitors reduce dopamine
release, which helps suppress the hyperkinetic movements .
Question 4
A 30-year-old patient with bipolar II disorder is started on lamotrigine. The PMHNP
recommends a slow titration schedule. What is the primary reason for this slow titration?
A) To minimize gastrointestinal side effects
B) To reduce the risk of Stevens-Johnson syndrome
C) To prevent weight gain
D) To avoid sedation
Correct Answer: B
Rationale: Lamotrigine carries a black box warning for serious skin rashes, including
Stevens-Johnson syndrome and toxic epidermal necrolysis. Slow titration is essential to
minimize this risk. The standard titration is 25 mg daily for 2 weeks, then 50 mg daily for
2 weeks, then 100 mg daily, with further increases as tolerated. Valproate inhibits
lamotrigine metabolism, requiring even slower titration (25 mg every other day). Stevens-
Johnson syndrome is a life-threatening dermatologic emergency that requires immediate
discontinuation .
Question 5
A patient with generalized anxiety disorder has been on alprazolam 1 mg TID for 6
months. The PMHNP plans to discontinue the medication. Which of the following is the
most appropriate approach?
A) Abruptly stop the medication
B) Cross-taper to a longer-acting benzodiazepine and slowly taper
C) Switch to buspirone immediately
D) Add fluoxetine and stop alprazolam
, Correct Answer: B
Rationale: Alprazolam has a short half-life and is associated with significant withdrawal
symptoms, including rebound anxiety, seizures, and insomnia. The safest approach is to
convert to a longer-acting benzodiazepine (such as clonazepam or diazepam) and then
slowly taper the dose over weeks to months. Abrupt discontinuation can cause life-
threatening withdrawal seizures. Switching to buspirone (C) may be part of the plan, but
cross-tapering is the standard approach to minimize withdrawal .
Question 6
A 72-year-old patient with Alzheimer's disease is started on memantine. What is the
mechanism of action of memantine?
A) Cholinesterase inhibition
B) NMDA receptor antagonist
C) Dopamine receptor agonist
D) Acetylcholine release enhancer
Correct Answer: B
Rationale: Memantine is an NMDA receptor antagonist that modulates glutamate
activity. It is thought to protect neurons from excitotoxicity due to excessive glutamate. It is
approved for moderate to severe Alzheimer's disease, often in combination with a
cholinesterase inhibitor (donepezil, rivastigmine, galantamine). Donepezil (A) is a
cholinesterase inhibitor. Memantine is not a dopamine agonist (C) or acetylcholine release
enhancer (D) .
Question 7
A 28-year-old patient with ADHD and a history of substance use disorder is prescribed a
non-stimulant medication. Which medication is most appropriate?
