W I L K E S U N I V E R S I T Y · G R A D U AT E N U R S I N G
NSG 552
PSYCHOPHARMACOLOGY EXAM 1, 2 & 3
NSG 552 Psychopharmacology
2026/2027 Edition
Actual Questions and Verified Correct Answers
Advanced Practice Psychopharmacology
A+ GRAD ED · 225 QUES TIONS
COURSE COD E NSG 552 · Wilkes University
T O TA L Q U E S T I O N S 225 Multiple Choice
SECTIONS 10 (Sections 1–10)
ED ITION
S TA N D A R D S ANCC PMHNP Certification Competencies
REFERENCE Evidence-Based Psychopharmacology
Aligned with Wilkes University NSG 552 Psychopharmacology Curriculum,
ANCC PMHNP Certification Competencies, and Evidence-Based Psychopharmacology Standards.
W I L K E S U N I V E R S I T Y G R A D U AT E N U R S I N G · P M H N P P R O G R A M
,NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 | WILKES UNIVERSITY | 2026/2027 225 Questions | A+ Graded
NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 |
WILKES UNIVERSITY
Actual Questions and Verified Correct Answers - Advanced Practice Psychopharmacology
Aligned with Wilkes University NSG 552 Psychopharmacology Curriculum, ANCC PMHNP Certification Competencies, and
Evidence-Based Psychopharmacology Standards (2026/2027 Edition).
Section 1: Neuroanatomy, Neurophysiology, & Pharmacodynamics
25 Questions · Question Range Q1–Q25
Q1: A 32-year-old patient with treatment-resistant depression is being evaluated for deep brain stimulation
(DBS). Which brain region is the PRIMARY target for DBS in treatment-resistant depression, based on
current evidence?
A. Subgenual anterior cingulate cortex (Brodmann area 25) *[CORRECT]*
B. Primary motor cortex
C. Occipital lobe visual cortex
D. Cerebellar vermis
Correct Answer: A
Rationale: The subgenual anterior cingulate cortex (Brodmann area 25) is hyperactive in treatment-resistant depression and is the
primary target for DBS based on research by Mayberg et al. NSG 552 curriculum emphasizes the role of the anterior cingulate in
mood regulation and the limbic-cortical dysregulation model of depression. Choices B, C, and D are not implicated in mood
regulation.
Q2: A PMHNP is explaining the mechanism of aripiprazole to a patient. Which receptor action BEST
describes aripiprazole's unique pharmacodynamic profile?
A. Full D2 antagonist with high affinity
B. Partial D2 agonist with high affinity *[CORRECT]*
C. Pure D1 antagonist
D. 5-HT1A full agonist only
Correct Answer: B
Rationale: Aripiprazole is a partial agonist at D2 receptors, providing functional antagonism in dopaminergically hyperactive
pathways (mesolimbic) and functional agonism in hypoactive pathways (mesocortical). NSG 552 curriculum emphasizes partial
agonism as a key concept in third-generation antipsychotic pharmacodynamics. Choice A describes FGAs; Choice C and D are
incorrect.
Q3: A patient is prescribed a medication that enhances GABA-A receptor function by increasing the
frequency of chloride channel openings. Which medication class does this BEST describe?
A. Benzodiazepines *[CORRECT]*
NSG 552 | Aligned with ANCC PMHNP Competencies & Evidence-Based Psychopharmacology Page 1
,NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 | WILKES UNIVERSITY | 2026/2027 225 Questions | A+ Graded
B. Barbiturates
C. SSRIs
D. Antipsychotics
Correct Answer: A
Rationale: Benzodiazepines bind to GABA-A receptors and increase the FREQUENCY of chloride channel openings (by binding to
the alpha subunit). Barbiturates increase the DURATION of channel openings. NSG 552 curriculum emphasizes the
pharmacodynamic difference between benzodiazepines (frequency) and barbiturates (duration), which has implications for safety
and overdose risk. Choices C and D act via different mechanisms.
Q4: A patient with schizophrenia exhibits predominantly negative symptoms (flat affect, alogia, avolition).
Which dopaminergic pathway is MOST likely hypofunctional?
A. Mesolimbic pathway
B. Mesocortical pathway *[CORRECT]*
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: Negative symptoms are theorized to result from hypodopaminergia in the mesocortical pathway (projections to prefrontal
cortex). NSG 552 curriculum emphasizes the dopamine hypothesis of schizophrenia, with mesolimbic hyperactivity causing positive
symptoms and mesocortical hypoactivity causing negative symptoms. Choice A (mesolimbic) hyperactivity causes positive symptoms;
Choice C (nigrostriatal) is motor; Choice D (tuberoinfundibular) is prolactin regulation.
Q5: A PMHNP is prescribing a medication that acts as an inverse agonist at the 5-HT2C receptor. Which
medication is MOST likely being prescribed?
A. Fluoxetine
B. Agomelatine *[CORRECT]*
C. Venlafaxine
D. Mirtazapine
Correct Answer: B
Rationale: Agomelatine is a 5-HT2C inverse agonist and MT1/MT2 melatonin receptor agonist, used for depression (available in
Europe, not FDA-approved in US). NSG 552 curriculum emphasizes inverse agonism as a distinct pharmacodynamic concept from
antagonism. Choice A is an SSRI; Choice C is an SNRI; Choice D is a 5-HT2 antagonist (not inverse agonist).
Q6: A patient taking an SSRI develops serotonin syndrome. Which second messenger system is PRIMARILY
responsible for the life-threatening hyperthermia in severe cases?
A. cAMP pathway
B. Phospholipase C / IP3 pathway *[CORRECT]*
C. Direct ion channel modulation
D. Nitric oxide pathway
Correct Answer: B
Rationale: Severe serotonin syndrome involves excessive 5-HT2A receptor stimulation, which couples to the phospholipase C / IP3
second messenger system, leading to hyperthermia and muscle rigidity. NSG 552 curriculum emphasizes G-protein coupled receptor
NSG 552 | Aligned with ANCC PMHNP Competencies & Evidence-Based Psychopharmacology Page 2
, NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 | WILKES UNIVERSITY | 2026/2027 225 Questions | A+ Graded
signaling pathways. Choice A (cAMP) is more relevant to other receptor subtypes; Choice C describes ionotropic receptors; Choice D is
unrelated.
Q7: A PMHNP is selecting an antidepressant for a patient with significant psychomotor agitation. Which
pharmacodynamic property of mirtazapine is MOST responsible for its sedating effects?
A. 5-HT1A partial agonism
B. H1 (histamine) antagonism and 5-HT2A antagonism *[CORRECT]*
C. Alpha-2 adrenergic antagonism
D. D2 antagonism
Correct Answer: B
Rationale: Mirtazapine's sedating effects are primarily due to H1 (histamine) antagonism and 5-HT2A antagonism. NSG 552
curriculum emphasizes that mirtazapine's receptor profile (5-HT2A, 5-HT2C, 5-HT3, H1 antagonist) explains its therapeutic effects
(improved sleep, appetite) and side effects (sedation, weight gain). Choice A is incorrect; Choice C (alpha-2 antagonism) increases NE
release; Choice D is not a property of mirtazapine.
Q8: A patient with bipolar depression is prescribed lamotrigine. Which receptor mechanism is the PRIMARY
mechanism of action of lamotrigine?
A. GABA-A receptor agonism
B. Inhibition of voltage-gated sodium channels, decreasing glutamate release *[CORRECT]*
C. D2 receptor antagonism
D. 5-HT1A partial agonism
Correct Answer: B
Rationale: Lamotrigine inhibits voltage-gated sodium channels, decreasing presynaptic glutamate release. NSG 552 curriculum
emphasizes lamotrigine's mechanism as a glutamate modulator, which distinguishes it from other mood stabilizers. This mechanism is
also relevant to its use in epilepsy. Choices A, C, and D are incorrect mechanisms for lamotrigine.
Q9: A PMHNP is teaching about clozapine's receptor profile. Which receptor action is responsible for
clozapine's reduced risk of extrapyramidal symptoms (EPS)?
A. Strong D2 blockade
B. 5-HT2A antagonism relative to D2 blockade *[CORRECT]*
C. D1 receptor agonism
D. Muscarinic agonism
Correct Answer: B
Rationale: Clozapine's 5-HT2A antagonism (relative to its weaker D2 blockade) is theorized to contribute to its low EPS risk. NSG
552 curriculum emphasizes the 5-HT2A/D2 ratio concept in atypical antipsychotics. Choice A would increase EPS risk; Choice C and
D are not relevant to clozapine's EPS profile.
Q10: A patient with schizophrenia is exhibiting EPS (parkinsonism) after starting haloperidol. Which
dopaminergic pathway is PRIMARILY affected?
A. Mesolimbic pathway
B. Mesocortical pathway
NSG 552 | Aligned with ANCC PMHNP Competencies & Evidence-Based Psychopharmacology Page 3
NSG 552
PSYCHOPHARMACOLOGY EXAM 1, 2 & 3
NSG 552 Psychopharmacology
2026/2027 Edition
Actual Questions and Verified Correct Answers
Advanced Practice Psychopharmacology
A+ GRAD ED · 225 QUES TIONS
COURSE COD E NSG 552 · Wilkes University
T O TA L Q U E S T I O N S 225 Multiple Choice
SECTIONS 10 (Sections 1–10)
ED ITION
S TA N D A R D S ANCC PMHNP Certification Competencies
REFERENCE Evidence-Based Psychopharmacology
Aligned with Wilkes University NSG 552 Psychopharmacology Curriculum,
ANCC PMHNP Certification Competencies, and Evidence-Based Psychopharmacology Standards.
W I L K E S U N I V E R S I T Y G R A D U AT E N U R S I N G · P M H N P P R O G R A M
,NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 | WILKES UNIVERSITY | 2026/2027 225 Questions | A+ Graded
NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 |
WILKES UNIVERSITY
Actual Questions and Verified Correct Answers - Advanced Practice Psychopharmacology
Aligned with Wilkes University NSG 552 Psychopharmacology Curriculum, ANCC PMHNP Certification Competencies, and
Evidence-Based Psychopharmacology Standards (2026/2027 Edition).
Section 1: Neuroanatomy, Neurophysiology, & Pharmacodynamics
25 Questions · Question Range Q1–Q25
Q1: A 32-year-old patient with treatment-resistant depression is being evaluated for deep brain stimulation
(DBS). Which brain region is the PRIMARY target for DBS in treatment-resistant depression, based on
current evidence?
A. Subgenual anterior cingulate cortex (Brodmann area 25) *[CORRECT]*
B. Primary motor cortex
C. Occipital lobe visual cortex
D. Cerebellar vermis
Correct Answer: A
Rationale: The subgenual anterior cingulate cortex (Brodmann area 25) is hyperactive in treatment-resistant depression and is the
primary target for DBS based on research by Mayberg et al. NSG 552 curriculum emphasizes the role of the anterior cingulate in
mood regulation and the limbic-cortical dysregulation model of depression. Choices B, C, and D are not implicated in mood
regulation.
Q2: A PMHNP is explaining the mechanism of aripiprazole to a patient. Which receptor action BEST
describes aripiprazole's unique pharmacodynamic profile?
A. Full D2 antagonist with high affinity
B. Partial D2 agonist with high affinity *[CORRECT]*
C. Pure D1 antagonist
D. 5-HT1A full agonist only
Correct Answer: B
Rationale: Aripiprazole is a partial agonist at D2 receptors, providing functional antagonism in dopaminergically hyperactive
pathways (mesolimbic) and functional agonism in hypoactive pathways (mesocortical). NSG 552 curriculum emphasizes partial
agonism as a key concept in third-generation antipsychotic pharmacodynamics. Choice A describes FGAs; Choice C and D are
incorrect.
Q3: A patient is prescribed a medication that enhances GABA-A receptor function by increasing the
frequency of chloride channel openings. Which medication class does this BEST describe?
A. Benzodiazepines *[CORRECT]*
NSG 552 | Aligned with ANCC PMHNP Competencies & Evidence-Based Psychopharmacology Page 1
,NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 | WILKES UNIVERSITY | 2026/2027 225 Questions | A+ Graded
B. Barbiturates
C. SSRIs
D. Antipsychotics
Correct Answer: A
Rationale: Benzodiazepines bind to GABA-A receptors and increase the FREQUENCY of chloride channel openings (by binding to
the alpha subunit). Barbiturates increase the DURATION of channel openings. NSG 552 curriculum emphasizes the
pharmacodynamic difference between benzodiazepines (frequency) and barbiturates (duration), which has implications for safety
and overdose risk. Choices C and D act via different mechanisms.
Q4: A patient with schizophrenia exhibits predominantly negative symptoms (flat affect, alogia, avolition).
Which dopaminergic pathway is MOST likely hypofunctional?
A. Mesolimbic pathway
B. Mesocortical pathway *[CORRECT]*
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: Negative symptoms are theorized to result from hypodopaminergia in the mesocortical pathway (projections to prefrontal
cortex). NSG 552 curriculum emphasizes the dopamine hypothesis of schizophrenia, with mesolimbic hyperactivity causing positive
symptoms and mesocortical hypoactivity causing negative symptoms. Choice A (mesolimbic) hyperactivity causes positive symptoms;
Choice C (nigrostriatal) is motor; Choice D (tuberoinfundibular) is prolactin regulation.
Q5: A PMHNP is prescribing a medication that acts as an inverse agonist at the 5-HT2C receptor. Which
medication is MOST likely being prescribed?
A. Fluoxetine
B. Agomelatine *[CORRECT]*
C. Venlafaxine
D. Mirtazapine
Correct Answer: B
Rationale: Agomelatine is a 5-HT2C inverse agonist and MT1/MT2 melatonin receptor agonist, used for depression (available in
Europe, not FDA-approved in US). NSG 552 curriculum emphasizes inverse agonism as a distinct pharmacodynamic concept from
antagonism. Choice A is an SSRI; Choice C is an SNRI; Choice D is a 5-HT2 antagonist (not inverse agonist).
Q6: A patient taking an SSRI develops serotonin syndrome. Which second messenger system is PRIMARILY
responsible for the life-threatening hyperthermia in severe cases?
A. cAMP pathway
B. Phospholipase C / IP3 pathway *[CORRECT]*
C. Direct ion channel modulation
D. Nitric oxide pathway
Correct Answer: B
Rationale: Severe serotonin syndrome involves excessive 5-HT2A receptor stimulation, which couples to the phospholipase C / IP3
second messenger system, leading to hyperthermia and muscle rigidity. NSG 552 curriculum emphasizes G-protein coupled receptor
NSG 552 | Aligned with ANCC PMHNP Competencies & Evidence-Based Psychopharmacology Page 2
, NSG 552 PSYCHOPHARMACOLOGY EXAM 1, 2 & 3 | WILKES UNIVERSITY | 2026/2027 225 Questions | A+ Graded
signaling pathways. Choice A (cAMP) is more relevant to other receptor subtypes; Choice C describes ionotropic receptors; Choice D is
unrelated.
Q7: A PMHNP is selecting an antidepressant for a patient with significant psychomotor agitation. Which
pharmacodynamic property of mirtazapine is MOST responsible for its sedating effects?
A. 5-HT1A partial agonism
B. H1 (histamine) antagonism and 5-HT2A antagonism *[CORRECT]*
C. Alpha-2 adrenergic antagonism
D. D2 antagonism
Correct Answer: B
Rationale: Mirtazapine's sedating effects are primarily due to H1 (histamine) antagonism and 5-HT2A antagonism. NSG 552
curriculum emphasizes that mirtazapine's receptor profile (5-HT2A, 5-HT2C, 5-HT3, H1 antagonist) explains its therapeutic effects
(improved sleep, appetite) and side effects (sedation, weight gain). Choice A is incorrect; Choice C (alpha-2 antagonism) increases NE
release; Choice D is not a property of mirtazapine.
Q8: A patient with bipolar depression is prescribed lamotrigine. Which receptor mechanism is the PRIMARY
mechanism of action of lamotrigine?
A. GABA-A receptor agonism
B. Inhibition of voltage-gated sodium channels, decreasing glutamate release *[CORRECT]*
C. D2 receptor antagonism
D. 5-HT1A partial agonism
Correct Answer: B
Rationale: Lamotrigine inhibits voltage-gated sodium channels, decreasing presynaptic glutamate release. NSG 552 curriculum
emphasizes lamotrigine's mechanism as a glutamate modulator, which distinguishes it from other mood stabilizers. This mechanism is
also relevant to its use in epilepsy. Choices A, C, and D are incorrect mechanisms for lamotrigine.
Q9: A PMHNP is teaching about clozapine's receptor profile. Which receptor action is responsible for
clozapine's reduced risk of extrapyramidal symptoms (EPS)?
A. Strong D2 blockade
B. 5-HT2A antagonism relative to D2 blockade *[CORRECT]*
C. D1 receptor agonism
D. Muscarinic agonism
Correct Answer: B
Rationale: Clozapine's 5-HT2A antagonism (relative to its weaker D2 blockade) is theorized to contribute to its low EPS risk. NSG
552 curriculum emphasizes the 5-HT2A/D2 ratio concept in atypical antipsychotics. Choice A would increase EPS risk; Choice C and
D are not relevant to clozapine's EPS profile.
Q10: A patient with schizophrenia is exhibiting EPS (parkinsonism) after starting haloperidol. Which
dopaminergic pathway is PRIMARILY affected?
A. Mesolimbic pathway
B. Mesocortical pathway
NSG 552 | Aligned with ANCC PMHNP Competencies & Evidence-Based Psychopharmacology Page 3
