NR547 PMHNP EXAM COMPREHENSIVE
REVIEW QUESTIONS AND ANSWERS
1. Which dopaminergic pathway is primarily associated with the development of negative
symptoms and cognitive impairment in schizophrenia when dopamine activity is diminished?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The mesocortical pathway projects from the ventral tegmental
area to the prefrontal cortex. A deficit in dopamine in this pathway is hypothesized to cause
negative symptoms like alogia and cognitive deficits.
2. A patient on Lithium therapy presents with coarse tremors, ataxia, and confusion. The
serum lithium level is 2.2 mEq/L. What is the most likely diagnosis?
A. Therapeutic side effects
B. Moderate to severe lithium toxicity
,C. Mild lithium toxicity
D. Serotonin syndrome
Answer: B
Conceptual Explanation: Lithium levels between 1.5 and 2.5 mEq/L represent moderate
to severe toxicity, characterized by coarse tremors, neurological impairment, and ataxia.
3. Which antidepressant is contraindicated in patients with a history of seizure disorders or
bulimia nervosa?
A. Fluoxetine
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion is known to lower the seizure threshold, particularly
in patients with electrolyte imbalances associated with eating disorders or pre-existing
seizure conditions.
4. A PMHNP is treating a patient with Clozapine. The patient’s Absolute Neutrophil Count
(ANC) is 900/mm³. What is the required clinical action according to the Clozapine REMS
program?
A. Continue treatment and monitor weekly
, B. Increase the dose to combat infection
C. Switch to an alternative second-generation antipsychotic immediately
D. Interrupt treatment and monitor ANC daily
Answer: D
Conceptual Explanation: For the general population, an ANC below 1000/mm³ requires
the interruption of Clozapine treatment to prevent life-threatening agranulocytosis.
5. Which mechanism of action explains the efficacy of Benzodiazepines in treating anxiety?
A. Antagonism of the NMDA receptor
B. Positive allosteric modulation of GABA-A receptors
C. Inhibition of the Serotonin Transporter (SERT)
D. Agonism of the 5-HT1A receptor
Answer: B
Conceptual Explanation: Benzodiazepines bind to a specific site on the GABA-A receptor,
increasing the frequency of chloride channel opening in the presence of GABA, leading to
neuronal hyperpolarization.
6. In the treatment of Alzheimer’s disease, what is the primary mechanism of Memantine?
A. Cholinesterase inhibition
B. Alpha-2 adrenergic antagonism
REVIEW QUESTIONS AND ANSWERS
1. Which dopaminergic pathway is primarily associated with the development of negative
symptoms and cognitive impairment in schizophrenia when dopamine activity is diminished?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The mesocortical pathway projects from the ventral tegmental
area to the prefrontal cortex. A deficit in dopamine in this pathway is hypothesized to cause
negative symptoms like alogia and cognitive deficits.
2. A patient on Lithium therapy presents with coarse tremors, ataxia, and confusion. The
serum lithium level is 2.2 mEq/L. What is the most likely diagnosis?
A. Therapeutic side effects
B. Moderate to severe lithium toxicity
,C. Mild lithium toxicity
D. Serotonin syndrome
Answer: B
Conceptual Explanation: Lithium levels between 1.5 and 2.5 mEq/L represent moderate
to severe toxicity, characterized by coarse tremors, neurological impairment, and ataxia.
3. Which antidepressant is contraindicated in patients with a history of seizure disorders or
bulimia nervosa?
A. Fluoxetine
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion is known to lower the seizure threshold, particularly
in patients with electrolyte imbalances associated with eating disorders or pre-existing
seizure conditions.
4. A PMHNP is treating a patient with Clozapine. The patient’s Absolute Neutrophil Count
(ANC) is 900/mm³. What is the required clinical action according to the Clozapine REMS
program?
A. Continue treatment and monitor weekly
, B. Increase the dose to combat infection
C. Switch to an alternative second-generation antipsychotic immediately
D. Interrupt treatment and monitor ANC daily
Answer: D
Conceptual Explanation: For the general population, an ANC below 1000/mm³ requires
the interruption of Clozapine treatment to prevent life-threatening agranulocytosis.
5. Which mechanism of action explains the efficacy of Benzodiazepines in treating anxiety?
A. Antagonism of the NMDA receptor
B. Positive allosteric modulation of GABA-A receptors
C. Inhibition of the Serotonin Transporter (SERT)
D. Agonism of the 5-HT1A receptor
Answer: B
Conceptual Explanation: Benzodiazepines bind to a specific site on the GABA-A receptor,
increasing the frequency of chloride channel opening in the presence of GABA, leading to
neuronal hyperpolarization.
6. In the treatment of Alzheimer’s disease, what is the primary mechanism of Memantine?
A. Cholinesterase inhibition
B. Alpha-2 adrenergic antagonism
