NR 546 Psychopharmacology for the Psychiatric-
Mental Health Nurse Practitioner – Chamberlain
College of Nursing – Midterm Examination5
2026/2027
Question 1: A 34-year-old patient with treatment-resistant depression is
started on a medication that acts as a serotonin antagonist and reuptake
inhibitor (SARI). Which receptor profile is most consistent with this
mechanism?
A. Full agonist at 5-HT1A and antagonist at 5-HT2A
B. Antagonist at 5-HT2A and weak reuptake inhibition of serotonin
C. Antagonist at H1 and partial agonist at D2
D. Inverse agonist at 5-HT2C and reuptake inhibition of norepinephrine
CORRECT ANSWER: B. Antagonist at 5-HT2A and weak reuptake inhibition of
serotonin
Rationale: The SARI class, exemplified by trazodone, acts as a postsynaptic 5-HT2A
antagonist and a weak serotonin reuptake inhibitor. This combination enhances
serotonergic transmission through 5-HT1A receptors while avoiding stimulation of 5-
HT2A receptors, which may improve sleep and reduce anxiety. Option A describes
buspirone-like activity. Option C describes some atypical antipsychotics like quetiapine.
Option D describes agents like agomelatine .
Question 2: A PMHNP is prescribing lamotrigine for a patient with bipolar
depression. The provider understands that the primary mechanism of action
for this medication is:
A. Blockade of voltage-gated sodium channels and inhibition of glutamate release
B. Direct agonism at GABA-A receptors
C. Inhibition of monoamine oxidase type B
D. Blockade of dopamine D2 receptors in the mesolimbic pathway
CORRECT ANSWER: A. Blockade of voltage-gated sodium channels and
inhibition of glutamate release
Rationale: Lamotrigine stabilizes neuronal membranes by blocking voltage-gated
sodium channels, which inhibits the release of the excitatory neurotransmitter
glutamate. This mechanism is thought to contribute to its efficacy in bipolar depression .
Option B describes benzodiazepines. Option C describes selegiline. Option D describes
antipsychotics.
Question 3: A patient prescribed fluoxetine for major depressive disorder
reports that the medication "doesn't seem to work" after one week. The
PMHNP explains that the delayed therapeutic effect of SSRIs is most likely due
to:
A. The long half-life of fluoxetine requiring five weeks to reach steady state
B. The time required for CYP2D6 enzyme induction to increase drug metabolism
C. The need for desensitization of presynaptic 5-HT1A autoreceptors to enhance
,serotonergic neurotransmission
D. The gradual upregulation of postsynaptic serotonin receptors
CORRECT ANSWER: C. The need for desensitization of presynaptic 5-HT1A
autoreceptors to enhance serotonergic neurotransmission
Rationale: Initially, SSRIs increase synaptic serotonin, which activates presynaptic 5-
HT1A autoreceptors, leading to negative feedback and reduced serotonin release. Over
2-4 weeks, these autoreceptors desensitize, allowing sustained enhancement of
serotonergic neurotransmission. This desensitization aligns with the delayed onset of
clinical effects . Option A describes fluoxetine's half-life but is not the primary reason for
delayed onset.
Question 4: A patient with schizophrenia is experiencing severe
extrapyramidal symptoms (EPS) after starting haloperidol. The PMHNP
explains that EPS is most directly related to dopamine D2 receptor blockade in
which brain pathway?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
CORRECT ANSWER: C. Nigrostriatal pathway
Rationale: The nigrostriatal pathway, which projects from the substantia nigra to the
striatum, is critical for motor control. D2 receptor blockade in this pathway is the
primary mechanism underlying EPS, including parkinsonism, dystonia, and akathisia .
Option A is associated with efficacy and reward. Option B is associated with negative
and cognitive symptoms. Option D is associated with prolactin elevation.
Question 5: A 45-year-old patient with major depressive disorder and
comorbid nicotine dependence requests an antidepressant that is weight
neutral and does not cause sexual side effects. Which medication is the most
appropriate choice?
A. Mirtazapine
B. Bupropion
C. Paroxetine
D. Escitalopram
CORRECT ANSWER: B. Bupropion
Rationale: Bupropion is a norepinephrine and dopamine reuptake inhibitor that is
weight neutral and has no sexual side effects. In fact, it may improve sexual function. It
is also FDA-approved for smoking cessation, making it an ideal choice for patients with
depression and nicotine dependence . Option A often causes weight gain and sedation.
Options C and D are SSRIs associated with sexual dysfunction and weight gain.
, Question 6: A PMHNP is explaining the therapeutic serum range for lithium to
a patient. Which range represents the standard maintenance target for bipolar
disorder?
A. 0.3 – 0.5 mEq/L
B. 0.6 – 1.2 mEq/L
C. 1.5 – 2.0 mEq/L
D. 2.0 – 2.5 mEq/L
CORRECT ANSWER: B. 0.6 – 1.2 mEq/L
Rationale: The standard therapeutic range for lithium maintenance is 0.6–1.2 mEq/L.
Levels above this range increase the risk of toxicity, while levels below may be
subtherapeutic. Option A is considered subtherapeutic for maintenance but may be used
in elderly patients. Options C and D are considered toxic ranges .
Question 7: A patient with bipolar disorder is prescribed valproic acid
(Depakote). The PMHNP should monitor for which side effect characteristic of
this medication?
A. Nephrogenic diabetes insipidus
B. Polycystic ovarian syndrome
C. Weight loss and insomnia
D. Hypothyroidism and bradycardia
CORRECT ANSWER: B. Polycystic ovarian syndrome
Rationale: Valproic acid is associated with a risk of polycystic ovarian syndrome
(PCOS) in women of reproductive age, alongside weight gain, metabolic syndrome, and
teratogenic effects. Option A is associated with lithium. Option C is more associated
with SSRIs or bupropion. Option D is associated with lithium and beta-blockers .
Question 8: A PMHNP prescribes aripiprazole to a patient with schizophrenia.
The provider understands that this medication is unique among antipsychotics
because it:
A. Is a full D2 receptor antagonist
B. Acts as a partial dopamine D2 receptor agonist
C. Primarily blocks serotonin 5-HT2A receptors without affecting dopamine
D. Inhibits the reuptake of norepinephrine and dopamine
CORRECT ANSWER: B. Acts as a partial dopamine D2 receptor agonist
Rationale: Aripiprazole is a third-generation antipsychotic that functions as a partial
agonist at D2 receptors. This mechanism stabilizes dopamine activity—reducing it in
hyperdopaminergic areas (mesolimbic) and enhancing it in hypodopaminergic areas
(mesocortical), which is associated with a lower risk of EPS and hyperprolactinemia .
Option A describes typical antipsychotics. Option C describes some atypical
antipsychotics but omits D2 action.
Mental Health Nurse Practitioner – Chamberlain
College of Nursing – Midterm Examination5
2026/2027
Question 1: A 34-year-old patient with treatment-resistant depression is
started on a medication that acts as a serotonin antagonist and reuptake
inhibitor (SARI). Which receptor profile is most consistent with this
mechanism?
A. Full agonist at 5-HT1A and antagonist at 5-HT2A
B. Antagonist at 5-HT2A and weak reuptake inhibition of serotonin
C. Antagonist at H1 and partial agonist at D2
D. Inverse agonist at 5-HT2C and reuptake inhibition of norepinephrine
CORRECT ANSWER: B. Antagonist at 5-HT2A and weak reuptake inhibition of
serotonin
Rationale: The SARI class, exemplified by trazodone, acts as a postsynaptic 5-HT2A
antagonist and a weak serotonin reuptake inhibitor. This combination enhances
serotonergic transmission through 5-HT1A receptors while avoiding stimulation of 5-
HT2A receptors, which may improve sleep and reduce anxiety. Option A describes
buspirone-like activity. Option C describes some atypical antipsychotics like quetiapine.
Option D describes agents like agomelatine .
Question 2: A PMHNP is prescribing lamotrigine for a patient with bipolar
depression. The provider understands that the primary mechanism of action
for this medication is:
A. Blockade of voltage-gated sodium channels and inhibition of glutamate release
B. Direct agonism at GABA-A receptors
C. Inhibition of monoamine oxidase type B
D. Blockade of dopamine D2 receptors in the mesolimbic pathway
CORRECT ANSWER: A. Blockade of voltage-gated sodium channels and
inhibition of glutamate release
Rationale: Lamotrigine stabilizes neuronal membranes by blocking voltage-gated
sodium channels, which inhibits the release of the excitatory neurotransmitter
glutamate. This mechanism is thought to contribute to its efficacy in bipolar depression .
Option B describes benzodiazepines. Option C describes selegiline. Option D describes
antipsychotics.
Question 3: A patient prescribed fluoxetine for major depressive disorder
reports that the medication "doesn't seem to work" after one week. The
PMHNP explains that the delayed therapeutic effect of SSRIs is most likely due
to:
A. The long half-life of fluoxetine requiring five weeks to reach steady state
B. The time required for CYP2D6 enzyme induction to increase drug metabolism
C. The need for desensitization of presynaptic 5-HT1A autoreceptors to enhance
,serotonergic neurotransmission
D. The gradual upregulation of postsynaptic serotonin receptors
CORRECT ANSWER: C. The need for desensitization of presynaptic 5-HT1A
autoreceptors to enhance serotonergic neurotransmission
Rationale: Initially, SSRIs increase synaptic serotonin, which activates presynaptic 5-
HT1A autoreceptors, leading to negative feedback and reduced serotonin release. Over
2-4 weeks, these autoreceptors desensitize, allowing sustained enhancement of
serotonergic neurotransmission. This desensitization aligns with the delayed onset of
clinical effects . Option A describes fluoxetine's half-life but is not the primary reason for
delayed onset.
Question 4: A patient with schizophrenia is experiencing severe
extrapyramidal symptoms (EPS) after starting haloperidol. The PMHNP
explains that EPS is most directly related to dopamine D2 receptor blockade in
which brain pathway?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
CORRECT ANSWER: C. Nigrostriatal pathway
Rationale: The nigrostriatal pathway, which projects from the substantia nigra to the
striatum, is critical for motor control. D2 receptor blockade in this pathway is the
primary mechanism underlying EPS, including parkinsonism, dystonia, and akathisia .
Option A is associated with efficacy and reward. Option B is associated with negative
and cognitive symptoms. Option D is associated with prolactin elevation.
Question 5: A 45-year-old patient with major depressive disorder and
comorbid nicotine dependence requests an antidepressant that is weight
neutral and does not cause sexual side effects. Which medication is the most
appropriate choice?
A. Mirtazapine
B. Bupropion
C. Paroxetine
D. Escitalopram
CORRECT ANSWER: B. Bupropion
Rationale: Bupropion is a norepinephrine and dopamine reuptake inhibitor that is
weight neutral and has no sexual side effects. In fact, it may improve sexual function. It
is also FDA-approved for smoking cessation, making it an ideal choice for patients with
depression and nicotine dependence . Option A often causes weight gain and sedation.
Options C and D are SSRIs associated with sexual dysfunction and weight gain.
, Question 6: A PMHNP is explaining the therapeutic serum range for lithium to
a patient. Which range represents the standard maintenance target for bipolar
disorder?
A. 0.3 – 0.5 mEq/L
B. 0.6 – 1.2 mEq/L
C. 1.5 – 2.0 mEq/L
D. 2.0 – 2.5 mEq/L
CORRECT ANSWER: B. 0.6 – 1.2 mEq/L
Rationale: The standard therapeutic range for lithium maintenance is 0.6–1.2 mEq/L.
Levels above this range increase the risk of toxicity, while levels below may be
subtherapeutic. Option A is considered subtherapeutic for maintenance but may be used
in elderly patients. Options C and D are considered toxic ranges .
Question 7: A patient with bipolar disorder is prescribed valproic acid
(Depakote). The PMHNP should monitor for which side effect characteristic of
this medication?
A. Nephrogenic diabetes insipidus
B. Polycystic ovarian syndrome
C. Weight loss and insomnia
D. Hypothyroidism and bradycardia
CORRECT ANSWER: B. Polycystic ovarian syndrome
Rationale: Valproic acid is associated with a risk of polycystic ovarian syndrome
(PCOS) in women of reproductive age, alongside weight gain, metabolic syndrome, and
teratogenic effects. Option A is associated with lithium. Option C is more associated
with SSRIs or bupropion. Option D is associated with lithium and beta-blockers .
Question 8: A PMHNP prescribes aripiprazole to a patient with schizophrenia.
The provider understands that this medication is unique among antipsychotics
because it:
A. Is a full D2 receptor antagonist
B. Acts as a partial dopamine D2 receptor agonist
C. Primarily blocks serotonin 5-HT2A receptors without affecting dopamine
D. Inhibits the reuptake of norepinephrine and dopamine
CORRECT ANSWER: B. Acts as a partial dopamine D2 receptor agonist
Rationale: Aripiprazole is a third-generation antipsychotic that functions as a partial
agonist at D2 receptors. This mechanism stabilizes dopamine activity—reducing it in
hyperdopaminergic areas (mesolimbic) and enhancing it in hypodopaminergic areas
(mesocortical), which is associated with a lower risk of EPS and hyperprolactinemia .
Option A describes typical antipsychotics. Option C describes some atypical
antipsychotics but omits D2 action.
