NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
Wilkes NSG 552 - Exam 3
Psychopharmacology (2026) | 100 Questions | Total:
100 Points | Suggested Time: 150 Minutes
Student Name: Date: Score _____ / 100
1. A PMHNP student is asked to explain the primary mechanism of action of
selective serotonin reuptake inhibitors (SSRIs). Which statement is most
accurate?
A. They increase the presynaptic release of serotonin into the synaptic cleft.
B. They inhibit monoamine oxidase, reducing the breakdown of serotonin.
C. They act as full agonists at postsynaptic 5-HT1A receptors.
D. They block the serotonin transporter (SERT), increasing serotonin concentration
in the synaptic cleft.
Correct Answer: D
Correct answer: D. SSRIs bind to and inhibit the serotonin transporter (SERT), blocking presynaptic reuptake and
increasing serotonin availability in the synaptic cleft. Acute reuptake blockade triggers adaptive receptor changes
over weeks, which partly explains the 2-6 week therapeutic delay. Option A is incorrect because SSRIs do not
promote serotonin release; amphetamines and related agents promote monoamine release. Option C describes a
receptor-level action (buspirone is a 5-HT1A partial agonist), not an SSRI mechanism. Option B describes
monoamine oxidase inhibitors (MAOIs).
1
,NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
2. A 24-year-old woman with major depressive disorder has stopped two
antidepressant trials early because she frequently misses doses. Which SSRI is the
most appropriate choice given her adherence pattern?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Citalopram
Correct Answer: B
Correct answer: B. Fluoxetine has the longest half-life of any SSRI (parent 4-6 days; active metabolite norfluoxetine
7-15 days), so occasional missed doses cause far less fluctuation in plasma levels, and it produces the mildest
discontinuation syndrome. Option A (paroxetine) is the worst choice here because its short half-life makes missed
doses and abrupt stops more likely to trigger discontinuation symptoms. Options D and C are reasonable
antidepressants but offer no particular advantage for poor adherence.
3. A 28-year-old woman is planning to become pregnant and asks which
antidepressant to avoid. She also notes she developed severe dizziness and 'electric
shock' sensations when she once ran out of her medication. Which SSRI fits both
concerns?
A. Escitalopram
B. Sertraline
C. Paroxetine
D. Vortioxetine
Correct Answer: C
Correct answer: C. Paroxetine carries the strongest prenatal safety concerns among SSRIs (association with cardiac
septal defects and persistent pulmonary hypertension of the newborn) and is generally avoided when pregnancy is
planned. It also has the shortest half-life of the SSRIs (about 21 hours), producing the highest risk and severity of
discontinuation symptoms, which matches her prior experience. Option B (sertraline) is often preferred in
pregnancy because of the most reassuring accumulated data. Options A and D do not carry paroxetine-specific
pregnancy or discontinuation concerns.
2
,NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
4. A 62-year-old man develops a major depressive episode 3 weeks after an
uncomplicated myocardial infarction. Which antidepressant has the best evidence for
safety in the post-myocardial infarction period?
A. Sertraline
B. Venlafaxine XR
C. Amitriptyline
D. Imipramine
Correct Answer: A
Correct answer: A. Sertraline was studied in post-MI and unstable angina patients (SADHART trial) and
demonstrated cardiac safety, making it a first-line SSRI after myocardial infarction. Options C and D are tricyclic
antidepressants with quinidine-like sodium-channel effects and are arrhythmogenic after MI, so they are avoided.
Option B (venlafaxine) is associated with dose-related blood pressure and heart rate elevations and has less
reassuring data in the immediate post-MI setting.
5. A 70-year-old man with major depressive disorder is to be started on
citalopram. What is the maximum recommended daily dose for this patient and
why?
A. 40 mg/day, the same maximum used for all adults
B. 10 mg/day, because citalopram is contraindicated after age 65
C. 60 mg/day, because older adults require higher doses
D. 20 mg/day, because age-related changes increase the risk of QT prolongation
Correct Answer: D
Correct answer: D. FDA labeling limits citalopram to 20 mg/day in patients older than 60 years, in hepatic
impairment, in CYP2C19 poor metabolizers, and with cimetidine, because these factors raise citalopram exposure
and its dose-dependent QT-interval prolongation risk. Option A incorrectly applies the general 40 mg adult
maximum. Option C is the opposite of the true limit. Option B is false; citalopram is not contraindicated in older
adults, only dose-capped.
3
, NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
6. A 45-year-old patient takes seven medications for cardiovascular disease and asks for
the SSRI least likely to cause drug-drug interactions through cytochrome P450
inhibition. Which agent is the best choice?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Paroxetine
Correct Answer: A
Correct answer: A. Escitalopram has the weakest CYP450 inhibition profile among the SSRIs, making it the
preferred agent in medically complex polypharmacy patients. Options C and D are potent CYP2D6 inhibitors that
raise levels of many cardiac drugs (for example, metoprolol, flecainide, and some statins). Option B is a strong
CYP1A2 and CYP2C19 inhibitor with notable interactions (for example, with clozapine, theophylline, and
omeprazole).
7. A 38-year-old man with well-controlled depression on sertraline reports decreased
libido and delayed orgasm. His depression is stable and he strongly prefers to stay on
sertraline. Which management strategy has the strongest supporting evidence?
A. Immediately discontinue sertraline and observe without treatment
B. Schedule weekend drug holidays every other week
C. Add a phosphodiesterase-5 inhibitor such as sildenafil
D. Increase the sertraline dose to improve mood and libido
Correct Answer: C
Correct answer: C. Adding a phosphodiesterase-5 inhibitor has the best evidence for SSRI-induced sexual
dysfunction and preserves the effective antidepressant regimen. Other valid strategies include waiting for partial
tolerance, cautious dose reduction, or switching to bupropion or mirtazapine. Option B (drug holidays) risks relapse
and discontinuation symptoms and is unreliable, particularly with agents of intermediate half-life. Option A
abandons an effective medication and invites relapse. Option D will not improve sexual dysfunction and may worsen
it.
4
Wilkes NSG 552 - Exam 3
Psychopharmacology (2026) | 100 Questions | Total:
100 Points | Suggested Time: 150 Minutes
Student Name: Date: Score _____ / 100
1. A PMHNP student is asked to explain the primary mechanism of action of
selective serotonin reuptake inhibitors (SSRIs). Which statement is most
accurate?
A. They increase the presynaptic release of serotonin into the synaptic cleft.
B. They inhibit monoamine oxidase, reducing the breakdown of serotonin.
C. They act as full agonists at postsynaptic 5-HT1A receptors.
D. They block the serotonin transporter (SERT), increasing serotonin concentration
in the synaptic cleft.
Correct Answer: D
Correct answer: D. SSRIs bind to and inhibit the serotonin transporter (SERT), blocking presynaptic reuptake and
increasing serotonin availability in the synaptic cleft. Acute reuptake blockade triggers adaptive receptor changes
over weeks, which partly explains the 2-6 week therapeutic delay. Option A is incorrect because SSRIs do not
promote serotonin release; amphetamines and related agents promote monoamine release. Option C describes a
receptor-level action (buspirone is a 5-HT1A partial agonist), not an SSRI mechanism. Option B describes
monoamine oxidase inhibitors (MAOIs).
1
,NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
2. A 24-year-old woman with major depressive disorder has stopped two
antidepressant trials early because she frequently misses doses. Which SSRI is the
most appropriate choice given her adherence pattern?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Citalopram
Correct Answer: B
Correct answer: B. Fluoxetine has the longest half-life of any SSRI (parent 4-6 days; active metabolite norfluoxetine
7-15 days), so occasional missed doses cause far less fluctuation in plasma levels, and it produces the mildest
discontinuation syndrome. Option A (paroxetine) is the worst choice here because its short half-life makes missed
doses and abrupt stops more likely to trigger discontinuation symptoms. Options D and C are reasonable
antidepressants but offer no particular advantage for poor adherence.
3. A 28-year-old woman is planning to become pregnant and asks which
antidepressant to avoid. She also notes she developed severe dizziness and 'electric
shock' sensations when she once ran out of her medication. Which SSRI fits both
concerns?
A. Escitalopram
B. Sertraline
C. Paroxetine
D. Vortioxetine
Correct Answer: C
Correct answer: C. Paroxetine carries the strongest prenatal safety concerns among SSRIs (association with cardiac
septal defects and persistent pulmonary hypertension of the newborn) and is generally avoided when pregnancy is
planned. It also has the shortest half-life of the SSRIs (about 21 hours), producing the highest risk and severity of
discontinuation symptoms, which matches her prior experience. Option B (sertraline) is often preferred in
pregnancy because of the most reassuring accumulated data. Options A and D do not carry paroxetine-specific
pregnancy or discontinuation concerns.
2
,NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
4. A 62-year-old man develops a major depressive episode 3 weeks after an
uncomplicated myocardial infarction. Which antidepressant has the best evidence for
safety in the post-myocardial infarction period?
A. Sertraline
B. Venlafaxine XR
C. Amitriptyline
D. Imipramine
Correct Answer: A
Correct answer: A. Sertraline was studied in post-MI and unstable angina patients (SADHART trial) and
demonstrated cardiac safety, making it a first-line SSRI after myocardial infarction. Options C and D are tricyclic
antidepressants with quinidine-like sodium-channel effects and are arrhythmogenic after MI, so they are avoided.
Option B (venlafaxine) is associated with dose-related blood pressure and heart rate elevations and has less
reassuring data in the immediate post-MI setting.
5. A 70-year-old man with major depressive disorder is to be started on
citalopram. What is the maximum recommended daily dose for this patient and
why?
A. 40 mg/day, the same maximum used for all adults
B. 10 mg/day, because citalopram is contraindicated after age 65
C. 60 mg/day, because older adults require higher doses
D. 20 mg/day, because age-related changes increase the risk of QT prolongation
Correct Answer: D
Correct answer: D. FDA labeling limits citalopram to 20 mg/day in patients older than 60 years, in hepatic
impairment, in CYP2C19 poor metabolizers, and with cimetidine, because these factors raise citalopram exposure
and its dose-dependent QT-interval prolongation risk. Option A incorrectly applies the general 40 mg adult
maximum. Option C is the opposite of the true limit. Option B is false; citalopram is not contraindicated in older
adults, only dose-capped.
3
, NSG 552 - Exam 3 Practice: Psychopharmacology (2026) Total: 100 Points
6. A 45-year-old patient takes seven medications for cardiovascular disease and asks for
the SSRI least likely to cause drug-drug interactions through cytochrome P450
inhibition. Which agent is the best choice?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Paroxetine
Correct Answer: A
Correct answer: A. Escitalopram has the weakest CYP450 inhibition profile among the SSRIs, making it the
preferred agent in medically complex polypharmacy patients. Options C and D are potent CYP2D6 inhibitors that
raise levels of many cardiac drugs (for example, metoprolol, flecainide, and some statins). Option B is a strong
CYP1A2 and CYP2C19 inhibitor with notable interactions (for example, with clozapine, theophylline, and
omeprazole).
7. A 38-year-old man with well-controlled depression on sertraline reports decreased
libido and delayed orgasm. His depression is stable and he strongly prefers to stay on
sertraline. Which management strategy has the strongest supporting evidence?
A. Immediately discontinue sertraline and observe without treatment
B. Schedule weekend drug holidays every other week
C. Add a phosphodiesterase-5 inhibitor such as sildenafil
D. Increase the sertraline dose to improve mood and libido
Correct Answer: C
Correct answer: C. Adding a phosphodiesterase-5 inhibitor has the best evidence for SSRI-induced sexual
dysfunction and preserves the effective antidepressant regimen. Other valid strategies include waiting for partial
tolerance, cautious dose reduction, or switching to bupropion or mirtazapine. Option B (drug holidays) risks relapse
and discontinuation symptoms and is unreliable, particularly with agents of intermediate half-life. Option A
abandons an effective medication and invites relapse. Option D will not improve sexual dysfunction and may worsen
it.
4
