NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
PRACTICE EXAMINATION · GRADUATE PSYCHOPHARMACOLOGY REVIEW
Wilkes NSG 552 Exam 2
Psychopharmacology (2026 update)
100 Questions · Verified Answers with Detailed Rationales
1. A newly licensed nurse asks the psychiatric-mental health nurse practitioner
(PMHNP) to explain how selective serotonin reuptake inhibitors (SSRIs)
produce their antidepressant effect. Which mechanism best answers the
question?
A. Blockade of alpha-2 noradrenergic autoreceptors on the presynaptic terminal
B. Reversible inhibition of monoamine oxidase-A in the synaptic cleft
C. Selective blockade of the presynaptic serotonin transporter (SERT),
increasing synaptic serotonin availability
D. Antagonism of postsynaptic 5-HT2A and 5-HT2C receptors
Correct Answer: C Selective blockade of the presynaptic serotonin transporter (SERT), increasing synaptic serotonin
availability
Rationale: SSRIs bind the serotonin transporter (SERT) on the presynaptic terminal, blocking reuptake of 5-HT and
progressively increasing serotonergic neurotransmission; the delayed receptor down-regulation explains the 2-6 week
onset. Option A describes monoamine oxidase inhibitors such as phenelzine. Options C and D describe mirtazapine,
whose 5-HT2/5-HT3 and alpha-2 antagonism defines its NaSSA mechanism.
100 Questions with Verified Answers and Rationales 1
,NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
2. A 47-year-old man taking phenelzine attends a party where he consumes aged
cheese and red wine. Hours later he has a severe occipital headache, neck
stiffness, sweating, and a blood pressure of 218/126 mmHg. What is the
correct diagnosis and immediate management?
A. Panic attack; coach breathing and observe
B. Tension headache; treat with ibuprofen at home
C. Hypertensive crisis from tyramine ingestion; emergency evaluation with IV
alpha-blockade such as phentolamine
D. Serotonin syndrome; give cyproheptadine
Correct Answer: C Hypertensive crisis from tyramine ingestion; emergency evaluation with IV alpha-blockade such
as phentolamine
Rationale: Irreversible MAOIs impair intestinal and hepatic degradation of dietary tyramine, and tyramine-rich foods
trigger a catecholamine surge producing the classic hypertensive crisis: throbbing occipital headache, neck stiffness,
sweating, and severe hypertension with stroke risk. This is a medical emergency managed with IV phentolamine or
another rapidly acting alpha-blocker. Antihistamines and reassurance are dangerously inadequate, and cyproheptadine
targets serotonergic, not adrenergic, toxicity.
3. A 49-year-old man has taken venlafaxine XR 225 mg daily for 6 weeks. His blood
pressure was 118/76 mmHg at baseline but is now 146/92 and 150/94 on two
separate visits. What is the best interpretation and action?
A. Stop venlafaxine immediately and start phenelzine
B. This is white-coat hypertension unrelated to treatment; no action is needed
C. This likely represents the dose-related blood pressure effect of venlafaxine;
assess the dose contribution, treat or reduce the dose, and consider switching
if BP remains elevated
D. Add hydralazine and continue venlafaxine unchanged
Correct Answer: C This likely represents the dose-related blood pressure effect of venlafaxine; assess the dose
contribution, treat or reduce the dose, and consider switching if BP remains elevated
Rationale: Venlafaxine produces dose-dependent norepinephrine reuptake inhibition with rising norepinephrine
transporter occupancy, and sustained blood pressure elevation is a known class effect, most common above 225 mg/day
but possible at 225 mg. Management includes confirming the relationship, optimizing dose, adding antihypertensive
therapy, or switching agents. Attributing it to white-coat effect (A) ignores the temporal relationship, and abruptly
starting an MAOI (D) creates serotonergic and pressor risk.
100 Questions with Verified Answers and Rationales 2
,NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
4. A 57-year-old woman with sertraline-associated serotonin syndrome (agitation,
inducible clonus, hyperreflexia, temperature 38.6 C) is stabilized in the
emergency department. Which treatment regimen is correct?
A. Stop all serotonergic agents, provide supportive care with benzodiazepines
as needed, and consider oral cyproheptadine
B. Continue sertraline and add an antipsychotic
C. Administer naloxone and activated charcoal
D. Begin dantrolene and cool aggressively as in malignant hyperthermia
Correct Answer: A Stop all serotonergic agents, provide supportive care with benzodiazepines as needed, and consider
oral cyproheptadine
Rationale: Definitive management of serotonin syndrome is removal of all serotonergic agents, active support (oxygen,
IV fluids, cardiac monitoring), benzodiazepines for agitation, and the 5-HT2A antagonist cyproheptadine (commonly
12 mg orally initially, followed by maintenance dosing) for moderate to severe cases. Continuing the serotonergic drug
is dangerous, naloxone has no role, and dantrolene is reserved for malignant hyperthermia.
5. A 27-year-old woman started sertraline 50 mg daily for major depressive disorder
2 weeks ago. She reports mild improvement in sleep and energy but says she
still feels depressed, and asks when the medication will really work. What is
the most appropriate counseling point?
A. Because she has not responded by week 2, the medication should be
discontinued as ineffective
B. The dose should be doubled today to force a faster response
C. Antidepressants rarely produce improvement before 3 months of continuous
treatment
D. Early improvement is encouraging, but a full therapeutic response typically
requires 4 to 6 or more weeks at a therapeutic dose
Correct Answer: D Early improvement is encouraging, but a full therapeutic response typically requires 4 to 6 or
more weeks at a therapeutic dose
Rationale: Early partial improvement at 1-2 weeks predicts eventual response, and patients should be told to expect
meaningful benefit at 4-6 or more weeks before judging efficacy. Discontinuing at week 2 (B) abandons a working
strategy, and abrupt doubling (C) invites side effects without evidence of accelerated remission. Option D is incorrect
because meaningful improvement often begins within 1-2 weeks.
100 Questions with Verified Answers and Rationales 3
, NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
6. A 76-year-old woman has taken amitriptyline 25 mg nightly for neuropathic pain
for 2 months. Her family reports worsening confusion, dry mouth, constipation,
and one fall last week. What is the best course of action?
A. Continue unchanged because falls are expected at her age
B. Increase amitriptyline to improve pain control
C. Add an anticholinergic agent for the urinary and bowel symptoms
D. Taper and discontinue amitriptyline and transition to an agent with lower
anticholinergic burden
Correct Answer: D Taper and discontinue amitriptyline and transition to an agent with lower anticholinergic burden
Rationale: Amitriptyline has the strongest anticholinergic burden of the TCAs and is explicitly listed in the Beers
Criteria as potentially inappropriate in older adults due to cognitive impairment, delirium, constipation, urinary
retention, and fall risk. The correct action is a careful taper with substitution by lower-risk agents such as an SNRI,
gabapentinoid, or duloxetine. Escalating the dose (A) or layering more anticholinergics (B) compounds the toxicity, and
normalizing falls (D) is unsafe.
7. A patient starting tranylcypromine receives dietary counseling. Which of the
following foods is acceptable for this patient?
A. Draught (tap) beer
B. Aged cheddar cheese
C. Dry-cured salami
D. Pasteurized cottage cheese and cream cheese
Correct Answer: D Pasteurized cottage cheese and cream cheese
Rationale: Tyramine accumulates with aging, fermentation, and bacterial action, so aged cheeses, cured or fermented
meats, fermented soy products, sauerkraut, overripe fruit, fava beans, and tap beer are restricted; freshly cooked foods
and pasteurized fresh dairy such as cottage cheese, cream cheese, and yogurt contain negligible tyramine and are
permitted. Options A, B, and D are among the highest-risk items and must be avoided.
100 Questions with Verified Answers and Rationales 4
PRACTICE EXAMINATION · GRADUATE PSYCHOPHARMACOLOGY REVIEW
Wilkes NSG 552 Exam 2
Psychopharmacology (2026 update)
100 Questions · Verified Answers with Detailed Rationales
1. A newly licensed nurse asks the psychiatric-mental health nurse practitioner
(PMHNP) to explain how selective serotonin reuptake inhibitors (SSRIs)
produce their antidepressant effect. Which mechanism best answers the
question?
A. Blockade of alpha-2 noradrenergic autoreceptors on the presynaptic terminal
B. Reversible inhibition of monoamine oxidase-A in the synaptic cleft
C. Selective blockade of the presynaptic serotonin transporter (SERT),
increasing synaptic serotonin availability
D. Antagonism of postsynaptic 5-HT2A and 5-HT2C receptors
Correct Answer: C Selective blockade of the presynaptic serotonin transporter (SERT), increasing synaptic serotonin
availability
Rationale: SSRIs bind the serotonin transporter (SERT) on the presynaptic terminal, blocking reuptake of 5-HT and
progressively increasing serotonergic neurotransmission; the delayed receptor down-regulation explains the 2-6 week
onset. Option A describes monoamine oxidase inhibitors such as phenelzine. Options C and D describe mirtazapine,
whose 5-HT2/5-HT3 and alpha-2 antagonism defines its NaSSA mechanism.
100 Questions with Verified Answers and Rationales 1
,NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
2. A 47-year-old man taking phenelzine attends a party where he consumes aged
cheese and red wine. Hours later he has a severe occipital headache, neck
stiffness, sweating, and a blood pressure of 218/126 mmHg. What is the
correct diagnosis and immediate management?
A. Panic attack; coach breathing and observe
B. Tension headache; treat with ibuprofen at home
C. Hypertensive crisis from tyramine ingestion; emergency evaluation with IV
alpha-blockade such as phentolamine
D. Serotonin syndrome; give cyproheptadine
Correct Answer: C Hypertensive crisis from tyramine ingestion; emergency evaluation with IV alpha-blockade such
as phentolamine
Rationale: Irreversible MAOIs impair intestinal and hepatic degradation of dietary tyramine, and tyramine-rich foods
trigger a catecholamine surge producing the classic hypertensive crisis: throbbing occipital headache, neck stiffness,
sweating, and severe hypertension with stroke risk. This is a medical emergency managed with IV phentolamine or
another rapidly acting alpha-blocker. Antihistamines and reassurance are dangerously inadequate, and cyproheptadine
targets serotonergic, not adrenergic, toxicity.
3. A 49-year-old man has taken venlafaxine XR 225 mg daily for 6 weeks. His blood
pressure was 118/76 mmHg at baseline but is now 146/92 and 150/94 on two
separate visits. What is the best interpretation and action?
A. Stop venlafaxine immediately and start phenelzine
B. This is white-coat hypertension unrelated to treatment; no action is needed
C. This likely represents the dose-related blood pressure effect of venlafaxine;
assess the dose contribution, treat or reduce the dose, and consider switching
if BP remains elevated
D. Add hydralazine and continue venlafaxine unchanged
Correct Answer: C This likely represents the dose-related blood pressure effect of venlafaxine; assess the dose
contribution, treat or reduce the dose, and consider switching if BP remains elevated
Rationale: Venlafaxine produces dose-dependent norepinephrine reuptake inhibition with rising norepinephrine
transporter occupancy, and sustained blood pressure elevation is a known class effect, most common above 225 mg/day
but possible at 225 mg. Management includes confirming the relationship, optimizing dose, adding antihypertensive
therapy, or switching agents. Attributing it to white-coat effect (A) ignores the temporal relationship, and abruptly
starting an MAOI (D) creates serotonergic and pressor risk.
100 Questions with Verified Answers and Rationales 2
,NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
4. A 57-year-old woman with sertraline-associated serotonin syndrome (agitation,
inducible clonus, hyperreflexia, temperature 38.6 C) is stabilized in the
emergency department. Which treatment regimen is correct?
A. Stop all serotonergic agents, provide supportive care with benzodiazepines
as needed, and consider oral cyproheptadine
B. Continue sertraline and add an antipsychotic
C. Administer naloxone and activated charcoal
D. Begin dantrolene and cool aggressively as in malignant hyperthermia
Correct Answer: A Stop all serotonergic agents, provide supportive care with benzodiazepines as needed, and consider
oral cyproheptadine
Rationale: Definitive management of serotonin syndrome is removal of all serotonergic agents, active support (oxygen,
IV fluids, cardiac monitoring), benzodiazepines for agitation, and the 5-HT2A antagonist cyproheptadine (commonly
12 mg orally initially, followed by maintenance dosing) for moderate to severe cases. Continuing the serotonergic drug
is dangerous, naloxone has no role, and dantrolene is reserved for malignant hyperthermia.
5. A 27-year-old woman started sertraline 50 mg daily for major depressive disorder
2 weeks ago. She reports mild improvement in sleep and energy but says she
still feels depressed, and asks when the medication will really work. What is
the most appropriate counseling point?
A. Because she has not responded by week 2, the medication should be
discontinued as ineffective
B. The dose should be doubled today to force a faster response
C. Antidepressants rarely produce improvement before 3 months of continuous
treatment
D. Early improvement is encouraging, but a full therapeutic response typically
requires 4 to 6 or more weeks at a therapeutic dose
Correct Answer: D Early improvement is encouraging, but a full therapeutic response typically requires 4 to 6 or
more weeks at a therapeutic dose
Rationale: Early partial improvement at 1-2 weeks predicts eventual response, and patients should be told to expect
meaningful benefit at 4-6 or more weeks before judging efficacy. Discontinuing at week 2 (B) abandons a working
strategy, and abrupt doubling (C) invites side effects without evidence of accelerated remission. Option D is incorrect
because meaningful improvement often begins within 1-2 weeks.
100 Questions with Verified Answers and Rationales 3
, NSG 552 Exam 2 - Psychopharmacology (2026) Practice Examination
6. A 76-year-old woman has taken amitriptyline 25 mg nightly for neuropathic pain
for 2 months. Her family reports worsening confusion, dry mouth, constipation,
and one fall last week. What is the best course of action?
A. Continue unchanged because falls are expected at her age
B. Increase amitriptyline to improve pain control
C. Add an anticholinergic agent for the urinary and bowel symptoms
D. Taper and discontinue amitriptyline and transition to an agent with lower
anticholinergic burden
Correct Answer: D Taper and discontinue amitriptyline and transition to an agent with lower anticholinergic burden
Rationale: Amitriptyline has the strongest anticholinergic burden of the TCAs and is explicitly listed in the Beers
Criteria as potentially inappropriate in older adults due to cognitive impairment, delirium, constipation, urinary
retention, and fall risk. The correct action is a careful taper with substitution by lower-risk agents such as an SNRI,
gabapentinoid, or duloxetine. Escalating the dose (A) or layering more anticholinergics (B) compounds the toxicity, and
normalizing falls (D) is unsafe.
7. A patient starting tranylcypromine receives dietary counseling. Which of the
following foods is acceptable for this patient?
A. Draught (tap) beer
B. Aged cheddar cheese
C. Dry-cured salami
D. Pasteurized cottage cheese and cream cheese
Correct Answer: D Pasteurized cottage cheese and cream cheese
Rationale: Tyramine accumulates with aging, fermentation, and bacterial action, so aged cheeses, cured or fermented
meats, fermented soy products, sauerkraut, overripe fruit, fava beans, and tap beer are restricted; freshly cooked foods
and pasteurized fresh dairy such as cottage cheese, cream cheese, and yogurt contain negligible tyramine and are
permitted. Options A, B, and D are among the highest-risk items and must be avoided.
100 Questions with Verified Answers and Rationales 4
