,Table of Contents
Content Area Questions Key Topics
NR 546 Evaluation Advanced 1-30 Disorder, Pharmacodynamic, Treatment-resistant, Depression,
Pharmacology FOR Efficacy
Psychiatric-mental Health
Nurse Practitioners
2026/2027 Academic YEAR
AND FOR Pmhnp Students
Advanced Pharmacology
FOR Psychiatric-mental
Health Nurse Practitioners
Graduate
Appropriate 31-60 Disorder, Pharmacodynamic, Mechanism, Bipolar, Depression
Depression 61-90 Disorder, Develops, Bipolar, Started, Appropriate
Treatment-resistant 91-120 Disorder, Appropriate, Explains, Depression, Develops
Bipolar 121-150 Disorder, Appropriate, Develops, Anxiety, Medication
Mechanism 151-180 Disorder, Appropriate, Clozapine, Level, Schizophrenia
TOTAL 180 All questions include answers and detailed rationales
,Section A - NR 546 Evaluation Advanced Pharmacology
FOR Psychiatric-mental Health Nurse Practitioners
2026/2027 Academic YEAR AND FOR Pmhnp Students
Advanced Pharmacology FOR Psychiatric-mental Health
Nurse Practitioners Graduate
Q1.
A patient with treatment-resistant depression has failed two SSRIs and one SNRI.
Considering augmentation strategies, which agent is most appropriate to augment with an
SSRI to target the glutamatergic system?
A. Lithium B. Aripiprazole
C. Ketamine D. Bupropion
Correct: C - Ketamine
Rationale:Ketamine is an NMDA receptor antagonist that modulates glutamatergic
transmission, providing rapid antidepressant effects. Lithium and aripiprazole are
augmentation options but do not primarily target glutamate. Bupropion is not typically used to
augment SSRIs for glutamate modulation.
Q2.
A patient on clozapine for treatment-resistant schizophrenia presents with new-onset
tachycardia, diaphoresis, and tremors. Which laboratory value is most critical to assess
immediately?
A. Complete blood count with differential B. Serum clozapine level
C. Serum creatine kinase D. Thyroid-stimulating hormone
Correct: C - Serum creatine kinase
Rationale:The symptoms suggest neuroleptic malignant syndrome or clozapine-induced
myopathy; elevated creatine kinase is a key diagnostic indicator. CBC is important for
agranulocytosis but not acute symptoms. Clozapine level is not urgent. TSH would not
explain these symptoms.
Q3.
According to current evidence, which medication has the most robust efficacy for treating
acute bipolar depression while minimizing risk of switching to mania?
A. Lamotrigine B. Quetiapine
Page 3
, Section A - NR 546 Evaluation Advanced Pharmacology FOR Psychiatric-mental Health Nurse Practitioners 2026/2027 Academic YEAR AND
FOR Pmhnp Students Advanced Pharmacology FOR Psychiatric-mental Health Nurse Practitioners Graduate
C. Valproate D. Carbamazepine
Correct: B - Quetiapine
Rationale:Quetiapine is FDA-approved for bipolar depression and has demonstrated efficacy
in multiple trials with relatively low switch rates. Lamotrigine is effective but slower and less
robust acutely. Valproate and carbamazepine are more established for mania than acute
depression.
Q4.
A patient with generalized anxiety disorder has not responded to first-line SSRIs after 8
weeks. Which alternative mechanism offers a rapidly acting, non-benzodiazepine option?
A. Pregabalin B. Buspirone
C. Hydroxyzine D. Propranolol
Correct: A - Pregabalin
Rationale:Pregabalin, a calcium channel modulator, has evidence for rapid anxiolytic effects
in GAD and is considered a second-line alternative. Buspirone takes weeks and is less
effective for severe anxiety. Hydroxyzine is sedating but not rapidly acting in the same way.
Propranolol is for performance anxiety.
Q5.
Which pharmacogenetic variant is most strongly associated with poor metabolism of
CYP2D6 substrates like risperidone, leading to higher plasma levels and increased risk of
adverse effects?
A. CYP2C19 poor metabolizer B. CYP2D6 ultrarapid metabolizer
C. CYP2D6 poor metabolizer D. CYP3A4 inducer
Correct: C - CYP2D6 poor metabolizer
Rationale:CYP2D6 poor metabolizers have reduced enzyme activity, causing elevated levels
of substrates like risperidone, increasing EPS and other side effects. CYP2C19 affects drugs
like citalopram. Ultrarapid metabolizers have lower levels. CYP3A4 induction affects different
drugs.
Q6.
A patient with bipolar I disorder is stabilized on lithium. Which combination of factors
most significantly increases the risk of lithium toxicity?
A. High sodium intake and thiazide diuretics B. Low sodium intake and NSAID use
Page 4
Content Area Questions Key Topics
NR 546 Evaluation Advanced 1-30 Disorder, Pharmacodynamic, Treatment-resistant, Depression,
Pharmacology FOR Efficacy
Psychiatric-mental Health
Nurse Practitioners
2026/2027 Academic YEAR
AND FOR Pmhnp Students
Advanced Pharmacology
FOR Psychiatric-mental
Health Nurse Practitioners
Graduate
Appropriate 31-60 Disorder, Pharmacodynamic, Mechanism, Bipolar, Depression
Depression 61-90 Disorder, Develops, Bipolar, Started, Appropriate
Treatment-resistant 91-120 Disorder, Appropriate, Explains, Depression, Develops
Bipolar 121-150 Disorder, Appropriate, Develops, Anxiety, Medication
Mechanism 151-180 Disorder, Appropriate, Clozapine, Level, Schizophrenia
TOTAL 180 All questions include answers and detailed rationales
,Section A - NR 546 Evaluation Advanced Pharmacology
FOR Psychiatric-mental Health Nurse Practitioners
2026/2027 Academic YEAR AND FOR Pmhnp Students
Advanced Pharmacology FOR Psychiatric-mental Health
Nurse Practitioners Graduate
Q1.
A patient with treatment-resistant depression has failed two SSRIs and one SNRI.
Considering augmentation strategies, which agent is most appropriate to augment with an
SSRI to target the glutamatergic system?
A. Lithium B. Aripiprazole
C. Ketamine D. Bupropion
Correct: C - Ketamine
Rationale:Ketamine is an NMDA receptor antagonist that modulates glutamatergic
transmission, providing rapid antidepressant effects. Lithium and aripiprazole are
augmentation options but do not primarily target glutamate. Bupropion is not typically used to
augment SSRIs for glutamate modulation.
Q2.
A patient on clozapine for treatment-resistant schizophrenia presents with new-onset
tachycardia, diaphoresis, and tremors. Which laboratory value is most critical to assess
immediately?
A. Complete blood count with differential B. Serum clozapine level
C. Serum creatine kinase D. Thyroid-stimulating hormone
Correct: C - Serum creatine kinase
Rationale:The symptoms suggest neuroleptic malignant syndrome or clozapine-induced
myopathy; elevated creatine kinase is a key diagnostic indicator. CBC is important for
agranulocytosis but not acute symptoms. Clozapine level is not urgent. TSH would not
explain these symptoms.
Q3.
According to current evidence, which medication has the most robust efficacy for treating
acute bipolar depression while minimizing risk of switching to mania?
A. Lamotrigine B. Quetiapine
Page 3
, Section A - NR 546 Evaluation Advanced Pharmacology FOR Psychiatric-mental Health Nurse Practitioners 2026/2027 Academic YEAR AND
FOR Pmhnp Students Advanced Pharmacology FOR Psychiatric-mental Health Nurse Practitioners Graduate
C. Valproate D. Carbamazepine
Correct: B - Quetiapine
Rationale:Quetiapine is FDA-approved for bipolar depression and has demonstrated efficacy
in multiple trials with relatively low switch rates. Lamotrigine is effective but slower and less
robust acutely. Valproate and carbamazepine are more established for mania than acute
depression.
Q4.
A patient with generalized anxiety disorder has not responded to first-line SSRIs after 8
weeks. Which alternative mechanism offers a rapidly acting, non-benzodiazepine option?
A. Pregabalin B. Buspirone
C. Hydroxyzine D. Propranolol
Correct: A - Pregabalin
Rationale:Pregabalin, a calcium channel modulator, has evidence for rapid anxiolytic effects
in GAD and is considered a second-line alternative. Buspirone takes weeks and is less
effective for severe anxiety. Hydroxyzine is sedating but not rapidly acting in the same way.
Propranolol is for performance anxiety.
Q5.
Which pharmacogenetic variant is most strongly associated with poor metabolism of
CYP2D6 substrates like risperidone, leading to higher plasma levels and increased risk of
adverse effects?
A. CYP2C19 poor metabolizer B. CYP2D6 ultrarapid metabolizer
C. CYP2D6 poor metabolizer D. CYP3A4 inducer
Correct: C - CYP2D6 poor metabolizer
Rationale:CYP2D6 poor metabolizers have reduced enzyme activity, causing elevated levels
of substrates like risperidone, increasing EPS and other side effects. CYP2C19 affects drugs
like citalopram. Ultrarapid metabolizers have lower levels. CYP3A4 induction affects different
drugs.
Q6.
A patient with bipolar I disorder is stabilized on lithium. Which combination of factors
most significantly increases the risk of lithium toxicity?
A. High sodium intake and thiazide diuretics B. Low sodium intake and NSAID use
Page 4
