NSG 552 Exam 2 – Wilkes
Psychopharmacology (2026) Question
Practice Exam with Verified Answers &
Rationales | Instant Pdf Download
SECTION 1: ANXIETY DISORDERS & ANXIOLYTICS (Questions 1-25)
Question 1
A 45-year-old female with Generalized Anxiety Disorder (GAD) has been
prescribed buspirone. The patient reports after one week that "it doesn't work
for my panic spikes." What is the NP's most appropriate response?
A. "We can increase the dose and use it PRN for panic attacks."
B. "Buspirone requires 2-4 weeks of consistent dosing to reach full therapeutic
effect and is not effective for acute panic."
C. "Let's switch to alprazolam for better immediate relief."
D. "Buspirone works immediately; you should feel relief within 24 hours."
Correct Answer: B
Rationale: Buspirone is a non-benzodiazepine anxiolytic with a delayed onset
of action, typically requiring 2-4 weeks for therapeutic effect. It is not effective
for acute panic or PRN use. Benzodiazepines are indicated for acute anxiety but
carry dependence risks. Patient education about realistic expectations is
essential for adherence .
Question 2
Which of the following benzodiazepines is most appropriate for an older adult
patient with severe liver disease requiring short-term treatment for acute
anxiety?
,A. Diazepam
B. Lorazepam
C. Clonazepam
D. Flurazepam
Correct Answer: B
Rationale: Lorazepam, oxazepam, and temazepam (the "OTL" group) are not
significantly metabolized by the liver and are safer for patients with hepatic
impairment. Diazepam, clonazepam, and flurazepam rely on hepatic
metabolism and would accumulate in liver disease, increasing sedation and
toxicity risk .
Question 3
A 68-year-old woman has been taking high-dose alprazolam for several years.
She wants to stop "cold turkey." Which response best reflects appropriate
clinical practice?
A. "That is a good idea; stopping abruptly prevents long-term side effects."
B. "We must taper your dose by approximately 10% per week because abrupt
cessation can be life-threatening."
C. "There is no withdrawal with benzodiazepines; you can stop whenever you
like."
D. "We will switch you directly to zolpidem and discontinue the
benzodiazepine."
Correct Answer: B
Rationale: Abrupt discontinuation of chronic benzodiazepines can cause life-
threatening withdrawal including seizures, autonomic instability, and severe
anxiety. Tapering approximately 10% of total dose per week is recommended,
often with conversion from short-acting to long-acting benzodiazepines.
Zolpidem does not prevent benzodiazepine withdrawal .
,Question 4
A patient with GAD is prescribed buspirone. Which statement by the patient
indicates understanding of this medication?
A. "I can take this as needed when I feel anxious."
B. "This medication will work right away for my anxiety."
C. "It may take several weeks for this medication to be effective, and I should
take it daily as prescribed."
D. "I can drink alcohol while taking this medication."
Correct Answer: C
Rationale: Buspirone requires daily consistent dosing for 2-4 weeks to achieve
therapeutic effect and is not effective PRN. Alcohol can increase CNS
depression and should be avoided. This distinguishes buspirone from
benzodiazepines in onset and usage patterns .
Question 5
Which patient scenario best demonstrates the effect of decreased GABAergic
activity in anxiety disorders?
A. A calm patient who sleeps deeply after taking zolpidem
B. A patient with hypervigilance and heightened arousal that improves with
benzodiazepines
C. A patient with hypersomnia after taking modafinil
D. A patient with cataplexy relieved by sodium oxybate
Correct Answer: B
Rationale: GABA is the primary inhibitory neurotransmitter, serving as the "off
switch" for neuronal activity. Benzodiazepines potentiate GABA-A receptors,
reducing anxiety and hyperarousal. Improvement of hypervigilance with
benzodiazepines illustrates deficient GABAergic inhibition in anxiety
disorders .
, Question 6
A patient taking a benzodiazepine nightly reports that when she skips a dose,
her sleep is worse than before starting the medication. Which phenomenon
explains this?
A. Auto-induction
B. Rebound insomnia
C. REM suppression
D. Cataplexy
Correct Answer: B
Rationale: Rebound insomnia is a known limitation of benzodiazepine therapy
where sleep quality worsens upon drug discontinuation. Auto-induction refers to
carbamazepine metabolism. Non-benzodiazepine hypnotics generally do not
affect REM sleep significantly. Cataplexy is a symptom of narcolepsy .
Question 7
Which benzodiazepine is preferred when a patient has a history of substance use
disorder requiring PRN anxiety management?
A. Alprazolam
B. Lorazepam
C. Clonazepam
D. Diazepam
Correct Answer: B
Rationale: While all benzodiazepines carry abuse potential, lorazepam is often
preferred in substance use disorder patients due to its intermediate duration, lack
of active metabolites, and lower abuse liability compared to alprazolam.
Diazepam and clonazepam have long half-lives and active metabolites that
increase accumulation and dependence risk .
Psychopharmacology (2026) Question
Practice Exam with Verified Answers &
Rationales | Instant Pdf Download
SECTION 1: ANXIETY DISORDERS & ANXIOLYTICS (Questions 1-25)
Question 1
A 45-year-old female with Generalized Anxiety Disorder (GAD) has been
prescribed buspirone. The patient reports after one week that "it doesn't work
for my panic spikes." What is the NP's most appropriate response?
A. "We can increase the dose and use it PRN for panic attacks."
B. "Buspirone requires 2-4 weeks of consistent dosing to reach full therapeutic
effect and is not effective for acute panic."
C. "Let's switch to alprazolam for better immediate relief."
D. "Buspirone works immediately; you should feel relief within 24 hours."
Correct Answer: B
Rationale: Buspirone is a non-benzodiazepine anxiolytic with a delayed onset
of action, typically requiring 2-4 weeks for therapeutic effect. It is not effective
for acute panic or PRN use. Benzodiazepines are indicated for acute anxiety but
carry dependence risks. Patient education about realistic expectations is
essential for adherence .
Question 2
Which of the following benzodiazepines is most appropriate for an older adult
patient with severe liver disease requiring short-term treatment for acute
anxiety?
,A. Diazepam
B. Lorazepam
C. Clonazepam
D. Flurazepam
Correct Answer: B
Rationale: Lorazepam, oxazepam, and temazepam (the "OTL" group) are not
significantly metabolized by the liver and are safer for patients with hepatic
impairment. Diazepam, clonazepam, and flurazepam rely on hepatic
metabolism and would accumulate in liver disease, increasing sedation and
toxicity risk .
Question 3
A 68-year-old woman has been taking high-dose alprazolam for several years.
She wants to stop "cold turkey." Which response best reflects appropriate
clinical practice?
A. "That is a good idea; stopping abruptly prevents long-term side effects."
B. "We must taper your dose by approximately 10% per week because abrupt
cessation can be life-threatening."
C. "There is no withdrawal with benzodiazepines; you can stop whenever you
like."
D. "We will switch you directly to zolpidem and discontinue the
benzodiazepine."
Correct Answer: B
Rationale: Abrupt discontinuation of chronic benzodiazepines can cause life-
threatening withdrawal including seizures, autonomic instability, and severe
anxiety. Tapering approximately 10% of total dose per week is recommended,
often with conversion from short-acting to long-acting benzodiazepines.
Zolpidem does not prevent benzodiazepine withdrawal .
,Question 4
A patient with GAD is prescribed buspirone. Which statement by the patient
indicates understanding of this medication?
A. "I can take this as needed when I feel anxious."
B. "This medication will work right away for my anxiety."
C. "It may take several weeks for this medication to be effective, and I should
take it daily as prescribed."
D. "I can drink alcohol while taking this medication."
Correct Answer: C
Rationale: Buspirone requires daily consistent dosing for 2-4 weeks to achieve
therapeutic effect and is not effective PRN. Alcohol can increase CNS
depression and should be avoided. This distinguishes buspirone from
benzodiazepines in onset and usage patterns .
Question 5
Which patient scenario best demonstrates the effect of decreased GABAergic
activity in anxiety disorders?
A. A calm patient who sleeps deeply after taking zolpidem
B. A patient with hypervigilance and heightened arousal that improves with
benzodiazepines
C. A patient with hypersomnia after taking modafinil
D. A patient with cataplexy relieved by sodium oxybate
Correct Answer: B
Rationale: GABA is the primary inhibitory neurotransmitter, serving as the "off
switch" for neuronal activity. Benzodiazepines potentiate GABA-A receptors,
reducing anxiety and hyperarousal. Improvement of hypervigilance with
benzodiazepines illustrates deficient GABAergic inhibition in anxiety
disorders .
, Question 6
A patient taking a benzodiazepine nightly reports that when she skips a dose,
her sleep is worse than before starting the medication. Which phenomenon
explains this?
A. Auto-induction
B. Rebound insomnia
C. REM suppression
D. Cataplexy
Correct Answer: B
Rationale: Rebound insomnia is a known limitation of benzodiazepine therapy
where sleep quality worsens upon drug discontinuation. Auto-induction refers to
carbamazepine metabolism. Non-benzodiazepine hypnotics generally do not
affect REM sleep significantly. Cataplexy is a symptom of narcolepsy .
Question 7
Which benzodiazepine is preferred when a patient has a history of substance use
disorder requiring PRN anxiety management?
A. Alprazolam
B. Lorazepam
C. Clonazepam
D. Diazepam
Correct Answer: B
Rationale: While all benzodiazepines carry abuse potential, lorazepam is often
preferred in substance use disorder patients due to its intermediate duration, lack
of active metabolites, and lower abuse liability compared to alprazolam.
Diazepam and clonazepam have long half-lives and active metabolites that
increase accumulation and dependence risk .
