NUR 5461 ADVANCED
PSYCHOPHARMACOLOGY EXAM
REVIEW QUESTIONS AND CORRECT
ANSWERS 2026/2027
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which absolute
neutrophil count (ANC) value would necessitate the immediate discontinuation of the
medication and consultation with a hematologist?
A. ANC < 1500/mm³
B. ANC < 2000/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: D
Conceptual Explanation: For the general population, Clozapine must be interrupted if the
ANC falls below 1000/mm³, but an ANC below 500/mm³ is considered severe neutropenia
requiring immediate cessation and specialist care.
2. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) when D2 receptors are blocked by first-generation antipsychotics?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The nigrostriatal pathway controls motor function; blockade of
D2 receptors in this pathway leads to EPS like dystonia and parkinsonism.
3. A patient taking Phenelzine (an MAOI) arrives at the ED with a blood pressure of 210/120
mmHg after eating aged cheese. What is the primary mechanism causing this hypertensive
crisis?
A. Inhibition of Tyramine breakdown leading to Norepinephrine release
B. Excessive release of Serotonin
C. Blockade of Alpha-1 adrenergic receptors
D. Direct stimulation of Beta-2 receptors
Answer: A
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine in the gut. Tyramine
acts as a sympathomimetic amine, causing massive release of stored norepinephrine.
4. Which of the following antidepressants is most likely to cause a dose-dependent increase
in blood pressure due to its effect on norepinephrine reuptake?
A. Sertraline
, B. Fluoxetine
C. Venlafaxine
D. Escitalopram
Answer: C
Conceptual Explanation: Venlafaxine is an SNRI; at higher doses (>150mg), its effect on
norepinephrine reuptake becomes significant, leading to potential hypertension.
5. A patient with Bipolar Disorder taking Lithium Carbonate presents with coarse tremors,
ataxia, and confusion. The serum lithium level is 2.1 mEq/L. What is the priority intervention?
A. Administer a dose of Benztropine
B. Encourage increased fluid intake only
C. Switch the patient to Valproic Acid immediately
D. Hold the dose and prepare for possible hemodialysis
Answer: D
Conceptual Explanation: A level above 1.5 mEq/L is toxic, and levels above 2.0 with
severe symptoms like ataxia or confusion often require aggressive management including
hemodialysis.
6. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders due to an increased risk of lowering the seizure threshold?
A. Bupropion
PSYCHOPHARMACOLOGY EXAM
REVIEW QUESTIONS AND CORRECT
ANSWERS 2026/2027
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which absolute
neutrophil count (ANC) value would necessitate the immediate discontinuation of the
medication and consultation with a hematologist?
A. ANC < 1500/mm³
B. ANC < 2000/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: D
Conceptual Explanation: For the general population, Clozapine must be interrupted if the
ANC falls below 1000/mm³, but an ANC below 500/mm³ is considered severe neutropenia
requiring immediate cessation and specialist care.
2. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) when D2 receptors are blocked by first-generation antipsychotics?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The nigrostriatal pathway controls motor function; blockade of
D2 receptors in this pathway leads to EPS like dystonia and parkinsonism.
3. A patient taking Phenelzine (an MAOI) arrives at the ED with a blood pressure of 210/120
mmHg after eating aged cheese. What is the primary mechanism causing this hypertensive
crisis?
A. Inhibition of Tyramine breakdown leading to Norepinephrine release
B. Excessive release of Serotonin
C. Blockade of Alpha-1 adrenergic receptors
D. Direct stimulation of Beta-2 receptors
Answer: A
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine in the gut. Tyramine
acts as a sympathomimetic amine, causing massive release of stored norepinephrine.
4. Which of the following antidepressants is most likely to cause a dose-dependent increase
in blood pressure due to its effect on norepinephrine reuptake?
A. Sertraline
, B. Fluoxetine
C. Venlafaxine
D. Escitalopram
Answer: C
Conceptual Explanation: Venlafaxine is an SNRI; at higher doses (>150mg), its effect on
norepinephrine reuptake becomes significant, leading to potential hypertension.
5. A patient with Bipolar Disorder taking Lithium Carbonate presents with coarse tremors,
ataxia, and confusion. The serum lithium level is 2.1 mEq/L. What is the priority intervention?
A. Administer a dose of Benztropine
B. Encourage increased fluid intake only
C. Switch the patient to Valproic Acid immediately
D. Hold the dose and prepare for possible hemodialysis
Answer: D
Conceptual Explanation: A level above 1.5 mEq/L is toxic, and levels above 2.0 with
severe symptoms like ataxia or confusion often require aggressive management including
hemodialysis.
6. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders due to an increased risk of lowering the seizure threshold?
A. Bupropion
