NSG 552 Exam 3 V1 | NSG 552 Psychopharmacology | Actual Q&A
with Rationale (NSG 552 Exam 3) | Wilkes University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being considered for
Lithium therapy. Which of the following laboratory tests is most critical to obtain before
initiating treatment?
A. Serum amylase and lipase
B. Liver function tests (ALT/AST)
C. Serum creatinine and Blood Urea Nitrogen (BUN)
D. Fast blood glucose and lipid panel
Answer: C
Rationale: Lithium is primarily excreted unchanged by the kidneys, making renal function
assessment mandatory before starting treatment. If renal clearance is impaired, lithium can
quickly accumulate to toxic levels. This assessment provides a baseline for future
monitoring of the patient’s renal health throughout long-term therapy.
2. Blocking dopamine in the tuberoinfundibular pathway as a result of first-generation
antipsychotic use most likely leads to which side effect?
A. Worsening of negative symptoms
B. Hyperprolactinemia
C. Extrapyramidal symptoms (EPS)
D. Reduction of hallucinations
Answer: B
Rationale: The tuberoinfundibular pathway controls prolactin secretion; dopamine
normally inhibits prolactin release. When D2 receptors are blocked in this pathway,
prolactin levels rise, leading to gynecomastia, galactorrhea, and sexual dysfunction. This is
a common side effect of first-generation antipsychotics and some second-generation agents
like Risperidone.
3. Which of the following medications is a partial agonist at the D2 receptor and is often
referred to as a ‘dopamine stabilizer’?
A. Olanzapine
B. Haloperidol
C. Aripiprazole
D. Quetiapine
,Answer: C
Rationale: Aripiprazole acts as a partial agonist, meaning it reduces dopamine activity
where it is too high and increases it where it is too low. This unique mechanism helps treat
positive symptoms while minimizing EPS and prolactin elevation. It is categorized as a
third-generation antipsychotic because of this dopamine-modulating property.
4. A patient taking Clozapine presents with a sore throat, fever, and mouth sores. What is the
most immediate priority for the Psychiatric Mental Health Nurse Practitioner (PMHNP)?
A. Order a Stat EKG to check for myocarditis
B. Obtain a Complete Blood Count (CBC) with differential
C. Prescribe a broad-spectrum antibiotic
D. Increase the dose of Clozapine to cover psychotic relapse
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis, which can manifest
as signs of infection like fever and sore throat. The PMHNP must check the Absolute
Neutrophil Count (ANC) immediately to ensure it has not fallen below safe levels. If the
ANC is critically low, Clozapine must be discontinued to prevent life-threatening sepsis.
5. Which mood stabilizer is most strongly associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly in patients who are titrated too quickly?
A. Lamotrigine
B. Valproate
C. Lithium
D. Carbamazepine
Answer: A
Rationale: Lamotrigine requires a very slow titration schedule to minimize the risk of
serious rashes, including Stevens-Johnson Syndrome. Patients must be educated to report
any new rash, especially when starting the medication or increasing the dose. The risk is
significantly increased if Lamotrigine is used concurrently with Valproate, which inhibits
its metabolism.
6. In the treatment of ADHD, what is the primary mechanism of action for stimulant
medications like Methylphenidate?
A. Selective inhibition of serotonin reuptake
B. Agonism of alpha-2 adrenergic receptors
C. Antagonism of NMDA receptors
, D. Blockade of dopamine and norepinephrine transporters
Answer: D
Rationale: Methylphenidate works by blocking the reuptake of dopamine and
norepinephrine, thereby increasing their availability in the synaptic cleft. This increased
catecholamine activity in the prefrontal cortex improves attention and impulse control.
Unlike amphetamines, methylphenidate does not primarily promote the release of
dopamine from pre-synaptic vesicles.
7. A 45-year-old male with Schizophrenia has been on Haloperidol for several years. He now
exhibits involuntary rhythmic tongue protrusion and puffing of the cheeks. What is the most
likely diagnosis?
A. Akathisia
B. Acute Dystonia
C. Tardive Dyskinesia
D. Pseudoparkinsonism
Answer: C
Rationale: Tardive Dyskinesia (TD) is a late-onset extrapyramidal symptom characterized
by involuntary movements of the face, tongue, and extremities. It results from long-term
D2 receptor blockade, leading to receptor supersensitivity in the nigrostriatal pathway.
Treatment often involves switching to an atypical antipsychotic or using VMAT2 inhibitors
like Valbenazine.
8. Which second-generation antipsychotic is known for having a significant requirement for
being taken with food (at least 500 calories) to ensure adequate absorption?
A. Risperidone
B. Ziprasidone
C. Olanzapine
D. Aripiprazole
Answer: B
Rationale: Ziprasidone absorption is significantly increased when taken with a meal of at
least 500 calories; without food, its bioavailability drops by about 50%. This is a crucial
teaching point for patients to ensure consistent therapeutic blood levels. Failure to take it
with food can lead to treatment failure despite compliance with the dosing schedule.
9. A patient diagnosed with Alzheimer’s disease is prescribed Memantine. What is the
pharmacological mechanism of this drug?
A. Cholinesterase inhibition
with Rationale (NSG 552 Exam 3) | Wilkes University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being considered for
Lithium therapy. Which of the following laboratory tests is most critical to obtain before
initiating treatment?
A. Serum amylase and lipase
B. Liver function tests (ALT/AST)
C. Serum creatinine and Blood Urea Nitrogen (BUN)
D. Fast blood glucose and lipid panel
Answer: C
Rationale: Lithium is primarily excreted unchanged by the kidneys, making renal function
assessment mandatory before starting treatment. If renal clearance is impaired, lithium can
quickly accumulate to toxic levels. This assessment provides a baseline for future
monitoring of the patient’s renal health throughout long-term therapy.
2. Blocking dopamine in the tuberoinfundibular pathway as a result of first-generation
antipsychotic use most likely leads to which side effect?
A. Worsening of negative symptoms
B. Hyperprolactinemia
C. Extrapyramidal symptoms (EPS)
D. Reduction of hallucinations
Answer: B
Rationale: The tuberoinfundibular pathway controls prolactin secretion; dopamine
normally inhibits prolactin release. When D2 receptors are blocked in this pathway,
prolactin levels rise, leading to gynecomastia, galactorrhea, and sexual dysfunction. This is
a common side effect of first-generation antipsychotics and some second-generation agents
like Risperidone.
3. Which of the following medications is a partial agonist at the D2 receptor and is often
referred to as a ‘dopamine stabilizer’?
A. Olanzapine
B. Haloperidol
C. Aripiprazole
D. Quetiapine
,Answer: C
Rationale: Aripiprazole acts as a partial agonist, meaning it reduces dopamine activity
where it is too high and increases it where it is too low. This unique mechanism helps treat
positive symptoms while minimizing EPS and prolactin elevation. It is categorized as a
third-generation antipsychotic because of this dopamine-modulating property.
4. A patient taking Clozapine presents with a sore throat, fever, and mouth sores. What is the
most immediate priority for the Psychiatric Mental Health Nurse Practitioner (PMHNP)?
A. Order a Stat EKG to check for myocarditis
B. Obtain a Complete Blood Count (CBC) with differential
C. Prescribe a broad-spectrum antibiotic
D. Increase the dose of Clozapine to cover psychotic relapse
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis, which can manifest
as signs of infection like fever and sore throat. The PMHNP must check the Absolute
Neutrophil Count (ANC) immediately to ensure it has not fallen below safe levels. If the
ANC is critically low, Clozapine must be discontinued to prevent life-threatening sepsis.
5. Which mood stabilizer is most strongly associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly in patients who are titrated too quickly?
A. Lamotrigine
B. Valproate
C. Lithium
D. Carbamazepine
Answer: A
Rationale: Lamotrigine requires a very slow titration schedule to minimize the risk of
serious rashes, including Stevens-Johnson Syndrome. Patients must be educated to report
any new rash, especially when starting the medication or increasing the dose. The risk is
significantly increased if Lamotrigine is used concurrently with Valproate, which inhibits
its metabolism.
6. In the treatment of ADHD, what is the primary mechanism of action for stimulant
medications like Methylphenidate?
A. Selective inhibition of serotonin reuptake
B. Agonism of alpha-2 adrenergic receptors
C. Antagonism of NMDA receptors
, D. Blockade of dopamine and norepinephrine transporters
Answer: D
Rationale: Methylphenidate works by blocking the reuptake of dopamine and
norepinephrine, thereby increasing their availability in the synaptic cleft. This increased
catecholamine activity in the prefrontal cortex improves attention and impulse control.
Unlike amphetamines, methylphenidate does not primarily promote the release of
dopamine from pre-synaptic vesicles.
7. A 45-year-old male with Schizophrenia has been on Haloperidol for several years. He now
exhibits involuntary rhythmic tongue protrusion and puffing of the cheeks. What is the most
likely diagnosis?
A. Akathisia
B. Acute Dystonia
C. Tardive Dyskinesia
D. Pseudoparkinsonism
Answer: C
Rationale: Tardive Dyskinesia (TD) is a late-onset extrapyramidal symptom characterized
by involuntary movements of the face, tongue, and extremities. It results from long-term
D2 receptor blockade, leading to receptor supersensitivity in the nigrostriatal pathway.
Treatment often involves switching to an atypical antipsychotic or using VMAT2 inhibitors
like Valbenazine.
8. Which second-generation antipsychotic is known for having a significant requirement for
being taken with food (at least 500 calories) to ensure adequate absorption?
A. Risperidone
B. Ziprasidone
C. Olanzapine
D. Aripiprazole
Answer: B
Rationale: Ziprasidone absorption is significantly increased when taken with a meal of at
least 500 calories; without food, its bioavailability drops by about 50%. This is a crucial
teaching point for patients to ensure consistent therapeutic blood levels. Failure to take it
with food can lead to treatment failure despite compliance with the dosing schedule.
9. A patient diagnosed with Alzheimer’s disease is prescribed Memantine. What is the
pharmacological mechanism of this drug?
A. Cholinesterase inhibition
