NSG 552 Final Exam V1 | NSG 552 Psychopharmacology | Actual Q&A
with Rationale (NSG 552 Final Exam) | Wilkes University
1. A 24-year-old male patient with schizophrenia is started on a high-potency first-generation
antipsychotic. Within 48 hours, he develops severe muscle rigidity, fever of 103°F, and
autonomic instability. Which of the following is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Acute Dystonic Reaction
D. Anticholinergic Toxicity
Answer: B
Rationale: Neuroleptic Malignant Syndrome is a rare but life-threatening reaction to
dopamine antagonists. It is characterized by the ‘lead pipe’ muscle rigidity, hyperthermia,
and mental status changes. Management requires immediate discontinuation of the
offending agent and supportive care.
2. When prescribing Lithium for a patient with Bipolar I Disorder, which laboratory test is
most critical to monitor periodically to avoid toxicity related to renal clearance?
A. Liver Function Tests (LFTs)
B. Hemoglobin A1c
C. Complete Blood Count (CBC)
D. Serum Creatinine and GFR
Answer: D
Rationale: Lithium is excreted almost entirely by the kidneys and has a very narrow
therapeutic index. Changes in renal function can lead to toxic accumulation of the drug in
the bloodstream. Therefore, clinicians must regularly monitor serum creatinine and
glomerular filtration rate to ensure safe dosing.
3. A patient taking Phenelzine (an MAOI) is admitted to the emergency department with a
severe occipital headache and a blood pressure of 210/120 mmHg. Which dietary indiscretion
most likely caused this event?
A. Consumption of aged cheese and red wine
B. Consumption of leafy green vegetables
C. Excessive intake of grapefruit juice
D. High-protein diet with red meat
,Answer: A
Rationale: MAOIs inhibit the breakdown of tyramine, a substance found in fermented or
aged foods. High levels of tyramine cause a massive release of norepinephrine, leading to a
hypertensive crisis. Patients must be strictly educated on avoiding aged cheeses, cured
meats, and certain alcoholic beverages.
4. Which antidepressant is most likely to be avoided in a patient with a history of a seizure
disorder or an active diagnosis of bulimia nervosa?
A. Fluoxetine
B. Sertraline
C. Escitalopram
D. Bupropion
Answer: D
Rationale: Bupropion is known to lower the seizure threshold, particularly at higher
doses. It is specifically contraindicated in patients with eating disorders due to the
increased risk of electrolyte imbalances that further lower the seizure threshold. Clinicians
should screen for these conditions before initiating treatment with this norepinephrine-
dopamine reuptake inhibitor.
5. A patient is started on Clozapine for treatment-resistant schizophrenia. According to the
Clozapine REMS program, which value must be checked before each refill during the first six
months?
A. Serum Clozapine level
B. Platelet count
C. Absolute Neutrophil Count (ANC)
D. Fastest Blood Glucose
Answer: C
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe
decrease in white blood cells. The REMS program requires frequent monitoring of the
Absolute Neutrophil Count to ensure the patient’s immune system remains functional. If
the ANC falls below specific thresholds, the medication must be discontinued immediately.
6. Which of the following SSRIs has the longest half-life, making it a preferred choice for
patients who occasionally forget to take their daily dose?
A. Paroxetine
B. Sertraline
C. Fluvoxamine
, D. Fluoxetine
Answer: D
Rationale: Fluoxetine has a very long half-life of 2 to 4 days, and its active metabolite
norfluoxetine can last even longer. This makes it more ‘forgiving’ if a patient misses a dose,
as the plasma levels decrease slowly. Conversely, it requires a longer washout period
before switching to other agents like MAOIs.
7. A 65-year-old patient is prescribed a new medication for anxiety. Which benzodiazepine is
preferred in geriatric populations due to its lack of active metabolites and Phase II
metabolism?
A. Diazepam
B. Lorazepam
C. Chlordiazepoxide
D. Alprazolam
Answer: B
Rationale: Lorazepam, along with Oxazepam and Temazepam (the ‘LOT’ drugs), undergo
simple glucuronidation. They do not have active metabolites that accumulate, making them
safer for the elderly. Diazepam and Chlordiazepoxide have long-acting metabolites that
significantly increase the risk of falls and cognitive impairment in older adults.
8. What is the primary mechanism of action for the stimulant Methylphenidate in the
treatment of ADHD?
A. Agonism of Alpha-2 receptors in the prefrontal cortex
B. Increase in the release of serotonin from synaptic vesicles
C. Blockade of the reuptake of dopamine and norepinephrine
D. Antagonism of NMDA glutamate receptors
Answer: C
Rationale: Methylphenidate works primarily by blocking the dopamine transporter (DAT)
and norepinephrine transporter (NET). This increases the concentration of these
catecholamines in the synaptic cleft, particularly in the prefrontal cortex. Improved
signaling in these areas helps enhance focus and reduce impulsivity.
9. A patient develops Stevens-Johnson Syndrome (SJS) after starting a mood stabilizer. Which
medication is most likely responsible?
A. Lithium
B. Lamotrigine
with Rationale (NSG 552 Final Exam) | Wilkes University
1. A 24-year-old male patient with schizophrenia is started on a high-potency first-generation
antipsychotic. Within 48 hours, he develops severe muscle rigidity, fever of 103°F, and
autonomic instability. Which of the following is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Acute Dystonic Reaction
D. Anticholinergic Toxicity
Answer: B
Rationale: Neuroleptic Malignant Syndrome is a rare but life-threatening reaction to
dopamine antagonists. It is characterized by the ‘lead pipe’ muscle rigidity, hyperthermia,
and mental status changes. Management requires immediate discontinuation of the
offending agent and supportive care.
2. When prescribing Lithium for a patient with Bipolar I Disorder, which laboratory test is
most critical to monitor periodically to avoid toxicity related to renal clearance?
A. Liver Function Tests (LFTs)
B. Hemoglobin A1c
C. Complete Blood Count (CBC)
D. Serum Creatinine and GFR
Answer: D
Rationale: Lithium is excreted almost entirely by the kidneys and has a very narrow
therapeutic index. Changes in renal function can lead to toxic accumulation of the drug in
the bloodstream. Therefore, clinicians must regularly monitor serum creatinine and
glomerular filtration rate to ensure safe dosing.
3. A patient taking Phenelzine (an MAOI) is admitted to the emergency department with a
severe occipital headache and a blood pressure of 210/120 mmHg. Which dietary indiscretion
most likely caused this event?
A. Consumption of aged cheese and red wine
B. Consumption of leafy green vegetables
C. Excessive intake of grapefruit juice
D. High-protein diet with red meat
,Answer: A
Rationale: MAOIs inhibit the breakdown of tyramine, a substance found in fermented or
aged foods. High levels of tyramine cause a massive release of norepinephrine, leading to a
hypertensive crisis. Patients must be strictly educated on avoiding aged cheeses, cured
meats, and certain alcoholic beverages.
4. Which antidepressant is most likely to be avoided in a patient with a history of a seizure
disorder or an active diagnosis of bulimia nervosa?
A. Fluoxetine
B. Sertraline
C. Escitalopram
D. Bupropion
Answer: D
Rationale: Bupropion is known to lower the seizure threshold, particularly at higher
doses. It is specifically contraindicated in patients with eating disorders due to the
increased risk of electrolyte imbalances that further lower the seizure threshold. Clinicians
should screen for these conditions before initiating treatment with this norepinephrine-
dopamine reuptake inhibitor.
5. A patient is started on Clozapine for treatment-resistant schizophrenia. According to the
Clozapine REMS program, which value must be checked before each refill during the first six
months?
A. Serum Clozapine level
B. Platelet count
C. Absolute Neutrophil Count (ANC)
D. Fastest Blood Glucose
Answer: C
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe
decrease in white blood cells. The REMS program requires frequent monitoring of the
Absolute Neutrophil Count to ensure the patient’s immune system remains functional. If
the ANC falls below specific thresholds, the medication must be discontinued immediately.
6. Which of the following SSRIs has the longest half-life, making it a preferred choice for
patients who occasionally forget to take their daily dose?
A. Paroxetine
B. Sertraline
C. Fluvoxamine
, D. Fluoxetine
Answer: D
Rationale: Fluoxetine has a very long half-life of 2 to 4 days, and its active metabolite
norfluoxetine can last even longer. This makes it more ‘forgiving’ if a patient misses a dose,
as the plasma levels decrease slowly. Conversely, it requires a longer washout period
before switching to other agents like MAOIs.
7. A 65-year-old patient is prescribed a new medication for anxiety. Which benzodiazepine is
preferred in geriatric populations due to its lack of active metabolites and Phase II
metabolism?
A. Diazepam
B. Lorazepam
C. Chlordiazepoxide
D. Alprazolam
Answer: B
Rationale: Lorazepam, along with Oxazepam and Temazepam (the ‘LOT’ drugs), undergo
simple glucuronidation. They do not have active metabolites that accumulate, making them
safer for the elderly. Diazepam and Chlordiazepoxide have long-acting metabolites that
significantly increase the risk of falls and cognitive impairment in older adults.
8. What is the primary mechanism of action for the stimulant Methylphenidate in the
treatment of ADHD?
A. Agonism of Alpha-2 receptors in the prefrontal cortex
B. Increase in the release of serotonin from synaptic vesicles
C. Blockade of the reuptake of dopamine and norepinephrine
D. Antagonism of NMDA glutamate receptors
Answer: C
Rationale: Methylphenidate works primarily by blocking the dopamine transporter (DAT)
and norepinephrine transporter (NET). This increases the concentration of these
catecholamines in the synaptic cleft, particularly in the prefrontal cortex. Improved
signaling in these areas helps enhance focus and reduce impulsivity.
9. A patient develops Stevens-Johnson Syndrome (SJS) after starting a mood stabilizer. Which
medication is most likely responsible?
A. Lithium
B. Lamotrigine
