NSG 552 Exam 2 V2 | NSG 552 Psychopharmacology | Actual Q&A
with Rationale (NSG 552 Exam 2) | Wilkes University
1. A 34-year-old female patient is prescribed Venlafaxine (Effexor) for generalized anxiety
disorder. Which physical assessment parameter is most critical to monitor due to the drug’s
mechanism at higher doses?
A. Respiratory rate
B. Blood pressure
C. Abdominal girth
D. Deep tendon reflexes
Answer: B
Rationale: Venlafaxine acts as an SNRI and can lead to dose-dependent increases in blood
pressure due to its norepinephrine reuptake inhibition. Patients should have their blood
pressure monitored regularly, especially when the dose exceeds 150 mg per day.
Significant hypertension may require a dose reduction or a switch to a different
pharmacological agent.
2. Lithium carbonate is prescribed for a patient with Bipolar I disorder. What is the
therapeutic serum range for maintenance treatment?
A. 0.4 - 0.8 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.0 - 1.5 mEq/L
D. 1.5 - 2.0 mEq/L
Answer: B
Rationale: The standard therapeutic range for Lithium during the maintenance phase is
generally accepted as 0.6 to 1.2 mEq/L. Levels above 1.5 mEq/L are considered toxic and
require immediate intervention to prevent neurological damage. Routine serum
monitoring is essential to ensure efficacy while minimizing the risk of renal and thyroid
complications.
3. A patient taking Clozapine (Clozaril) must have regular blood work to monitor for which
life-threatening adverse effect?
A. Thrombocytopenia
B. Hepatic failure
C. Agranulocytosis
,D. Metabolic acidosis
Answer: C
Rationale: Clozapine is associated with a high risk of agranulocytosis, which is a severe
decrease in the absolute neutrophil count (ANC). Patients must be registered in the
Clozapine REMS program and undergo weekly to monthly blood monitoring depending on
the duration of treatment. If the ANC falls below 1500/mm3, treatment must be closely
evaluated or discontinued according to strict protocols.
4. Which antidepressant is most likely to cause anticholinergic side effects such as dry mouth,
blurred vision, and urinary retention?
A. Amitriptyline
B. Sertraline
C. Bupropion
D. Fluoxetine
Answer: A
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with high affinity for
muscarinic receptors, leading to significant anticholinergic effects. These side effects are
particularly problematic in elderly populations, increasing the risk of falls and delirium.
Modern antidepressants like SSRIs generally lack these potent anticholinergic properties,
making them safer for long-term use.
5. When switching a patient from Phenelzine (Nardil) to Fluoxetine (Prozac), how long must
the provider wait to avoid serotonin syndrome?
A. 24 hours
B. 7 days
C. 5 weeks
D. 14 days
Answer: D
Rationale: A washout period of 14 days is required when switching from an MAOI to most
other antidepressants to allow the monoamine oxidase enzyme to regenerate. This interval
prevents the dangerous accumulation of serotonin that could lead to life-threatening
serotonin syndrome. Conversely, when switching from Fluoxetine to an MAOI, a longer 5-
week washout is required due to Fluoxetine’s long half-life.
6. A patient with bipolar disorder presents with a severe skin rash after starting a new
medication. Which of the following is most likely responsible?
A. Lithium
, B. Valproate
C. Topiramate
D. Lamotrigine
Answer: D
Rationale: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome (SJS), a
potentially fatal dermatological reaction. The risk is minimized by following a very slow
titration schedule over several weeks. Providers must educate patients to report any new
rash immediately, as early discontinuation is the most effective way to prevent progression
to toxic epidermal necrolysis.
7. Which mechanism of action is primarily responsible for the extrapyramidal symptoms (EPS)
associated with typical antipsychotics like Haloperidol?
A. Serotonin 2A antagonism
B. Alpha-1 adrenergic blockade
C. Dopamine D2 receptor blockade in the nigrostriatal pathway
D. Histamine H1 receptor antagonism
Answer: C
Rationale: The blockade of D2 receptors in the nigrostriatal pathway results in a lack of
dopamine, leading to movement disorders known as EPS. These symptoms include acute
dystonia, akathisia, and pseudoparkinsonism. Balancing D2 blockade with anticholinergic
or serotonergic activity is the strategy used in newer atypical antipsychotics to reduce
these risks.
8. A 28-year-old male on Risperidone develops breast enlargement and galactorrhea. This is
caused by dopamine blockade in which pathway?
A. Tuberoinfundibular
B. Mesocortical
C. Mesolimbic
D. Nigrostriatal
Answer: A
Rationale: Dopamine normally inhibits the secretion of prolactin in the tuberoinfundibular
pathway. When antipsychotics block D2 receptors in this area, prolactin levels rise, leading
to hyperprolactinemia, gynecomastia, and sexual dysfunction. Risperidone is particularly
known for its high risk of elevating prolactin compared to other second-generation
antipsychotics.
with Rationale (NSG 552 Exam 2) | Wilkes University
1. A 34-year-old female patient is prescribed Venlafaxine (Effexor) for generalized anxiety
disorder. Which physical assessment parameter is most critical to monitor due to the drug’s
mechanism at higher doses?
A. Respiratory rate
B. Blood pressure
C. Abdominal girth
D. Deep tendon reflexes
Answer: B
Rationale: Venlafaxine acts as an SNRI and can lead to dose-dependent increases in blood
pressure due to its norepinephrine reuptake inhibition. Patients should have their blood
pressure monitored regularly, especially when the dose exceeds 150 mg per day.
Significant hypertension may require a dose reduction or a switch to a different
pharmacological agent.
2. Lithium carbonate is prescribed for a patient with Bipolar I disorder. What is the
therapeutic serum range for maintenance treatment?
A. 0.4 - 0.8 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.0 - 1.5 mEq/L
D. 1.5 - 2.0 mEq/L
Answer: B
Rationale: The standard therapeutic range for Lithium during the maintenance phase is
generally accepted as 0.6 to 1.2 mEq/L. Levels above 1.5 mEq/L are considered toxic and
require immediate intervention to prevent neurological damage. Routine serum
monitoring is essential to ensure efficacy while minimizing the risk of renal and thyroid
complications.
3. A patient taking Clozapine (Clozaril) must have regular blood work to monitor for which
life-threatening adverse effect?
A. Thrombocytopenia
B. Hepatic failure
C. Agranulocytosis
,D. Metabolic acidosis
Answer: C
Rationale: Clozapine is associated with a high risk of agranulocytosis, which is a severe
decrease in the absolute neutrophil count (ANC). Patients must be registered in the
Clozapine REMS program and undergo weekly to monthly blood monitoring depending on
the duration of treatment. If the ANC falls below 1500/mm3, treatment must be closely
evaluated or discontinued according to strict protocols.
4. Which antidepressant is most likely to cause anticholinergic side effects such as dry mouth,
blurred vision, and urinary retention?
A. Amitriptyline
B. Sertraline
C. Bupropion
D. Fluoxetine
Answer: A
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with high affinity for
muscarinic receptors, leading to significant anticholinergic effects. These side effects are
particularly problematic in elderly populations, increasing the risk of falls and delirium.
Modern antidepressants like SSRIs generally lack these potent anticholinergic properties,
making them safer for long-term use.
5. When switching a patient from Phenelzine (Nardil) to Fluoxetine (Prozac), how long must
the provider wait to avoid serotonin syndrome?
A. 24 hours
B. 7 days
C. 5 weeks
D. 14 days
Answer: D
Rationale: A washout period of 14 days is required when switching from an MAOI to most
other antidepressants to allow the monoamine oxidase enzyme to regenerate. This interval
prevents the dangerous accumulation of serotonin that could lead to life-threatening
serotonin syndrome. Conversely, when switching from Fluoxetine to an MAOI, a longer 5-
week washout is required due to Fluoxetine’s long half-life.
6. A patient with bipolar disorder presents with a severe skin rash after starting a new
medication. Which of the following is most likely responsible?
A. Lithium
, B. Valproate
C. Topiramate
D. Lamotrigine
Answer: D
Rationale: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome (SJS), a
potentially fatal dermatological reaction. The risk is minimized by following a very slow
titration schedule over several weeks. Providers must educate patients to report any new
rash immediately, as early discontinuation is the most effective way to prevent progression
to toxic epidermal necrolysis.
7. Which mechanism of action is primarily responsible for the extrapyramidal symptoms (EPS)
associated with typical antipsychotics like Haloperidol?
A. Serotonin 2A antagonism
B. Alpha-1 adrenergic blockade
C. Dopamine D2 receptor blockade in the nigrostriatal pathway
D. Histamine H1 receptor antagonism
Answer: C
Rationale: The blockade of D2 receptors in the nigrostriatal pathway results in a lack of
dopamine, leading to movement disorders known as EPS. These symptoms include acute
dystonia, akathisia, and pseudoparkinsonism. Balancing D2 blockade with anticholinergic
or serotonergic activity is the strategy used in newer atypical antipsychotics to reduce
these risks.
8. A 28-year-old male on Risperidone develops breast enlargement and galactorrhea. This is
caused by dopamine blockade in which pathway?
A. Tuberoinfundibular
B. Mesocortical
C. Mesolimbic
D. Nigrostriatal
Answer: A
Rationale: Dopamine normally inhibits the secretion of prolactin in the tuberoinfundibular
pathway. When antipsychotics block D2 receptors in this area, prolactin levels rise, leading
to hyperprolactinemia, gynecomastia, and sexual dysfunction. Risperidone is particularly
known for its high risk of elevating prolactin compared to other second-generation
antipsychotics.
