NR 546 PSYCHOPHARMACOLOGY
MIDTERM EXAM 5 QUESTIONS AND
ANSWERS (LATEST), (A+ GUARANTEE).
JUST RELEASED
1. A 45-year-old patient with depression is prescribed Fluoxetine. The nurse practitioner
knows that this medication is a potent inhibitor of which cytochrome P450 enzyme,
potentially increasing levels of beta-blockers or TCAs?
A. CYP3A4
B. CYP2C19
C. CYP1A2
D. CYP2D6
Answer: D
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which is responsible for the metabolism of many beta-blockers, tricyclic antidepressants
(TCAs), and some antipsychotics.
2. Which specific dopamine pathway is associated with the development of Extrapyramidal
Symptoms (EPS) when D2 receptors are blocked by first-generation antipsychotics?
A. Mesolimbic pathway
,B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The Nigrostriatal pathway controls motor function. Blockade of
D2 receptors in this pathway leads to EPS, such as akathisia and dystonia.
3. A patient taking Lithium presents with a tremor, ataxia, confusion, and a serum lithium
level of 2.1 mEq/L. What is the most appropriate next step in management?
A. Maintain the current dose and recheck in 24 hours
B. Hold the lithium and initiate hydration/stabilization
C. Increase fluid intake and add a benzodiazepine
D. Switch to Valproic acid immediately
Answer: B
Conceptual Explanation: A lithium level of 2.1 mEq/L indicates moderate to severe
toxicity. The medication must be held, and medical stabilization (fluids, monitoring) is
required.
4. 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. Sertraline
, B. Bupropion
C. Mirtazapine
D. Venlafaxine
Answer: B
Conceptual Explanation: Bupropion is known to lower the seizure threshold and is
strictly contraindicated in patients with bulimia or anorexia nervosa due to electrolyte
imbalances increasing seizure risk.
5. When initiating Clozapine, the provider must monitor the Absolute Neutrophil Count
(ANC). What is the minimum ANC required to start treatment in a non-benign ethnic
neutropenic patient?
A. 500/mm3
B. 1500/mm3
C. 1000/mm3
D. 2000/mm3
Answer: B
Conceptual Explanation: Standard protocol requires an ANC of at least 1500/mm3 to
initiate Clozapine therapy to mitigate the risk of agranulocytosis.
MIDTERM EXAM 5 QUESTIONS AND
ANSWERS (LATEST), (A+ GUARANTEE).
JUST RELEASED
1. A 45-year-old patient with depression is prescribed Fluoxetine. The nurse practitioner
knows that this medication is a potent inhibitor of which cytochrome P450 enzyme,
potentially increasing levels of beta-blockers or TCAs?
A. CYP3A4
B. CYP2C19
C. CYP1A2
D. CYP2D6
Answer: D
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which is responsible for the metabolism of many beta-blockers, tricyclic antidepressants
(TCAs), and some antipsychotics.
2. Which specific dopamine pathway is associated with the development of Extrapyramidal
Symptoms (EPS) when D2 receptors are blocked by first-generation antipsychotics?
A. Mesolimbic pathway
,B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The Nigrostriatal pathway controls motor function. Blockade of
D2 receptors in this pathway leads to EPS, such as akathisia and dystonia.
3. A patient taking Lithium presents with a tremor, ataxia, confusion, and a serum lithium
level of 2.1 mEq/L. What is the most appropriate next step in management?
A. Maintain the current dose and recheck in 24 hours
B. Hold the lithium and initiate hydration/stabilization
C. Increase fluid intake and add a benzodiazepine
D. Switch to Valproic acid immediately
Answer: B
Conceptual Explanation: A lithium level of 2.1 mEq/L indicates moderate to severe
toxicity. The medication must be held, and medical stabilization (fluids, monitoring) is
required.
4. 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. Sertraline
, B. Bupropion
C. Mirtazapine
D. Venlafaxine
Answer: B
Conceptual Explanation: Bupropion is known to lower the seizure threshold and is
strictly contraindicated in patients with bulimia or anorexia nervosa due to electrolyte
imbalances increasing seizure risk.
5. When initiating Clozapine, the provider must monitor the Absolute Neutrophil Count
(ANC). What is the minimum ANC required to start treatment in a non-benign ethnic
neutropenic patient?
A. 500/mm3
B. 1500/mm3
C. 1000/mm3
D. 2000/mm3
Answer: B
Conceptual Explanation: Standard protocol requires an ANC of at least 1500/mm3 to
initiate Clozapine therapy to mitigate the risk of agranulocytosis.
