NR 546 Final Exam V1 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Final
Exam) | Chamberlain University
1. A PMHNP is treating a patient with schizophrenia who is experiencing significant weight
gain and dyslipidemia on Olanzapine. Which of the following pathways is primarily associated
with the therapeutic antipsychotic effects by blocking D2 receptors?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Correct Answer: A
Explanation: The mesolimbic pathway is associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions. Blocking D2 receptors in this pathway
reduces these symptoms. Conversely, blocking receptors in the nigrostriatal pathway can
lead to extrapyramidal side effects.
2. A 24-year-old patient is being started on Clozapine after failing two other antipsychotic
trials. What is the minimum Absolute Neutrophil Count (ANC) required to initiate treatment?
A. 1500/mm³
B. 1000/mm³
,C. 500/mm³
D. 2000/mm³
Correct Answer: A
Explanation: To initiate Clozapine, the ANC must be greater than or equal to 1500/mm³
for the general population. This monitoring is critical due to the risk of severe neutropenia
and agranulocytosis. The PMHNP must follow the REMS program guidelines for regular
blood draws.
3. Lithium toxicity can occur even at therapeutic levels if certain factors change. Which of the
following medications can increase lithium levels and lead to toxicity?
A. Aspirin
B. Theophylline
C. Acetaminophen
D. Ibuprofen
Correct Answer: D
Explanation: NSAIDs like ibuprofen reduce renal clearance of lithium, which can lead to
increased serum levels and toxicity. Patients should be educated to avoid most NSAIDs
while on lithium therapy. Acetaminophen is generally considered a safer alternative for
pain management in these patients.
, 4. A patient taking Phenelzine (an MAOI) presents to the emergency room with a severe
headache, nausea, and a blood pressure of 210/120 mmHg. Which dietary indiscretion most
likely caused this?
A. Aged cheddar cheese
B. Fresh strawberries
C. Egg white omelet
D. Whole grain bread
Correct Answer: A
Explanation: Aged cheeses contain high levels of tyramine, which can trigger a
hypertensive crisis in patients taking MAOIs. MAOIs inhibit the breakdown of tyramine in
the gut, leading to massive norepinephrine release. This condition is a medical emergency
that requires immediate treatment with antihypertensives.
5. Which of the following antidepressants is most likely to cause a dose-dependent increase
in blood pressure?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Paroxetine
Correct Answer: C
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Final
Exam) | Chamberlain University
1. A PMHNP is treating a patient with schizophrenia who is experiencing significant weight
gain and dyslipidemia on Olanzapine. Which of the following pathways is primarily associated
with the therapeutic antipsychotic effects by blocking D2 receptors?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Correct Answer: A
Explanation: The mesolimbic pathway is associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions. Blocking D2 receptors in this pathway
reduces these symptoms. Conversely, blocking receptors in the nigrostriatal pathway can
lead to extrapyramidal side effects.
2. A 24-year-old patient is being started on Clozapine after failing two other antipsychotic
trials. What is the minimum Absolute Neutrophil Count (ANC) required to initiate treatment?
A. 1500/mm³
B. 1000/mm³
,C. 500/mm³
D. 2000/mm³
Correct Answer: A
Explanation: To initiate Clozapine, the ANC must be greater than or equal to 1500/mm³
for the general population. This monitoring is critical due to the risk of severe neutropenia
and agranulocytosis. The PMHNP must follow the REMS program guidelines for regular
blood draws.
3. Lithium toxicity can occur even at therapeutic levels if certain factors change. Which of the
following medications can increase lithium levels and lead to toxicity?
A. Aspirin
B. Theophylline
C. Acetaminophen
D. Ibuprofen
Correct Answer: D
Explanation: NSAIDs like ibuprofen reduce renal clearance of lithium, which can lead to
increased serum levels and toxicity. Patients should be educated to avoid most NSAIDs
while on lithium therapy. Acetaminophen is generally considered a safer alternative for
pain management in these patients.
, 4. A patient taking Phenelzine (an MAOI) presents to the emergency room with a severe
headache, nausea, and a blood pressure of 210/120 mmHg. Which dietary indiscretion most
likely caused this?
A. Aged cheddar cheese
B. Fresh strawberries
C. Egg white omelet
D. Whole grain bread
Correct Answer: A
Explanation: Aged cheeses contain high levels of tyramine, which can trigger a
hypertensive crisis in patients taking MAOIs. MAOIs inhibit the breakdown of tyramine in
the gut, leading to massive norepinephrine release. This condition is a medical emergency
that requires immediate treatment with antihypertensives.
5. Which of the following antidepressants is most likely to cause a dose-dependent increase
in blood pressure?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Paroxetine
Correct Answer: C
