NR 546 Final Exam V3 q ueations and answers
2027
1. A PMHNP is considering starting a patient on Fluoxetine. What is a unique pharmacokinetic
property of Fluoxetine compared to other SSRIs?
A. It has the shortest half-life among all SSRIs.
B. It is strictly contraindicated in patients with liver disease.
C. It is the only SSRI that does not inhibit the CYP2D6 enzyme.
D. It has a very long half-life due to its active metabolite, norfluoxetine.
Correct Answer: D
Explanation: Fluoxetine is characterized by a very long half-life, which can last several
days, while its active metabolite norfluoxetine can last up to two weeks. This long duration
of action provides a built-in taper that reduces the risk of discontinuation syndrome if a
patient misses a dose. Consequently, a longer washout period is required when switching
from fluoxetine to a monoamine oxidase inhibitor (MAOI).
2. Which of the following describes the mechanism of action of Buspirone in the treatment of
Generalized Anxiety Disorder?
A. GABA-A receptor positive allosteric modulator
B. Serotonin 1A receptor partial agonist
C. Alpha-2-delta ligand at voltage-gated calcium channels
,D. Selective norepinephrine reuptake inhibitor
Correct Answer: B
Explanation: Buspirone acts as a partial agonist at the 5-HT1A (serotonin 1A) receptor,
which helps modulate serotonin neurotransmission. Unlike benzodiazepines, it does not
interact with GABA receptors and lacks sedative, muscle relaxant, or anticonvulsant
properties. It is often used as an augmenting agent or a second-line treatment for chronic
anxiety due to its delayed onset of action.
3. A patient taking Clozapine presents for a routine follow-up. Which laboratory value is the
primary safety concern and requires mandatory monitoring?
A. Serum creatinine
B. Serum Alanine Aminotransferase (ALT)
C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Correct Answer: D
Explanation: Clozapine carries a boxed warning for severe neutropenia, which can lead to
life-threatening infections. The Absolute Neutrophil Count (ANC) must be monitored
regularly through the Clozapine REMS program to ensure patient safety. If the ANC falls
below specific thresholds, clozapine must be interrupted or discontinued to prevent
agranulocytosis.
, 4. Which mechanism is responsible for the dietary restrictions associated with traditional
Monoamine Oxidase Inhibitors (MAOIs)?
A. Potentiation of GABAergic neurons in the enteric nervous system.
B. Inhibition of intestinal MAO-A, leading to increased absorption of tyramine.
C. Direct stimulation of beta-2 adrenergic receptors by tyramine.
D. Inhibition of the CYP3A4 enzyme system.
Correct Answer: B
Explanation: MAOIs inhibit the breakdown of tyramine in the gut and liver by blocking the
MAO-A enzyme. When high-tyramine foods like aged cheeses are consumed, tyramine
enters the systemic circulation and displaces stored norepinephrine, leading to a
hypertensive crisis. Patients on these medications must adhere to a low-tyramine diet to
avoid potentially fatal spikes in blood pressure.
5. A patient with ADHD is prescribed Atomoxetine. What is the primary mechanism of action
for this non-stimulant medication?
A. Dopamine reuptake inhibition in the nucleus accumbens
B. Selective inhibition of the norepinephrine transporter (NET)
C. Antagonism of the NMDA glutamate receptor
D. Agonism of the alpha-2A adrenergic receptor
Correct Answer: B
2027
1. A PMHNP is considering starting a patient on Fluoxetine. What is a unique pharmacokinetic
property of Fluoxetine compared to other SSRIs?
A. It has the shortest half-life among all SSRIs.
B. It is strictly contraindicated in patients with liver disease.
C. It is the only SSRI that does not inhibit the CYP2D6 enzyme.
D. It has a very long half-life due to its active metabolite, norfluoxetine.
Correct Answer: D
Explanation: Fluoxetine is characterized by a very long half-life, which can last several
days, while its active metabolite norfluoxetine can last up to two weeks. This long duration
of action provides a built-in taper that reduces the risk of discontinuation syndrome if a
patient misses a dose. Consequently, a longer washout period is required when switching
from fluoxetine to a monoamine oxidase inhibitor (MAOI).
2. Which of the following describes the mechanism of action of Buspirone in the treatment of
Generalized Anxiety Disorder?
A. GABA-A receptor positive allosteric modulator
B. Serotonin 1A receptor partial agonist
C. Alpha-2-delta ligand at voltage-gated calcium channels
,D. Selective norepinephrine reuptake inhibitor
Correct Answer: B
Explanation: Buspirone acts as a partial agonist at the 5-HT1A (serotonin 1A) receptor,
which helps modulate serotonin neurotransmission. Unlike benzodiazepines, it does not
interact with GABA receptors and lacks sedative, muscle relaxant, or anticonvulsant
properties. It is often used as an augmenting agent or a second-line treatment for chronic
anxiety due to its delayed onset of action.
3. A patient taking Clozapine presents for a routine follow-up. Which laboratory value is the
primary safety concern and requires mandatory monitoring?
A. Serum creatinine
B. Serum Alanine Aminotransferase (ALT)
C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Correct Answer: D
Explanation: Clozapine carries a boxed warning for severe neutropenia, which can lead to
life-threatening infections. The Absolute Neutrophil Count (ANC) must be monitored
regularly through the Clozapine REMS program to ensure patient safety. If the ANC falls
below specific thresholds, clozapine must be interrupted or discontinued to prevent
agranulocytosis.
, 4. Which mechanism is responsible for the dietary restrictions associated with traditional
Monoamine Oxidase Inhibitors (MAOIs)?
A. Potentiation of GABAergic neurons in the enteric nervous system.
B. Inhibition of intestinal MAO-A, leading to increased absorption of tyramine.
C. Direct stimulation of beta-2 adrenergic receptors by tyramine.
D. Inhibition of the CYP3A4 enzyme system.
Correct Answer: B
Explanation: MAOIs inhibit the breakdown of tyramine in the gut and liver by blocking the
MAO-A enzyme. When high-tyramine foods like aged cheeses are consumed, tyramine
enters the systemic circulation and displaces stored norepinephrine, leading to a
hypertensive crisis. Patients on these medications must adhere to a low-tyramine diet to
avoid potentially fatal spikes in blood pressure.
5. A patient with ADHD is prescribed Atomoxetine. What is the primary mechanism of action
for this non-stimulant medication?
A. Dopamine reuptake inhibition in the nucleus accumbens
B. Selective inhibition of the norepinephrine transporter (NET)
C. Antagonism of the NMDA glutamate receptor
D. Agonism of the alpha-2A adrenergic receptor
Correct Answer: B
