NR 546 Week 5 Exam V2 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
5 Exam) | Chamberlain University
1. A patient is prescribed Fluoxetine for Major Depressive Disorder. Which pharmacokinetic
property of Fluoxetine distinguishes it from other SSRIs?
A. It has a very short half-life requiring twice-daily dosing.
B. It has a long half-life of its active metabolite, norfluoxetine.
C. It is the only SSRI that does not inhibit CYP450 enzymes.
D. It is primarily excreted via the biliary route rather than renal.
Correct Answer: B
Explanation: Fluoxetine is unique among SSRIs because its active metabolite,
norfluoxetine, has a half-life of 1 to 2 weeks. This long half-life allows for a self-tapering
effect, which reduces the risk of discontinuation syndrome if a dose is missed. Clinicians
must account for this duration when switching to a Monoamine Oxidase Inhibitor (MAOI),
requiring a 5-week washout period.
2. When initiating Lithium therapy, which baseline laboratory assessment is most critical for
long-term safety monitoring?
A. Pulmonary function tests (PFTs)
B. Liver Function Tests (LFTs)
,C. Thyroid Stimulating Hormone (TSH) and Serum Creatinine
D. Serum Amylase and Lipase
Correct Answer: C
Explanation: Lithium is primarily excreted by the kidneys and can cause interstitial
nephritis, making baseline serum creatinine and GFR essential. It is also known to cause
hypothyroidism and goiter, necessitating baseline and periodic TSH monitoring. Routine
assessment ensures that the PMHNP can detect lithium-induced organ dysfunction before
it becomes irreversible.
3. A patient taking Phenelzine (Nardil) presents to the emergency department with a severe
occipital headache, palpitations, and a blood pressure of 210/120 mmHg. Which dietary
indiscretion most likely caused this?
A. Consumption of aged cheddar cheese
B. Eating fresh citrus fruits
C. Eating boiled white rice
D. Drinking tap water
Correct Answer: A
Explanation: Phenelzine is a non-selective MAOI that inhibits the breakdown of tyramine
in the gut. High levels of tyramine trigger the release of norepinephrine, leading to a
hypertensive crisis characterized by extreme blood pressure elevation and headache.
,Patients on MAOIs must strictly avoid tyramine-rich foods like aged cheeses, cured meats,
and draft beers.
4. Which of the following is the mechanism of action of Buspirone (Buspar)?
A. GABA-A receptor positive allosteric modulator
B. Voltage-gated sodium channel blocker
C. Norepinephrine reuptake inhibitor
D. 5-HT1A partial agonist
Correct Answer: D
Explanation: Buspirone acts as a partial agonist at the 5-HT1A receptor, which helps
modulate serotonin neurotransmission in the brain. Unlike benzodiazepines, it does not
affect GABA receptors and therefore lacks sedative, anticonvulsant, or muscle relaxant
properties. It is indicated for Generalized Anxiety Disorder but typically takes 2-4 weeks to
reach therapeutic efficacy.
5. A PMHNP is considering Lamotrigine for a patient with Bipolar II Disorder. What is the most
critical education point regarding the initiation of this medication?
A. Stop the medication immediately if any rash develops.
B. The medication must be taken on an empty stomach for absorption.
C. Expect immediate improvement in depressive symptoms within 48 hours.
D. Double the dose every 3 days to reach therapeutic levels faster.
, Correct Answer: A
Explanation: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome (SJS)
and Toxic Epidermal Necrolysis (TEN). To minimize this risk, the dosage must be titrated
slowly over several weeks. Any new rash requires immediate clinical evaluation and
usually permanent discontinuation of the drug.
6. Which antidepressant is specifically contraindicated in patients with a history of seizures or
eating disorders?
A. Sertraline
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Correct Answer: C
Explanation: Bupropion lowers the seizure threshold and is significantly associated with
seizures in patients with bulimia or anorexia nervosa due to electrolyte imbalances. It acts
via norepinephrine and dopamine reuptake inhibition, making it effective for depression
and smoking cessation. However, the PMHNP must screen for seizure history and eating
disorders prior to prescribing.
7. A patient with Generalized Anxiety Disorder is prescribed a Benzodiazepine for short-term
relief. Which neurotransmitter system do Benzodiazepines primarily affect?
A. Dopamine
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
5 Exam) | Chamberlain University
1. A patient is prescribed Fluoxetine for Major Depressive Disorder. Which pharmacokinetic
property of Fluoxetine distinguishes it from other SSRIs?
A. It has a very short half-life requiring twice-daily dosing.
B. It has a long half-life of its active metabolite, norfluoxetine.
C. It is the only SSRI that does not inhibit CYP450 enzymes.
D. It is primarily excreted via the biliary route rather than renal.
Correct Answer: B
Explanation: Fluoxetine is unique among SSRIs because its active metabolite,
norfluoxetine, has a half-life of 1 to 2 weeks. This long half-life allows for a self-tapering
effect, which reduces the risk of discontinuation syndrome if a dose is missed. Clinicians
must account for this duration when switching to a Monoamine Oxidase Inhibitor (MAOI),
requiring a 5-week washout period.
2. When initiating Lithium therapy, which baseline laboratory assessment is most critical for
long-term safety monitoring?
A. Pulmonary function tests (PFTs)
B. Liver Function Tests (LFTs)
,C. Thyroid Stimulating Hormone (TSH) and Serum Creatinine
D. Serum Amylase and Lipase
Correct Answer: C
Explanation: Lithium is primarily excreted by the kidneys and can cause interstitial
nephritis, making baseline serum creatinine and GFR essential. It is also known to cause
hypothyroidism and goiter, necessitating baseline and periodic TSH monitoring. Routine
assessment ensures that the PMHNP can detect lithium-induced organ dysfunction before
it becomes irreversible.
3. A patient taking Phenelzine (Nardil) presents to the emergency department with a severe
occipital headache, palpitations, and a blood pressure of 210/120 mmHg. Which dietary
indiscretion most likely caused this?
A. Consumption of aged cheddar cheese
B. Eating fresh citrus fruits
C. Eating boiled white rice
D. Drinking tap water
Correct Answer: A
Explanation: Phenelzine is a non-selective MAOI that inhibits the breakdown of tyramine
in the gut. High levels of tyramine trigger the release of norepinephrine, leading to a
hypertensive crisis characterized by extreme blood pressure elevation and headache.
,Patients on MAOIs must strictly avoid tyramine-rich foods like aged cheeses, cured meats,
and draft beers.
4. Which of the following is the mechanism of action of Buspirone (Buspar)?
A. GABA-A receptor positive allosteric modulator
B. Voltage-gated sodium channel blocker
C. Norepinephrine reuptake inhibitor
D. 5-HT1A partial agonist
Correct Answer: D
Explanation: Buspirone acts as a partial agonist at the 5-HT1A receptor, which helps
modulate serotonin neurotransmission in the brain. Unlike benzodiazepines, it does not
affect GABA receptors and therefore lacks sedative, anticonvulsant, or muscle relaxant
properties. It is indicated for Generalized Anxiety Disorder but typically takes 2-4 weeks to
reach therapeutic efficacy.
5. A PMHNP is considering Lamotrigine for a patient with Bipolar II Disorder. What is the most
critical education point regarding the initiation of this medication?
A. Stop the medication immediately if any rash develops.
B. The medication must be taken on an empty stomach for absorption.
C. Expect immediate improvement in depressive symptoms within 48 hours.
D. Double the dose every 3 days to reach therapeutic levels faster.
, Correct Answer: A
Explanation: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome (SJS)
and Toxic Epidermal Necrolysis (TEN). To minimize this risk, the dosage must be titrated
slowly over several weeks. Any new rash requires immediate clinical evaluation and
usually permanent discontinuation of the drug.
6. Which antidepressant is specifically contraindicated in patients with a history of seizures or
eating disorders?
A. Sertraline
B. Venlafaxine
C. Bupropion
D. Mirtazapine
Correct Answer: C
Explanation: Bupropion lowers the seizure threshold and is significantly associated with
seizures in patients with bulimia or anorexia nervosa due to electrolyte imbalances. It acts
via norepinephrine and dopamine reuptake inhibition, making it effective for depression
and smoking cessation. However, the PMHNP must screen for seizure history and eating
disorders prior to prescribing.
7. A patient with Generalized Anxiety Disorder is prescribed a Benzodiazepine for short-term
relief. Which neurotransmitter system do Benzodiazepines primarily affect?
A. Dopamine
