NR 546 Week 5 Exam V3 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
5 Exam) | Chamberlain University
1. A PMHNP is considering starting an SSRI for a patient with Major Depressive Disorder.
Which medication is known for having the longest half-life, thereby reducing the risk of
discontinuation syndrome?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Fluvoxamine
Correct Answer: A
Explanation: Fluoxetine has a very long half-life, especially its active metabolite
norfluoxetine, which can last up to two weeks. This long duration of action provides a ‘self-
tapering’ effect that significantly minimizes the risk of withdrawal or discontinuation
symptoms. In contrast, Paroxetine has a very short half-life and is most associated with
severe discontinuation syndrome.
2. Which mechanism of action is primarily responsible for the antidepressant effects of
Bupropion?
A. Selective inhibition of serotonin reuptake
,B. Irreversible inhibition of Monoamine Oxidase
C. Antagonism of Alpha-2 adrenergic receptors
D. Inhibition of norepinephrine and dopamine reuptake
Correct Answer: D
Explanation: Bupropion is classified as a Norepinephrine-Dopamine Reuptake Inhibitor
(NDRI). It lacks significant serotonergic activity, which accounts for its lower profile of
sexual side effects and weight gain. By increasing synaptic concentrations of dopamine and
norepinephrine, it is particularly effective for symptoms of fatigue and loss of
concentration.
3. A patient taking Phenelzine for treatment-resistant depression arrives at the emergency
department with a severe headache, palpitations, and a blood pressure of 210/120 mmHg.
Which dietary indiscretion most likely caused this?
A. Eating excessive amounts of citrus fruit
B. Consuming fresh green leafy vegetables
C. Eating aged cheese and cured meats
D. Drinking caffeinated black coffee
Correct Answer: C
Explanation: Phenelzine is a non-selective MAOI that inhibits the breakdown of tyramine
in the gut. Tyramine acts as a sympathomimetic amine, and its accumulation can lead to a
,hypertensive crisis characterized by extreme blood pressure elevation. Patients on MAOIs
must strictly avoid high-tyramine foods such as aged cheeses, air-dried meats, and
fermented soy products.
4. A 24-year-old patient with Generalized Anxiety Disorder (GAD) is started on Buspirone.
What is the most important education to provide regarding the onset of action?
A. It will provide immediate relief for panic attacks.
B. It should be taken only when feeling anxious.
C. It may take 2 to 4 weeks to see a therapeutic effect.
D. It is highly addictive and requires a strict taper.
Correct Answer: C
Explanation: Buspirone is a 5-HT1A partial agonist used for chronic anxiety but is not
effective for acute anxiety or panic due to its delayed onset. Unlike benzodiazepines, it
requires consistent daily dosing to build therapeutic levels over several weeks. Educating
the patient on this delay is crucial to ensure adherence and prevent premature
discontinuation.
5. Which of the following antidepressants is contraindicated in a patient with a history of
Bulimia Nervosa or a seizure disorder?
A. Bupropion
B. Venlafaxine
C. Citalopram
, D. Mirtazapine
Correct Answer: A
Explanation: Bupropion carries a specific contraindication for patients with eating
disorders due to an increased risk of seizures in these populations. It also lowers the
seizure threshold generally, making it unsafe for patients with pre-existing epilepsy. The
PMHNP must screen for these conditions before prescribing any formulation of Bupropion.
6. Which neurotransmitter system is primarily targeted by Benzodiazepines to produce their
anxiolytic and sedative effects?
A. Glutamate
B. D2 Dopamine
C. Serotonin 2A
D. GABA-A
Correct Answer: D
Explanation: Benzodiazepines act as positive allosteric modulators at the GABA-A
receptor complex. By increasing the frequency of chloride channel opening, they enhance
the inhibitory effects of gamma-aminobutyric acid (GABA). This result in rapid CNS
depression, producing anxiolysis, sedation, and muscle relaxation.
7. A patient complains of ‘brain shocks’ and extreme irritability after missing two doses of
their antidepressant. Which medication is most likely responsible?
A. Fluoxetine
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
5 Exam) | Chamberlain University
1. A PMHNP is considering starting an SSRI for a patient with Major Depressive Disorder.
Which medication is known for having the longest half-life, thereby reducing the risk of
discontinuation syndrome?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Fluvoxamine
Correct Answer: A
Explanation: Fluoxetine has a very long half-life, especially its active metabolite
norfluoxetine, which can last up to two weeks. This long duration of action provides a ‘self-
tapering’ effect that significantly minimizes the risk of withdrawal or discontinuation
symptoms. In contrast, Paroxetine has a very short half-life and is most associated with
severe discontinuation syndrome.
2. Which mechanism of action is primarily responsible for the antidepressant effects of
Bupropion?
A. Selective inhibition of serotonin reuptake
,B. Irreversible inhibition of Monoamine Oxidase
C. Antagonism of Alpha-2 adrenergic receptors
D. Inhibition of norepinephrine and dopamine reuptake
Correct Answer: D
Explanation: Bupropion is classified as a Norepinephrine-Dopamine Reuptake Inhibitor
(NDRI). It lacks significant serotonergic activity, which accounts for its lower profile of
sexual side effects and weight gain. By increasing synaptic concentrations of dopamine and
norepinephrine, it is particularly effective for symptoms of fatigue and loss of
concentration.
3. A patient taking Phenelzine for treatment-resistant depression arrives at the emergency
department with a severe headache, palpitations, and a blood pressure of 210/120 mmHg.
Which dietary indiscretion most likely caused this?
A. Eating excessive amounts of citrus fruit
B. Consuming fresh green leafy vegetables
C. Eating aged cheese and cured meats
D. Drinking caffeinated black coffee
Correct Answer: C
Explanation: Phenelzine is a non-selective MAOI that inhibits the breakdown of tyramine
in the gut. Tyramine acts as a sympathomimetic amine, and its accumulation can lead to a
,hypertensive crisis characterized by extreme blood pressure elevation. Patients on MAOIs
must strictly avoid high-tyramine foods such as aged cheeses, air-dried meats, and
fermented soy products.
4. A 24-year-old patient with Generalized Anxiety Disorder (GAD) is started on Buspirone.
What is the most important education to provide regarding the onset of action?
A. It will provide immediate relief for panic attacks.
B. It should be taken only when feeling anxious.
C. It may take 2 to 4 weeks to see a therapeutic effect.
D. It is highly addictive and requires a strict taper.
Correct Answer: C
Explanation: Buspirone is a 5-HT1A partial agonist used for chronic anxiety but is not
effective for acute anxiety or panic due to its delayed onset. Unlike benzodiazepines, it
requires consistent daily dosing to build therapeutic levels over several weeks. Educating
the patient on this delay is crucial to ensure adherence and prevent premature
discontinuation.
5. Which of the following antidepressants is contraindicated in a patient with a history of
Bulimia Nervosa or a seizure disorder?
A. Bupropion
B. Venlafaxine
C. Citalopram
, D. Mirtazapine
Correct Answer: A
Explanation: Bupropion carries a specific contraindication for patients with eating
disorders due to an increased risk of seizures in these populations. It also lowers the
seizure threshold generally, making it unsafe for patients with pre-existing epilepsy. The
PMHNP must screen for these conditions before prescribing any formulation of Bupropion.
6. Which neurotransmitter system is primarily targeted by Benzodiazepines to produce their
anxiolytic and sedative effects?
A. Glutamate
B. D2 Dopamine
C. Serotonin 2A
D. GABA-A
Correct Answer: D
Explanation: Benzodiazepines act as positive allosteric modulators at the GABA-A
receptor complex. By increasing the frequency of chloride channel opening, they enhance
the inhibitory effects of gamma-aminobutyric acid (GABA). This result in rapid CNS
depression, producing anxiolysis, sedation, and muscle relaxation.
7. A patient complains of ‘brain shocks’ and extreme irritability after missing two doses of
their antidepressant. Which medication is most likely responsible?
A. Fluoxetine
