NR 546 Week 9 Exam V1 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
9 Exam) | Chamberlain University
1. A 10-year-old child with ADHD is started on Guanfacine ER (Intuniv). Which mechanism of
action correctly describes this medication?
A. It acts as a potent antagonist at the dopamine D2 receptor.
B. It increases dopamine release from the presynaptic neuron.
C. It inhibits the reuptake of norepinephrine in the synaptic cleft.
D. It is a selective alpha-2a adrenergic receptor agonist.
Correct Answer: D
Explanation: Guanfacine is a selective alpha-2a adrenergic receptor agonist that
specifically targets receptors in the prefrontal cortex. This action improves executive
function, attention, and impulse control by strengthening the signal-to-noise ratio in the
brain. It is often utilized as an adjunct to stimulants or as a monotherapy for patients who
cannot tolerate stimulants.
2. When prescribing Atomoxetine (Strattera) to a pediatric patient, which black box warning
must the PMHNP discuss with the parents?
A. Risk of suicidal ideation in children and adolescents.
B. Risk of Stevens-Johnson syndrome.
,C. Increased risk of sudden cardiac death.
D. Severe hepatotoxicity leading to liver failure.
Correct Answer: A
Explanation: Atomoxetine carries a black box warning regarding the increased risk of
suicidal ideation in pediatric patients. Providers must monitor patients closely for clinical
worsening or unusual changes in behavior, especially during the first few months of
treatment. Families should be educated to report any signs of depressive symptoms or
suicidality immediately.
3. A patient with Alcohol Use Disorder is prescribed Acamprosate. What is a critical
contraindication for this medication?
A. Active liver cirrhosis with elevated AST/ALT.
B. Severe renal impairment (CrCl < 30 mL/min).
C. History of opioid dependence.
D. History of severe depression or bipolar disorder.
Correct Answer: B
Explanation: Acamprosate is primarily excreted through the kidneys and is
contraindicated in patients with severe renal impairment, defined as a creatinine clearance
less than 30 mL/min. For patients with moderate renal impairment, a dosage reduction is
typically required. Unlike Naltrexone, Acamprosate does not undergo significant hepatic
metabolism and is safe for patients with liver disease.
,4. Which pharmacological treatment for Opioid Use Disorder is a partial mu-opioid agonist
with a ‘ceiling effect’ on respiratory depression?
A. Methadone
B. Naltrexone
C. Buprenorphine
D. Naloxone
Correct Answer: C
Explanation: Buprenorphine is a partial mu-opioid agonist that exhibits a ceiling effect,
which means higher doses do not lead to proportional increases in respiratory depression.
This pharmacological profile makes it significantly safer than full agonists like methadone
in the event of an overdose. It also has a high affinity for the mu-receptor, allowing it to
displace full agonists and prevent withdrawal symptoms.
5. A PMHNP is considering Lisdexamfetamine (Vyvanse) for an adult with ADHD. How does
the pharmacology of this drug differ from other stimulants?
A. It has a very short half-life requiring multiple daily doses.
B. It bypasses the liver and is metabolized strictly in the kidneys.
C. It acts exclusively on the serotonin transporter system.
D. It is a prodrug that requires enzymatic conversion in the blood.
Correct Answer: D
, Explanation: Lisdexamfetamine is a prodrug that is inactive until it is converted to d-
amphetamine by red blood cell enzymes. This conversion process is rate-limited, which
results in a smoother delivery of the medication and a lower potential for abuse via
injection or insufflation. Because of its pharmacokinetic profile, it generally provides a
longer duration of effect compared to immediate-release stimulants.
6. Which medication is considered the first-line treatment for managing acute alcohol
withdrawal symptoms?
A. Disulfiram
B. Naltrexone
C. Benzodiazepines
D. Gabapentin
Correct Answer: C
Explanation: Benzodiazepines, such as Diazepam or Lorazepam, are the gold standard for
treating acute alcohol withdrawal because they provide cross-tolerance with alcohol at the
GABA-A receptor. They help prevent severe complications like seizures and delirium
tremens during the detoxification process. Choice of specific benzodiazepine often depends
on the patient’s liver function and the drug’s half-life.
7. A patient taking Disulfiram (Antabuse) consumes a small amount of alcohol. Which
physiological response is expected?
A. Severe headache, flushing, nausea, and tachycardia.
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
9 Exam) | Chamberlain University
1. A 10-year-old child with ADHD is started on Guanfacine ER (Intuniv). Which mechanism of
action correctly describes this medication?
A. It acts as a potent antagonist at the dopamine D2 receptor.
B. It increases dopamine release from the presynaptic neuron.
C. It inhibits the reuptake of norepinephrine in the synaptic cleft.
D. It is a selective alpha-2a adrenergic receptor agonist.
Correct Answer: D
Explanation: Guanfacine is a selective alpha-2a adrenergic receptor agonist that
specifically targets receptors in the prefrontal cortex. This action improves executive
function, attention, and impulse control by strengthening the signal-to-noise ratio in the
brain. It is often utilized as an adjunct to stimulants or as a monotherapy for patients who
cannot tolerate stimulants.
2. When prescribing Atomoxetine (Strattera) to a pediatric patient, which black box warning
must the PMHNP discuss with the parents?
A. Risk of suicidal ideation in children and adolescents.
B. Risk of Stevens-Johnson syndrome.
,C. Increased risk of sudden cardiac death.
D. Severe hepatotoxicity leading to liver failure.
Correct Answer: A
Explanation: Atomoxetine carries a black box warning regarding the increased risk of
suicidal ideation in pediatric patients. Providers must monitor patients closely for clinical
worsening or unusual changes in behavior, especially during the first few months of
treatment. Families should be educated to report any signs of depressive symptoms or
suicidality immediately.
3. A patient with Alcohol Use Disorder is prescribed Acamprosate. What is a critical
contraindication for this medication?
A. Active liver cirrhosis with elevated AST/ALT.
B. Severe renal impairment (CrCl < 30 mL/min).
C. History of opioid dependence.
D. History of severe depression or bipolar disorder.
Correct Answer: B
Explanation: Acamprosate is primarily excreted through the kidneys and is
contraindicated in patients with severe renal impairment, defined as a creatinine clearance
less than 30 mL/min. For patients with moderate renal impairment, a dosage reduction is
typically required. Unlike Naltrexone, Acamprosate does not undergo significant hepatic
metabolism and is safe for patients with liver disease.
,4. Which pharmacological treatment for Opioid Use Disorder is a partial mu-opioid agonist
with a ‘ceiling effect’ on respiratory depression?
A. Methadone
B. Naltrexone
C. Buprenorphine
D. Naloxone
Correct Answer: C
Explanation: Buprenorphine is a partial mu-opioid agonist that exhibits a ceiling effect,
which means higher doses do not lead to proportional increases in respiratory depression.
This pharmacological profile makes it significantly safer than full agonists like methadone
in the event of an overdose. It also has a high affinity for the mu-receptor, allowing it to
displace full agonists and prevent withdrawal symptoms.
5. A PMHNP is considering Lisdexamfetamine (Vyvanse) for an adult with ADHD. How does
the pharmacology of this drug differ from other stimulants?
A. It has a very short half-life requiring multiple daily doses.
B. It bypasses the liver and is metabolized strictly in the kidneys.
C. It acts exclusively on the serotonin transporter system.
D. It is a prodrug that requires enzymatic conversion in the blood.
Correct Answer: D
, Explanation: Lisdexamfetamine is a prodrug that is inactive until it is converted to d-
amphetamine by red blood cell enzymes. This conversion process is rate-limited, which
results in a smoother delivery of the medication and a lower potential for abuse via
injection or insufflation. Because of its pharmacokinetic profile, it generally provides a
longer duration of effect compared to immediate-release stimulants.
6. Which medication is considered the first-line treatment for managing acute alcohol
withdrawal symptoms?
A. Disulfiram
B. Naltrexone
C. Benzodiazepines
D. Gabapentin
Correct Answer: C
Explanation: Benzodiazepines, such as Diazepam or Lorazepam, are the gold standard for
treating acute alcohol withdrawal because they provide cross-tolerance with alcohol at the
GABA-A receptor. They help prevent severe complications like seizures and delirium
tremens during the detoxification process. Choice of specific benzodiazepine often depends
on the patient’s liver function and the drug’s half-life.
7. A patient taking Disulfiram (Antabuse) consumes a small amount of alcohol. Which
physiological response is expected?
A. Severe headache, flushing, nausea, and tachycardia.
