NR 546 Week 7 Exam V2 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
7 Exam) | Chamberlain University
1. A 9-year-old male is diagnosed with ADHD, predominantly hyperactive-impulsive type.
Which of the following is the first-line pharmacological treatment according to the American
Academy of Pediatrics?
A. Methylphenidate
B. Atomoxetine
C. Guanfacine
D. Bupropion
Correct Answer: A
Explanation: Stimulants such as Methylphenidate or amphetamines are considered first-
line pharmacological treatments for ADHD in children aged 6 and older. These medications
work by increasing the availability of dopamine and norepinephrine in the prefrontal
cortex. The PMHNP must monitor for side effects like decreased appetite and insomnia
during treatment.
2. When prescribing Disulfiram for a patient with Alcohol Use Disorder, which educational
point is most critical?
A. Liver function tests are not necessary during treatment.
,B. The medication should be taken only when the patient feels an urge to drink.
C. Disulfiram will reduce the cravings for alcohol by modulating glutamate.
D. The patient should avoid all forms of alcohol, including those in mouthwash and hand
sanitizers.
Correct Answer: D
Explanation: Disulfiram acts as an irreversible inhibitor of aldehyde dehydrogenase,
leading to the accumulation of acetaldehyde if alcohol is consumed. This causes a highly
unpleasant reaction including flushing, nausea, and palpitations, which serves as a
deterrent. Patients must be warned about hidden sources of alcohol in hygiene products
and food to prevent an accidental reaction.
3. A PMHNP is considering Acamprosate for a patient with alcohol use disorder. Which
laboratory value would be a contraindication for this medication?
A. ALT/AST > 3 times the upper limit of normal
B. Hemoglobin A1c > 7%
C. Creatinine Clearance < 30 mL/min
D. Platelet count < 100,000/mm³
Correct Answer: C
Explanation: Acamprosate is primarily excreted by the kidneys and is contraindicated in
patients with severe renal impairment, defined as a creatinine clearance less than 30
,mL/min. It is generally preferred in patients with liver disease because it is not
metabolized by the liver. The medication helps maintain abstinence by modulating the
glutamate and GABA neurotransmitter systems.
4. Which mechanism of action best describes how Buprenorphine functions in the treatment
of Opioid Use Disorder?
A. Full Mu-opioid receptor agonist
B. Partial Mu-opioid receptor agonist
C. Full Mu-opioid receptor antagonist
D. Selective serotonin reuptake inhibitor
Correct Answer: B
Explanation: Buprenorphine is a partial agonist at the mu-opioid receptor, meaning it has
a high affinity but low intrinsic activity. This creates a ceiling effect on respiratory
depression and euphoria, making it safer than full agonists like methadone. It also has
antagonist properties at the kappa-opioid receptor, which may contribute to its clinical
profile.
5. A patient is started on Atomoxetine for ADHD. What is the primary mechanism of action
for this non-stimulant medication?
A. Alpha-2 adrenergic agonist
B. Dopamine D2 receptor antagonist
C. Selective Norepinephrine Reuptake Inhibitor (SNRI)
, D. GABA-A receptor modulator
Correct Answer: C
Explanation: Atomoxetine works by selectively inhibiting the presynaptic norepinephrine
transporter in the prefrontal cortex. Because the prefrontal cortex lacks a high density of
dopamine transporters, atomoxetine also increases dopamine levels in this specific brain
region. It is often chosen for patients with a history of substance abuse or those who cannot
tolerate stimulants.
6. What is the FDA-approved age for the use of Fluoxetine in treating Pediatric Major
Depressive Disorder?
A. 8 years and older
B. 6 years and older
C. 12 years and older
D. 18 years and older
Correct Answer: A
Explanation: Fluoxetine is FDA-approved for the treatment of Major Depressive Disorder
in children and adolescents aged 8 years and older. It is also approved for Obsessive-
Compulsive Disorder in patients aged 7 years and older. The PMHNP must monitor for the
Black Box Warning regarding increased suicidal ideation in this age group.
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
7 Exam) | Chamberlain University
1. A 9-year-old male is diagnosed with ADHD, predominantly hyperactive-impulsive type.
Which of the following is the first-line pharmacological treatment according to the American
Academy of Pediatrics?
A. Methylphenidate
B. Atomoxetine
C. Guanfacine
D. Bupropion
Correct Answer: A
Explanation: Stimulants such as Methylphenidate or amphetamines are considered first-
line pharmacological treatments for ADHD in children aged 6 and older. These medications
work by increasing the availability of dopamine and norepinephrine in the prefrontal
cortex. The PMHNP must monitor for side effects like decreased appetite and insomnia
during treatment.
2. When prescribing Disulfiram for a patient with Alcohol Use Disorder, which educational
point is most critical?
A. Liver function tests are not necessary during treatment.
,B. The medication should be taken only when the patient feels an urge to drink.
C. Disulfiram will reduce the cravings for alcohol by modulating glutamate.
D. The patient should avoid all forms of alcohol, including those in mouthwash and hand
sanitizers.
Correct Answer: D
Explanation: Disulfiram acts as an irreversible inhibitor of aldehyde dehydrogenase,
leading to the accumulation of acetaldehyde if alcohol is consumed. This causes a highly
unpleasant reaction including flushing, nausea, and palpitations, which serves as a
deterrent. Patients must be warned about hidden sources of alcohol in hygiene products
and food to prevent an accidental reaction.
3. A PMHNP is considering Acamprosate for a patient with alcohol use disorder. Which
laboratory value would be a contraindication for this medication?
A. ALT/AST > 3 times the upper limit of normal
B. Hemoglobin A1c > 7%
C. Creatinine Clearance < 30 mL/min
D. Platelet count < 100,000/mm³
Correct Answer: C
Explanation: Acamprosate is primarily excreted by the kidneys and is contraindicated in
patients with severe renal impairment, defined as a creatinine clearance less than 30
,mL/min. It is generally preferred in patients with liver disease because it is not
metabolized by the liver. The medication helps maintain abstinence by modulating the
glutamate and GABA neurotransmitter systems.
4. Which mechanism of action best describes how Buprenorphine functions in the treatment
of Opioid Use Disorder?
A. Full Mu-opioid receptor agonist
B. Partial Mu-opioid receptor agonist
C. Full Mu-opioid receptor antagonist
D. Selective serotonin reuptake inhibitor
Correct Answer: B
Explanation: Buprenorphine is a partial agonist at the mu-opioid receptor, meaning it has
a high affinity but low intrinsic activity. This creates a ceiling effect on respiratory
depression and euphoria, making it safer than full agonists like methadone. It also has
antagonist properties at the kappa-opioid receptor, which may contribute to its clinical
profile.
5. A patient is started on Atomoxetine for ADHD. What is the primary mechanism of action
for this non-stimulant medication?
A. Alpha-2 adrenergic agonist
B. Dopamine D2 receptor antagonist
C. Selective Norepinephrine Reuptake Inhibitor (SNRI)
, D. GABA-A receptor modulator
Correct Answer: C
Explanation: Atomoxetine works by selectively inhibiting the presynaptic norepinephrine
transporter in the prefrontal cortex. Because the prefrontal cortex lacks a high density of
dopamine transporters, atomoxetine also increases dopamine levels in this specific brain
region. It is often chosen for patients with a history of substance abuse or those who cannot
tolerate stimulants.
6. What is the FDA-approved age for the use of Fluoxetine in treating Pediatric Major
Depressive Disorder?
A. 8 years and older
B. 6 years and older
C. 12 years and older
D. 18 years and older
Correct Answer: A
Explanation: Fluoxetine is FDA-approved for the treatment of Major Depressive Disorder
in children and adolescents aged 8 years and older. It is also approved for Obsessive-
Compulsive Disorder in patients aged 7 years and older. The PMHNP must monitor for the
Black Box Warning regarding increased suicidal ideation in this age group.
