NR 546 Week 10 Exam V1 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. Which of the following is the primary mechanism of action for methylphenidate in the
treatment of ADHD?
A. Selective inhibition of the norepinephrine transporter (NET) only.
B. Promotion of dopamine release from presynaptic storage vesicles.
C. Inhibition of both the dopamine transporter (DAT) and the norepinephrine transporter
(NET).
D. Antagonism at the alpha-2 adrenergic receptors in the prefrontal cortex.
Correct Answer: C
Explanation: Methylphenidate acts by blocking the reuptake of dopamine and
norepinephrine by inhibiting their respective transporters. Unlike amphetamines, it does
not significantly promote the release of dopamine from storage vesicles. This increase in
synaptic catecholamines in the prefrontal cortex helps improve attention and impulse
control.
2. A 72-year-old patient with Alzheimer’s disease is prescribed Donepezil. What is the most
common side effect the PMHNP should warn the caregiver about?
A. Hypertension
,B. Gastrointestinal distress including nausea and diarrhea
C. Urinary retention
D. Dry mouth and blurred vision
Correct Answer: B
Explanation: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels,
which can lead to parasympathetic overstimulation. The most frequently reported adverse
effects involve the gastrointestinal system, such as nausea, vomiting, and diarrhea. These
symptoms are often dose-related and may improve over time or with a lower starting dose.
3. Which medication used for Medication-Assisted Treatment (MAT) of opioid use disorder
acts as a partial mu-opioid agonist?
A. Buprenorphine
B. Naltrexone
C. Methadone
D. Naloxone
Correct Answer: A
Explanation: Buprenorphine is a partial mu-opioid agonist that exhibits a ceiling effect,
reducing the risk of respiratory depression compared to full agonists. It has a high affinity
for the mu-receptor, meaning it can displace other opioids and potentially precipitate
,withdrawal if given too early. It is often combined with naloxone to prevent intravenous
misuse.
4. When prescribing Atomoxetine for ADHD, which Black Box Warning must the PMHNP
discuss with the patient and family?
A. Risk of Stevens-Johnson Syndrome
B. Potential for severe liver injury
C. High potential for abuse and physical dependence
D. Increased risk of suicidal ideation in children and adolescents
Correct Answer: D
Explanation: Atomoxetine carries a Black Box Warning regarding the increased risk of
suicidal ideation in pediatric patients. While liver injury is a rare potential side effect, it is
not the primary Black Box Warning focused on psychiatric monitoring. Providers must
regularly assess for changes in mood or behavior during the initial months of treatment.
5. Memantine (Namenda) is indicated for moderate to severe Alzheimer’s disease. What is its
unique mechanism of action?
A. Reversible inhibition of acetylcholinesterase
B. Potentiation of GABAergic neurotransmission
C. Uncompetitive NMDA receptor antagonism
D. Beta-amyloid plaque degradation
, Correct Answer: C
Explanation: Memantine acts as an NMDA receptor antagonist by binding to the
magnesium site when the channel is excessively open. This helps regulate glutamate
activity and prevents excitotoxicity which is thought to contribute to neuronal cell death in
Alzheimer’s. It is often used in combination with cholinesterase inhibitors for synergistic
effects.
6. A patient is being treated for alcohol use disorder with Disulfiram. What is the critical
mechanism behind the ‘disulfiram reaction’?
A. Inhibition of the enzyme aldehyde dehydrogenase
B. Blockade of opioid receptors leading to dysphoria
C. Rapid depletion of dopamine in the reward pathway
D. Competitive inhibition of alcohol dehydrogenase
Correct Answer: A
Explanation: Disulfiram inhibits aldehyde dehydrogenase, the enzyme responsible for
breaking down acetaldehyde, a toxic metabolite of alcohol. When alcohol is consumed,
acetaldehyde accumulates, causing severe physical reactions like flushing, nausea, and
tachycardia. This serves as a psychological deterrent rather than a physiological craving
reducer.
7. Which of the following stimulants is a prodrug intended to reduce the potential for abuse?
A. Vyvanse (Lisdexamfetamine)
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. Which of the following is the primary mechanism of action for methylphenidate in the
treatment of ADHD?
A. Selective inhibition of the norepinephrine transporter (NET) only.
B. Promotion of dopamine release from presynaptic storage vesicles.
C. Inhibition of both the dopamine transporter (DAT) and the norepinephrine transporter
(NET).
D. Antagonism at the alpha-2 adrenergic receptors in the prefrontal cortex.
Correct Answer: C
Explanation: Methylphenidate acts by blocking the reuptake of dopamine and
norepinephrine by inhibiting their respective transporters. Unlike amphetamines, it does
not significantly promote the release of dopamine from storage vesicles. This increase in
synaptic catecholamines in the prefrontal cortex helps improve attention and impulse
control.
2. A 72-year-old patient with Alzheimer’s disease is prescribed Donepezil. What is the most
common side effect the PMHNP should warn the caregiver about?
A. Hypertension
,B. Gastrointestinal distress including nausea and diarrhea
C. Urinary retention
D. Dry mouth and blurred vision
Correct Answer: B
Explanation: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels,
which can lead to parasympathetic overstimulation. The most frequently reported adverse
effects involve the gastrointestinal system, such as nausea, vomiting, and diarrhea. These
symptoms are often dose-related and may improve over time or with a lower starting dose.
3. Which medication used for Medication-Assisted Treatment (MAT) of opioid use disorder
acts as a partial mu-opioid agonist?
A. Buprenorphine
B. Naltrexone
C. Methadone
D. Naloxone
Correct Answer: A
Explanation: Buprenorphine is a partial mu-opioid agonist that exhibits a ceiling effect,
reducing the risk of respiratory depression compared to full agonists. It has a high affinity
for the mu-receptor, meaning it can displace other opioids and potentially precipitate
,withdrawal if given too early. It is often combined with naloxone to prevent intravenous
misuse.
4. When prescribing Atomoxetine for ADHD, which Black Box Warning must the PMHNP
discuss with the patient and family?
A. Risk of Stevens-Johnson Syndrome
B. Potential for severe liver injury
C. High potential for abuse and physical dependence
D. Increased risk of suicidal ideation in children and adolescents
Correct Answer: D
Explanation: Atomoxetine carries a Black Box Warning regarding the increased risk of
suicidal ideation in pediatric patients. While liver injury is a rare potential side effect, it is
not the primary Black Box Warning focused on psychiatric monitoring. Providers must
regularly assess for changes in mood or behavior during the initial months of treatment.
5. Memantine (Namenda) is indicated for moderate to severe Alzheimer’s disease. What is its
unique mechanism of action?
A. Reversible inhibition of acetylcholinesterase
B. Potentiation of GABAergic neurotransmission
C. Uncompetitive NMDA receptor antagonism
D. Beta-amyloid plaque degradation
, Correct Answer: C
Explanation: Memantine acts as an NMDA receptor antagonist by binding to the
magnesium site when the channel is excessively open. This helps regulate glutamate
activity and prevents excitotoxicity which is thought to contribute to neuronal cell death in
Alzheimer’s. It is often used in combination with cholinesterase inhibitors for synergistic
effects.
6. A patient is being treated for alcohol use disorder with Disulfiram. What is the critical
mechanism behind the ‘disulfiram reaction’?
A. Inhibition of the enzyme aldehyde dehydrogenase
B. Blockade of opioid receptors leading to dysphoria
C. Rapid depletion of dopamine in the reward pathway
D. Competitive inhibition of alcohol dehydrogenase
Correct Answer: A
Explanation: Disulfiram inhibits aldehyde dehydrogenase, the enzyme responsible for
breaking down acetaldehyde, a toxic metabolite of alcohol. When alcohol is consumed,
acetaldehyde accumulates, causing severe physical reactions like flushing, nausea, and
tachycardia. This serves as a psychological deterrent rather than a physiological craving
reducer.
7. Which of the following stimulants is a prodrug intended to reduce the potential for abuse?
A. Vyvanse (Lisdexamfetamine)
