NU 643 Exam 4 V1 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 4) | Regis University
1. A 10-year-old child is diagnosed with ADHD. The Advanced Practice Nurse (APN) decides to
prescribe methylphenidate. What is the primary mechanism of action for this medication?
A. Selective inhibition of the norepinephrine transporter (NET) only.
B. Blockade of the reuptake of dopamine and norepinephrine via DAT and NET.
C. Promotion of dopamine release from presynaptic storage vesicles.
D. Agonism of the alpha-2A adrenergic receptor in the prefrontal cortex.
Correct Answer: B
Explanation: Methylphenidate primarily acts by blocking the dopamine transporter (DAT)
and norepinephrine transporter (NET), thereby increasing the synaptic concentration of
these neurotransmitters. Unlike amphetamines, methylphenidate does not significantly
promote the release of dopamine from storage vesicles. This mechanism helps improve
attention and impulse control by enhancing signal-to-noise ratios in the prefrontal cortex.
2. When initiating Atomoxetine for the treatment of ADHD, which specific warning must the
provider include in the patient education?
A. Risk of potential liver injury and suicidal ideation in children/adolescents.
B. Risk of severe skin reactions like Stevens-Johnson Syndrome.
,C. Possibility of developing type 2 diabetes mellitus.
D. High potential for diversion and physical dependence.
Correct Answer: A
Explanation: Atomoxetine carries a black box warning regarding the increased risk of
suicidal ideation in pediatric patients. Additionally, it has been associated with rare but
severe liver injury, necessitating monitoring for jaundice or dark urine. As a non-stimulant,
it does not carry the same risk of diversion as Schedule II stimulants.
3. An 82-year-old female with Alzheimer’s Disease is prescribed Donepezil. Which side effect
is most likely to occur due to its mechanism of action?
A. Severe constipation and dry mouth.
B. Urinary retention and blurry vision.
C. Gastrointestinal distress, including nausea and diarrhea.
D. Significant hypertension and tachycardia.
Correct Answer: C
Explanation: Donepezil is an acetylcholinesterase inhibitor that increases cholinergic
activity throughout the body. This increased acetylcholine often leads to gastrointestinal
side effects such as nausea, vomiting, and diarrhea. Providers should also monitor for
bradycardia, as cholinergic stimulation can slow the heart rate.
,4. Which of the following describes the mechanism of action of Memantine in the treatment
of moderate to severe Alzheimer’s Disease?
A. Reversible inhibition of butyrylcholinesterase.
B. Dopamine D2 receptor agonist.
C. Selective serotonin reuptake inhibitor.
D. Uncompetitive NMDA receptor antagonist.
Correct Answer: D
Explanation: Memantine acts as an uncompetitive antagonist at the N-methyl-D-aspartate
(NMDA) receptor. By binding to these receptors, it prevents excessive glutamate
stimulation, which can lead to neurotoxicity. This mechanism is thought to protect neurons
from ‘noise’ while still allowing for normal physiological neurotransmission.
5. The APN is considering an FDA-approved medication for the treatment of irritability
associated with autism in a 7-year-old child. Which medication is appropriate?
A. Risperidone
B. Fluoxetine
C. Methylphenidate
D. Lithium
Correct Answer: A
, Explanation: Risperidone was the first medication FDA-approved for the treatment of
irritability (including aggression and self-injury) in children and adolescents with autism.
Aripiprazole is the only other antipsychotic with this specific FDA approval. Clinicians must
monitor for metabolic side effects and extrapyramidal symptoms when using these agents.
6. A patient with Alcohol Use Disorder (AUD) is interested in a medication to reduce cravings
but is currently taking methadone for opioid maintenance. Which AUD medication is
contraindicated?
A. Naltrexone
B. Disulfiram
C. Acamprosate
D. Gabapentin
Correct Answer: A
Explanation: Naltrexone is a mu-opioid receptor antagonist and will precipitate acute
opioid withdrawal in individuals who are physically dependent on opioids like methadone.
It is used in AUD to block the rewarding effects of alcohol by modulating the endogenous
opioid system. Acamprosate would be a safer alternative for a patient on opioid
maintenance therapy.
7. What is the mechanism by which Guanfacine ER (Intuniv) improves symptoms of ADHD?
A. Non-selective activation of alpha-1, alpha-2, and beta-adrenergic receptors.
B. Selective agonism of postsynaptic alpha-2A receptors in the prefrontal cortex.
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 4) | Regis University
1. A 10-year-old child is diagnosed with ADHD. The Advanced Practice Nurse (APN) decides to
prescribe methylphenidate. What is the primary mechanism of action for this medication?
A. Selective inhibition of the norepinephrine transporter (NET) only.
B. Blockade of the reuptake of dopamine and norepinephrine via DAT and NET.
C. Promotion of dopamine release from presynaptic storage vesicles.
D. Agonism of the alpha-2A adrenergic receptor in the prefrontal cortex.
Correct Answer: B
Explanation: Methylphenidate primarily acts by blocking the dopamine transporter (DAT)
and norepinephrine transporter (NET), thereby increasing the synaptic concentration of
these neurotransmitters. Unlike amphetamines, methylphenidate does not significantly
promote the release of dopamine from storage vesicles. This mechanism helps improve
attention and impulse control by enhancing signal-to-noise ratios in the prefrontal cortex.
2. When initiating Atomoxetine for the treatment of ADHD, which specific warning must the
provider include in the patient education?
A. Risk of potential liver injury and suicidal ideation in children/adolescents.
B. Risk of severe skin reactions like Stevens-Johnson Syndrome.
,C. Possibility of developing type 2 diabetes mellitus.
D. High potential for diversion and physical dependence.
Correct Answer: A
Explanation: Atomoxetine carries a black box warning regarding the increased risk of
suicidal ideation in pediatric patients. Additionally, it has been associated with rare but
severe liver injury, necessitating monitoring for jaundice or dark urine. As a non-stimulant,
it does not carry the same risk of diversion as Schedule II stimulants.
3. An 82-year-old female with Alzheimer’s Disease is prescribed Donepezil. Which side effect
is most likely to occur due to its mechanism of action?
A. Severe constipation and dry mouth.
B. Urinary retention and blurry vision.
C. Gastrointestinal distress, including nausea and diarrhea.
D. Significant hypertension and tachycardia.
Correct Answer: C
Explanation: Donepezil is an acetylcholinesterase inhibitor that increases cholinergic
activity throughout the body. This increased acetylcholine often leads to gastrointestinal
side effects such as nausea, vomiting, and diarrhea. Providers should also monitor for
bradycardia, as cholinergic stimulation can slow the heart rate.
,4. Which of the following describes the mechanism of action of Memantine in the treatment
of moderate to severe Alzheimer’s Disease?
A. Reversible inhibition of butyrylcholinesterase.
B. Dopamine D2 receptor agonist.
C. Selective serotonin reuptake inhibitor.
D. Uncompetitive NMDA receptor antagonist.
Correct Answer: D
Explanation: Memantine acts as an uncompetitive antagonist at the N-methyl-D-aspartate
(NMDA) receptor. By binding to these receptors, it prevents excessive glutamate
stimulation, which can lead to neurotoxicity. This mechanism is thought to protect neurons
from ‘noise’ while still allowing for normal physiological neurotransmission.
5. The APN is considering an FDA-approved medication for the treatment of irritability
associated with autism in a 7-year-old child. Which medication is appropriate?
A. Risperidone
B. Fluoxetine
C. Methylphenidate
D. Lithium
Correct Answer: A
, Explanation: Risperidone was the first medication FDA-approved for the treatment of
irritability (including aggression and self-injury) in children and adolescents with autism.
Aripiprazole is the only other antipsychotic with this specific FDA approval. Clinicians must
monitor for metabolic side effects and extrapyramidal symptoms when using these agents.
6. A patient with Alcohol Use Disorder (AUD) is interested in a medication to reduce cravings
but is currently taking methadone for opioid maintenance. Which AUD medication is
contraindicated?
A. Naltrexone
B. Disulfiram
C. Acamprosate
D. Gabapentin
Correct Answer: A
Explanation: Naltrexone is a mu-opioid receptor antagonist and will precipitate acute
opioid withdrawal in individuals who are physically dependent on opioids like methadone.
It is used in AUD to block the rewarding effects of alcohol by modulating the endogenous
opioid system. Acamprosate would be a safer alternative for a patient on opioid
maintenance therapy.
7. What is the mechanism by which Guanfacine ER (Intuniv) improves symptoms of ADHD?
A. Non-selective activation of alpha-1, alpha-2, and beta-adrenergic receptors.
B. Selective agonism of postsynaptic alpha-2A receptors in the prefrontal cortex.
