NSG 552 Psychopharmacology Exam 1 — 300
Questions & Answers with Rationales | 2027
Edition
TABLE OF CONTENTS
Antipsychotics, EPS, and Dopamine Pathways — Questions 1–156
Mood Stabilizers: Lithium and Valproate — Questions 5–5
Antidepressants and Serotonergic Pharmacology — Questions 36–166
Mood Stabilizers: Lithium, Valproate, Carbamazepine, and Lamotrigine — Questions 66–176
Anxiolytics, Sedative-Hypnotics, and Related Agents — Questions 86–186
ADHD Pharmacotherapy — Questions 101–191
Substance Use Disorders and Psychopharmacology — Questions 109–199
Sleep, Cognitive Disorders, and Other Neuropsychiatric Medications — Questions 119–205
Psychopharmacology Safety, Interactions, and Monitoring — Questions 127–215
Integrated Clinical Application — Questions 137–225
Safety and Clinical Application — Questions 226–300
Antipsychotics, EPS, and Dopamine Pathways
Question 1 (SINGLE BEST ANSWER)
A 24-year-old male with schizophrenia is prescribed haloperidol 10 mg IM for acute agitation. Which medication should be co-
administered to reduce the risk of severe extrapyramidal symptoms (EPS)?
A. Propranolol
B. Benztropine
C. Amantadine
D. Clonazepam
Correct Answer: B
Rationale: IM haloperidol can produce acute dystonia and other EPS. An anticholinergic such as benztropine can be used to
reduce or treat acute dystonic reactions.
Question 2 (SINGLE BEST ANSWER)
A patient presents with involuntary movements of the facial muscles, tongue protrusion, and lip smacking after 5 years of antipsychotic
therapy. Which condition is most likely?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Neuroleptic malignant syndrome
Correct Answer: C
Rationale: Tardive dyskinesia is a late-onset movement disorder associated with prolonged exposure to dopamine-receptor-
blocking antipsychotics. Orofacial movements such as lip smacking and tongue movements are characteristic.
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 1
, Question 3 (SELECT ALL THAT APPLY)
A patient on clozapine presents with fever, sore throat, and malaise. The PMHNP suspects agranulocytosis. Select all that apply
regarding clozapine monitoring.
A. Monitor WBC and ANC weekly for the first 6 months
B. Discontinue clozapine if ANC falls below 1,500/mm³
C. Agranulocytosis occurs in approximately 1% of patients
D. Sialorrhea occurs in 30–80% of patients and is managed with glycopyrrolate
E. Clozapine is first-line for all patients with schizophrenia
Correct Answer: A, B, C, D
Rationale: Clozapine requires hematologic monitoring because severe neutropenia/agranulocytosis can occur. Fever and sore
throat require prompt evaluation. Clozapine is generally reserved for treatment-resistant schizophrenia or specific clinical
circumstances rather than being first-line for every patient.
Question 4 (SINGLE BEST ANSWER)
A 35-year-old female on risperidone reports galactorrhea and amenorrhea. Which pathway is responsible for this adverse effect?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: D
Rationale: Dopamine blockade in the tuberoinfundibular pathway can increase prolactin secretion, producing effects such as
galactorrhea, amenorrhea, and sexual dysfunction.
Mood Stabilizers: Lithium and Valproate
Question 5 (SINGLE BEST ANSWER)
A patient with bipolar disorder has a lithium level of 2.1 mEq/L. Which clinical manifestation is most concerning?
A. Coarse tremor and ataxia
B. Seizures and coma
C. Mild thirst only
D. Increased appetite
Correct Answer: B
Rationale: A lithium concentration of 2.1 mEq/L is in a toxic range. Severe toxicity can produce neurologic manifestations
including confusion, seizures, decreased consciousness, and potentially coma. This requires urgent clinical assessment.
Antipsychotics, EPS, and Dopamine Pathways
Question 6 (SINGLE BEST ANSWER)
A patient receiving haloperidol develops painful neck twisting and upward deviation of the eyes within hours of the first dose. Which
adverse effect is most likely?
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Metabolic syndrome
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 2
, Correct Answer: A
Rationale: Acute dystonia can occur shortly after dopamine-receptor blockade and commonly involves the neck, jaw, eyes, or
other muscles. Anticholinergics are commonly used for treatment.
Question 7 (SINGLE BEST ANSWER)
A patient taking an antipsychotic says, “I cannot sit still and feel like I have to keep moving.” Which adverse effect should the clinician
suspect?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Agranulocytosis
Correct Answer: A
Rationale: Akathisia is characterized by an uncomfortable sense of inner restlessness with an urge to move. It can be mistaken
for worsening agitation.
Question 8 (SINGLE BEST ANSWER)
Which finding is most characteristic of neuroleptic malignant syndrome (NMS)?
A. Lead-pipe rigidity, hyperthermia, and autonomic instability
B. Lip smacking and tongue movements
C. Weight gain and increased appetite
D. Postural tremor without fever
Correct Answer: A
Rationale: NMS is a medical emergency associated with dopamine blockade and is characterized by severe rigidity,
hyperthermia, altered mental status, and autonomic instability.
Question 9 (SINGLE BEST ANSWER)
A patient taking an antipsychotic develops fever, severe muscle rigidity, confusion, and diaphoresis. What is the priority action?
A. Hold the antipsychotic and obtain urgent medical evaluation
B. Give the next dose with food
C. Encourage exercise
D. Add another dopamine blocker
Correct Answer: A
Rationale: The presentation is concerning for NMS. The causative antipsychotic should be stopped and the patient requires
urgent medical management.
Question 10 (SINGLE BEST ANSWER)
Which antipsychotic is most strongly associated with agranulocytosis and requires ANC monitoring?
A. Clozapine
B. Aripiprazole
C. Ziprasidone
D. Lurasidone
Correct Answer: A
Rationale: Clozapine can cause severe neutropenia/agranulocytosis, so ANC monitoring and prompt evaluation of infection
symptoms are essential.
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 3
, Question 11 (SINGLE BEST ANSWER)
Which symptom in a patient taking clozapine should be reported immediately?
A. Fever and sore throat
B. Mild dry mouth
C. Increased appetite
D. Occasional yawning
Correct Answer: A
Rationale: Fever and sore throat can signal infection associated with neutropenia and require prompt assessment in a patient
taking clozapine.
Question 12 (SINGLE BEST ANSWER)
Which adverse effect is particularly associated with second-generation antipsychotics such as olanzapine?
A. Weight gain and metabolic abnormalities
B. Agranulocytosis in nearly every patient
C. Severe diarrhea in most patients
D. Permanent hearing loss
Correct Answer: A
Rationale: Several second-generation antipsychotics, especially olanzapine, are associated with weight gain, dyslipidemia, and
glucose abnormalities.
Question 13 (SINGLE BEST ANSWER)
Which baseline assessment is especially important before starting an antipsychotic with substantial metabolic risk?
A. Weight, waist circumference, blood pressure, glucose/A1c, and lipids
B. Hearing acuity only
C. Visual acuity only
D. Serum amylase only
Correct Answer: A
Rationale: Baseline metabolic measures help identify risk and allow monitoring for treatment-emergent weight, glucose, and
lipid changes.
Question 14 (SINGLE BEST ANSWER)
A patient on risperidone develops breast enlargement and sexual dysfunction. Which mechanism best explains the symptoms?
A. Dopamine D2 blockade increasing prolactin
B. Serotonin 5-HT1A stimulation
C. Muscarinic stimulation
D. GABA-A blockade
Correct Answer: A
Rationale: D2 blockade in the tuberoinfundibular pathway removes dopamine's inhibitory effect on prolactin release.
Question 15 (SINGLE BEST ANSWER)
Which dopamine pathway is associated with antipsychotic-related EPS when dopamine activity is reduced?
A. Nigrostriatal
B. Mesolimbic
C. Tuberoinfundibular
D. Mesocortical
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 4
Questions & Answers with Rationales | 2027
Edition
TABLE OF CONTENTS
Antipsychotics, EPS, and Dopamine Pathways — Questions 1–156
Mood Stabilizers: Lithium and Valproate — Questions 5–5
Antidepressants and Serotonergic Pharmacology — Questions 36–166
Mood Stabilizers: Lithium, Valproate, Carbamazepine, and Lamotrigine — Questions 66–176
Anxiolytics, Sedative-Hypnotics, and Related Agents — Questions 86–186
ADHD Pharmacotherapy — Questions 101–191
Substance Use Disorders and Psychopharmacology — Questions 109–199
Sleep, Cognitive Disorders, and Other Neuropsychiatric Medications — Questions 119–205
Psychopharmacology Safety, Interactions, and Monitoring — Questions 127–215
Integrated Clinical Application — Questions 137–225
Safety and Clinical Application — Questions 226–300
Antipsychotics, EPS, and Dopamine Pathways
Question 1 (SINGLE BEST ANSWER)
A 24-year-old male with schizophrenia is prescribed haloperidol 10 mg IM for acute agitation. Which medication should be co-
administered to reduce the risk of severe extrapyramidal symptoms (EPS)?
A. Propranolol
B. Benztropine
C. Amantadine
D. Clonazepam
Correct Answer: B
Rationale: IM haloperidol can produce acute dystonia and other EPS. An anticholinergic such as benztropine can be used to
reduce or treat acute dystonic reactions.
Question 2 (SINGLE BEST ANSWER)
A patient presents with involuntary movements of the facial muscles, tongue protrusion, and lip smacking after 5 years of antipsychotic
therapy. Which condition is most likely?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Neuroleptic malignant syndrome
Correct Answer: C
Rationale: Tardive dyskinesia is a late-onset movement disorder associated with prolonged exposure to dopamine-receptor-
blocking antipsychotics. Orofacial movements such as lip smacking and tongue movements are characteristic.
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 1
, Question 3 (SELECT ALL THAT APPLY)
A patient on clozapine presents with fever, sore throat, and malaise. The PMHNP suspects agranulocytosis. Select all that apply
regarding clozapine monitoring.
A. Monitor WBC and ANC weekly for the first 6 months
B. Discontinue clozapine if ANC falls below 1,500/mm³
C. Agranulocytosis occurs in approximately 1% of patients
D. Sialorrhea occurs in 30–80% of patients and is managed with glycopyrrolate
E. Clozapine is first-line for all patients with schizophrenia
Correct Answer: A, B, C, D
Rationale: Clozapine requires hematologic monitoring because severe neutropenia/agranulocytosis can occur. Fever and sore
throat require prompt evaluation. Clozapine is generally reserved for treatment-resistant schizophrenia or specific clinical
circumstances rather than being first-line for every patient.
Question 4 (SINGLE BEST ANSWER)
A 35-year-old female on risperidone reports galactorrhea and amenorrhea. Which pathway is responsible for this adverse effect?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: D
Rationale: Dopamine blockade in the tuberoinfundibular pathway can increase prolactin secretion, producing effects such as
galactorrhea, amenorrhea, and sexual dysfunction.
Mood Stabilizers: Lithium and Valproate
Question 5 (SINGLE BEST ANSWER)
A patient with bipolar disorder has a lithium level of 2.1 mEq/L. Which clinical manifestation is most concerning?
A. Coarse tremor and ataxia
B. Seizures and coma
C. Mild thirst only
D. Increased appetite
Correct Answer: B
Rationale: A lithium concentration of 2.1 mEq/L is in a toxic range. Severe toxicity can produce neurologic manifestations
including confusion, seizures, decreased consciousness, and potentially coma. This requires urgent clinical assessment.
Antipsychotics, EPS, and Dopamine Pathways
Question 6 (SINGLE BEST ANSWER)
A patient receiving haloperidol develops painful neck twisting and upward deviation of the eyes within hours of the first dose. Which
adverse effect is most likely?
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Metabolic syndrome
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 2
, Correct Answer: A
Rationale: Acute dystonia can occur shortly after dopamine-receptor blockade and commonly involves the neck, jaw, eyes, or
other muscles. Anticholinergics are commonly used for treatment.
Question 7 (SINGLE BEST ANSWER)
A patient taking an antipsychotic says, “I cannot sit still and feel like I have to keep moving.” Which adverse effect should the clinician
suspect?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Agranulocytosis
Correct Answer: A
Rationale: Akathisia is characterized by an uncomfortable sense of inner restlessness with an urge to move. It can be mistaken
for worsening agitation.
Question 8 (SINGLE BEST ANSWER)
Which finding is most characteristic of neuroleptic malignant syndrome (NMS)?
A. Lead-pipe rigidity, hyperthermia, and autonomic instability
B. Lip smacking and tongue movements
C. Weight gain and increased appetite
D. Postural tremor without fever
Correct Answer: A
Rationale: NMS is a medical emergency associated with dopamine blockade and is characterized by severe rigidity,
hyperthermia, altered mental status, and autonomic instability.
Question 9 (SINGLE BEST ANSWER)
A patient taking an antipsychotic develops fever, severe muscle rigidity, confusion, and diaphoresis. What is the priority action?
A. Hold the antipsychotic and obtain urgent medical evaluation
B. Give the next dose with food
C. Encourage exercise
D. Add another dopamine blocker
Correct Answer: A
Rationale: The presentation is concerning for NMS. The causative antipsychotic should be stopped and the patient requires
urgent medical management.
Question 10 (SINGLE BEST ANSWER)
Which antipsychotic is most strongly associated with agranulocytosis and requires ANC monitoring?
A. Clozapine
B. Aripiprazole
C. Ziprasidone
D. Lurasidone
Correct Answer: A
Rationale: Clozapine can cause severe neutropenia/agranulocytosis, so ANC monitoring and prompt evaluation of infection
symptoms are essential.
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 3
, Question 11 (SINGLE BEST ANSWER)
Which symptom in a patient taking clozapine should be reported immediately?
A. Fever and sore throat
B. Mild dry mouth
C. Increased appetite
D. Occasional yawning
Correct Answer: A
Rationale: Fever and sore throat can signal infection associated with neutropenia and require prompt assessment in a patient
taking clozapine.
Question 12 (SINGLE BEST ANSWER)
Which adverse effect is particularly associated with second-generation antipsychotics such as olanzapine?
A. Weight gain and metabolic abnormalities
B. Agranulocytosis in nearly every patient
C. Severe diarrhea in most patients
D. Permanent hearing loss
Correct Answer: A
Rationale: Several second-generation antipsychotics, especially olanzapine, are associated with weight gain, dyslipidemia, and
glucose abnormalities.
Question 13 (SINGLE BEST ANSWER)
Which baseline assessment is especially important before starting an antipsychotic with substantial metabolic risk?
A. Weight, waist circumference, blood pressure, glucose/A1c, and lipids
B. Hearing acuity only
C. Visual acuity only
D. Serum amylase only
Correct Answer: A
Rationale: Baseline metabolic measures help identify risk and allow monitoring for treatment-emergent weight, glucose, and
lipid changes.
Question 14 (SINGLE BEST ANSWER)
A patient on risperidone develops breast enlargement and sexual dysfunction. Which mechanism best explains the symptoms?
A. Dopamine D2 blockade increasing prolactin
B. Serotonin 5-HT1A stimulation
C. Muscarinic stimulation
D. GABA-A blockade
Correct Answer: A
Rationale: D2 blockade in the tuberoinfundibular pathway removes dopamine's inhibitory effect on prolactin release.
Question 15 (SINGLE BEST ANSWER)
Which dopamine pathway is associated with antipsychotic-related EPS when dopamine activity is reduced?
A. Nigrostriatal
B. Mesolimbic
C. Tuberoinfundibular
D. Mesocortical
NSG 552 Psychopharmacology — 300-Question Practice Exam Page 4
