NR 546 ADVANCED PSYCHOPHARMACOLOGY FOR THE PMHNP WEEK 4 MIDTERM
EXAM QUESTIONS AND ANSWERS | 100% PASS GUARANTEED | GRADED A+
SECTION A: ANTIDEPRESSANT PHARMACOLOGY AND MECHANISMS
1. A 34-year-old patient with major depressive disorder is prescribed sertraline. The
PMHNP understands that the therapeutic mechanism of action primarily involves
which of the following?
A. Inhibition of monoamine oxidase type A
B. Selective blockade of serotonin reuptake transporters
C. Antagonism of presynaptic alpha-2 adrenergic receptors
D. Blockade of dopamine D2 receptors
Answer: B
Rationale: Sertraline is an SSRI that selectively inhibits the serotonin transporter
(SERT), increasing synaptic serotonin availability. MAOIs inhibit monoamine oxidase,
while alpha-2 antagonists and D2 blockers represent other classes.
2. Which antidepressant is most appropriate for a patient with depression and
concurrent neuropathic pain?
A. Fluoxetine
B. Sertraline
C. Duloxetine
D. Bupropion
Answer: C
,Rationale: Duloxetine is an SNRI approved for both major depressive disorder and
diabetic peripheral neuropathic pain. Its dual serotonin-norepinephrine reuptake
inhibition provides analgesic benefit not seen with pure SSRIs.
3. A patient on phenelzine reports eating aged cheese and subsequently develops
severe headache, hypertension, and tachycardia. The PMHNP recognizes this as
which of the following?
A. Serotonin syndrome
B. Hypertensive crisis from tyramine reaction
C. Neuroleptic malignant syndrome
D. Anticholinergic toxicity
Answer: B
Rationale: MAOIs prevent breakdown of tyramine found in aged cheese, causing
massive norepinephrine release and hypertensive crisis. This is the classic "cheese
reaction."
4. Which of the following best describes the mechanism of action of bupropion?
A. Serotonin reuptake inhibition
B. Norepinephrine-dopamine reuptake inhibition
C. Monoamine oxidase inhibition
D. Serotonin receptor antagonism
Answer: B
Rationale: Bupropion inhibits norepinephrine and dopamine reuptake with minimal
serotonergic activity. This explains its efficacy for depression and smoking cessation
without sexual side effects typical of SSRIs.
5. A patient initiated on fluoxetine three weeks ago presents with agitation,
diaphoresis, hyperreflexia, and clonus. The PMHNP suspects serotonin syndrome.
Which medication combination is most likely responsible?
A. Fluoxetine and lorazepam
B. Fluoxetine and tramadol
, C. Fluoxetine and metformin
D. Fluoxetine and acetaminophen
Answer: B
Rationale: Tramadol has serotonergic properties and combined with fluoxetine can
precipitate serotonin syndrome. The triad of mental status changes, autonomic
instability, and neuromuscular abnormalities confirms this diagnosis.
6. The PMHNP understands that mirtazapine's mechanism of action involves which of
the following?
A. Selective serotonin reuptake inhibition
B. Alpha-2 adrenergic receptor antagonism enhancing norepinephrine and serotonin
release
C. Dopamine D2 receptor blockade
D. GABA-A receptor potentiation
Answer: B
Rationale: Mirtazapine blocks presynaptic alpha-2 autoreceptors and
heteroreceptors, increasing norepinephrine and serotonin release. It also antagonizes
5-HT2 and 5-HT3 receptors, contributing to its antidepressant and appetite-
stimulating effects.
7. Which laboratory value should be monitored in a patient taking lithium for bipolar
disorder?
A. Serum glucose
B. Serum creatinine and thyroid function
C. Liver function tests
D. Complete blood count only
Answer: B
Rationale: Lithium is renally excreted and can cause nephrogenic diabetes insipidus
and hypothyroidism. Regular monitoring of renal function and thyroid hormones is
essential for safety.
EXAM QUESTIONS AND ANSWERS | 100% PASS GUARANTEED | GRADED A+
SECTION A: ANTIDEPRESSANT PHARMACOLOGY AND MECHANISMS
1. A 34-year-old patient with major depressive disorder is prescribed sertraline. The
PMHNP understands that the therapeutic mechanism of action primarily involves
which of the following?
A. Inhibition of monoamine oxidase type A
B. Selective blockade of serotonin reuptake transporters
C. Antagonism of presynaptic alpha-2 adrenergic receptors
D. Blockade of dopamine D2 receptors
Answer: B
Rationale: Sertraline is an SSRI that selectively inhibits the serotonin transporter
(SERT), increasing synaptic serotonin availability. MAOIs inhibit monoamine oxidase,
while alpha-2 antagonists and D2 blockers represent other classes.
2. Which antidepressant is most appropriate for a patient with depression and
concurrent neuropathic pain?
A. Fluoxetine
B. Sertraline
C. Duloxetine
D. Bupropion
Answer: C
,Rationale: Duloxetine is an SNRI approved for both major depressive disorder and
diabetic peripheral neuropathic pain. Its dual serotonin-norepinephrine reuptake
inhibition provides analgesic benefit not seen with pure SSRIs.
3. A patient on phenelzine reports eating aged cheese and subsequently develops
severe headache, hypertension, and tachycardia. The PMHNP recognizes this as
which of the following?
A. Serotonin syndrome
B. Hypertensive crisis from tyramine reaction
C. Neuroleptic malignant syndrome
D. Anticholinergic toxicity
Answer: B
Rationale: MAOIs prevent breakdown of tyramine found in aged cheese, causing
massive norepinephrine release and hypertensive crisis. This is the classic "cheese
reaction."
4. Which of the following best describes the mechanism of action of bupropion?
A. Serotonin reuptake inhibition
B. Norepinephrine-dopamine reuptake inhibition
C. Monoamine oxidase inhibition
D. Serotonin receptor antagonism
Answer: B
Rationale: Bupropion inhibits norepinephrine and dopamine reuptake with minimal
serotonergic activity. This explains its efficacy for depression and smoking cessation
without sexual side effects typical of SSRIs.
5. A patient initiated on fluoxetine three weeks ago presents with agitation,
diaphoresis, hyperreflexia, and clonus. The PMHNP suspects serotonin syndrome.
Which medication combination is most likely responsible?
A. Fluoxetine and lorazepam
B. Fluoxetine and tramadol
, C. Fluoxetine and metformin
D. Fluoxetine and acetaminophen
Answer: B
Rationale: Tramadol has serotonergic properties and combined with fluoxetine can
precipitate serotonin syndrome. The triad of mental status changes, autonomic
instability, and neuromuscular abnormalities confirms this diagnosis.
6. The PMHNP understands that mirtazapine's mechanism of action involves which of
the following?
A. Selective serotonin reuptake inhibition
B. Alpha-2 adrenergic receptor antagonism enhancing norepinephrine and serotonin
release
C. Dopamine D2 receptor blockade
D. GABA-A receptor potentiation
Answer: B
Rationale: Mirtazapine blocks presynaptic alpha-2 autoreceptors and
heteroreceptors, increasing norepinephrine and serotonin release. It also antagonizes
5-HT2 and 5-HT3 receptors, contributing to its antidepressant and appetite-
stimulating effects.
7. Which laboratory value should be monitored in a patient taking lithium for bipolar
disorder?
A. Serum glucose
B. Serum creatinine and thyroid function
C. Liver function tests
D. Complete blood count only
Answer: B
Rationale: Lithium is renally excreted and can cause nephrogenic diabetes insipidus
and hypothyroidism. Regular monitoring of renal function and thyroid hormones is
essential for safety.
