NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
NSG552 / NSG 552 EXAM 2 (LATEST ):
PSYCHOPHARMACOLOGY
Grade A Questions and Verified Answers | 100% Correct - Wilkes
Institution Wilkes University
Course NSG 552 - Psychopharmacology (Graduate Nursing / Advanced Practice)
Examination Exam 2 - Latest Edition
Total Questions 100 Multiple Choice (4 options, 1 correct)
Cognitive Mix 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-based | 25% Direct Knowledge
Aligned With AACN Essentials of Master’s Education; Advanced Psychopharmacology Competencies
Structure 7 Sections: Principles, Antidepressants, Antipsychotics, Mood Stabilizers, Anxiolytics & Sedative-Hypnotics, Psychostimu
Instructions: Each question has four options (A-D) with exactly one correct answer. Correct answers are marked
*[CORRECT]*. Read each rationale carefully; rationales integrate NSG 552 curriculum content, AACN Essentials,
and core psychopharmacology principles.
Page 1 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
,NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
Section 1: Principles of Psychopharmacology | Questions 1–15 | 15 Questions
Q1: A 42-year-old patient is started on a medication that is a substrate of CYP2D6. The prescriber
knows the patient is a CYP2D6 poor metabolizer. Which pharmacogenomic implication is MOST
accurate?
A. Standard dosing will produce subtherapeutic plasma concentrations requiring dose escalation.
B. Reduced enzyme activity leads to higher plasma drug concentrations and increased risk of
dose-dependent adverse effects. *[CORRECT]*
C. CYP2D6 status only affects prodrugs and has no bearing on active parent compounds.
D. CYP2D6 poor metabolizers require supplemental dosing with a CYP2D6 inducer such as rifampin.
Correct Answer: B
Rationale:
CYP2D6 poor metabolizers have reduced enzymatic clearance of substrate drugs (e.g., atomoxetine, paroxetine,
codeine activation), resulting in elevated plasma concentrations and heightened risk of adverse effects. The AACN
Essentials and NSG 552 curriculum require the advanced practice nurse to interpret pharmacogenomic results before
prescribing. Option A is incorrect because dose escalation would worsen toxicity. Option C is incorrect because
CYP2D6 metabolizes many active parent compounds, not only prodrugs. Option D is incorrect because inducing
alternative pathways is not standard practice and may provoke interactions.
Q2: Which statement BEST describes the role of P-glycoprotein (P-gp) in psychopharmacology?
A. P-gp is a hepatic enzyme responsible for phase II conjugation of selective serotonin reuptake inhibitors.
B. P-gp is an efflux transporter at the blood-brain barrier that limits central nervous system
penetration of many drugs. *[CORRECT]*
C. P-gp is a postsynaptic receptor that mediates the therapeutic effects of atypical antipsychotics.
D. P-gp is a renal tubular protein that enhances lithium reabsorption.
Correct Answer: B
Rationale:
P-glycoprotein (ABCB1) is an efflux transporter expressed at the blood-brain barrier, gut, and renal tubules; it actively
pumps substrates such as risperidone, olanzapine, and many antidepressants back into the lumen, thereby limiting
CNS penetration. The NSG 552 curriculum emphasizes P-gp as a key determinant of central drug exposure and a
source of pharmacokinetic variability. Option A confuses P-gp with CYP enzymes. Option C confuses it with receptor
pharmacodynamics. Option D is incorrect because P-gp is an efflux transporter, not a reabsorption enhancer for
lithium.
Q3: A patient taking warfarin is started on fluoxetine. Two weeks later the INR rises to 4.2. Which
pharmacokinetic mechanism BEST explains this interaction?
A. Fluoxetine induces CYP2C9, accelerating warfarin metabolism.
B. Fluoxetine inhibits CYP2D6, reducing warfarin activation.
C. Fluoxetine and its metabolite norfluoxetine inhibit CYP2C9, reducing S-warfarin clearance.
*[CORRECT]*
D. Fluoxetine displaces warfarin from plasma protein alpha-1-acid glycoprotein only.
Correct Answer: C
Rationale:
Page 2 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
,NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
Fluoxetine and norfluoxetine are potent inhibitors of CYP2C9, the primary metabolizer of the pharmacologically active
S-enantiomer of warfarin, leading to reduced clearance, elevated plasma levels, and increased INR. The NSG 552
curriculum requires identification of CYP-mediated drug interactions before prescribing. Option A is incorrect because
fluoxetine inhibits rather than induces CYP2C9. Option B is incorrect because CYP2D6 is not the principal pathway
for S-warfarin. Option D is incorrect because protein-binding displacement alone cannot account for a clinically
significant INR rise.
Q4: A patient with treatment-resistant depression is being considered for genotype-guided
therapy. The pharmacogenomic panel reports a CYP2C19 ultrarapid metabolizer phenotype. Which
antidepressant is MOST likely to be subtherapeutic at standard dosing?
A. Amitriptyline
B. Sertraline
C. Escitalopram
D. Both B and C *[CORRECT]*
Correct Answer: D
Rationale:
CYP2C19 ultrarapid metabolizers have increased clearance of CYP2C19 substrates. Both escitalopram and
sertraline are heavily dependent on CYP2C19 metabolism; ultrarapid metabolism is associated with lower plasma
concentrations and reduced antidepressant response at standard doses (CPIC 2023 guideline). NSG 552
emphasizes pharmacogenomic-guided selection of antidepressants. Option A is incorrect because amitriptyline is
primarily metabolized by CYP2D6 and CYP2C19, and ultrarapid CYP2C19 alone does not predict subtherapeutic
levels as strongly as it does for escitalopram and sertraline.
Q5: Which property of the blood-brain barrier MOST directly limits the CNS penetration of highly
water-soluble, ionized psychotropic medications?
A. High density of fenestrated capillaries allowing free diffusion.
B. Tight junctions between endothelial cells and efflux transporters such as P-glycoprotein.
*[CORRECT]*
C. Active transport of all lipophilic drugs across the astrocyte foot processes.
D. Presence of monoamine oxidase at the luminal membrane of brain capillaries.
Correct Answer: B
Rationale:
The blood-brain barrier is formed by tight junctions between capillary endothelial cells supported by astrocyte
end-feet, and it expresses efflux transporters such as P-glycoprotein that actively remove xenobiotics. Water-soluble
and ionized drugs have minimal passive diffusion across this barrier. NSG 552 requires understanding of CNS drug
delivery. Option A is incorrect because the BBB lacks fenestrations. Option C is incorrect because lipophilic drugs
cross by passive diffusion, not active transport. Option D is incorrect because MAO is intracellular, not a BBB
structural element.
Q6: A patient on lithium has a trough level of 1.4 mEq/L and reports coarse tremor, nausea, and
confusion. The prescriber orders a level and asks the nurse about contributing factors. Which
medication is MOST likely to raise lithium levels?
A. Lisinopril *[CORRECT]*
B. Furosemide
C. Sodium chloride tablets
D. Caffeine 400 mg daily
Page 3 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
, NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
Correct Answer: A
Rationale:
ACE inhibitors such as lisinopril reduce glomerular filtration of lithium and increase proximal tubular reabsorption,
raising plasma lithium levels and risking toxicity. NSG 552 requires recognition of medications that alter lithium
clearance. Option B is incorrect because loop diuretics (with chronic use) tend to increase lithium levels but less
predictably than thiazides or ACE inhibitors; the more classic interaction is hydrochlorothiazide. Option C is incorrect
because sodium loading enhances lithium excretion. Option D is incorrect because caffeine increases lithium
clearance.
Q7: An advanced practice nurse is establishing care for a 68-year-old patient taking nine
medications. Which pharmacokinetic change of normal aging MOST increases the risk of
psychotropic adverse effects?
A. Increased total body water and decreased fat stores.
B. Increased hepatic phase I oxidative metabolism.
C. Decreased renal clearance and increased fat stores prolonging drug half-life. *[CORRECT]*
D. Enhanced blood-brain barrier integrity reducing CNS penetration.
Correct Answer: C
Rationale:
Aging is associated with decreased renal clearance (lower GFR) and increased body fat, both of which prolong the
half-life of lipophilic psychotropics (e.g., diazepam, fluoxetine) and renally cleared agents (e.g., lithium, gabapentin).
Beers Criteria and NSG 552 principles emphasize starting low and going slow in older adults. Option A is incorrect
because total body water declines and fat increases. Option B is incorrect because phase I oxidative metabolism
declines with age. Option D is incorrect because BBB permeability actually increases in aging.
Q8: Which schedule of controlled substances correctly identifies a medication with a LOW
potential for abuse relative to Schedule II, accepted medical use, and abuse potentially leading to
moderate or low physical dependence?
A. Schedule I (e.g., heroin).
B. Schedule II (e.g., methylphenidate).
C. Schedule III (e.g., buprenorphine).
D. Schedule IV (e.g., alprazolam). *[CORRECT]*
Correct Answer: D
Rationale:
Schedule IV controlled substances (e.g., alprazolam, lorazepam, diazepam, modafinil) have lower abuse potential
than Schedule II drugs, accepted medical use, and abuse may lead to limited physical or psychological dependence.
DEA scheduling and prescriptive authority are core NSG 552 content. Option A is incorrect because Schedule I has
no accepted medical use. Option B is incorrect because Schedule II has high abuse potential. Option C is incorrect
because Schedule III has moderate physical dependence potential higher than Schedule IV.
Q9: A nurse practitioner is completing an informed consent discussion for aripiprazole in a
24-year-old with schizophrenia. Which element is a NON-NEGOTIABLE component of informed
consent?
A. A signed written waiver acknowledging that the medication will cure schizophrenia.
B. Disclosure of material risks, benefits, alternatives, and the right to refuse or withdraw consent.
*[CORRECT]*
C. A guarantee that the patient will not experience any extrapyramidal symptoms during therapy.
Page 4 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
NSG552 / NSG 552 EXAM 2 (LATEST ):
PSYCHOPHARMACOLOGY
Grade A Questions and Verified Answers | 100% Correct - Wilkes
Institution Wilkes University
Course NSG 552 - Psychopharmacology (Graduate Nursing / Advanced Practice)
Examination Exam 2 - Latest Edition
Total Questions 100 Multiple Choice (4 options, 1 correct)
Cognitive Mix 20% Recall | 50% Application | 30% Analysis
Question Style 75% Scenario-based | 25% Direct Knowledge
Aligned With AACN Essentials of Master’s Education; Advanced Psychopharmacology Competencies
Structure 7 Sections: Principles, Antidepressants, Antipsychotics, Mood Stabilizers, Anxiolytics & Sedative-Hypnotics, Psychostimu
Instructions: Each question has four options (A-D) with exactly one correct answer. Correct answers are marked
*[CORRECT]*. Read each rationale carefully; rationales integrate NSG 552 curriculum content, AACN Essentials,
and core psychopharmacology principles.
Page 1 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
,NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
Section 1: Principles of Psychopharmacology | Questions 1–15 | 15 Questions
Q1: A 42-year-old patient is started on a medication that is a substrate of CYP2D6. The prescriber
knows the patient is a CYP2D6 poor metabolizer. Which pharmacogenomic implication is MOST
accurate?
A. Standard dosing will produce subtherapeutic plasma concentrations requiring dose escalation.
B. Reduced enzyme activity leads to higher plasma drug concentrations and increased risk of
dose-dependent adverse effects. *[CORRECT]*
C. CYP2D6 status only affects prodrugs and has no bearing on active parent compounds.
D. CYP2D6 poor metabolizers require supplemental dosing with a CYP2D6 inducer such as rifampin.
Correct Answer: B
Rationale:
CYP2D6 poor metabolizers have reduced enzymatic clearance of substrate drugs (e.g., atomoxetine, paroxetine,
codeine activation), resulting in elevated plasma concentrations and heightened risk of adverse effects. The AACN
Essentials and NSG 552 curriculum require the advanced practice nurse to interpret pharmacogenomic results before
prescribing. Option A is incorrect because dose escalation would worsen toxicity. Option C is incorrect because
CYP2D6 metabolizes many active parent compounds, not only prodrugs. Option D is incorrect because inducing
alternative pathways is not standard practice and may provoke interactions.
Q2: Which statement BEST describes the role of P-glycoprotein (P-gp) in psychopharmacology?
A. P-gp is a hepatic enzyme responsible for phase II conjugation of selective serotonin reuptake inhibitors.
B. P-gp is an efflux transporter at the blood-brain barrier that limits central nervous system
penetration of many drugs. *[CORRECT]*
C. P-gp is a postsynaptic receptor that mediates the therapeutic effects of atypical antipsychotics.
D. P-gp is a renal tubular protein that enhances lithium reabsorption.
Correct Answer: B
Rationale:
P-glycoprotein (ABCB1) is an efflux transporter expressed at the blood-brain barrier, gut, and renal tubules; it actively
pumps substrates such as risperidone, olanzapine, and many antidepressants back into the lumen, thereby limiting
CNS penetration. The NSG 552 curriculum emphasizes P-gp as a key determinant of central drug exposure and a
source of pharmacokinetic variability. Option A confuses P-gp with CYP enzymes. Option C confuses it with receptor
pharmacodynamics. Option D is incorrect because P-gp is an efflux transporter, not a reabsorption enhancer for
lithium.
Q3: A patient taking warfarin is started on fluoxetine. Two weeks later the INR rises to 4.2. Which
pharmacokinetic mechanism BEST explains this interaction?
A. Fluoxetine induces CYP2C9, accelerating warfarin metabolism.
B. Fluoxetine inhibits CYP2D6, reducing warfarin activation.
C. Fluoxetine and its metabolite norfluoxetine inhibit CYP2C9, reducing S-warfarin clearance.
*[CORRECT]*
D. Fluoxetine displaces warfarin from plasma protein alpha-1-acid glycoprotein only.
Correct Answer: C
Rationale:
Page 2 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
,NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
Fluoxetine and norfluoxetine are potent inhibitors of CYP2C9, the primary metabolizer of the pharmacologically active
S-enantiomer of warfarin, leading to reduced clearance, elevated plasma levels, and increased INR. The NSG 552
curriculum requires identification of CYP-mediated drug interactions before prescribing. Option A is incorrect because
fluoxetine inhibits rather than induces CYP2C9. Option B is incorrect because CYP2D6 is not the principal pathway
for S-warfarin. Option D is incorrect because protein-binding displacement alone cannot account for a clinically
significant INR rise.
Q4: A patient with treatment-resistant depression is being considered for genotype-guided
therapy. The pharmacogenomic panel reports a CYP2C19 ultrarapid metabolizer phenotype. Which
antidepressant is MOST likely to be subtherapeutic at standard dosing?
A. Amitriptyline
B. Sertraline
C. Escitalopram
D. Both B and C *[CORRECT]*
Correct Answer: D
Rationale:
CYP2C19 ultrarapid metabolizers have increased clearance of CYP2C19 substrates. Both escitalopram and
sertraline are heavily dependent on CYP2C19 metabolism; ultrarapid metabolism is associated with lower plasma
concentrations and reduced antidepressant response at standard doses (CPIC 2023 guideline). NSG 552
emphasizes pharmacogenomic-guided selection of antidepressants. Option A is incorrect because amitriptyline is
primarily metabolized by CYP2D6 and CYP2C19, and ultrarapid CYP2C19 alone does not predict subtherapeutic
levels as strongly as it does for escitalopram and sertraline.
Q5: Which property of the blood-brain barrier MOST directly limits the CNS penetration of highly
water-soluble, ionized psychotropic medications?
A. High density of fenestrated capillaries allowing free diffusion.
B. Tight junctions between endothelial cells and efflux transporters such as P-glycoprotein.
*[CORRECT]*
C. Active transport of all lipophilic drugs across the astrocyte foot processes.
D. Presence of monoamine oxidase at the luminal membrane of brain capillaries.
Correct Answer: B
Rationale:
The blood-brain barrier is formed by tight junctions between capillary endothelial cells supported by astrocyte
end-feet, and it expresses efflux transporters such as P-glycoprotein that actively remove xenobiotics. Water-soluble
and ionized drugs have minimal passive diffusion across this barrier. NSG 552 requires understanding of CNS drug
delivery. Option A is incorrect because the BBB lacks fenestrations. Option C is incorrect because lipophilic drugs
cross by passive diffusion, not active transport. Option D is incorrect because MAO is intracellular, not a BBB
structural element.
Q6: A patient on lithium has a trough level of 1.4 mEq/L and reports coarse tremor, nausea, and
confusion. The prescriber orders a level and asks the nurse about contributing factors. Which
medication is MOST likely to raise lithium levels?
A. Lisinopril *[CORRECT]*
B. Furosemide
C. Sodium chloride tablets
D. Caffeine 400 mg daily
Page 3 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
, NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology Wilkes University | Grade A | 100% Correct
Correct Answer: A
Rationale:
ACE inhibitors such as lisinopril reduce glomerular filtration of lithium and increase proximal tubular reabsorption,
raising plasma lithium levels and risking toxicity. NSG 552 requires recognition of medications that alter lithium
clearance. Option B is incorrect because loop diuretics (with chronic use) tend to increase lithium levels but less
predictably than thiazides or ACE inhibitors; the more classic interaction is hydrochlorothiazide. Option C is incorrect
because sodium loading enhances lithium excretion. Option D is incorrect because caffeine increases lithium
clearance.
Q7: An advanced practice nurse is establishing care for a 68-year-old patient taking nine
medications. Which pharmacokinetic change of normal aging MOST increases the risk of
psychotropic adverse effects?
A. Increased total body water and decreased fat stores.
B. Increased hepatic phase I oxidative metabolism.
C. Decreased renal clearance and increased fat stores prolonging drug half-life. *[CORRECT]*
D. Enhanced blood-brain barrier integrity reducing CNS penetration.
Correct Answer: C
Rationale:
Aging is associated with decreased renal clearance (lower GFR) and increased body fat, both of which prolong the
half-life of lipophilic psychotropics (e.g., diazepam, fluoxetine) and renally cleared agents (e.g., lithium, gabapentin).
Beers Criteria and NSG 552 principles emphasize starting low and going slow in older adults. Option A is incorrect
because total body water declines and fat increases. Option B is incorrect because phase I oxidative metabolism
declines with age. Option D is incorrect because BBB permeability actually increases in aging.
Q8: Which schedule of controlled substances correctly identifies a medication with a LOW
potential for abuse relative to Schedule II, accepted medical use, and abuse potentially leading to
moderate or low physical dependence?
A. Schedule I (e.g., heroin).
B. Schedule II (e.g., methylphenidate).
C. Schedule III (e.g., buprenorphine).
D. Schedule IV (e.g., alprazolam). *[CORRECT]*
Correct Answer: D
Rationale:
Schedule IV controlled substances (e.g., alprazolam, lorazepam, diazepam, modafinil) have lower abuse potential
than Schedule II drugs, accepted medical use, and abuse may lead to limited physical or psychological dependence.
DEA scheduling and prescriptive authority are core NSG 552 content. Option A is incorrect because Schedule I has
no accepted medical use. Option B is incorrect because Schedule II has high abuse potential. Option C is incorrect
because Schedule III has moderate physical dependence potential higher than Schedule IV.
Q9: A nurse practitioner is completing an informed consent discussion for aripiprazole in a
24-year-old with schizophrenia. Which element is a NON-NEGOTIABLE component of informed
consent?
A. A signed written waiver acknowledging that the medication will cure schizophrenia.
B. Disclosure of material risks, benefits, alternatives, and the right to refuse or withdraw consent.
*[CORRECT]*
C. A guarantee that the patient will not experience any extrapyramidal symptoms during therapy.
Page 4 | NSG 552 Psychopharmacology Exam 2 | 100 Questions
