NSG 552 PSYCHOPHARMACOLOGY — FINAL EXAM COMPLETE
TEST BANK COMPREHENSIVE FINAL EXAM 300 QUESTIONS WITH
NGN CASE SCENARIOS & DETAILED RATIONALES 2026/2027
UPDATE
1. A patient starting sertraline asks how long it will take to feel better. What is the most accurate
response?
A) "You will feel the full effect within 24 to 48 hours."
B) "It may take 2 to 4 weeks for full therapeutic effects."
C) "You will feel better after the first dose."
D) "It takes at least 6 months to work."
Answer: B
Rationale:
SSRIs like sertraline require several weeks to produce full therapeutic effects because they depend on
downstream neuroadaptive changes, including receptor desensitization and increased neuroplasticity,
rather than immediate neurotransmitter elevation.
2. Which serotonergic side effect is most commonly reported with SSRIs?
A) Sexual dysfunction
B) Hypertensive crisis
C) Agranulocytosis
D) Nephrotoxicity
Answer: A
Rationale:
SSRIs commonly cause sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia,
due to increased serotonin activity at 5-HT2 receptors. This is a frequent reason for nonadherence.
3. A patient on fluoxetine reports agitation, diaphoresis, and tremor after starting tramadol. What
syndrome should the nurse suspect?
A) Neuroleptic malignant syndrome
,B) Serotonin syndrome
C) Anticholinergic toxicity
D) Malignant hyperthermia
Answer: B
Rationale:
Serotonin syndrome results from excessive serotonergic activity, often due to combining SSRIs with other
serotonergic agents like tramadol. Symptoms include mental status changes, autonomic instability, and
neuromuscular abnormalities.
4. Which medication is a serotonin-norepinephrine reuptake inhibitor?
A) Sertraline
B) Venlafaxine
C) Bupropion
D) Mirtazapine
Answer: B
Rationale:
Venlafaxine inhibits reuptake of both serotonin and norepinephrine, with norepinephrine effects becoming
more prominent at higher doses. SSRIs primarily affect serotonin.
5. A patient on venlafaxine should have which vital sign monitored regularly?
A) Respiratory rate
B) Blood pressure
C) Temperature
D) Oxygen saturation
Answer: B
Rationale:
Venlafaxine can increase norepinephrine activity, leading to dose-dependent hypertension. Blood pressure
monitoring is essential, especially at higher doses.
6. Which antidepressant is least likely to cause sexual dysfunction?
A) Paroxetine
B) Sertraline
C) Bupropion
2
,D) Fluoxetine
Answer: C
Rationale:
Bupropion does not significantly affect serotonin and is associated with minimal sexual dysfunction. It is
often used when sexual side effects are a concern.
7. A patient on bupropion should be warned about which serious adverse effect?
A) Hypertensive crisis
B) Seizures
C) Agranulocytosis
D) QT prolongation
Answer: B
Rationale:
Bupropion lowers the seizure threshold, especially at higher doses or in patients with eating disorders or
seizure history. It should be used cautiously in these populations.
8. Which antidepressant is a monoamine oxidase inhibitor?
A) Phenelzine
B) Amitriptyline
C) Duloxetine
D) Escitalopram
Answer: A
Rationale:
Phenelzine is an MAOI that irreversibly inhibits monoamine oxidase, increasing norepinephrine, serotonin,
and dopamine. It requires dietary tyramine restriction.
9. A patient on phenelzine should avoid which food to prevent hypertensive crisis?
A) Bread
B) Aged cheese
C) Rice
D) Apples
Answer: B
3
, Rationale:
Aged cheese contains tyramine, which can trigger hypertensive crisis in patients taking MAOIs because
tyramine is not metabolized and causes massive catecholamine release.
10. Which tricyclic antidepressant is associated with the highest risk of anticholinergic effects?
A) Nortriptyline
B) Amitriptyline
C) Desipramine
D) Imipramine
Answer: B
Rationale:
Amitriptyline has strong anticholinergic properties, causing dry mouth, constipation, urinary retention, and
blurred vision. Tertiary amines are more anticholinergic than secondary amines.
11. A patient on amitriptyline reports palpitations and syncope. Which complication should the
nurse suspect?
A) Hypertensive crisis
B) Cardiac conduction delay
C) Serotonin syndrome
D) Nephrotoxicity
Answer: B
Rationale:
TCAs can prolong cardiac conduction and cause arrhythmias, especially in overdose. ECG monitoring is
important in at-risk patients.
12. Which antidepressant is a norepinephrine-dopamine reuptake inhibitor?
A) Bupropion
B) Mirtazapine
C) Trazodone
D) Venlafaxine
Answer: A
4
TEST BANK COMPREHENSIVE FINAL EXAM 300 QUESTIONS WITH
NGN CASE SCENARIOS & DETAILED RATIONALES 2026/2027
UPDATE
1. A patient starting sertraline asks how long it will take to feel better. What is the most accurate
response?
A) "You will feel the full effect within 24 to 48 hours."
B) "It may take 2 to 4 weeks for full therapeutic effects."
C) "You will feel better after the first dose."
D) "It takes at least 6 months to work."
Answer: B
Rationale:
SSRIs like sertraline require several weeks to produce full therapeutic effects because they depend on
downstream neuroadaptive changes, including receptor desensitization and increased neuroplasticity,
rather than immediate neurotransmitter elevation.
2. Which serotonergic side effect is most commonly reported with SSRIs?
A) Sexual dysfunction
B) Hypertensive crisis
C) Agranulocytosis
D) Nephrotoxicity
Answer: A
Rationale:
SSRIs commonly cause sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia,
due to increased serotonin activity at 5-HT2 receptors. This is a frequent reason for nonadherence.
3. A patient on fluoxetine reports agitation, diaphoresis, and tremor after starting tramadol. What
syndrome should the nurse suspect?
A) Neuroleptic malignant syndrome
,B) Serotonin syndrome
C) Anticholinergic toxicity
D) Malignant hyperthermia
Answer: B
Rationale:
Serotonin syndrome results from excessive serotonergic activity, often due to combining SSRIs with other
serotonergic agents like tramadol. Symptoms include mental status changes, autonomic instability, and
neuromuscular abnormalities.
4. Which medication is a serotonin-norepinephrine reuptake inhibitor?
A) Sertraline
B) Venlafaxine
C) Bupropion
D) Mirtazapine
Answer: B
Rationale:
Venlafaxine inhibits reuptake of both serotonin and norepinephrine, with norepinephrine effects becoming
more prominent at higher doses. SSRIs primarily affect serotonin.
5. A patient on venlafaxine should have which vital sign monitored regularly?
A) Respiratory rate
B) Blood pressure
C) Temperature
D) Oxygen saturation
Answer: B
Rationale:
Venlafaxine can increase norepinephrine activity, leading to dose-dependent hypertension. Blood pressure
monitoring is essential, especially at higher doses.
6. Which antidepressant is least likely to cause sexual dysfunction?
A) Paroxetine
B) Sertraline
C) Bupropion
2
,D) Fluoxetine
Answer: C
Rationale:
Bupropion does not significantly affect serotonin and is associated with minimal sexual dysfunction. It is
often used when sexual side effects are a concern.
7. A patient on bupropion should be warned about which serious adverse effect?
A) Hypertensive crisis
B) Seizures
C) Agranulocytosis
D) QT prolongation
Answer: B
Rationale:
Bupropion lowers the seizure threshold, especially at higher doses or in patients with eating disorders or
seizure history. It should be used cautiously in these populations.
8. Which antidepressant is a monoamine oxidase inhibitor?
A) Phenelzine
B) Amitriptyline
C) Duloxetine
D) Escitalopram
Answer: A
Rationale:
Phenelzine is an MAOI that irreversibly inhibits monoamine oxidase, increasing norepinephrine, serotonin,
and dopamine. It requires dietary tyramine restriction.
9. A patient on phenelzine should avoid which food to prevent hypertensive crisis?
A) Bread
B) Aged cheese
C) Rice
D) Apples
Answer: B
3
, Rationale:
Aged cheese contains tyramine, which can trigger hypertensive crisis in patients taking MAOIs because
tyramine is not metabolized and causes massive catecholamine release.
10. Which tricyclic antidepressant is associated with the highest risk of anticholinergic effects?
A) Nortriptyline
B) Amitriptyline
C) Desipramine
D) Imipramine
Answer: B
Rationale:
Amitriptyline has strong anticholinergic properties, causing dry mouth, constipation, urinary retention, and
blurred vision. Tertiary amines are more anticholinergic than secondary amines.
11. A patient on amitriptyline reports palpitations and syncope. Which complication should the
nurse suspect?
A) Hypertensive crisis
B) Cardiac conduction delay
C) Serotonin syndrome
D) Nephrotoxicity
Answer: B
Rationale:
TCAs can prolong cardiac conduction and cause arrhythmias, especially in overdose. ECG monitoring is
important in at-risk patients.
12. Which antidepressant is a norepinephrine-dopamine reuptake inhibitor?
A) Bupropion
B) Mirtazapine
C) Trazodone
D) Venlafaxine
Answer: A
4
