WILKES UNIVERSITY ·
A+
VERIFIED
NSG 552 Exam 2:
Psychopharmacology (Grade A
Verified)
Advanced psychopharmacology assessment emphasizing safe prescribing, receptor
pharmacology, drug interactions, and monitoring across the psychiatric medication classes.
100 5 100%
QUESTIONS SECTIONS W I T H R AT I O N A L E S
W H AT T H I S C O V E R S
High-Yield Domains & Competencies
Antidepressants & Mood Disorders Antipsychotics & Schizophrenia
SSRIs/SNRIs/atypicals/MAOIs/augmentation with washouts FGAs, SGAs, LAIs, metabolic monitoring, NMS, EPS, VMAT2
and switches. inhibitors.
Anxiolytics, Sedative-Hypnotics & Substance Mood Stabilizers & Bipolar Disorder
Use Lithium, valproate, carbamazepine, lamotrigine, atypicals for
BDZs, buspirone, Z-drugs, orexin antagonists, AUD/OUD/SUD bipolar.
pharmacotherapy.
ADHD, Stimulants & Cognitive Enhancers
Stimulants, non-stimulants, cholinesterase inhibitors, dementia
agents.
ABOUT THIS ASSESSMENT
Original Grade-A psychopharmacology assessment aligned to NSG 552 Exam 2 outcomes.
This assessment emphasizes applied prescribing decisions for adult and special-population psychiatric care. Items
address mechanism of action, receptor pharmacology, FDA-approved and off-label indications, titration and cross-taper
schedules, serum-level monitoring, cytochrome P450 drug interactions, pregnancy and lactation considerations, hepatic
and renal dose adjustment, and boxed warnings. Learners must justify agent selection using patient-specific factors such
as comorbidity, age, organ function, reproductive status, and concurrent medications rather than relying on memorized
first-line choices alone.
Safety-critical content is featured throughout: serotonin syndrome management and washout intervals, MAOI
hypertensive crisis, neuroleptic malignant syndrome treatment, lithium toxicity and dialysis thresholds, QTc prolongation,
metabolic syndrome surveillance, SIADH-associated hyponatremia, Stevens-Johnson syndrome with lamotrigine and
carbamazepine, anticholinergic burden in the elderly, VMAT2 inhibitor use for tardive dyskinesia, and REMS programs
for clozapine, isotretinoin-like monitoring, and long-acting buprenorphine. Special attention is given to switching
strategies between antidepressant classes and to stabilizing therapy across the perinatal period.
STUVIA ACTUAL EXAM Wil k es U ni vers i ty · O ri g in al S tudy A id · E du catio n al Rev iew
Every item in this document is original, written for educational review, and is not affiliated with or endorsed by any testing
,NSG 552 Exam 2 - Psychopharmacology (Grade A) Wilkes University ·
NSG 552 Exam 2: Psychopharmacology (Grade A Wilkes University ·
Verified)
Questions: 100 · Sections: 5 · Passing Score: 80% · Format: Multiple Choice (A/B/C/D)
Section 1 - Antidepressants & Mood Disorders Q1–Q25 · 25 questions
SSRIs, SNRIs, atypical antidepressants, MAOIs (including transdermal selegiline, isocarboxazid, tranylcypromine), augmentation
strategies, washout and switching protocols, perinatal and geriatric considerations.
1. A 41-year-old woman with atypical depression has failed two adequate SSRI trials. The provider plans
to initiate tranylcypromine. What is the minimum washout interval after discontinuing sertraline before
starting the MAOI?
A. 14 days
B. 7 days
C. 10 days
D. 28 days
Correct Answer: A — 14 days
Sertraline has a half-life of about 26 hours, so at least 14 days must elapse after stopping it before initiating an MAOI to
allow clearance and minimize serotonin syndrome risk. Fluoxetine uniquely requires a longer 5-week washout because
of norfluoxetine's prolonged half-life. Starting an MAOI earlier risks a life-threatening serotonergic reaction.
2. A patient is switched from fluoxetine 20 mg daily to phenelzine after treatment-resistant depression.
How long must the provider wait before starting phenelzine?
A. 2 weeks
B. 10 days
C. 1 week
D. 5 weeks
Correct Answer: D — 5 weeks
Fluoxetine's active metabolite norfluoxetine has a half-life of 7 to 15 days, requiring a minimum 5-week washout before
an MAOI can be safely initiated. Shorter intervals risk precipitating serotonin syndrome. Other SSRIs typically require
only a 2-week washout.
3. A 38-year-old man with major depressive disorder and prominent anergia is started on selegiline
transdermal patch 6 mg/24 hr. What dietary counseling is required at this starting dose?
A. Strict tyramine restriction at all doses
B. No tyramine restriction needed at 6 mg/24 hr
C. Avoid aged cheeses only
D. Avoid all fermented foods
Correct Answer: B — No tyramine restriction needed at 6 mg/24 hr
At the 6 mg/24 hr starting dose, selegiline transdermal delivery selectively inhibits MAO-A in the brain while largely
sparing MAO-A in the gut, so tyramine dietary restriction is generally not required. Doses of 9 mg/24 hr and 12 mg/24
hr do require dietary counseling. Patients should still avoid sympathomimetic agents.
Original Study Aid · Educational Review STUVIA ACTUAL EXAM Page 1
,NSG 552 Exam 2 - Psychopharmacology (Grade A) Wilkes University ·
4. A 52-year-old woman on sertraline 100 mg daily for 8 weeks reports partial response with persistent
anhedonia. The provider adds aripiprazole 2 mg daily. What is the rationale for low-dose aripiprazole
augmentation?
A. Blocks dopamine D2 to maximize sedation
B. Inhibits CYP2D6 to raise SSRI levels
C. Acts as a serotonin antagonist
D. Partial D2 agonism enhances dopaminergic tone
Correct Answer: D — Partial D2 agonism enhances dopaminergic tone
Low-dose aripiprazole enhances dopaminergic activity through partial D2 agonism in mesocortical pathways,
addressing residual anergia and anhedonia. At higher doses it becomes more antagonistic and can cause akathisia. It
does not meaningfully inhibit CYP2D6 at augmentation doses.
5. A patient on escitalopram presents with diaphoresis, myoclonus, hyperreflexia, and confusion after a
single dose of tramadol. Which medication is the most specific antidote for severe serotonin syndrome?
A. Naloxone
B. Flumazenil
C. Cyproheptadine
D. Physostigmine
Correct Answer: C — Cyproheptadine
Cyproheptadine is a 5-HT2A antagonist used as a specific antidote in moderate to severe serotonin syndrome when
supportive care and benzodiazepines are insufficient. Naloxone reverses opioids, flumazenil reverses
benzodiazepines, and physostigmine is for anticholinergic toxicity. Agitation and neuromuscular symptoms typically
drive the diagnosis.
6. A 67-year-old man starts citalopram 20 mg daily. Two weeks later his serum sodium is 128 mEq/L,
down from 138 mEq/L. What is the most likely mechanism?
A. SIADH from increased ADH secretion
B. Direct renal tubular sodium wasting
C. Aldosterone suppression
D. Nephrogenic diabetes insipidus
Correct Answer: A — SIADH from increased ADH secretion
SSRIs can trigger syndrome of inappropriate antidiuretic hormone secretion, causing water retention and dilutional
hyponatremia, particularly in older adults and within the first 2 weeks of therapy. Risk increases with concurrent
diuretics or low body weight. Management includes fluid restriction and, in severe cases, hypertonic saline.
7. A 29-year-old woman with major depression and irritable bowel syndrome is started on vilazodone.
What dual mechanism best describes this agent?
A. SNRI plus alpha-2 antagonist
B. SSRI plus 5-HT3 antagonist
C. NRI plus D2 antagonist
D. SSRI plus 5-HT1A partial agonism
Correct Answer: D — SSRI plus 5-HT1A partial agonism
Vilazodone combines serotonin reuptake inhibition with partial agonist activity at postsynaptic 5-HT1A receptors, which
may reduce sexual dysfunction compared with traditional SSRIs. It must be taken with food. Common adverse effects
include diarrhea and nausea.
Original Study Aid · Educational Review STUVIA ACTUAL EXAM Page 2
, NSG 552 Exam 2 - Psychopharmacology (Grade A) Wilkes University ·
8. A 44-year-old patient on duloxetine 60 mg daily for depression and fibromyalgia develops new-onset
dark urine and right upper quadrant pain. Liver enzymes are markedly elevated. What is the most
appropriate next step?
A. Continue and recheck in 4 weeks
B. Reduce dose to 30 mg
C. Discontinue duloxetine immediately
D. Add N-acetylcysteine
Correct Answer: C — Discontinue duloxetine immediately
Duloxetine carries a rare but serious risk of hepatotoxicity; new transaminase elevations with symptoms of liver injury
warrant immediate discontinuation and workup for other causes. Duloxetine should be avoided in patients with
pre-existing hepatic impairment or heavy alcohol use. Re-exposure is contraindicated.
9. A patient with major depression and obesity (BMI 36) needs an antidepressant with weight-neutral
profile and minimal sexual dysfunction. Which agent is the most appropriate first-line choice?
A. Mirtazapine
B. Paroxetine
C. Bupropion XL
D. Duloxetine
Correct Answer: C — Bupropion XL
Bupropion is weight-neutral or weight-loss promoting and is associated with low rates of sexual dysfunction because it
does not directly increase serotonergic tone. Mirtazapine and paroxetine commonly cause weight gain. Duloxetine has
variable effects on weight and sexual function.
10. An 81-year-old woman with depression, glaucoma, and urinary retention requires pharmacotherapy.
Which antidepressant is most appropriate to avoid?
A. Sertraline
B. Nortriptyline
C. Mirtazapine
D. Escitalopram
Correct Answer: B — Nortriptyline
Nortriptyline is a tricyclic antidepressant with significant anticholinergic activity that can precipitate urinary retention,
worsen narrow-angle glaucoma, and cause confusion in older adults. SSRIs such as sertraline or escitalopram are
preferred in geriatric depression. The Beers Criteria lists TCAs as potentially inappropriate in older adults.
11. A 36-year-old patient with treatment-resistant depression has failed multiple antidepressants. The
provider initiates esketamine intranasal as an adjunct to oral antidepressant. What monitoring is required
after each administration?
A. 2-hour observation for sedation and dissociation
B. Discharge immediately after dose
C. Overnight inpatient observation
D. 30-minute blood pressure check only
Correct Answer: A — 2-hour observation for sedation and dissociation
Esketamine intranasal requires a 2-hour post-dose observation period for sedation, dissociation, and transient blood
pressure elevation under the REMS program. Patients must be driven home and cannot drive until the day after a
restful sleep. The observation addresses dissociation and potential abuse potential.
Original Study Aid · Educational Review STUVIA ACTUAL EXAM Page 3
A+
VERIFIED
NSG 552 Exam 2:
Psychopharmacology (Grade A
Verified)
Advanced psychopharmacology assessment emphasizing safe prescribing, receptor
pharmacology, drug interactions, and monitoring across the psychiatric medication classes.
100 5 100%
QUESTIONS SECTIONS W I T H R AT I O N A L E S
W H AT T H I S C O V E R S
High-Yield Domains & Competencies
Antidepressants & Mood Disorders Antipsychotics & Schizophrenia
SSRIs/SNRIs/atypicals/MAOIs/augmentation with washouts FGAs, SGAs, LAIs, metabolic monitoring, NMS, EPS, VMAT2
and switches. inhibitors.
Anxiolytics, Sedative-Hypnotics & Substance Mood Stabilizers & Bipolar Disorder
Use Lithium, valproate, carbamazepine, lamotrigine, atypicals for
BDZs, buspirone, Z-drugs, orexin antagonists, AUD/OUD/SUD bipolar.
pharmacotherapy.
ADHD, Stimulants & Cognitive Enhancers
Stimulants, non-stimulants, cholinesterase inhibitors, dementia
agents.
ABOUT THIS ASSESSMENT
Original Grade-A psychopharmacology assessment aligned to NSG 552 Exam 2 outcomes.
This assessment emphasizes applied prescribing decisions for adult and special-population psychiatric care. Items
address mechanism of action, receptor pharmacology, FDA-approved and off-label indications, titration and cross-taper
schedules, serum-level monitoring, cytochrome P450 drug interactions, pregnancy and lactation considerations, hepatic
and renal dose adjustment, and boxed warnings. Learners must justify agent selection using patient-specific factors such
as comorbidity, age, organ function, reproductive status, and concurrent medications rather than relying on memorized
first-line choices alone.
Safety-critical content is featured throughout: serotonin syndrome management and washout intervals, MAOI
hypertensive crisis, neuroleptic malignant syndrome treatment, lithium toxicity and dialysis thresholds, QTc prolongation,
metabolic syndrome surveillance, SIADH-associated hyponatremia, Stevens-Johnson syndrome with lamotrigine and
carbamazepine, anticholinergic burden in the elderly, VMAT2 inhibitor use for tardive dyskinesia, and REMS programs
for clozapine, isotretinoin-like monitoring, and long-acting buprenorphine. Special attention is given to switching
strategies between antidepressant classes and to stabilizing therapy across the perinatal period.
STUVIA ACTUAL EXAM Wil k es U ni vers i ty · O ri g in al S tudy A id · E du catio n al Rev iew
Every item in this document is original, written for educational review, and is not affiliated with or endorsed by any testing
,NSG 552 Exam 2 - Psychopharmacology (Grade A) Wilkes University ·
NSG 552 Exam 2: Psychopharmacology (Grade A Wilkes University ·
Verified)
Questions: 100 · Sections: 5 · Passing Score: 80% · Format: Multiple Choice (A/B/C/D)
Section 1 - Antidepressants & Mood Disorders Q1–Q25 · 25 questions
SSRIs, SNRIs, atypical antidepressants, MAOIs (including transdermal selegiline, isocarboxazid, tranylcypromine), augmentation
strategies, washout and switching protocols, perinatal and geriatric considerations.
1. A 41-year-old woman with atypical depression has failed two adequate SSRI trials. The provider plans
to initiate tranylcypromine. What is the minimum washout interval after discontinuing sertraline before
starting the MAOI?
A. 14 days
B. 7 days
C. 10 days
D. 28 days
Correct Answer: A — 14 days
Sertraline has a half-life of about 26 hours, so at least 14 days must elapse after stopping it before initiating an MAOI to
allow clearance and minimize serotonin syndrome risk. Fluoxetine uniquely requires a longer 5-week washout because
of norfluoxetine's prolonged half-life. Starting an MAOI earlier risks a life-threatening serotonergic reaction.
2. A patient is switched from fluoxetine 20 mg daily to phenelzine after treatment-resistant depression.
How long must the provider wait before starting phenelzine?
A. 2 weeks
B. 10 days
C. 1 week
D. 5 weeks
Correct Answer: D — 5 weeks
Fluoxetine's active metabolite norfluoxetine has a half-life of 7 to 15 days, requiring a minimum 5-week washout before
an MAOI can be safely initiated. Shorter intervals risk precipitating serotonin syndrome. Other SSRIs typically require
only a 2-week washout.
3. A 38-year-old man with major depressive disorder and prominent anergia is started on selegiline
transdermal patch 6 mg/24 hr. What dietary counseling is required at this starting dose?
A. Strict tyramine restriction at all doses
B. No tyramine restriction needed at 6 mg/24 hr
C. Avoid aged cheeses only
D. Avoid all fermented foods
Correct Answer: B — No tyramine restriction needed at 6 mg/24 hr
At the 6 mg/24 hr starting dose, selegiline transdermal delivery selectively inhibits MAO-A in the brain while largely
sparing MAO-A in the gut, so tyramine dietary restriction is generally not required. Doses of 9 mg/24 hr and 12 mg/24
hr do require dietary counseling. Patients should still avoid sympathomimetic agents.
Original Study Aid · Educational Review STUVIA ACTUAL EXAM Page 1
,NSG 552 Exam 2 - Psychopharmacology (Grade A) Wilkes University ·
4. A 52-year-old woman on sertraline 100 mg daily for 8 weeks reports partial response with persistent
anhedonia. The provider adds aripiprazole 2 mg daily. What is the rationale for low-dose aripiprazole
augmentation?
A. Blocks dopamine D2 to maximize sedation
B. Inhibits CYP2D6 to raise SSRI levels
C. Acts as a serotonin antagonist
D. Partial D2 agonism enhances dopaminergic tone
Correct Answer: D — Partial D2 agonism enhances dopaminergic tone
Low-dose aripiprazole enhances dopaminergic activity through partial D2 agonism in mesocortical pathways,
addressing residual anergia and anhedonia. At higher doses it becomes more antagonistic and can cause akathisia. It
does not meaningfully inhibit CYP2D6 at augmentation doses.
5. A patient on escitalopram presents with diaphoresis, myoclonus, hyperreflexia, and confusion after a
single dose of tramadol. Which medication is the most specific antidote for severe serotonin syndrome?
A. Naloxone
B. Flumazenil
C. Cyproheptadine
D. Physostigmine
Correct Answer: C — Cyproheptadine
Cyproheptadine is a 5-HT2A antagonist used as a specific antidote in moderate to severe serotonin syndrome when
supportive care and benzodiazepines are insufficient. Naloxone reverses opioids, flumazenil reverses
benzodiazepines, and physostigmine is for anticholinergic toxicity. Agitation and neuromuscular symptoms typically
drive the diagnosis.
6. A 67-year-old man starts citalopram 20 mg daily. Two weeks later his serum sodium is 128 mEq/L,
down from 138 mEq/L. What is the most likely mechanism?
A. SIADH from increased ADH secretion
B. Direct renal tubular sodium wasting
C. Aldosterone suppression
D. Nephrogenic diabetes insipidus
Correct Answer: A — SIADH from increased ADH secretion
SSRIs can trigger syndrome of inappropriate antidiuretic hormone secretion, causing water retention and dilutional
hyponatremia, particularly in older adults and within the first 2 weeks of therapy. Risk increases with concurrent
diuretics or low body weight. Management includes fluid restriction and, in severe cases, hypertonic saline.
7. A 29-year-old woman with major depression and irritable bowel syndrome is started on vilazodone.
What dual mechanism best describes this agent?
A. SNRI plus alpha-2 antagonist
B. SSRI plus 5-HT3 antagonist
C. NRI plus D2 antagonist
D. SSRI plus 5-HT1A partial agonism
Correct Answer: D — SSRI plus 5-HT1A partial agonism
Vilazodone combines serotonin reuptake inhibition with partial agonist activity at postsynaptic 5-HT1A receptors, which
may reduce sexual dysfunction compared with traditional SSRIs. It must be taken with food. Common adverse effects
include diarrhea and nausea.
Original Study Aid · Educational Review STUVIA ACTUAL EXAM Page 2
, NSG 552 Exam 2 - Psychopharmacology (Grade A) Wilkes University ·
8. A 44-year-old patient on duloxetine 60 mg daily for depression and fibromyalgia develops new-onset
dark urine and right upper quadrant pain. Liver enzymes are markedly elevated. What is the most
appropriate next step?
A. Continue and recheck in 4 weeks
B. Reduce dose to 30 mg
C. Discontinue duloxetine immediately
D. Add N-acetylcysteine
Correct Answer: C — Discontinue duloxetine immediately
Duloxetine carries a rare but serious risk of hepatotoxicity; new transaminase elevations with symptoms of liver injury
warrant immediate discontinuation and workup for other causes. Duloxetine should be avoided in patients with
pre-existing hepatic impairment or heavy alcohol use. Re-exposure is contraindicated.
9. A patient with major depression and obesity (BMI 36) needs an antidepressant with weight-neutral
profile and minimal sexual dysfunction. Which agent is the most appropriate first-line choice?
A. Mirtazapine
B. Paroxetine
C. Bupropion XL
D. Duloxetine
Correct Answer: C — Bupropion XL
Bupropion is weight-neutral or weight-loss promoting and is associated with low rates of sexual dysfunction because it
does not directly increase serotonergic tone. Mirtazapine and paroxetine commonly cause weight gain. Duloxetine has
variable effects on weight and sexual function.
10. An 81-year-old woman with depression, glaucoma, and urinary retention requires pharmacotherapy.
Which antidepressant is most appropriate to avoid?
A. Sertraline
B. Nortriptyline
C. Mirtazapine
D. Escitalopram
Correct Answer: B — Nortriptyline
Nortriptyline is a tricyclic antidepressant with significant anticholinergic activity that can precipitate urinary retention,
worsen narrow-angle glaucoma, and cause confusion in older adults. SSRIs such as sertraline or escitalopram are
preferred in geriatric depression. The Beers Criteria lists TCAs as potentially inappropriate in older adults.
11. A 36-year-old patient with treatment-resistant depression has failed multiple antidepressants. The
provider initiates esketamine intranasal as an adjunct to oral antidepressant. What monitoring is required
after each administration?
A. 2-hour observation for sedation and dissociation
B. Discharge immediately after dose
C. Overnight inpatient observation
D. 30-minute blood pressure check only
Correct Answer: A — 2-hour observation for sedation and dissociation
Esketamine intranasal requires a 2-hour post-dose observation period for sedation, dissociation, and transient blood
pressure elevation under the REMS program. Patients must be driven home and cannot drive until the day after a
restful sleep. The observation addresses dissociation and potential abuse potential.
Original Study Aid · Educational Review STUVIA ACTUAL EXAM Page 3
