NSG 552 Psychopharmacology Exam 1 Questions &
Detailed Solutions – 2026/2027
NSG 552 PSYCHOPHARMACOLOGY EXAM 1 - PRACTICE QUESTIONS
====================================================================
============
DOCUMENT OVERVIEW:
• Comprehensive practice examination with 210 questions covering antidepressants,
antipsychotics, anxiolytics, mood stabilizers, stimulants, and psychopharmacological principles
• Detailed solutions with evidence-based rationales designed to enhance understanding of drug
mechanisms, clinical applications, side effects, and nursing considerations
====================================================================
============
QUESTION 1: Which neurotransmitter system is primarily targeted by selective serotonin
reuptake inhibitors (SSRIs)?
A) Dopamine reuptake inhibition in the nucleus accumbens
B) Serotonin reuptake inhibition at the presynaptic membrane
C) Acetylcholine antagonism at muscarinic receptors
D) Norepinephrine reuptake at the locus coeruleus
CORRECT ANSWER: B) Serotonin reuptake inhibition at the presynaptic membrane
RATIONALE: SSRIs work by selectively blocking the reuptake of serotonin at the presynaptic
terminal, increasing serotonin availability in the synaptic cleft. This increased serotonin binding
to postsynaptic receptors improves mood regulation and alleviates depressive symptoms. Unlike
tricyclic antidepressants (TCAs), SSRIs have minimal effects on dopamine or norepinephrine
reuptake, giving them a more favorable side effect profile with reduced anticholinergic and
cardiac effects.
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===========
QUESTION 2: A 35-year-old female with major depressive disorder is started on
sertraline. What is the typical time frame for therapeutic response to occur?
A) Within 3-5 days of initiation
B) Between 2-4 weeks of consistent therapy
C) After 8-12 weeks of treatment
D) Immediately upon first dose
CORRECT ANSWER: B) Between 2-4 weeks of consistent therapy
,RATIONALE: Most patients taking SSRIs like sertraline require 2-4 weeks to begin
experiencing therapeutic benefits. However, full therapeutic effects may not be evident until 4-8
weeks of consistent use. This delay is important for patient education and expectations. Some
side effects (nausea, jitteriness) may occur within the first 1-2 weeks but typically diminish with
continued use. Patients should be counseled that improvement takes time and premature
medication changes should be avoided.
=====================================================================
===========
QUESTION 3: Which of the following antidepressants has the greatest risk of
hyponatremia, particularly in elderly patients?
A) Bupropion
B) SSRIs and SNRIs
C) Tricyclic antidepressants
D) Lithium
CORRECT ANSWER: B) SSRIs and SNRIs
RATIONALE: SSRIs and SNRIs have been associated with syndrome of inappropriate
antidiuretic hormone (SIADH), leading to hyponatremia, especially in elderly patients and
during the first 2 weeks of therapy. Symptoms include confusion, lethargy, headache, nausea,
and in severe cases, seizures and coma. Baseline sodium levels should be obtained, and
monitoring is recommended. Bupropion has minimal risk for hyponatremia, and TCAs affect
sodium balance through different mechanisms. Lithium is directly toxic to kidneys and affects
multiple electrolytes.
=====================================================================
===========
QUESTION 4: A patient on fluoxetine reports persistent sexual dysfunction. Which
alternative SSRI or augmentation strategy might be most appropriate?
A) Increase the fluoxetine dose
B) Add buspirone or switch to bupropion
C) Add an anticholinergic medication
D) Discontinue antidepressant therapy
CORRECT ANSWER: B) Add buspiron or switch to bupropion
RATIONALE: Sexual dysfunction is a common adverse effect of SSRIs affecting 25-60% of
patients, mediated by serotonin's inhibitory effects on sexual response. Bupropion is a
norepinephrine-dopamine reuptake inhibitor (NDRI) with minimal sexual side effects and can
,improve sexual function. Buspirone augmentation (5-20 mg daily) can enhance sexual function
by its dopaminergic activity. Increasing the SSRI dose typically worsens sexual dysfunction.
Anticholinergics worsen sexual function. Complete discontinuation abandons needed psychiatric
treatment.
=====================================================================
===========
QUESTION 5: Which tricyclic antidepressant (TCA) is most sedating and often used as a
sleep aid?
A) Nortriptyline
B) Doxepin
C) Desipramine
D) Protriptyline
CORRECT ANSWER: B) Doxepin
RATIONALE: Doxepin is the most sedating TCA due to its potent H1-receptor antagonism and
anticholinergic properties. It is frequently prescribed at low doses (10-100 mg) as a sleep aid.
Nortriptyline is moderately sedating and sometimes used for sleep. Desipramine and
protriptyline are more activating and less suitable for insomnia. TCAs carry risks of cardiac
arrhythmias, orthostatic hypotension, and anticholinergic toxicity (dry mouth, urinary retention,
constipation, confusion). Baseline ECG is recommended due to QT prolongation risk.
=====================================================================
===========
QUESTION 6: A 28-year-old male with depression and comorbid anxiety is prescribed
venlafaxine (an SNRI). Which neurotransmitter system is affected at higher doses?
A) Primarily serotonin at all doses; norepinephrine at higher doses
B) Primarily norepinephrine; serotonin activity is negligible
C) Primarily dopamine reuptake inhibition
D) Acetylcholine antagonism similar to anticholinergic drugs
CORRECT ANSWER: A) Primarily serotonin at all doses; norepinephrine at higher doses
RATIONALE: SNRIs like venlafaxine demonstrate dose-dependent neurotransmitter selectivity.
At lower doses (75-150 mg), venlafaxine primarily inhibits serotonin reuptake. As doses increase
(225-375 mg), norepinephrine reuptake inhibition becomes prominent, providing additional
anxiolytic and pain-relief benefits. This dual action makes SNRIs effective for both mood and
anxiety disorders, as well as chronic pain syndromes. The SNRI mechanism also provides fewer
sexual side effects compared to SSRIs alone.
, =====================================================================
===========
QUESTION 7: Which monoamine oxidase inhibitor (MAOI) is most commonly used and
considered safest in clinical practice?
A) Tranylcypromine
B) Phenelzine
C) Isocarboxazid
D) Moclobemide
CORRECT ANSWER: D) Moclobemide
RATIONALE: Moclobemide is a reversible MAOI (RIMA) that selectively inhibits MAO-A
with reversibility. This allows for safer use with reduced dietary restrictions and fewer drug
interactions compared to irreversible MAOIs like tranylcypromine, phenelzine, and
isocarboxazid. Traditional irreversible MAOIs require strict low-tyramine diets to prevent
hypertensive crisis. Moclobemide has a shorter washout period (24 hours vs. 7-14 days for
irreversible MAOIs), making it easier to switch to other antidepressants. However, availability is
limited in the US.
=====================================================================
===========
QUESTION 8: A patient on phenelzine (an MAOI) is at risk for a hypertensive crisis.
Which food interaction is most likely to trigger this emergency?
A) Fresh vegetables like carrots and celery
B) Aged cheeses, cured meats, and fermented products
C) White chicken breast and fresh fish
D) Bread, pasta, and cereal grains
CORRECT ANSWER: B) Aged cheeses, cured meats, and fermented products
RATIONALE: Irreversible MAOIs like phenelzine inhibit the enzyme that breaks down
tyramine, a sympathomimetic amine found in aged and fermented foods. When dietary tyramine
accumulates, it triggers massive norepinephrine release, causing hypertensive crisis (severe
headache, chest pain, hypertension, potential stroke). High-tyramine foods include aged cheeses,
cured meats, soy products, fermented vegetables, and some alcoholic beverages. Fresh foods are
generally safe. Patients require detailed dietary counseling and written guidelines. Emergency
treatment includes alpha-blockers (phentolamine) for acute hypertensive episodes.
=====================================================================
===========
Detailed Solutions – 2026/2027
NSG 552 PSYCHOPHARMACOLOGY EXAM 1 - PRACTICE QUESTIONS
====================================================================
============
DOCUMENT OVERVIEW:
• Comprehensive practice examination with 210 questions covering antidepressants,
antipsychotics, anxiolytics, mood stabilizers, stimulants, and psychopharmacological principles
• Detailed solutions with evidence-based rationales designed to enhance understanding of drug
mechanisms, clinical applications, side effects, and nursing considerations
====================================================================
============
QUESTION 1: Which neurotransmitter system is primarily targeted by selective serotonin
reuptake inhibitors (SSRIs)?
A) Dopamine reuptake inhibition in the nucleus accumbens
B) Serotonin reuptake inhibition at the presynaptic membrane
C) Acetylcholine antagonism at muscarinic receptors
D) Norepinephrine reuptake at the locus coeruleus
CORRECT ANSWER: B) Serotonin reuptake inhibition at the presynaptic membrane
RATIONALE: SSRIs work by selectively blocking the reuptake of serotonin at the presynaptic
terminal, increasing serotonin availability in the synaptic cleft. This increased serotonin binding
to postsynaptic receptors improves mood regulation and alleviates depressive symptoms. Unlike
tricyclic antidepressants (TCAs), SSRIs have minimal effects on dopamine or norepinephrine
reuptake, giving them a more favorable side effect profile with reduced anticholinergic and
cardiac effects.
=====================================================================
===========
QUESTION 2: A 35-year-old female with major depressive disorder is started on
sertraline. What is the typical time frame for therapeutic response to occur?
A) Within 3-5 days of initiation
B) Between 2-4 weeks of consistent therapy
C) After 8-12 weeks of treatment
D) Immediately upon first dose
CORRECT ANSWER: B) Between 2-4 weeks of consistent therapy
,RATIONALE: Most patients taking SSRIs like sertraline require 2-4 weeks to begin
experiencing therapeutic benefits. However, full therapeutic effects may not be evident until 4-8
weeks of consistent use. This delay is important for patient education and expectations. Some
side effects (nausea, jitteriness) may occur within the first 1-2 weeks but typically diminish with
continued use. Patients should be counseled that improvement takes time and premature
medication changes should be avoided.
=====================================================================
===========
QUESTION 3: Which of the following antidepressants has the greatest risk of
hyponatremia, particularly in elderly patients?
A) Bupropion
B) SSRIs and SNRIs
C) Tricyclic antidepressants
D) Lithium
CORRECT ANSWER: B) SSRIs and SNRIs
RATIONALE: SSRIs and SNRIs have been associated with syndrome of inappropriate
antidiuretic hormone (SIADH), leading to hyponatremia, especially in elderly patients and
during the first 2 weeks of therapy. Symptoms include confusion, lethargy, headache, nausea,
and in severe cases, seizures and coma. Baseline sodium levels should be obtained, and
monitoring is recommended. Bupropion has minimal risk for hyponatremia, and TCAs affect
sodium balance through different mechanisms. Lithium is directly toxic to kidneys and affects
multiple electrolytes.
=====================================================================
===========
QUESTION 4: A patient on fluoxetine reports persistent sexual dysfunction. Which
alternative SSRI or augmentation strategy might be most appropriate?
A) Increase the fluoxetine dose
B) Add buspirone or switch to bupropion
C) Add an anticholinergic medication
D) Discontinue antidepressant therapy
CORRECT ANSWER: B) Add buspiron or switch to bupropion
RATIONALE: Sexual dysfunction is a common adverse effect of SSRIs affecting 25-60% of
patients, mediated by serotonin's inhibitory effects on sexual response. Bupropion is a
norepinephrine-dopamine reuptake inhibitor (NDRI) with minimal sexual side effects and can
,improve sexual function. Buspirone augmentation (5-20 mg daily) can enhance sexual function
by its dopaminergic activity. Increasing the SSRI dose typically worsens sexual dysfunction.
Anticholinergics worsen sexual function. Complete discontinuation abandons needed psychiatric
treatment.
=====================================================================
===========
QUESTION 5: Which tricyclic antidepressant (TCA) is most sedating and often used as a
sleep aid?
A) Nortriptyline
B) Doxepin
C) Desipramine
D) Protriptyline
CORRECT ANSWER: B) Doxepin
RATIONALE: Doxepin is the most sedating TCA due to its potent H1-receptor antagonism and
anticholinergic properties. It is frequently prescribed at low doses (10-100 mg) as a sleep aid.
Nortriptyline is moderately sedating and sometimes used for sleep. Desipramine and
protriptyline are more activating and less suitable for insomnia. TCAs carry risks of cardiac
arrhythmias, orthostatic hypotension, and anticholinergic toxicity (dry mouth, urinary retention,
constipation, confusion). Baseline ECG is recommended due to QT prolongation risk.
=====================================================================
===========
QUESTION 6: A 28-year-old male with depression and comorbid anxiety is prescribed
venlafaxine (an SNRI). Which neurotransmitter system is affected at higher doses?
A) Primarily serotonin at all doses; norepinephrine at higher doses
B) Primarily norepinephrine; serotonin activity is negligible
C) Primarily dopamine reuptake inhibition
D) Acetylcholine antagonism similar to anticholinergic drugs
CORRECT ANSWER: A) Primarily serotonin at all doses; norepinephrine at higher doses
RATIONALE: SNRIs like venlafaxine demonstrate dose-dependent neurotransmitter selectivity.
At lower doses (75-150 mg), venlafaxine primarily inhibits serotonin reuptake. As doses increase
(225-375 mg), norepinephrine reuptake inhibition becomes prominent, providing additional
anxiolytic and pain-relief benefits. This dual action makes SNRIs effective for both mood and
anxiety disorders, as well as chronic pain syndromes. The SNRI mechanism also provides fewer
sexual side effects compared to SSRIs alone.
, =====================================================================
===========
QUESTION 7: Which monoamine oxidase inhibitor (MAOI) is most commonly used and
considered safest in clinical practice?
A) Tranylcypromine
B) Phenelzine
C) Isocarboxazid
D) Moclobemide
CORRECT ANSWER: D) Moclobemide
RATIONALE: Moclobemide is a reversible MAOI (RIMA) that selectively inhibits MAO-A
with reversibility. This allows for safer use with reduced dietary restrictions and fewer drug
interactions compared to irreversible MAOIs like tranylcypromine, phenelzine, and
isocarboxazid. Traditional irreversible MAOIs require strict low-tyramine diets to prevent
hypertensive crisis. Moclobemide has a shorter washout period (24 hours vs. 7-14 days for
irreversible MAOIs), making it easier to switch to other antidepressants. However, availability is
limited in the US.
=====================================================================
===========
QUESTION 8: A patient on phenelzine (an MAOI) is at risk for a hypertensive crisis.
Which food interaction is most likely to trigger this emergency?
A) Fresh vegetables like carrots and celery
B) Aged cheeses, cured meats, and fermented products
C) White chicken breast and fresh fish
D) Bread, pasta, and cereal grains
CORRECT ANSWER: B) Aged cheeses, cured meats, and fermented products
RATIONALE: Irreversible MAOIs like phenelzine inhibit the enzyme that breaks down
tyramine, a sympathomimetic amine found in aged and fermented foods. When dietary tyramine
accumulates, it triggers massive norepinephrine release, causing hypertensive crisis (severe
headache, chest pain, hypertension, potential stroke). High-tyramine foods include aged cheeses,
cured meats, soy products, fermented vegetables, and some alcoholic beverages. Fresh foods are
generally safe. Patients require detailed dietary counseling and written guidelines. Emergency
treatment includes alpha-blockers (phentolamine) for acute hypertensive episodes.
=====================================================================
===========
