NR 546 Exam 2 Actual Exam V1 | NR 546 Advanced
Psychopharmacology for the PMHNP (NR546 Exam 2) [PDF] |
Chamberlain University
1. A 28-year-old female patient diagnosed with Major Depressive Disorder is concerned about
weight gain and sexual dysfunction often associated with antidepressants. Which medication
would be most appropriate to prescribe?
A. Bupropion
B. Mirtazapine
C. Paroxetine
D. Amitriptyline
Answer: A
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that does
not have significant serotonergic activity, which typically spares the patient from sexual
side effects. It is also considered weight-neutral or may even lead to slight weight loss in
some patients. This profile makes it a preferred choice for individuals who are sensitive to
the metabolic and sexual side effects of SSRIs.
2. When initiating Lithium for a patient with Bipolar I Disorder, which of the following sets of
labs is most critical to obtain at baseline?
A. Liver function tests, CBC, and ECG
B. Serum creatinine, TSH, and pregnancy test
C. Amylase, lipase, and glucose
D. Lipid panel, Vitamin B12, and Folate
Answer: B
Rationale: Lithium is primarily excreted by the kidneys, making the assessment of renal
function through serum creatinine and GFR essential. It is also known to cause
hypothyroidism, so baseline TSH is required for future monitoring. Because lithium is
teratogenic and associated with Ebstein’s anomaly, a pregnancy test is vital for women of
childbearing age.
3. A patient is being switched from the MAOI phenelzine to the SSRI sertraline. What is the
minimum recommended washout period to prevent serotonin syndrome?
A. 2 days
B. 14 days
,C. 7 days
D. 5 weeks
Answer: B
Rationale: A washout period of at least 14 days is necessary when switching from an MAOI
to an SSRI to allow for the regeneration of the monoamine oxidase enzyme. Starting a
serotonergic agent too soon can lead to an accumulation of serotonin and potentially fatal
serotonin syndrome. This safety window is standard practice in psychopharmacology to
ensure patient safety during transitions.
4. Which of the following antidepressants is categorized as a Serotonin Antagonist and
Reuptake Inhibitor (SARI) and is frequently used off-label for insomnia?
A. Venlafaxine
B. Trazodone
C. Duloxetine
D. Fluoxetine
Answer: B
Rationale: Trazodone acts as a 5-HT2A and 5-HT2C receptor antagonist and a serotonin
reuptake inhibitor, primarily at higher doses. At lower doses, its H1 histamine and alpha-1
adrenergic antagonism provide significant sedative effects without the side effect profile of
traditional hypnotics. It is commonly used off-label to treat antidepressant-induced
insomnia or primary insomnia.
5. A 45-year-old male with a history of hypertension is diagnosed with Generalized Anxiety
Disorder and MDD. Which medication should be used with caution due to the risk of dose-
dependent blood pressure increases?
A. Sertraline
B. Venlafaxine
C. Escitalopram
D. Buspirone
Answer: B
Rationale: Venlafaxine is an SNRI that can cause increases in diastolic and systolic blood
pressure, particularly at doses above 225 mg. This effect is thought to be mediated by the
increased noradrenergic activity at higher doses. Patients with pre-existing hypertension
should have their blood pressure monitored regularly while taking this medication.
, 6. A patient presents with symptoms of serotonin syndrome, including hyperreflexia,
tremors, and agitation, after an accidental overdose. Which medication can be used as a
specific pharmacological antagonist to treat this condition?
A. Flumazenil
B. Naloxone
C. Cyproheptadine
D. Dantrolene
Answer: C
Rationale: Cyproheptadine is a first-generation antihistamine with potent 5-HT2A
antagonist properties, which makes it effective in reversing the effects of serotonin
syndrome. It is often used in moderate to severe cases when supportive care alone is
insufficient. Other treatments include benzodiazepines for agitation and the removal of the
offending agents.
7. Which mood stabilizer is most strongly associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly if the dose is titrated too quickly?
A. Lithium
B. Valproate
C. Lamotrigine
D. Carbamazepine
Answer: C
Rationale: Lamotrigine carries a black box warning for serious rashes, including Stevens-
Johnson Syndrome, which is why a slow titration schedule is mandatory. The risk is
significantly increased if it is started at high doses or escalated too rapidly. If a patient
develops any rash during the initiation phase, the medication must be discontinued
immediately.
8. A patient with Bipolar Disorder who is taking Valproic acid (Depakote) should be
monitored for which of the following potentially serious adverse effects?
A. Agranulocytosis
B. Nephrogenic diabetes insipidus
C. Hepatotoxicity and pancreatitis
D. QTc prolongation
Answer: C
Psychopharmacology for the PMHNP (NR546 Exam 2) [PDF] |
Chamberlain University
1. A 28-year-old female patient diagnosed with Major Depressive Disorder is concerned about
weight gain and sexual dysfunction often associated with antidepressants. Which medication
would be most appropriate to prescribe?
A. Bupropion
B. Mirtazapine
C. Paroxetine
D. Amitriptyline
Answer: A
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that does
not have significant serotonergic activity, which typically spares the patient from sexual
side effects. It is also considered weight-neutral or may even lead to slight weight loss in
some patients. This profile makes it a preferred choice for individuals who are sensitive to
the metabolic and sexual side effects of SSRIs.
2. When initiating Lithium for a patient with Bipolar I Disorder, which of the following sets of
labs is most critical to obtain at baseline?
A. Liver function tests, CBC, and ECG
B. Serum creatinine, TSH, and pregnancy test
C. Amylase, lipase, and glucose
D. Lipid panel, Vitamin B12, and Folate
Answer: B
Rationale: Lithium is primarily excreted by the kidneys, making the assessment of renal
function through serum creatinine and GFR essential. It is also known to cause
hypothyroidism, so baseline TSH is required for future monitoring. Because lithium is
teratogenic and associated with Ebstein’s anomaly, a pregnancy test is vital for women of
childbearing age.
3. A patient is being switched from the MAOI phenelzine to the SSRI sertraline. What is the
minimum recommended washout period to prevent serotonin syndrome?
A. 2 days
B. 14 days
,C. 7 days
D. 5 weeks
Answer: B
Rationale: A washout period of at least 14 days is necessary when switching from an MAOI
to an SSRI to allow for the regeneration of the monoamine oxidase enzyme. Starting a
serotonergic agent too soon can lead to an accumulation of serotonin and potentially fatal
serotonin syndrome. This safety window is standard practice in psychopharmacology to
ensure patient safety during transitions.
4. Which of the following antidepressants is categorized as a Serotonin Antagonist and
Reuptake Inhibitor (SARI) and is frequently used off-label for insomnia?
A. Venlafaxine
B. Trazodone
C. Duloxetine
D. Fluoxetine
Answer: B
Rationale: Trazodone acts as a 5-HT2A and 5-HT2C receptor antagonist and a serotonin
reuptake inhibitor, primarily at higher doses. At lower doses, its H1 histamine and alpha-1
adrenergic antagonism provide significant sedative effects without the side effect profile of
traditional hypnotics. It is commonly used off-label to treat antidepressant-induced
insomnia or primary insomnia.
5. A 45-year-old male with a history of hypertension is diagnosed with Generalized Anxiety
Disorder and MDD. Which medication should be used with caution due to the risk of dose-
dependent blood pressure increases?
A. Sertraline
B. Venlafaxine
C. Escitalopram
D. Buspirone
Answer: B
Rationale: Venlafaxine is an SNRI that can cause increases in diastolic and systolic blood
pressure, particularly at doses above 225 mg. This effect is thought to be mediated by the
increased noradrenergic activity at higher doses. Patients with pre-existing hypertension
should have their blood pressure monitored regularly while taking this medication.
, 6. A patient presents with symptoms of serotonin syndrome, including hyperreflexia,
tremors, and agitation, after an accidental overdose. Which medication can be used as a
specific pharmacological antagonist to treat this condition?
A. Flumazenil
B. Naloxone
C. Cyproheptadine
D. Dantrolene
Answer: C
Rationale: Cyproheptadine is a first-generation antihistamine with potent 5-HT2A
antagonist properties, which makes it effective in reversing the effects of serotonin
syndrome. It is often used in moderate to severe cases when supportive care alone is
insufficient. Other treatments include benzodiazepines for agitation and the removal of the
offending agents.
7. Which mood stabilizer is most strongly associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly if the dose is titrated too quickly?
A. Lithium
B. Valproate
C. Lamotrigine
D. Carbamazepine
Answer: C
Rationale: Lamotrigine carries a black box warning for serious rashes, including Stevens-
Johnson Syndrome, which is why a slow titration schedule is mandatory. The risk is
significantly increased if it is started at high doses or escalated too rapidly. If a patient
develops any rash during the initiation phase, the medication must be discontinued
immediately.
8. A patient with Bipolar Disorder who is taking Valproic acid (Depakote) should be
monitored for which of the following potentially serious adverse effects?
A. Agranulocytosis
B. Nephrogenic diabetes insipidus
C. Hepatotoxicity and pancreatitis
D. QTc prolongation
Answer: C
