NR 547 Psychopharmacology – PMHNP Midterm & Final Exam
Study Guide – Nurse Practitioner Program 2025–2026 – Verified
Questions and Answers (Graded A+)
This up-to-date NR 547 test bank provides the most recent and accurate preparation
material for both the Midterm and Final Exams in the 2025–2026 PMHNP
psychopharmacology curriculum. It includes real, graded A+ questions and verified
answers covering all key areas: neurotransmitter systems, pharmacokinetics, drug-receptor
interactions, psychiatric medication management, and clinical case applications. Ideal for
students aiming for top scores in their NP program.
1. Ameeta, a 42-year-old female, presents to the primary care clinic with a
three-month history of "feeling low and sad" with poor energy, inability to
concentrate, and irritability. She indicates that the symptoms were initially
present once per week but have increased to 4-5 times per week. She reports
making an error last week at the grocery store where she works as a cashier
and snapping at the customer when the error was brought to her attention.
She is concerned about her loss of interest in her usual social activities and
a 20-pound weight gain. She also reports frequent headaches, difficulty
getting out of bed in the morning, feeling worthless, and low libido. She
acknowledges that she feels guilty daily as she has not visited her son in 6
months and believes that she has "let him down". Thinking about it keeps her
"up at night". She has difficulty falling and staying asleep every night. She
denies suicidal idea: citalopram 20 mg po daily
,Rationale: Although all three drugs are appropriate to use when treating unipolar
depression, Citalopram is an SSRI and is considered a first-line choice.
2. Seth is a 22-year-old with a court-ordered referral for assessment. He
was arrested on charges of stealing from an aunt while he was house-sitting.
This is the third time he has been caught stealing from the family in the past
two years, but the first time that the victim pressed charges. Seth states that
he isn't too worried about his stealing behaviors, because his family "has a
lot of money, and they are not going to miss a little here and there." Seth has
held several entry-level jobs over the past three years, but he has left each
position after only a few months because he felt he was "above that kind of
work". He endorses having multiple unprotected sexual experiences, but he
denies ever being in a relationship.
Seth meets several criteria for antisocial personality disorder. Which of the
following statements will help support this diagnosis? Select all that apply.
Seth states that he has been stealing from: -Dependent personal disorder
Rationale: Nora meets diagnostic criteria for dependent personality disorder. She
has difficulty making decisions without input from others, has difficulty expressing
disagreement, and has feelings of discomfort about being alone and caring for
herself.
3. SDRIs: -inhibit DA reuptake (‘alertness, motivation) -inhibit NE reuptake
(‘energy) -Adverse effects:
• agitation
• headache
• dry mouth
• constipation • weight loss
4. TCAs: -Action: inhibits the reuptake of serotonin and norepinephrine;
blocks norepinephrine, histamine, and acetylcholine receptors -Examples:
amitriptyline, clomipramine, desipramine, doxepin -Common Side Effects:
• dry mouth
,• constipation
• blurred vision
• urinary retention
• sedation
• weight gain
• hypotension
• tachycardia
• sexual dysfunction
5. MAOIs: -Action: increases norepinephrine and serotonin by inhibiting the
enzyme that inactivates it
-Examples: isocarboxazid, phenelzine, tranylcypromine -
Common Side Effects:
• sedation
• dizziness
• sexual dysfunction
• hypertensive crisis
6. Prescribing pearls: citalopram (Celexa): mild antihistamine effects
7. Prescribing pearls: escitalopram (Lexapro): no known drug interactions
8. Prescribing pearls: fluoxetine (Prozac): longest half-life
9. Prescribing pearls: paroxetine (Paxil): also treats social anxiety and insomnia
10. Prescribing pearls: fluvoxamine (Luvox): treats anxious depression
smokers require increased dose
11. Prescribing pearls: sertraline (Zoloft): also treats social anxiety and
hypersomnolence
12. Prescribing pearls: bupropion (Wellbutrin): NDRI may improve energy,
alertness, and motivation; not first line treatment for anxiety; contraindicated in
clients with a history of seizures
13. Prescribing pearls: duloxetine (Cymbalta): effective for atypical pain at
higher doses; appropriate for clients who present with somatic symptoms of
depression; effective for atypical pain, such as fibromyalgia and diabetic neuropathy
14. Prescribing pearls: venlafaxine (Effexor): treats both depression and
anxiety disorders, ensure trial of higher dose before switching to a different
medication
, 15. Prescribing pearls: desvenlafaxine (Pristiq): effective for perimenopausal
vasomotor symptoms
16. considered when selecting a medication:: -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
17. if a medication is not achieving efficacy:: -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
18. Use to protect against suicide: lithium
19. MDD and BPD genetics: genetic factors contribute 31-42% of the disease risk
in MDD and 59-85% in BPD
20. monoamine hypothesis of depression: -posits that depression occurs as a
result of a deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine -
while mania may result from an excess
*Emphasis is now shifted from the monoamines to their receptors and other
downstream events such as the regulation of gene expression, growth factors,
environmental factors, and epigenetic changes
21. : Three principal neurotransmitters
-norepinephrine (NE), dopamine (DA), and serotonin 5HT
• comprise the monoamine neurotransmitter system
• implications for the pathophysiology and treatment of mood disorders
• All known pharmacologic treatments for mood disorders act upon one or more of
these three neurotransmitters
-Many of the symptoms of mood disorders are hypothesized to involve dysfunction
of various combinations of the monoamine neurotransmitters
22. Mood disorders include ____________________ and
Study Guide – Nurse Practitioner Program 2025–2026 – Verified
Questions and Answers (Graded A+)
This up-to-date NR 547 test bank provides the most recent and accurate preparation
material for both the Midterm and Final Exams in the 2025–2026 PMHNP
psychopharmacology curriculum. It includes real, graded A+ questions and verified
answers covering all key areas: neurotransmitter systems, pharmacokinetics, drug-receptor
interactions, psychiatric medication management, and clinical case applications. Ideal for
students aiming for top scores in their NP program.
1. Ameeta, a 42-year-old female, presents to the primary care clinic with a
three-month history of "feeling low and sad" with poor energy, inability to
concentrate, and irritability. She indicates that the symptoms were initially
present once per week but have increased to 4-5 times per week. She reports
making an error last week at the grocery store where she works as a cashier
and snapping at the customer when the error was brought to her attention.
She is concerned about her loss of interest in her usual social activities and
a 20-pound weight gain. She also reports frequent headaches, difficulty
getting out of bed in the morning, feeling worthless, and low libido. She
acknowledges that she feels guilty daily as she has not visited her son in 6
months and believes that she has "let him down". Thinking about it keeps her
"up at night". She has difficulty falling and staying asleep every night. She
denies suicidal idea: citalopram 20 mg po daily
,Rationale: Although all three drugs are appropriate to use when treating unipolar
depression, Citalopram is an SSRI and is considered a first-line choice.
2. Seth is a 22-year-old with a court-ordered referral for assessment. He
was arrested on charges of stealing from an aunt while he was house-sitting.
This is the third time he has been caught stealing from the family in the past
two years, but the first time that the victim pressed charges. Seth states that
he isn't too worried about his stealing behaviors, because his family "has a
lot of money, and they are not going to miss a little here and there." Seth has
held several entry-level jobs over the past three years, but he has left each
position after only a few months because he felt he was "above that kind of
work". He endorses having multiple unprotected sexual experiences, but he
denies ever being in a relationship.
Seth meets several criteria for antisocial personality disorder. Which of the
following statements will help support this diagnosis? Select all that apply.
Seth states that he has been stealing from: -Dependent personal disorder
Rationale: Nora meets diagnostic criteria for dependent personality disorder. She
has difficulty making decisions without input from others, has difficulty expressing
disagreement, and has feelings of discomfort about being alone and caring for
herself.
3. SDRIs: -inhibit DA reuptake (‘alertness, motivation) -inhibit NE reuptake
(‘energy) -Adverse effects:
• agitation
• headache
• dry mouth
• constipation • weight loss
4. TCAs: -Action: inhibits the reuptake of serotonin and norepinephrine;
blocks norepinephrine, histamine, and acetylcholine receptors -Examples:
amitriptyline, clomipramine, desipramine, doxepin -Common Side Effects:
• dry mouth
,• constipation
• blurred vision
• urinary retention
• sedation
• weight gain
• hypotension
• tachycardia
• sexual dysfunction
5. MAOIs: -Action: increases norepinephrine and serotonin by inhibiting the
enzyme that inactivates it
-Examples: isocarboxazid, phenelzine, tranylcypromine -
Common Side Effects:
• sedation
• dizziness
• sexual dysfunction
• hypertensive crisis
6. Prescribing pearls: citalopram (Celexa): mild antihistamine effects
7. Prescribing pearls: escitalopram (Lexapro): no known drug interactions
8. Prescribing pearls: fluoxetine (Prozac): longest half-life
9. Prescribing pearls: paroxetine (Paxil): also treats social anxiety and insomnia
10. Prescribing pearls: fluvoxamine (Luvox): treats anxious depression
smokers require increased dose
11. Prescribing pearls: sertraline (Zoloft): also treats social anxiety and
hypersomnolence
12. Prescribing pearls: bupropion (Wellbutrin): NDRI may improve energy,
alertness, and motivation; not first line treatment for anxiety; contraindicated in
clients with a history of seizures
13. Prescribing pearls: duloxetine (Cymbalta): effective for atypical pain at
higher doses; appropriate for clients who present with somatic symptoms of
depression; effective for atypical pain, such as fibromyalgia and diabetic neuropathy
14. Prescribing pearls: venlafaxine (Effexor): treats both depression and
anxiety disorders, ensure trial of higher dose before switching to a different
medication
, 15. Prescribing pearls: desvenlafaxine (Pristiq): effective for perimenopausal
vasomotor symptoms
16. considered when selecting a medication:: -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
17. if a medication is not achieving efficacy:: -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
18. Use to protect against suicide: lithium
19. MDD and BPD genetics: genetic factors contribute 31-42% of the disease risk
in MDD and 59-85% in BPD
20. monoamine hypothesis of depression: -posits that depression occurs as a
result of a deficiency of one or all three monoamine transmitters
• serotonin, norepinephrine, and dopamine -
while mania may result from an excess
*Emphasis is now shifted from the monoamines to their receptors and other
downstream events such as the regulation of gene expression, growth factors,
environmental factors, and epigenetic changes
21. : Three principal neurotransmitters
-norepinephrine (NE), dopamine (DA), and serotonin 5HT
• comprise the monoamine neurotransmitter system
• implications for the pathophysiology and treatment of mood disorders
• All known pharmacologic treatments for mood disorders act upon one or more of
these three neurotransmitters
-Many of the symptoms of mood disorders are hypothesized to involve dysfunction
of various combinations of the monoamine neurotransmitters
22. Mood disorders include ____________________ and
