NSG 552 Psychopharmacology Exam 2 (Wilkes University)
Comprehensive Practice Questions/Study Guide Newest
Actual Questions & Answers (GRADED A+)
A 28-year-old with major depressive disorder has failed two adequate SSRI trials. Which is the best next pharmacologic
option?
A. Add bupropion
B. Start phenelzine
C. Switch to venlafaxine (SNRI)
D. Start low-dose haloperidol
Answer: C.
Rationale: For SSRI-resistant depression, switching to an SNRI (e.g., venlafaxine) is a common next step; MAOI (phenelzine) is
reserved after multiple failures or specific indications.
2
Which antidepressant is most associated with seizures at high doses or in predisposed patients?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Mirtazapine
Answer: B.
Rationale: Bupropion lowers seizure threshold, especially at high doses or with eating disorders, electrolyte disturbances, or
concomitant drugs.
3
A patient on lithium presents with coarse tremor, polyuria, polydipsia, and ataxia. Lithium level is 2.2 mEq/L. Best immediate
action?
,1
A 28-year-old with major depressive disorder has failed two adequate SSRI trials. Which is the best next
pharmacologic option?
A. Add bupropion
B. Start phenelzine
C. Switch to venlafaxine (SNRI)
D. Start low-dose haloperidol
Answer: C.
Rationale: For SSRI-resistant depression, switching to an SNRI (e.g., venlafaxine) is a common next step;
MAOI (phenelzine) is reserved after multiple failures or specific indications.
2
Which antidepressant is most associated with seizures at high doses or in predisposed patients?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Mirtazapine
Answer: B.
Rationale: Bupropion lowers seizure threshold, especially at high doses or with eating disorders,
electrolyte disturbances, or concomitant drugs.
3
A patient on lithium presents with coarse tremor, polyuria, polydipsia, and ataxia. Lithium level is 2.2
mEq/L. Best immediate action?
A. Continue and observe
B. Stop lithium and arrange urgent evaluation — consider dialysis
,C. Give IV fluids and increase dose
D. Add propranolol for tremor
Answer: B.
Rationale: Level >2.0 with neurologic signs suggests severe toxicity — stop lithium and consider
emergent treatment/dialysis.
4
Which atypical antipsychotic has the highest risk of metabolic syndrome (weight gain, dyslipidemia)?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Haloperidol
Answer: C.
Rationale: Olanzapine is strongly associated with significant weight gain and metabolic abnormalities.
5
A 65-year-old with Parkinson disease has psychosis (visual hallucinations). Which antipsychotic is
preferred because it has the least risk of worsening motor symptoms?
A. Risperidone
B. Clozapine
C. Quetiapine
D. Olanzapine
Answer: C.
Rationale: Quetiapine and clozapine are preferred for psychosis in Parkinson’s; quetiapine is commonly
used due to easier monitoring than clozapine.
6
Which medication requires regular ANC (absolute neutrophil count) monitoring because of risk of
agranulocytosis?
, A. Haloperidol
B. Clozapine
C. Risperidone
D. Lurasidone
Answer: B.
Rationale: Clozapine carries significant agranulocytosis risk — mandatory ANC monitoring.
7
Which benzodiazepine is preferred in older adults due to shorter half-life and no active metabolites?
A. Diazepam
B. Lorazepam
C. Chlordiazepoxide
D. Clonazepam
Answer: B.
Rationale: Lorazepam has no active metabolites and intermediate half-life; preferred in elderly to reduce
accumulation.
8
An SSRI started for panic disorder commonly causes which early adverse effect that usually improves?
A. Sexual dysfunction
B. Worsening anxiety/agitation
C. Weight loss
D. Bradycardia
Answer: B.
Rationale: Increased anxiety/agitation often occurs early in SSRI treatment for anxiety/panic and typically
subsides.
9
Which mood stabilizer is teratogenic (risk of neural tube defects) and should be avoided in pregnancy?
Comprehensive Practice Questions/Study Guide Newest
Actual Questions & Answers (GRADED A+)
A 28-year-old with major depressive disorder has failed two adequate SSRI trials. Which is the best next pharmacologic
option?
A. Add bupropion
B. Start phenelzine
C. Switch to venlafaxine (SNRI)
D. Start low-dose haloperidol
Answer: C.
Rationale: For SSRI-resistant depression, switching to an SNRI (e.g., venlafaxine) is a common next step; MAOI (phenelzine) is
reserved after multiple failures or specific indications.
2
Which antidepressant is most associated with seizures at high doses or in predisposed patients?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Mirtazapine
Answer: B.
Rationale: Bupropion lowers seizure threshold, especially at high doses or with eating disorders, electrolyte disturbances, or
concomitant drugs.
3
A patient on lithium presents with coarse tremor, polyuria, polydipsia, and ataxia. Lithium level is 2.2 mEq/L. Best immediate
action?
,1
A 28-year-old with major depressive disorder has failed two adequate SSRI trials. Which is the best next
pharmacologic option?
A. Add bupropion
B. Start phenelzine
C. Switch to venlafaxine (SNRI)
D. Start low-dose haloperidol
Answer: C.
Rationale: For SSRI-resistant depression, switching to an SNRI (e.g., venlafaxine) is a common next step;
MAOI (phenelzine) is reserved after multiple failures or specific indications.
2
Which antidepressant is most associated with seizures at high doses or in predisposed patients?
A. Sertraline
B. Bupropion
C. Fluoxetine
D. Mirtazapine
Answer: B.
Rationale: Bupropion lowers seizure threshold, especially at high doses or with eating disorders,
electrolyte disturbances, or concomitant drugs.
3
A patient on lithium presents with coarse tremor, polyuria, polydipsia, and ataxia. Lithium level is 2.2
mEq/L. Best immediate action?
A. Continue and observe
B. Stop lithium and arrange urgent evaluation — consider dialysis
,C. Give IV fluids and increase dose
D. Add propranolol for tremor
Answer: B.
Rationale: Level >2.0 with neurologic signs suggests severe toxicity — stop lithium and consider
emergent treatment/dialysis.
4
Which atypical antipsychotic has the highest risk of metabolic syndrome (weight gain, dyslipidemia)?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Haloperidol
Answer: C.
Rationale: Olanzapine is strongly associated with significant weight gain and metabolic abnormalities.
5
A 65-year-old with Parkinson disease has psychosis (visual hallucinations). Which antipsychotic is
preferred because it has the least risk of worsening motor symptoms?
A. Risperidone
B. Clozapine
C. Quetiapine
D. Olanzapine
Answer: C.
Rationale: Quetiapine and clozapine are preferred for psychosis in Parkinson’s; quetiapine is commonly
used due to easier monitoring than clozapine.
6
Which medication requires regular ANC (absolute neutrophil count) monitoring because of risk of
agranulocytosis?
, A. Haloperidol
B. Clozapine
C. Risperidone
D. Lurasidone
Answer: B.
Rationale: Clozapine carries significant agranulocytosis risk — mandatory ANC monitoring.
7
Which benzodiazepine is preferred in older adults due to shorter half-life and no active metabolites?
A. Diazepam
B. Lorazepam
C. Chlordiazepoxide
D. Clonazepam
Answer: B.
Rationale: Lorazepam has no active metabolites and intermediate half-life; preferred in elderly to reduce
accumulation.
8
An SSRI started for panic disorder commonly causes which early adverse effect that usually improves?
A. Sexual dysfunction
B. Worsening anxiety/agitation
C. Weight loss
D. Bradycardia
Answer: B.
Rationale: Increased anxiety/agitation often occurs early in SSRI treatment for anxiety/panic and typically
subsides.
9
Which mood stabilizer is teratogenic (risk of neural tube defects) and should be avoided in pregnancy?
