Stahl's Essential Psychopharmacology
Neuroscientific Basis and Practical Applications
5th Edition
Author(s)Stephen M. Stahl
TEST BANK
Question 1
Reference: Ch. 1, Chemical Neurotransmission
Question Stem:
A patient with major depressive disorder is prescribed a
selective serotonin reuptake inhibitor (SSRI). The nurse
educator explains that the therapeutic effect is not immediate
because it requires time for which of the following
neuroadaptive processes to occur?
Options:
A) Downregulation of postsynaptic serotonin receptors
B) Desensitization and downregulation of serotonin
autoreceptors
C) Upregulation of presynaptic serotonin transporters
D) Increased enzymatic breakdown of serotonin in the synaptic
cleft
,Correct Answer: B
Rationales:
• Correct: The initial increase in serotonin with an SSRI
stimulates presynaptic 5-HT1A autoreceptors, which
paradoxically reduces serotonin release. Over time, these
autoreceptors desensitize and downregulate, allowing for
a sustained increase in serotonin neurotransmission, which
correlates with the therapeutic effect.
• Incorrect A: Downregulation of postsynaptic receptors is
often associated with the development of tolerance to a
drug or its side effects, not the initiation of a therapeutic
antidepressant effect.
• Incorrect C: Upregulation of transporters would increase
reuptake, decreasing synaptic serotonin levels, which is the
opposite of the SSRI's intended effect.
• Incorrect D: SSRIs do not primarily work by inhibiting
enzymatic breakdown; that is the mechanism of
monoamine oxidase inhibitors (MAOIs).
Teaching Point: SSRIs' delayed effect stems from autoreceptor
downregulation, not the immediate increase in serotonin.
Citation: Ch. 1, Chemical Neurotransmission
Question 2
Reference: Ch. 1, Chemical Neurotransmission
,Question Stem:
A patient taking a first-generation antipsychotic for
schizophrenia develops muscle rigidity, hyperthermia, and
altered mental status. The nurse recognizes this as neuroleptic
malignant syndrome (NMS), which is primarily caused by which
mechanism?
Options:
A) Acute dopamine toxicity in the nigrostriatal pathway
B) A rapid upregulation of D2 receptors in the hypothalamus
C) A sudden surge in glutamate release in the cortex
D) A profound blockade of dopamine D2 receptors
Correct Answer: D
Rationales:
• Correct: NMS is a life-threatening condition caused by a
profound and often rapid blockade of postsynaptic
dopamine D2 receptors, particularly in the hypothalamus
(leading to hyperthermia) and nigrostriatal pathway
(leading to rigidity).
• Incorrect A: NMS is caused by dopamine deficiency, not
toxicity, in these pathways.
• Incorrect B: Receptor upregulation is a slower,
compensatory process, not the acute cause of NMS.
• Incorrect C: While glutamate may be involved, the primary
and well-established mechanism of NMS is central D2
receptor antagonism.
, Teaching Point: NMS results from acute, profound D2 receptor
blockade, causing dopamine deficiency.
Citation: Ch. 1, Chemical Neurotransmission
Question 3
Reference: Ch. 1, Chemical Neurotransmission
Question Stem:
When discussing the mechanism of benzodiazepines with a
patient, the psychiatric-mental health nurse practitioner
(PMHNP) correctly explains that these drugs exert their
anxiolytic effect by which action?
Options:
A) Directly stimulating GABA-A receptors to open chloride
channels
B) Antagonizing glutamate receptors to reduce neuronal
excitability
C) Potentiating the effect of GABA by increasing the frequency
of chloride channel opening
D) Inhibiting the reuptake of GABA into the presynaptic neuron
Correct Answer: C
Rationales:
• Correct: Benzodiazepines are positive allosteric
modulators. They bind to a site on the GABA-A receptor
distinct from GABA itself, which increases
Neuroscientific Basis and Practical Applications
5th Edition
Author(s)Stephen M. Stahl
TEST BANK
Question 1
Reference: Ch. 1, Chemical Neurotransmission
Question Stem:
A patient with major depressive disorder is prescribed a
selective serotonin reuptake inhibitor (SSRI). The nurse
educator explains that the therapeutic effect is not immediate
because it requires time for which of the following
neuroadaptive processes to occur?
Options:
A) Downregulation of postsynaptic serotonin receptors
B) Desensitization and downregulation of serotonin
autoreceptors
C) Upregulation of presynaptic serotonin transporters
D) Increased enzymatic breakdown of serotonin in the synaptic
cleft
,Correct Answer: B
Rationales:
• Correct: The initial increase in serotonin with an SSRI
stimulates presynaptic 5-HT1A autoreceptors, which
paradoxically reduces serotonin release. Over time, these
autoreceptors desensitize and downregulate, allowing for
a sustained increase in serotonin neurotransmission, which
correlates with the therapeutic effect.
• Incorrect A: Downregulation of postsynaptic receptors is
often associated with the development of tolerance to a
drug or its side effects, not the initiation of a therapeutic
antidepressant effect.
• Incorrect C: Upregulation of transporters would increase
reuptake, decreasing synaptic serotonin levels, which is the
opposite of the SSRI's intended effect.
• Incorrect D: SSRIs do not primarily work by inhibiting
enzymatic breakdown; that is the mechanism of
monoamine oxidase inhibitors (MAOIs).
Teaching Point: SSRIs' delayed effect stems from autoreceptor
downregulation, not the immediate increase in serotonin.
Citation: Ch. 1, Chemical Neurotransmission
Question 2
Reference: Ch. 1, Chemical Neurotransmission
,Question Stem:
A patient taking a first-generation antipsychotic for
schizophrenia develops muscle rigidity, hyperthermia, and
altered mental status. The nurse recognizes this as neuroleptic
malignant syndrome (NMS), which is primarily caused by which
mechanism?
Options:
A) Acute dopamine toxicity in the nigrostriatal pathway
B) A rapid upregulation of D2 receptors in the hypothalamus
C) A sudden surge in glutamate release in the cortex
D) A profound blockade of dopamine D2 receptors
Correct Answer: D
Rationales:
• Correct: NMS is a life-threatening condition caused by a
profound and often rapid blockade of postsynaptic
dopamine D2 receptors, particularly in the hypothalamus
(leading to hyperthermia) and nigrostriatal pathway
(leading to rigidity).
• Incorrect A: NMS is caused by dopamine deficiency, not
toxicity, in these pathways.
• Incorrect B: Receptor upregulation is a slower,
compensatory process, not the acute cause of NMS.
• Incorrect C: While glutamate may be involved, the primary
and well-established mechanism of NMS is central D2
receptor antagonism.
, Teaching Point: NMS results from acute, profound D2 receptor
blockade, causing dopamine deficiency.
Citation: Ch. 1, Chemical Neurotransmission
Question 3
Reference: Ch. 1, Chemical Neurotransmission
Question Stem:
When discussing the mechanism of benzodiazepines with a
patient, the psychiatric-mental health nurse practitioner
(PMHNP) correctly explains that these drugs exert their
anxiolytic effect by which action?
Options:
A) Directly stimulating GABA-A receptors to open chloride
channels
B) Antagonizing glutamate receptors to reduce neuronal
excitability
C) Potentiating the effect of GABA by increasing the frequency
of chloride channel opening
D) Inhibiting the reuptake of GABA into the presynaptic neuron
Correct Answer: C
Rationales:
• Correct: Benzodiazepines are positive allosteric
modulators. They bind to a site on the GABA-A receptor
distinct from GABA itself, which increases
