NSG 552 Psychopharmacology Exam 3 Actual
2026/2027 – Complete Exam-Style Questions |
100% Verified – Pass Guaranteed – A+ Graded
NSG 552 Psychopharmacology Exam 3
Comprehensive Practice Examination 2026/2027
Section I: Substance Use Disorders – Opioids
1. A 54-year-old man with severe alcohol use disorder presents with confusion,
ataxia, and nystagmus. The NP suspects Wernicke's encephalopathy. What is the
priority pharmacologic intervention?
• A) Start high-dose IV lorazepam
• B) Administer parenteral thiamine before glucose
• C) Start oral naltrexone 50 mg daily
• D) Begin acamprosate for relapse prevention
Answer: B
Rationale: Wernicke's encephalopathy is a life-threatening thiamine (B1)
deficiency characterized by confusion, ataxia, and eye findings
(nystagmus/ophthalmoplegia). Parenteral thiamine must be given before glucose
to prevent precipitation or worsening of Wernicke's encephalopathy . Lorazepam
treats alcohol withdrawal but does not correct the underlying deficiency.
Naltrexone and acamprosate are for relapse prevention, not acute management.
,2. A hospitalized patient with a long history of heavy alcohol use develops visual
hallucinations of "bugs crawling" and severe autonomic instability 72 hours
after his last drink. His CIWA score is 18. Which medication class should be the
first-line treatment?
• A) Atypical antipsychotics
• B) Benzodiazepines
• C) Beta-blockers
• D) Anticonvulsants alone
Answer: B
Rationale: Benzodiazepines are the first-line treatment for alcohol withdrawal,
including delirium tremens. Symptom-triggered dosing with long-acting agents
(diazepam, chlordiazepoxide) or short-acting agents (lorazepam, oxazepam in liver
disease) is recommended . Antipsychotics may be used as adjuncts for severe
agitation but are not first-line. Beta-blockers may help autonomic symptoms but
do not treat the underlying withdrawal.
*3. A patient on long-term antipsychotic therapy develops involuntary lip smacking
and tongue protrusion. This is most likely: *
• A) Acute dystonia
• B) Akathisia
• C) Parkinsonism
• D) Tardive dyskinesia
Answer: D
Rationale: Tardive dyskinesia (TD) is a late-onset, often irreversible movement
disorder characterized by involuntary orofacial movements including lip smacking,
,tongue protrusion, and chewing movements associated with prolonged
antipsychotic use . Acute dystonia presents with sustained muscle contractions
(stiff neck, locked jaw, oculogyric crisis) occurring within days of starting an
antipsychotic .
*4. A patient taking haloperidol presents with a stiff neck, locked jaw, and
oculogyric crisis. This is best described as: *
• A) Tardive dyskinesia
• B) Neuroleptic malignant syndrome
• C) Acute dystonia
• D) Akathisia
Answer: C
Rationale: Acute dystonia is an extrapyramidal symptom that presents as
sustained muscle contractions (stiff neck, locked jaw, tongue protrusion,
oculogyric crisis). It typically occurs within days of starting an antipsychotic and is
treated with anticholinergic medications such as benztropine or
diphenhydramine .
5. The mnemonic FALTERED is used to assess which life-threatening condition?
• A) Serotonin syndrome
• B) Neuroleptic malignant syndrome
• C) Tardive dyskinesia
• D) Anticholinergic toxicity
Answer: B
Rationale: FALTERED stands for Fever, Autonomic instability, Leukocytosis, Tremor,
Elevated CK, Rigidity, Excessive sweating, and Delirium—key features of
, Neuroleptic Malignant Syndrome (NMS) . NMS is a medical emergency requiring
immediate antipsychotic discontinuation and supportive care.
6. A patient on clozapine must have regular monitoring of which laboratory
value due to risk of a life-threatening adverse effect?
• A) Liver function tests
• B) Absolute neutrophil count
• C) Serum creatinine
• D) Thyroid function tests
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis (ANC
<500/mm³). Mandatory monitoring through the REMS program is required with
regular absolute neutrophil count checks .
7. Which dopamine pathway, when blocked, causes extrapyramidal symptoms?
• A) Mesolimbic pathway
• B) Mesocortical pathway
• C) Nigrostriatal pathway
• D) Tuberoinfundibular pathway
Answer: C
Rationale: The nigrostriatal pathway (substantia nigra to striatum) controls
voluntary movement. D2 receptor blockade in this pathway causes extrapyramidal
symptoms (EPS) . The mesolimbic pathway is associated with positive symptoms
of psychosis; the tuberoinfundibular pathway blockade causes
hyperprolactinemia.
2026/2027 – Complete Exam-Style Questions |
100% Verified – Pass Guaranteed – A+ Graded
NSG 552 Psychopharmacology Exam 3
Comprehensive Practice Examination 2026/2027
Section I: Substance Use Disorders – Opioids
1. A 54-year-old man with severe alcohol use disorder presents with confusion,
ataxia, and nystagmus. The NP suspects Wernicke's encephalopathy. What is the
priority pharmacologic intervention?
• A) Start high-dose IV lorazepam
• B) Administer parenteral thiamine before glucose
• C) Start oral naltrexone 50 mg daily
• D) Begin acamprosate for relapse prevention
Answer: B
Rationale: Wernicke's encephalopathy is a life-threatening thiamine (B1)
deficiency characterized by confusion, ataxia, and eye findings
(nystagmus/ophthalmoplegia). Parenteral thiamine must be given before glucose
to prevent precipitation or worsening of Wernicke's encephalopathy . Lorazepam
treats alcohol withdrawal but does not correct the underlying deficiency.
Naltrexone and acamprosate are for relapse prevention, not acute management.
,2. A hospitalized patient with a long history of heavy alcohol use develops visual
hallucinations of "bugs crawling" and severe autonomic instability 72 hours
after his last drink. His CIWA score is 18. Which medication class should be the
first-line treatment?
• A) Atypical antipsychotics
• B) Benzodiazepines
• C) Beta-blockers
• D) Anticonvulsants alone
Answer: B
Rationale: Benzodiazepines are the first-line treatment for alcohol withdrawal,
including delirium tremens. Symptom-triggered dosing with long-acting agents
(diazepam, chlordiazepoxide) or short-acting agents (lorazepam, oxazepam in liver
disease) is recommended . Antipsychotics may be used as adjuncts for severe
agitation but are not first-line. Beta-blockers may help autonomic symptoms but
do not treat the underlying withdrawal.
*3. A patient on long-term antipsychotic therapy develops involuntary lip smacking
and tongue protrusion. This is most likely: *
• A) Acute dystonia
• B) Akathisia
• C) Parkinsonism
• D) Tardive dyskinesia
Answer: D
Rationale: Tardive dyskinesia (TD) is a late-onset, often irreversible movement
disorder characterized by involuntary orofacial movements including lip smacking,
,tongue protrusion, and chewing movements associated with prolonged
antipsychotic use . Acute dystonia presents with sustained muscle contractions
(stiff neck, locked jaw, oculogyric crisis) occurring within days of starting an
antipsychotic .
*4. A patient taking haloperidol presents with a stiff neck, locked jaw, and
oculogyric crisis. This is best described as: *
• A) Tardive dyskinesia
• B) Neuroleptic malignant syndrome
• C) Acute dystonia
• D) Akathisia
Answer: C
Rationale: Acute dystonia is an extrapyramidal symptom that presents as
sustained muscle contractions (stiff neck, locked jaw, tongue protrusion,
oculogyric crisis). It typically occurs within days of starting an antipsychotic and is
treated with anticholinergic medications such as benztropine or
diphenhydramine .
5. The mnemonic FALTERED is used to assess which life-threatening condition?
• A) Serotonin syndrome
• B) Neuroleptic malignant syndrome
• C) Tardive dyskinesia
• D) Anticholinergic toxicity
Answer: B
Rationale: FALTERED stands for Fever, Autonomic instability, Leukocytosis, Tremor,
Elevated CK, Rigidity, Excessive sweating, and Delirium—key features of
, Neuroleptic Malignant Syndrome (NMS) . NMS is a medical emergency requiring
immediate antipsychotic discontinuation and supportive care.
6. A patient on clozapine must have regular monitoring of which laboratory
value due to risk of a life-threatening adverse effect?
• A) Liver function tests
• B) Absolute neutrophil count
• C) Serum creatinine
• D) Thyroid function tests
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis (ANC
<500/mm³). Mandatory monitoring through the REMS program is required with
regular absolute neutrophil count checks .
7. Which dopamine pathway, when blocked, causes extrapyramidal symptoms?
• A) Mesolimbic pathway
• B) Mesocortical pathway
• C) Nigrostriatal pathway
• D) Tuberoinfundibular pathway
Answer: C
Rationale: The nigrostriatal pathway (substantia nigra to striatum) controls
voluntary movement. D2 receptor blockade in this pathway causes extrapyramidal
symptoms (EPS) . The mesolimbic pathway is associated with positive symptoms
of psychosis; the tuberoinfundibular pathway blockade causes
hyperprolactinemia.
