NSG 552 Psychopharmacology | Wilkes University | 2026–2027 Study Guide & Exam
Prep | NSG 552 Exams 1, 2 & 3 Review | Advanced Practice Psychiatric Nursing |
Neurotransmitters & Receptors, Pharmacokinetics & Pharmacodynamics,
Antidepressants, Antipsychotics, Mood Stabilizers, Anxiolytics, Psychostimulants,
Substance Use Pharmacotherapy, Adverse Effects, Drug Interactions, Medication
Monitoring, Clinical Decision-Making & Evidence-Based Prescribing | Practice
Questions, Answers & Detailed Rationales
Question 1: Which of the following pharmacokinetic processes is most directly responsible for
the termination of drug action at the synaptic cleft?
A. Absorption from the gastrointestinal tract
B. Distribution to adipose tissue
C. Renal excretion of the parent compound
D. Metabolism and reuptake mechanisms
CORRECT ANSWER: D. Metabolism and reuptake mechanisms
Rationale: The termination of drug action at the synaptic cleft is primarily achieved through
enzymatic degradation (metabolism) and reuptake into the presynaptic neuron. While renal
excretion and distribution affect overall drug levels, they do not directly terminate the
immediate synaptic action.
Question 2: A patient with a history of substance use disorder is prescribed a medication with
a high potential for abuse. Which schedule of controlled substances would this medication
most likely belong to?
A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
CORRECT ANSWER: B. Schedule II
Rationale: Schedule II drugs have a high potential for abuse which may lead to severe
psychological or physical dependence. Examples include morphine, fentanyl, and
amphetamines. Schedule I drugs have no accepted medical use, while Schedules III and IV have
lower abuse potential.
Question 3: The therapeutic index (TI) of a drug is a critical safety parameter. A narrow
therapeutic index indicates that the drug:
A. Has a wide margin of safety
B. Requires no blood level monitoring
C. Has a small range between effective and toxic doses
D. Is safe for over-the-counter use
,CORRECT ANSWER: C. Has a small range between effective and toxic doses
Rationale: The therapeutic index is the ratio of the toxic dose to the therapeutic dose. A narrow
TI indicates that the drug must be dosed carefully and often monitored, as small increases in
dose can lead to toxicity (e.g., lithium, warfarin).
Question 4: Which neurotransmitter is primarily implicated in the rewarding effects of drugs
of abuse and is a major target for medications treating addiction?
A. Serotonin
B. Norepinephrine
C. Dopamine
D. Acetylcholine
CORRECT ANSWER: C. Dopamine
Rationale: The mesolimbic dopamine pathway is the primary neural substrate for reward. Most
addictive substances increase dopamine levels in the nucleus accumbens, making it a primary
target for pharmacotherapies aimed at reducing craving and withdrawal.
Question 5: A patient is started on an SSRI for major depressive disorder. The nurse should
educate the patient that the full therapeutic effect may not be seen for:
A. 24 to 48 hours
B. 2 to 4 days
C. 2 to 4 weeks
D. 24 hours
CORRECT ANSWER: C. 2 to 4 weeks
Rationale: SSRIs increase synaptic serotonin within hours, but the therapeutic effect for
depression typically requires 2 to 4 weeks. This latency is thought to be due to downstream
neuroadaptive changes, such as receptor desensitization and neurogenesis.
Question 6: Which of the following is a common side effect of first-generation (typical)
antipsychotics that is primarily related to dopamine D2 receptor blockade in the nigrostriatal
pathway?
A. Sedation
B. Weight gain
C. Extrapyramidal symptoms (EPS)
D. Orthostatic hypotension
CORRECT ANSWER: C. Extrapyramidal symptoms (EPS)
,Rationale: EPS, such as dystonia, parkinsonism, and tardive dyskinesia, are caused by D2
receptor blockade in the nigrostriatal pathway. Sedation and orthostatic hypotension are more
related to histaminergic and alpha-adrenergic blockade, respectively.
Question 7: A client is prescribed a monoamine oxidase inhibitor (MAOI). Which dietary
education is critical to prevent a hypertensive crisis?
A. Avoid foods high in tyramine
B. Increase intake of folic acid
C. Avoid foods high in potassium
D. Increase fluid intake to 3 liters per day
CORRECT ANSWER: A. Avoid foods high in tyramine
Rationale: MAOIs inhibit the breakdown of tyramine. Ingesting tyramine-rich foods (aged
cheese, cured meats, fermented products) can lead to a massive release of norepinephrine and
a hypertensive crisis, which is a medical emergency.
Question 8: The mechanism of action of benzodiazepines involves which of the following
receptor interactions?
A. Antagonism of serotonin 5-HT2A receptors
B. Positive allosteric modulation of GABA-A receptors
C. Blockade of voltage-gated sodium channels
D. Inhibition of norepinephrine reuptake
CORRECT ANSWER: B. Positive allosteric modulation of GABA-A receptors
Rationale: Benzodiazepines bind to a specific site on the GABA-A receptor complex and
enhance the inhibitory effects of GABA by increasing the frequency of chloride channel
opening. They do not directly open the channel like barbiturates.
Question 9: A patient taking lithium carbonate presents with nausea, vomiting, coarse
tremors, and confusion. The serum lithium level is 2.0 mEq/L. This clinical picture is most
consistent with:
A. Therapeutic response
B. Mild toxicity
C. Moderate to severe toxicity
D. Hypothyroidism
CORRECT ANSWER: C. Moderate to severe toxicity
Rationale: Lithium toxicity occurs at levels above 1.5 mEq/L. Mild toxicity (1.5-2.0 mEq/L)
includes GI upset and fine tremor, whereas levels above 2.0 mEq/L are associated with
, confusion, coarse tremors, and risk of seizures, indicating moderate to severe toxicity requiring
immediate intervention.
Question 10: In the context of psychopharmacology, pharmacodynamics refers to:
A. The movement of drugs through the body
B. The study of genetic influences on drug response
C. The effect of the drug on the body and its mechanism of action
D. The process of drug absorption and distribution
CORRECT ANSWER: C. The effect of the drug on the body and its mechanism of action
Rationale: Pharmacodynamics describes what the drug does to the body, including receptor
binding, signal transduction, and physiological effects. Pharmacokinetics (A and D) describes
what the body does to the drug.
Question 11: Which of the following medications is a selective serotonin and norepinephrine
reuptake inhibitor (SNRI) used for major depressive disorder and generalized anxiety
disorder?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Bupropion
CORRECT ANSWER: C. Venlafaxine
Rationale: Venlafaxine is a potent SNRI. Sertraline and fluoxetine are SSRIs, and bupropion
inhibits norepinephrine and dopamine reuptake (NDRI). SNRIs are often used for depression
and anxiety, particularly when fatigue and pain are prominent.
Question 12: A patient abruptly stops taking a short-acting benzodiazepine (e.g., alprazolam)
after chronic use. Which withdrawal symptom is a medical emergency?
A. Diaphoresis
B. Tachycardia
C. Seizures
D. Tremor
CORRECT ANSWER: C. Seizures
Rationale: Abrupt withdrawal from benzodiazepines can lead to life-threatening seizures and
status epilepticus. Other withdrawal symptoms include diaphoresis, tachycardia, tremor, and
anxiety, but seizures are the most critical medical emergency.
Question 13: Clozapine is a unique antipsychotic reserved for treatment-resistant
schizophrenia, but it requires rigorous monitoring due to the risk of:
Prep | NSG 552 Exams 1, 2 & 3 Review | Advanced Practice Psychiatric Nursing |
Neurotransmitters & Receptors, Pharmacokinetics & Pharmacodynamics,
Antidepressants, Antipsychotics, Mood Stabilizers, Anxiolytics, Psychostimulants,
Substance Use Pharmacotherapy, Adverse Effects, Drug Interactions, Medication
Monitoring, Clinical Decision-Making & Evidence-Based Prescribing | Practice
Questions, Answers & Detailed Rationales
Question 1: Which of the following pharmacokinetic processes is most directly responsible for
the termination of drug action at the synaptic cleft?
A. Absorption from the gastrointestinal tract
B. Distribution to adipose tissue
C. Renal excretion of the parent compound
D. Metabolism and reuptake mechanisms
CORRECT ANSWER: D. Metabolism and reuptake mechanisms
Rationale: The termination of drug action at the synaptic cleft is primarily achieved through
enzymatic degradation (metabolism) and reuptake into the presynaptic neuron. While renal
excretion and distribution affect overall drug levels, they do not directly terminate the
immediate synaptic action.
Question 2: A patient with a history of substance use disorder is prescribed a medication with
a high potential for abuse. Which schedule of controlled substances would this medication
most likely belong to?
A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
CORRECT ANSWER: B. Schedule II
Rationale: Schedule II drugs have a high potential for abuse which may lead to severe
psychological or physical dependence. Examples include morphine, fentanyl, and
amphetamines. Schedule I drugs have no accepted medical use, while Schedules III and IV have
lower abuse potential.
Question 3: The therapeutic index (TI) of a drug is a critical safety parameter. A narrow
therapeutic index indicates that the drug:
A. Has a wide margin of safety
B. Requires no blood level monitoring
C. Has a small range between effective and toxic doses
D. Is safe for over-the-counter use
,CORRECT ANSWER: C. Has a small range between effective and toxic doses
Rationale: The therapeutic index is the ratio of the toxic dose to the therapeutic dose. A narrow
TI indicates that the drug must be dosed carefully and often monitored, as small increases in
dose can lead to toxicity (e.g., lithium, warfarin).
Question 4: Which neurotransmitter is primarily implicated in the rewarding effects of drugs
of abuse and is a major target for medications treating addiction?
A. Serotonin
B. Norepinephrine
C. Dopamine
D. Acetylcholine
CORRECT ANSWER: C. Dopamine
Rationale: The mesolimbic dopamine pathway is the primary neural substrate for reward. Most
addictive substances increase dopamine levels in the nucleus accumbens, making it a primary
target for pharmacotherapies aimed at reducing craving and withdrawal.
Question 5: A patient is started on an SSRI for major depressive disorder. The nurse should
educate the patient that the full therapeutic effect may not be seen for:
A. 24 to 48 hours
B. 2 to 4 days
C. 2 to 4 weeks
D. 24 hours
CORRECT ANSWER: C. 2 to 4 weeks
Rationale: SSRIs increase synaptic serotonin within hours, but the therapeutic effect for
depression typically requires 2 to 4 weeks. This latency is thought to be due to downstream
neuroadaptive changes, such as receptor desensitization and neurogenesis.
Question 6: Which of the following is a common side effect of first-generation (typical)
antipsychotics that is primarily related to dopamine D2 receptor blockade in the nigrostriatal
pathway?
A. Sedation
B. Weight gain
C. Extrapyramidal symptoms (EPS)
D. Orthostatic hypotension
CORRECT ANSWER: C. Extrapyramidal symptoms (EPS)
,Rationale: EPS, such as dystonia, parkinsonism, and tardive dyskinesia, are caused by D2
receptor blockade in the nigrostriatal pathway. Sedation and orthostatic hypotension are more
related to histaminergic and alpha-adrenergic blockade, respectively.
Question 7: A client is prescribed a monoamine oxidase inhibitor (MAOI). Which dietary
education is critical to prevent a hypertensive crisis?
A. Avoid foods high in tyramine
B. Increase intake of folic acid
C. Avoid foods high in potassium
D. Increase fluid intake to 3 liters per day
CORRECT ANSWER: A. Avoid foods high in tyramine
Rationale: MAOIs inhibit the breakdown of tyramine. Ingesting tyramine-rich foods (aged
cheese, cured meats, fermented products) can lead to a massive release of norepinephrine and
a hypertensive crisis, which is a medical emergency.
Question 8: The mechanism of action of benzodiazepines involves which of the following
receptor interactions?
A. Antagonism of serotonin 5-HT2A receptors
B. Positive allosteric modulation of GABA-A receptors
C. Blockade of voltage-gated sodium channels
D. Inhibition of norepinephrine reuptake
CORRECT ANSWER: B. Positive allosteric modulation of GABA-A receptors
Rationale: Benzodiazepines bind to a specific site on the GABA-A receptor complex and
enhance the inhibitory effects of GABA by increasing the frequency of chloride channel
opening. They do not directly open the channel like barbiturates.
Question 9: A patient taking lithium carbonate presents with nausea, vomiting, coarse
tremors, and confusion. The serum lithium level is 2.0 mEq/L. This clinical picture is most
consistent with:
A. Therapeutic response
B. Mild toxicity
C. Moderate to severe toxicity
D. Hypothyroidism
CORRECT ANSWER: C. Moderate to severe toxicity
Rationale: Lithium toxicity occurs at levels above 1.5 mEq/L. Mild toxicity (1.5-2.0 mEq/L)
includes GI upset and fine tremor, whereas levels above 2.0 mEq/L are associated with
, confusion, coarse tremors, and risk of seizures, indicating moderate to severe toxicity requiring
immediate intervention.
Question 10: In the context of psychopharmacology, pharmacodynamics refers to:
A. The movement of drugs through the body
B. The study of genetic influences on drug response
C. The effect of the drug on the body and its mechanism of action
D. The process of drug absorption and distribution
CORRECT ANSWER: C. The effect of the drug on the body and its mechanism of action
Rationale: Pharmacodynamics describes what the drug does to the body, including receptor
binding, signal transduction, and physiological effects. Pharmacokinetics (A and D) describes
what the body does to the drug.
Question 11: Which of the following medications is a selective serotonin and norepinephrine
reuptake inhibitor (SNRI) used for major depressive disorder and generalized anxiety
disorder?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Bupropion
CORRECT ANSWER: C. Venlafaxine
Rationale: Venlafaxine is a potent SNRI. Sertraline and fluoxetine are SSRIs, and bupropion
inhibits norepinephrine and dopamine reuptake (NDRI). SNRIs are often used for depression
and anxiety, particularly when fatigue and pain are prominent.
Question 12: A patient abruptly stops taking a short-acting benzodiazepine (e.g., alprazolam)
after chronic use. Which withdrawal symptom is a medical emergency?
A. Diaphoresis
B. Tachycardia
C. Seizures
D. Tremor
CORRECT ANSWER: C. Seizures
Rationale: Abrupt withdrawal from benzodiazepines can lead to life-threatening seizures and
status epilepticus. Other withdrawal symptoms include diaphoresis, tachycardia, tremor, and
anxiety, but seizures are the most critical medical emergency.
Question 13: Clozapine is a unique antipsychotic reserved for treatment-resistant
schizophrenia, but it requires rigorous monitoring due to the risk of:
