NSG 552 Psychopharmacology Practice Exams
Exams 1 2 and 3
Wilkes University | Graduate Nursing | Independent Evidence Informed Study Resource
This document contains three original practice examinations designed to help PMHNP learners apply
psychopharmacology principles across the lifespan. It is not an official Wilkes University examination and does
not reproduce restricted or leaked questions.
Institution Wilkes University
Course NSG 552 Psychopharmacology
Assessments Practice Exam 1, Practice Exam 2, and Practice Exam 3
Questions 40 per exam; 120 total
Suggested time 60 minutes per exam
Research note
Wilkes identifies NSG 552 as a two-credit PMHNP psychopharmacology course focused on prescribing and
monitoring agents used for common psychiatric disorders across the lifespan. A publicly posted 2024-2025
syllabus confirms the course identity and prerequisite. Multiple course-specific study guides consistently map
Exam 1 to psychosis, depression, bipolar disorder, and foundational pharmacology; Exam 2 to anxiety, trauma-
related, somatic, eating, and sleep-wake disorders; and Exam 3 to substance use, pediatric, geriatric, and
neurocognitive psychopharmacology. Public course-specific materials explicitly report 40 questions and 60
minutes for Exam 1. Public Exam 3 study material also describes a 40-question structure, but an official Wilkes
blueprint for all three exams was not publicly accessible. To provide consistent coverage without implying
official status, each practice exam uses 40 questions and a suggested 60-minute limit.
Questions are original and emphasize prescribing decisions, adverse-effect recognition, monitoring, interactions,
patient education, safety, and clinical judgment. No dosage-calculation items are included because course-
specific sources did not establish calculations as a tested format and drug-level interpretation is more authentic
to this course.
Independent practice assessment | Wilkes University NSG 552
, Practice Exam 1
Institution: Wilkes University
Course Code and Title: NSG 552 Psychopharmacology
Assessment: Practice Exam 1
Total Questions: 40
Suggested Time Limit: 60 minutes
Question Formats: Multiple choice, select all that apply, prioritization, ordered clinical reasoning, and case-based
application
Content blueprint
pic Questions
rmacokinetics, pharmacodynamics, interactions 5
chosis and antipsychotics 15
pression and antidepressants 11
olar disorder and mood stabilizers 9
Instructions
Choose the single best answer unless the item states Select all that apply. Complete the exam before reviewing
the answer and rationale. In urgent scenarios, prioritize airway, breathing, circulation, immediate safety, and
reversible causes.
Question 1
A patient starts an oral medication that undergoes extensive first-pass metabolism. Which pharmacokinetic
effect should the PMHNP anticipate?
A. Higher oral bioavailability
B. Lower oral bioavailability
C. Immediate steady state
D. Elimination independent of the liver
Correct Answer: B. Lower oral bioavailability
Rationale: First-pass hepatic metabolism removes part of an orally administered dose before it reaches
systemic circulation, reducing bioavailability.
Why the Other Options Are Incorrect:
A. First-pass metabolism lowers rather than raises systemic exposure.
B. This is the correct option for the reason stated in the rationale.
C. Steady state generally requires repeated dosing for several half-lives.
D. Hepatic metabolism makes liver function and interactions more relevant, not irrelevant.
Question 2
A strong CYP3A4 inhibitor is added to a stable regimen containing a CYP3A4 substrate with a narrow
therapeutic index. What is the priority response?
A. Expect a lower substrate concentration
B. Double the substrate dose
C. Assume no change unless the drugs share a receptor
Independent practice assessment | Wilkes University NSG 552
,D. Assess for toxicity and consider reducing the substrate dose
Correct Answer: D. Assess for toxicity and consider reducing the substrate dose
Rationale: Enzyme inhibition can reduce substrate metabolism, raise exposure, and cause toxicity; close
monitoring and dose adjustment may be needed.
Why the Other Options Are Incorrect:
A. Inhibition usually raises, not lowers, substrate concentration.
B. Increasing the dose could worsen toxicity.
C. Pharmacokinetic interactions do not require shared receptor targets.
D. This is the correct option for the reason stated in the rationale.
Question 3
Which statement best describes a partial agonist?
A. It produces a submaximal receptor response even at full occupancy
B. It blocks a receptor without intrinsic activity
C. It irreversibly destroys the receptor
D. It produces the same maximal effect as a full agonist
Correct Answer: A. It produces a submaximal receptor response even at full occupancy
Rationale: A partial agonist has intrinsic activity but a lower maximal effect than a full agonist and may
functionally dampen signaling when endogenous agonist tone is high.
Why the Other Options Are Incorrect:
A. This is the correct option for the reason stated in the rationale.
B. That describes an antagonist.
C. Partial agonism does not require receptor destruction.
D. A full agonist, not a partial agonist, produces the system's maximal response.
Question 4
Which findings are appropriate baseline or ongoing monitoring considerations for a patient receiving a second-
generation antipsychotic? Select all that apply.
A. Weight and BMI
B. Waist circumference
C. Blood pressure
D. Fasting glucose or A1C
E. Fasting lipid profile
F. Daily serum troponin for every agent
Correct Answer: A. Weight and BMI, B. Waist circumference, C. Blood pressure, D. Fasting glucose or A1C, E.
Fasting lipid profile
Rationale: Second-generation antipsychotics can contribute to weight gain, dyslipidemia, and dysglycemia;
cardiometabolic monitoring should include weight-related measures, blood pressure, glucose status, and lipids.
Routine daily troponin is not standard for every antipsychotic.
Option-by-Option Explanation:
A. Correct: tracks weight-related metabolic change.
B. Correct: helps characterize central adiposity.
Independent practice assessment | Wilkes University NSG 552
, C. Correct: cardiovascular risk monitoring is appropriate.
D. Correct: detects dysglycemia.
E. Correct: detects dyslipidemia.
F. Incorrect: troponin is reserved for a clinical indication, not universal daily screening.
Question 5
A patient with schizophrenia has auditory hallucinations and delusions. Excess dopamine signaling in which
pathway is most associated with these positive symptoms?
A. Mesocortical
B. Nigrostriatal
C. Mesolimbic
D. Tuberoinfundibular
Correct Answer: C. Mesolimbic
Rationale: Hyperdopaminergic activity in the mesolimbic pathway is associated with positive psychotic
symptoms.
Why the Other Options Are Incorrect:
A. Mesocortical hypodopaminergia is associated more with negative and cognitive symptoms.
B. Nigrostriatal blockade produces extrapyramidal effects.
C. This is the correct option for the reason stated in the rationale.
D. Tuberoinfundibular blockade can elevate prolactin.
Question 6
A patient taking haloperidol develops painful neck spasm and upward eye deviation several hours after a dose
increase. Which intervention is most appropriate?
A. Start valbenazine
B. Give propranolol and continue observation
C. Stop all treatment and give dantrolene
D. Administer benztropine or diphenhydramine promptly
Correct Answer: D. Administer benztropine or diphenhydramine promptly
Rationale: Acute dystonia is an early extrapyramidal reaction treated promptly with an anticholinergic such as
benztropine or an antihistamine with anticholinergic activity such as diphenhydramine.
Why the Other Options Are Incorrect:
A. VMAT2 inhibitors are used for tardive dyskinesia, not acute dystonia.
B. Propranolol is more useful for akathisia.
C. Dantrolene is used in neuroleptic malignant syndrome, which includes systemic rigidity, fever, and autonomic
instability.
D. This is the correct option for the reason stated in the rationale.
Question 7
A patient taking an antipsychotic reports an unbearable inner restlessness and constantly paces. Which adverse
effect is most likely?
A. Acute dystonia
Independent practice assessment | Wilkes University NSG 552
Exams 1 2 and 3
Wilkes University | Graduate Nursing | Independent Evidence Informed Study Resource
This document contains three original practice examinations designed to help PMHNP learners apply
psychopharmacology principles across the lifespan. It is not an official Wilkes University examination and does
not reproduce restricted or leaked questions.
Institution Wilkes University
Course NSG 552 Psychopharmacology
Assessments Practice Exam 1, Practice Exam 2, and Practice Exam 3
Questions 40 per exam; 120 total
Suggested time 60 minutes per exam
Research note
Wilkes identifies NSG 552 as a two-credit PMHNP psychopharmacology course focused on prescribing and
monitoring agents used for common psychiatric disorders across the lifespan. A publicly posted 2024-2025
syllabus confirms the course identity and prerequisite. Multiple course-specific study guides consistently map
Exam 1 to psychosis, depression, bipolar disorder, and foundational pharmacology; Exam 2 to anxiety, trauma-
related, somatic, eating, and sleep-wake disorders; and Exam 3 to substance use, pediatric, geriatric, and
neurocognitive psychopharmacology. Public course-specific materials explicitly report 40 questions and 60
minutes for Exam 1. Public Exam 3 study material also describes a 40-question structure, but an official Wilkes
blueprint for all three exams was not publicly accessible. To provide consistent coverage without implying
official status, each practice exam uses 40 questions and a suggested 60-minute limit.
Questions are original and emphasize prescribing decisions, adverse-effect recognition, monitoring, interactions,
patient education, safety, and clinical judgment. No dosage-calculation items are included because course-
specific sources did not establish calculations as a tested format and drug-level interpretation is more authentic
to this course.
Independent practice assessment | Wilkes University NSG 552
, Practice Exam 1
Institution: Wilkes University
Course Code and Title: NSG 552 Psychopharmacology
Assessment: Practice Exam 1
Total Questions: 40
Suggested Time Limit: 60 minutes
Question Formats: Multiple choice, select all that apply, prioritization, ordered clinical reasoning, and case-based
application
Content blueprint
pic Questions
rmacokinetics, pharmacodynamics, interactions 5
chosis and antipsychotics 15
pression and antidepressants 11
olar disorder and mood stabilizers 9
Instructions
Choose the single best answer unless the item states Select all that apply. Complete the exam before reviewing
the answer and rationale. In urgent scenarios, prioritize airway, breathing, circulation, immediate safety, and
reversible causes.
Question 1
A patient starts an oral medication that undergoes extensive first-pass metabolism. Which pharmacokinetic
effect should the PMHNP anticipate?
A. Higher oral bioavailability
B. Lower oral bioavailability
C. Immediate steady state
D. Elimination independent of the liver
Correct Answer: B. Lower oral bioavailability
Rationale: First-pass hepatic metabolism removes part of an orally administered dose before it reaches
systemic circulation, reducing bioavailability.
Why the Other Options Are Incorrect:
A. First-pass metabolism lowers rather than raises systemic exposure.
B. This is the correct option for the reason stated in the rationale.
C. Steady state generally requires repeated dosing for several half-lives.
D. Hepatic metabolism makes liver function and interactions more relevant, not irrelevant.
Question 2
A strong CYP3A4 inhibitor is added to a stable regimen containing a CYP3A4 substrate with a narrow
therapeutic index. What is the priority response?
A. Expect a lower substrate concentration
B. Double the substrate dose
C. Assume no change unless the drugs share a receptor
Independent practice assessment | Wilkes University NSG 552
,D. Assess for toxicity and consider reducing the substrate dose
Correct Answer: D. Assess for toxicity and consider reducing the substrate dose
Rationale: Enzyme inhibition can reduce substrate metabolism, raise exposure, and cause toxicity; close
monitoring and dose adjustment may be needed.
Why the Other Options Are Incorrect:
A. Inhibition usually raises, not lowers, substrate concentration.
B. Increasing the dose could worsen toxicity.
C. Pharmacokinetic interactions do not require shared receptor targets.
D. This is the correct option for the reason stated in the rationale.
Question 3
Which statement best describes a partial agonist?
A. It produces a submaximal receptor response even at full occupancy
B. It blocks a receptor without intrinsic activity
C. It irreversibly destroys the receptor
D. It produces the same maximal effect as a full agonist
Correct Answer: A. It produces a submaximal receptor response even at full occupancy
Rationale: A partial agonist has intrinsic activity but a lower maximal effect than a full agonist and may
functionally dampen signaling when endogenous agonist tone is high.
Why the Other Options Are Incorrect:
A. This is the correct option for the reason stated in the rationale.
B. That describes an antagonist.
C. Partial agonism does not require receptor destruction.
D. A full agonist, not a partial agonist, produces the system's maximal response.
Question 4
Which findings are appropriate baseline or ongoing monitoring considerations for a patient receiving a second-
generation antipsychotic? Select all that apply.
A. Weight and BMI
B. Waist circumference
C. Blood pressure
D. Fasting glucose or A1C
E. Fasting lipid profile
F. Daily serum troponin for every agent
Correct Answer: A. Weight and BMI, B. Waist circumference, C. Blood pressure, D. Fasting glucose or A1C, E.
Fasting lipid profile
Rationale: Second-generation antipsychotics can contribute to weight gain, dyslipidemia, and dysglycemia;
cardiometabolic monitoring should include weight-related measures, blood pressure, glucose status, and lipids.
Routine daily troponin is not standard for every antipsychotic.
Option-by-Option Explanation:
A. Correct: tracks weight-related metabolic change.
B. Correct: helps characterize central adiposity.
Independent practice assessment | Wilkes University NSG 552
, C. Correct: cardiovascular risk monitoring is appropriate.
D. Correct: detects dysglycemia.
E. Correct: detects dyslipidemia.
F. Incorrect: troponin is reserved for a clinical indication, not universal daily screening.
Question 5
A patient with schizophrenia has auditory hallucinations and delusions. Excess dopamine signaling in which
pathway is most associated with these positive symptoms?
A. Mesocortical
B. Nigrostriatal
C. Mesolimbic
D. Tuberoinfundibular
Correct Answer: C. Mesolimbic
Rationale: Hyperdopaminergic activity in the mesolimbic pathway is associated with positive psychotic
symptoms.
Why the Other Options Are Incorrect:
A. Mesocortical hypodopaminergia is associated more with negative and cognitive symptoms.
B. Nigrostriatal blockade produces extrapyramidal effects.
C. This is the correct option for the reason stated in the rationale.
D. Tuberoinfundibular blockade can elevate prolactin.
Question 6
A patient taking haloperidol develops painful neck spasm and upward eye deviation several hours after a dose
increase. Which intervention is most appropriate?
A. Start valbenazine
B. Give propranolol and continue observation
C. Stop all treatment and give dantrolene
D. Administer benztropine or diphenhydramine promptly
Correct Answer: D. Administer benztropine or diphenhydramine promptly
Rationale: Acute dystonia is an early extrapyramidal reaction treated promptly with an anticholinergic such as
benztropine or an antihistamine with anticholinergic activity such as diphenhydramine.
Why the Other Options Are Incorrect:
A. VMAT2 inhibitors are used for tardive dyskinesia, not acute dystonia.
B. Propranolol is more useful for akathisia.
C. Dantrolene is used in neuroleptic malignant syndrome, which includes systemic rigidity, fever, and autonomic
instability.
D. This is the correct option for the reason stated in the rationale.
Question 7
A patient taking an antipsychotic reports an unbearable inner restlessness and constantly paces. Which adverse
effect is most likely?
A. Acute dystonia
Independent practice assessment | Wilkes University NSG 552
