NSG 552 Psychopharmacology Exam 1, 2 & 3 |
Wilkes University Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed –
A+ Graded
EXAM 1: Foundations of Psychopharmacology
Neurobiology & Neurotransmitter Systems
Q1: Which dopaminergic pathway is most closely associated with the positive symptoms of
schizophrenia, such as delusions and hallucinations?
A. Nigrostriatal
B. Tuberoinfundibular
C. Mesolimbic [CORRECT]
D. Mesocortical
Correct Answer: C
Rationale: The best answer is C. The mesolimbic pathway runs from the ventral tegmental
area to the nucleus accumbens, and hyperactivity there is tied to positive psychotic
symptoms, while the nigrostriatal and tuberoinfundibular tracts account for motor and
prolactin-related drug effects.
Q2: A 24-year-old man started on haloperidol three weeks ago now shows a shuffling gait,
masked facies, and cogwheel rigidity on examination. Which dopamine pathway is
responsible for these drug effects?
A. Mesolimbic
B. Nigrostriatal [CORRECT]
C. Tuberoinfundibular
D. Mesocortical
Correct Answer: B
Rationale: This choice is correct because D2 blockade in the nigrostriatal tract produces the
parkinsonian motor effects — a separate pathway from the one responsible for his
symptom improvement.
Q3: Benzodiazepines produce their anxiolytic effect by binding to which site?
A. An allosteric site on the GABA-A receptor, which increases the frequency of chloride
channel opening [CORRECT]
B. The chloride channel pore itself, blocking ion flow
C. The GABA-B receptor, inhibiting calcium channels
D. The glutamate site on the NMDA receptor
Correct Answer: A
,Rationale: The best answer is A. Benzodiazepines need endogenous GABA to be present and
simply make the chloride channel open more often, which is why they enhance rather than
replace GABAergic inhibition.
Q4: A 46-year-old woman with severe depression that has not responded to multiple
medication trials receives an IV infusion in an outpatient setting. Within hours she reports
her mood is noticeably lighter, though she had transient dissociation during the infusion.
Which receptor is the primary target of this medication?
A. GABA-B
B. Dopamine D2
C. Nicotinic acetylcholine
D. NMDA glutamate [CORRECT]
Correct Answer: D
Rationale: This choice is correct because the medication is ketamine, a glutamatergic agent
whose rapid antidepressant effect comes from NMDA receptor antagonism — a very
different timeline from the weeks required for monoaminergic drugs.
Q5: The largest cluster of noradrenergic neurons in the brain, heavily involved in arousal,
attention, and the stress response, is located in the:
A. Raphe nuclei
B. Substantia nigra
C. Locus coeruleus [CORRECT]
D. Nucleus accumbens
Correct Answer: C
Rationale: The best answer is the locus coeruleus — remember, the raphe nuclei are
serotonin and the substantia nigra is dopamine, so this noradrenergic hub is the one to
connect with norepinephrine-related drugs affecting alertness and anxiety.
Q6: A 58-year-old woman on amitriptyline for chronic pain reports dry mouth, constipation,
urinary hesitancy, and blurred vision. Which receptor effect accounts for these complaints?
A. Histamine H1 blockade
B. Alpha-1 adrenergic blockade
C. Muscarinic acetylcholine blockade [CORRECT]
D. Serotonin reuptake inhibition
Correct Answer: C
Rationale: This choice is correct because classic anticholinergic effects — dry mouth,
constipation, urinary retention, and blurred vision — come from muscarinic blockade, a
major reason TCAs cause so much trouble in older adults.
Q7: Lithium's mood-stabilizing action has been linked to its effect on second messenger
systems. Which mechanism is most characteristic?
A. It increases cAMP generation at the receptor level
B. It inhibits inositol monophosphatase, dampening phosphoinositide cycle signaling
[CORRECT]
C. It directly blocks dopamine D2 receptors
D. It enhances GABA transaminase activity
Correct Answer: B
, Rationale: The best answer is B. By blocking inositol monophosphatase, lithium depletes
inositol and blunts downstream second-messenger signaling in the phosphoinositide
pathway — a classic tie between a drug mechanism and cellular physiology.
Q8: A patient with schizophrenia is switched from risperidone to aripiprazole, and her
elevated prolactin level returns to normal within a month. What property of aripiprazole
explains this?
A. Full D2 receptor blockade with high affinity
B. Irreversible binding at the receptor site
C. Partial agonist activity at D2 receptors, which stabilizes dopaminergic tone [CORRECT]
D. Monoamine oxidase inhibition
Correct Answer: C
Rationale: This choice is correct because a partial agonist occupies the receptor while
producing only modest activation, so it tones down dopaminergic output where it is
excessive — like the pituitary — while supporting it where it is low.
Q9: Which enzyme is rate-limiting in the synthesis of serotonin?
A. Tyrosine hydroxylase
B. Dopa decarboxylase
C. Tryptophan hydroxylase [CORRECT]
D. Catechol-O-methyltransferase
Correct Answer: C
Rationale: Remember the pairing — tryptophan hydroxylase controls serotonin production
from tryptophan, while tyrosine hydroxylase does the same job for the catecholamines.
Q10: A patient asks why her antidepressant will take several weeks to work even though she
takes it every day. The best neurobiological explanation involves:
A. Time-dependent receptor downregulation and downstream neuroadaptive changes
[CORRECT]
B. Slow gastrointestinal absorption of oral antidepressants
C. Delayed penetration of the blood-brain barrier
D. Gradual depletion of monoamine stores
Correct Answer: A
Rationale: The best answer is A. Synaptic monoamine levels rise within hours of the first
dose, so the delay is attributed to slower adaptations, including postsynaptic receptor
downregulation — the classic explanation for the antidepressant lag.
Q11: A 66-year-old man started on nortriptyline reports dizziness when standing, and his
orthostatic vitals confirm a positional drop in blood pressure. Which receptor effect is
responsible?
A. Muscarinic blockade
B. Histamine H1 blockade
C. Dopamine D2 blockade
D. Alpha-1 adrenergic blockade [CORRECT]
Correct Answer: D
Wilkes University Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed –
A+ Graded
EXAM 1: Foundations of Psychopharmacology
Neurobiology & Neurotransmitter Systems
Q1: Which dopaminergic pathway is most closely associated with the positive symptoms of
schizophrenia, such as delusions and hallucinations?
A. Nigrostriatal
B. Tuberoinfundibular
C. Mesolimbic [CORRECT]
D. Mesocortical
Correct Answer: C
Rationale: The best answer is C. The mesolimbic pathway runs from the ventral tegmental
area to the nucleus accumbens, and hyperactivity there is tied to positive psychotic
symptoms, while the nigrostriatal and tuberoinfundibular tracts account for motor and
prolactin-related drug effects.
Q2: A 24-year-old man started on haloperidol three weeks ago now shows a shuffling gait,
masked facies, and cogwheel rigidity on examination. Which dopamine pathway is
responsible for these drug effects?
A. Mesolimbic
B. Nigrostriatal [CORRECT]
C. Tuberoinfundibular
D. Mesocortical
Correct Answer: B
Rationale: This choice is correct because D2 blockade in the nigrostriatal tract produces the
parkinsonian motor effects — a separate pathway from the one responsible for his
symptom improvement.
Q3: Benzodiazepines produce their anxiolytic effect by binding to which site?
A. An allosteric site on the GABA-A receptor, which increases the frequency of chloride
channel opening [CORRECT]
B. The chloride channel pore itself, blocking ion flow
C. The GABA-B receptor, inhibiting calcium channels
D. The glutamate site on the NMDA receptor
Correct Answer: A
,Rationale: The best answer is A. Benzodiazepines need endogenous GABA to be present and
simply make the chloride channel open more often, which is why they enhance rather than
replace GABAergic inhibition.
Q4: A 46-year-old woman with severe depression that has not responded to multiple
medication trials receives an IV infusion in an outpatient setting. Within hours she reports
her mood is noticeably lighter, though she had transient dissociation during the infusion.
Which receptor is the primary target of this medication?
A. GABA-B
B. Dopamine D2
C. Nicotinic acetylcholine
D. NMDA glutamate [CORRECT]
Correct Answer: D
Rationale: This choice is correct because the medication is ketamine, a glutamatergic agent
whose rapid antidepressant effect comes from NMDA receptor antagonism — a very
different timeline from the weeks required for monoaminergic drugs.
Q5: The largest cluster of noradrenergic neurons in the brain, heavily involved in arousal,
attention, and the stress response, is located in the:
A. Raphe nuclei
B. Substantia nigra
C. Locus coeruleus [CORRECT]
D. Nucleus accumbens
Correct Answer: C
Rationale: The best answer is the locus coeruleus — remember, the raphe nuclei are
serotonin and the substantia nigra is dopamine, so this noradrenergic hub is the one to
connect with norepinephrine-related drugs affecting alertness and anxiety.
Q6: A 58-year-old woman on amitriptyline for chronic pain reports dry mouth, constipation,
urinary hesitancy, and blurred vision. Which receptor effect accounts for these complaints?
A. Histamine H1 blockade
B. Alpha-1 adrenergic blockade
C. Muscarinic acetylcholine blockade [CORRECT]
D. Serotonin reuptake inhibition
Correct Answer: C
Rationale: This choice is correct because classic anticholinergic effects — dry mouth,
constipation, urinary retention, and blurred vision — come from muscarinic blockade, a
major reason TCAs cause so much trouble in older adults.
Q7: Lithium's mood-stabilizing action has been linked to its effect on second messenger
systems. Which mechanism is most characteristic?
A. It increases cAMP generation at the receptor level
B. It inhibits inositol monophosphatase, dampening phosphoinositide cycle signaling
[CORRECT]
C. It directly blocks dopamine D2 receptors
D. It enhances GABA transaminase activity
Correct Answer: B
, Rationale: The best answer is B. By blocking inositol monophosphatase, lithium depletes
inositol and blunts downstream second-messenger signaling in the phosphoinositide
pathway — a classic tie between a drug mechanism and cellular physiology.
Q8: A patient with schizophrenia is switched from risperidone to aripiprazole, and her
elevated prolactin level returns to normal within a month. What property of aripiprazole
explains this?
A. Full D2 receptor blockade with high affinity
B. Irreversible binding at the receptor site
C. Partial agonist activity at D2 receptors, which stabilizes dopaminergic tone [CORRECT]
D. Monoamine oxidase inhibition
Correct Answer: C
Rationale: This choice is correct because a partial agonist occupies the receptor while
producing only modest activation, so it tones down dopaminergic output where it is
excessive — like the pituitary — while supporting it where it is low.
Q9: Which enzyme is rate-limiting in the synthesis of serotonin?
A. Tyrosine hydroxylase
B. Dopa decarboxylase
C. Tryptophan hydroxylase [CORRECT]
D. Catechol-O-methyltransferase
Correct Answer: C
Rationale: Remember the pairing — tryptophan hydroxylase controls serotonin production
from tryptophan, while tyrosine hydroxylase does the same job for the catecholamines.
Q10: A patient asks why her antidepressant will take several weeks to work even though she
takes it every day. The best neurobiological explanation involves:
A. Time-dependent receptor downregulation and downstream neuroadaptive changes
[CORRECT]
B. Slow gastrointestinal absorption of oral antidepressants
C. Delayed penetration of the blood-brain barrier
D. Gradual depletion of monoamine stores
Correct Answer: A
Rationale: The best answer is A. Synaptic monoamine levels rise within hours of the first
dose, so the delay is attributed to slower adaptations, including postsynaptic receptor
downregulation — the classic explanation for the antidepressant lag.
Q11: A 66-year-old man started on nortriptyline reports dizziness when standing, and his
orthostatic vitals confirm a positional drop in blood pressure. Which receptor effect is
responsible?
A. Muscarinic blockade
B. Histamine H1 blockade
C. Dopamine D2 blockade
D. Alpha-1 adrenergic blockade [CORRECT]
Correct Answer: D
