NURS 660 Exam 1 V1 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 1 2026)
1. A patient is prescribed Fluoxetine for Major Depressive Disorder. Which cytochrome P450
enzyme is most significantly inhibited by this medication, potentially leading to drug-drug
interactions?
A. CYP1A2
B. CYP3A4
C. CYP2C19
D. CYP2D6
Answer: D
Rationale: Fluoxetine is a potent inhibitor of the CYP2D6 enzyme system. This inhibition
can lead to increased serum levels of other drugs metabolized by this pathway, such as
certain beta-blockers and antipsychotics. Understanding these pharmacokinetic properties
is vital for the PMHNP to prevent toxicity in polypharmacy scenarios.
2. Which dopamine pathway is primarily responsible for the ‘positive’ symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
,B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: C
Rationale: The mesolimbic pathway involves dopamine projections from the ventral
tegmental area to the nucleus accumbens. Hyperactivity in this specific pathway is
clinically associated with the positive symptoms of psychosis. Most antipsychotic
medications aim to reduce dopamine neurotransmission in this area to alleviate these
symptoms.
3. A 28-year-old female patient on Lithium for Bipolar I Disorder expresses a desire to become
pregnant. Which congenital anomaly is most closely associated with Lithium use during the
first trimester?
A. Neural tube defects
B. Spina bifida
C. Cleft palate
D. Ebstein’s anomaly
Answer: D
Rationale: Ebstein’s anomaly is a rare cardiovascular defect characterized by the
downward displacement of the tricuspid valve. While the absolute risk is relatively low, it
,is significantly higher in infants exposed to Lithium in utero compared to the general
population. PMHNPs must engage in thorough risk-benefit discussions and preconception
counseling with female patients of childbearing age.
4. Which medication is considered a partial agonist at the Dopamine D2 receptor and is often
referred to as a ‘dopamine stabilizer’?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Aripiprazole
Answer: D
Rationale: Aripiprazole functions as a partial agonist at D2 receptors, meaning it provides
moderate stimulation where dopamine is low and acts as an antagonist where dopamine is
high. This unique mechanism helps balance dopamine activity across different brain
regions. Consequently, it typically carries a lower risk of extrapyramidal symptoms and
prolactin elevation compared to full antagonists.
5. A patient taking Phenelzine (an MAOI) presents with a severe occipital headache,
palpitations, and a blood pressure of 190/110 mmHg. What is the most likely cause?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Hypertensive Crisis due to tyramine ingestion
, D. Anticholinergic toxicity
Answer: C
Rationale: MAOIs inhibit the breakdown of tyramine in the gut; when high-tyramine foods
(like aged cheese) are consumed, norepinephrine is released massively. This leads to
profound vasoconstriction and a potentially fatal hypertensive crisis. Education on a low-
tyramine diet is a mandatory safety intervention for any patient prescribed an MAOI.
6. What is the primary mechanism of action for Benzodiazepines in treating anxiety?
A. Positive allosteric modulation of the GABA-A receptor
B. Directly opening chloride channels
C. Antagonism of the NMDA receptor
D. Inhibition of Serotonin reuptake
Answer: A
Rationale: Benzodiazepines bind to a specific site on the GABA-A receptor complex,
enhancing the frequency of channel opening in the presence of GABA. This increases the
influx of chloride ions, leading to hyperpolarization of the neuron and reduced excitability.
This mechanism underlies their sedative, anxiolytic, and anticonvulsant properties.
7. Which side effect of Clozapine requires mandatory weekly blood monitoring for the first six
months of treatment?
A. Hepatotoxicity
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 1 2026)
1. A patient is prescribed Fluoxetine for Major Depressive Disorder. Which cytochrome P450
enzyme is most significantly inhibited by this medication, potentially leading to drug-drug
interactions?
A. CYP1A2
B. CYP3A4
C. CYP2C19
D. CYP2D6
Answer: D
Rationale: Fluoxetine is a potent inhibitor of the CYP2D6 enzyme system. This inhibition
can lead to increased serum levels of other drugs metabolized by this pathway, such as
certain beta-blockers and antipsychotics. Understanding these pharmacokinetic properties
is vital for the PMHNP to prevent toxicity in polypharmacy scenarios.
2. Which dopamine pathway is primarily responsible for the ‘positive’ symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
,B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: C
Rationale: The mesolimbic pathway involves dopamine projections from the ventral
tegmental area to the nucleus accumbens. Hyperactivity in this specific pathway is
clinically associated with the positive symptoms of psychosis. Most antipsychotic
medications aim to reduce dopamine neurotransmission in this area to alleviate these
symptoms.
3. A 28-year-old female patient on Lithium for Bipolar I Disorder expresses a desire to become
pregnant. Which congenital anomaly is most closely associated with Lithium use during the
first trimester?
A. Neural tube defects
B. Spina bifida
C. Cleft palate
D. Ebstein’s anomaly
Answer: D
Rationale: Ebstein’s anomaly is a rare cardiovascular defect characterized by the
downward displacement of the tricuspid valve. While the absolute risk is relatively low, it
,is significantly higher in infants exposed to Lithium in utero compared to the general
population. PMHNPs must engage in thorough risk-benefit discussions and preconception
counseling with female patients of childbearing age.
4. Which medication is considered a partial agonist at the Dopamine D2 receptor and is often
referred to as a ‘dopamine stabilizer’?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Aripiprazole
Answer: D
Rationale: Aripiprazole functions as a partial agonist at D2 receptors, meaning it provides
moderate stimulation where dopamine is low and acts as an antagonist where dopamine is
high. This unique mechanism helps balance dopamine activity across different brain
regions. Consequently, it typically carries a lower risk of extrapyramidal symptoms and
prolactin elevation compared to full antagonists.
5. A patient taking Phenelzine (an MAOI) presents with a severe occipital headache,
palpitations, and a blood pressure of 190/110 mmHg. What is the most likely cause?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Hypertensive Crisis due to tyramine ingestion
, D. Anticholinergic toxicity
Answer: C
Rationale: MAOIs inhibit the breakdown of tyramine in the gut; when high-tyramine foods
(like aged cheese) are consumed, norepinephrine is released massively. This leads to
profound vasoconstriction and a potentially fatal hypertensive crisis. Education on a low-
tyramine diet is a mandatory safety intervention for any patient prescribed an MAOI.
6. What is the primary mechanism of action for Benzodiazepines in treating anxiety?
A. Positive allosteric modulation of the GABA-A receptor
B. Directly opening chloride channels
C. Antagonism of the NMDA receptor
D. Inhibition of Serotonin reuptake
Answer: A
Rationale: Benzodiazepines bind to a specific site on the GABA-A receptor complex,
enhancing the frequency of channel opening in the presence of GABA. This increases the
influx of chloride ions, leading to hyperpolarization of the neuron and reduced excitability.
This mechanism underlies their sedative, anxiolytic, and anticonvulsant properties.
7. Which side effect of Clozapine requires mandatory weekly blood monitoring for the first six
months of treatment?
A. Hepatotoxicity
