,NR 546 Midterm Exam | Advanced
Psychopharmacology (2026) Q&A | Chamberlain College
1. The PMHNP is teaching a student about language areas. Damage to which brain region
would most likely result in expressive aphasia?
A) Broca's area
B) Wernicke's area
C) Amygdala
D) Thalamus
Correct Answer: A) Broca's area
Rationale: Broca's area, located in the inferior frontal gyrus, governs speech production. A
lesion here causes expressive aphasia with intact comprehension. Wernicke's area damage
causes receptive aphasia. The amygdala processes fear and olfaction; the thalamus relays
sensory information. This distinction is critical for neuropsychiatric assessment.
2. A 58-year-old patient with chronic schizophrenia has been stable on haloperidol for years.
The PMHNP notes involuntary tongue thrusting and lip smacking. Which scale is most
appropriate to assess these movements?
A) Brief Psychiatric Rating Scale
B) Abnormal Involuntary Movement Scale (AIMS)
C) Hamilton Depression Rating Scale
D) Mini-Mental State Examination
Correct Answer: B) Abnormal Involuntary Movement Scale (AIMS)
Rationale: The AIMS is specifically designed to detect and monitor tardive dyskinesia, an
involuntary movement disorder caused by long-term dopamine antagonist use. Other scales
measure psychosis, depression, or cognition but not drug-induced dyskinesias. Regular AIMS
examinations are an evidence-based monitoring standard for patients on antipsychotics.
,3. Which CYP450 enzyme is the most abundant and metabolizes approximately 50% of all
prescribed drugs?
A) CYP2D6
B) CYP2C19
C) CYP3A4
D) CYP1A2
Correct Answer: C) CYP3A4
Rationale: CYP3A4 is the predominant cytochrome P450 enzyme in the liver and intestine,
responsible for metabolizing a vast array of medications, including many psychotropics.
CYP2D6 and CYP2C19 are polymorphic but less quantitatively dominant. CYP1A2 is induced by
smoking. Understanding enzyme prevalence guides drug interaction predictions.
4. A 34-year-old patient with bipolar I disorder is prescribed carbamazepine for mood
stabilization. Carbamazepine is a potent CYP450 inducer. What is the most likely
pharmacokinetic consequence when this patient is also prescribed a drug metabolized by
CYP3A4?
A) Increased plasma levels of the substrate drug
B) Decreased metabolism of carbamazepine
C) Prolonged half-life of the substrate drug
D) Decreased plasma levels and possible reduced efficacy of the substrate drug
Correct Answer: D) Decreased plasma levels and possible reduced efficacy of the substrate
drug
Rationale: CYP450 inducers like carbamazepine accelerate the metabolism of co-administered
substrates, lowering their serum concentrations and potentially causing therapeutic failure.
Dose increases of the affected drug may be needed. The opposite occurs with inhibitors. This
principle is fundamental to avoiding drug interactions in psychiatric polypharmacy.
, 5. A patient who sustained a traumatic brain injury now has difficulty recognizing objects by
touch alone, despite intact sensation. Which lobe of the brain has most likely been damaged?
A) Frontal lobe
B) Temporal lobe
C) Occipital lobe
D) Parietal lobe
Correct Answer: D) Parietal lobe
Rationale: The parietal lobe processes somatosensory information, including stereognosis—
the ability to identify objects by touch. Astereognosis is a classic sign of anterior parietal
damage. The frontal lobe governs executive function, the temporal lobe memory and
language, and the occipital lobe vision, making them less likely responsible.
6. A 26-year-old patient with generalized anxiety disorder has been taking diazepam 10 mg
three times daily for one year. The PMHNP decides to discontinue the benzodiazepine. Which
withdrawal symptom must be monitored most closely?
A) Hypersomnia and weight gain
B) Tremor and rebound anxiety
C) Bradycardia and hypotension
D) Euphoria and increased appetite
Correct Answer: B) Tremor and rebound anxiety
Rationale: Benzodiazepine discontinuation can cause a withdrawal syndrome characterized
by anxiety, tremor, agitation, and, in severe cases, seizures. Tapering slowly mitigates these
symptoms. Hypersomnia and bradycardia are not typical withdrawal manifestations.
Educating patients about the tapering process is essential to prevent relapse and medical
complications.
Psychopharmacology (2026) Q&A | Chamberlain College
1. The PMHNP is teaching a student about language areas. Damage to which brain region
would most likely result in expressive aphasia?
A) Broca's area
B) Wernicke's area
C) Amygdala
D) Thalamus
Correct Answer: A) Broca's area
Rationale: Broca's area, located in the inferior frontal gyrus, governs speech production. A
lesion here causes expressive aphasia with intact comprehension. Wernicke's area damage
causes receptive aphasia. The amygdala processes fear and olfaction; the thalamus relays
sensory information. This distinction is critical for neuropsychiatric assessment.
2. A 58-year-old patient with chronic schizophrenia has been stable on haloperidol for years.
The PMHNP notes involuntary tongue thrusting and lip smacking. Which scale is most
appropriate to assess these movements?
A) Brief Psychiatric Rating Scale
B) Abnormal Involuntary Movement Scale (AIMS)
C) Hamilton Depression Rating Scale
D) Mini-Mental State Examination
Correct Answer: B) Abnormal Involuntary Movement Scale (AIMS)
Rationale: The AIMS is specifically designed to detect and monitor tardive dyskinesia, an
involuntary movement disorder caused by long-term dopamine antagonist use. Other scales
measure psychosis, depression, or cognition but not drug-induced dyskinesias. Regular AIMS
examinations are an evidence-based monitoring standard for patients on antipsychotics.
,3. Which CYP450 enzyme is the most abundant and metabolizes approximately 50% of all
prescribed drugs?
A) CYP2D6
B) CYP2C19
C) CYP3A4
D) CYP1A2
Correct Answer: C) CYP3A4
Rationale: CYP3A4 is the predominant cytochrome P450 enzyme in the liver and intestine,
responsible for metabolizing a vast array of medications, including many psychotropics.
CYP2D6 and CYP2C19 are polymorphic but less quantitatively dominant. CYP1A2 is induced by
smoking. Understanding enzyme prevalence guides drug interaction predictions.
4. A 34-year-old patient with bipolar I disorder is prescribed carbamazepine for mood
stabilization. Carbamazepine is a potent CYP450 inducer. What is the most likely
pharmacokinetic consequence when this patient is also prescribed a drug metabolized by
CYP3A4?
A) Increased plasma levels of the substrate drug
B) Decreased metabolism of carbamazepine
C) Prolonged half-life of the substrate drug
D) Decreased plasma levels and possible reduced efficacy of the substrate drug
Correct Answer: D) Decreased plasma levels and possible reduced efficacy of the substrate
drug
Rationale: CYP450 inducers like carbamazepine accelerate the metabolism of co-administered
substrates, lowering their serum concentrations and potentially causing therapeutic failure.
Dose increases of the affected drug may be needed. The opposite occurs with inhibitors. This
principle is fundamental to avoiding drug interactions in psychiatric polypharmacy.
, 5. A patient who sustained a traumatic brain injury now has difficulty recognizing objects by
touch alone, despite intact sensation. Which lobe of the brain has most likely been damaged?
A) Frontal lobe
B) Temporal lobe
C) Occipital lobe
D) Parietal lobe
Correct Answer: D) Parietal lobe
Rationale: The parietal lobe processes somatosensory information, including stereognosis—
the ability to identify objects by touch. Astereognosis is a classic sign of anterior parietal
damage. The frontal lobe governs executive function, the temporal lobe memory and
language, and the occipital lobe vision, making them less likely responsible.
6. A 26-year-old patient with generalized anxiety disorder has been taking diazepam 10 mg
three times daily for one year. The PMHNP decides to discontinue the benzodiazepine. Which
withdrawal symptom must be monitored most closely?
A) Hypersomnia and weight gain
B) Tremor and rebound anxiety
C) Bradycardia and hypotension
D) Euphoria and increased appetite
Correct Answer: B) Tremor and rebound anxiety
Rationale: Benzodiazepine discontinuation can cause a withdrawal syndrome characterized
by anxiety, tremor, agitation, and, in severe cases, seizures. Tapering slowly mitigates these
symptoms. Hypersomnia and bradycardia are not typical withdrawal manifestations.
Educating patients about the tapering process is essential to prevent relapse and medical
complications.
