NR546 PSYCHOPHARMACOLOGY FOR
PMHNP ADVANCED PRACTICE EXAM
PREP
1. Which dopamine pathway is associated with the positive symptoms of schizophrenia and is
the primary target for antipsychotic efficacy?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The mesolimbic pathway involves the projection from the
ventral tegmental area to the nucleus accumbens. Hyperactivity here is linked to positive
symptoms like hallucinations and delusions.
2. A patient taking Clozapine presents with a fever, sore throat, and mouth sores. Which
laboratory finding is the most critical to evaluate immediately?
A. Absolute Neutrophil Count (ANC)
,B. Liver function tests
C. Hemoglobin A1c
D. Serum Clozapine level
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. A
fever and sore throat are signs of infection, necessitating an immediate ANC check to
ensure it hasn’t dropped below safe levels.
3. Which cytochrome P450 enzyme is significantly induced by cigarette smoking, potentially
lowering the serum levels of drugs like olanzapine and clozapine?
A. CYP2D6
B. CYP1A2
C. CYP3A4
D. CYP2C19
Answer: B
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce
CYP1A2. If a patient smokes, higher doses of clozapine or olanzapine may be needed;
conversely, if they quit, levels may rise to toxicity.
, 4. What is the primary mechanism of action for second-generation (atypical) antipsychotics
that distinguishes them from first-generation antipsychotics?
A. Pure D2 receptor antagonism
B. Selective serotonin reuptake inhibition
C. GABA-A receptor modulation
D. D2 antagonism and 5HT2A antagonism
Answer: D
Conceptual Explanation: Second-generation antipsychotics are defined by their ability to
block both D2 receptors and 5HT2A (serotonin) receptors, which helps mitigate
extrapyramidal symptoms and potentially treat negative symptoms.
5. Which mood stabilizer is most strongly associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly if titrated too rapidly?
A. Lithium
B. Valproic Acid
C. Lamotrigine
D. Gabapentin
Answer: C
Conceptual Explanation: Lamotrigine has a black box warning for serious rashes,
including SJS. The risk is minimized by following a very slow titration schedule.
PMHNP ADVANCED PRACTICE EXAM
PREP
1. Which dopamine pathway is associated with the positive symptoms of schizophrenia and is
the primary target for antipsychotic efficacy?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The mesolimbic pathway involves the projection from the
ventral tegmental area to the nucleus accumbens. Hyperactivity here is linked to positive
symptoms like hallucinations and delusions.
2. A patient taking Clozapine presents with a fever, sore throat, and mouth sores. Which
laboratory finding is the most critical to evaluate immediately?
A. Absolute Neutrophil Count (ANC)
,B. Liver function tests
C. Hemoglobin A1c
D. Serum Clozapine level
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. A
fever and sore throat are signs of infection, necessitating an immediate ANC check to
ensure it hasn’t dropped below safe levels.
3. Which cytochrome P450 enzyme is significantly induced by cigarette smoking, potentially
lowering the serum levels of drugs like olanzapine and clozapine?
A. CYP2D6
B. CYP1A2
C. CYP3A4
D. CYP2C19
Answer: B
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce
CYP1A2. If a patient smokes, higher doses of clozapine or olanzapine may be needed;
conversely, if they quit, levels may rise to toxicity.
, 4. What is the primary mechanism of action for second-generation (atypical) antipsychotics
that distinguishes them from first-generation antipsychotics?
A. Pure D2 receptor antagonism
B. Selective serotonin reuptake inhibition
C. GABA-A receptor modulation
D. D2 antagonism and 5HT2A antagonism
Answer: D
Conceptual Explanation: Second-generation antipsychotics are defined by their ability to
block both D2 receptors and 5HT2A (serotonin) receptors, which helps mitigate
extrapyramidal symptoms and potentially treat negative symptoms.
5. Which mood stabilizer is most strongly associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly if titrated too rapidly?
A. Lithium
B. Valproic Acid
C. Lamotrigine
D. Gabapentin
Answer: C
Conceptual Explanation: Lamotrigine has a black box warning for serious rashes,
including SJS. The risk is minimized by following a very slow titration schedule.
