NR546 PSYCHOPHARMACOLOGY
ADVANCED PRACTICE COMPENDIUM
EXAM QUESTIONS AND ANSWERS
1. A patient with schizophrenia presents with significant negative symptoms and cognitive
impairment. Which dopamine pathway is primarily associated with these clinical
manifestations?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The mesocortical pathway, which projects from the ventral
tegmental area to the prefrontal cortex, is hypothesized to be underactive in schizophrenia,
leading to negative symptoms and cognitive deficits.
,2. Which mechanism best explains why Second-Generation Antipsychotics (SGAs) carry a
lower risk of Extrapyramidal Symptoms (EPS) compared to First-Generation Antipsychotics
(FGAs)?
A. D2 receptor partial agonism
B. 5-HT2A receptor antagonism increasing dopamine in the striatum
C. Potent H1 receptor blockade
D. Rapid dissociation from D3 receptors
Answer: B
Conceptual Explanation: 5-HT2A antagonism in SGAs allows for increased dopamine
release in the nigrostriatal pathway, which competes with D2 blockade, thereby reducing
EPS risk.
3. A PMHNP is considering Clozapine for a treatment-resistant patient. What is the absolute
neutrophil count (ANC) threshold required to initiate Clozapine therapy in a non-benign
ethnic neutropenia (BEN) patient?
A. Greater than or equal to 1,500/µL
B. Greater than or equal to 1,000/µL
C. Greater than or equal to 500/µL
D. Greater than or equal to 2,000/µL
Answer: A
, Conceptual Explanation: For general population patients, the ANC must be 1,500/µL or
greater to start Clozapine to monitor for potential agranulocytosis.
4. Which antidepressant is uniquely characterized as a Norepinephrine-Dopamine Reuptake
Inhibitor (NDRI) and lacks significant serotonergic activity?
A. Venlafaxine
B. Duloxetine
C. Mirtazapine
D. Bupropion
Answer: D
Conceptual Explanation: Bupropion inhibits the reuptake of norepinephrine and
dopamine, making it useful for depression with low energy and avoiding serotonin-related
side effects like sexual dysfunction.
5. Lithium toxicity can be precipitated by several medications. Which of the following is most
likely to increase Lithium levels?
A. Acetaminophen
B. Furosemide
C. Calcium carbonate
D. Lisinopril
Answer: D
ADVANCED PRACTICE COMPENDIUM
EXAM QUESTIONS AND ANSWERS
1. A patient with schizophrenia presents with significant negative symptoms and cognitive
impairment. Which dopamine pathway is primarily associated with these clinical
manifestations?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The mesocortical pathway, which projects from the ventral
tegmental area to the prefrontal cortex, is hypothesized to be underactive in schizophrenia,
leading to negative symptoms and cognitive deficits.
,2. Which mechanism best explains why Second-Generation Antipsychotics (SGAs) carry a
lower risk of Extrapyramidal Symptoms (EPS) compared to First-Generation Antipsychotics
(FGAs)?
A. D2 receptor partial agonism
B. 5-HT2A receptor antagonism increasing dopamine in the striatum
C. Potent H1 receptor blockade
D. Rapid dissociation from D3 receptors
Answer: B
Conceptual Explanation: 5-HT2A antagonism in SGAs allows for increased dopamine
release in the nigrostriatal pathway, which competes with D2 blockade, thereby reducing
EPS risk.
3. A PMHNP is considering Clozapine for a treatment-resistant patient. What is the absolute
neutrophil count (ANC) threshold required to initiate Clozapine therapy in a non-benign
ethnic neutropenia (BEN) patient?
A. Greater than or equal to 1,500/µL
B. Greater than or equal to 1,000/µL
C. Greater than or equal to 500/µL
D. Greater than or equal to 2,000/µL
Answer: A
, Conceptual Explanation: For general population patients, the ANC must be 1,500/µL or
greater to start Clozapine to monitor for potential agranulocytosis.
4. Which antidepressant is uniquely characterized as a Norepinephrine-Dopamine Reuptake
Inhibitor (NDRI) and lacks significant serotonergic activity?
A. Venlafaxine
B. Duloxetine
C. Mirtazapine
D. Bupropion
Answer: D
Conceptual Explanation: Bupropion inhibits the reuptake of norepinephrine and
dopamine, making it useful for depression with low energy and avoiding serotonin-related
side effects like sexual dysfunction.
5. Lithium toxicity can be precipitated by several medications. Which of the following is most
likely to increase Lithium levels?
A. Acetaminophen
B. Furosemide
C. Calcium carbonate
D. Lisinopril
Answer: D
