NR546 / NR 546 Final Exam - Advanced
Pharmacology Psychopharmacology for the PMHNP
2026/2027-Edition Real Exam Questions And 100%
Correct Answers
OVERVIEW OF THIS EXAM:
This comprehensive 250-question final exam review is designed for the Psychiatric-Mental Health
Nurse Practitioner (PMHNP) student in NR546 Advanced Pharmacology Psychopharmacology. It
covers all high-yield domains tested on the final: Antidepressants (SSRIs, SNRIs, TCAs, MAOIs,
atypicals), Antipsychotics (First & Second Generation, mechanisms, EPS, metabolic syndrome),
Mood Stabilizers (Lithium, Valproate, Lamotrigine, Carbamazepine), Anxiolytics &
Sedative-Hypnotics (Benzodiazepines, Buspirone, Z-drugs), ADHD & Stimulants, Substance Use
Disorder Pharmacology (Naltrexone, Buprenorphine, Disulfiram, etc.), Neurotransmitter systems,
Pharmacokinetics/Pharmacodynamics, Drug interactions, Black box warnings, Geriatric, Pediatric,
Pregnancy considerations, and Treatment-resistant strategies.
Format: Each section begins with a subtitle. Each question ends with a question mark (?) for clarity.
Four options (A-D) are provided with the correct answer mixed randomly and highlighted in GREEN.
Directly under the answers, a clear unshaded Rationale explains why the correct answer is right.
SECTION 1: Foundations - Neurotransmitters, Pharmacokinetics &
Pharmacodynamics
1. A patient on sertraline develops agitation, hyperthermia, clonus and diaphoresis after
starting tramadol, what syndrome should you suspect?
A. Anticholinergic toxicity
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Serotonin syndrome
Rationale: Correct answer is D. Serotonin syndrome (in GREEN). SSRIs + tramadol (serotonergic)
increase serotonin. Clonus is hallmark of serotonin syndrome vs rigidity in NMS. The other options are
incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline for
this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and patient
safety.
2. Which SSRI has the longest half-life and is least likely to cause discontinuation syndrome?
A. Sertraline
B. Fluvoxamine
C. Fluoxetine
D. Paroxetine
, Rationale: Correct answer is C. Fluoxetine (in GREEN). Fluoxetine half-life 4-6 days, active metabolite
norfluoxetine up to 16 days, self-tapering effect. The other options are incorrect because they do not match
the mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus on
neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
3. What is the required washout period when switching from fluoxetine to an MAOI?
A. 24 hours
B. 2 weeks
C. 1 week
D. At least 5 weeks
Rationale: Correct answer is D. At least 5 weeks (in GREEN). Fluoxetine long half-life requires 5-week
washout to avoid serotonin syndrome; other antidepressants require 2 weeks. The other options are
incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline for
this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and patient
safety.
4. Which antidepressant is most associated with hypertensive crisis if combined with
tyramine-rich foods?
A. Escitalopram
B. Bupropion
C. Phenelzine
D. Mirtazapine
Rationale: Correct answer is C. Phenelzine (in GREEN). MAOIs like phenelzine inhibit tyramine
breakdown, leading to hypertensive crisis. The other options are incorrect because they do not match the
mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus on
neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
5. Bupropion is contraindicated in which condition?
A. Smoking cessation
B. Adult ADHD
C. Depression with low energy
D. Bulimia nervosa / Anorexia nervosa with seizure risk
Rationale: Correct answer is D. Bulimia nervosa / Anorexia nervosa with seizure risk (in GREEN).
Bupropion lowers seizure threshold, contraindicated in eating disorders and seizure history. The other
options are incorrect because they do not match the mechanism, indication, adverse effect, or monitoring
guideline for this clinical situation. Focus on neurotransmitter targets, black box warnings,
pharmacokinetics, and patient safety.
6. Which medication is best for depression with prominent insomnia and weight loss?
A. Bupropion
B. Venlafaxine
, C. Atomoxetine
D. Mirtazapine
Rationale: Correct answer is D. Mirtazapine (in GREEN). Mirtazapine causes sedation and weight gain via
H1 and 5-HT2C blockade, helpful for insomnia/anorexia. The other options are incorrect because they do
not match the mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus
on neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
7. Venlafaxine discontinuation is most likely to cause what?
A. Hypertension only
B. No withdrawal symptoms
C. Severe discontinuation syndrome with dizziness and electric shocks
D. EPS
Rationale: Correct answer is C. Severe discontinuation syndrome with dizziness and electric shocks
(in GREEN). SNRIs especially venlafaxine have notorious discontinuation syndrome due to short half-life.
The other options are incorrect because they do not match the mechanism, indication, adverse effect, or
monitoring guideline for this clinical situation. Focus on neurotransmitter targets, black box warnings,
pharmacokinetics, and patient safety.
8. A patient on haloperidol develops acute torticollis and oculogyric crisis within 2 days, what
is the best treatment?
A. Increase haloperidol dose
B. Start metformin
C. Benztropine IM and consider prophylaxis
D. Start propranolol
Rationale: Correct answer is C. Benztropine IM and consider prophylaxis (in GREEN). Acute dystonia
is early EPS from D2 blockade, treat with anticholinergic benztropine/diphenhydramine. The other options
are incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline
for this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and
patient safety.
9. Which second-generation antipsychotic carries the highest risk of agranulocytosis and
requires ANC monitoring?
A. Clozapine
B. Risperidone
C. Quetiapine
D. Aripiprazole
Rationale: Correct answer is A. Clozapine (in GREEN). Clozapine requires weekly to monthly ANC due to
1-2% agranulocytosis risk, REMS program. The other options are incorrect because they do not match the
mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus on
neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
, 10. Which antipsychotic has the highest risk of QTc prolongation and sudden cardiac death?
A. Lurasidone
B. Brexpiprazole
C. Ziprasidone and Thioridazine
D. Aripiprazole
Rationale: Correct answer is C. Ziprasidone and Thioridazine (in GREEN). Ziprasidone and first-gen
thioridazine are most QTc prolonging; avoid in cardiac risk. The other options are incorrect because they do
not match the mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus
on neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
11. What lab monitoring is essential for a patient on olanzapine long-term?
A. Only TSH
B. Only ANC
C. Only LFTs
D. BMI, fasting glucose, lipids, HbA1c
Rationale: Correct answer is D. BMI, fasting glucose, lipids, HbA1c (in GREEN). SGAs cause metabolic
syndrome, requires baseline and ongoing metabolic monitoring per ADA guidelines. The other options are
incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline for
this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and patient
safety.
12. Aripiprazole's mechanism is best described as?
A. GABA agonist
B. Pure serotonin reuptake inhibitor
C. Full D2 antagonist
D. Partial agonist at D2 and 5-HT1A, antagonist at 5-HT2A
Rationale: Correct answer is D. Partial agonist at D2 and 5-HT1A, antagonist at 5-HT2A (in GREEN).
Aripiprazole is a D2 partial agonist, reduces psychosis without complete blockade, lower EPS. The other
options are incorrect because they do not match the mechanism, indication, adverse effect, or monitoring
guideline for this clinical situation. Focus on neurotransmitter targets, black box warnings,
pharmacokinetics, and patient safety.
13. What is the therapeutic range for lithium for acute mania?
A. 0.1 - 0.2 mEq/L
B. 0.2 - 0.4 mEq/L
C. 0.8 - 1.2 mEq/L
D. 2.0 - 3.0 mEq/L
Rationale: Correct answer is C. 0.8 - 1.2 mEq/L (in GREEN). Acute mania 0.8-1.2, maintenance 0.6-1.0,
>1.5 toxic. The other options are incorrect because they do not match the mechanism, indication, adverse
effect, or monitoring guideline for this clinical situation. Focus on neurotransmitter targets, black box
warnings, pharmacokinetics, and patient safety.
Pharmacology Psychopharmacology for the PMHNP
2026/2027-Edition Real Exam Questions And 100%
Correct Answers
OVERVIEW OF THIS EXAM:
This comprehensive 250-question final exam review is designed for the Psychiatric-Mental Health
Nurse Practitioner (PMHNP) student in NR546 Advanced Pharmacology Psychopharmacology. It
covers all high-yield domains tested on the final: Antidepressants (SSRIs, SNRIs, TCAs, MAOIs,
atypicals), Antipsychotics (First & Second Generation, mechanisms, EPS, metabolic syndrome),
Mood Stabilizers (Lithium, Valproate, Lamotrigine, Carbamazepine), Anxiolytics &
Sedative-Hypnotics (Benzodiazepines, Buspirone, Z-drugs), ADHD & Stimulants, Substance Use
Disorder Pharmacology (Naltrexone, Buprenorphine, Disulfiram, etc.), Neurotransmitter systems,
Pharmacokinetics/Pharmacodynamics, Drug interactions, Black box warnings, Geriatric, Pediatric,
Pregnancy considerations, and Treatment-resistant strategies.
Format: Each section begins with a subtitle. Each question ends with a question mark (?) for clarity.
Four options (A-D) are provided with the correct answer mixed randomly and highlighted in GREEN.
Directly under the answers, a clear unshaded Rationale explains why the correct answer is right.
SECTION 1: Foundations - Neurotransmitters, Pharmacokinetics &
Pharmacodynamics
1. A patient on sertraline develops agitation, hyperthermia, clonus and diaphoresis after
starting tramadol, what syndrome should you suspect?
A. Anticholinergic toxicity
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Serotonin syndrome
Rationale: Correct answer is D. Serotonin syndrome (in GREEN). SSRIs + tramadol (serotonergic)
increase serotonin. Clonus is hallmark of serotonin syndrome vs rigidity in NMS. The other options are
incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline for
this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and patient
safety.
2. Which SSRI has the longest half-life and is least likely to cause discontinuation syndrome?
A. Sertraline
B. Fluvoxamine
C. Fluoxetine
D. Paroxetine
, Rationale: Correct answer is C. Fluoxetine (in GREEN). Fluoxetine half-life 4-6 days, active metabolite
norfluoxetine up to 16 days, self-tapering effect. The other options are incorrect because they do not match
the mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus on
neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
3. What is the required washout period when switching from fluoxetine to an MAOI?
A. 24 hours
B. 2 weeks
C. 1 week
D. At least 5 weeks
Rationale: Correct answer is D. At least 5 weeks (in GREEN). Fluoxetine long half-life requires 5-week
washout to avoid serotonin syndrome; other antidepressants require 2 weeks. The other options are
incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline for
this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and patient
safety.
4. Which antidepressant is most associated with hypertensive crisis if combined with
tyramine-rich foods?
A. Escitalopram
B. Bupropion
C. Phenelzine
D. Mirtazapine
Rationale: Correct answer is C. Phenelzine (in GREEN). MAOIs like phenelzine inhibit tyramine
breakdown, leading to hypertensive crisis. The other options are incorrect because they do not match the
mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus on
neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
5. Bupropion is contraindicated in which condition?
A. Smoking cessation
B. Adult ADHD
C. Depression with low energy
D. Bulimia nervosa / Anorexia nervosa with seizure risk
Rationale: Correct answer is D. Bulimia nervosa / Anorexia nervosa with seizure risk (in GREEN).
Bupropion lowers seizure threshold, contraindicated in eating disorders and seizure history. The other
options are incorrect because they do not match the mechanism, indication, adverse effect, or monitoring
guideline for this clinical situation. Focus on neurotransmitter targets, black box warnings,
pharmacokinetics, and patient safety.
6. Which medication is best for depression with prominent insomnia and weight loss?
A. Bupropion
B. Venlafaxine
, C. Atomoxetine
D. Mirtazapine
Rationale: Correct answer is D. Mirtazapine (in GREEN). Mirtazapine causes sedation and weight gain via
H1 and 5-HT2C blockade, helpful for insomnia/anorexia. The other options are incorrect because they do
not match the mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus
on neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
7. Venlafaxine discontinuation is most likely to cause what?
A. Hypertension only
B. No withdrawal symptoms
C. Severe discontinuation syndrome with dizziness and electric shocks
D. EPS
Rationale: Correct answer is C. Severe discontinuation syndrome with dizziness and electric shocks
(in GREEN). SNRIs especially venlafaxine have notorious discontinuation syndrome due to short half-life.
The other options are incorrect because they do not match the mechanism, indication, adverse effect, or
monitoring guideline for this clinical situation. Focus on neurotransmitter targets, black box warnings,
pharmacokinetics, and patient safety.
8. A patient on haloperidol develops acute torticollis and oculogyric crisis within 2 days, what
is the best treatment?
A. Increase haloperidol dose
B. Start metformin
C. Benztropine IM and consider prophylaxis
D. Start propranolol
Rationale: Correct answer is C. Benztropine IM and consider prophylaxis (in GREEN). Acute dystonia
is early EPS from D2 blockade, treat with anticholinergic benztropine/diphenhydramine. The other options
are incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline
for this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and
patient safety.
9. Which second-generation antipsychotic carries the highest risk of agranulocytosis and
requires ANC monitoring?
A. Clozapine
B. Risperidone
C. Quetiapine
D. Aripiprazole
Rationale: Correct answer is A. Clozapine (in GREEN). Clozapine requires weekly to monthly ANC due to
1-2% agranulocytosis risk, REMS program. The other options are incorrect because they do not match the
mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus on
neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
, 10. Which antipsychotic has the highest risk of QTc prolongation and sudden cardiac death?
A. Lurasidone
B. Brexpiprazole
C. Ziprasidone and Thioridazine
D. Aripiprazole
Rationale: Correct answer is C. Ziprasidone and Thioridazine (in GREEN). Ziprasidone and first-gen
thioridazine are most QTc prolonging; avoid in cardiac risk. The other options are incorrect because they do
not match the mechanism, indication, adverse effect, or monitoring guideline for this clinical situation. Focus
on neurotransmitter targets, black box warnings, pharmacokinetics, and patient safety.
11. What lab monitoring is essential for a patient on olanzapine long-term?
A. Only TSH
B. Only ANC
C. Only LFTs
D. BMI, fasting glucose, lipids, HbA1c
Rationale: Correct answer is D. BMI, fasting glucose, lipids, HbA1c (in GREEN). SGAs cause metabolic
syndrome, requires baseline and ongoing metabolic monitoring per ADA guidelines. The other options are
incorrect because they do not match the mechanism, indication, adverse effect, or monitoring guideline for
this clinical situation. Focus on neurotransmitter targets, black box warnings, pharmacokinetics, and patient
safety.
12. Aripiprazole's mechanism is best described as?
A. GABA agonist
B. Pure serotonin reuptake inhibitor
C. Full D2 antagonist
D. Partial agonist at D2 and 5-HT1A, antagonist at 5-HT2A
Rationale: Correct answer is D. Partial agonist at D2 and 5-HT1A, antagonist at 5-HT2A (in GREEN).
Aripiprazole is a D2 partial agonist, reduces psychosis without complete blockade, lower EPS. The other
options are incorrect because they do not match the mechanism, indication, adverse effect, or monitoring
guideline for this clinical situation. Focus on neurotransmitter targets, black box warnings,
pharmacokinetics, and patient safety.
13. What is the therapeutic range for lithium for acute mania?
A. 0.1 - 0.2 mEq/L
B. 0.2 - 0.4 mEq/L
C. 0.8 - 1.2 mEq/L
D. 2.0 - 3.0 mEq/L
Rationale: Correct answer is C. 0.8 - 1.2 mEq/L (in GREEN). Acute mania 0.8-1.2, maintenance 0.6-1.0,
>1.5 toxic. The other options are incorrect because they do not match the mechanism, indication, adverse
effect, or monitoring guideline for this clinical situation. Focus on neurotransmitter targets, black box
warnings, pharmacokinetics, and patient safety.
