1|Page
NR 546 FINAL EXAM (2025–2026) ADVANCED PHARMACOLOGY
– PSYCHOPHARMACOLOGY PMHNP | 120 QUESTIONS WITH
100% CORRECT ANSWERS & RATIONALES ALREADY GRADED
A+
1. A 42-year-old patient with major depressive disorder has failed two SSRI
trials. The provider considers switching to venlafaxine. Which
pharmacological mechanism gives venlafaxine an advantage in treatment-
resistant depression?
A. Pure serotonin reuptake inhibition
B. Dual serotonin and norepinephrine reuptake inhibition
C. Dopamine receptor blockade
D. GABA-A receptor potentiation
Correct Answer: B
Rationale: Venlafaxine is an SNRI, targeting both serotonin and
norepinephrine reuptake, which is beneficial in patients not responding to
SSRIs.
2. A patient with schizophrenia develops tardive dyskinesia after long-term
antipsychotic use. Which agent is most appropriate for treatment?
,2|Page
A. Clozapine
B. Valbenazine
C. Haloperidol
D. Fluoxetine
Correct Answer: B
Rationale: Valbenazine, a VMAT2 inhibitor, is FDA-approved for tardive
dyskinesia. Clozapine may help but is not first-line.
3. A 29-year-old woman with bipolar disorder is prescribed lithium. Which
lab monitoring is essential during long-term treatment?
A. Liver function tests
B. Renal function and thyroid function tests
C. Complete blood count only
D. Vitamin D levels
Correct Answer: B
Rationale: Lithium can cause nephrotoxicity and hypothyroidism, requiring
regular monitoring of renal and thyroid function.
4. A 65-year-old patient with generalized anxiety disorder is prescribed
buspirone. Which property distinguishes it from benzodiazepines?
A. Rapid onset of action
B. Risk of physical dependence
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C. Partial agonism at serotonin 5-HT1A receptors
D. Potentiation of GABAergic activity
Correct Answer: C
Rationale: Buspirone is a 5-HT1A partial agonist with delayed onset and
minimal risk of dependence compared to benzodiazepines.
5. A patient is prescribed fluoxetine and reports new-onset restlessness,
tremor, and diaphoresis. Which condition should the provider suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Hypertensive crisis
Correct Answer: B
Rationale: Serotonin syndrome results from excess serotonergic activity,
often with SSRI use or interactions.
6. A 35-year-old man with alcohol use disorder is prescribed naltrexone.
What is the primary mechanism of action?
A. GABA receptor agonism
B. Mu-opioid receptor antagonism
C. NMDA receptor blockade
D. Dopamine reuptake inhibition
, 4|Page
Correct Answer: B
Rationale: Naltrexone blocks opioid receptors, reducing alcohol cravings
and the reinforcing effects of alcohol.
7. A 41-year-old woman with bipolar disorder reports weight gain and
sedation on olanzapine. Which alternative antipsychotic has lower metabolic
risk?
A. Clozapine
B. Risperidone
C. Ziprasidone
D. Quetiapine
Correct Answer: C
Rationale: Ziprasidone has a lower risk of metabolic side effects compared
to olanzapine and clozapine.
8. A 19-year-old male with ADHD has a history of substance use disorder.
Which medication is the safest option?
A. Methylphenidate
B. Amphetamine salts
C. Atomoxetine
D. Lisdexamfetamine
NR 546 FINAL EXAM (2025–2026) ADVANCED PHARMACOLOGY
– PSYCHOPHARMACOLOGY PMHNP | 120 QUESTIONS WITH
100% CORRECT ANSWERS & RATIONALES ALREADY GRADED
A+
1. A 42-year-old patient with major depressive disorder has failed two SSRI
trials. The provider considers switching to venlafaxine. Which
pharmacological mechanism gives venlafaxine an advantage in treatment-
resistant depression?
A. Pure serotonin reuptake inhibition
B. Dual serotonin and norepinephrine reuptake inhibition
C. Dopamine receptor blockade
D. GABA-A receptor potentiation
Correct Answer: B
Rationale: Venlafaxine is an SNRI, targeting both serotonin and
norepinephrine reuptake, which is beneficial in patients not responding to
SSRIs.
2. A patient with schizophrenia develops tardive dyskinesia after long-term
antipsychotic use. Which agent is most appropriate for treatment?
,2|Page
A. Clozapine
B. Valbenazine
C. Haloperidol
D. Fluoxetine
Correct Answer: B
Rationale: Valbenazine, a VMAT2 inhibitor, is FDA-approved for tardive
dyskinesia. Clozapine may help but is not first-line.
3. A 29-year-old woman with bipolar disorder is prescribed lithium. Which
lab monitoring is essential during long-term treatment?
A. Liver function tests
B. Renal function and thyroid function tests
C. Complete blood count only
D. Vitamin D levels
Correct Answer: B
Rationale: Lithium can cause nephrotoxicity and hypothyroidism, requiring
regular monitoring of renal and thyroid function.
4. A 65-year-old patient with generalized anxiety disorder is prescribed
buspirone. Which property distinguishes it from benzodiazepines?
A. Rapid onset of action
B. Risk of physical dependence
,3|Page
C. Partial agonism at serotonin 5-HT1A receptors
D. Potentiation of GABAergic activity
Correct Answer: C
Rationale: Buspirone is a 5-HT1A partial agonist with delayed onset and
minimal risk of dependence compared to benzodiazepines.
5. A patient is prescribed fluoxetine and reports new-onset restlessness,
tremor, and diaphoresis. Which condition should the provider suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Hypertensive crisis
Correct Answer: B
Rationale: Serotonin syndrome results from excess serotonergic activity,
often with SSRI use or interactions.
6. A 35-year-old man with alcohol use disorder is prescribed naltrexone.
What is the primary mechanism of action?
A. GABA receptor agonism
B. Mu-opioid receptor antagonism
C. NMDA receptor blockade
D. Dopamine reuptake inhibition
, 4|Page
Correct Answer: B
Rationale: Naltrexone blocks opioid receptors, reducing alcohol cravings
and the reinforcing effects of alcohol.
7. A 41-year-old woman with bipolar disorder reports weight gain and
sedation on olanzapine. Which alternative antipsychotic has lower metabolic
risk?
A. Clozapine
B. Risperidone
C. Ziprasidone
D. Quetiapine
Correct Answer: C
Rationale: Ziprasidone has a lower risk of metabolic side effects compared
to olanzapine and clozapine.
8. A 19-year-old male with ADHD has a history of substance use disorder.
Which medication is the safest option?
A. Methylphenidate
B. Amphetamine salts
C. Atomoxetine
D. Lisdexamfetamine
