NR 546 Psychopharmacology for PMHNPs – 100-Question
Comprehensive Final Exam Study Guide with Answers &
Rationales
Introduction
,Prepare with confidence for your NR 546 Psychopharmacology for PMHNP final or certification exam
using this comprehensive 100-question practice study guide.
Created to mirror the rigor and clinical reasoning expected of advanced nurse practitioner students, this
resource blends board-style multiple-choice questions with clear, evidence-based rationales to
reinforce psychopharmacologic principles and safe prescribing practices.
1. A 42-year-old woman presents with major depressive disorder. She reports sexual dysfunction after
starting sertraline. Which antidepressant would be the best alternative?
A. Fluoxetine
B. Paroxetine
C. Bupropion
D. Escitalopram
Answer > C. Bupropion
Rationale: Bupropion is a norepinephrine–dopamine reuptake inhibitor that improves energy and has
minimal sexual side effects.
2. A patient stabilized on lithium for bipolar disorder develops hand tremor and nausea. Serum lithium
level is 1.6 mEq/L. What is the best next step?
A. Continue lithium and monitor
B. Hold lithium and recheck level
C. Add propranolol
D. Increase dose
Answer > B. Hold lithium and recheck level
Rationale: Symptoms indicate lithium toxicity; medication should be withheld until level normalizes.
3. Clozapine’s antipsychotic effect primarily results from:
A. Dopamine D2 receptor blockade
B. Dopamine D4 and serotonin 5-HT2A blockade
C. Histamine receptor blockade
D. NMDA antagonism
Answer > B. Dopamine D4 and serotonin 5-HT2A blockade
Rationale: Clozapine has weak D2 affinity but strong D4 and 5-HT2A blockade, explaining its unique
efficacy.
4. A 30-year-old woman taking an MAOI eats aged cheese and develops severe hypertension. What is
the mechanism?
A. Tyramine displaces norepinephrine from storage vesicles
B. Inhibition of dopamine metabolism
, C. Activation of serotonin receptors
D. Increased GABA release
Answer > A. Tyramine displaces norepinephrine from storage vesicles
Rationale: MAOIs prevent breakdown of tyramine, leading to excessive norepinephrine release and
hypertensive crisis.
5. Which antidepressant has the shortest half-life and highest risk of withdrawal?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Escitalopram
Answer > B. Paroxetine
Rationale: Paroxetine’s short half-life and potent serotonin reuptake inhibition cause rapid onset of
discontinuation syndrome.
6. A 35-year-old patient treated with fluoxetine reports anxiety and insomnia after the first few doses.
What is the best initial management?
A. Discontinue medication
B. Add a short-term benzodiazepine
C. Increase the dose
D. Switch to a TCA
Answer > B. Add a short-term benzodiazepine
Rationale: SSRIs may initially increase anxiety via serotonin activation; a temporary benzodiazepine can
help early on.
7. A patient on risperidone develops galactorrhea. What is the cause?
A. Dopamine blockade in mesolimbic pathway
B. Dopamine blockade in tuberoinfundibular pathway
C. Serotonin blockade in cortex
D. Alpha-adrenergic blockade
Answer > B. Dopamine blockade in tuberoinfundibular pathway
Rationale: Dopamine normally inhibits prolactin; blocking it increases prolactin release leading to
galactorrhea.
8. A 24-year-old with depression and chronic pain may benefit most from:
A. Fluoxetine
B. Venlafaxine
C. Sertraline
D. Escitalopram
Comprehensive Final Exam Study Guide with Answers &
Rationales
Introduction
,Prepare with confidence for your NR 546 Psychopharmacology for PMHNP final or certification exam
using this comprehensive 100-question practice study guide.
Created to mirror the rigor and clinical reasoning expected of advanced nurse practitioner students, this
resource blends board-style multiple-choice questions with clear, evidence-based rationales to
reinforce psychopharmacologic principles and safe prescribing practices.
1. A 42-year-old woman presents with major depressive disorder. She reports sexual dysfunction after
starting sertraline. Which antidepressant would be the best alternative?
A. Fluoxetine
B. Paroxetine
C. Bupropion
D. Escitalopram
Answer > C. Bupropion
Rationale: Bupropion is a norepinephrine–dopamine reuptake inhibitor that improves energy and has
minimal sexual side effects.
2. A patient stabilized on lithium for bipolar disorder develops hand tremor and nausea. Serum lithium
level is 1.6 mEq/L. What is the best next step?
A. Continue lithium and monitor
B. Hold lithium and recheck level
C. Add propranolol
D. Increase dose
Answer > B. Hold lithium and recheck level
Rationale: Symptoms indicate lithium toxicity; medication should be withheld until level normalizes.
3. Clozapine’s antipsychotic effect primarily results from:
A. Dopamine D2 receptor blockade
B. Dopamine D4 and serotonin 5-HT2A blockade
C. Histamine receptor blockade
D. NMDA antagonism
Answer > B. Dopamine D4 and serotonin 5-HT2A blockade
Rationale: Clozapine has weak D2 affinity but strong D4 and 5-HT2A blockade, explaining its unique
efficacy.
4. A 30-year-old woman taking an MAOI eats aged cheese and develops severe hypertension. What is
the mechanism?
A. Tyramine displaces norepinephrine from storage vesicles
B. Inhibition of dopamine metabolism
, C. Activation of serotonin receptors
D. Increased GABA release
Answer > A. Tyramine displaces norepinephrine from storage vesicles
Rationale: MAOIs prevent breakdown of tyramine, leading to excessive norepinephrine release and
hypertensive crisis.
5. Which antidepressant has the shortest half-life and highest risk of withdrawal?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Escitalopram
Answer > B. Paroxetine
Rationale: Paroxetine’s short half-life and potent serotonin reuptake inhibition cause rapid onset of
discontinuation syndrome.
6. A 35-year-old patient treated with fluoxetine reports anxiety and insomnia after the first few doses.
What is the best initial management?
A. Discontinue medication
B. Add a short-term benzodiazepine
C. Increase the dose
D. Switch to a TCA
Answer > B. Add a short-term benzodiazepine
Rationale: SSRIs may initially increase anxiety via serotonin activation; a temporary benzodiazepine can
help early on.
7. A patient on risperidone develops galactorrhea. What is the cause?
A. Dopamine blockade in mesolimbic pathway
B. Dopamine blockade in tuberoinfundibular pathway
C. Serotonin blockade in cortex
D. Alpha-adrenergic blockade
Answer > B. Dopamine blockade in tuberoinfundibular pathway
Rationale: Dopamine normally inhibits prolactin; blocking it increases prolactin release leading to
galactorrhea.
8. A 24-year-old with depression and chronic pain may benefit most from:
A. Fluoxetine
B. Venlafaxine
C. Sertraline
D. Escitalopram
