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NR509 Finals Practice Questions, Study notes of Nursing

Chamberlain College of NursingNursing

NR509 Finals Practice Questions

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2024/2025

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Midterms and Finals Practice Exams:
Midterms:
Week 1: Foundations of Psychopharmacology (1–10)
1. Which statement best describes the primary goal of psychopharmacology?
A. To modify behavior through environmental changes
B. To use medications that correct neurochemical imbalances contributing to psychiatric
symptoms
C. To eliminate the need for psychotherapy
D. To enhance placebo response rates
2. When initiating pharmacologic treatment, which principle supports individualized
prescribing?
A. Starting all patients on the same therapeutic dose
B. Ignoring pharmacogenetic variations
C. Adjusting medications based on patient-specific metabolism, age, and comorbidities
D. Avoiding baseline labs before prescribing
3. A patient with depression demonstrates partial response to sertraline. Genetic testing
reveals CYP2C19 ultrarapid metabolism. What is the most appropriate action?
A. Increase the dose of sertraline
B. Discontinue sertraline and switch to fluvoxamine
C. Add an enzyme inhibitor
D. Continue the same dose
4. Medication adherence is often improved when the provider:
A. Emphasizes patient autonomy and provides psychoeducation
B. Avoids discussing side effects to reduce anxiety
C. Changes medications frequently
D. Relies solely on digital reminders
5. Informed consent requires the provider to:
A. Ensure the patient has a full understanding of risks, benefits, and alternatives
B. Provide minimal details to prevent anxiety
C. Obtain a signature only when prescribing controlled substances
D. Defer discussion of adverse effects until follow-up
6. A provider prescribes an antidepressant for insomnia and low appetite. This is an
example of:
A. Off-label prescribing
B. Polypharmacy
C. Contraindicated prescribing
D. Compassionate use
7. Which ethical principle is demonstrated when a provider allows a competent patient to
refuse medication?
A. Beneficence
B. Autonomy
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Midterms and Finals Practice Exams: Midterms:

Week 1: Foundations of Psychopharmacology (1–10)

  1. Which statement best describes the primary goal of psychopharmacology? A. To modify behavior through environmental changes B. To use medications that correct neurochemical imbalances contributing to psychiatric symptoms C. To eliminate the need for psychotherapy D. To enhance placebo response rates
  2. When initiating pharmacologic treatment, which principle supports individualized prescribing? A. Starting all patients on the same therapeutic dose B. Ignoring pharmacogenetic variations C. Adjusting medications based on patient-specific metabolism, age, and comorbidities D. Avoiding baseline labs before prescribing
  3. A patient with depression demonstrates partial response to sertraline. Genetic testing reveals CYP2C19 ultrarapid metabolism. What is the most appropriate action? A. Increase the dose of sertraline B. Discontinue sertraline and switch to fluvoxamine C. Add an enzyme inhibitor D. Continue the same dose
  4. Medication adherence is often improved when the provider: A. Emphasizes patient autonomy and provides psychoeducation B. Avoids discussing side effects to reduce anxiety C. Changes medications frequently D. Relies solely on digital reminders
  5. Informed consent requires the provider to: A. Ensure the patient has a full understanding of risks, benefits, and alternatives B. Provide minimal details to prevent anxiety C. Obtain a signature only when prescribing controlled substances D. Defer discussion of adverse effects until follow-up
  6. A provider prescribes an antidepressant for insomnia and low appetite. This is an example of: A. Off-label prescribing B. Polypharmacy C. Contraindicated prescribing D. Compassionate use
  7. Which ethical principle is demonstrated when a provider allows a competent patient to refuse medication? A. Beneficence B. Autonomy

C. Justice D. Nonmaleficence

  1. Identical twins have differing risks for schizophrenia because: A. They have different DNA B. Environmental and epigenetic factors affect gene expression C. One twin experienced trauma, altering serotonin synthesis permanently D. Schizophrenia is not heritable
  2. Which CYP450 enzyme is most involved in psychotropic drug metabolism? A. CYP2D B. CYP3A C. CYP1A D. All of the above
  3. A CYP450 inducer such as carbamazepine will: A. Decrease metabolism of other drugs B. Increase plasma levels of substrates C. Enhance metabolism, leading to reduced drug levels D. Have no effect on other medications

Week 2: Neurotransmission and Drug Metabolism (11–20)

  1. Which neurotransmitter is the primary excitatory transmitter in the CNS? A. GABA B. Dopamine C. Glutamate D. Serotonin
  2. The “wiring” type of neurotransmission refers to: A. Classical synaptic communication between adjacent neurons B. Diffuse signaling across long distances C. Autoreceptor feedback inhibition D. Gene transcription within the nucleus
  3. Which best explains why SSRIs take several weeks for full antidepressant effect? A. They require hepatic activation B. They downregulate postsynaptic receptors and modify signal transduction pathways C. They immediately increase serotonin receptor activity D. They must accumulate in adipose tissue first
  4. A full agonist: A. Produces no effect at the receptor B. Produces maximal receptor activation C. Blocks the effects of endogenous neurotransmitters D. Produces an effect opposite to the natural ligand
  5. A partial agonist acts by: A. Producing less than maximal receptor response even when fully bound
  1. Atypical antipsychotics differ from typicals primarily by: A. Higher risk of EPS B. Combined D2 and 5-HT2A antagonism C. Lack of dopamine receptor action D. Stronger histamine blockade
  2. Which antipsychotic is associated with the lowest risk of weight gain? A. Olanzapine B. Risperidone C. Aripiprazole D. Clozapine
  3. A patient on haloperidol presents with muscle rigidity, hyperthermia, and elevated CK. Diagnosis? A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Akathisia D. Dystonia
  4. First-line antipsychotic for new-onset schizophrenia is: A. Clozapine B. Risperidone C. Ziprasidone D. Haloperidol
  5. Clozapine requires regular monitoring due to risk of: A. Agranulocytosis B. QT prolongation C. Hepatic failure D. Tardive dyskinesia
  6. Which antipsychotic carries the highest risk for hyperprolactinemia? A. Aripiprazole B. Risperidone C. Ziprasidone D. Clozapine
  7. The treatment of tardive dyskinesia involves: A. Benzodiazepines B. VMAT2 inhibitors C. Beta-blockers D. Anticholinergics
  8. Which antipsychotic demonstrates pro-cognitive effects due to partial D2 agonism? A. Haloperidol B. Clozapine C. Brexpiprazole D. Quetiapine

Week 4: Anxiety and Related Disorders (31–40)

  1. The amygdala primarily mediates: A. Long-term memory consolidation B. The fear response C. Executive function D. Hormone secretion
  2. Which neurotransmitter is the chief inhibitory modulator of anxiety? A. Glutamate B. Dopamine C. GABA D. Serotonin
  3. The hypothalamic-pituitary-adrenal (HPA) axis releases: A. Norepinephrine B. Cortisol C. Dopamine D. Melatonin
  4. First-line pharmacologic treatment for generalized anxiety disorder (GAD): A. SSRI B. Benzodiazepine C. Beta-blocker D. Antihistamine
  5. A patient with PTSD continues to have nightmares. Which medication can be added? A. Buspirone B. Prazosin C. Alprazolam D. Trazodone
  6. Which statement about benzodiazepines is true? A. Should be prescribed for long-term maintenance therapy B. Should be tapered gradually to prevent withdrawal C. Are preferred in pregnancy D. Have minimal abuse potential
  7. The recommended tapering rate for benzodiazepines is: A. 50% per day B. 10–20% every 1–2 weeks C. Immediate discontinuation D. Reduce by half every 3 days
  8. Which medication is contraindicated in pregnancy? A. Clonazepam B. Lorazepam C. Diazepam D. Alprazolam
  9. SSRIs should be started at half the usual dose in anxious patients because: A. To avoid serotonin toxicity

21. B

  1. B (provide rationale)
  2. A (provide rationale)
  3. B (provide rationale)
  4. B (provide rationale)
  5. B (provide rationale)
  6. A
  7. B (provide rationale)
  8. D (provide rationale)
  9. C (provide rationale) Week 4
  10. B (provide rationale)
  11. C
  12. B
  13. D (provide rationale)
  14. D (provide rationale)
  15. B
  16. B (provide rationale)
  17. A (provide rationale)
  18. B (provide rationale)
  19. B

✅ Rationales by Question

Week 1 – Foundations of Psychopharmacology

  1. B. Psychopharmacology aims to correct underlying neurochemical imbalances responsible for psychiatric symptoms, not merely alter behavior (Stahl, 2021).
  2. C. Individualized prescribing considers factors like metabolism, age, genetics, and comorbidities to optimize efficacy and minimize risk.
  3. A. Ultrametabolizers of CYP2C19 clear sertraline quickly, so increasing the dose may improve therapeutic response.
  4. A. Psychoeducation and promoting autonomy enhance treatment adherence through collaboration and trust.
  5. A. Informed consent requires discussing risks, benefits, and alternatives to support patient autonomy and ethical standards.
  6. A. Using an antidepressant for insomnia or appetite stimulation (e.g., mirtazapine) is an example of off-label use supported by evidence.
  7. B. Autonomy refers to the patient’s right to make informed choices, even if declining treatment.
  8. B. Epigenetic and environmental factors influence gene expression and risk, explaining differences among identical twins.
  1. D. Many psychotropics are metabolized by multiple CYP450 enzymes (CYP2D6, 3A4, 1A2).
  2. C. Enzyme inducers (like carbamazepine) increase metabolism, reducing drug levels and potentially lowering efficacy.

Week 2 – Neurotransmission and Drug Metabolism

  1. C. Glutamate is the brain’s primary excitatory neurotransmitter, crucial for cognition and memory.
  2. A. “Wiring” transmission describes direct, point-to-point synaptic signaling between adjacent neurons.
  3. B. SSRIs require weeks because neuronal adaptation involves receptor downregulation and intracellular signaling changes.
  4. B. A full agonist fully activates its receptor to produce the maximal biological response.
  5. A. A partial agonist (e.g., aripiprazole) binds to the receptor but elicits only partial activation, stabilizing neurotransmission.
  6. B. Fluvoxamine inhibits CYP450 enzymes, raising levels of co-administered SSRIs and increasing toxicity risk.
  7. B. Retrograde transmission occurs when postsynaptic messengers like endocannabinoids modulate presynaptic neurotransmitter release.
  8. B. G-protein–coupled receptors (metabotropic) activate second-messenger systems to produce longer-lasting effects.
  9. B. Carbamazepine induces CYP450 metabolism, decreasing SSRI plasma concentrations and reducing effectiveness. 20. C. The liver and intestinal wall are primary sites for CYP450 metabolism and first- pass drug clearance.

Week 3 – Schizophrenia and Antipsychotics

  1. B. Overactivity in the mesolimbic pathway produces positive psychotic symptoms such as hallucinations and delusions.
  2. B. The mesocortical pathway is linked to affective and cognitive deficits in schizophrenia due to dopamine hypoactivity.
  3. B. Atypical antipsychotics combine D2 and 5-HT2A receptor antagonism, improving negative symptoms and reducing EPS.
  4. C. Aripiprazole, a partial D2 agonist, has minimal metabolic side effects compared to olanzapine or clozapine.
  5. B. Neuroleptic malignant syndrome (NMS) results from D2 blockade causing rigidity, fever, and autonomic instability.

Finals Week 5

✅ WEEK 5 EXAM: Mood Disorders & Pharmacologic

Treatments

Choose the best answer for each question.

I. Mood Disorders & Neurobiological Basis

  1. Which neurotransmitters are primarily implicated in the monoamine hypothesis of depression? A. Serotonin, norepinephrine, dopamine B. GABA, acetylcholine, histamine C. Glutamate, aspartate, glycine D. Serotonin, GABA, glutamate
  2. Mania in bipolar disorder is thought to be associated with: A. Decreased dopamine activity B. Excessive dopamine and norepinephrine activity C. Reduced glutamate transmission D. Increased serotonin reuptake 3. Which brain region is most associated with anhedonia in major depressive disorder? A. Amygdala B. Striatum C. Prefrontal cortex **D. Thalamus
  3. The monoamine hypothesis primarily fails to explain:** A. Genetic susceptibility to depression B. Rapid onset of antidepressant action C. Delayed antidepressant response D. Neuroplasticity and gene expression changes
  4. Decreased positive affect in depression reflects dysfunction in which neurotransmitter systems? A. Dopamine and norepinephrine B. GABA and glutamate C. Serotonin and histamine D. Acetylcholine and GABA

II. Major Depressive Disorder & SSRIs

  1. Before prescribing an SSRI, the PMHNP should screen for: A. Eating disorders B. Past mania or hypomania C. Obsessive-compulsive traits D. Tobacco use
  2. Which SSRI is least likely to have significant CYP450 interactions? A. Fluoxetine B. Fluvoxamine C. Escitalopram D. Paroxetine
  3. Which SSRI has the longest half-life, reducing discontinuation risk? A. Sertraline B. Citalopram C. Fluoxetine D. Paroxetine 9. Which SSRI carries the highest risk of discontinuation syndrome? A. Escitalopram B. Paroxetine C. Sertraline **D. Fluoxetine
  4. Which SSRI may exacerbate panic or anxiety symptoms initially?** A. Fluoxetine B. Escitalopram C. Paroxetine D. Sertraline

III. Serotonin Syndrome & Adverse Effects

11. Which of the following is not a hallmark feature of serotonin syndrome? A. Hyperreflexia B. Clonus C. Bradycardia **D. Tremor

  1. Combining an SSRI with which substance increases serotonin syndrome risk?** A. Acetaminophen B. St. John’s Wort C. Ibuprofen **D. Nicotine
  2. Which antidepressant is most likely to cause sexual dysfunction?** A. Bupropion

B. Weight loss and insomnia C. Anhedonia and agitation D. Hypertension and anxiety

V. MAOIs & Interactions

21. MAOIs exert their antidepressant effect by: A. Blocking serotonin reuptake B. Inhibiting breakdown of monoamines C. Increasing GABA activity **D. Stimulating dopamine receptors

  1. Which food should be avoided when taking MAOIs?** A. Milk B. Fresh vegetables C. Aged cheese **D. Pasta
  2. The most serious adverse reaction of MAOIs when tyramine is ingested is:** A. Hypoglycemia B. Hypertensive crisis C. Hypotension D. Bradycardia
  3. Selegiline transdermal patch differs from oral MAOIs because: A. It requires tyramine restriction B. It bypasses gut MAO-A inhibition C. It causes more orthostatic hypotension D. It has no dopaminergic effects 25. How long should serotonergic medications be avoided after discontinuing an MAOI? A. 24 hours B. 3 days C. 2 weeks D. 5 half-lives

VI. Bipolar Disorder & Mood Stabilizers

  1. Which medication is the gold standard for treating bipolar disorder? A. Valproate B. Lithium C. Lamotrigine D. Carbamazepine

27. Which laboratory test is essential prior to lithium initiation? A. Liver function tests B. CBC with differential C. Renal and thyroid function **D. Serum glucose

  1. Which substance can increase lithium levels?** A. Caffeine B. NSAIDs C. Theophylline **D. Sodium bicarbonate
  2. Which substance can decrease lithium levels?** A. Thiazide diuretics B. ACE inhibitors C. Theophylline **D. NSAIDs
  3. What is the typical therapeutic serum level for lithium maintenance?** A. 0.1–0.5 mEq/L B. 0.6–1.2 mEq/L C. 1.5–2.5 mEq/L D. 2.0–3.0 mEq/L

VII. Anticonvulsants & SGAs in Bipolar

31. Valproic acid is contraindicated in: A. Elderly patients B. Women of childbearing age C. Patients with migraines **D. Patients with anxiety

  1. Lamotrigine is most effective for:** A. Acute mania B. Bipolar depression prevention C. Rapid cycling D. Mixed episodes 33. A serious adverse effect of lamotrigine is: A. Hepatotoxicity B. Steven-Johnson syndrome C. Weight gain **D. Renal failure
  2. Which second-generation antipsychotic is FDA-approved for bipolar depression?** A. Olanzapine B. Quetiapine C. Ziprasidone D. Risperidone

B. Sertraline C. Escitalopram D. Mirtazapine

42. Which antidepressant is considered safest for geriatric patients? A. Paroxetine B. Fluoxetine C. Sertraline **D. Amitriptyline

  1. QTc prolongation risk is highest with:** A. Escitalopram B. Citalopram C. Fluoxetine D. Bupropion
  2. Which antidepressant is helpful in smoking cessation? A. Sertraline B. Bupropion C. Mirtazapine D. Vilazodone 45. Which antidepressant mimics the pharmacology of an SSRI plus buspirone? A. Vortioxetine B. Vilazodone C. Trazodone D. Nefazodone

X. Advanced & Miscellaneous

46. Which mood stabilizer is associated with polycystic ovarian syndrome (PCOS)? A. Valproate B. Lithium C. Lamotrigine D. Carbamazepine

  1. What is the black box warning for all antidepressants in children and adolescents? A. Hypertension B. Increased risk of suicidality C. Weight gain D. Tardive dyskinesia
  2. Which drug class should never be used as monotherapy in bipolar disorder due to mania risk? A. SSRIs B. SGAs C. Anticonvulsants D. MAOIs

49. The half-life of fluoxetine is important because: A. It reduces dosing frequency B. It increases risk of serotonin syndrome C. It causes sedation D. It enhances discontinuation syndrome

  1. Which drug combination is contraindicated due to serotonin syndrome risk? A. SSRI + Trazodone B. SSRI + MAOI C. SSRI + Bupropion D. SSRI + Lithium

XI. Case-Based Scenarios

51. A 25-year-old reports fatigue, hypersomnia, and weight gain. The best initial antidepressant is: A. Paroxetine B. Mirtazapine C. Bupropion D. Fluoxetine

  1. A patient with MDD and neuropathic pain might benefit most from: A. Sertraline B. Duloxetine C. Citalopram D. Vilazodone
  2. A bipolar patient on lithium presents with tremors, nausea, and confusion. First step? A. Continue dose B. Check lithium level C. Add benzodiazepine D. Increase salt intake 54. A patient develops rash 3 weeks after starting lamotrigine. Next step: A. Stop immediately B. Reduce dose C. Continue and monitor **D. Add antihistamine
  3. A patient on fluoxetine wants to stop abruptly. The PMHNP explains:** A. No taper needed due to long half-life B. Stop immediately to avoid serotonin syndrome C. Taper over 1 week D. Add another SSRI
  4. A 70-year-old woman with depression and insomnia: A. Mirtazapine at bedtime B. Fluoxetine in morning

✅ WEEK 6 COMPREHENSIVE EXAM

Topic: Substance Use Disorders, MAT, Reward Pathways, and Impulsivity–Compulsivity Format: Chamberlain PMHNP Midterm/Final Style (Board-prep format)

QUESTIONS

1. Which neurotransmitter plays the most significant role in the brain’s reward pathway associated with substance use? A. Serotonin B. Dopamine C. Acetylcholine D. GABA 2. The mesolimbic dopamine pathway begins in which brain structure? A. Amygdala B. Hippocampus C. Ventral tegmental area (VTA) D. Nucleus accumbens 3. Chronic substance use causes tolerance primarily by: A. Increasing dopamine receptor sensitivity B. Decreasing dopamine receptor sensitivity C. Increasing serotonin reuptake D. Inhibiting glutamate release 4. A client using opioids presents with pinpoint pupils and respiratory depression. The immediate treatment is: A. Methadone B. Buprenorphine C. Naloxone D. Naltrexone **5. Which of the following medications is used for maintenance treatment in opioid use disorder and can only be dispensed in federally licensed clinics? A. Methadone B. Buprenorphine C. Naltrexone D. Clonidine

  1. A client is beginning buprenorphine therapy for opioid dependence. When should the first dose be administered?**

A. During active intoxication B. Immediately after the last opioid use C. During mild-to-moderate withdrawal D. After 7 days of abstinence

**7. Which MAT agent can precipitate withdrawal if started too soon after opioid use? A. Naltrexone B. Buprenorphine C. Methadone D. Disulfiram

  1. Methadone carries a risk for which potentially fatal adverse effect? A. Agranulocytosis B. QT prolongation C. Hepatic failure D. Stevens–Johnson syndrome 9.** The CIWA-Ar tool is primarily used to assess severity of withdrawal from which substance? A. Opioids B. Alcohol C. Cannabis D. Benzodiazepines 10. Which medication is most appropriate for a patient with alcohol use disorder and hepatic impairment? A. Disulfiram B. Naltrexone C. Acamprosate D. Topiramate **11. A client receiving disulfiram must be counseled to avoid which product? A. Caffeine B. Alcohol-containing mouthwash C. Nicotine gum D. Grapefruit juice
  2. Which neurotransmitter system is most involved in the reinforcing effects of nicotine? A. Glutamate B. Dopamine C. Acetylcholine D. GABA
  3. Which FDA-approved medication assists with nicotine cessation by partial agonism at nicotinic acetylcholine receptors? A. Bupropion**