NURS 6630 PSYCHOPHARMACOLOGY
MIDTERM EXAM 2021
Question 1
A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify
the best response made by the psychiatric-mental health nurse practitioner (PMHNP).
Answer: C. “Most medications that work in the brain will result in restoring an imbalance of one
or more neurotransmitters that your body already produces helping to alleviate your symptoms .”
Question 2
Ms. Hill is currently being treated for schizophrenia but has stopped taking her medications due
to some side effects she claims she was experiencing. She presents to the clinic today with
worsening symptoms. She is experiencing anhedonia, agitation, attentional impairment, and
affective blunting. Which one of the symptoms mentioned is considered a positive symptom of
schizophrenia?
Answer: B. Agitation
Question 3
Which statement about neurotransmitters and medications is true?
Answer: D. An imbalance of serotonin has been directly linked to depression. Following the
discovery of this neurotransmitter, pharmacologists were able to develop a well- known drugProzac as the first medication used to restore the balance of serotonin.
Question 4
When an unstable patient asks why it is necessary to add medications to his current regimen, the
PMHNP’s best response would be:
Answer: C. “Many psychiatric illnesses involve several dys-functioning neurotransmitter
systems in the brain. Often, a single medication may only effect one or two of the dysfunctioning systems. The addition of another medication can work with the current medication in
stabilizing multiple neurotransmitter systems and help to alleviate your symptoms.”
Question 5
During gene expression, what must occur prior to a gene being expressed?
Answer: A. Transcription factor must bind to the regulatory region within the cell’s nucleus.
Question 6
While genes have potential to modify behavior, behavior can also modify genes. How do genes
impact this process?
Answer: B. Changes made to proteins lead to changes in behavior.
Question 7
Though medications have the ability to target neurotransmitter release into the synapse by the
presynaptic neuron it is not always necessary. The PMHNP understands that this is because:
Answer: C. Neurotransmitters can spread by diffusion.
Question 8
Why is the cytochrome P450 enzyme system of significance to the PMHNP?
Answer: B. The bioavailability of the medication after it passes through the stomach and liver
can be altered.
Question 9
It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe
and monitor medications. Which of the following statements does the competent PMHNP
identify as true?
Answer: A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants
and antipsychotics.
Question 10
As it relates to G-protein linked receptors, what does the PMHNP understand about medications
that are used in practice?
Answer: A. Most medications that act on G-protein linked receptors have antagonistic traits.
Question 11
The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his
schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the
dose needed to effectively treat his condition:
Answer: A. The patient smokes cigarettes.
Question 12
A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol),
aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the
carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his
next best action is to:
Answer: B. Write an order for a different mood stabilizer
Question 13
A patient recently transferred following a suicide attempt has a history of schizophrenia,
depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin,
and fluoxetine (Prozac). When assessing the psychiatric medications and the reason for
admission, what would be the best course of action for the PMHNP with this client?
Answer: A. Review Amitriptyline (Elavil) level
Question 14
A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and
neurotransmitter serotonin. What is the rationale for prescribing a medication such as this?
Answer: D. To help decrease the amount of serotonin and dopamine
Question 15
The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines
would be beneficial?
Answer: D. “I feel nervous to go outside and be in large crowds.”
Question 16
Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors.
She is curious about the effects of the drug and how it will act on her symptoms. Which
statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s
prescription?
Answer: A. “The drug will have an almost immediate effect.”
Question 17
A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the
PMHNP prescribe to the patient?
Answer: D. Varenicline (Chantix)
Question 18
The PMHNP is caring for a new patient who has been transferred from another office. When
meeting with the new patient, the patient reports, “I feel like I am improving with the
stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of
drug?
Answer: C. Partial agonists
Question 19
A patient presents with frequent episodes of mania. Which statement describes an appropriate
treatment approach for this patient?
Answer: B. “The patient could benefit from an anticonvulsant.”
Question 20
What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in
common?
Answer: A. Ligand-gated ion channels with a pentameric structure
Question 21
Which statement made by the patient suggests the patient will need to be treated with
antipsychotics that target paranoid psychosis?
Answer: D. “I don’t know that I even want to go to that meeting. It doesn’t seem worth it
anymore.”
Question 22
Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin
wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP
selects this agent because of which action it has on patients like Mr. McCullin?
Answer: D. D2 receptors are the primary binding site for dopamine agonists.
Question 23
Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but
occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires
about the use of amphetamines to help with her energy levels. Which response made by the
PMHNP is most appropriate?
Answer: C. “Amphetamines can cause hallucinations, so I would advise against this type of
prescription.”
Question 24
The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment
approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine
hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on
the patient?
Answer: D. The neuroanatomy of dopamine neuronal pathways can explain symptoms of
schizophrenia.
Question 25
A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the
cognitive symptoms of the disease?
Answer: B. Achieving overactivity of the mesocorticol projections to the ventromedial
prefrontal cortex
Question 26
What is accurate about the clinical description of psychosis?
Answer: C. It is a syndrome that can be associated with a number of psychiatric disorders.
Question 27
The PMNHP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors.
This client has begun to develop a common side effect of this medication. What is this side
effect?
Answer: D. Tardive dyskinesia
Question 28
The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the
patient that the patient would be placed on a different antipsychotic agent called an atypical
antipsychotic. What neurotransmitters will this new medication work on?
Answer: A. dopamine and serotonin
Question 29
Which statement made by the PMHNP exemplifies correct teaching of physiological effects in
the body?
Answer: D. D2 partial agonists are associated with increased efficacy in treating positive
symptoms of schizophrenia.
Question 30
Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of
depression. When meeting with the PMHNP, she presents with apathy and withdrawn social
behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer
from this encounter with the patient?
Answer: B. The recent change of a 2nd generation antipsychotic to a conventional one
Question 31
Mrs. Schwartzman is a 52-year-old client with schizophrenia and no established history of
depression. When meeting with the PMHNP, she presents with apathy and withdrawn social
behavior, and she reports a loss of joy from enjoyable activities since starting her new
medication. What does the PMHNP infer from this encounter with the client?
Answer: C. The new medication is blocking D2 receptors in the mesolimbic system
Question 32
The student inquires about antipsychotic medications. Which response by the PMHNP describes
the factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who
take antipsychotics?
Answer: C. D2 receptors that are blocked in the nigrostriatal pathway
Question 33
Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the
PMHNP, he reports positive responses to the medication, stating, “I really feel as though the
effects of my depression are going away.” Which receptor action in antipsychotic medications is
believed to be the most beneficial in producing the effects described by Mr. Gordon?
Answer: A. 5HT2 antagonism
Question 34
Mr. Gordon is a middle-aged client who was started on antidepressant monotherapy for
depression. After beginning this medication, the PMHNP noticed that this client seemed to swing
into a hypomanic episode. What can the PMHNP infer from this behavior change?
Answer: B. He may have bipolar disorder, and the antidepressant has triggered a hypomanic
episode.
Question 35
Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a
new PMHNP, after not getting along well with her previous provider. The new PHMNP is
reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the
PMHNP sees that the former provider last documented “patient had rapid poop out.” What does
the PMHNP infer about the patient’s prescription based on this documentation?
Answer: A. The patient has an unsustained response to antidepressants.
Question 36
The PMHNP recognizes that which patient would be contraindicated for antidepressant
monotherapy?
Answer: B. Patient with a bipolar II designation
Question 37
The PMHNP spends a session with a client and notices behaviors correlating with a potential
manic episode. All of the following are possible manic symptoms the PMHNP could observe
except:
Answer: D. A low self esteem
Question 38
The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP
understand regarding this patient’s response to selective serotonin reuptake inhibitor
(SSRI)/SNRI treatment?
Answer: D. The patient may be less responsive or tolerant to the treatment.
Question 39
Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which
action of norepinephrine will affect Ms. Boeckh’s serotonin levels?
Answer: B. Norepinephrine inhibits 5HT release through a2 receptors.
Question 40
Ms. Boeckh is a 42-year-old client who is taking an antidepressant therapy. The PMHNP
understands that this medication can have substantial food interactions that can cause Ms.
Boeckh to develop a hypertensive crisis. Which antidepressant class is Ms. Boeckh’s medication
in?
Answer: B. MAO inhibitors
Question 41
The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the
PMHNP that he does not understand why his depression has not lifted after being on four
different antidepressants over the course of a year. Which of the following symptoms can be
residual symptoms for patients who do not achieve remission with major depressive disorder?
Answer: A. Low energy, sleep disturbances, and difficulty concentrating.
Question 42
Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true
regarding the action of this medication?
Answer: D. The action at the somatodendritic end of the serotonin neuron may best explain the
therapeutic action of SSRIs.
Question 43
Fluoxetine (Prozac) has been prescribed for a client with depression. Which of the following
statements is true regarding the action of this medication?
Answer: B. Fluoxetine inhibits the serotonin transporter (SERT).
Question 44
The nurse education knows that teaching was effective when one of the students compares
fluvoxamine to sertraline and notes which of the following similarities?
Answer: D. Both have actions at sigma receptors which contribute to both anxiolytic and
antipsychotic effects.
Question 45
A 45 year old female client with allergic rhinitis and normal blood pressure has had no reduction
in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions
are needed when considering phenelzine in treating her depression?
Answer: B. The client will need to minimize dietary intake of foods that are high in tyramine.
Question 46
A 51-year-old female patient presents with symptoms of depression, including lack of motivation
and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of
depression?
Answer: A. Family history of depression, chronic medical conditions, and hormonal changes
Question 47
A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns
that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She
approaches the PMHNP and asks what the next treatment option could be in this seemingly
treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the
following regimen:
Answer: B. SSRI/SNRI plus NDRI
Question 48
A nurse overhears that a client has failed monotherapy with an SSRI and an SNRI. She also
learns that the client has failed dual SSRI + SNRI therapy. The nurse approaches the PMHNP
and asks what treatment options should be considered in this treatment resistant client. The
PMHNP tells the nurse that she will treat the client with the following regimen.
Answer: B. SSRI + NDRI
Question 49
A patient is prescribed fluoxetine but is concerned about the side effects. Which statement
demonstrates accurate patient teaching when discussing the side effects associated with
fluoxetine?
Answer: C. Induction of mania is rare.
Question 50
A client is prescribed fluoxetine but is concerned about side effects. Which statement
demonstrates accurate client teaching when discussing the side effects associated with
fluoxetine?
Answer: C. Sedation is unusual
Question 51
A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses
concern regarding “how she will feel and look” from taking the medicine. Which statement
correctly describes the side effects as a result of taking this medication?
Answer: D. Weight gain is unusual.
Question 52
Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat
his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of
arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40–
50 hours a week as a contractor and “manages his stress” by smoking 3–4 cigarettes a day and
having 8–10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr.
Ruby?
Answer: C. He uses alcohol.
Question 53
A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially
cause anxiety or insomnia, what should the PMHNP do?
Answer: B. Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.
Question 54
A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive
disorder. What does the PMHNP understand about this patient?
Answer: C. The patient has severe renal impairment.
Question 55
The PMHNP understands that which mechanism contributes to a worse tolerability profile for
patients taking tricyclic antidepressants (TCAs)?
Answer: B. Muscarinic M1 receptor blockade causes blurred vision.
Question 56
A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which
statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for
MAO inhibitors?
Answer: A. “You must avoid soy products, such as tofu.”
Question 57
A patient who is prescribed MAO inhibitors asks about whether he can continue taking
pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper
understanding of drug-drug interactions?
Answer: D. “Decongestants should be avoided due to risk of hypertensive crisis.”
Question 58
Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil),
and reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the
PMHNP understand about this patient?
Answer: C. Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking
the 45 mg in three doses.
Question 59
The PMHNP is caring for several patients who present with various symptoms and health issues.
For which patient does the PMHNP prescribe pregabalin (Lyrica)?
Answer: B. Patient with partial seizures
Question 60
Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing
lorazepam (Ativan). What does the PMHNP understand regarding this prescription?
Answer: A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.
Question 61
A patient is being prescribed a sedating antidepressant, but is concerned about weight gain.
Which medication is most likely to be prescribed to addresses the patient’s concerns?
Answer: D. trazadone (Oleptro)
Question 62
A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is
being prescribed a mood stabilizer. What is the appropriate response?
Answer: C. Mood stabilizers can target mania and mania relapse and also reduce symptoms of
bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to
target all four therapeutic actions
Question 63
A client who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is
being prescribed a mood stabilizer. What is the appropriate response?
Answer: C. Mood stabilizers can treat either manic phases or depressive phases of bipolar
disorder.
Question 64
The PMHNP is assessing a client in the emergency room. The client shares that he has been on
lithium for many years. What blood test does the PMHNP order?
Answer: A. Thyroid Stimulating Hormone
Question 65
A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is
unclear about most effective outcomes. Which of the following agents does the PMHNP convey
as having uncertain outcomes?
Answer: B. Gabapentin (Neurontin)
Question 66
A nursing student is seeking clarification on the use of anticonvulsants to treat bipolar depression
and is unclear about which anticonvulsants have the most effective outcomes in treating bipolar
depression. Which of the following anticonvulsants is NOT used for treating bipolar depression?
Answer: B. Gabapentin (Neurontin)
Question 67
The PMHNP is meeting with a new mother who would like to begin taking medication again to
treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP
recognizes that which of the following medications is contraindicated for this patient?
Answer: C. Lithium (Lithobid)
Question 68
The PMHNP is meeting with a new mother who would like to begin taking medication again to
treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP
recognizes that which of the following medications is contraindicated for this client?
Answer: C. Lithium (Lithobid)
Question 69
A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin)
twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is
necessary to wean him off of the Clonazepam (klonopin) the best response is:
Answer: C. Clonazepam (klonopin) was used as an aid to treat your condition while you were
adjusting to citalopram (celexa)
Question 70
During assessment a patient states “Why are you asking me about my heart, I am here for my
head”, the PMHNP’s best response is:
Answer: C. “Chronic conditions such as Lupus can cause an area in your brain to malfunction,
specifically your hippocampus.”
Question 71
There are a number of endocrine reactions that accompany fear. A quick boost of cortisol may
enhance survival when encountering a real but short-term threat. However, chronic elevations in
cortisol can lead to increased medical comorbidities. Which of the following medical conditions
may be related to these persistent cortisol elevations?
Answer: A. Hypertension, obesity, and insulin resistance.
Question 72
The PMHNP understands that the potential of alcohol abuse in the anxious client is higher for the
following reasons:
Answer: A. Alcohol exerts an effect on GABAA receptors.
Question 73
After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which
possible effect?
Answer: A. Seizures.
Question 74
The PMHNP evaluates the patient for “fear conditioning” when he asks:
Answer: D. What makes your fear better?
Question 75
A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands
that he was prescribed this medication for what purpose:
Answer: B. Beta blockers are linked to reconsolidation.
