NR 546 FINAL EXAM VERSION 1 AND VERSION 2 NEWEST 2026 ACTUAL EXAM
QUESTIONS AND WELL DETAILED ANSWERS/NEWEST UPDATE!!!
Question 1
Which of the following criteria is required for a definitive diagnosis of Bipolar I Disorder?
A) At least one hypomanic episode lasting 4 days.
B) Chronic presentation of hypomanic and depressive symptoms for 2 years.
C) At least one manic episode lasting for at least one week.
D) A current depressive episode with no history of mania.
E) A history of major depressive episodes only.
Correct Answer: C) At least one manic episode lasting for at least one week.
Rationale: According to the diagnostic criteria, Bipolar I requires at least one manic episode
for at least one week (or any duration if hospitalization is required). Bipolar II requires
hypomania and depression, while Cyclothymia involves chronic symptoms that do not meet
full criteria for either. MDD history is common in Bipolar I but the "manic episode" is the
defining requirement.
Question 2
A 22-year-old client presents with a depressed mood and loss of interest. If the PMHNP
incorrectly diagnoses Bipolar Depression as Unipolar Major Depressive Disorder (MDD) and
prescribes antidepressant monotherapy, what is the most significant risk?
A) Severe weight gain and metabolic syndrome.
B) Induction of a manic episode or rapid-cycling.
C) Immediate renal failure.
D) Development of Stevens-Johnson Syndrome.
E) Tardive Dyskinesia.
Correct Answer: B) Induction of a manic episode or rapid-cycling.
Rationale: Prescribing an antidepressant alone (monotherapy) to a client with Bipolar
Disorder can precipitate a manic switch or induce rapid-cycling. Antidepressants should
always be combined with a mood stabilizer in Bipolar clients to prevent this outcome.
Question 3
Which neurotransmitter dysfunction is primarily associated with symptoms of "decreased
positive affect," such as loss of joy, lack of interest, and decreased alertness?
A) Serotonin and GABA.
B) Dopamine and Norepinephrine.
C) Acetylcholine and Histamine.
D) Glutamate and Serotonin.
E) GABA and Dopamine.
Correct Answer: B) Dopamine and Norepinephrine.
Rationale: Dopamine (DA) and Norepinephrine (NE) are linked to the reward and alertness
systems of the brain. Dysfunction in these pathways leads to a decrease in positive affect
, 2
(loss of energy, joy, and alertness). Serotonin (5HT) dysfunction is more strongly linked to
increased "negative affect" (guilt, fear, hostility).
Question 4
Which class of medications is considered the "Last Choice" for the treatment of depression due
to the risk of hypertensive crisis and extensive dietary restrictions?
A) SSRIs
B) SNRIs
C) SARIs
D) MAOIs
E) TCAs
Correct Answer: D) MAOIs
Rationale: Monoamine Oxidase Inhibitors (MAOIs) are considered a last-line treatment
because they inhibit the breakdown of tyramine. Ingestion of tyramine-rich foods while on
an MAOI can lead to a life-threatening hypertensive crisis. They also have significant drug-
drug interactions, specifically with other serotonergic agents.
Question 5
A PMHNP is starting a client on Lithium for Bipolar maintenance. Which of the following is the
correct therapeutic range for chronic treatment?
A) 0.1 to 0.5 mEq/L
B) 0.6 to 1.2 mEq/L
C) 1.0 to 1.5 mEq/L
D) 2.0 to 2.5 mEq/L
E) 5.0 to 10.0 mEq/L
Correct Answer: B) 0.6 to 1.2 mEq/L
Rationale: Lithium has a narrow therapeutic index. For chronic maintenance treatment, the
range is 0.6 to 1.2 mEq/L. For acute treatment of mania, a slightly higher level (1.0 to 1.5
mEq/L) may be utilized. Levels above 1.5 mEq/L are considered toxic.
Question 6
Which SSRI is noted for having the longest half-life, making it a preferred option for clients who
may occasionally forget a dose?
A) Citalopram
B) Escitalopram
C) Fluoxetine
D) Paroxetine
E) Sertraline
Correct Answer: C) Fluoxetine
Rationale: Fluoxetine (Prozac) has the longest half-life of the SSRIs (approximately 2-3 days
, 3
for the parent drug and even longer for its active metabolite). This provides a "built-in"
taper and makes it more forgiving if a client misses a dose.
Question 7
A client prescribed Venlafaxine (Effexor) for MDD and GAD requires which of the following
physical assessments regularly?
A) Liver function tests (LFTs)
B) Serum glucose
C) Blood pressure monitoring
D) Thyroid stimulating hormone (TSH)
E) Intraocular pressure
Correct Answer: C) Blood pressure monitoring
Rationale: Venlafaxine is an SNRI. Increased norepinephrine (NE) levels can lead to dose-
dependent increases in blood pressure. It is a "prescribing pearl" to check blood pressure
before initiating treatment and regularly throughout therapy.
Question 8
Which medication would be most appropriate for a depressed client who is also suffering from
insomnia and significant weight loss?
A) Bupropion
B) Fluoxetine
C) Mirtazapine
D) Venlafaxine
E) Duloxetine
Correct Answer: C) Mirtazapine
Rationale: Mirtazapine (Remeron) has potent antihistamine effects that cause sedation
(useful for insomnia) and increases appetite/weight gain (useful for depression-related
wasting). Bupropion would be inappropriate here as it often causes weight loss and
agitation.
Question 9
What is the mechanism of action for Selective Serotonin Reuptake Inhibitors (SSRIs)?
A) They increase the destruction of serotonin in the synapse.
B) They inhibit the reuptake of 5-HT (Serotonin).
C) They block alpha-2 receptors to boost norepinephrine.
D) They act as dopamine receptor antagonists.
E) They inhibit the monoamine oxidase enzyme in the gut.
Correct Answer: B) They inhibit the reuptake of 5-HT (Serotonin).
Rationale: SSRIs work by specifically blocking the serotonin transporter (SERT),
preventing the reabsorption (reuptake) of serotonin into the presynaptic neuron, thereby
, 4
increasing the amount of serotonin available in the synaptic cleft to bind to postsynaptic
receptors.
Question 10
A client is taking Phenelzine (Nardil). Which of the following food items must be strictly
avoided?
A) Fresh apples and bananas.
B) Smoked meats and aged cheeses.
C) White rice and steamed vegetables.
D) Grilled chicken and pasta.
E) Skim milk and eggs.
Correct Answer: B) Smoked meats and aged cheeses.
Rationale: Phenelzine is an MAOI. Aged or preserved foods (smoked meats, cheeses,
sauerkraut, soy products) contain high levels of tyramine. MAOIs block the enzyme that
breaks down tyramine; excessive tyramine causes a massive release of norepinephrine,
leading to hypertensive crisis.
Question 11
Which medication is a Serotonin Antagonist and Reuptake Inhibitor (SARI) that is commonly
used off-label for insomnia but carries a rare risk of priapism?
A) Mirtazapine
B) Trazodone
C) Duloxetine
D) Vilazodone
E) Vortioxetine
Correct Answer: B) Trazodone
Rationale: Trazodone is a SARI that is very sedating and frequently used for sleep. A rare
but serious medical emergency associated with Trazodone is priapism (prolonged erection).
Clients must be educated to seek immediate emergency care if this occurs.
Question 12
When initiating Valproic Acid (Depakene), which set of laboratory tests is required before
starting treatment?
A) Serum Lithium and TSH.
B) CBC with differential, Coagulation tests, and LFTs.
C) HbA1C and Lipid profile.
D) Renal function (BUN/Creatinine) and Electrolytes.
E) Vitamin B12 and Folate.
Correct Answer: B) CBC with differential, Coagulation tests, and LFTs.
Rationale: Valproic acid can cause hepatotoxicity, liver failure, and thrombocytopenia (low
QUESTIONS AND WELL DETAILED ANSWERS/NEWEST UPDATE!!!
Question 1
Which of the following criteria is required for a definitive diagnosis of Bipolar I Disorder?
A) At least one hypomanic episode lasting 4 days.
B) Chronic presentation of hypomanic and depressive symptoms for 2 years.
C) At least one manic episode lasting for at least one week.
D) A current depressive episode with no history of mania.
E) A history of major depressive episodes only.
Correct Answer: C) At least one manic episode lasting for at least one week.
Rationale: According to the diagnostic criteria, Bipolar I requires at least one manic episode
for at least one week (or any duration if hospitalization is required). Bipolar II requires
hypomania and depression, while Cyclothymia involves chronic symptoms that do not meet
full criteria for either. MDD history is common in Bipolar I but the "manic episode" is the
defining requirement.
Question 2
A 22-year-old client presents with a depressed mood and loss of interest. If the PMHNP
incorrectly diagnoses Bipolar Depression as Unipolar Major Depressive Disorder (MDD) and
prescribes antidepressant monotherapy, what is the most significant risk?
A) Severe weight gain and metabolic syndrome.
B) Induction of a manic episode or rapid-cycling.
C) Immediate renal failure.
D) Development of Stevens-Johnson Syndrome.
E) Tardive Dyskinesia.
Correct Answer: B) Induction of a manic episode or rapid-cycling.
Rationale: Prescribing an antidepressant alone (monotherapy) to a client with Bipolar
Disorder can precipitate a manic switch or induce rapid-cycling. Antidepressants should
always be combined with a mood stabilizer in Bipolar clients to prevent this outcome.
Question 3
Which neurotransmitter dysfunction is primarily associated with symptoms of "decreased
positive affect," such as loss of joy, lack of interest, and decreased alertness?
A) Serotonin and GABA.
B) Dopamine and Norepinephrine.
C) Acetylcholine and Histamine.
D) Glutamate and Serotonin.
E) GABA and Dopamine.
Correct Answer: B) Dopamine and Norepinephrine.
Rationale: Dopamine (DA) and Norepinephrine (NE) are linked to the reward and alertness
systems of the brain. Dysfunction in these pathways leads to a decrease in positive affect
, 2
(loss of energy, joy, and alertness). Serotonin (5HT) dysfunction is more strongly linked to
increased "negative affect" (guilt, fear, hostility).
Question 4
Which class of medications is considered the "Last Choice" for the treatment of depression due
to the risk of hypertensive crisis and extensive dietary restrictions?
A) SSRIs
B) SNRIs
C) SARIs
D) MAOIs
E) TCAs
Correct Answer: D) MAOIs
Rationale: Monoamine Oxidase Inhibitors (MAOIs) are considered a last-line treatment
because they inhibit the breakdown of tyramine. Ingestion of tyramine-rich foods while on
an MAOI can lead to a life-threatening hypertensive crisis. They also have significant drug-
drug interactions, specifically with other serotonergic agents.
Question 5
A PMHNP is starting a client on Lithium for Bipolar maintenance. Which of the following is the
correct therapeutic range for chronic treatment?
A) 0.1 to 0.5 mEq/L
B) 0.6 to 1.2 mEq/L
C) 1.0 to 1.5 mEq/L
D) 2.0 to 2.5 mEq/L
E) 5.0 to 10.0 mEq/L
Correct Answer: B) 0.6 to 1.2 mEq/L
Rationale: Lithium has a narrow therapeutic index. For chronic maintenance treatment, the
range is 0.6 to 1.2 mEq/L. For acute treatment of mania, a slightly higher level (1.0 to 1.5
mEq/L) may be utilized. Levels above 1.5 mEq/L are considered toxic.
Question 6
Which SSRI is noted for having the longest half-life, making it a preferred option for clients who
may occasionally forget a dose?
A) Citalopram
B) Escitalopram
C) Fluoxetine
D) Paroxetine
E) Sertraline
Correct Answer: C) Fluoxetine
Rationale: Fluoxetine (Prozac) has the longest half-life of the SSRIs (approximately 2-3 days
, 3
for the parent drug and even longer for its active metabolite). This provides a "built-in"
taper and makes it more forgiving if a client misses a dose.
Question 7
A client prescribed Venlafaxine (Effexor) for MDD and GAD requires which of the following
physical assessments regularly?
A) Liver function tests (LFTs)
B) Serum glucose
C) Blood pressure monitoring
D) Thyroid stimulating hormone (TSH)
E) Intraocular pressure
Correct Answer: C) Blood pressure monitoring
Rationale: Venlafaxine is an SNRI. Increased norepinephrine (NE) levels can lead to dose-
dependent increases in blood pressure. It is a "prescribing pearl" to check blood pressure
before initiating treatment and regularly throughout therapy.
Question 8
Which medication would be most appropriate for a depressed client who is also suffering from
insomnia and significant weight loss?
A) Bupropion
B) Fluoxetine
C) Mirtazapine
D) Venlafaxine
E) Duloxetine
Correct Answer: C) Mirtazapine
Rationale: Mirtazapine (Remeron) has potent antihistamine effects that cause sedation
(useful for insomnia) and increases appetite/weight gain (useful for depression-related
wasting). Bupropion would be inappropriate here as it often causes weight loss and
agitation.
Question 9
What is the mechanism of action for Selective Serotonin Reuptake Inhibitors (SSRIs)?
A) They increase the destruction of serotonin in the synapse.
B) They inhibit the reuptake of 5-HT (Serotonin).
C) They block alpha-2 receptors to boost norepinephrine.
D) They act as dopamine receptor antagonists.
E) They inhibit the monoamine oxidase enzyme in the gut.
Correct Answer: B) They inhibit the reuptake of 5-HT (Serotonin).
Rationale: SSRIs work by specifically blocking the serotonin transporter (SERT),
preventing the reabsorption (reuptake) of serotonin into the presynaptic neuron, thereby
, 4
increasing the amount of serotonin available in the synaptic cleft to bind to postsynaptic
receptors.
Question 10
A client is taking Phenelzine (Nardil). Which of the following food items must be strictly
avoided?
A) Fresh apples and bananas.
B) Smoked meats and aged cheeses.
C) White rice and steamed vegetables.
D) Grilled chicken and pasta.
E) Skim milk and eggs.
Correct Answer: B) Smoked meats and aged cheeses.
Rationale: Phenelzine is an MAOI. Aged or preserved foods (smoked meats, cheeses,
sauerkraut, soy products) contain high levels of tyramine. MAOIs block the enzyme that
breaks down tyramine; excessive tyramine causes a massive release of norepinephrine,
leading to hypertensive crisis.
Question 11
Which medication is a Serotonin Antagonist and Reuptake Inhibitor (SARI) that is commonly
used off-label for insomnia but carries a rare risk of priapism?
A) Mirtazapine
B) Trazodone
C) Duloxetine
D) Vilazodone
E) Vortioxetine
Correct Answer: B) Trazodone
Rationale: Trazodone is a SARI that is very sedating and frequently used for sleep. A rare
but serious medical emergency associated with Trazodone is priapism (prolonged erection).
Clients must be educated to seek immediate emergency care if this occurs.
Question 12
When initiating Valproic Acid (Depakene), which set of laboratory tests is required before
starting treatment?
A) Serum Lithium and TSH.
B) CBC with differential, Coagulation tests, and LFTs.
C) HbA1C and Lipid profile.
D) Renal function (BUN/Creatinine) and Electrolytes.
E) Vitamin B12 and Folate.
Correct Answer: B) CBC with differential, Coagulation tests, and LFTs.
Rationale: Valproic acid can cause hepatotoxicity, liver failure, and thrombocytopenia (low
