,NR 546 Advanced Psychopharmacology PMHNP Week 4 | Exam study
Questions and Answers + Rationales | 2026/27 Updates | 100% correct
1. Which of the following is considered a first-line treatment for major depressive disorder
according to NR546 Week 4 content?
A) Monoamine Oxidase Inhibitor (MAOI)
B) Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)
C) Selective Serotonin Reuptake Inhibitor (SSRI)
D) Tricyclic Antidepressant (TCA)
Correct Answer: Selective Serotonin Reuptake Inhibitor (SSRI)
Rationale: SSRIs are considered the first-line pharmacological treatment for depression due to
their favorable side effect profile and efficacy . While SNRIs are also a common choice, SSRIs are
typically the initial agent selected. MAOIs and TCAs are reserved for treatment-resistant cases
due to their side effect burden.
2. The PMHNP is educating a patient starting escitalopram. The patient asks how long it will
take to feel better. Which of the following statements is the most accurate response?
A) "You will feel better immediately after the first dose."
B) "It may take up to 6 weeks before you notice a significant improvement in your depressive
symptoms."
C) "You will only notice side effects, never the therapeutic effect."
D) "The medication takes exactly 10 days to start working."
Correct Answer: "It may take up to 6 weeks before you notice a significant improvement in
your depressive symptoms."
, Rationale: Antidepressants typically have a delayed onset of action, and patients should be
educated that it can take 4-6 weeks to see the full therapeutic effect . This is due to the
downstream effects of signal transduction cascades on gene expression, rather than immediate
neurotransmitter changes.
3. A patient starting sertraline reports an upset stomach and diarrhea on day three of
treatment. What is the most appropriate response from the PMHNP?
A) "Stop taking it immediately and go to the local emergency department."
B) "Most side effects subside after 4-5 days as your body adjusts to increased serotonin
levels."
C) "Start doubling your dose, and your symptoms will ease."
D) "You must take sertraline with food or you will always have GI symptoms."
Correct Answer: "Most side effects subside after 4-5 days as your body adjusts to increased
serotonin levels."
Rationale: Nausea and gastrointestinal upset are common initial side effects of SSRIs due to
serotonin receptor activation in the gut . These side effects often diminish within the first week
of treatment as the body adjusts. Reassurance and supportive care are appropriate.
4. A patient with a long history of depression has been on an SSRI with limited response. The
PMHNP decides to switch to a medication that is a "serotonin antagonist and reuptake
inhibitor" (SARI). Which medication fits this description?
A) Fluoxetine
B) Trazodone
C) Duloxetine
D) Sertraline
Correct Answer: Trazodone
, Rationale: Trazodone is a serotonin antagonist and reuptake inhibitor (SARI). Its action
involves both blocking serotonin receptors (5HT-2A) and inhibiting serotonin reuptake . It is
often used as a sleep adjunct due to its sedating properties.
5. A 70-year-old patient with major depressive disorder reports a recent 40-pound weight loss
within the last 3 months. Which medication should the PMHNP consider adding to the
treatment regimen?
A) Quetiapine
B) Mirtazapine
C) Valproic acid
D) Haloperidol
Correct Answer: Mirtazapine
Rationale: Mirtazapine is an atypical antidepressant with strong histamine H1 receptor
antagonism, which commonly causes increased appetite and weight gain . This property makes
it a beneficial choice for depressed patients experiencing significant weight loss.
6. Which of the following SSRI antidepressants has the shortest half-life and is most likely to
cause discontinuation syndrome if abruptly stopped?
A) Fluoxetine
B) Escitalopram
C) Paroxetine
D) Sertraline
Correct Answer: Paroxetine
Questions and Answers + Rationales | 2026/27 Updates | 100% correct
1. Which of the following is considered a first-line treatment for major depressive disorder
according to NR546 Week 4 content?
A) Monoamine Oxidase Inhibitor (MAOI)
B) Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)
C) Selective Serotonin Reuptake Inhibitor (SSRI)
D) Tricyclic Antidepressant (TCA)
Correct Answer: Selective Serotonin Reuptake Inhibitor (SSRI)
Rationale: SSRIs are considered the first-line pharmacological treatment for depression due to
their favorable side effect profile and efficacy . While SNRIs are also a common choice, SSRIs are
typically the initial agent selected. MAOIs and TCAs are reserved for treatment-resistant cases
due to their side effect burden.
2. The PMHNP is educating a patient starting escitalopram. The patient asks how long it will
take to feel better. Which of the following statements is the most accurate response?
A) "You will feel better immediately after the first dose."
B) "It may take up to 6 weeks before you notice a significant improvement in your depressive
symptoms."
C) "You will only notice side effects, never the therapeutic effect."
D) "The medication takes exactly 10 days to start working."
Correct Answer: "It may take up to 6 weeks before you notice a significant improvement in
your depressive symptoms."
, Rationale: Antidepressants typically have a delayed onset of action, and patients should be
educated that it can take 4-6 weeks to see the full therapeutic effect . This is due to the
downstream effects of signal transduction cascades on gene expression, rather than immediate
neurotransmitter changes.
3. A patient starting sertraline reports an upset stomach and diarrhea on day three of
treatment. What is the most appropriate response from the PMHNP?
A) "Stop taking it immediately and go to the local emergency department."
B) "Most side effects subside after 4-5 days as your body adjusts to increased serotonin
levels."
C) "Start doubling your dose, and your symptoms will ease."
D) "You must take sertraline with food or you will always have GI symptoms."
Correct Answer: "Most side effects subside after 4-5 days as your body adjusts to increased
serotonin levels."
Rationale: Nausea and gastrointestinal upset are common initial side effects of SSRIs due to
serotonin receptor activation in the gut . These side effects often diminish within the first week
of treatment as the body adjusts. Reassurance and supportive care are appropriate.
4. A patient with a long history of depression has been on an SSRI with limited response. The
PMHNP decides to switch to a medication that is a "serotonin antagonist and reuptake
inhibitor" (SARI). Which medication fits this description?
A) Fluoxetine
B) Trazodone
C) Duloxetine
D) Sertraline
Correct Answer: Trazodone
, Rationale: Trazodone is a serotonin antagonist and reuptake inhibitor (SARI). Its action
involves both blocking serotonin receptors (5HT-2A) and inhibiting serotonin reuptake . It is
often used as a sleep adjunct due to its sedating properties.
5. A 70-year-old patient with major depressive disorder reports a recent 40-pound weight loss
within the last 3 months. Which medication should the PMHNP consider adding to the
treatment regimen?
A) Quetiapine
B) Mirtazapine
C) Valproic acid
D) Haloperidol
Correct Answer: Mirtazapine
Rationale: Mirtazapine is an atypical antidepressant with strong histamine H1 receptor
antagonism, which commonly causes increased appetite and weight gain . This property makes
it a beneficial choice for depressed patients experiencing significant weight loss.
6. Which of the following SSRI antidepressants has the shortest half-life and is most likely to
cause discontinuation syndrome if abruptly stopped?
A) Fluoxetine
B) Escitalopram
C) Paroxetine
D) Sertraline
Correct Answer: Paroxetine
