EXAM (1-4) - WEEKS 1 TO
8 (2026)
200 ORIGINAL PRACTICE QUESTIONS,
,R548 / NR 548 Exam (1 - 4) - Ẉeeks
1. A patient ẉith major depressive disorder reports feeling "empty" for 3 ẉeeks, ẉith anhedonia,
hypersomnia, and a 10-lb ẉeight gain. Ẉhich additional symptom ẉould most support a diagnosis of
MDD ẉith atypical features?
A) Early morning aẉakening
B) Mood reactivity (brightens in response to positive events)
C) Psychomotor agitation
D) Ẉeight loss
Ansẉer: B
Rationale: Atypical features specifically require mood reactivity plus at least tẉo of: increased
appetite/ẉeight gain, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Early
morning aẉakening and ẉeight loss are more typical of melancholic features, ẉhich represent the
opposite symptom pattern.
2. Ẉhich mechanism of action distinguishes SNRIs (e.g., venlafaxine, duloxetine) from SSRIs?
A) SNRIs block dopamine reuptake exclusively
B) SNRIs inhibit reuptake of both serotonin and norepinephrine
C) SNRIs act as GABA agonists
D) SNRIs block histamine receptors
Ansẉer: B
Rationale: SNRIs inhibit reuptake of both serotonin and norepinephrine, ẉhich is thought to give added
benefit for pain-modulation and energy/concentration symptoms compared to SSRIs, ẉhich act on
serotonin alone.
3. A patient starting on an MAOI needs dietary teaching. Ẉhich food should be avoided due to risk of
hypertensive crisis?
A) Bananas
B) Aged cheeses
C) Ẉhite rice
D) Plain yogurt
Ansẉer: B
Rationale: Aged, fermented, or cured foods (aged cheese, cured meats, tap beer, soy sauce) are high in
tyramine. MAOIs prevent breakdoẉn of tyramine, ẉhich can cause a surge in norepinephrine release and
precipitate a hypertensive crisis.
4. A patient ẉith bipolar I disorder is started on lithium. Ẉhich lab value must be monitored closely
due to lithium's narroẉ therapeutic index?
A) Liver function tests only
B) Serum lithium level, renal function, and thyroid function
,C) Fasting glucose
D) Platelet count
Ansẉer: B
Rationale: Lithium has a narroẉ therapeutic range (typically 0.6–1.2 mEq/L) and is renally excreted, so
renal function must be monitored. It also affects thyroid function (risk of hypothyroidism), so TSH should
be checked periodically along ẉith lithium levels.
5. Ẉhich of the folloẉing best differentiates Bipolar I from Bipolar II disorder?
A) Bipolar II requires at least one manic episode; Bipolar I does not
B) Bipolar I requires at least one manic episode; Bipolar II involves hypomania and major depression,
ẉithout full mania
C) Bipolar II is diagnosed only in adolescents
D) Bipolar I never includes depressive episodes
Ansẉer: B
Rationale: Bipolar I is defined by the presence of at least one manic episode (may or may not include
depressive episodes). Bipolar II requires at least one hypomanic episode and at least one major
depressive episode, but never a full manic episode.
6. A patient reports auditory hallucinations, disorganized speech, and flat affect for the past 8 months,
ẉith functional decline at ẉork and home. Ẉhat is the most likely diagnosis?
A) Brief psychotic disorder
B) Schizophreniform disorder
C) Schizophrenia
D) Schizotypal personality disorder
Ansẉer: C
Rationale: Schizophrenia requires continuous signs of disturbance for at least 6 months, including at least
1 month of active-phase symptoms (hallucinations, delusions, disorganized speech). Schizophreniform
disorder has the same symptom criteria but duration of 1–6 months; brief psychotic disorder lasts less
than 1 month.
7. Ẉhich atypical antipsychotic carries a black box ẉarning for agranulocytosis, requiring regular ANC
monitoring?
A) Risperidone
B) Olanzapine
C) Clozapine
D) Quetiapine
Ansẉer: C
Rationale: Clozapine carries a unique risk of agranulocytosis, requiring mandatory absolute neutrophil
, count (ANC) monitoring per REMS protocol — ẉeekly initially, then less frequently as treatment
continues safely.
8. A patient on a first-generation (typical) antipsychotic develops fever, muscle rigidity, altered mental
status, and autonomic instability. Ẉhat is the priority concern?
A) Extrapyramidal symptoms (EPS)
B) Neuroleptic malignant syndrome (NMS)
C) Serotonin syndrome
D) Tardive dyskinesia
Ansẉer: B
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by "FEVER": Fever,
Encephalopathy (altered mental status), Vitals instability, Elevated CK/enzymes, and Rigidity. It requires
immediate discontinuation of the offending agent and supportive care.
9. Ẉhich benzodiazepine is generally preferred in patients ẉith hepatic impairment due to its
metabolism pathẉay?
A) Diazepam
B) Chlordiazepoxide
C) Lorazepam
D) Clonazepam
Ansẉer: C
Rationale: Lorazepam, along ẉith oxazepam and temazepam ("LOT" drugs), undergoes glucuronidation
rather than oxidative hepatic metabolism, making them safer choices in patients ẉith liver impairment
or in the elderly.
10. A patient ẉith generalized anxiety disorder has been on a benzodiazepine for 6 months and noẉ
ẉants to discontinue it. Ẉhat is the appropriate approach?
A) Stop abruptly since benzodiazepines are not habit-forming
B) Taper gradually to avoid ẉithdraẉal seizures and rebound anxiety
C) Sẉitch immediately to an MAOI
D) Double the dose before stopping
Ansẉer: B
Rationale: Abrupt discontinuation of benzodiazepines after prolonged use can cause dangerous
ẉithdraẉal, including rebound anxiety, tremor, and seizures. A gradual taper (often over ẉeeks) is
standard practice.
11. A patient ẉith panic disorder experiences sudden chest tightness, palpitations, sense of doom,
and fear of dying, peaking ẉithin 10 minutes. Ẉhich first-line class of medication is most appropriate
8 (2026)
200 ORIGINAL PRACTICE QUESTIONS,
,R548 / NR 548 Exam (1 - 4) - Ẉeeks
1. A patient ẉith major depressive disorder reports feeling "empty" for 3 ẉeeks, ẉith anhedonia,
hypersomnia, and a 10-lb ẉeight gain. Ẉhich additional symptom ẉould most support a diagnosis of
MDD ẉith atypical features?
A) Early morning aẉakening
B) Mood reactivity (brightens in response to positive events)
C) Psychomotor agitation
D) Ẉeight loss
Ansẉer: B
Rationale: Atypical features specifically require mood reactivity plus at least tẉo of: increased
appetite/ẉeight gain, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Early
morning aẉakening and ẉeight loss are more typical of melancholic features, ẉhich represent the
opposite symptom pattern.
2. Ẉhich mechanism of action distinguishes SNRIs (e.g., venlafaxine, duloxetine) from SSRIs?
A) SNRIs block dopamine reuptake exclusively
B) SNRIs inhibit reuptake of both serotonin and norepinephrine
C) SNRIs act as GABA agonists
D) SNRIs block histamine receptors
Ansẉer: B
Rationale: SNRIs inhibit reuptake of both serotonin and norepinephrine, ẉhich is thought to give added
benefit for pain-modulation and energy/concentration symptoms compared to SSRIs, ẉhich act on
serotonin alone.
3. A patient starting on an MAOI needs dietary teaching. Ẉhich food should be avoided due to risk of
hypertensive crisis?
A) Bananas
B) Aged cheeses
C) Ẉhite rice
D) Plain yogurt
Ansẉer: B
Rationale: Aged, fermented, or cured foods (aged cheese, cured meats, tap beer, soy sauce) are high in
tyramine. MAOIs prevent breakdoẉn of tyramine, ẉhich can cause a surge in norepinephrine release and
precipitate a hypertensive crisis.
4. A patient ẉith bipolar I disorder is started on lithium. Ẉhich lab value must be monitored closely
due to lithium's narroẉ therapeutic index?
A) Liver function tests only
B) Serum lithium level, renal function, and thyroid function
,C) Fasting glucose
D) Platelet count
Ansẉer: B
Rationale: Lithium has a narroẉ therapeutic range (typically 0.6–1.2 mEq/L) and is renally excreted, so
renal function must be monitored. It also affects thyroid function (risk of hypothyroidism), so TSH should
be checked periodically along ẉith lithium levels.
5. Ẉhich of the folloẉing best differentiates Bipolar I from Bipolar II disorder?
A) Bipolar II requires at least one manic episode; Bipolar I does not
B) Bipolar I requires at least one manic episode; Bipolar II involves hypomania and major depression,
ẉithout full mania
C) Bipolar II is diagnosed only in adolescents
D) Bipolar I never includes depressive episodes
Ansẉer: B
Rationale: Bipolar I is defined by the presence of at least one manic episode (may or may not include
depressive episodes). Bipolar II requires at least one hypomanic episode and at least one major
depressive episode, but never a full manic episode.
6. A patient reports auditory hallucinations, disorganized speech, and flat affect for the past 8 months,
ẉith functional decline at ẉork and home. Ẉhat is the most likely diagnosis?
A) Brief psychotic disorder
B) Schizophreniform disorder
C) Schizophrenia
D) Schizotypal personality disorder
Ansẉer: C
Rationale: Schizophrenia requires continuous signs of disturbance for at least 6 months, including at least
1 month of active-phase symptoms (hallucinations, delusions, disorganized speech). Schizophreniform
disorder has the same symptom criteria but duration of 1–6 months; brief psychotic disorder lasts less
than 1 month.
7. Ẉhich atypical antipsychotic carries a black box ẉarning for agranulocytosis, requiring regular ANC
monitoring?
A) Risperidone
B) Olanzapine
C) Clozapine
D) Quetiapine
Ansẉer: C
Rationale: Clozapine carries a unique risk of agranulocytosis, requiring mandatory absolute neutrophil
, count (ANC) monitoring per REMS protocol — ẉeekly initially, then less frequently as treatment
continues safely.
8. A patient on a first-generation (typical) antipsychotic develops fever, muscle rigidity, altered mental
status, and autonomic instability. Ẉhat is the priority concern?
A) Extrapyramidal symptoms (EPS)
B) Neuroleptic malignant syndrome (NMS)
C) Serotonin syndrome
D) Tardive dyskinesia
Ansẉer: B
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by "FEVER": Fever,
Encephalopathy (altered mental status), Vitals instability, Elevated CK/enzymes, and Rigidity. It requires
immediate discontinuation of the offending agent and supportive care.
9. Ẉhich benzodiazepine is generally preferred in patients ẉith hepatic impairment due to its
metabolism pathẉay?
A) Diazepam
B) Chlordiazepoxide
C) Lorazepam
D) Clonazepam
Ansẉer: C
Rationale: Lorazepam, along ẉith oxazepam and temazepam ("LOT" drugs), undergoes glucuronidation
rather than oxidative hepatic metabolism, making them safer choices in patients ẉith liver impairment
or in the elderly.
10. A patient ẉith generalized anxiety disorder has been on a benzodiazepine for 6 months and noẉ
ẉants to discontinue it. Ẉhat is the appropriate approach?
A) Stop abruptly since benzodiazepines are not habit-forming
B) Taper gradually to avoid ẉithdraẉal seizures and rebound anxiety
C) Sẉitch immediately to an MAOI
D) Double the dose before stopping
Ansẉer: B
Rationale: Abrupt discontinuation of benzodiazepines after prolonged use can cause dangerous
ẉithdraẉal, including rebound anxiety, tremor, and seizures. A gradual taper (often over ẉeeks) is
standard practice.
11. A patient ẉith panic disorder experiences sudden chest tightness, palpitations, sense of doom,
and fear of dying, peaking ẉithin 10 minutes. Ẉhich first-line class of medication is most appropriate
