NR 546 Final Exam Chamberlain
Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
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1. A 24-year-old female is initiated on fluoxetine 20 mg for major
depressive disorder. When is the optimal time to evaluate the full
therapeutic response to this medication?
A) 48 hours
B) 1 week
C) 4 to 6 weeks
D) 3 months
Answer: C. Rationale: SSRIs typically require 4 to 6 weeks of
continuous therapy to achieve full therapeutic plasma levels and
receptor downregulation necessary for symptom remission.
2. Which of the following side effects of SSRIs is caused by an
indirect effect on serotonin receptors in the gastrointestinal tract?
A) Weight gain
B) Sexual dysfunction
C) Nausea and GI upset
D) Hyponatremia
Answer: C. Rationale: Serotonin receptors in the GI tract (specifically
5-HT3) are stimulated by SSRIs, leading to nausea and
gastrointestinal distress, which usually resolves after a few weeks.
3. A patient taking phenelzine (Nardil), an MAOI, presents with a
severe headache, stiff neck, and blood pressure of 190/110 mmHg.
Which food is most likely responsible for this hypertensive crisis?
A) Aged cheddar cheese
B) Grapefruit juice
C) Dark chocolate
D) Processed white bread
Answer: A. Rationale: Aged cheeses contain tyramine, which is
normally metabolized by monoamine oxidase (MAO) in the gut.
When MAO is inhibited, tyramine enters the systemic circulation,
,causing a massive release of norepinephrine and a hypertensive
crisis.
4. When prescribing bupropion (Wellbutrin), the PMHNP must screen
the patient for a history of which condition due to a specific black
box warning?
A) Cardiac arrhythmias
B) Seizure disorder
C) Hepatic impairment
D) Hyponatremia
Answer: B. Rationale: Bupropion lowers the seizure threshold and
carries a black box warning for use in patients with seizure
disorders or those at high risk for seizures (e.g., eating disorder
patients, those undergoing abrupt alcohol withdrawal).
5. A patient is switched from fluoxetine to tranylcypromine (PMAOI).
What is the minimum washout period required to prevent serotonin
syndrome?
A) 2 days
B) 7 days
C) 2 weeks
D) 5 weeks
Answer: D. Rationale: Fluoxetine has a long half-life (up to 7 days
for its active metabolite, norfluoxetine). A minimum of 5 weeks
must elapse between discontinuing fluoxetine and starting an MAOI
to avoid serotonin syndrome.
6. Which of the following symptoms is most characteristic of
Serotonin Syndrome?
A) Hyporeflexia and lethargy
B) Hyperreflexia and clonus
C) Mask-like facies and bradykinesia
D) Lead-pipe rigidity and high fever
, Answer: B. Rationale: Serotonin syndrome classically presents with
neuromuscular hyperactivity, including hyperreflexia, clonus
(especially in the lower extremities), agitation, and autonomic
instability.
7. A patient presents with profound muscle rigidity, confusion, and
a temperature of 104°F (40°C) after starting an antipsychotic. The
PMHNP recognizes this as Neuroleptic Malignant Syndrome (NMS).
What is the first intervention?
A) Administer lorazepam IM
B) Discontinue the antipsychotic immediately
C) Prescribe acetaminophen
D) Increase antipsychotic dose to target psychosis
Answer: B. Rationale: NMS is a life-threatening emergency. The
absolute first step is to immediately discontinue the offending
antipsychotic agent and provide supportive medical care.
8. Which antipsychotic medication is most commonly associated
with the highest risk of metabolic syndrome, including significant
weight gain and dyslipidemia?
A) Aripiprazole (Abilify)
B) Ziprasidone (Geodon)
C) Clozapine (Clozaril)
D) Lurasidone (Latuda)
Answer: C. Rationale: Clozapine and olanzapine carry the highest
risk for metabolic side effects, including substantial weight gain,
insulin resistance, and dyslipidemia.
9. A patient on clozapine presents with a fever and sore throat. A
CBC reveals an absolute neutrophil count (ANC) of 1,200/mm³. What
is the appropriate action?
A) Continue the medication and recheck in 1 month
B) Reduce the dose by 50%
C) Interrupt treatment and monitor ANC daily
Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
1. A 24-year-old female is initiated on fluoxetine 20 mg for major
depressive disorder. When is the optimal time to evaluate the full
therapeutic response to this medication?
A) 48 hours
B) 1 week
C) 4 to 6 weeks
D) 3 months
Answer: C. Rationale: SSRIs typically require 4 to 6 weeks of
continuous therapy to achieve full therapeutic plasma levels and
receptor downregulation necessary for symptom remission.
2. Which of the following side effects of SSRIs is caused by an
indirect effect on serotonin receptors in the gastrointestinal tract?
A) Weight gain
B) Sexual dysfunction
C) Nausea and GI upset
D) Hyponatremia
Answer: C. Rationale: Serotonin receptors in the GI tract (specifically
5-HT3) are stimulated by SSRIs, leading to nausea and
gastrointestinal distress, which usually resolves after a few weeks.
3. A patient taking phenelzine (Nardil), an MAOI, presents with a
severe headache, stiff neck, and blood pressure of 190/110 mmHg.
Which food is most likely responsible for this hypertensive crisis?
A) Aged cheddar cheese
B) Grapefruit juice
C) Dark chocolate
D) Processed white bread
Answer: A. Rationale: Aged cheeses contain tyramine, which is
normally metabolized by monoamine oxidase (MAO) in the gut.
When MAO is inhibited, tyramine enters the systemic circulation,
,causing a massive release of norepinephrine and a hypertensive
crisis.
4. When prescribing bupropion (Wellbutrin), the PMHNP must screen
the patient for a history of which condition due to a specific black
box warning?
A) Cardiac arrhythmias
B) Seizure disorder
C) Hepatic impairment
D) Hyponatremia
Answer: B. Rationale: Bupropion lowers the seizure threshold and
carries a black box warning for use in patients with seizure
disorders or those at high risk for seizures (e.g., eating disorder
patients, those undergoing abrupt alcohol withdrawal).
5. A patient is switched from fluoxetine to tranylcypromine (PMAOI).
What is the minimum washout period required to prevent serotonin
syndrome?
A) 2 days
B) 7 days
C) 2 weeks
D) 5 weeks
Answer: D. Rationale: Fluoxetine has a long half-life (up to 7 days
for its active metabolite, norfluoxetine). A minimum of 5 weeks
must elapse between discontinuing fluoxetine and starting an MAOI
to avoid serotonin syndrome.
6. Which of the following symptoms is most characteristic of
Serotonin Syndrome?
A) Hyporeflexia and lethargy
B) Hyperreflexia and clonus
C) Mask-like facies and bradykinesia
D) Lead-pipe rigidity and high fever
, Answer: B. Rationale: Serotonin syndrome classically presents with
neuromuscular hyperactivity, including hyperreflexia, clonus
(especially in the lower extremities), agitation, and autonomic
instability.
7. A patient presents with profound muscle rigidity, confusion, and
a temperature of 104°F (40°C) after starting an antipsychotic. The
PMHNP recognizes this as Neuroleptic Malignant Syndrome (NMS).
What is the first intervention?
A) Administer lorazepam IM
B) Discontinue the antipsychotic immediately
C) Prescribe acetaminophen
D) Increase antipsychotic dose to target psychosis
Answer: B. Rationale: NMS is a life-threatening emergency. The
absolute first step is to immediately discontinue the offending
antipsychotic agent and provide supportive medical care.
8. Which antipsychotic medication is most commonly associated
with the highest risk of metabolic syndrome, including significant
weight gain and dyslipidemia?
A) Aripiprazole (Abilify)
B) Ziprasidone (Geodon)
C) Clozapine (Clozaril)
D) Lurasidone (Latuda)
Answer: C. Rationale: Clozapine and olanzapine carry the highest
risk for metabolic side effects, including substantial weight gain,
insulin resistance, and dyslipidemia.
9. A patient on clozapine presents with a fever and sore throat. A
CBC reveals an absolute neutrophil count (ANC) of 1,200/mm³. What
is the appropriate action?
A) Continue the medication and recheck in 1 month
B) Reduce the dose by 50%
C) Interrupt treatment and monitor ANC daily
