NR 546 FINAL EXAM VERSION 1 AND VERSION 2 NEWEST
2026/2027 ACTUAL EXAM QUESTIONS AND WELL DETAILED
ANSWERS/NEWEST UPDATE!!
Question 1
A 45-year-old female presents with depressive symptoms including
fatigue, hypersomnia, and increased appetite. She reports these
episodes occur every winter and resolve in spring. Which diagnosis is
most consistent with her presentation?
A) Major Depressive Disorder with Seasonal Pattern
B) Bipolar II Disorder
C) Persistent Depressive Disorder
D) Premenstrual Dysphoric Disorder
E) Disruptive Mood Dysregulation Disorder
Correct Answer: A) Major Depressive Disorder with Seasonal Pattern
Rationale: The specifier "with seasonal pattern" applies when episodes
of depression occur at a specific time of year (typically winter) and
remit during other seasons. The patient's symptoms of hypersomnia
and increased appetite are characteristic of atypical depression, which
is commonly seen in seasonal pattern presentations.
Question 2
A patient with treatment-resistant depression has been on multiple
antidepressants without success. The PMHNP is considering
augmentation therapy. Which augmentation strategy has the strongest
,evidence base for treatment-resistant depression?
A) Lithium augmentation
B) Thyroid hormone augmentation
C) Buspirone augmentation
D) Omega-3 fatty acid augmentation
E) Vitamin D augmentation
Correct Answer: A) Lithium augmentation
Rationale: Lithium augmentation of antidepressants is one of the best-
evidenced strategies for treatment-resistant depression. Multiple
randomized controlled trials support its efficacy in augmenting
antidepressant response in patients who have failed monotherapy.
Question 3
Which cytochrome P450 enzyme is primarily responsible for the
metabolism of fluoxetine?
A) CYP1A2
B) CYP2C9
C) CYP2D6
D) CYP3A4
E) CYP2C19
Correct Answer: C) CYP2D6
Rationale: Fluoxetine is metabolized primarily by CYP2D6 to its active
metabolite norfluoxetine. CYP2D6 is a highly polymorphic enzyme, and
genetic variations can significantly affect fluoxetine metabolism, leading
to variable therapeutic responses and side effect profiles.
,Question 4
A 28-year-old male with Bipolar I Disorder is experiencing acute mania
with psychotic features. He has a history of non-adherence to
medications. Which medication would be most appropriate for rapid
control of acute manic symptoms?
A) Lithium carbonate
B) Valproic acid
C) Aripiprazole
D) Quetiapine
E) Lamotrigine
Correct Answer: D) Quetiapine
Rationale: Quetiapine has demonstrated efficacy for acute mania and is
available in an immediate-release formulation that can be rapidly
titrated to achieve therapeutic effect. Antipsychotics generally work
faster than lithium or valproate for acute mania, especially when
psychotic features are present.
Question 5
What is the primary mechanism of action for buspirone?
A) Full 5-HT1A receptor agonist
B) Partial 5-HT1A receptor agonist
C) 5-HT2A receptor antagonist
D) D2 receptor antagonist
E) GABA-A receptor positive modulator
Correct Answer: B) Partial 5-HT1A receptor agonist
Rationale: Buspirone acts as a partial agonist at serotonin 5-HT1A
receptors. It has no significant affinity for benzodiazepine receptors and
, does not cause sedation, cognitive impairment, or dependence. Its
efficacy in generalized anxiety disorder is well-established.
Question 6
A patient on clozapine develops fever, tachycardia, and confusion. Lab
results show elevated creatine phosphokinase (CPK). What is the most
likely diagnosis?
A) Neuroleptic Malignant Syndrome
B) Serotonin Syndrome
C) Clozapine-induced myocarditis
D) Agranulocytosis
E) Tardive Dyskinesia
Correct Answer: A) Neuroleptic Malignant Syndrome
Rationale: Neuroleptic Malignant Syndrome presents with fever, muscle
rigidity, altered mental status, and autonomic instability. Elevated CPK is
a hallmark finding. Clozapine, like other antipsychotics, can cause NMS,
though it is less commonly associated with it than high-potency typical
antipsychotics.
Question 7
Which laboratory value must be monitored closely when a patient is
taking carbamazepine?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
E) Serum phosphorus
2026/2027 ACTUAL EXAM QUESTIONS AND WELL DETAILED
ANSWERS/NEWEST UPDATE!!
Question 1
A 45-year-old female presents with depressive symptoms including
fatigue, hypersomnia, and increased appetite. She reports these
episodes occur every winter and resolve in spring. Which diagnosis is
most consistent with her presentation?
A) Major Depressive Disorder with Seasonal Pattern
B) Bipolar II Disorder
C) Persistent Depressive Disorder
D) Premenstrual Dysphoric Disorder
E) Disruptive Mood Dysregulation Disorder
Correct Answer: A) Major Depressive Disorder with Seasonal Pattern
Rationale: The specifier "with seasonal pattern" applies when episodes
of depression occur at a specific time of year (typically winter) and
remit during other seasons. The patient's symptoms of hypersomnia
and increased appetite are characteristic of atypical depression, which
is commonly seen in seasonal pattern presentations.
Question 2
A patient with treatment-resistant depression has been on multiple
antidepressants without success. The PMHNP is considering
augmentation therapy. Which augmentation strategy has the strongest
,evidence base for treatment-resistant depression?
A) Lithium augmentation
B) Thyroid hormone augmentation
C) Buspirone augmentation
D) Omega-3 fatty acid augmentation
E) Vitamin D augmentation
Correct Answer: A) Lithium augmentation
Rationale: Lithium augmentation of antidepressants is one of the best-
evidenced strategies for treatment-resistant depression. Multiple
randomized controlled trials support its efficacy in augmenting
antidepressant response in patients who have failed monotherapy.
Question 3
Which cytochrome P450 enzyme is primarily responsible for the
metabolism of fluoxetine?
A) CYP1A2
B) CYP2C9
C) CYP2D6
D) CYP3A4
E) CYP2C19
Correct Answer: C) CYP2D6
Rationale: Fluoxetine is metabolized primarily by CYP2D6 to its active
metabolite norfluoxetine. CYP2D6 is a highly polymorphic enzyme, and
genetic variations can significantly affect fluoxetine metabolism, leading
to variable therapeutic responses and side effect profiles.
,Question 4
A 28-year-old male with Bipolar I Disorder is experiencing acute mania
with psychotic features. He has a history of non-adherence to
medications. Which medication would be most appropriate for rapid
control of acute manic symptoms?
A) Lithium carbonate
B) Valproic acid
C) Aripiprazole
D) Quetiapine
E) Lamotrigine
Correct Answer: D) Quetiapine
Rationale: Quetiapine has demonstrated efficacy for acute mania and is
available in an immediate-release formulation that can be rapidly
titrated to achieve therapeutic effect. Antipsychotics generally work
faster than lithium or valproate for acute mania, especially when
psychotic features are present.
Question 5
What is the primary mechanism of action for buspirone?
A) Full 5-HT1A receptor agonist
B) Partial 5-HT1A receptor agonist
C) 5-HT2A receptor antagonist
D) D2 receptor antagonist
E) GABA-A receptor positive modulator
Correct Answer: B) Partial 5-HT1A receptor agonist
Rationale: Buspirone acts as a partial agonist at serotonin 5-HT1A
receptors. It has no significant affinity for benzodiazepine receptors and
, does not cause sedation, cognitive impairment, or dependence. Its
efficacy in generalized anxiety disorder is well-established.
Question 6
A patient on clozapine develops fever, tachycardia, and confusion. Lab
results show elevated creatine phosphokinase (CPK). What is the most
likely diagnosis?
A) Neuroleptic Malignant Syndrome
B) Serotonin Syndrome
C) Clozapine-induced myocarditis
D) Agranulocytosis
E) Tardive Dyskinesia
Correct Answer: A) Neuroleptic Malignant Syndrome
Rationale: Neuroleptic Malignant Syndrome presents with fever, muscle
rigidity, altered mental status, and autonomic instability. Elevated CPK is
a hallmark finding. Clozapine, like other antipsychotics, can cause NMS,
though it is less commonly associated with it than high-potency typical
antipsychotics.
Question 7
Which laboratory value must be monitored closely when a patient is
taking carbamazepine?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
E) Serum phosphorus
