NR 546 FINAL EXAM 2026/2027 |
Questions with Revised Answers | A+
Guarantee | Psychiatric Men
1. A patient presents with anhedonia, fatigue, and feelings of worthlessness for
the past 3 weeks. Which neurotransmitter system is most classically implicated
in the pathophysiology of major depressive disorder?
• A. Dopaminergic
• B. GABAergic
• C. Serotonergic
• D. Glutamatergic
Rationale: The monoamine hypothesis of depression, which is the foundation
for most antidepressant treatments, primarily implicates a deficiency in serotonin
(5-HT), norepinephrine (NE), and/or dopamine (DA). While all are involved, the
serotonergic system is the most classically and heavily targeted.
2. A patient is started on Sertraline for depression. The NP should educate the
patient that the full therapeutic effect may take:
• A. 1-2 days
• B. 1-2 weeks
• C. 4-6 weeks
• D. 3 months
Rationale: While some side effects (like nausea or anxiety) may occur within
days, the full therapeutic benefit of SSRIs for depression typically takes 4-6 weeks
to manifest. This is a crucial point for patient education to prevent premature
discontinuation.
,3. Which of the following is a classic side effect of Selective Serotonin Reuptake
Inhibitors (SSRIs)?
• A. Hypertensive crisis
• B. Sexual dysfunction
• C. Weight loss
• D. Bradycardia
Rationale: Sexual dysfunction (decreased libido, delayed ejaculation,
anorgasmia) is a very common and often distressing side effect of SSRIs due to
their serotonergic activity. It is a leading cause of non-adherence.
4. A patient on an MAOI is given a list of dietary restrictions. Which of the
following foods must be avoided to prevent a hypertensive crisis?
• A. Leafy green vegetables
• B. Aged cheese
• C. Grilled chicken
• D. White rice
Rationale: Aged cheese, cured meats, and fermented products are high in
tyramine. MAOIs prevent the breakdown of tyramine, which can lead to a massive
release of norepinephrine and a hypertensive crisis.
5. Which medication requires regular monitoring of absolute neutrophil count
(ANC) due to the risk of agranulocytosis?
• A. Lithium
• B. Valproic acid
• C. Clozapine
• D. Olanzapine
, Rationale: Clozapine is uniquely associated with a significant risk of severe
neutropenia/agranulocytosis. This requires mandatory, regular ANC monitoring
(weekly for the first 6 months, then biweekly, then monthly).
6. A patient with bipolar I disorder is prescribed Lithium. The NP should educate
the patient on maintaining a consistent intake of:
• A. Potassium
• B. Sodium
• C. Calcium
• D. Magnesium
Rationale: Lithium is a salt and competes with sodium for reabsorption in the
kidneys. A low-sodium diet or dehydration can lead to increased lithium retention
and toxicity. Patients must maintain consistent sodium and fluid intake.
7. The therapeutic range for Lithium in the treatment of acute mania is
generally:
• A. 0.2 - 0.4 mEq/L
• B. 0.6 - 1.2 mEq/L
• C. 1.5 - 2.5 mEq/L
• D. 3.0 - 4.0 mEq/L
Rationale: The therapeutic serum level for lithium is narrow, typically between
0.6 and 1.2 mEq/L for maintenance and acute treatment. Levels above 1.5 mEq/L
are considered toxic.
8. A patient taking Lithium reports coarse hand tremors, vomiting, and
confusion. The NP should suspect:
• A. A manic episode
• B. Lithium toxicity
, • C. Serotonin syndrome
• D. Neuroleptic Malignant Syndrome
Rationale: Coarse tremors, severe GI upset (vomiting, diarrhea), and
neurological symptoms (confusion, ataxia) are classic signs of moderate to severe
lithium toxicity. This is a medical emergency.
9. Which atypical antipsychotic is most associated with significant weight gain
and metabolic syndrome?
• A. Ziprasidone
• B. Aripiprazole
• C. Olanzapine
• D. Lurasidone
Rationale: Olanzapine (and Clozapine) has the highest risk among atypical
antipsychotics for causing significant weight gain, hyperglycemia, and
dyslipidemia. Ziprasidone and Aripiprazole are considered more weight-neutral.
10. A patient presents with a flat affect, avolition, alogia, and social withdrawal.
These are known as:
• A. Positive symptoms
• B. Negative symptoms
• C. Cognitive symptoms
• D. Affective symptoms
Rationale: Negative symptoms refer to a decrease or loss of normal functions.
Avolition (lack of motivation), alogia (poverty of speech), and flat affect are core
negative symptoms of schizophrenia. Positive symptoms are added experiences
(e.g., hallucinations, delusions).
11. Which of the following is a positive symptom of schizophrenia?
Questions with Revised Answers | A+
Guarantee | Psychiatric Men
1. A patient presents with anhedonia, fatigue, and feelings of worthlessness for
the past 3 weeks. Which neurotransmitter system is most classically implicated
in the pathophysiology of major depressive disorder?
• A. Dopaminergic
• B. GABAergic
• C. Serotonergic
• D. Glutamatergic
Rationale: The monoamine hypothesis of depression, which is the foundation
for most antidepressant treatments, primarily implicates a deficiency in serotonin
(5-HT), norepinephrine (NE), and/or dopamine (DA). While all are involved, the
serotonergic system is the most classically and heavily targeted.
2. A patient is started on Sertraline for depression. The NP should educate the
patient that the full therapeutic effect may take:
• A. 1-2 days
• B. 1-2 weeks
• C. 4-6 weeks
• D. 3 months
Rationale: While some side effects (like nausea or anxiety) may occur within
days, the full therapeutic benefit of SSRIs for depression typically takes 4-6 weeks
to manifest. This is a crucial point for patient education to prevent premature
discontinuation.
,3. Which of the following is a classic side effect of Selective Serotonin Reuptake
Inhibitors (SSRIs)?
• A. Hypertensive crisis
• B. Sexual dysfunction
• C. Weight loss
• D. Bradycardia
Rationale: Sexual dysfunction (decreased libido, delayed ejaculation,
anorgasmia) is a very common and often distressing side effect of SSRIs due to
their serotonergic activity. It is a leading cause of non-adherence.
4. A patient on an MAOI is given a list of dietary restrictions. Which of the
following foods must be avoided to prevent a hypertensive crisis?
• A. Leafy green vegetables
• B. Aged cheese
• C. Grilled chicken
• D. White rice
Rationale: Aged cheese, cured meats, and fermented products are high in
tyramine. MAOIs prevent the breakdown of tyramine, which can lead to a massive
release of norepinephrine and a hypertensive crisis.
5. Which medication requires regular monitoring of absolute neutrophil count
(ANC) due to the risk of agranulocytosis?
• A. Lithium
• B. Valproic acid
• C. Clozapine
• D. Olanzapine
, Rationale: Clozapine is uniquely associated with a significant risk of severe
neutropenia/agranulocytosis. This requires mandatory, regular ANC monitoring
(weekly for the first 6 months, then biweekly, then monthly).
6. A patient with bipolar I disorder is prescribed Lithium. The NP should educate
the patient on maintaining a consistent intake of:
• A. Potassium
• B. Sodium
• C. Calcium
• D. Magnesium
Rationale: Lithium is a salt and competes with sodium for reabsorption in the
kidneys. A low-sodium diet or dehydration can lead to increased lithium retention
and toxicity. Patients must maintain consistent sodium and fluid intake.
7. The therapeutic range for Lithium in the treatment of acute mania is
generally:
• A. 0.2 - 0.4 mEq/L
• B. 0.6 - 1.2 mEq/L
• C. 1.5 - 2.5 mEq/L
• D. 3.0 - 4.0 mEq/L
Rationale: The therapeutic serum level for lithium is narrow, typically between
0.6 and 1.2 mEq/L for maintenance and acute treatment. Levels above 1.5 mEq/L
are considered toxic.
8. A patient taking Lithium reports coarse hand tremors, vomiting, and
confusion. The NP should suspect:
• A. A manic episode
• B. Lithium toxicity
, • C. Serotonin syndrome
• D. Neuroleptic Malignant Syndrome
Rationale: Coarse tremors, severe GI upset (vomiting, diarrhea), and
neurological symptoms (confusion, ataxia) are classic signs of moderate to severe
lithium toxicity. This is a medical emergency.
9. Which atypical antipsychotic is most associated with significant weight gain
and metabolic syndrome?
• A. Ziprasidone
• B. Aripiprazole
• C. Olanzapine
• D. Lurasidone
Rationale: Olanzapine (and Clozapine) has the highest risk among atypical
antipsychotics for causing significant weight gain, hyperglycemia, and
dyslipidemia. Ziprasidone and Aripiprazole are considered more weight-neutral.
10. A patient presents with a flat affect, avolition, alogia, and social withdrawal.
These are known as:
• A. Positive symptoms
• B. Negative symptoms
• C. Cognitive symptoms
• D. Affective symptoms
Rationale: Negative symptoms refer to a decrease or loss of normal functions.
Avolition (lack of motivation), alogia (poverty of speech), and flat affect are core
negative symptoms of schizophrenia. Positive symptoms are added experiences
(e.g., hallucinations, delusions).
11. Which of the following is a positive symptom of schizophrenia?
