NR 547 Final Study Guide - PMHNP
Questions And Correct Answers
Course
NR547
1. A patient with major depressive disorder reports depressed mood, anhedonia, fatigue,
poor concentration, and insomnia. Which neurotransmitter system is most commonly
associated with the pathophysiology of depression?
A. Dopamine only
B. Serotonin, norepinephrine, and dopamine
C. Acetylcholine only
D. Glutamate only
Answer: B
Rationale: Depression involves complex neurobiological mechanisms involving serotonin,
norepinephrine, and dopamine pathways, along with changes in neuroplasticity and stress-
response systems. No single neurotransmitter completely explains depression.
2. Which finding is most concerning in a patient taking an SSRI?
A. Mild nausea during the first week
B. Slight headache
C. New suicidal thoughts
D. Mild dry mouth
Answer: C
Rationale: New or worsening suicidal ideation requires prompt assessment and intervention.
Although antidepressants are not considered to cause suicide, some patients—particularly
younger patients—may experience increased suicidal thoughts early in treatment or during
dosage changes.
3. Which medication is considered a first-line pharmacologic treatment for generalized
anxiety disorder?
A. Sertraline
B. Haloperidol
,C. Lithium
D. Benztropine
Answer: A
Rationale: SSRIs such as sertraline are commonly used as first-line treatments for generalized
anxiety disorder. SNRIs are also commonly used. Antipsychotics and mood stabilizers are not
routine first-line treatments for uncomplicated GAD.
4. A patient taking sertraline develops agitation, diaphoresis, diarrhea, hyperreflexia, and
clonus. What should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Answer: B
Rationale: Serotonin syndrome is associated with excessive serotonergic activity. Characteristic
findings include mental-status changes, autonomic instability, gastrointestinal symptoms,
hyperreflexia, and clonus.
5. Which combination presents the greatest concern for serotonin syndrome?
A. Sertraline and another serotonergic medication
B. Acetaminophen and ibuprofen
C. Amoxicillin and acetaminophen
D. Calcium carbonate and vitamin D
Answer: A
Rationale: Combining serotonergic agents can increase serotonin activity and the risk of
serotonin syndrome. Medication reconciliation is therefore essential before adding another
serotonergic drug.
6. Which symptom is characteristic of mania?
A. Decreased need for sleep with increased energy
B. Psychomotor retardation
,C. Persistent hypersomnia
D. Social withdrawal without increased activity
Answer: A
Rationale: Mania may involve elevated or irritable mood, increased energy or activity,
decreased need for sleep, pressured speech, racing thoughts, grandiosity, distractibility, and
risky behavior.
7. A patient with bipolar disorder develops four days of elevated mood, increased energy,
decreased need for sleep, and impulsive spending but remains able to function without
marked impairment. Which episode is most consistent with these findings?
A. Major depressive episode
B. Hypomanic episode
C. Delirium
D. Negative-symptom syndrome
Answer: B
Rationale: Hypomania is a distinct period of elevated, expansive, or irritable mood and
increased activity that is less severe than mania and does not cause the marked functional
impairment or hospitalization characteristic of mania.
8. Which medication requires particularly close monitoring of serum levels, renal function,
thyroid function, and hydration status?
A. Lithium
B. Fluoxetine
C. Buspirone
D. Hydroxyzine
Answer: A
Rationale: Lithium has a narrow therapeutic index and is primarily eliminated through the
kidneys. Renal function, thyroid function, hydration, interacting medications, and serum lithium
concentrations require monitoring.
9. Which patient statement while taking lithium requires immediate follow-up?
, A. “I occasionally feel mildly thirsty.”
B. “I have developed severe diarrhea, vomiting, and worsening tremors.”
C. “I take my medication at the same time each day.”
D. “I know I need regular laboratory monitoring.”
Answer: B
Rationale: Severe gastrointestinal symptoms, worsening tremor, confusion, ataxia, or marked
weakness can indicate lithium toxicity. Dehydration can increase lithium concentrations and
worsen toxicity.
10. Which medication is commonly considered first-line treatment for schizophrenia?
A. An atypical antipsychotic
B. A benzodiazepine alone
C. A stimulant
D. A cholinesterase inhibitor
Answer: A
Rationale: Second-generation or atypical antipsychotics are commonly used in the treatment of
schizophrenia. Medication selection depends on symptom profile, adverse-effect risks, previous
response, comorbidities, and patient preference.
11. A patient taking an antipsychotic develops severe muscle rigidity, fever, altered mental
status, and autonomic instability. What condition should be suspected?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Akathisia
Answer: B
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction associated
with dopamine blockade. Classic findings include severe rigidity, hyperthermia, altered mental
status, and autonomic instability.
12. Which adverse effect is particularly associated with long-term exposure to dopamine-
blocking antipsychotics?
Questions And Correct Answers
Course
NR547
1. A patient with major depressive disorder reports depressed mood, anhedonia, fatigue,
poor concentration, and insomnia. Which neurotransmitter system is most commonly
associated with the pathophysiology of depression?
A. Dopamine only
B. Serotonin, norepinephrine, and dopamine
C. Acetylcholine only
D. Glutamate only
Answer: B
Rationale: Depression involves complex neurobiological mechanisms involving serotonin,
norepinephrine, and dopamine pathways, along with changes in neuroplasticity and stress-
response systems. No single neurotransmitter completely explains depression.
2. Which finding is most concerning in a patient taking an SSRI?
A. Mild nausea during the first week
B. Slight headache
C. New suicidal thoughts
D. Mild dry mouth
Answer: C
Rationale: New or worsening suicidal ideation requires prompt assessment and intervention.
Although antidepressants are not considered to cause suicide, some patients—particularly
younger patients—may experience increased suicidal thoughts early in treatment or during
dosage changes.
3. Which medication is considered a first-line pharmacologic treatment for generalized
anxiety disorder?
A. Sertraline
B. Haloperidol
,C. Lithium
D. Benztropine
Answer: A
Rationale: SSRIs such as sertraline are commonly used as first-line treatments for generalized
anxiety disorder. SNRIs are also commonly used. Antipsychotics and mood stabilizers are not
routine first-line treatments for uncomplicated GAD.
4. A patient taking sertraline develops agitation, diaphoresis, diarrhea, hyperreflexia, and
clonus. What should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Answer: B
Rationale: Serotonin syndrome is associated with excessive serotonergic activity. Characteristic
findings include mental-status changes, autonomic instability, gastrointestinal symptoms,
hyperreflexia, and clonus.
5. Which combination presents the greatest concern for serotonin syndrome?
A. Sertraline and another serotonergic medication
B. Acetaminophen and ibuprofen
C. Amoxicillin and acetaminophen
D. Calcium carbonate and vitamin D
Answer: A
Rationale: Combining serotonergic agents can increase serotonin activity and the risk of
serotonin syndrome. Medication reconciliation is therefore essential before adding another
serotonergic drug.
6. Which symptom is characteristic of mania?
A. Decreased need for sleep with increased energy
B. Psychomotor retardation
,C. Persistent hypersomnia
D. Social withdrawal without increased activity
Answer: A
Rationale: Mania may involve elevated or irritable mood, increased energy or activity,
decreased need for sleep, pressured speech, racing thoughts, grandiosity, distractibility, and
risky behavior.
7. A patient with bipolar disorder develops four days of elevated mood, increased energy,
decreased need for sleep, and impulsive spending but remains able to function without
marked impairment. Which episode is most consistent with these findings?
A. Major depressive episode
B. Hypomanic episode
C. Delirium
D. Negative-symptom syndrome
Answer: B
Rationale: Hypomania is a distinct period of elevated, expansive, or irritable mood and
increased activity that is less severe than mania and does not cause the marked functional
impairment or hospitalization characteristic of mania.
8. Which medication requires particularly close monitoring of serum levels, renal function,
thyroid function, and hydration status?
A. Lithium
B. Fluoxetine
C. Buspirone
D. Hydroxyzine
Answer: A
Rationale: Lithium has a narrow therapeutic index and is primarily eliminated through the
kidneys. Renal function, thyroid function, hydration, interacting medications, and serum lithium
concentrations require monitoring.
9. Which patient statement while taking lithium requires immediate follow-up?
, A. “I occasionally feel mildly thirsty.”
B. “I have developed severe diarrhea, vomiting, and worsening tremors.”
C. “I take my medication at the same time each day.”
D. “I know I need regular laboratory monitoring.”
Answer: B
Rationale: Severe gastrointestinal symptoms, worsening tremor, confusion, ataxia, or marked
weakness can indicate lithium toxicity. Dehydration can increase lithium concentrations and
worsen toxicity.
10. Which medication is commonly considered first-line treatment for schizophrenia?
A. An atypical antipsychotic
B. A benzodiazepine alone
C. A stimulant
D. A cholinesterase inhibitor
Answer: A
Rationale: Second-generation or atypical antipsychotics are commonly used in the treatment of
schizophrenia. Medication selection depends on symptom profile, adverse-effect risks, previous
response, comorbidities, and patient preference.
11. A patient taking an antipsychotic develops severe muscle rigidity, fever, altered mental
status, and autonomic instability. What condition should be suspected?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Akathisia
Answer: B
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction associated
with dopamine blockade. Classic findings include severe rigidity, hyperthermia, altered mental
status, and autonomic instability.
12. Which adverse effect is particularly associated with long-term exposure to dopamine-
blocking antipsychotics?
