CHAMBERLAIN UNIVERSITY – NR
546 FINAL EXAM – QUESTIONS
AND ANSWERS | 2026/2027
LATEST UPDATE
Course
CHAMBERLAIN UNIVERSITY – NR 546
1. Which neurotransmitter system is most directly associated with the therapeutic effects of
selective serotonin reuptake inhibitors (SSRIs)?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. Histamine
Answer: B. Serotonin
Rationale: SSRIs primarily inhibit the serotonin transporter, increasing serotonin availability in
the synaptic cleft. Their clinical effects develop over time despite relatively rapid changes in
serotonin reuptake.
2. A patient taking an SSRI develops agitation, diaphoresis, hyperreflexia, clonus, and fever
after another serotonergic medication is added. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome is characterized by serotonergic excess, with neuromuscular
findings such as hyperreflexia and clonus, autonomic instability, and altered mental status.
Combining serotonergic agents increases risk.
3. Which medication is a first-line pharmacologic option for major depressive disorder?
A. Sertraline
B. Haloperidol
C. Lithium only
D. Benztropine
,Answer: A. Sertraline
Rationale: SSRIs such as sertraline are commonly used first-line treatments for major depressive
disorder because of their efficacy and generally favorable tolerability profile.
4. What is an important counseling point when initiating an antidepressant in a young
adult?
A. Suicidal thoughts can never occur during treatment
B. Monitor for worsening suicidal thoughts or behavioral changes, especially early in treatment
C. Stop the medication after one dose if mood does not improve
D. Therapeutic effects always occur within hours
Answer: B. Monitor for worsening suicidal thoughts or behavioral changes, especially early
in treatment
Rationale: Younger patients should be monitored for emergent suicidal thoughts or behavioral
activation, particularly during initiation and dose changes. Antidepressant benefit generally takes
longer than a few days to become apparent.
5. Which adverse effect is particularly associated with SSRIs?
A. Sexual dysfunction
B. Severe hypokalemia in all patients
C. Permanent hearing loss
D. Agranulocytosis in most patients
Answer: A. Sexual dysfunction
Rationale: Sexual dysfunction is a common SSRI adverse effect and may include decreased
libido, delayed orgasm, or erectile difficulties. Other common effects include gastrointestinal
symptoms and sleep disturbances.
6. A patient taking an SSRI wants to discontinue treatment abruptly because of side effects.
What is generally the best approach?
A. Abruptly discontinue every SSRI
B. Discuss a planned taper when clinically appropriate
C. Double the dose first
D. Add another antidepressant without evaluation
Answer: B. Discuss a planned taper when clinically appropriate
Rationale: Abrupt discontinuation can produce antidepressant discontinuation symptoms,
particularly with some agents. A gradual taper can reduce these symptoms when discontinuation
is appropriate.
, 7. Which antidepressant is also a norepinephrine-dopamine reuptake inhibitor?
A. Bupropion
B. Fluoxetine
C. Sertraline
D. Paroxetine
Answer: A. Bupropion
Rationale: Bupropion primarily affects norepinephrine and dopamine reuptake. It is also
associated with relatively low rates of sexual adverse effects compared with many serotonergic
antidepressants.
8. Which patient requires particular caution with bupropion?
A. Patient with a history of seizure disorder
B. Patient with seasonal allergies
C. Patient with uncomplicated hypertension controlled on medication
D. Patient with mild acne
Answer: A. Patient with a history of seizure disorder
Rationale: Bupropion lowers the seizure threshold and is contraindicated in certain patients with
seizure disorders and eating disorders. Risk depends on formulation, dose, and patient factors.
9. Which antidepressant class requires dietary restrictions because of the risk of
hypertensive reactions with tyramine-containing foods?
A. MAOIs
B. SSRIs
C. SNRIs
D. NDRIs
Answer: A. MAOIs
Rationale: Monoamine oxidase inhibitors can interfere with tyramine metabolism. Excess
tyramine can produce substantial catecholamine release and potentially severe hypertension.
10. A patient taking phenelzine develops severe headache and markedly elevated blood
pressure after consuming a tyramine-rich food. What complication is most concerning?
A. Hypertensive crisis
B. Hypoglycemia
C. Serotonin withdrawal
D. Neuroleptic malignant syndrome
Answer: A. Hypertensive crisis
546 FINAL EXAM – QUESTIONS
AND ANSWERS | 2026/2027
LATEST UPDATE
Course
CHAMBERLAIN UNIVERSITY – NR 546
1. Which neurotransmitter system is most directly associated with the therapeutic effects of
selective serotonin reuptake inhibitors (SSRIs)?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. Histamine
Answer: B. Serotonin
Rationale: SSRIs primarily inhibit the serotonin transporter, increasing serotonin availability in
the synaptic cleft. Their clinical effects develop over time despite relatively rapid changes in
serotonin reuptake.
2. A patient taking an SSRI develops agitation, diaphoresis, hyperreflexia, clonus, and fever
after another serotonergic medication is added. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome is characterized by serotonergic excess, with neuromuscular
findings such as hyperreflexia and clonus, autonomic instability, and altered mental status.
Combining serotonergic agents increases risk.
3. Which medication is a first-line pharmacologic option for major depressive disorder?
A. Sertraline
B. Haloperidol
C. Lithium only
D. Benztropine
,Answer: A. Sertraline
Rationale: SSRIs such as sertraline are commonly used first-line treatments for major depressive
disorder because of their efficacy and generally favorable tolerability profile.
4. What is an important counseling point when initiating an antidepressant in a young
adult?
A. Suicidal thoughts can never occur during treatment
B. Monitor for worsening suicidal thoughts or behavioral changes, especially early in treatment
C. Stop the medication after one dose if mood does not improve
D. Therapeutic effects always occur within hours
Answer: B. Monitor for worsening suicidal thoughts or behavioral changes, especially early
in treatment
Rationale: Younger patients should be monitored for emergent suicidal thoughts or behavioral
activation, particularly during initiation and dose changes. Antidepressant benefit generally takes
longer than a few days to become apparent.
5. Which adverse effect is particularly associated with SSRIs?
A. Sexual dysfunction
B. Severe hypokalemia in all patients
C. Permanent hearing loss
D. Agranulocytosis in most patients
Answer: A. Sexual dysfunction
Rationale: Sexual dysfunction is a common SSRI adverse effect and may include decreased
libido, delayed orgasm, or erectile difficulties. Other common effects include gastrointestinal
symptoms and sleep disturbances.
6. A patient taking an SSRI wants to discontinue treatment abruptly because of side effects.
What is generally the best approach?
A. Abruptly discontinue every SSRI
B. Discuss a planned taper when clinically appropriate
C. Double the dose first
D. Add another antidepressant without evaluation
Answer: B. Discuss a planned taper when clinically appropriate
Rationale: Abrupt discontinuation can produce antidepressant discontinuation symptoms,
particularly with some agents. A gradual taper can reduce these symptoms when discontinuation
is appropriate.
, 7. Which antidepressant is also a norepinephrine-dopamine reuptake inhibitor?
A. Bupropion
B. Fluoxetine
C. Sertraline
D. Paroxetine
Answer: A. Bupropion
Rationale: Bupropion primarily affects norepinephrine and dopamine reuptake. It is also
associated with relatively low rates of sexual adverse effects compared with many serotonergic
antidepressants.
8. Which patient requires particular caution with bupropion?
A. Patient with a history of seizure disorder
B. Patient with seasonal allergies
C. Patient with uncomplicated hypertension controlled on medication
D. Patient with mild acne
Answer: A. Patient with a history of seizure disorder
Rationale: Bupropion lowers the seizure threshold and is contraindicated in certain patients with
seizure disorders and eating disorders. Risk depends on formulation, dose, and patient factors.
9. Which antidepressant class requires dietary restrictions because of the risk of
hypertensive reactions with tyramine-containing foods?
A. MAOIs
B. SSRIs
C. SNRIs
D. NDRIs
Answer: A. MAOIs
Rationale: Monoamine oxidase inhibitors can interfere with tyramine metabolism. Excess
tyramine can produce substantial catecholamine release and potentially severe hypertension.
10. A patient taking phenelzine develops severe headache and markedly elevated blood
pressure after consuming a tyramine-rich food. What complication is most concerning?
A. Hypertensive crisis
B. Hypoglycemia
C. Serotonin withdrawal
D. Neuroleptic malignant syndrome
Answer: A. Hypertensive crisis
