NURS 5357 Exam 2 Review| Comprehensive Questions and Answers with Rationales |
2026/2027 Update | 100% Correct - University of Texas, Tyler.
Questions 1–25 | Major depressive disorder, neurobiology, neuroendocrinology, neural circuits,
and clinical reasoning
Question 1
A 34-year-old patient reports persistent sadness, diminished interest in previously enjoyable
activities, fatigue, impaired concentration, and disrupted sleep for three weeks. The symptoms
interfere significantly with occupational functioning.
Which diagnosis should the psychiatric-mental health nurse practitioner consider most strongly?
A. Cyclothymic disorder B. Major depressive disorder C. Bipolar I disorder D. Adjustment
disorder without depressed mood
Correct Answer: B. Major depressive disorder
Rationale: Major depressive disorder (MDD) is characterized by a qualifying constellation of
depressive symptoms lasting at least two weeks, accompanied by clinically significant distress or
functional impairment. Depressed mood or loss of interest or pleasure must be present, and the
episode must meet the required symptom threshold.
The described presentation is consistent with a major depressive episode, provided the full
diagnostic criteria and exclusions are satisfied. The clinician should also evaluate for previous
manic or hypomanic episodes, medical conditions, and medication-related explanations.
Question 2
A patient with depression states, "I no longer enjoy spending time with my friends or
participating in activities that used to make me happy."
Which clinical term best describes this symptom?
A. Avolition B. Akathisia C. Anhedonia D. Alexithymia
Correct Answer: C. Anhedonia
Rationale: Anhedonia refers to markedly diminished interest or pleasure in activities that were
previously rewarding. It is a central symptom of major depressive episodes.
Anhedonia may involve disruption of reward-related neural networks, including interactions
among the ventral striatum, prefrontal cortex, and dopaminergic pathways. It is distinct from
,akathisia, which involves motor restlessness, and alexithymia, which involves difficulty
identifying or describing emotions.
Question 3
Which neurotransmitter is most directly involved in reward prediction, motivational salience,
and reinforcement learning, making its circuitry relevant to anhedonia in depression?
A. Dopamine B. Glycine C. Histamine D. Acetylcholine
Correct Answer: A. Dopamine
Rationale: Dopaminergic pathways, particularly those involving the ventral tegmental area and
ventral striatum, are important in reward-related learning, motivation, and behavioral
reinforcement.
Altered reward-network function has been associated with reduced motivation and anhedonia in
depression. However, depression cannot be explained simply as a universal dopamine deficiency.
Question 4
A psychiatric researcher examines interactions among the hypothalamus, pituitary gland, and
adrenal cortex in patients with depression.
Which biological system is being investigated?
A. Renin-angiotensin-aldosterone system B. Somatic motor system C. Vestibular system D.
Hypothalamic-pituitary-adrenal axis
Correct Answer: D. Hypothalamic-pituitary-adrenal axis
Rationale: The hypothalamic-pituitary-adrenal (HPA) axis coordinates a major component of the
physiological stress response.
The hypothalamus releases corticotropin-releasing hormone, which stimulates pituitary
adrenocorticotropic hormone (ACTH) release. ACTH then stimulates cortisol production from
the adrenal cortex.
HPA-axis dysregulation is observed in some patients with depression, although findings vary and
are not diagnostically specific.
Question 5
A patient experiences prolonged stress. Laboratory research demonstrates increased
hypothalamic corticotropin-releasing hormone signaling.
, Which downstream response is expected in the HPA axis?
A. Direct inhibition of pituitary ACTH release B. Increased pituitary ACTH secretion and
stimulation of adrenal cortisol production C. Complete suppression of adrenal glucocorticoid
production D. Reduced communication between the hypothalamus and pituitary gland
Correct Answer: B. Increased pituitary ACTH secretion and stimulation of adrenal cortisol
production
Rationale: Corticotropin-releasing hormone (CRH) stimulates ACTH secretion from the anterior
pituitary. ACTH subsequently promotes cortisol synthesis and release from the adrenal cortex.
Cortisol normally participates in negative feedback regulation of the HPA axis. Persistent stress-
system activation and altered feedback regulation have been implicated in certain depressive
phenotypes.
Question 6
A neurobiology student is studying the relationship between chronic stress, neuronal adaptation,
and depression.
Which molecule has an established role in neuronal survival, synaptic plasticity, and activity-
dependent neural adaptation?
A. Albumin B. Myoglobin C. Brain-derived neurotrophic factor D. Fibrinogen
Correct Answer: C. Brain-derived neurotrophic factor
Rationale: Brain-derived neurotrophic factor (BDNF) contributes to neuronal survival, synaptic
maintenance, and plasticity. It activates intracellular signaling pathways through its TrkB
receptor.
Abnormal neuroplasticity and altered BDNF-related signaling have been investigated in
depressive disorders. However, BDNF concentrations alone cannot establish or exclude
depression, and the relationship between peripheral BDNF measurements and brain function is
complex.
Question 7
A patient with depression demonstrates difficulty regulating negative emotional responses.
Functional neuroimaging suggests altered communication between the prefrontal cortex and
amygdala.
Which explanation best describes the possible clinical significance?
2026/2027 Update | 100% Correct - University of Texas, Tyler.
Questions 1–25 | Major depressive disorder, neurobiology, neuroendocrinology, neural circuits,
and clinical reasoning
Question 1
A 34-year-old patient reports persistent sadness, diminished interest in previously enjoyable
activities, fatigue, impaired concentration, and disrupted sleep for three weeks. The symptoms
interfere significantly with occupational functioning.
Which diagnosis should the psychiatric-mental health nurse practitioner consider most strongly?
A. Cyclothymic disorder B. Major depressive disorder C. Bipolar I disorder D. Adjustment
disorder without depressed mood
Correct Answer: B. Major depressive disorder
Rationale: Major depressive disorder (MDD) is characterized by a qualifying constellation of
depressive symptoms lasting at least two weeks, accompanied by clinically significant distress or
functional impairment. Depressed mood or loss of interest or pleasure must be present, and the
episode must meet the required symptom threshold.
The described presentation is consistent with a major depressive episode, provided the full
diagnostic criteria and exclusions are satisfied. The clinician should also evaluate for previous
manic or hypomanic episodes, medical conditions, and medication-related explanations.
Question 2
A patient with depression states, "I no longer enjoy spending time with my friends or
participating in activities that used to make me happy."
Which clinical term best describes this symptom?
A. Avolition B. Akathisia C. Anhedonia D. Alexithymia
Correct Answer: C. Anhedonia
Rationale: Anhedonia refers to markedly diminished interest or pleasure in activities that were
previously rewarding. It is a central symptom of major depressive episodes.
Anhedonia may involve disruption of reward-related neural networks, including interactions
among the ventral striatum, prefrontal cortex, and dopaminergic pathways. It is distinct from
,akathisia, which involves motor restlessness, and alexithymia, which involves difficulty
identifying or describing emotions.
Question 3
Which neurotransmitter is most directly involved in reward prediction, motivational salience,
and reinforcement learning, making its circuitry relevant to anhedonia in depression?
A. Dopamine B. Glycine C. Histamine D. Acetylcholine
Correct Answer: A. Dopamine
Rationale: Dopaminergic pathways, particularly those involving the ventral tegmental area and
ventral striatum, are important in reward-related learning, motivation, and behavioral
reinforcement.
Altered reward-network function has been associated with reduced motivation and anhedonia in
depression. However, depression cannot be explained simply as a universal dopamine deficiency.
Question 4
A psychiatric researcher examines interactions among the hypothalamus, pituitary gland, and
adrenal cortex in patients with depression.
Which biological system is being investigated?
A. Renin-angiotensin-aldosterone system B. Somatic motor system C. Vestibular system D.
Hypothalamic-pituitary-adrenal axis
Correct Answer: D. Hypothalamic-pituitary-adrenal axis
Rationale: The hypothalamic-pituitary-adrenal (HPA) axis coordinates a major component of the
physiological stress response.
The hypothalamus releases corticotropin-releasing hormone, which stimulates pituitary
adrenocorticotropic hormone (ACTH) release. ACTH then stimulates cortisol production from
the adrenal cortex.
HPA-axis dysregulation is observed in some patients with depression, although findings vary and
are not diagnostically specific.
Question 5
A patient experiences prolonged stress. Laboratory research demonstrates increased
hypothalamic corticotropin-releasing hormone signaling.
, Which downstream response is expected in the HPA axis?
A. Direct inhibition of pituitary ACTH release B. Increased pituitary ACTH secretion and
stimulation of adrenal cortisol production C. Complete suppression of adrenal glucocorticoid
production D. Reduced communication between the hypothalamus and pituitary gland
Correct Answer: B. Increased pituitary ACTH secretion and stimulation of adrenal cortisol
production
Rationale: Corticotropin-releasing hormone (CRH) stimulates ACTH secretion from the anterior
pituitary. ACTH subsequently promotes cortisol synthesis and release from the adrenal cortex.
Cortisol normally participates in negative feedback regulation of the HPA axis. Persistent stress-
system activation and altered feedback regulation have been implicated in certain depressive
phenotypes.
Question 6
A neurobiology student is studying the relationship between chronic stress, neuronal adaptation,
and depression.
Which molecule has an established role in neuronal survival, synaptic plasticity, and activity-
dependent neural adaptation?
A. Albumin B. Myoglobin C. Brain-derived neurotrophic factor D. Fibrinogen
Correct Answer: C. Brain-derived neurotrophic factor
Rationale: Brain-derived neurotrophic factor (BDNF) contributes to neuronal survival, synaptic
maintenance, and plasticity. It activates intracellular signaling pathways through its TrkB
receptor.
Abnormal neuroplasticity and altered BDNF-related signaling have been investigated in
depressive disorders. However, BDNF concentrations alone cannot establish or exclude
depression, and the relationship between peripheral BDNF measurements and brain function is
complex.
Question 7
A patient with depression demonstrates difficulty regulating negative emotional responses.
Functional neuroimaging suggests altered communication between the prefrontal cortex and
amygdala.
Which explanation best describes the possible clinical significance?
