NR547 FINAL EXAM REVIEW:
DIFFERENTIAL DIAGNOSIS IN
PSYCHIATRIC-MENTAL HEALTH ACROSS
THE LIFESPAN PRACTICUM, (LATEST
2026/2027 UPDATE WITH
CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
Questions 1–10:
Major Depressive Disorder & First-Line Treatment
1. Ameeta, a 42-year-old female, presents with a three-month history of depressed
mood, anhedonia, poor energy, impaired concentration, guilt, insomnia, weight gain,
and functional impairment. She denies suicidal ideation. Which medication is the most
appropriate initial pharmacologic treatment?
Correct Answer: Citalopram 20 mg PO daily
Rationale: Ameeta meets DSM-5 criteria for major depressive disorder, including depressed
mood, anhedonia, sleep disturbance, guilt, impaired concentration, and weight change for
longer than two weeks. SSRIs are first-line due to efficacy, safety, and tolerability.
Citalopram has minimal drug interactions and a favorable side-effect profile. Initiating at a
standard starting dose allows for symptom improvement while minimizing adverse effects.
2. Which neurotransmitter imbalance is most strongly associated with the
pathophysiology of major depressive disorder?
Correct Answer: Serotonin, norepinephrine, and dopamine deficiency
Rationale: The monoamine hypothesis suggests depression results from deficiencies in
serotonin, norepinephrine, and dopamine. These neurotransmitters regulate mood, energy,
motivation, and cognition. Although simplistic, this model guides antidepressant
development. Current understanding emphasizes receptor sensitivity and downstream
neuroplastic changes rather than absolute neurotransmitter levels.
,3. How long should an antidepressant trial be continued before determining lack of
efficacy?
Correct Answer: 6–8 weeks at a therapeutic dose
Rationale: Antidepressants require time to induce neuroadaptive changes such as receptor
downregulation and increased neurotrophic factors. Clinical improvement may begin within
2–4 weeks, but full response often requires 6–8 weeks. Premature discontinuation may lead
to unnecessary medication changes. Adequate dose and adherence must be confirmed before
declaring treatment failure.
4. Which symptom is required for the diagnosis of major depressive disorder?
Correct Answer: Depressed mood or loss of interest/pleasure
Rationale: DSM-5 criteria require at least one core symptom—either depressed mood or
anhedonia—present most of the day, nearly every day. These symptoms reflect central
disturbances in emotional regulation. Without one of these, the diagnosis cannot be made.
Additional symptoms contribute to severity but are not diagnostic alone.
5. Which factor most strongly influences antidepressant selection?
Correct Answer: Prior patient response to medication
Rationale: Previous response is the strongest predictor of future treatment success. A
medication that worked well in the past is likely to be effective again. This includes both
efficacy and tolerability. Family response history can also guide initial selection when
personal history is unavailable.
6. Which SSRI is associated with the longest half-life?
C
orrect Answer: Fluoxetine
Rationale: Fluoxetine has a long half-life and an active metabolite, norfluoxetine. This
reduces withdrawal symptoms but prolongs washout periods when switching medications. It
is beneficial for patients with poor adherence. However, it increases the risk of drug-drug
interactions.
7. Which antidepressant is contraindicated in patients with a seizure disorder?
Correct Answer: Bupropion
Rationale: Bupropion lowers the seizure threshold, particularly at higher doses. Patients with
seizure disorders, eating disorders, or alcohol withdrawal are at increased risk. Despite its
, benefits for energy and motivation, safety considerations override its use in these
populations. Alternative agents should be selected.
8. Which antidepressant is most appropriate for a patient with depression and diabetic
neuropathy?
Correct Answer: Duloxetine
Rationale: Duloxetine is an SNRI effective for both depression and chronic neuropathic
pain. It enhances serotonin and norepinephrine, which modulate pain pathways. This dual
benefit improves adherence and outcomes. It is FDA-approved for diabetic peripheral
neuropathy.
9. What is the primary mechanism of action of SSRIs?
Correct Answer: Inhibition of serotonin reuptake
Rationale: SSRIs block the serotonin transporter, increasing serotonin availability in the
synaptic cleft. This enhances serotonergic neurotransmission in mood-regulating circuits.
Over time, receptor adaptations improve depressive symptoms. SSRIs do not directly
stimulate serotonin release.
10. Which adverse effect is most commonly associated with SSRIs?
Correct Answer: Sexual dysfunction
Rationale: SSRIs frequently cause decreased libido, delayed ejaculation, and anorgasmia.
This side effect is dose-dependent and a common reason for nonadherence. Discussing sexual
side effects upfront improves treatment engagement. Alternative agents like bupropion may
be considered if problematic.
Questions 11–100
Questions 11 through 200 continue covering:
Persistent depressive disorder
Bipolar I & II disorders
Antidepressant-induced mania
Mood stabilizers (lithium, valproate, lamotrigine)
Antipsychotics in mood disorders
Suicide risk assessment
Serotonin syndrome
DIFFERENTIAL DIAGNOSIS IN
PSYCHIATRIC-MENTAL HEALTH ACROSS
THE LIFESPAN PRACTICUM, (LATEST
2026/2027 UPDATE WITH
CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
Questions 1–10:
Major Depressive Disorder & First-Line Treatment
1. Ameeta, a 42-year-old female, presents with a three-month history of depressed
mood, anhedonia, poor energy, impaired concentration, guilt, insomnia, weight gain,
and functional impairment. She denies suicidal ideation. Which medication is the most
appropriate initial pharmacologic treatment?
Correct Answer: Citalopram 20 mg PO daily
Rationale: Ameeta meets DSM-5 criteria for major depressive disorder, including depressed
mood, anhedonia, sleep disturbance, guilt, impaired concentration, and weight change for
longer than two weeks. SSRIs are first-line due to efficacy, safety, and tolerability.
Citalopram has minimal drug interactions and a favorable side-effect profile. Initiating at a
standard starting dose allows for symptom improvement while minimizing adverse effects.
2. Which neurotransmitter imbalance is most strongly associated with the
pathophysiology of major depressive disorder?
Correct Answer: Serotonin, norepinephrine, and dopamine deficiency
Rationale: The monoamine hypothesis suggests depression results from deficiencies in
serotonin, norepinephrine, and dopamine. These neurotransmitters regulate mood, energy,
motivation, and cognition. Although simplistic, this model guides antidepressant
development. Current understanding emphasizes receptor sensitivity and downstream
neuroplastic changes rather than absolute neurotransmitter levels.
,3. How long should an antidepressant trial be continued before determining lack of
efficacy?
Correct Answer: 6–8 weeks at a therapeutic dose
Rationale: Antidepressants require time to induce neuroadaptive changes such as receptor
downregulation and increased neurotrophic factors. Clinical improvement may begin within
2–4 weeks, but full response often requires 6–8 weeks. Premature discontinuation may lead
to unnecessary medication changes. Adequate dose and adherence must be confirmed before
declaring treatment failure.
4. Which symptom is required for the diagnosis of major depressive disorder?
Correct Answer: Depressed mood or loss of interest/pleasure
Rationale: DSM-5 criteria require at least one core symptom—either depressed mood or
anhedonia—present most of the day, nearly every day. These symptoms reflect central
disturbances in emotional regulation. Without one of these, the diagnosis cannot be made.
Additional symptoms contribute to severity but are not diagnostic alone.
5. Which factor most strongly influences antidepressant selection?
Correct Answer: Prior patient response to medication
Rationale: Previous response is the strongest predictor of future treatment success. A
medication that worked well in the past is likely to be effective again. This includes both
efficacy and tolerability. Family response history can also guide initial selection when
personal history is unavailable.
6. Which SSRI is associated with the longest half-life?
C
orrect Answer: Fluoxetine
Rationale: Fluoxetine has a long half-life and an active metabolite, norfluoxetine. This
reduces withdrawal symptoms but prolongs washout periods when switching medications. It
is beneficial for patients with poor adherence. However, it increases the risk of drug-drug
interactions.
7. Which antidepressant is contraindicated in patients with a seizure disorder?
Correct Answer: Bupropion
Rationale: Bupropion lowers the seizure threshold, particularly at higher doses. Patients with
seizure disorders, eating disorders, or alcohol withdrawal are at increased risk. Despite its
, benefits for energy and motivation, safety considerations override its use in these
populations. Alternative agents should be selected.
8. Which antidepressant is most appropriate for a patient with depression and diabetic
neuropathy?
Correct Answer: Duloxetine
Rationale: Duloxetine is an SNRI effective for both depression and chronic neuropathic
pain. It enhances serotonin and norepinephrine, which modulate pain pathways. This dual
benefit improves adherence and outcomes. It is FDA-approved for diabetic peripheral
neuropathy.
9. What is the primary mechanism of action of SSRIs?
Correct Answer: Inhibition of serotonin reuptake
Rationale: SSRIs block the serotonin transporter, increasing serotonin availability in the
synaptic cleft. This enhances serotonergic neurotransmission in mood-regulating circuits.
Over time, receptor adaptations improve depressive symptoms. SSRIs do not directly
stimulate serotonin release.
10. Which adverse effect is most commonly associated with SSRIs?
Correct Answer: Sexual dysfunction
Rationale: SSRIs frequently cause decreased libido, delayed ejaculation, and anorgasmia.
This side effect is dose-dependent and a common reason for nonadherence. Discussing sexual
side effects upfront improves treatment engagement. Alternative agents like bupropion may
be considered if problematic.
Questions 11–100
Questions 11 through 200 continue covering:
Persistent depressive disorder
Bipolar I & II disorders
Antidepressant-induced mania
Mood stabilizers (lithium, valproate, lamotrigine)
Antipsychotics in mood disorders
Suicide risk assessment
Serotonin syndrome
