NR 546 FINAL EXAM VERSION 1 AND VERSION 2 NEWEST 2025/2026
ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
Lithium
Anticonvulsants
Second generation antipsychotics - ANSWER-Pharmacologic Treatment of Bipolar
Disorder
major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest
(13.1%) among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms. -
ANSWER-Unipolar depression
Chronic condition characterized by extreme fluctuations in mood, energy, and ability to
function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or
psychotic features
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a
history of one or more major depressive episodes
-high risk for suicide - ANSWER-Bipolar disorder (BD)
characterized by a persistently elevated, expansive, or irritable mood. Related
symptoms may include inflated self-esteem, increased goal-directed activity or energy,
including grandiosity, decreased need for sleep, excessive talkativeness, racing
thoughts, flight of ideas (FOI), distractibility, psychomotor agitation, and a propensity to
be involved in high-risk activities. Mania leads to significant functional impairment and
may include psychotic features or necessitate hospitalization - ANSWER-mania
requires at least one episode of mania for at least one week (or any duration if
hospitalization due to symptoms is required) - ANSWER-Bipolar Type I:
diagnosis requires a current or past hypomanic episode and a current or past major
depressive episode. Symptoms last for at least 4 days but fewer than seven.
,-Hypomanic symptoms are not of sufficient duration or severity to cause significant
functional impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms,
making bipolar more difficult to diagnose if the client presents in the depression phase. -
ANSWER-Bipolar Type II:
involves the chronic presentation of hypomanic and depressive symptoms that do not
meet the diagnostic criteria for a major depressive or manic/hypomanic episode. -
ANSWER-Cyclothymia:
antidepressant therapy may precipitate a manic episode or induce rapid-cycling bipolar
depression
-may contribute to the increased incidence of death by suicide in children and adults
younger than 25 - ANSWER-If bipolar depression is mistaken for MDD:
monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a
hypomanic or manic episode - ANSWER-Antidepressants are used cautiously in clients
with bipolar disorder and never as ________________.
Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes - ANSWER-DA, NE Dysfunction causes what mood related symptoms
Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes - ANSWER-5HT, NE Dysfunction causes what mood related
symptoms
-depression occurs as a result of a deficiency of one or all three monoamine
transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess - ANSWER-monoamine hypothesis of
depression
,• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER-Medication
Management for Depression, First-Line Treatment:
Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
-sexual side effects - ANSWER-SSRI's
Mechanism of action
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase cognition)
Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation - ANSWER-SNRI's
Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss - ANSWER-NDRI's
citalopram (Celexa) - ANSWER-SSRI Prescribing Pearls: med with mild antihistamine
effects
escitalopram (Lexapro) - ANSWER-SSRI Prescribing Pearls: med with no known drug
interactions
fluoxetine (Prozac) - ANSWER-SSRI Prescribing Pearls: med with longest half-life
paroxetine (Paxil) - ANSWER-SSRI Prescribing Pearls: med that also treats social
anxiety and insomnia
, fluvoxamine (Luvox) - ANSWER-SSRI Prescribing Pearls: med that treats anxious
depression; smokers require an increased dose
sertraline (Zoloft) - ANSWER-SSRI Prescribing Pearls: med that also treats social
anxiety and hypersomnolence
INDICATION
-Depression
-GAD
-Social anxiety disorder
-Panic disorder
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine.
TESTS
-Check bp before initiating tx & regularly during tx
Starting Dose
-Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-
release)
Adverse Effects
-H/A, nervousness, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual
dysfunction, asthenia, sweating, SIADH, hyponatremia, increase BP
PEARLS
-treats both depression and anxiety disorders, ensure trial of higher dose before
switching to a different medication
-preferred treatments for treatment-resistant depression - ANSWER-venlafaxine
(Effexor)
INDICATION
-MDD
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine
TESTS
-Monitor BP before and during treatment.
Starting Dose
-50 mg/day
ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
Lithium
Anticonvulsants
Second generation antipsychotics - ANSWER-Pharmacologic Treatment of Bipolar
Disorder
major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest
(13.1%) among individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms. -
ANSWER-Unipolar depression
Chronic condition characterized by extreme fluctuations in mood, energy, and ability to
function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or
psychotic features
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a
history of one or more major depressive episodes
-high risk for suicide - ANSWER-Bipolar disorder (BD)
characterized by a persistently elevated, expansive, or irritable mood. Related
symptoms may include inflated self-esteem, increased goal-directed activity or energy,
including grandiosity, decreased need for sleep, excessive talkativeness, racing
thoughts, flight of ideas (FOI), distractibility, psychomotor agitation, and a propensity to
be involved in high-risk activities. Mania leads to significant functional impairment and
may include psychotic features or necessitate hospitalization - ANSWER-mania
requires at least one episode of mania for at least one week (or any duration if
hospitalization due to symptoms is required) - ANSWER-Bipolar Type I:
diagnosis requires a current or past hypomanic episode and a current or past major
depressive episode. Symptoms last for at least 4 days but fewer than seven.
,-Hypomanic symptoms are not of sufficient duration or severity to cause significant
functional impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms,
making bipolar more difficult to diagnose if the client presents in the depression phase. -
ANSWER-Bipolar Type II:
involves the chronic presentation of hypomanic and depressive symptoms that do not
meet the diagnostic criteria for a major depressive or manic/hypomanic episode. -
ANSWER-Cyclothymia:
antidepressant therapy may precipitate a manic episode or induce rapid-cycling bipolar
depression
-may contribute to the increased incidence of death by suicide in children and adults
younger than 25 - ANSWER-If bipolar depression is mistaken for MDD:
monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a
hypomanic or manic episode - ANSWER-Antidepressants are used cautiously in clients
with bipolar disorder and never as ________________.
Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
decreased alertness
decreased self-confidence
appetite changes - ANSWER-DA, NE Dysfunction causes what mood related symptoms
Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes - ANSWER-5HT, NE Dysfunction causes what mood related
symptoms
-depression occurs as a result of a deficiency of one or all three monoamine
transmitters
• serotonin, norepinephrine, and dopamine
-while mania may result from an excess - ANSWER-monoamine hypothesis of
depression
,• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
• Norepinephrine Dopamine Reuptake Inhibitors (NDRI)
• Serotonin Antagonist and Reuptake Inhibitors (SARIs) - ANSWER-Medication
Management for Depression, First-Line Treatment:
Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
-sexual side effects - ANSWER-SSRI's
Mechanism of action
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase cognition)
Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation - ANSWER-SNRI's
Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss - ANSWER-NDRI's
citalopram (Celexa) - ANSWER-SSRI Prescribing Pearls: med with mild antihistamine
effects
escitalopram (Lexapro) - ANSWER-SSRI Prescribing Pearls: med with no known drug
interactions
fluoxetine (Prozac) - ANSWER-SSRI Prescribing Pearls: med with longest half-life
paroxetine (Paxil) - ANSWER-SSRI Prescribing Pearls: med that also treats social
anxiety and insomnia
, fluvoxamine (Luvox) - ANSWER-SSRI Prescribing Pearls: med that treats anxious
depression; smokers require an increased dose
sertraline (Zoloft) - ANSWER-SSRI Prescribing Pearls: med that also treats social
anxiety and hypersomnolence
INDICATION
-Depression
-GAD
-Social anxiety disorder
-Panic disorder
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine.
TESTS
-Check bp before initiating tx & regularly during tx
Starting Dose
-Initial 37.5 mg daily (extended-release) or 25-50 mg divided into 2-3 doses (immediate-
release)
Adverse Effects
-H/A, nervousness, insomnia, sedation, nausea, diarrhea, decreased appetite, sexual
dysfunction, asthenia, sweating, SIADH, hyponatremia, increase BP
PEARLS
-treats both depression and anxiety disorders, ensure trial of higher dose before
switching to a different medication
-preferred treatments for treatment-resistant depression - ANSWER-venlafaxine
(Effexor)
INDICATION
-MDD
Mechanism of Action
-SNRI (dual serotonin and norepinephrine reuptake inhibitor), Boosts neurotransmitters
serotonin, norepinephrine/noradrenaline, and dopamine
TESTS
-Monitor BP before and during treatment.
Starting Dose
-50 mg/day
