1|Page
NURS 6630 FINAL COMPREHENSIVE EXAM
PREP 2026 WALDEN UNIVERSITY |QUESTIONS
AND VERIFIED ANSWERS |RATED A+ | NEW AND
REVISED
1. A patient prescribed fluoxetine reports insomnia and agitation after 5
days of therapy. Which explanation best accounts for this reaction?
A. Delayed downregulation of serotonin receptors
B. Early increase in synaptic serotonin before receptor adaptation
C. Dopamine blockade in the mesolimbic pathway
D. Anticholinergic rebound
Rationale: SSRIs initially increase serotonin availability before
receptor adaptation, which can cause early anxiety, agitation, and
insomnia.
2. Which neurotransmitter imbalance is most strongly associated with
major depressive disorder?
A. Increased dopamine in the nigrostriatal pathway
B. Increased glutamate in the limbic system
C. Decreased serotonin and norepinephrine activity
D. Increased acetylcholine activity
Rationale: Depression is classically associated with decreased
monoamine neurotransmission, particularly serotonin and
norepinephrine.
3. A patient stabilized on lithium presents with tremor, diarrhea, and
confusion. The priority action is to:
,2|Page
A. Reassure the patient
B. Obtain a serum lithium level immediately
C. Administer propranolol
D. Reduce sodium intake
Rationale: These are classic signs of lithium toxicity, requiring urgent
serum level assessment.
4. Which antidepressant is most appropriate for a patient with
neuropathic pain and depression?
A. Fluoxetine
B. Bupropion
C. Duloxetine
D. Mirtazapine
Rationale: SNRIs such as duloxetine are effective for both depression
and neuropathic pain.
5. A client taking clozapine must be monitored closely for which life-
threatening adverse effect?
A. QT prolongation
B. Agranulocytosis
C. Tardive dyskinesia
D. Serotonin syndrome
Rationale: Clozapine carries a black box warning for agranulocytosis,
requiring routine ANC monitoring.
6. Which enzyme is primarily responsible for the metabolism of many
psychotropic medications?
A. MAO-A
B. COMT
C. Cytochrome P450
,3|Page
D. Acetylcholinesterase
Rationale: The CYP450 enzyme system plays a central role in
psychotropic drug metabolism.
7. A patient with bipolar I disorder presents in acute mania. Which
medication is most appropriate for rapid mood stabilization?
A. Fluoxetine
B. Bupropion
C. Lithium
D. Buspirone
Rationale: Lithium is a first-line mood stabilizer for acute mania.
8. Which medication is associated with significant weight gain and
metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Rationale: Olanzapine has one of the highest risks for metabolic
adverse effects.
9. The therapeutic serum level for lithium during maintenance therapy
is:
A. 0.1–0.3 mEq/L
B. 0.6–1.2 mEq/L
C. 1.5–2.0 mEq/L
D. >2.5 mEq/L
Rationale: Maintenance lithium levels are typically maintained
between 0.6 and 1.2 mEq/L.
, 4|Page
10. A patient develops hyperreflexia, fever, and clonus after combining
sertraline and linezolid. This condition is best described as:
A. Neuroleptic malignant syndrome
B. Acute dystonia
C. Serotonin syndrome
D. Malignant hyperthermia
Rationale: Serotonin syndrome results from excessive serotonergic
activity, often due to drug interactions.
11. Which class of medications is first-line for ADHD in children?
A. SSRIs
B. Stimulants
C. Atypical antipsychotics
D. Benzodiazepines
Rationale: Stimulants such as methylphenidate are first-line for
pediatric ADHD.
12. A patient with depression and seizure disorder should avoid which
antidepressant?
A. Sertraline
B. Escitalopram
C. Bupropion
D. Fluoxetine
Rationale: Bupropion lowers the seizure threshold.
13. Which medication requires dietary restrictions to prevent
hypertensive crisis?
A. SSRIs
NURS 6630 FINAL COMPREHENSIVE EXAM
PREP 2026 WALDEN UNIVERSITY |QUESTIONS
AND VERIFIED ANSWERS |RATED A+ | NEW AND
REVISED
1. A patient prescribed fluoxetine reports insomnia and agitation after 5
days of therapy. Which explanation best accounts for this reaction?
A. Delayed downregulation of serotonin receptors
B. Early increase in synaptic serotonin before receptor adaptation
C. Dopamine blockade in the mesolimbic pathway
D. Anticholinergic rebound
Rationale: SSRIs initially increase serotonin availability before
receptor adaptation, which can cause early anxiety, agitation, and
insomnia.
2. Which neurotransmitter imbalance is most strongly associated with
major depressive disorder?
A. Increased dopamine in the nigrostriatal pathway
B. Increased glutamate in the limbic system
C. Decreased serotonin and norepinephrine activity
D. Increased acetylcholine activity
Rationale: Depression is classically associated with decreased
monoamine neurotransmission, particularly serotonin and
norepinephrine.
3. A patient stabilized on lithium presents with tremor, diarrhea, and
confusion. The priority action is to:
,2|Page
A. Reassure the patient
B. Obtain a serum lithium level immediately
C. Administer propranolol
D. Reduce sodium intake
Rationale: These are classic signs of lithium toxicity, requiring urgent
serum level assessment.
4. Which antidepressant is most appropriate for a patient with
neuropathic pain and depression?
A. Fluoxetine
B. Bupropion
C. Duloxetine
D. Mirtazapine
Rationale: SNRIs such as duloxetine are effective for both depression
and neuropathic pain.
5. A client taking clozapine must be monitored closely for which life-
threatening adverse effect?
A. QT prolongation
B. Agranulocytosis
C. Tardive dyskinesia
D. Serotonin syndrome
Rationale: Clozapine carries a black box warning for agranulocytosis,
requiring routine ANC monitoring.
6. Which enzyme is primarily responsible for the metabolism of many
psychotropic medications?
A. MAO-A
B. COMT
C. Cytochrome P450
,3|Page
D. Acetylcholinesterase
Rationale: The CYP450 enzyme system plays a central role in
psychotropic drug metabolism.
7. A patient with bipolar I disorder presents in acute mania. Which
medication is most appropriate for rapid mood stabilization?
A. Fluoxetine
B. Bupropion
C. Lithium
D. Buspirone
Rationale: Lithium is a first-line mood stabilizer for acute mania.
8. Which medication is associated with significant weight gain and
metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Rationale: Olanzapine has one of the highest risks for metabolic
adverse effects.
9. The therapeutic serum level for lithium during maintenance therapy
is:
A. 0.1–0.3 mEq/L
B. 0.6–1.2 mEq/L
C. 1.5–2.0 mEq/L
D. >2.5 mEq/L
Rationale: Maintenance lithium levels are typically maintained
between 0.6 and 1.2 mEq/L.
, 4|Page
10. A patient develops hyperreflexia, fever, and clonus after combining
sertraline and linezolid. This condition is best described as:
A. Neuroleptic malignant syndrome
B. Acute dystonia
C. Serotonin syndrome
D. Malignant hyperthermia
Rationale: Serotonin syndrome results from excessive serotonergic
activity, often due to drug interactions.
11. Which class of medications is first-line for ADHD in children?
A. SSRIs
B. Stimulants
C. Atypical antipsychotics
D. Benzodiazepines
Rationale: Stimulants such as methylphenidate are first-line for
pediatric ADHD.
12. A patient with depression and seizure disorder should avoid which
antidepressant?
A. Sertraline
B. Escitalopram
C. Bupropion
D. Fluoxetine
Rationale: Bupropion lowers the seizure threshold.
13. Which medication requires dietary restrictions to prevent
hypertensive crisis?
A. SSRIs
