1
NR 507 Week 5 Study Guide – Alterations in
Neurobiological Functions (Exam Review)
1. A 55-year-old patient is diagnosed with Parkinson's disease. The pathophysiological basis for this
patient's motor symptoms is a deficiency of which neurotransmitter in the basal ganglia?
A. Serotonin
B. Acetylcholine
C. Dopamine
D. Norepinephrine
✅ Correct Answer: C
Rationale: The motor symptoms of Parkinson's disease are primarily due to the progressive loss of
dopamine-producing neurons in the substantia nigra, leading to a dopamine deficiency in the basal
ganglia circuitry.
2. A patient reports experiencing a sudden onset of a severe, "thunderclap" headache and vomiting.
The nurse suspects a subarachnoid hemorrhage. Which pathophysiological event directly contributes
to the rapid increase in intracranial pressure (ICP) in this patient?
A. Ischemia from a thrombotic occlusion
B. Autoregulation of cerebral blood flow
C. Accumulation of blood in the subarachnoid space
D. Meningeal inflammation
✅ Correct Answer: C
Rationale: A subarachnoid hemorrhage involves bleeding into the subarachnoid space. The
accumulating blood acts as a space-occupying lesion, increasing intracranial volume and immediately
raising ICP.
3. A patient is admitted to the emergency department following a tonic-clonic seizure. The patient is
now awake but confused, disoriented, and has muscle flaccidity. The nurse correctly identifies this
period as the:
A. Aura phase
B. Ictal phase
C. Post-ictal phase
D. Prodromal phase
✅ Correct Answer: C
Rationale: The post-ictal phase is the recovery period immediately following a seizure. It is characterized
by confusion, unresponsiveness, and muscle flaccidity as the brain recovers from the abnormal electrical
activity.
,2
Neurotransmitter Imbalance & Depression (4–30)
4. A 32-year-old patient with major depressive disorder reports a persistent inability to feel pleasure,
even when engaging in previously enjoyable activities. This symptom is best described as:
A) Anhedonia
B) Avolition
C) Dysphoria
D) Alexithymia
✅ Correct Answer: A
Rationale: Anhedonia is the loss of interest or pleasure in activities once found enjoyable. It is a core
symptom of major depressive disorder and is closely linked to dopamine dysregulation in the reward
pathway. Avolition is lack of motivation; dysphoria is a general state of unease; alexithymia is difficulty
identifying emotions.
5. A patient with depression has been treated with an SSRI for 6 weeks with minimal improvement.
The PMHNP considers that this patient may have a deficiency primarily in which neurotransmitter
system?
A) Serotonin only
B) Norepinephrine and dopamine
C) GABA and glutamate
D) Acetylcholine
✅ Correct Answer: B
Rationale: While SSRIs target serotonin, some patients have predominant deficiencies in norepinephrine
and dopamine. This may explain inadequate response to SSRIs, and such patients may benefit from an
SNRI or bupropion.
6. Which of the following symptoms is most characteristic of the melancholic subtype of major
depressive disorder?
A) Mood reactivity (can brighten in response to positive events)
B) Hypersomnia and increased appetite
C) Anhedonia and early morning awakening
D) Leaden paralysis and rejection sensitivity
✅ Correct Answer: C
Rationale: Melancholic depression is defined by pervasive anhedonia, lack of mood reactivity, early
morning awakening, psychomotor disturbance, and significant weight loss. Options A, B, and D are
features of atypical depression.
7. A 45-year-old patient has had mild depressive symptoms for over 2 years, including low energy,
poor self-esteem, and difficulty concentrating, but has never met full criteria for major depressive
disorder. This presentation is most consistent with:
A) Bipolar II disorder
,3
B) Dysthymia (Persistent Depressive Disorder)
C) Adjustment disorder with depressed mood
D) Cyclothymic disorder
✅ Correct Answer: B
Rationale: Dysthymia (persistent depressive disorder) requires depressed mood for at least 2 years in
adults, with at least two additional symptoms, but the severity is less than that of major depressive
disorder. Symptoms never remit for more than 2 months at a time.
8. A postpartum patient reports feeling sad, tearful, and overwhelmed for the past 3 weeks. She has
trouble sleeping even when the baby sleeps. The onset of her symptoms occurred 2 weeks after
delivery. The most likely diagnosis is:
A) Postpartum psychosis
B) Baby blues
C) Postpartum depression
D) Adjustment disorder
✅ Correct Answer: C
Rationale: Postpartum depression typically begins within 4 weeks of delivery and lasts longer than 2
weeks, with symptoms meeting criteria for major depression. Baby blues are milder, self-limited (up to 2
weeks), and do not cause significant functional impairment.
9. Which of the following statements about the monoamine deficiency theory of depression is
accurate?
A) It fully explains all cases of depression.
B) It posits that elevated monoamine levels cause depression.
C) It is supported by the mechanism of action of many antidepressants.
D) It has been definitively proven by brain imaging studies.
✅ Correct Answer: C
Rationale: The monoamine deficiency theory is supported by the observation that many effective
antidepressants increase synaptic availability of serotonin, norepinephrine, or dopamine. However, it is
an oversimplification and does not explain all aspects of depression.
10. A patient with major depressive disorder reports difficulty concentrating, fatigue, and feelings of
worthlessness. Which neurotransmitter deficiency is most directly associated with the cognitive
symptom of poor concentration?
A) Serotonin
B) Norepinephrine
C) Dopamine
D) GABA
✅ Correct Answer: B
, 4
Rationale: Norepinephrine is involved in attention, focus, and arousal. Deficiency in norepinephrine is
linked to reduced attention and concentration, as well as anxiety. Serotonin is more associated with
mood and sleep; dopamine with motivation and reward.
11. A 28-year-old patient with major depressive disorder is prescribed an SSRI. The patient asks how
the medication works. The nurse’s best response is:
A) “It increases the amount of serotonin your brain produces.”
B) “It blocks the reuptake of serotonin, making more available in the synapse.”
C) “It replaces the serotonin that your brain is missing.”
D) “It stimulates serotonin receptors directly.”
✅ Correct Answer: B
Rationale: SSRIs (selective serotonin reuptake inhibitors) block the serotonin transporter (SERT),
preventing the reuptake of serotonin from the synaptic cleft, thereby increasing its availability. They do
not increase production or directly activate receptors.
12. A patient with depression reports an inability to experience pleasure, even when eating favorite
foods or spending time with loved ones. The nurse understands that this symptom is most closely
associated with dysfunction in which brain pathway?
A) Mesolimbic dopamine pathway
B) Locus coeruleus norepinephrine pathway
C) Raphe nuclei serotonin pathway
D) Tuberoinfundibular dopamine pathway
✅ Correct Answer: A
Rationale: The mesolimbic dopamine pathway (ventral tegmental area to nucleus accumbens) is the
brain’s primary reward circuit. Dysfunction here leads to anhedonia. The locus coeruleus is for
norepinephrine (arousal); raphe nuclei for serotonin (mood, sleep); tuberoinfundibular pathway
regulates prolactin.
13. A patient with major depressive disorder has been on sertraline for 8 weeks with partial
improvement. The provider adds bupropion. The rationale for this combination is that bupropion:
A) Is an SSRI that will further increase serotonin
B) Inhibits norepinephrine and dopamine reuptake, targeting different symptoms
C) Is a sedative that will help with insomnia
D) Potentiates the effects of sertraline by inhibiting its metabolism
✅ Correct Answer: B
Rationale: Bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor). Adding it to an SSRI can
address residual symptoms of low energy, poor concentration, and anhedonia that may not respond to
serotonin alone. It also may counteract SSRI-induced sexual dysfunction.
14. Which of the following is a diagnostic criterion for major depressive disorder?
A) Depressed mood most of the day, nearly every day
B) A single episode of mania
NR 507 Week 5 Study Guide – Alterations in
Neurobiological Functions (Exam Review)
1. A 55-year-old patient is diagnosed with Parkinson's disease. The pathophysiological basis for this
patient's motor symptoms is a deficiency of which neurotransmitter in the basal ganglia?
A. Serotonin
B. Acetylcholine
C. Dopamine
D. Norepinephrine
✅ Correct Answer: C
Rationale: The motor symptoms of Parkinson's disease are primarily due to the progressive loss of
dopamine-producing neurons in the substantia nigra, leading to a dopamine deficiency in the basal
ganglia circuitry.
2. A patient reports experiencing a sudden onset of a severe, "thunderclap" headache and vomiting.
The nurse suspects a subarachnoid hemorrhage. Which pathophysiological event directly contributes
to the rapid increase in intracranial pressure (ICP) in this patient?
A. Ischemia from a thrombotic occlusion
B. Autoregulation of cerebral blood flow
C. Accumulation of blood in the subarachnoid space
D. Meningeal inflammation
✅ Correct Answer: C
Rationale: A subarachnoid hemorrhage involves bleeding into the subarachnoid space. The
accumulating blood acts as a space-occupying lesion, increasing intracranial volume and immediately
raising ICP.
3. A patient is admitted to the emergency department following a tonic-clonic seizure. The patient is
now awake but confused, disoriented, and has muscle flaccidity. The nurse correctly identifies this
period as the:
A. Aura phase
B. Ictal phase
C. Post-ictal phase
D. Prodromal phase
✅ Correct Answer: C
Rationale: The post-ictal phase is the recovery period immediately following a seizure. It is characterized
by confusion, unresponsiveness, and muscle flaccidity as the brain recovers from the abnormal electrical
activity.
,2
Neurotransmitter Imbalance & Depression (4–30)
4. A 32-year-old patient with major depressive disorder reports a persistent inability to feel pleasure,
even when engaging in previously enjoyable activities. This symptom is best described as:
A) Anhedonia
B) Avolition
C) Dysphoria
D) Alexithymia
✅ Correct Answer: A
Rationale: Anhedonia is the loss of interest or pleasure in activities once found enjoyable. It is a core
symptom of major depressive disorder and is closely linked to dopamine dysregulation in the reward
pathway. Avolition is lack of motivation; dysphoria is a general state of unease; alexithymia is difficulty
identifying emotions.
5. A patient with depression has been treated with an SSRI for 6 weeks with minimal improvement.
The PMHNP considers that this patient may have a deficiency primarily in which neurotransmitter
system?
A) Serotonin only
B) Norepinephrine and dopamine
C) GABA and glutamate
D) Acetylcholine
✅ Correct Answer: B
Rationale: While SSRIs target serotonin, some patients have predominant deficiencies in norepinephrine
and dopamine. This may explain inadequate response to SSRIs, and such patients may benefit from an
SNRI or bupropion.
6. Which of the following symptoms is most characteristic of the melancholic subtype of major
depressive disorder?
A) Mood reactivity (can brighten in response to positive events)
B) Hypersomnia and increased appetite
C) Anhedonia and early morning awakening
D) Leaden paralysis and rejection sensitivity
✅ Correct Answer: C
Rationale: Melancholic depression is defined by pervasive anhedonia, lack of mood reactivity, early
morning awakening, psychomotor disturbance, and significant weight loss. Options A, B, and D are
features of atypical depression.
7. A 45-year-old patient has had mild depressive symptoms for over 2 years, including low energy,
poor self-esteem, and difficulty concentrating, but has never met full criteria for major depressive
disorder. This presentation is most consistent with:
A) Bipolar II disorder
,3
B) Dysthymia (Persistent Depressive Disorder)
C) Adjustment disorder with depressed mood
D) Cyclothymic disorder
✅ Correct Answer: B
Rationale: Dysthymia (persistent depressive disorder) requires depressed mood for at least 2 years in
adults, with at least two additional symptoms, but the severity is less than that of major depressive
disorder. Symptoms never remit for more than 2 months at a time.
8. A postpartum patient reports feeling sad, tearful, and overwhelmed for the past 3 weeks. She has
trouble sleeping even when the baby sleeps. The onset of her symptoms occurred 2 weeks after
delivery. The most likely diagnosis is:
A) Postpartum psychosis
B) Baby blues
C) Postpartum depression
D) Adjustment disorder
✅ Correct Answer: C
Rationale: Postpartum depression typically begins within 4 weeks of delivery and lasts longer than 2
weeks, with symptoms meeting criteria for major depression. Baby blues are milder, self-limited (up to 2
weeks), and do not cause significant functional impairment.
9. Which of the following statements about the monoamine deficiency theory of depression is
accurate?
A) It fully explains all cases of depression.
B) It posits that elevated monoamine levels cause depression.
C) It is supported by the mechanism of action of many antidepressants.
D) It has been definitively proven by brain imaging studies.
✅ Correct Answer: C
Rationale: The monoamine deficiency theory is supported by the observation that many effective
antidepressants increase synaptic availability of serotonin, norepinephrine, or dopamine. However, it is
an oversimplification and does not explain all aspects of depression.
10. A patient with major depressive disorder reports difficulty concentrating, fatigue, and feelings of
worthlessness. Which neurotransmitter deficiency is most directly associated with the cognitive
symptom of poor concentration?
A) Serotonin
B) Norepinephrine
C) Dopamine
D) GABA
✅ Correct Answer: B
, 4
Rationale: Norepinephrine is involved in attention, focus, and arousal. Deficiency in norepinephrine is
linked to reduced attention and concentration, as well as anxiety. Serotonin is more associated with
mood and sleep; dopamine with motivation and reward.
11. A 28-year-old patient with major depressive disorder is prescribed an SSRI. The patient asks how
the medication works. The nurse’s best response is:
A) “It increases the amount of serotonin your brain produces.”
B) “It blocks the reuptake of serotonin, making more available in the synapse.”
C) “It replaces the serotonin that your brain is missing.”
D) “It stimulates serotonin receptors directly.”
✅ Correct Answer: B
Rationale: SSRIs (selective serotonin reuptake inhibitors) block the serotonin transporter (SERT),
preventing the reuptake of serotonin from the synaptic cleft, thereby increasing its availability. They do
not increase production or directly activate receptors.
12. A patient with depression reports an inability to experience pleasure, even when eating favorite
foods or spending time with loved ones. The nurse understands that this symptom is most closely
associated with dysfunction in which brain pathway?
A) Mesolimbic dopamine pathway
B) Locus coeruleus norepinephrine pathway
C) Raphe nuclei serotonin pathway
D) Tuberoinfundibular dopamine pathway
✅ Correct Answer: A
Rationale: The mesolimbic dopamine pathway (ventral tegmental area to nucleus accumbens) is the
brain’s primary reward circuit. Dysfunction here leads to anhedonia. The locus coeruleus is for
norepinephrine (arousal); raphe nuclei for serotonin (mood, sleep); tuberoinfundibular pathway
regulates prolactin.
13. A patient with major depressive disorder has been on sertraline for 8 weeks with partial
improvement. The provider adds bupropion. The rationale for this combination is that bupropion:
A) Is an SSRI that will further increase serotonin
B) Inhibits norepinephrine and dopamine reuptake, targeting different symptoms
C) Is a sedative that will help with insomnia
D) Potentiates the effects of sertraline by inhibiting its metabolism
✅ Correct Answer: B
Rationale: Bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor). Adding it to an SSRI can
address residual symptoms of low energy, poor concentration, and anhedonia that may not respond to
serotonin alone. It also may counteract SSRI-induced sexual dysfunction.
14. Which of the following is a diagnostic criterion for major depressive disorder?
A) Depressed mood most of the day, nearly every day
B) A single episode of mania
