NR 546 Exam UPDATED QUESTIONS
AND CORRECT ANSWERS
Lithium
Anticonvulsants
Second generation antipsychotics - CORRECT 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. - CORRECT
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 - CORRECT 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 - CORRECT
ANSWER mania
requires at least one episode of mania for at least one week (or any duration if hospitalization due to
symptoms is required) - CORRECT 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. - CORRECT
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. - CORRECT
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 -
CORRECT 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 - CORRECT 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 - CORRECT ANSWER DA, NE Dysfunction causes what mood related
symptoms
Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes - CORRECT 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 - CORRECT 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) - CORRECT ANSWER Medication
Management for Depression, First-Line Treatment:
Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
, -sexual side effects - CORRECT 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 - CORRECT 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 - CORRECT ANSWER NDRI's
citalopram (Celexa) - CORRECT ANSWER SSRI Prescribing Pearls: med with mild
antihistamine effects
escitalopram (Lexapro) - CORRECT ANSWER SSRI Prescribing Pearls: med with no known
drug interactions
fluoxetine (Prozac) - CORRECT ANSWER SSRI Prescribing Pearls: med with longest half-life
AND CORRECT ANSWERS
Lithium
Anticonvulsants
Second generation antipsychotics - CORRECT 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. - CORRECT
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 - CORRECT 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 - CORRECT
ANSWER mania
requires at least one episode of mania for at least one week (or any duration if hospitalization due to
symptoms is required) - CORRECT 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. - CORRECT
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. - CORRECT
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 -
CORRECT 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 - CORRECT 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 - CORRECT ANSWER DA, NE Dysfunction causes what mood related
symptoms
Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes - CORRECT 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 - CORRECT 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) - CORRECT ANSWER Medication
Management for Depression, First-Line Treatment:
Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
-weight gain
, -sexual side effects - CORRECT 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 - CORRECT 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 - CORRECT ANSWER NDRI's
citalopram (Celexa) - CORRECT ANSWER SSRI Prescribing Pearls: med with mild
antihistamine effects
escitalopram (Lexapro) - CORRECT ANSWER SSRI Prescribing Pearls: med with no known
drug interactions
fluoxetine (Prozac) - CORRECT ANSWER SSRI Prescribing Pearls: med with longest half-life
