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NR 546 / NR546 Final Exam
2025/2026
1. Which neurotransmitter is most commonly associated with depression?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. GABA
✔ Correct Answer: B. Serotonin
Rationale:
Serotonin plays a vital role in regulating mood, emotional well-being, sleep, and
appetite. Decreased levels of serotonin are strongly linked to depressive
symptoms. Most first-line antidepressants—especially SSRIs (Selective
Serotonin Reuptake Inhibitors)—work by increasing serotonin availability in
the brain. The monoamine hypothesis of depression highlights serotonin
deficiency as a primary cause of mood dysregulation. While dopamine also
plays a role, serotonin remains the most strongly associated neurotransmitter
with major depressive disorder.
, 2
2. A patient taking clozapine should be routinely monitored for which
potentially life-threatening side effect?
A. Liver failure
B. Agranulocytosis
C. Hypertension
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D. Hyperthyroidism
✔ Correct Answer: B. Agranulocytosis
Rationale:
Clozapine is an atypical antipsychotic used for treatment-resistant
schizophrenia. One of its most serious adverse effects is agranulocytosis, a
dangerous drop in neutrophils (a type of white blood cell), which can leave
patients highly vulnerable to infections. Due to this risk, prescribers must enroll
patients in the REMS (Risk Evaluation and Mitigation Strategy) program, and
regular CBC (complete blood count) monitoring is mandatory. Early detection
of low white cell counts is essential to prevent fatal complications.
3. Which class of medications is considered first-line treatment for
generalized anxiety disorder (GAD)?
A. Benzodiazepines
B. Antipsychotics
C. SSRIs
D. MAOIs
✔ Correct Answer: C. SSRIs
Rationale:
SSRIs (Selective Serotonin Reuptake Inhibitors), such as sertraline and
escitalopram, are considered first-line pharmacologic treatment for GAD due to
their favorable side effect profile and efficacy in reducing anxiety symptoms
over time. Unlike benzodiazepines, which act quickly but carry a high risk for
dependence, SSRIs work gradually by enhancing serotonin transmission, thus
offering long-term anxiety management. They are safer for chronic use and are
well-supported by clinical guidelines for treating generalized anxiety disorder.
4. A client is prescribed lithium. Which of the following should the nurse
practitioner advise the patient to avoid?
A. Salt
B. NSAIDs
C. Potassium supplements
D. Vitamin C
, 3
✔ Correct Answer: B. NSAIDs
Rationale:
NSAIDs (e.g., ibuprofen, naproxen) can decrease renal clearance of lithium,
leading to elevated lithium levels and increasing the risk of toxicity. Lithium
has a narrow therapeutic range, and its excretion is almost entirely renal.
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NSAIDs reduce blood flow to the kidneys, impairing lithium clearance. Patients
should be advised to use acetaminophen for pain instead. Lithium toxicity can
present with tremors, confusion, and even seizures, making this drug interaction
critical to prevent through patient education.
5. What is a significant early symptom of serotonin syndrome?
A. Bradycardia
B. Hypotension
C. Hyperreflexia
D. Constipation
✔ Correct Answer: C. Hyperreflexia
Rationale:
Serotonin syndrome is a potentially life-threatening condition caused by
excessive serotonergic activity, often due to drug interactions or overdose of
serotonergic agents like SSRIs, SNRIs, or MAOIs. Early symptoms include
hyperreflexia, agitation, tremor, and clonus, especially in the lower limbs. As
the condition progresses, it can lead to hyperthermia, seizures, and even death.
Rapid recognition and discontinuation of the offending agent(s) are key to
preventing escalation. Nurses and prescribers must monitor patients closely for
these neuromuscular signs.
6. A child diagnosed with ADHD is started on methylphenidate. Which side
effect should the provider monitor most closely during follow-up?
A. Weight gain
B. Sedation
C. Appetite suppression
D. Bradycardia
✔ Correct Answer: C. Appetite suppression
Rationale:
Methylphenidate, a central nervous system stimulant, is commonly prescribed
for ADHD. One of its most frequent and concerning side effects is appetite
suppression, which can lead to weight loss and stunted growth in pediatric
patients. Providers should monitor growth parameters and appetite regularly
during treatment. In some cases, adjusting dosing schedules or trying alternative
Page | 1
NR 546 / NR546 Final Exam
2025/2026
1. Which neurotransmitter is most commonly associated with depression?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. GABA
✔ Correct Answer: B. Serotonin
Rationale:
Serotonin plays a vital role in regulating mood, emotional well-being, sleep, and
appetite. Decreased levels of serotonin are strongly linked to depressive
symptoms. Most first-line antidepressants—especially SSRIs (Selective
Serotonin Reuptake Inhibitors)—work by increasing serotonin availability in
the brain. The monoamine hypothesis of depression highlights serotonin
deficiency as a primary cause of mood dysregulation. While dopamine also
plays a role, serotonin remains the most strongly associated neurotransmitter
with major depressive disorder.
, 2
2. A patient taking clozapine should be routinely monitored for which
potentially life-threatening side effect?
A. Liver failure
B. Agranulocytosis
C. Hypertension
Page | 2
D. Hyperthyroidism
✔ Correct Answer: B. Agranulocytosis
Rationale:
Clozapine is an atypical antipsychotic used for treatment-resistant
schizophrenia. One of its most serious adverse effects is agranulocytosis, a
dangerous drop in neutrophils (a type of white blood cell), which can leave
patients highly vulnerable to infections. Due to this risk, prescribers must enroll
patients in the REMS (Risk Evaluation and Mitigation Strategy) program, and
regular CBC (complete blood count) monitoring is mandatory. Early detection
of low white cell counts is essential to prevent fatal complications.
3. Which class of medications is considered first-line treatment for
generalized anxiety disorder (GAD)?
A. Benzodiazepines
B. Antipsychotics
C. SSRIs
D. MAOIs
✔ Correct Answer: C. SSRIs
Rationale:
SSRIs (Selective Serotonin Reuptake Inhibitors), such as sertraline and
escitalopram, are considered first-line pharmacologic treatment for GAD due to
their favorable side effect profile and efficacy in reducing anxiety symptoms
over time. Unlike benzodiazepines, which act quickly but carry a high risk for
dependence, SSRIs work gradually by enhancing serotonin transmission, thus
offering long-term anxiety management. They are safer for chronic use and are
well-supported by clinical guidelines for treating generalized anxiety disorder.
4. A client is prescribed lithium. Which of the following should the nurse
practitioner advise the patient to avoid?
A. Salt
B. NSAIDs
C. Potassium supplements
D. Vitamin C
, 3
✔ Correct Answer: B. NSAIDs
Rationale:
NSAIDs (e.g., ibuprofen, naproxen) can decrease renal clearance of lithium,
leading to elevated lithium levels and increasing the risk of toxicity. Lithium
has a narrow therapeutic range, and its excretion is almost entirely renal.
Page | 3
NSAIDs reduce blood flow to the kidneys, impairing lithium clearance. Patients
should be advised to use acetaminophen for pain instead. Lithium toxicity can
present with tremors, confusion, and even seizures, making this drug interaction
critical to prevent through patient education.
5. What is a significant early symptom of serotonin syndrome?
A. Bradycardia
B. Hypotension
C. Hyperreflexia
D. Constipation
✔ Correct Answer: C. Hyperreflexia
Rationale:
Serotonin syndrome is a potentially life-threatening condition caused by
excessive serotonergic activity, often due to drug interactions or overdose of
serotonergic agents like SSRIs, SNRIs, or MAOIs. Early symptoms include
hyperreflexia, agitation, tremor, and clonus, especially in the lower limbs. As
the condition progresses, it can lead to hyperthermia, seizures, and even death.
Rapid recognition and discontinuation of the offending agent(s) are key to
preventing escalation. Nurses and prescribers must monitor patients closely for
these neuromuscular signs.
6. A child diagnosed with ADHD is started on methylphenidate. Which side
effect should the provider monitor most closely during follow-up?
A. Weight gain
B. Sedation
C. Appetite suppression
D. Bradycardia
✔ Correct Answer: C. Appetite suppression
Rationale:
Methylphenidate, a central nervous system stimulant, is commonly prescribed
for ADHD. One of its most frequent and concerning side effects is appetite
suppression, which can lead to weight loss and stunted growth in pediatric
patients. Providers should monitor growth parameters and appetite regularly
during treatment. In some cases, adjusting dosing schedules or trying alternative
