NUR612/NUR612 Exam 4 V2 | Advance
Pharmacology Q&A with Rationale |
William Paterson University
1. A patient is started on Fluoxetine (Prozac) for depression. How long should the nurse
practitioner advise the patient it may take to see full therapeutic effects?
A. 4 to 6 weeks
B. 1 week
C. 2 to 4 days
D. 3 months
Answer: A
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine require several
weeks to achieve steady-state concentrations and produce full therapeutic changes. While
some minor improvements may be seen early, most patients require 4 to 6 weeks of
consistent dosing for significant relief. This delay is attributed to the time needed for
downregulation of post-synaptic receptors in the brain.
2. Which of the following laboratory values is the most critical to monitor for a patient taking
Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum potassium
,C. Serum creatinine
D. Liver enzymes (ALT/AST)
Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe and
potentially fatal drop in white blood cell count. Regular monitoring of the Absolute
Neutrophil Count (ANC) is mandatory under the Clozapine REMS program to ensure
patient safety. If the ANC falls below a certain threshold, the medication must be
discontinued immediately to prevent life-threatening infections.
3. A patient on Lithium Carbonate presents with coarse hand tremors, confusion, and a serum
lithium level of 1.9 mEq/L. What is the most appropriate action?
A. Hold the dose and notify the provider immediately
B. Continue the current dose and retest in one week
C. Increase fluid intake and repeat the lab test
D. Administer a dose of Benztropine
Answer: A
Rationale: A lithium level of 1.9 mEq/L is considered toxic, as the standard therapeutic
range is typically 0.6 to 1.2 mEq/L. Symptoms like coarse tremors and confusion are
clinical indicators of moderate to severe toxicity that require urgent intervention. Holding
the dose prevents further accumulation, and the provider must be notified to initiate
detoxification protocols or dose adjustments.
, 4. Which side effect is a common reason for patients to discontinue ACE inhibitors like
Lisinopril?
A. Peripheral edema
B. Hyperglycemia
C. Dry, non-productive cough
D. Constipation
Answer: C
Rationale: ACE inhibitors prevent the breakdown of bradykinin and substance P, which
can accumulate in the lungs and trigger a persistent, dry cough. This side effect occurs in
about 5% to 20% of patients and is not relieved by cough suppressants. If the cough
becomes intolerable, the clinician usually switches the patient to an Angiotensin II
Receptor Blocker (ARB) which does not affect bradykinin.
5. A patient with Parkinson’s disease is taking Levodopa/Carbidopa. Which dietary instruction
should be provided to maximize drug absorption?
A. Take the medication with a high-protein meal
B. Avoid taking the medication with high-protein foods
C. Take the medication with grapefruit juice
D. Avoid green leafy vegetables high in Vitamin K
Answer: B
Pharmacology Q&A with Rationale |
William Paterson University
1. A patient is started on Fluoxetine (Prozac) for depression. How long should the nurse
practitioner advise the patient it may take to see full therapeutic effects?
A. 4 to 6 weeks
B. 1 week
C. 2 to 4 days
D. 3 months
Answer: A
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine require several
weeks to achieve steady-state concentrations and produce full therapeutic changes. While
some minor improvements may be seen early, most patients require 4 to 6 weeks of
consistent dosing for significant relief. This delay is attributed to the time needed for
downregulation of post-synaptic receptors in the brain.
2. Which of the following laboratory values is the most critical to monitor for a patient taking
Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum potassium
,C. Serum creatinine
D. Liver enzymes (ALT/AST)
Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe and
potentially fatal drop in white blood cell count. Regular monitoring of the Absolute
Neutrophil Count (ANC) is mandatory under the Clozapine REMS program to ensure
patient safety. If the ANC falls below a certain threshold, the medication must be
discontinued immediately to prevent life-threatening infections.
3. A patient on Lithium Carbonate presents with coarse hand tremors, confusion, and a serum
lithium level of 1.9 mEq/L. What is the most appropriate action?
A. Hold the dose and notify the provider immediately
B. Continue the current dose and retest in one week
C. Increase fluid intake and repeat the lab test
D. Administer a dose of Benztropine
Answer: A
Rationale: A lithium level of 1.9 mEq/L is considered toxic, as the standard therapeutic
range is typically 0.6 to 1.2 mEq/L. Symptoms like coarse tremors and confusion are
clinical indicators of moderate to severe toxicity that require urgent intervention. Holding
the dose prevents further accumulation, and the provider must be notified to initiate
detoxification protocols or dose adjustments.
, 4. Which side effect is a common reason for patients to discontinue ACE inhibitors like
Lisinopril?
A. Peripheral edema
B. Hyperglycemia
C. Dry, non-productive cough
D. Constipation
Answer: C
Rationale: ACE inhibitors prevent the breakdown of bradykinin and substance P, which
can accumulate in the lungs and trigger a persistent, dry cough. This side effect occurs in
about 5% to 20% of patients and is not relieved by cough suppressants. If the cough
becomes intolerable, the clinician usually switches the patient to an Angiotensin II
Receptor Blocker (ARB) which does not affect bradykinin.
5. A patient with Parkinson’s disease is taking Levodopa/Carbidopa. Which dietary instruction
should be provided to maximize drug absorption?
A. Take the medication with a high-protein meal
B. Avoid taking the medication with high-protein foods
C. Take the medication with grapefruit juice
D. Avoid green leafy vegetables high in Vitamin K
Answer: B
