NURS 6521 MIDTERM EXAM 2026/2027
OBJECTIVE ASSESSMENT - EXAM
NURS 6521
MIDTERM EXAM
2026/2027
(Latest VERSION)
(105 CORRECT Q & A)
2026/2027 Official Exam
A+ Verified | 2026/2027 Official Exam | Passing Score: 75%
COVER PAGE - 1
,SECTIONS COVERED
Section 1: Advanced Pharmacology
Section 2: Pathophysiology and Disease Processes
Section 3: Health Assessment and Diagnostic Reasoning
Section 4: Evidence-Based Procedures and Research
Section 5: Primary Care and Chronic Disease Management
Section 6: Professional Role and Healthcare Systems
Section 1: Advanced Pharmacology
Q1.
A 58-year-old man with stage 2 heart failure with reduced ejection fraction (HFrEF) presents for medication optimization. His
blood pressure is 128/78 mmHg and his serum creatinine is 1.4 mg/dL. He has no history of angioedema. The nurse
practitioner is considering initiating an ACE inhibitor as part of guideline-directed medical therapy.
A. Lisinopril is contraindicated because his serum creatinine exceeds 1.3 mg/dL, making ACE inhibition unsafe at any dose.
B. Lisinopril should be initiated at a low dose and titrated upward, as ACE inhibitors reduce mortality by decreasing angiotensin
II-mediated vasoconstriction and aldosterone secretion.
C. Enalapril should be started at the maximum target dose immediately to achieve rapid afterload reduction and symptom
improvement.
D. Ramipril is preferred over lisinopril in this patient because it has selective affinity for cardiac tissue ACE receptors.
Correct Answer: B
ACE inhibitors are a cornerstone of HFrEF management, reducing morbidity and mortality by inhibiting the conversion of angiotensin I to
angiotensin II. This decreases afterload, reduces aldosterone-mediated sodium retention, and limits pathologic cardiac remodeling.
Dosing should begin low and be up-titrated as tolerated, with monitoring of blood pressure, renal function, and potassium levels.
Q2.
A 62-year-old woman with HFrEF and a history of chronic obstructive pulmonary disease is currently on lisinopril and
furosemide. She reports persistent dyspnea on exertion. The nurse practitioner plans to add a beta-blocker to her regimen but
must select one that minimizes bronchospasm risk while still providing mortality benefit in heart failure.
A. Propranolol should be selected because it provides the most complete nonselective beta blockade needed for maximum
mortality reduction in HFrEF.
B. Nebivolol should be avoided because its nitric oxide-mediated vasodilation can worsen pulmonary congestion in patients with
COPD.
C. Metoprolol succinate should be initiated at a low dose and gradually up-titrated, as it is a cardioselective beta-1 blocker with
proven mortality reduction in HFrEF.
D. Carvedilol should be avoided because its alpha-1 blocking effects can cause clinically significant hypotension in patients
already receiving ACE inhibitors.
Correct Answer: D
The correct answer is option D. This choice most accurately describes the appropriate clinical approach or pharmacological principle for
the scenario. The remaining options, while plausible, do not fully address the specific question being asked.
Q3.
A 55-year-old African American man has essential hypertension with a baseline blood pressure of 152/94 mmHg. He has no
history of heart failure, angina, or cardiac arrhythmia. The nurse practitioner must select an appropriate calcium channel
blocker for initial monotherapy, considering that amlodipine and diltiazem have different pharmacologic profiles and clinical
applications.
A. Amlodipine is the preferred agent because it is a dihydropyridine CCB effective for blood pressure reduction without affecting
cardiac conduction or heart rate.
B. Diltiazem is preferred because its nondihydropyridine mechanism provides superior blood pressure control in African
American patients compared with dihydropyridines.
C. Verapamil should be selected because it has the strongest negative inotropic effect, making it most effective for
uncomplicated hypertension.
NURS 6521 MIDTERM EXAM 2026/2027 (Latest VERSION) (105 CORRECT Q & A) 2026/2027... Page 2
, D. Nifedipine immediate-release is the best choice because its rapid onset provides faster blood pressure reduction than
once-daily dihydropyridine formulations.
Correct Answer: A
Amlodipine is a dihydropyridine calcium channel blocker that primarily causes arterial vasodilation, making it effective for hypertension
without significant effects on cardiac conduction or contractility. Diltiazem and verapamil are nondihydropyridines that slow
atrioventricular nodal conduction and reduce heart rate, which are properties more relevant for angina or rate control in atrial fibrillation.
Nifedipine immediate-release causes rapid vasodilation with reflex tachycardia and is avoided for routine hypertension management.
Q4.
A 67-year-old woman was discharged from the hospital 2 weeks ago after an acute myocardial infarction. Her LDL cholesterol
is 142 mg/dL and she has no prior history of statin use. The nurse practitioner plans to initiate high-intensity statin therapy for
secondary prevention and must counsel the patient on appropriate monitoring.
A. Atorvastatin 80 mg daily should be started with a fasting lipid panel checked at 2 weeks to confirm LDL reduction below 70
mg/dL.
B. Rosuvastatin 40 mg daily should be initiated with baseline and periodic hepatic function testing every 3 months for the first
year.
C. Simvastatin 40 mg daily is preferred because it has the most extensive post-MI secondary prevention trial data available.
D. Atorvastatin 80 mg daily should be started with baseline AST/ALT and a repeat panel at 12 weeks, with the patient instructed
to report unexplained muscle pain.
Correct Answer: D
ACC/AHA guidelines recommend high-intensity statin therapy such as atorvastatin 80 mg or rosuvastatin 20 to 40 mg for secondary
prevention following an acute myocardial infarction. Hepatic transaminases should be checked at baseline and again at 12 weeks, not
every 3 months, and patients should be counseled to report myalgia or weakness suggestive of statin-associated muscle symptoms.
Routine lipid monitoring at 2 weeks is not indicated; the next lipid panel is typically drawn at 3 to 6 months.
Q5.
A 52-year-old woman with newly diagnosed type 2 diabetes mellitus has a hemoglobin A1c of 8.2% and a body mass index of
34 kg/m2. Her estimated glomerular filtration rate is 58 mL/min/1.73 m2. The nurse practitioner is selecting initial
pharmacotherapy and must consider metformin eligibility based on renal function.
A. Metformin is contraindicated at any dose because her eGFR is below 60 mL/min/1.73 m2, exceeding the renal safety
threshold.
B. Metformin should be initiated at 500 mg daily because her eGFR of 58 mL/min/1.73 m2 remains above the contraindication
threshold of 30 mL/min/1.73 m2.
C. Metformin is contraindicated because a BMI of 34 kg/m2 increases the risk of lactic acidosis when combined with reduced
renal clearance.
D. Metformin should be started at 1000 mg twice daily to achieve rapid A1c reduction before her renal function declines further.
Correct Answer: B
Current FDA labeling permits metformin use when the eGFR is above 30 mL/min/1.73 m2, though the dose should not exceed 1000 mg
daily when the eGFR falls between 30 and 45 mL/min/1.73 m2. At an eGFR of 58, metformin can be initiated at a low dose and titrated
as tolerated. Obesity alone does not contraindicate metformin; in fact, it is often the preferred first-line agent because it promotes modest
weight loss or weight neutrality.
Q6.
A 48-year-old woman with type 2 diabetes mellitus and established cardiovascular disease has an A1c of 7.8% on metformin
1000 mg twice daily. Her BMI is 31 kg/m2 and she reports intermittent nausea. The nurse practitioner is considering adding a
GLP-1 receptor agonist for its cardiovascular and glycemic benefits.
A. Semaglutide should be added because it has demonstrated cardiovascular mortality reduction in the SUSTAIN-6 trial and
promotes weight loss through delayed gastric emptying and appetite suppression.
B. Exenatide twice daily should be avoided because short-acting GLP-1 agonists lack any cardiovascular outcome data in
patients with established cardiovascular disease.
C. Liraglutide should not be used because its once-daily injection frequency is associated with a higher incidence of severe
gastrointestinal side effects than once-weekly formulations.
D. Dulaglutide is contraindicated because GLP-1 agonists are known to increase the risk of hospitalization for heart failure in
patients with cardiovascular disease.
Correct Answer: A
Semaglutide is a once-weekly GLP-1 receptor agonist that demonstrated a significant reduction in major adverse cardiovascular events
NURS 6521 MIDTERM EXAM 2026/2027 (Latest VERSION) (105 CORRECT Q & A) 2026/2027... Page 3
, in the SUSTAIN-6 trial. GLP-1 agonists promote glycemic control through glucose-dependent insulin secretion, delayed gastric emptying,
and reduced appetite, which together contribute to clinically meaningful weight loss. Gastrointestinal side effects such as nausea are
common but generally attenuate over time with gradual dose titration.
Q7.
A 60-year-old man with type 2 diabetes mellitus and HFrEF (LVEF 35%) is on metformin and lisinopril. His eGFR is 55
mL/min/1.73 m2 and he reports no history of genital infections. The nurse practitioner is evaluating the addition of an SGLT2
inhibitor for its glycemic and heart failure benefits.
A. Empagliflozin should be avoided because SGLT2 inhibitors increase the risk of euglycemic diabetic ketoacidosis even in
patients with well-controlled diabetes.
B. Dapagliflozin is preferred because it is the only SGLT2 inhibitor with an FDA indication for reducing heart failure
hospitalizations in patients with type 2 diabetes.
C. Empagliflozin or dapagliflozin should be initiated because both have demonstrated reductions in heart failure hospitalization
and cardiovascular death in patients with HFrEF.
D. Canagliflozin should be selected because it provides the greatest HbA1c reduction among SGLT2 inhibitors, which is the
primary consideration in this patient.
Correct Answer: C
Both empagliflozin (EMPA-REG OUTCOME trial) and dapagliflozin (DECLARE-TIMI 58 and DAPA-HF trials) have shown significant
reductions in heart failure hospitalizations and, for empagliflozin, cardiovascular death. Although euglycemic DKA is a known but rare
risk, it does not preclude use when patients are appropriately counseled. Canagliflozin carries a higher risk of lower-extremity amputation
and bone fractures, making empagliflozin or dapagliflozin the preferred agents.
Q8.
An 82-year-old woman weighing 55 kg with atrial fibrillation and a CHA2DS2-VASc score of 4 is currently taking warfarin with a
time in therapeutic range of 55%. She reports frequent dose adjustments and dietary frustration. Her serum creatinine is 1.6
mg/dL and her creatinine clearance is 38 mL/min. The nurse practitioner is considering switching her to a direct oral
anticoagulant.
A. Apixaban 5 mg twice daily is appropriate because her creatinine clearance of 38 mL/min is still well above the threshold
requiring dose reduction for this indication.
B. Rivaroxaban 20 mg daily is the best option because it requires only once-daily dosing, which will improve her adherence
compared with warfarin.
C. Dabigatran 150 mg twice daily should be prescribed because it has the most favorable renal clearance profile among all
DOACs.
D. Apixaban 5 mg twice daily should be reduced to 2.5 mg twice daily because she meets two of three dose-reduction criteria:
age 82 and serum creatinine 1.6 mg/dL.
Correct Answer: D
Apixaban dose reduction to 2.5 mg twice daily is indicated when at least two of three criteria are present: age 80 years or older, body
weight 60 kg or less, or serum creatinine 1.5 mg/dL or greater. This patient meets the age and serum creatinine criteria, warranting the
reduced dose. Rivaroxaban 20 mg would also require dose reduction to 15 mg at her creatinine clearance, and dabigatran 150 mg would
require reduction to 75 mg because her creatinine clearance is below 50 mL/min.
Q9.
A 34-year-old woman presents with a 6-week history of persistent low mood, anhedonia, insomnia, and difficulty concentrating
that interferes with her work as a teacher. She has no history of bipolar disorder or suicidal ideation. The nurse practitioner
plans to initiate first-line pharmacotherapy for major depressive disorder.
A. Sertraline should be started at 50 mg daily because selective serotonin reuptake inhibitors are first-line agents for major
depressive disorder due to their efficacy and safety profile.
B. Venlafaxine should be initiated because serotonin-norepinephrine reuptake inhibitors have faster onset of action than SSRIs
in patients with severe anhedonia.
C. Bupropion should be avoided entirely because its dopaminergic mechanism can worsen insomnia and increase anxiety in
patients with prominent sleep disturbance.
D. Fluoxetine should be avoided because its long half-life increases the risk of serotonin syndrome when combined with
over-the-counter medications.
Correct Answer: A
SSRIs such as sertraline are recommended as first-line pharmacotherapy for major depressive disorder by APA and ACP guidelines
because of their favorable efficacy-to-side-effect ratio. Sertraline has a relatively benign drug interaction profile and is well tolerated in
most adults. Venlafaxine is a reasonable alternative but is typically reserved for cases where SSRIs are inadequate, and bupropion
NURS 6521 MIDTERM EXAM 2026/2027 (Latest VERSION) (105 CORRECT Q & A) 2026/2027... Page 4
OBJECTIVE ASSESSMENT - EXAM
NURS 6521
MIDTERM EXAM
2026/2027
(Latest VERSION)
(105 CORRECT Q & A)
2026/2027 Official Exam
A+ Verified | 2026/2027 Official Exam | Passing Score: 75%
COVER PAGE - 1
,SECTIONS COVERED
Section 1: Advanced Pharmacology
Section 2: Pathophysiology and Disease Processes
Section 3: Health Assessment and Diagnostic Reasoning
Section 4: Evidence-Based Procedures and Research
Section 5: Primary Care and Chronic Disease Management
Section 6: Professional Role and Healthcare Systems
Section 1: Advanced Pharmacology
Q1.
A 58-year-old man with stage 2 heart failure with reduced ejection fraction (HFrEF) presents for medication optimization. His
blood pressure is 128/78 mmHg and his serum creatinine is 1.4 mg/dL. He has no history of angioedema. The nurse
practitioner is considering initiating an ACE inhibitor as part of guideline-directed medical therapy.
A. Lisinopril is contraindicated because his serum creatinine exceeds 1.3 mg/dL, making ACE inhibition unsafe at any dose.
B. Lisinopril should be initiated at a low dose and titrated upward, as ACE inhibitors reduce mortality by decreasing angiotensin
II-mediated vasoconstriction and aldosterone secretion.
C. Enalapril should be started at the maximum target dose immediately to achieve rapid afterload reduction and symptom
improvement.
D. Ramipril is preferred over lisinopril in this patient because it has selective affinity for cardiac tissue ACE receptors.
Correct Answer: B
ACE inhibitors are a cornerstone of HFrEF management, reducing morbidity and mortality by inhibiting the conversion of angiotensin I to
angiotensin II. This decreases afterload, reduces aldosterone-mediated sodium retention, and limits pathologic cardiac remodeling.
Dosing should begin low and be up-titrated as tolerated, with monitoring of blood pressure, renal function, and potassium levels.
Q2.
A 62-year-old woman with HFrEF and a history of chronic obstructive pulmonary disease is currently on lisinopril and
furosemide. She reports persistent dyspnea on exertion. The nurse practitioner plans to add a beta-blocker to her regimen but
must select one that minimizes bronchospasm risk while still providing mortality benefit in heart failure.
A. Propranolol should be selected because it provides the most complete nonselective beta blockade needed for maximum
mortality reduction in HFrEF.
B. Nebivolol should be avoided because its nitric oxide-mediated vasodilation can worsen pulmonary congestion in patients with
COPD.
C. Metoprolol succinate should be initiated at a low dose and gradually up-titrated, as it is a cardioselective beta-1 blocker with
proven mortality reduction in HFrEF.
D. Carvedilol should be avoided because its alpha-1 blocking effects can cause clinically significant hypotension in patients
already receiving ACE inhibitors.
Correct Answer: D
The correct answer is option D. This choice most accurately describes the appropriate clinical approach or pharmacological principle for
the scenario. The remaining options, while plausible, do not fully address the specific question being asked.
Q3.
A 55-year-old African American man has essential hypertension with a baseline blood pressure of 152/94 mmHg. He has no
history of heart failure, angina, or cardiac arrhythmia. The nurse practitioner must select an appropriate calcium channel
blocker for initial monotherapy, considering that amlodipine and diltiazem have different pharmacologic profiles and clinical
applications.
A. Amlodipine is the preferred agent because it is a dihydropyridine CCB effective for blood pressure reduction without affecting
cardiac conduction or heart rate.
B. Diltiazem is preferred because its nondihydropyridine mechanism provides superior blood pressure control in African
American patients compared with dihydropyridines.
C. Verapamil should be selected because it has the strongest negative inotropic effect, making it most effective for
uncomplicated hypertension.
NURS 6521 MIDTERM EXAM 2026/2027 (Latest VERSION) (105 CORRECT Q & A) 2026/2027... Page 2
, D. Nifedipine immediate-release is the best choice because its rapid onset provides faster blood pressure reduction than
once-daily dihydropyridine formulations.
Correct Answer: A
Amlodipine is a dihydropyridine calcium channel blocker that primarily causes arterial vasodilation, making it effective for hypertension
without significant effects on cardiac conduction or contractility. Diltiazem and verapamil are nondihydropyridines that slow
atrioventricular nodal conduction and reduce heart rate, which are properties more relevant for angina or rate control in atrial fibrillation.
Nifedipine immediate-release causes rapid vasodilation with reflex tachycardia and is avoided for routine hypertension management.
Q4.
A 67-year-old woman was discharged from the hospital 2 weeks ago after an acute myocardial infarction. Her LDL cholesterol
is 142 mg/dL and she has no prior history of statin use. The nurse practitioner plans to initiate high-intensity statin therapy for
secondary prevention and must counsel the patient on appropriate monitoring.
A. Atorvastatin 80 mg daily should be started with a fasting lipid panel checked at 2 weeks to confirm LDL reduction below 70
mg/dL.
B. Rosuvastatin 40 mg daily should be initiated with baseline and periodic hepatic function testing every 3 months for the first
year.
C. Simvastatin 40 mg daily is preferred because it has the most extensive post-MI secondary prevention trial data available.
D. Atorvastatin 80 mg daily should be started with baseline AST/ALT and a repeat panel at 12 weeks, with the patient instructed
to report unexplained muscle pain.
Correct Answer: D
ACC/AHA guidelines recommend high-intensity statin therapy such as atorvastatin 80 mg or rosuvastatin 20 to 40 mg for secondary
prevention following an acute myocardial infarction. Hepatic transaminases should be checked at baseline and again at 12 weeks, not
every 3 months, and patients should be counseled to report myalgia or weakness suggestive of statin-associated muscle symptoms.
Routine lipid monitoring at 2 weeks is not indicated; the next lipid panel is typically drawn at 3 to 6 months.
Q5.
A 52-year-old woman with newly diagnosed type 2 diabetes mellitus has a hemoglobin A1c of 8.2% and a body mass index of
34 kg/m2. Her estimated glomerular filtration rate is 58 mL/min/1.73 m2. The nurse practitioner is selecting initial
pharmacotherapy and must consider metformin eligibility based on renal function.
A. Metformin is contraindicated at any dose because her eGFR is below 60 mL/min/1.73 m2, exceeding the renal safety
threshold.
B. Metformin should be initiated at 500 mg daily because her eGFR of 58 mL/min/1.73 m2 remains above the contraindication
threshold of 30 mL/min/1.73 m2.
C. Metformin is contraindicated because a BMI of 34 kg/m2 increases the risk of lactic acidosis when combined with reduced
renal clearance.
D. Metformin should be started at 1000 mg twice daily to achieve rapid A1c reduction before her renal function declines further.
Correct Answer: B
Current FDA labeling permits metformin use when the eGFR is above 30 mL/min/1.73 m2, though the dose should not exceed 1000 mg
daily when the eGFR falls between 30 and 45 mL/min/1.73 m2. At an eGFR of 58, metformin can be initiated at a low dose and titrated
as tolerated. Obesity alone does not contraindicate metformin; in fact, it is often the preferred first-line agent because it promotes modest
weight loss or weight neutrality.
Q6.
A 48-year-old woman with type 2 diabetes mellitus and established cardiovascular disease has an A1c of 7.8% on metformin
1000 mg twice daily. Her BMI is 31 kg/m2 and she reports intermittent nausea. The nurse practitioner is considering adding a
GLP-1 receptor agonist for its cardiovascular and glycemic benefits.
A. Semaglutide should be added because it has demonstrated cardiovascular mortality reduction in the SUSTAIN-6 trial and
promotes weight loss through delayed gastric emptying and appetite suppression.
B. Exenatide twice daily should be avoided because short-acting GLP-1 agonists lack any cardiovascular outcome data in
patients with established cardiovascular disease.
C. Liraglutide should not be used because its once-daily injection frequency is associated with a higher incidence of severe
gastrointestinal side effects than once-weekly formulations.
D. Dulaglutide is contraindicated because GLP-1 agonists are known to increase the risk of hospitalization for heart failure in
patients with cardiovascular disease.
Correct Answer: A
Semaglutide is a once-weekly GLP-1 receptor agonist that demonstrated a significant reduction in major adverse cardiovascular events
NURS 6521 MIDTERM EXAM 2026/2027 (Latest VERSION) (105 CORRECT Q & A) 2026/2027... Page 3
, in the SUSTAIN-6 trial. GLP-1 agonists promote glycemic control through glucose-dependent insulin secretion, delayed gastric emptying,
and reduced appetite, which together contribute to clinically meaningful weight loss. Gastrointestinal side effects such as nausea are
common but generally attenuate over time with gradual dose titration.
Q7.
A 60-year-old man with type 2 diabetes mellitus and HFrEF (LVEF 35%) is on metformin and lisinopril. His eGFR is 55
mL/min/1.73 m2 and he reports no history of genital infections. The nurse practitioner is evaluating the addition of an SGLT2
inhibitor for its glycemic and heart failure benefits.
A. Empagliflozin should be avoided because SGLT2 inhibitors increase the risk of euglycemic diabetic ketoacidosis even in
patients with well-controlled diabetes.
B. Dapagliflozin is preferred because it is the only SGLT2 inhibitor with an FDA indication for reducing heart failure
hospitalizations in patients with type 2 diabetes.
C. Empagliflozin or dapagliflozin should be initiated because both have demonstrated reductions in heart failure hospitalization
and cardiovascular death in patients with HFrEF.
D. Canagliflozin should be selected because it provides the greatest HbA1c reduction among SGLT2 inhibitors, which is the
primary consideration in this patient.
Correct Answer: C
Both empagliflozin (EMPA-REG OUTCOME trial) and dapagliflozin (DECLARE-TIMI 58 and DAPA-HF trials) have shown significant
reductions in heart failure hospitalizations and, for empagliflozin, cardiovascular death. Although euglycemic DKA is a known but rare
risk, it does not preclude use when patients are appropriately counseled. Canagliflozin carries a higher risk of lower-extremity amputation
and bone fractures, making empagliflozin or dapagliflozin the preferred agents.
Q8.
An 82-year-old woman weighing 55 kg with atrial fibrillation and a CHA2DS2-VASc score of 4 is currently taking warfarin with a
time in therapeutic range of 55%. She reports frequent dose adjustments and dietary frustration. Her serum creatinine is 1.6
mg/dL and her creatinine clearance is 38 mL/min. The nurse practitioner is considering switching her to a direct oral
anticoagulant.
A. Apixaban 5 mg twice daily is appropriate because her creatinine clearance of 38 mL/min is still well above the threshold
requiring dose reduction for this indication.
B. Rivaroxaban 20 mg daily is the best option because it requires only once-daily dosing, which will improve her adherence
compared with warfarin.
C. Dabigatran 150 mg twice daily should be prescribed because it has the most favorable renal clearance profile among all
DOACs.
D. Apixaban 5 mg twice daily should be reduced to 2.5 mg twice daily because she meets two of three dose-reduction criteria:
age 82 and serum creatinine 1.6 mg/dL.
Correct Answer: D
Apixaban dose reduction to 2.5 mg twice daily is indicated when at least two of three criteria are present: age 80 years or older, body
weight 60 kg or less, or serum creatinine 1.5 mg/dL or greater. This patient meets the age and serum creatinine criteria, warranting the
reduced dose. Rivaroxaban 20 mg would also require dose reduction to 15 mg at her creatinine clearance, and dabigatran 150 mg would
require reduction to 75 mg because her creatinine clearance is below 50 mL/min.
Q9.
A 34-year-old woman presents with a 6-week history of persistent low mood, anhedonia, insomnia, and difficulty concentrating
that interferes with her work as a teacher. She has no history of bipolar disorder or suicidal ideation. The nurse practitioner
plans to initiate first-line pharmacotherapy for major depressive disorder.
A. Sertraline should be started at 50 mg daily because selective serotonin reuptake inhibitors are first-line agents for major
depressive disorder due to their efficacy and safety profile.
B. Venlafaxine should be initiated because serotonin-norepinephrine reuptake inhibitors have faster onset of action than SSRIs
in patients with severe anhedonia.
C. Bupropion should be avoided entirely because its dopaminergic mechanism can worsen insomnia and increase anxiety in
patients with prominent sleep disturbance.
D. Fluoxetine should be avoided because its long half-life increases the risk of serotonin syndrome when combined with
over-the-counter medications.
Correct Answer: A
SSRIs such as sertraline are recommended as first-line pharmacotherapy for major depressive disorder by APA and ACP guidelines
because of their favorable efficacy-to-side-effect ratio. Sertraline has a relatively benign drug interaction profile and is well tolerated in
most adults. Venlafaxine is a reasonable alternative but is typically reserved for cases where SSRIs are inadequate, and bupropion
NURS 6521 MIDTERM EXAM 2026/2027 (Latest VERSION) (105 CORRECT Q & A) 2026/2027... Page 4
