NSG 533 Advanced Pharmacology Exam 2 | Questions
and Correct Answers plus Rationale (Already Graded
A+) | New Update 2026-2027 | Wilkes University
Question 1 - 1 mark
What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose acetaminophen?
A. In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen
B. In elderly patients, it is recommended not to exceed >4,000 mg per day of
acetaminophen
C. In elderly patients, it is recommended not to exceed >2,000 mg per day of
acetaminophen
D. In elderly patients, acetaminophen should be avoided entirely
Correct Answer: A. In elderly patients, it is recommended not to exceed >3,000
mg per day of acetaminophen
Expert Rationale: In elderly patients, it is recommended not to exceed >3,000 mg
per day of acetaminophen. This is due to age-related changes in hepatic
metabolism and increased susceptibility to hepatotoxicity. The standard maximum
daily dose for younger adults is 4,000 mg, but for elderly patients, the lower
threshold of 3,000 mg is recommended.
Question 2 - 1 mark
What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A. SNRIs (duloxetine or venlafaxine)
B. SSRIs (fluoxetine or sertraline)
,C. TCAs (amitriptyline)
D. Gabapentin
Correct Answer: A. SNRIs (duloxetine or venlafaxine)
Expert Rationale: SNRIs such as duloxetine or venlafaxine have been successfully
used in diabetic peripheral neuropathy and also have antidepressant effects. This
dual action makes them particularly useful for diabetic patients with neuropathic
pain and comorbid depression. TCAs (C) also have both analgesic and
antidepressant effects but have more side effects. Gabapentin (D) treats
neuropathic pain but does not have antidepressant effects.
Question 3 - 1 mark
In addition, be sure to understand which non-opioid medications you would use
for a patient with neuropathic pain.
A. Gabapentin, pregabalin, transdermal lidocaine, TCAs
B. NSAIDs and acetaminophen
C. Opioids only
D. Muscle relaxants
Correct Answer: A. Gabapentin, pregabalin, transdermal lidocaine, TCAs
Expert Rationale: Non-opioid medications for neuropathic pain include
gabapentin, pregabalin, transdermal lidocaine, and TCAs. These medications work
through different mechanisms—gabapentin and pregabalin bind to calcium
channels, lidocaine blocks sodium channels, and TCAs inhibit reuptake of
norepinephrine and serotonin. NSAIDs and acetaminophen (B) are less effective
for neuropathic pain.
Question 4 - 1 mark
If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A. Fentanyl
B. Hydrocodone
, C. Oxycodone
D. No other opioid should be used
Correct Answer: A. Fentanyl
Expert Rationale: True opioid allergies are rare. When a true allergy is present, an
agent from another opiate class should be used. For example, a patient with a
true opiate allergy could receive fentanyl, which has a different chemical structure
from morphine and is less likely to cross-react.
Question 5 - 1 mark
Know the common side effects which opioids can cause.
A. Excessive sedation, constipation, nausea/vomiting, gastroparesis, vertigo,
respiratory depression, CNS irritability
B. Only constipation and nausea
C. Only sedation and respiratory depression
D. Only vertigo and CNS irritability
Correct Answer: A. Excessive sedation, constipation, nausea/vomiting,
gastroparesis, vertigo, respiratory depression, CNS irritability
Expert Rationale: Common side effects of opioids include: excessive sedation
(reduce dose by 25%), constipation (senna, dulcolax), nausea/vomiting
(hydroxyzine/diphenhydramine), gastroparesis, vertigo, respiratory depression,
and CNS irritability. Management strategies include dose reduction for sedation
and prophylactic laxatives for constipation.
Question 6 - 1 mark
Know the WHO pain treatment algorithm.
A. Mild pain (1-3): non-opioid analgesic scheduled ATC; Moderate pain (4-6): Add
opioid to scheduled non-opioid ATC; Severe pain (7-10): Switch to high dose
opioid, ATC
B. Mild pain: opioid only; Moderate pain: NSAID only; Severe pain: combination
therapy
and Correct Answers plus Rationale (Already Graded
A+) | New Update 2026-2027 | Wilkes University
Question 1 - 1 mark
What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose acetaminophen?
A. In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen
B. In elderly patients, it is recommended not to exceed >4,000 mg per day of
acetaminophen
C. In elderly patients, it is recommended not to exceed >2,000 mg per day of
acetaminophen
D. In elderly patients, acetaminophen should be avoided entirely
Correct Answer: A. In elderly patients, it is recommended not to exceed >3,000
mg per day of acetaminophen
Expert Rationale: In elderly patients, it is recommended not to exceed >3,000 mg
per day of acetaminophen. This is due to age-related changes in hepatic
metabolism and increased susceptibility to hepatotoxicity. The standard maximum
daily dose for younger adults is 4,000 mg, but for elderly patients, the lower
threshold of 3,000 mg is recommended.
Question 2 - 1 mark
What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A. SNRIs (duloxetine or venlafaxine)
B. SSRIs (fluoxetine or sertraline)
,C. TCAs (amitriptyline)
D. Gabapentin
Correct Answer: A. SNRIs (duloxetine or venlafaxine)
Expert Rationale: SNRIs such as duloxetine or venlafaxine have been successfully
used in diabetic peripheral neuropathy and also have antidepressant effects. This
dual action makes them particularly useful for diabetic patients with neuropathic
pain and comorbid depression. TCAs (C) also have both analgesic and
antidepressant effects but have more side effects. Gabapentin (D) treats
neuropathic pain but does not have antidepressant effects.
Question 3 - 1 mark
In addition, be sure to understand which non-opioid medications you would use
for a patient with neuropathic pain.
A. Gabapentin, pregabalin, transdermal lidocaine, TCAs
B. NSAIDs and acetaminophen
C. Opioids only
D. Muscle relaxants
Correct Answer: A. Gabapentin, pregabalin, transdermal lidocaine, TCAs
Expert Rationale: Non-opioid medications for neuropathic pain include
gabapentin, pregabalin, transdermal lidocaine, and TCAs. These medications work
through different mechanisms—gabapentin and pregabalin bind to calcium
channels, lidocaine blocks sodium channels, and TCAs inhibit reuptake of
norepinephrine and serotonin. NSAIDs and acetaminophen (B) are less effective
for neuropathic pain.
Question 4 - 1 mark
If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A. Fentanyl
B. Hydrocodone
, C. Oxycodone
D. No other opioid should be used
Correct Answer: A. Fentanyl
Expert Rationale: True opioid allergies are rare. When a true allergy is present, an
agent from another opiate class should be used. For example, a patient with a
true opiate allergy could receive fentanyl, which has a different chemical structure
from morphine and is less likely to cross-react.
Question 5 - 1 mark
Know the common side effects which opioids can cause.
A. Excessive sedation, constipation, nausea/vomiting, gastroparesis, vertigo,
respiratory depression, CNS irritability
B. Only constipation and nausea
C. Only sedation and respiratory depression
D. Only vertigo and CNS irritability
Correct Answer: A. Excessive sedation, constipation, nausea/vomiting,
gastroparesis, vertigo, respiratory depression, CNS irritability
Expert Rationale: Common side effects of opioids include: excessive sedation
(reduce dose by 25%), constipation (senna, dulcolax), nausea/vomiting
(hydroxyzine/diphenhydramine), gastroparesis, vertigo, respiratory depression,
and CNS irritability. Management strategies include dose reduction for sedation
and prophylactic laxatives for constipation.
Question 6 - 1 mark
Know the WHO pain treatment algorithm.
A. Mild pain (1-3): non-opioid analgesic scheduled ATC; Moderate pain (4-6): Add
opioid to scheduled non-opioid ATC; Severe pain (7-10): Switch to high dose
opioid, ATC
B. Mild pain: opioid only; Moderate pain: NSAID only; Severe pain: combination
therapy
