NSG 552
EXAM 3
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
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➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
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NSG 552 EXAM 3 - PSYCHOPHARMACOLOGY
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or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 552 Exam 3........................................................... 2
NSG 552 Exam 3 Study Guide .................................... 63
NSG 552 Exam 3
SECTION 1: SUBSTANCE USE DISORDERS
Question 1
A 34-year-old male is brought to the emergency department by EMS. His
girlfriend reports finding him unresponsive in the bathroom with a syringe
nearby. On examination, he has pinpoint pupils, respiratory rate of 6
breaths/minute, and blood pressure of 88/52 mmHg. Which medication
should be administered first?
• A. Naloxone (Narcan)
• B. Methadone
• C. Buprenorphine (Suboxone)
• D. Naltrexone
Correct Answer: A. Naloxone (Narcan)
Rationale: The patient presents with the classic triad of opioid intoxication:
miosis (pinpoint pupils), respiratory depression (RR 6), and hypotension
(88/52). Naloxone is a potent opioid antagonist and the treatment of choice for
acute opioid overdose. It rapidly reverses respiratory depression. Methadone
and buprenorphine are maintenance medications, not emergency treatments.
Naltrexone is an antagonist used after detoxification and would not be
appropriate in an acute overdose.
,──────────────────────────────────────────────────
──────────────────────────────
Question 2 [SELECT ALL THAT APPLY]
A nurse is assessing a patient suspected of opioid intoxication. Which findings
are consistent with this diagnosis? Select all that apply.
• A. Miosis (pinpoint pupils)
• B. Respiratory depression
• C. Tachycardia
• D. Hypotension
• E. Bradycardia
• F. Hypertension
Correct Answer: A, B, D, E
Rationale: Opioid intoxication presents with miosis (pinpoint pupils),
respiratory depression, bradycardia, hypotension, and unconsciousness.
Tachycardia and hypertension are NOT features of opioid intoxication; these
are more consistent with stimulant intoxication (e.g., cocaine). The classic
presentation is the triad of pinpoint pupils, respiratory depression, and
decreased level of consciousness.
──────────────────────────────────────────────────
──────────────────────────────
Question 3
A 28-year-old female presents to the clinic 24 hours after her last heroin use.
She reports severe anxiety, lacrimation (excessive tearing), muscle aches,
diarrhea, and abdominal cramps. Her vital signs show mild tachycardia and
hypertension. Which medication is most appropriate for managing her
symptoms?
• A. Naloxone
• B. Methadone
• C. Naltrexone
• D. Disulfiram
Correct Answer: B. Methadone
,Rationale: This patient is experiencing opioid withdrawal, characterized by
anxiety, lacrimation, muscle aches, diarrhea, and abdominal cramps.
Methadone is a long-acting full mu opioid agonist used for opioid use disorder
maintenance. It decreases cravings and withdrawal symptoms. Naloxone is for
overdose, not withdrawal. Naltrexone is an antagonist used after detoxification
and would precipitate withdrawal if given now. Disulfiram is for alcohol use
disorder.
──────────────────────────────────────────────────
──────────────────────────────
Question 4
A nurse practitioner is initiating buprenorphine (Suboxone) therapy for a
patient with opioid use disorder. The patient last used heroin 8 hours ago.
What is the most important consideration before starting buprenorphine?
• A. The patient must be in moderate withdrawal before starting
• B. Buprenorphine can be started immediately regardless of withdrawal
status
• C. The patient should receive a loading dose of methadone first
• D. Naloxone must be administered prior to buprenorphine
Correct Answer: A. The patient must be in moderate withdrawal before
starting
Rationale: Buprenorphine is a partial mu opioid agonist. Starting it too soon
after a full opioid agonist (like heroin) can precipitate withdrawal because it
displaces opioids from the mu receptors. The patient should be in moderate
withdrawal (typically 12-24 hours after short-acting opioids) before initiating
buprenorphine. This is a critical clinical pearl for safe buprenorphine initiation.
──────────────────────────────────────────────────
──────────────────────────────
Question 5 [SELECT ALL THAT APPLY]
A patient has been prescribed methadone for opioid use disorder
maintenance. Which monitoring parameters are essential? Select all that
apply.
• A. QTc interval on ECG
, • B. Liver function tests
• C. Respiratory rate
• D. Blood pressure
• E. Weight
• F. Electrolytes
Correct Answer: A, C, D
Rationale: Methadone is a long-acting full mu opioid agonist used for
maintenance therapy in patients with severe opioid dependence. Key
monitoring includes ECG for QTc prolongation (methadone can prolong the QT
interval, increasing risk of torsades de pointes), respiratory rate (risk of
respiratory depression), and blood pressure. While general health monitoring is
important, QTc monitoring is specifically highlighted in the study guide as a
critical parameter for methadone.
──────────────────────────────────────────────────
──────────────────────────────
Question 6
A 42-year-old male is brought to the emergency department after using
cocaine at a party. He is extremely agitated, hallucinating, and has a blood
pressure of 190/110 mmHg and heart rate of 128 bpm. He becomes violent
and requires immediate intervention. Which medication is most appropriate
for managing his agitation?
• A. Haloperidol
• B. Lorazepam
• C. Propranolol
• D. Nitroglycerin
Correct Answer: B. Lorazepam
Rationale: Cocaine intoxication presents with agitation, hallucinations,
hypertension, tachycardia, and violent behavior. Benzodiazepines (like
lorazepam) are the treatment of choice for agitation in stimulant intoxication.
Haloperidol can lower seizure threshold and is not first-line. Propranolol (a
beta-blocker) is contraindicated in cocaine-induced chest pain because
, NSG 552 Exam 3 Study Guide
1. Substance Use Disorders (SUD)
Core Concepts
Intoxication: Reversible syndrome caused by a specific substance affecting
memory, judgment, behavior, or social/occupational functioning.
Withdrawal: Substance-specific symptoms that occur after stopping or
reducing use.
Neurotransmitter: Dopamine mediates the positive rewards of
reinforcement in SUD (increases DA in the nucleus accumbens).
DSM-5 Criteria for SUD
• • Impairment in function (2-3 = mild, 4-5 = moderate, 6+ = severe)
• • Impaired control (larger amounts, efforts to cut down, craving)
• • Social impairment
• • Risky use (failure to abstain)
• • Pharmacologic (tolerance and withdrawal)
2. Alcohol Use Disorder
Alcohol Intoxication Clinical Manifestations
• • Impaired fine motor control
• • Impaired judgment & coordination
• • Ataxic gait & poor balance
• • Lethargy, difficulty sitting upright
• • Nausea/vomiting
• • Coma at levels ≥300 mg/dL
• • Respiratory depression; death possible
Alcohol Withdrawal
• • Mild: Insomnia, irritability, hand tremor
• • Moderate: Autonomic hyperactivity (diaphoresis, tachycardia, HTN),
fever
,• • Severe: Seizures (12-48 hours), hallucinations, delirium tremens (48-96
hours), anxiety, anorexia, N/V, psychomotor agitation
Delirium Tremens (DTs)
Life-threatening alcohol withdrawal syndrome characterized by confusion,
hallucinations, autonomic instability, fever, HTN, and tachycardia. Requires
immediate benzodiazepine treatment.
CIWA-Ar (Clinical Institute Withdrawal Assessment)
• Assessment tool for alcohol withdrawal severity:
• < 10 = Mild (often no meds needed, monitor + supportive care)
• 10-15 = Moderate (may require benzos + closer monitoring)
• > 15 = Severe (high risk for seizures/DT; requires meds + hospitalization)
• Assesses: N/V, tremor, paroxysmal sweats, anxiety, agitation,
tactile/auditory/visual hallucinations, headache, orientation
First-Line Treatment for Alcohol Withdrawal
• • Benzodiazepines are first-line (prevent seizures and delirium)
• • Lorazepam preferred in liver disease (no active metabolites)
• • Diazepam and chlordiazepoxide have longer durations
• • Careful with antipsychotics — they lower seizure threshold
Wernicke Encephalopathy & Korsakoff's Syndrome
• • Caused by thiamine deficiency in chronic alcohol use
• • Administer parenteral thiamine BEFORE glucose to prevent Wernicke's
• • Banana bag: Thiamine + multivitamin + folic acid
• • Untreated Wernicke's → Korsakoff's syndrome (confabulation, amnesia)
FDA-Approved Medications for Alcohol Use Disorder
Medication Mechanism of Action Key Points
Naltrexone (Revia, Competitive mu-opioid First-line for heavy
Vivitrol) antagonist; blocks drinkers; PO, injection,
enjoyment of drinking or implant; NO liquid
& decreases cravings form; monitor liver
function; avoid in
patients currently using
opioids
Acamprosate Reduces glutamate First-line for
,(Campral) activity; acts as maintaining abstinence
"artificial alcohol";after detox; safe in liver
reduces neuronal disease;
hyperactivity during contraindicated in
early recovery severe renal
impairment
Disulfiram Blocks aldehyde Second-line; for highly
(Antabuse) dehydrogenase enzyme motivated patients who
in liver have achieved
abstinence; must be
alcohol-free for 12
hours before starting
Disulfiram Aversion Reaction (if alcohol consumed)
• • Flushing, headache, N/V, palpitations, SOB, vertigo, hypotension
Disulfiram Patient Education — Products to Avoid
• • Anything containing alcohol: mouthwash, cough medicine, cooking wine
• • Vinegar, perfumes, aftershaves
• • Must avoid during treatment and up to 2 weeks after discontinuation
Acamprosate vs. Naltrexone — When to Choose
• • Acamprosate: Maintenance; first-line for maintaining abstinence or
recently relapsed
• • Naltrexone: First-line for heavy drinkers trying to achieve abstinence
• • Consider acamprosate over naltrexone if patient has acute hepatitis, liver
failure/disease, or is still drinking alcohol
Other Medications in AUD
• • Gabapentin: May help anxiety, insomnia, mild alcohol withdrawal; no
sedative effects; not metabolized by liver; no blood monitoring needed
• • Bupropion: Increases risk of withdrawal seizures in ETOH patients
• • Topiramate: Off-label use for alcohol dependence
3. Opioid Use Disorder
Opioid Intoxication
• • Drowsiness, sedation
• • Nausea/vomiting, decreased GI motility (constipation, abdominal
cramps)
, NSG 552
EXAM 3
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
EXAM 3
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 552 EXAM 3 - PSYCHOPHARMACOLOGY
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 552 Exam 3........................................................... 2
NSG 552 Exam 3 Study Guide .................................... 63
NSG 552 Exam 3
SECTION 1: SUBSTANCE USE DISORDERS
Question 1
A 34-year-old male is brought to the emergency department by EMS. His
girlfriend reports finding him unresponsive in the bathroom with a syringe
nearby. On examination, he has pinpoint pupils, respiratory rate of 6
breaths/minute, and blood pressure of 88/52 mmHg. Which medication
should be administered first?
• A. Naloxone (Narcan)
• B. Methadone
• C. Buprenorphine (Suboxone)
• D. Naltrexone
Correct Answer: A. Naloxone (Narcan)
Rationale: The patient presents with the classic triad of opioid intoxication:
miosis (pinpoint pupils), respiratory depression (RR 6), and hypotension
(88/52). Naloxone is a potent opioid antagonist and the treatment of choice for
acute opioid overdose. It rapidly reverses respiratory depression. Methadone
and buprenorphine are maintenance medications, not emergency treatments.
Naltrexone is an antagonist used after detoxification and would not be
appropriate in an acute overdose.
,──────────────────────────────────────────────────
──────────────────────────────
Question 2 [SELECT ALL THAT APPLY]
A nurse is assessing a patient suspected of opioid intoxication. Which findings
are consistent with this diagnosis? Select all that apply.
• A. Miosis (pinpoint pupils)
• B. Respiratory depression
• C. Tachycardia
• D. Hypotension
• E. Bradycardia
• F. Hypertension
Correct Answer: A, B, D, E
Rationale: Opioid intoxication presents with miosis (pinpoint pupils),
respiratory depression, bradycardia, hypotension, and unconsciousness.
Tachycardia and hypertension are NOT features of opioid intoxication; these
are more consistent with stimulant intoxication (e.g., cocaine). The classic
presentation is the triad of pinpoint pupils, respiratory depression, and
decreased level of consciousness.
──────────────────────────────────────────────────
──────────────────────────────
Question 3
A 28-year-old female presents to the clinic 24 hours after her last heroin use.
She reports severe anxiety, lacrimation (excessive tearing), muscle aches,
diarrhea, and abdominal cramps. Her vital signs show mild tachycardia and
hypertension. Which medication is most appropriate for managing her
symptoms?
• A. Naloxone
• B. Methadone
• C. Naltrexone
• D. Disulfiram
Correct Answer: B. Methadone
,Rationale: This patient is experiencing opioid withdrawal, characterized by
anxiety, lacrimation, muscle aches, diarrhea, and abdominal cramps.
Methadone is a long-acting full mu opioid agonist used for opioid use disorder
maintenance. It decreases cravings and withdrawal symptoms. Naloxone is for
overdose, not withdrawal. Naltrexone is an antagonist used after detoxification
and would precipitate withdrawal if given now. Disulfiram is for alcohol use
disorder.
──────────────────────────────────────────────────
──────────────────────────────
Question 4
A nurse practitioner is initiating buprenorphine (Suboxone) therapy for a
patient with opioid use disorder. The patient last used heroin 8 hours ago.
What is the most important consideration before starting buprenorphine?
• A. The patient must be in moderate withdrawal before starting
• B. Buprenorphine can be started immediately regardless of withdrawal
status
• C. The patient should receive a loading dose of methadone first
• D. Naloxone must be administered prior to buprenorphine
Correct Answer: A. The patient must be in moderate withdrawal before
starting
Rationale: Buprenorphine is a partial mu opioid agonist. Starting it too soon
after a full opioid agonist (like heroin) can precipitate withdrawal because it
displaces opioids from the mu receptors. The patient should be in moderate
withdrawal (typically 12-24 hours after short-acting opioids) before initiating
buprenorphine. This is a critical clinical pearl for safe buprenorphine initiation.
──────────────────────────────────────────────────
──────────────────────────────
Question 5 [SELECT ALL THAT APPLY]
A patient has been prescribed methadone for opioid use disorder
maintenance. Which monitoring parameters are essential? Select all that
apply.
• A. QTc interval on ECG
, • B. Liver function tests
• C. Respiratory rate
• D. Blood pressure
• E. Weight
• F. Electrolytes
Correct Answer: A, C, D
Rationale: Methadone is a long-acting full mu opioid agonist used for
maintenance therapy in patients with severe opioid dependence. Key
monitoring includes ECG for QTc prolongation (methadone can prolong the QT
interval, increasing risk of torsades de pointes), respiratory rate (risk of
respiratory depression), and blood pressure. While general health monitoring is
important, QTc monitoring is specifically highlighted in the study guide as a
critical parameter for methadone.
──────────────────────────────────────────────────
──────────────────────────────
Question 6
A 42-year-old male is brought to the emergency department after using
cocaine at a party. He is extremely agitated, hallucinating, and has a blood
pressure of 190/110 mmHg and heart rate of 128 bpm. He becomes violent
and requires immediate intervention. Which medication is most appropriate
for managing his agitation?
• A. Haloperidol
• B. Lorazepam
• C. Propranolol
• D. Nitroglycerin
Correct Answer: B. Lorazepam
Rationale: Cocaine intoxication presents with agitation, hallucinations,
hypertension, tachycardia, and violent behavior. Benzodiazepines (like
lorazepam) are the treatment of choice for agitation in stimulant intoxication.
Haloperidol can lower seizure threshold and is not first-line. Propranolol (a
beta-blocker) is contraindicated in cocaine-induced chest pain because
, NSG 552 Exam 3 Study Guide
1. Substance Use Disorders (SUD)
Core Concepts
Intoxication: Reversible syndrome caused by a specific substance affecting
memory, judgment, behavior, or social/occupational functioning.
Withdrawal: Substance-specific symptoms that occur after stopping or
reducing use.
Neurotransmitter: Dopamine mediates the positive rewards of
reinforcement in SUD (increases DA in the nucleus accumbens).
DSM-5 Criteria for SUD
• • Impairment in function (2-3 = mild, 4-5 = moderate, 6+ = severe)
• • Impaired control (larger amounts, efforts to cut down, craving)
• • Social impairment
• • Risky use (failure to abstain)
• • Pharmacologic (tolerance and withdrawal)
2. Alcohol Use Disorder
Alcohol Intoxication Clinical Manifestations
• • Impaired fine motor control
• • Impaired judgment & coordination
• • Ataxic gait & poor balance
• • Lethargy, difficulty sitting upright
• • Nausea/vomiting
• • Coma at levels ≥300 mg/dL
• • Respiratory depression; death possible
Alcohol Withdrawal
• • Mild: Insomnia, irritability, hand tremor
• • Moderate: Autonomic hyperactivity (diaphoresis, tachycardia, HTN),
fever
,• • Severe: Seizures (12-48 hours), hallucinations, delirium tremens (48-96
hours), anxiety, anorexia, N/V, psychomotor agitation
Delirium Tremens (DTs)
Life-threatening alcohol withdrawal syndrome characterized by confusion,
hallucinations, autonomic instability, fever, HTN, and tachycardia. Requires
immediate benzodiazepine treatment.
CIWA-Ar (Clinical Institute Withdrawal Assessment)
• Assessment tool for alcohol withdrawal severity:
• < 10 = Mild (often no meds needed, monitor + supportive care)
• 10-15 = Moderate (may require benzos + closer monitoring)
• > 15 = Severe (high risk for seizures/DT; requires meds + hospitalization)
• Assesses: N/V, tremor, paroxysmal sweats, anxiety, agitation,
tactile/auditory/visual hallucinations, headache, orientation
First-Line Treatment for Alcohol Withdrawal
• • Benzodiazepines are first-line (prevent seizures and delirium)
• • Lorazepam preferred in liver disease (no active metabolites)
• • Diazepam and chlordiazepoxide have longer durations
• • Careful with antipsychotics — they lower seizure threshold
Wernicke Encephalopathy & Korsakoff's Syndrome
• • Caused by thiamine deficiency in chronic alcohol use
• • Administer parenteral thiamine BEFORE glucose to prevent Wernicke's
• • Banana bag: Thiamine + multivitamin + folic acid
• • Untreated Wernicke's → Korsakoff's syndrome (confabulation, amnesia)
FDA-Approved Medications for Alcohol Use Disorder
Medication Mechanism of Action Key Points
Naltrexone (Revia, Competitive mu-opioid First-line for heavy
Vivitrol) antagonist; blocks drinkers; PO, injection,
enjoyment of drinking or implant; NO liquid
& decreases cravings form; monitor liver
function; avoid in
patients currently using
opioids
Acamprosate Reduces glutamate First-line for
,(Campral) activity; acts as maintaining abstinence
"artificial alcohol";after detox; safe in liver
reduces neuronal disease;
hyperactivity during contraindicated in
early recovery severe renal
impairment
Disulfiram Blocks aldehyde Second-line; for highly
(Antabuse) dehydrogenase enzyme motivated patients who
in liver have achieved
abstinence; must be
alcohol-free for 12
hours before starting
Disulfiram Aversion Reaction (if alcohol consumed)
• • Flushing, headache, N/V, palpitations, SOB, vertigo, hypotension
Disulfiram Patient Education — Products to Avoid
• • Anything containing alcohol: mouthwash, cough medicine, cooking wine
• • Vinegar, perfumes, aftershaves
• • Must avoid during treatment and up to 2 weeks after discontinuation
Acamprosate vs. Naltrexone — When to Choose
• • Acamprosate: Maintenance; first-line for maintaining abstinence or
recently relapsed
• • Naltrexone: First-line for heavy drinkers trying to achieve abstinence
• • Consider acamprosate over naltrexone if patient has acute hepatitis, liver
failure/disease, or is still drinking alcohol
Other Medications in AUD
• • Gabapentin: May help anxiety, insomnia, mild alcohol withdrawal; no
sedative effects; not metabolized by liver; no blood monitoring needed
• • Bupropion: Increases risk of withdrawal seizures in ETOH patients
• • Topiramate: Off-label use for alcohol dependence
3. Opioid Use Disorder
Opioid Intoxication
• • Drowsiness, sedation
• • Nausea/vomiting, decreased GI motility (constipation, abdominal
cramps)
, NSG 552
EXAM 3
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
