NU 673 Midterm Exam Actual Exam
2026/2027 –Questions and Answers
with Detailed Rationales | (100%
Verified) | Guaranteed Pass/(GRADED
A+)
Question 1: Pharmacokinetics
A patient has been taking a medication with a half-life of 24
hours. Approximately how many days will it take for the drug to
reach steady state?
A. 2 days
B. 5 days
C. 10 days
D. 14 days
Answer: B. 5 days
Rationale: Steady state is reached after approximately 4 to 5 half-
lives. 5 half-lives x 24 hours = 120 hours (5 days). This concept is
the most consistent pharmacology principle tested on the
midterm regarding medication onset and dosing intervals.
Question 2: SSRI Side Effects
A patient newly started on Sertraline (Zoloft) returns to the clinic
after 3 days complaining of increased anxiety, jitteriness, and
insomnia. What is the most appropriate initial management?
A. Discontinue the medication immediately and switch to an SNRI.
B. Add a benzodiazepine or reduce the starting dose for the short
,term.
C. Immediately increase the dose to overcome the side effects.
D. Order an EKG to rule out prolonged QTc interval.
Answer: B. Add a benzodiazepine or reduce the starting dose for
the short term.
Rationale: Activation syndrome (agitation, anxiety, insomnia) is
common in the first 1-2 weeks of SSRI/SNRI initiation as the brain
adjusts to increased serotonin. This is not an allergic reaction; it
usually subsides. Management includes starting at a lower dose,
using a short-term benzodiazepine for symptom relief, or waiting
it out. Discontinuation is usually reserved for severe reactions.
Question 3: Antipsychotic Monitoring
A patient is started on Olanzapine (Zyprexa) for bipolar disorder.
Which of the following baseline assessments is most critical to
perform due to the specific metabolic profile of this drug?
A. Fasting blood glucose and lipid panel
B. Serum sodium levels
C. Complete blood count (CBC) with differential
D. Liver function tests (AST/ALT)
Answer: A. Fasting blood glucose and lipid panel
Rationale: Olanzapine (along with Clozapine) has the highest risk
for metabolic syndrome, including significant weight gain,
hyperglycemia (diabetes), and hyperlipidemia. While liver and
blood counts are monitored for other drugs (like Valproate or
Clozapine), the metabolic screening is non-negotiable for atypical
antipsychotics.
Question 4: Drug Interactions
A patient taking Fluoxetine (Prozac) is prescribed a new
,medication. The Fluoxetine inhibits CYP2D6. If the patient is
started on a medication that is a CYP2D6 substrate, the provider
should anticipate:
A. Decreased levels of the new medication, requiring a higher
dose.
B. Increased levels of the new medication, increasing risk of
toxicity.
C. No change in the level of the new medication.
D. Rapid clearance of Fluoxetine from the system.
Answer: B. Increased levels of the new medication, increasing risk
of toxicity.
Rationale: Inhibition of CYP2D6 blocks the breakdown of drugs
that rely on that pathway. This leads to elevated serum levels of
the substrate drug (e.g., certain beta-blockers, antipsychotics),
potentially leading to dose-related toxicity. The provider must
start the new drug at a lower dose.
Question 5: Neurotransmitters
A patient presents with classic signs of parkinsonism (rigidity,
bradykinesia) after being started on a low-potency antipsychotic.
This side effect is primarily associated with the blockade of which
neurotransmitter receptor?
A. Serotonin (5-HT2A)
B. Histamine (H1)
C. Dopamine (D2)
D. Acetylcholine (Muscarinic)
Answer: C. Dopamine (D2)
Rationale: Extrapyramidal symptoms (EPS) are caused by
blockade of dopamine (D2) receptors in the nigrostriatal pathway
, of the brain. Antipsychotics, especially the high-potency first-
generation agents, have a high affinity for D2 receptors, leading
to these movement disorders.
Question 6: Major Depressive Disorder
A patient with MDD reports severe insomnia and a lack of
appetite. Which of the following antidepressants would be most
helpful for promoting sleep and appetite stimulation?
A. Fluoxetine
B. Bupropion
C. Mirtazapine
D. Duloxetine
Answer: C. Mirtazapine
Rationale: Mirtazapine is unique in that it is a potent antagonist
at histamine (H1) receptors, causing significant sedation, and it
has strong 5-HT2 antagonism, which often stimulates appetite
and contributes to weight gain. This makes it a "low-side-effect"
choice for patients with insomnia and anorexia.
Question 7: Antipsychotic Side Effects (EPS)
A 45-year-old male on Haloperidol for schizophrenia presents
with a stiff neck, tongue protrusion, and oculogyric crisis. What is
the first-line immediate treatment?
A. Diphenhydramine (Benadryl) IV/IM
B. Lorazepam (Ativan) PO
C. Propranolol PO
D. Amantadine PO
Answer: A. Diphenhydramine (Benadryl) IV/IM
Rationale: This is an acute dystonic reaction, a type of
extrapyramidal symptom (EPS) caused by D2 blockade.
2026/2027 –Questions and Answers
with Detailed Rationales | (100%
Verified) | Guaranteed Pass/(GRADED
A+)
Question 1: Pharmacokinetics
A patient has been taking a medication with a half-life of 24
hours. Approximately how many days will it take for the drug to
reach steady state?
A. 2 days
B. 5 days
C. 10 days
D. 14 days
Answer: B. 5 days
Rationale: Steady state is reached after approximately 4 to 5 half-
lives. 5 half-lives x 24 hours = 120 hours (5 days). This concept is
the most consistent pharmacology principle tested on the
midterm regarding medication onset and dosing intervals.
Question 2: SSRI Side Effects
A patient newly started on Sertraline (Zoloft) returns to the clinic
after 3 days complaining of increased anxiety, jitteriness, and
insomnia. What is the most appropriate initial management?
A. Discontinue the medication immediately and switch to an SNRI.
B. Add a benzodiazepine or reduce the starting dose for the short
,term.
C. Immediately increase the dose to overcome the side effects.
D. Order an EKG to rule out prolonged QTc interval.
Answer: B. Add a benzodiazepine or reduce the starting dose for
the short term.
Rationale: Activation syndrome (agitation, anxiety, insomnia) is
common in the first 1-2 weeks of SSRI/SNRI initiation as the brain
adjusts to increased serotonin. This is not an allergic reaction; it
usually subsides. Management includes starting at a lower dose,
using a short-term benzodiazepine for symptom relief, or waiting
it out. Discontinuation is usually reserved for severe reactions.
Question 3: Antipsychotic Monitoring
A patient is started on Olanzapine (Zyprexa) for bipolar disorder.
Which of the following baseline assessments is most critical to
perform due to the specific metabolic profile of this drug?
A. Fasting blood glucose and lipid panel
B. Serum sodium levels
C. Complete blood count (CBC) with differential
D. Liver function tests (AST/ALT)
Answer: A. Fasting blood glucose and lipid panel
Rationale: Olanzapine (along with Clozapine) has the highest risk
for metabolic syndrome, including significant weight gain,
hyperglycemia (diabetes), and hyperlipidemia. While liver and
blood counts are monitored for other drugs (like Valproate or
Clozapine), the metabolic screening is non-negotiable for atypical
antipsychotics.
Question 4: Drug Interactions
A patient taking Fluoxetine (Prozac) is prescribed a new
,medication. The Fluoxetine inhibits CYP2D6. If the patient is
started on a medication that is a CYP2D6 substrate, the provider
should anticipate:
A. Decreased levels of the new medication, requiring a higher
dose.
B. Increased levels of the new medication, increasing risk of
toxicity.
C. No change in the level of the new medication.
D. Rapid clearance of Fluoxetine from the system.
Answer: B. Increased levels of the new medication, increasing risk
of toxicity.
Rationale: Inhibition of CYP2D6 blocks the breakdown of drugs
that rely on that pathway. This leads to elevated serum levels of
the substrate drug (e.g., certain beta-blockers, antipsychotics),
potentially leading to dose-related toxicity. The provider must
start the new drug at a lower dose.
Question 5: Neurotransmitters
A patient presents with classic signs of parkinsonism (rigidity,
bradykinesia) after being started on a low-potency antipsychotic.
This side effect is primarily associated with the blockade of which
neurotransmitter receptor?
A. Serotonin (5-HT2A)
B. Histamine (H1)
C. Dopamine (D2)
D. Acetylcholine (Muscarinic)
Answer: C. Dopamine (D2)
Rationale: Extrapyramidal symptoms (EPS) are caused by
blockade of dopamine (D2) receptors in the nigrostriatal pathway
, of the brain. Antipsychotics, especially the high-potency first-
generation agents, have a high affinity for D2 receptors, leading
to these movement disorders.
Question 6: Major Depressive Disorder
A patient with MDD reports severe insomnia and a lack of
appetite. Which of the following antidepressants would be most
helpful for promoting sleep and appetite stimulation?
A. Fluoxetine
B. Bupropion
C. Mirtazapine
D. Duloxetine
Answer: C. Mirtazapine
Rationale: Mirtazapine is unique in that it is a potent antagonist
at histamine (H1) receptors, causing significant sedation, and it
has strong 5-HT2 antagonism, which often stimulates appetite
and contributes to weight gain. This makes it a "low-side-effect"
choice for patients with insomnia and anorexia.
Question 7: Antipsychotic Side Effects (EPS)
A 45-year-old male on Haloperidol for schizophrenia presents
with a stiff neck, tongue protrusion, and oculogyric crisis. What is
the first-line immediate treatment?
A. Diphenhydramine (Benadryl) IV/IM
B. Lorazepam (Ativan) PO
C. Propranolol PO
D. Amantadine PO
Answer: A. Diphenhydramine (Benadryl) IV/IM
Rationale: This is an acute dystonic reaction, a type of
extrapyramidal symptom (EPS) caused by D2 blockade.
