NUR 5461 EXAM 3: ADVANCED
PHARMACOLOGY QUESTIONS AND
CORRECT ANSWERS 2026/2027
1. A patient taking lithium for bipolar disorder presents with ataxia, coarse tremors, and a
serum level of 2.1 mEq/L. Which medication, recently added to the regimen, is the most likely
culprit for this toxicity?
A. Furosemide
B. Aspirin
C. Hydrochlorothiazide
D. Acetaminophen
Answer: C
Conceptual Explanation: Thiazide diuretics like hydrochlorothiazide reduce renal
clearance of lithium by increasing proximal tubule reabsorption of sodium and lithium,
leading to toxic accumulation.
2. When switching a patient from a Selective Serotonin Reuptake Inhibitor (SSRI) to a
Monoamine Oxidase Inhibitor (MAOI), what is the mandatory washout period to prevent
serotonin syndrome?
A. 2 days
,B. 7 days
C. 24 hours
D. 14 days
Answer: D
Conceptual Explanation: A washout period of at least 14 days is required when switching
from most SSRIs to an MAOI to ensure the SSRI is cleared, avoiding lethal serotonin
syndrome. Fluoxetine requires 5 weeks due to its long half-life.
3. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or bulimia nervosa?
A. Bupropion
B. Venlafaxine
C. Sertraline
D. Mirtazapine
Answer: A
Conceptual Explanation: Bupropion lowers the seizure threshold and is contraindicated
in patients with seizure disorders or active/history of eating disorders due to increased
seizure risk.
, 4. A patient on Clozapine therapy presents for a routine check-up. Which Absolute Neutrophil
Count (ANC) result would necessitate immediate discontinuation of the drug and notification
of the REMS program?
A. ANC 2500/mm3
B. ANC 1800/mm3
C. ANC 900/mm3
D. ANC 1200/mm3
Answer: C
Conceptual Explanation: Clozapine-induced agranulocytosis is a major risk. For the
general population, an ANC below 1000/mm3 (Severe Neutropenia) requires treatment
interruption.
5. Which mechanism explains the development of Tardive Dyskinesia in patients taking long-
term first-generation antipsychotics?
A. Acute blockade of D2 receptors in the tuberoinfundibular pathway
B. Cholinergic excess in the basal ganglia
C. Serotonin depletion in the prefrontal cortex
D. Dopamine receptor hypersensitivity in the nigrostriatal pathway
Answer: D
PHARMACOLOGY QUESTIONS AND
CORRECT ANSWERS 2026/2027
1. A patient taking lithium for bipolar disorder presents with ataxia, coarse tremors, and a
serum level of 2.1 mEq/L. Which medication, recently added to the regimen, is the most likely
culprit for this toxicity?
A. Furosemide
B. Aspirin
C. Hydrochlorothiazide
D. Acetaminophen
Answer: C
Conceptual Explanation: Thiazide diuretics like hydrochlorothiazide reduce renal
clearance of lithium by increasing proximal tubule reabsorption of sodium and lithium,
leading to toxic accumulation.
2. When switching a patient from a Selective Serotonin Reuptake Inhibitor (SSRI) to a
Monoamine Oxidase Inhibitor (MAOI), what is the mandatory washout period to prevent
serotonin syndrome?
A. 2 days
,B. 7 days
C. 24 hours
D. 14 days
Answer: D
Conceptual Explanation: A washout period of at least 14 days is required when switching
from most SSRIs to an MAOI to ensure the SSRI is cleared, avoiding lethal serotonin
syndrome. Fluoxetine requires 5 weeks due to its long half-life.
3. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or bulimia nervosa?
A. Bupropion
B. Venlafaxine
C. Sertraline
D. Mirtazapine
Answer: A
Conceptual Explanation: Bupropion lowers the seizure threshold and is contraindicated
in patients with seizure disorders or active/history of eating disorders due to increased
seizure risk.
, 4. A patient on Clozapine therapy presents for a routine check-up. Which Absolute Neutrophil
Count (ANC) result would necessitate immediate discontinuation of the drug and notification
of the REMS program?
A. ANC 2500/mm3
B. ANC 1800/mm3
C. ANC 900/mm3
D. ANC 1200/mm3
Answer: C
Conceptual Explanation: Clozapine-induced agranulocytosis is a major risk. For the
general population, an ANC below 1000/mm3 (Severe Neutropenia) requires treatment
interruption.
5. Which mechanism explains the development of Tardive Dyskinesia in patients taking long-
term first-generation antipsychotics?
A. Acute blockade of D2 receptors in the tuberoinfundibular pathway
B. Cholinergic excess in the basal ganglia
C. Serotonin depletion in the prefrontal cortex
D. Dopamine receptor hypersensitivity in the nigrostriatal pathway
Answer: D
