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NURS 660 EXAM 2 QUESTIONS WITH CORRECT
VERIFIED SOLUTIONS 100% GUARANTEED PASS
(LATEST UPDATE)
1. A patient is prescribed sertraline for major depressive disorder. The nurse
understands that this medication's mechanism of action involves:
A. Blocking norepinephrine reuptake pumps only
B. Boosting serotonin and blocking the serotonin reuptake pump, with some ability to
block dopamine reuptake
C. Inhibiting monoamine oxidase enzymes
D. Blocking serotonin 2A receptors
CORRECT ANSWER: B
Rationale: Sertraline boosts neurotransmitter serotonin, blocks the serotonin reuptake
pump (serotonin transporter), and desensitizes serotonin receptors, especially serotonin
1A receptors. It also has some ability to block the dopamine reuptake pump (dopamine
transporter), which could increase dopamine neurotransmission and contribute to its
therapeutic actions.
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2. A patient taking sertraline is prescribed tramadol for pain. The nurse should
monitor this patient closely for:
A. Increased antidepressant efficacy
B. Decreased pain relief
C. Increased risk of seizures
D. Hypotension
CORRECT ANSWER: C
Rationale: Tramadol increases the risk of seizures in patients taking an antidepressant.
This is a major drug interaction that requires careful monitoring when these medications
are used concomitantly.
3. A patient is being switched from a monoamine oxidase inhibitor (MAOI) to
sertraline. How long should the nurse ensure the patient has been off the MAOI
before starting sertraline?
A. 24 hours
B. 5-7 days
C. 14 days
D. 4 weeks
CORRECT ANSWER: C
Rationale: Sertraline can cause fatal "serotonin syndrome" when combined with MAOIs.
It should not be used with MAOIs or for at least 14 days after MAOIs are stopped.
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Conversely, an MAOI should not be started for at least 5 half-lives (5 to 7 days for most
drugs) after discontinuing sertraline.
4. A patient taking sertraline is also prescribed warfarin. The nurse should monitor
for:
A. Decreased warfarin efficacy
B. Increased risk of bleeding
C. Decreased sertraline levels
D. Increased seizure risk
CORRECT ANSWER: B
Rationale: Sertraline may displace highly protein-bound drugs such as warfarin, leading
to increased anticoagulant effect. There is also a possible increased risk of bleeding,
especially when combined with anticoagulants (e.g., warfarin, NSAIDs).
5. A patient taking sertraline is started on simvastatin. The nurse should monitor
for signs and symptoms of:
A. Rhabdomyolysis
B. Serotonin syndrome
C. Hepatic failure
D. Renal impairment
CORRECT ANSWER: A
Rationale: Via CYP450 3A4 inhibition, sertraline may increase concentrations of certain
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cholesterol-lowering HMG CoA reductase inhibitors, especially simvastatin, atorvastatin,
and lovastatin, increasing the risk of rhabdomyolysis. Coadministration should proceed
with caution.
6. A pregnant patient is currently taking sertraline for depression. The nurse should
be aware that exposure to SSRIs beyond the 20th week of pregnancy may be
associated with increased risk of:
A. Neural tube defects
B. Pulmonary hypertension in newborns
C. Cleft palate
D. Limb malformations
CORRECT ANSWER: B
Rationale: SSRI use beyond the 20th week of pregnancy may be associated with
increased risk of pulmonary hypertension in newborns, although this is not proven.
Exposure early in pregnancy may be associated with increased risk of septal heart defects
(absolute risk is small).
7. A newborn exposed to an SSRI late in the third trimester develops respiratory
distress, cyanosis, feeding difficulty, and irritability. The nurse recognizes these
symptoms as consistent with:
A. Neonatal abstinence syndrome
B. Direct toxic effect of SSRI or drug discontinuation syndrome
NURS 660 EXAM 2 QUESTIONS WITH CORRECT
VERIFIED SOLUTIONS 100% GUARANTEED PASS
(LATEST UPDATE)
1. A patient is prescribed sertraline for major depressive disorder. The nurse
understands that this medication's mechanism of action involves:
A. Blocking norepinephrine reuptake pumps only
B. Boosting serotonin and blocking the serotonin reuptake pump, with some ability to
block dopamine reuptake
C. Inhibiting monoamine oxidase enzymes
D. Blocking serotonin 2A receptors
CORRECT ANSWER: B
Rationale: Sertraline boosts neurotransmitter serotonin, blocks the serotonin reuptake
pump (serotonin transporter), and desensitizes serotonin receptors, especially serotonin
1A receptors. It also has some ability to block the dopamine reuptake pump (dopamine
transporter), which could increase dopamine neurotransmission and contribute to its
therapeutic actions.
,2|Page
2. A patient taking sertraline is prescribed tramadol for pain. The nurse should
monitor this patient closely for:
A. Increased antidepressant efficacy
B. Decreased pain relief
C. Increased risk of seizures
D. Hypotension
CORRECT ANSWER: C
Rationale: Tramadol increases the risk of seizures in patients taking an antidepressant.
This is a major drug interaction that requires careful monitoring when these medications
are used concomitantly.
3. A patient is being switched from a monoamine oxidase inhibitor (MAOI) to
sertraline. How long should the nurse ensure the patient has been off the MAOI
before starting sertraline?
A. 24 hours
B. 5-7 days
C. 14 days
D. 4 weeks
CORRECT ANSWER: C
Rationale: Sertraline can cause fatal "serotonin syndrome" when combined with MAOIs.
It should not be used with MAOIs or for at least 14 days after MAOIs are stopped.
,3|Page
Conversely, an MAOI should not be started for at least 5 half-lives (5 to 7 days for most
drugs) after discontinuing sertraline.
4. A patient taking sertraline is also prescribed warfarin. The nurse should monitor
for:
A. Decreased warfarin efficacy
B. Increased risk of bleeding
C. Decreased sertraline levels
D. Increased seizure risk
CORRECT ANSWER: B
Rationale: Sertraline may displace highly protein-bound drugs such as warfarin, leading
to increased anticoagulant effect. There is also a possible increased risk of bleeding,
especially when combined with anticoagulants (e.g., warfarin, NSAIDs).
5. A patient taking sertraline is started on simvastatin. The nurse should monitor
for signs and symptoms of:
A. Rhabdomyolysis
B. Serotonin syndrome
C. Hepatic failure
D. Renal impairment
CORRECT ANSWER: A
Rationale: Via CYP450 3A4 inhibition, sertraline may increase concentrations of certain
, 4|Page
cholesterol-lowering HMG CoA reductase inhibitors, especially simvastatin, atorvastatin,
and lovastatin, increasing the risk of rhabdomyolysis. Coadministration should proceed
with caution.
6. A pregnant patient is currently taking sertraline for depression. The nurse should
be aware that exposure to SSRIs beyond the 20th week of pregnancy may be
associated with increased risk of:
A. Neural tube defects
B. Pulmonary hypertension in newborns
C. Cleft palate
D. Limb malformations
CORRECT ANSWER: B
Rationale: SSRI use beyond the 20th week of pregnancy may be associated with
increased risk of pulmonary hypertension in newborns, although this is not proven.
Exposure early in pregnancy may be associated with increased risk of septal heart defects
(absolute risk is small).
7. A newborn exposed to an SSRI late in the third trimester develops respiratory
distress, cyanosis, feeding difficulty, and irritability. The nurse recognizes these
symptoms as consistent with:
A. Neonatal abstinence syndrome
B. Direct toxic effect of SSRI or drug discontinuation syndrome
