NU 578 - Unit 2 EXAM 2025 | ACTUAL REAL EXAM ACCURATE QUESTIONS AND ANSWERS WITH RATIONALES | VERIFIED AND LATEST UPDATED |GUARANTEED PASS

Which non-controlled substance is used for sleep due to its melatonin agonist action? A. Zolpidem (Ambien) B. Ramelteon (Rozerem) C. Lorazepam (Ativan) D. Diphenhydramine (Benadryl) Correct Answer: B. Ramelteon (Rozerem) Rationale: Ramelteon is a melatonin receptor agonist that promotes sleep without risk of dependence, unlike controlled sedative-hypnotics. What is considered the first-line treatment for depression? A. MAOIs B. Tricyclic antidepressants (TCAs) C. SSRIs or atypical antidepressants D. Benzodiazepines Correct Answer: C. SSRIs or atypical antidepressants Rationale: SSRIs and atypical antidepressants are first-line due to safety and tolerability. MAOIs and TCAs are reserved for resistant cases. Which of the following is a tricyclic antidepressant (TCA)? A. Amitriptyline B. Fluoxetine C. Venlafaxine D. Bupropion Correct Answer: A. Amitriptyline Rationale: Amitriptyline is a TCA, which works by blocking reuptake of norepinephrine and serotonin. What is the mechanism of action of tricyclic antidepressants (TCAs)? A. Block dopamine receptors B. Block reuptake of norepinephrine and serotonin C. Inhibit monoamine oxidase D. Stimulate melatonin receptors Correct Answer: B. Block reuptake of norepinephrine and serotonin Rationale: TCAs elevate synaptic concentrations of NE and serotonin by blocking their reuptake. Which of the following is a common side effect of TCAs? A. Hypoglycemia B. Anticholinergic effects C. Increased libido D. Weight loss Correct Answer: B. Anticholinergic effects Rationale: TCAs commonly cause dry mouth, blurred vision, constipation, and urinary retention due to anticholinergic action. Which patient teaching is important with TCA therapy? A. Effects are immediate B. Effects are seen in 2–3 weeks C. Stop drug abruptly if side effects occur D. Take with tyramine-rich foods Correct Answer: B. Effects are seen in 2–3 weeks Rationale: TCAs require several weeks for therapeutic benefit due to gradual adaptive cellular changes. Which drug is an SSRI? A. Amitriptyline B. Venlafaxine C. Fluoxetine D. Bupropion Correct Answer: C. Fluoxetine Rationale: Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI). What is the major adverse effect of SSRIs? A. Severe hypertension B. Sexual dysfunction C. Hypoglycemia D. Renal failure Correct Answer: B. Sexual dysfunction Rationale: SSRIs are commonly associated with sexual dysfunction, weight gain, and GI upset. Which condition can result from SSRI use combined with other serotonergic drugs? A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Hypertensive crisis D. Malignant hyperthermia Correct Answer: A. Serotonin syndrome Rationale: Excess serotonin causes agitation, hallucinations, hyperreflexia, fever, and tremors. Which antidepressant has the lowest risk of sexual side effects? A. Fluoxetine B. Bupropion C. Amitriptyline D. Paroxetine Correct Answer: B. Bupropion Rationale: Bupropion is an atypical antidepressant that affects dopamine and carries the lowest incidence of sexual dysfunction. Which of the following is an SNRI? A. Venlafaxine B. Amitriptyline C. Fluoxetine D. Bupropion Correct Answer: A. Venlafaxine Rationale: SNRIs (Venlafaxine, Duloxetine) block reuptake of both serotonin and norepinephrine. Which of the following is a monoamine oxidase inhibitor (MAOI)? A. Amitriptyline B. Phenelzine C. Fluoxetine D. Sertraline Correct Answer: B. Phenelzine Rationale: Phenelzine is an MAOI that prevents breakdown of neurotransmitters, increasing their concentration. Which food interaction can trigger hypertensive crisis in a patient taking MAOIs? A. Dairy products B. High-fat foods C. Tyramine-rich foods D. Caffeine Correct Answer: C. Tyramine-rich foods Rationale: Tyramine increases norepinephrine release; with MAOIs, this can cause severe hypertension. Which mood stabilizer is associated with GI upset, tremors, and risk of diabetes insipidus? A. Fluoxetine B. Venlafaxine C. Lithium D. Sertraline Correct Answer: C. Lithium Rationale: Lithium is used for bipolar disorder but can cause tremors, polyuria, dehydration, and renal complications. A patient with lithium toxicity (serum level 2.5 mEq/L) is most at risk for which complication? A. Fine tremor B. Vomiting C. Convulsions and death D. Mild confusion Correct Answer: C. Convulsions and death Rationale: Lithium levels above 2.5 mEq/L are life-threatening and can cause coma, seizures, and death. At therapeutic doses, which of the following side effects is most common with lithium? A. Hypoglycemia and weight gain B. GI upset, polyuria, fine tremor C. Severe confusion and seizures D. Orthostatic hypotension Correct Answer: B. GI upset, polyuria, fine tremor Rationale: At therapeutic levels, lithium often causes mild tremor, GI disturbances, and increased urination. Which drug interaction increases the risk of lithium toxicity? A. NSAIDs B. Antibiotics C. Antihistamines D. Acetaminophen Correct Answer: A. NSAIDs Rationale: NSAIDs decrease renal clearance of lithium, increasing serum concentrations and risk of toxicity. What effect does a low-sodium diet have on lithium levels? A. Decreases lithium absorption B. Increases lithium toxicity risk C. Causes lithium to be ineffective D. Has no effect on lithium Correct Answer: B. Increases lithium toxicity risk Rationale: Sodium depletion increases lithium reabsorption in the kidneys, leading to elevated lithium levels. At a lithium level of 1.5–2.0 mEq/L, which symptom is expected? A. Fine tremor B. Coarse tremor and confusion C. Convulsions and death D. No symptoms Correct Answer: B. Coarse tremor and confusion Rationale: Moderate toxicity causes coarse tremor, confusion, ECG changes, and lack of coordination. At a lithium level of 2.0–2.5 mEq/L, which complication is most likely? A. Severe ECG changes and coma B. Mild GI upset only C. Weight loss and insomnia D. Hypertensive crisis Correct Answer: A. Severe ECG changes and coma Rationale: This range indicates severe toxicity with cardiovascular instability, coma, and hypotension. Which finding indicates life-threatening lithium toxicity (2.5 mEq/L)? A. Fine tremor and nausea B. Seizures and convulsions C. GI upset only D. Weight gain Correct Answer: B. Seizures and convulsions Rationale: Extremely high lithium levels (2.5 mEq/L) can cause convulsions, coma, and death. Which drug class should be avoided with both MAOIs and TCAs due to risk of hypertensive crisis? A. Sympathomimetics B. Antihistamines C. Antacids D. Antiemetics Correct Answer: A. Sympathomimetics Rationale: Drugs like epinephrine and dopamine can dangerously elevate norepinephrine when combined with MAOIs or TCAs. Which black box warning is associated with SSRIs? A. Risk of agranulocytosis B. Risk of increased suicidality in young patients C. Risk of renal failure D. Risk of pulmonary fibrosis Correct Answer: B. Risk of increased suicidality in young patients Rationale: SSRIs carry an FDA black box warning for increased risk of suicidal thoughts and behaviors in children and adolescents.