ESTUDYR
NU664C STUDY GUIDE FOR MIDTERM EXAM UPDATED WITH
MOST TESTED QUESTIONS AND ANSWERS | GRADED A+ |
ASSURED SUCCESS WITH DETAILED RATIONALES
1
What is the recommended route of administration for asenapine (Saphris)?
A. Oral swallowed tablet
B. Intramuscular injection
C. Sublingual tablet ✅
D. Transdermal patch
Rationale: Asenapine is sublingual; it has very poor bioavailability if swallowed (≈2%), but ~35% when
absorbed sublingually.
2
Which instruction should you give a patient taking sublingual asenapine?
A. Swallow immediately after placing under tongue
B. Chew the tablet for faster absorption
C. Do not eat or drink for 10 minutes after administration; allow tablet to dissolve under the tongue ✅
D. Rinse mouth immediately after dissolution
Rationale: Eating/drinking can wash the drug into the stomach (where it’s poorly absorbed). Tablet must
dissolve sublingually and not be chewed or swallowed.
3
Why might asenapine be used as a PRN (as-needed) option for agitation?
A. It is intramuscular only
B. It has extremely long onset of action
C. Rapid onset due to sublingual absorption ✅
D. It requires dietary fat for absorption
Rationale: Sublingual route allows rapid absorption, so it can be used for acute agitation instead of an
injection in some cases.
4
,ESTUDYR
Which atypical antipsychotic is associated with the greatest incidence of QTc prolongation?
A. Olanzapine
B. Risperidone
C. Ziprasidone (Geodon) ✅
D. Quetiapine
Rationale: Ziprasidone is known for dose-related QTc prolongation; it carries higher QTc risk than many
other second-generation antipsychotics.
5
At approximately what QTc value should a cardiology consult be obtained according to your notes?
A. >430 ms
B. >470 ms ✅
C. >520 ms
D. >600 ms
Rationale: Per the notes: >470 ms → call cardiology, and >500 ms is a threshold to stop meds (high
torsades risk).
6
Which antipsychotic’s absorption is increased by taking with food and therefore has specific food-intake
instructions?
A. Olanzapine
B. Ziprasidone (Geodon) ✅
C. Clozapine
D. Haloperidol
Rationale: Ziprasidone requires food (a substantial meal) for adequate absorption; lurasidone (Latuda)
also has food requirements.
7
Which antipsychotic also requires taking with food (has minimum food/diet restrictions)?
A. Olanzapine (Zyprexa)
B. Lurasidone (Latuda) ✅
C. Aripiprazole (Abilify)
D. Haloperidol
, ESTUDYR
Rationale: Lurasidone (Latuda) must be taken with food (≥350 kcal) to achieve proper absorption.
8
A patient has gained significant weight and developed diabetes on olanzapine. Which alternative
atypical is reasonable to consider for less weight gain?
A. Clozapine
B. Olanzapine dose increase
C. Aripiprazole (Abilify), Ziprasidone (Geodon), or Lurasidone (Latuda) ✅
D. Increase sugar intake to compensate
Rationale: Aripiprazole, ziprasidone, and lurasidone are generally more weight-neutral compared with
olanzapine.
9
A patient on clozapine has an ANC of <500/mm³ this week. What is the most appropriate
recommendation?
A. Continue the drug and recheck in 4 weeks
B. Stop the drug immediately due to agranulocytosis risk ✅
C. Double the clozapine dose
D. Switch to ziprasidone without further labs
Rationale: Severe neutropenia (ANC <500/mm³) requires immediate discontinuation of clozapine
because of life-threatening agranulocytosis.
10
Which lab monitoring is critical before and during clozapine therapy?
A. HbA1c only
B. Lipid panel only
C. Absolute neutrophil count (ANC) / CBC ✅
D. Urine pregnancy test only
Rationale: Frequent ANC/CBC monitoring is essential due to risk of neutropenia/agranulocytosis with
clozapine.
11
NU664C STUDY GUIDE FOR MIDTERM EXAM UPDATED WITH
MOST TESTED QUESTIONS AND ANSWERS | GRADED A+ |
ASSURED SUCCESS WITH DETAILED RATIONALES
1
What is the recommended route of administration for asenapine (Saphris)?
A. Oral swallowed tablet
B. Intramuscular injection
C. Sublingual tablet ✅
D. Transdermal patch
Rationale: Asenapine is sublingual; it has very poor bioavailability if swallowed (≈2%), but ~35% when
absorbed sublingually.
2
Which instruction should you give a patient taking sublingual asenapine?
A. Swallow immediately after placing under tongue
B. Chew the tablet for faster absorption
C. Do not eat or drink for 10 minutes after administration; allow tablet to dissolve under the tongue ✅
D. Rinse mouth immediately after dissolution
Rationale: Eating/drinking can wash the drug into the stomach (where it’s poorly absorbed). Tablet must
dissolve sublingually and not be chewed or swallowed.
3
Why might asenapine be used as a PRN (as-needed) option for agitation?
A. It is intramuscular only
B. It has extremely long onset of action
C. Rapid onset due to sublingual absorption ✅
D. It requires dietary fat for absorption
Rationale: Sublingual route allows rapid absorption, so it can be used for acute agitation instead of an
injection in some cases.
4
,ESTUDYR
Which atypical antipsychotic is associated with the greatest incidence of QTc prolongation?
A. Olanzapine
B. Risperidone
C. Ziprasidone (Geodon) ✅
D. Quetiapine
Rationale: Ziprasidone is known for dose-related QTc prolongation; it carries higher QTc risk than many
other second-generation antipsychotics.
5
At approximately what QTc value should a cardiology consult be obtained according to your notes?
A. >430 ms
B. >470 ms ✅
C. >520 ms
D. >600 ms
Rationale: Per the notes: >470 ms → call cardiology, and >500 ms is a threshold to stop meds (high
torsades risk).
6
Which antipsychotic’s absorption is increased by taking with food and therefore has specific food-intake
instructions?
A. Olanzapine
B. Ziprasidone (Geodon) ✅
C. Clozapine
D. Haloperidol
Rationale: Ziprasidone requires food (a substantial meal) for adequate absorption; lurasidone (Latuda)
also has food requirements.
7
Which antipsychotic also requires taking with food (has minimum food/diet restrictions)?
A. Olanzapine (Zyprexa)
B. Lurasidone (Latuda) ✅
C. Aripiprazole (Abilify)
D. Haloperidol
, ESTUDYR
Rationale: Lurasidone (Latuda) must be taken with food (≥350 kcal) to achieve proper absorption.
8
A patient has gained significant weight and developed diabetes on olanzapine. Which alternative
atypical is reasonable to consider for less weight gain?
A. Clozapine
B. Olanzapine dose increase
C. Aripiprazole (Abilify), Ziprasidone (Geodon), or Lurasidone (Latuda) ✅
D. Increase sugar intake to compensate
Rationale: Aripiprazole, ziprasidone, and lurasidone are generally more weight-neutral compared with
olanzapine.
9
A patient on clozapine has an ANC of <500/mm³ this week. What is the most appropriate
recommendation?
A. Continue the drug and recheck in 4 weeks
B. Stop the drug immediately due to agranulocytosis risk ✅
C. Double the clozapine dose
D. Switch to ziprasidone without further labs
Rationale: Severe neutropenia (ANC <500/mm³) requires immediate discontinuation of clozapine
because of life-threatening agranulocytosis.
10
Which lab monitoring is critical before and during clozapine therapy?
A. HbA1c only
B. Lipid panel only
C. Absolute neutrophil count (ANC) / CBC ✅
D. Urine pregnancy test only
Rationale: Frequent ANC/CBC monitoring is essential due to risk of neutropenia/agranulocytosis with
clozapine.
11
