Chamberlain University NR 566 Advanced Pharmacology
Final Exam New Latest Version with All 100 Questions,
Answers and Rationale
Question 1
A 68-year-old male with Parkinson's disease reports sudden, overwhelming sleepiness that
occurs without warning while watching television. He is currently taking carbidopa/levodopa.
Which of the following is most likely responsible for these "sleep attacks"?
a) The carbidopa/levodopa is causing a toxic reaction due to delayed gastric emptying.
b) The patient is experiencing a natural progression of Parkinson's disease, leading to sleep
dysregulation.
c) Dopamine agonists, often used as adjunctive therapy, are known to cause sudden onset sleep.
d) This is a rare, idiopathic reaction that requires an immediate sleep study.
Correct Answer: c) Dopamine agonists, often used as adjunctive therapy, are known to cause
sudden onset sleep.
Rationale: While carbidopa/levodopa can cause drowsiness, sudden and irresistible "sleep
attacks" are most classically associated with dopamine agonists (e.g., pramipexole, ropinirole)
used in the treatment of Parkinson's disease. Patients must be warned about this potentially
dangerous side effect, especially when driving .
Question 2
A patient with Alzheimer's disease is prescribed rivastigmine (Exelon). What is the primary
mechanism of action of this medication?
a) It blocks NMDA receptors to regulate glutamate activity and prevent neuronal damage.
b) It acts centrally to inhibit both acetylcholinesterase and butyrylcholinesterase.
c) It increases the production of dopamine in the basal ganglia to improve motor function.
d) It selectively inhibits monoamine oxidase B (MAO-B) to prevent the breakdown of dopamine.
Correct Answer: b) It acts centrally to inhibit both acetylcholinesterase and
butyrylcholinesterase.
Rationale: Rivastigmine is a cholinesterase inhibitor that is unique because it inhibits both
acetylcholinesterase and butyrylcholinesterase. This action increases the concentration of
acetylcholine in the brain, which can help slow the progression of cognitive symptoms in
Alzheimer's disease .
Question 3
A 72-year-old female with a history of depression is being started on an antidepressant. She is
concerned about falls and fractures. Which antidepressant should the nurse practitioner consider
avoiding due to its strong association with this risk?
a) Sertraline (Zoloft)
b) Bupropion (Wellbutrin)
c) Paroxetine (Paxil)
d) Venlafaxine (Effexor XR)
Correct Answer: c) Paroxetine (Paxil)
Rationale: Paroxetine is an SSRI with significant anticholinergic effects and a higher risk of
sedation compared to other SSRIs. In older adults, it should be avoided due to its strong
association with an increased risk of falls and fractures.
,Question 4
A 30-year-old female at 32 weeks gestation is diagnosed with major depressive disorder. She
requires pharmacological intervention. Which antidepressant is considered the safest first-line
choice during pregnancy?
a) Paroxetine (Paxil)
b) Sertraline (Zoloft)
c) Lithium
d) Phenytoin (Dilantin)
Correct Answer: b) Sertraline (Zoloft)
Rationale: Sertraline is generally considered the preferred SSRI during pregnancy due to its
favorable safety profile. Paroxetine, in contrast, has been associated with a small risk of fetal
cardiac malformations and is typically avoided .
Question 5
An infant is born to a mother who was taking an SNRI for depression throughout her pregnancy.
The newborn should be monitored closely for which of the following in the first few days of life?
a) Hyperglycemia and poor feeding
b) Irritability, tremors, and respiratory distress
c) Prolonged jaundice and hepatomegaly
d) Structural cardiac defects on echocardiogram
Correct Answer: b) Irritability, tremors, and respiratory distress
Rationale: Newborns exposed to SNRIs (and SSRIs) late in pregnancy are at risk for poor
neonatal adaptation syndrome. This transient syndrome can present with irritability, tremors,
respiratory distress, and poor feeding, and requires close monitoring after delivery.
Question 6
A 25-year-old patient is starting an antidepressant. The nurse practitioner provides education
about the risk of suicidal thoughts. In which age group is this risk most prevalent?
a) Older adults over the age of 65
b) Middle-aged adults between 40-60
c) Children, adolescents, and young adults under 25
d) The risk is equal across all age groups
Correct Answer: c) Children, adolescents, and young adults under 25
Rationale: The FDA black box warning for antidepressants highlights an increased risk of
suicidal thinking and behavior in children, adolescents, and young adults (up to age 24) during
the initial stages of treatment.
Question 7
A patient with bipolar disorder is started on lithium. The nurse practitioner knows that
monitoring is essential. When should the first serum lithium level be checked?
a) Immediately, before the first dose is given
b) One day after the first dose
c) Five days after the initial dose or a dose change
d) Only if the patient shows signs of toxicity
Correct Answer: c) Five days after the initial dose or a dose change
Rationale: Lithium has a narrow therapeutic index, and serum levels must be monitored closely
to ensure efficacy and avoid toxicity. A steady-state level is typically achieved after about 5
days, so levels are checked 5 days after initiation or any dose adjustment, and then every 6-12
months once stable .
, Question 8
A patient is prescribed phenytoin (Dilantin) for tonic-clonic seizures. Which statement
demonstrates a critical understanding of patient teaching regarding this medication?
a) "I can stop taking this medication once my seizures are controlled for 6 months."
b) "I need to practice good oral hygiene and see my dentist regularly because this drug can cause
gum problems."
c) "This medication is safe to take during pregnancy as it poses no risk to the fetus."
d) "I should take this medication with antacids to prevent stomach upset."
Correct Answer: b) "I need to practice good oral hygiene and see my dentist regularly because
this drug can cause gum problems."
Rationale: Phenytoin is known to cause gingival hyperplasia (overgrowth of gum tissue). Good
oral hygiene and regular dental care are essential to manage this side effect. It is teratogenic,
should not be stopped abruptly, and its absorption is affected by antacids.
Question 9
A patient of Asian ancestry is being considered for carbamazepine therapy. What is a critical
safety consideration for this population?
a) They require a much higher starting dose due to faster metabolism.
b) They are at an increased risk for agranulocytosis.
c) They should be screened for the HLA-B*1502 allele due to the risk of severe skin reactions.
d) The drug is contraindicated because it causes QT prolongation more frequently in this group.
Correct Answer: c) They should be screened for the HLA-B*1502 allele due to the risk of
severe skin reactions.
Rationale: Patients with Asian ancestry have a significantly higher risk of developing severe,
potentially fatal skin reactions (like Stevens-Johnson syndrome) from carbamazepine. Genetic
screening for the HLA-B*1502 allele is recommended before starting therapy.
Question 10
A patient with Alzheimer's disease has an elevated creatinine clearance due to early renal
impairment. How does this affect the dosing of memantine?
a) No dosage adjustment is needed as memantine is not renally cleared.
b) The dose should be increased because the drug will be cleared too quickly.
c) The dose may need to be reduced because memantine is primarily excreted unchanged in the
urine.
d) Memantine is contraindicated in any patient with abnormal renal function.
Correct Answer: c) The dose may need to be reduced because memantine is primarily excreted
unchanged in the urine.
Rationale: Memantine is eliminated largely unchanged by the kidneys. In patients with reduced
renal function, the dose must be adjusted downward to prevent accumulation and toxicity.
Question 11
A patient is being started on spironolactone for heart failure. Which laboratory value requires the
closest follow-up?
a) Serum sodium
b) Serum potassium
c) Blood urea nitrogen (BUN)
d) Hemoglobin A1c
Correct Answer: b) Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Its primary risk is causing
Final Exam New Latest Version with All 100 Questions,
Answers and Rationale
Question 1
A 68-year-old male with Parkinson's disease reports sudden, overwhelming sleepiness that
occurs without warning while watching television. He is currently taking carbidopa/levodopa.
Which of the following is most likely responsible for these "sleep attacks"?
a) The carbidopa/levodopa is causing a toxic reaction due to delayed gastric emptying.
b) The patient is experiencing a natural progression of Parkinson's disease, leading to sleep
dysregulation.
c) Dopamine agonists, often used as adjunctive therapy, are known to cause sudden onset sleep.
d) This is a rare, idiopathic reaction that requires an immediate sleep study.
Correct Answer: c) Dopamine agonists, often used as adjunctive therapy, are known to cause
sudden onset sleep.
Rationale: While carbidopa/levodopa can cause drowsiness, sudden and irresistible "sleep
attacks" are most classically associated with dopamine agonists (e.g., pramipexole, ropinirole)
used in the treatment of Parkinson's disease. Patients must be warned about this potentially
dangerous side effect, especially when driving .
Question 2
A patient with Alzheimer's disease is prescribed rivastigmine (Exelon). What is the primary
mechanism of action of this medication?
a) It blocks NMDA receptors to regulate glutamate activity and prevent neuronal damage.
b) It acts centrally to inhibit both acetylcholinesterase and butyrylcholinesterase.
c) It increases the production of dopamine in the basal ganglia to improve motor function.
d) It selectively inhibits monoamine oxidase B (MAO-B) to prevent the breakdown of dopamine.
Correct Answer: b) It acts centrally to inhibit both acetylcholinesterase and
butyrylcholinesterase.
Rationale: Rivastigmine is a cholinesterase inhibitor that is unique because it inhibits both
acetylcholinesterase and butyrylcholinesterase. This action increases the concentration of
acetylcholine in the brain, which can help slow the progression of cognitive symptoms in
Alzheimer's disease .
Question 3
A 72-year-old female with a history of depression is being started on an antidepressant. She is
concerned about falls and fractures. Which antidepressant should the nurse practitioner consider
avoiding due to its strong association with this risk?
a) Sertraline (Zoloft)
b) Bupropion (Wellbutrin)
c) Paroxetine (Paxil)
d) Venlafaxine (Effexor XR)
Correct Answer: c) Paroxetine (Paxil)
Rationale: Paroxetine is an SSRI with significant anticholinergic effects and a higher risk of
sedation compared to other SSRIs. In older adults, it should be avoided due to its strong
association with an increased risk of falls and fractures.
,Question 4
A 30-year-old female at 32 weeks gestation is diagnosed with major depressive disorder. She
requires pharmacological intervention. Which antidepressant is considered the safest first-line
choice during pregnancy?
a) Paroxetine (Paxil)
b) Sertraline (Zoloft)
c) Lithium
d) Phenytoin (Dilantin)
Correct Answer: b) Sertraline (Zoloft)
Rationale: Sertraline is generally considered the preferred SSRI during pregnancy due to its
favorable safety profile. Paroxetine, in contrast, has been associated with a small risk of fetal
cardiac malformations and is typically avoided .
Question 5
An infant is born to a mother who was taking an SNRI for depression throughout her pregnancy.
The newborn should be monitored closely for which of the following in the first few days of life?
a) Hyperglycemia and poor feeding
b) Irritability, tremors, and respiratory distress
c) Prolonged jaundice and hepatomegaly
d) Structural cardiac defects on echocardiogram
Correct Answer: b) Irritability, tremors, and respiratory distress
Rationale: Newborns exposed to SNRIs (and SSRIs) late in pregnancy are at risk for poor
neonatal adaptation syndrome. This transient syndrome can present with irritability, tremors,
respiratory distress, and poor feeding, and requires close monitoring after delivery.
Question 6
A 25-year-old patient is starting an antidepressant. The nurse practitioner provides education
about the risk of suicidal thoughts. In which age group is this risk most prevalent?
a) Older adults over the age of 65
b) Middle-aged adults between 40-60
c) Children, adolescents, and young adults under 25
d) The risk is equal across all age groups
Correct Answer: c) Children, adolescents, and young adults under 25
Rationale: The FDA black box warning for antidepressants highlights an increased risk of
suicidal thinking and behavior in children, adolescents, and young adults (up to age 24) during
the initial stages of treatment.
Question 7
A patient with bipolar disorder is started on lithium. The nurse practitioner knows that
monitoring is essential. When should the first serum lithium level be checked?
a) Immediately, before the first dose is given
b) One day after the first dose
c) Five days after the initial dose or a dose change
d) Only if the patient shows signs of toxicity
Correct Answer: c) Five days after the initial dose or a dose change
Rationale: Lithium has a narrow therapeutic index, and serum levels must be monitored closely
to ensure efficacy and avoid toxicity. A steady-state level is typically achieved after about 5
days, so levels are checked 5 days after initiation or any dose adjustment, and then every 6-12
months once stable .
, Question 8
A patient is prescribed phenytoin (Dilantin) for tonic-clonic seizures. Which statement
demonstrates a critical understanding of patient teaching regarding this medication?
a) "I can stop taking this medication once my seizures are controlled for 6 months."
b) "I need to practice good oral hygiene and see my dentist regularly because this drug can cause
gum problems."
c) "This medication is safe to take during pregnancy as it poses no risk to the fetus."
d) "I should take this medication with antacids to prevent stomach upset."
Correct Answer: b) "I need to practice good oral hygiene and see my dentist regularly because
this drug can cause gum problems."
Rationale: Phenytoin is known to cause gingival hyperplasia (overgrowth of gum tissue). Good
oral hygiene and regular dental care are essential to manage this side effect. It is teratogenic,
should not be stopped abruptly, and its absorption is affected by antacids.
Question 9
A patient of Asian ancestry is being considered for carbamazepine therapy. What is a critical
safety consideration for this population?
a) They require a much higher starting dose due to faster metabolism.
b) They are at an increased risk for agranulocytosis.
c) They should be screened for the HLA-B*1502 allele due to the risk of severe skin reactions.
d) The drug is contraindicated because it causes QT prolongation more frequently in this group.
Correct Answer: c) They should be screened for the HLA-B*1502 allele due to the risk of
severe skin reactions.
Rationale: Patients with Asian ancestry have a significantly higher risk of developing severe,
potentially fatal skin reactions (like Stevens-Johnson syndrome) from carbamazepine. Genetic
screening for the HLA-B*1502 allele is recommended before starting therapy.
Question 10
A patient with Alzheimer's disease has an elevated creatinine clearance due to early renal
impairment. How does this affect the dosing of memantine?
a) No dosage adjustment is needed as memantine is not renally cleared.
b) The dose should be increased because the drug will be cleared too quickly.
c) The dose may need to be reduced because memantine is primarily excreted unchanged in the
urine.
d) Memantine is contraindicated in any patient with abnormal renal function.
Correct Answer: c) The dose may need to be reduced because memantine is primarily excreted
unchanged in the urine.
Rationale: Memantine is eliminated largely unchanged by the kidneys. In patients with reduced
renal function, the dose must be adjusted downward to prevent accumulation and toxicity.
Question 11
A patient is being started on spironolactone for heart failure. Which laboratory value requires the
closest follow-up?
a) Serum sodium
b) Serum potassium
c) Blood urea nitrogen (BUN)
d) Hemoglobin A1c
Correct Answer: b) Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic. Its primary risk is causing
