NSG 533 Advanced Pharmacology —
Examination 3 ACTUAL EXAM 2026/2027 |
Advanced Pharm Core Topics | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: CNS & Psychiatric Pharmacology (Questions 1–13)
Q1: A 28-year-old female with major depressive disorder has been taking sertraline 50 mg daily for 6
weeks. She reports improvement in mood but is distressed by decreased libido and difficulty reaching
orgasm. Which is the most appropriate next step?
A. Add bupropion 150 mg daily [CORRECT]
B. Discontinue sertraline immediately
C. Increase sertraline to 100 mg daily
D. Switch to phenelzine
Correct Answer: A
Rationale: Bupropion is often added to SSRIs to ameliorate sexual side effects due to its dopaminergic
and noradrenergic activity without significant serotonin effects. Discontinuing sertraline abruptly risks
discontinuation syndrome and relapse, while increasing the dose would likely worsen sexual
dysfunction.
Q2: A 45-year-old male with bipolar disorder has been stable on lithium 900 mg daily for two years.
Recent labs show serum lithium 1.4 mEq/L, BUN 32 mg/dL, and creatinine 1.8 mg/dL (baseline 1.0). He
reports nausea and mild tremor. Which action is most appropriate?
A. Increase lithium dose to achieve therapeutic range
B. Discontinue lithium and switch to valproate [CORRECT]
C. Add a thiazide diuretic to enhance lithium clearance
D. Continue current dose and recheck levels in one month
Correct Answer: B
Rationale: Lithium toxicity (level 1.4 with renal impairment and symptoms) requires discontinuation.
Valproate is an appropriate mood stabilizer alternative that does not rely primarily on renal elimination.
Thiazides reduce lithium clearance and would worsen toxicity.
,Q3: A patient taking phenelzine for depression presents to the emergency department with severe
headache, hypertensive crisis (BP 220/120), and diaphoresis after eating at a restaurant. Which dietary
component most likely precipitated this crisis?
A. Red wine and aged cheese [CORRECT]
B. Fresh green vegetables
C. Grilled chicken breast
D. Steamed white rice
Correct Answer: A
Rationale: MAOIs prevent breakdown of tyramine, found in aged cheeses, cured meats, and red wine.
Tyramine accumulation causes norepinephrine release and hypertensive crisis. Fresh foods without
aging or fermentation are generally safe.
Q4: A 22-year-old male with schizophrenia refuses depot antipsychotic injections due to needle phobia.
He has poor medication adherence leading to recurrent hospitalizations. Which oral agent offers the
best pharmacokinetic profile for partial adherence?
A. Haloperidol
B. Risperidone
C. Olanzapine [CORRECT]
D. Chlorpromazine
Correct Answer: C
Rationale: Olanzapine has a longer half-life (21-54 hours) and reaches steady state slowly, providing
some protection against missed doses compared to shorter-acting agents. However, long-acting
injectables remain preferred for non-adherence; olanzapine offers the best oral alternative.
Q5: A 35-year-old female with generalized anxiety disorder has a history of substance use disorder.
Which medication is most appropriate for long-term anxiety management without abuse potential?
A. Alprazolam
B. Lorazepam
C. Buspirone [CORRECT]
D. Diazepam
Correct Answer: C
Rationale: Buspirone is a non-benzodiazepine anxiolytic with no abuse potential, tolerance, or
withdrawal syndrome. It requires 2-4 weeks for onset but is safe in patients with substance use history.
Benzodiazepines carry significant risk in this population.
, Q6: A patient on clozapine for treatment-resistant schizophrenia presents with fever, sore throat, and
malaise. Lab results show absolute neutrophil count (ANC) 800/μL. Which is the priority action?
A. Continue clozapine and prescribe antibiotics for viral symptoms
B. Hold clozapine immediately and obtain repeat ANC [CORRECT]
C. Increase clozapine dose to overcome infection
D. Switch to haloperidol and continue monitoring
Correct Answer: B
Rationale: ANC 800-1499/μL with infection symptoms requires immediate clozapine discontinuation and
confirmation. This represents moderate neutropenia (ANC 500-1000 is severe). Clozapine REMS requires
interruption until ANC recovers to ≥1000/μL.
Q7: A 30-year-old with ADHD and comorbid anxiety experiences increased anxiety and insomnia after
starting methylphenidate. Which alternative agent is most appropriate?
A. Increase methylphenidate dose to induce tolerance
B. Switch to immediate-release amphetamine
C. Consider atomoxetine or guanfacine [CORRECT]
D. Add alprazolam for anxiety
Correct Answer: C
Rationale: Atomoxetine (SNRI mechanism) and guanfacine (alpha-2A agonist) are non-stimulant ADHD
treatments without the anxiogenic effects of stimulants. Adding benzodiazepines risks dependence and
does not address the underlying stimulant intolerance.
Q8: A patient presents with muscle rigidity, fever 103°F, altered mental status, and autonomic instability
after starting haloperidol two days ago. Which medication is the priority treatment?
A. Bromocriptine [CORRECT]
B. Diphenhydramine
C. Propranolol
D. Levodopa
Correct Answer: A
Rationale: These findings indicate neuroleptic malignant syndrome (NMS). Bromocriptine (dopamine
agonist) and dantrolene are primary treatments. Diphenhydramine treats dystonia, not NMS. Immediate
discontinuation of the offending antipsychotic is essential.
Q9: A patient on carbamazepine for bipolar disorder reports dizziness, ataxia, and nausea. Serum
sodium is 128 mEq/L. Which mechanism explains these findings?
A. SIADH from carbamazepine [CORRECT]
Examination 3 ACTUAL EXAM 2026/2027 |
Advanced Pharm Core Topics | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: CNS & Psychiatric Pharmacology (Questions 1–13)
Q1: A 28-year-old female with major depressive disorder has been taking sertraline 50 mg daily for 6
weeks. She reports improvement in mood but is distressed by decreased libido and difficulty reaching
orgasm. Which is the most appropriate next step?
A. Add bupropion 150 mg daily [CORRECT]
B. Discontinue sertraline immediately
C. Increase sertraline to 100 mg daily
D. Switch to phenelzine
Correct Answer: A
Rationale: Bupropion is often added to SSRIs to ameliorate sexual side effects due to its dopaminergic
and noradrenergic activity without significant serotonin effects. Discontinuing sertraline abruptly risks
discontinuation syndrome and relapse, while increasing the dose would likely worsen sexual
dysfunction.
Q2: A 45-year-old male with bipolar disorder has been stable on lithium 900 mg daily for two years.
Recent labs show serum lithium 1.4 mEq/L, BUN 32 mg/dL, and creatinine 1.8 mg/dL (baseline 1.0). He
reports nausea and mild tremor. Which action is most appropriate?
A. Increase lithium dose to achieve therapeutic range
B. Discontinue lithium and switch to valproate [CORRECT]
C. Add a thiazide diuretic to enhance lithium clearance
D. Continue current dose and recheck levels in one month
Correct Answer: B
Rationale: Lithium toxicity (level 1.4 with renal impairment and symptoms) requires discontinuation.
Valproate is an appropriate mood stabilizer alternative that does not rely primarily on renal elimination.
Thiazides reduce lithium clearance and would worsen toxicity.
,Q3: A patient taking phenelzine for depression presents to the emergency department with severe
headache, hypertensive crisis (BP 220/120), and diaphoresis after eating at a restaurant. Which dietary
component most likely precipitated this crisis?
A. Red wine and aged cheese [CORRECT]
B. Fresh green vegetables
C. Grilled chicken breast
D. Steamed white rice
Correct Answer: A
Rationale: MAOIs prevent breakdown of tyramine, found in aged cheeses, cured meats, and red wine.
Tyramine accumulation causes norepinephrine release and hypertensive crisis. Fresh foods without
aging or fermentation are generally safe.
Q4: A 22-year-old male with schizophrenia refuses depot antipsychotic injections due to needle phobia.
He has poor medication adherence leading to recurrent hospitalizations. Which oral agent offers the
best pharmacokinetic profile for partial adherence?
A. Haloperidol
B. Risperidone
C. Olanzapine [CORRECT]
D. Chlorpromazine
Correct Answer: C
Rationale: Olanzapine has a longer half-life (21-54 hours) and reaches steady state slowly, providing
some protection against missed doses compared to shorter-acting agents. However, long-acting
injectables remain preferred for non-adherence; olanzapine offers the best oral alternative.
Q5: A 35-year-old female with generalized anxiety disorder has a history of substance use disorder.
Which medication is most appropriate for long-term anxiety management without abuse potential?
A. Alprazolam
B. Lorazepam
C. Buspirone [CORRECT]
D. Diazepam
Correct Answer: C
Rationale: Buspirone is a non-benzodiazepine anxiolytic with no abuse potential, tolerance, or
withdrawal syndrome. It requires 2-4 weeks for onset but is safe in patients with substance use history.
Benzodiazepines carry significant risk in this population.
, Q6: A patient on clozapine for treatment-resistant schizophrenia presents with fever, sore throat, and
malaise. Lab results show absolute neutrophil count (ANC) 800/μL. Which is the priority action?
A. Continue clozapine and prescribe antibiotics for viral symptoms
B. Hold clozapine immediately and obtain repeat ANC [CORRECT]
C. Increase clozapine dose to overcome infection
D. Switch to haloperidol and continue monitoring
Correct Answer: B
Rationale: ANC 800-1499/μL with infection symptoms requires immediate clozapine discontinuation and
confirmation. This represents moderate neutropenia (ANC 500-1000 is severe). Clozapine REMS requires
interruption until ANC recovers to ≥1000/μL.
Q7: A 30-year-old with ADHD and comorbid anxiety experiences increased anxiety and insomnia after
starting methylphenidate. Which alternative agent is most appropriate?
A. Increase methylphenidate dose to induce tolerance
B. Switch to immediate-release amphetamine
C. Consider atomoxetine or guanfacine [CORRECT]
D. Add alprazolam for anxiety
Correct Answer: C
Rationale: Atomoxetine (SNRI mechanism) and guanfacine (alpha-2A agonist) are non-stimulant ADHD
treatments without the anxiogenic effects of stimulants. Adding benzodiazepines risks dependence and
does not address the underlying stimulant intolerance.
Q8: A patient presents with muscle rigidity, fever 103°F, altered mental status, and autonomic instability
after starting haloperidol two days ago. Which medication is the priority treatment?
A. Bromocriptine [CORRECT]
B. Diphenhydramine
C. Propranolol
D. Levodopa
Correct Answer: A
Rationale: These findings indicate neuroleptic malignant syndrome (NMS). Bromocriptine (dopamine
agonist) and dantrolene are primary treatments. Diphenhydramine treats dystonia, not NMS. Immediate
discontinuation of the offending antipsychotic is essential.
Q9: A patient on carbamazepine for bipolar disorder reports dizziness, ataxia, and nausea. Serum
sodium is 128 mEq/L. Which mechanism explains these findings?
A. SIADH from carbamazepine [CORRECT]
