NURS 5663 FINAL EXAM – TEXAS WOMAN'S UNIVERSITY
2026.2027 UPDATE COMPLETE QUESTIONS WITH CORRECT
ANSWERS AND RATIONALES
1. Which of the following correctly describes the mechanism of action of
etanercept?
A. TNF-alpha inhibitor
B. IL-1 receptor antagonist
C. B-cell depleting agent
D. JAK inhibitor
Correct Answer: A
Rationale: Etanercept is a soluble TNF receptor fusion protein that binds tumor
necrosis factor-alpha (TNF-α), preventing it from binding to cell surface receptors
and reducing inflammation in autoimmune diseases like rheumatoid arthritis.
2. Which of the following DMARDs has (have) the action of binding to the tumor
necrosis factor (TNF) of inflammatory response?
A. Etanercept
B. Azathioprine
C. Auranofin
D. All of the above
Correct Answer: A
Rationale: Etanercept is a TNF inhibitor. Azathioprine is an antimetabolite (purine
synthesis inhibitor). Auranofin is a gold compound (mechanism unclear, not TNF-
specific). Only etanercept directly binds TNF.
,3. A patient is beginning therapy with oral methotrexate for rheumatoid
arthritis. You should teach this patient about the importance of:
A. Having routine renal and hepatic tests
B. Taking the medication on a daily basis
C. Reporting alopecia and rash
D. Limiting folic acid consumption
Correct Answer: A
Rationale: Methotrexate can cause hepatotoxicity, nephrotoxicity, and bone
marrow suppression. Routine monitoring of LFTs, creatinine, and CBC is essential.
Methotrexate for RA is taken weekly, not daily. Folic acid supplementation is
recommended, not limited. Alopecia is less common at low RA doses.
4. You determine a serotonin/norepinephrine reuptake inhibitor (SNRI) will be
prescribed for a patient who is experiencing major depression. When conducting
a pretreatment health history, you learn the patient has a recent history of
alcohol abuse. Which SNRI would be contraindicated for this patient?
A. Venlafaxine (Effexor XR)
B. Lexapro (escitalopram) – Note: Lexapro is an SSRI, not an SNRI
C. Pristiq (desvenlafaxine)
D. Cymbalta (duloxetine)
Correct Answer: D
Rationale: Duloxetine (Cymbalta) carries a risk of hepatotoxicity and is
contraindicated in patients with substantial alcohol use or chronic liver disease.
Lexapro is an SSRI, not an SNRI, and would not be the correct SNRI choice.
Venlafaxine and desvenlafaxine have lower hepatic risk.
5. Which is the best option for treating an acute migraine in an 8-year-old boy?
A. Almotriptan
B. Zolmitriptan
C. Ibuprofen
, Correct Answer: C
Rationale: Ibuprofen is first-line for acute migraine in children due to safety,
efficacy, and availability. Triptans (almotriptan, zolmitriptan) are not FDA-approved
for children under 12 (some triptans down to age 6, but ibuprofen remains
preferred first-line).
6. Which of the following prophylactic treatments could potentially lead to the
development of serotonin syndrome in a patient prescribed rizatriptan (Maxalt)
for migraine headache?
A. Inderal (propranolol)
B. Topamax (topiramate)
C. Dtexor XR (likely a typo for Effexor XR / venlafaxine)
D. Valproic acid
Correct Answer: C
Rationale: Venlafaxine (an SNRI) combined with rizatriptan (a triptan) increases
serotonin activity, raising the risk of serotonin syndrome. Propranolol, topiramate,
and valproic acid do not significantly increase serotonin.
7. A 46-year-old man started tramadol 100 mg every 4 to 6 hours for back pain.
Yesterday he had a generalized tonic-clonic seizure. He has no prior history of
seizures and his neurological exam is normal. His back pain is affecting his mood,
and he feels depressed. Which of the following would be the best treatment
option?
A. Ultram (tramadol – same drug, not appropriate now)
B. Start Tegretol (carbamazepine) for the seizures
C. Start Wellbutrin (bupropion) for depression
Correct Answer: None of the above are optimal. Best answer based on options:
B is incorrect; C is dangerous. The correct action is to discontinue tramadol and
choose a different analgesic and antidepressant. Among given choices, none are
safe. But if forced: neither B nor C is correct. Tramadol lowers seizure threshold;
2026.2027 UPDATE COMPLETE QUESTIONS WITH CORRECT
ANSWERS AND RATIONALES
1. Which of the following correctly describes the mechanism of action of
etanercept?
A. TNF-alpha inhibitor
B. IL-1 receptor antagonist
C. B-cell depleting agent
D. JAK inhibitor
Correct Answer: A
Rationale: Etanercept is a soluble TNF receptor fusion protein that binds tumor
necrosis factor-alpha (TNF-α), preventing it from binding to cell surface receptors
and reducing inflammation in autoimmune diseases like rheumatoid arthritis.
2. Which of the following DMARDs has (have) the action of binding to the tumor
necrosis factor (TNF) of inflammatory response?
A. Etanercept
B. Azathioprine
C. Auranofin
D. All of the above
Correct Answer: A
Rationale: Etanercept is a TNF inhibitor. Azathioprine is an antimetabolite (purine
synthesis inhibitor). Auranofin is a gold compound (mechanism unclear, not TNF-
specific). Only etanercept directly binds TNF.
,3. A patient is beginning therapy with oral methotrexate for rheumatoid
arthritis. You should teach this patient about the importance of:
A. Having routine renal and hepatic tests
B. Taking the medication on a daily basis
C. Reporting alopecia and rash
D. Limiting folic acid consumption
Correct Answer: A
Rationale: Methotrexate can cause hepatotoxicity, nephrotoxicity, and bone
marrow suppression. Routine monitoring of LFTs, creatinine, and CBC is essential.
Methotrexate for RA is taken weekly, not daily. Folic acid supplementation is
recommended, not limited. Alopecia is less common at low RA doses.
4. You determine a serotonin/norepinephrine reuptake inhibitor (SNRI) will be
prescribed for a patient who is experiencing major depression. When conducting
a pretreatment health history, you learn the patient has a recent history of
alcohol abuse. Which SNRI would be contraindicated for this patient?
A. Venlafaxine (Effexor XR)
B. Lexapro (escitalopram) – Note: Lexapro is an SSRI, not an SNRI
C. Pristiq (desvenlafaxine)
D. Cymbalta (duloxetine)
Correct Answer: D
Rationale: Duloxetine (Cymbalta) carries a risk of hepatotoxicity and is
contraindicated in patients with substantial alcohol use or chronic liver disease.
Lexapro is an SSRI, not an SNRI, and would not be the correct SNRI choice.
Venlafaxine and desvenlafaxine have lower hepatic risk.
5. Which is the best option for treating an acute migraine in an 8-year-old boy?
A. Almotriptan
B. Zolmitriptan
C. Ibuprofen
, Correct Answer: C
Rationale: Ibuprofen is first-line for acute migraine in children due to safety,
efficacy, and availability. Triptans (almotriptan, zolmitriptan) are not FDA-approved
for children under 12 (some triptans down to age 6, but ibuprofen remains
preferred first-line).
6. Which of the following prophylactic treatments could potentially lead to the
development of serotonin syndrome in a patient prescribed rizatriptan (Maxalt)
for migraine headache?
A. Inderal (propranolol)
B. Topamax (topiramate)
C. Dtexor XR (likely a typo for Effexor XR / venlafaxine)
D. Valproic acid
Correct Answer: C
Rationale: Venlafaxine (an SNRI) combined with rizatriptan (a triptan) increases
serotonin activity, raising the risk of serotonin syndrome. Propranolol, topiramate,
and valproic acid do not significantly increase serotonin.
7. A 46-year-old man started tramadol 100 mg every 4 to 6 hours for back pain.
Yesterday he had a generalized tonic-clonic seizure. He has no prior history of
seizures and his neurological exam is normal. His back pain is affecting his mood,
and he feels depressed. Which of the following would be the best treatment
option?
A. Ultram (tramadol – same drug, not appropriate now)
B. Start Tegretol (carbamazepine) for the seizures
C. Start Wellbutrin (bupropion) for depression
Correct Answer: None of the above are optimal. Best answer based on options:
B is incorrect; C is dangerous. The correct action is to discontinue tramadol and
choose a different analgesic and antidepressant. Among given choices, none are
safe. But if forced: neither B nor C is correct. Tramadol lowers seizure threshold;
