NR567 Final Review Questions and Answers (Latest 2026/2027
Update)
Advanced Pharmacology for the AGACNP — Chamberlain University
150 Questions & Answers with Rationales
1. A patient is prescribed alprazolam for generalized anxiety disorder. Which
mechanism of action best explains this drug's therapeutic effect?
A. Blockade of dopamine D2 receptors
B. Enhancement of GABA-A receptor chloride channel activity
C. Inhibition of serotonin reuptake
D. Antagonism of NMDA glutamate receptors
Correct Answer: B. Enhancement of GABA-A receptor chloride channel activity
Explanation: Benzodiazepines like alprazolam bind to the GABA-A receptor complex and
enhance chloride ion influx, increasing the inhibitory effect of GABA and producing anxiolytic
and sedative effects.
2. Which adverse effect is of greatest concern when prescribing benzodiazepines to an
older adult patient?
A. Hypertension
B. Increased fall risk and cognitive impairment
C. Hyperglycemia
D. Tachycardia
Correct Answer: B. Increased fall risk and cognitive impairment
Explanation: Benzodiazepines cause sedation and psychomotor impairment that
disproportionately increase fall risk and confusion in older adults, making them a Beers Criteria
concern in this population.
3. A patient taking lithium for bipolar disorder should be monitored closely for which
condition that increases the risk of lithium toxicity?
A. Hyperkalemia
B. Dehydration and sodium depletion
C. Hypoglycemia
D. Hyperthyroidism
Correct Answer: B. Dehydration and sodium depletion
Explanation: Lithium is renally excreted similarly to sodium; dehydration or low-sodium states
increase renal reabsorption of lithium, raising serum levels and toxicity risk.
4. Which class of medications is considered first-line pharmacotherapy for major
depressive disorder due to a favorable side effect profile?
, A. Tricyclic antidepressants
B. Monoamine oxidase inhibitors
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Typical antipsychotics
Correct Answer: C. Selective serotonin reuptake inhibitors (SSRIs)
Explanation: SSRIs are generally preferred as first-line agents for depression because they
have fewer anticholinergic and cardiac side effects compared to tricyclics or MAOIs.
5. A patient on an SSRI is started on a triptan for migraines. What serious interaction
should the provider monitor for?
A. Hypertensive crisis
B. Serotonin syndrome
C. Agranulocytosis
D. QT prolongation only
Correct Answer: B. Serotonin syndrome
Explanation: Combining SSRIs with triptans increases serotonergic activity and raises the risk
of serotonin syndrome, characterized by agitation, hyperthermia, and neuromuscular
abnormalities.
6. Which symptom cluster is most characteristic of serotonin syndrome?
A. Bradycardia, hypotension, miosis
B. Hyperthermia, clonus, agitation, hyperreflexia
C. Hypothermia, bradypnea, sedation
D. Hypoglycemia, diaphoresis, tremor
Correct Answer: B. Hyperthermia, clonus, agitation, hyperreflexia
Explanation: Serotonin syndrome classically presents with autonomic instability
(hyperthermia), neuromuscular hyperactivity (clonus, hyperreflexia), and altered mental status
(agitation).
7. A patient newly started on an atypical antipsychotic should be monitored for which
metabolic adverse effect?
A. Hypoglycemia
B. Weight gain and dyslipidemia
C. Hyperthyroidism
D. Hypocalcemia
Correct Answer: B. Weight gain and dyslipidemia
Explanation: Atypical antipsychotics, particularly olanzapine and clozapine, are associated
with significant weight gain, dyslipidemia, and increased risk of new-onset diabetes.
,8. Clozapine therapy requires which mandatory laboratory monitoring due to a
life-threatening adverse effect?
A. Liver function tests weekly
B. Absolute neutrophil count due to agranulocytosis risk
C. Renal function tests daily
D. Thyroid panel monthly
Correct Answer: B. Absolute neutrophil count due to agranulocytosis risk
Explanation: Clozapine carries a risk of agranulocytosis, requiring mandatory absolute
neutrophil count monitoring through a registry program before each dispensed supply.
9. Which medication is considered first-line for acute management of a tonic-clonic
seizure in the emergency setting?
A. Phenytoin
B. Lorazepam
C. Valproic acid
D. Gabapentin
Correct Answer: B. Lorazepam
Explanation: Benzodiazepines such as IV lorazepam are first-line for acute seizure
termination due to their rapid onset of GABAergic inhibition.
10. A patient taking valproic acid during pregnancy is at increased risk for which fetal
complication?
A. Limb reduction defects
B. Neural tube defects
C. Cardiac septal defects only
D. Renal agenesis
Correct Answer: B. Neural tube defects
Explanation: Valproic acid is a known human teratogen strongly associated with neural tube
defects, such as spina bifida, when used during the first trimester.
11. Which laboratory parameter should be routinely monitored in a patient maintained
on long-term phenytoin therapy?
A. Serum phenytoin level and liver function
B. Serum potassium only
C. Hemoglobin A1c
D. TSH level
Correct Answer: A. Serum phenytoin level and liver function
Explanation: Phenytoin has a narrow therapeutic index and undergoes hepatic metabolism,
so monitoring serum drug levels and liver function helps prevent toxicity and detect hepatic
effects.
, 12. A patient with acute agitation and psychosis in the ICU is given haloperidol IV.
Which cardiac effect requires monitoring?
A. Bradycardia only
B. QT interval prolongation
C. Hypertension
D. Atrial fibrillation
Correct Answer: B. QT interval prolongation
Explanation: Haloperidol, especially when given intravenously, can prolong the QT interval
and increase the risk of torsades de pointes, warranting ECG monitoring.
13. Which mechanism best describes how typical antipsychotics produce
extrapyramidal symptoms?
A. Excess dopamine D2 blockade in the nigrostriatal pathway
B. Excess serotonin reuptake inhibition
C. GABA receptor antagonism
D. Acetylcholine receptor upregulation
Correct Answer: A. Excess dopamine D2 blockade in the nigrostriatal pathway
Explanation: Typical antipsychotics block D2 receptors broadly, including in the nigrostriatal
pathway, which disrupts normal dopaminergic motor regulation and produces extrapyramidal
symptoms.
14. A patient with insomnia who has a history of substance use disorder would most
appropriately be prescribed which agent, given its lower abuse potential compared to
benzodiazepines?
A. Diazepam
B. Ramelteon
C. Triazolam
D. Lorazepam
Correct Answer: B. Ramelteon
Explanation: Ramelteon is a melatonin receptor agonist without significant abuse potential,
making it a safer option for insomnia in patients with a history of substance misuse.
15. Which class of antidepressants carries the highest risk of lethality in overdose due
to cardiotoxicity?
A. SSRIs
B. SNRIs
C. Tricyclic antidepressants
D. Bupropion
Update)
Advanced Pharmacology for the AGACNP — Chamberlain University
150 Questions & Answers with Rationales
1. A patient is prescribed alprazolam for generalized anxiety disorder. Which
mechanism of action best explains this drug's therapeutic effect?
A. Blockade of dopamine D2 receptors
B. Enhancement of GABA-A receptor chloride channel activity
C. Inhibition of serotonin reuptake
D. Antagonism of NMDA glutamate receptors
Correct Answer: B. Enhancement of GABA-A receptor chloride channel activity
Explanation: Benzodiazepines like alprazolam bind to the GABA-A receptor complex and
enhance chloride ion influx, increasing the inhibitory effect of GABA and producing anxiolytic
and sedative effects.
2. Which adverse effect is of greatest concern when prescribing benzodiazepines to an
older adult patient?
A. Hypertension
B. Increased fall risk and cognitive impairment
C. Hyperglycemia
D. Tachycardia
Correct Answer: B. Increased fall risk and cognitive impairment
Explanation: Benzodiazepines cause sedation and psychomotor impairment that
disproportionately increase fall risk and confusion in older adults, making them a Beers Criteria
concern in this population.
3. A patient taking lithium for bipolar disorder should be monitored closely for which
condition that increases the risk of lithium toxicity?
A. Hyperkalemia
B. Dehydration and sodium depletion
C. Hypoglycemia
D. Hyperthyroidism
Correct Answer: B. Dehydration and sodium depletion
Explanation: Lithium is renally excreted similarly to sodium; dehydration or low-sodium states
increase renal reabsorption of lithium, raising serum levels and toxicity risk.
4. Which class of medications is considered first-line pharmacotherapy for major
depressive disorder due to a favorable side effect profile?
, A. Tricyclic antidepressants
B. Monoamine oxidase inhibitors
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Typical antipsychotics
Correct Answer: C. Selective serotonin reuptake inhibitors (SSRIs)
Explanation: SSRIs are generally preferred as first-line agents for depression because they
have fewer anticholinergic and cardiac side effects compared to tricyclics or MAOIs.
5. A patient on an SSRI is started on a triptan for migraines. What serious interaction
should the provider monitor for?
A. Hypertensive crisis
B. Serotonin syndrome
C. Agranulocytosis
D. QT prolongation only
Correct Answer: B. Serotonin syndrome
Explanation: Combining SSRIs with triptans increases serotonergic activity and raises the risk
of serotonin syndrome, characterized by agitation, hyperthermia, and neuromuscular
abnormalities.
6. Which symptom cluster is most characteristic of serotonin syndrome?
A. Bradycardia, hypotension, miosis
B. Hyperthermia, clonus, agitation, hyperreflexia
C. Hypothermia, bradypnea, sedation
D. Hypoglycemia, diaphoresis, tremor
Correct Answer: B. Hyperthermia, clonus, agitation, hyperreflexia
Explanation: Serotonin syndrome classically presents with autonomic instability
(hyperthermia), neuromuscular hyperactivity (clonus, hyperreflexia), and altered mental status
(agitation).
7. A patient newly started on an atypical antipsychotic should be monitored for which
metabolic adverse effect?
A. Hypoglycemia
B. Weight gain and dyslipidemia
C. Hyperthyroidism
D. Hypocalcemia
Correct Answer: B. Weight gain and dyslipidemia
Explanation: Atypical antipsychotics, particularly olanzapine and clozapine, are associated
with significant weight gain, dyslipidemia, and increased risk of new-onset diabetes.
,8. Clozapine therapy requires which mandatory laboratory monitoring due to a
life-threatening adverse effect?
A. Liver function tests weekly
B. Absolute neutrophil count due to agranulocytosis risk
C. Renal function tests daily
D. Thyroid panel monthly
Correct Answer: B. Absolute neutrophil count due to agranulocytosis risk
Explanation: Clozapine carries a risk of agranulocytosis, requiring mandatory absolute
neutrophil count monitoring through a registry program before each dispensed supply.
9. Which medication is considered first-line for acute management of a tonic-clonic
seizure in the emergency setting?
A. Phenytoin
B. Lorazepam
C. Valproic acid
D. Gabapentin
Correct Answer: B. Lorazepam
Explanation: Benzodiazepines such as IV lorazepam are first-line for acute seizure
termination due to their rapid onset of GABAergic inhibition.
10. A patient taking valproic acid during pregnancy is at increased risk for which fetal
complication?
A. Limb reduction defects
B. Neural tube defects
C. Cardiac septal defects only
D. Renal agenesis
Correct Answer: B. Neural tube defects
Explanation: Valproic acid is a known human teratogen strongly associated with neural tube
defects, such as spina bifida, when used during the first trimester.
11. Which laboratory parameter should be routinely monitored in a patient maintained
on long-term phenytoin therapy?
A. Serum phenytoin level and liver function
B. Serum potassium only
C. Hemoglobin A1c
D. TSH level
Correct Answer: A. Serum phenytoin level and liver function
Explanation: Phenytoin has a narrow therapeutic index and undergoes hepatic metabolism,
so monitoring serum drug levels and liver function helps prevent toxicity and detect hepatic
effects.
, 12. A patient with acute agitation and psychosis in the ICU is given haloperidol IV.
Which cardiac effect requires monitoring?
A. Bradycardia only
B. QT interval prolongation
C. Hypertension
D. Atrial fibrillation
Correct Answer: B. QT interval prolongation
Explanation: Haloperidol, especially when given intravenously, can prolong the QT interval
and increase the risk of torsades de pointes, warranting ECG monitoring.
13. Which mechanism best describes how typical antipsychotics produce
extrapyramidal symptoms?
A. Excess dopamine D2 blockade in the nigrostriatal pathway
B. Excess serotonin reuptake inhibition
C. GABA receptor antagonism
D. Acetylcholine receptor upregulation
Correct Answer: A. Excess dopamine D2 blockade in the nigrostriatal pathway
Explanation: Typical antipsychotics block D2 receptors broadly, including in the nigrostriatal
pathway, which disrupts normal dopaminergic motor regulation and produces extrapyramidal
symptoms.
14. A patient with insomnia who has a history of substance use disorder would most
appropriately be prescribed which agent, given its lower abuse potential compared to
benzodiazepines?
A. Diazepam
B. Ramelteon
C. Triazolam
D. Lorazepam
Correct Answer: B. Ramelteon
Explanation: Ramelteon is a melatonin receptor agonist without significant abuse potential,
making it a safer option for insomnia in patients with a history of substance misuse.
15. Which class of antidepressants carries the highest risk of lethality in overdose due
to cardiotoxicity?
A. SSRIs
B. SNRIs
C. Tricyclic antidepressants
D. Bupropion
