NURS 300 (Pharmacology) Unit Exam 2
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A 28-year-old patient with major depressive disorder is prescribed fluoxetine. After 2 weeks,
the patient reports increased anxiety and insomnia. The nurse should:
A. Discontinue the medication immediately due to treatment failure
B. Reassure the patient that these symptoms often improve with continued therapy
C. Increase the dose to overcome the activating side effects
D. Switch to a benzodiazepine for faster symptom control
Correct Answer: B
Selective serotonin reuptake inhibitors such as fluoxetine frequently cause activating side effects
including anxiety and insomnia during the first 2 to 4 weeks of therapy before antidepressant
benefits emerge. These symptoms are typically transient and resolve as the central nervous
system adapts to increased synaptic serotonin. Discontinuing or increasing the dose prematurely
disrupts the therapeutic timeline, and benzodiazepines are not first-line for depression.
Q2. A patient with schizophrenia is prescribed haloperidol. The nurse should prioritize
monitoring for:
A. Hyperglycemia and weight gain
B. Extrapyramidal symptoms and tardive dyskinesia
C. Agranulocytosis and myocarditis
D. Sedation and orthostatic hypotension
Correct Answer: B
Haloperidol is a high-potency typical antipsychotic with strong dopamine D2 receptor
antagonism, which carries a high risk of extrapyramidal symptoms including acute dystonia,
akathisia, parkinsonism, and potentially irreversible tardive dyskinesia. Hyperglycemia and
weight gain are more characteristic of atypical antipsychotics, agranulocytosis is associated with
,clozapine, and sedation with orthostatic hypotension are more common with low-potency typical
antipsychotics.
Q3. A patient is prescribed lorazepam 1 mg twice daily for generalized anxiety disorder. After 3
months, the patient wants to discontinue the medication. The nurse should instruct the patient to:
A. Stop the medication immediately to avoid dependence
B. Taper the dose gradually over several weeks to prevent withdrawal seizures
C. Switch directly to buspirone without a taper
D. Double the dose for 1 week before stopping
Correct Answer: B
Benzodiazepines such as lorazepam cause physical dependence with prolonged use, and abrupt
discontinuation can precipitate withdrawal symptoms including rebound anxiety, insomnia,
tremors, and seizures. Gradual tapering over weeks to months allows the gamma-aminobutyric
acid receptors to upregulate and adapt, minimizing withdrawal severity. Direct switching to
buspirone without tapering does not prevent benzodiazepine withdrawal, and dose escalation
would worsen dependence.
Q4. A patient with epilepsy is prescribed phenytoin. The nurse should instruct the patient to
maintain good oral hygiene because phenytoin can cause:
A. Dental caries from reduced saliva production
B. Gingival hyperplasia
C. Oral candidiasis
D. Temporomandibular joint dysfunction
Correct Answer: B
Phenytoin commonly causes dose-dependent gingival hyperplasia characterized by gum tissue
overgrowth, which can be minimized with meticulous oral hygiene, regular flossing, and
professional dental care. Dental caries are not directly caused by phenytoin, oral candidiasis is
associated with immunosuppression or antibiotics, and temporomandibular joint dysfunction is
unrelated to anticonvulsant therapy.
Q5. A patient with Parkinson's disease experiences wearing-off phenomenon before the next
dose of levodopa-carbidopa. The prescriber adds entacapone. The nurse understands that
entacapone works by:
, A. Increasing dopamine synthesis in the substantia nigra
B. Inhibiting peripheral catechol-O-methyltransferase to prolong levodopa availability
C. Stimulating dopamine release from presynaptic terminals
D. Blocking muscarinic receptors to restore cholinergic-dopaminergic balance
Correct Answer: B
Entacapone is a catechol-O-methyltransferase inhibitor that blocks peripheral metabolism of
levodopa, extending its plasma half-life and increasing the amount available for central nervous
system conversion to dopamine. This reduces wearing-off phenomena and increases on-time
without increasing the levodopa dose. Increasing dopamine synthesis, stimulating release, and
muscarinic blockade are mechanisms of other antiparkinsonian agents.
Q6. A patient with chronic lower back pain is prescribed extended-release oxycodone. The nurse
should include which instruction?
A. Crush the tablet if swallowing is difficult
B. Take the medication every 4 to 6 hours as needed for breakthrough pain
C. Do not crush, chew, or split the tablet
D. Take with grapefruit juice to enhance absorption
Correct Answer: C
Extended-release oxycodone tablets must be swallowed intact to maintain the controlled-release
matrix and prevent rapid release of the full dose, which could cause fatal respiratory depression.
Crushing, chewing, or splitting destroys the extended-release mechanism. These formulations are
scheduled around-the-clock, not as-needed, and grapefruit juice inhibits CYP3A4 metabolism,
potentially causing dangerous accumulation.
Q7. A patient with alcohol use disorder is prescribed disulfiram. The nurse should instruct the
patient to avoid:
A. Foods containing tyramine such as aged cheese
B. All products containing alcohol including mouthwash and cooking wine
C. Grapefruit juice and calcium supplements
D. High-fat meals and dairy products
Correct Answer: B
Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde if alcohol is
consumed and producing a severe reaction including flushing, vomiting, headache, and
cardiovascular collapse. Patients must avoid all alcohol sources including mouthwash, cough
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A 28-year-old patient with major depressive disorder is prescribed fluoxetine. After 2 weeks,
the patient reports increased anxiety and insomnia. The nurse should:
A. Discontinue the medication immediately due to treatment failure
B. Reassure the patient that these symptoms often improve with continued therapy
C. Increase the dose to overcome the activating side effects
D. Switch to a benzodiazepine for faster symptom control
Correct Answer: B
Selective serotonin reuptake inhibitors such as fluoxetine frequently cause activating side effects
including anxiety and insomnia during the first 2 to 4 weeks of therapy before antidepressant
benefits emerge. These symptoms are typically transient and resolve as the central nervous
system adapts to increased synaptic serotonin. Discontinuing or increasing the dose prematurely
disrupts the therapeutic timeline, and benzodiazepines are not first-line for depression.
Q2. A patient with schizophrenia is prescribed haloperidol. The nurse should prioritize
monitoring for:
A. Hyperglycemia and weight gain
B. Extrapyramidal symptoms and tardive dyskinesia
C. Agranulocytosis and myocarditis
D. Sedation and orthostatic hypotension
Correct Answer: B
Haloperidol is a high-potency typical antipsychotic with strong dopamine D2 receptor
antagonism, which carries a high risk of extrapyramidal symptoms including acute dystonia,
akathisia, parkinsonism, and potentially irreversible tardive dyskinesia. Hyperglycemia and
weight gain are more characteristic of atypical antipsychotics, agranulocytosis is associated with
,clozapine, and sedation with orthostatic hypotension are more common with low-potency typical
antipsychotics.
Q3. A patient is prescribed lorazepam 1 mg twice daily for generalized anxiety disorder. After 3
months, the patient wants to discontinue the medication. The nurse should instruct the patient to:
A. Stop the medication immediately to avoid dependence
B. Taper the dose gradually over several weeks to prevent withdrawal seizures
C. Switch directly to buspirone without a taper
D. Double the dose for 1 week before stopping
Correct Answer: B
Benzodiazepines such as lorazepam cause physical dependence with prolonged use, and abrupt
discontinuation can precipitate withdrawal symptoms including rebound anxiety, insomnia,
tremors, and seizures. Gradual tapering over weeks to months allows the gamma-aminobutyric
acid receptors to upregulate and adapt, minimizing withdrawal severity. Direct switching to
buspirone without tapering does not prevent benzodiazepine withdrawal, and dose escalation
would worsen dependence.
Q4. A patient with epilepsy is prescribed phenytoin. The nurse should instruct the patient to
maintain good oral hygiene because phenytoin can cause:
A. Dental caries from reduced saliva production
B. Gingival hyperplasia
C. Oral candidiasis
D. Temporomandibular joint dysfunction
Correct Answer: B
Phenytoin commonly causes dose-dependent gingival hyperplasia characterized by gum tissue
overgrowth, which can be minimized with meticulous oral hygiene, regular flossing, and
professional dental care. Dental caries are not directly caused by phenytoin, oral candidiasis is
associated with immunosuppression or antibiotics, and temporomandibular joint dysfunction is
unrelated to anticonvulsant therapy.
Q5. A patient with Parkinson's disease experiences wearing-off phenomenon before the next
dose of levodopa-carbidopa. The prescriber adds entacapone. The nurse understands that
entacapone works by:
, A. Increasing dopamine synthesis in the substantia nigra
B. Inhibiting peripheral catechol-O-methyltransferase to prolong levodopa availability
C. Stimulating dopamine release from presynaptic terminals
D. Blocking muscarinic receptors to restore cholinergic-dopaminergic balance
Correct Answer: B
Entacapone is a catechol-O-methyltransferase inhibitor that blocks peripheral metabolism of
levodopa, extending its plasma half-life and increasing the amount available for central nervous
system conversion to dopamine. This reduces wearing-off phenomena and increases on-time
without increasing the levodopa dose. Increasing dopamine synthesis, stimulating release, and
muscarinic blockade are mechanisms of other antiparkinsonian agents.
Q6. A patient with chronic lower back pain is prescribed extended-release oxycodone. The nurse
should include which instruction?
A. Crush the tablet if swallowing is difficult
B. Take the medication every 4 to 6 hours as needed for breakthrough pain
C. Do not crush, chew, or split the tablet
D. Take with grapefruit juice to enhance absorption
Correct Answer: C
Extended-release oxycodone tablets must be swallowed intact to maintain the controlled-release
matrix and prevent rapid release of the full dose, which could cause fatal respiratory depression.
Crushing, chewing, or splitting destroys the extended-release mechanism. These formulations are
scheduled around-the-clock, not as-needed, and grapefruit juice inhibits CYP3A4 metabolism,
potentially causing dangerous accumulation.
Q7. A patient with alcohol use disorder is prescribed disulfiram. The nurse should instruct the
patient to avoid:
A. Foods containing tyramine such as aged cheese
B. All products containing alcohol including mouthwash and cooking wine
C. Grapefruit juice and calcium supplements
D. High-fat meals and dairy products
Correct Answer: B
Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde if alcohol is
consumed and producing a severe reaction including flushing, vomiting, headache, and
cardiovascular collapse. Patients must avoid all alcohol sources including mouthwash, cough
