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 patient with major depressive disorder is started on sertraline. Two weeks later, the patient
reports increased anxiety and restlessness. The nurse's best response is:
A. "These are signs the medication is not working and should be stopped."
B. "This is common early in treatment and usually improves within 2 to 4 weeks."
C. "The dose needs to be doubled immediately to overcome this effect."
D. "You should switch to a benzodiazepine for faster relief."
Correct Answer: B
Activation symptoms including anxiety, restlessness, and insomnia are common during the first 2
to 4 weeks of SSRI therapy as central serotonin levels increase before postsynaptic receptor
adaptation occurs. These symptoms typically resolve spontaneously and do not indicate
treatment failure. Premature discontinuation or dose escalation disrupts the therapeutic timeline,
and benzodiazepines are not first-line for depression management.
Q2. A patient with schizophrenia is prescribed chlorpromazine. The nurse should prioritize
monitoring for:
A. Severe extrapyramidal symptoms and acute dystonia
B. Agranulocytosis requiring weekly blood counts
C. Significant weight gain and metabolic syndrome
D. Orthostatic hypotension and sedation
Correct Answer: D
Chlorpromazine is a low-potency typical antipsychotic with potent alpha-1 adrenergic and
histamine H1 antagonism, causing pronounced orthostatic hypotension and sedation. While
extrapyramidal symptoms occur, they are less severe than with high-potency agents like
haloperidol. Agranulocytosis is specific to clozapine, and metabolic effects are more
characteristic of atypical antipsychotics.
,Q3. A patient with panic disorder is prescribed alprazolam. After 6 months, the prescriber wants
to discontinue the medication. The nurse should plan to:
A. Stop the medication immediately to prevent dependence
B. Taper the dose gradually over 4 to 8 weeks to minimize withdrawal
C. Switch directly to buspirone at the same time as stopping alprazolam
D. Increase the dose for 1 week before tapering to stabilize receptors
Correct Answer: C
Benzodiazepine discontinuation requires gradual tapering over weeks to months to prevent
withdrawal symptoms including rebound anxiety, insomnia, tremors, and seizures. Abrupt
cessation is dangerous and can precipitate severe withdrawal. Direct switching to buspirone
without overlap does not prevent benzodiazepine withdrawal, and dose escalation before tapering
is counterproductive.
Q4. A patient with epilepsy is prescribed valproic acid. The nurse must monitor for which life-
threatening adverse effect?
A. Hypokalemia and cardiac arrhythmias
B. Hepatotoxicity and acute pancreatitis
C. Aplastic anemia and infection
D. Pulmonary fibrosis and dyspnea
Correct Answer: B
Valproic acid carries black box warnings for hepatotoxicity, including fatal hepatic failure, and
life-threatening pancreatitis. Baseline and periodic liver function tests, along with patient
education about symptoms such as jaundice, abdominal pain, and vomiting, are essential.
Hypokalemia, aplastic anemia, and pulmonary fibrosis are not characteristic adverse effects of
valproic acid.
Q5. A patient with Parkinson's disease experiences end-of-dose wearing off. The prescriber adds
rasagiline. The nurse understands that rasagiline:
A. Is a catechol-O-methyltransferase inhibitor that prolongs levodopa action
B. Is a selective monoamine oxidase B inhibitor that reduces dopamine breakdown
C. Is a direct dopamine receptor agonist that stimulates postsynaptic receptors
D. Is an anticholinergic that restores cholinergic-dopaminergic balance
Correct Answer: A
, Rasagiline is a selective, irreversible monoamine oxidase B inhibitor that reduces central
dopamine metabolism, extending the duration of levodopa action and reducing wearing-off
phenomena. It is not a COMT inhibitor (entacapone), direct agonist (pramipexole), or
anticholinergic (benztropine). Dietary tyramine restrictions are less stringent at standard doses
compared to nonselective MAOIs.
Q6. A patient with cancer-related pain is prescribed transdermal fentanyl. The nurse discovers
the patient is using a heating pad on the patch for back pain. The nurse should:
A. Document the finding and continue current therapy
B. Instruct the patient to remove the heating pad immediately due to overdose risk
C. Increase the patch dose to compensate for heat-induced metabolism
D. Apply a second patch to the heated area for better pain control
Correct Answer: C
Heat increases the rate of fentanyl absorption from the transdermal patch, potentially causing
dangerous plasma level elevations and respiratory depression. Patients must avoid heating pads,
hot tubs, fevers, and direct sunlight on the patch site. Increasing the dose or adding patches
would compound the overdose risk, and documentation without intervention is unsafe.
Q7. A patient with alcohol use disorder is started on acamprosate. The nurse understands that
acamprosate works by:
A. Causing aversive effects if alcohol is consumed
B. Modulating glutamate and GABA neurotransmission to reduce craving
C. Blocking opioid receptors to reduce the rewarding effects of alcohol
D. Inducing hepatic enzymes to accelerate alcohol metabolism
Correct Answer: B
Acamprosate is a synthetic compound structurally similar to GABA that modulates glutamate
neurotransmission at NMDA receptors and enhances GABAergic activity, reducing post-acute
withdrawal symptoms and craving. It does not cause disulfiram-like reactions, block opioid
receptors (naltrexone), or affect alcohol metabolism. Abstinence should be established before
starting acamprosate.
Q8. A patient with bipolar disorder is prescribed lithium. The patient reports increased thirst and
frequent urination. The nurse should:
Latest 2026/2027 | Newly Released
San Diego State University (SDSU).
50 Questions and Answers With Expert Rationales
Guaranteed Pass | Graded A +
Q1. A patient with major depressive disorder is started on sertraline. Two weeks later, the patient
reports increased anxiety and restlessness. The nurse's best response is:
A. "These are signs the medication is not working and should be stopped."
B. "This is common early in treatment and usually improves within 2 to 4 weeks."
C. "The dose needs to be doubled immediately to overcome this effect."
D. "You should switch to a benzodiazepine for faster relief."
Correct Answer: B
Activation symptoms including anxiety, restlessness, and insomnia are common during the first 2
to 4 weeks of SSRI therapy as central serotonin levels increase before postsynaptic receptor
adaptation occurs. These symptoms typically resolve spontaneously and do not indicate
treatment failure. Premature discontinuation or dose escalation disrupts the therapeutic timeline,
and benzodiazepines are not first-line for depression management.
Q2. A patient with schizophrenia is prescribed chlorpromazine. The nurse should prioritize
monitoring for:
A. Severe extrapyramidal symptoms and acute dystonia
B. Agranulocytosis requiring weekly blood counts
C. Significant weight gain and metabolic syndrome
D. Orthostatic hypotension and sedation
Correct Answer: D
Chlorpromazine is a low-potency typical antipsychotic with potent alpha-1 adrenergic and
histamine H1 antagonism, causing pronounced orthostatic hypotension and sedation. While
extrapyramidal symptoms occur, they are less severe than with high-potency agents like
haloperidol. Agranulocytosis is specific to clozapine, and metabolic effects are more
characteristic of atypical antipsychotics.
,Q3. A patient with panic disorder is prescribed alprazolam. After 6 months, the prescriber wants
to discontinue the medication. The nurse should plan to:
A. Stop the medication immediately to prevent dependence
B. Taper the dose gradually over 4 to 8 weeks to minimize withdrawal
C. Switch directly to buspirone at the same time as stopping alprazolam
D. Increase the dose for 1 week before tapering to stabilize receptors
Correct Answer: C
Benzodiazepine discontinuation requires gradual tapering over weeks to months to prevent
withdrawal symptoms including rebound anxiety, insomnia, tremors, and seizures. Abrupt
cessation is dangerous and can precipitate severe withdrawal. Direct switching to buspirone
without overlap does not prevent benzodiazepine withdrawal, and dose escalation before tapering
is counterproductive.
Q4. A patient with epilepsy is prescribed valproic acid. The nurse must monitor for which life-
threatening adverse effect?
A. Hypokalemia and cardiac arrhythmias
B. Hepatotoxicity and acute pancreatitis
C. Aplastic anemia and infection
D. Pulmonary fibrosis and dyspnea
Correct Answer: B
Valproic acid carries black box warnings for hepatotoxicity, including fatal hepatic failure, and
life-threatening pancreatitis. Baseline and periodic liver function tests, along with patient
education about symptoms such as jaundice, abdominal pain, and vomiting, are essential.
Hypokalemia, aplastic anemia, and pulmonary fibrosis are not characteristic adverse effects of
valproic acid.
Q5. A patient with Parkinson's disease experiences end-of-dose wearing off. The prescriber adds
rasagiline. The nurse understands that rasagiline:
A. Is a catechol-O-methyltransferase inhibitor that prolongs levodopa action
B. Is a selective monoamine oxidase B inhibitor that reduces dopamine breakdown
C. Is a direct dopamine receptor agonist that stimulates postsynaptic receptors
D. Is an anticholinergic that restores cholinergic-dopaminergic balance
Correct Answer: A
, Rasagiline is a selective, irreversible monoamine oxidase B inhibitor that reduces central
dopamine metabolism, extending the duration of levodopa action and reducing wearing-off
phenomena. It is not a COMT inhibitor (entacapone), direct agonist (pramipexole), or
anticholinergic (benztropine). Dietary tyramine restrictions are less stringent at standard doses
compared to nonselective MAOIs.
Q6. A patient with cancer-related pain is prescribed transdermal fentanyl. The nurse discovers
the patient is using a heating pad on the patch for back pain. The nurse should:
A. Document the finding and continue current therapy
B. Instruct the patient to remove the heating pad immediately due to overdose risk
C. Increase the patch dose to compensate for heat-induced metabolism
D. Apply a second patch to the heated area for better pain control
Correct Answer: C
Heat increases the rate of fentanyl absorption from the transdermal patch, potentially causing
dangerous plasma level elevations and respiratory depression. Patients must avoid heating pads,
hot tubs, fevers, and direct sunlight on the patch site. Increasing the dose or adding patches
would compound the overdose risk, and documentation without intervention is unsafe.
Q7. A patient with alcohol use disorder is started on acamprosate. The nurse understands that
acamprosate works by:
A. Causing aversive effects if alcohol is consumed
B. Modulating glutamate and GABA neurotransmission to reduce craving
C. Blocking opioid receptors to reduce the rewarding effects of alcohol
D. Inducing hepatic enzymes to accelerate alcohol metabolism
Correct Answer: B
Acamprosate is a synthetic compound structurally similar to GABA that modulates glutamate
neurotransmission at NMDA receptors and enhances GABAergic activity, reducing post-acute
withdrawal symptoms and craving. It does not cause disulfiram-like reactions, block opioid
receptors (naltrexone), or affect alcohol metabolism. Abstinence should be established before
starting acamprosate.
Q8. A patient with bipolar disorder is prescribed lithium. The patient reports increased thirst and
frequent urination. The nurse should:
