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 escitalopram. After 3 weeks, the
patient reports improved mood but persistent fatigue. The nurse should anticipate that the
prescriber may:
A. Discontinue the antidepressant due to partial response
B. Augment with bupropion to address residual fatigue
C. Switch to a benzodiazepine for energy enhancement
D. Increase the escitalopram dose to maximum immediately
Correct Answer: C
Residual fatigue in depression treated with SSRIs may respond to augmentation with bupropion,
a norepinephrine-dopamine reuptake inhibitor with activating properties. Discontinuation is
inappropriate for partial response, benzodiazepines cause sedation rather than energy, and
immediate maximum dosing increases adverse effects without proven benefit for fatigue.
Q2. A patient with schizophrenia is prescribed fluphenazine decanoate long-acting injectable.
The nurse should administer the injection:
A. Subcutaneously in the abdomen for slow absorption
B. Intramuscularly in the deltoid or gluteal muscle
C. Intravenously for rapid therapeutic levels
D. Orally with food to enhance bioavailability
Correct Answer: B
Fluphenazine decanoate is a depot antipsychotic formulated in sesame oil for intramuscular
administration in the deltoid or gluteal muscle, providing therapeutic plasma levels for 2 to 4
,weeks. Subcutaneous and intravenous routes are not used, and oral fluphenazine is a separate
formulation with different pharmacokinetics.
Q3. A patient with generalized anxiety disorder is prescribed lorazepam for 2 weeks during a
crisis. The nurse should instruct the patient that:
A. Long-term daily use is safe and effective for chronic anxiety
B. The medication should be tapered after 2 weeks to prevent withdrawal
C. The dose can be doubled if anxiety returns before the next dose
D. Alcohol can be used occasionally to enhance the anxiolytic effect
Correct Answer: A
Benzodiazepines such as lorazepam are indicated for short-term use only due to tolerance,
dependence, and cognitive adverse effects with prolonged administration. Tapering after 2 weeks
prevents withdrawal symptoms including rebound anxiety and seizures. Dose escalation and
alcohol co-use increase the risk of respiratory depression and overdose.
Q4. A patient with epilepsy is prescribed phenobarbital. The nurse should monitor for which
adverse effect?
A. Gingival hyperplasia and hirsutism
B. Sedation, cognitive slowing, and dependence
C. Nephrolithiasis and metabolic acidosis
D. Aplastic anemia and hepatotoxicity
Correct Answer: B
Phenobarbital is a barbiturate anticonvulsant that causes dose-related central nervous system
depression including sedation, cognitive impairment, and psychological or physical dependence.
Gingival hyperplasia is associated with phenytoin, nephrolithiasis with topiramate and
zonisamide, and aplastic anemia with felbamate.
Q5. A patient with Parkinson's disease reports freezing of gait episodes. The nurse understands
that management may include:
A. Increasing levodopa dose to prevent all freezing episodes
B. Adding amantadine to reduce dyskinesias
C. Using visual cues such as laser lines to overcome freezing
D. Discontinuing all dopaminergic medications
, Correct Answer: C
Freezing of gait is a debilitating Parkinson's symptom that responds to behavioral strategies
including visual cues, auditory cues, and rhythmic movements rather than simple medication
adjustments. While dopaminergic medications may help, freezing often occurs at peak dose and
does not consistently respond to dose changes. Amantadine addresses dyskinesias, not freezing,
and medication discontinuation worsens all motor symptoms.
Q6. A patient with cancer pain is prescribed oral morphine solution. The patient accidentally
spills half the dose. The nurse should:
A. Administer an additional full dose to ensure adequate analgesia
B. Document the spill and administer only the remaining amount
C. Switch to intravenous morphine to prevent future spills
D. Double the next scheduled dose to compensate
Correct Answer: B
Accidental spillage of opioid doses requires documentation of the partial administration and
assessment of pain control rather than automatic redosing, which risks overdose. Switching
routes is unnecessary for a single incident, and double-dosing is unsafe and against opioid
stewardship principles.
Q7. A patient with alcohol use disorder is prescribed disulfiram. The patient asks about using
alcohol-based hand sanitizer. The nurse should respond:
A. "Alcohol-based hand sanitizer is safe as it is not ingested."
B. "Even small amounts of absorbed alcohol can trigger a reaction; use non-alcohol sanitizer."
C. "Hand sanitizer is only dangerous if you drink more than one ounce."
D. "You can use hand sanitizer if you take your disulfiram after using it."
Correct Answer: B
Disulfiram inhibits aldehyde dehydrogenase, and even small amounts of alcohol absorbed
through the skin or mucous membranes can trigger a disulfiram-ethanol reaction. Patients should
avoid all alcohol-containing products including hand sanitizers, mouthwashes, and aftershaves.
Non-alcohol alternatives should be used to prevent accidental exposure.
Q8. A patient with bipolar disorder is prescribed valproic acid. The nurse should instruct the
patient to report:
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 escitalopram. After 3 weeks, the
patient reports improved mood but persistent fatigue. The nurse should anticipate that the
prescriber may:
A. Discontinue the antidepressant due to partial response
B. Augment with bupropion to address residual fatigue
C. Switch to a benzodiazepine for energy enhancement
D. Increase the escitalopram dose to maximum immediately
Correct Answer: C
Residual fatigue in depression treated with SSRIs may respond to augmentation with bupropion,
a norepinephrine-dopamine reuptake inhibitor with activating properties. Discontinuation is
inappropriate for partial response, benzodiazepines cause sedation rather than energy, and
immediate maximum dosing increases adverse effects without proven benefit for fatigue.
Q2. A patient with schizophrenia is prescribed fluphenazine decanoate long-acting injectable.
The nurse should administer the injection:
A. Subcutaneously in the abdomen for slow absorption
B. Intramuscularly in the deltoid or gluteal muscle
C. Intravenously for rapid therapeutic levels
D. Orally with food to enhance bioavailability
Correct Answer: B
Fluphenazine decanoate is a depot antipsychotic formulated in sesame oil for intramuscular
administration in the deltoid or gluteal muscle, providing therapeutic plasma levels for 2 to 4
,weeks. Subcutaneous and intravenous routes are not used, and oral fluphenazine is a separate
formulation with different pharmacokinetics.
Q3. A patient with generalized anxiety disorder is prescribed lorazepam for 2 weeks during a
crisis. The nurse should instruct the patient that:
A. Long-term daily use is safe and effective for chronic anxiety
B. The medication should be tapered after 2 weeks to prevent withdrawal
C. The dose can be doubled if anxiety returns before the next dose
D. Alcohol can be used occasionally to enhance the anxiolytic effect
Correct Answer: A
Benzodiazepines such as lorazepam are indicated for short-term use only due to tolerance,
dependence, and cognitive adverse effects with prolonged administration. Tapering after 2 weeks
prevents withdrawal symptoms including rebound anxiety and seizures. Dose escalation and
alcohol co-use increase the risk of respiratory depression and overdose.
Q4. A patient with epilepsy is prescribed phenobarbital. The nurse should monitor for which
adverse effect?
A. Gingival hyperplasia and hirsutism
B. Sedation, cognitive slowing, and dependence
C. Nephrolithiasis and metabolic acidosis
D. Aplastic anemia and hepatotoxicity
Correct Answer: B
Phenobarbital is a barbiturate anticonvulsant that causes dose-related central nervous system
depression including sedation, cognitive impairment, and psychological or physical dependence.
Gingival hyperplasia is associated with phenytoin, nephrolithiasis with topiramate and
zonisamide, and aplastic anemia with felbamate.
Q5. A patient with Parkinson's disease reports freezing of gait episodes. The nurse understands
that management may include:
A. Increasing levodopa dose to prevent all freezing episodes
B. Adding amantadine to reduce dyskinesias
C. Using visual cues such as laser lines to overcome freezing
D. Discontinuing all dopaminergic medications
, Correct Answer: C
Freezing of gait is a debilitating Parkinson's symptom that responds to behavioral strategies
including visual cues, auditory cues, and rhythmic movements rather than simple medication
adjustments. While dopaminergic medications may help, freezing often occurs at peak dose and
does not consistently respond to dose changes. Amantadine addresses dyskinesias, not freezing,
and medication discontinuation worsens all motor symptoms.
Q6. A patient with cancer pain is prescribed oral morphine solution. The patient accidentally
spills half the dose. The nurse should:
A. Administer an additional full dose to ensure adequate analgesia
B. Document the spill and administer only the remaining amount
C. Switch to intravenous morphine to prevent future spills
D. Double the next scheduled dose to compensate
Correct Answer: B
Accidental spillage of opioid doses requires documentation of the partial administration and
assessment of pain control rather than automatic redosing, which risks overdose. Switching
routes is unnecessary for a single incident, and double-dosing is unsafe and against opioid
stewardship principles.
Q7. A patient with alcohol use disorder is prescribed disulfiram. The patient asks about using
alcohol-based hand sanitizer. The nurse should respond:
A. "Alcohol-based hand sanitizer is safe as it is not ingested."
B. "Even small amounts of absorbed alcohol can trigger a reaction; use non-alcohol sanitizer."
C. "Hand sanitizer is only dangerous if you drink more than one ounce."
D. "You can use hand sanitizer if you take your disulfiram after using it."
Correct Answer: B
Disulfiram inhibits aldehyde dehydrogenase, and even small amounts of alcohol absorbed
through the skin or mucous membranes can trigger a disulfiram-ethanol reaction. Patients should
avoid all alcohol-containing products including hand sanitizers, mouthwashes, and aftershaves.
Non-alcohol alternatives should be used to prevent accidental exposure.
Q8. A patient with bipolar disorder is prescribed valproic acid. The nurse should instruct the
patient to report:
