NURS 6512 Final Exam | NURS 6512 Advanced
Pharmacology | Actual Q&A with Rationale (NURS
6512 Final Exam) | Walden
Section A: Neurology & Psychiatric Drugs (Questions 1–20)
Q1. A patient with major depressive disorder is started on a selective serotonin
reuptake inhibitor (SSRI). Which mechanism of action best describes how SSRIs
improve mood?
A. Blockade of dopamine reuptake
B. Inhibition of serotonin reuptake into the presynaptic neuron ✅
C. Antagonism of serotonin receptors
D. Inhibition of monoamine oxidase
Rationale: SSRIs work by blocking the serotonin transporter (SERT) on the presynaptic
neuron, which increases the concentration of serotonin in the synaptic cleft. This
enhanced serotonergic activity is thought to improve mood, anxiety, and obsessive-
compulsive symptoms over several weeks. Unlike MAOIs, SSRIs do not inhibit
monoamine oxidase, and they have minimal effect on dopamine or norepinephrine
reuptake.
Q2. A patient on an SSRI develops serotonin syndrome after adding a second
serotonergic drug. Which of the following is a hallmark symptom of serotonin
syndrome?
A. Hypothermia and bradycardia
B. Hyperthermia, clonus, and agitation ✅
,C. Dry mouth and urinary retention
D. Sedation and hypotension
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by
excessive serotonergic activity, often from combining SSRIs, MAOIs, or other
serotonergic agents. Key features include hyperthermia, muscle clonus, hyperreflexia,
agitation, and autonomic instability. Treatment involves discontinuing the offending
agents and providing supportive care, including benzodiazepines for agitation.
Q3. Which antipsychotic is most likely to cause extrapyramidal symptoms (EPS) due to
strong D2 blockade?
A. Clozapine
B. Quetiapine
C. Haloperidol ✅
D. Olanzapine
Rationale: Haloperidol is a first-generation (typical) antipsychotic with high affinity for
dopamine D2 receptors in the striatum, which directly correlates with a high risk of EPS.
EPS include acute dystonia, parkinsonism, akathisia, and tardive dyskinesia, caused by
excessive dopamine blockade. Second-generation antipsychotics like clozapine and
quetiapine have lower D2 affinity and higher serotonin blockade, reducing EPS risk but
increasing metabolic side effects.
Q4. A patient with bipolar disorder is started on lithium. Which of the following requires
regular monitoring during lithium therapy?
A. Liver function tests
B. Serum lithium levels, renal function, and thyroid function ✅
C. Complete blood count only
D. Electrocardiogram only
,Rationale: Lithium has a narrow therapeutic index (0.6–1.2 mEq/L), and levels above 1.5
mEq/L can cause toxicity, including nausea, tremor, ataxia, and seizures. Chronic lithium
use can impair renal concentrating ability and cause hypothyroidism, so serum
creatinine, TSH, and lithium levels must be monitored regularly. Dehydration, NSAIDs,
and diuretics can increase lithium levels, so patient education is critical.
Q5. Which anticonvulsant is a first-line treatment for trigeminal neuralgia?
A. Phenytoin
B. Gabapentin
C. Carbamazepine ✅
D. Valproic acid
Rationale: Carbamazepine is the drug of choice for trigeminal neuralgia because it
stabilizes neuronal membranes by blocking sodium channels, reducing the frequency of
pain paroxysms. Gabapentin and pregabalin are also used for neuropathic pain but are
not first-line for trigeminal neuralgia. Carbamazepine requires monitoring of CBC, liver
function, and serum levels due to its narrow therapeutic index and risk of
agranulocytosis.
Q6. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement about buspirone is correct?
A. It has a rapid onset of action within 24 hours
B. It is a partial agonist at serotonin 5-HT1A receptors ✅
C. It is contraindicated with SSRIs
D. It causes significant sedation and dependence
Rationale: Buspirone is a partial agonist at serotonin 5-HT1A receptors, which reduces
anxiety without the sedation, dependence, or withdrawal seen with benzodiazepines. Its
onset of action is delayed, typically taking 2–4 weeks to achieve full therapeutic effect,
, similar to antidepressants. Buspirone is safe to combine with SSRIs and has no abuse
potential, making it a good option for chronic anxiety.
Q7. Which of the following is a contraindication to using clozapine?
A. History of hypertension
B. History of agranulocytosis ✅
C. History of diabetes
D. History of obesity
Rationale: Clozapine is associated with a significant risk of agranulocytosis (1–2% of
patients), which requires regular absolute neutrophil count (ANC) monitoring. It is
contraindicated in patients with a history of clozapine-induced agranulocytosis or
severe neutropenia. Despite this risk, clozapine is the most effective antipsychotic for
treatment-resistant schizophrenia and is also used to reduce suicidal behavior.
Q8. A patient on phenytoin develops nystagmus, ataxia, and slurred speech. These
symptoms most likely indicate:
A. Allergic reaction
B. Phenytoin toxicity ✅
C. Therapeutic effect
D. Drug interaction with food
Rationale: Phenytoin has nonlinear pharmacokinetics; small dose increases can cause
disproportionate rises in serum levels, leading to toxicity. Symptoms of phenytoin
toxicity include nystagmus, ataxia, dysarthria, and sedation, which correlate with serum
levels above 20 mcg/mL. Management involves holding the dose, checking serum level,
and adjusting the dose based on therapeutic drug monitoring.
Q9. Which antidepressant is most appropriate for a patient with depression and
Pharmacology | Actual Q&A with Rationale (NURS
6512 Final Exam) | Walden
Section A: Neurology & Psychiatric Drugs (Questions 1–20)
Q1. A patient with major depressive disorder is started on a selective serotonin
reuptake inhibitor (SSRI). Which mechanism of action best describes how SSRIs
improve mood?
A. Blockade of dopamine reuptake
B. Inhibition of serotonin reuptake into the presynaptic neuron ✅
C. Antagonism of serotonin receptors
D. Inhibition of monoamine oxidase
Rationale: SSRIs work by blocking the serotonin transporter (SERT) on the presynaptic
neuron, which increases the concentration of serotonin in the synaptic cleft. This
enhanced serotonergic activity is thought to improve mood, anxiety, and obsessive-
compulsive symptoms over several weeks. Unlike MAOIs, SSRIs do not inhibit
monoamine oxidase, and they have minimal effect on dopamine or norepinephrine
reuptake.
Q2. A patient on an SSRI develops serotonin syndrome after adding a second
serotonergic drug. Which of the following is a hallmark symptom of serotonin
syndrome?
A. Hypothermia and bradycardia
B. Hyperthermia, clonus, and agitation ✅
,C. Dry mouth and urinary retention
D. Sedation and hypotension
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by
excessive serotonergic activity, often from combining SSRIs, MAOIs, or other
serotonergic agents. Key features include hyperthermia, muscle clonus, hyperreflexia,
agitation, and autonomic instability. Treatment involves discontinuing the offending
agents and providing supportive care, including benzodiazepines for agitation.
Q3. Which antipsychotic is most likely to cause extrapyramidal symptoms (EPS) due to
strong D2 blockade?
A. Clozapine
B. Quetiapine
C. Haloperidol ✅
D. Olanzapine
Rationale: Haloperidol is a first-generation (typical) antipsychotic with high affinity for
dopamine D2 receptors in the striatum, which directly correlates with a high risk of EPS.
EPS include acute dystonia, parkinsonism, akathisia, and tardive dyskinesia, caused by
excessive dopamine blockade. Second-generation antipsychotics like clozapine and
quetiapine have lower D2 affinity and higher serotonin blockade, reducing EPS risk but
increasing metabolic side effects.
Q4. A patient with bipolar disorder is started on lithium. Which of the following requires
regular monitoring during lithium therapy?
A. Liver function tests
B. Serum lithium levels, renal function, and thyroid function ✅
C. Complete blood count only
D. Electrocardiogram only
,Rationale: Lithium has a narrow therapeutic index (0.6–1.2 mEq/L), and levels above 1.5
mEq/L can cause toxicity, including nausea, tremor, ataxia, and seizures. Chronic lithium
use can impair renal concentrating ability and cause hypothyroidism, so serum
creatinine, TSH, and lithium levels must be monitored regularly. Dehydration, NSAIDs,
and diuretics can increase lithium levels, so patient education is critical.
Q5. Which anticonvulsant is a first-line treatment for trigeminal neuralgia?
A. Phenytoin
B. Gabapentin
C. Carbamazepine ✅
D. Valproic acid
Rationale: Carbamazepine is the drug of choice for trigeminal neuralgia because it
stabilizes neuronal membranes by blocking sodium channels, reducing the frequency of
pain paroxysms. Gabapentin and pregabalin are also used for neuropathic pain but are
not first-line for trigeminal neuralgia. Carbamazepine requires monitoring of CBC, liver
function, and serum levels due to its narrow therapeutic index and risk of
agranulocytosis.
Q6. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement about buspirone is correct?
A. It has a rapid onset of action within 24 hours
B. It is a partial agonist at serotonin 5-HT1A receptors ✅
C. It is contraindicated with SSRIs
D. It causes significant sedation and dependence
Rationale: Buspirone is a partial agonist at serotonin 5-HT1A receptors, which reduces
anxiety without the sedation, dependence, or withdrawal seen with benzodiazepines. Its
onset of action is delayed, typically taking 2–4 weeks to achieve full therapeutic effect,
, similar to antidepressants. Buspirone is safe to combine with SSRIs and has no abuse
potential, making it a good option for chronic anxiety.
Q7. Which of the following is a contraindication to using clozapine?
A. History of hypertension
B. History of agranulocytosis ✅
C. History of diabetes
D. History of obesity
Rationale: Clozapine is associated with a significant risk of agranulocytosis (1–2% of
patients), which requires regular absolute neutrophil count (ANC) monitoring. It is
contraindicated in patients with a history of clozapine-induced agranulocytosis or
severe neutropenia. Despite this risk, clozapine is the most effective antipsychotic for
treatment-resistant schizophrenia and is also used to reduce suicidal behavior.
Q8. A patient on phenytoin develops nystagmus, ataxia, and slurred speech. These
symptoms most likely indicate:
A. Allergic reaction
B. Phenytoin toxicity ✅
C. Therapeutic effect
D. Drug interaction with food
Rationale: Phenytoin has nonlinear pharmacokinetics; small dose increases can cause
disproportionate rises in serum levels, leading to toxicity. Symptoms of phenytoin
toxicity include nystagmus, ataxia, dysarthria, and sedation, which correlate with serum
levels above 20 mcg/mL. Management involves holding the dose, checking serum level,
and adjusting the dose based on therapeutic drug monitoring.
Q9. Which antidepressant is most appropriate for a patient with depression and
