NSG 533
EXAM 2
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
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Get the Complete PDF After Purchase
NSG 533 - EXAM 2 - Advanced Pharmacology
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or in need of any study resources,
feel free to Message me.
EXAM PREVIEW STUDY GUIDE FULL PDF LINKED
,Table of Contents
NSG 533 Exam 2 ................................................................................ 2
NSG 533 Exam 2 ............................................................................. 40
NSG 533 Exam 2 Study Guide ................................................. 69
NSG 533 Exam 2
1. What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose of acetaminophen?
A) The patient may develop renal toxicity from acetaminophen overdose.
B) In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen.
C) Acetaminophen causes significant gastrointestinal bleeding in elderly patients.
D) Vicodin contains no acetaminophen, so there is no concern.
Correct Answer: B
Rationale: Vicodin is a combination medication containing hydrocodone and
acetaminophen. In elderly patients, the recommended maximum daily dose of
acetaminophen is 3,000 mg to reduce the risk of hepatotoxicity. Many patients may
unknowingly exceed this limit by taking multiple medications containing acetaminophen
(APAP). The FDA has set a maximum daily dose of 4,000 mg for the general population, but
geriatric patients and those with liver disease should not exceed 3,000 mg/day.
Acetaminophen does not cause significant GI bleeding (that's NSAIDs), and Vicodin
definitely contains acetaminophen.
,---
2. What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A) Gabapentin
B) Duloxetine or venlafaxine
C) Tramadol
D) Amitriptyline
Correct Answer: B
Rationale: SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), specifically duloxetine
and venlafaxine, are dual-purpose medications. They are FDA-approved for the treatment of
diabetic peripheral neuropathic pain and are also effective antidepressants. Duloxetine is
particularly beneficial because it addresses both the neuropathic pain common in diabetes
and comorbid depression. Gabapentin treats neuropathic pain but is not an antidepressant.
Tramadol is an opioid analgesic with weak SSRI/SNRI properties but is not indicated for
depression. Amitriptyline is a TCA that can treat both conditions but is not the best answer
here as the question specifically asks about SNRIs.
---
3. In addition, be sure to understand which non-opioid medications you would use for a
patient with neuropathic pain. (Select All That Apply)
A) Gabapentin
B) Pregabalin
C) Transdermal lidocaine
,D) Tricyclic antidepressants (TCAs)
E) Acetaminophen
Correct Answers: A, B, C, D
Rationale: Neuropathic pain arises from damage to the nervous system and responds
poorly to traditional analgesics like acetaminophen and NSAIDs. First-line non-opioid
treatments for neuropathic pain include: Gabapentin and pregabalin (calcium channel
alpha-2-delta ligands that modulate neurotransmitter release), transdermal lidocaine (local
anesthetic that blocks sodium channels and nerve conduction), and TCAs such as
amitriptyline and nortriptyline (which inhibit reuptake of serotonin and norepinephrine,
modulating pain pathways). Acetaminophen is effective for nociceptive pain (inflammatory,
somatic) but has minimal efficacy for neuropathic pain.
---
4. If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A) No opioid can be used if the patient has a true morphine allergy.
B) An agent from another opiate class should be used.
C) Only synthetic opioids like fentanyl can be used.
D) Hydromorphone is the safest alternative because it is structurally identical to morphine.
Correct Answer: B
Rationale: True opioid allergies are rare; most reported "allergies" are actually adverse
effects (nausea, itching, sedation). When a true allergy is present, an agent from a different
opiate class should be selected. Morphine is a phenanthrene derivative. Alternative classes
include: phenylpiperidines (fentanyl, meperidine), diphenylheptanes (methadone), or
benzomorphans. Hydromorphone is also a phenanthrene derivative and structurally
,similar to morphine, so it would NOT be a safe alternative. The key principle is to select
from a different structural class to minimize cross-reactivity risk.
---
5. Know the common side effects which opioids can cause: (Select All That Apply)
A) Excessive sedation
B) Constipation
C) Nausea and vomiting
D) Gastroparesis
E) Vertigo
F) Respiratory depression
G) CNS depression
Correct Answers: A, B, C, D, E, F, G
Rationale: Opioids produce numerous side effects through mu-receptor activation:
Excessive sedation (reduce dose by 25% if problematic); Constipation (most common and
persistent side effect—treat prophylactically with senna, dulcolax, or stool softeners);
Nausea/vomiting (often transient; treat with hydroxyzine or diphenhydramine);
Gastroparesis (delayed gastric emptying due to decreased GI motility); Vertigo (due to
vestibular effects); Respiratory depression (dose-dependent depression of medullary
respiratory centers—most serious adverse effect); CNS depression (sedation, confusion,
euphoria). Constipation is the only side effect that does NOT diminish with tolerance
development.
---
, NSG 533 Exam 2
1. A patient with diabetic peripheral neuropathy reports burning, electric-shooting
pain in both feet. Which medication is FIRST-LINE for this type of pain?
A) Ibuprofen 600 mg every 6 hours
B) Duloxetine 60 mg daily
C) Hydrocodone-acetaminophen 5/325 mg every 4-6 hours PRN
D) Prednisone 20 mg daily
Correct Answer: B
Rationale: Diabetic peripheral neuropathy (DPN) is a neuropathic pain condition
characterized by burning, electric, shooting, and tingling sensations. Neuropathic pain does
NOT respond to NSAIDs or acetaminophen because these target inflammatory
prostaglandin-mediated pathways, not abnormal nerve signaling. Duloxetine, an SNRI, is
FDA-approved for DPN and works by increasing serotonin and norepinephrine in
descending inhibitory pain pathways. It also treats comorbid depression common in
diabetic patients. Gabapentin and pregabalin are also first-line. Opioids like hydrocodone
are NOT first-line for neuropathic pain due to poor efficacy, tolerance, dependence, and
hyperalgesia risks. Prednisone has no role in neuropathic pain management.
2. A 55-year-old patient with osteoarthritis of the knee has been taking
acetaminophen 1,000 mg three times daily for 4 weeks with minimal relief. She has a
history of peptic ulcer disease and stage 3 CKD. What is the MOST appropriate next
step?
A) Switch to ibuprofen 800 mg three times daily
B) Add diclofenac gel (Voltaren) to the knee
C) Start oral prednisone 10 mg daily
D) Discontinue all medications and recommend only rest
Correct Answer: B
,Rationale: This patient has contraindications to oral NSAIDs: peptic ulcer disease (high GI
bleed risk from COX-1 inhibition) and stage 3 CKD (NSAIDs reduce afferent arteriole
vasodilation via prostaglandin inhibition, worsening renal function—the "triple whammy").
Topical NSAIDs (diclofenac gel) provide local anti-inflammatory effects with minimal
systemic absorption, making them ideal for superficial joints (knee, hand) in patients with
GI and renal risks. Oral prednisone is not indicated for OA. Rest alone is insufficient for
functional OA management.
3. Which statement about the WHO three-step analgesic ladder is CORRECT?
A) Step 1 for mild pain uses strong opioids plus adjuvants
B) Step 2 for moderate pain adds a weak opioid to scheduled non-opioid therapy
C) Step 3 for severe pain discontinues all non-opioids and uses only strong opioids
D) Adjuvant medications should only be added in Step 3
Correct Answer: B
Rationale: The WHO analgesic ladder: Step 1 (Mild pain 1-3/10): Non-opioid ± adjuvant,
scheduled ATC. Step 2 (Moderate pain 4-6/10): Weak opioid (codeine, tramadol,
hydrocodone) + non-opioid ± adjuvant, scheduled ATC. Step 3 (Severe pain 7-10/10):
Strong opioid (morphine, oxycodone, fentanyl, hydromorphone) + non-opioid ± adjuvant,
ATC. Key principles: "By the mouth, by the clock, by the ladder, for the individual." Non-
opioids and adjuvants are continued at ALL steps. Adjuvants can be added at any step,
especially for neuropathic pain.
4. A patient on long-term morphine for cancer pain develops increasing constipation
despite taking docusate daily. What is the BEST management?
A) Discontinue morphine and switch to tramadol
B) Add senna (stimulant laxative) and consider PEG if needed
C) Reduce the morphine dose by 50%
D) Tell the patient constipation is temporary and will resolve with tolerance
Correct Answer: B
Rationale: Constipation is the ONLY opioid side effect that does NOT develop tolerance.
Docusate (stool softener) alone is insufficient; stimulant laxatives (senna, bisacodyl) are
,required to counteract opioid-induced decreased GI motility and increased water
absorption. The "No Poo" mnemonic reminds us that constipation persists. For refractory
cases, PEG, lubiprostone, naloxegol, or methylnaltrexone may be needed. Discontinuing
effective cancer pain medication is inappropriate. Tramadol also causes constipation. Never
wait for tolerance to develop.
5. Which opioid is the SAFEST choice for a patient with severe chronic kidney disease
(CrCl <30 mL/min)?
A) Morphine
B) Codeine
C) Fentanyl
D) Meperidine
Correct Answer: C
Rationale: In severe CKD, avoid opioids with renally excreted active metabolites: Morphine
→ M6G accumulates (sedation, respiratory depression, neurotoxicity). Codeine →
unpredictable metabolism, parent drug accumulation. Meperidine → normeperidine
accumulates (seizures, delirium). Fentanyl is metabolized hepatically via CYP3A4 with no
active renally excreted metabolites, making it the safest opioid in renal impairment.
Methadone is also hepatically metabolized and safe in CKD.
6. A patient with a true morphine allergy (anaphylaxis) requires opioid analgesia
post-operatively. Which opioid is the MOST appropriate alternative?
A) Hydromorphone
B) Oxycodone
C) Fentanyl
D) Codeine
Correct Answer: C
Rationale: Morphine, hydromorphone, oxycodone, oxymorphone, hydrocodone, and
codeine are all PHENANTHRENES—high cross-reactivity risk. Fentanyl is a
PHENYLPIPERIDINE—structurally distinct with minimal cross-reactivity, making it the
safest alternative for true morphine allergy. Methadone (diphenylheptane) is another safe
, NSG 533 Exam 2 Study Guide
Comprehensive Review of Pain Management, Headaches, Arthritis, Osteoporosis, Gout, and
Infectious Diseases
1. PAIN MANAGEMENT
Types of Pain
Acute Pain: Sudden onset, protective, usually from tissue injury, resolves with healing
Chronic Pain: Pain lasting >3 months, may persist beyond tissue healing, often involves
central sensitization
Nociceptive Pain: Pain from tissue damage; described as aching, throbbing
Neuropathic Pain: Pain from nerve damage; burning, tingling, electric
Malignant Pain: Cancer-related pain due to tumor invasion or compression
Non-Pharmacological Approaches to Pain
Heat, ice, PT, exercise, TENS, massage, acupuncture, CBT, stress management
WHO Three-Step Ladder Approach
Core Principles: By the mouth (oral preferred), By the clock (scheduled dosing), By the
ladder (stepwise escalation), For the individual (patient-specific)
Step 1 – Mild Pain (1-3/10)
Non-opioid ± adjuvant
Medications: Acetaminophen 1g q6h, NSAIDs (600mg q6h), ± Adjuvant (TCA, gabapentin,
duloxetine)
Key Concept: Scheduled dosing preferred (not PRN only)
Step 2 – Moderate Pain (4-6/10)
Weak opioid + non-opioid ± adjuvant
Medications: Hydrocodone, Codeine, Tramadol + Acetaminophen or NSAID
Key Concept: Combination therapy improves analgesia
Step 3 – Severe Pain (7-10/10)
Strong opioid ± non-opioid ± adjuvant
Medications: Morphine, Hydromorphone, Oxycodone, Fentanyl, Methadone
EXAM 2
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 533 - EXAM 2 - Advanced Pharmacology
If you require further clarification
or in need of any study resources,
feel free to Message me.
EXAM PREVIEW STUDY GUIDE FULL PDF LINKED
,Table of Contents
NSG 533 Exam 2 ................................................................................ 2
NSG 533 Exam 2 ............................................................................. 40
NSG 533 Exam 2 Study Guide ................................................. 69
NSG 533 Exam 2
1. What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose of acetaminophen?
A) The patient may develop renal toxicity from acetaminophen overdose.
B) In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen.
C) Acetaminophen causes significant gastrointestinal bleeding in elderly patients.
D) Vicodin contains no acetaminophen, so there is no concern.
Correct Answer: B
Rationale: Vicodin is a combination medication containing hydrocodone and
acetaminophen. In elderly patients, the recommended maximum daily dose of
acetaminophen is 3,000 mg to reduce the risk of hepatotoxicity. Many patients may
unknowingly exceed this limit by taking multiple medications containing acetaminophen
(APAP). The FDA has set a maximum daily dose of 4,000 mg for the general population, but
geriatric patients and those with liver disease should not exceed 3,000 mg/day.
Acetaminophen does not cause significant GI bleeding (that's NSAIDs), and Vicodin
definitely contains acetaminophen.
,---
2. What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A) Gabapentin
B) Duloxetine or venlafaxine
C) Tramadol
D) Amitriptyline
Correct Answer: B
Rationale: SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), specifically duloxetine
and venlafaxine, are dual-purpose medications. They are FDA-approved for the treatment of
diabetic peripheral neuropathic pain and are also effective antidepressants. Duloxetine is
particularly beneficial because it addresses both the neuropathic pain common in diabetes
and comorbid depression. Gabapentin treats neuropathic pain but is not an antidepressant.
Tramadol is an opioid analgesic with weak SSRI/SNRI properties but is not indicated for
depression. Amitriptyline is a TCA that can treat both conditions but is not the best answer
here as the question specifically asks about SNRIs.
---
3. In addition, be sure to understand which non-opioid medications you would use for a
patient with neuropathic pain. (Select All That Apply)
A) Gabapentin
B) Pregabalin
C) Transdermal lidocaine
,D) Tricyclic antidepressants (TCAs)
E) Acetaminophen
Correct Answers: A, B, C, D
Rationale: Neuropathic pain arises from damage to the nervous system and responds
poorly to traditional analgesics like acetaminophen and NSAIDs. First-line non-opioid
treatments for neuropathic pain include: Gabapentin and pregabalin (calcium channel
alpha-2-delta ligands that modulate neurotransmitter release), transdermal lidocaine (local
anesthetic that blocks sodium channels and nerve conduction), and TCAs such as
amitriptyline and nortriptyline (which inhibit reuptake of serotonin and norepinephrine,
modulating pain pathways). Acetaminophen is effective for nociceptive pain (inflammatory,
somatic) but has minimal efficacy for neuropathic pain.
---
4. If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A) No opioid can be used if the patient has a true morphine allergy.
B) An agent from another opiate class should be used.
C) Only synthetic opioids like fentanyl can be used.
D) Hydromorphone is the safest alternative because it is structurally identical to morphine.
Correct Answer: B
Rationale: True opioid allergies are rare; most reported "allergies" are actually adverse
effects (nausea, itching, sedation). When a true allergy is present, an agent from a different
opiate class should be selected. Morphine is a phenanthrene derivative. Alternative classes
include: phenylpiperidines (fentanyl, meperidine), diphenylheptanes (methadone), or
benzomorphans. Hydromorphone is also a phenanthrene derivative and structurally
,similar to morphine, so it would NOT be a safe alternative. The key principle is to select
from a different structural class to minimize cross-reactivity risk.
---
5. Know the common side effects which opioids can cause: (Select All That Apply)
A) Excessive sedation
B) Constipation
C) Nausea and vomiting
D) Gastroparesis
E) Vertigo
F) Respiratory depression
G) CNS depression
Correct Answers: A, B, C, D, E, F, G
Rationale: Opioids produce numerous side effects through mu-receptor activation:
Excessive sedation (reduce dose by 25% if problematic); Constipation (most common and
persistent side effect—treat prophylactically with senna, dulcolax, or stool softeners);
Nausea/vomiting (often transient; treat with hydroxyzine or diphenhydramine);
Gastroparesis (delayed gastric emptying due to decreased GI motility); Vertigo (due to
vestibular effects); Respiratory depression (dose-dependent depression of medullary
respiratory centers—most serious adverse effect); CNS depression (sedation, confusion,
euphoria). Constipation is the only side effect that does NOT diminish with tolerance
development.
---
, NSG 533 Exam 2
1. A patient with diabetic peripheral neuropathy reports burning, electric-shooting
pain in both feet. Which medication is FIRST-LINE for this type of pain?
A) Ibuprofen 600 mg every 6 hours
B) Duloxetine 60 mg daily
C) Hydrocodone-acetaminophen 5/325 mg every 4-6 hours PRN
D) Prednisone 20 mg daily
Correct Answer: B
Rationale: Diabetic peripheral neuropathy (DPN) is a neuropathic pain condition
characterized by burning, electric, shooting, and tingling sensations. Neuropathic pain does
NOT respond to NSAIDs or acetaminophen because these target inflammatory
prostaglandin-mediated pathways, not abnormal nerve signaling. Duloxetine, an SNRI, is
FDA-approved for DPN and works by increasing serotonin and norepinephrine in
descending inhibitory pain pathways. It also treats comorbid depression common in
diabetic patients. Gabapentin and pregabalin are also first-line. Opioids like hydrocodone
are NOT first-line for neuropathic pain due to poor efficacy, tolerance, dependence, and
hyperalgesia risks. Prednisone has no role in neuropathic pain management.
2. A 55-year-old patient with osteoarthritis of the knee has been taking
acetaminophen 1,000 mg three times daily for 4 weeks with minimal relief. She has a
history of peptic ulcer disease and stage 3 CKD. What is the MOST appropriate next
step?
A) Switch to ibuprofen 800 mg three times daily
B) Add diclofenac gel (Voltaren) to the knee
C) Start oral prednisone 10 mg daily
D) Discontinue all medications and recommend only rest
Correct Answer: B
,Rationale: This patient has contraindications to oral NSAIDs: peptic ulcer disease (high GI
bleed risk from COX-1 inhibition) and stage 3 CKD (NSAIDs reduce afferent arteriole
vasodilation via prostaglandin inhibition, worsening renal function—the "triple whammy").
Topical NSAIDs (diclofenac gel) provide local anti-inflammatory effects with minimal
systemic absorption, making them ideal for superficial joints (knee, hand) in patients with
GI and renal risks. Oral prednisone is not indicated for OA. Rest alone is insufficient for
functional OA management.
3. Which statement about the WHO three-step analgesic ladder is CORRECT?
A) Step 1 for mild pain uses strong opioids plus adjuvants
B) Step 2 for moderate pain adds a weak opioid to scheduled non-opioid therapy
C) Step 3 for severe pain discontinues all non-opioids and uses only strong opioids
D) Adjuvant medications should only be added in Step 3
Correct Answer: B
Rationale: The WHO analgesic ladder: Step 1 (Mild pain 1-3/10): Non-opioid ± adjuvant,
scheduled ATC. Step 2 (Moderate pain 4-6/10): Weak opioid (codeine, tramadol,
hydrocodone) + non-opioid ± adjuvant, scheduled ATC. Step 3 (Severe pain 7-10/10):
Strong opioid (morphine, oxycodone, fentanyl, hydromorphone) + non-opioid ± adjuvant,
ATC. Key principles: "By the mouth, by the clock, by the ladder, for the individual." Non-
opioids and adjuvants are continued at ALL steps. Adjuvants can be added at any step,
especially for neuropathic pain.
4. A patient on long-term morphine for cancer pain develops increasing constipation
despite taking docusate daily. What is the BEST management?
A) Discontinue morphine and switch to tramadol
B) Add senna (stimulant laxative) and consider PEG if needed
C) Reduce the morphine dose by 50%
D) Tell the patient constipation is temporary and will resolve with tolerance
Correct Answer: B
Rationale: Constipation is the ONLY opioid side effect that does NOT develop tolerance.
Docusate (stool softener) alone is insufficient; stimulant laxatives (senna, bisacodyl) are
,required to counteract opioid-induced decreased GI motility and increased water
absorption. The "No Poo" mnemonic reminds us that constipation persists. For refractory
cases, PEG, lubiprostone, naloxegol, or methylnaltrexone may be needed. Discontinuing
effective cancer pain medication is inappropriate. Tramadol also causes constipation. Never
wait for tolerance to develop.
5. Which opioid is the SAFEST choice for a patient with severe chronic kidney disease
(CrCl <30 mL/min)?
A) Morphine
B) Codeine
C) Fentanyl
D) Meperidine
Correct Answer: C
Rationale: In severe CKD, avoid opioids with renally excreted active metabolites: Morphine
→ M6G accumulates (sedation, respiratory depression, neurotoxicity). Codeine →
unpredictable metabolism, parent drug accumulation. Meperidine → normeperidine
accumulates (seizures, delirium). Fentanyl is metabolized hepatically via CYP3A4 with no
active renally excreted metabolites, making it the safest opioid in renal impairment.
Methadone is also hepatically metabolized and safe in CKD.
6. A patient with a true morphine allergy (anaphylaxis) requires opioid analgesia
post-operatively. Which opioid is the MOST appropriate alternative?
A) Hydromorphone
B) Oxycodone
C) Fentanyl
D) Codeine
Correct Answer: C
Rationale: Morphine, hydromorphone, oxycodone, oxymorphone, hydrocodone, and
codeine are all PHENANTHRENES—high cross-reactivity risk. Fentanyl is a
PHENYLPIPERIDINE—structurally distinct with minimal cross-reactivity, making it the
safest alternative for true morphine allergy. Methadone (diphenylheptane) is another safe
, NSG 533 Exam 2 Study Guide
Comprehensive Review of Pain Management, Headaches, Arthritis, Osteoporosis, Gout, and
Infectious Diseases
1. PAIN MANAGEMENT
Types of Pain
Acute Pain: Sudden onset, protective, usually from tissue injury, resolves with healing
Chronic Pain: Pain lasting >3 months, may persist beyond tissue healing, often involves
central sensitization
Nociceptive Pain: Pain from tissue damage; described as aching, throbbing
Neuropathic Pain: Pain from nerve damage; burning, tingling, electric
Malignant Pain: Cancer-related pain due to tumor invasion or compression
Non-Pharmacological Approaches to Pain
Heat, ice, PT, exercise, TENS, massage, acupuncture, CBT, stress management
WHO Three-Step Ladder Approach
Core Principles: By the mouth (oral preferred), By the clock (scheduled dosing), By the
ladder (stepwise escalation), For the individual (patient-specific)
Step 1 – Mild Pain (1-3/10)
Non-opioid ± adjuvant
Medications: Acetaminophen 1g q6h, NSAIDs (600mg q6h), ± Adjuvant (TCA, gabapentin,
duloxetine)
Key Concept: Scheduled dosing preferred (not PRN only)
Step 2 – Moderate Pain (4-6/10)
Weak opioid + non-opioid ± adjuvant
Medications: Hydrocodone, Codeine, Tramadol + Acetaminophen or NSAID
Key Concept: Combination therapy improves analgesia
Step 3 – Severe Pain (7-10/10)
Strong opioid ± non-opioid ± adjuvant
Medications: Morphine, Hydromorphone, Oxycodone, Fentanyl, Methadone
