NUR 210 Exam 4 V3 | NUR 210 Pharmacology | Actual Q&A with
Rationale (NUR 210 Exam 4) | Galen
1. A patient is prescribed Phenelzine (Nardil) for depression. Which dietary choice requires
immediate intervention by the nurse?
A. Grilled chicken breast with steamed broccoli
B. Hard-boiled eggs and whole-wheat toast
C. Fresh salad with vinaigrette dressing
D. Pepperoni pizza and a glass of red wine
Answer: D
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) which can lead to a
hypertensive crisis if consumed with tyramine-rich foods. Foods like aged cheeses, cured
meats like pepperoni, and red wine contain high levels of tyramine. The nurse must
educate the patient to avoid these items to prevent potentially fatal blood pressure spikes.
2. A nurse is monitoring a patient taking Lithium Carbonate. Which laboratory value should
the nurse report to the provider as a sign of toxicity?
A. Serum lithium level of 0.8 mEq/L
B. Serum sodium level of 140 mEq/L
C. White blood cell count of 8,000/mm3
D. Serum lithium level of 1.8 mEq/L
Answer: D
Rationale: The therapeutic range for lithium is narrow, typically between 0.6 and 1.2
mEq/L for maintenance therapy. A level of 1.8 mEq/L indicates moderate to severe toxicity,
which can lead to seizures and cardiac arrhythmias. The nurse should immediately
withhold the medication and prepare for potential gastric lavage or hemodialysis
depending on symptoms.
3. A patient taking Fluoxetine reports feeling confused, having muscle twitches, and sweating
profusely. What should the nurse suspect?
A. Extrapyramidal side effects
B. Neuroleptic malignant syndrome
C. Anticholinergic crisis
D. Serotonin syndrome
,Answer: D
Rationale: Serotonin syndrome is a life-threatening complication of SSRI therapy
characterized by mental status changes, neuromuscular hyperactivity, and autonomic
instability. Fluoxetine increases serotonin levels, and excessive accumulation can trigger
these symptoms. This condition requires immediate discontinuation of the offending agent
and supportive care.
4. A patient is brought to the Emergency Department with suspected Alprazolam overdose.
Which medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Acetylcysteine
D. Protamine sulfate
Answer: B
Rationale: Flumazenil is the specific reversal agent for benzodiazepine toxicity, including
Alprazolam. It works by competitively inhibiting the benzodiazepine binding site on the
GABA-A receptor. The nurse must monitor for seizures following administration, especially
in patients with chronic benzodiazepine use.
5. Which adverse effect is most associated with the first-generation antipsychotic
Haloperidol?
A. Acute dystonia
B. Agranulocytosis
C. Weight loss
D. Hypertension
Answer: A
Rationale: Haloperidol is a high-potency typical antipsychotic that frequently causes
extrapyramidal symptoms (EPS), with acute dystonia being one of the earliest signs. Acute
dystonia involves severe spasms of the tongue, neck, face, and back. The nurse should be
prepared to administer an anticholinergic medication like Benztropine to treat these
symptoms.
6. A patient is being started on Clozapine. What mandatory lab test must be performed
weekly during the first six months of treatment?
A. Liver function tests (LFTs)
B. Serum potassium
C. Blood Urea Nitrogen (BUN) and Creatinine
, D. Complete Blood Count (CBC) with differential
Answer: D
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a
dangerously low white blood cell count. Regular monitoring of the Absolute Neutrophil
Count (ANC) is required to ensure patient safety and detect bone marrow suppression
early. If the ANC falls below a certain threshold, the medication must be discontinued
immediately.
7. Which symptom would differentiate Neuroleptic Malignant Syndrome (NMS) from
Serotonin Syndrome?
A. Fever
B. Altered mental status
C. Tachycardia
D. Lead-pipe muscle rigidity
Answer: D
Rationale: While both conditions involve fever and tachycardia, NMS is specifically
associated with “lead-pipe” muscle rigidity and is caused by dopamine depletion from
antipsychotics. Serotonin syndrome typically presents with hyperreflexia and myoclonus
rather than rigidity. NMS is a medical emergency that often requires treatment with
Dantrolene or Bromocriptine.
8. A nurse is providing discharge teaching for a patient prescribed Amitriptyline. Which
instruction is a priority?
A. Avoid drinking orange juice
B. Take the medication with a high-fiber meal
C. Change positions slowly to prevent falls
D. Expect the therapeutic effect within 24 hours
Answer: C
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) that commonly causes
orthostatic hypotension due to alpha-1 adrenergic blockade. Patients are at high risk for
falls, particularly the elderly, so they should be taught to dangle their legs before standing.
Additionally, TCAs can take several weeks to reach full therapeutic effectiveness.
9. A patient with ADHD is prescribed Methylphenidate. What should the nurse include in the
teaching plan regarding administration?
A. Take the last dose at bedtime to improve sleep
B. Take the medication before 4:00 PM to prevent insomnia
Rationale (NUR 210 Exam 4) | Galen
1. A patient is prescribed Phenelzine (Nardil) for depression. Which dietary choice requires
immediate intervention by the nurse?
A. Grilled chicken breast with steamed broccoli
B. Hard-boiled eggs and whole-wheat toast
C. Fresh salad with vinaigrette dressing
D. Pepperoni pizza and a glass of red wine
Answer: D
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) which can lead to a
hypertensive crisis if consumed with tyramine-rich foods. Foods like aged cheeses, cured
meats like pepperoni, and red wine contain high levels of tyramine. The nurse must
educate the patient to avoid these items to prevent potentially fatal blood pressure spikes.
2. A nurse is monitoring a patient taking Lithium Carbonate. Which laboratory value should
the nurse report to the provider as a sign of toxicity?
A. Serum lithium level of 0.8 mEq/L
B. Serum sodium level of 140 mEq/L
C. White blood cell count of 8,000/mm3
D. Serum lithium level of 1.8 mEq/L
Answer: D
Rationale: The therapeutic range for lithium is narrow, typically between 0.6 and 1.2
mEq/L for maintenance therapy. A level of 1.8 mEq/L indicates moderate to severe toxicity,
which can lead to seizures and cardiac arrhythmias. The nurse should immediately
withhold the medication and prepare for potential gastric lavage or hemodialysis
depending on symptoms.
3. A patient taking Fluoxetine reports feeling confused, having muscle twitches, and sweating
profusely. What should the nurse suspect?
A. Extrapyramidal side effects
B. Neuroleptic malignant syndrome
C. Anticholinergic crisis
D. Serotonin syndrome
,Answer: D
Rationale: Serotonin syndrome is a life-threatening complication of SSRI therapy
characterized by mental status changes, neuromuscular hyperactivity, and autonomic
instability. Fluoxetine increases serotonin levels, and excessive accumulation can trigger
these symptoms. This condition requires immediate discontinuation of the offending agent
and supportive care.
4. A patient is brought to the Emergency Department with suspected Alprazolam overdose.
Which medication should the nurse anticipate administering?
A. Naloxone
B. Flumazenil
C. Acetylcysteine
D. Protamine sulfate
Answer: B
Rationale: Flumazenil is the specific reversal agent for benzodiazepine toxicity, including
Alprazolam. It works by competitively inhibiting the benzodiazepine binding site on the
GABA-A receptor. The nurse must monitor for seizures following administration, especially
in patients with chronic benzodiazepine use.
5. Which adverse effect is most associated with the first-generation antipsychotic
Haloperidol?
A. Acute dystonia
B. Agranulocytosis
C. Weight loss
D. Hypertension
Answer: A
Rationale: Haloperidol is a high-potency typical antipsychotic that frequently causes
extrapyramidal symptoms (EPS), with acute dystonia being one of the earliest signs. Acute
dystonia involves severe spasms of the tongue, neck, face, and back. The nurse should be
prepared to administer an anticholinergic medication like Benztropine to treat these
symptoms.
6. A patient is being started on Clozapine. What mandatory lab test must be performed
weekly during the first six months of treatment?
A. Liver function tests (LFTs)
B. Serum potassium
C. Blood Urea Nitrogen (BUN) and Creatinine
, D. Complete Blood Count (CBC) with differential
Answer: D
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a
dangerously low white blood cell count. Regular monitoring of the Absolute Neutrophil
Count (ANC) is required to ensure patient safety and detect bone marrow suppression
early. If the ANC falls below a certain threshold, the medication must be discontinued
immediately.
7. Which symptom would differentiate Neuroleptic Malignant Syndrome (NMS) from
Serotonin Syndrome?
A. Fever
B. Altered mental status
C. Tachycardia
D. Lead-pipe muscle rigidity
Answer: D
Rationale: While both conditions involve fever and tachycardia, NMS is specifically
associated with “lead-pipe” muscle rigidity and is caused by dopamine depletion from
antipsychotics. Serotonin syndrome typically presents with hyperreflexia and myoclonus
rather than rigidity. NMS is a medical emergency that often requires treatment with
Dantrolene or Bromocriptine.
8. A nurse is providing discharge teaching for a patient prescribed Amitriptyline. Which
instruction is a priority?
A. Avoid drinking orange juice
B. Take the medication with a high-fiber meal
C. Change positions slowly to prevent falls
D. Expect the therapeutic effect within 24 hours
Answer: C
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) that commonly causes
orthostatic hypotension due to alpha-1 adrenergic blockade. Patients are at high risk for
falls, particularly the elderly, so they should be taught to dangle their legs before standing.
Additionally, TCAs can take several weeks to reach full therapeutic effectiveness.
9. A patient with ADHD is prescribed Methylphenidate. What should the nurse include in the
teaching plan regarding administration?
A. Take the last dose at bedtime to improve sleep
B. Take the medication before 4:00 PM to prevent insomnia
