MSN 611 NKU FINAL EXAM STUDY GUIDE & PRACTICE
QUESTIONS 2026/2027
A 65-year-old man presents with chronic insomnia. He reports that his sleep has improved after
beginning a new medication, but he is experiencing concerning adverse effects. His wife noticed
him sleepwalking, eating during the night, and attempting to drive his car at night. The patient
has no recollection of these events and is concerned. Vitals signs are blood pressure 130/80
mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and temperature 98.0 F (36.7 C).
Physical examination is normal. What is the mechanism of action of the medication responsible
for the patient's adverse effects? - ANS✔✔ GABA-A receptor agonist
A 26-year-old woman is brought to the emergency department with an acute severe headache.
Her partner reports that it started 6 hours ago and that she vomited several times at home. The
patient is holding her hands over her eyes and reports severe unilateral retroorbital throbbing
pain. She has no significant past medical history and takes no regular medications. Her vital
signs are within normal limits. There is no gross neurological deficit on examination of the
cranial nerves and limbs. Given the most likely diagnosis, what is the mechanism of action of
the best drug for the acute treatment of this patient's condition? - ANS✔✔ Cerebral
vasoconstriction
A 42-year-old man presents with a 6-month history of severe, throbbing headaches that are
generally unilateral, worsened by light and sound, and occur biweekly and occasionally interrupt
his workday. He has no significant improvement with ibuprofen, naproxen, or acetaminophen.
Vital signs are blood pressure 139/80 mmHg, heart rate 82 bpm, respiratory rate 14
breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. Which of the
following effects is caused by the most appropriate treatment option? - ANS✔✔ Constriction of
cerebral blood vessels.
A 20-year-old woman presents with a severe headache. She is G2P1 at 32 weeks gestation. Her
blood pressure is 201/98 mm Hg. A urine dipstick shows 3+ protein. Preparations are made for
an emergency cesarean section. She is started on a continuous intravenous infusion of
magnesium sulfate for the prevention of seizures. What is a severe, yet preventable,
,complication of continuous intravenous magnesium sulfate therapy? - ANS✔✔ Respiratory
depression
A 55-year-old man presents with difficulty passing urine and suprapubic discomfort for the past
2 days. His symptoms are progressively worsening. The patient's past medical history is
significant for depression, and he was recently started on a new medication due to refractory
symptoms. The physical examination reveals tachycardia, a dry mouth, and suprapubic fullness.
What is the class of medication that is responsible for this patient's presenting symptoms? -
ANS✔✔ Tricyclic antidepressants
A 55-year-old man presents with a 1-month history of insomnia and fatigue. He states that he
has been unable to complete work tasks and no longer enjoys his hobbies or going out with
friends. He also reports a decreased appetite and bouts of crying. The patient has a past
medical history of seizures, hypothyroidism, diabetes mellitus, and asthma. His blood pressure
is 110/75 mm Hg, and his heart rate is 75 bpm. The clinician prescribes venlafaxine. Which of
the following conditions requires caution when using venlafaxine in this patient? - ANS✔✔
Seizures
A 34-year-old woman has been troubled by migraine headaches that typically occur 5 to 6 times
monthly. Treatment of the headaches when they occur is moderately successful. She asks
whether there is anything she can do to reduce the frequency with which these headaches
occur. She also has been troubled by long-standing mood issues, with episodes that are weeks
long where she feels sad. What therapy might be recommended that can both reduce the
frequency of her migraine attacks and may also be useful in improving her mood? - ANS✔✔
Venlafaxine
A patient is diagnosed with metabolic acidosis. His medication record shows that he is
prescribed diclofenac, atenolol, albuterol, and topiramate. Which of these medications is most
likely responsible for the patient's condition? - ANS✔✔ Topiramate
A 60-year-old man is brought to the emergency department after an episode of syncope. The
patient was watching television when he felt light-headed and lost consciousness. He regained
consciousness after a minute spontaneously. The patient's past medical history is significant for
,hypertension, diabetes, and peripheral neuropathy. His medications include metformin,
hydrochlorothiazide, and amitriptyline. ECG in the emergency department shows a QT interval
of 480 ms. What is the mechanism of action of the drug responsible for this patient's symptoms
and ECG findings? - ANS✔✔ Blocking the reuptake of both serotonin and norepinephrine
neurotransmitters
A 23-year-old man recently started taking a new medication for a long-standing history of
hallucinations, poor eye contact, flat affect, and poor work performance. After six days of using
this medication, this patient presents to the emergency department with acute neck stiffness.
On exam, his head is rotated to the left and flexed in a fixed position. The medication used by
this patient mainly works by blocking which of the following receptor? - ANS✔✔ Dopamine
receptor
A 40-year-old man is brought to the emergency department due to a severe headache for the
past hour. His symptoms started 2 hours after having dinner with his family. On further
questioning, his wife reveals that they had pizza and red wine for dinner. On physical exam, he
appears anxious and tremulous. Medical history includes atypical depression being treated with
phenelzine. He does not smoke or use illicit drugs. Which of the following Is the most likely
finding? - ANS✔✔ Hypertension
A 25-year-old woman presents with depression resistant to multiple classes of antidepressants.
A nonselective monoamine oxidase inhibitor (MAOI) is prescribed. Which of the following
should be included in patient counseling regarding the prevention of one of the most serious
adverse effects of this drug? - ANS✔✔ Avoid tyramine-containing foods
A 48-year-old man with a 20-pack-year smoking history presents with 3 weeks of insomnia,
anhedonia, and decreased concentration after losing his father to lung cancer. He worries that
he will die of cancer and be unable to provide for his family. He often feels down and spends
most of his day in bed. He has lost 5 lbs (2.2 kg) over the past 2 weeks due to poor appetite. He
denies suicidal ideation and would like to quit smoking. What is the best pharmacotherapy for
this patient? - ANS✔✔ Bupropion
, A 65-year-old woman presents to the clinic with signs and symptoms of depression. She states
she has been feeling hopeless and depressed for the past six months since her mother's death
and the loss of her job. She has a past medical history of chronic sinusitis, for which she has
been taking antihistamines for the past two months. Her current vital signs are as follows; blood
pressure 126/80 mmHg, heart rate 70/min, respiratory rate 18/min, and temperature 98.6 F.
What is the next best step for this patient? - ANS✔✔ Start on sertraline
A 17-year-old female presents for a follow-up on major depressive disorder therapy with
venlafaxine. The mother and patient state that the patient's symptoms have improved. She has
been performing better at school, enjoying activities with her friends, and going to the gym
every day. However, the patient has trouble falling asleep. The mother states that she gives her
daughter a cough medication, dextromethorphan, to make her drowsy and help her fall asleep.
The mother and patient ask if they should be concerned about the use of dextromethorphan.
What is the best response to their question? - ANS✔✔ There is an increased risk of serotonin
syndrome if dextromethorphan is used with venlafaxine.
A 25-year-old woman presents with severe acute asthma exacerbation. She inadequately
responds to a combination of nebulized albuterol, inhaled ipratropium, prednisone, and oxygen.
The clinical team decides to administer intravenous magnesium. While placing the order, the
clinician receives an alert for potential overdose with this medication. Which of the following
symptoms is most likely to occur if there is an overdose? - ANS✔✔ Muscle weakness
A 40-year-old male with a history of bipolar 1 disorder is admitted to a psychiatric inpatient
facility after an episode of aggression and is currently prescribed aripiprazole. While on the
inpatient psychiatric unit, he continues to be agitated with the inpatient staff and other patients
on the unit. The psychiatrist prescribes him lithium to augment treatment for agitation. Lithium,
by acting on which of the neurotransmitters, will be helpful for the patient's agitation? -
ANS✔✔ Serotonin
A 45-year-old man is brought to the hospital by his sister with a history of seeing a man
following him for the last nine months. He says that only he can see this man. She also says he
lost his job four months ago because of poor performance. Since then, the patient has been
living in his room and does not go outside because he thinks someone might kill him. On
examination, the patient's vitals are normal. The clinician prescribes a medication that is known
QUESTIONS 2026/2027
A 65-year-old man presents with chronic insomnia. He reports that his sleep has improved after
beginning a new medication, but he is experiencing concerning adverse effects. His wife noticed
him sleepwalking, eating during the night, and attempting to drive his car at night. The patient
has no recollection of these events and is concerned. Vitals signs are blood pressure 130/80
mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and temperature 98.0 F (36.7 C).
Physical examination is normal. What is the mechanism of action of the medication responsible
for the patient's adverse effects? - ANS✔✔ GABA-A receptor agonist
A 26-year-old woman is brought to the emergency department with an acute severe headache.
Her partner reports that it started 6 hours ago and that she vomited several times at home. The
patient is holding her hands over her eyes and reports severe unilateral retroorbital throbbing
pain. She has no significant past medical history and takes no regular medications. Her vital
signs are within normal limits. There is no gross neurological deficit on examination of the
cranial nerves and limbs. Given the most likely diagnosis, what is the mechanism of action of
the best drug for the acute treatment of this patient's condition? - ANS✔✔ Cerebral
vasoconstriction
A 42-year-old man presents with a 6-month history of severe, throbbing headaches that are
generally unilateral, worsened by light and sound, and occur biweekly and occasionally interrupt
his workday. He has no significant improvement with ibuprofen, naproxen, or acetaminophen.
Vital signs are blood pressure 139/80 mmHg, heart rate 82 bpm, respiratory rate 14
breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. Which of the
following effects is caused by the most appropriate treatment option? - ANS✔✔ Constriction of
cerebral blood vessels.
A 20-year-old woman presents with a severe headache. She is G2P1 at 32 weeks gestation. Her
blood pressure is 201/98 mm Hg. A urine dipstick shows 3+ protein. Preparations are made for
an emergency cesarean section. She is started on a continuous intravenous infusion of
magnesium sulfate for the prevention of seizures. What is a severe, yet preventable,
,complication of continuous intravenous magnesium sulfate therapy? - ANS✔✔ Respiratory
depression
A 55-year-old man presents with difficulty passing urine and suprapubic discomfort for the past
2 days. His symptoms are progressively worsening. The patient's past medical history is
significant for depression, and he was recently started on a new medication due to refractory
symptoms. The physical examination reveals tachycardia, a dry mouth, and suprapubic fullness.
What is the class of medication that is responsible for this patient's presenting symptoms? -
ANS✔✔ Tricyclic antidepressants
A 55-year-old man presents with a 1-month history of insomnia and fatigue. He states that he
has been unable to complete work tasks and no longer enjoys his hobbies or going out with
friends. He also reports a decreased appetite and bouts of crying. The patient has a past
medical history of seizures, hypothyroidism, diabetes mellitus, and asthma. His blood pressure
is 110/75 mm Hg, and his heart rate is 75 bpm. The clinician prescribes venlafaxine. Which of
the following conditions requires caution when using venlafaxine in this patient? - ANS✔✔
Seizures
A 34-year-old woman has been troubled by migraine headaches that typically occur 5 to 6 times
monthly. Treatment of the headaches when they occur is moderately successful. She asks
whether there is anything she can do to reduce the frequency with which these headaches
occur. She also has been troubled by long-standing mood issues, with episodes that are weeks
long where she feels sad. What therapy might be recommended that can both reduce the
frequency of her migraine attacks and may also be useful in improving her mood? - ANS✔✔
Venlafaxine
A patient is diagnosed with metabolic acidosis. His medication record shows that he is
prescribed diclofenac, atenolol, albuterol, and topiramate. Which of these medications is most
likely responsible for the patient's condition? - ANS✔✔ Topiramate
A 60-year-old man is brought to the emergency department after an episode of syncope. The
patient was watching television when he felt light-headed and lost consciousness. He regained
consciousness after a minute spontaneously. The patient's past medical history is significant for
,hypertension, diabetes, and peripheral neuropathy. His medications include metformin,
hydrochlorothiazide, and amitriptyline. ECG in the emergency department shows a QT interval
of 480 ms. What is the mechanism of action of the drug responsible for this patient's symptoms
and ECG findings? - ANS✔✔ Blocking the reuptake of both serotonin and norepinephrine
neurotransmitters
A 23-year-old man recently started taking a new medication for a long-standing history of
hallucinations, poor eye contact, flat affect, and poor work performance. After six days of using
this medication, this patient presents to the emergency department with acute neck stiffness.
On exam, his head is rotated to the left and flexed in a fixed position. The medication used by
this patient mainly works by blocking which of the following receptor? - ANS✔✔ Dopamine
receptor
A 40-year-old man is brought to the emergency department due to a severe headache for the
past hour. His symptoms started 2 hours after having dinner with his family. On further
questioning, his wife reveals that they had pizza and red wine for dinner. On physical exam, he
appears anxious and tremulous. Medical history includes atypical depression being treated with
phenelzine. He does not smoke or use illicit drugs. Which of the following Is the most likely
finding? - ANS✔✔ Hypertension
A 25-year-old woman presents with depression resistant to multiple classes of antidepressants.
A nonselective monoamine oxidase inhibitor (MAOI) is prescribed. Which of the following
should be included in patient counseling regarding the prevention of one of the most serious
adverse effects of this drug? - ANS✔✔ Avoid tyramine-containing foods
A 48-year-old man with a 20-pack-year smoking history presents with 3 weeks of insomnia,
anhedonia, and decreased concentration after losing his father to lung cancer. He worries that
he will die of cancer and be unable to provide for his family. He often feels down and spends
most of his day in bed. He has lost 5 lbs (2.2 kg) over the past 2 weeks due to poor appetite. He
denies suicidal ideation and would like to quit smoking. What is the best pharmacotherapy for
this patient? - ANS✔✔ Bupropion
, A 65-year-old woman presents to the clinic with signs and symptoms of depression. She states
she has been feeling hopeless and depressed for the past six months since her mother's death
and the loss of her job. She has a past medical history of chronic sinusitis, for which she has
been taking antihistamines for the past two months. Her current vital signs are as follows; blood
pressure 126/80 mmHg, heart rate 70/min, respiratory rate 18/min, and temperature 98.6 F.
What is the next best step for this patient? - ANS✔✔ Start on sertraline
A 17-year-old female presents for a follow-up on major depressive disorder therapy with
venlafaxine. The mother and patient state that the patient's symptoms have improved. She has
been performing better at school, enjoying activities with her friends, and going to the gym
every day. However, the patient has trouble falling asleep. The mother states that she gives her
daughter a cough medication, dextromethorphan, to make her drowsy and help her fall asleep.
The mother and patient ask if they should be concerned about the use of dextromethorphan.
What is the best response to their question? - ANS✔✔ There is an increased risk of serotonin
syndrome if dextromethorphan is used with venlafaxine.
A 25-year-old woman presents with severe acute asthma exacerbation. She inadequately
responds to a combination of nebulized albuterol, inhaled ipratropium, prednisone, and oxygen.
The clinical team decides to administer intravenous magnesium. While placing the order, the
clinician receives an alert for potential overdose with this medication. Which of the following
symptoms is most likely to occur if there is an overdose? - ANS✔✔ Muscle weakness
A 40-year-old male with a history of bipolar 1 disorder is admitted to a psychiatric inpatient
facility after an episode of aggression and is currently prescribed aripiprazole. While on the
inpatient psychiatric unit, he continues to be agitated with the inpatient staff and other patients
on the unit. The psychiatrist prescribes him lithium to augment treatment for agitation. Lithium,
by acting on which of the neurotransmitters, will be helpful for the patient's agitation? -
ANS✔✔ Serotonin
A 45-year-old man is brought to the hospital by his sister with a history of seeing a man
following him for the last nine months. He says that only he can see this man. She also says he
lost his job four months ago because of poor performance. Since then, the patient has been
living in his room and does not go outside because he thinks someone might kill him. On
examination, the patient's vitals are normal. The clinician prescribes a medication that is known
