NSG 533 - ADVANCED PHARMACOLOGY EXAM 2
2026/2027-EDITION REAL EXAM QUESTIONS
AND 100% VERIFIED ANSWERS
OVERVIEW
This 2026 practice pack is designed for Wilkes University NSG 533 Advanced Pharmacology Exam 2. It
covers all high-yield systems tested in Exam 2, using clear language, case-based thinking, and
NCLEX-style critical reasoning. All answers are verified against current guidelines (2026-2027). Answers
appear in GREEN and Rationales for instant review.
1. Exam Focus Areas
Exam 2 typically focuses on: Autonomic Pharmacology, CNS drugs (Anxiolytics, Sedative-Hypnotics,
Antidepressants, Antipsychotics, Mood Stabilizers), Pain Management (Opioids, Non-opioids, Adjuvants,
Migraine), Substance Use, Anti-epileptics, and Neurodegenerative drugs. Weight: ~30% Pain/Analgesia,
30% Psych/CNS, 20% Neuro, 20% Autonomic/Substance.
2. How To Use This PDF
140 Multiple Choice (A-D), 20 Select-All-That-Apply (SATA), 12 True/False with correction, 10 Case
Studies with 2-3 linked questions. Read question, attempt answer, then check GREEN answer and
BLUE rationale. Rationales explain WHY other options are wrong - key for exam logic.
3. Key Study Tips
• Know Prototype Drugs: e.g., Morphine for opioids, Diazepam for benzodiazepines, Fluoxetine for SSRIs,
Haloperidol for typical antipsychotics. • Black Box Warnings: SSRIs & suicidality, Opioids & respiratory
depression, Clozapine & agranulocytosis. • Antidotes: Naloxone for opioids, Flumazenil for
benzodiazepines. • CYP450 Interactions: Fluoxetine, Paroxetine inhibit 2D6; Carbamazepine induces
3A4.
4. Grading Scale
182 Questions = 182 points. 165+ = A (90%+), 146-164 = B, 128-145 = C. Time yourself: 3 hours
recommended to simulate real exam.
PRACTICE QUESTIONS
Q1. [MCQ] A patient on chronic morphine 30mg PO q6h reports pain 8/10. Which is the priority
assessment?
A. Bowel function
, B. Respiratory rate and sedation
C. Blood pressure
D. Urine output
Answer: B. Respiratory rate and sedation
Rationale: Opioids cause dose-dependent respiratory depression via mu receptors in brainstem. Sedation
precedes respiratory depression - ABCs priority. Bowel is common side effect but not life-threatening.
Q2. [MCQ] Tramadol maximum daily dose is 400mg (300mg if >75yo). Which combination
increases seizure and serotonin syndrome risk?
A. Tramadol + Acetaminophen
B. Tramadol + MAOI + SSRI
C. Tramadol + Ibuprofen
D. Tramadol + Naloxone
Answer: B. Tramadol + MAOI + SSRI
Rationale: Tramadol lowers seizure threshold and inhibits serotonin/norepinephrine reuptake. Combining
with MAOIs, SSRIs, TCAs increases serotonin syndrome and seizure risk. Contraindicated within 14 days of
MAOI.
Q3. [MCQ] Patient prescribed diazepam for anxiety. Teaching should include:
A. Safe with alcohol
B. Avoid abrupt discontinuation - taper needed
C. No risk of dependence
D. Take with grapefruit juice
Answer: B. Avoid abrupt discontinuation - taper needed
Rationale: Benzodiazepines enhance GABA-A. Abrupt stop causes withdrawal: anxiety, tremors, seizures.
Taper over weeks. Alcohol increases CNS depression. Long-term risk of tolerance/dependence.
Q4. [MCQ] SSRI fluoxetine teaching: When will patient feel full antidepressant effect?
A. Immediately
B. 24 hours
C. 4-6 weeks
D. 6 months
Answer: C. 4-6 weeks
Rationale: SSRIs increase synaptic serotonin immediately but downstream neuroplastic changes take 4-6
weeks. Initial side effects appear early; warn about worsening anxiety/suicidal ideation in first 1-2 weeks -
black box warning for <25yo.
Q5. [MCQ] Lithium level 1.8 mEq/L. Patient has tremor, confusion, ataxia. What is priority
action?
A. Encourage fluids
B. Hold lithium and check level, hydrate, notify provider
C. Give next dose
D. Reassure
Answer: B. Hold lithium and check level, hydrate, notify provider
Rationale: Therapeutic 0.6-1.2 mEq/L, toxic >1.5. S/S: coarse tremor, ataxia, confusion, polyuria. Lithium is
renally cleared, narrow TI. Hold drug, hydrate (normal saline), check BMP, lithium level. Risk with NSAIDs,
, dehydration, low sodium.
Q6. [MCQ] A client is prescribed Haloperidol for chronic pain/depression. Which assessment
finding requires immediate reporting?
Respiratory rate 8/min
Mild Tardive dyskinesia
Pain 3/10
Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Haloperidol - typical antipsychotic D2 blockade -> EPS. Respiratory depression is life-threatening
and priority over Tardive dyskinesia which is expected.
Q7. [MCQ] What is the primary mechanism of action of Morphine?
Blocks mu agonist -> analgesia, respiratory depression, constipation, miosis
Enhances GABA
Inhibits reuptake of monoamines
mu agonist -> analgesia, respiratory depression, constipation, miosis
Answer: D. mu agonist -> analgesia, respiratory depression, constipation, miosis
Rationale: Morphine works via mu agonist -> analgesia, respiratory depression, constipation, miosis.
Knowing prototype mechanism helps predict effects and side effects.
Q8. [MCQ] Which statement indicates patient understands teaching about Sumatriptan?
"I will stop it abruptly if I feel better"
"I will avoid alcohol and report severe dizziness"
"I can double dose if I miss one"
"I will take with MAOI"
Answer: B. "I will avoid alcohol and report severe dizziness"
Rationale: Patient teaching for Sumatriptan: triptan 5-HT1B/1D. Avoid CNS depressants, no abrupt stop,
adherence important. Correct statement shows understanding of safety.
Q9. [SATA] A client is prescribed Gabapentin for chronic pain/depression. Which assessment
finding requires immediate reporting?
■ Respiratory rate 8/min
■ Mild Sedation, dizziness
■ Pain 3/10
■ Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Gabapentin - binds alpha2delta Ca channel, for neuropathic pain. Respiratory depression is
life-threatening and priority over Sedation, dizziness which is expected.
Q10. [MCQ] Which lab/test is essential to monitor for a patient on Clozapine?
Lithium level / LFTs / ANC / ECG depending on drug
HbA1c
Only blood pressure
No monitoring needed
Answer: A. Lithium level / LFTs / ANC / ECG depending on drug
, Rationale: Clozapine requires monitoring: e.g., Lithium levels, thyroid, renal; Valproate LFTs, platelets;
Clozapine ANC weekly; Phenytoin drug level, CBC. Requires weekly ANC is clue to monitor.
Q11. [MCQ] Which lab/test is essential to monitor for a patient on Fentanyl?
Lithium level / LFTs / ANC / ECG depending on drug
HbA1c
Only blood pressure
No monitoring needed
Answer: A. Lithium level / LFTs / ANC / ECG depending on drug
Rationale: Fentanyl requires monitoring: e.g., Lithium levels, thyroid, renal; Valproate LFTs, platelets;
Clozapine ANC weekly; Phenytoin drug level, CBC. Chest wall rigidity is clue to monitor.
Q12. [MCQ] A client is prescribed Bupropion for chronic pain/depression. Which assessment
finding requires immediate reporting?
Respiratory rate 8/min
Mild Insomnia
Pain 3/10
Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Bupropion - NDRI, lowers seizure threshold, no sexual side effects. Respiratory depression is
life-threatening and priority over Insomnia which is expected.
Q13. [MCQ] A client is prescribed Morphine for chronic pain/depression. Which assessment
finding requires immediate reporting?
Respiratory rate 8/min
Mild Constipation
Pain 3/10
Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Morphine - mu agonist -> analgesia, respiratory depression, constipation, miosis. Respiratory
depression is life-threatening and priority over Constipation which is expected.
Q14. [MCQ] Which statement indicates patient understands teaching about Duloxetine?
"I will stop it abruptly if I feel better"
"I will avoid alcohol and report severe dizziness"
"I can double dose if I miss one"
"I will take with MAOI"
Answer: B. "I will avoid alcohol and report severe dizziness"
Rationale: Patient teaching for Duloxetine: SNRI for diabetic neuropathy. Avoid CNS depressants, no abrupt
stop, adherence important. Correct statement shows understanding of safety.
Q15. [True/False] Which lab/test is essential to monitor for a patient on Valproate?
■ True ■ False
Answer: A. Lithium level / LFTs / ANC / ECG depending on drug
Rationale: Valproate requires monitoring: e.g., Lithium levels, thyroid, renal; Valproate LFTs, platelets;
Clozapine ANC weekly; Phenytoin drug level, CBC. Thrombocytopenia is clue to monitor.
2026/2027-EDITION REAL EXAM QUESTIONS
AND 100% VERIFIED ANSWERS
OVERVIEW
This 2026 practice pack is designed for Wilkes University NSG 533 Advanced Pharmacology Exam 2. It
covers all high-yield systems tested in Exam 2, using clear language, case-based thinking, and
NCLEX-style critical reasoning. All answers are verified against current guidelines (2026-2027). Answers
appear in GREEN and Rationales for instant review.
1. Exam Focus Areas
Exam 2 typically focuses on: Autonomic Pharmacology, CNS drugs (Anxiolytics, Sedative-Hypnotics,
Antidepressants, Antipsychotics, Mood Stabilizers), Pain Management (Opioids, Non-opioids, Adjuvants,
Migraine), Substance Use, Anti-epileptics, and Neurodegenerative drugs. Weight: ~30% Pain/Analgesia,
30% Psych/CNS, 20% Neuro, 20% Autonomic/Substance.
2. How To Use This PDF
140 Multiple Choice (A-D), 20 Select-All-That-Apply (SATA), 12 True/False with correction, 10 Case
Studies with 2-3 linked questions. Read question, attempt answer, then check GREEN answer and
BLUE rationale. Rationales explain WHY other options are wrong - key for exam logic.
3. Key Study Tips
• Know Prototype Drugs: e.g., Morphine for opioids, Diazepam for benzodiazepines, Fluoxetine for SSRIs,
Haloperidol for typical antipsychotics. • Black Box Warnings: SSRIs & suicidality, Opioids & respiratory
depression, Clozapine & agranulocytosis. • Antidotes: Naloxone for opioids, Flumazenil for
benzodiazepines. • CYP450 Interactions: Fluoxetine, Paroxetine inhibit 2D6; Carbamazepine induces
3A4.
4. Grading Scale
182 Questions = 182 points. 165+ = A (90%+), 146-164 = B, 128-145 = C. Time yourself: 3 hours
recommended to simulate real exam.
PRACTICE QUESTIONS
Q1. [MCQ] A patient on chronic morphine 30mg PO q6h reports pain 8/10. Which is the priority
assessment?
A. Bowel function
, B. Respiratory rate and sedation
C. Blood pressure
D. Urine output
Answer: B. Respiratory rate and sedation
Rationale: Opioids cause dose-dependent respiratory depression via mu receptors in brainstem. Sedation
precedes respiratory depression - ABCs priority. Bowel is common side effect but not life-threatening.
Q2. [MCQ] Tramadol maximum daily dose is 400mg (300mg if >75yo). Which combination
increases seizure and serotonin syndrome risk?
A. Tramadol + Acetaminophen
B. Tramadol + MAOI + SSRI
C. Tramadol + Ibuprofen
D. Tramadol + Naloxone
Answer: B. Tramadol + MAOI + SSRI
Rationale: Tramadol lowers seizure threshold and inhibits serotonin/norepinephrine reuptake. Combining
with MAOIs, SSRIs, TCAs increases serotonin syndrome and seizure risk. Contraindicated within 14 days of
MAOI.
Q3. [MCQ] Patient prescribed diazepam for anxiety. Teaching should include:
A. Safe with alcohol
B. Avoid abrupt discontinuation - taper needed
C. No risk of dependence
D. Take with grapefruit juice
Answer: B. Avoid abrupt discontinuation - taper needed
Rationale: Benzodiazepines enhance GABA-A. Abrupt stop causes withdrawal: anxiety, tremors, seizures.
Taper over weeks. Alcohol increases CNS depression. Long-term risk of tolerance/dependence.
Q4. [MCQ] SSRI fluoxetine teaching: When will patient feel full antidepressant effect?
A. Immediately
B. 24 hours
C. 4-6 weeks
D. 6 months
Answer: C. 4-6 weeks
Rationale: SSRIs increase synaptic serotonin immediately but downstream neuroplastic changes take 4-6
weeks. Initial side effects appear early; warn about worsening anxiety/suicidal ideation in first 1-2 weeks -
black box warning for <25yo.
Q5. [MCQ] Lithium level 1.8 mEq/L. Patient has tremor, confusion, ataxia. What is priority
action?
A. Encourage fluids
B. Hold lithium and check level, hydrate, notify provider
C. Give next dose
D. Reassure
Answer: B. Hold lithium and check level, hydrate, notify provider
Rationale: Therapeutic 0.6-1.2 mEq/L, toxic >1.5. S/S: coarse tremor, ataxia, confusion, polyuria. Lithium is
renally cleared, narrow TI. Hold drug, hydrate (normal saline), check BMP, lithium level. Risk with NSAIDs,
, dehydration, low sodium.
Q6. [MCQ] A client is prescribed Haloperidol for chronic pain/depression. Which assessment
finding requires immediate reporting?
Respiratory rate 8/min
Mild Tardive dyskinesia
Pain 3/10
Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Haloperidol - typical antipsychotic D2 blockade -> EPS. Respiratory depression is life-threatening
and priority over Tardive dyskinesia which is expected.
Q7. [MCQ] What is the primary mechanism of action of Morphine?
Blocks mu agonist -> analgesia, respiratory depression, constipation, miosis
Enhances GABA
Inhibits reuptake of monoamines
mu agonist -> analgesia, respiratory depression, constipation, miosis
Answer: D. mu agonist -> analgesia, respiratory depression, constipation, miosis
Rationale: Morphine works via mu agonist -> analgesia, respiratory depression, constipation, miosis.
Knowing prototype mechanism helps predict effects and side effects.
Q8. [MCQ] Which statement indicates patient understands teaching about Sumatriptan?
"I will stop it abruptly if I feel better"
"I will avoid alcohol and report severe dizziness"
"I can double dose if I miss one"
"I will take with MAOI"
Answer: B. "I will avoid alcohol and report severe dizziness"
Rationale: Patient teaching for Sumatriptan: triptan 5-HT1B/1D. Avoid CNS depressants, no abrupt stop,
adherence important. Correct statement shows understanding of safety.
Q9. [SATA] A client is prescribed Gabapentin for chronic pain/depression. Which assessment
finding requires immediate reporting?
■ Respiratory rate 8/min
■ Mild Sedation, dizziness
■ Pain 3/10
■ Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Gabapentin - binds alpha2delta Ca channel, for neuropathic pain. Respiratory depression is
life-threatening and priority over Sedation, dizziness which is expected.
Q10. [MCQ] Which lab/test is essential to monitor for a patient on Clozapine?
Lithium level / LFTs / ANC / ECG depending on drug
HbA1c
Only blood pressure
No monitoring needed
Answer: A. Lithium level / LFTs / ANC / ECG depending on drug
, Rationale: Clozapine requires monitoring: e.g., Lithium levels, thyroid, renal; Valproate LFTs, platelets;
Clozapine ANC weekly; Phenytoin drug level, CBC. Requires weekly ANC is clue to monitor.
Q11. [MCQ] Which lab/test is essential to monitor for a patient on Fentanyl?
Lithium level / LFTs / ANC / ECG depending on drug
HbA1c
Only blood pressure
No monitoring needed
Answer: A. Lithium level / LFTs / ANC / ECG depending on drug
Rationale: Fentanyl requires monitoring: e.g., Lithium levels, thyroid, renal; Valproate LFTs, platelets;
Clozapine ANC weekly; Phenytoin drug level, CBC. Chest wall rigidity is clue to monitor.
Q12. [MCQ] A client is prescribed Bupropion for chronic pain/depression. Which assessment
finding requires immediate reporting?
Respiratory rate 8/min
Mild Insomnia
Pain 3/10
Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Bupropion - NDRI, lowers seizure threshold, no sexual side effects. Respiratory depression is
life-threatening and priority over Insomnia which is expected.
Q13. [MCQ] A client is prescribed Morphine for chronic pain/depression. Which assessment
finding requires immediate reporting?
Respiratory rate 8/min
Mild Constipation
Pain 3/10
Dry mouth
Answer: A. Respiratory rate 8/min
Rationale: Morphine - mu agonist -> analgesia, respiratory depression, constipation, miosis. Respiratory
depression is life-threatening and priority over Constipation which is expected.
Q14. [MCQ] Which statement indicates patient understands teaching about Duloxetine?
"I will stop it abruptly if I feel better"
"I will avoid alcohol and report severe dizziness"
"I can double dose if I miss one"
"I will take with MAOI"
Answer: B. "I will avoid alcohol and report severe dizziness"
Rationale: Patient teaching for Duloxetine: SNRI for diabetic neuropathy. Avoid CNS depressants, no abrupt
stop, adherence important. Correct statement shows understanding of safety.
Q15. [True/False] Which lab/test is essential to monitor for a patient on Valproate?
■ True ■ False
Answer: A. Lithium level / LFTs / ANC / ECG depending on drug
Rationale: Valproate requires monitoring: e.g., Lithium levels, thyroid, renal; Valproate LFTs, platelets;
Clozapine ANC weekly; Phenytoin drug level, CBC. Thrombocytopenia is clue to monitor.
