NURS 752 Final
A 54 yo man wants to quit smoking. He smokes 1 ppd. He has been smoking since age 18. He
smokes his first cigarette approximately 1 hour after awakening. His PMH includes asthma,
depression, seizure disorder and CAD s/p 3 v CABG (5 years ago). His medications include
paroxetine, carvedilol, topiramate, levetiracetam, ramipril, and aspirin. He experiences one
seizure approximately every 6 months.
Which medication would be best for this patient?
A.Bupropion
B.Nicotine Nasal Spray
C.Nicotine Patch
D.Varenicline - ANS C
Due to the patient's seizure disorder, choices A and D are not correct. Choice B is also not
correct because the patient has asthma. Choice C, the patch is a good option for this patient.
A 50-year-old patient has been admitted to the medical unit for alcohol withdrawal. He has a 30
year history of alcohol use disorder. His last drink was 3 days ago. He is confused and agitated
and experiencing tremors, hallucinations and tachycardia. Past medical history includes HTN
and cirrhosis.
Which benzodiazepine would be best to give this
patient?
A.Alprazolam
B.Chlordiazepoxide
C.Diazepam
D.Lorazepam - ANS D
Lorazepam can be given intramuscularly and is appropriate because of the patient's liver
abnormalities (Answer D is correct). Lorazepam undergoes glucuronidation and does not rely on
oxidative pathways for metabolism. Chlordiazepoxide and diazepam should be avoided in
patients with liver disease (Answers B and C are incorrect). Alprazolam is generally not used for
alcohol withdrawal and is not given intramuscularly (Answer A is incorrect).
A 24 year old man wishes to stop using oxycodone. He has been buying it off the street, and
takes 160 mg daily. He is not interested in methadone maintenance. He would like to enroll in an
outpatient program. He is 24 hours after his last dose. He is experiencing some anxiety and
muscle aches. He will be initiating his treatment in the clinic.
What is the best formulation and dose to initiate in
this patient?
A.Buprenorphine 2 mg
B.Buprenorphine 4 mg
C.Buprenorphine/naloxone 2/1
D.Buprenorphine/naloxone 4/1 - ANS D
, Since the patient does not want methadone, is willing to come to the clinic for tx, and is within
12-24 hours of the last oxycodone dose, giving buprenorphine/naloxone 4/1 is recommended as
the initial dose as part of the induction phase.
A patient is taking the maximum dose of phentermine/topiramate for obesity. Baseline BMI is 36
kg/m2 and weight 255 lb. What is minimal weight loss expected to consider continuation of
therapy after 12 weeks?
a.7 lbs
b.13 lbs
c.17 lbs
d.26 lbs - ANS B
The minimal weight loss after 12 weeks of therapy with phentermine/topiramate should be 5%;
otherwise, the medication should be discontinued. Given this patient's baseline weight, a
minimum of 5.9 kg (13 pounds), Answer B, is necessary to continue therapy. The other answers
provided are too low (Answer A), or they exceed the 5% minimal expectation (Answers C and
D).
A 24 yo woman has obsessive compulsive disorder (OCD). Her symptoms worsened when she
was treated with bupropion. Treatment with fluoxetine gave no improvement in symptoms. She
is currently taking clomipramine at high therapeutic doses. She shows no signs of improvement
over baseline and believes her obsessions and compulsions to be entirely real.
Which is the best treatment option?
A.Add alprazolam
B.Switch to fluvoxamine
C.Add haloperidol
D.Add risperidone - ANS B
An antidepressant with serotonin activity is necessary for the treatment of OCD in this patient,
so switching to fluvoxamine is the best choice for this patient. Benzodiazepines are not effective
in OCD (answer A is incorrect). The patient does not exhibit treatment resistant OCD, so
answers C and D are incorrect.
Nicotine and pregnancy:
•Gum is Pregnancy Category ____
•Transdermal patch is Pregnancy Category ____ - ANS C
D
Signs of opioid intoxication (7) - ANS Constricted pupils
Slurred speech
Itching
Euphoria/agitation
Dry mouth
Drowsiness
Poor judgment
A 54 yo man wants to quit smoking. He smokes 1 ppd. He has been smoking since age 18. He
smokes his first cigarette approximately 1 hour after awakening. His PMH includes asthma,
depression, seizure disorder and CAD s/p 3 v CABG (5 years ago). His medications include
paroxetine, carvedilol, topiramate, levetiracetam, ramipril, and aspirin. He experiences one
seizure approximately every 6 months.
Which medication would be best for this patient?
A.Bupropion
B.Nicotine Nasal Spray
C.Nicotine Patch
D.Varenicline - ANS C
Due to the patient's seizure disorder, choices A and D are not correct. Choice B is also not
correct because the patient has asthma. Choice C, the patch is a good option for this patient.
A 50-year-old patient has been admitted to the medical unit for alcohol withdrawal. He has a 30
year history of alcohol use disorder. His last drink was 3 days ago. He is confused and agitated
and experiencing tremors, hallucinations and tachycardia. Past medical history includes HTN
and cirrhosis.
Which benzodiazepine would be best to give this
patient?
A.Alprazolam
B.Chlordiazepoxide
C.Diazepam
D.Lorazepam - ANS D
Lorazepam can be given intramuscularly and is appropriate because of the patient's liver
abnormalities (Answer D is correct). Lorazepam undergoes glucuronidation and does not rely on
oxidative pathways for metabolism. Chlordiazepoxide and diazepam should be avoided in
patients with liver disease (Answers B and C are incorrect). Alprazolam is generally not used for
alcohol withdrawal and is not given intramuscularly (Answer A is incorrect).
A 24 year old man wishes to stop using oxycodone. He has been buying it off the street, and
takes 160 mg daily. He is not interested in methadone maintenance. He would like to enroll in an
outpatient program. He is 24 hours after his last dose. He is experiencing some anxiety and
muscle aches. He will be initiating his treatment in the clinic.
What is the best formulation and dose to initiate in
this patient?
A.Buprenorphine 2 mg
B.Buprenorphine 4 mg
C.Buprenorphine/naloxone 2/1
D.Buprenorphine/naloxone 4/1 - ANS D
, Since the patient does not want methadone, is willing to come to the clinic for tx, and is within
12-24 hours of the last oxycodone dose, giving buprenorphine/naloxone 4/1 is recommended as
the initial dose as part of the induction phase.
A patient is taking the maximum dose of phentermine/topiramate for obesity. Baseline BMI is 36
kg/m2 and weight 255 lb. What is minimal weight loss expected to consider continuation of
therapy after 12 weeks?
a.7 lbs
b.13 lbs
c.17 lbs
d.26 lbs - ANS B
The minimal weight loss after 12 weeks of therapy with phentermine/topiramate should be 5%;
otherwise, the medication should be discontinued. Given this patient's baseline weight, a
minimum of 5.9 kg (13 pounds), Answer B, is necessary to continue therapy. The other answers
provided are too low (Answer A), or they exceed the 5% minimal expectation (Answers C and
D).
A 24 yo woman has obsessive compulsive disorder (OCD). Her symptoms worsened when she
was treated with bupropion. Treatment with fluoxetine gave no improvement in symptoms. She
is currently taking clomipramine at high therapeutic doses. She shows no signs of improvement
over baseline and believes her obsessions and compulsions to be entirely real.
Which is the best treatment option?
A.Add alprazolam
B.Switch to fluvoxamine
C.Add haloperidol
D.Add risperidone - ANS B
An antidepressant with serotonin activity is necessary for the treatment of OCD in this patient,
so switching to fluvoxamine is the best choice for this patient. Benzodiazepines are not effective
in OCD (answer A is incorrect). The patient does not exhibit treatment resistant OCD, so
answers C and D are incorrect.
Nicotine and pregnancy:
•Gum is Pregnancy Category ____
•Transdermal patch is Pregnancy Category ____ - ANS C
D
Signs of opioid intoxication (7) - ANS Constricted pupils
Slurred speech
Itching
Euphoria/agitation
Dry mouth
Drowsiness
Poor judgment
