NURS6630 Midterm Exam | All Answers Verified |
Guaranteed Grade A CREATE THE QUESTIONS AND
ANSWERS 100 MCQAS WELL STRUCTURED
1
A 28-year-old with major depressive disorder is started on an SSRI. Which mechanism best
describes SSRIs?
A. Block dopamine reuptake
B. Inhibit monoamine oxidase enzyme
C. Inhibit presynaptic serotonin reuptake transporter
D. Block postsynaptic serotonin receptors
Answer: C.
Explanation: SSRIs increase synaptic serotonin primarily by inhibiting the presynaptic serotonin
transporter (SERT), enhancing serotonergic neurotransmission over time. Monitoring for
serotonin syndrome is required. NCBI
2
Which adverse effect is most classically associated with tricyclic antidepressants (TCAs)?
A. Sexual dysfunction only
B. Anticholinergic effects (dry mouth, constipation) and orthostatic hypotension
C. Weight loss and insomnia
D. Bradycardia and cold extremities
Answer: B.
Explanation: TCAs antagonize muscarinic, histaminic, and alpha-1 receptors, producing
anticholinergic effects and orthostatic hypotension; cardiac conduction slowing is also a serious
concern in overdose. Michigan Medicine
3
A patient on an MAOI should avoid which food to prevent hypertensive crisis?
A. Fresh apples
,B. Aged cheeses and cured meats (tyramine-rich foods)
C. Leafy green vegetables
D. Plain yogurt
Answer: B.
Explanation: MAOIs inhibit MAO—leading to impaired tyramine breakdown; ingesting
tyramine-rich foods (aged cheese, cured meats) can trigger dangerous hypertensive crisis. NCBI
4
Which antipsychotic has the highest risk of agranulocytosis requiring WBC monitoring?
A. Haloperidol
B. Risperidone
C. Clozapine
D. Olanzapine
Answer: C.
Explanation: Clozapine carries a notable risk of agranulocytosis; mandatory regular ANC/WBC
monitoring is required per prescribing programs to detect neutropenia early. NCBI
5
Lithium’s most reliable early sign of toxicity is:
A. Hypotension
B. Fine tremor progressing to coarse tremor, confusion, ataxia
C. Bradycardia
D. Hyperreflexia only
Answer: B.
Explanation: Lithium toxicity commonly presents first with GI upset and fine tremor that can
progress to coarse tremor, confusion, ataxia; monitor levels and renal function closely. NCBI
6
Which antidepressant is contraindicated with MAOIs due to long washout requirement (often 5
weeks)?
A. Sertraline
B. Fluoxetine
C. Paroxetine
D. Escitalopram
,Answer: B.
Explanation: Fluoxetine’s long half-life (and active metabolite norfluoxetine) necessitates a
longer washout (≈5 weeks) before initiating MAOI to avoid serotonin syndrome. PBM
7
An elderly patient started on an SSRI develops hyponatremia. Which mechanism is most likely?
A. MAOI interaction
B. SSRIs causing SIADH (syndrome of inappropriate ADH)
C. Increased renal excretion of sodium
D. SSRI-induced hyperaldosteronism
Answer: B.
Explanation: SSRIs can cause SIADH, particularly in older adults, leading to hyponatremia;
monitor sodium when initiating or escalating dose. NCBI
8
Which class of antipsychotics is most associated with extrapyramidal symptoms (EPS) like acute
dystonia?
A. Atypical antipsychotics (low D2 affinity)
B. Typical (first-generation) antipsychotics with high D2 blockade
C. SSRIs
D. Mood stabilizers
Answer: B.
Explanation: First-generation antipsychotics (e.g., haloperidol) have potent D2 antagonism in
nigrostriatal pathway, increasing EPS risk including acute dystonia and parkinsonism. NCBI
9
Which medication is a partial dopamine agonist used for schizophrenia and has lower prolactin
elevation risk?
A. Risperidone
B. Aripiprazole
C. Haloperidol
D. Chlorpromazine
Answer: B.
, Explanation: Aripiprazole is a D2 partial agonist, which can stabilize dopaminergic tone and
tends to cause less hyperprolactinemia than strong D2 antagonists. NCBI
10
First-line pharmacologic therapy for generalized anxiety disorder commonly includes:
A. Beta-blockers only
B. Benzodiazepines indefinitely
C. SSRIs or SNRIs plus psychotherapy
D. MAOIs first line
Answer: C.
Explanation: SSRIs/SNRIs are first-line due to efficacy and safety; short benzodiazepine courses
may be used for acute relief but not indefinite therapy due to dependence risk. OpenStax
11
Which stimulant is commonly used as first-line treatment for ADHD in adults?
A. Atomoxetine (first-line always)
B. Methylphenidate or amphetamine preparations
C. Benzodiazepines
D. Bupropion only
Answer: B.
Explanation: Stimulants (methylphenidate, amphetamines) remain first-line for ADHD across
ages due to robust efficacy; atomoxetine is a nonstimulant alternative. OpenStax
12
Which adverse metabolic effect is most associated with many atypical antipsychotics (e.g.,
olanzapine)?
A. Hypoglycemia
B. Weight gain, dyslipidemia, insulin resistance (metabolic syndrome)
C. Hypolipidemia
D. Decreased appetite only
Answer: B.
Explanation: Atypical antipsychotics (particularly olanzapine, clozapine) increase appetite,
weight, and risk of metabolic syndrome; baseline and interval metabolic monitoring is
recommended. NCBI
Guaranteed Grade A CREATE THE QUESTIONS AND
ANSWERS 100 MCQAS WELL STRUCTURED
1
A 28-year-old with major depressive disorder is started on an SSRI. Which mechanism best
describes SSRIs?
A. Block dopamine reuptake
B. Inhibit monoamine oxidase enzyme
C. Inhibit presynaptic serotonin reuptake transporter
D. Block postsynaptic serotonin receptors
Answer: C.
Explanation: SSRIs increase synaptic serotonin primarily by inhibiting the presynaptic serotonin
transporter (SERT), enhancing serotonergic neurotransmission over time. Monitoring for
serotonin syndrome is required. NCBI
2
Which adverse effect is most classically associated with tricyclic antidepressants (TCAs)?
A. Sexual dysfunction only
B. Anticholinergic effects (dry mouth, constipation) and orthostatic hypotension
C. Weight loss and insomnia
D. Bradycardia and cold extremities
Answer: B.
Explanation: TCAs antagonize muscarinic, histaminic, and alpha-1 receptors, producing
anticholinergic effects and orthostatic hypotension; cardiac conduction slowing is also a serious
concern in overdose. Michigan Medicine
3
A patient on an MAOI should avoid which food to prevent hypertensive crisis?
A. Fresh apples
,B. Aged cheeses and cured meats (tyramine-rich foods)
C. Leafy green vegetables
D. Plain yogurt
Answer: B.
Explanation: MAOIs inhibit MAO—leading to impaired tyramine breakdown; ingesting
tyramine-rich foods (aged cheese, cured meats) can trigger dangerous hypertensive crisis. NCBI
4
Which antipsychotic has the highest risk of agranulocytosis requiring WBC monitoring?
A. Haloperidol
B. Risperidone
C. Clozapine
D. Olanzapine
Answer: C.
Explanation: Clozapine carries a notable risk of agranulocytosis; mandatory regular ANC/WBC
monitoring is required per prescribing programs to detect neutropenia early. NCBI
5
Lithium’s most reliable early sign of toxicity is:
A. Hypotension
B. Fine tremor progressing to coarse tremor, confusion, ataxia
C. Bradycardia
D. Hyperreflexia only
Answer: B.
Explanation: Lithium toxicity commonly presents first with GI upset and fine tremor that can
progress to coarse tremor, confusion, ataxia; monitor levels and renal function closely. NCBI
6
Which antidepressant is contraindicated with MAOIs due to long washout requirement (often 5
weeks)?
A. Sertraline
B. Fluoxetine
C. Paroxetine
D. Escitalopram
,Answer: B.
Explanation: Fluoxetine’s long half-life (and active metabolite norfluoxetine) necessitates a
longer washout (≈5 weeks) before initiating MAOI to avoid serotonin syndrome. PBM
7
An elderly patient started on an SSRI develops hyponatremia. Which mechanism is most likely?
A. MAOI interaction
B. SSRIs causing SIADH (syndrome of inappropriate ADH)
C. Increased renal excretion of sodium
D. SSRI-induced hyperaldosteronism
Answer: B.
Explanation: SSRIs can cause SIADH, particularly in older adults, leading to hyponatremia;
monitor sodium when initiating or escalating dose. NCBI
8
Which class of antipsychotics is most associated with extrapyramidal symptoms (EPS) like acute
dystonia?
A. Atypical antipsychotics (low D2 affinity)
B. Typical (first-generation) antipsychotics with high D2 blockade
C. SSRIs
D. Mood stabilizers
Answer: B.
Explanation: First-generation antipsychotics (e.g., haloperidol) have potent D2 antagonism in
nigrostriatal pathway, increasing EPS risk including acute dystonia and parkinsonism. NCBI
9
Which medication is a partial dopamine agonist used for schizophrenia and has lower prolactin
elevation risk?
A. Risperidone
B. Aripiprazole
C. Haloperidol
D. Chlorpromazine
Answer: B.
, Explanation: Aripiprazole is a D2 partial agonist, which can stabilize dopaminergic tone and
tends to cause less hyperprolactinemia than strong D2 antagonists. NCBI
10
First-line pharmacologic therapy for generalized anxiety disorder commonly includes:
A. Beta-blockers only
B. Benzodiazepines indefinitely
C. SSRIs or SNRIs plus psychotherapy
D. MAOIs first line
Answer: C.
Explanation: SSRIs/SNRIs are first-line due to efficacy and safety; short benzodiazepine courses
may be used for acute relief but not indefinite therapy due to dependence risk. OpenStax
11
Which stimulant is commonly used as first-line treatment for ADHD in adults?
A. Atomoxetine (first-line always)
B. Methylphenidate or amphetamine preparations
C. Benzodiazepines
D. Bupropion only
Answer: B.
Explanation: Stimulants (methylphenidate, amphetamines) remain first-line for ADHD across
ages due to robust efficacy; atomoxetine is a nonstimulant alternative. OpenStax
12
Which adverse metabolic effect is most associated with many atypical antipsychotics (e.g.,
olanzapine)?
A. Hypoglycemia
B. Weight gain, dyslipidemia, insulin resistance (metabolic syndrome)
C. Hypolipidemia
D. Decreased appetite only
Answer: B.
Explanation: Atypical antipsychotics (particularly olanzapine, clozapine) increase appetite,
weight, and risk of metabolic syndrome; baseline and interval metabolic monitoring is
recommended. NCBI
