NSG 318 Exam 4 Pharmacology Review 2026 – GCU
1. A patient is prescribed lithium carbonate for bipolar disorder. Which serum
lithium level indicates the patient is within the therapeutic range?
A. 0.2 - 0.5 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.5 - 3.0 mEq/L
Answer: B
Rationale: The therapeutic reference range for serum lithium is generally 0.6 to 1.2
mEq/L. Levels above 1.5 mEq/L are considered toxic.
2. Which teaching point is most important for a patient starting an MAOI
(Monoamine Oxidase Inhibitor)?
A. Expect a full therapeutic effect within 24 hours.
B. Take the medication with orange juice to increase absorption.
C. Stop taking the medication immediately if a headache occurs.
D. Avoid foods containing tyramine, such as aged cheeses and red wine.
Answer: D
Rationale: MAOIs interact with tyramine-rich foods to cause a hypertensive crisis. Patients
must follow a low-tyramine diet.
,3. A patient taking clozapine (Clozaril) must have regular blood tests to monitor
for which life-threatening adverse effect?
A. Agranulocytosis
B. Hyperkalemia
C. Thrombocytopenia
D. Hypocalcemia
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis (severe low white blood cell count),
requiring weekly or bi-weekly CBC monitoring.
4. Which medication is considered a first-line treatment for an acute panic
attack in the emergency department?
A. Fluoxetine
B. Amitriptyline
C. Buspirone
D. Lorazepam
Answer: D
Rationale: Benzodiazepines like lorazepam work quickly to enhance GABA effects, making
them suitable for acute anxiety or panic.
5. A patient is exhibiting muscle rigidity, high fever, and autonomic instability
while taking haloperidol. What is the suspected condition?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Extrapyramidal Symptoms (EPS)
D. Tardive Dyskinesia
Answer: B
Rationale: NMS is a medical emergency associated with antipsychotics, characterized by
‘lead pipe’ rigidity, hyperpyrexia, and tachycardia.
, 6. What is the mechanism of action of SSRIs?
A. They block the reuptake of serotonin, increasing its availability in the synaptic cleft.
B. They increase the production of dopamine in the basal ganglia.
C. They decrease the sensitivity of GABA receptors.
D. They inhibit the enzyme that breaks down norepinephrine.
Answer: A
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) work specifically by inhibiting
the reuptake of serotonin at the presynaptic membrane.
7. Which of the following is a common side effect of methylphenidate (Ritalin)
used for ADHD?
A. Weight gain and increased appetite
B. Somnolence and lethargy
C. Bradycardia and hypotension
D. Insomnia and decreased appetite
Answer: D
Rationale: Stimulants like methylphenidate commonly cause CNS stimulation (insomnia)
and appetite suppression.
8. A patient is prescribed disulfiram (Antabuse) for alcohol abstinence. What
happens if the patient consumes alcohol?
A. The alcohol effects are neutralized.
B. The patient experiences severe vomiting, throbbing headache, and chest pain.
C. The patient becomes extremely euphoric.
D. The patient falls into a deep sleep.
Answer: B
Rationale: Disulfiram causes an accumulation of acetaldehyde when alcohol is ingested,
leading to a highly unpleasant ‘disulfiram reaction.’
1. A patient is prescribed lithium carbonate for bipolar disorder. Which serum
lithium level indicates the patient is within the therapeutic range?
A. 0.2 - 0.5 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.5 - 3.0 mEq/L
Answer: B
Rationale: The therapeutic reference range for serum lithium is generally 0.6 to 1.2
mEq/L. Levels above 1.5 mEq/L are considered toxic.
2. Which teaching point is most important for a patient starting an MAOI
(Monoamine Oxidase Inhibitor)?
A. Expect a full therapeutic effect within 24 hours.
B. Take the medication with orange juice to increase absorption.
C. Stop taking the medication immediately if a headache occurs.
D. Avoid foods containing tyramine, such as aged cheeses and red wine.
Answer: D
Rationale: MAOIs interact with tyramine-rich foods to cause a hypertensive crisis. Patients
must follow a low-tyramine diet.
,3. A patient taking clozapine (Clozaril) must have regular blood tests to monitor
for which life-threatening adverse effect?
A. Agranulocytosis
B. Hyperkalemia
C. Thrombocytopenia
D. Hypocalcemia
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis (severe low white blood cell count),
requiring weekly or bi-weekly CBC monitoring.
4. Which medication is considered a first-line treatment for an acute panic
attack in the emergency department?
A. Fluoxetine
B. Amitriptyline
C. Buspirone
D. Lorazepam
Answer: D
Rationale: Benzodiazepines like lorazepam work quickly to enhance GABA effects, making
them suitable for acute anxiety or panic.
5. A patient is exhibiting muscle rigidity, high fever, and autonomic instability
while taking haloperidol. What is the suspected condition?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Extrapyramidal Symptoms (EPS)
D. Tardive Dyskinesia
Answer: B
Rationale: NMS is a medical emergency associated with antipsychotics, characterized by
‘lead pipe’ rigidity, hyperpyrexia, and tachycardia.
, 6. What is the mechanism of action of SSRIs?
A. They block the reuptake of serotonin, increasing its availability in the synaptic cleft.
B. They increase the production of dopamine in the basal ganglia.
C. They decrease the sensitivity of GABA receptors.
D. They inhibit the enzyme that breaks down norepinephrine.
Answer: A
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) work specifically by inhibiting
the reuptake of serotonin at the presynaptic membrane.
7. Which of the following is a common side effect of methylphenidate (Ritalin)
used for ADHD?
A. Weight gain and increased appetite
B. Somnolence and lethargy
C. Bradycardia and hypotension
D. Insomnia and decreased appetite
Answer: D
Rationale: Stimulants like methylphenidate commonly cause CNS stimulation (insomnia)
and appetite suppression.
8. A patient is prescribed disulfiram (Antabuse) for alcohol abstinence. What
happens if the patient consumes alcohol?
A. The alcohol effects are neutralized.
B. The patient experiences severe vomiting, throbbing headache, and chest pain.
C. The patient becomes extremely euphoric.
D. The patient falls into a deep sleep.
Answer: B
Rationale: Disulfiram causes an accumulation of acetaldehyde when alcohol is ingested,
leading to a highly unpleasant ‘disulfiram reaction.’
