1
NU 578 - Unit 2 EXAM 2025 ACTUAL
REAL EXAM ACCURATE QUESTIONS
AND ANSWERS WITH RATIONALES |
VERIFIED AND LATEST UPDATED |
GUARANTEED PASS
TABLE OF CONTENTS
1. Sleep Disorders & Sedative-Hypnotics
2. Antidepressants - SSRIs & Atypical
3. Antidepressants - SNRIs, TCAs, MAOIs
4. Antipsychotics
5. Anxiolytics & Benzodiazepines
6. Mood Stabilizers
7. ADHD Medications
8. Substance Use Disorders
9. Pharmacokinetics & Pharmacodynamics
SLEEP DISORDERS & SEDATIVE-HYPNOTICS
Question 1:
Which non-controlled substance is used for sleep due to its action on melatonin
receptors?
A. Zolpidem (Ambien)
B. Ramelteon (Rozerem)
C. Lorazepam (Ativan)
D. Diphenhydramine (Benadryl)
Correct Answer: B. Ramelteon (Rozerem)
pg. 1
,2
Rationale: Ramelteon is a melatonin receptor agonist that promotes sleep onset by
targeting MT1 and MT2 receptors in the suprachiasmatic nucleus. It is a non-
controlled substance and does not have abuse potential, making it unique among
sleep medications. It is FDA-approved for insomnia characterized by difficulty
with sleep onset.
Question 2:
Which benzodiazepine receptor agonist has a rapid onset and short half-life,
making it ideal for sleep onset insomnia?
A. Zolpidem (Ambien)
B. Flurazepam
C. Temazepam
D. Trazodone
Correct Answer: A. Zolpidem (Ambien)
Rationale: Zolpidem is a non-benzodiazepine hypnotic that selectively binds to
the α1 subunit of GABA-A receptors. It has a rapid onset of action (30 minutes)
and a short half-life (2-3 hours), making it ideal for sleep onset insomnia without
significant next-day sedation. It is a Schedule IV controlled substance.
Question 3:
Which medication is FDA-approved for both sleep onset and sleep maintenance
insomnia?
A. Zolpidem immediate-release
B. Ramelteon
C. Eszopiclone (Lunesta)
D. Diphenhydramine
Correct Answer: C. Eszopiclone (Lunesta)
Rationale: Eszopiclone is a non-benzodiazepine hypnotic approved for long-term
treatment of both sleep onset and sleep maintenance insomnia. It has a longer half-
life (6 hours) compared to zolpidem, making it effective for maintaining sleep
throughout the night. It is a Schedule IV controlled substance.
pg. 2
,3
Question 4:
A patient reports taking diphenhydramine (Benadryl) nightly for sleep. What is the
primary concern with long-term use?
A. Respiratory depression
B. Anticholinergic effects and tolerance
C. Hepatotoxicity
D. Hypertensive crisis
Correct Answer: B. Anticholinergic effects and tolerance
Rationale: Diphenhydramine is a first-generation antihistamine that causes
sedation via H1 receptor antagonism. Long-term use leads to tolerance requiring
higher doses, and significant anticholinergic side effects including dry mouth,
constipation, urinary retention, cognitive impairment, and increased fall risk in
elderly patients. It is not recommended as a first-line sleep aid.
Question 5:
Which sleep medication is a selective orexin receptor antagonist that promotes
wakefulness suppression?
A. Zaleplon (Sonata)
B. Suvorexant (Belsomra)
C. Eszopiclone (Lunesta)
D. Ramelteon (Rozerem)
Correct Answer: B. Suvorexant (Belsomra)
Rationale: Suvorexant is a dual orexin receptor antagonist (DORA) that blocks the
action of orexin, a neuropeptide that promotes wakefulness. It is FDA-approved for
insomnia characterized by difficulty with sleep onset and/or sleep maintenance. It
is a Schedule IV controlled substance with fewer dependence concerns than
benzodiazepine receptor agonists.
Question 6:
What is the maximum recommended dose of zolpidem for women?
A. 10 mg
B. 5 mg
pg. 3
, 4
C. 15 mg
D. 20 mg
Correct Answer: B. 5 mg
Rationale: The FDA recommends a lower dose of zolpidem for women (5 mg
immediate-release, 6.25 mg extended-release) compared to men (10 mg) due to
slower clearance in women, leading to higher drug levels and increased risk of
next-day impairment, including driving accidents. This dose reduction was
mandated in 2013 to improve safety.
Question 7:
A patient on ramelteon reports no improvement in sleep after 7 days. What is the
appropriate next step?
A. Increase dose
B. Add a benzodiazepine
C. Discontinue and reassess
D. Switch to trazodone
Correct Answer: C. Discontinue and reassess
Rationale: Ramelteon should be discontinued if there is no improvement in sleep
within 7-10 days of treatment. This suggests that the insomnia may be due to other
underlying conditions that require different treatment approaches. Further
evaluation for psychiatric or medical causes of insomnia should be considered.
Question 8:
Which of the following is a contraindication for using trazodone for sleep?
A. Hypertension
B. Prolonged QT interval
C. Diabetes mellitus
D. Asthma
Correct Answer: B. Prolonged QT interval
Rationale: Trazodone can cause QT prolongation and should be used cautiously in
patients with pre-existing cardiac conditions, prolonged QT interval, or those
pg. 4
NU 578 - Unit 2 EXAM 2025 ACTUAL
REAL EXAM ACCURATE QUESTIONS
AND ANSWERS WITH RATIONALES |
VERIFIED AND LATEST UPDATED |
GUARANTEED PASS
TABLE OF CONTENTS
1. Sleep Disorders & Sedative-Hypnotics
2. Antidepressants - SSRIs & Atypical
3. Antidepressants - SNRIs, TCAs, MAOIs
4. Antipsychotics
5. Anxiolytics & Benzodiazepines
6. Mood Stabilizers
7. ADHD Medications
8. Substance Use Disorders
9. Pharmacokinetics & Pharmacodynamics
SLEEP DISORDERS & SEDATIVE-HYPNOTICS
Question 1:
Which non-controlled substance is used for sleep due to its action on melatonin
receptors?
A. Zolpidem (Ambien)
B. Ramelteon (Rozerem)
C. Lorazepam (Ativan)
D. Diphenhydramine (Benadryl)
Correct Answer: B. Ramelteon (Rozerem)
pg. 1
,2
Rationale: Ramelteon is a melatonin receptor agonist that promotes sleep onset by
targeting MT1 and MT2 receptors in the suprachiasmatic nucleus. It is a non-
controlled substance and does not have abuse potential, making it unique among
sleep medications. It is FDA-approved for insomnia characterized by difficulty
with sleep onset.
Question 2:
Which benzodiazepine receptor agonist has a rapid onset and short half-life,
making it ideal for sleep onset insomnia?
A. Zolpidem (Ambien)
B. Flurazepam
C. Temazepam
D. Trazodone
Correct Answer: A. Zolpidem (Ambien)
Rationale: Zolpidem is a non-benzodiazepine hypnotic that selectively binds to
the α1 subunit of GABA-A receptors. It has a rapid onset of action (30 minutes)
and a short half-life (2-3 hours), making it ideal for sleep onset insomnia without
significant next-day sedation. It is a Schedule IV controlled substance.
Question 3:
Which medication is FDA-approved for both sleep onset and sleep maintenance
insomnia?
A. Zolpidem immediate-release
B. Ramelteon
C. Eszopiclone (Lunesta)
D. Diphenhydramine
Correct Answer: C. Eszopiclone (Lunesta)
Rationale: Eszopiclone is a non-benzodiazepine hypnotic approved for long-term
treatment of both sleep onset and sleep maintenance insomnia. It has a longer half-
life (6 hours) compared to zolpidem, making it effective for maintaining sleep
throughout the night. It is a Schedule IV controlled substance.
pg. 2
,3
Question 4:
A patient reports taking diphenhydramine (Benadryl) nightly for sleep. What is the
primary concern with long-term use?
A. Respiratory depression
B. Anticholinergic effects and tolerance
C. Hepatotoxicity
D. Hypertensive crisis
Correct Answer: B. Anticholinergic effects and tolerance
Rationale: Diphenhydramine is a first-generation antihistamine that causes
sedation via H1 receptor antagonism. Long-term use leads to tolerance requiring
higher doses, and significant anticholinergic side effects including dry mouth,
constipation, urinary retention, cognitive impairment, and increased fall risk in
elderly patients. It is not recommended as a first-line sleep aid.
Question 5:
Which sleep medication is a selective orexin receptor antagonist that promotes
wakefulness suppression?
A. Zaleplon (Sonata)
B. Suvorexant (Belsomra)
C. Eszopiclone (Lunesta)
D. Ramelteon (Rozerem)
Correct Answer: B. Suvorexant (Belsomra)
Rationale: Suvorexant is a dual orexin receptor antagonist (DORA) that blocks the
action of orexin, a neuropeptide that promotes wakefulness. It is FDA-approved for
insomnia characterized by difficulty with sleep onset and/or sleep maintenance. It
is a Schedule IV controlled substance with fewer dependence concerns than
benzodiazepine receptor agonists.
Question 6:
What is the maximum recommended dose of zolpidem for women?
A. 10 mg
B. 5 mg
pg. 3
, 4
C. 15 mg
D. 20 mg
Correct Answer: B. 5 mg
Rationale: The FDA recommends a lower dose of zolpidem for women (5 mg
immediate-release, 6.25 mg extended-release) compared to men (10 mg) due to
slower clearance in women, leading to higher drug levels and increased risk of
next-day impairment, including driving accidents. This dose reduction was
mandated in 2013 to improve safety.
Question 7:
A patient on ramelteon reports no improvement in sleep after 7 days. What is the
appropriate next step?
A. Increase dose
B. Add a benzodiazepine
C. Discontinue and reassess
D. Switch to trazodone
Correct Answer: C. Discontinue and reassess
Rationale: Ramelteon should be discontinued if there is no improvement in sleep
within 7-10 days of treatment. This suggests that the insomnia may be due to other
underlying conditions that require different treatment approaches. Further
evaluation for psychiatric or medical causes of insomnia should be considered.
Question 8:
Which of the following is a contraindication for using trazodone for sleep?
A. Hypertension
B. Prolonged QT interval
C. Diabetes mellitus
D. Asthma
Correct Answer: B. Prolonged QT interval
Rationale: Trazodone can cause QT prolongation and should be used cautiously in
patients with pre-existing cardiac conditions, prolonged QT interval, or those
pg. 4
