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# NSG552 / NSG 552 EXAM 3
## COMPREHENSIVE PRACTICE QUESTION
BANK
### 2026-2027 ACADEMIC YEAR
[Cite your source here.]
# MODULE 1: SUBSTANCE USE DISORDERS
## 1.1 Opioid Use Disorder
### Question 1
A 34-year-old patient with opioid use disorder is brought to the emergency department after
being found unresponsive with respiratory depression (respiratory rate 6 breaths/min) and
pinpoint pupils. Which intervention should the provider implement FIRST?
A. Administer intramuscular haloperidol
B. Administer intravenous naloxone
C. Administer oral methadone
D. Initiate cardiac monitoring and observe
**Correct Answer: B. Administer intravenous naloxone**
**Rationale:** Naloxone is a pure opioid antagonist that competes and displaces opioids at
receptor sites, reversing life-threatening respiratory depression associated with opioid
intoxication. It is the first-line treatment for opioid overdose when cardiac or respiratory
depression is a concern. Intravenous administration provides the most rapid onset of action. The
,2|Page
combination of unresponsiveness, respiratory depression, and pinpoint pupils (miosis) is classic
for opioid intoxication and requires immediate reversal.
**Why the other options are incorrect:**
- **A. Haloperidol** is incorrect because haloperidol is an antipsychotic used for agitation or
psychosis, not for reversing opioid-induced respiratory depression. Administering haloperidol
would not address the underlying respiratory compromise and could further depress the central
nervous system.
- **C. Methadone** is incorrect because methadone is a full mu-opioid receptor agonist used for
maintenance therapy or pain management, not for acute overdose reversal. Administering an
opioid agonist to a patient already experiencing opioid toxicity would worsen respiratory
depression.
- **D. Observation only** is incorrect because the patient is in acute respiratory distress
requiring immediate pharmacological intervention. Delaying treatment with naloxone could
result in irreversible brain injury or death from respiratory arrest.
---
### Question 2
A 28-year-old patient with opioid use disorder is being initiated on buprenorphine/naloxone
(Suboxone) for medication-assisted treatment. The patient reports taking their last dose of heroin
approximately 6 hours ago. What is the MOST significant risk of administering buprenorphine at
this time?
A. Anaphylactic reaction
B. Precipitated withdrawal
C. Respiratory depression
D. Hepatotoxicity
**Correct Answer: B. Precipitated withdrawal**
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**Rationale:** Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low
intrinsic activity at the receptor. If administered when a patient still has significant amounts of
full opioid agonists (like heroin or oxycodone) on their receptors, buprenorphine will displace
these full agonists and precipitate an intense, rapid-onset withdrawal syndrome. Patients should
ideally be in mild to moderate withdrawal (COWS score ≥ 12) before initiating buprenorphine to
avoid this complication. The patient's last heroin use 6 hours ago places them at high risk for
precipitated withdrawal.
**Why the other options are incorrect:**
- **A. Anaphylactic reaction** is incorrect because severe allergic reactions to buprenorphine
are rare. The primary concern with early administration is precipitated withdrawal, not
anaphylaxis.
- **C. Respiratory depression** is incorrect because buprenorphine has a ceiling effect on
respiratory depression due to its partial agonist properties, making it safer in this regard than full
agonists. However, when combined with benzodiazepines or other CNS depressants, respiratory
depression risk increases.
- **D. Hepatotoxicity** is incorrect because while buprenorphine undergoes hepatic metabolism
and can cause elevated liver enzymes, this is not the acute concern with early administration.
Hepatotoxicity is more relevant with chronic use or pre-existing hepatic impairment.
---
### Question 3
A 45-year-old patient with chronic pain and opioid use disorder is being evaluated for
medication-assisted treatment. The patient requires ongoing pain management for chronic back
pain. Which medication is MOST appropriate for this patient?
A. Methadone
B. Naltrexone
C. Buprenorphine/naloxone combination
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D. Extended-release naltrexone
**Correct Answer: C. Buprenorphine/naloxone combination**
**Rationale:** Buprenorphine/naloxone is the preferred medication for opioid use disorder in
patients with comorbid pain because buprenorphine provides partial opioid agonism that can
address both opioid use disorder and pain symptoms. The addition of naloxone deters
intravenous misuse. Buprenorphine's partial agonist properties allow for pain relief while
reducing the risk of abuse and respiratory depression compared to full agonists. The combination
formulation is specifically indicated for opioid dependence and can be beneficial when patients
have co-occurring pain conditions requiring ongoing opioid management.
**Why the other options are incorrect:**
- **A. Methadone** is incorrect because while methadone is effective for OUD and provides
pain relief, it is a full mu-opioid agonist with higher abuse potential and requires specialized
dosing facilities. It would be appropriate but the buprenorphine/naloxone combination is often
preferred due to its improved safety profile and office-based prescribing availability.
- **B. Naltrexone** is incorrect because naltrexone is a pure opioid antagonist that would block
all opioid effects, including analgesia, rendering it ineffective for pain management. This would
be inappropriate for a patient with ongoing pain needs.
- **D. Extended-release naltrexone** is incorrect for the same reason as B; as an opioid
antagonist, it would block pain relief from opioids and would not address the patient's chronic
pain condition.
---
### Question 4
A 30-year-old patient is being treated for opioid use disorder with buprenorphine/naloxone. The
patient reports taking their prescribed dose but continues to experience intense cravings and mild
withdrawal symptoms. Which of the following is the MOST appropriate next step?
# NSG552 / NSG 552 EXAM 3
## COMPREHENSIVE PRACTICE QUESTION
BANK
### 2026-2027 ACADEMIC YEAR
[Cite your source here.]
# MODULE 1: SUBSTANCE USE DISORDERS
## 1.1 Opioid Use Disorder
### Question 1
A 34-year-old patient with opioid use disorder is brought to the emergency department after
being found unresponsive with respiratory depression (respiratory rate 6 breaths/min) and
pinpoint pupils. Which intervention should the provider implement FIRST?
A. Administer intramuscular haloperidol
B. Administer intravenous naloxone
C. Administer oral methadone
D. Initiate cardiac monitoring and observe
**Correct Answer: B. Administer intravenous naloxone**
**Rationale:** Naloxone is a pure opioid antagonist that competes and displaces opioids at
receptor sites, reversing life-threatening respiratory depression associated with opioid
intoxication. It is the first-line treatment for opioid overdose when cardiac or respiratory
depression is a concern. Intravenous administration provides the most rapid onset of action. The
,2|Page
combination of unresponsiveness, respiratory depression, and pinpoint pupils (miosis) is classic
for opioid intoxication and requires immediate reversal.
**Why the other options are incorrect:**
- **A. Haloperidol** is incorrect because haloperidol is an antipsychotic used for agitation or
psychosis, not for reversing opioid-induced respiratory depression. Administering haloperidol
would not address the underlying respiratory compromise and could further depress the central
nervous system.
- **C. Methadone** is incorrect because methadone is a full mu-opioid receptor agonist used for
maintenance therapy or pain management, not for acute overdose reversal. Administering an
opioid agonist to a patient already experiencing opioid toxicity would worsen respiratory
depression.
- **D. Observation only** is incorrect because the patient is in acute respiratory distress
requiring immediate pharmacological intervention. Delaying treatment with naloxone could
result in irreversible brain injury or death from respiratory arrest.
---
### Question 2
A 28-year-old patient with opioid use disorder is being initiated on buprenorphine/naloxone
(Suboxone) for medication-assisted treatment. The patient reports taking their last dose of heroin
approximately 6 hours ago. What is the MOST significant risk of administering buprenorphine at
this time?
A. Anaphylactic reaction
B. Precipitated withdrawal
C. Respiratory depression
D. Hepatotoxicity
**Correct Answer: B. Precipitated withdrawal**
,3|Page
**Rationale:** Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low
intrinsic activity at the receptor. If administered when a patient still has significant amounts of
full opioid agonists (like heroin or oxycodone) on their receptors, buprenorphine will displace
these full agonists and precipitate an intense, rapid-onset withdrawal syndrome. Patients should
ideally be in mild to moderate withdrawal (COWS score ≥ 12) before initiating buprenorphine to
avoid this complication. The patient's last heroin use 6 hours ago places them at high risk for
precipitated withdrawal.
**Why the other options are incorrect:**
- **A. Anaphylactic reaction** is incorrect because severe allergic reactions to buprenorphine
are rare. The primary concern with early administration is precipitated withdrawal, not
anaphylaxis.
- **C. Respiratory depression** is incorrect because buprenorphine has a ceiling effect on
respiratory depression due to its partial agonist properties, making it safer in this regard than full
agonists. However, when combined with benzodiazepines or other CNS depressants, respiratory
depression risk increases.
- **D. Hepatotoxicity** is incorrect because while buprenorphine undergoes hepatic metabolism
and can cause elevated liver enzymes, this is not the acute concern with early administration.
Hepatotoxicity is more relevant with chronic use or pre-existing hepatic impairment.
---
### Question 3
A 45-year-old patient with chronic pain and opioid use disorder is being evaluated for
medication-assisted treatment. The patient requires ongoing pain management for chronic back
pain. Which medication is MOST appropriate for this patient?
A. Methadone
B. Naltrexone
C. Buprenorphine/naloxone combination
, 4|Page
D. Extended-release naltrexone
**Correct Answer: C. Buprenorphine/naloxone combination**
**Rationale:** Buprenorphine/naloxone is the preferred medication for opioid use disorder in
patients with comorbid pain because buprenorphine provides partial opioid agonism that can
address both opioid use disorder and pain symptoms. The addition of naloxone deters
intravenous misuse. Buprenorphine's partial agonist properties allow for pain relief while
reducing the risk of abuse and respiratory depression compared to full agonists. The combination
formulation is specifically indicated for opioid dependence and can be beneficial when patients
have co-occurring pain conditions requiring ongoing opioid management.
**Why the other options are incorrect:**
- **A. Methadone** is incorrect because while methadone is effective for OUD and provides
pain relief, it is a full mu-opioid agonist with higher abuse potential and requires specialized
dosing facilities. It would be appropriate but the buprenorphine/naloxone combination is often
preferred due to its improved safety profile and office-based prescribing availability.
- **B. Naltrexone** is incorrect because naltrexone is a pure opioid antagonist that would block
all opioid effects, including analgesia, rendering it ineffective for pain management. This would
be inappropriate for a patient with ongoing pain needs.
- **D. Extended-release naltrexone** is incorrect for the same reason as B; as an opioid
antagonist, it would block pain relief from opioids and would not address the patient's chronic
pain condition.
---
### Question 4
A 30-year-old patient is being treated for opioid use disorder with buprenorphine/naloxone. The
patient reports taking their prescribed dose but continues to experience intense cravings and mild
withdrawal symptoms. Which of the following is the MOST appropriate next step?
