NSG 533
EXAM 2
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
,Table of Contents
NSG 533 Exam 2 ................................................................................ 2
NSG 533 Exam 2 ............................................................................. 40
NSG 533 Exam 2 Study Guide ................................................. 69
NSG 533 Exam 2
1. What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose of acetaminophen?
A) The patient may develop renal toxicity from acetaminophen overdose.
B) In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen.
C) Acetaminophen causes significant gastrointestinal bleeding in elderly patients.
D) Vicodin contains no acetaminophen, so there is no concern.
Correct Answer: B
Rationale: Vicodin is a combination medication containing hydrocodone and
acetaminophen. In elderly patients, the recommended maximum daily dose of
acetaminophen is 3,000 mg to reduce the risk of hepatotoxicity. Many patients may
unknowingly exceed this limit by taking multiple medications containing acetaminophen
(APAP). The FDA has set a maximum daily dose of 4,000 mg for the general population, but
geriatric patients and those with liver disease should not exceed 3,000 mg/day.
Acetaminophen does not cause significant GI bleeding (that's NSAIDs), and Vicodin
definitely contains acetaminophen.
,---
2. What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A) Gabapentin
B) Duloxetine or venlafaxine
C) Tramadol
D) Amitriptyline
Correct Answer: B
Rationale: SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), specifically duloxetine
and venlafaxine, are dual-purpose medications. They are FDA-approved for the treatment of
diabetic peripheral neuropathic pain and are also effective antidepressants. Duloxetine is
particularly beneficial because it addresses both the neuropathic pain common in diabetes
and comorbid depression. Gabapentin treats neuropathic pain but is not an antidepressant.
Tramadol is an opioid analgesic with weak SSRI/SNRI properties but is not indicated for
depression. Amitriptyline is a TCA that can treat both conditions but is not the best answer
here as the question specifically asks about SNRIs.
---
3. In addition, be sure to understand which non-opioid medications you would use for a
patient with neuropathic pain. (Select All That Apply)
A) Gabapentin
B) Pregabalin
C) Transdermal lidocaine
, D) Tricyclic antidepressants (TCAs)
E) Acetaminophen
Correct Answers: A, B, C, D
Rationale: Neuropathic pain arises from damage to the nervous system and responds
poorly to traditional analgesics like acetaminophen and NSAIDs. First-line non-opioid
treatments for neuropathic pain include: Gabapentin and pregabalin (calcium channel
alpha-2-delta ligands that modulate neurotransmitter release), transdermal lidocaine (local
anesthetic that blocks sodium channels and nerve conduction), and TCAs such as
amitriptyline and nortriptyline (which inhibit reuptake of serotonin and norepinephrine,
modulating pain pathways). Acetaminophen is effective for nociceptive pain (inflammatory,
somatic) but has minimal efficacy for neuropathic pain.
---
4. If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A) No opioid can be used if the patient has a true morphine allergy.
B) An agent from another opiate class should be used.
C) Only synthetic opioids like fentanyl can be used.
D) Hydromorphone is the safest alternative because it is structurally identical to morphine.
Correct Answer: B
Rationale: True opioid allergies are rare; most reported "allergies" are actually adverse
effects (nausea, itching, sedation). When a true allergy is present, an agent from a different
opiate class should be selected. Morphine is a phenanthrene derivative. Alternative classes
include: phenylpiperidines (fentanyl, meperidine), diphenylheptanes (methadone), or
benzomorphans. Hydromorphone is also a phenanthrene derivative and structurally
EXAM 2
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 2 Comprehensive Study Guide
,Table of Contents
NSG 533 Exam 2 ................................................................................ 2
NSG 533 Exam 2 ............................................................................. 40
NSG 533 Exam 2 Study Guide ................................................. 69
NSG 533 Exam 2
1. What would you be concerned with regarding the first patient's use of Vicodin in
terms of the dose of acetaminophen?
A) The patient may develop renal toxicity from acetaminophen overdose.
B) In elderly patients, it is recommended not to exceed >3,000 mg per day of
acetaminophen.
C) Acetaminophen causes significant gastrointestinal bleeding in elderly patients.
D) Vicodin contains no acetaminophen, so there is no concern.
Correct Answer: B
Rationale: Vicodin is a combination medication containing hydrocodone and
acetaminophen. In elderly patients, the recommended maximum daily dose of
acetaminophen is 3,000 mg to reduce the risk of hepatotoxicity. Many patients may
unknowingly exceed this limit by taking multiple medications containing acetaminophen
(APAP). The FDA has set a maximum daily dose of 4,000 mg for the general population, but
geriatric patients and those with liver disease should not exceed 3,000 mg/day.
Acetaminophen does not cause significant GI bleeding (that's NSAIDs), and Vicodin
definitely contains acetaminophen.
,---
2. What medication could you recommend for a diabetic patient in pain that could
also be used to help treat depression?
A) Gabapentin
B) Duloxetine or venlafaxine
C) Tramadol
D) Amitriptyline
Correct Answer: B
Rationale: SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), specifically duloxetine
and venlafaxine, are dual-purpose medications. They are FDA-approved for the treatment of
diabetic peripheral neuropathic pain and are also effective antidepressants. Duloxetine is
particularly beneficial because it addresses both the neuropathic pain common in diabetes
and comorbid depression. Gabapentin treats neuropathic pain but is not an antidepressant.
Tramadol is an opioid analgesic with weak SSRI/SNRI properties but is not indicated for
depression. Amitriptyline is a TCA that can treat both conditions but is not the best answer
here as the question specifically asks about SNRIs.
---
3. In addition, be sure to understand which non-opioid medications you would use for a
patient with neuropathic pain. (Select All That Apply)
A) Gabapentin
B) Pregabalin
C) Transdermal lidocaine
, D) Tricyclic antidepressants (TCAs)
E) Acetaminophen
Correct Answers: A, B, C, D
Rationale: Neuropathic pain arises from damage to the nervous system and responds
poorly to traditional analgesics like acetaminophen and NSAIDs. First-line non-opioid
treatments for neuropathic pain include: Gabapentin and pregabalin (calcium channel
alpha-2-delta ligands that modulate neurotransmitter release), transdermal lidocaine (local
anesthetic that blocks sodium channels and nerve conduction), and TCAs such as
amitriptyline and nortriptyline (which inhibit reuptake of serotonin and norepinephrine,
modulating pain pathways). Acetaminophen is effective for nociceptive pain (inflammatory,
somatic) but has minimal efficacy for neuropathic pain.
---
4. If a patient has a true allergy to morphine, what opioid, if any, could you try
instead?
A) No opioid can be used if the patient has a true morphine allergy.
B) An agent from another opiate class should be used.
C) Only synthetic opioids like fentanyl can be used.
D) Hydromorphone is the safest alternative because it is structurally identical to morphine.
Correct Answer: B
Rationale: True opioid allergies are rare; most reported "allergies" are actually adverse
effects (nausea, itching, sedation). When a true allergy is present, an agent from a different
opiate class should be selected. Morphine is a phenanthrene derivative. Alternative classes
include: phenylpiperidines (fentanyl, meperidine), diphenylheptanes (methadone), or
benzomorphans. Hydromorphone is also a phenanthrene derivative and structurally
