NSG 552: COMPREHENSIVE FINAL EXAM
ADVANCED PSYCHOPHARMACOLY
COVERAGE : MODULES 1 - 10
2026/2027/2028 TESTING CYCLE
100 VERIFIED Q & A, WITH EXPERT RATIONALES | GUARANTEED PASS
GRADED A+
Q1: A patient on lithium has a serum level of 2.5 mEq/L and exhibits coarse tremors, ataxia, and
vomiting. Which intervention is required?
A. Activated charcoal
B. Hemodialysis
C. Sodium bicarbonate
D. Flumazenil
Correct Answer: B
Rationale: Severe lithium toxicity (level >2.5 mEq/L with severe symptoms) requires
hemodialysis. Lithium is a small molecule effectively removed by dialysis.
Q2: Which medication is FDA-approved for acute mania?
A. Lamotrigine
B. Aripiprazole
C. Fluoxetine
D. Buspirone
Correct Answer: B
Rationale: Aripiprazole (Abilify) is FDA-approved for acute mania and maintenance of bipolar
disorder.
,Q3: A patient on valproic acid is planning to become pregnant. Which fetal risk should the nurse
discuss?
A. Ebstein's anomaly
B. Neural tube defects
C. Cleft palate
D. Limb defects
Correct Answer: B
Rationale: Valproic acid is associated with neural tube defects, particularly spina bifida.
Q4: Which medication is approved for bipolar depression?
A. Olanzapine-fluoxetine combination
B. Haloperidol
C. Clonazepam
D. Atomoxetine
Correct Answer: A
Rationale: Olanzapine-fluoxetine combination (Symbyax) is FDA-approved for bipolar
depression.
Q5: A patient on carbamazepine is prescribed oral contraceptives. Which effect should the nurse
anticipate?
A. Increased contraceptive efficacy
B. Decreased carbamazepine levels
C. Decreased contraceptive efficacy
D. No interaction
Correct Answer: C
Rationale: Carbamazepine is a potent CYP3A4 inducer that accelerates the metabolism of oral
contraceptives, decreasing their efficacy.
,Q6: Which medication requires a gradual taper to prevent withdrawal seizures?
A. Lithium
B. Carbamazepine
C. Fluoxetine
D. Buspirone
Correct Answer: B
Rationale: Carbamazepine requires a gradual taper to prevent withdrawal seizures.
Q7: A patient with alcohol use disorder has a CIWA score of 18. Which medication should the
nurse anticipate administering?
A. Lorazepam
B. Naltrexone
C. Acamprosate
D. Disulfiram
Correct Answer: A
Rationale: A CIWA score of 18 indicates moderate-to-severe withdrawal. Benzodiazepines like
lorazepam are first-line.
Q8: A patient with alcohol use disorder is admitted with confusion and ataxia. Which medication
should be administered FIRST?
A. Oral glucose
B. IV thiamine
C. IV fluids
D. Lorazepam
Correct Answer: B
Rationale: Confusion and ataxia suggest Wernicke's encephalopathy. IV thiamine must be
administered BEFORE glucose.
, Q9: Which medication is contraindicated in severe renal impairment for alcohol use disorder?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Thiamine
Correct Answer: B
Rationale: Acamprosate is renally cleared and contraindicated in severe renal impairment (CrCl
<30 mL/min).
Q10: A patient on disulfiram drinks alcohol and develops severe nausea and vomiting. Which
mechanism explains this reaction?
A. Increased GABA activity
B. Blockade of mu-opioid receptors
C. Accumulation of acetaldehyde
D. Inhibition of glutamate
Correct Answer: C
Rationale: Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation
when alcohol is consumed.
Q11: A patient with opioid use disorder is being inducted on buprenorphine. Which assessment
is required before administration?
A. COWS score indicating withdrawal
B. CIWA score indicating withdrawal
C. Blood alcohol level
D. Serum lithium level
Correct Answer: A
Rationale: Buprenorphine induction must be delayed until objective withdrawal signs (COWS
score ≥8) are visible.
ADVANCED PSYCHOPHARMACOLY
COVERAGE : MODULES 1 - 10
2026/2027/2028 TESTING CYCLE
100 VERIFIED Q & A, WITH EXPERT RATIONALES | GUARANTEED PASS
GRADED A+
Q1: A patient on lithium has a serum level of 2.5 mEq/L and exhibits coarse tremors, ataxia, and
vomiting. Which intervention is required?
A. Activated charcoal
B. Hemodialysis
C. Sodium bicarbonate
D. Flumazenil
Correct Answer: B
Rationale: Severe lithium toxicity (level >2.5 mEq/L with severe symptoms) requires
hemodialysis. Lithium is a small molecule effectively removed by dialysis.
Q2: Which medication is FDA-approved for acute mania?
A. Lamotrigine
B. Aripiprazole
C. Fluoxetine
D. Buspirone
Correct Answer: B
Rationale: Aripiprazole (Abilify) is FDA-approved for acute mania and maintenance of bipolar
disorder.
,Q3: A patient on valproic acid is planning to become pregnant. Which fetal risk should the nurse
discuss?
A. Ebstein's anomaly
B. Neural tube defects
C. Cleft palate
D. Limb defects
Correct Answer: B
Rationale: Valproic acid is associated with neural tube defects, particularly spina bifida.
Q4: Which medication is approved for bipolar depression?
A. Olanzapine-fluoxetine combination
B. Haloperidol
C. Clonazepam
D. Atomoxetine
Correct Answer: A
Rationale: Olanzapine-fluoxetine combination (Symbyax) is FDA-approved for bipolar
depression.
Q5: A patient on carbamazepine is prescribed oral contraceptives. Which effect should the nurse
anticipate?
A. Increased contraceptive efficacy
B. Decreased carbamazepine levels
C. Decreased contraceptive efficacy
D. No interaction
Correct Answer: C
Rationale: Carbamazepine is a potent CYP3A4 inducer that accelerates the metabolism of oral
contraceptives, decreasing their efficacy.
,Q6: Which medication requires a gradual taper to prevent withdrawal seizures?
A. Lithium
B. Carbamazepine
C. Fluoxetine
D. Buspirone
Correct Answer: B
Rationale: Carbamazepine requires a gradual taper to prevent withdrawal seizures.
Q7: A patient with alcohol use disorder has a CIWA score of 18. Which medication should the
nurse anticipate administering?
A. Lorazepam
B. Naltrexone
C. Acamprosate
D. Disulfiram
Correct Answer: A
Rationale: A CIWA score of 18 indicates moderate-to-severe withdrawal. Benzodiazepines like
lorazepam are first-line.
Q8: A patient with alcohol use disorder is admitted with confusion and ataxia. Which medication
should be administered FIRST?
A. Oral glucose
B. IV thiamine
C. IV fluids
D. Lorazepam
Correct Answer: B
Rationale: Confusion and ataxia suggest Wernicke's encephalopathy. IV thiamine must be
administered BEFORE glucose.
, Q9: Which medication is contraindicated in severe renal impairment for alcohol use disorder?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Thiamine
Correct Answer: B
Rationale: Acamprosate is renally cleared and contraindicated in severe renal impairment (CrCl
<30 mL/min).
Q10: A patient on disulfiram drinks alcohol and develops severe nausea and vomiting. Which
mechanism explains this reaction?
A. Increased GABA activity
B. Blockade of mu-opioid receptors
C. Accumulation of acetaldehyde
D. Inhibition of glutamate
Correct Answer: C
Rationale: Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation
when alcohol is consumed.
Q11: A patient with opioid use disorder is being inducted on buprenorphine. Which assessment
is required before administration?
A. COWS score indicating withdrawal
B. CIWA score indicating withdrawal
C. Blood alcohol level
D. Serum lithium level
Correct Answer: A
Rationale: Buprenorphine induction must be delayed until objective withdrawal signs (COWS
score ≥8) are visible.
