NU 578 Unit 3 Exam (2026/2027 Update) University of South
Alabama Advanced Practice Nursing – Pharmacology
Complete A+ Guide with Rationales
Section 1: Antidepressants – SSRIs and SNRIs (Questions 1-40)
1. A patient is prescribed fluoxetine (Prozac) for major depressive
disorder. The nurse understands that this medication belongs to
which class of antidepressants?
A. Tricyclic antidepressants (TCAs)
B. Monoamine oxidase inhibitors (MAOIs)
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Atypical antidepressants
Answer: C. Selective serotonin reuptake inhibitors (SSRIs)
Rationale: Fluoxetine is an SSRI that works by selectively inhibiting
serotonin reuptake, increasing serotonin availability in the synaptic
cleft . SSRIs are first-line treatment for depression due to their
favorable side effect profile.
2. A patient starting sertraline (Zoloft) asks the nurse how long it
will take for the medication to work. What is the most accurate
response?
A. 24-48 hours
B. 3-7 days
C. 2-4 weeks
D. 8-12 weeks
Answer: C. 2-4 weeks
Rationale: Antidepressants, including SSRIs, typically take 2-4
,weeks to achieve therapeutic effects. Initial side effects may occur
before therapeutic benefits are noticed . Full response may take 6-8
weeks.
3. The nurse is educating a patient starting an SSRI. Which
statement by the patient indicates understanding of the
medication's side effect profile?
A. "I should expect to gain a lot of weight on this medication."
B. "I might experience sexual side effects, and I should report these
to my provider."
C. "This medication will work immediately to improve my mood."
D. "I can stop taking this medication when I feel better."
Answer: B. "I might experience sexual side effects, and I should
report these to my provider."
Rationale: Sexual side effects (decreased libido, delayed
ejaculation, anorgasmia) are common with SSRIs and should be
reported to the provider for management options . Weight gain is
possible but not universal; immediate effects are not typical;
abrupt discontinuation should be avoided.
4. A patient prescribed paroxetine (Paxil) reports experiencing
sexual dysfunction. What should the nurse recommend?
A. Discontinue the medication immediately
B. Discuss with the provider; options may include dose adjustment
or switching to another agent
C. Take an over-the-counter sexual enhancement supplement
D. Double the dose to overcome the side effect
Answer: B. Discuss with the provider; options may include dose
adjustment or switching to another agent
,Rationale: Sexual side effects are common with SSRIs and should
be discussed with the provider. Management options include dose
reduction, switching to another SSRI (e.g., fluvoxamine or
sertraline), switching to bupropion, or adding adjunctive therapy .
5. The nurse is teaching a patient about serotonin syndrome.
Which symptoms should the patient be instructed to report
immediately?
A. Dry mouth and constipation
B. Agitation, confusion, and rapid heart rate
C. Drowsiness and headache
D. Weight gain and increased appetite
Answer: B. Agitation, confusion, and rapid heart rate
Rationale: Serotonin syndrome is characterized by altered mental
status (confusion, agitation), autonomic instability (tachycardia,
hypertension, hyperthermia), and neuromuscular abnormalities
(tremor, rigidity) . It is a potentially life-threatening condition
requiring immediate intervention.
6. A patient taking an SSRI is prescribed tramadol for pain. The
nurse should be concerned about which potential drug interaction?
A. Increased risk of bleeding
B. Serotonin syndrome
C. QT prolongation
D. Nephrotoxicity
Answer: B. Serotonin syndrome
Rationale: Tramadol has serotonergic properties and can
precipitate serotonin syndrome when combined with SSRIs . This
combination should be used with caution or avoided.
, 7. Which SSRI has the highest risk of drug interactions due to
inhibition of multiple CYP450 enzymes?
A. Escitalopram (Lexapro)
B. Sertraline (Zoloft)
C. Fluoxetine (Prozac)
D. Citalopram (Celexa)
Answer: C. Fluoxetine (Prozac)
Rationale: Fluoxetine and its active metabolite norfluoxetine are
potent inhibitors of CYP2D6 and affect multiple CYP enzymes,
leading to significant drug interactions . Paroxetine also has
significant CYP2D6 inhibition.
8. The nurse is monitoring a patient taking citalopram (Celexa).
Which laboratory finding is most concerning?
A. Potassium 3.8 mEq/L
B. Corrected QT interval 480 msec
C. Sodium 138 mEq/L
D. Blood glucose 95 mg/dL
Answer: B. Corrected QT interval 480 msec
Rationale: Citalopram can cause dose-dependent QT prolongation.
A corrected QT interval >450 msec in men or >470 msec in women
is concerning; >500 msec increases risk of torsades de pointes .
Citalopram should not exceed 40 mg/day (20 mg/day in patients
with hepatic impairment or over 60 years).
9. A patient with a history of myocardial infarction is prescribed an
SSRI. The nurse knows that which SSRI is preferred due to minimal
cardiac effects?
A. Citalopram (Celexa)
Alabama Advanced Practice Nursing – Pharmacology
Complete A+ Guide with Rationales
Section 1: Antidepressants – SSRIs and SNRIs (Questions 1-40)
1. A patient is prescribed fluoxetine (Prozac) for major depressive
disorder. The nurse understands that this medication belongs to
which class of antidepressants?
A. Tricyclic antidepressants (TCAs)
B. Monoamine oxidase inhibitors (MAOIs)
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Atypical antidepressants
Answer: C. Selective serotonin reuptake inhibitors (SSRIs)
Rationale: Fluoxetine is an SSRI that works by selectively inhibiting
serotonin reuptake, increasing serotonin availability in the synaptic
cleft . SSRIs are first-line treatment for depression due to their
favorable side effect profile.
2. A patient starting sertraline (Zoloft) asks the nurse how long it
will take for the medication to work. What is the most accurate
response?
A. 24-48 hours
B. 3-7 days
C. 2-4 weeks
D. 8-12 weeks
Answer: C. 2-4 weeks
Rationale: Antidepressants, including SSRIs, typically take 2-4
,weeks to achieve therapeutic effects. Initial side effects may occur
before therapeutic benefits are noticed . Full response may take 6-8
weeks.
3. The nurse is educating a patient starting an SSRI. Which
statement by the patient indicates understanding of the
medication's side effect profile?
A. "I should expect to gain a lot of weight on this medication."
B. "I might experience sexual side effects, and I should report these
to my provider."
C. "This medication will work immediately to improve my mood."
D. "I can stop taking this medication when I feel better."
Answer: B. "I might experience sexual side effects, and I should
report these to my provider."
Rationale: Sexual side effects (decreased libido, delayed
ejaculation, anorgasmia) are common with SSRIs and should be
reported to the provider for management options . Weight gain is
possible but not universal; immediate effects are not typical;
abrupt discontinuation should be avoided.
4. A patient prescribed paroxetine (Paxil) reports experiencing
sexual dysfunction. What should the nurse recommend?
A. Discontinue the medication immediately
B. Discuss with the provider; options may include dose adjustment
or switching to another agent
C. Take an over-the-counter sexual enhancement supplement
D. Double the dose to overcome the side effect
Answer: B. Discuss with the provider; options may include dose
adjustment or switching to another agent
,Rationale: Sexual side effects are common with SSRIs and should
be discussed with the provider. Management options include dose
reduction, switching to another SSRI (e.g., fluvoxamine or
sertraline), switching to bupropion, or adding adjunctive therapy .
5. The nurse is teaching a patient about serotonin syndrome.
Which symptoms should the patient be instructed to report
immediately?
A. Dry mouth and constipation
B. Agitation, confusion, and rapid heart rate
C. Drowsiness and headache
D. Weight gain and increased appetite
Answer: B. Agitation, confusion, and rapid heart rate
Rationale: Serotonin syndrome is characterized by altered mental
status (confusion, agitation), autonomic instability (tachycardia,
hypertension, hyperthermia), and neuromuscular abnormalities
(tremor, rigidity) . It is a potentially life-threatening condition
requiring immediate intervention.
6. A patient taking an SSRI is prescribed tramadol for pain. The
nurse should be concerned about which potential drug interaction?
A. Increased risk of bleeding
B. Serotonin syndrome
C. QT prolongation
D. Nephrotoxicity
Answer: B. Serotonin syndrome
Rationale: Tramadol has serotonergic properties and can
precipitate serotonin syndrome when combined with SSRIs . This
combination should be used with caution or avoided.
, 7. Which SSRI has the highest risk of drug interactions due to
inhibition of multiple CYP450 enzymes?
A. Escitalopram (Lexapro)
B. Sertraline (Zoloft)
C. Fluoxetine (Prozac)
D. Citalopram (Celexa)
Answer: C. Fluoxetine (Prozac)
Rationale: Fluoxetine and its active metabolite norfluoxetine are
potent inhibitors of CYP2D6 and affect multiple CYP enzymes,
leading to significant drug interactions . Paroxetine also has
significant CYP2D6 inhibition.
8. The nurse is monitoring a patient taking citalopram (Celexa).
Which laboratory finding is most concerning?
A. Potassium 3.8 mEq/L
B. Corrected QT interval 480 msec
C. Sodium 138 mEq/L
D. Blood glucose 95 mg/dL
Answer: B. Corrected QT interval 480 msec
Rationale: Citalopram can cause dose-dependent QT prolongation.
A corrected QT interval >450 msec in men or >470 msec in women
is concerning; >500 msec increases risk of torsades de pointes .
Citalopram should not exceed 40 mg/day (20 mg/day in patients
with hepatic impairment or over 60 years).
9. A patient with a history of myocardial infarction is prescribed an
SSRI. The nurse knows that which SSRI is preferred due to minimal
cardiac effects?
A. Citalopram (Celexa)
