NUR 6011 Exam 3 Questions and 100%
Correct Answers 2026/27 Update –
William Paterson University
1. A patient with a 30-year history of generalized anxiety disorder (GAD) has been
taking alprazolam daily for the past 8 years. What primary concern should the
nurse practitioner consider with long-term benzodiazepine use?
A) Tolerance to therapeutic effects
B) Increased risk of seizures
C) Weight gain and metabolic syndrome
D) Hepatotoxicity
Correct Answer: A) Tolerance to therapeutic effects
Rationale: Long-term benzodiazepine use is associated with the development of
tolerance, requiring dose escalation to maintain therapeutic effects. Physical
dependence is also common. Seizures are a withdrawal risk, not a direct effect of
long-term use.
2. Which statement about the mechanism of action of selective serotonin reuptake
inhibitors (SSRIs) is most accurate?
A) They block the reuptake of norepinephrine and dopamine
B) They inhibit the presynaptic reuptake of serotonin, increasing its availability in
the synaptic cleft
,C) They act as agonists at postsynaptic serotonin receptors
D) They inhibit monoamine oxidase, preventing serotonin breakdown
Correct Answer: B) They inhibit the presynaptic reuptake of serotonin, increasing
its availability in the synaptic cleft
Rationale: SSRIs selectively block the serotonin transporter (SERT), preventing
serotonin reuptake into the presynaptic neuron. This increases serotonin
concentration in the synaptic cleft, enhancing serotonergic neurotransmission.
3. A patient starting fluoxetine reports insomnia and jitteriness during the first
week. What is the most appropriate nursing intervention?
A) Discontinue the medication immediately
B) Add a sedative-hypnotic medication
C) Reassure the patient these symptoms often subside within 1-2 weeks
D) Double the dose to accelerate therapeutic effects
Correct Answer: C) Reassure the patient these symptoms often subside within 1-2
weeks
Rationale: Early activation side effects such as insomnia, anxiety, and jitteriness
are common with SSRI initiation and typically resolve within 1-2 weeks as
tolerance develops. Abrupt discontinuation is unnecessary, and dose increases may
worsen symptoms.
4. A patient with major depressive disorder has failed two adequate trials of SSRIs.
Which class of medication should the nurse practitioner consider next?
A) Tricyclic antidepressants (TCAs)
B) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
, C) Monoamine oxidase inhibitors (MAOIs)
D) Benzodiazepines
Correct Answer: B) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Rationale: After inadequate response to two SSRIs, switching to an SNRI is an
appropriate next step in treatment-resistant depression. SNRIs have a different
mechanism (dual reuptake inhibition) that may provide benefit where SSRIs have
failed.
5. Which laboratory finding would be most concerning in a patient taking valproic
acid for bipolar disorder?
A) Serum sodium 135 mEq/L
B) AST 180 U/L (normal <40 U/L)
C) Serum creatinine 0.8 mg/dL
D) Hemoglobin 13.5 g/dL
Correct Answer: B) AST 180 U/L (normal <40 U/L)
Rationale: Valproic acid carries a black box warning for hepatotoxicity. Elevated
liver enzymes (AST, ALT) require monitoring and may indicate drug-induced liver
injury requiring dose adjustment or discontinuation.
6. A patient with obsessive-compulsive disorder (OCD) has been taking
clomipramine. Which adverse effect is most specific to this medication compared
to SSRIs?
A) Sexual dysfunction
B) Weight gain
Correct Answers 2026/27 Update –
William Paterson University
1. A patient with a 30-year history of generalized anxiety disorder (GAD) has been
taking alprazolam daily for the past 8 years. What primary concern should the
nurse practitioner consider with long-term benzodiazepine use?
A) Tolerance to therapeutic effects
B) Increased risk of seizures
C) Weight gain and metabolic syndrome
D) Hepatotoxicity
Correct Answer: A) Tolerance to therapeutic effects
Rationale: Long-term benzodiazepine use is associated with the development of
tolerance, requiring dose escalation to maintain therapeutic effects. Physical
dependence is also common. Seizures are a withdrawal risk, not a direct effect of
long-term use.
2. Which statement about the mechanism of action of selective serotonin reuptake
inhibitors (SSRIs) is most accurate?
A) They block the reuptake of norepinephrine and dopamine
B) They inhibit the presynaptic reuptake of serotonin, increasing its availability in
the synaptic cleft
,C) They act as agonists at postsynaptic serotonin receptors
D) They inhibit monoamine oxidase, preventing serotonin breakdown
Correct Answer: B) They inhibit the presynaptic reuptake of serotonin, increasing
its availability in the synaptic cleft
Rationale: SSRIs selectively block the serotonin transporter (SERT), preventing
serotonin reuptake into the presynaptic neuron. This increases serotonin
concentration in the synaptic cleft, enhancing serotonergic neurotransmission.
3. A patient starting fluoxetine reports insomnia and jitteriness during the first
week. What is the most appropriate nursing intervention?
A) Discontinue the medication immediately
B) Add a sedative-hypnotic medication
C) Reassure the patient these symptoms often subside within 1-2 weeks
D) Double the dose to accelerate therapeutic effects
Correct Answer: C) Reassure the patient these symptoms often subside within 1-2
weeks
Rationale: Early activation side effects such as insomnia, anxiety, and jitteriness
are common with SSRI initiation and typically resolve within 1-2 weeks as
tolerance develops. Abrupt discontinuation is unnecessary, and dose increases may
worsen symptoms.
4. A patient with major depressive disorder has failed two adequate trials of SSRIs.
Which class of medication should the nurse practitioner consider next?
A) Tricyclic antidepressants (TCAs)
B) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
, C) Monoamine oxidase inhibitors (MAOIs)
D) Benzodiazepines
Correct Answer: B) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Rationale: After inadequate response to two SSRIs, switching to an SNRI is an
appropriate next step in treatment-resistant depression. SNRIs have a different
mechanism (dual reuptake inhibition) that may provide benefit where SSRIs have
failed.
5. Which laboratory finding would be most concerning in a patient taking valproic
acid for bipolar disorder?
A) Serum sodium 135 mEq/L
B) AST 180 U/L (normal <40 U/L)
C) Serum creatinine 0.8 mg/dL
D) Hemoglobin 13.5 g/dL
Correct Answer: B) AST 180 U/L (normal <40 U/L)
Rationale: Valproic acid carries a black box warning for hepatotoxicity. Elevated
liver enzymes (AST, ALT) require monitoring and may indicate drug-induced liver
injury requiring dose adjustment or discontinuation.
6. A patient with obsessive-compulsive disorder (OCD) has been taking
clomipramine. Which adverse effect is most specific to this medication compared
to SSRIs?
A) Sexual dysfunction
B) Weight gain
