NR 509 FINAL EXAM QUESTIONS AND CORRECT
ANSWERS| ACCURATE REAL EXAM WITH FREQUENTLY
TESTED QUESTIONS AND RATIONALE|ALREADY A
GRADED|GUARANTEED PASS|LATEST UPDATE 2025.
Carbamazepine drug interactions - CORRECT ANSWER -Enzyme-inducing antiepileptic drugs
(carbamazepine itself as well as phenobarbital, phenytoin, and primidone) may increase the
clearance of carbamazepine and LOWER its plasma levels
-CYP450 3A4 inhibitors, such as nefazodone, fluvoxamine, and fluoxetine, can INCREASE
plasma levels of carbamazepine
Olanzapine (zyprexa) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia age 13 and older, acute agitation, acute mania/mixed mania, bipolar
maintenance, bipolar depression, borderline personality disorder, PTSD
-Starting dose: Initial 5-10 mg once daily orally
Risk:
High metabolic risk
Highest risk for weight gain, sedation, blood dyscrasias, QT prolongation, cardiovascular
disease, cerebrovascular effects, hyperglycemia, and hyperprolactinemia
quetiapine (seroquel) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia ages 13 and older, mania, bipolar maintenance, depression, severe
treatment-resistant anxiety, PTSD, behavioral disturbances in dementias, Parkinson's disease,
children, and adolescents.
-Starting dosing: initial 25 mg/day twice a day; increase by 25-50 mg twice a day each day until
desired efficacy is reached; maximum approved dose 800 mg/day
Risk:
Sedation
Moderate metabolic risk
Low EPS risk
Risk of orthostatic hypotension, blood dyscrasias (neutropenia, leukopenia, and agranulocytosis),
QT prolongation, weight gain, and renal and hepatic impairment
asenapine (Saphris) - CORRECT ANSWER SGA - Atypical
dopamine, serotonin, norepinephrine receptor antagonist
Indication: schizophrenia ages 10 and older, mania, bipolar, depression, impulse control, PTSD,
behavior disturbances in dementia and in children and adolescents
-Starting dosing: usual dosage range Schizophrenia and bipolar mania (sublingual): 10-20
mg/day in 2 divided doses, Schizophrenia (transdermal): 3.8 mg/24 hours
Risk:
,Low metabolic risk
Tardive dyskinesia (reduced risk compared to conventional antipsychotics)
clozapine (Clozaril) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: treatment-resistant schizophrenia, chronic SUICIDAL behavior in schizophrenia or
schizoaffective disorder, treatment-resistant bipolar disorder, violent aggressive patients with
psychosis and other brain disorders not responsive to other treatments.
-Starting dosing: Initial 25 mg at night, increase 25-50 mg/day every 48-72 hours as tolerated
Not indicated in acute presentation of schizophrenia
Special Comments: The Absolute Neutrophil Count (ANC) must be >1500/mm3 when used and
requires initial and weekly monitoring of WBC, granulocyte, and neutrophil counts.
Risk:
High metabolic risk
Highest risk for weight gain.
Sedation
Low EPS risk.
BLACK BOX WARNING: may cause severe neutropenia
Contraindicated in liver disease and hepatic failure
Not a first-choice mediation for treating schizophrenia
risperidone (Risperidol) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia ages 13 and older, mania, autism, bipolar, depression, impulse control,
PTSD
-Starting dosing: usual is Oral: 2-8 mg/day for acute psychosis and bipolar disorder (0.5-2mg for
kids and elderly). In adults 1 mg/day orally in 2 divided doses, Increase each day by 1 mg/day
orally until desired efficacy is reached. (16mg/day max)
Risk:
Moderate metabolic risk
Highest risk of hyperprolactinemia
Risk of blood dyscrasias, QT prolongation, cardiovascular, and cerebrovascular effects
Sexual dysfunction
paliperidone (Invega) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia ages 12 and older, mania, bipolar, depression, impulse control, PTSD,
behavior disturbances in dementia and in children and adolescents.
-Starting dosing: 6 mg/day taken in morning, Can increase by 3 mg/day every 5 days (max 12
mg/day)
Risk:
,Moderate metabolic risk
Tardive dyskinesia (reduced risk compared to conventional antipsychotics)
ziprasidone (Geodon) - CORRECT ANSWER SGA - Atypical
dopamine and serotonin receptor antagonist
Indication: schizophrenia in ages 10 and older, acute agitation, mania, bipolar
maintenance/depression, impulse control, PTSD, behavioral disturbances in dementias and in
children and adolescents
-dosing:
• Schizophrenia: 40-200 mg/day (in divided doses) orally
• Bipolar disorder: 80-160 mg/day (in divided doses) orally
• 10-20 mg intramuscularly
-Special Comments: IM dosing in acute agitation associated with schizophrenia
Risk:
Low metabolic risk
Lowest risk for weight gain
Contraindicated in clients with QT, recent myocardial infarction, or uncompensated heart failure
High incidence of rash/urticaria related to Stevens-Johnson syndrome and Drug Reaction with
Eosinophilia and Systemic Syndrome (DRESS)
Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke - CORRECT
ANSWER A 74-year-old bus driver is delivered to the hospital via emergency transport after an
astute passenger noted that the patient exhibited drooping facial features and slurred speech. The
patient was diagnosed rapidly with ischemic (nonhemorrhagic) stroke, and urgent intervention
lead to a near complete recovery from his symptoms. The astute passenger was thanked and
congratulated for recognizing the signs of acute stroke; this individual credited this recognition
to a public safety awareness campaign that outlined the critical public health need to recognize
strokes early. Which of the following statements is true for risks and rapid recognition of
suspected strokes?
The patient most likely has had an isolated peripheral lower motor neuron (LMN) lesion
involving cranial nerve (CN) VII, the facial nerve - CORRECT ANSWER A 70-year-old male
presents to the Emergency Department accompanied by his wife, who is concerned that he has
experienced a stroke. She states that he awoke with drooping of the right side of his mouth. He
has a history of hypertension and diet-controlled diabetes, but no history of prior transient
ischemic attacks (TIAs), strokes, or neurologic deficits. Physical examination reveals a well-
nourished, right-handed male, who has an obvious flattening of the right nasolabial fold at rest.
He is unable to close his right eye, wrinkle his forehead, or raise his eyebrows. The remainder of
the neurologic examination is symmetric with intact strength and normal deep tendon reflexes.
Based on this history and physical examination, which of the following statements is true?
Internal capsule - CORRECT ANSWER In longstanding and poorly controlled hypertension,
white matter tracts in the brain are subjected to ateriolosclerotic effects. Which one of the
following is most vulnerable to this process?
, CN III - CORRECT ANSWER A 14-year-old student comes with her family to the urgent care
center, having been hit in the right eye with a plastic baseball during a family reunion. She
complains of a painful, watery, red right eye and sensitivity to light. She has normal visual acuity
in both eyes, no diplopia, and can open and close her eyes normally. The pupils are unequal in
size, 3 mm in diameter on the left, 5 mm in diameter on the right. Which cranial nerve (CN)
would be implicated as the cause of the photosensitivity complaint and the pupillary asymmetry?
CN IX - CORRECT ANSWER Parents bring in their 3-year-old toddler, stating that he has been
pulling at his right ear and fussing all day. Examination of the auditory canal shows a small
green plastic toy piece partially obstructing the passage. Which cranial nerve (CN) supplies the
sensory innervation to that area and is conducting the boy's pain sensation?
Left abducens nerve (CN VI) - CORRECT ANSWER A new mother brings in her 6-month-old
baby for not being able to keep his eyes together when looking to the left. On examination, both
of his eyes appear in alignment (conjugate) when looking to the right. However, when looking to
the left, the baby's left eye stays in the forward gaze position, while the right continues on with
full adduction to the left. The eyes appear to be out of alignment (dysconjugate). Which cranial
nerve (CN) is responsible for the dysfunction in looking left?
Corticobulbar tract - CORRECT ANSWER A 45-year-old physician is having increasing
difficulty with speech for the past 6 months. She is less precise in pronunciation of words
(dysarthria), has found it more effortful to speak, and finds that her voice sounds more nasal than
usual . On examination, her articulation is less than precise, especially with rapid repetition of
single syllables, such as "ta - ta - ta - ta ," "go - go - go - go," "la - la- la - la ," and "ba - ba - ba ."
Her neurological examination is otherwise normal. Which nervous system pathway is
responsible for control of the muscles producing this symptom?
Right ankle - CORRECT ANSWER A 63-year-old practicing attorney makes an appointment
with the office urgently for pain in his right leg for 3 days. Since working in the garden moving
heavy bags of mulch for his wife this past weekend, he has had intermittent but excruciating pain
shooting down the posterior aspect of his right leg. On examination, sensory loss to light touch in
the right leg posteriorly, corresponding to a sacral 1 (S1) dermatome, is noted. Which reflex
would be expected to be decreased compared to the other side?
Peripheral nerve - CORRECT ANSWER An 82-year-old retired insurance broker complains of
difficulty in walking, having to consciously lift up his feet so he does not trip, stumble, or fall.
Both feet are affected equally; he has no sensory complaints or pain. This has been worsening
over the past 3 years, and he has had to give up his beloved hiking. The symptoms are improved
while wearing tall boots and worse when walking around the house with house slippers. What is
the likely location of the pathology in this man?
This patient was in compliance with the US Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint - CORRECT
ANSWER A 44-year-old female mathematician presents to clinic with a complaint of a mass in
the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because she
has only had one mammogram and does not engage in breast self-examination (BSE) on any
ANSWERS| ACCURATE REAL EXAM WITH FREQUENTLY
TESTED QUESTIONS AND RATIONALE|ALREADY A
GRADED|GUARANTEED PASS|LATEST UPDATE 2025.
Carbamazepine drug interactions - CORRECT ANSWER -Enzyme-inducing antiepileptic drugs
(carbamazepine itself as well as phenobarbital, phenytoin, and primidone) may increase the
clearance of carbamazepine and LOWER its plasma levels
-CYP450 3A4 inhibitors, such as nefazodone, fluvoxamine, and fluoxetine, can INCREASE
plasma levels of carbamazepine
Olanzapine (zyprexa) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia age 13 and older, acute agitation, acute mania/mixed mania, bipolar
maintenance, bipolar depression, borderline personality disorder, PTSD
-Starting dose: Initial 5-10 mg once daily orally
Risk:
High metabolic risk
Highest risk for weight gain, sedation, blood dyscrasias, QT prolongation, cardiovascular
disease, cerebrovascular effects, hyperglycemia, and hyperprolactinemia
quetiapine (seroquel) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia ages 13 and older, mania, bipolar maintenance, depression, severe
treatment-resistant anxiety, PTSD, behavioral disturbances in dementias, Parkinson's disease,
children, and adolescents.
-Starting dosing: initial 25 mg/day twice a day; increase by 25-50 mg twice a day each day until
desired efficacy is reached; maximum approved dose 800 mg/day
Risk:
Sedation
Moderate metabolic risk
Low EPS risk
Risk of orthostatic hypotension, blood dyscrasias (neutropenia, leukopenia, and agranulocytosis),
QT prolongation, weight gain, and renal and hepatic impairment
asenapine (Saphris) - CORRECT ANSWER SGA - Atypical
dopamine, serotonin, norepinephrine receptor antagonist
Indication: schizophrenia ages 10 and older, mania, bipolar, depression, impulse control, PTSD,
behavior disturbances in dementia and in children and adolescents
-Starting dosing: usual dosage range Schizophrenia and bipolar mania (sublingual): 10-20
mg/day in 2 divided doses, Schizophrenia (transdermal): 3.8 mg/24 hours
Risk:
,Low metabolic risk
Tardive dyskinesia (reduced risk compared to conventional antipsychotics)
clozapine (Clozaril) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: treatment-resistant schizophrenia, chronic SUICIDAL behavior in schizophrenia or
schizoaffective disorder, treatment-resistant bipolar disorder, violent aggressive patients with
psychosis and other brain disorders not responsive to other treatments.
-Starting dosing: Initial 25 mg at night, increase 25-50 mg/day every 48-72 hours as tolerated
Not indicated in acute presentation of schizophrenia
Special Comments: The Absolute Neutrophil Count (ANC) must be >1500/mm3 when used and
requires initial and weekly monitoring of WBC, granulocyte, and neutrophil counts.
Risk:
High metabolic risk
Highest risk for weight gain.
Sedation
Low EPS risk.
BLACK BOX WARNING: may cause severe neutropenia
Contraindicated in liver disease and hepatic failure
Not a first-choice mediation for treating schizophrenia
risperidone (Risperidol) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia ages 13 and older, mania, autism, bipolar, depression, impulse control,
PTSD
-Starting dosing: usual is Oral: 2-8 mg/day for acute psychosis and bipolar disorder (0.5-2mg for
kids and elderly). In adults 1 mg/day orally in 2 divided doses, Increase each day by 1 mg/day
orally until desired efficacy is reached. (16mg/day max)
Risk:
Moderate metabolic risk
Highest risk of hyperprolactinemia
Risk of blood dyscrasias, QT prolongation, cardiovascular, and cerebrovascular effects
Sexual dysfunction
paliperidone (Invega) - CORRECT ANSWER SGA - Atypical
serotonin-dopamine antagonist
Indication: schizophrenia ages 12 and older, mania, bipolar, depression, impulse control, PTSD,
behavior disturbances in dementia and in children and adolescents.
-Starting dosing: 6 mg/day taken in morning, Can increase by 3 mg/day every 5 days (max 12
mg/day)
Risk:
,Moderate metabolic risk
Tardive dyskinesia (reduced risk compared to conventional antipsychotics)
ziprasidone (Geodon) - CORRECT ANSWER SGA - Atypical
dopamine and serotonin receptor antagonist
Indication: schizophrenia in ages 10 and older, acute agitation, mania, bipolar
maintenance/depression, impulse control, PTSD, behavioral disturbances in dementias and in
children and adolescents
-dosing:
• Schizophrenia: 40-200 mg/day (in divided doses) orally
• Bipolar disorder: 80-160 mg/day (in divided doses) orally
• 10-20 mg intramuscularly
-Special Comments: IM dosing in acute agitation associated with schizophrenia
Risk:
Low metabolic risk
Lowest risk for weight gain
Contraindicated in clients with QT, recent myocardial infarction, or uncompensated heart failure
High incidence of rash/urticaria related to Stevens-Johnson syndrome and Drug Reaction with
Eosinophilia and Systemic Syndrome (DRESS)
Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke - CORRECT
ANSWER A 74-year-old bus driver is delivered to the hospital via emergency transport after an
astute passenger noted that the patient exhibited drooping facial features and slurred speech. The
patient was diagnosed rapidly with ischemic (nonhemorrhagic) stroke, and urgent intervention
lead to a near complete recovery from his symptoms. The astute passenger was thanked and
congratulated for recognizing the signs of acute stroke; this individual credited this recognition
to a public safety awareness campaign that outlined the critical public health need to recognize
strokes early. Which of the following statements is true for risks and rapid recognition of
suspected strokes?
The patient most likely has had an isolated peripheral lower motor neuron (LMN) lesion
involving cranial nerve (CN) VII, the facial nerve - CORRECT ANSWER A 70-year-old male
presents to the Emergency Department accompanied by his wife, who is concerned that he has
experienced a stroke. She states that he awoke with drooping of the right side of his mouth. He
has a history of hypertension and diet-controlled diabetes, but no history of prior transient
ischemic attacks (TIAs), strokes, or neurologic deficits. Physical examination reveals a well-
nourished, right-handed male, who has an obvious flattening of the right nasolabial fold at rest.
He is unable to close his right eye, wrinkle his forehead, or raise his eyebrows. The remainder of
the neurologic examination is symmetric with intact strength and normal deep tendon reflexes.
Based on this history and physical examination, which of the following statements is true?
Internal capsule - CORRECT ANSWER In longstanding and poorly controlled hypertension,
white matter tracts in the brain are subjected to ateriolosclerotic effects. Which one of the
following is most vulnerable to this process?
, CN III - CORRECT ANSWER A 14-year-old student comes with her family to the urgent care
center, having been hit in the right eye with a plastic baseball during a family reunion. She
complains of a painful, watery, red right eye and sensitivity to light. She has normal visual acuity
in both eyes, no diplopia, and can open and close her eyes normally. The pupils are unequal in
size, 3 mm in diameter on the left, 5 mm in diameter on the right. Which cranial nerve (CN)
would be implicated as the cause of the photosensitivity complaint and the pupillary asymmetry?
CN IX - CORRECT ANSWER Parents bring in their 3-year-old toddler, stating that he has been
pulling at his right ear and fussing all day. Examination of the auditory canal shows a small
green plastic toy piece partially obstructing the passage. Which cranial nerve (CN) supplies the
sensory innervation to that area and is conducting the boy's pain sensation?
Left abducens nerve (CN VI) - CORRECT ANSWER A new mother brings in her 6-month-old
baby for not being able to keep his eyes together when looking to the left. On examination, both
of his eyes appear in alignment (conjugate) when looking to the right. However, when looking to
the left, the baby's left eye stays in the forward gaze position, while the right continues on with
full adduction to the left. The eyes appear to be out of alignment (dysconjugate). Which cranial
nerve (CN) is responsible for the dysfunction in looking left?
Corticobulbar tract - CORRECT ANSWER A 45-year-old physician is having increasing
difficulty with speech for the past 6 months. She is less precise in pronunciation of words
(dysarthria), has found it more effortful to speak, and finds that her voice sounds more nasal than
usual . On examination, her articulation is less than precise, especially with rapid repetition of
single syllables, such as "ta - ta - ta - ta ," "go - go - go - go," "la - la- la - la ," and "ba - ba - ba ."
Her neurological examination is otherwise normal. Which nervous system pathway is
responsible for control of the muscles producing this symptom?
Right ankle - CORRECT ANSWER A 63-year-old practicing attorney makes an appointment
with the office urgently for pain in his right leg for 3 days. Since working in the garden moving
heavy bags of mulch for his wife this past weekend, he has had intermittent but excruciating pain
shooting down the posterior aspect of his right leg. On examination, sensory loss to light touch in
the right leg posteriorly, corresponding to a sacral 1 (S1) dermatome, is noted. Which reflex
would be expected to be decreased compared to the other side?
Peripheral nerve - CORRECT ANSWER An 82-year-old retired insurance broker complains of
difficulty in walking, having to consciously lift up his feet so he does not trip, stumble, or fall.
Both feet are affected equally; he has no sensory complaints or pain. This has been worsening
over the past 3 years, and he has had to give up his beloved hiking. The symptoms are improved
while wearing tall boots and worse when walking around the house with house slippers. What is
the likely location of the pathology in this man?
This patient was in compliance with the US Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint - CORRECT
ANSWER A 44-year-old female mathematician presents to clinic with a complaint of a mass in
the right breast. Her partner noticed this mass 2 days ago, and the patient feels guilty because she
has only had one mammogram and does not engage in breast self-examination (BSE) on any
