1. A nurse provides instructions to a client taking fluoxetine (Prozac) a selective serotonin reuptake inhibitors (SSRI) antidepressant.

The nurse tells the client to take the medication:

A. Early in the morning.
B. During lunch time.
C. At snack time.
D. At bedtime.

2. The risk of experiencing serotonin syndrome when SSRI’s are given with monoamine oxidase inhibitors such as phenelzine
(Nardil). Serotonin syndrome is best characterized in which of the following? 
A. Hypotension and urinary retention.
B. Muscle rigidity and high fever.
C. A productive cough and vomiting.
D. Tea-colored urine and constipation.

3. A client with depression who has been taking amitriptyline for three months returns to the clinic for a follow-up. The nurse
observes the client in which of the following symptoms?
A. Suicidal thoughts.
B. Lack of energy.
C. Loss of interest in personal appearance.
D. Neglect of responsibilities.

4. A client is prescribed with sertraline (Zoloft). To guarantee a safe administration of the medication, a nurse would administer the
dose:
A. As needed only for depressions.
B. Early in the morning.
C. Take on an empty stomach.
D. At bedtime.

5. A client arrives in the emergency room with a tricyclic antidepressant overdose. Which of the following measures should the nurse
do, except?
A. Maintain a patent airway.
B. Administration of sodium bicarbonate.
C. Gastric lavage with activated charcoal.
D. Obtain an electrocardiogram.
E. Administration of an antipyretic.

6. A newly admit client has started taking bupropion (Wellbutrin). The nurse monitors in which of the following side effects that would
indicate an overdosage of the medication?
A. Headache.
B. Dizziness.
C. Constipation.
D. Seizure.
7. A nurse is giving discharge instructions to a client who is prescribed with isocarboxazid (Marplan). The nurse will tell the client to
anticipate which of the following side effects of this medication?
A. Weight loss.
B. Dry skin.
C. Dizziness.
D. Fever.

8. A client with depression is taking phenelzine (Nardil). The nurse advises the client to avoid consuming which foods while taking
the medication 
A. Crackers.
B. Vegetable salad.
C. Oatmeal.
D. Yogurt.

9. Patients taking MAOIs have the tendency to experience hypertensive crisis especially during an interaction with other drugs such
as epinephrine. Which of the following is a sign of hypertensive crisis?
A. Orthostatic hypotension.
B. Diplopia.
C. Delay in ejaculation.
D. Hair loss.

10. During a hypertensive crisis, the nurse make sure which of this medicine is readily available?
A. Lithium citrate.
B. Diazepam.
C. Phentolamine.
D. Phenobarbital sodium.
11. A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle
weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as:
A. Normal level.
B. Toxic level.
C. Below normal level.
D. Above normal level.

12. A nurse is giving instructions to a client receiving lithium citrate. The nurse tells the client to do which of the following to prevent
lithium toxicity:
A. Avoid becoming dehydrated during exercise.
B. Instruct the client to change positions slowly.
C. Restrict salt intake in the diet.
D. Limit fluid intake.

13. Which of the following symptoms is classified as a mild lithium toxicity:

A. Confusion and ataxia.
B. Muscle fasciculations and oliguria.
C. Tinnitus and blurred vision.
D. Apathy and Lethargy.

14. A nurse is giving instructions to a client taking risperidone (Risperdal). The nurse advise the client to which of the following?
A. Take it on an empty stomach.
B. Change position slowly.
C. Get a daily source of sunlight.
D. Discontinue medication once the symptoms went away.

15. A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the
lips and tongue. The nurse determines that the client is experiencing?
A. Hypertensive crisis.
B. Parkinsonism.
C. Tardive dyskinesia.
D. Neuroleptic malignant syndrome.

16. A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). A nurse assesses the results of
which laboratory study to monitor for adverse effect related to this medication?
A. White blood cell.
B. Platelet count.
C. Liver function studies.
D. Random blood sugar.

17. Methylphenidate (Ritalin) is prescribed to an 8-year-old child for the treatment of attention deficit hyperactivity disorder (ADHD).
The nurse will most likely monitor which of the following during the medication therapy?
A. Deep tendon reflex.
B. Intake and output.
C. Temperature and breath sound.
D. Height and weight.

18. Which of the following medications that treat Alzheimer’s disease causes slowing of the heart rate and fainting episodes?
A. Tacrine (Cognex).
B. Galantamine (Razadyne).
C. Donepezil (Aricept).
D. All of the above.

19. A client who has been taking buspirone (BuSpar) for two months returns to the clinic for a follow-up. The nurse determines that
the medication is effective if there is an absent display of?
A. Feelings of panic, fear, and uneasiness.
B. Thought broadcasting or delusions.
C. Paranoid and suicidal thought process.
D. Alcohol withdrawal symptoms.

20. A nurse is giving discharge instructions to a client who will be taking phenobarbital (Luminal). The nurse would educate the client
in which of the following that directly correlates with the safety of the client?
A. Take the medication at the same time each day.
B. Take the medication with meals only.
C. Avoid using sleep aids while taking the medication.
D. Decrease the dosage once with symptoms of dizziness and lightheadedness.
Answers and Rationale

1. Answer: A. Early in the morning.

Fluoxetine is used to treat major depressive disorder, bulimia nervosa  obsessive-compulsive disorder, panic
disorder, and premenstrual dysphoric disorder (PMDD). It is taken early in the morning to prevent interference
with sleep.

2. Answer: B. Muscle rigidity and high fever.

Serotonin syndrome symptoms include high body temperature, agitation, muscle rigidity, tremor, sweating,
dilated pupils, and diarrhea.

3. Answer: A. Suicidal thoughts.

Clients may have thoughts about suicide when taking an antidepressant such as amitriptyline, especially clients
younger than 24 years old.
Options B, C, and D are signs of depressions but are most likely improved as the treatment goes on.

4. Answer: D. At bedtime.
Sertraline (Zoloft) is an antidepressant. It may be administered in the morning or evening, but giving it in the
evening is more favored since drowsiness is one of the side effects.

5. Answer: E. Administration of an antipyretic.

One of the signs and symptoms of a tricyclic antidepressant overdose is hypothermia, so an administration of
an antipyretic will not help in the treatment.
Option A: Maintain a patent airway by providing measures such as oxygen.
Option B: Sodium bicarbonate resolves metabolic acidosis and cardiovascular complications.
Option C: Gastric lavage with activated charcoal is done for GI decontamination.
Option D: An ECG is done to check for dysrhythmias.

6. Answer: D. Seizure.
Wellbutrin (bupropion) is an antidepressant medication used to treat major depressive disorder and seasonal
affective disorder. Overdose symptoms may include seizure, muscle stiffness, hallucinations, fast or uneven
heartbeat, shallow breathing, or fainting.
Options A, B, and C are the common side effects of the medication.

7. Answer: C. Dizziness.
Isocarboxazid is a monoamine oxidase (MAO) inhibitor. Dizziness, drowsiness, tiredness, weakness, problems
sleeping, constipation, and dry mouth may occur while taking it.
Options A, B, and D are not side effects related to the medication.

8. Answer: D. Yogurt.
Phenelzine (Nardil) is a monoamine oxidase (MAO) inhibitor. The client should avoid eating tyramine-rich foods
such as chocolate, alcoholic beverages, aged cheese, yogurt, processed meats, and fruits such as raisins,
avocados, bananas, or figs.

9. Answer: B. Diplopia.
Monoamine Oxidase Inhibitor Toxicity symptoms include hypertension, tachycardia, diplopia, nausea, dilated
pupils, palpitations, constricting chest painand altered mental status.
Options A and C are a common side effect of monoamine oxidase inhibitor.
Option D is not a related symptoms of hypertensive crisis.

10. Answer: C. Phentolamine.

In a hypertensive emergency, the first goal is to bring down the blood pressure as quickly as possible with
intravenous (IV) blood pressure medications to prevent further organ damage. Phentolamine Mesylate
(phentolamine mesylate) is used as an antidote for a hypertensive crisis.
Option A: Lithium citrate is a mood stabilizer.
Option C: Diazepam is a benzodiazpepines.
Option D: Phenobarbital sodium is a barbiturate and sedative hypnotics.

11. Answer: B. Toxic level.

The therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L.

12. Answer: A. Avoid becoming dehydrated during exercise.

Lithium toxicity usually occurs during chronic treatment because of reduced drug excretion (dehydration,
worsening renal function, concurrent infections, and drug interactions).
Option B is not a related intervention to prevent lithium toxicity.
Options C and D: The client should maintain a fluid intake of 6-8 glasses of water a day and an adequate salt
intake to prevent lithium toxicity.

13. Answer: D. Apathy and Lethargy. 

Mild toxicity has a lithium serum level of 1.5 mEq/L. Symptoms include apathy, lethargy, coarse hand tremors
and slight muscle weakness.
Options A and C are classified under moderate lithium toxicity.
Option B is classified under severe lithium toxicity.

14. Answer: B. Change position slowly.

Risperidone (Risperdal) can cause orthostatic hypotension so instruct the client to change positions slowly to
avoid it.
Option A: The medication is taken with food or milk to decrease gastric upset.
Option C: Sunlight should be avoided while taking the medication.
Option D: The medication is to be reduced gradually to avoid sudden recurrence of psychotic symptoms.

15. Answer: C. Tardive dyskinesia.

Tardive dyskinesia is characterized by uncontrollable involuntary movements of the body and extremities
(especially of the face, lips, mouth, tongue, arms or legs).
Option A: Hypertensive crisis occurs from the use of MAOIs.
Option B: Parkinsonism is characterize by tremor, slow movement, impaired speech or muscle stiffness.
Option D: Neuroleptic malignant syndrome is a life-threatening condition caused by an adverse reaction to
antipsychotic drugs. Symptoms include high fever, sweating, unstable blood pressure, stupor, muscular rigidity,
and autonomic dysfunction.

16. Answer: A. White blood cell.

Agranulocytosis my experience by the client taking clozapine which can be monitored by evaluating the white
blood cell count.
Options B, C, and D are not related specifically to the use of the medication.

17. Answer: D. Height and weight.

Methylphenidate (Ritalin) may cause slow growth. The nurse will need to keep track of the client’s height and
weight to make sure that there is a normal growth and development.

18. Answer: D. All of the above.

Tacrine (Cognex), Galantamine (Razadyne), and Donepezil (Aricept) are anti-Alzheimer drugs known to
provoke slower heart rates and fainting episodes.

19. Answer: A. Feelings of panic, fear, and uneasiness

Buspirone (BuSpar) is used to treat symptoms of anxiety, such as fear, tension, irritability, dizziness, pounding
heartbeat, and other physical symptoms.

20. Answer: C. Avoid using sleep aids while taking the medication.
Phenobarbital (Luminal) is an anticonvulsant and hypnotic drug. The client should avoid drinking alcohol or use
medicines that may cause drowsiness (eg, sleep aids, muscle relaxers).
Option A: Taking the medication at the same time daily improves compliance and maintains more stable blood
levels of the medication.
Option B: The medication is taken without regard to meals.
Option D: Decreasing the dosage is not done without the approval of the physician.