PSYCHOTROPIC BOOSTER (PNLE MAY 2022)

1. The client is receiving MAOI, 6 mg of selegiline transdermal system every

24 hours for major depression. The nurse should judge teaching about
Emsam to be effective when the client makes which statement? a. “I need to
avoid using the sauna at the gym.”
b. “I can cut the patch and use a smaller piece.”
c. “I need to wait until the next day to put on a new patch if it falls off.”
d. “I might gain at least 10 lb (4.5 kg) from the medication.”

2. A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta)

twice daily for 2 months because of depression and vague aches and pains.
While interacting with the nurse, the client discloses a pattern of drinking a
six-pack of beer daily for the past 10 years to help with sleep. What should
the nurse do first?
a. Refer the client to the dual diagnosis program at the clinic.
b. Share the information at the next interdisciplinary treatment conference.
c. Report the client's beer consumption to the primary health care provider.
d. Teach the client relaxation exercises to perform before bedtime.

3. The client is taking 50 mg of lamotrigine (Lamictal) daily for bipolar

depression. The client shows the nurse a rash on his arm. What should the
nurse do?
a. Report the rash to the primary health care provider.
b. Explain that the rash is a temporary adverse effect.
c. Give the client an ice pack for his arm.
d. Question the client about recent sun exposure.

4. A 16-year-old client is prescribed 10 mg of paroxetine (Paxil) at bedtime

for major depression. The nurse should instruct the client and parents to
monitor the client closely for which adverse effect?
a. Headache.
b. Nausea.
c. Fatigue.
d. Agitation.

5. A client is receiving paroxetine (Paxil) 20 mg every morning. After taking

the first three doses, the client tells the nurse that the medication upsets the
stomach. Which of the following instructions should the nurse give to the
client?
a. “Take the medication an hour before breakfast.”
b. “Take the medication with some food.”
c. “Take the medication at bedtime.”
d. “Take the medication with 4 oz (120 mL) of orange juice.”
6. The primary health care provider prescribes fluoxetine (Prozac) orally
every morning for a 72-year-old client with depression. Which transient
adverse effect of this drug requires immediate action by the nurse? a.
Nausea.
b. Dizziness.
c. Sedation.
d. Dry mouth.

7. Which of the following statements by a client taking trazodone (Desyrel)

as prescribed by the primary health care provider indicates to the nurse that
further teaching about the medication is needed?
a. “I will continue to take my medication after a light snack.”
b. “Taking Desyrel at night will help me to sleep.”
c. “My depression will be gone in about 5 to 7 days.”
d. “I won't drink alcohol while taking Desyrel.”

8. The client who has been taking venlafaxine (Effexor) 25 mg PO three

times a day for the past 2 days states, “This medicine isn't doing me any
good. I'm still so depressed.” Which of the following responses by the nurse
is most appropriate?
a. “Perhaps we'll need to increase your dose.”
b. “Let's wait a few days and see how you feel.”
c. “It takes about 2 to 4 weeks to receive the full effects.”
d. “It's too soon to tell if your medication will help you.”

9. The client states to the nurse, “I take citalopram (Celexa) 40 mg every

day as my primary health care provider prescribed. I have also been taking
St. John's wort 750 mg daily for the past 2 weeks.” All of the the following
indicate that the client developing is serotonin syndrome except a.
Confusion.
b. Constipation.
c. Diaphoresis.
d. Ataxia.

10.When teaching the client with atypical depression about foods to avoid while
taking phenelzine (Nardil, which of the following should the nurse include?
a. Roasted chicken.
b. Salami.
c. Fresh fish.
d. Hamburger.

11.A client is taking phenelzine (Nardil) 15 mg PO three times a day. The

nurse is about to administer the 1 PM dose when the client tells the nurse
about having a throbbing headache. Which of the following should the nurse
do first?
a. Give the client an analgesic prescribed PRN.
b. Call the primary health care provider to report the symptom.
 c. Administer the client's next dose of phenelzine.
d. Obtain the client's vital signs.

12.The client with major depression and suicidal ideation has been taking
bupropion (Wellbutrin) 100 mg PO four times daily for 5 days.
Assessment reveals the client to be somewhat less withdrawn, able to
perform activities of daily living with minimal assistance, and eating 50% of
each meal. At this time, the nurse should monitor the client specifically for
which of the following behaviors?
A. Seizure activity.
B. Suicide attempt.
C. Visual disturbances.
D. Increased libido.

13.When preparing a teaching plan for a client about imipramine

(Tofranil), which of the following substances should the nurse tell the
client to avoid while taking the medication?
a. Caffeinated coffee.
b. Sunscreen.
c. Alcohol.
d. Artificial tears.

14.The client with depression who is taking imipramine (Tofranil) states to

the nurse, “My doctor wants me to have an electrocardiogram (ECG) in 2
weeks, but my heart is fine.” Which response by the nurse is most
appropriate?
a. “It's routine practice to have ECGs periodically because there is a slight
chance that the drug may affect the heart.”
b. “It's probably a precautionary measure because I'm not aware that you
have a cardiac condition.”
c. “Try not to worry too much about this. Your doctor is just being very
thorough in monitoring your condition.”
d. “You had an ECG before you were prescribed imipramine and the
procedure will be the same.”

15.A client with depression who is taking doxepin (Sinequan) 100 mg PO at

bedtime has dizziness on arising. Which of the following suggestions is most
appropriate?
a. “Try taking a hot shower.”
b. “Get up slowly and dangle your feet before standing.”
c. “Stay in bed until you are feeling better.”
d. “You need to limit the fluids you drink.”

16.The primary health care provider prescribes mirtazapine (Remeron) 30 mg

PO at bedtime for a client diagnosed with depression. The nurse should: a.
Give the medication as prescribed.
b. Question the primary health care provider's prescription.
 c. Request to give the medication in the morning.
d. Give the medication in three divided doses.
17.A client taking mirtazapine is disheartened about a 20 lb (9 kg) weight gain
over the past 3 months. The client tells the nurse, “I stopped taking my
mirtazapine 15 days ago. I don't want to get depressed again, but I feel
awful about my weight.” Which response by the nurse is most appropriate?
a. “Focusing on diet and exercise alone should control your weight.” b. “Your
depression is much better now, so your medication is helping you.” c. “Look
at all the positive things that have happened to you since you started
mirtazapine.”
d. “I hear how difficult this is for you and will help you approach the doctor
about it.”

18.A client taking paroxetine (Paxil) 40 mg PO every morning tells the nurse
that her mouth “feels like cotton.” Which of the following statements by the
client necessitates further assessment by the nurse?
a. “I'm sucking on ice chips.”
b. “I'm using sugarless gum.”
c. “I'm sucking on sugarless candy.”
d. “I'm drinking 12 glasses of water every day.”

19.The client with depression has been consistent with taking 12.5 mg of
paroxetine (Paxil) extended release daily. The nurse judges the client to
be benefiting from this drug therapy when the client demonstrates the
following except:
a. Takes 2-hour evening naps daily.
b. Completes homework assignments.
c. Decreases pacing.
d. Verbalizes feelings.

20.The intake nurse is making an assessment of a client who has just arrived at
the emergency department. Which of the following comments from this client
who is taking Nardil (phenelzine), a monoamine oxidase (MAO)
inhibitor, for treatment-resistant depression should be given top priority? a.
“My bowels haven't moved in the last 2 days.”
b. “What was my temperature? I'm feeling warm.”
c. “My legs feel stiff after I sit in the chair for a while.”
d. “I have a throbbing headache.”

21.Which of the following statements made by an adolescent who has just

begun taking an antidepressant would indicate the need for further
teaching about the action of antidepressants in treating depression?
a. “Now that I have been taking my antidepressant for a week, I'm going to
feel better about myself.”
b. “A week ago when I started my antidepressant, I didn't care about eating,
but now I want to eat a bit more.”
c. After a week of taking my antidepressant, I can sleep a little better—6
 hours or so each night.”
d. “Now that I've had a week of my antidepressant, it is a little easier to get
up in the morning.”

22.In a predischarge program to educate clients with bipolar disorder and their
family members, the nurse emphasizes that the most significant indicators
for the onset of relapse include which of the following symptoms? a. A
sense of pleasure and motivation for new endeavors.
b. Decreased need for sleep and racing thoughts.
c. Self-concern about increase in energy.
d. Leaving a good job to start a new business.

23.A client has just been admitted to the hospital for medication adjustment
after outpatient treatment failure of his bipolar disorder and returning mania.
He tells his primary nurse about his medications and treatment. Which of his
following statements would raise the most urgent need for more medication
instruction about his lithium therapy?
a. “My doctor tells me that my lithium level is 1.0 so I don't have to worry
about my levels.”
b. “I've been getting a lot of good exercise playing on a local soccer team.”
c. “I'm trying hard to watch my diet and eat healthy.
d. “I have learned to take my lithium even when I'm not feeling well, like
when I had the stomach flu.”

24.A young woman comes to the mental health clinic for her routine medication
follow-up. She has been married for 2 years and reports that she and her
husband are ready to start a family. She has a diagnosis of bipolar I disorder
and has been well managed on divalproex sodium (Depakote) for at least
3 years. What is the most essential counsel for the nurse to give her? a.
“Schedule an appointment for a complete gynecological exam if you have
not had one in the past year.”
b. “Pay careful attention to eating healthy from this point on in order to
maximize the health of both mother and baby.”
c. “Check with your prescriber today as Depakote carries an increased risk
for birth defects, especially during the first 3 months of pregnancy.” d. “It is
very important for you to take steps to reduce your stress and this will
help you to stay in balance during your pregnancy and reduce your
chances of developing post-partum depression.”

25.A health care provider has prescribed valproic acid for a client with bipolar
disorder who has achieved limited success with lithium carbonate. The nurse
should instruct the client about which of the following?
a. Follow-up blood tests are necessary while on this medication. b.
The extended-release tablet can be crushed if necessary for ease of
swallowing.
c. Tachycardia and upset stomach are common side effects. d. Consumption
of a moderate amount of alcohol is safe if the medication is taken in the
 morning.
26.The client with acute mania is prescribed 600 mg of lithium (lithium
carbonate) PO three times per day. The primary health care provider also
prescribes 5 mg of haloperidol (Haldol) PO at bedtime. Which action should
the nurse take?
a. Administer the medication as prescribed.
b. Question the primary health care provider about the prescription.
c. Administer the Haldol, but not the lithium.
d. Consult with the nursing supervisor before administering the medications.

27.A client will be discharged on lithium carbonate 600 mg three times daily.
When teaching the client and his family about lithium therapy, the nurse
determines that teaching has been effective if the client and family state that
they will notify the prescribing health care provider immediately if which of
the following occur?
1. Nausea.
2. Muscle weakness and vertigo.
3. Fine hand tremor
4. Anorexia.

28.After the nurse teaches a client with bipolar disorder about lithium
therapy, which of the following client statements indicates the need for
additional teaching?
a. “It's important to keep using a regular amount of salt in my diet.” b.
“It's okay to double my next dose of lithium if I forget a dose.” c. “I
should drink about 8 to 10 eight-ounce glasses (240 to 300 mL) of
water each day.”
d. “I need to take my medicine at the same time each day.”

29.The primary health care provider prescribes valproic acid for a client with
bipolar disorder who has achieved limited success with lithium carbonate.
Which of the following should the nurse include in the client's medication
teaching plan?
a. Follow-up blood tests are unnecessary.
b. The tablet can be crushed if necessary.
c. Drowsiness and upset stomach are common side effects.
d. Consumption of a moderate amount of alcohol is safe.

30.The client with bipolar disorder, manic phase, has a valproic acid level of
15 mg/mL (104 μmol/L). Which of the following client behaviors should
the nurse judge to be due to this level of valproic acid?
a. Grandiosity and flight of Ideas
b. Anhedonia and anorexia
c. Hypersomnia
d. Apathy
31.The client with rapid-cycling bipolar disorder who is about to receive his 5 PM
dose of carbamazepine (Tegretol) tells the nurse he has a sore throat and
chills. Which of the following should the nurse do next?
a. Administer the prescribed dose of carbamazepine.
b. First, give the client acetaminophen (Tylenol) as prescribed PRN. c.
Report the symptoms to the primary health care provider in the morning. d.
Call the primary health care provider to report the symptoms.

32.After the nurse administers haloperidol (Haldol) 5 mg PO to a client with

acute mania, the client refuses to lie down on her bed, runs out on the unit,
pushes clients in her vicinity out of the way, and screams threatening
remarks to the staff. Which of the following should the nurse do next? a.
Follow the client and ask her to calm down.
b. Tell the client to lie down on the sofa in the community room.
c. Seclude the client and use restraints if necessary.
d. Tell the staff to ignore the client's remarks.

33.Which of the following amounts of medications is appropriate for a client who

is being treated with imipramine (Tofranil) on an outpatient basis for
recurring depression and suicidal ideation to have at one time? a. A 30-day
supply.
b. A 21-day supply.
c. A 14-day supply.
d. A 7-day supply.

34.A client diagnosed with paranoid schizophrenia is still withdrawn, unkempt,

and unmotivated to get out of bed. A mental health aide asks the nurse why
the client is this way after being on fluphenazine 10 mg for 7 days. The
nurse should tell the health aide:
a. “Fluphenazine is most effective with the positive symptoms of
schizophrenia.”
b. “The client will be less withdrawn and unmotivated when the fluphenazine
takes effect.”
c. “The client's fluphenazine dose probably needs to be increased again.”
d. “Lack of motivation is a common side effect of fluphenazine.”

35.An outpatient client who has a history of paranoid schizophrenia and chronic
alcohol dependency has been taking risperidone (Risperdal) for several
months. She reports that she stopped drinking 4 days ago. The client is very
frightened by the tactile hallucinations of bugs crawling under her skin.
Which of the following factors should the nurse incorporate into the plan of
care when explaining the tactile hallucinations?
A. Alcohol intoxication.
 B. Ineffectiveness of risperidone.
C. Alcohol withdrawal.
D. Interaction of alcohol and risperidone

36.A client is being successfully treated with clozapine (Clozaril). Which of the
following statements by the client reflects a need for further teaching about
managing the drug's adverse effects?
a. “If I eat too many fruits, I'll get constipated.”
b. “I need to take the medicine with food to avoid nausea.”
c. “I have to get up slowly so I don't get dizzy.”
d. “Sometimes I have to push myself because I'm sleepy.”

37.The nurse is assessing a client who is taking an antipsychotic medication.

Which of the following symptoms is uniquely indicative of neuroleptic
malignant syndrome (NMS) and requires immediate attention? a.
Very high temperature.
b. Tongue protrusion.
c. Tremors.
d. Altered consciousness.

38.A client diagnosed with undifferentiated schizophrenia gained 50 lb (22.7 kg)

in 6 months while taking olanzapine. After seeing her psychiatrist who
changed the medication to ziprasidone, the client tells the nurse, “I don't
want to take this ziprasidone either. I can't gain any more weight.” Which
response by the nurse is most appropriate for this client?
a. “Ziprasidone causes less weight gain than the other atypical
antipsychotics.”
b. “We can give it to you as an injection rather than in capsule form.”
c. “Abnormal movements are not as common with ziprasidone.” d.
“You can take it just before bedtime, so you won't need a snack.”

39.At an outpatient visit 3 months after discharge from the hospital, a client
says he has stopped his olanzapine (Zyprexa) even though it controls his
symptoms of schizophrenia better than other medications. “I have gained 20
lb (9.1 kg) already. I can't stand anymore.” Which response by the nurse is
most appropriate?
a. “I don't think you look fat; why do you think so?”
b. “I can help you with a diet and exercise plan to keep your weight down.”
c. “You can be switched to another medicine.”
d. “Your weight gain will level off if you stay on the medication 3 more
months.”

40.A client diagnosed with schizophrenia is being switched to risperidone long

acting injection (Risperdal Consta). He is told that he will remain on his oral
dose of risperidone (Risperdal) daily for approximately 1 month. The client
says, “I didn't have to take pills when I was on fluphenazine decanoate
(Prolixin Decanoate/Modecate) shots in the past.” The nurse should tell the
 client:
A. “Taking fluphenazine orally and by injection would not be as effective as
the injection alone.”
B. “Risperdal Consta is less potent than Prolixin Decanoate/Modecate.”
C. “The doctor didn't believe you would take both the pills and Prolixin
Decanoate/Modecate.
D. “Risperdal Consta initially takes a little longer to reach the ideal blood
level.”
41.A 77-year-old client is brought to the emergency department by her son. The
client has a severe headache and lack of sleep because “I'm so worried about
everything.” Her son says that she has heart failure and chronic
schizophrenia. “In addition to all of her heart medicines, she is on
aripiprazole (Abilify), which was increased to 30 mg by her family doctor 3
days ago.” In addition to documenting all of the client's medications and
exact dosages, the nurse should particularly investigate which of the
following? Select all that apply.
A. The qualifications of the client's primary care provider.
B. The client’s gastrointestinal health
C. The client's symptoms of heart failure.
D. The client's relationship with her son.

42.A client with schizophrenia comes to the outpatient mental health clinic 5
days after being discharged from the hospital. The client was given a 1-week
supply of clozapine (Clozaril). The client tells the nurse that she has too
much saliva and frequently needs to spit. The nurse interprets the client's
statement as indicating which of the following?
a. Delusion, requiring further assessment.
b. Unusual reaction to clozapine.
c. Expected adverse effect of clozapine.
d. Unresolved symptom of schizophrenia.

NOTE: Generally, antipsychotics causes DRY MOUTH. Clozapine,

however can cause either XEROSTOMIA (reduced salivary flow) or
SIALORRHEA (increased salivary flow).

43.The plan of care for an outpatient client with chronic undifferentiated

schizophrenia (CUS) includes risperidone (Risperdal) therapy. The nurse
prepares to administer this drug based on the understanding of which of the
following?
a. The positive symptoms of CUS are usually more prominent than the
negative symptoms.
b. Agranulocytosis is less of a risk with risperidone therapy than
with clozapine (Clozaril).
c. Traditional antipsychotics help with negative symptoms, but not as well as
Risperdal does.
d. Risperidone is less expensive than traditional antipsychotics.
44.A client diagnosed with undifferentiated schizophrenia is being discharged on
aripiprazole (Abilify) 5 mg every night. When developing the teaching plan
about the most common adverse effects, the nurse would include the
following except?
a. Headaches that will subside in a few weeks.
b. Transient mild anxiety.
c. Insomnia.
d. Torticollis.
45.A nurse on the geropsychiatric unit receives a call from the son of a recently
discharged client. He reports that his father just got a prescription for
memantine (Namenda) to take “on top of his donepezil (Aricept).”
The son then asks, “Why does he have to take extra medicines?” The nurse
should tell the son:
a. “Maybe the Aricept alone isn't improving his dementia fast enough or well
enough.
b. “Namenda and Aricept are commonly used together to slow the
progression of dementia.”
c. “Namenda is more effective than Aricept. Your father will be tapered off
the Aricept.”
d. “Aricept has a short half-life and Namenda has a long half-life. They work
well together.”

46.The husband of a client who was diagnosed 6 years ago with Alzheimer's
disease approaches the nurse and says, “I'm so excited that my wife is
starting to use donepezil (Aricept) for her illness.” The nurse should tell
the husband:
a. The medication is effective mostly in the early stages of the illness.
b. The adverse effects of the drug are numerous.
c. The client will attain a functional level of that of 6 years ago. d.
Effectiveness in the terminal phase of the illness is scientifically proven.

47.The nurse has been teaching a caregiver about donepezil (Aricept). The
nurse knows that teaching has been effective when the caregiver makes
which statement?
a. “Let’s hope this medication will stop the Alzheimer disease from
progressing any further.”
b. “It is important to take this medication on an empty stomach.” c.
“I’ll be eager to see if this medication makes any improvement in
concentration.”
d. “This medication will slow the progress of Alzheimer disease temporarily.”

48.When teaching a client about memantine (Namenda), the nurse will

include which information?
a. Lab tests to monitor the client’s liver function are needed.
b. Namenda can cause elevated blood pressure.
c. Taking Namenda will improve the client’s cognitive functioning. d. The
 most common side effect of Namenda is gastrointestinal bleeding.

49.The primary health care provider prescribes risperidone (Risperdal) for a

client with Alzheimer's disease. The nurse anticipates administering this
medication to help decrease which of the following behaviors? a. Sleep
disturbances.
b. Concomitant depression.
c. Agitation and assaultiveness.
d. Confusion and withdrawal.
50.The nurse is making a home visit with a client diagnosed with Alzheimer's
disease. The client recently started on lorazepam (Ativan) due to increased
anxiety. The nurse is cautioning the family about the use of lorazepam. The
nurse should instruct the family to report which of the following significant
side effects to the health care provider?
a. Paradoxical excitement.
b. Headache.
c. Slowing of reflexes.
d. Fatigue