1
HESI Exit Exam Psychiatric Pharmacology
Bank: Med Safety, Monitoring & NCLEX
Review
Table of Contents
Subtopic 1: Antidepressants – Safety, Side Effects, and Monitoring................2
Subtopic 2: Antipsychotic Medications – Monitoring and Adverse Effects......10
Subtopic 3: Mood Stabilizers – Lithium and Anticonvulsants Monitoring and
Safety.............................................................................................................19
Subtopic 4: Anxiolytics – Benzodiazepines and Non-Benzodiazepines: Safety
and Dependence............................................................................................27
Subtopic 5: Stimulants and ADHD Medications – Cardiovascular and
Behavioral Safety Monitoring.........................................................................36
Subtopic 6: Sedative-Hypnotics – Monitoring for Dependence, Tolerance, and
Safe Use.........................................................................................................44
Subtopic 7: Antidepressants in Special Populations – Geriatric, Pediatric, and
Pregnant Clients.............................................................................................53
Subtopic 8: Medication Interactions and Polypharmacy in Psychiatric Drug
Use.................................................................................................................62
Subtopic 9: Psychiatric Medication Administration – Best Practices and Safety
Protocols........................................................................................................70
Subtopic 10: Cultural, Ethical, and Legal Considerations in Psychiatric
Medication Management................................................................................79
, 2
Subtopic 1: Antidepressants – Safety, Side
Effects, and Monitoring
Question 1:
A nurse is monitoring a patient who recently began taking fluoxetine for
major depressive disorder. Which symptom should prompt the most
immediate intervention?
A. Nausea and decreased appetite
B. New-onset suicidal thoughts
C. Headache and dry mouth
D. Insomnia
Correct Answer: B. New-onset suicidal thoughts
Rationale: SSRIs like fluoxetine may increase suicidal ideation in some
individuals, particularly adolescents and young adults, early in treatment.
This requires immediate intervention.
Question 2:
A client taking amitriptyline reports confusion, dry mouth, and blurred vision.
What is the nurse's best action?
A. Reassure the client that symptoms are transient
B. Notify the provider; symptoms suggest anticholinergic toxicity
C. Encourage fluid intake and rest
D. Document the findings and continue monitoring
Correct Answer: B. Notify the provider; symptoms suggest anticholinergic
toxicity
, 3
Rationale: Tricyclic antidepressants like amitriptyline can cause serious
anticholinergic side effects; confusion and blurred vision may indicate
toxicity.
Question 3:
What teaching should be provided to a client beginning sertraline therapy?
A. Take medication with grapefruit juice to increase absorption
B. Expect immediate improvement in mood within 24 hours
C. It may take several weeks to notice the full therapeutic effect
D. Stop taking the drug if headaches occur
Correct Answer: C. It may take several weeks to notice the full therapeutic
effect
Rationale: SSRIs typically take 2–4 weeks to show full benefit. Patients should
be advised to continue taking the medication as prescribed.
Question 4:
A patient taking phenelzine reports eating aged cheese and red wine at a
party. What is the nurse’s primary concern?
A. Gastrointestinal distress
B. Hypertensive crisis
C. Hypoglycemia
D. Tardive dyskinesia
Correct Answer: B. Hypertensive crisis
Rationale: MAOIs like phenelzine can interact with tyramine-containing foods,
causing potentially life-threatening hypertensive crises.
Question 5:
, 4
Which assessment finding is most concerning in a client taking citalopram?
A. Mild nausea
B. QT interval prolongation on ECG
C. Mild headache
D. Decreased libido
Correct Answer: B. QT interval prolongation on ECG
Rationale: Citalopram is associated with dose-dependent QT prolongation,
which increases the risk of life-threatening arrhythmias.
Question 6:
Which lab value is most important to monitor in a patient on duloxetine?
A. Hemoglobin A1c
B. Platelet count
C. Liver function tests
D. Thyroid-stimulating hormone
Correct Answer: C. Liver function tests
Rationale: Duloxetine can cause hepatotoxicity; liver enzymes should be
monitored during therapy.
Question 7:
What is a priority nursing action when a client on bupropion complains of
tremors and agitation?
A. Encourage relaxation techniques
B. Administer PRN lorazepam
C. Assess for signs of seizure activity
D. Monitor blood pressure
HESI Exit Exam Psychiatric Pharmacology
Bank: Med Safety, Monitoring & NCLEX
Review
Table of Contents
Subtopic 1: Antidepressants – Safety, Side Effects, and Monitoring................2
Subtopic 2: Antipsychotic Medications – Monitoring and Adverse Effects......10
Subtopic 3: Mood Stabilizers – Lithium and Anticonvulsants Monitoring and
Safety.............................................................................................................19
Subtopic 4: Anxiolytics – Benzodiazepines and Non-Benzodiazepines: Safety
and Dependence............................................................................................27
Subtopic 5: Stimulants and ADHD Medications – Cardiovascular and
Behavioral Safety Monitoring.........................................................................36
Subtopic 6: Sedative-Hypnotics – Monitoring for Dependence, Tolerance, and
Safe Use.........................................................................................................44
Subtopic 7: Antidepressants in Special Populations – Geriatric, Pediatric, and
Pregnant Clients.............................................................................................53
Subtopic 8: Medication Interactions and Polypharmacy in Psychiatric Drug
Use.................................................................................................................62
Subtopic 9: Psychiatric Medication Administration – Best Practices and Safety
Protocols........................................................................................................70
Subtopic 10: Cultural, Ethical, and Legal Considerations in Psychiatric
Medication Management................................................................................79
, 2
Subtopic 1: Antidepressants – Safety, Side
Effects, and Monitoring
Question 1:
A nurse is monitoring a patient who recently began taking fluoxetine for
major depressive disorder. Which symptom should prompt the most
immediate intervention?
A. Nausea and decreased appetite
B. New-onset suicidal thoughts
C. Headache and dry mouth
D. Insomnia
Correct Answer: B. New-onset suicidal thoughts
Rationale: SSRIs like fluoxetine may increase suicidal ideation in some
individuals, particularly adolescents and young adults, early in treatment.
This requires immediate intervention.
Question 2:
A client taking amitriptyline reports confusion, dry mouth, and blurred vision.
What is the nurse's best action?
A. Reassure the client that symptoms are transient
B. Notify the provider; symptoms suggest anticholinergic toxicity
C. Encourage fluid intake and rest
D. Document the findings and continue monitoring
Correct Answer: B. Notify the provider; symptoms suggest anticholinergic
toxicity
, 3
Rationale: Tricyclic antidepressants like amitriptyline can cause serious
anticholinergic side effects; confusion and blurred vision may indicate
toxicity.
Question 3:
What teaching should be provided to a client beginning sertraline therapy?
A. Take medication with grapefruit juice to increase absorption
B. Expect immediate improvement in mood within 24 hours
C. It may take several weeks to notice the full therapeutic effect
D. Stop taking the drug if headaches occur
Correct Answer: C. It may take several weeks to notice the full therapeutic
effect
Rationale: SSRIs typically take 2–4 weeks to show full benefit. Patients should
be advised to continue taking the medication as prescribed.
Question 4:
A patient taking phenelzine reports eating aged cheese and red wine at a
party. What is the nurse’s primary concern?
A. Gastrointestinal distress
B. Hypertensive crisis
C. Hypoglycemia
D. Tardive dyskinesia
Correct Answer: B. Hypertensive crisis
Rationale: MAOIs like phenelzine can interact with tyramine-containing foods,
causing potentially life-threatening hypertensive crises.
Question 5:
, 4
Which assessment finding is most concerning in a client taking citalopram?
A. Mild nausea
B. QT interval prolongation on ECG
C. Mild headache
D. Decreased libido
Correct Answer: B. QT interval prolongation on ECG
Rationale: Citalopram is associated with dose-dependent QT prolongation,
which increases the risk of life-threatening arrhythmias.
Question 6:
Which lab value is most important to monitor in a patient on duloxetine?
A. Hemoglobin A1c
B. Platelet count
C. Liver function tests
D. Thyroid-stimulating hormone
Correct Answer: C. Liver function tests
Rationale: Duloxetine can cause hepatotoxicity; liver enzymes should be
monitored during therapy.
Question 7:
What is a priority nursing action when a client on bupropion complains of
tremors and agitation?
A. Encourage relaxation techniques
B. Administer PRN lorazepam
C. Assess for signs of seizure activity
D. Monitor blood pressure
