NURS 222: Advanced Psychopharmacology - Antidepressants and
Antipsychotics (2026/2027) WCU
1. A patient taking Phenelzine (an MAOI) presents to the emergency
department with a severe occipital headache, palpitations, and a blood pressure
of 210/120 mmHg. Which food item most likely contributed to this condition?
A. Cottage cheese and fresh apples
B. Grilled chicken and steamed broccoli
C. Aged cheddar cheese and red wine
D. White bread and orange juice
Answer: C
Rationale: Phenelzine is an MAOI that prevents the breakdown of tyramine. Consumption
of high-tyramine foods like aged cheese and red wine leads to a hypertensive crisis due to
excessive norepinephrine release.
2. Which of the following assessments is most critical for a patient starting
Clozapine (Clozaril)?
A. Periodic Electrocardiograms (ECGs)
B. Daily weights and glucose monitoring
C. Liver function tests (LFTs) every 6 months
D. Weekly Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine carries a black box warning for agranulocytosis. Frequent monitoring
of the ANC is mandatory to detect life-threatening neutropenia.
,3. A patient diagnosed with schizophrenia and treated with Haloperidol (Haldol)
develops high fever, muscle rigidity, and autonomic instability. What is the
priority nursing intervention?
A. Administering Benztropine (Cogentin) intramuscularly
B. Increasing the patient’s fluid intake to lower the temperature
C. Reassuring the patient that this is a common side effect
D. Discontinuing the medication and notifying the provider immediately
Answer: D
Rationale: The symptoms describe Neuroleptic Malignant Syndrome (NMS), a medical
emergency. The priority is to stop the causative antipsychotic and provide supportive care.
4. Which antidepressant is most likely to be avoided in a patient with a history
of seizure disorders or bulimia nervosa?
A. Fluoxetine (Prozac)
B. Sertraline (Zoloft)
C. Bupropion (Wellbutrin)
D. Duloxetine (Cymbalta)
Answer: C
Rationale: Bupropion lowers the seizure threshold and is contraindicated in patients with
seizure disorders and eating disorders due to an increased risk of seizures in these
populations.
, 5. A patient being treated for Major Depressive Disorder reports feeling
‘restless, sweaty, and shaky’ shortly after their SSRI dose was increased. The
nurse notes hyperreflexia and tremors. This likely indicates:
A. Anticholinergic toxicity
B. Akathisia
C. Dopamine withdrawal
D. Serotonin Syndrome
Answer: D
Rationale: Serotonin Syndrome is characterized by mental status changes, autonomic
hyperactivity (sweating, fever), and neuromuscular abnormalities (hyperreflexia, tremors).
6. Amitriptyline (Elavil), a Tricyclic Antidepressant (TCA), is most dangerous in
overdose primarily due to:
A. Liver failure
B. Acute renal failure
C. Cardiac arrhythmias and QRS widening
D. Severe gastrointestinal bleeding
Answer: C
Rationale: TCAs are cardiotoxic in overdose because they block sodium channels in the
heart, leading to lethal arrhythmias and prolonged QRS complexes.
7. The nurse is educating a patient about Risperidone (Risperdal). Which
metabolic side effect should the nurse emphasize?
A. Weight loss and decreased appetite
B. Decreased bone density
C. Increased thyroid hormone levels
D. Hyperglycemia and dyslipidemia
Answer: D
Antipsychotics (2026/2027) WCU
1. A patient taking Phenelzine (an MAOI) presents to the emergency
department with a severe occipital headache, palpitations, and a blood pressure
of 210/120 mmHg. Which food item most likely contributed to this condition?
A. Cottage cheese and fresh apples
B. Grilled chicken and steamed broccoli
C. Aged cheddar cheese and red wine
D. White bread and orange juice
Answer: C
Rationale: Phenelzine is an MAOI that prevents the breakdown of tyramine. Consumption
of high-tyramine foods like aged cheese and red wine leads to a hypertensive crisis due to
excessive norepinephrine release.
2. Which of the following assessments is most critical for a patient starting
Clozapine (Clozaril)?
A. Periodic Electrocardiograms (ECGs)
B. Daily weights and glucose monitoring
C. Liver function tests (LFTs) every 6 months
D. Weekly Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine carries a black box warning for agranulocytosis. Frequent monitoring
of the ANC is mandatory to detect life-threatening neutropenia.
,3. A patient diagnosed with schizophrenia and treated with Haloperidol (Haldol)
develops high fever, muscle rigidity, and autonomic instability. What is the
priority nursing intervention?
A. Administering Benztropine (Cogentin) intramuscularly
B. Increasing the patient’s fluid intake to lower the temperature
C. Reassuring the patient that this is a common side effect
D. Discontinuing the medication and notifying the provider immediately
Answer: D
Rationale: The symptoms describe Neuroleptic Malignant Syndrome (NMS), a medical
emergency. The priority is to stop the causative antipsychotic and provide supportive care.
4. Which antidepressant is most likely to be avoided in a patient with a history
of seizure disorders or bulimia nervosa?
A. Fluoxetine (Prozac)
B. Sertraline (Zoloft)
C. Bupropion (Wellbutrin)
D. Duloxetine (Cymbalta)
Answer: C
Rationale: Bupropion lowers the seizure threshold and is contraindicated in patients with
seizure disorders and eating disorders due to an increased risk of seizures in these
populations.
, 5. A patient being treated for Major Depressive Disorder reports feeling
‘restless, sweaty, and shaky’ shortly after their SSRI dose was increased. The
nurse notes hyperreflexia and tremors. This likely indicates:
A. Anticholinergic toxicity
B. Akathisia
C. Dopamine withdrawal
D. Serotonin Syndrome
Answer: D
Rationale: Serotonin Syndrome is characterized by mental status changes, autonomic
hyperactivity (sweating, fever), and neuromuscular abnormalities (hyperreflexia, tremors).
6. Amitriptyline (Elavil), a Tricyclic Antidepressant (TCA), is most dangerous in
overdose primarily due to:
A. Liver failure
B. Acute renal failure
C. Cardiac arrhythmias and QRS widening
D. Severe gastrointestinal bleeding
Answer: C
Rationale: TCAs are cardiotoxic in overdose because they block sodium channels in the
heart, leading to lethal arrhythmias and prolonged QRS complexes.
7. The nurse is educating a patient about Risperidone (Risperdal). Which
metabolic side effect should the nurse emphasize?
A. Weight loss and decreased appetite
B. Decreased bone density
C. Increased thyroid hormone levels
D. Hyperglycemia and dyslipidemia
Answer: D
