200+ QUESTIONS & ANSWERS WITH
RATIONALES
, ATI RN MENTAL HEALTH PHARMACOLOGY MIDTERM EXAM 2026 | STUDY GUIDE, PRACTICE
QUESTIONS & ANSWERS WITH RATIONALES
Section 1: Antidepressants
Q1. A client prescribed fluoxetine (Prozac) for major depressive disorder reports nausea,
headache, and insomnia during the first week of therapy. Which action should the nurse
take?
A) Discontinue the medication immediately
B) Administer the medication in the morning to reduce insomnia
C) Instruct the client to stop the medication and notify the provider
D) Reassure the client that these side effects typically subside within 1-2 weeks
Correct Answer: D
Rationale: Fluoxetine is an SSRI that commonly causes gastrointestinal distress, headache, and
sleep disturbances during the initial weeks of therapy. These side effects are usually transient
and resolve as the body adjusts to the medication. The medication should be taken in the
morning to minimize insomnia, but discontinuing abruptly can cause withdrawal symptoms and
loss of therapeutic benefit.
Q2. A client taking an MAOI for depression reports consuming aged cheddar cheese and
pepperoni at lunch. Which assessment finding requires immediate nursing intervention?
A) Blood pressure 138/88 mmHg
B) Heart rate 92 bpm
C) Client reports severe headache and palpitations
D) Client reports mild dizziness upon standing
,Correct Answer: C
Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, cured meats, fermented
products, fava beans) to cause a hypertensive crisis characterized by severe headache,
palpitations, hypertension, and potentially stroke. This is a medical emergency requiring
immediate intervention. Mild dizziness from orthostatic hypotension is an expected side effect
and requires teaching about slow position changes.
Q3. A client prescribed venlafaxine (Effexor) for depression reports missing two doses. What
should the nurse include in client education?
A) Take a double dose to make up for missed doses
B) Resume regular dosing without taking extra doses
C) Discontinue the medication and contact the provider
D) Skip the missed dose and resume with the next scheduled dose
Correct Answer: B
Rationale: SNRIs like venlafaxine have a short half-life, and abrupt discontinuation can cause
withdrawal symptoms. Clients should resume regular dosing as prescribed without taking extra
or double doses. If several doses are missed, the provider should be consulted for dose
adjustment guidance.
Q4. A client prescribed sertraline (Zoloft) reports sexual dysfunction. The client is distressed
and considering stopping the medication. Which nursing response is most appropriate?
A) "Sexual side effects are permanent and you should accept this"
B) "This is a common side effect; discuss options like bupropion with your provider"
C) "You should stop the medication immediately"
D) "This means the medication is not working properly"
, Correct Answer: B
Rationale: SSRIs commonly cause sexual side effects, which can lead to non-adherence. The
nurse should validate the client's concerns and encourage discussion with the provider. Options
may include switching to bupropion (which has lower sexual side effect risk), dose reduction, or
drug holidays. The client should not stop medication abruptly.
Q5. A client taking duloxetine (Cymbalta) reports dark urine and yellowing of the eyes. Which
laboratory test should the nurse anticipate?
A) Serum creatinine
B) Liver function tests
C) Complete blood count
D) Thyroid function tests
Correct Answer: B
Rationale: Duloxetine can cause hepatotoxicity, presenting with dark urine, jaundice, and
elevated liver enzymes. Baseline and periodic liver function tests are recommended. This
finding requires prompt provider notification and potential medication discontinuation.
Section 2: Antipsychotics
Q6. A client taking risperidone (Risperdal) develops galactorrhea and gynecomastia. Which
pathophysiological mechanism explains these findings?
A) D2 receptor antagonism in the pituitary
B) Alpha-1 adrenergic blockade
RATIONALES
, ATI RN MENTAL HEALTH PHARMACOLOGY MIDTERM EXAM 2026 | STUDY GUIDE, PRACTICE
QUESTIONS & ANSWERS WITH RATIONALES
Section 1: Antidepressants
Q1. A client prescribed fluoxetine (Prozac) for major depressive disorder reports nausea,
headache, and insomnia during the first week of therapy. Which action should the nurse
take?
A) Discontinue the medication immediately
B) Administer the medication in the morning to reduce insomnia
C) Instruct the client to stop the medication and notify the provider
D) Reassure the client that these side effects typically subside within 1-2 weeks
Correct Answer: D
Rationale: Fluoxetine is an SSRI that commonly causes gastrointestinal distress, headache, and
sleep disturbances during the initial weeks of therapy. These side effects are usually transient
and resolve as the body adjusts to the medication. The medication should be taken in the
morning to minimize insomnia, but discontinuing abruptly can cause withdrawal symptoms and
loss of therapeutic benefit.
Q2. A client taking an MAOI for depression reports consuming aged cheddar cheese and
pepperoni at lunch. Which assessment finding requires immediate nursing intervention?
A) Blood pressure 138/88 mmHg
B) Heart rate 92 bpm
C) Client reports severe headache and palpitations
D) Client reports mild dizziness upon standing
,Correct Answer: C
Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, cured meats, fermented
products, fava beans) to cause a hypertensive crisis characterized by severe headache,
palpitations, hypertension, and potentially stroke. This is a medical emergency requiring
immediate intervention. Mild dizziness from orthostatic hypotension is an expected side effect
and requires teaching about slow position changes.
Q3. A client prescribed venlafaxine (Effexor) for depression reports missing two doses. What
should the nurse include in client education?
A) Take a double dose to make up for missed doses
B) Resume regular dosing without taking extra doses
C) Discontinue the medication and contact the provider
D) Skip the missed dose and resume with the next scheduled dose
Correct Answer: B
Rationale: SNRIs like venlafaxine have a short half-life, and abrupt discontinuation can cause
withdrawal symptoms. Clients should resume regular dosing as prescribed without taking extra
or double doses. If several doses are missed, the provider should be consulted for dose
adjustment guidance.
Q4. A client prescribed sertraline (Zoloft) reports sexual dysfunction. The client is distressed
and considering stopping the medication. Which nursing response is most appropriate?
A) "Sexual side effects are permanent and you should accept this"
B) "This is a common side effect; discuss options like bupropion with your provider"
C) "You should stop the medication immediately"
D) "This means the medication is not working properly"
, Correct Answer: B
Rationale: SSRIs commonly cause sexual side effects, which can lead to non-adherence. The
nurse should validate the client's concerns and encourage discussion with the provider. Options
may include switching to bupropion (which has lower sexual side effect risk), dose reduction, or
drug holidays. The client should not stop medication abruptly.
Q5. A client taking duloxetine (Cymbalta) reports dark urine and yellowing of the eyes. Which
laboratory test should the nurse anticipate?
A) Serum creatinine
B) Liver function tests
C) Complete blood count
D) Thyroid function tests
Correct Answer: B
Rationale: Duloxetine can cause hepatotoxicity, presenting with dark urine, jaundice, and
elevated liver enzymes. Baseline and periodic liver function tests are recommended. This
finding requires prompt provider notification and potential medication discontinuation.
Section 2: Antipsychotics
Q6. A client taking risperidone (Risperdal) develops galactorrhea and gynecomastia. Which
pathophysiological mechanism explains these findings?
A) D2 receptor antagonism in the pituitary
B) Alpha-1 adrenergic blockade
