, Question 1
In a vSIM scenario, a patient with schizophrenia who recently started clozapine
presents with fever, tachycardia, and a clozapine level of 1200 ng/mL. Which
complication should the nurse suspect FIRST?
A. Neuroleptic malignant syndrome
B. Clozapine-induced myocarditis
C. Serotonin syndrome
D. Acute dystonic reaction
Correct Answer: B - Clozapine-induced myocarditis
RATIONALE
Clozapine-induced myocarditis typically presents with fever,
tachycardia, and elevated clozapine levels, often within the first 2
months of therapy. NMS is characterized by rigidity and elevated CK,
serotonin syndrome by clonus and hyperreflexia, and acute dystonia
by muscle spasms.
Question 2
A patient with major depressive disorder on phenelzine reports consuming
aged cheese and now has a blood pressure of 210/110 mm Hg. Which action
should the nurse take FIRST?
A. Administer a PRN dose of lorazepam
B. Obtain an ECG and administer nitroprusside
C. Hold the next phenelzine dose and monitor
D. Encourage oral fluids and recheck BP in 1 hour
Correct Answer: B - Obtain an ECG and administer
nitroprusside
Page 2
, RATIONALE
This is a hypertensive crisis from tyramine interaction with an MAOI.
Immediate treatment includes IV nitroprusside and cardiac
monitoring. Lorazepam is not indicated, holding the dose is
insufficient, and oral fluids do not address the crisis.
Question 3
In a vSIM mental health assessment, which finding best differentiates a panic
attack from generalized anxiety disorder?
A. Presence of excessive worry about multiple events
B. Sudden onset of intense fear peaking within minutes
C. Duration of symptoms for at least 6 months
D. Avoidance of social situations
Correct Answer: B - Sudden onset of intense fear peaking within
minutes
RATIONALE
Panic attacks are characterized by abrupt, intense fear that peaks
rapidly, often within 10 minutes. GAD involves chronic, excessive
worry lasting 6 months or more. Avoidance is common in both but not
distinguishing.
Question 4
A patient with bipolar I disorder in a manic episode is prescribed lithium.
Which laboratory value should the nurse monitor most closely to prevent
toxicity?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: A - Serum sodium
Page 3
In a vSIM scenario, a patient with schizophrenia who recently started clozapine
presents with fever, tachycardia, and a clozapine level of 1200 ng/mL. Which
complication should the nurse suspect FIRST?
A. Neuroleptic malignant syndrome
B. Clozapine-induced myocarditis
C. Serotonin syndrome
D. Acute dystonic reaction
Correct Answer: B - Clozapine-induced myocarditis
RATIONALE
Clozapine-induced myocarditis typically presents with fever,
tachycardia, and elevated clozapine levels, often within the first 2
months of therapy. NMS is characterized by rigidity and elevated CK,
serotonin syndrome by clonus and hyperreflexia, and acute dystonia
by muscle spasms.
Question 2
A patient with major depressive disorder on phenelzine reports consuming
aged cheese and now has a blood pressure of 210/110 mm Hg. Which action
should the nurse take FIRST?
A. Administer a PRN dose of lorazepam
B. Obtain an ECG and administer nitroprusside
C. Hold the next phenelzine dose and monitor
D. Encourage oral fluids and recheck BP in 1 hour
Correct Answer: B - Obtain an ECG and administer
nitroprusside
Page 2
, RATIONALE
This is a hypertensive crisis from tyramine interaction with an MAOI.
Immediate treatment includes IV nitroprusside and cardiac
monitoring. Lorazepam is not indicated, holding the dose is
insufficient, and oral fluids do not address the crisis.
Question 3
In a vSIM mental health assessment, which finding best differentiates a panic
attack from generalized anxiety disorder?
A. Presence of excessive worry about multiple events
B. Sudden onset of intense fear peaking within minutes
C. Duration of symptoms for at least 6 months
D. Avoidance of social situations
Correct Answer: B - Sudden onset of intense fear peaking within
minutes
RATIONALE
Panic attacks are characterized by abrupt, intense fear that peaks
rapidly, often within 10 minutes. GAD involves chronic, excessive
worry lasting 6 months or more. Avoidance is common in both but not
distinguishing.
Question 4
A patient with bipolar I disorder in a manic episode is prescribed lithium.
Which laboratory value should the nurse monitor most closely to prevent
toxicity?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: A - Serum sodium
Page 3
