COMPREHENSIVE NURSING EXAM & RATIONALES:
PEDIATRIC & ADOLESCENT PSYCHIATRIC MENTAL
HEALTH NURSING
Focus: Selective Serotonin Reuptake Inhibitors (SSRIs), Major
Depressive Disorder, Suicide Risk, and Safety in Adolescents
Total: 200 Clinical Questions with Detailed Rationales
DOMAIN 1: Suicide Risk Assessment & FDA Black Box Warnings
Q1. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #1 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I have decided to give away my favorite guitar and vintage
comic collection to my best friend because I won't need them
anymore."
B. "I felt a little bit nauseated this morning after taking my pill with
breakfast, but it went away by noon."
C. "My mouth has felt slightly dry over the past couple of days, so I
am chewing sugarless gum."
D. "I had trouble falling asleep last night, but I practiced my deep
breathing exercises and eventually fell asleep."
Rationale: Correct Answer (A). Giving away prized possessions is a
classic, high-risk behavioral indicator of imminent suicide intent in an
adolescent with MDD. This requires immediate crisis intervention,
constant observation, and provider notification. Options B, C, and D
reflect expected, mild initial somatic side effects (nausea, dry mouth,
mild insomnia) managed with supportive care.
,Q2. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #2 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I read online that SSRIs can cause initial activation, so I will
report any increased restlessness or agitation immediately."
B. "I am planning to stop taking my fluoxetine starting tomorrow
because I feel better and want to see how I do without it."
C. "I am taking my sertraline every morning with food to help reduce
the stomach upset."
D. "I understand it might take 4 to 6 weeks before I feel the full
antidepressant effect of this medication."
Rationale: Correct Answer (B). Abrupt discontinuation of SSRIs in
adolescents can precipitate severe discontinuation syndrome
(dizziness, irritability, rebound depression) and increases relapse risk.
Medication cessation must be gradual and provider-supervised.
Options A, C, and D demonstrate correct client understanding of
SSRI therapy.
Q3. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #3 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "My muscles feel extremely rigid, my temperature is 103.2°F,
and my heart rate is 145 beats per minute."
B. "I have noticed a mild headache that resolves with a single dose of
acetaminophen."
, C. "I have had a slight decrease in my appetite over the first week of
starting the medication."
D. "I feel mildly drowsy in the evenings, so I take my dose right
before bedtime."
Rationale: Correct Answer (A). Extreme muscle rigidity,
hyperthermia, and tachycardia are hallmark signs of serotonin
syndrome or neuroleptic malignant syndrome, representing a life-
threatening medical emergency requiring immediate drug cessation
and emergency medical care. Options B, C, and D are minor, non-
emergent complaints.
Q4. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #4 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I am taking St. John's wort every morning alongside my
escitalopram to boost my mood naturally."
B. "I make sure to take my citalopram in the morning to prevent
nighttime insomnia."
C. "I have been attending my weekly cognitive behavioral therapy
sessions regularly."
D. "My parents locked up all medications in the house to ensure my
safety."
Rationale: Correct Answer (A). St. John's wort is a potent
serotonergic herbal supplement. Combining it with an SSRI
drastically increases the risk of precipitating fatal serotonin
syndrome. The nurse must intervene immediately. Options B, C, and
D represent safe, therapeutic practices.
, Q5. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #5 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I have decided to give away my favorite guitar and vintage
comic collection to my best friend because I won't need them
anymore."
B. "I felt a little bit nauseated this morning after taking my pill with
breakfast, but it went away by noon."
C. "My mouth has felt slightly dry over the past couple of days, so I
am chewing sugarless gum."
D. "I had trouble falling asleep last night, but I practiced my deep
breathing exercises and eventually fell asleep."
Rationale: Correct Answer (A). Giving away prized possessions is a
classic, high-risk behavioral indicator of imminent suicide intent in an
adolescent with MDD. This requires immediate crisis intervention,
constant observation, and provider notification. Options B, C, and D
reflect expected, mild initial somatic side effects (nausea, dry mouth,
mild insomnia) managed with supportive care.
Q6. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #6 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I read online that SSRIs can cause initial activation, so I will
report any increased restlessness or agitation immediately."
B. "I am planning to stop taking my fluoxetine starting tomorrow
because I feel better and want to see how I do without it."
PEDIATRIC & ADOLESCENT PSYCHIATRIC MENTAL
HEALTH NURSING
Focus: Selective Serotonin Reuptake Inhibitors (SSRIs), Major
Depressive Disorder, Suicide Risk, and Safety in Adolescents
Total: 200 Clinical Questions with Detailed Rationales
DOMAIN 1: Suicide Risk Assessment & FDA Black Box Warnings
Q1. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #1 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I have decided to give away my favorite guitar and vintage
comic collection to my best friend because I won't need them
anymore."
B. "I felt a little bit nauseated this morning after taking my pill with
breakfast, but it went away by noon."
C. "My mouth has felt slightly dry over the past couple of days, so I
am chewing sugarless gum."
D. "I had trouble falling asleep last night, but I practiced my deep
breathing exercises and eventually fell asleep."
Rationale: Correct Answer (A). Giving away prized possessions is a
classic, high-risk behavioral indicator of imminent suicide intent in an
adolescent with MDD. This requires immediate crisis intervention,
constant observation, and provider notification. Options B, C, and D
reflect expected, mild initial somatic side effects (nausea, dry mouth,
mild insomnia) managed with supportive care.
,Q2. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #2 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I read online that SSRIs can cause initial activation, so I will
report any increased restlessness or agitation immediately."
B. "I am planning to stop taking my fluoxetine starting tomorrow
because I feel better and want to see how I do without it."
C. "I am taking my sertraline every morning with food to help reduce
the stomach upset."
D. "I understand it might take 4 to 6 weeks before I feel the full
antidepressant effect of this medication."
Rationale: Correct Answer (B). Abrupt discontinuation of SSRIs in
adolescents can precipitate severe discontinuation syndrome
(dizziness, irritability, rebound depression) and increases relapse risk.
Medication cessation must be gradual and provider-supervised.
Options A, C, and D demonstrate correct client understanding of
SSRI therapy.
Q3. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #3 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "My muscles feel extremely rigid, my temperature is 103.2°F,
and my heart rate is 145 beats per minute."
B. "I have noticed a mild headache that resolves with a single dose of
acetaminophen."
, C. "I have had a slight decrease in my appetite over the first week of
starting the medication."
D. "I feel mildly drowsy in the evenings, so I take my dose right
before bedtime."
Rationale: Correct Answer (A). Extreme muscle rigidity,
hyperthermia, and tachycardia are hallmark signs of serotonin
syndrome or neuroleptic malignant syndrome, representing a life-
threatening medical emergency requiring immediate drug cessation
and emergency medical care. Options B, C, and D are minor, non-
emergent complaints.
Q4. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #4 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I am taking St. John's wort every morning alongside my
escitalopram to boost my mood naturally."
B. "I make sure to take my citalopram in the morning to prevent
nighttime insomnia."
C. "I have been attending my weekly cognitive behavioral therapy
sessions regularly."
D. "My parents locked up all medications in the house to ensure my
safety."
Rationale: Correct Answer (A). St. John's wort is a potent
serotonergic herbal supplement. Combining it with an SSRI
drastically increases the risk of precipitating fatal serotonin
syndrome. The nurse must intervene immediately. Options B, C, and
D represent safe, therapeutic practices.
, Q5. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #5 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I have decided to give away my favorite guitar and vintage
comic collection to my best friend because I won't need them
anymore."
B. "I felt a little bit nauseated this morning after taking my pill with
breakfast, but it went away by noon."
C. "My mouth has felt slightly dry over the past couple of days, so I
am chewing sugarless gum."
D. "I had trouble falling asleep last night, but I practiced my deep
breathing exercises and eventually fell asleep."
Rationale: Correct Answer (A). Giving away prized possessions is a
classic, high-risk behavioral indicator of imminent suicide intent in an
adolescent with MDD. This requires immediate crisis intervention,
constant observation, and provider notification. Options B, C, and D
reflect expected, mild initial somatic side effects (nausea, dry mouth,
mild insomnia) managed with supportive care.
Q6. A nurse is caring for an adolescent client with severe major
depressive disorder who has been prescribed an SSRI (Clinical scenario
variation #6 focusing on suicide risk). Which of the following client
statements or clinical findings requires the nurse's immediate
intervention?
A. "I read online that SSRIs can cause initial activation, so I will
report any increased restlessness or agitation immediately."
B. "I am planning to stop taking my fluoxetine starting tomorrow
because I feel better and want to see how I do without it."
