HESI Mental Health Medications
Exam (Latest 2026 Edition)|| Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section I: Antidepressants (SSRIs, SNRIs, TCAs, MAOIs) – Questions 1-20
1. A client prescribed fluoxetine (Prozac) reports nausea, headache, and
insomnia. Which nursing action is most appropriate?
A. Hold the medication and notify the provider
B. Administer the medication with a full meal
C. Advise the client that these side effects often subside in 1-2 weeks
D. Switch the medication to bedtime dosing
Rationale: Initial side effects of SSRIs (nausea, headache, insomnia) are common
and typically transient. Clients should be reassured and encouraged to continue
unless severe.
2. A client taking sertraline (Zoloft) for 6 weeks reports no improvement in
mood. What is the nurse’s best response?
A. “You need a higher dose immediately.”
B. “Let’s discuss switching to an SNRI.”
C. “Full therapeutic effect may take 8-12 weeks.”
D. “This medication is not working for you.”
Rationale: Antidepressants require 6-8 weeks (sometimes 12) for full effect.
Premature discontinuation is common but incorrect.
3. Which dietary restriction is critical for a client prescribed phenelzine
(Nardil), an MAOI?
A. Avoid grapefruit juice
B. Avoid aged cheeses, smoked meats, and red wine
,C. Limit caffeine to 1 cup/day
D. Increase fiber intake
Rationale: MAOIs interact with tyramine-rich foods → hypertensive crisis. Aged
cheese, cured meats, fermented products are high tyramine.
4. A client on venlafaxine (Effexor XR) misses two doses and reports dizziness,
nausea, and “brain zaps.” What is the most likely cause?
A. Serotonin syndrome
B. Discontinuation syndrome
C. Allergic reaction
D. Hypertensive crisis
Rationale: Venlafaxine has a short half-life; abrupt cessation causes withdrawal
(discontinuation syndrome) including paresthesias, dizziness, GI upset.
5. Which lab value requires immediate attention in a client taking trazodone
for insomnia?
A. Sodium 135 mEq/L
B. Potassium 5.9 mEq/L
C. Glucose 110 mg/dL
D. Creatinine 0.8 mg/dL
Rationale: Trazodone is safe but hyperkalemia (K >5.5) is a general medical
emergency; not directly drug-related but must be addressed. (Trick question: no
direct lab, but this tests priority.)
6. A client with depression and a history of seizure disorder should avoid
which antidepressant?
A. Escitalopram (Lexapro)
B. Bupropion (Wellbutrin)
C. Duloxetine (Cymbalta)
D. Mirtazapine (Remeron)
Rationale: Bupropion lowers seizure threshold and is contraindicated in seizure
disorders.
7. A client develops confusion, fever, muscle rigidity, and diaphoresis 3 days
after starting fluoxetine. What is the priority action?
A. Administer diphenhydramine
B. Stop the medication and prepare for possible serotonin syndrome
, C. Increase fluids
D. Give acetaminophen
Rationale: Symptoms suggest serotonin syndrome (especially with recent SSRI
start). Treatment includes stopping the drug and supportive care.
8. To prevent serotonin syndrome, how long after stopping fluoxetine should a
client wait to start an MAOI?
A. 2 weeks
B. 5 weeks
C. 10 days
D. 7 days
Rationale: Fluoxetine has a long half-life (including active metabolite
norfluoxetine). Washout of 5 weeks is required before starting an MAOI.
9. Which adverse effect is unique to tricyclic antidepressants (TCAs)
compared to SSRIs?
A. Sexual dysfunction
B. Cardiotoxicity in overdose
C. Insomnia
D. Weight loss
Rationale: TCAs cause QTc prolongation and fatal arrhythmias in overdose.
SSRIs are safer in OD.
10. A client on amitriptyline (Elavil) reports dry mouth and constipation.
What is the best nursing intervention?
A. Discontinue the medication
B. Sugar-free candy, fluids, and stool softeners
C. Reduce the dose by half
D. Switch to nortriptyline
Rationale: Anticholinergic effects (dry mouth, constipation) are common with
TCAs and managed symptomatically.
11. Which medication is most likely to cause hyponatremia in an older adult?
A. Bupropion
B. Mirtazapine
C. Sertraline (Zoloft)
D. Trazodone
Exam (Latest 2026 Edition)|| Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Section I: Antidepressants (SSRIs, SNRIs, TCAs, MAOIs) – Questions 1-20
1. A client prescribed fluoxetine (Prozac) reports nausea, headache, and
insomnia. Which nursing action is most appropriate?
A. Hold the medication and notify the provider
B. Administer the medication with a full meal
C. Advise the client that these side effects often subside in 1-2 weeks
D. Switch the medication to bedtime dosing
Rationale: Initial side effects of SSRIs (nausea, headache, insomnia) are common
and typically transient. Clients should be reassured and encouraged to continue
unless severe.
2. A client taking sertraline (Zoloft) for 6 weeks reports no improvement in
mood. What is the nurse’s best response?
A. “You need a higher dose immediately.”
B. “Let’s discuss switching to an SNRI.”
C. “Full therapeutic effect may take 8-12 weeks.”
D. “This medication is not working for you.”
Rationale: Antidepressants require 6-8 weeks (sometimes 12) for full effect.
Premature discontinuation is common but incorrect.
3. Which dietary restriction is critical for a client prescribed phenelzine
(Nardil), an MAOI?
A. Avoid grapefruit juice
B. Avoid aged cheeses, smoked meats, and red wine
,C. Limit caffeine to 1 cup/day
D. Increase fiber intake
Rationale: MAOIs interact with tyramine-rich foods → hypertensive crisis. Aged
cheese, cured meats, fermented products are high tyramine.
4. A client on venlafaxine (Effexor XR) misses two doses and reports dizziness,
nausea, and “brain zaps.” What is the most likely cause?
A. Serotonin syndrome
B. Discontinuation syndrome
C. Allergic reaction
D. Hypertensive crisis
Rationale: Venlafaxine has a short half-life; abrupt cessation causes withdrawal
(discontinuation syndrome) including paresthesias, dizziness, GI upset.
5. Which lab value requires immediate attention in a client taking trazodone
for insomnia?
A. Sodium 135 mEq/L
B. Potassium 5.9 mEq/L
C. Glucose 110 mg/dL
D. Creatinine 0.8 mg/dL
Rationale: Trazodone is safe but hyperkalemia (K >5.5) is a general medical
emergency; not directly drug-related but must be addressed. (Trick question: no
direct lab, but this tests priority.)
6. A client with depression and a history of seizure disorder should avoid
which antidepressant?
A. Escitalopram (Lexapro)
B. Bupropion (Wellbutrin)
C. Duloxetine (Cymbalta)
D. Mirtazapine (Remeron)
Rationale: Bupropion lowers seizure threshold and is contraindicated in seizure
disorders.
7. A client develops confusion, fever, muscle rigidity, and diaphoresis 3 days
after starting fluoxetine. What is the priority action?
A. Administer diphenhydramine
B. Stop the medication and prepare for possible serotonin syndrome
, C. Increase fluids
D. Give acetaminophen
Rationale: Symptoms suggest serotonin syndrome (especially with recent SSRI
start). Treatment includes stopping the drug and supportive care.
8. To prevent serotonin syndrome, how long after stopping fluoxetine should a
client wait to start an MAOI?
A. 2 weeks
B. 5 weeks
C. 10 days
D. 7 days
Rationale: Fluoxetine has a long half-life (including active metabolite
norfluoxetine). Washout of 5 weeks is required before starting an MAOI.
9. Which adverse effect is unique to tricyclic antidepressants (TCAs)
compared to SSRIs?
A. Sexual dysfunction
B. Cardiotoxicity in overdose
C. Insomnia
D. Weight loss
Rationale: TCAs cause QTc prolongation and fatal arrhythmias in overdose.
SSRIs are safer in OD.
10. A client on amitriptyline (Elavil) reports dry mouth and constipation.
What is the best nursing intervention?
A. Discontinue the medication
B. Sugar-free candy, fluids, and stool softeners
C. Reduce the dose by half
D. Switch to nortriptyline
Rationale: Anticholinergic effects (dry mouth, constipation) are common with
TCAs and managed symptomatically.
11. Which medication is most likely to cause hyponatremia in an older adult?
A. Bupropion
B. Mirtazapine
C. Sertraline (Zoloft)
D. Trazodone
