PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY QUESTIONS AND
ANSWERS A+ GUARANTEE 2023 UPDATE
2026–2027 Updated Exam 100% (VERIFIED ANSWERS)|A+ GRADE BRAND NEW
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 1 of 150
Learning Objective: Analyze the physiological and behavioral indications for scheduling daily fluoxetine (Prozac) dosing early in the morning.
Question: A nurse is providing discharge instructions to a client who is newly prescribed with fluoxetine (Prozac) 20 mg PO daily for Major Depressive Disorder. At which
of the following times should the nurse instruct the client to take this medication to maximize clinical safety and compliance?
A. Early in the morning. B. During lunch time.
C. At snack time. D. At bedtime.
ANSWER ✓: A — Early in the morning.
Explanation: Fluoxetine (Prozac) is a Selective Serotonin Reuptake Inhibitor (SSRI) used to treat major depressive disorder, bulimia nervosa, obsessive-compulsive
disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). It should be scheduled early in the morning because it acts as a central nervous system
stimulant and can cause insomnia or interfere with sleep patterns if taken later in the day.
Question 2 of 150
Learning Objective: Evaluate the clinical signs, symptoms, and pathophysiological presentation of drug-induced Serotonin Syndrome.
Question: An advanced practice nurse is monitoring a psychiatric patient who is transitioning from phenelzine (Nardil) to fluoxetine (Prozac). The patient presents with
muscle rigidity, a temperature of 103.8 F (39.9 C), severe tachycardia, and hyperreflexia. The nurse should immediately recognize these symptoms as characteristic of
which potentially life-threatening condition?
A. Tricyclic antidepressant-induced anticholinergic toxicity. B. Mild lithium-induced neuromuscular irritability.
C. Drug-induced Serotonin Syndrome. D. Agranulocytosis-related systemic septic shock.
ANSWER ✓: C — Drug-induced Serotonin Syndrome.
Explanation: Serotonin syndrome is a potentially life-threatening drug reaction caused by excessive serotonergic activity in the central nervous system, most commonly
occurring when SSRIs are co-administered with Monoamine Oxidase Inhibitors (MAOIs) like phenelzine. It is clinically characterized by cognitive/behavioral alterations
(agitation, confusion), autonomic dysfunction (tachycardia, high fever, hypertension, diaphoresis, diarrhea), and neuromuscular hyperactivity (muscle rigidity, tremors,
clonus, dilated pupils).
Question 3 of 150
Learning Objective: Implement clinical surveillance protocols for monitoring suicidal thoughts in clients taking antidepressants.
Question: A client with major depression has been receiving amitriptyline PO daily for three months and returns to the mental health clinic for a scheduled follow-up.
During the clinical interview, which of the following assessments should the nurse prioritize to prevent self-harm and ensure safety?
A. Lack of energy. B. Suicidal thoughts.
C. Loss of interest in personal appearance. D. Neglect of responsibilities.
ANSWER ✓: B — Suicidal thoughts.
Explanation: Clients taking antidepressant medications (such as amitriptyline or SSRIs) have an increased risk of experiencing suicidal thoughts, especially during the
initial phase of therapy (first few weeks) and at any time when dosage adjustments are made. The nurse must prioritize evaluating the presence of suicidal ideation and
formulating a safety contract. The other options represent typical signs of depression that are expected to improve as treatment continues.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 1 of 50
,PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 4 of 150
Learning Objective: Differentiate the clinical side effect profiles of selective serotonin reuptake inhibitors to optimize drug scheduling.
Question: A nurse is preparing a medication administration plan for a client who is newly prescribed with sertraline (Zoloft) for the treatment of Panic Disorder and
obsessive-compulsive disorder (OCD). To ensure clinical safety and manage side effects, which of the following schedules is most favored?
A. As needed only for severe panic attacks. B. At lunchtime with a high-protein meal.
C. On an empty stomach immediately before exercise. D. At bedtime.
ANSWER ✓: D — At bedtime.
Explanation: Sertraline (Zoloft) is an SSRI used to treat major depressive disorder, panic attacks, obsessive-compulsive disorder (OCD), social phobia, and post-traumatic
stress disorder (PTSD). While sertraline can be administered in the morning or evening, scheduling the dose at bedtime is clinically favored because drowsiness,
somnolence, and sedation are prominent side effects of this medication.
Question 5 of 150
Learning Objective: Formulate client education regarding the therapeutic onset and behavioral management of SSRIs.
Question: A client is starting a new prescription for fluoxetine (Prozac). The client asks the nurse, "When will I begin to feel better and notice a significant improvement in
my depressive symptoms?" Which of the following responses by the nurse is clinically accurate?
A. You will notice a complete resolution of your symptoms within 24 to 48 hours of B. It typically takes 1 to 2 weeks for an initial response, with a full therapeutic effect
your first dose. appearing in 6 to 8 weeks.
C. SSRIs only work when taken on an empty stomach twice a week as needed. D. There is no therapeutic response until the drug is titrated to its maximum toxic
level.
ANSWER ✓: B — It typically takes 1 to 2 weeks for an initial response, with a full therapeutic effect appearing in 6 to 8 weeks.
Explanation: Antidepressants like fluoxetine do not produce an immediate cure or resolution of symptoms. An initial clinical response may be noted in 1 to 2 weeks, but a
full therapeutic effect requires approximately 6 to 8 weeks of daily adherence. Patients should be educated to continue taking the drug even if they do not see immediate
improvement.
Question 6 of 150
Learning Objective: Analyze the legal and clinical safety hazards associated with the sudden discontinuation of SSRIs.
Question: A client who has been taking paroxetine (Paxil) PO daily for six months tells the nurse that they feel completely cured and intend to stop taking the medication
tomorrow. What critical educational point should the nurse discuss with the client?
A. Stopping the drug abruptly is safe as long as the client drinks 6-8 glasses of B. The medication must be reduced and tapered gradually under medical
water. supervision to avoid discontinuation syndrome.
C. The client should immediately replace the antidepressant with a central nervous D. SSRIs should only be taken when active depressive symptoms are displayed.
system stimulant.
ANSWER ✓: B — The medication must be reduced and tapered gradually under medical supervision to avoid discontinuation syndrome.
Explanation: SSRIs must be tapered off gradually to prevent the onset of antidepressant discontinuation syndrome, which can present as dizziness, paresthesia, irritability,
vivid dreams, tremors, and nausea. Abrupt cessation can also precipitate a rapid, severe recurrence of the original depressive or anxiety symptoms.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 2 of 50
,PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 7 of 150
Learning Objective: Evaluate the pharmacotherapeutic guidelines for managing the washout period between MAOIs and SSRIs.
Question: To prevent the development of a fatal hypertensive crisis or serotonin syndrome, which of the following represents the required washout period when
transitioning a client from phenelzine (Nardil) to an SSRI antidepressant?
A. No washout period is required; the drugs can be co-administered immediately. B. At least 14 days must elapse between discontinuing the MAOI and initiating the
SSRI.
C. Exactly 24 hours of hydration with saline solution is sufficient. D. The client must undergo an emergency gastric lavage with activated charcoal
before taking the first dose.
ANSWER ✓: B — At least 14 days must elapse between discontinuing the MAOI and initiating the SSRI.
Explanation: Due to the long-lasting, irreversible inhibition of monoamine oxidase by drugs like phenelzine, at least 14 days must be allowed for the synthesis of new MAO
enzymes before starting an SSRI. Co-administration or inadequate washout intervals can lead to severe serotonin syndrome or hypertensive emergencies.
Question 8 of 150
Learning Objective: Identify key endocrine and sexual side effects of SSRIs to support client counseling and adherence.
Question: During a follow-up visit, a male client taking sertraline (Zoloft) complains of a delay in ejaculation, decreased libido, and mild weight gain. Which of the following
responses by the nurse is most appropriate?
A. These are signs of severe lithium-like toxicity and require immediate dialysis. B. These are common, documented side effects of SSRI therapy; we can discuss
management or alternatives with your provider.
C. You must immediately stop taking your medication to reverse these permanent D. These symptoms are purely psychological and are not related to your sertraline
endocrine changes. therapy.
ANSWER ✓: B — These are common, documented side effects of SSRI therapy; we can discuss management or alternatives with your provider.
Explanation: Sexual dysfunction (including delayed ejaculation, anorgasmia, and decreased libido) and mild weight changes are common, well-documented adverse
effects of SSRIs. Open communication allows the healthcare team to explore options, such as dose adjustment, a drug holiday, or switching to an atypical agent like
bupropion.
Question 9 of 150
Learning Objective: Analyze the gastrointestinal safety and administration guidelines for SSRI pharmacotherapy.
Question: A client taking sertraline (Zoloft) reports experiencing moderate nausea and dyspepsia. What advice should the nurse provide to minimize these gastrointestinal
side effects?
A. Take the medication with food, milk, or a full glass of water. B. Drink a high-potency alcoholic beverage immediately after taking the pill.
C. Crush the medication and mix it with a highly acidic juice like grapefruit juice. D. Limit overall fluid intake to less than 2 glasses of water per day.
ANSWER ✓: A — Take the medication with food, milk, or a full glass of water.
Explanation: Gastrointestinal upset, including nausea, vomiting, dyspepsia, and diarrhea, is common upon initiating SSRI therapy due to the high density of serotonin
receptors in the gut. Taking the medication with food or milk helps buffer the gastric mucosa and reduce these symptoms.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 3 of 50
, PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 10 of 150
Learning Objective: Implement clinical assessment priorities when Serotonin Syndrome is clinically suspected.
Question: A client taking an SSRI presents to the clinic with suspected serotonin syndrome. Which of the following sets of physical findings should the nurse expect to
observe during the physical assessment?
A. Hypothermia, bradycardia, and cold, dry skin. B. Agitation, tachycardia, muscle rigidity, tremors, and hyperthermia.
C. Constipation, urinary retention, and profound miosis. D. Mottled skin discoloration (livedo reticularis) and severe bradykinesia.
ANSWER ✓: B — Agitation, tachycardia, muscle rigidity, tremors, and hyperthermia.
Explanation: Serotonin syndrome is characterized by a triad of cognitive/behavioral signs (agitation, restlessness, confusion), autonomic hyperactivity (tachycardia,
hyperthermia, diaphoresis, hypertension, dilated pupils, diarrhea), and neuromuscular excitement (muscle rigidity, hyperreflexia, tremors, myoclonus).
Question 11 of 150
Learning Objective: Evaluate the risk of QT-interval prolongation associated with specific SSRIs.
Question: An older adult patient is prescribed citalopram (Celexa). What cardiac risk must the nurse monitor for when administering Celexa to geriatric populations,
especially at doses exceeding 20 mg PO daily?
A. Uncontrolled ventricular bigeminy and complete AV block. B. QT-interval prolongation and torsades de pointes.
C. Transient myocardial infarction and severe coronary spasm. D. Hypertensive crisis secondary to acute tyramine accumulation.
ANSWER ✓: B — QT-interval prolongation and torsades de pointes.
Explanation: Citalopram (Celexa) and escitalopram are known to cause dose-dependent QT-interval prolongation. In older adults or patients with hepatic impairment, the
maximum daily dose of citalopram is capped at 20 mg PO daily to avoid predisposing the patient to life-threatening ventricular arrhythmias like torsades de pointes.
Question 12 of 150
Learning Objective: Apply clinical guidelines for managing mild SSRI-induced hyponatremia in geriatric cohorts.
Question: A 78-year-old female patient taking sertraline (Zoloft) is admitted with lethargy and confusion. Her laboratory studies reveal a serum sodium level of 122 mEq/L
(normal: 135-145 mEq/L). The nurse should identify this finding as which of the following common SSRI complications in the elderly?
A. Lithium-like sodium retention. B. Drug-induced diabetes insipidus.
C. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) causing hyponatremia. D. Anticholinergic-induced fluid depletion.
ANSWER ✓: C — Syndrome of Inappropriate Antidiuretic Hormone (SIADH) causing hyponatremia.
Explanation: Geriatric patients taking SSRIs are at an increased risk of developing SIADH, which leads to water retention and dilutional hyponatremia (sodium < 135
mEq/L). The nurse must monitor for symptoms such as confusion, lethargy, muscle weakness, and seizures, and report abnormal sodium levels immediately.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 4 of 50
PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY QUESTIONS AND
ANSWERS A+ GUARANTEE 2023 UPDATE
2026–2027 Updated Exam 100% (VERIFIED ANSWERS)|A+ GRADE BRAND NEW
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 1 of 150
Learning Objective: Analyze the physiological and behavioral indications for scheduling daily fluoxetine (Prozac) dosing early in the morning.
Question: A nurse is providing discharge instructions to a client who is newly prescribed with fluoxetine (Prozac) 20 mg PO daily for Major Depressive Disorder. At which
of the following times should the nurse instruct the client to take this medication to maximize clinical safety and compliance?
A. Early in the morning. B. During lunch time.
C. At snack time. D. At bedtime.
ANSWER ✓: A — Early in the morning.
Explanation: Fluoxetine (Prozac) is a Selective Serotonin Reuptake Inhibitor (SSRI) used to treat major depressive disorder, bulimia nervosa, obsessive-compulsive
disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD). It should be scheduled early in the morning because it acts as a central nervous system
stimulant and can cause insomnia or interfere with sleep patterns if taken later in the day.
Question 2 of 150
Learning Objective: Evaluate the clinical signs, symptoms, and pathophysiological presentation of drug-induced Serotonin Syndrome.
Question: An advanced practice nurse is monitoring a psychiatric patient who is transitioning from phenelzine (Nardil) to fluoxetine (Prozac). The patient presents with
muscle rigidity, a temperature of 103.8 F (39.9 C), severe tachycardia, and hyperreflexia. The nurse should immediately recognize these symptoms as characteristic of
which potentially life-threatening condition?
A. Tricyclic antidepressant-induced anticholinergic toxicity. B. Mild lithium-induced neuromuscular irritability.
C. Drug-induced Serotonin Syndrome. D. Agranulocytosis-related systemic septic shock.
ANSWER ✓: C — Drug-induced Serotonin Syndrome.
Explanation: Serotonin syndrome is a potentially life-threatening drug reaction caused by excessive serotonergic activity in the central nervous system, most commonly
occurring when SSRIs are co-administered with Monoamine Oxidase Inhibitors (MAOIs) like phenelzine. It is clinically characterized by cognitive/behavioral alterations
(agitation, confusion), autonomic dysfunction (tachycardia, high fever, hypertension, diaphoresis, diarrhea), and neuromuscular hyperactivity (muscle rigidity, tremors,
clonus, dilated pupils).
Question 3 of 150
Learning Objective: Implement clinical surveillance protocols for monitoring suicidal thoughts in clients taking antidepressants.
Question: A client with major depression has been receiving amitriptyline PO daily for three months and returns to the mental health clinic for a scheduled follow-up.
During the clinical interview, which of the following assessments should the nurse prioritize to prevent self-harm and ensure safety?
A. Lack of energy. B. Suicidal thoughts.
C. Loss of interest in personal appearance. D. Neglect of responsibilities.
ANSWER ✓: B — Suicidal thoughts.
Explanation: Clients taking antidepressant medications (such as amitriptyline or SSRIs) have an increased risk of experiencing suicidal thoughts, especially during the
initial phase of therapy (first few weeks) and at any time when dosage adjustments are made. The nurse must prioritize evaluating the presence of suicidal ideation and
formulating a safety contract. The other options represent typical signs of depression that are expected to improve as treatment continues.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 1 of 50
,PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 4 of 150
Learning Objective: Differentiate the clinical side effect profiles of selective serotonin reuptake inhibitors to optimize drug scheduling.
Question: A nurse is preparing a medication administration plan for a client who is newly prescribed with sertraline (Zoloft) for the treatment of Panic Disorder and
obsessive-compulsive disorder (OCD). To ensure clinical safety and manage side effects, which of the following schedules is most favored?
A. As needed only for severe panic attacks. B. At lunchtime with a high-protein meal.
C. On an empty stomach immediately before exercise. D. At bedtime.
ANSWER ✓: D — At bedtime.
Explanation: Sertraline (Zoloft) is an SSRI used to treat major depressive disorder, panic attacks, obsessive-compulsive disorder (OCD), social phobia, and post-traumatic
stress disorder (PTSD). While sertraline can be administered in the morning or evening, scheduling the dose at bedtime is clinically favored because drowsiness,
somnolence, and sedation are prominent side effects of this medication.
Question 5 of 150
Learning Objective: Formulate client education regarding the therapeutic onset and behavioral management of SSRIs.
Question: A client is starting a new prescription for fluoxetine (Prozac). The client asks the nurse, "When will I begin to feel better and notice a significant improvement in
my depressive symptoms?" Which of the following responses by the nurse is clinically accurate?
A. You will notice a complete resolution of your symptoms within 24 to 48 hours of B. It typically takes 1 to 2 weeks for an initial response, with a full therapeutic effect
your first dose. appearing in 6 to 8 weeks.
C. SSRIs only work when taken on an empty stomach twice a week as needed. D. There is no therapeutic response until the drug is titrated to its maximum toxic
level.
ANSWER ✓: B — It typically takes 1 to 2 weeks for an initial response, with a full therapeutic effect appearing in 6 to 8 weeks.
Explanation: Antidepressants like fluoxetine do not produce an immediate cure or resolution of symptoms. An initial clinical response may be noted in 1 to 2 weeks, but a
full therapeutic effect requires approximately 6 to 8 weeks of daily adherence. Patients should be educated to continue taking the drug even if they do not see immediate
improvement.
Question 6 of 150
Learning Objective: Analyze the legal and clinical safety hazards associated with the sudden discontinuation of SSRIs.
Question: A client who has been taking paroxetine (Paxil) PO daily for six months tells the nurse that they feel completely cured and intend to stop taking the medication
tomorrow. What critical educational point should the nurse discuss with the client?
A. Stopping the drug abruptly is safe as long as the client drinks 6-8 glasses of B. The medication must be reduced and tapered gradually under medical
water. supervision to avoid discontinuation syndrome.
C. The client should immediately replace the antidepressant with a central nervous D. SSRIs should only be taken when active depressive symptoms are displayed.
system stimulant.
ANSWER ✓: B — The medication must be reduced and tapered gradually under medical supervision to avoid discontinuation syndrome.
Explanation: SSRIs must be tapered off gradually to prevent the onset of antidepressant discontinuation syndrome, which can present as dizziness, paresthesia, irritability,
vivid dreams, tremors, and nausea. Abrupt cessation can also precipitate a rapid, severe recurrence of the original depressive or anxiety symptoms.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 2 of 50
,PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 7 of 150
Learning Objective: Evaluate the pharmacotherapeutic guidelines for managing the washout period between MAOIs and SSRIs.
Question: To prevent the development of a fatal hypertensive crisis or serotonin syndrome, which of the following represents the required washout period when
transitioning a client from phenelzine (Nardil) to an SSRI antidepressant?
A. No washout period is required; the drugs can be co-administered immediately. B. At least 14 days must elapse between discontinuing the MAOI and initiating the
SSRI.
C. Exactly 24 hours of hydration with saline solution is sufficient. D. The client must undergo an emergency gastric lavage with activated charcoal
before taking the first dose.
ANSWER ✓: B — At least 14 days must elapse between discontinuing the MAOI and initiating the SSRI.
Explanation: Due to the long-lasting, irreversible inhibition of monoamine oxidase by drugs like phenelzine, at least 14 days must be allowed for the synthesis of new MAO
enzymes before starting an SSRI. Co-administration or inadequate washout intervals can lead to severe serotonin syndrome or hypertensive emergencies.
Question 8 of 150
Learning Objective: Identify key endocrine and sexual side effects of SSRIs to support client counseling and adherence.
Question: During a follow-up visit, a male client taking sertraline (Zoloft) complains of a delay in ejaculation, decreased libido, and mild weight gain. Which of the following
responses by the nurse is most appropriate?
A. These are signs of severe lithium-like toxicity and require immediate dialysis. B. These are common, documented side effects of SSRI therapy; we can discuss
management or alternatives with your provider.
C. You must immediately stop taking your medication to reverse these permanent D. These symptoms are purely psychological and are not related to your sertraline
endocrine changes. therapy.
ANSWER ✓: B — These are common, documented side effects of SSRI therapy; we can discuss management or alternatives with your provider.
Explanation: Sexual dysfunction (including delayed ejaculation, anorgasmia, and decreased libido) and mild weight changes are common, well-documented adverse
effects of SSRIs. Open communication allows the healthcare team to explore options, such as dose adjustment, a drug holiday, or switching to an atypical agent like
bupropion.
Question 9 of 150
Learning Objective: Analyze the gastrointestinal safety and administration guidelines for SSRI pharmacotherapy.
Question: A client taking sertraline (Zoloft) reports experiencing moderate nausea and dyspepsia. What advice should the nurse provide to minimize these gastrointestinal
side effects?
A. Take the medication with food, milk, or a full glass of water. B. Drink a high-potency alcoholic beverage immediately after taking the pill.
C. Crush the medication and mix it with a highly acidic juice like grapefruit juice. D. Limit overall fluid intake to less than 2 glasses of water per day.
ANSWER ✓: A — Take the medication with food, milk, or a full glass of water.
Explanation: Gastrointestinal upset, including nausea, vomiting, dyspepsia, and diarrhea, is common upon initiating SSRI therapy due to the high density of serotonin
receptors in the gut. Taking the medication with food or milk helps buffer the gastric mucosa and reduce these symptoms.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 3 of 50
, PSYCHIATRIC DRUGS AND MEDICATIONS: NURSING PHARMACOLOGY 2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS)
CHAPTER 1: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) & RELATED ANTIDEPRESSANTS
Question 10 of 150
Learning Objective: Implement clinical assessment priorities when Serotonin Syndrome is clinically suspected.
Question: A client taking an SSRI presents to the clinic with suspected serotonin syndrome. Which of the following sets of physical findings should the nurse expect to
observe during the physical assessment?
A. Hypothermia, bradycardia, and cold, dry skin. B. Agitation, tachycardia, muscle rigidity, tremors, and hyperthermia.
C. Constipation, urinary retention, and profound miosis. D. Mottled skin discoloration (livedo reticularis) and severe bradykinesia.
ANSWER ✓: B — Agitation, tachycardia, muscle rigidity, tremors, and hyperthermia.
Explanation: Serotonin syndrome is characterized by a triad of cognitive/behavioral signs (agitation, restlessness, confusion), autonomic hyperactivity (tachycardia,
hyperthermia, diaphoresis, hypertension, dilated pupils, diarrhea), and neuromuscular excitement (muscle rigidity, hyperreflexia, tremors, myoclonus).
Question 11 of 150
Learning Objective: Evaluate the risk of QT-interval prolongation associated with specific SSRIs.
Question: An older adult patient is prescribed citalopram (Celexa). What cardiac risk must the nurse monitor for when administering Celexa to geriatric populations,
especially at doses exceeding 20 mg PO daily?
A. Uncontrolled ventricular bigeminy and complete AV block. B. QT-interval prolongation and torsades de pointes.
C. Transient myocardial infarction and severe coronary spasm. D. Hypertensive crisis secondary to acute tyramine accumulation.
ANSWER ✓: B — QT-interval prolongation and torsades de pointes.
Explanation: Citalopram (Celexa) and escitalopram are known to cause dose-dependent QT-interval prolongation. In older adults or patients with hepatic impairment, the
maximum daily dose of citalopram is capped at 20 mg PO daily to avoid predisposing the patient to life-threatening ventricular arrhythmias like torsades de pointes.
Question 12 of 150
Learning Objective: Apply clinical guidelines for managing mild SSRI-induced hyponatremia in geriatric cohorts.
Question: A 78-year-old female patient taking sertraline (Zoloft) is admitted with lethargy and confusion. Her laboratory studies reveal a serum sodium level of 122 mEq/L
(normal: 135-145 mEq/L). The nurse should identify this finding as which of the following common SSRI complications in the elderly?
A. Lithium-like sodium retention. B. Drug-induced diabetes insipidus.
C. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) causing hyponatremia. D. Anticholinergic-induced fluid depletion.
ANSWER ✓: C — Syndrome of Inappropriate Antidiuretic Hormone (SIADH) causing hyponatremia.
Explanation: Geriatric patients taking SSRIs are at an increased risk of developing SIADH, which leads to water retention and dilutional hyponatremia (sodium < 135
mEq/L). The nurse must monitor for symptoms such as confusion, lethargy, muscle weakness, and seizures, and report abnormal sodium levels immediately.
OAKLAND COMMUNITY COLLEGE — CLINICAL PHARMACOLOGY STUDY SERIES Page 4 of 50
