200+ QUESTIONS & ANSWERS WITH
RATIONALES
,ATI RN Pharmacology Exam 2026 – Mental Health Midterm Study Guide Questions & Answers
with Rationales
SECTION 1: ANTIDEPRESSANTS
Q1. A client prescribed fluoxetine (Prozac) for bulimia nervosa reports binge-eating episodes
continue. What is the appropriate nursing response?
A) "Let's discuss increasing your dose to 80 mg daily."
B) "Fluoxetine at 60 mg/day is FDA-approved for bulimia nervosa; therapeutic effects may take
time."
C) "Fluoxetine is not effective for bulimia; we should discuss switching medications."
D) "You should stop the medication immediately and notify your provider."
Answer: B
Rationale: Fluoxetine is FDA-approved for bulimia nervosa at doses of 60 mg/day and has been
shown to reduce binge-eating and purging episodes . The nurse should provide education about
therapeutic dosing and expected timeframes rather than suggesting dose changes or
discontinuation without provider consultation. Option A incorrectly suggests an unapproved
dose adjustment, C is incorrect because fluoxetine IS effective, and D would be unsafe.
Q2. A nurse is teaching a client about MAOI dietary restrictions. Which foods should the
client avoid? (Select all that apply)
A) Aged cheese
B) Pickled herring
C) Soy sauce
D) Yogurt
E) Fresh meat
,Answer: A, B, C
Rationale: Tyramine-rich foods can precipitate a hypertensive crisis in clients taking MAOIs .
Foods to avoid include aged cheeses, pickled or smoked fish, cured meats, fermented foods like
soy sauce, sauerkraut, and fava beans. Yogurt and fresh meat are generally considered safe.
The nurse should emphasize that even small amounts of tyramine can trigger a life-threatening
hypertensive crisis characterized by severe headache, hypertension, tachycardia, and potential
stroke.
Q3. A client taking an MAOI develops fever, agitation, muscle rigidity, and diaphoresis. The
nurse suspects which condition?
A) Hypertensive crisis
B) Serotonin syndrome
C) Neuroleptic malignant syndrome
D) MAOI toxicity
Answer: B
Rationale: Serotonin syndrome presents with a classic triad: mental status changes (agitation,
confusion), neuromuscular excitation (rigidity, hyperreflexia, clonus), and autonomic instability
(fever, tachycardia, diaphoresis) . This can occur with MAOIs when combined with other
serotonergic drugs or inadvertently with tyramine-rich foods. Hypertensive crisis (A) typically
presents with severe headache and elevated blood pressure. NMS (C) is associated with
antipsychotics and presents with "lead pipe" rigidity and fever. MAOI toxicity (D) is less specific.
Q4. A client is prescribed nortriptyline (Pamelor) for depression. What side effect should the
nurse instruct the client to monitor for?
A) Weight loss
B) Increased energy
, C) Orthostatic hypotension
D) Insomnia
Answer: C
Rationale: Tricyclic antidepressants (TCAs), including nortriptyline, cause orthostatic
hypotension due to alpha-1 adrenergic blockade . Clients should be taught to change positions
slowly, rising from lying to sitting gradually, and sit on the edge of the bed before standing.
TCAs are more commonly associated with sedation, weight gain, and anticholinergic effects (dry
mouth, constipation, urinary retention) rather than weight loss, increased energy, or insomnia.
Q5. A client is started on duloxetine (Cymbalta). Which laboratory value should be monitored
periodically?
A) Complete blood count
B) Liver enzymes
C) Thyroid function
D) Electrolytes
Answer: B
Rationale: Duloxetine can cause hepatotoxicity, manifesting as elevated liver enzymes .
Baseline and periodic liver function tests are recommended, especially in clients with pre-
existing liver disease. The nurse should also monitor for signs of hepatic injury including
jaundice, dark urine, and right upper quadrant pain. CBC (A), thyroid function (C), and
electrolytes (D) are not specifically indicated for routine monitoring with duloxetine.
Q6. A client with depression and a history of seizures is prescribed an antidepressant. Which
medication is most likely to lower the seizure threshold and should be avoided?
A) Escitalopram
B) Bupropion
RATIONALES
,ATI RN Pharmacology Exam 2026 – Mental Health Midterm Study Guide Questions & Answers
with Rationales
SECTION 1: ANTIDEPRESSANTS
Q1. A client prescribed fluoxetine (Prozac) for bulimia nervosa reports binge-eating episodes
continue. What is the appropriate nursing response?
A) "Let's discuss increasing your dose to 80 mg daily."
B) "Fluoxetine at 60 mg/day is FDA-approved for bulimia nervosa; therapeutic effects may take
time."
C) "Fluoxetine is not effective for bulimia; we should discuss switching medications."
D) "You should stop the medication immediately and notify your provider."
Answer: B
Rationale: Fluoxetine is FDA-approved for bulimia nervosa at doses of 60 mg/day and has been
shown to reduce binge-eating and purging episodes . The nurse should provide education about
therapeutic dosing and expected timeframes rather than suggesting dose changes or
discontinuation without provider consultation. Option A incorrectly suggests an unapproved
dose adjustment, C is incorrect because fluoxetine IS effective, and D would be unsafe.
Q2. A nurse is teaching a client about MAOI dietary restrictions. Which foods should the
client avoid? (Select all that apply)
A) Aged cheese
B) Pickled herring
C) Soy sauce
D) Yogurt
E) Fresh meat
,Answer: A, B, C
Rationale: Tyramine-rich foods can precipitate a hypertensive crisis in clients taking MAOIs .
Foods to avoid include aged cheeses, pickled or smoked fish, cured meats, fermented foods like
soy sauce, sauerkraut, and fava beans. Yogurt and fresh meat are generally considered safe.
The nurse should emphasize that even small amounts of tyramine can trigger a life-threatening
hypertensive crisis characterized by severe headache, hypertension, tachycardia, and potential
stroke.
Q3. A client taking an MAOI develops fever, agitation, muscle rigidity, and diaphoresis. The
nurse suspects which condition?
A) Hypertensive crisis
B) Serotonin syndrome
C) Neuroleptic malignant syndrome
D) MAOI toxicity
Answer: B
Rationale: Serotonin syndrome presents with a classic triad: mental status changes (agitation,
confusion), neuromuscular excitation (rigidity, hyperreflexia, clonus), and autonomic instability
(fever, tachycardia, diaphoresis) . This can occur with MAOIs when combined with other
serotonergic drugs or inadvertently with tyramine-rich foods. Hypertensive crisis (A) typically
presents with severe headache and elevated blood pressure. NMS (C) is associated with
antipsychotics and presents with "lead pipe" rigidity and fever. MAOI toxicity (D) is less specific.
Q4. A client is prescribed nortriptyline (Pamelor) for depression. What side effect should the
nurse instruct the client to monitor for?
A) Weight loss
B) Increased energy
, C) Orthostatic hypotension
D) Insomnia
Answer: C
Rationale: Tricyclic antidepressants (TCAs), including nortriptyline, cause orthostatic
hypotension due to alpha-1 adrenergic blockade . Clients should be taught to change positions
slowly, rising from lying to sitting gradually, and sit on the edge of the bed before standing.
TCAs are more commonly associated with sedation, weight gain, and anticholinergic effects (dry
mouth, constipation, urinary retention) rather than weight loss, increased energy, or insomnia.
Q5. A client is started on duloxetine (Cymbalta). Which laboratory value should be monitored
periodically?
A) Complete blood count
B) Liver enzymes
C) Thyroid function
D) Electrolytes
Answer: B
Rationale: Duloxetine can cause hepatotoxicity, manifesting as elevated liver enzymes .
Baseline and periodic liver function tests are recommended, especially in clients with pre-
existing liver disease. The nurse should also monitor for signs of hepatic injury including
jaundice, dark urine, and right upper quadrant pain. CBC (A), thyroid function (C), and
electrolytes (D) are not specifically indicated for routine monitoring with duloxetine.
Q6. A client with depression and a history of seizures is prescribed an antidepressant. Which
medication is most likely to lower the seizure threshold and should be avoided?
A) Escitalopram
B) Bupropion
