, Question 1
A client with schizophrenia is prescribed clozapine. Which laboratory
monitoring schedule and intervention is most critical to prevent a potentially
fatal adverse effect?
A. Weekly serum clozapine levels; hold dose if level exceeds 350 ng/mL.
B. Weekly absolute neutrophil count (ANC) for 6 months, then every 2
weeks for 6 months, then monthly; interrupt therapy if ANC < 1000/µL.
C. Monthly liver function tests; discontinue if ALT is twice the upper
limit of normal.
D. Every-3-month fasting lipid panel; initiate statin if LDL > 130 mg/dL.
Correct Answer: B - Weekly absolute neutrophil count (ANC) for
6 months, then every 2 weeks for 6 months, then monthly;
interrupt therapy if ANC < 1000/µL.
RATIONALE
Clozapine carries a boxed warning for severe
neutropenia/agranulocytosis; the FDA-mandated REMS program
requires ANC monitoring with specific thresholds (interrupt if ANC <
1000/µL) to prevent fatal infection. Clozapine levels (A) are not
routinely used for agranulocytosis prevention, LFTs (C) monitor
hepatotoxicity but are not the most critical fatal risk, and lipid
monitoring (D) addresses metabolic syndrome but not the immediate
life-threatening risk.
Question 2
A client experiencing a panic attack is brought to the emergency department.
Which nursing action should be implemented first?
A. Teach the client to use a cognitive restructuring worksheet to
challenge catastrophic thoughts.
B. Administer the prescribed PRN lorazepam immediately to abort the
panic attack.
C. Stay with the client and use a calm, simple, repetitive voice to validate
Page 2
, safety and reduce stimuli.
D. Initiate a detailed assessment of triggers and history of panic attacks to
identify patterns.
Correct Answer: C - Stay with the client and use a calm, simple,
repetitive voice to validate safety and reduce stimuli.
RATIONALE
During an acute panic attack, the priority is to reduce anxiety and
ensure safety by staying with the client, using a calm presence, and
minimizing environmental stimuli; this aligns with crisis intervention
principles. Administering PRN medication (B) may be appropriate but
is not the first-line nursing action unless the client is a danger to
self/others. Cognitive restructuring (A) and detailed assessment (D)
are more appropriate after the acute phase has subsided.
Question 3
A client with major depressive disorder has been taking sertraline for 4 weeks
and reports no improvement. Which assessment finding would most strongly
suggest the need to reconsider the diagnosis or treatment plan?
A. The client reports improved sleep but continued anhedonia.
B. The client exhibits psychomotor retardation and hypersomnia.
C. The client has a history of hypomanic episodes while taking
antidepressants.
D. The client's PHQ-9 score decreased from 18 to 14.
Correct Answer: C - The client has a history of hypomanic
episodes while taking antidepressants.
Page 3
, RATIONALE
A history of hypomanic episodes during antidepressant treatment
suggests bipolar II disorder rather than unipolar depression;
antidepressants can induce mania/hypomania and worsen the course.
This requires a shift to mood stabilizers. The other findings (A, B, D)
are consistent with depression or partial response and do not
necessitate a diagnostic re-evaluation as urgently.
Question 4
A client is admitted with alcohol withdrawal. The nurse notes tremors,
diaphoresis, and a heart rate of 120 bpm. Which medication order should the
nurse anticipate to manage these symptoms and prevent progression to
seizures?
A. Haloperidol 5 mg IM PRN for agitation.
B. Lorazepam 2 mg IV every 4 hours PRN based on CIWA-Ar score.
C. Naltrexone 50 mg PO daily to reduce cravings.
D. Thiamine 100 mg IV daily to prevent Wernicke's encephalopathy.
Correct Answer: B - Lorazepam 2 mg IV every 4 hours PRN
based on CIWA-Ar score.
RATIONALE
Benzodiazepines (e.g., lorazepam) are the standard of care for
managing alcohol withdrawal symptoms and preventing seizures and
delirium tremens, guided by CIWA-Ar scores. Haloperidol (A) may
lower seizure threshold and is not first-line. Naltrexone (C) reduces
cravings but does not treat acute withdrawal. Thiamine (D) is essential
for Wernicke's prevention but does not manage autonomic
hyperactivity.
Page 4
A client with schizophrenia is prescribed clozapine. Which laboratory
monitoring schedule and intervention is most critical to prevent a potentially
fatal adverse effect?
A. Weekly serum clozapine levels; hold dose if level exceeds 350 ng/mL.
B. Weekly absolute neutrophil count (ANC) for 6 months, then every 2
weeks for 6 months, then monthly; interrupt therapy if ANC < 1000/µL.
C. Monthly liver function tests; discontinue if ALT is twice the upper
limit of normal.
D. Every-3-month fasting lipid panel; initiate statin if LDL > 130 mg/dL.
Correct Answer: B - Weekly absolute neutrophil count (ANC) for
6 months, then every 2 weeks for 6 months, then monthly;
interrupt therapy if ANC < 1000/µL.
RATIONALE
Clozapine carries a boxed warning for severe
neutropenia/agranulocytosis; the FDA-mandated REMS program
requires ANC monitoring with specific thresholds (interrupt if ANC <
1000/µL) to prevent fatal infection. Clozapine levels (A) are not
routinely used for agranulocytosis prevention, LFTs (C) monitor
hepatotoxicity but are not the most critical fatal risk, and lipid
monitoring (D) addresses metabolic syndrome but not the immediate
life-threatening risk.
Question 2
A client experiencing a panic attack is brought to the emergency department.
Which nursing action should be implemented first?
A. Teach the client to use a cognitive restructuring worksheet to
challenge catastrophic thoughts.
B. Administer the prescribed PRN lorazepam immediately to abort the
panic attack.
C. Stay with the client and use a calm, simple, repetitive voice to validate
Page 2
, safety and reduce stimuli.
D. Initiate a detailed assessment of triggers and history of panic attacks to
identify patterns.
Correct Answer: C - Stay with the client and use a calm, simple,
repetitive voice to validate safety and reduce stimuli.
RATIONALE
During an acute panic attack, the priority is to reduce anxiety and
ensure safety by staying with the client, using a calm presence, and
minimizing environmental stimuli; this aligns with crisis intervention
principles. Administering PRN medication (B) may be appropriate but
is not the first-line nursing action unless the client is a danger to
self/others. Cognitive restructuring (A) and detailed assessment (D)
are more appropriate after the acute phase has subsided.
Question 3
A client with major depressive disorder has been taking sertraline for 4 weeks
and reports no improvement. Which assessment finding would most strongly
suggest the need to reconsider the diagnosis or treatment plan?
A. The client reports improved sleep but continued anhedonia.
B. The client exhibits psychomotor retardation and hypersomnia.
C. The client has a history of hypomanic episodes while taking
antidepressants.
D. The client's PHQ-9 score decreased from 18 to 14.
Correct Answer: C - The client has a history of hypomanic
episodes while taking antidepressants.
Page 3
, RATIONALE
A history of hypomanic episodes during antidepressant treatment
suggests bipolar II disorder rather than unipolar depression;
antidepressants can induce mania/hypomania and worsen the course.
This requires a shift to mood stabilizers. The other findings (A, B, D)
are consistent with depression or partial response and do not
necessitate a diagnostic re-evaluation as urgently.
Question 4
A client is admitted with alcohol withdrawal. The nurse notes tremors,
diaphoresis, and a heart rate of 120 bpm. Which medication order should the
nurse anticipate to manage these symptoms and prevent progression to
seizures?
A. Haloperidol 5 mg IM PRN for agitation.
B. Lorazepam 2 mg IV every 4 hours PRN based on CIWA-Ar score.
C. Naltrexone 50 mg PO daily to reduce cravings.
D. Thiamine 100 mg IV daily to prevent Wernicke's encephalopathy.
Correct Answer: B - Lorazepam 2 mg IV every 4 hours PRN
based on CIWA-Ar score.
RATIONALE
Benzodiazepines (e.g., lorazepam) are the standard of care for
managing alcohol withdrawal symptoms and preventing seizures and
delirium tremens, guided by CIWA-Ar scores. Haloperidol (A) may
lower seizure threshold and is not first-line. Naltrexone (C) reduces
cravings but does not treat acute withdrawal. Thiamine (D) is essential
for Wernicke's prevention but does not manage autonomic
hyperactivity.
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