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HESI Exit Exam Prep:
Psychopharmacology Safety &
Side Effect Monitoring Guide
Table of Contents
Subtopic 1: Antidepressants – Safety, Side Effects, and Monitoring................3
Subtopic 2: Antipsychotics – Safety, Extrapyramidal Symptoms (EPS), and
Metabolic Monitoring.....................................................................................11
Subtopic 3: Mood Stabilizers – Monitoring, Interactions, and Safety
Parameters.....................................................................................................20
Subtopic 4: Anxiolytics and Sedatives – Benzodiazepine Safety, Dependence,
and Alternatives.............................................................................................29
Subtopic 5: Stimulants and ADHD Medications – Cardiovascular, Psychiatric,
and Abuse Monitoring....................................................................................38
Subtopic 6: Mood Stabilizers – Lithium, Anticonvulsants, and Toxicity
Monitoring......................................................................................................46
Subtopic 7: Sedatives, Hypnotics, and Anxiolytics – Safety, Dependency, and
Withdrawal Monitoring...................................................................................55
Subtopic 8: Anticholinergic Burden and CNS Effects of Psychiatric Medications
.......................................................................................................................64
Subtopic 9: Medication-Induced Movement Disorders and Nursing Actions. .72
Subtopic 10: Patient Education and Adherence Strategies in
Psychopharmacology.....................................................................................81
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Subtopic 1: Antidepressants – Safety, Side
Effects, and Monitoring
(Questions 1–20)
Question 1:
A patient recently started on sertraline reports increased anxiety and
restlessness. What is the most appropriate nursing action?
A. Encourage continued use and schedule a follow-up in one month
B. Educate the patient that initial anxiety may occur and monitor closely
C. Discontinue the medication immediately
D. Instruct the patient to double the dose to speed up effectiveness
Correct answer: B. Educate the patient that initial anxiety may occur and
monitor closely
Rationale: SSRIs like sertraline may initially increase anxiety before
therapeutic effects emerge. Education and close monitoring are essential to
prevent premature discontinuation.
Question 2:
Which side effect is most concerning and requires immediate intervention in
a patient taking clomipramine?
A. Constipation
B. Urinary retention
C. Dry mouth
D. Weight gain
Correct answer: B. Urinary retention
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Rationale: Tricyclic antidepressants like clomipramine can cause
anticholinergic effects. Urinary retention can lead to bladder distention and
renal complications, requiring urgent attention.
Question 3:
Which laboratory test should be monitored regularly for a patient on lithium
therapy?
A. AST and ALT
B. Serum sodium levels
C. CBC with differential
D. Hemoglobin A1c
Correct answer: B. Serum sodium levels
Rationale: Lithium excretion is influenced by sodium levels. Hyponatremia
increases the risk of lithium toxicity; therefore, sodium levels must be
monitored routinely.
Question 4:
What is the priority nursing intervention when a patient on phenelzine
complains of a severe headache and neck stiffness?
A. Encourage hydration
B. Provide a dark room
C. Check blood pressure and notify provider immediately
D. Administer acetaminophen
Correct answer: C. Check blood pressure and notify provider immediately
Rationale: These symptoms suggest hypertensive crisis, a known adverse
effect of MAOIs like phenelzine. Prompt assessment and intervention are
critical.
HESI Exit Exam Prep:
Psychopharmacology Safety &
Side Effect Monitoring Guide
Table of Contents
Subtopic 1: Antidepressants – Safety, Side Effects, and Monitoring................3
Subtopic 2: Antipsychotics – Safety, Extrapyramidal Symptoms (EPS), and
Metabolic Monitoring.....................................................................................11
Subtopic 3: Mood Stabilizers – Monitoring, Interactions, and Safety
Parameters.....................................................................................................20
Subtopic 4: Anxiolytics and Sedatives – Benzodiazepine Safety, Dependence,
and Alternatives.............................................................................................29
Subtopic 5: Stimulants and ADHD Medications – Cardiovascular, Psychiatric,
and Abuse Monitoring....................................................................................38
Subtopic 6: Mood Stabilizers – Lithium, Anticonvulsants, and Toxicity
Monitoring......................................................................................................46
Subtopic 7: Sedatives, Hypnotics, and Anxiolytics – Safety, Dependency, and
Withdrawal Monitoring...................................................................................55
Subtopic 8: Anticholinergic Burden and CNS Effects of Psychiatric Medications
.......................................................................................................................64
Subtopic 9: Medication-Induced Movement Disorders and Nursing Actions. .72
Subtopic 10: Patient Education and Adherence Strategies in
Psychopharmacology.....................................................................................81
,2
, 3
Subtopic 1: Antidepressants – Safety, Side
Effects, and Monitoring
(Questions 1–20)
Question 1:
A patient recently started on sertraline reports increased anxiety and
restlessness. What is the most appropriate nursing action?
A. Encourage continued use and schedule a follow-up in one month
B. Educate the patient that initial anxiety may occur and monitor closely
C. Discontinue the medication immediately
D. Instruct the patient to double the dose to speed up effectiveness
Correct answer: B. Educate the patient that initial anxiety may occur and
monitor closely
Rationale: SSRIs like sertraline may initially increase anxiety before
therapeutic effects emerge. Education and close monitoring are essential to
prevent premature discontinuation.
Question 2:
Which side effect is most concerning and requires immediate intervention in
a patient taking clomipramine?
A. Constipation
B. Urinary retention
C. Dry mouth
D. Weight gain
Correct answer: B. Urinary retention
, 4
Rationale: Tricyclic antidepressants like clomipramine can cause
anticholinergic effects. Urinary retention can lead to bladder distention and
renal complications, requiring urgent attention.
Question 3:
Which laboratory test should be monitored regularly for a patient on lithium
therapy?
A. AST and ALT
B. Serum sodium levels
C. CBC with differential
D. Hemoglobin A1c
Correct answer: B. Serum sodium levels
Rationale: Lithium excretion is influenced by sodium levels. Hyponatremia
increases the risk of lithium toxicity; therefore, sodium levels must be
monitored routinely.
Question 4:
What is the priority nursing intervention when a patient on phenelzine
complains of a severe headache and neck stiffness?
A. Encourage hydration
B. Provide a dark room
C. Check blood pressure and notify provider immediately
D. Administer acetaminophen
Correct answer: C. Check blood pressure and notify provider immediately
Rationale: These symptoms suggest hypertensive crisis, a known adverse
effect of MAOIs like phenelzine. Prompt assessment and intervention are
critical.
