🧪 Meds, Mechanisms & Mayhem
Multiple Choice
A client with Bipolar Disorder, starting lithium, has a lab level of 0.8 meq/l. What should the nurse do?
A. Hold dose
B. Notify provider
C. Administer as prescribed
D. Increase fluids to dilute lithium
What is "C"?
Rationale: The therapeutic range is 0.6-1.2 meq/l. 0.8 is within range; no change is indicated. Increasing fluids intentionally to "dilute" lithium is unsafe and unnecessary.
Multiple choice
SSRI + linezolid → Which danger sign?
A. Dry mouth
B. Clonus and hyperreflexia
C. Low bp
D. Constipation
What is "B"?
Rationale: Linezolid has MAOI-like properties; with SSRIs it can trigger serotonin syndrome: agitation, hyperreflexia, clonus, fever, diarrhea.
Multiple choice:
Client: "I feel hopeless." Best response:
A. Stop thinking that
B. "Tell me more about what's making you feel this way."
C. You're fine
D. Look at the bright side
What is “B”?
Rationale: Open-ended exploration and reflection validate feelings and elicit more information; avoid minimizing or false reassurance.
Multiple choice:
Voluntary client wants to leave. First action?
A. Restrain
B. Assess risk to self/others and notify provider
C. Allow to leave immediately
D. Call security
What is “B”?
Rationale: Voluntary clients may leave unless dangerous. Assess for risk and initiate legal processes if criteria are met.
Multiple choice:
Who do you assess first?
A. Depressed client sleeping
B. Client with command hallucinations to harm others
C. Mild anxiety
D. Hungry bipolar client
What is “B”?
Rationale: Immediate safety risk to others (and possibly self) takes priority.
Multiple choice:
Which finding most strongly differentiates neuroleptic malignant syndrome (nms) from serotonin syndrome?
A. Diarrhea
B. "Lead-pipe" muscle rigidity with hyporeflexia
C. Rapid onset within hours
D. Mydriasis
What is “B”?
Rationale: NMS= severe rigidity, bradyreflexia/hyporeflexia, hyperthermia, tck; serotonin syndrome = hyperreflexia/clonus, gi. Hyperactivity (e.g., diarrhea, autonomic instability, often rapid onset after serotonergic change.
Multiple choice:
SSRIs increases which neurotransmitter?
A. Dopamine
B. Serotonin
C. Gaba
D. Norepinephrine
What is "B"?
Rationale: SSRIs inhibit reuptake of serotonin, increasing synaptic availability to improve mood/anxiety symptoms.
Fill in the blank:
Acute dystonia from haloperidol is treated with _________(im/iv).
What is “benztropine or diphenhydramine”?
Rationale: These anticholinergics rapidly reverse acute dystonic reactions (e.g., oculogyric crisis, torticollis, laryngospasm).
Select all that apply:
Therapeutic communication techniques include:
A. Silence
B. Reflection/restating
C. Giving advice
D. Open-ended questions
E. "Why" questions
What is “A, B, D”?
Rationale: Silence and reflection promote client expression; open-ended questions foster engagement. Advice-giving and "Why" can feel judgmental and block communication.
Fill in the blank:
Provider must complete face-to-face evaluation for violent/self-destructive restraints
within __ hour(s).
What is “1”?
Rationale: Regulations typically require within 1 hour for adult behavioral restraints; always follow facility policy/state law.
Select all that apply:
Withdrawal findings needing urgent intervention:
A. Alcohol withdrawal with tremors, htn, diaphoresis
B. Alcohol withdrawal with seizure history
C. Opiate withdrawal with chills
D. Alcohol withdrawal with confusion (possible dts)
E. Cannabis withdrawal
What is “A, B, D”?
Rationale: Alcohol withdrawal can be life-threatening (seizures, delirium tremens). Opiate/cannabis withdrawal rarely threaten life (supportive care).
Question:
Which bipolar maintenance regimen is most appropriate for a client with stage 3 chronic kidney disease (egfr 39 ml/min)?
A. Lamotrigine monotherapy
B. Lithium at usual dose
C. Lithium + nsaid for headache
D. Valproate + lithium
What is “A”?
Rationale: Lithium is renally excreted and risky in ckd; nsaids further increase lithium levels.
Lamotrigine is effective for maintenance (especially depression-prevention) and safer in
Renal impairment.
A client newly prescribed phenelzine says, "I love pepperoni pizza." teach to: (Select all that apply.)
A. Avoid aged/fermented foods
B. Avoid SSRIs/SNRIs
C. Avoid salt
D. Monitor for hypertensive crisis
E. Allow 2-week washout between antidepressants
What is "A, B, D, E"?
Rationale: MAOIs + Tyramine (aged Cheeses, cured meats like Pepperoni) risk hypertensive crisis. MAOIs interact with serotonergic agents (SSRIs/SNRIs); washout prevents serotonin syndrome. Salt intake is unrelated to MAOIs.
Select all that apply:
What teachings will you give your patient for first time lithium use?
A. Maintain fluid intake and consistent sodium
B. Avoid NSAIDs unless approved
C. Report diarrhea/tremor worsening
D. Double dose if missed
E. Avoid dehydration/heat
What is “A, B, C, E”?
Rationale: Sodium/water balance affects lithium levels; NSAIDs can increase levels; GI loss and dehydration precipitate toxicity. Never double doses.
Multiple choice:
Client with paranoia: "You are poisoning me." Best response?
A. That's not true
B. "I hear that you're afraid. This medication is to help with your symptoms. Let's review it together."
C. Take it anyway
D. Ignore
What is “B”?
Rationale: Acknowledge fear, present reality, and provide factual information without arguing or forcing.
Select all that apply:
HIPAA-appropriate behaviors:
A. Discuss cases in private clinical areas
B. Share minimum necessary information
C. Talk in elevator
D. Client can access their own record
E. Share with family without consent
What is “A, B, D”?
Rationale: Protect privacy and confidentiality; client rights include record access; avoid public disclosure without consent.
Multiple choice:
Bipolar mania, pacing, intrusive, not eating. Best action:
A. Full meals in dining room
B. High-calorie finger foods and fluids on the go
C. Group therapy now
D. Insight therapy
What is “B”?
Rationale: Meet physiologic needs in a way compatible with psychomotor agitation.
Multiple choice
A postpartum patient (3 days pp) with schizoaffective disorder stopped meds during pregnancy. She is now disorganized with auditory hallucinations. She wishes to breastfeed. Which antipsychotic is most reasonable to restart first?
A. Clozapine
B. Quetiapine
C. Ziprasidone
D. Haloperidol (lai)
What is “B”?
Rationale: Quetiapine has relatively lower transfer into breast milk and favorable infant safety data; clozapine is generally avoided in lactation due to agranulocytosis/sedation risk in infants; lai re-initiation requires stabilization; ziprasidone has qt concerns and less lactation data.
Medications used to treat acute mania include: (Select all that apply.)
A. Lithium
B. Valproate
c. SGAs (e.g., olanzapine)
d. St. John's wort
e. Benztropine
What is "A, B, C"?
Rationale: First-line options for acute mania: mood stabilizers (lithium, valproate) and second-generation antipsychotics. St. John's wort is not indicated; benztropine treats episodes, not mania.
Select all that apply:
Benzodiazepine overdose management:
A. Airway/breathing support
B. Flumazenil risks seizures-use cautiously
C. Monitor for respiratory depression
D. Induce vomiting
E. Activated charcoal if mixed overdose & early
Answer:
What is “A, B, C, E”?
Rationale: Primary management is supportive; flumazenil can precipitate withdrawal seizures, especially with chronic use or co-ingestants. Emesis is not recommended.
Fill in the blank:
Priority suicide assessment, what is crucial to ask the patient? "Do you have a _________?"
What is “Plan”?
Rationale: Presence of a plan, means, and intent increases risk and guides immediate safety interventions.
Multiple choice:
Which order must be clarified?
A. Q15 min safety checks
B. 1:1 sitter
C. Four-point restraints prn agitation for 24h
D. Close observation
What is “C”?
Rationale: PRN restraint orders are not appropriate; restraints require time-limited, situation-specific orders and frequent reassessments.
Select all that apply:
Refeeding syndrome monitoring in anorexia nervosa:
A. Phosphate
B. Potassium
C. Ecg for arrhythmias
D. High-fiber diet immediately
E. Slow, structured caloric advancement
What is “A, B, C, E”?
Rationale: Rapid refeeding shifts phosphate/potassium into cells → arrhythmias, heart failure, edema. Advance slowly and monitor ecg.
A 16-year-old with MDD and active suicidal ideation needs pharmacotherapy and psychotherapy. Which initial antidepressant is most appropriate?
A. Fluoxetine
B. Paroxetine
C. Bupropion
D. Venlafaxine
What is “A”?
Rationale: Fluoxetine has the strongest evidence and FDA approval for adolescent depression.
Paroxetine is generally avoided in adolescents;
Bupropion lowers seizure threshold and may worsen anxiety; venlafaxine has bp concerns and less robust pediatric approval.
A client started on valproate. Which baseline tests are priorities?
A. CBC Only
b. LFTs and platelets
c. BMP only
D. TSH and T4
What is "B"?
Rationale: Valproate can cause hepatotoxicity and
thrombocytopenia-monitor liver function and platelet count.
Multiple choice:
Scenario provider prescribes bupropion for a client with bulimia. What should the nurse do?
A. Administer
B. Add SSRI
C. Question order
D. Encourage fluids
What is “C”?
Rationale: Bupropion is contraindicated in eating seizure disorders) due to seizure risk.
Select all that apply:
De-escalation techniques:
A. Maintain two arm-lengths distance
B. Calm tone, nonthreatening posture
C. Stand over the client
D. Offer choices and space
E. Reduce environmental stimuli/remove others
What is “A, B, D”?
Rationale: Safety and non-confrontational approaches lower arousal; avoid cornering or towering postures.
Select all that apply:
Clozapine administration safety:
A. Check anc per program schedule
B. Document education and consent per rems/clinic policy
C. Skip orthostatic vitals
D. Baseline ecg if qt risk/cardiac history
E. Adhere to dispensing/monitoring program rules
What is “A, B, D, E”?
Rationale: Clozapine requires strict hematologic monitoring and adherence to program rules; monitor cardiac risk (myocarditis/qt). Orthostatic vitals are important, not optional.
Multiple choice:
Clozapine + severe constipation not relieved by otc meds. Priority?
A. Document only
B. Assess for obstruction/ileus and escalate
C. Give loperamide
D. Restrict fluids
Answer:
What is “B”?
Rationale: Clozapine can cause gi hypomotility/ileus, which can be fatal; urgent assessment and management are required.
What is “B”?
Rationale: Clozapine can cause gi hypomotility/ileus, which can be fatal; urgent assessment and management are required.
Which bipolar maintenance regimen is most appropriate for a client with stage 3 chronic kidney disease (egfr 39 ml/min)?
A. Lamotrigine monotherapy
B. Lithium at usual dose
C. Lithium + nsaid for headache
D. Valproate + lithium
What is “A”?
Rationale: Lithium is renally excreted and risky in ckd; nsaids further increase lithium levels.
Lamotrigine is effective for maintenance (especially depression-prevention) and safer in
Renal impairment.