Medication Safety & Nursing Priorities
A nurse is providing discharge teaching to a client who has a new prescription for lorazepam (Ativan) to manage anxiety.
Which statement by the client indicates a need for further teaching?
A. "I should avoid drinking alcohol while taking this medication."
B. "I should avoid driving until I know how this medication affects me."
C. "I can stop taking this medication suddenly once my anxiety improves."
D. "This medication can cause drowsiness and dizziness."
Correct Answer: C.
Rationale: Lorazepam is a benzodiazepine. Abrupt discontinuation after regular use can cause withdrawal symptoms, including rebound anxiety, tremors, and potentially seizures.
ATI Tip: Benzodiazepines = sedation, fall risk, dependence, and withdrawal. Avoid alcohol and do not abruptly discontinue after prolonged use.
A nurse is reviewing prescriptions for a client diagnosed with bipolar I disorder. Which medication is classified as a mood stabilizer commonly used to treat acute mania and for maintenance therapy?
A. Sertraline
B. Lithium
C. Venlafaxine
D. Amitriptyline
Correct Answer: B. Lithium
Rationale: Lithium is a mood stabilizer used to treat acute mania and prevent future mood episodes in bipolar disorder. Sertraline, venlafaxine, and amitriptyline are antidepressants.
ATI Tip: Your professor's mood stabilizer list includes lithium, valproate, carbamazepine, and lamotrigine.
A nurse is providing dietary teaching to a client prescribed phenelzine (Nardil) for major depressive disorder.
Which meal selection indicates the client needs further teaching?
A. Grilled chicken, steamed carrots, and brown rice
B. Fresh salmon, broccoli, and baked potato
C. Aged cheddar cheese, salami, and red wine
D. Scrambled eggs, whole-wheat toast, and fresh fruit
Correct Answer: C. Aged cheddar cheese, salami, and red wine.
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Foods high in tyramine, including aged cheeses, cured meats, and certain wines, can trigger a life-threatening hypertensive crisis.
ATI Tip: MAOIs + tyramine = hypertensive crisis. Watch for severe headache, markedly elevated blood pressure, and palpitations.
Question — ATI Application:
A nurse is reviewing medications prescribed for a client with major depressive disorder. Which medication is classified as an atypical antidepressant rather than a tricyclic antidepressant (TCA)?
A. Amitriptyline
B. Nortriptyline
C. Bupropion
D. Imipramine
Correct Answer: C. Bupropion
Rationale: Bupropion is classified as an atypical antidepressant. Amitriptyline, nortriptyline, and imipramine are tricyclic antidepressants.
ATI Tip: Remember your professor's medication classifications:
Atypical: Bupropion, vilazodone
TCAs: Amitriptyline, nortriptyline, imipramine
A nurse is reviewing medication prescriptions for four clients diagnosed with depressive disorders. Which medication is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI)?
A. Sertraline
B. Paroxetine
C. Venlafaxine
D. Citalopram
Correct Answer: C. Venlafaxine
Rationale: Venlafaxine is an SNRI. Sertraline, paroxetine, and citalopram are SSRIs.
ATI Tip: The two SNRIs on your exam list are venlafaxine and duloxetine.
A nurse is caring for a client who started taking sertraline (Zoloft) 3 days ago. The client reports increased anxiety, restlessness, and difficulty sleeping.
Which nursing action is most appropriate?
A. Discontinue sertraline immediately because these symptoms indicate toxicity.
B. Assess the severity of symptoms, including suicidal thoughts, and notify the provider of concerning findings.
C. Reassure the client that the medication should relieve all anxiety within 24 hours.
D. Instruct the client to double the dose to achieve a faster therapeutic effect.
Correct Answer: B.
Rationale: SSRIs such as sertraline can initially cause increased anxiety, agitation, and insomnia.
The nurse should assess symptom severity and monitor for worsening depression, suicidal ideation, or severe restlessness (akathisia), especially early in treatment.
ATI Tip: SSRIs take several weeks for full therapeutic benefit. Monitor for increased suicidal thoughts during initiation and dose changes, particularly in younger clients.
A nurse is caring for a client with bipolar disorder who has been prescribed lamotrigine (Lamictal). During assessment, the client reports developing a widespread rash with blistering and painful sores inside the mouth.
Which action should the nurse take first?
A. Administer diphenhydramine and reassess the rash in 1 hour.
B. Reassure the client that skin reactions are expected during treatment.
C. Withhold lamotrigine and notify the provider immediately.
D. Apply a topical corticosteroid and continue the medication.
Correct Answer: C.
Rationale: Lamotrigine can cause Stevens-Johnson syndrome (SJS), a potentially life-threatening skin reaction. Blistering and mucosal lesions are warning signs requiring immediate medical evaluation.
ATI Tip: Lamotrigine + rash with blisters or mouth sores = suspect SJS. Hold medication and notify the provider immediately.
A nurse is reviewing the medication history of a client prescribed tranylcypromine (Parnate) for major depressive disorder. The client reports taking St. John's Wort daily.
Which action should the nurse take?
A. Encourage the client to continue both medications to improve antidepressant effectiveness.
B. Instruct the client to take St. John's Wort at least 4 hours after tranylcypromine.
C. Hold the MAOI and notify the provider about the potential for serotonin syndrome.
D. Recommend taking both medications with food to decrease gastrointestinal effects.
Correct Answer: C.
Rationale: St. John's Wort has serotonergic effects and should not be combined with MAOIs such as tranylcypromine because of the risk of serotonin syndrome.
The nurse should withhold the medication pending clarification, notify the provider, and assess for signs of serotonin toxicity.
ATI Tip: MAOI + St. John's Wort = dangerous interaction. Watch for agitation, hyperthermia, tremors, and hyperreflexia.
A nurse is reviewing the medical history of a client newly prescribed bupropion (Wellbutrin) for major depressive disorder.
Which finding should the nurse report to the provider before administering the medication?
A. History of hypertension
B. History of bulimia nervosa
C. Difficulty sleeping
D. History of constipation
Correct Answer: B. History of bulimia nervosa
Rationale: Bupropion lowers the seizure threshold and is contraindicated in clients with a current or prior diagnosis of bulimia nervosa or anorexia nervosa because of the increased risk of seizures.
ATI Tip: Bupropion + eating disorders = increased seizure risk. Question the prescription.
A nurse is providing discharge teaching to a client newly prescribed sertraline (Zoloft) for major depressive disorder.
Which statement by the client indicates a need for further teaching?
A. "I should take this medication consistently, even if I don't notice immediate improvement."
B. "It may take several weeks before I experience the full therapeutic effects."
C. "I can stop taking this medication abruptly once my depressive symptoms improve."
D. "I should notify my provider if I experience worsening depression or suicidal thoughts."
Correct Answer: C.
Rationale: Sertraline is an SSRI that requires consistent administration. Abrupt discontinuation can cause withdrawal-like symptoms, including dizziness, nausea, irritability, and sensory disturbances. Clients should consult their provider before stopping or tapering the medication.
ATI Tip: SSRIs = delayed therapeutic effects, consistent administration, and no abrupt discontinuation.
A nurse is caring for a client who takes fluoxetine (Prozac) for major depressive disorder. The client recently started taking St. John's Wort without consulting the provider.
The client develops agitation, diaphoresis, diarrhea, muscle rigidity, and a temperature of 102.4°F (39.1°C).
What is the nurse's priority action?
A. Administer the next dose of fluoxetine to stabilize serotonin levels.
B. Encourage oral fluids and reassess the client in 4 hours.
C. Withhold serotonergic medications and notify the provider immediately.
D. Reassure the client that these symptoms are expected when combining herbal supplements with antidepressants.
Correct Answer: C.
Rationale: The client is exhibiting signs of serotonin syndrome, a potentially life-threatening reaction caused by excessive serotonergic activity.
Fluoxetine combined with St. John's Wort increases this risk. The nurse should withhold serotonergic medications, immediately notify the provider, and initiate emergency assessment and supportive care.
ATI Tip: Remember serotonin syndrome:
Agitation and confusion
Fever and sweating
Diarrhea
Tremors, hyperreflexia, or clonus
Exam clue: SSRI + St. John's Wort = serotonin syndrome risk.
A nurse is caring for a client with bipolar I disorder who has been taking valproate (Depakote). The client reports severe abdominal pain radiating to the back, persistent nausea, and vomiting.
Which action should the nurse take first?
A. Administer the medication with food to reduce gastrointestinal irritation.
B. Withhold valproate and notify the provider immediately.
C. Encourage increased fluid intake and reassess in 2 hours.
D. Reassure the client that gastrointestinal discomfort is an expected adverse effect.
Correct Answer: B.
Rationale: Valproate can cause acute pancreatitis, a potentially life-threatening adverse reaction. Severe abdominal pain radiating to the back with persistent nausea and vomiting requires immediate evaluation.
The nurse should withhold the medication, notify the provider, and anticipate serum lipase testing.
ATI Tip: Valproate = monitor for pancreatitis, hepatotoxicity, and thrombocytopenia.
A nurse is caring for a client prescribed phenelzine (Nardil) for depression. Two hours after eating lunch, the client develops a severe occipital headache, palpitations, diaphoresis, and a blood pressure of 210/116 mmHg.
Which action should the nurse take first?
A. Administer the next scheduled dose of phenelzine.
B. Encourage oral fluids and reassess blood pressure in 30 minutes.
C. Activate the emergency response system, assess the client, and notify the provider immediately.
D. Place the client in a quiet room and encourage relaxation techniques.
Correct Answer: C.
Rationale: The client is exhibiting signs of a potentially life-threatening hypertensive crisis, which can occur when a client taking an MAOI consumes tyramine-rich foods.
Immediate emergency assessment and treatment are necessary to prevent complications such as stroke.
ATI Tip: MAOI + severe headache + extremely elevated BP = suspect hypertensive crisis.
A nurse is caring for an older adult who recently started amitriptyline (Elavil) for depression. The client reports dizziness when standing, blurred vision, and difficulty urinating.
Which nursing intervention is the priority?
A. Encourage increased dietary fiber to prevent constipation.
B. Implement fall precautions and assess orthostatic blood pressure.
C. Reassure the client that these symptoms will resolve with continued treatment.
D. Restrict oral fluid intake to prevent urinary retention.
Reveal Answer & Rationale
Correct Answer: B.
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) that can cause orthostatic hypotension and anticholinergic effects, including blurred vision, urinary retention, dry mouth, and constipation.
The nurse should prioritize preventing falls and assessing orthostatic hypotension. The urinary difficulty also requires assessment and provider notification if retention is suspected.
ATI Tip: TCAs = anticholinergic effects + orthostatic hypotension + fall risk.
A nurse is assessing a client who recently started venlafaxine (Effexor) for major depressive disorder. The client reports headaches and dizziness. The nurse obtains a blood pressure of 168/98 mmHg, compared with a baseline of 118/76 mmHg.
Which action should the nurse take first?
A. Reassure the client that elevated blood pressure is an expected temporary effect.
B. Encourage increased fluid intake and reassess the client in 24 hours.
C. Reassess the blood pressure and notify the provider of the significant elevation.
D. Administer the next dose of venlafaxine to prevent withdrawal symptoms.
Correct Answer: C.
Rationale: Venlafaxine is an SNRI that can increase blood pressure due to its norepinephrine effects. A significant increase from baseline requires prompt reassessment and provider notification, particularly when accompanied by headache and dizziness.
ATI Tip: SNRIs, especially venlafaxine, can cause hypertension. Monitor blood pressure during treatment.
Question — Advanced ATI Clinical Judgment
A nurse is reviewing prescriptions for four clients receiving psychiatric medications.
Which prescription should the nurse question before administration?
A. Bupropion for a client with a history of bulimia nervosa.
B. Duloxetine for a client with generalized anxiety disorder.
C. Sertraline for a client with major depressive disorder.
D. Lamotrigine for a client with bipolar disorder.
Correct Answer: A. Bupropion for a client with a history of bulimia nervosa.
Rationale: Bupropion lowers the seizure threshold and is contraindicated in clients with a current or prior diagnosis of bulimia nervosa or anorexia nervosa because of the increased risk of seizures.
Why the others are incorrect:
B: Duloxetine is approved for generalized anxiety disorder.
C: Sertraline is commonly prescribed for major depressive disorder.
D: Lamotrigine is used for maintenance treatment of bipolar I disorder.
ATI Tip: Bupropion + eating disorder or seizure disorder = contraindication.
A nurse is assessing a client with bipolar disorder who takes lithium. The client reports vomiting and diarrhea for 2 days. The nurse observes coarse hand tremors, muscle weakness, and an unsteady gait.
Which action should the nurse take first?
A. Encourage the client to restrict sodium intake.
B. Administer the next dose of lithium with food.
C. Withhold lithium and notify the provider immediately.
D. Reassure the client that these are expected therapeutic effects.
Correct Answer: C. Withhold lithium and notify the provider immediately.
Rationale: The client is exhibiting signs of lithium toxicity. Vomiting and diarrhea can cause dehydration and increase lithium levels.
Coarse tremors, muscle weakness, and ataxia (unsteady gait) are concerning toxicity findings.
The nurse should withhold lithium, notify the provider, and anticipate checking serum lithium levels, electrolytes, and kidney function.
ATI Tip:
Fine hand tremor = possible common side effect.
Coarse hand tremor + ataxia = suspect lithium toxicity.
Dehydration and sodium depletion increase toxicity risk.
Question — Advanced ATI Clinical Judgment:
A nurse is reviewing discharge instructions for a client prescribed tranylcypromine (Parnate). The client reports having nasal congestion and asks whether they can take an over-the-counter cold medication containing pseudoephedrine.
Which response by the nurse is most appropriate?
A. "You can take pseudoephedrine as long as you monitor your blood pressure."
B. "Take half the recommended dose to prevent adverse effects."
C. "Avoid pseudoephedrine because combining it with an MAOI can cause a life-threatening hypertensive crisis."
D. "You can safely take pseudoephedrine if you separate the medications by 6 hours."
Correct Answer: C.
Rationale: Tranylcypromine is an MAOI. Pseudoephedrine is a sympathomimetic decongestant that can dangerously elevate blood pressure when combined with MAOIs.
Why the others are incorrect:
A: Blood pressure monitoring does not make the combination safe.
B: Reducing the dose does not eliminate the interaction.
D: Separating administration times does not prevent the interaction.
ATI Tip: MAOIs + sympathomimetic decongestants = hypertensive crisis risk.
A nurse is caring for a client with major depressive disorder who is prescribed imipramine (Tofranil). The client reports taking more than the prescribed dose several hours ago.
Assessment findings include:
Heart rate: 138/min
Blood pressure: 84/48 mmHg
Confusion and dilated pupils
ECG: Widened QRS complex
Which action should the nurse take first?
A. Administer activated charcoal and reassess in 30 minutes.
B. Initiate emergency response, place the client on continuous cardiac monitoring, and prepare for IV sodium bicarbonate.
C. Administer the next scheduled dose of imipramine to prevent withdrawal.
D. Encourage oral fluids and monitor for anticholinergic effects.
Correct Answer: B.
Rationale: The client is exhibiting signs of severe tricyclic antidepressant toxicity, including hypotension, tachycardia, altered mental status, and QRS widening.
TCA overdose can cause life-threatening ventricular dysrhythmias and seizures. Immediate emergency stabilization and cardiac monitoring are priorities. IV sodium bicarbonate is a key treatment for TCA-induced QRS widening.
ATI Tip: TCA overdose + widened QRS = cardiac toxicity. Think emergency response, ECG monitoring, and sodium bicarbonate.
A nurse is caring for a client prescribed fluoxetine (Prozac) for major depressive disorder. The client reports taking St. John's Wort daily to improve their mood.
During assessment, the nurse notes agitation, diaphoresis, diarrhea, tremors, and hyperreflexia.
Which action should the nurse take first?
A. Encourage the client to increase fluid intake and continue both medications.
B. Administer the next dose of fluoxetine and reassess in 30 minutes.
C. Withhold fluoxetine, notify the provider immediately, and assess for serotonin syndrome.
D. Explain that these symptoms are expected during the first few weeks of SSRI therapy.
Correct Answer: C.
Rationale: Combining fluoxetine (SSRI) with St. John's Wort increases serotonergic activity and can cause serotonin syndrome.
Symptoms include agitation, sweating, diarrhea, tremors, and hyperreflexia. The nurse should withhold serotonergic medications, notify the provider immediately, and initiate appropriate monitoring and emergency interventions.
ATI Tip: SSRIs + St. John's Wort = increased risk of serotonin syndrome.
Question — Advanced ATI Priority Setting
A nurse receives reports about four clients receiving psychiatric medications.
Which client should the nurse assess FIRST?
A. A client taking amitriptyline who reports dry mouth and constipation.
B. A client taking venlafaxine who reports increased sweating and mild nausea.
C. A client taking lithium who reports increased thirst and frequent urination.
D. A client taking citalopram who reports palpitations, dizziness, and a brief episode of fainting.
Correct Answer: D.
Rationale: Citalopram can cause QT interval prolongation, which increases the risk of life-threatening cardiac dysrhythmias.
Palpitations, dizziness, and syncope are warning signs requiring immediate cardiac assessment, vital signs, and an ECG.
Why the others are incorrect:
A: Dry mouth and constipation are common anticholinergic effects of TCAs.
B: Sweating and mild nausea can occur with SNRIs.
C: Increased thirst and urination can occur with lithium and require evaluation for possible nephrogenic diabetes insipidus, but the cardiac symptoms in D are more immediately concerning.
ATI Tip: When prioritizing clients, choose the one with signs of a potentially life-threatening complication.
Citalopram + fainting + palpitations = suspect dysrhythmia.
A nurse is reviewing laboratory results for a client with bipolar disorder who has been taking carbamazepine (Tegretol) for 6 weeks.
The client reports fever, sore throat, and unusual fatigue.
Which laboratory finding requires immediate intervention?
A. Serum sodium of 138 mEq/L
B. White blood cell count of 1,800/mm³
C. Platelet count of 220,000/mm³
D. Hemoglobin of 13.5 g/dL
Correct Answer: B. White blood cell count of 1,800/mm³
Rationale: Carbamazepine can cause serious bone marrow suppression, including agranulocytosis and aplastic anemia.
A severely decreased WBC count combined with fever and sore throat suggests a potentially life-threatening infection risk.
Nursing priority: Withhold carbamazepine, notify the provider immediately, and anticipate further evaluation, including a differential and absolute neutrophil count.
ATI Tip: Carbamazepine = monitor CBC, sodium, and liver function.
Remember: Fever + sore throat + low WBC = possible bone marrow suppression.
A nurse receives reports about four clients taking antidepressants. Which client requires immediate intervention?
A. A client taking selegiline who reports mild dizziness when standing.
B. A client taking phenelzine who develops a severe headache and blood pressure of 198/112 mmHg after eating aged cheese.
C. A client taking tranylcypromine who reports difficulty sleeping.
D. A client taking fluoxetine who reports mild nausea during the first week of treatment.
Correct Answer: B.
Rationale: The client taking phenelzine is experiencing signs of a life-threatening hypertensive crisis caused by a potential tyramine interaction.
Severe headache and markedly elevated blood pressure require immediate emergency assessment and treatment.
Why the others are incorrect:
A: Orthostatic dizziness requires assessment and fall precautions but is less urgent.
C: Insomnia can occur with MAOI therapy and requires follow-up.
D: Mild nausea is a common early SSRI adverse effect.
ATI Tip: MAOI + tyramine + severe hypertension = hypertensive crisis. Prioritize the client with signs of acute end-organ risk.
A nurse is reviewing prescriptions for four clients receiving antidepressant therapy. Which client requires immediate intervention?
A. A client taking bupropion who reports insomnia and dry mouth.
B. A client taking nortriptyline who reports constipation and mild dizziness when standing.
C. A client taking vilazodone who reports mild nausea after beginning treatment.
D. A client taking amitriptyline who develops a heart rate of 146/min, blood pressure of 82/46 mmHg, and a widened QRS complex on ECG.
Correct Answer: D.
Rationale: Amitriptyline is a tricyclic antidepressant. Severe tachycardia, hypotension, and QRS widening suggest life-threatening cardiac toxicity.
Priority actions: Activate emergency response, assess ABCs, initiate continuous cardiac monitoring, and prepare for prescribed emergency treatment.
Why the others are incorrect:
A: Insomnia and dry mouth are common bupropion adverse effects.
B: Constipation and orthostatic dizziness are common TCA effects requiring assessment and fall precautions.
C: Mild nausea is a common early adverse effect of vilazodone.
ATI Tip: TCA cardiac toxicity = widened QRS + hypotension + dysrhythmia risk.
Question — Advanced ATI Clinical Judgment:
A nurse is reviewing prescriptions for four clients receiving antidepressant therapy. Which prescription should the nurse question immediately?
A. A client taking sertraline who is prescribed acetaminophen for a headache.
B. A client taking duloxetine who is prescribed a blood pressure assessment every shift.
C. A client who discontinued paroxetine 3 days ago and is prescribed phenelzine to begin today.
D. A client taking fluoxetine who is instructed to take the medication consistently each morning.
Correct Answer: C.
Rationale: Paroxetine is an SSRI, and phenelzine is an MAOI. Starting an MAOI only 3 days after discontinuing an SSRI increases the risk of life-threatening serotonin syndrome.
A minimum 14-day washout period is generally required when switching from paroxetine to an MAOI.
Why the others are incorrect:
A: Acetaminophen does not have a significant serotonergic interaction with sertraline.
B: Blood pressure monitoring is appropriate for clients taking SNRIs.
D: Consistent daily administration is appropriate teaching for fluoxetine.
ATI Tip: SSRIs and MAOIs must not be combined. Remember the washout periods:
Most SSRIs → MAOI: at least 14 days.
Fluoxetine → MAOI: at least 5 weeks.