A client taking sertraline was given tramadol for pain two days ago. The client is now agitated, diaphoretic, tremulous, has inducible clonus, temperature 38.6 C and diarrhea. What should the nurse do first?
Hold serotonergic drugs and notify the prescriber immediately for supportive care
Give acetaminophen and recheck in one hour
Give the next scheduled sertraline dose
Encourage fluids and rest
Show the answer and explanation
Answer: A. Hold serotonergic drugs and notify the prescriber immediately for supportive care
Topic: serotonin syndrome
Agitation, autonomic instability, tremor, clonus and fever after combining serotonergic drugs indicate serotonin syndrome, a medical emergency. The offending drugs are held and the prescriber is notified for supportive treatment.
Why the others are wrong
B – Antipyretics do not fix the cause and delay treatment.
C – Another sertraline dose adds to the toxicity.
D – Rest and fluids are inadequate for an emergency.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A client taking tranylcypromine develops a severe occipital headache, neck stiffness and palpitations after eating pizza with aged cheese. Blood pressure is 210/118 mm Hg. What should the nurse do first?
Give as-needed acetaminophen and reassess in an hour
Ask the client about every food eaten before acting
Notify the provider immediately, keep the head of the bed raised and monitor blood pressure frequently
Lay the client flat with the legs raised
Show the answer and explanation
Answer: C. Notify the provider immediately, keep the head of the bed raised and monitor blood pressure frequently
Topic: MAOI hypertensive crisis
Tyramine in aged foods with a monoamine oxidase inhibitor can cause hypertensive crisis. This is an emergency needing immediate provider notification, blood pressure monitoring and, usually, an IV antihypertensive.
Why the others are wrong
A – Acetaminophen does not treat the crisis and a one-hour delay is unsafe.
B – A food history is useful later but should not delay treatment.
D – Lying flat with legs raised does not lower the pressure and may worsen the headache.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A client has started olanzapine. Which monitoring should the nurse expect as part of metabolic surveillance?
Select all that apply.
Weight and body mass index
Waist circumference
Fasting glucose or hemoglobin A1c
Fasting lipid panel
Serum lithium level
Weekly absolute neutrophil count
Show the answers and explanation
Answers: A, B, C and D.
A – Weight and body mass index
B – Waist circumference
C – Fasting glucose or hemoglobin A1c
D – Fasting lipid panel
Topic: metabolic monitoring
Second-generation antipsychotics such as olanzapine increase risk of weight gain, diabetes and dyslipidemia, so weight, waist, blood pressure, glucose and lipids are monitored at baseline and on a schedule. Lithium level and neutrophil count belong to other drugs.
Why the others are wrong
E – Lithium levels apply to lithium, not olanzapine.
F – Neutrophil counts are the clozapine requirement.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A client taking quetiapine for six months reports excessive thirst, frequent urination, blurred vision and increased hunger. What should the nurse do first?
Advise reducing sugary drinks and wait until the next visit
Check a capillary blood glucose and report the findings to the prescriber
Tell the client to stop the quetiapine
Explain these are expected harmless effects
Show the answer and explanation
Answer: B. Check a capillary blood glucose and report the findings to the prescriber
Topic: hyperglycemia on antipsychotic
Polydipsia, polyuria and polyphagia suggest hyperglycemia, a recognized metabolic effect of second-generation antipsychotics. The nurse checks glucose and reports promptly for evaluation.
Why the others are wrong
A – Waiting delays diagnosis and risks complications.
C – Stopping an antipsychotic on one's own risks relapse; the prescriber decides.
D – These symptoms are not harmless.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A client with generalized anxiety disorder is prescribed buspirone. Which statement by the client shows that teaching was effective?
'It may take a couple of weeks of taking it every day before I feel the full benefit.'
'I can take an extra tablet whenever I feel a panic attack coming on.'
'It is a benzodiazepine, so I will need to be weaned off slowly.'
'I should take it only on the days when I feel anxious.'
Show the answer and explanation
Answer: A. 'It may take a couple of weeks of taking it every day before I feel the full benefit.'
Topic: buspirone teaching
Buspirone is not a benzodiazepine and does not work immediately. It needs regular daily dosing, and the full effect usually takes one to two weeks or more. It does not cause the sedation or dependence that benzodiazepines do, and it is not used for as-needed relief of panic.
Why the others are wrong
B – Buspirone does not act fast, so extra tablets during a panic attack will not help and could cause adverse effects.
C – Buspirone is not a benzodiazepine and does not need to be weaned off for dependence.
D – As-needed use does not work because the drug takes time to build up.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A client who takes sertraline was started on tramadol for back pain two days ago. The nurse is concerned about serotonin syndrome. Which findings support this concern?
Select all that apply.
Hyperreflexia and inducible clonus
Sluggish reflexes and low muscle tone
Tremor, sweating and diarrhea
Pinpoint pupils with sedation
Agitation with a fast heart rate
Bradycardia and a low body temperature
Show the answers and explanation
Answers: A, C and E.
A – Hyperreflexia and inducible clonus
C – Tremor, sweating and diarrhea
E – Agitation with a fast heart rate
Topic: serotonin syndrome findings
Serotonin syndrome follows a combination of serotonergic drugs and develops over hours. It produces neuromuscular signs such as hyperreflexia, clonus and tremor, autonomic signs such as sweating, diarrhea, tachycardia and fever, and mental changes such as agitation. Reflexes are brisk, not sluggish, and the heart rate and temperature are raised, not lowered.
Why the others are wrong
B – Reflexes are brisk with clonus in this syndrome; low tone and sluggish reflexes point elsewhere.
D – Pinpoint pupils with sedation suggest opioid effect; in serotonin syndrome the pupils are often dilated.
F – The heart rate is fast and the temperature is high, not low.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
Two hours after receiving an injection of haloperidol, a client has a sudden painful twisting of the neck, upward deviation of the eyes and difficulty swallowing. Which action does the nurse take first?
Document the findings and plan to reassess the client in one hour, since the effect should wear off
Reassure the client that the stiffness will pass soon and offer sips of water to ease the throat
Notify the provider immediately, expect an anticholinergic such as benztropine, and watch the airway
Give the next scheduled dose of haloperidol, which will relax the muscle spasm
Show the answer and explanation
Answer: C. Notify the provider immediately, expect an anticholinergic such as benztropine, and watch the airway
Topic: acute dystonic reaction
These findings describe an acute dystonic reaction, a medication emergency that can compromise the airway when the throat and tongue are involved. The provider is notified immediately for an anticholinergic such as benztropine or diphenhydramine, and the nurse monitors breathing and swallowing. Offering fluids or waiting risks aspiration and airway obstruction.
Why the others are wrong
A – Waiting an hour leaves a threatened airway and a painful reaction untreated.
B – Offering water to a client with difficulty swallowing risks aspiration.
D – More haloperidol would worsen the reaction.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A client with schizophrenia is starting olanzapine. Which parameters should the nurse plan to monitor during therapy?
Select all that apply.
Weight, body mass index and waist circumference
Serum lithium level
Fasting blood glucose or hemoglobin A1C
Fasting lipid profile
Absolute neutrophil count each week for six months
Blood pressure
Show the answers and explanation
Answers: A, C, D and F.
A – Weight, body mass index and waist circumference
C – Fasting blood glucose or hemoglobin A1C
D – Fasting lipid profile
F – Blood pressure
Topic: metabolic monitoring of antipsychotics
Olanzapine, like other second-generation antipsychotics, can cause weight gain, high glucose, abnormal lipids and raised blood pressure. Baseline and regular follow-up of weight, glucose, lipids and blood pressure are recommended. Lithium levels apply to lithium, and weekly neutrophil counts apply to clozapine.
Why the others are wrong
B – Lithium levels are monitored only in clients taking lithium.
E – Weekly absolute neutrophil counts are required for clozapine, not olanzapine.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A client is newly diagnosed with bipolar I disorder after a manic episode. The nurse prepares teaching about the long-established mood stabilizer that the prescriber is most likely to start and that requires regular serum level monitoring. Which medication is this?
Sertraline
Buspirone
Lithium carbonate
Methylphenidate extended-release
Show the answer and explanation
Answer: C. Lithium carbonate
Topic: first-line drug for bipolar disorder
Lithium is a long-established first-line mood stabilizer for bipolar disorder and has a narrow therapeutic range, so serum levels are checked regularly. The other drugs treat depression, anxiety or attention problems, and a stimulant or an antidepressant alone can worsen mania.
Why the others are wrong
A – Sertraline is an antidepressant; alone it can trigger or worsen mania.
B – Buspirone treats anxiety and does not stabilize mood.
D – Methylphenidate is a stimulant for attention disorders and could worsen mania.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A client with newly diagnosed generalized anxiety disorder is about to start medication. Which order would the nurse expect for initial drug therapy?
Escitalopram daily
Alprazolam three times daily on a fixed schedule
Oxycodone as needed for nervousness
Zolpidem at bedtime every night
Show the answer and explanation
Answer: A. Escitalopram daily
Topic: first-line medication for anxiety disorders
Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are first-line drugs for generalized anxiety disorder. They carry a lower risk of dependence than benzodiazepines, which are reserved for short-term or adjunct use.
Why the others are wrong
B – Benzodiazepines carry dependence and sedation risks and are not first-line for ongoing treatment.
C – Opioids are not indicated for anxiety and carry misuse and respiratory risks.
D – Zolpidem is a hypnotic for insomnia and does not treat anxiety disorders.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
The mother of a young adult in a first episode of schizophrenia asks about the main treatment. Which response by the nurse is best?
Electroconvulsive therapy is tried first in most clients
Talk therapy alone is enough for most clients, and medication is added only if therapy has failed
Antipsychotic medication, along with psychosocial support, is the foundation of treatment
Cognitive remediation must be completed before any medication is started
Show the answer and explanation
Answer: C. Antipsychotic medication, along with psychosocial support, is the foundation of treatment
Topic: first-line treatment for schizophrenia
Antipsychotic medication is the first-line treatment for schizophrenia, combined with psychosocial interventions such as family education, supported employment and skills training. Electroconvulsive therapy is reserved for specific situations such as treatment resistance or catatonia.
Why the others are wrong
A – ECT is not first-line; it is considered for treatment-resistant illness or catatonia.
B – Psychotherapy alone does not adequately treat psychosis.
D – Cognitive remediation is an adjunct, and medication should not be delayed.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
A client who has taken lorazepam daily for eight months for panic disorder says, 'I am quitting today because I do not want to be hooked.' Which response by the nurse is the priority?
Support the decision, since stopping at once shows commitment
Reassure the client that dependence cannot occur at prescribed doses
Explain that stopping suddenly can cause rebound anxiety, and even seizures, so a gradual taper should be arranged with the prescriber
Suggest that the client halve the dose each day without contacting the prescriber
Show the answer and explanation
Answer: C. Explain that stopping suddenly can cause rebound anxiety, and even seizures, so a gradual taper should be arranged with the prescriber
Topic: benzodiazepine dependence and discontinuation
Long-term benzodiazepine use produces physiological dependence even at prescribed doses. Abrupt cessation can cause rebound anxiety, insomnia, and seizures, so discontinuation should be a gradual taper supervised by the prescriber.
Why the others are wrong
A – Abrupt cessation is unsafe and supporting it could lead to seizures.
B – Physiological dependence can develop at prescribed doses, so this is false.
D – An unsupervised taper schedule may be too fast and lacks monitoring.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
A client with PTSD asks the prescriber for alprazolam to 'calm the flashbacks.' Which understanding should guide the nurse's response?
Benzodiazepines are the strongest first-line drugs for PTSD
Benzodiazepines cure the underlying trauma response within a week
Alprazolam is the only drug that reduces flashbacks
Benzodiazepines are not recommended for PTSD, so trauma-focused psychotherapy and antidepressants are preferred
Show the answer and explanation
Answer: D. Benzodiazepines are not recommended for PTSD, so trauma-focused psychotherapy and antidepressants are preferred
Topic: medication for PTSD
PTSD guidelines recommend trauma-focused psychotherapy and certain antidepressants such as sertraline, paroxetine and venlafaxine, and advise against routine benzodiazepine use because they do not improve core symptoms, may interfere with recovery, and carry dependence risks.
Why the others are wrong
A – They are not first-line; guidelines advise against their routine use.
B – They do not resolve the trauma response.
C – Several antidepressants and therapy treat flashbacks and are preferred.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
A client who has taken sertraline for six weeks for anxiety says, 'I feel great, so I will stop the pills and skip therapy.' Which statement by the nurse is most appropriate?
Stop whenever you feel well, since there are no risks
Stopping suddenly is safe because the drug is not habit-forming
Symptoms often return when medication alone is stopped, so talk with your prescriber about a gradual plan and keep using the skills you learn in therapy
Therapy is no longer helpful once medication is working
Show the answer and explanation
Answer: C. Symptoms often return when medication alone is stopped, so talk with your prescriber about a gradual plan and keep using the skills you learn in therapy
Topic: relapse after stopping anxiolytic treatment
Anxiety frequently returns after medication is stopped unless the client has also learned coping skills in psychotherapy. Abrupt discontinuation of an SSRI can also cause discontinuation symptoms, so any stop should be a gradual plan with the prescriber.
Why the others are wrong
A – Relapse is common after stopping, so this advice is unsafe.
B – SSRIs are not habit-forming, but abrupt stopping can cause discontinuation symptoms.
D – Therapy adds durable coping skills that reduce relapse.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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