Mental health questions
12 questions. Choose an answer to see the rationale.
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A patient started sertraline 10 days ago and says it is not working. What is the best response?
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Answer B: Full benefit usually takes several weeks; keep taking it as prescribed SSRIs often need 4 to 6 weeks for full effect. Monitor mood and suicide risk during this period.
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Which finding suggests serotonin syndrome?
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Answer A: Agitation, hyperthermia, tremor and muscle twitching Serotonin syndrome causes mental status changes, autonomic instability (fever, tachycardia, sweating) and neuromuscular hyperactivity (tremor, clonus).
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A patient taking phenelzine should avoid which food?
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Answer C: Aged cheddar cheese Phenelzine is an MAOI. Aged cheese is rich in tyramine, which can cause a hypertensive crisis.
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A patient on lithium has a level of 2.1 mEq/L with vomiting and coarse tremor. What is the priority?
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Answer A: Hold lithium and notify the provider: these are signs of toxicity A level above the therapeutic range with GI and neurologic symptoms indicates lithium toxicity.
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Which over-the-counter drug can raise lithium levels?
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Answer A: Ibuprofen NSAIDs reduce lithium excretion by the kidneys and can cause toxicity.
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What teaching about diet is correct for a patient on lithium?
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Answer B: Keep salt and fluid intake consistent Low sodium or dehydration makes the kidney keep more lithium; consistency keeps levels stable.
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A patient on haloperidol has a temperature of 104°F (40°C), rigid muscles and confusion. What does the nurse suspect?
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Answer D: Neuroleptic malignant syndrome Hyperthermia, lead-pipe rigidity, altered mental status and autonomic instability are the hallmarks of neuroleptic malignant syndrome.
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Which monitoring is most important for a patient starting olanzapine?
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Answer B: Weight, blood glucose and lipids Second-generation antipsychotics, especially olanzapine and clozapine, cause weight gain and metabolic syndrome.
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A patient on clozapine reports a sore throat and fever. What is the priority?
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Answer B: Notify the provider and check the absolute neutrophil count Clozapine can cause severe neutropenia; signs of infection require an urgent ANC.
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What is the reversal agent for a benzodiazepine overdose?
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Answer D: Flumazenil Flumazenil is a benzodiazepine receptor antagonist. Naloxone reverses opioids.
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Which combination poses the greatest risk of fatal respiratory depression?
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Answer B: Lorazepam and an opioid Benzodiazepines and opioids together carry a boxed warning for profound sedation, respiratory depression, coma and death.
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A patient has taken alprazolam daily for a year and wants to stop. What is the best advice?
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Answer D: Taper slowly under the provider's direction Abrupt withdrawal after long-term use can cause rebound anxiety, insomnia and seizures; a supervised taper is needed.