NSG 552 EXAM 2 PSYCHOPHARMACOLOGY
— COMPLETE 150-QUESTION PRACTICE
EXAM Wilkes University | 2026/2027 | Questions with
Answers & Rationales
SECTION 1: MOOD STABILIZERS & BIPOLAR DISORDER (Questions 1-40)
Lithium, Anticonvulsants, Acute Mania, Maintenance Therapy
1. A patient diagnosed with Bipolar I Disorder is experiencing acute mania
with psychotic features. The patient is agitated and refusing oral
medications. What is the most appropriate initial pharmacologic
intervention?
A. Begin oral lithium and wait for therapeutic levels
B. Administer IM haloperidol plus an anticholinergic agent (benztropine or
diphenhydramine)
C. Start lamotrigine 25 mg daily
D. Begin clozapine 12.5 mg at bedtime
Correct Answer: B
Rationale: Severely agitated patients who cannot take oral
medications require immediate IM intervention. IM haloperidol
provides rapid tranquilization for acute mania, and the addition of
benztropine or diphenhydramine mitigates the risk of severe
EPS/dystonia in this psychiatric emergency .
2. The gold standard mood stabilizer for acute mania and maintenance
therapy in Bipolar I Disorder, with robust evidence for reducing suicide risk,
is:
A. Valproate (Depakote)
B. Lamotrigine (Lamictal)
C. Lithium
D. Carbamazepine (Tegretol)
,Correct Answer: C
Rationale: Lithium is the gold standard for bipolar disorder, effective
for both acute mania and maintenance. It is the only mood stabilizer
with strong evidence for reducing the risk of completed suicide .
3. A patient newly started on lithium asks how long it will take to feel the full
therapeutic effect. The nurse's best response is:
A. "You should feel completely better within 3 days."
B. "It may take 1-3 weeks for acute mania to resolve, and full stabilization
may take months."
C. "Lithium works immediately like a benzodiazepine."
D. "You won't notice any changes for at least 6 months."
Correct Answer: B
*Rationale: Lithium has a delayed onset of action. While some
improvement may be seen within days, full resolution of acute mania
typically takes 1-3 weeks. Long-term mood stabilization requires
consistent therapeutic levels.*
4. The therapeutic serum level range for lithium maintenance therapy is:
A. 0.1-0.4 mEq/L
B. 0.6-1.2 mEq/L
C. 1.5-2.0 mEq/L
D. 2.5-3.5 mEq/L
Correct Answer: B
*Rationale: The target therapeutic range for lithium maintenance is
0.6-1.2 mEq/L. Levels above 1.5 mEq/L indicate toxicity, and levels
above 2.5 mEq/L are life-threatening and may require hemodialysis.*
5. A patient on lithium reports coarse hand tremor, nausea, vomiting, and
confusion. The nurse should suspect:
A. Therapeutic lithium level
B. Lithium toxicity
C. Hypokalemia
D. Normal side effects that will resolve
,Correct Answer: B
Rationale: Fine tremor is a common side effect at therapeutic levels.
However, coarse tremor, nausea, vomiting, diarrhea, confusion, and
ataxia indicate lithium toxicity requiring immediate medical
evaluation and likely serum level assessment.
6. A patient taking lithium should be educated to maintain adequate intake
of:
A. Potassium-rich foods
B. Sodium and water
C. Calcium-rich foods
D. Iron-rich foods
Correct Answer: B
Rationale: Lithium is handled by the kidneys similarly to sodium.
Dehydration or low sodium intake causes the kidneys to retain
lithium, increasing serum levels and toxicity risk. Consistent sodium
and fluid intake is essential .
7. A patient on lithium develops polyuria, polydipsia, and nocturia. The
nurse recognizes these as signs of:
A. Lithium toxicity
B. Nephrogenic diabetes insipidus
C. Hypothyroidism
D. Hyperparathyroidism
Correct Answer: B
Rationale: Lithium can antagonize ADH action in the collecting ducts,
causing nephrogenic diabetes insipidus. This presents with excessive
dilute urine output, thirst, and nocturia. Amiloride or dose reduction
may be considered.
8. Baseline and ongoing monitoring for a patient on lithium should include
all of the following EXCEPT:
A. Serum lithium level (trough)
B. Thyroid function tests (TSH, free T4)
, C. Liver function tests (ALT, AST)
D. Renal function tests (BUN, creatinine, eGFR)
Correct Answer: C
Rationale: Lithium requires monitoring of renal function (due to
excretion and risk of nephrotoxicity), thyroid function (risk of
hypothyroidism), and serum lithium levels. Liver function monitoring
is more critical with valproate and carbamazepine, not lithium.
9. A patient on lithium is prescribed hydrochlorothiazide (HCTZ) for
hypertension. The nurse should anticipate:
A. No change in lithium levels
B. Decreased lithium levels
C. Increased lithium levels and potential toxicity
D. The need to discontinue lithium
Correct Answer: C
Rationale: Thiazide diuretics decrease lithium clearance by promoting
sodium reabsorption in the proximal tubule, causing the kidneys to
retain lithium. This can significantly increase serum lithium levels
and cause toxicity.
10. A patient on lithium is started on ibuprofen for arthritis pain. The nurse
should educate the patient that:
A. NSAIDs have no effect on lithium
B. NSAIDs decrease lithium levels and reduce efficacy
C. NSAIDs increase lithium levels and risk of toxicity
D. NSAIDs are safe with lithium if taken with food
Correct Answer: C
*Rationale: NSAIDs (except aspirin and sulindac) decrease renal
clearance of lithium, increasing serum levels by 30-50% and raising the
risk of toxicity. Acetaminophen is the preferred analgesic.*
11. A patient with bipolar disorder and comorbid migraine headaches is
started on valproate (Depakote). The nurse should monitor for which serious
— COMPLETE 150-QUESTION PRACTICE
EXAM Wilkes University | 2026/2027 | Questions with
Answers & Rationales
SECTION 1: MOOD STABILIZERS & BIPOLAR DISORDER (Questions 1-40)
Lithium, Anticonvulsants, Acute Mania, Maintenance Therapy
1. A patient diagnosed with Bipolar I Disorder is experiencing acute mania
with psychotic features. The patient is agitated and refusing oral
medications. What is the most appropriate initial pharmacologic
intervention?
A. Begin oral lithium and wait for therapeutic levels
B. Administer IM haloperidol plus an anticholinergic agent (benztropine or
diphenhydramine)
C. Start lamotrigine 25 mg daily
D. Begin clozapine 12.5 mg at bedtime
Correct Answer: B
Rationale: Severely agitated patients who cannot take oral
medications require immediate IM intervention. IM haloperidol
provides rapid tranquilization for acute mania, and the addition of
benztropine or diphenhydramine mitigates the risk of severe
EPS/dystonia in this psychiatric emergency .
2. The gold standard mood stabilizer for acute mania and maintenance
therapy in Bipolar I Disorder, with robust evidence for reducing suicide risk,
is:
A. Valproate (Depakote)
B. Lamotrigine (Lamictal)
C. Lithium
D. Carbamazepine (Tegretol)
,Correct Answer: C
Rationale: Lithium is the gold standard for bipolar disorder, effective
for both acute mania and maintenance. It is the only mood stabilizer
with strong evidence for reducing the risk of completed suicide .
3. A patient newly started on lithium asks how long it will take to feel the full
therapeutic effect. The nurse's best response is:
A. "You should feel completely better within 3 days."
B. "It may take 1-3 weeks for acute mania to resolve, and full stabilization
may take months."
C. "Lithium works immediately like a benzodiazepine."
D. "You won't notice any changes for at least 6 months."
Correct Answer: B
*Rationale: Lithium has a delayed onset of action. While some
improvement may be seen within days, full resolution of acute mania
typically takes 1-3 weeks. Long-term mood stabilization requires
consistent therapeutic levels.*
4. The therapeutic serum level range for lithium maintenance therapy is:
A. 0.1-0.4 mEq/L
B. 0.6-1.2 mEq/L
C. 1.5-2.0 mEq/L
D. 2.5-3.5 mEq/L
Correct Answer: B
*Rationale: The target therapeutic range for lithium maintenance is
0.6-1.2 mEq/L. Levels above 1.5 mEq/L indicate toxicity, and levels
above 2.5 mEq/L are life-threatening and may require hemodialysis.*
5. A patient on lithium reports coarse hand tremor, nausea, vomiting, and
confusion. The nurse should suspect:
A. Therapeutic lithium level
B. Lithium toxicity
C. Hypokalemia
D. Normal side effects that will resolve
,Correct Answer: B
Rationale: Fine tremor is a common side effect at therapeutic levels.
However, coarse tremor, nausea, vomiting, diarrhea, confusion, and
ataxia indicate lithium toxicity requiring immediate medical
evaluation and likely serum level assessment.
6. A patient taking lithium should be educated to maintain adequate intake
of:
A. Potassium-rich foods
B. Sodium and water
C. Calcium-rich foods
D. Iron-rich foods
Correct Answer: B
Rationale: Lithium is handled by the kidneys similarly to sodium.
Dehydration or low sodium intake causes the kidneys to retain
lithium, increasing serum levels and toxicity risk. Consistent sodium
and fluid intake is essential .
7. A patient on lithium develops polyuria, polydipsia, and nocturia. The
nurse recognizes these as signs of:
A. Lithium toxicity
B. Nephrogenic diabetes insipidus
C. Hypothyroidism
D. Hyperparathyroidism
Correct Answer: B
Rationale: Lithium can antagonize ADH action in the collecting ducts,
causing nephrogenic diabetes insipidus. This presents with excessive
dilute urine output, thirst, and nocturia. Amiloride or dose reduction
may be considered.
8. Baseline and ongoing monitoring for a patient on lithium should include
all of the following EXCEPT:
A. Serum lithium level (trough)
B. Thyroid function tests (TSH, free T4)
, C. Liver function tests (ALT, AST)
D. Renal function tests (BUN, creatinine, eGFR)
Correct Answer: C
Rationale: Lithium requires monitoring of renal function (due to
excretion and risk of nephrotoxicity), thyroid function (risk of
hypothyroidism), and serum lithium levels. Liver function monitoring
is more critical with valproate and carbamazepine, not lithium.
9. A patient on lithium is prescribed hydrochlorothiazide (HCTZ) for
hypertension. The nurse should anticipate:
A. No change in lithium levels
B. Decreased lithium levels
C. Increased lithium levels and potential toxicity
D. The need to discontinue lithium
Correct Answer: C
Rationale: Thiazide diuretics decrease lithium clearance by promoting
sodium reabsorption in the proximal tubule, causing the kidneys to
retain lithium. This can significantly increase serum lithium levels
and cause toxicity.
10. A patient on lithium is started on ibuprofen for arthritis pain. The nurse
should educate the patient that:
A. NSAIDs have no effect on lithium
B. NSAIDs decrease lithium levels and reduce efficacy
C. NSAIDs increase lithium levels and risk of toxicity
D. NSAIDs are safe with lithium if taken with food
Correct Answer: C
*Rationale: NSAIDs (except aspirin and sulindac) decrease renal
clearance of lithium, increasing serum levels by 30-50% and raising the
risk of toxicity. Acetaminophen is the preferred analgesic.*
11. A patient with bipolar disorder and comorbid migraine headaches is
started on valproate (Depakote). The nurse should monitor for which serious
