ADVANCED PSYCHIATRIC NURSING NCLEX-STYLE
EXAM LATEST 2026 UPDATE 100 QUESTIONS AND
DETAILED VERIFIED ANSWERS FROM ACTUAL
EXAMS TEST GRADE A+
1. A psychiatric nurse practitioner is assessing a patient with major depressive disorder
who reports sleeping 3 hours per night, feelings of hopelessness, and poor appetite for 1
month. Which neurotransmitter imbalance is most associated with depression?
A. Increased dopamine
B. Decreased serotonin
C. Increased acetylcholine
D. Decreased histamine
Answer: B. Decreased serotonin
Rationale: Depression is strongly associated with decreased serotonin levels, which affect mood,
sleep, appetite, and emotional regulation.
2. A patient diagnosed with schizophrenia states, “The FBI implanted a chip in my brain.”
What is the nurse’s best response?
A. “That is impossible.”
B. “Why do you think the FBI targeted you?”
C. “I understand this feels real to you, but I do not see evidence of that.”
D. “You should report this to the police.”
Answer: C. “I understand this feels real to you, but I do not see evidence of that.”
Rationale: The nurse should acknowledge the patient’s feelings without validating the delusion.
Arguing or reinforcing the delusion is inappropriate.
3. A patient taking lithium reports diarrhea, coarse tremors, and confusion. What is the
nurse’s priority action?
A. Encourage fluids
B. Hold lithium and notify the provider
,C. Administer the next dose with food
D. Reassure the patient this is expected
Answer: B. Hold lithium and notify the provider
Rationale: These findings suggest lithium toxicity. The medication should be held immediately
and the provider notified.
4. Which symptom is considered a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Flat affect
D. Disorganized speech
Answer: C. Flat affect
Rationale: Negative symptoms involve loss of normal function, including flat affect, avolition,
and social withdrawal.
5. A manic patient is pacing rapidly and yelling at staff. What is the nurse’s first
intervention?
A. Place the patient in restraints
B. Administer sedatives immediately
C. Use calm, concise communication
D. Confront the inappropriate behavior
Answer: C. Use calm, concise communication
Rationale: Calm, simple communication helps decrease stimulation and promotes de-escalation
during mania.
6. A patient with generalized anxiety disorder asks why benzodiazepines are prescribed
cautiously. What is the best response?
A. “They can worsen psychosis.”
B. “They may cause physical dependence.”
C. “They always cause insomnia.”
D. “They cure anxiety permanently.”
,Answer: B. “They may cause physical dependence.”
Rationale: Benzodiazepines can cause tolerance, dependence, and withdrawal symptoms if used
long term.
7. A patient prescribed clozapine should be monitored for which potentially fatal adverse
effect?
A. Hypertension
B. Agranulocytosis
C. Hyperthyroidism
D. Glaucoma
Answer: B. Agranulocytosis
Rationale: Clozapine can cause severe neutropenia/agranulocytosis, requiring regular CBC
monitoring.
8. Which statement by a patient with obsessive-compulsive disorder indicates
understanding of the disorder?
A. “My compulsions are always logical.”
B. “I cannot recognize my obsessions.”
C. “My rituals reduce my anxiety temporarily.”
D. “My thoughts are controlled by others.”
Answer: C. “My rituals reduce my anxiety temporarily.”
Rationale: Compulsions temporarily relieve anxiety caused by obsessive thoughts.
9. A patient abruptly stops taking paroxetine. Which withdrawal symptom should the nurse
expect?
A. Hypertension
B. Dizziness and flu-like symptoms
C. Hyperglycemia
D. Tinnitus only
Answer: B. Dizziness and flu-like symptoms
, Rationale: SSRI discontinuation syndrome commonly causes dizziness, nausea, headache, and
flu-like symptoms.
10. During a panic attack, which intervention is most appropriate?
A. Teach complex coping skills
B. Leave the patient alone
C. Stay with the patient and speak calmly
D. Encourage group interaction
Answer: C. Stay with the patient and speak calmly
Rationale: Remaining with the patient provides reassurance and safety during acute panic.
11. Which laboratory value is most important before initiating valproic acid therapy?
A. Platelet count
B. Sodium level
C. Calcium level
D. Hemoglobin A1C
Answer: A. Platelet count
Rationale: Valproic acid can cause thrombocytopenia and hepatotoxicity; platelet monitoring is
essential.
12. A patient says, “I hear voices telling me to hurt myself.” What is the nurse’s priority
assessment?
A. Frequency of hallucinations
B. Presence of a suicide plan
C. Family psychiatric history
D. Educational background
Answer: B. Presence of a suicide plan
Rationale: Safety is the priority when command hallucinations involve self-harm.
EXAM LATEST 2026 UPDATE 100 QUESTIONS AND
DETAILED VERIFIED ANSWERS FROM ACTUAL
EXAMS TEST GRADE A+
1. A psychiatric nurse practitioner is assessing a patient with major depressive disorder
who reports sleeping 3 hours per night, feelings of hopelessness, and poor appetite for 1
month. Which neurotransmitter imbalance is most associated with depression?
A. Increased dopamine
B. Decreased serotonin
C. Increased acetylcholine
D. Decreased histamine
Answer: B. Decreased serotonin
Rationale: Depression is strongly associated with decreased serotonin levels, which affect mood,
sleep, appetite, and emotional regulation.
2. A patient diagnosed with schizophrenia states, “The FBI implanted a chip in my brain.”
What is the nurse’s best response?
A. “That is impossible.”
B. “Why do you think the FBI targeted you?”
C. “I understand this feels real to you, but I do not see evidence of that.”
D. “You should report this to the police.”
Answer: C. “I understand this feels real to you, but I do not see evidence of that.”
Rationale: The nurse should acknowledge the patient’s feelings without validating the delusion.
Arguing or reinforcing the delusion is inappropriate.
3. A patient taking lithium reports diarrhea, coarse tremors, and confusion. What is the
nurse’s priority action?
A. Encourage fluids
B. Hold lithium and notify the provider
,C. Administer the next dose with food
D. Reassure the patient this is expected
Answer: B. Hold lithium and notify the provider
Rationale: These findings suggest lithium toxicity. The medication should be held immediately
and the provider notified.
4. Which symptom is considered a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Flat affect
D. Disorganized speech
Answer: C. Flat affect
Rationale: Negative symptoms involve loss of normal function, including flat affect, avolition,
and social withdrawal.
5. A manic patient is pacing rapidly and yelling at staff. What is the nurse’s first
intervention?
A. Place the patient in restraints
B. Administer sedatives immediately
C. Use calm, concise communication
D. Confront the inappropriate behavior
Answer: C. Use calm, concise communication
Rationale: Calm, simple communication helps decrease stimulation and promotes de-escalation
during mania.
6. A patient with generalized anxiety disorder asks why benzodiazepines are prescribed
cautiously. What is the best response?
A. “They can worsen psychosis.”
B. “They may cause physical dependence.”
C. “They always cause insomnia.”
D. “They cure anxiety permanently.”
,Answer: B. “They may cause physical dependence.”
Rationale: Benzodiazepines can cause tolerance, dependence, and withdrawal symptoms if used
long term.
7. A patient prescribed clozapine should be monitored for which potentially fatal adverse
effect?
A. Hypertension
B. Agranulocytosis
C. Hyperthyroidism
D. Glaucoma
Answer: B. Agranulocytosis
Rationale: Clozapine can cause severe neutropenia/agranulocytosis, requiring regular CBC
monitoring.
8. Which statement by a patient with obsessive-compulsive disorder indicates
understanding of the disorder?
A. “My compulsions are always logical.”
B. “I cannot recognize my obsessions.”
C. “My rituals reduce my anxiety temporarily.”
D. “My thoughts are controlled by others.”
Answer: C. “My rituals reduce my anxiety temporarily.”
Rationale: Compulsions temporarily relieve anxiety caused by obsessive thoughts.
9. A patient abruptly stops taking paroxetine. Which withdrawal symptom should the nurse
expect?
A. Hypertension
B. Dizziness and flu-like symptoms
C. Hyperglycemia
D. Tinnitus only
Answer: B. Dizziness and flu-like symptoms
, Rationale: SSRI discontinuation syndrome commonly causes dizziness, nausea, headache, and
flu-like symptoms.
10. During a panic attack, which intervention is most appropriate?
A. Teach complex coping skills
B. Leave the patient alone
C. Stay with the patient and speak calmly
D. Encourage group interaction
Answer: C. Stay with the patient and speak calmly
Rationale: Remaining with the patient provides reassurance and safety during acute panic.
11. Which laboratory value is most important before initiating valproic acid therapy?
A. Platelet count
B. Sodium level
C. Calcium level
D. Hemoglobin A1C
Answer: A. Platelet count
Rationale: Valproic acid can cause thrombocytopenia and hepatotoxicity; platelet monitoring is
essential.
12. A patient says, “I hear voices telling me to hurt myself.” What is the nurse’s priority
assessment?
A. Frequency of hallucinations
B. Presence of a suicide plan
C. Family psychiatric history
D. Educational background
Answer: B. Presence of a suicide plan
Rationale: Safety is the priority when command hallucinations involve self-harm.
