200+ NCLEX-STYLE QUESTIONS & ANSWERS
WITH RATIONALES
,ATI RN Mental Health Pharmacology Comprehensive Final 2026 NCLEX-Style Practice Exam —
Questions
1. A nurse is caring for a client who has a prescription for fluoxetine. Which adverse effect
should the nurse monitor for?
A. Severe hypertension
B. Serotonin syndrome
C. Agranulocytosis
D. Acute renal failure
Answer: B. Serotonin syndrome
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Excessive serotonergic
activity can cause serotonin syndrome, manifested by agitation, confusion, diaphoresis,
hyperreflexia, tremor, and hyperthermia. The other conditions are not characteristic primary
adverse effects of fluoxetine.
2. A nurse is teaching a client who is beginning sertraline therapy. Which statement by the
client indicates understanding?
A. "I should expect immediate relief of my depression."
B. "I should stop taking the medication when I feel better."
C. "It might take several weeks before I notice the full therapeutic effect."
D. "I should take an extra dose if I miss one."
Answer: C. "It might take several weeks before I notice the full therapeutic effect."
Rationale: SSRIs generally require several weeks to produce their full antidepressant effect.
Clients should continue taking the medication as prescribed and should not abruptly
discontinue therapy.
3. A client taking phenelzine asks which food should be avoided. Which food should the nurse
identify?
A. Fresh apples
B. Aged cheese
C. Steamed vegetables
D. White rice
Answer: B. Aged cheese
,Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Foods high in tyramine,
including aged cheeses, cured meats, fermented foods, and some alcoholic beverages, can
cause a potentially life-threatening hypertensive reaction.
4. A nurse is assessing a client who recently started lithium therapy. Which finding requires
immediate intervention?
A. Mild thirst
B. Fine hand tremor
C. Severe diarrhea and vomiting
D. Increased urination
Answer: C. Severe diarrhea and vomiting
Rationale: Severe gastrointestinal losses can cause dehydration and increase lithium
concentrations, placing the client at risk for lithium toxicity. Early toxicity can include nausea,
vomiting, diarrhea, coarse tremor, ataxia, and confusion.
5. A nurse is monitoring a client receiving lithium. Which laboratory value is most important to
monitor routinely?
A. Serum lithium concentration
B. Serum amylase
C. Hemoglobin A1c
D. Troponin level
Answer: A. Serum lithium concentration
Rationale: Lithium has a narrow therapeutic index. Serum concentrations must be monitored to
maintain therapeutic levels and detect toxicity. Renal and thyroid function are also monitored
during long-term therapy.
6. A client taking lithium reports worsening tremors, confusion, and difficulty walking. Which
action should the nurse take?
A. Administer the next dose with food.
B. Encourage the client to exercise.
C. Hold the medication and notify the provider.
D. Give an additional dose at bedtime.
Answer: C. Hold the medication and notify the provider.
, Rationale: Coarse tremor, confusion, and ataxia are manifestations of lithium toxicity. The
medication should be withheld and the provider notified promptly.
7. A nurse is teaching a client taking clozapine. Which laboratory test is particularly important?
A. Absolute neutrophil count
B. Serum calcium
C. Troponin every week
D. Amylase level
Answer: A. Absolute neutrophil count
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. ANC monitoring is
required to identify potentially dangerous reductions in neutrophils.
8. A client taking clozapine reports a sore throat and fever. What should the nurse do?
A. Reassure the client that this is expected.
B. Tell the client to increase the dose.
C. Notify the provider promptly.
D. Recommend taking the medication with milk.
Answer: C. Notify the provider promptly.
Rationale: Fever and sore throat can indicate infection associated with neutropenia. The client
requires prompt evaluation and an ANC assessment.
9. A nurse is administering haloperidol to a client with schizophrenia. Which finding suggests
the client is experiencing an extrapyramidal adverse effect?
A. Lip smacking and tongue movements
B. Increased appetite
C. Excessive urination
D. Hypoglycemia
Answer: A. Lip smacking and tongue movements
Rationale: Repetitive involuntary movements of the mouth and tongue can indicate tardive
dyskinesia, an extrapyramidal adverse effect associated with antipsychotic medications.
WITH RATIONALES
,ATI RN Mental Health Pharmacology Comprehensive Final 2026 NCLEX-Style Practice Exam —
Questions
1. A nurse is caring for a client who has a prescription for fluoxetine. Which adverse effect
should the nurse monitor for?
A. Severe hypertension
B. Serotonin syndrome
C. Agranulocytosis
D. Acute renal failure
Answer: B. Serotonin syndrome
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Excessive serotonergic
activity can cause serotonin syndrome, manifested by agitation, confusion, diaphoresis,
hyperreflexia, tremor, and hyperthermia. The other conditions are not characteristic primary
adverse effects of fluoxetine.
2. A nurse is teaching a client who is beginning sertraline therapy. Which statement by the
client indicates understanding?
A. "I should expect immediate relief of my depression."
B. "I should stop taking the medication when I feel better."
C. "It might take several weeks before I notice the full therapeutic effect."
D. "I should take an extra dose if I miss one."
Answer: C. "It might take several weeks before I notice the full therapeutic effect."
Rationale: SSRIs generally require several weeks to produce their full antidepressant effect.
Clients should continue taking the medication as prescribed and should not abruptly
discontinue therapy.
3. A client taking phenelzine asks which food should be avoided. Which food should the nurse
identify?
A. Fresh apples
B. Aged cheese
C. Steamed vegetables
D. White rice
Answer: B. Aged cheese
,Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Foods high in tyramine,
including aged cheeses, cured meats, fermented foods, and some alcoholic beverages, can
cause a potentially life-threatening hypertensive reaction.
4. A nurse is assessing a client who recently started lithium therapy. Which finding requires
immediate intervention?
A. Mild thirst
B. Fine hand tremor
C. Severe diarrhea and vomiting
D. Increased urination
Answer: C. Severe diarrhea and vomiting
Rationale: Severe gastrointestinal losses can cause dehydration and increase lithium
concentrations, placing the client at risk for lithium toxicity. Early toxicity can include nausea,
vomiting, diarrhea, coarse tremor, ataxia, and confusion.
5. A nurse is monitoring a client receiving lithium. Which laboratory value is most important to
monitor routinely?
A. Serum lithium concentration
B. Serum amylase
C. Hemoglobin A1c
D. Troponin level
Answer: A. Serum lithium concentration
Rationale: Lithium has a narrow therapeutic index. Serum concentrations must be monitored to
maintain therapeutic levels and detect toxicity. Renal and thyroid function are also monitored
during long-term therapy.
6. A client taking lithium reports worsening tremors, confusion, and difficulty walking. Which
action should the nurse take?
A. Administer the next dose with food.
B. Encourage the client to exercise.
C. Hold the medication and notify the provider.
D. Give an additional dose at bedtime.
Answer: C. Hold the medication and notify the provider.
, Rationale: Coarse tremor, confusion, and ataxia are manifestations of lithium toxicity. The
medication should be withheld and the provider notified promptly.
7. A nurse is teaching a client taking clozapine. Which laboratory test is particularly important?
A. Absolute neutrophil count
B. Serum calcium
C. Troponin every week
D. Amylase level
Answer: A. Absolute neutrophil count
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. ANC monitoring is
required to identify potentially dangerous reductions in neutrophils.
8. A client taking clozapine reports a sore throat and fever. What should the nurse do?
A. Reassure the client that this is expected.
B. Tell the client to increase the dose.
C. Notify the provider promptly.
D. Recommend taking the medication with milk.
Answer: C. Notify the provider promptly.
Rationale: Fever and sore throat can indicate infection associated with neutropenia. The client
requires prompt evaluation and an ANC assessment.
9. A nurse is administering haloperidol to a client with schizophrenia. Which finding suggests
the client is experiencing an extrapyramidal adverse effect?
A. Lip smacking and tongue movements
B. Increased appetite
C. Excessive urination
D. Hypoglycemia
Answer: A. Lip smacking and tongue movements
Rationale: Repetitive involuntary movements of the mouth and tongue can indicate tardive
dyskinesia, an extrapyramidal adverse effect associated with antipsychotic medications.
