200+ NCLEX-STYLE QUESTIONS & ANSWERS
WITH RATIONALES
,Mental Health ATI RN Pharmacology Final Exam 2026 | NCLEX-Style Questions, Answers & Rationales
SECTION J: ANTIDEPRESSANTS (Continued) & SEROTONIN SYNDROME
Question 31
A client taking fluoxetine reports agitation, diaphoresis, and muscle rigidity after starting St. John's wort.
The nurse suspects serotonin syndrome. Which action should the nurse take FIRST?
A) Administer acetaminophen for fever
B) Discontinue the fluoxetine and St. John's wort
C) Apply cooling blankets
D) Administer IV fluids
Answer: B) Discontinue the fluoxetine and St. John's wort
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excessive
serotonergic activity. The immediate priority is to discontinue all serotonergic agents. St. John's wort
combined with SSRIs significantly increases serotonin syndrome risk. Other interventions (cooling, fluids,
supportive care) follow after the offending agents are stopped. Severe cases may require
cyproheptadine (a serotonin antagonist).
Question 32
A client with major depressive disorder is switching from fluoxetine to phenelzine. The nurse should
ensure a washout period of at least:
A) 24 hours
B) 7 days
C) 14 days
D) 5 weeks
Answer: D) 5 weeks
Rationale: Fluoxetine has a long half-life (active metabolite with half-life of 7-15 days). A 5-week
washout period is recommended before starting an MAOI to prevent serotonin syndrome. Other SSRIs
with shorter half-lives typically require a 2-week washout. This is a critical safety consideration that the
nurse must verify before MAOI initiation.
Question 33
,A client prescribed venlafaxine reports nausea, dizziness, and headache. The nurse notes blood pressure
152/94 mmHg. Which action is most appropriate?
A) Administer the medication with food
B) Hold the medication and notify the provider
C) Document findings as expected side effects
D) Administer an antiemetic
Answer: B) Hold the medication and notify the provider
Rationale: Venlafaxine (SNRI) can cause dose-dependent hypertension. Blood pressure should be
monitored regularly. The elevated BP (152/94) requires provider notification and potential dose
adjustment or medication change. While nausea may improve with food, hypertension is a significant
adverse effect requiring intervention.
Question 34
A client with depression and chronic pain is prescribed duloxetine. Which therapeutic effect does the
nurse anticipate?
A) Immediate pain relief within hours
B) Reduction of both depressive symptoms and neuropathic pain
C) Improved sleep only
D) Increased energy with first dose
Answer: B) Reduction of both depressive symptoms and neuropathic pain
Rationale: Duloxetine (Cymbalta) is an SNRI approved for both major depressive disorder and diabetic
peripheral neuropathy. It modulates both serotonin and norepinephrine, addressing both mood
symptoms and pain pathways. Therapeutic effects typically take 2-4 weeks for depression and may be
somewhat faster for pain.
SECTION K: ATYPICAL ANTIDEPRESSANTS & OTHER AGENTS
Question 35
A client with treatment-resistant depression is prescribed trazodone. The nurse should include which
priority teaching point?
A) "Take this medication in the morning to avoid insomnia"
B) "This medication may cause drowsiness; take it at bedtime"
C) "You should avoid all carbohydrates while on this medication"
D) "This medication works immediately for depression"
, Answer: B) "This medication may cause drowsiness; take it at bedtime"
Rationale: Trazodone is highly sedating and is often prescribed at lower doses for sleep induction. At
higher doses for depression, it should be taken at bedtime to minimize daytime sedation. Priapism is a
rare but serious side effect requiring immediate medical attention. The antidepressant effect takes
weeks to develop.
Question 36
A client prescribed methylphenidate for ADHD reports weight loss and decreased appetite. Which
nursing intervention is most appropriate?
A) Discontinue the medication immediately
B) Instruct the client to take the medication with meals
C) Monitor growth parameters and schedule medication holidays
D) Switch to an immediate-release formulation
Answer: C) Monitor growth parameters and schedule medication holidays
Rationale: Stimulants (methylphenidate, amphetamines) commonly cause appetite suppression and
weight loss in children and adolescents. Height and weight should be monitored regularly. Medication
holidays (drug-free periods) may be recommended to allow catch-up growth. Taking with meals may
help maintain nutrition.
SECTION L: ANTIPSYCHOTICS (Continued)
Question 37
A client taking haloperidol develops a shuffling gait, tremor, and pill-rolling movements. The nurse
recognizes these as:
A) Tardive dyskinesia
B) Acute dystonia
C) Parkinsonism
D) Akathisia
Answer: C) Parkinsonism
Rationale: Parkinsonism is an extrapyramidal side effect of first-generation antipsychotics characterized
by bradykinesia, tremor, rigidity, and shuffling gait. It results from dopamine blockade in the
nigrostriatal pathway. Tardive dyskinesia involves involuntary choreoathetoid movements (tongue
WITH RATIONALES
,Mental Health ATI RN Pharmacology Final Exam 2026 | NCLEX-Style Questions, Answers & Rationales
SECTION J: ANTIDEPRESSANTS (Continued) & SEROTONIN SYNDROME
Question 31
A client taking fluoxetine reports agitation, diaphoresis, and muscle rigidity after starting St. John's wort.
The nurse suspects serotonin syndrome. Which action should the nurse take FIRST?
A) Administer acetaminophen for fever
B) Discontinue the fluoxetine and St. John's wort
C) Apply cooling blankets
D) Administer IV fluids
Answer: B) Discontinue the fluoxetine and St. John's wort
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excessive
serotonergic activity. The immediate priority is to discontinue all serotonergic agents. St. John's wort
combined with SSRIs significantly increases serotonin syndrome risk. Other interventions (cooling, fluids,
supportive care) follow after the offending agents are stopped. Severe cases may require
cyproheptadine (a serotonin antagonist).
Question 32
A client with major depressive disorder is switching from fluoxetine to phenelzine. The nurse should
ensure a washout period of at least:
A) 24 hours
B) 7 days
C) 14 days
D) 5 weeks
Answer: D) 5 weeks
Rationale: Fluoxetine has a long half-life (active metabolite with half-life of 7-15 days). A 5-week
washout period is recommended before starting an MAOI to prevent serotonin syndrome. Other SSRIs
with shorter half-lives typically require a 2-week washout. This is a critical safety consideration that the
nurse must verify before MAOI initiation.
Question 33
,A client prescribed venlafaxine reports nausea, dizziness, and headache. The nurse notes blood pressure
152/94 mmHg. Which action is most appropriate?
A) Administer the medication with food
B) Hold the medication and notify the provider
C) Document findings as expected side effects
D) Administer an antiemetic
Answer: B) Hold the medication and notify the provider
Rationale: Venlafaxine (SNRI) can cause dose-dependent hypertension. Blood pressure should be
monitored regularly. The elevated BP (152/94) requires provider notification and potential dose
adjustment or medication change. While nausea may improve with food, hypertension is a significant
adverse effect requiring intervention.
Question 34
A client with depression and chronic pain is prescribed duloxetine. Which therapeutic effect does the
nurse anticipate?
A) Immediate pain relief within hours
B) Reduction of both depressive symptoms and neuropathic pain
C) Improved sleep only
D) Increased energy with first dose
Answer: B) Reduction of both depressive symptoms and neuropathic pain
Rationale: Duloxetine (Cymbalta) is an SNRI approved for both major depressive disorder and diabetic
peripheral neuropathy. It modulates both serotonin and norepinephrine, addressing both mood
symptoms and pain pathways. Therapeutic effects typically take 2-4 weeks for depression and may be
somewhat faster for pain.
SECTION K: ATYPICAL ANTIDEPRESSANTS & OTHER AGENTS
Question 35
A client with treatment-resistant depression is prescribed trazodone. The nurse should include which
priority teaching point?
A) "Take this medication in the morning to avoid insomnia"
B) "This medication may cause drowsiness; take it at bedtime"
C) "You should avoid all carbohydrates while on this medication"
D) "This medication works immediately for depression"
, Answer: B) "This medication may cause drowsiness; take it at bedtime"
Rationale: Trazodone is highly sedating and is often prescribed at lower doses for sleep induction. At
higher doses for depression, it should be taken at bedtime to minimize daytime sedation. Priapism is a
rare but serious side effect requiring immediate medical attention. The antidepressant effect takes
weeks to develop.
Question 36
A client prescribed methylphenidate for ADHD reports weight loss and decreased appetite. Which
nursing intervention is most appropriate?
A) Discontinue the medication immediately
B) Instruct the client to take the medication with meals
C) Monitor growth parameters and schedule medication holidays
D) Switch to an immediate-release formulation
Answer: C) Monitor growth parameters and schedule medication holidays
Rationale: Stimulants (methylphenidate, amphetamines) commonly cause appetite suppression and
weight loss in children and adolescents. Height and weight should be monitored regularly. Medication
holidays (drug-free periods) may be recommended to allow catch-up growth. Taking with meals may
help maintain nutrition.
SECTION L: ANTIPSYCHOTICS (Continued)
Question 37
A client taking haloperidol develops a shuffling gait, tremor, and pill-rolling movements. The nurse
recognizes these as:
A) Tardive dyskinesia
B) Acute dystonia
C) Parkinsonism
D) Akathisia
Answer: C) Parkinsonism
Rationale: Parkinsonism is an extrapyramidal side effect of first-generation antipsychotics characterized
by bradykinesia, tremor, rigidity, and shuffling gait. It results from dopamine blockade in the
nigrostriatal pathway. Tardive dyskinesia involves involuntary choreoathetoid movements (tongue
