NSG 526 Exam 1 Study Guide 2026 – Comprehensive
Nursing Review
1. A nurse is assessing a client who has been taking an SSRI for 3 days and reports no improvement in
mood. Which of the following responses by the nurse is most appropriate?
A) "You may need a higher dose; I will call your provider."
B) "It can take 4 to 6 weeks for full therapeutic effects to occur."
C) "You should stop the medication and try a different class."
D) "You are likely experiencing a placebo effect."
Answer: B
Rationale:
SSRIs typically require 4 to 6 weeks to achieve full therapeutic effect. Clients should be educated about this
delay to prevent premature discontinuation. Dose adjustments are considered after adequate trials, and
stopping abruptly can cause discontinuation syndrome.
2. Which neurotransmitter is primarily implicated in the pathophysiology of schizophrenia?
A) Serotonin
B) Dopamine
C) GABA
D) Acetylcholine
Answer: B
Rationale:
The dopamine hypothesis suggests that positive symptoms of schizophrenia are related to excess dopamine
activity in the mesolimbic pathway, while negative symptoms relate to decreased dopamine in the
mesocortical pathway. All antipsychotics work by blocking dopamine receptors.
3. A client on lithium carbonate reports increased thirst, frequent urination, and fine hand tremors.
Which action should the nurse take first?
A) Document the findings as expected side effects.
B) Hold the next dose and notify the provider.
C) Encourage increased sodium intake.
,D) Administer the next dose with food.
Answer: B
Rationale:
Increased thirst, polyuria, and tremors are early signs of lithium toxicity. The nurse should hold the next
dose and notify the provider immediately. Serum lithium levels should be obtained. Increasing sodium intake
without guidance can worsen the condition.
4. A nurse is caring for a client experiencing acute alcohol withdrawal. Which medication should the
nurse anticipate administering?
A) Naltrexone
B) Lorazepam
C) Disulfiram
D) Acamprosate
Answer: B
Rationale:
Benzodiazepines such as lorazepam are the standard treatment for acute alcohol withdrawal because they
enhance GABA activity and reduce withdrawal symptoms, including seizures and delirium tremens.
Naltrexone, disulfiram, and acamprosate are used for maintenance of abstinence.
5. Which of the following is a positive symptom of schizophrenia?
A) Flat affect
B) Avolition
C) Hallucinations
D) Anhedonia
Answer: C
Rationale:
Positive symptoms add to normal experience and include hallucinations, delusions, disorganized speech, and
grossly disorganized behavior. Negative symptoms involve a decrease or loss of normal function, such as flat
affect, avolition, and anhedonia.
6. A nurse is teaching a client about clozapine. Which of the following instructions is most important?
A) "Take this medication with grapefruit juice."
B) "Report any sore throat or fever immediately."
2
,C) "You can stop taking this medication once you feel better."
D) "This medication is safe during pregnancy."
Answer: B
Rationale:
Clozapine carries a black box warning for agranulocytosis. Sore throat and fever are early signs of infection
and require immediate medical attention. Clients must have regular ANC monitoring. Grapefruit juice can
increase levels, and the medication should not be stopped abruptly.
7. Which class of medications is associated with metabolic syndrome as a significant adverse effect?
A) SSRIs
B) Atypical antipsychotics
C) Benzodiazepines
D) Tricyclic antidepressants
Answer: B
Rationale:
Atypical antipsychotics such as olanzapine, clozapine, and quetiapine are associated with significant weight
gain, hyperglycemia, dyslipidemia, and hypertension. Patients on these medications require regular
monitoring of weight, BMI, glucose, and lipids.
8. A client with bipolar I disorder is experiencing an acute manic episode. Which medication is most
appropriate for acute management?
A) Fluoxetine
B) Lithium carbonate
C) Lorazepam
D) Bupropion
Answer: B
Rationale:
Lithium is a first-line mood stabilizer for acute mania and maintenance treatment of bipolar I disorder.
Antidepressants like fluoxetine and bupropion can trigger mania and should be avoided during acute manic
episodes.
9. Which screening tool is most commonly used to assess depression severity?
A) PHQ-9
3
, B) GAD-7
C) MMSE
D) CAGE
Answer: A
Rationale:
The PHQ-9 is a validated, self-administered tool specifically designed to screen for and assess the severity of
depression based on DSM criteria. GAD-7 assesses anxiety, MMSE assesses cognition, and CAGE screens for
alcohol use disorders.
10. A patient reports hearing voices telling them to hurt themselves. This symptom is best described
as:
A) Visual hallucination
B) Command hallucination
C) Delusion of persecution
D) Thought broadcasting
Answer: B
Rationale:
A command hallucination is an auditory hallucination in which voices instruct the patient to perform specific
actions, which may include self-harm or harm to others. Command hallucinations are considered a
psychiatric emergency requiring immediate intervention.
11. A nurse is assessing a client on haloperidol who reports a stiff neck and difficulty swallowing.
Which action should the nurse take first?
A) Administer benztropine as prescribed.
B) Document the findings.
C) Reassure the client that this is a common side effect.
D) Hold the next dose of haloperidol.
Answer: A
Rationale:
The client is experiencing acute dystonia, a serious extrapyramidal side effect. The priority is to administer
benztropine, an anticholinergic medication used to treat acute dystonia. Documentation and holding the next
dose are secondary to immediate treatment.
4
Nursing Review
1. A nurse is assessing a client who has been taking an SSRI for 3 days and reports no improvement in
mood. Which of the following responses by the nurse is most appropriate?
A) "You may need a higher dose; I will call your provider."
B) "It can take 4 to 6 weeks for full therapeutic effects to occur."
C) "You should stop the medication and try a different class."
D) "You are likely experiencing a placebo effect."
Answer: B
Rationale:
SSRIs typically require 4 to 6 weeks to achieve full therapeutic effect. Clients should be educated about this
delay to prevent premature discontinuation. Dose adjustments are considered after adequate trials, and
stopping abruptly can cause discontinuation syndrome.
2. Which neurotransmitter is primarily implicated in the pathophysiology of schizophrenia?
A) Serotonin
B) Dopamine
C) GABA
D) Acetylcholine
Answer: B
Rationale:
The dopamine hypothesis suggests that positive symptoms of schizophrenia are related to excess dopamine
activity in the mesolimbic pathway, while negative symptoms relate to decreased dopamine in the
mesocortical pathway. All antipsychotics work by blocking dopamine receptors.
3. A client on lithium carbonate reports increased thirst, frequent urination, and fine hand tremors.
Which action should the nurse take first?
A) Document the findings as expected side effects.
B) Hold the next dose and notify the provider.
C) Encourage increased sodium intake.
,D) Administer the next dose with food.
Answer: B
Rationale:
Increased thirst, polyuria, and tremors are early signs of lithium toxicity. The nurse should hold the next
dose and notify the provider immediately. Serum lithium levels should be obtained. Increasing sodium intake
without guidance can worsen the condition.
4. A nurse is caring for a client experiencing acute alcohol withdrawal. Which medication should the
nurse anticipate administering?
A) Naltrexone
B) Lorazepam
C) Disulfiram
D) Acamprosate
Answer: B
Rationale:
Benzodiazepines such as lorazepam are the standard treatment for acute alcohol withdrawal because they
enhance GABA activity and reduce withdrawal symptoms, including seizures and delirium tremens.
Naltrexone, disulfiram, and acamprosate are used for maintenance of abstinence.
5. Which of the following is a positive symptom of schizophrenia?
A) Flat affect
B) Avolition
C) Hallucinations
D) Anhedonia
Answer: C
Rationale:
Positive symptoms add to normal experience and include hallucinations, delusions, disorganized speech, and
grossly disorganized behavior. Negative symptoms involve a decrease or loss of normal function, such as flat
affect, avolition, and anhedonia.
6. A nurse is teaching a client about clozapine. Which of the following instructions is most important?
A) "Take this medication with grapefruit juice."
B) "Report any sore throat or fever immediately."
2
,C) "You can stop taking this medication once you feel better."
D) "This medication is safe during pregnancy."
Answer: B
Rationale:
Clozapine carries a black box warning for agranulocytosis. Sore throat and fever are early signs of infection
and require immediate medical attention. Clients must have regular ANC monitoring. Grapefruit juice can
increase levels, and the medication should not be stopped abruptly.
7. Which class of medications is associated with metabolic syndrome as a significant adverse effect?
A) SSRIs
B) Atypical antipsychotics
C) Benzodiazepines
D) Tricyclic antidepressants
Answer: B
Rationale:
Atypical antipsychotics such as olanzapine, clozapine, and quetiapine are associated with significant weight
gain, hyperglycemia, dyslipidemia, and hypertension. Patients on these medications require regular
monitoring of weight, BMI, glucose, and lipids.
8. A client with bipolar I disorder is experiencing an acute manic episode. Which medication is most
appropriate for acute management?
A) Fluoxetine
B) Lithium carbonate
C) Lorazepam
D) Bupropion
Answer: B
Rationale:
Lithium is a first-line mood stabilizer for acute mania and maintenance treatment of bipolar I disorder.
Antidepressants like fluoxetine and bupropion can trigger mania and should be avoided during acute manic
episodes.
9. Which screening tool is most commonly used to assess depression severity?
A) PHQ-9
3
, B) GAD-7
C) MMSE
D) CAGE
Answer: A
Rationale:
The PHQ-9 is a validated, self-administered tool specifically designed to screen for and assess the severity of
depression based on DSM criteria. GAD-7 assesses anxiety, MMSE assesses cognition, and CAGE screens for
alcohol use disorders.
10. A patient reports hearing voices telling them to hurt themselves. This symptom is best described
as:
A) Visual hallucination
B) Command hallucination
C) Delusion of persecution
D) Thought broadcasting
Answer: B
Rationale:
A command hallucination is an auditory hallucination in which voices instruct the patient to perform specific
actions, which may include self-harm or harm to others. Command hallucinations are considered a
psychiatric emergency requiring immediate intervention.
11. A nurse is assessing a client on haloperidol who reports a stiff neck and difficulty swallowing.
Which action should the nurse take first?
A) Administer benztropine as prescribed.
B) Document the findings.
C) Reassure the client that this is a common side effect.
D) Hold the next dose of haloperidol.
Answer: A
Rationale:
The client is experiencing acute dystonia, a serious extrapyramidal side effect. The priority is to administer
benztropine, an anticholinergic medication used to treat acute dystonia. Documentation and holding the next
dose are secondary to immediate treatment.
4
