NCLEX Psychiatric Pharmacology 2025 — 50 Q&A
Antipsychotics Antidepressants Verified
Series:
CrashCourses Professional Study Series
Author:
Dr Z. Moomba, MBChB, MRCPsych | BethelWellness Ltd
Exam Target:
NCLEX RN PN
Year:
2025/2026
Format:
50 Questions with Verified Answers and Rationales
>
Author's Note:
This document is an original work produced for the CrashCourses Professional Study Series.
Clinical questions and professional scenarios were composed by Dr Z. Moomba based on current
exam objectives, published guidelines, and evidence-based sources (2024–2025). All patient
names, ages, and case details are fictional. Any resemblance to existing published Q&A banks is
coincidental. For personal study use only — not for reproduction or redistribution.
SECTION A — FOUNDATIONS
1. A patient with schizophrenia is started on haloperidol. Three days later, the nurse observes the
patient experiencing severe muscle spasms of the neck and back, causing the head to arch
backward. Which medication should the nurse anticipate administering immediately?
A) Propranolol
B) Diphenhydramine
C) Dantrolene
D) Valbenazine
Answer: B
,Rationale:
a) Acute dystonia, characterised by severe muscle spasms (opisthotonos, torticollis), is treated
with anticholinergics or antihistamines like diphenhydramine or benztropine.
b) The rapid onset of severe spasms days after starting a first-generation antipsychotic confirms
acute dystonia, not tardive dyskinesia or NMS.
c) Propranolol is used for akathisia (restlessness), not dystonia.
d) Examiner pearl: Acute dystonia is a medical emergency requiring IM/IV anticholinergics to
prevent airway compromise. [APA Guidelines 2024]
2. A nurse is reviewing the medication list for a patient prescribed phenelzine for atypical
depression. Which dietary choice indicates the patient understands the required tyramine
restrictions?
A) Smoked salmon and cream cheese bagel
B) Grilled chicken breast with fresh vegetables
C) Salami sandwich with aged cheddar
D) Pepperoni pizza with a glass of tap beer
Answer: B
Rationale:
a) Phenelzine is an MAOI. Patients must avoid tyramine-rich foods to prevent hypertensive crisis.
b) Fresh chicken and vegetables contain negligible tyramine.
c) Smoked, cured meats, and aged cheeses (salami, cheddar, pepperoni) are high in tyramine.
d) Examiner pearl: MAOIs require a strict tyramine-free diet and a 14-day washout period before
switching to SSRIs to avoid serotonin syndrome. [NICE CG90]
3. A patient taking lithium carbonate for bipolar disorder presents with a serum lithium level of 1.8
mEq/L. The patient reports nausea, vomiting, and coarse hand tremors. What is the priority nursing
action?
A) Administer the next scheduled dose of lithium
B) Hold the lithium and notify the healthcare provider
C) Administer PRN ondansetron for nausea
D) Instruct the patient to decrease sodium intake
, Answer: B
Rationale:
a) A lithium level of 1.8 mEq/L is toxic (therapeutic range: 0.6–1.2 mEq/L). The medication must be
held immediately.
b) Coarse tremors and persistent GI upset are classic signs of advanced lithium toxicity requiring
intervention.
c) Administering antiemetics masks symptoms without addressing the underlying toxicity.
d) Examiner pearl: Decreasing sodium intake actually increases lithium retention, worsening
toxicity. [BNF 2025]
4. A 22-year-old patient with generalised anxiety disorder is prescribed buspirone. The patient asks
the nurse, "When will I feel less anxious?" What is the most accurate response?
A) "You should feel relief within 30 to 60 minutes."
B) "It may take 2 to 4 weeks to experience the full therapeutic effect."
C) "Buspirone works immediately but only lasts a few hours."
D) "It will take about 3 to 6 months to see any changes."
Answer: B
Rationale:
a) Buspirone is a non-benzodiazepine anxiolytic that requires continuous use for 2-4 weeks to
reach full efficacy.
b) Unlike benzodiazepines, buspirone lacks immediate anxiolytic effects and has no abuse
potential.
c) Promising immediate relief would set false expectations and lead to premature discontinuation.
d) Examiner pearl: Buspirone does not cause central nervous system depression, making it safe
for patients with a history of substance use disorder. [Stahl 2024]
5. A pediatric patient is prescribed methylphenidate for ADHD. Which of the following is a priority
assessment during the follow-up visit?
A) Serum potassium levels
B) Height and weight measurements
C) White blood cell count
Antipsychotics Antidepressants Verified
Series:
CrashCourses Professional Study Series
Author:
Dr Z. Moomba, MBChB, MRCPsych | BethelWellness Ltd
Exam Target:
NCLEX RN PN
Year:
2025/2026
Format:
50 Questions with Verified Answers and Rationales
>
Author's Note:
This document is an original work produced for the CrashCourses Professional Study Series.
Clinical questions and professional scenarios were composed by Dr Z. Moomba based on current
exam objectives, published guidelines, and evidence-based sources (2024–2025). All patient
names, ages, and case details are fictional. Any resemblance to existing published Q&A banks is
coincidental. For personal study use only — not for reproduction or redistribution.
SECTION A — FOUNDATIONS
1. A patient with schizophrenia is started on haloperidol. Three days later, the nurse observes the
patient experiencing severe muscle spasms of the neck and back, causing the head to arch
backward. Which medication should the nurse anticipate administering immediately?
A) Propranolol
B) Diphenhydramine
C) Dantrolene
D) Valbenazine
Answer: B
,Rationale:
a) Acute dystonia, characterised by severe muscle spasms (opisthotonos, torticollis), is treated
with anticholinergics or antihistamines like diphenhydramine or benztropine.
b) The rapid onset of severe spasms days after starting a first-generation antipsychotic confirms
acute dystonia, not tardive dyskinesia or NMS.
c) Propranolol is used for akathisia (restlessness), not dystonia.
d) Examiner pearl: Acute dystonia is a medical emergency requiring IM/IV anticholinergics to
prevent airway compromise. [APA Guidelines 2024]
2. A nurse is reviewing the medication list for a patient prescribed phenelzine for atypical
depression. Which dietary choice indicates the patient understands the required tyramine
restrictions?
A) Smoked salmon and cream cheese bagel
B) Grilled chicken breast with fresh vegetables
C) Salami sandwich with aged cheddar
D) Pepperoni pizza with a glass of tap beer
Answer: B
Rationale:
a) Phenelzine is an MAOI. Patients must avoid tyramine-rich foods to prevent hypertensive crisis.
b) Fresh chicken and vegetables contain negligible tyramine.
c) Smoked, cured meats, and aged cheeses (salami, cheddar, pepperoni) are high in tyramine.
d) Examiner pearl: MAOIs require a strict tyramine-free diet and a 14-day washout period before
switching to SSRIs to avoid serotonin syndrome. [NICE CG90]
3. A patient taking lithium carbonate for bipolar disorder presents with a serum lithium level of 1.8
mEq/L. The patient reports nausea, vomiting, and coarse hand tremors. What is the priority nursing
action?
A) Administer the next scheduled dose of lithium
B) Hold the lithium and notify the healthcare provider
C) Administer PRN ondansetron for nausea
D) Instruct the patient to decrease sodium intake
, Answer: B
Rationale:
a) A lithium level of 1.8 mEq/L is toxic (therapeutic range: 0.6–1.2 mEq/L). The medication must be
held immediately.
b) Coarse tremors and persistent GI upset are classic signs of advanced lithium toxicity requiring
intervention.
c) Administering antiemetics masks symptoms without addressing the underlying toxicity.
d) Examiner pearl: Decreasing sodium intake actually increases lithium retention, worsening
toxicity. [BNF 2025]
4. A 22-year-old patient with generalised anxiety disorder is prescribed buspirone. The patient asks
the nurse, "When will I feel less anxious?" What is the most accurate response?
A) "You should feel relief within 30 to 60 minutes."
B) "It may take 2 to 4 weeks to experience the full therapeutic effect."
C) "Buspirone works immediately but only lasts a few hours."
D) "It will take about 3 to 6 months to see any changes."
Answer: B
Rationale:
a) Buspirone is a non-benzodiazepine anxiolytic that requires continuous use for 2-4 weeks to
reach full efficacy.
b) Unlike benzodiazepines, buspirone lacks immediate anxiolytic effects and has no abuse
potential.
c) Promising immediate relief would set false expectations and lead to premature discontinuation.
d) Examiner pearl: Buspirone does not cause central nervous system depression, making it safe
for patients with a history of substance use disorder. [Stahl 2024]
5. A pediatric patient is prescribed methylphenidate for ADHD. Which of the following is a priority
assessment during the follow-up visit?
A) Serum potassium levels
B) Height and weight measurements
C) White blood cell count
