Mental Health Nursing Exam –
Psychopharmacology & Case Studies
(2026)
Comprehensive Practice Examination – 150
Questions
SECTION 1: PSYCHOPHARMACOLOGY – ANTIDEPRESSANTS & MOOD STABILIZERS (Questions 1-35)
Question 1:
A patient with bipolar disorder is prescribed lithium. The nurse should teach the patient that lithium
levels must be monitored to prevent which complication?
A) Hepatotoxicity
B) Nephrotoxicity and neurotoxicity
C) Cardiotoxicity
D) Pulmonary fibrosis
Answer: B) Nephrotoxicity and neurotoxicity
Rationale: Lithium has a narrow therapeutic window (0.6-1.2 mEq/L). Toxicity can cause nephrotoxicity
(polyuria, polydipsia, renal failure) and neurotoxicity (tremor, confusion, seizures). Regular monitoring of
serum levels, renal function, and thyroid function is essential.
Question 2:
The nurse is caring for a patient on lithium who reports excessive thirst and urination. This is MOST likely
due to:
A) Nephrogenic diabetes insipidus
B) SIADH
C) Diabetes mellitus
D) Psychogenic polydipsia
Answer: A) Nephrogenic diabetes insipidus
Rationale: Lithium can cause nephrogenic diabetes insipidus by inhibiting the effect of ADH on the
kidney, leading to polyuria and polydipsia. This can lead to dehydration and hypernatremia. Patients
should be educated about fluid intake and monitoring.
,Question 3:
A patient with bipolar disorder is prescribed valproic acid. Which laboratory value must be monitored?
A) Serum sodium
B) Serum potassium
C) Liver function tests and serum valproate levels
D) Serum glucose
Answer: C) Liver function tests and serum valproate levels
Rationale: Valproic acid can cause hepatotoxicity, especially in children and patients on multiple
anticonvulsants. Liver function tests should be monitored at baseline and periodically. Serum valproate
levels (50-100 mcg/mL) are also monitored. Thrombocytopenia is another concern.
Question 4:
The nurse is teaching a patient about lithium. Which statement indicates understanding?
A) "I will maintain a consistent sodium intake"
B) "I can stop the medication when my mood is stable"
C) "I will take this medication with grapefruit juice"
D) "I will take this medication on an empty stomach"
Answer: A) "I will maintain a consistent sodium intake"
Rationale: Lithium and sodium compete for reabsorption in the kidneys. Changes in sodium intake (low-
sodium diet, dehydration) can increase lithium levels and cause toxicity. Patients should maintain a
consistent sodium and fluid intake. Lithium should not be stopped abruptly.
Question 5:
A patient on lithium has a serum level of 1.5 mEq/L. The nurse should assess for which signs of toxicity?
A) Tremor, ataxia, and confusion
B) Weight gain and sedation
C) Polyuria and polydipsia
D) Hyperthyroidism
Answer: A) Tremor, ataxia, and confusion
Rationale: Lithium toxicity (levels >1.2 mEq/L) presents with tremor, ataxia, confusion, nausea, vomiting,
and diarrhea. Severe toxicity (>2.0 mEq/L) can cause seizures, coma, and death. Levels >1.5 mEq/L are
concerning and require dose adjustment.
Question 6:
The nurse is caring for a patient with bipolar disorder who is prescribed lamotrigine. Which side effect is
MOST concerning?
,A) Weight gain
B) Stevens-Johnson syndrome
C) Sedation
D) Hair loss
Answer: B) Stevens-Johnson syndrome
Rationale: Lamotrigine can cause Stevens-Johnson syndrome (SJS), a life-threatening rash. The risk is
higher with rapid dose titration. Patients should be started on a low dose and titrated slowly. Any rash
should be reported immediately.
Question 7:
A patient with bipolar disorder is prescribed quetiapine. The nurse should monitor for which side effect?
A) Weight gain and metabolic syndrome
B) Weight loss
C) Insomnia
D) Diarrhea
Answer: A) Weight gain and metabolic syndrome
Rationale: Quetiapine (an atypical antipsychotic) is associated with significant weight gain,
hyperglycemia, and hyperlipidemia. Patients should be monitored for metabolic changes. Weight, blood
glucose, and lipids should be checked regularly.
Question 8:
The nurse is teaching a patient about lithium. Which symptom should be reported immediately?
A) Fine tremor
B) Increased thirst
C) Vomiting and diarrhea
D) Weight gain
Answer: C) Vomiting and diarrhea
Rationale: Vomiting and diarrhea can lead to dehydration, which increases lithium levels and risk of
toxicity. These symptoms should be reported immediately. Fine tremor and increased thirst are common
side effects. Weight gain is a common side effect but not emergent.
Question 9:
A patient on lithium is found to have a serum level of 2.5 mEq/L. Which intervention is MOST
appropriate?
A) Continue the medication
B) Hold lithium and notify the provider
C) Increase the dose
D) Administer an antidote
, Answer: B) Hold lithium and notify the provider
Rationale: A lithium level of 2.5 mEq/L indicates severe toxicity requiring immediate intervention. The
medication should be held and the provider notified. The patient may need IV fluids and hemodialysis for
severe toxicity. This is a medical emergency.
Question 10:
The nurse is assessing a patient on valproic acid who develops nausea and vomiting. Which action is
MOST appropriate?
A) Continue the medication
B) Notify the provider
C) Administer an antiemetic
D) Increase the dose
Answer: B) Notify the provider
Rationale: Nausea and vomiting may indicate valproic acid toxicity or hepatotoxicity. The provider should
be notified. Liver function tests should be checked. Antiemetics may be needed but are not the priority.
Question 11:
A patient with bipolar disorder is prescribed carbamazepine. The nurse should monitor for which side
effect?
A) Agranulocytosis
B) Weight gain
C) Sedation
D) Hair loss
Answer: A) Agranulocytosis
Rationale: Carbamazepine can cause agranulocytosis, a life-threatening drop in white blood cells. CBC
should be monitored at baseline and periodically. Patients should report signs of infection (fever, sore
throat). Weight gain, sedation, and hair loss are also possible.
Question 12:
The nurse is teaching a patient about lithium. Which statement indicates understanding?
A) "I will take this medication with a high-salt diet"
B) "I will maintain consistent salt and fluid intake"
C) "I will stop this medication if I gain weight"
D) "I will take this medication with grapefruit juice"
Answer: B) "I will maintain consistent salt and fluid intake"
Rationale: Lithium levels are affected by sodium and fluid intake. Consistent intake prevents fluctuations
in serum levels. A high-salt diet can lower lithium levels. Grapefruit juice is not a concern with lithium.
Psychopharmacology & Case Studies
(2026)
Comprehensive Practice Examination – 150
Questions
SECTION 1: PSYCHOPHARMACOLOGY – ANTIDEPRESSANTS & MOOD STABILIZERS (Questions 1-35)
Question 1:
A patient with bipolar disorder is prescribed lithium. The nurse should teach the patient that lithium
levels must be monitored to prevent which complication?
A) Hepatotoxicity
B) Nephrotoxicity and neurotoxicity
C) Cardiotoxicity
D) Pulmonary fibrosis
Answer: B) Nephrotoxicity and neurotoxicity
Rationale: Lithium has a narrow therapeutic window (0.6-1.2 mEq/L). Toxicity can cause nephrotoxicity
(polyuria, polydipsia, renal failure) and neurotoxicity (tremor, confusion, seizures). Regular monitoring of
serum levels, renal function, and thyroid function is essential.
Question 2:
The nurse is caring for a patient on lithium who reports excessive thirst and urination. This is MOST likely
due to:
A) Nephrogenic diabetes insipidus
B) SIADH
C) Diabetes mellitus
D) Psychogenic polydipsia
Answer: A) Nephrogenic diabetes insipidus
Rationale: Lithium can cause nephrogenic diabetes insipidus by inhibiting the effect of ADH on the
kidney, leading to polyuria and polydipsia. This can lead to dehydration and hypernatremia. Patients
should be educated about fluid intake and monitoring.
,Question 3:
A patient with bipolar disorder is prescribed valproic acid. Which laboratory value must be monitored?
A) Serum sodium
B) Serum potassium
C) Liver function tests and serum valproate levels
D) Serum glucose
Answer: C) Liver function tests and serum valproate levels
Rationale: Valproic acid can cause hepatotoxicity, especially in children and patients on multiple
anticonvulsants. Liver function tests should be monitored at baseline and periodically. Serum valproate
levels (50-100 mcg/mL) are also monitored. Thrombocytopenia is another concern.
Question 4:
The nurse is teaching a patient about lithium. Which statement indicates understanding?
A) "I will maintain a consistent sodium intake"
B) "I can stop the medication when my mood is stable"
C) "I will take this medication with grapefruit juice"
D) "I will take this medication on an empty stomach"
Answer: A) "I will maintain a consistent sodium intake"
Rationale: Lithium and sodium compete for reabsorption in the kidneys. Changes in sodium intake (low-
sodium diet, dehydration) can increase lithium levels and cause toxicity. Patients should maintain a
consistent sodium and fluid intake. Lithium should not be stopped abruptly.
Question 5:
A patient on lithium has a serum level of 1.5 mEq/L. The nurse should assess for which signs of toxicity?
A) Tremor, ataxia, and confusion
B) Weight gain and sedation
C) Polyuria and polydipsia
D) Hyperthyroidism
Answer: A) Tremor, ataxia, and confusion
Rationale: Lithium toxicity (levels >1.2 mEq/L) presents with tremor, ataxia, confusion, nausea, vomiting,
and diarrhea. Severe toxicity (>2.0 mEq/L) can cause seizures, coma, and death. Levels >1.5 mEq/L are
concerning and require dose adjustment.
Question 6:
The nurse is caring for a patient with bipolar disorder who is prescribed lamotrigine. Which side effect is
MOST concerning?
,A) Weight gain
B) Stevens-Johnson syndrome
C) Sedation
D) Hair loss
Answer: B) Stevens-Johnson syndrome
Rationale: Lamotrigine can cause Stevens-Johnson syndrome (SJS), a life-threatening rash. The risk is
higher with rapid dose titration. Patients should be started on a low dose and titrated slowly. Any rash
should be reported immediately.
Question 7:
A patient with bipolar disorder is prescribed quetiapine. The nurse should monitor for which side effect?
A) Weight gain and metabolic syndrome
B) Weight loss
C) Insomnia
D) Diarrhea
Answer: A) Weight gain and metabolic syndrome
Rationale: Quetiapine (an atypical antipsychotic) is associated with significant weight gain,
hyperglycemia, and hyperlipidemia. Patients should be monitored for metabolic changes. Weight, blood
glucose, and lipids should be checked regularly.
Question 8:
The nurse is teaching a patient about lithium. Which symptom should be reported immediately?
A) Fine tremor
B) Increased thirst
C) Vomiting and diarrhea
D) Weight gain
Answer: C) Vomiting and diarrhea
Rationale: Vomiting and diarrhea can lead to dehydration, which increases lithium levels and risk of
toxicity. These symptoms should be reported immediately. Fine tremor and increased thirst are common
side effects. Weight gain is a common side effect but not emergent.
Question 9:
A patient on lithium is found to have a serum level of 2.5 mEq/L. Which intervention is MOST
appropriate?
A) Continue the medication
B) Hold lithium and notify the provider
C) Increase the dose
D) Administer an antidote
, Answer: B) Hold lithium and notify the provider
Rationale: A lithium level of 2.5 mEq/L indicates severe toxicity requiring immediate intervention. The
medication should be held and the provider notified. The patient may need IV fluids and hemodialysis for
severe toxicity. This is a medical emergency.
Question 10:
The nurse is assessing a patient on valproic acid who develops nausea and vomiting. Which action is
MOST appropriate?
A) Continue the medication
B) Notify the provider
C) Administer an antiemetic
D) Increase the dose
Answer: B) Notify the provider
Rationale: Nausea and vomiting may indicate valproic acid toxicity or hepatotoxicity. The provider should
be notified. Liver function tests should be checked. Antiemetics may be needed but are not the priority.
Question 11:
A patient with bipolar disorder is prescribed carbamazepine. The nurse should monitor for which side
effect?
A) Agranulocytosis
B) Weight gain
C) Sedation
D) Hair loss
Answer: A) Agranulocytosis
Rationale: Carbamazepine can cause agranulocytosis, a life-threatening drop in white blood cells. CBC
should be monitored at baseline and periodically. Patients should report signs of infection (fever, sore
throat). Weight gain, sedation, and hair loss are also possible.
Question 12:
The nurse is teaching a patient about lithium. Which statement indicates understanding?
A) "I will take this medication with a high-salt diet"
B) "I will maintain consistent salt and fluid intake"
C) "I will stop this medication if I gain weight"
D) "I will take this medication with grapefruit juice"
Answer: B) "I will maintain consistent salt and fluid intake"
Rationale: Lithium levels are affected by sodium and fluid intake. Consistent intake prevents fluctuations
in serum levels. A high-salt diet can lower lithium levels. Grapefruit juice is not a concern with lithium.
