1
NCLEX-RN / NCLEX-PN / PSYCHOTROPIC PHARMACOLOGY
2026 PSYCHOTROPIC MEDICATIONS NGN BUNDLE | 150 PRACTICE
QUESTIONS WITH DETAILED RATIONALES & PARTIAL CREDIT
SCORING | SSRIs, MAOIs, LITHIUM TOXICITY, EPS & NMS | RN & PN
HIGH-YIELD REVIEW
QUESTION 1: SSRI ONSET OF THERAPEUTIC EFFECT
• Question: A client started on sertraline two weeks ago reports no improvement in mood.
What is the most appropriate nursing response?
• Options:
A. “The medication is not working; we should stop it.”
B. “Therapeutic effects often take 4–6 weeks; continue the medication as prescribed.”
C. “Double the dose immediately.”
D. “Switch to an MAOI today.”
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: SSRIs require several weeks for full therapeutic
effect because of downstream receptor changes.
o Distractor Pitfalls: Premature discontinuation or unapproved dose changes are
unsafe.
QUESTION 2: SSRI COMMON EARLY SIDE EFFECTS
• Question: Which side effects are most common in the first days of SSRI therapy?
• Options:
A. Extrapyramidal symptoms
B. Nausea, headache, and sleep changes
C. Severe hypertension
D. Agranulocytosis
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Gastrointestinal and activating or sedating effects
are frequent early in treatment.
, 2
o Distractor Pitfalls: EPS and agranulocytosis are associated with other drug
classes.
QUESTION 3: SEROTONIN SYNDROME RECOGNITION
• Question: A client taking an SSRI and recently started on tramadol develops agitation,
hyperreflexia, tremor, fever, and diarrhea. What is the priority action?
• Options:
A. Continue both medications
B. Hold both agents and notify the provider
C. Increase the SSRI dose
D. Administer an additional dose of tramadol
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: These signs indicate possible serotonin syndrome;
all serotonergic agents must be stopped.
o Distractor Pitfalls: Continuing or increasing either drug worsens the condition.
QUESTION 4: MAOI DIETARY RESTRICTION
• Question: A client prescribed phenelzine must avoid which foods?
• Options:
A. Fresh fruits and vegetables
B. Aged cheeses, cured meats, and fermented products
C. Grilled chicken and rice
D. Water and clear liquids
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Tyramine-rich foods can precipitate hypertensive
crisis in clients taking MAOIs.
o Distractor Pitfalls: Fresh foods are generally safe; aged and fermented items are
high-risk.
QUESTION 5: HYPERTENSIVE CRISIS SYMPTOMS
• Question: A client on an MAOI who ate aged cheese develops severe occipital headache,
stiff neck, and blood pressure 210/120 mm Hg. What is the priority action?
, 3
• Options:
A. Administer the next MAOI dose
B. Hold the MAOI, notify the provider, and prepare for emergency treatment
C. Encourage more tyramine-rich foods
D. Give a stimulating antidepressant
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Hypertensive crisis is a medical emergency
requiring immediate intervention.
o Distractor Pitfalls: Further MAOI or tyramine exposure worsens the crisis.
QUESTION 6: LITHIUM THERAPEUTIC RANGE
• Question: The usual therapeutic serum level for lithium is:
• Options:
A. 0.1–0.3 mEq/L
B. 0.6–1.2 mEq/L
C. 2.5–3.5 mEq/L
D. 5–10 mEq/L
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Most guidelines target 0.6–1.2 mEq/L for
maintenance; higher levels risk toxicity.
o Distractor Pitfalls: Levels above 1.5 mEq/L are generally considered toxic.
QUESTION 7: LITHIUM TOXICITY EARLY SIGNS
• Question: Early signs of lithium toxicity include:
• Options:
A. Mild thirst and fine tremor only
B. Coarse tremor, nausea, diarrhea, and ataxia
C. Complete absence of symptoms until level >4
D. Only sedation
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
, 4
o Pathophysiology Summary: Neurologic and gastrointestinal symptoms appear
as levels rise above the therapeutic range.
o Distractor Pitfalls: Fine tremor can be a side effect at therapeutic levels; coarse
tremor signals toxicity.
QUESTION 8: LITHIUM AND SODIUM RELATIONSHIP
• Question: Why does dehydration or sodium loss increase the risk of lithium toxicity?
• Options:
A. Lithium levels fall
B. The kidney reabsorbs more lithium when sodium is depleted
C. No relationship exists
D. Sodium loss decreases lithium absorption
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Lithium is reabsorbed in the proximal tubule
similarly to sodium; sodium depletion increases lithium retention.
o Distractor Pitfalls: Volume or sodium loss elevates, rather than lowers, lithium
concentration.
QUESTION 9: EXTRAPYRAMIDAL SIDE EFFECT – ACUTE DYSTONIA
• Question: A client who received intramuscular haloperidol develops severe muscle
spasms of the neck and jaw. What is the priority medication?
• Options:
A. Additional antipsychotic
B. Diphenhydramine or benztropine
C. Lithium
D. An SSRI
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Acute dystonia is rapidly reversed by
anticholinergic agents.
o Distractor Pitfalls: More antipsychotic worsens the dystonia.
QUESTION 10: AKATHISIA RECOGNITION
NCLEX-RN / NCLEX-PN / PSYCHOTROPIC PHARMACOLOGY
2026 PSYCHOTROPIC MEDICATIONS NGN BUNDLE | 150 PRACTICE
QUESTIONS WITH DETAILED RATIONALES & PARTIAL CREDIT
SCORING | SSRIs, MAOIs, LITHIUM TOXICITY, EPS & NMS | RN & PN
HIGH-YIELD REVIEW
QUESTION 1: SSRI ONSET OF THERAPEUTIC EFFECT
• Question: A client started on sertraline two weeks ago reports no improvement in mood.
What is the most appropriate nursing response?
• Options:
A. “The medication is not working; we should stop it.”
B. “Therapeutic effects often take 4–6 weeks; continue the medication as prescribed.”
C. “Double the dose immediately.”
D. “Switch to an MAOI today.”
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: SSRIs require several weeks for full therapeutic
effect because of downstream receptor changes.
o Distractor Pitfalls: Premature discontinuation or unapproved dose changes are
unsafe.
QUESTION 2: SSRI COMMON EARLY SIDE EFFECTS
• Question: Which side effects are most common in the first days of SSRI therapy?
• Options:
A. Extrapyramidal symptoms
B. Nausea, headache, and sleep changes
C. Severe hypertension
D. Agranulocytosis
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Gastrointestinal and activating or sedating effects
are frequent early in treatment.
, 2
o Distractor Pitfalls: EPS and agranulocytosis are associated with other drug
classes.
QUESTION 3: SEROTONIN SYNDROME RECOGNITION
• Question: A client taking an SSRI and recently started on tramadol develops agitation,
hyperreflexia, tremor, fever, and diarrhea. What is the priority action?
• Options:
A. Continue both medications
B. Hold both agents and notify the provider
C. Increase the SSRI dose
D. Administer an additional dose of tramadol
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: These signs indicate possible serotonin syndrome;
all serotonergic agents must be stopped.
o Distractor Pitfalls: Continuing or increasing either drug worsens the condition.
QUESTION 4: MAOI DIETARY RESTRICTION
• Question: A client prescribed phenelzine must avoid which foods?
• Options:
A. Fresh fruits and vegetables
B. Aged cheeses, cured meats, and fermented products
C. Grilled chicken and rice
D. Water and clear liquids
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Tyramine-rich foods can precipitate hypertensive
crisis in clients taking MAOIs.
o Distractor Pitfalls: Fresh foods are generally safe; aged and fermented items are
high-risk.
QUESTION 5: HYPERTENSIVE CRISIS SYMPTOMS
• Question: A client on an MAOI who ate aged cheese develops severe occipital headache,
stiff neck, and blood pressure 210/120 mm Hg. What is the priority action?
, 3
• Options:
A. Administer the next MAOI dose
B. Hold the MAOI, notify the provider, and prepare for emergency treatment
C. Encourage more tyramine-rich foods
D. Give a stimulating antidepressant
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Hypertensive crisis is a medical emergency
requiring immediate intervention.
o Distractor Pitfalls: Further MAOI or tyramine exposure worsens the crisis.
QUESTION 6: LITHIUM THERAPEUTIC RANGE
• Question: The usual therapeutic serum level for lithium is:
• Options:
A. 0.1–0.3 mEq/L
B. 0.6–1.2 mEq/L
C. 2.5–3.5 mEq/L
D. 5–10 mEq/L
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Most guidelines target 0.6–1.2 mEq/L for
maintenance; higher levels risk toxicity.
o Distractor Pitfalls: Levels above 1.5 mEq/L are generally considered toxic.
QUESTION 7: LITHIUM TOXICITY EARLY SIGNS
• Question: Early signs of lithium toxicity include:
• Options:
A. Mild thirst and fine tremor only
B. Coarse tremor, nausea, diarrhea, and ataxia
C. Complete absence of symptoms until level >4
D. Only sedation
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
, 4
o Pathophysiology Summary: Neurologic and gastrointestinal symptoms appear
as levels rise above the therapeutic range.
o Distractor Pitfalls: Fine tremor can be a side effect at therapeutic levels; coarse
tremor signals toxicity.
QUESTION 8: LITHIUM AND SODIUM RELATIONSHIP
• Question: Why does dehydration or sodium loss increase the risk of lithium toxicity?
• Options:
A. Lithium levels fall
B. The kidney reabsorbs more lithium when sodium is depleted
C. No relationship exists
D. Sodium loss decreases lithium absorption
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Lithium is reabsorbed in the proximal tubule
similarly to sodium; sodium depletion increases lithium retention.
o Distractor Pitfalls: Volume or sodium loss elevates, rather than lowers, lithium
concentration.
QUESTION 9: EXTRAPYRAMIDAL SIDE EFFECT – ACUTE DYSTONIA
• Question: A client who received intramuscular haloperidol develops severe muscle
spasms of the neck and jaw. What is the priority medication?
• Options:
A. Additional antipsychotic
B. Diphenhydramine or benztropine
C. Lithium
D. An SSRI
• Zero-Flip Premium Rationale Box:
o Correct Answer: B
o Pathophysiology Summary: Acute dystonia is rapidly reversed by
anticholinergic agents.
o Distractor Pitfalls: More antipsychotic worsens the dystonia.
QUESTION 10: AKATHISIA RECOGNITION
