200+ QUESTIONS & ANSWERS WITH
RATIONALES
,ATI Mental Health Pharmacology — Practice Midterm Original NCLEX-Style Practice Questions
with Rationales
Section 1: Antipsychotics
1. A client taking clozapine reports a sore throat and fever. What is the nurse's priority action?
A. Administer acetaminophen and reassess in 4 hours B. Instruct the client to gargle with warm
salt water C. Obtain a WBC/ANC count immediately D. Document and monitor at the next
scheduled visit
Answer: C Rationale: Clozapine carries a risk of agranulocytosis. Fever and sore throat are early
signs of infection related to a dangerously low white blood cell count. An ANC must be drawn
immediately to rule out agranulocytosis before any other intervention.
2. A client on haloperidol develops a fever of 104°F (40°C), muscle rigidity, and altered mental
status. Which condition should the nurse suspect? A. Serotonin syndrome B. Neuroleptic
malignant syndrome (NMS) C. Tardive dyskinesia D. Acute dystonia
Answer: B Rationale: NMS is a life-threatening reaction to antipsychotics (especially typical
agents) characterized by hyperthermia, "lead-pipe" muscle rigidity, autonomic instability, and
altered consciousness. The drug must be stopped immediately and supportive care initiated.
3. Which finding in a client taking an atypical antipsychotic (e.g., olanzapine) requires the most
immediate follow-up? A. Weight gain of 3 lb in one month B. Fasting glucose of 180 mg/dL C.
Mild sedation in the morning D. Dry mouth
Answer: B Rationale: Atypical antipsychotics carry a black box-level concern for metabolic
syndrome, including hyperglycemia and new-onset diabetes. A fasting glucose of 180 mg/dL is
significantly elevated and needs prompt provider notification.
,4. A client has been taking a typical antipsychotic for several years and now displays lip
smacking and tongue protrusion. The nurse recognizes this as: A. Akathisia B. Tardive dyskinesia
C. Pseudoparkinsonism D. Dystonic reaction
Answer: B Rationale: Tardive dyskinesia is a late-onset, potentially irreversible movement
disorder from long-term dopamine-blocking antipsychotic use, presenting as involuntary
movements of the face and tongue.
5. The nurse is teaching a client about a new prescription for clozapine. Which statement
indicates a need for further teaching? A. "I will need weekly blood tests at first." B. "I can stop
this medication abruptly if I feel better." C. "I should report any fever right away." D. "This
medication is usually reserved for treatment-resistant symptoms."
Answer: B Rationale: Antipsychotics should never be stopped abruptly; this can cause rebound
psychosis and withdrawal effects. This statement shows misunderstanding and requires
correction.
Section 2: Antidepressants
6. A client starting an SSRI asks how soon they will feel better. The nurse's best response is: A.
"You should feel improvement within 24 hours." B. "Full therapeutic effect typically takes 4–6
weeks." C. "SSRIs work immediately but wear off quickly." D. "You will need to double the dose
after one week."
Answer: B Rationale: SSRIs require sustained use, typically 4–6 weeks, before full therapeutic
benefit is seen, even though some side effects appear sooner. Clients need this teaching to
support adherence.
, 7. A client taking an MAOI (phenelzine) asks about diet. Which food should the nurse instruct
the client to avoid? A. Fresh bananas B. Aged cheeses C. White rice D. Grilled chicken
Answer: B Rationale: Tyramine-rich foods (aged cheese, cured meats, fermented products) can
trigger a hypertensive crisis in clients taking MAOIs, since MAOIs prevent the breakdown of
tyramine.
8. A client taking sertraline and tramadol together develops agitation, diaphoresis,
hyperreflexia, and tremor. The nurse should suspect: A. Neuroleptic malignant syndrome B.
Serotonin syndrome C. Cholinergic crisis D. Discontinuation syndrome
Answer: B Rationale: Combining serotonergic agents (SSRI + tramadol) increases the risk of
serotonin syndrome, presenting with autonomic instability, neuromuscular hyperactivity, and
altered mental status.
9. A client has been taking amitriptyline (a TCA) for depression. Which client statement raises
the greatest safety concern? A. "I've been feeling a little more tired than usual." B. "My mouth
feels dry most of the day." C. "I stockpiled a month's worth of pills at home." D. "I sometimes
get a little dizzy standing up."
Answer: C Rationale: TCAs are highly lethal in overdose due to cardiotoxicity. A client with
depression who is stockpiling medication raises significant concern for suicide risk and must be
assessed immediately.
10. The nurse is discontinuing a client's SSRI. Which approach is correct? A. Stop the medication
immediately once symptoms resolve B. Taper the dose gradually over time C. Switch abruptly to
a different antidepressant class D. Double the dose for one week before stopping
RATIONALES
,ATI Mental Health Pharmacology — Practice Midterm Original NCLEX-Style Practice Questions
with Rationales
Section 1: Antipsychotics
1. A client taking clozapine reports a sore throat and fever. What is the nurse's priority action?
A. Administer acetaminophen and reassess in 4 hours B. Instruct the client to gargle with warm
salt water C. Obtain a WBC/ANC count immediately D. Document and monitor at the next
scheduled visit
Answer: C Rationale: Clozapine carries a risk of agranulocytosis. Fever and sore throat are early
signs of infection related to a dangerously low white blood cell count. An ANC must be drawn
immediately to rule out agranulocytosis before any other intervention.
2. A client on haloperidol develops a fever of 104°F (40°C), muscle rigidity, and altered mental
status. Which condition should the nurse suspect? A. Serotonin syndrome B. Neuroleptic
malignant syndrome (NMS) C. Tardive dyskinesia D. Acute dystonia
Answer: B Rationale: NMS is a life-threatening reaction to antipsychotics (especially typical
agents) characterized by hyperthermia, "lead-pipe" muscle rigidity, autonomic instability, and
altered consciousness. The drug must be stopped immediately and supportive care initiated.
3. Which finding in a client taking an atypical antipsychotic (e.g., olanzapine) requires the most
immediate follow-up? A. Weight gain of 3 lb in one month B. Fasting glucose of 180 mg/dL C.
Mild sedation in the morning D. Dry mouth
Answer: B Rationale: Atypical antipsychotics carry a black box-level concern for metabolic
syndrome, including hyperglycemia and new-onset diabetes. A fasting glucose of 180 mg/dL is
significantly elevated and needs prompt provider notification.
,4. A client has been taking a typical antipsychotic for several years and now displays lip
smacking and tongue protrusion. The nurse recognizes this as: A. Akathisia B. Tardive dyskinesia
C. Pseudoparkinsonism D. Dystonic reaction
Answer: B Rationale: Tardive dyskinesia is a late-onset, potentially irreversible movement
disorder from long-term dopamine-blocking antipsychotic use, presenting as involuntary
movements of the face and tongue.
5. The nurse is teaching a client about a new prescription for clozapine. Which statement
indicates a need for further teaching? A. "I will need weekly blood tests at first." B. "I can stop
this medication abruptly if I feel better." C. "I should report any fever right away." D. "This
medication is usually reserved for treatment-resistant symptoms."
Answer: B Rationale: Antipsychotics should never be stopped abruptly; this can cause rebound
psychosis and withdrawal effects. This statement shows misunderstanding and requires
correction.
Section 2: Antidepressants
6. A client starting an SSRI asks how soon they will feel better. The nurse's best response is: A.
"You should feel improvement within 24 hours." B. "Full therapeutic effect typically takes 4–6
weeks." C. "SSRIs work immediately but wear off quickly." D. "You will need to double the dose
after one week."
Answer: B Rationale: SSRIs require sustained use, typically 4–6 weeks, before full therapeutic
benefit is seen, even though some side effects appear sooner. Clients need this teaching to
support adherence.
, 7. A client taking an MAOI (phenelzine) asks about diet. Which food should the nurse instruct
the client to avoid? A. Fresh bananas B. Aged cheeses C. White rice D. Grilled chicken
Answer: B Rationale: Tyramine-rich foods (aged cheese, cured meats, fermented products) can
trigger a hypertensive crisis in clients taking MAOIs, since MAOIs prevent the breakdown of
tyramine.
8. A client taking sertraline and tramadol together develops agitation, diaphoresis,
hyperreflexia, and tremor. The nurse should suspect: A. Neuroleptic malignant syndrome B.
Serotonin syndrome C. Cholinergic crisis D. Discontinuation syndrome
Answer: B Rationale: Combining serotonergic agents (SSRI + tramadol) increases the risk of
serotonin syndrome, presenting with autonomic instability, neuromuscular hyperactivity, and
altered mental status.
9. A client has been taking amitriptyline (a TCA) for depression. Which client statement raises
the greatest safety concern? A. "I've been feeling a little more tired than usual." B. "My mouth
feels dry most of the day." C. "I stockpiled a month's worth of pills at home." D. "I sometimes
get a little dizzy standing up."
Answer: C Rationale: TCAs are highly lethal in overdose due to cardiotoxicity. A client with
depression who is stockpiling medication raises significant concern for suicide risk and must be
assessed immediately.
10. The nurse is discontinuing a client's SSRI. Which approach is correct? A. Stop the medication
immediately once symptoms resolve B. Taper the dose gradually over time C. Switch abruptly to
a different antidepressant class D. Double the dose for one week before stopping
