NCLEX RN Psychiatric Medications
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A client taking lithium for bipolar disorder reports severe diarrhea,
vomiting, and worsening tremors. What should the nurse do first?
A. Administer the next dose with food
B. Encourage the client to increase sodium restriction
C. Hold the lithium and notify the provider
D. Reassure the client that these effects are expected
Answer: C. Hold the lithium and notify the provider
Rationale: Severe diarrhea, vomiting, and worsening tremors can indicate
lithium toxicity. The medication should be withheld and the provider notified.
2. Which laboratory value is most important for the nurse to monitor in a
client taking lithium?
A. Hemoglobin
B. Serum lithium level
C. Platelet count
D. Serum amylase
Answer: B. Serum lithium level
Rationale: Serum lithium levels must be monitored because lithium has a
narrow therapeutic range and toxicity can occur with relatively small
increases in serum concentration.
3. A client taking lithium asks why maintaining adequate fluid intake is
important. What is the best response?
,A. “Fluids prevent lithium from being absorbed.”
B. “Adequate hydration helps prevent lithium toxicity.”
C. “Fluids increase lithium effectiveness.”
D. “Fluids prevent all adverse effects of lithium.”
Answer: B. “Adequate hydration helps prevent lithium toxicity.”
Rationale: Dehydration can increase lithium concentration and increase the
risk of toxicity. Consistent fluid and sodium intake are important.
4. Which finding should the nurse recognize as a potential early sign of
lithium toxicity?
A. Mild thirst
B. Fine hand tremor
C. Severe diarrhea
D. Increased appetite
Answer: C. Severe diarrhea
Rationale: Severe diarrhea, vomiting, coarse tremors, ataxia, confusion, and
slurred speech are concerning for lithium toxicity.
5. A client taking lithium has a serum lithium level of 2.2 mEq/L. What is
the nurse’s priority action?
A. Administer the medication as prescribed
B. Encourage a high-calcium diet
C. Hold lithium and notify the provider immediately
D. Recheck the level in 1 week
Answer: C. Hold lithium and notify the provider immediately
Rationale: A lithium level of 2.2 mEq/L is toxic. Lithium should be withheld
and urgent medical evaluation initiated.
6. Which medication is commonly used to treat acute mania?
A. Lithium
B. Donepezil
C. Buspirone
D. Fluoxetine only
,Answer: A. Lithium
Rationale: Lithium is a mood stabilizer commonly used for bipolar disorder,
including acute mania and long-term maintenance.
7. A client taking lithium should be taught to avoid which medication unless
specifically approved by the provider?
A. Acetaminophen
B. Ibuprofen
C. Vitamin C
D. Calcium carbonate
Answer: B. Ibuprofen
Rationale: NSAIDs such as ibuprofen can decrease renal lithium clearance and
increase lithium levels, increasing the risk of toxicity.
8. A client taking valproic acid develops abdominal pain, nausea, and
vomiting. Which complication should the nurse suspect?
A. Pancreatitis
B. Hypoglycemia
C. Agranulocytosis
D. Pulmonary edema
Answer: A. Pancreatitis
Rationale: Valproic acid can cause pancreatitis. Persistent abdominal pain,
nausea, and vomiting require prompt evaluation.
9. Which laboratory tests are particularly important for a client receiving
valproic acid?
A. Liver function tests and platelet count
B. Troponin and CK-MB
C. Calcium and phosphate only
D. Hemoglobin A1c only
Answer: A. Liver function tests and platelet count
Rationale: Valproic acid can cause hepatotoxicity and thrombocytopenia, so
liver function and platelet counts should be monitored.
, 10.Which adverse effect is associated with valproic acid?
A. Severe hypothermia
B. Hepatotoxicity
C. Permanent hearing loss
D. Severe hypertension in all clients
Answer: B. Hepatotoxicity
Rationale: Hepatotoxicity is a serious adverse effect of valproic acid and
warrants monitoring for abdominal pain, jaundice, dark urine, and abnormal
liver function tests.
11.A client taking carbamazepine develops fever and a sore throat. What
should the nurse do?
A. Tell the client to continue therapy without concern
B. Recommend taking the medication with milk
C. Notify the provider and anticipate a CBC
D. Encourage strenuous exercise
Answer: C. Notify the provider and anticipate a CBC
Rationale: Carbamazepine can cause leukopenia and agranulocytosis. Fever
and sore throat may indicate infection associated with decreased white blood
cells.
12.Which adverse effect is associated with carbamazepine?
A. Agranulocytosis
B. Hypercalcemia
C. Severe constipation in every client
D. Cataracts
Answer: A. Agranulocytosis
Rationale: Carbamazepine can cause serious blood dyscrasias, including
leukopenia and agranulocytosis. CBC monitoring is important.
13.A client prescribed lamotrigine reports a new widespread skin rash.
What is the nurse’s priority action?
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A client taking lithium for bipolar disorder reports severe diarrhea,
vomiting, and worsening tremors. What should the nurse do first?
A. Administer the next dose with food
B. Encourage the client to increase sodium restriction
C. Hold the lithium and notify the provider
D. Reassure the client that these effects are expected
Answer: C. Hold the lithium and notify the provider
Rationale: Severe diarrhea, vomiting, and worsening tremors can indicate
lithium toxicity. The medication should be withheld and the provider notified.
2. Which laboratory value is most important for the nurse to monitor in a
client taking lithium?
A. Hemoglobin
B. Serum lithium level
C. Platelet count
D. Serum amylase
Answer: B. Serum lithium level
Rationale: Serum lithium levels must be monitored because lithium has a
narrow therapeutic range and toxicity can occur with relatively small
increases in serum concentration.
3. A client taking lithium asks why maintaining adequate fluid intake is
important. What is the best response?
,A. “Fluids prevent lithium from being absorbed.”
B. “Adequate hydration helps prevent lithium toxicity.”
C. “Fluids increase lithium effectiveness.”
D. “Fluids prevent all adverse effects of lithium.”
Answer: B. “Adequate hydration helps prevent lithium toxicity.”
Rationale: Dehydration can increase lithium concentration and increase the
risk of toxicity. Consistent fluid and sodium intake are important.
4. Which finding should the nurse recognize as a potential early sign of
lithium toxicity?
A. Mild thirst
B. Fine hand tremor
C. Severe diarrhea
D. Increased appetite
Answer: C. Severe diarrhea
Rationale: Severe diarrhea, vomiting, coarse tremors, ataxia, confusion, and
slurred speech are concerning for lithium toxicity.
5. A client taking lithium has a serum lithium level of 2.2 mEq/L. What is
the nurse’s priority action?
A. Administer the medication as prescribed
B. Encourage a high-calcium diet
C. Hold lithium and notify the provider immediately
D. Recheck the level in 1 week
Answer: C. Hold lithium and notify the provider immediately
Rationale: A lithium level of 2.2 mEq/L is toxic. Lithium should be withheld
and urgent medical evaluation initiated.
6. Which medication is commonly used to treat acute mania?
A. Lithium
B. Donepezil
C. Buspirone
D. Fluoxetine only
,Answer: A. Lithium
Rationale: Lithium is a mood stabilizer commonly used for bipolar disorder,
including acute mania and long-term maintenance.
7. A client taking lithium should be taught to avoid which medication unless
specifically approved by the provider?
A. Acetaminophen
B. Ibuprofen
C. Vitamin C
D. Calcium carbonate
Answer: B. Ibuprofen
Rationale: NSAIDs such as ibuprofen can decrease renal lithium clearance and
increase lithium levels, increasing the risk of toxicity.
8. A client taking valproic acid develops abdominal pain, nausea, and
vomiting. Which complication should the nurse suspect?
A. Pancreatitis
B. Hypoglycemia
C. Agranulocytosis
D. Pulmonary edema
Answer: A. Pancreatitis
Rationale: Valproic acid can cause pancreatitis. Persistent abdominal pain,
nausea, and vomiting require prompt evaluation.
9. Which laboratory tests are particularly important for a client receiving
valproic acid?
A. Liver function tests and platelet count
B. Troponin and CK-MB
C. Calcium and phosphate only
D. Hemoglobin A1c only
Answer: A. Liver function tests and platelet count
Rationale: Valproic acid can cause hepatotoxicity and thrombocytopenia, so
liver function and platelet counts should be monitored.
, 10.Which adverse effect is associated with valproic acid?
A. Severe hypothermia
B. Hepatotoxicity
C. Permanent hearing loss
D. Severe hypertension in all clients
Answer: B. Hepatotoxicity
Rationale: Hepatotoxicity is a serious adverse effect of valproic acid and
warrants monitoring for abdominal pain, jaundice, dark urine, and abnormal
liver function tests.
11.A client taking carbamazepine develops fever and a sore throat. What
should the nurse do?
A. Tell the client to continue therapy without concern
B. Recommend taking the medication with milk
C. Notify the provider and anticipate a CBC
D. Encourage strenuous exercise
Answer: C. Notify the provider and anticipate a CBC
Rationale: Carbamazepine can cause leukopenia and agranulocytosis. Fever
and sore throat may indicate infection associated with decreased white blood
cells.
12.Which adverse effect is associated with carbamazepine?
A. Agranulocytosis
B. Hypercalcemia
C. Severe constipation in every client
D. Cataracts
Answer: A. Agranulocytosis
Rationale: Carbamazepine can cause serious blood dyscrasias, including
leukopenia and agranulocytosis. CBC monitoring is important.
13.A client prescribed lamotrigine reports a new widespread skin rash.
What is the nurse’s priority action?
