1.	A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to	
A)	Get a stat order for a serum drug level	
B)	Hold the client's medication until the symptoms subside	
C)	Place an urgent call to the client's physician	
D)	Give a PRN dose of benztropine (Cogentin) IM	

2.	One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103 °F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of	
A)	Acute dystonic reaction	
B)	Extrapyramidal side effects	
C)	Neuroleptic malignant syndrome	
D)	Tardive dyskinesia	

3.	A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see?	
A)	Constipation and postural hypotension	
B)	Fever, muscle rigidity, and disorientation	
C)	Nausea, diarrhea, and confusion	
D)	None; the serum level is in therapeutic range	

4.	The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements?	
A)	“I'm glad I can eat pizza since it's my favorite food.”	
B)	“I must follow this diet or I will have severe vomiting.”	
C)	“It will be difficult for me to avoid pepperoni.”	
D)	“None of the foods that are restricted are part of a regular daily diet.”	

5.	When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods?	
A)	Broad beans	
B)	Citrus fruit	
C)	Egg products	
D)	Fried foods	

6.	For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately?	
A)	Inability to stand still for 1 minute	
B)	Mild rash	
C)	Photosensitivity reaction	
D)	Sore throat and malaise	

7.	A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated?	
A)	Call the physician for an increase in dosage.	
B)	Do not give the next dose, and call the physician.	
C)	Increase fluid intake for the next week.	
D)	No intervention is necessary at this time.	

8.	A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially?	
A)	Instruct the client to stop the medication for a few days to see if the nausea goes away.	
B)	Reassure the client that this is an expected side effect that will improve with time.	
C)	Suggest that the client take the medication with food.	
D)	Tell the client to contact the physician for a change in medication.	

9.	In planning for a client's discharge, the nurse must know that the greatest risk for the client taking a tricyclic antidepressant is which of the following?	
A)	Hypotension	
B)	Narrow-angle glaucoma	
C)	Seizures	
D)	Suicide by overdose	

10.	A 50-year-old client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of	
A)	Extrapyramidal side effects	
B)	Loss of voluntary muscle control	
C)	Posturing	
D)	Tardive dyskinesia	

11.	The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury?	
A)	Cerebrum	
B)	Cerebellum	
C)	Medulla	
D)	Amygdala	

12.	A patient with bipolar disorder asks the nurse, “Why did I get this illness? I don’t want to be sick.” The nurse would best respond with:	
A)	“People who develop mental illnesses often had very traumatic childhood experiences.”	
B)	“There is some evidence that contracting a virus during childhood can lead to mental disorders.” 	
C)	“Sometimes people with mental illness have an overactive immune system.” 	
D)	“We don’t fully understand the cause, but mental illnesses do seem to run in families.”	

13.	A nurse is leading a medication education group for patients with depression. A patient states they have read that herbal treatments are just as effective as prescription medications. The best response is: 	
A)	“When studies are published they can be trusted to be accurate.”	
B)	“We need to look at the research very closely to see how reliable the studies are.”	
C)	“Your prescribed medication is the best for your condition so you should not read those studies.”	
D)	“Switching medications will alter the course of your illness. It is not advised.”	

14.	The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient:	
A)	“Have you ever had an allergic reaction to radioactive dye?”	
B)	“Have you had anything to eat in the last 24 hours?”	
C)	“Does your insurance cover the cost of this scan?”	
D)	“Are you anxious about being in tight spaces?”	

15.	A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on?	
A)	Aripiprazole (Abilfy)	
B)	Risperidone (Risperdal Consta)	
C)	Fluphenazine (Prolixin)	
D)	Fluoxatine (Prozac)	

16.	A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. Nurse explains that the mechanism by which the olanzapine controls the patient’s psychotic symptoms is believed to be:	
A)	Increasing the amount of serotonin and norepinephrine in the brain	
B)	Decreasing the amount of an enzyme that breaks down neurotransmitters	
C)	Normalizing the levels of serotonin, norepinephrine, and dopamine	
D)	Blocking dopamine receptors in the brain	

17.	A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report?	
A)	A headache after eating wine and cheese	
B)	A decrease in sexual pleasure during intimacy 	
C)	Weight gain of 10 pounds	
D)	Persistent runny nose	

18.	A patient with biploar disorder takes lithium 300mg three times daily. The nurse evaluates the dose is appropriate when the patient reports:	
A)	Feeling sleepy and less energetic	
B)	Weight gain of 7 pounds in the last 6 months	
C)	Minimal mood swings	
D)	Increased feelings of self-worth	

19.	A patient is seen for frequent exacerbation of schizophrenia due to non-adherence to medication regime. The nurse should assess for which of the following common contributors to non-adherence:	
A)	The patient is symptom-free and therefore does not need to adhere to the medication regime	
B)	The patient cannot clearly see the instructions written on the prescription bottle	
C)	The patient dislikes the weight gain associated with antipsychotic therapy	
D)	The patient sells the antipsychotics to addicts in the neighborhood	

20.	The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply:	
A)	Drink plenty of fruit juice 	
B)	Developing an exercise program is important	
C)	Increase foods high in fiber 	
D)	Laxatives can be used as needed	
E)	Use sunscreen when outdoors	
F)	For missed doses, take double the dose at the next scheduled time.	

21.	A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following?	
A)	Tardive dyskinesia	
B)	Neuroleptic malignant syndrome	
C)	Dystonia	
D)	Akathisia	

22.	Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia?	
A)	Opisthotonus	
B)	Oculogyric crisis	
C)	Torticollis	
D)	Pseudoparkinsonism	

23.	Which of the following medications rarely causes extrapyramidal side effects (EPS)?	
A)	Ziprasidone (Geodon)	
B)	Chlorpromazine (Thorazine)	
C)	Haloperidol (Haldol)	
D)	Fluphenazine (Prolixin)	

24.	Which of the following increases the risk for neuroleptic malignant syndrome (NMS)?	
A)	Overhydration	
B)	Intake of vitamins	
C)	Dehydration	
D)	Vegetarian diet	

25.	Which of the following was the first nonstimulant medication specifically designed and tested for ADHD?	
A)	Methylphenidate (Ritalin)	
B)	Amphetamine (Adderall)	
C)	Atomoxetine (Strattera)	
D)	Pemoline (Cylert)	

26.	Which of the following is a primary concern with clients taking antidepressants?	
A)	Decreased mobility	
B)	Emotional changes	
C)	Suicide	
D)	Increased sleep	

27.	Which of the following would not be included as a symptom of drug-induced Parkinsonism?	
A)	Stooped posture	
B)	Cogwheel rigidity	
C)	Drooling	
D)	Tachycardia	

28.	Which drug classification is the primary medication treatment for schizophrenia?	
A)	Anticoagulants	
B)	Antidepressants	
C)	Antimanics	
D)	Antipsychotics	

29.	Which of the following is an inhibitory neurotransmitter?	
A)	Dopamine	
B)	GABA	
C)	Norepinephrine	
D)	Epinephrine	

30.	Which of the following is a neuromodulator?	
A)	Neuropeptides	
B)	Glutamate	
C)	Dopamine	
D)	GABA	

Answer Key

1.	D	
2.	C	
3.	C	
4.	C	
5.	A	
6.	D	
7.	D	
8.	C	
9.	D	
10.	D	
11.	A	
12.	D	
13.	B	
14.	D	
15.	A	
16.	D	
17.	B	
18.	C	
19.	C	
20.	B, C, E	
21.	D	
22.	B	
23.	A	
24.	C	
25.	C	
26.	C	
27.	D	
28.	D	
29.	B	
30.	A