Antipsychotic Meds NCLEX practice test

A client with schizophrenia says, “The TV newscaster is sending me secret messages.” The nurse documents this as:
A. Alogia
B. Delusion of reference
C. Flat affect
D. Anhedonia

Which finding is a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Disorganized speech
C. Flat affect
D. Persecutory delusions

A client says, “The voices tell me I’m evil.” Which nurse responses are therapeutic? (Select all that apply.)
A. “I don’t hear the voices, but I can see this is scary for you.”
B. “You’re wrong—there are no voices.”
C. “What are the voices saying right now?”
D. “Let’s find a quiet place and use coping strategies.”
E. “Ignore them and they’ll stop.”

A client states, “The voices are telling me to jump out the window.” What is the nurse’s priority action?
A. Offer PRN hydroxyzine
B. Ask what the voices are saying and assess intent/plan
C. Redirect to a group activity
D. Explain hallucinations are common

Which antipsychotic is a first-generation (typical) medication?
A. Haloperidol
B. Olanzapine
C. Risperidone
D. Quetiapine

High-potency first-generation antipsychotics (e.g., haloperidol) are more likely to cause:
A. Sedation and anticholinergic effects
B. Extrapyramidal symptoms (EPS)
C. Weight gain and diabetes
D. Agranulocytosis

A client taking chlorpromazine reports severe dry mouth and constipation. This is most consistent with:
A. EPS
B. Anticholinergic effects
C. Neuroleptic malignant syndrome (NMS)
D. Serotonin syndrome

Which findings suggest acute dystonia? (Select all that apply.)
A. Neck stiffening with head turned to one side
B. Lip smacking and tongue rolling for 6 months
C. Upward deviation of the eyes (oculogyric crisis)
D. Shuffling gait and pill-rolling tremor
E. Jaw spasm (trismus)

A client develops acute dystonia after haloperidol. The nurse anticipates:
A. IM benztropine or diphenhydramine
B. Naloxone

A client on an antipsychotic is pacing and says, “I can’t sit still.” The nurse anticipates which intervention?
A. Increase antipsychotic dose
B. Propranolol (or benzodiazepine) per order
C. Give atropine
D. Give furosemide

Which statements about tardive dyskinesia are accurate? (Select all that apply.)
A. It may be irreversible
B. It typically occurs early in treatment
C. It includes lip smacking and tongue movements
D. VMAT2 inhibitors may be prescribed
E. It is treated first-line with IM diphenhydramine

A client on antipsychotics has fever, “lead-pipe” rigidity, diaphoresis, and confusion. Priority is:
A. Continue medication and recheck temperature in 1 hour
B. Stop antipsychotic and notify provider immediately
C. Give PRN stimulant
D. Encourage group therapy

Which client should the nurse assess first?
A. Client with tremor and shuffling gait after risperidone
B. Client with sore throat on clozapine
C. Client with fever 103°F (39.4°C), rigidity, tachycardia on haloperidol
D. Client with dry mouth on chlorpromazine

EHR excerpt: Client on haloperidol IV: T 102.8°F (39.3°C), HR 128, BP 168/96, rigid muscles, confused, CK elevated.
Which provider order should the nurse question?
A. Discontinue haloperidol
B. Begin cooling measures and IV fluids
C. Administer bromocriptine or dantrolene as ordered
D. Give next scheduled dose of haloperidol to control agitation

Which second-generation antipsychotic is most associated with weight gain/metabolic syndrome?
A. Olanzapine
B. Ziprasidone
C. Aripiprazole
D. Lurasidone

A client starts olanzapine. Which monitoring is appropriate? (Select all that apply.)
A. Weight/BMI and waist circumference
B. Fasting glucose or A1c
C. Lipid panel
D. Serum potassium weekly for 6 months
E. Blood pressure

Which antipsychotic is most likely to cause hyperprolactinemia?
A. Risperidone
B. Aripiprazole
C. Clozapine
D. Ziprasidone

Teaching includes: (Select all that apply.)
A. Rise slowly from sitting/lying positions
B. Increase fluids if not contraindicated
C. Sit down if dizzy
D. Take with grapefruit juice
E. Avoid alcohol

Which medication is most associated with QT prolongation among atypicals?
A. Ziprasidone
B. Quetiapine
C. Olanzapine
D. Clozapine

The nurse should hold an antipsychotic and notify the provider for which finding?
A. Dry mouth on chlorpromazine
B. AIMS score of 1
C. QTc 520 ms on ECG before ziprasidone dose
D. Mild sedation after first dose of quetiapine

Which symptom requires immediate action?
A. Increased appetite
B. Sore throat and fever
C. Mild constipation
D. Drowsiness after dose

EHR excerpt: Client on clozapine. ANC today: 900/mm³.
What is the nurse’s best action?
A. Administer medication as scheduled
B. Hold clozapine and notify provider
C. Give PRN benztropine
D. Encourage low-carb diet

Which teaching points are essential? (Select all that apply.)
A. Report fever, sore throat, or infection symptoms
B. Keep scheduled lab appointments (ANC monitoring)
C. Stop the medication abruptly if you feel better
D. Report severe constipation or abdominal pain
E. Watch for chest pain/shortness of breath early in therapy

A client with narrow-angle glaucoma is prescribed an antipsychotic with strong anticholinergic effects. Higher risk with:
A. Chlorpromazine
B. Haloperidol
C. Ziprasidone
D. Lurasidone

Which teaching is priority for chlorpromazine?
A. Avoid aged cheeses
B. Use sunscreen and protective clothing
C. Avoid tyramine foods
D. Take with grapefruit juice

Appropriate reasons include: (Select all that apply.)
A. History of medication nonadherence
B. Frequent relapse/hospitalizations
C. Client prefers fewer daily pills
D. Current suspected NMS
E. Stable client needing maintenance therapy

Which statement indicates understanding?
A. “I should stop my oral antipsychotic the same day I get the shot.”
B. “This injection helps maintain steady medication levels over weeks.”
C. “I’ll take extra doses if I feel symptoms returning.”
D. “If I miss an injection, it’s not important.”

Which client requires immediate intervention?
A. Client on haloperidol with torticollis and difficulty swallowing
B. Client on olanzapine with 5-lb weight gain
C. Client on risperidone with mild tremor
D. Client on quetiapine with dry mouth

A client on a typical antipsychotic has shuffling gait and pill-rolling tremor. This is:
A. Akathisia
B. Parkinsonism (EPS)
C. Tardive dyskinesia
D. NMS

Which actions are appropriate? (Select all that apply.)
A. Use AIMS or movement-rating scales routinely
B. Teach the client to report new muscle stiffness/spasms promptly
C. Administer benztropine as ordered for acute EPS
D. Encourage abrupt discontinuation of antipsychotic without provider input
E. Implement fall precautions if gait is affected

EHR excerpt: Client newly started on olanzapine reports extreme thirst and frequent urination. Random glucose: 356 mg/dL.
Priority nursing action:
A. Document as expected side effects
B. Notify provider—possible hyperglycemia
C. Offer sugar-free candy and water
D. Encourage increased caloric intake

The nurse recognizes:
A. Antipsychotics are first-line for dementia behaviors
B. Increased risk of stroke and mortality in dementia-related psychosis
C. No serious risks if used short-term
D. Antipsychotics improve cognition long-term

Which statements show understanding? (Select all that apply.)
A. “I’ll keep taking my medication even when I feel well.”
B. “I’ll avoid alcohol and recreational drugs.”
C. “If I have side effects, I’ll stop the medication immediately.”
D. “I’ll keep follow-up appointments with my mental health provider.”
E. “I’ll ask about long-acting injections if daily pills are hard.”

A client says, “The FBI planted a chip in my brain.” Best response:
A. “That’s not true.”
B. “Why would the FBI do that?”
C. “I don’t believe that, but I can see you feel afraid.”
D. “Let’s call the FBI to confirm.”

Four clients call the clinic. Who should be told to come in immediately?
A. Clozapine client with mild drooling
B. Clozapine client with constipation for 2 days
C. Clozapine client with fever 101.8°F (38.8°C) and sore throat
D. Clozapine client with increased appetite

A client is starting quetiapine at bedtime. Best teaching:
A. “Drive to see how you respond.”
B. “Avoid alcohol and use caution with driving until you know the effects.”
C. “Take in the morning to prevent daytime sleepiness.”
D. “Stop if you feel sleepy.”

Which findings are consistent with disorganized symptoms? (Select all that apply.)
A. Word salad
B. Loose associations
C. Waxy flexibility
D. Inappropriate affect
E. Neologisms

Client on ziprasidone. Labs: K⁺ 2.9 mEq/L, Mg²⁺ low. Reports palpitations.
Best nursing action:
A. Administer ziprasidone and reassess later
B. Hold medication and notify provider; anticipate electrolyte replacement
C. Encourage fluids and ambulation
D. Give PRN diphenhydramine

Which statement is most accurate?
A. Typical antipsychotics best improve negative symptoms
B. Atypical antipsychotics may help both positive symptoms and some negative symptoms
C. Antipsychotics cure schizophrenia after 6 months
D. Antipsychotics are only used for acute agitation

Which are common early relapse warning signs in schizophrenia? (Select all that apply.)
A. Sleep disturbance
B. Increased social withdrawal
C. New suspiciousness/irritability
D. Sudden improvement in insight
E. Decline in self-care