CNS, psychiatric and anti-infective drugs

48 NCLEX-RN practice questions on CNS, psychiatric and anti-infective drugs, part of Pharmacological and Parenteral Therapies. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium · Matrix
Several clients have psychotropic drugs due. For each finding, indicate whether the nurse should give the drug as prescribed or hold it and notify the provider.
For each row, choose: Give as prescribed / Hold and notify
1. IV haloperidol due; QTc 520 ms on this morning's ECG
2. Quetiapine due; QTc 440 ms and magnesium 2.0 mg/dL
3. Citalopram 60 mg daily newly prescribed for a 70-year-old
4. Citalopram 20 mg due; QTc 430 ms
5. Haloperidol due; serum potassium 2.9 mEq/L
Show answerHide answer
Answer:
- IV haloperidol due; QTc 520 ms on this morning's ECG: Hold and notify
- Quetiapine due; QTc 440 ms and magnesium 2.0 mg/dL: Give as prescribed
- Citalopram 60 mg daily newly prescribed for a 70-year-old: Hold and notify
- Citalopram 20 mg due; QTc 430 ms: Give as prescribed
- Haloperidol due; serum potassium 2.9 mEq/L: Hold and notify
Analyze cues: many antipsychotics and citalopram prolong the QT interval. A QTc over 500 ms, low potassium or magnesium, or a dose above the age limit are reasons to hold the drug and call the provider before giving it.
- IV haloperidol due; QTc 520 ms on this morning's ECG: A QTc over 500 ms raises the risk of torsades de pointes.
- Quetiapine due; QTc 440 ms and magnesium 2.0 mg/dL: The QTc and magnesium are acceptable.
- Citalopram 60 mg daily newly prescribed for a 70-year-old: The maximum recommended citalopram dose over age 60 is 20 mg daily.
- Citalopram 20 mg due; QTc 430 ms: This QTc is normal at a standard dose.
- Haloperidol due; serum potassium 2.9 mEq/L: Hypokalemia adds to the risk of QT prolongation and arrhythmia.
Question 2 · Medium · Select all that apply
A woman of childbearing age is starting valproic acid for seizures. Which instructions should the nurse give?
1. AUse effective contraception while taking this drug
2. BChew the delayed-release tablets to speed absorption
3. CExpect easy bruising as a normal effect
4. DReport abdominal pain with nausea or vomiting at once
5. EStop the drug at once if you think you are pregnant
Show answerHide answer
Answer: A, D
Generate solutions: valproic acid carries boxed warnings for hepatotoxicity, pancreatitis and fetal harm. Women of childbearing potential need effective contraception and a plan with the provider before pregnancy; the drug is never stopped abruptly.
- B: Delayed-release tablets are swallowed whole.
- C: Bruising may mean thrombocytopenia and should be reported.
- E: Stopping suddenly risks seizures; the provider is contacted first.
Question 3 · Hard · Select all that apply
A client with HIV is starting antiretroviral therapy. Which statements should the nurse include in the teaching?
1. AIf you miss a dose, take a double dose next time.
2. BAvoid St. John's wort while on these drugs.
3. CYou can stop the drugs once the viral load is undetectable.
4. DTake every dose on schedule, even when you feel well.
5. EMissed doses can let the virus become drug resistant.
6. FTreatment is usually finished after 6 months.
Show answerHide answer
Answer: B, D, E
Generate solutions: antiretroviral therapy is lifelong and works only with consistent adherence; gaps allow resistance. Many herbal products and drugs interact through liver enzymes. The nurse reviews each new medicine with the pharmacist.
- A: Doubling raises toxicity; follow the drug's missed-dose advice.
- C: Therapy is lifelong; stopping lets the virus rebound.
- F: Antiretroviral therapy is lifelong.
Question 4 · Easy · Select all that apply
A client who takes lithium calls the clinic. Which reported findings are early signs of lithium toxicity?
1. ARepeated vomiting since yesterday
2. BA coarse tremor of both hands
3. CPassing large amounts of urine
4. DSlow weight gain over months
5. EMuscle weakness and drowsiness
6. FSeveral loose stools a day
Show answerHide answer
Answer: A, B, E, F
Recognize cues: early lithium toxicity (about 1.5 to 2 mEq/L) shows as vomiting, diarrhea, coarse tremor, weakness and drowsiness. Polyuria, thirst, fine tremor and weight gain occur at therapeutic levels. A client with toxic signs should hold the next dose and have a level drawn.
- C: Polyuria and thirst are common side effects at therapeutic levels.
- D: Weight gain is a long-term side effect, not a sign of toxicity.
Question 5 · Hard · Select all that apply
A client who takes phenelzine is at the pharmacy counter. Which products should the nurse warn the client not to use?
1. ADextromethorphan cough syrup
2. BSumatriptan for migraine
3. CSt. John's wort supplement
4. DPseudoephedrine for nasal congestion
5. EAcetaminophen for headache
6. FMeperidine for pain
Show answerHide answer
Answer: A, B, C, D, F
Take action through teaching: MAOIs interact with sympathomimetics (hypertensive crisis) and with serotonergic drugs such as dextromethorphan, meperidine, triptans and St. John's wort (serotonin syndrome). The client checks with the pharmacist before any OTC product. Acetaminophen is a safe analgesic choice.
- E: Acetaminophen does not interact with MAOIs.
Question 6 · Medium · Select all that apply
A client is starting olanzapine for schizophrenia. Which assessments should the nurse plan to monitor at baseline and during therapy?
1. ABlood pressure
2. BFasting glucose or A1C
3. CSerum ammonia level
4. DWaist circumference
5. EFasting lipid panel
6. FWeight and body mass index
Answer and explanation in LearnFree account
Question 7 · Hard · Matrix
For each feature, indicate whether it points to serotonin syndrome, neuroleptic malignant syndrome or both.
For each row, choose: Serotonin syndrome / Neuroleptic malignant syndrome / Both
1. Onset within 24 hours of adding a second serotonergic drug
2. Onset over several days after an antipsychotic dose increase
3. High fever with unstable blood pressure
4. Lead-pipe rigidity with slowed reflexes
5. Dilated pupils
6. Myoclonus and brisk reflexes, worse in the legs
Answer and explanation in LearnFree account
Question 8 · Medium · Matrix
The nurse reviews morning drug levels. Targets used on this unit: gentamicin trough under 2 mcg/mL (conventional dosing) and carbamazepine 4 to 12 mcg/mL. For each result, indicate how it compares with the usual target.
For each row, choose: Within target / Above target / Below target
1. Lithium 1.8 mEq/L on maintenance therapy
2. Phenytoin 14 mcg/mL
3. Valproic acid 38 mcg/mL
4. Carbamazepine 9 mcg/mL
5. Gentamicin trough 3.0 mcg/mL
Answer and explanation in LearnFree account
Question 9 · Medium · Matrix
The nurse is assessing clients who take haloperidol. For each finding, indicate the extrapyramidal reaction it represents.
For each row, choose: Acute dystonia / Pseudoparkinsonism / Tardive dyskinesia
1. Shuffling gait and a masklike face after three weeks
2. Painful spasm of the jaw muscles within hours of an IM dose
3. Worm-like tongue movements after years of therapy
4. Cogwheel rigidity felt when the wrist is flexed
5. Neck twisted to one side with eyes rolled upward, a day after the first dose
Answer and explanation in LearnFree account
Question 10 · Medium · Select all that apply
A client is receiving IV vancomycin every 12 hours, with trough levels prescribed. Which actions should the nurse take?
1. AMonitor serum creatinine and urine output
2. BDraw the trough 30 minutes after the infusion ends
3. CInfuse each 1 g dose over at least 60 minutes
4. DHave the trough drawn just before the next dose
5. EGive the dose by IV push over 5 minutes
6. FAsk the client to report ringing in the ears
Answer and explanation in LearnFree account
Question 11 · Hard · Matrix
The nurse reviews clients taking antiretroviral drugs. For each finding, indicate whether the nurse should report it promptly or reassure and monitor.
For each row, choose: Report promptly / Reassure and monitor
1. Hemoglobin falling from 13 to 9 g/dL on zidovudine
2. Mild nausea in the first week of a new regimen
3. Fever, rash and vomiting in week 2 of an abacavir regimen
4. Vivid dreams during the first 2 weeks of efavirenz
5. Creatinine rising from 0.9 to 1.6 mg/dL on tenofovir disoproxil
Answer and explanation in LearnFree account
Question 12 · Medium · Matrix
A client is receiving isoniazid, rifampin and ethambutol for tuberculosis. For each finding or teaching point, indicate the drug it relates to.
For each row, choose: Isoniazid / Rifampin / Ethambutol
1. Numbness and tingling in the feet
2. Trouble telling red from green
3. Orange-red tears and urine
4. Baseline visual acuity testing before the first dose
5. Reduced effect of hormonal contraceptives
Answer and explanation in LearnFree account
Question 13 · Hard · Select all that apply
The nurse on a mental health unit reviews the morning report. Which client findings require prompt follow-up with the provider?
1. AMild nausea on day 3 of sertraline
2. BLithium level 1.9 mEq/L in a client who has been vomiting
3. CBP 192/110 with a pounding headache in a client taking phenelzine
4. DAbsolute neutrophil count of 900/mm3 in a client taking clozapine
5. EBupropion newly prescribed for a client with bulimia nervosa
6. FFine hand tremor with a lithium level of 0.9 mEq/L
Answer and explanation in LearnFree account
Question 14 · Medium · Select all that apply
A client taking venlafaxine has used a dextromethorphan cough syrup for 2 days. Which findings support serotonin syndrome?
1. AHot, dry, flushed skin
2. BHeavy sweating with diarrhea
3. CRestlessness and agitation
4. DHyperreflexia with ankle clonus
5. ELead-pipe rigidity developing over 5 days
6. FHeart rate of 52 beats/min
Answer and explanation in LearnFree account
Question 15 · Easy · Select all that apply
A client is being discharged on oral phenytoin. Which instructions should the nurse give?
1. ADo not stop the drug suddenly
2. BTake an antacid at the same time to protect the stomach
3. CStop the drug if your gums start to swell
4. DSkip a dose when you feel drowsy
5. EKeep appointments for blood level checks
6. FBrush and floss daily and see a dentist regularly
Answer and explanation in LearnFree account
Question 16 · Medium · Select all that apply
A client is starting sertraline for major depression. Which statements should the nurse include in the teaching?
1. ADo not stop the drug suddenly; the dose is tapered.
2. BThe full benefit may take several weeks to appear.
3. CTake it with St. John's wort for a faster response.
4. DExpect the full effect within 2 days.
5. EReport any new or worse thoughts of suicide.
6. FStop the drug once your mood feels better.
Answer and explanation in LearnFree account
Question 17 · Hard · Select all that apply
A nurse is screening clients before isoniazid is started. Which client factors raise the risk of isoniazid hepatotoxicity?
1. AAge 60 years
2. BChronic hepatitis C infection
3. CCurrently pregnant
4. DAlso taking rifampin
5. ETaking pyridoxine 25 mg daily
6. FDrinks alcohol daily
Answer and explanation in LearnFree account
Question 18 · Hard · Matrix
The nurse reviews findings in three clients taking antiepileptic drugs. For each finding, indicate the drug most likely responsible.
For each row, choose: Phenytoin / Carbamazepine / Valproic acid
1. Serum sodium of 126 mEq/L
2. Level falls in the first weeks because the drug speeds its own metabolism
3. Overgrowth of the gums
4. Discolored, painful, swollen hand after an IV dose
5. Lethargy with a raised serum ammonia
6. Severe abdominal pain with a raised lipase
Answer and explanation in LearnFree account
Question 19 · Medium
A client who has taken fluphenazine for 9 years has repeated lip smacking, tongue thrusting and grimacing that the client seems unaware of. The nurse documents these findings as:
1. ATardive dyskinesia
2. BAkathisia
3. CPseudoparkinsonism
4. DAcute dystonia
Answer and explanation in LearnFree account
Question 20 · Medium
The nurse is preparing to give phenytoin IV push through a peripheral IV. Which action is correct?
1. ADilute the dose in 5% dextrose to reduce irritation
2. BGive it through the line running D5W at 75 mL/h
3. CFlush the line with 0.9% sodium chloride before and after
4. DPush the dose at about 100 mg per minute
Answer and explanation in LearnFree account
Question 21 · Medium
A client on day 5 of IV gentamicin is assessed. Which finding is most important to report to the health care provider?
1. AUrine output of 50 mL per hour
2. BTemperature down from 101.6 °F to 99.5 °F
3. CMild nausea after the breakfast tray
4. DRinging in both ears and an unsteady gait
Answer and explanation in LearnFree account
Question 22 · Hard
A client on lithium for bipolar disorder reports 3 days of vomiting and watery diarrhea. Nurse's notes: coarse hand tremor, slurred speech, unsteady gait. BP 102/64, HR 104. Lithium level 2.1 mEq/L (range 0.6 to 1.2). The 0900 lithium dose is due. What should the nurse do first?
1. AGive an as-needed antiemetic and recheck at noon
2. BEncourage 3 L of oral fluid and recheck tomorrow
3. CHold the lithium and notify the health care provider
4. DGive the dose with food to reduce stomach upset
Answer and explanation in LearnFree account
Question 23 · Easy
A client starting isoniazid for latent tuberculosis infection is also prescribed pyridoxine (vitamin B6). The nurse explains that pyridoxine is added to prevent:
1. AHyperuricemia and gout
2. BOptic neuritis
3. CRed-orange body fluids
4. DPeripheral neuropathy
Answer and explanation in LearnFree account
Question 24 · Easy
A client on maintenance lithium therapy has a serum level drawn 12 hours after the last dose. Which result falls within the usual maintenance range of 0.6 to 1.2 mEq/L?
1. A0.3 mEq/L
2. B2.6 mEq/L
3. C1.8 mEq/L
4. D0.9 mEq/L
Answer and explanation in LearnFree account
Question 25 · Medium
Before discharge, a client on lithium summarizes self-care at home. Which client statement shows that more teaching is needed?
1. A"I'll check with my provider before I take ibuprofen."
2. B"I'll go on a low-salt diet to keep my blood pressure down."
3. C"I'll call if I get diarrhea or my hand shaking gets worse."
4. D"I'll drink about 2 to 3 liters of fluid every day."
Answer and explanation in LearnFree account

23 more CNS, psychiatric and anti-infective drugs questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Pharmacological and Parenteral Therapies

CNS, psychiatric and anti-infective drugs

Several clients have psychotropic drugs due. For each finding, indicate whether the nurse should give the drug as prescribed or hold it and notify the provider.

A woman of childbearing age is starting valproic acid for seizures. Which instructions should the nurse give?

A client with HIV is starting antiretroviral therapy. Which statements should the nurse include in the teaching?

A client who takes lithium calls the clinic. Which reported findings are early signs of lithium toxicity?

A client who takes phenelzine is at the pharmacy counter. Which products should the nurse warn the client not to use?

A client is starting olanzapine for schizophrenia. Which assessments should the nurse plan to monitor at baseline and during therapy?

For each feature, indicate whether it points to serotonin syndrome, neuroleptic malignant syndrome or both.

The nurse reviews morning drug levels. Targets used on this unit: gentamicin trough under 2 mcg/mL (conventional dosing) and carbamazepine 4 to 12 mcg/mL. For each result, indicate how it compares with the usual target.

The nurse is assessing clients who take haloperidol. For each finding, indicate the extrapyramidal reaction it represents.

A client is receiving IV vancomycin every 12 hours, with trough levels prescribed. Which actions should the nurse take?

The nurse reviews clients taking antiretroviral drugs. For each finding, indicate whether the nurse should report it promptly or reassure and monitor.

A client is receiving isoniazid, rifampin and ethambutol for tuberculosis. For each finding or teaching point, indicate the drug it relates to.

The nurse on a mental health unit reviews the morning report. Which client findings require prompt follow-up with the provider?

A client taking venlafaxine has used a dextromethorphan cough syrup for 2 days. Which findings support serotonin syndrome?

A client is being discharged on oral phenytoin. Which instructions should the nurse give?

A client is starting sertraline for major depression. Which statements should the nurse include in the teaching?

A nurse is screening clients before isoniazid is started. Which client factors raise the risk of isoniazid hepatotoxicity?

The nurse reviews findings in three clients taking antiepileptic drugs. For each finding, indicate the drug most likely responsible.

A client who has taken fluphenazine for 9 years has repeated lip smacking, tongue thrusting and grimacing that the client seems unaware of. The nurse documents these findings as:

The nurse is preparing to give phenytoin IV push through a peripheral IV. Which action is correct?

A client on day 5 of IV gentamicin is assessed. Which finding is most important to report to the health care provider?

A client on lithium for bipolar disorder reports 3 days of vomiting and watery diarrhea. Nurse's notes: coarse hand tremor, slurred speech, unsteady gait. BP 102/64, HR 104. Lithium level 2.1 mEq/L (range 0.6 to 1.2). The 0900 lithium dose is due. What should the nurse do first?

A client starting isoniazid for latent tuberculosis infection is also prescribed pyridoxine (vitamin B6). The nurse explains that pyridoxine is added to prevent:

A client on maintenance lithium therapy has a serum level drawn 12 hours after the last dose. Which result falls within the usual maintenance range of 0.6 to 1.2 mEq/L?

Before discharge, a client on lithium summarizes self-care at home. Which client statement shows that more teaching is needed?