📘 Introduction:
Preparing for the NCLEX Psychiatric & Mental Health Nursing section can be challenging due to its focus on psychological disorders, therapies, and psychotropic medications. This Part 4 (151–200) set of MCQs is designed to strengthen your concepts with evidence-based explanations. Covering personality disorders, anxiety management, schizophrenia, and therapeutic communication, these questions are crafted to boost your confidence for exams.
✅ NCLEX Psychiatric Nursing MCQs (151–200)
151. Which drug is used to reduce alcohol cravings?
A. Disulfiram
B. Naltrexone
C. Diazepam
D. Buspirone
Answer: B. Naltrexone
👉 Explanation: Naltrexone reduces alcohol cravings, while disulfiram discourages drinking by causing unpleasant effects.
152. Which personality disorder is marked by excessive emotionality and attention-seeking?
A. Histrionic
B. Borderline
C. Paranoid
D. Schizoid
Answer: A. Histrionic
👉 Explanation: Histrionic personality disorder features dramatic behavior, need for approval, and attention-seeking.
153. Which benzodiazepine is commonly used for acute panic attacks?
A. Diazepam
B. Buspirone
C. Lithium
D. Fluoxetine
Answer: A. Diazepam
👉 Explanation: Benzodiazepines provide rapid relief in acute panic but are not suitable for long-term management due to dependence risk.
154. A nurse should suspect neuroleptic malignant syndrome (NMS) when a patient on antipsychotics develops:
A. Rigidity, fever, altered mental status
B. Hallucinations and delusions
C. Restlessness and tremors
D. Dry mouth and blurred vision
Answer: A. Rigidity, fever, altered mental status
👉 Explanation: NMS is a medical emergency caused by dopamine blockade, requiring immediate discontinuation of the drug.
155. Which therapy is considered first-line for obsessive-compulsive disorder (OCD)?
A. Psychoanalysis
B. Cognitive behavioral therapy (CBT)
C. ECT
D. Group therapy
Answer: B. Cognitive behavioral therapy (CBT)
👉 Explanation: CBT, particularly exposure and response prevention, is the most effective therapy for OCD.
156. Which condition is risperidone primarily used for?
A. Depression
B. Schizophrenia and bipolar disorder
C. ADHD
D. Anxiety disorder
Answer: B. Schizophrenia and bipolar disorder
👉 Explanation: Risperidone is an atypical antipsychotic effective in schizophrenia and mood stabilization.
157. A patient with depression says, “I feel hopeless.” The best nursing response is:
A. “You should think positively.”
B. “Can you tell me more about what makes you feel hopeless?”
C. “Don’t worry, things will get better soon.”
D. “You need to distract yourself.”
Answer: B. “Can you tell me more about what makes you feel hopeless?”
👉 Explanation: Therapeutic communication uses open-ended, empathetic questions instead of offering false reassurance.
158. Which symptom is common in generalized anxiety disorder (GAD)?
A. Sudden panic attacks
B. Persistent excessive worry
C. Dissociation
D. Delusions
Answer: B. Persistent excessive worry
👉 Explanation: GAD involves chronic, uncontrollable worry along with restlessness and irritability.
159. Clozapine requires monitoring of:
A. Platelets
B. WBC count
C. Blood sugar
D. Kidney function
Answer: B. WBC count
👉 Explanation: Clozapine may cause agranulocytosis, requiring regular monitoring of white blood cell counts.
160. Which defense mechanism involves transferring emotions from a threatening target to a safer one?
A. Projection
B. Displacement
C. Rationalization
D. Denial
Answer: B. Displacement
👉 Explanation: Displacement occurs when emotions are redirected to a less threatening substitute.
161. Which therapy is most effective for phobias?
A. Exposure therapy
B. ECT
C. Psychoanalysis
D. Group therapy
Answer: A. Exposure therapy
👉 Explanation: Systematic desensitization and exposure therapy are best for treating phobias.
162. Which symptom best indicates improvement in a patient with schizophrenia?
A. Reports fewer hallucinations
B. Avoids social contact
C. Exhibits flat affect
D. Refuses medication
Answer: A. Reports fewer hallucinations
👉 Explanation: Reduction in positive symptoms like hallucinations shows therapeutic progress.
163. Which class of drugs is most effective for acute anxiety?
A. Benzodiazepines
B. SSRIs
C. MAOIs
D. TCAs
Answer: A. Benzodiazepines
👉 Explanation: Benzodiazepines act quickly, but SSRIs are better for long-term management.
164. A patient on lithium should be educated to:
A. Avoid all fluids
B. Maintain normal salt and fluid intake
C. Increase caffeine intake
D. Double the dose if missed
Answer: B. Maintain normal salt and fluid intake
👉 Explanation: Sudden changes in sodium or fluid balance can lead to lithium toxicity.
165. Which finding suggests major depression rather than dysthymia?
A. Low mood for 2 weeks
B. Low mood for 2 years
C. Mild symptoms only
D. Intermittent euphoria
Answer: A. Low mood for 2 weeks
👉 Explanation: Major depression lasts at least 2 weeks, while dysthymia is chronic low mood for 2 years or more.
166. Which drug is contraindicated with alcohol use due to disulfiram-like reaction?
A. Metronidazole
B. Buspirone
C. Lithium
D. Sertraline
Answer: A. Metronidazole
👉 Explanation: Metronidazole can cause flushing, nausea, and vomiting if taken with alcohol.
167. Which therapy is most effective for borderline personality disorder?
A. DBT (Dialectical behavior therapy)
B. Psychoanalysis
C. Aversion therapy
D. ECT
Answer: A. DBT (Dialectical behavior therapy)
👉 Explanation: DBT improves emotional regulation and coping skills in borderline PD.
168. Which side effect of SSRIs requires immediate medical attention?
A. Sexual dysfunction
B. Weight gain
C. Serotonin syndrome
D. Dry mouth
Answer: C. Serotonin syndrome
👉 Explanation: Serotonin syndrome is life-threatening, with symptoms like fever, hyperreflexia, and confusion.
169. Which medication is first-line for PTSD?
A. SSRIs
B. Benzodiazepines
C. Lithium
D. Clozapine
Answer: A. SSRIs
👉 Explanation: SSRIs like sertraline are FDA-approved first-line medications for PTSD.
170. Which eating disorder involves bingeing without purging?
A. Bulimia nervosa
B. Binge eating disorder
C. Anorexia nervosa
D. Orthorexia
Answer: B. Binge eating disorder
👉 Explanation: Unlike bulimia, binge eating disorder does not include compensatory purging behaviors.
171. Which drug is used in opioid withdrawal management?
A. Methadone
B. Diazepam
C. Fluoxetine
D. Haloperidol
Answer: A. Methadone
👉 Explanation: Methadone is a long-acting opioid agonist used to reduce withdrawal symptoms.
172. Which term describes lack of pleasure in normally enjoyable activities?
A. Apathy
B. Anhedonia
C. Amnesia
D. Agnosia
Answer: B. Anhedonia
👉 Explanation: Anhedonia is a key symptom of major depression.
173. Which condition is treated with ECT most effectively?
A. PTSD
B. Severe depression with suicidal risk
C. Generalized anxiety disorder
D. Substance abuse
Answer: B. Severe depression with suicidal risk
👉 Explanation: ECT is highly effective for severe, treatment-resistant depression and suicidal ideation.
174. Which of the following is a long-term side effect of antipsychotics?
A. Tardive dyskinesia
B. Dystonia
C. Akathisia
D. Neuroleptic malignant syndrome
Answer: A. Tardive dyskinesia
👉 Explanation: Tardive dyskinesia develops after prolonged use of antipsychotics.
175. Which drug is a stimulant used in ADHD?
A. Risperidone
B. Methylphenidate
C. Fluoxetine
D. Buspirone
Answer: B. Methylphenidate
👉 Explanation: Stimulants improve focus and attention in ADHD.
176. Which nursing intervention is best for a client experiencing auditory hallucinations?
A. Argue with the client
B. Tell the client to ignore the voices
C. Acknowledge the voices but focus on reality
D. Pretend to hear the voices
Answer: C. Acknowledge the voices but focus on reality
👉 Explanation: Nurses should validate the patient’s experience while redirecting attention to reality.
177. A patient believes the TV is sending messages to them. This is:
A. Persecutory delusion
B. Thought broadcasting
C. Delusion of reference
D. Hallucination
Answer: C. Delusion of reference
👉 Explanation: Delusion of reference is when neutral events are interpreted as having personal meaning.
178. Which neurotransmitter is involved in Parkinsonism and schizophrenia?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. GABA
Answer: A. Dopamine
👉 Explanation: Dopamine excess is linked to schizophrenia; dopamine deficiency causes Parkinsonism.
179. Which antidepressant carries the highest risk of overdose toxicity?
A. TCA (tricyclic antidepressants)
B. SSRI
C. SNRI
D. MAOI
Answer: A. TCA (tricyclic antidepressants)
👉 Explanation: TCAs (like amitriptyline) can cause fatal arrhythmias in overdose.
180. Which drug is used in nicotine dependence treatment?
A. Bupropion
B. Clozapine
C. Valproate
D. Buspirone
Answer: A. Bupropion
👉 Explanation: Bupropion and varenicline are effective in smoking cessation therapy.
181. Which antipsychotic causes the least weight gain?
A. Olanzapine
B. Risperidone
C. Aripiprazole
D. Clozapine
Answer: C. Aripiprazole
👉 Explanation: Aripiprazole is a partial dopamine agonist with minimal metabolic side effects.
182. Which therapy is best for panic disorder?
A. CBT
B. ECT
C. Psychoanalysis
D. Group therapy
Answer: A. CBT
👉 Explanation: CBT, especially exposure-based, is most effective for panic disorder.
183. Which drug is a mood stabilizer and anticonvulsant?
A. Valproate
B. Sertraline
C. Diazepam
D. Haloperidol
Answer: A. Valproate
👉 Explanation: Valproate is used both as an anticonvulsant and in bipolar disorder.
184. Which finding suggests malingering?
A. Patient fabricates symptoms for secondary gain
B. Patient believes symptoms are real
C. Symptoms occur only during stress
D. No obvious motive is present
Answer: A. Patient fabricates symptoms for secondary gain
👉 Explanation: Malingering involves intentional symptom production for benefits like money or avoiding work.
185. Which term describes repetitive meaningless movements like hand flapping?
A. Stereotypy
B. Echopraxia
C. Catatonia
D. Automatism
Answer: A. Stereotypy
👉 Explanation: Stereotypy refers to repetitive, purposeless movements often seen in autism or schizophrenia.
186. Which electrolyte imbalance increases lithium toxicity risk?
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B. Hyponatremia
👉 Explanation: Low sodium levels increase lithium reabsorption, raising toxicity risk.
187. Which sleep stage is most affected in depression?
A. REM sleep
B. Stage 1
C. Stage 2
D. Stage 3
Answer: A. REM sleep
👉 Explanation: Depression is linked with shortened REM latency and increased REM density.
188. Which drug is given in acute alcohol withdrawal?
A. Diazepam
B. Lithium
C. Clozapine
D. Fluoxetine
Answer: A. Diazepam
👉 Explanation: Benzodiazepines prevent seizures and delirium tremens in alcohol withdrawal.
189. Which therapy is effective in autism spectrum disorder?
A. Behavioral therapy
B. Psychoanalysis
C. ECT
D. Hypnotherapy
Answer: A. Behavioral therapy
👉 Explanation: Early behavioral interventions improve social and communication skills in autism.
190. Which antidepressant is safe in pregnancy?
A. Sertraline
B. Paroxetine
C. Doxepin
D. MAOI
Answer: A. Sertraline
👉 Explanation: Sertraline is often preferred due to safety profile in pregnancy.
191. Which feature differentiates delirium from dementia?
A. Gradual onset
B. Impaired consciousness
C. Memory loss
D. Irreversible course
Answer: B. Impaired consciousness
👉 Explanation: Delirium is acute with fluctuating consciousness; dementia is gradual and chronic.
192. A patient says, “I am the president of the world.” This is:
A. Persecutory delusion
B. Grandiose delusion
C. Nihilistic delusion
D. Somatic delusion
Answer: B. Grandiose delusion
👉 Explanation: Grandiose delusions involve exaggerated self-importance or power.
193. Which benzodiazepine is short-acting?
A. Alprazolam
B. Diazepam
C. Chlordiazepoxide
D. Clonazepam
Answer: A. Alprazolam
👉 Explanation: Alprazolam has a short half-life and is commonly prescribed for acute anxiety.
194. Which finding suggests serotonin syndrome?
A. Muscle rigidity, confusion, fever
B. Sedation, constipation
C. Dry mouth, blurred vision
D. Bradycardia, tremors
Answer: A. Muscle rigidity, confusion, fever
👉 Explanation: Excess serotonin leads to hyperthermia, rigidity, and mental status changes.
195. Which drug is most likely to cause weight gain?
A. Clozapine
B. Fluoxetine
C. Buspirone
D. Bupropion
Answer: A. Clozapine
👉 Explanation: Clozapine and olanzapine are associated with significant metabolic side effects.
196. Which disorder involves fear of social situations due to judgment?
A. Social anxiety disorder
B. Agoraphobia
C. PTSD
D. Specific phobia
Answer: A. Social anxiety disorder
👉 Explanation: Social anxiety disorder involves intense fear of social interactions or performance.
197. Which therapy is effective for borderline personality disorder?
A. DBT
B. ECT
C. Hypnosis
D. Psychoanalysis
Answer: A. DBT
👉 Explanation: DBT is proven most effective for borderline PD, focusing on mindfulness and regulation.
198. Which drug is an atypical antidepressant improving sleep and appetite?
A. Mirtazapine
B. Fluoxetine
C. Bupropion
D. Sertraline
Answer: A. Mirtazapine
👉 Explanation: Mirtazapine enhances sleep and appetite, making it useful in depression with insomnia.
199. Which symptom is typical of catatonia?
A. Waxy flexibility
B. Insomnia
C. Delusions
D. Anxiety
Answer: A. Waxy flexibility
👉 Explanation: In catatonia, patients maintain bizarre postures for long durations.
200. Which intervention is most important for a patient with acute mania?
A. Encourage rest and reduce stimulation
B. Provide group therapy
C. Discuss long-term goals
D. Provide psychoeducation only
Answer: A. Encourage rest and reduce stimulation
👉 Explanation: In acute mania, patients need a calm environment with reduced stimulation to prevent exhaustion.
Previous Part: NCLEX Psychiatric & Mental Health Nursing Part 1
Previous Part: NCLEX Psychiatric & Mental Health Nursing Part 2
Previous Part: NCLEX Psychiatric & Mental Health Nursing Part 3
📘 Conclusion:
This completes our NCLEX Psychiatric & Mental Health Nursing MCQs (151–200) set. With all 200 questions covered in 4 parts, you now have a full practice portal for psychiatric nursing exam preparation. Consistent practice with answers and explanations will enhance both knowledge and test-taking confidence.