RxReady

PEBC Mental Health Practice Questions

Smoking cessation, antipsychotics, dementia and ADHD: ten mental health and addictions questions for the PEBC MCQ.

Updated November 13, 2026. Written by RxReady to the 2026 PEBC blueprint. These are practice questions, not real or recalled exam questions.

Mental health and addictions questions often combine pharmacology with sensitive counselling: monitoring antipsychotics, planning treatment around pregnancy, or helping someone quit smoking. Getting the safety detail right is usually the point of the question.

This set covers smoking cessation and the 5 As, zopiclone counselling, bipolar disorder in pregnancy, Lewy body dementia, antipsychotic monitoring, cholinesterase inhibitors and ADHD stimulants.

Look for the drug that is unsafe in this particular patient before you look for the best one. Several of these questions turn on a single contraindication.

Practice by topic

Ten mental health questions

Question 1 · Smoking cessation

I.D., a 44-year-old man, has been prescribed varenicline. Which of the following is the correct dose titration?

  1. A1 mg twice daily starting on day 1, then 0.5 mg twice daily after week 1
  2. B0.5 mg daily for days 1 to 7, then 1 mg daily from day 8 onward for 12 weeks
  3. C0.5 mg daily for days 1 to 3, 0.5 mg twice daily for days 4 to 7, then 1 mg twice daily
  4. D1 mg daily for days 1 to 3, 1 mg twice daily for days 4 to 7, then 2 mg twice daily
Show the answer

Answer: C) 0.5 mg daily for days 1 to 3, 0.5 mg twice daily for days 4 to 7, then 1 mg twice daily

The Canadian monograph titrates varenicline to reduce nausea: 0.5 mg once daily on days 1 to 3, 0.5 mg twice daily on days 4 to 7, then 1 mg twice daily from day 8 for 12 weeks. Starting at the full dose increases nausea. The other regimens do not reach or exceed the 1 mg twice-daily maintenance dose.

Why the other options are wrong

  • A) Starting at the full dose increases nausea, and stepping down to 0.5 mg BID gives a subtherapeutic maintenance dose.
  • B) Once-daily 1 mg never reaches the 1 mg twice-daily maintenance dose.
  • D) 2 mg twice daily is double the maximum maintenance dose of 1 mg twice daily.

Key point: Varenicline: 0.5 mg daily x3 days, 0.5 mg BID x4 days, then 1 mg BID for 12 weeks.

Question 2 · Smoking cessation

Using the 5 A's approach, a pharmacist has asked VW about tobacco use and advised her to quit. Which of the following is the next step?

  1. AArrange follow-up
  2. BAssist with a quit plan
  3. CAssess her willingness to quit
  4. DAdvise her again more strongly
Show the answer

Answer: C) Assess her willingness to quit

The 5 A's model is Ask, Advise, Assess, Assist and Arrange. After asking about tobacco use and advising quitting, the pharmacist assesses readiness to quit; assistance (e.g., pharmacotherapy and a quit plan) is tailored to that readiness, followed by arranging follow-up.

Why the other options are wrong

  • A) Arranging follow-up comes last.
  • B) Assistance is tailored after assessing readiness.
  • D) Repeating advice skips assessing readiness.

Key point: 5 A's: Ask, Advise, Assess, Assist, Arrange.

Question 3 · Insomnia

A 50-year-old man is prescribed zopiclone 3.75 mg at bedtime for short-term insomnia. Which of the following is the most appropriate counselling?

  1. AIt is safe to drive immediately on waking regardless of sleep duration
  2. BTake just before bed when 7 to 8 hours of sleep is possible; may cause a bitter taste
  3. CTake it in the early evening so it works by bedtime
  4. DTake it with a glass of wine at bedtime to enhance its effect and help you stay asleep
Show the answer

Answer: B) Take just before bed when 7 to 8 hours of sleep is possible; may cause a bitter taste

Zopiclone should be taken just before bedtime, only when a full night's sleep (7 to 8 hours) is possible, to reduce next-morning impairment; a bitter or metallic taste is common. Alcohol increases CNS depression and complex sleep behaviours, and patients should be cautioned about next-day psychomotor impairment, including driving.

Why the other options are wrong

  • A) Next-morning impairment is possible, so he should not drive on waking, especially after short sleep.
  • C) Taking it early in the evening can cause impairment before bed and complex sleep behaviours.
  • D) Alcohol increases CNS depression and complex sleep behaviours; never combine them.

Key point: Zopiclone: take at bedtime only with 7-8 hours to sleep; no alcohol; beware next-day impairment.

Question 4 · Bipolar disorder

A 24-year-old woman with bipolar I disorder plans to become pregnant within the next year. Which of the following mood stabilizers is most important to AVOID?

  1. AQuetiapine
  2. BDivalproex sodium
  3. CLithium
  4. DLamotrigine
Show the answer

Answer: B) Divalproex sodium

Valproate carries the highest teratogenic risk (neural tube defects, other major malformations and neurodevelopmental impairment) and should be avoided in women of childbearing potential unless no alternative exists. Lamotrigine and quetiapine have more reassuring data, and lithium carries a smaller risk that may be acceptable with monitoring.

Why the other options are wrong

  • A) Quetiapine has relatively reassuring pregnancy data.
  • C) Lithium carries a smaller risk that may be acceptable with monitoring.
  • D) Lamotrigine has relatively reassuring pregnancy data.

Key point: Avoid valproate in anyone who could become pregnant unless there is no alternative.

Question 5 · Dementia with Lewy bodies

FT, a 78-year-old man with dementia with Lewy bodies, has visual hallucinations. Which of the following drugs is MOST likely to cause a severe adverse reaction?

  1. ARivastigmine
  2. BDonepezil
  3. CAcetaminophen
  4. DHaloperidol
Show the answer

Answer: D) Haloperidol

Up to half of patients with dementia with Lewy bodies have severe neuroleptic sensitivity reactions (marked rigidity, confusion, autonomic instability, possibly fatal) with typical antipsychotics such as haloperidol. Cholinesterase inhibitors such as rivastigmine and donepezil may actually improve hallucinations in DLB, and acetaminophen is low risk.

Why the other options are wrong

  • A) Rivastigmine is used to treat dementia with Lewy bodies.
  • B) Donepezil is used to treat dementia with Lewy bodies.
  • C) Acetaminophen doesn't cause severe reactions here.

Key point: Lewy body dementia: avoid typical antipsychotics; cholinesterase inhibitors help hallucinations.

Question 6 · Schizophrenia

A 25-year-old man with schizophrenia is being started on an antipsychotic. Compared with aripiprazole, olanzapine is most associated with which of the following?

  1. AMarked QT prolongation requiring ECG every month
  2. BWeight gain, dyslipidemia and hyperglycemia
  3. CAgranulocytosis requiring weekly blood counts
  4. DAkathisia and activation
Show the answer

Answer: B) Weight gain, dyslipidemia and hyperglycemia

Olanzapine carries one of the highest risks of weight gain and metabolic adverse effects (with clozapine), so baseline and periodic weight, waist circumference, glucose/A1C and lipids are required. Aripiprazole is more associated with akathisia and has low metabolic risk. Agranulocytosis monitoring applies to clozapine.

Why the other options are wrong

  • A) Marked QT prolongation is not the key olanzapine risk, and monthly ECGs are not standard.
  • C) Agranulocytosis with routine blood count monitoring applies to clozapine, not olanzapine.
  • D) Akathisia and activation are more typical of aripiprazole than olanzapine.

Key point: Olanzapine (and clozapine): highest metabolic risk; monitor weight, waist, glucose/A1C and lipids.

Question 7 · Schizophrenia

QB, a 23-year-old man with first-episode psychosis, is starting olanzapine 10 mg daily. Which of the following should be monitored at baseline and during therapy?

  1. ACBC with absolute neutrophil count every week
  2. BWeight, waist, BP, glucose or A1C, and lipids
  3. CTSH, serum creatinine and electrolytes only
  4. DLiver enzymes and bilirubin only
Show the answer

Answer: B) Weight, waist, BP, glucose or A1C, and lipids

Second-generation antipsychotics, especially olanzapine, cause weight gain, dyslipidemia and hyperglycemia, so weight/BMI, waist circumference, BP, fasting glucose or A1C and lipids are measured at baseline and repeated (e.g., at 12 weeks, then at least annually; weight more frequently early on). Weekly ANC monitoring is specific to clozapine, and TSH, renal or isolated liver tests are not the standard monitoring.

Why the other options are wrong

  • A) Weekly CBC/ANC monitoring is for clozapine, not olanzapine.
  • C) TSH, creatinine and electrolytes alone miss the main metabolic risks.
  • D) Liver enzymes alone miss the main metabolic risks.

Key point: Second-generation antipsychotics: baseline and ongoing metabolic monitoring.

Question 8 · Dementia

HP, an 81-year-old man with newly diagnosed Alzheimer disease, is prescribed donepezil 5 mg daily. Which of the following baseline findings is of GREATEST concern?

  1. ASerum creatinine 115 µmol/L
  2. BMMSE score of 20/30
  3. CAcetaminophen 500 mg twice daily
  4. DHeart rate 48 beats/min
Show the answer

Answer: D) Heart rate 48 beats/min

Cholinesterase inhibitors increase vagal tone and can cause bradycardia, heart block and syncope, so symptomatic bradycardia warrants discussion with the prescriber before starting. Donepezil needs no renal adjustment, an MMSE of 20 fits the indication, and acetaminophen is not a concern.

Why the other options are wrong

  • A) Donepezil needs no renal adjustment.
  • B) An MMSE of 20 is consistent with mild-moderate Alzheimer disease, where donepezil is indicated.
  • C) Acetaminophen doesn't interact meaningfully with donepezil.

Key point: Cholinesterase inhibitors: check heart rate (bradycardia, syncope) before starting.

Question 9 · ADHD

A 9-year-old girl is started on long-acting methylphenidate for ADHD. In addition to symptom response, which of the following is most important to monitor regularly?

  1. AComplete blood count with differential every 2 weeks
  2. BHeight, weight, heart rate and blood pressure
  3. CSerum potassium and magnesium
  4. DLiver enzymes every month
Show the answer

Answer: B) Height, weight, heart rate and blood pressure

Stimulants can suppress appetite and growth and increase heart rate and blood pressure, so height, weight and vital signs should be tracked. Routine electrolytes, monthly liver enzymes or frequent CBCs are not required for methylphenidate.

Why the other options are wrong

  • A) Routine CBC every 2 weeks is not needed with methylphenidate.
  • C) Routine potassium and magnesium checks are not needed with methylphenidate.
  • D) Monthly liver enzymes are not needed with methylphenidate.

Key point: Stimulants for ADHD: monitor height, weight, heart rate and blood pressure.

Question 10 · ADHD

The father of an 8-year-old girl prescribed lisdexamfetamine capsules says she cannot swallow capsules. Which of the following is the most appropriate recommendation?

  1. ACrush the capsule contents and give half in the morning and half at bedtime
  2. BSwitch to immediate-release methylphenidate given only at bedtime
  3. COpen the capsule and mix the contents in yogurt, water or orange juice
  4. DDissolve the capsule contents in water and give over the whole day
Show the answer

Answer: C) Open the capsule and mix the contents in yogurt, water or orange juice

Lisdexamfetamine is a prodrug whose release is not dependent on capsule integrity; the capsule can be opened and the entire contents mixed into yogurt, water or orange juice and taken immediately (a chewable tablet is also available). It is given once daily in the morning because afternoon or evening dosing causes insomnia. Splitting doses or sipping throughout the day is not appropriate, and bedtime stimulant dosing causes insomnia.

Why the other options are wrong

  • A) Splitting the dose with half at bedtime causes insomnia; lisdexamfetamine is given once in the morning.
  • B) Bedtime stimulant dosing causes insomnia, and switching drugs is unnecessary.
  • D) Sipping the dose over the day gives inconsistent effect and late-day insomnia.

Key point: Lisdexamfetamine capsules can be opened into yogurt, water or OJ; give once in the morning.

Find your weakest topics

The free diagnostic grades you across all six PEBC competencies, then builds a study plan around the areas costing you the most marks. We also have 2,000+ practice questions and 98 OSCE stations where you talk to an AI patient out loud.

Take the free diagnosticTry a free OSCE station

More free study guides