Editing Mental Health and Psychosocial Nursing – LPN Practice Questions

Practice questions for '''[[Mental Health and Psychosocial Nursing]]''' at NCLEX-PN level. Items emphasize basic therapeutic communication, structured observation of behavior, data collection within an established plan of care, reinforcement of teaching, and timely reporting to the supervising registered nurse. Because the answer options render as a numbered list, each answer is given by number with the equivalent letter in parentheses.

==Question 1==
A client on the psychiatric unit tells the LPN, "I have decided there is no point in going on. I am going to end it tonight." Which action should the LPN take '''first'''?
# Leave the room to notify the registered nurse immediately.
# Stay with the client and use the call system to alert the registered nurse.
# Reassure the client that things will look better in the morning.
# Document the statement in the client's record and continue the medication pass.

'''Answer:''' 2 (B) - Stay with the client and use the call system to alert the registered nurse.

''Rationale:'' A client who states a suicidal intention with a time frame is at high risk and must never be left alone. The LPN stays with the client and summons help without leaving the room. Option 1 leaves the client unattended. Option 3 is false reassurance and dismisses the statement. Option 4 delays the report; documentation is necessary but never before ensuring safety and notifying the registered nurse.

==Question 2==
A client who was told this morning that her cancer has recurred is sitting on the edge of the bed crying. Which response by the LPN is '''most''' therapeutic?
# "Try not to cry. Crying will only make you feel worse."
# "I will come back later when you are feeling more composed."
# "You should focus on the fact that treatments have improved a lot."
# "This is very hard news. I will sit here with you."

'''Answer:''' 4 (D) - "This is very hard news. I will sit here with you."

''Rationale:'' Offering self and acknowledging the client's feeling communicates acceptance and presence, which is what a grieving client needs. Silence and presence are legitimate interventions. Option 1 discourages the expression of feeling. Option 2 abandons the client. Option 3 offers false reassurance and shifts to facts, blocking emotional expression.

==Question 3==
An LPN is caring for a client who has been taking lithium for 6 months. Which observation should the LPN report to the registered nurse '''immediately'''?
# The client reports mild thirst and increased urination.
# The client has a coarse hand tremor, vomiting, and an unsteady gait.
# The client reports a 3-pound weight gain over 2 months.
# The client states that a fine tremor of the hands began several months ago.

'''Answer:''' 2 (B) - Coarse hand tremor, vomiting, and an unsteady gait.

''Rationale:'' Coarse tremor, gastrointestinal symptoms, and ataxia are signs of lithium toxicity and require immediate reporting so the registered nurse can obtain a serum level and hold the drug. Thirst, increased urination, weight gain, and a fine tremor are common expected effects of lithium that are reported routinely rather than urgently.

==Question 4==
The LPN is observing a client admitted 4 days ago with major depression and suicidal ideation. Which observations should the LPN report promptly to the registered nurse? '''Select all that apply.'''
# The client who has been withdrawn all week is suddenly cheerful and energetic.
# The client gave a favorite watch to another client this morning.
# The client attended the morning group session for the first time and spoke once.
# The client was seen putting a medication cup to the mouth and then spitting into a tissue.
# The client slept 7 hours last night without waking.
# The client asked the LPN to return a pair of shoelaces from personal belongings.

'''Answer:''' 1, 2, 4, 6 (A, B, D, F)

''Rationale:'' A sudden unexplained lift in mood may mean the client has decided on suicide and feels relief. Giving away a prized possession is a classic warning sign. Cheeking medication suggests hoarding for an overdose. Requesting shoelaces is a request for a potential means of self-harm and must be refused and reported. Option 3 describes appropriate participation, and option 5 describes improved sleep; both are positive findings documented in the routine record rather than reported urgently.

==Question 5==
Two days after starting haloperidol, a client suddenly develops a twisted, rigid neck, and the eyes roll upward and remain fixed. The client appears frightened and has difficulty speaking. What should the LPN do '''first'''?
# Reassure the client that this reaction usually passes within a few hours.
# Stay with the client and notify the registered nurse immediately.
# Ask the client to try to relax the neck muscles and breathe deeply.
# Withhold the next dose of haloperidol and document the finding.

'''Answer:''' 2 (B) - Stay with the client and notify the registered nurse immediately.

''Rationale:'' This is acute dystonia, an extrapyramidal reaction that can progress to laryngospasm and airway compromise. It is treated urgently with intramuscular diphenhydramine or benztropine, so immediate reporting is required while the LPN stays with the frightened client. Option 1 is false reassurance about a potential emergency. Option 3 will not relieve an involuntary muscle spasm. Option 4 delays the needed treatment, and decisions to withhold a prescribed medication are made with the registered nurse and provider.

==Question 6==
A client with schizophrenia tells the LPN, "The government put a transmitter in my tooth so they can hear everything I say." Which response by the LPN is '''best'''?
# "That is not possible. No one has put anything in your tooth."
# "Which government agency do you believe is listening to you?"
# "It must be frightening to feel that you are being listened to."
# "Let me look in your mouth and I will show you there is nothing there."

'''Answer:''' 3 (C) - "It must be frightening to feel that you are being listened to."

''Rationale:'' The nurse neither agrees with nor argues against a delusion. Responding to the underlying feeling acknowledges the client's distress and builds trust without reinforcing the false belief. Option 1 challenges the delusion with logic, which increases defensiveness. Option 2 explores the delusional content and reinforces it. Option 4 attempts to disprove the delusion, which rarely succeeds and damages the relationship.

==Question 7==
A client appears to be listening to something and then says, "Do you hear them? They keep saying I am worthless." Which response by the LPN is '''most''' appropriate?
# "There is no one here but the two of us. You are imagining it."
# "I do not hear any voices, but I understand that you do. What are they saying to you?"
# "Try to ignore the voices and they will eventually go away."
# "Yes, I hear them too. Let's move to a quieter room."

'''Answer:''' 2 (B) - "I do not hear any voices, but I understand that you do. What are they saying to you?"

''Rationale:'' The nurse presents reality once without arguing, validates that the experience is real to the client, and asks what the voices say. Identifying content is essential because voices commanding self-harm or harm to others are a safety emergency that must be reported to the registered nurse at once. Option 1 belittles the client. Option 3 is dismissive advice. Option 4 is dishonest and reinforces the hallucination.

==Question 8==
Which statements by the LPN are examples of therapeutic communication? '''Select all that apply.'''
# "Tell me more about what happened when your sister visited."
# "Why did you stop taking your medication?"
# "You look tense and you are clenching your fists."
# "If I were you, I would move out of that apartment."
# "You said you feel empty. What does empty mean to you?"
# "Everything is going to be just fine."

'''Answer:''' 1, 3, 5 (A, C, E)

''Rationale:'' Exploring, making observations, and seeking consensual validation are therapeutic techniques that invite the client to say more. Option 2 asks "why," which demands justification and provokes defensiveness; asking "what happened when you stopped" is preferable. Option 4 gives advice and removes the client's autonomy. Option 6 is false reassurance that closes the conversation.

==Question 9==
Each afternoon around 4 p.m., a resident with Alzheimer disease becomes restless, agitated, and insists on going home to feed her children. Which action by the LPN is '''most''' appropriate?
# Explain that her children are grown and that this is now her home.
# Turn on the overhead lights, reduce noise, and walk with her while talking about her children.
# Place the resident in her room alone with the door closed until she calms down.
# Tell her that a family member will arrive shortly to take her home.

'''Answer:''' 2 (B) - Turn on the overhead lights, reduce noise, and walk with her while talking about her children.

''Rationale:'' This describes sundowning. Increasing light, decreasing stimulation, and redirecting through a calm familiar activity are the appropriate interventions in later-stage dementia. Option 1 uses reality orientation, which in advanced dementia commonly increases distress. Option 3 is isolating and unsafe for an agitated wandering resident. Option 4 is a lie that will erode trust and provoke further agitation when no one arrives.

==Question 10==
A client is breathing rapidly, trembling, and pacing, and says, "I can't breathe, I think I am dying." The client cannot follow simple directions. Which action by the LPN is '''most''' appropriate?
# Leave the client alone in a quiet room to calm down and check back in 15 minutes.
# Ask the client to describe in detail what triggered these feelings.
# Remain with the client, speak calmly in short simple sentences, and move to a low-stimulation area.
# Encourage the client to join the current group activity as a distraction.

'''Answer:''' 3 (C) - Remain with the client, speak calmly in short simple sentences, and move to a low-stimulation area.

''Rationale:'' A client at panic-level anxiety cannot process complex information and is at risk for injury, so the nurse stays with the client, uses brief repeated directions, and lowers stimulation. Option 1 abandons the client at the moment of greatest risk. Option 2 asks for insight the client cannot produce at this level of anxiety. Option 4 adds stimulation. The LPN also reports the episode to the registered nurse, who will evaluate the need for a PRN anxiolytic.

==Question 11==
An LPN is caring for a client admitted 18 hours ago whose last alcoholic drink was the morning of admission. Which findings should the LPN report to the registered nurse? '''Select all that apply.'''
# Heart rate that has risen from 92 to 124 beats per minute
# Blood pressure that has risen from 138/84 to 176/98 mm Hg
# The client reports seeing insects crawling on the wall
# The client requests a second cup of coffee
# The client is diaphoretic with a visible hand tremor
# The client asks for a family member's telephone number

'''Answer:''' 1, 2, 3, 5 (A, B, C, E)

''Rationale:'' Rising heart rate and blood pressure, hallucinations, diaphoresis, and tremor indicate progressing alcohol withdrawal, which can advance to seizures at 24 to 48 hours and delirium tremens at 48 to 96 hours. These findings must reach the registered nurse promptly so symptom-triggered benzodiazepine treatment and seizure precautions can be adjusted. Options 4 and 6 are ordinary requests, although caffeine is generally limited because it adds to agitation.

==Question 12==
The LPN is reinforcing teaching for a client starting sertraline. Which statement by the client indicates a '''need for further teaching'''?
# "It may take 4 to 6 weeks before I notice the full benefit."
# "If I do not feel better in a week, I will just stop taking it."
# "I should not stop this medication suddenly without talking to my provider."
# "I will tell my provider about any other medicines or herbal products I take."

'''Answer:''' 2 (B) - "If I do not feel better in a week, I will just stop taking it."

''Rationale:'' Selective serotonin reuptake inhibitors require approximately 4 to 6 weeks for full therapeutic effect, and stopping early is a leading cause of treatment failure. Abrupt discontinuation also produces a discontinuation syndrome with dizziness, flu-like symptoms, and paresthesias, so the drug is tapered. Options 1, 3, and 4 are all correct statements; option 4 matters because combining serotonergic agents, including St. John's wort, risks serotonin syndrome.

==Question 13==
A client has been placed in bilateral wrist restraints for violent behavior after less restrictive measures failed. Which actions are appropriate for the LPN in caring for this client? '''Select all that apply.'''
# Check circulation, sensation, and skin under each restraint at the intervals set by policy
# Observe the client at least every 15 minutes or as specified in the plan of care
# Offer fluids and toileting at regular intervals
# Release the restraints one limb at a time for range of motion
# Tie the restraints to the side rails so they are easy to reach
# Document the client's behavior and the less restrictive measures that were tried

'''Answer:''' 1, 2, 3, 4, 6 (A, B, C, D, F)

''Rationale:'' Restraint care includes frequent circulation, sensation, and skin checks, close observation, provision of fluids and toileting, periodic range of motion performed one limb at a time to maintain control, and thorough documentation including the less restrictive alternatives attempted. Option 5 is unsafe: restraints are secured to a fixed part of the bed frame that moves with the bed, never to side rails, because raising or lowering a rail can injure the client. Restraint always requires a provider order and is never used for staff convenience or punishment.

==Question 14==
A visitor approaches the LPN in the hallway and says, "I am a close friend of the client in room 12. Can you tell me what she was admitted for?" Which response by the LPN is '''most''' appropriate?
# "She was admitted for depression, but please do not repeat that."
# "I am not able to share any information about our clients."
# "I can tell you she is doing much better than when she came in."
# "Let me check her chart and see what I am allowed to tell you."

'''Answer:''' 2 (B) - "I am not able to share any information about our clients."

''Rationale:'' Client information, including whether a person is a client at all, is confidential and is not disclosed to visitors without the client's authorization. The LPN declines politely and may direct the visitor to speak with the client. Options 1 and 3 both disclose protected information. Option 4 implies that the chart determines what may be told to a visitor, which is not the case.

==Question 15==
A client on the unit is speaking loudly, pacing, and pointing at another client while clenching his fists. Which action should the LPN take '''first'''?
# Step close to the client and place a hand on his shoulder to calm him.
# Tell the client that he will lose his privileges if he does not stop.
# Speak calmly, keep at least two arm-lengths of distance, and summon additional staff.
# Move the other clients out of the dayroom and continue the scheduled activity.

'''Answer:''' 3 (C) - Speak calmly, keep at least two arm-lengths of distance, and summon additional staff.

''Rationale:'' Early de-escalation uses a calm low voice, safe personal space, an unobstructed exit, and adequate staff summoned before force is needed. Option 1 invades personal space and touches an escalating client, which frequently triggers assault. Option 2 threatens rather than de-escalates and is likely to escalate the situation. Option 4 partially addresses the safety of others but leaves the escalating client unattended and does not summon help. The LPN also reports the incident to the registered nurse, who evaluates the need for PRN medication or further intervention.

[[Category:Mental Health and Psychosocial Nursing]]
[[Category:Licensed Practical Nurse (NCLEX-PN)]]
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