Editing Mental Health and Psychosocial Nursing – RN Practice Questions

Practice questions for '''[[Mental Health and Psychosocial Nursing]]''' at NCLEX-RN level. Items emphasize therapeutic communication judgment, crisis and suicide risk prioritization, care planning, and management of high-risk medication effects. 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 with major depressive disorder tells the nurse, "My family would honestly be better off if I were gone." Which response by the nurse is '''most''' appropriate?
# "Your family loves you and would be devastated without you."
# "Are you having thoughts of killing yourself?"
# "Why would you think something like that about yourself?"
# "You have so much to live for. Let's talk about your grandchildren."

'''Answer:''' 2 (B) - "Are you having thoughts of killing yourself?"

''Rationale:'' A statement implying the client is a burden is a recognized warning sign, and the nurse must assess suicidal ideation directly and specifically. Asking directly does not plant the idea and is required before any other intervention. Option 1 is false reassurance and closes the topic. Option 3 asks "why," which demands justification and provokes defensiveness. Option 4 minimizes the statement and changes the subject.

==Question 2==
The charge nurse on an inpatient psychiatric unit receives report on four clients. Which client should the nurse assess '''first'''?
# A client with schizophrenia who states that a voice is telling him to jump from the dayroom window.
# A client with major depressive disorder who has eaten only 25 percent of meals for 2 days.
# A client in acute mania who has been pacing the hallway for the past hour.
# A client with generalized anxiety disorder who is requesting a PRN dose of lorazepam.

'''Answer:''' 1 (A) - The client with a command hallucination to jump from the window.

''Rationale:'' Command hallucinations directing self-harm represent imminent danger and take priority over all other findings. This client requires immediate assessment, one-to-one observation, and environmental safety measures. Poor intake, pacing in mania, and a PRN request are all genuine needs but none is immediately life-threatening, so they follow.

==Question 3==
A client who has been taking lithium for 8 months reports 2 days of vomiting and diarrhea. The client now has a coarse hand tremor and an unsteady gait, and the serum lithium level is 1.8 mEq/L. Which action should the nurse take '''first'''?
# Encourage the client to increase fluid and sodium intake and recheck the level in 1 week.
# Administer the next scheduled dose of lithium with a full glass of water.
# Hold the lithium and notify the health care provider.
# Obtain a serum creatinine and thyroid-stimulating hormone level.

'''Answer:''' 3 (C) - Hold the lithium and notify the health care provider.

''Rationale:'' A level of 1.8 mEq/L exceeds the therapeutic range of 0.6 to 1.2 mEq/L, and the coarse tremor plus ataxia are signs of toxicity. Gastrointestinal fluid and sodium losses raise lithium levels because lithium is reabsorbed in place of sodium. The immediate safety action is to withhold the drug and notify the provider. Option 1 delays treatment of an active toxicity. Option 2 would worsen the toxicity. Option 4 involves appropriate follow-up laboratory work, but obtaining labs is not the first action when a toxic level is already known.

==Question 4==
The nurse is teaching a client newly prescribed lithium carbonate. Which statements by the client indicate correct understanding? '''Select all that apply.'''
# "I will drink about 2 to 3 liters of water each day."
# "I should keep the amount of salt in my diet about the same each day."
# "I can take ibuprofen for my arthritis pain the way I always have."
# "I will call the clinic if I get vomiting, diarrhea, or a bad hand tremor."
# "I should have my blood level drawn about 12 hours after my last dose."
# "If I start sweating a lot in hot weather, I should cut back on fluids."

'''Answer:''' 1, 2, 4, 5 (A, B, D, E)

''Rationale:'' Adequate and consistent hydration (2 to 3 liters daily) and a stable sodium intake keep lithium levels stable, because sodium depletion increases lithium reabsorption and raises the level. Vomiting, diarrhea, and coarse tremor are early toxicity signs requiring prompt reporting. Trough levels are drawn approximately 12 hours after the last dose. Option 3 is incorrect because NSAIDs, thiazide diuretics, and ACE inhibitors raise lithium levels. Option 6 is dangerous; heavy sweating requires more fluid, not less.

==Question 5==
A client receiving haloperidol has a temperature of 104 degrees Fahrenheit (40 degrees Celsius), generalized "lead-pipe" muscle rigidity, blood pressure fluctuating between 90/50 and 170/100 mm Hg, and a decreased level of consciousness. Which action is the nurse's '''priority'''?
# Administer the ordered PRN benztropine intramuscularly.
# Withhold the antipsychotic and notify the rapid response team.
# Apply a cooling blanket and recheck the temperature in 1 hour.
# Obtain an order for a stat creatine kinase level.

'''Answer:''' 2 (B) - Withhold the antipsychotic and notify the rapid response team.

''Rationale:'' Hyperthermia, lead-pipe rigidity, autonomic instability, and altered consciousness describe neuroleptic malignant syndrome, a life-threatening emergency. The single most important action is to stop the causative agent and summon emergency medical support; dantrolene or bromocriptine, aggressive cooling, and hydration follow. Option 1 treats acute dystonia, not neuroleptic malignant syndrome. Option 3 is a necessary supportive measure but delaying reassessment for an hour is unsafe and does not address the cause. Option 4 confirms the diagnosis but does not take precedence over stopping the drug and getting help.

==Question 6==
A client admitted 5 days ago for severe depression with suicidal ideation has been withdrawn and tearful. This morning the client is smiling, has dressed neatly, and tells the nurse, "I feel at peace for the first time in months." Which nursing action is '''most''' appropriate?
# Document the improvement and request a reduction in the observation level.
# Praise the client's progress and encourage attendance at group therapy.
# Reassess suicide risk directly and maintain the current level of observation.
# Notify the provider that the client is ready for discharge planning.

'''Answer:''' 3 (C) - Reassess suicide risk directly and maintain the current level of observation.

''Rationale:'' A sudden, unexplained calm or lift in mood in a previously despondent client may signal that the client has decided on suicide and feels relief at having a plan. Risk also rises as antidepressant treatment restores energy before mood fully improves. The nurse reassesses risk directly and does not relax precautions. Options 1, 2, and 4 all interpret the change as genuine improvement and would reduce protection at a potentially high-risk moment.

==Question 7==
A client with borderline personality disorder tells the evening nurse, "You are the only one here who really understands me. The day shift nurses are cruel and incompetent." Which response by the nurse is '''best'''?
# "I appreciate that. I will try to be assigned to you every evening."
# "I am sorry they treated you that way. I will speak to them about it."
# "It sounds like you are having a hard time. All of us are following the same plan of care with you."
# "You should not talk about other staff members that way."

'''Answer:''' 3 (C) - "It sounds like you are having a hard time. All of us are following the same plan of care with you."

''Rationale:'' This is splitting, a defense in which people are perceived as all good or all bad. The therapeutic response acknowledges the client's distress while reinforcing that the team is consistent and unified, which is the single most important intervention for splitting. Option 1 accepts the special status and reinforces the split. Option 2 sides with the client against colleagues based on unverified report. Option 4 is a scolding, nontherapeutic response that shames the client rather than addressing the dynamic.

==Question 8==
A nurse is providing crisis intervention for a client whose home was destroyed in a flood 3 days ago. Which principles guide the nurse's care? '''Select all that apply.'''
# The focus is on the immediate problem rather than on long-standing personality issues.
# The nurse takes a directive role and helps develop concrete short-term actions.
# The goal is to return the client to at least the precrisis level of functioning.
# Assessment of suicide and homicide risk is deferred until the client is calmer.
# The nurse assesses the client's perception of the event, available support, and coping skills.
# Crisis intervention is typically time-limited, often around 4 to 6 weeks.

'''Answer:''' 1, 2, 3, 5, 6 (A, B, C, E, F)

''Rationale:'' Crisis intervention is present-focused, directive, time-limited, and aimed at restoring precrisis functioning rather than at personality change. Aguilera's balancing factors, realistic perception of the event, adequate situational support, and adequate coping mechanisms, structure the assessment. Option 4 is incorrect and unsafe; risk of harm to self or others is assessed at the outset, before any other work.

==Question 9==
A client with severe anorexia nervosa at 68 percent of ideal body weight is beginning nutritional rehabilitation. Which laboratory value is '''most''' important for the nurse to monitor closely during the first several days of refeeding?
# Serum albumin
# Serum phosphorus
# Serum calcium
# Serum bilirubin

'''Answer:''' 2 (B) - Serum phosphorus

''Rationale:'' Refeeding syndrome occurs when reintroduced carbohydrate triggers an insulin surge that drives phosphate, potassium, and magnesium into cells. Hypophosphatemia is the hallmark abnormality and can precipitate cardiac failure, respiratory failure, arrhythmias, and death. Nutrition is advanced slowly with electrolyte and cardiac monitoring. Albumin, calcium, and bilirubin may be abnormal in malnutrition but none carries the same acute lethal risk during refeeding.

==Question 10==
A client in acute mania has lost 8 pounds in 10 days and will not remain seated for meals. Which nursing intervention is '''most''' appropriate?
# Explain that the client must sit in the dining room until the meal is finished.
# Provide high-calorie, high-protein finger foods and fluids the client can carry.
# Serve meals in the client's room and document intake after each tray.
# Request an order for a nasogastric tube for supplemental feeding.

'''Answer:''' 2 (B) - Provide high-calorie, high-protein finger foods and fluids the client can carry.

''Rationale:'' Clients in acute mania cannot sit still long enough to complete a meal, and exhaustion and dehydration are the leading physical dangers of untreated mania. Portable, nutrient-dense foods meet the need without a power struggle. Option 1 sets up a confrontation the client cannot meet. Option 3 does not address the inability to sit and reduces monitoring. Option 4 is an invasive measure that is not the least restrictive effective intervention at this stage.

==Question 11==
A newly admitted client with obsessive-compulsive disorder must wash her hands 15 times before entering the dining room and is consistently late for meals. Which nursing action is '''most''' appropriate initially?
# Prevent the client from washing and escort her directly to the dining room.
# Tell the client the ritual is irrational and encourage her to resist it.
# Allow additional time before meals for the client to complete the ritual.
# Ignore the behavior entirely and document the number of handwashings.

'''Answer:''' 3 (C) - Allow additional time before meals for the client to complete the ritual.

''Rationale:'' Compulsions bind overwhelming anxiety. Abruptly blocking a ritual early in treatment causes a sharp rise in anxiety and can precipitate panic. The nurse initially permits the ritual while building trust, then collaboratively sets limits and gradually reduces the time allotted as alternative coping develops. The nurse also assesses skin integrity. Options 1 and 2 confront the ritual prematurely. Option 4 abandons the client and misses an opportunity for structured limit-setting.

==Question 12==
The nurse is assessing a client in the emergency department for suicide risk. Which findings indicate '''high''' acute risk? '''Select all that apply.'''
# The client made a suicide attempt by overdose 6 months ago.
# The client states, "I plan to shoot myself on Friday when my wife is at work."
# The client keeps a loaded handgun in the bedroom closet.
# The client reports feeling hopeless and says nothing will ever change.
# The client says he could never do it because it would hurt his young children.
# The client gave his guitar collection to his nephew last week.

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

''Rationale:'' A prior attempt is the strongest single predictor of suicide. A specific plan with a set time, ready access to a highly lethal means, hopelessness (a stronger predictor than depression severity itself), and giving away prized possessions all indicate high acute risk requiring immediate one-to-one observation and means restriction. Option 5 describes a protective factor, responsibility to children, and is not a risk finding, although protective factors never cancel out an active plan with means.

==Question 13==
A client is being discharged on phenelzine. Which lunch selection indicates that the client understands the required dietary restrictions?
# Aged cheddar sandwich with sauerkraut and a draft beer
# Grilled chicken breast, white rice, green beans, and water
# Pepperoni pizza with a glass of red wine
# Soy-glazed salmon with fava beans and yogurt

'''Answer:''' 2 (B) - Grilled chicken breast, white rice, green beans, and water

''Rationale:'' Phenelzine is a monoamine oxidase inhibitor, and tyramine-containing foods can precipitate hypertensive crisis with severe occipital headache, stiff neck, palpitations, and markedly elevated blood pressure. Aged cheese, sauerkraut, and tap or draft beer (option 1), cured meats and red wine (option 3), and soy sauce and fava beans (option 4) are all restricted. Fresh, unprocessed protein with plain starch and vegetables is safe. The client should also avoid over-the-counter sympathomimetic decongestants and allow a 2-week washout before starting most serotonergic drugs.

==Question 14==
A client whose blood alcohol level was 310 mg/dL on arrival to the emergency department 10 hours ago reports that his last drink was 12 hours ago. He is now tremulous, diaphoretic, and anxious, with a heart rate of 118 beats per minute and a blood pressure of 168/96 mm Hg. Which prescriptions and interventions should the nurse anticipate? '''Select all that apply.'''
# Symptom-triggered lorazepam based on CIWA-Ar scoring
# Thiamine administration before any glucose-containing solution
# Institution of seizure precautions
# Haloperidol as the primary agent for withdrawal management
# Frequent monitoring of vital signs and orientation
# Immediate ambulation in a brightly stimulating group setting

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

''Rationale:'' The client is in early alcohol withdrawal, which can progress to withdrawal seizures at 24 to 48 hours and delirium tremens at 48 to 96 hours. Benzodiazepines dosed by CIWA-Ar are the standard of care, thiamine is given before glucose to avoid precipitating Wernicke encephalopathy, seizure precautions are indicated, and close monitoring of vital signs and sensorium detects deterioration. Option 4 is incorrect: antipsychotics lower the seizure threshold and do not treat the underlying withdrawal, so haloperidol is at most an adjunct for agitation or hallucinations, never the primary agent. Option 6 is incorrect because a quiet, low-stimulation environment is indicated.

==Question 15==
During a session, a client with a history of violence tells the nurse in detail that he intends to kill his former supervisor, whom he names, and describes where the supervisor lives. Which action by the nurse is '''most''' appropriate?
# Maintain confidentiality because the statement was made in a therapeutic session.
# Document the statement and address it at the next scheduled team meeting.
# Notify the treatment team so the intended victim and law enforcement can be warned.
# Tell the client that repeating such threats will result in loss of unit privileges.

'''Answer:''' 3 (C) - Notify the treatment team so the intended victim and law enforcement can be warned.

''Rationale:'' A serious, credible threat against an identifiable person triggers the duty to warn and protect (the Tarasoff principle), which is a recognized exception to confidentiality. The nurse reports immediately so the team can assess, warn the identified victim, notify law enforcement, and consider commitment. Option 1 misapplies confidentiality, which is limited when there is a serious threat of harm. Option 2 dangerously delays action. Option 4 substitutes a behavioral consequence for a legally and ethically required protective response.

[[Category:Mental Health and Psychosocial Nursing]]
[[Category:Registered Nurse (NCLEX-RN)]]
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