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NCLEX-RN category

NCLEX Psychosocial Integrity Practice Questions

Quick answer

Psychosocial Integrity is 6 to 12% of the NCLEX-RN, which is roughly 5 to 18 questions depending on how long your exam runs. It covers how a nurse supports a client's emotional, social, cultural and spiritual wellbeing, and how the nurse responds when a client or family is grieving, in crisis, coping poorly or at risk.

  • 10 practice questions
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This category feels easy when you read about it and feels slippery when you sit the exam. The questions rarely have a lab value or a drug name to anchor you. Instead they hand you a short scene and ask what the nurse should do or say, and two of the four options usually sound kind. The trap is picking the option that comforts the nurse rather than the one that serves the client, such as explaining, reassuring or fixing when the client needs to be heard or assessed first. Another habit worth breaking is treating every religious or cultural detail as a rule to enforce. The exam wants you to ask the client, not assume. The ten questions below cover grief, coping, culture, family strain, crisis, elder abuse, substance use, limit setting and end of life care. Mental health disorders and therapeutic communication each have their own page in this category.

Practice questions

1

A client was told this morning that a breast biopsy is positive for cancer. That afternoon the client tells the nurse, "The pathologist must have mixed up the slides. I feel fine and nobody in my family has ever had cancer." Which stage of grief is the client showing, and what is the best nursing response?

  1. AAnger. Tell the client that it is normal to be upset and offer to call the chaplain
  2. BDenial. Stay with the client and let her talk without arguing about the result
  3. CBargaining. Explain that the lab has quality checks and the result is correct
  4. DAcceptance. Begin teaching about treatment options right away
Show answer

Answer: B

Refusing to believe a diagnosis hours after hearing it is denial, which is a normal first response and a form of protection while the news sinks in. The nurse supports the client by being present and listening, not by forcing the fact.

Why the others are wrong

Nothing in the statement shows anger or a deal being offered, so A and C name the wrong stage, and C also argues with the client. Acceptance is not present, and teaching about treatment before the client can take in the diagnosis will not be retained.

2

A client who is waiting for cardiac surgery spends the morning joking loudly with staff about "getting a tune up" and never mentions the surgery seriously. The client's spouse tells the nurse the client has not slept in two nights. Which defense mechanism is the client most likely using?

  1. AProjection
  2. BRationalization
  3. CHumor used as displacement
  4. DReaction formation
Show answer

Answer: C

Turning a frightening event into a joke moves the anxiety somewhere safer to express, which is displacement with humor as the outlet. The spouse's report of two sleepless nights tells you the fear is real underneath.

Why the others are wrong

Projection would be blaming others for his own feelings, such as saying the staff are the nervous ones. Rationalization would be giving a logical sounding excuse, such as "surgery is routine now so there is nothing to think about." Reaction formation would be behaving in the opposite way to the feeling, such as insisting he is eager for the operation.

3

A client who is a practicing Jehovah's Witness is scheduled for a hip replacement and the surgeon has written an order for two units of packed red blood cells to be available. The client tells the nurse, "I do not accept blood." Which action by the nurse is best?

  1. AExplain that the blood is only for an emergency and the client probably will not need it
  2. BAsk the client exactly which products and procedures are and are not acceptable, document the answer, and make sure the surgeon and anesthesia team know before surgery
  3. CAsk the client's spouse to help persuade the client to accept transfusion if needed
  4. DCancel the surgery because it cannot be done safely without blood available
Show answer

Answer: B

Many Jehovah's Witnesses refuse whole blood and primary components but may accept some fractions, cell salvage or other blood conservation methods, and the only way to know is to ask. The refusal has to be clear, documented and shared with the whole surgical team before the client is under anesthesia.

Why the others are wrong

Minimizing the chance of transfusion does not resolve the refusal and sets up a crisis in the operating room. Enlisting family to pressure the client violates autonomy. Cancelling surgery is not the nurse's decision and many procedures are done safely with a bloodless plan.

4

A hospitalized client who is Muslim asks the nurse for help so that he can pray at the required times. He has a fractured pelvis and cannot get out of bed. Which nursing action shows appropriate spiritual care?

  1. ATell the client that prayer can wait until he is able to kneel again
  2. BCall the hospital chaplain so the chaplain can pray with the client
  3. CAsk the client what he needs, such as help with washing, knowing the direction of Mecca, and uninterrupted time, and arrange it
  4. DExplain that prayer times will have to fit around medication and therapy schedules
Show answer

Answer: C

Spiritual care means finding out what the client's practice requires and removing the barriers you can. Washing before prayer, facing the right direction and a few minutes without interruption are all things a nurse can arrange from a bed.

Why the others are wrong

Islamic prayer can be performed sitting or lying when a person is ill, so telling him to wait is both wrong and dismissive. A chaplain can be offered but the client asked for help with his own practice, not for someone else's prayer. Scheduling prayer around the unit's convenience reverses the priority.

5

A 52 year old woman has been caring at home for her mother who has advanced dementia. During the mother's clinic visit the daughter says, "I have not slept through the night in a year. I snapped at her yesterday and I hate myself for it. I just cannot do this anymore." Which nursing response is most appropriate?

  1. A"You should not feel guilty. Everyone loses patience sometimes."
  2. B"It sounds like you are exhausted. Let's talk about what support is available, including respite care, so you are not doing this alone."
  3. C"Have you thought about placing your mother in a nursing home?"
  4. D"Your mother needs you. Caring for her will get easier once you learn some routines."
Show answer

Answer: B

The daughter is describing caregiver strain, which is a risk for her health and for her mother's safety. Naming what you hear and then moving to concrete help, such as respite, adult day programs and support groups, is the response that actually changes something.

Why the others are wrong

Telling her not to feel guilty dismisses the feeling instead of exploring it. Jumping to placement is a decision for the family after their options are laid out, not an opening line. Saying it will get easier is false reassurance and adds pressure to a person who is already at the edge.

6

A client arrives at the emergency department two hours after a house fire in which the family dog died and the home was destroyed. The client is pacing, cannot answer simple questions, and keeps repeating, "I do not know what to do." Which action should the nurse take first?

  1. AGive the client a list of community resources for housing and insurance claims
  2. BAsk the client to describe in detail how the fire started
  3. CSit with the client in a quiet space, speak in short sentences, and make sure the client is safe and not thinking of self harm
  4. DCall a family member to come and take the client home
Show answer

Answer: C

Crisis intervention starts with safety and with lowering the level of arousal. A person who cannot process questions needs a calm environment, simple direct communication, and an assessment for danger to self before anything else happens.

Why the others are wrong

Resources matter later, but a client who cannot answer a simple question cannot use a list. Retelling the event in detail is not the first step and can increase distress. Sending the client home before assessing safety and support is unsafe.

7

A home health nurse visits an 81 year old client who lives with an adult son. The client has lost 12 pounds in two months, has a strong odor of urine, is wearing the same soiled clothing seen at the last visit, and says the son "gets busy" and forgets meals. The client's medications have not been refilled for three weeks. Which action by the nurse is required?

  1. ATeach the son how to set up a medication box and a meal schedule
  2. BReport the suspected neglect to adult protective services as required by law, and document the objective findings
  3. CAsk the client privately whether the son is mistreating him, and act only if the client says yes
  4. DArrange for the client's medications to be refilled and recheck in one month
Show answer

Answer: B

Weight loss, poor hygiene, unfilled prescriptions and missed meals in a dependent older adult are signs of neglect, and nurses are mandated reporters. The report is based on reasonable suspicion, not proof, and the nurse documents exactly what was observed.

Why the others are wrong

Teaching the caregiver may be part of the plan but it does not replace the legal duty to report. Asking the client privately is good practice, but older adults often deny mistreatment to protect a family member, so the report cannot depend on the client's answer. Refilling medications and waiting a month leaves the client in the situation.

8

A nurse is screening a 44 year old client admitted for pancreatitis. The client reports drinking "a few beers most nights." Using the CAGE questions, the client says he has tried to cut down, gets annoyed when his wife mentions his drinking, and sometimes has a drink in the morning to settle his stomach. Which nursing response best reflects motivational interviewing?

  1. A"Your drinking is what caused your pancreatitis. You need to stop completely."
  2. B"Three of your four answers suggest a problem with alcohol. What do you think about that, and what, if anything, would you like to be different?"
  3. C"I will ask the physician to order a referral to an alcohol treatment program."
  4. D"Most people underestimate how much they drink. How much do you really have each night?"
Show answer

Answer: B

Three positive CAGE answers is a strong screen for alcohol use disorder. Motivational interviewing shares the finding without judgment, then asks the client for his own view and his own reasons for change, because change that the client argues for lasts longer than change that is ordered.

Why the others are wrong

A blunt directive invites defensiveness and ends the conversation. Arranging a referral before the client has said he wants help skips his readiness entirely. Implying the client is lying about his intake damages trust and is not an interviewing technique.

9

A client on a medical unit tells the evening nurse, "You are the only one here who understands me. The day nurse is useless. Can you just bring my pain pill an hour early? She would never do that for me." The client has made similar statements to other staff. Which nursing response is most appropriate?

  1. A"I can see you are uncomfortable. Your next dose is due at 9 pm, and I will bring it then. Let's look at what else can help you until then."
  2. B"Thank you. I will see if I can get the dose moved up this once."
  3. C"The day nurse is very good at her job. You should not talk about her that way."
  4. D"If you keep complaining about staff, nobody is going to want to take care of you."
Show answer

Answer: A

Splitting staff with flattery and criticism is a manipulative pattern, and the answer is a calm, consistent limit. The nurse acknowledges the discomfort, states the plan plainly, and offers legitimate alternatives, which keeps the care plan the same no matter who is on shift.

Why the others are wrong

Giving in rewards the behavior and makes the next shift's job harder. Defending the day nurse turns the exchange into an argument about staff instead of the client's needs. Threatening the client is punitive and unprofessional.

10

A client with end stage heart failure has been readmitted three times in two months. The physician has recommended hospice. The client's daughter tells the nurse, "If we agree to hospice we are giving up on him. Hospice means they just stop treating people." Which response by the nurse shows correct understanding of hospice care?

  1. A"Hospice is only for clients with cancer, so your father may not qualify anyway."
  2. B"You are right that treatment stops, but it is more peaceful for him."
  3. C"Hospice does not mean giving up. The focus shifts to comfort and quality of life, and he will still receive medications and nursing care for his symptoms, usually at home."
  4. D"This is really a decision for the physician, so you should trust his recommendation."
Show answer

Answer: C

Hospice is active care with a different goal. Diuretics, oxygen, pain and dyspnea management, and skilled nursing visits all continue, but the aim is comfort rather than cure, and most of it happens where the client wants to be. Correcting the misconception gives the family what they need to decide.

Why the others are wrong

Hospice covers any terminal diagnosis with a prognosis of about six months or less, including heart failure. Agreeing that treatment stops reinforces the misunderstanding. Handing the decision to the physician removes the family from a choice that belongs to them and the client.

Quick tips

  • When a client denies, bargains or lashes out after bad news, the correct answer is almost always to stay, listen and accept the feeling. Options that correct, teach or reassure in that moment are usually wrong.
  • To name a defense mechanism, ask where the feeling went. Blamed on someone else is projection, explained away is rationalization, aimed at a safer target is displacement, flipped to its opposite is reaction formation.
  • For any cultural or religious question, the winning option asks the client what they need and documents it. Assumptions about a whole group, even accurate ones, are the trap.
  • Abuse and neglect answers follow the law: reasonable suspicion is enough, the nurse reports, and objective documentation comes with it. Waiting for proof or for the client to confirm is wrong.
  • Limit setting is calm, consistent and offers an alternative. If an option argues, bargains, punishes or gives in, cross it out.

Related topics

FAQ

How many psychosocial integrity questions are on the NCLEX?

Psychosocial Integrity is 6 to 12% of the exam. On the shortest 85 question test that is about 5 to 10 questions, and on a 150 question test it can reach 18. It is smaller than the physiological categories but the questions are the ones students most often second guess.

What does psychosocial integrity cover on the NCLEX?

Grief and loss, coping and defense mechanisms, cultural and religious considerations, spiritual care, family dynamics, crisis intervention, abuse and neglect, substance use, behavioral interventions, end of life care, mental health disorders, and therapeutic communication.

How do I stop getting psychosocial questions wrong?

Read the option and ask who it helps. If it makes the nurse feel useful by explaining, reassuring or solving, but leaves the client unheard or unassessed, it is probably the distractor. The best answer usually acknowledges the feeling, checks safety, or asks the client what they need.

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