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Psychosocial Integrity

NCLEX Mental Health Practice Questions

Quick answer

Mental health questions test how you keep a client safe and how you respond when their thinking, mood or behavior is not working the way it should. They fall under Psychosocial Integrity, which is 6 to 12 percent of the NCLEX, and psychiatric medication questions can also show up inside pharmacology.

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Students who have done well in med-surg often lose points here because they answer with their instincts instead of the rule. A client says the voices are telling them to hurt someone, and the instinct is to reassure them that nobody is there. A client with mania is pacing and skipping meals, and the instinct is to sit them down for a proper lunch. Neither is the NCLEX answer. The trap on this topic is picking the kind, normal-conversation response over the clinical one. The exam wants you to assess risk first, accept the client's feelings without feeding the false belief, and know the handful of medication facts that can kill a client if missed: lithium levels, clozapine white counts, the stiff and febrile client on an antipsychotic. The questions below cover the mental health scenarios that come up again and again on the exam.

Practice questions

1

A client admitted after a job loss tells the nurse, "My family would be better off without me." Which response by the nurse is best?

  1. A"You have so much to live for. Let's talk about your family."
  2. B"Are you thinking about killing yourself?"
  3. C"Things feel bad now, but they will get better with time."
  4. D"Why would you say something like that?"
Show answer

Answer: B

A statement like this is a possible suicide cue, and the nurse's job is to assess directly. Asking plainly about suicide does not plant the idea; it opens the door for the client to say how serious things are so a safety plan can start.

Why the others are wrong

Telling a client what they have to live for (A) dismisses what they feel and closes the conversation. False reassurance (C) does the same and skips the assessment. A "why" question (D) sounds like a challenge and puts the client on the defensive.

2

During the admission interview, a client with major depression states that they have a specific plan to end their life. Which action should the nurse take first?

  1. AStart one-to-one observation and remove potential means from the client's room and belongings
  2. BAsk the client to sign a no-suicide contract
  3. CNotify the client's family of the admission
  4. DSchedule the client for the first available group therapy session
Show answer

Answer: A

A client with a plan is at high risk, and the first action is immediate protection: continuous one-to-one observation, a search of belongings, and removal of anything that could be used for self-harm. Everything else waits until the environment is safe.

Why the others are wrong

No-suicide contracts (B) have no proven protective value and never replace observation. Family notification (C) matters but comes after safety is secured and depends on the client's consent. Group therapy (D) is part of treatment later, not an acute safety measure.

3

A client started on sertraline for depression one week ago tells the nurse, "This medication is useless. I feel exactly the same, so I am going to stop taking it." Which response by the nurse is most appropriate?

  1. A"You are right. Let's ask the provider to switch you to a different antidepressant today."
  2. B"SSRIs usually take several weeks to reach their full effect, so please keep taking it and tell us how you feel at each visit."
  3. C"If it is not working, you can stop it. There is no harm in missing a few doses."
  4. D"You may need to double the dose to feel a difference sooner."
Show answer

Answer: B

SSRIs often take 2 to 4 weeks before mood improves and up to 6 to 8 weeks for full effect, and one week is far too early to judge. The nurse also teaches the client never to stop abruptly, because discontinuation symptoms (dizziness, nausea, irritability, flu-like feelings) are common.

Why the others are wrong

Switching after one week (A) is premature. Stopping on their own (C) risks discontinuation symptoms and a return of depression. Doses are adjusted by the provider, not doubled by the client (D).

4

A client with bipolar disorder in an acute manic episode has not slept in 2 days, is pacing the hallway, and refuses to sit down for meals. Which nursing intervention is the priority?

  1. AInsist that the client sit in the dining room until the full meal is finished
  2. BOffer high-calorie finger foods and fluids the client can eat while moving
  3. CEncourage the client to join the unit's group activities to burn off energy
  4. DPlace the client in the day room with the television on for distraction
Show answer

Answer: B

A client in mania burns a huge number of calories and often will not stop long enough to eat. Finger foods and portable drinks meet nutrition and hydration needs without a power struggle, which keeps the client and staff safe.

Why the others are wrong

Forcing the client to sit (A) sets up a confrontation that can escalate to aggression. Group activities (C) and a loud day room (D) add stimulation, and a manic client needs less stimulation, not more.

5

A client taking lithium reports nausea, diarrhea, hand tremors that have gotten worse, and feeling unsteady on their feet. The morning lithium level is 1.9 mEq/L. Which action should the nurse take?

  1. AGive the scheduled dose and recheck the level in one week
  2. BHold the dose, notify the provider, and monitor for worsening toxicity
  3. CEncourage the client to cut back on salt to lower the level
  4. DGive the dose with food to reduce the nausea
Show answer

Answer: B

Lithium has a narrow therapeutic range, usually 0.6 to 1.2 mEq/L, and 1.9 with GI symptoms, coarse tremor and ataxia is toxicity. The nurse holds the drug, reports the level, and watches for confusion, slurred speech and seizures.

Why the others are wrong

Giving the dose (A and D) adds more drug to a client who is already toxic. Cutting salt (C) raises lithium levels because the kidney holds on to lithium when sodium is low; clients should keep salt and fluid intake steady.

6

A client with schizophrenia says to the nurse, "The people in the walls are telling me I need to hurt my roommate before he hurts me." Which response by the nurse is best?

  1. A"There are no people in the walls. The room is empty except for us."
  2. B"What exactly are the voices telling you to do, and do you feel you have to do it?"
  3. C"Let's not talk about the voices. Would you like to go to the art group?"
  4. D"Your roommate is a nice person. He would never hurt you."
Show answer

Answer: B

These are command hallucinations with a target, which is a safety emergency. The nurse assesses what the voices are saying and whether the client intends to act, then protects both clients. Arguing about whether the voices are real does not help, but assessing what they command does.

Why the others are wrong

Flatly denying the experience (A) makes the client feel unheard and ends the assessment. Changing the subject (C) ignores a direct threat. Defending the roommate (D) argues with the delusion instead of assessing the risk.

7

A client who started haloperidol 3 days ago is found with a stiff neck twisted to one side, eyes rolled upward, and difficulty speaking. Which action should the nurse take first?

  1. AReassure the client that this is a common reaction that will pass on its own
  2. BGive the prescribed PRN benztropine and stay with the client
  3. CEncourage the client to walk around the unit to loosen the muscles
  4. DDocument the finding and reassess at the next scheduled vital signs
Show answer

Answer: B

This is acute dystonia, an extrapyramidal side effect that can involve the airway if the laryngeal muscles spasm. An anticholinergic such as benztropine or diphenhydramine reverses it, and the nurse stays to monitor breathing.

Why the others are wrong

Dystonia does not just pass (A) and can become dangerous. Walking (C) does nothing for a drug-induced muscle spasm. Waiting until the next vitals round (D) delays treatment of a possible airway problem.

8

A client taking fluphenazine has a temperature of 104.2 F, severe muscle rigidity, a heart rate of 128, and is becoming confused. Which condition should the nurse suspect?

  1. ATardive dyskinesia
  2. BNeuroleptic malignant syndrome
  3. CSerotonin syndrome
  4. DAkathisia
Show answer

Answer: B

High fever, "lead pipe" rigidity, autonomic instability (tachycardia, labile blood pressure, sweating) and a changing level of consciousness in a client on an antipsychotic is neuroleptic malignant syndrome. It is life threatening; the antipsychotic is stopped, the client is cooled and hydrated, and dantrolene or bromocriptine may be ordered.

Why the others are wrong

Tardive dyskinesia (A) is involuntary lip smacking and tongue movements after long-term use, with no fever. Serotonin syndrome (C) looks similar but comes from serotonergic drugs such as SSRIs, not a first-generation antipsychotic. Akathisia (D) is restlessness and an inability to sit still, not rigidity and fever.

9

A client taking clozapine calls the clinic reporting a sore throat, fever and chills for the past 2 days. Which action should the nurse take?

  1. ATell the client to rest, push fluids and call back if symptoms last another week
  2. BInstruct the client to come in for a white blood cell count and absolute neutrophil count today
  3. CAdvise the client to take an extra dose of clozapine until the symptoms pass
  4. DRecommend an over-the-counter cough and cold product
Show answer

Answer: B

Clozapine can cause agranulocytosis, a severe drop in neutrophils that leaves the client with no defense against infection. Any sign of infection is treated as a possible blood count emergency until the WBC and ANC prove otherwise.

Why the others are wrong

Waiting (A) could allow a serious infection to progress in a client with no neutrophils. There is never a reason to take extra clozapine (C). Treating the symptoms (D) without checking the count misses the cause.

10

A client in the emergency department is breathing rapidly, gripping the stretcher rails, and says, "I cannot breathe, my heart is pounding, I think I am dying." Vital signs and oxygen saturation are within normal limits and the provider has ruled out a cardiac cause. Which action should the nurse take first?

  1. ALeave the room so the client has quiet time to settle down
  2. BStay with the client, speak in short simple sentences, and dim the lights and reduce noise
  3. CExplain the physiology of panic attacks in detail so the client understands what is happening
  4. DAsk the client to describe what started the attack and what they were thinking at the time
Show answer

Answer: B

During a panic attack the client cannot process much, so the nurse stays present, uses a calm voice with brief directions, and cuts down on stimulation. Staying with the client is both a safety measure and the most effective way to reduce the fear.

Why the others are wrong

Leaving (A) abandons a frightened client who may feel they are dying. A detailed explanation (C) and asking about triggers (D) are useful later, once the client has calmed enough to take in information.

Quick tips

  • When a client hints at suicide, ask the direct question. Once there is a plan, the answer is one-to-one observation and removing means, never a contract or a phone call first.
  • Learn the antipsychotic emergencies as a set: acute dystonia gets benztropine, fever plus rigidity is neuroleptic malignant syndrome, and infection symptoms on clozapine mean draw a WBC and ANC today.
  • For hallucinations and delusions, never argue and never agree. Acknowledge the feeling ("That sounds frightening"), then assess whether the voices are telling the client to harm anyone.
  • Alcohol withdrawal starts 6 to 12 hours after the last drink, seizures peak around 24 to 48 hours, and delirium tremens shows up 48 to 72 hours in with confusion, fever, tachycardia and hallucinations. A client who is 2 days out and suddenly confused is a medical emergency, not a behavior problem.
  • With eating disorders, think structure and observation: stay with the client after meals, weigh at the same time each day with the client facing away from the scale, and do not comment on numbers or appearance.
  • For a client with dementia who becomes agitated in the late afternoon (sundowning), reduce noise, turn on lights before dusk, keep the daily routine the same, and reorient gently instead of correcting.
  • Clients with PTSD need control and predictability. Tell them before you touch them, give them an exit route in the room, and never push them to retell the trauma before they are ready.

Related topics

FAQ

how many mental health questions are on the NCLEX

Psychosocial Integrity is 6 to 12 percent of the exam, so roughly 5 to 15 questions on a short test. Mental health medications also appear under pharmacology, and safety questions about suicidal or violent clients can appear under Management of Care, so the real number is higher than the category share suggests.

what is the first thing to do if a patient says they want to kill themselves

Ask directly whether they are thinking about suicide and whether they have a plan. If they have a plan, start one-to-one observation and remove anything they could use to harm themselves before you do anything else, then notify the provider.

how do you answer NCLEX questions about hallucinations

Pick the option that accepts the client's feelings without confirming or denying the hallucination, then checks for danger. The right answer usually sounds like "That must be frightening. What are the voices saying to you?" and the wrong ones either argue, agree, or change the subject.

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