You choose the therapeutic response, the safety priority, and the cue that means the patient is getting worse. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the NCLEX-RN exam guide or more NCLEX-RN practice questions.
Five mental health questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
During the first meeting of a therapy group, members exhibit frequent periods of silence, tense laughter, and nervous movements. Which conclusion would the nurse make?
A. The group requires an active leader who will intervene to relieve signs of obvious stress.
B. The group process is unhealthy and there is unwillingness to openly relate.
C. The members are displaying expected behaviors because relationships are not yet established.
D. The behaviors should be immediately addressed so members will not become too uncomfortable.
Show answer and rationale
Correct answer: C — The members are displaying expected behaviors because relationships are not yet established.
During the initial stages of a therapy group, it is common for members to exhibit behaviors such as silence, tense laughter, and nervous movements. These behaviors indicate anxiety and insecurity due to the lack of established relationships and trust among the group members. This is a normal part of group development, and it does not necessarily mean that the group process is unhealthy. Intervening or addressing these behaviors immediately is not required as they are expected in the early stages of group interaction. As the group progresses and relationships are built, these behaviors are likely to diminish naturally without the need for active leader intervention. Therefore, the correct conclusion is that the members are displaying expected behaviors because relationships are not yet established. Choices A, B, and D are incorrect because active leader intervention is not necessary, the group process is not unhealthy, and addressing the behaviors immediately is not required as they are part of the early group dynamics and are expected to subside as relationships develop.
Question 2
During the first meeting of a therapy group, members exhibit frequent periods of silence, tense laughter, and nervous movements. Which conclusion would the nurse make?
A. The group requires an active leader who will intervene to relieve signs of obvious stress.
B. The group process is unhealthy and there is unwillingness to openly relate.
C. The members are displaying expected behaviors because relationships are not yet established.
D. The behaviors should be immediately addressed so members will not become too uncomfortable.
Show answer and rationale
Correct answer: C — The members are displaying expected behaviors because relationships are not yet established.
During the initial stages of a therapy group, it is common for members to exhibit behaviors such as silence, tense laughter, and nervous movements. These behaviors indicate anxiety and insecurity due to the lack of established relationships and trust among the group members. This is a normal part of group development, and it does not necessarily mean that the group process is unhealthy. Intervening or addressing these behaviors immediately is not required as they are expected in the early stages of group interaction. As the group progresses and relationships are built, these behaviors are likely to diminish naturally without the need for active leader intervention. Therefore, the correct conclusion is that the members are displaying expected behaviors because relationships are not yet established. Choices A, B, and D are incorrect because active leader intervention is not necessary, the group process is not unhealthy, and addressing the behaviors immediately is not required as they are part of the early group dynamics and are expected to subside as relationships develop.
Question 3
A Hispanic patient complains of abdominal cramping caused by empacho. Which action should the nurse take first?
A. Ask the patient what treatments are likely to help
B. Massage the patient's abdomen until the pain subsides.
C. Administer prescribed medications to decrease the cramping
D. Offer to contact a curandero(a) for a visit to the patient
Show answer and rationale
Correct answer: A — Ask the patient what treatments are likely to help
When a Hispanic patient presents with abdominal cramping related to empacho, it is crucial for the nurse to first understand the patient's cultural beliefs and preferences before initiating any interventions. In the case of a culture-bound syndrome like empacho, it is essential to acknowledge and respect the patient's cultural background. While options like administering medications, arranging a visit by a curandero(a), or providing massage may have potential benefits, assessing the patient's beliefs ensures that interventions are culturally sensitive and aligned with the patient's values. By engaging the patient in a discussion about potential treatments, the nurse can gather valuable information to tailor care effectively, promoting trust and collaboration in the healthcare process. This patient-centered approach enhances the quality of care and fosters a culturally competent nursing practice. Therefore, asking the patient about preferred treatments is the most appropriate initial action to address the patient's condition effectively.
Question 4
A Hispanic patient complains of abdominal cramping caused by empacho. Which action should the nurse take first?
A. Ask the patient what treatments are likely to help
B. Massage the patient's abdomen until the pain subsides.
C. Administer prescribed medications to decrease the cramping
D. Offer to contact a curandero(a) for a visit to the patient
Show answer and rationale
Correct answer: A — Ask the patient what treatments are likely to help
When a Hispanic patient presents with abdominal cramping related to empacho, it is crucial for the nurse to first understand the patient's cultural beliefs and preferences before initiating any interventions. In the case of a culture-bound syndrome like empacho, it is essential to acknowledge and respect the patient's cultural background. While options like administering medications, arranging a visit by a curandero(a), or providing massage may have potential benefits, assessing the patient's beliefs ensures that interventions are culturally sensitive and aligned with the patient's values. By engaging the patient in a discussion about potential treatments, the nurse can gather valuable information to tailor care effectively, promoting trust and collaboration in the healthcare process. This patient-centered approach enhances the quality of care and fosters a culturally competent nursing practice. Therefore, asking the patient about preferred treatments is the most appropriate initial action to address the patient's condition effectively.
Question 5
Why might a nurse manager suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions?
A. Individuals with this disorder respond well to small therapeutic groups.
B. Therapeutic group work tends to be threatening to individuals who are suspicious.
C. Compliance with unit rules and medication regimens increases as therapeutic group involvement increases.
D. Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.
Show answer and rationale
Correct answer: B — Therapeutic group work tends to be threatening to individuals who are suspicious.
The nurse manager would suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions because individuals who are suspicious find group settings threatening. Paranoid individuals struggle in groups as they may not trust others enough to engage effectively and tolerate the necessary interactions for group therapy. Therefore, the correct answer is that therapeutic group work tends to be threatening to individuals who are suspicious. Choices A, C, and D are incorrect. While some individuals with schizophrenia may respond well to small therapeutic groups, those with paranoid delusions may find them threatening. Compliance with unit rules and medication regimens may not necessarily increase with group therapy, especially for acutely ill psychiatric clients not ready to accept reality. Involvement in small therapeutic groups is not primarily aimed at decreasing regression and dependency associated with institutionalization, making it an inappropriate option for the client's specific needs.
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Question 6
What is the nurse's priority action when a client receiving a unit of packed red blood cells experiences tingling in the fingers and headache?
A. Call the health care provider (HCP).
B. Stop the transfusion.
C. Slow the infusion rate.
D. Assess the intravenous (IV) site for infiltration.
Correct answer:
When a client receiving a packed red blood cell transfusion experiences tingling in the fingers and headache, these symptoms may indicate an adverse reaction to the transfusion. The nurse's priority action is to immediately stop the transfusion and initiate a normal saline infusion at a keep vein open (KVO) rate. This helps maintain the client's vein patency while addressing the adverse reactions. After stopping the transfusion and initiating the saline infusion, the nurse should assess the client, including vital signs evaluation. Subsequently, the healthcare provider should be notified. Calling the healthcare provider is important, but it should be done after the immediate action of stopping the transfusion. Slowing the infusion rate is not appropriate during a suspected transfusion reaction as it can exacerbate the adverse effects. Assessing the IV site for infiltration is a routine nursing intervention and is not the priority when managing a potential adverse reaction to a blood transfusion.
In completing a client's preoperative routine, the nurse finds that the operative permit is not signed. The client begins to ask more questions about the surgical procedure. What action should the nurse take next?
A. Witness the client's signature on the permit.
B. Answer the client's questions about the surgery.
C. Inform the surgeon that the operative permit is not signed and the client has questions about the surgery.
D. Reassure the client that the surgeon will answer any questions before the anesthesia is administered.
Correct answer:
The correct action for the nurse to take in this situation is to inform the surgeon that the operative permit is not signed and that the client has questions about the surgery. It is the responsibility of the surgeon to explain the procedure to the client and obtain the client's signature on the permit. While the nurse can witness the client's signature on the permit, the procedure must first be explained by the healthcare provider or surgeon, including addressing the client's questions. Therefore, informing the surgeon is the priority to ensure proper communication and consent before the surgery. Answering the client's questions about the surgery (Choice B) may not provide accurate information and could lead to misunderstanding. Reassuring the client (Choice D) is important, but obtaining proper consent and addressing concerns should come first. Witnessing the client's signature (Choice A) is not sufficient if the client has unanswered questions and the permit is not signed.
A college athlete sustained a complete transection of the spinal cord while practicing on a trampoline. The health care provider explained that return of function to the lower extremities is not likely. Two weeks later, the client verbalizes the need to practice for an upcoming tournament. Which conclusion would the nurse make about the client's statement?
A. Exhibiting denial
B. Verbalizing a fantasy
C. No longer able to adapt
D. Motivated to recover mobility
Correct answer:
The correct answer is 'Exhibiting denial.' Denial is a common defense mechanism when facing a serious health issue. The individual rejects the existence of the problem due to the overwhelming anxiety and emotional distress it causes. In this case, the athlete's desire to practice for an upcoming tournament despite being informed about the unlikely return of lower extremity function indicates denial of the severity of their condition. Choice B, 'Verbalizing a fantasy,' is incorrect as a fantasy involves creating imagined events to fulfill unconscious wishes, which is not evident here. Choice C, 'No longer able to adapt,' is incorrect because the client is actually demonstrating a maladaptive coping mechanism by denying the reality of their situation. Choice D, 'Motivated to recover mobility,' is incorrect as the client's goal of practicing for a tournament does not align with the realistic expectation of recovering mobility after a complete spinal cord transection.
Which initial response would the nurse make to a 67-year-old man with type 2 diabetes who sadly confides in the nurse that he has been unable to have an erection for several years?
A. 'At your age, sex isn't that important.''
B. ''That is a natural occurrence at your age.''
C. ''You sound upset about not being able to have an erection.''
D. 'Maybe it's time for you to speak to your primary health care provider about this.''
Correct answer:
The correct response is, 'You sound upset about not being able to have an erection.' When a client discloses personal information, the nurse should respond in a non-judgmental manner to encourage further communication and gather more details. This response demonstrates empathy and understanding, opening the door for the patient to express his feelings and concerns. Choice A, 'At your age, sex isn't that important,' is dismissive and fails to address the client's emotions or concerns, potentially hindering open communication. Choice B, 'That is a natural occurrence at your age,' provides inaccurate information as the inability to have an erection is not considered a normal part of aging. Choice D, 'Maybe it's time for you to speak to your primary health care provider about this,' while important eventually, should not be the initial response as the nurse should first explore the client's feelings and concerns before discussing potential referrals or interventions.
Which of the following is a true statement about palliative care?
A. The goal of palliative care is to provide end-of-life care for a client as they transition toward death.
B. Palliative care provides comfort and support for those who may have a terminal illness.
C. Palliative care provides resources for funeral arrangements after death.
D. Palliative care is a support network for family and friends after the death of a loved one.
Correct answer:
Palliative care is a type of care that focuses on providing support and comfort to individuals who may have a terminal illness or severe symptoms. It aims to improve the quality of life for both the individual receiving care and their family. While it can be provided in various settings, including hospitals, homes, or specialized facilities, the primary focus is on symptom management and addressing the physical, emotional, and spiritual needs of the individual. Choice A is incorrect because palliative care is not solely limited to end-of-life care but also includes managing symptoms and improving quality of life. Choice C is incorrect as palliative care is focused on providing care and support during the individual's life, not on funeral arrangements after death. Choice D is incorrect as palliative care is primarily directed towards the individual receiving care, although it may also provide support to their family and friends during the care process.
Which nursing intervention would be provided to a hospitalized client during the identity versus role confusion stage?
A. Choosing creative ways to promote social participation
B. Providing information to the client about the treatment plan
C. Encouraging the client to participate actively in treatment procedures
D. Involving the client's partners or family members in the caring process
Correct answer:
During the identity versus role confusion stage, which occurs during adolescence or puberty, it is essential for the nurse to empower hospitalized adolescents by providing them with sufficient information about their treatment plan. This approach enables the clients to actively participate in decision-making regarding their care. Choosing creative ways to promote social participation is more aligned with assisting clients during the generativity versus self-absorption and stagnation stage, where fostering social engagement can contribute to a sense of fulfillment. Involving the client's partners or family members in the caring process is typically beneficial during the intimacy versus isolation stage to create a strong support system for the client. Encouraging active participation in treatment procedures is more relevant to the industry versus inferiority stage, ensuring that the hospitalized client engages effectively in their care.
A client is receiving treatment for delusional behavior. He believes that his neighbor is purposefully poisoning his water system in an attempt to make him sick. Which of the following responses of the nurse is most appropriate?
A. Did you have the water tested to be sure?
B. Why do you feel like your neighbor is trying to poison you?
C. Let's just sit here and watch this television program.
D. Don't be silly; your neighbor would do no such thing.
Correct answer:
When a client presents with delusional beliefs, the nurse should avoid arguing with the client and should accept the client's initial need to hold onto the delusions. By asking the client 'Why do you feel like your neighbor is trying to poison you?' the nurse encourages the client to express his beliefs further. This open-ended question allows the client to elaborate on his delusions without feeling judged. It helps build trust between the nurse and the client, which is crucial for therapeutic communication. This approach may eventually lead to the client being more receptive to exploring and addressing his delusions. Choices A, C, and D are incorrect. Choice A may come off as dismissive and does not address the client's underlying beliefs. Choice C is a distraction and does not address the client's concerns. Choice D is confrontational and dismissive of the client's beliefs, which can damage the therapeutic relationship.
During the evacuation of a group of clients from a medical unit due to a fire, the nurse observes an ambulatory client walking alone toward the stairway at the end of the hall. What action should the nurse take?
A. Assign an unlicensed assistive person to transport the client via a wheelchair.
B. Remind the client to walk carefully down the stairs until reaching a lower floor.
C. Ask the client to help by assisting a wheelchair-bound client to a nearby elevator.
D. Open the closest fire doors so that ambulatory clients can evacuate more rapidly.
Correct answer:
During the evacuation of a unit due to a fire, ambulatory clients should be evacuated via the stairway if possible and reminded to walk carefully to ensure their safety. They do not necessarily require assistance via a wheelchair. Elevators should not be used during a fire evacuation as they can pose a risk, and fire doors should be kept closed to contain the fire and smoke, preventing its spread to other areas of the building. Therefore, reminding the client to walk carefully down the stairs is the most appropriate action in this situation. Assigning an unlicensed assistive person to transport the client via a wheelchair may delay the evacuation process and put both individuals at risk. Asking the client to help by assisting a wheelchair-bound client to an elevator is not safe during a fire evacuation. Opening fire doors indiscriminately can lead to the spread of fire and smoke, endangering the clients and staff further.
The nurse is caring for a newly admitted patient. Which intervention is the best example of a culturally appropriate nursing intervention?
A. Insist that family members provide most of the patient's personal care.
B. Maintain a personal space of at least 2 feet when assessing the patient.
C. Ask permission before touching a patient during the physical assessment.
D. Consider the patient's ethnicity as an important factor in planning care.
Correct answer:
Culturally appropriate nursing care requires sensitivity to the beliefs and practices of diverse cultural groups. Asking permission before touching a patient during a physical assessment is a universally respectful practice, as many cultures consider it disrespectful to touch a person without consent. This approach demonstrates respect for the patient's autonomy and cultural preferences. Maintaining a personal space of at least 2 feet can be a good practice for infection control or personal comfort but may not be culturally significant for all patients. Insisting that family members provide most of the patient's personal care may not align with the patient's cultural norms or preferences. Considering a patient's ethnicity as the most important factor in care planning overlooks the individuality of the patient and may lead to stereotyping or assumptions that are not accurate or helpful in providing tailored care.
Which of the following is an appropriate tension-reduction intervention for a patient who may be escalating toward aggressive behavior?
A. Asking to speak to someone
B. Asking to be alone
C. Listening to music
D. All of the above
Correct answer:
All of the above interventions are appropriate tension-reduction techniques for a patient in the ICU. When a patient is escalating toward aggressive behavior, it is crucial to have a range of strategies to help de-escalate the situation. Asking to speak to someone can provide emotional support and an outlet for communication. Asking to be alone can help the patient have space and time to calm down. Listening to music can be soothing and distracting. These interventions, along with additional ones like walking the hallway, watching television, writing in a journal, or requesting a PRN medication, can be helpful. It is essential to involve the patient in developing the care plan to identify triggers and effective tension-reduction techniques. Patients in escalation may not always recognize the need for intervention, so staff must be observant and offer personalized techniques to address the situation effectively.
NCLEX-RN mental health practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
No. Nursier is independent practice. Register through the official path named on the NCLEX-RN exam guide.
The first five questions already include the rationale. Start full practice to unlock the remaining keys, missed-question review, and the rest of the bank.
Keep going past these 15 questions
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