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
Which behavior indicates that the client has learned the most effective method to cope with anger?
A. Goes for a long jog
B. Talks about the anger
C. Goes outside and screams
D. Focuses on cause of anger
Show answer and rationale
Correct answer: B — Talks about the anger
The correct answer is 'Talks about the anger.' This response indicates that the client has learned a positive coping method, as discussing angry feelings is a healthier way of dealing with anger. Talking about anger allows for expression and communication, leading to a better understanding of the emotions involved. Going for a long jog or screaming outside may provide temporary relief, but they do not address the root cause or help in processing the emotions effectively. Focusing solely on the cause of anger without expressing feelings may lead to increased frustration and escalation of anger, rather than promoting constructive coping mechanisms.
Question 2
When administering medications through a nasogastric tube connected to low intermittent suction, which action should the nurse do first?
A. Clamp the nasogastric tube
B. Confirm placement of the tube
C. Use a syringe to instill the medications
D. Turn off the intermittent suction device
Show answer and rationale
Correct answer: D — Turn off the intermittent suction device
When administering medications through a nasogastric tube connected to low intermittent suction, the nurse should first turn off the intermittent suction device. This step is crucial to prevent the medications from being immediately suctioned out before they can be absorbed. Clamping the nasogastric tube is not the initial action because it may cause pressure buildup and lead to complications. Confirming the placement of the tube is important but should not be the first step in this scenario. Using a syringe to instill the medications comes after ensuring the suction is turned off to enable proper administration and absorption of the medications.
Question 3
A client who has multiple sclerosis is admitted to the hospital with increasingly frequent and severe exacerbations. One day, the client's partner confides to the nurse, 'Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home.' After listening to the partner's concerns, which response would the nurse make?
A. 'Joining a support group of people who are coping with this situation may be helpful.'
B. 'You may be able to decrease your feelings of guilt by seeking counseling.'
C. 'It would be helpful if you became involved in volunteer work at this time.'
D. 'I recognize it's hard to deal with, but try to remember that this, too, shall pass.'
Show answer and rationale
Correct answer: A — 'Joining a support group of people who are coping with this situation may be helpful.'
Joining a support group of individuals facing similar circumstances can provide valuable support and the opportunity to share experiences, making it the most appropriate response. The response suggesting counseling to decrease feelings of guilt is premature because the partner did not directly express guilt and it may not be the most immediate need. Suggesting involvement in volunteer work at this time fails to address the partner's current emotional distress and may come across as dismissive. Offering false reassurance by stating 'this, too, shall pass' does not validate the partner's feelings and minimizes the seriousness of their concerns.
Question 4
The nurse selects the best site for insertion of an IV catheter in the client's right arm. Which documentation should the nurse use to identify the placement of the IV access?
A. Left brachial vein
B. Right cephalic vein
C. Dorsal side of the right wrist
D. Right upper extremity
Show answer and rationale
Correct answer: B — Right cephalic vein
The correct answer is the right cephalic vein. The cephalic vein is a large and superficial vein commonly used for IV access. Documenting the specific anatomic name of the vein used for IV access, such as the cephalic vein, is essential for accurate medical records. Option A, the left brachial vein, is incorrect as the brachial vein is too deep to be accessed for IV infusion. Option C, the dorsal side of the right wrist, is not a recommended IV access site due to fragile veins and potential pain for the patient. Option D, right upper extremity, is too broad and lacks the specificity necessary for precise documentation of the IV access site.
Question 5
A 5-year-old child has been recently admitted to the hospital. According to Erik Erikson's psychosocial development stages, the child is in which stage?
A. Trust vs. mistrust
B. Initiative vs. guilt
C. Autonomy vs. shame and doubt
D. Intimacy vs. isolation
Show answer and rationale
Correct answer: B — Initiative vs. guilt
The correct answer is 'Initiative vs. guilt.' According to Erik Erikson's psychosocial development stages, children aged 3-6 years old are in the stage of initiative versus guilt. During this stage, children begin to assert their power and control over the environment. They develop a sense of purpose and direction, but may also experience feelings of guilt if they believe their actions have caused harm or conflict. Choices A, C, and D are incorrect. 'Trust vs. mistrust' is the first stage for infants, 'Autonomy vs. shame and doubt' is the second stage for toddlers, and 'Intimacy vs. isolation' is a stage that occurs later in adulthood.
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Question 6
Which of the following medications would NOT be an appropriate prn medication for use during an episode of aggression or violence for the patient with a psychiatric diagnosis?
A. Olanzapine
B. Meperidine
C. Ziprasidone
D. Haloperidol
Correct answer:
Meperidine is an opioid used to treat pain and is not suitable for managing aggressive or violent behavior in patients with psychiatric diagnoses. Olanzapine, ziprasidone, and haloperidol are appropriate choices for managing aggression or violence. Olanzapine and ziprasidone are second-generation antipsychotic medications, while haloperidol is a traditional antipsychotic. These medications have demonstrated effectiveness in managing aggressive behavior, with or without the adjunctive use of a benzodiazepine. Meperidine's primary indication is for pain relief, making it unsuitable for managing psychiatric-related aggression or violence.
What step should be taken when administering ear drops to an adult client?
A. Place the client in a side-lying position.
B. Hold the dropper 1 cm above the ear canal.
C. Place a cotton ball into the outermost canal.
D. Pull the auricle down and back.
Correct answer:
The correct step when administering ear drops to an adult client is to place the client in a side-lying position (A). This position allows for easier administration of the drops and helps prevent spillage. The dropper should be held approximately 1 cm (½ inch) above the ear canal (B) to ensure accurate delivery of the medication. Placing a cotton ball into the outermost canal (C) is unnecessary and may interfere with the absorption of the ear drops. Pulling the auricle down and back (D) is a technique used for children younger than 3 years old to straighten the ear canal, but it is not necessary for adults and may cause discomfort.
The parents tell the nurse that their preschooler often awakes from sleep screaming in the middle of the night. The preschooler is not easily comforted and screams if the parents try to restrain the child. What should the nurse instruct the parents to do?
A. Always read a story to the child before bedtime.
B. Intervene only if necessary to protect the child from injury.
C. Discuss counseling options with the primary health care provider.
D. Try to wake the child and ask the child to describe the dream.
Correct answer:
Waking up screaming from sleep at night indicates sleep terrors. The nurse would advise the parents to observe the child and intervene only if there is a risk for injury. Reading a story before bedtime helps calm the child before sleeping, but it does not ensure that the child will not have a sleep terror. There is no need for professional counseling because sleep terrors are a common phenomenon in preschool-age children. Trying to wake the child and asking the child to describe the dream is not appropriate as the child is not aware of anybody's presence during a sleep terror, and this may cause the child to scream and thrash more.
Which of the following examples indicates that the nurse is giving recognition as a form of therapeutic communication?
A. You need to take your medicine now, Adam.
B. Jill, your father is trying to make amends with you.
C. The physician wants to meet with you and your husband, Amy.
D. Linda, you brushed your hair this morning.
Correct answer:
Recognition is a form of therapeutic communication in which the nurse points out a positive aspect of the client's behavior. Noting that a client brushed her hair herself indicates that the nurse recognizes the client's attempts at self-care. This recognition shows the client that the nurse is paying attention and may be open to further communication. Choices A, B, and C do not demonstrate recognition. Choice A focuses on a directive statement, Choice B involves informing the client about a situation without acknowledging their actions, and Choice C informs the client about a meeting without providing recognition for any behavior.
Which term describes what an adolescent client is experiencing when she says to the nurse who has been caring for her, 'You're just like my mother; I hate you'?
A. Insight
B. Universality
C. Transference
D. Identification
Correct answer:
Transference occurs when a client unconsciously assigns feelings and attitudes originally associated with another important person in the client's life. In this scenario, the adolescent client is projecting emotions connected to her mother onto the nurse. This client's statement does not demonstrate insight but rather reflects the mechanism of transference. Universality refers to the sense that one is not alone in any situation, which is not evident in the client's statement. Identification is a defense mechanism where an individual takes on characteristics of someone considered admirable, which is not the case in this situation.
The client has a new colostomy. Which client outcome is most important for achievement of long-range goals associated with adjusting to a new colostomy?
A. Mastery of colostomy care techniques
B. Readiness to accept an altered body function
C. Awareness of community resources available
D. Understanding necessary dietary modifications
Correct answer:
The most crucial client outcome for successful adjustment to a new colostomy is the readiness to accept an altered body function. Acceptance of changes in body image and function is essential to facilitate mastery of colostomy care techniques and optimal utilization of community resources. Without readiness to accept the altered body function, the client may not be open to learning and adopting necessary changes, hindering the achievement of long-term goals. Understanding dietary modifications, while important, is secondary to the fundamental acceptance of the altered body function in the process of adjusting to a new colostomy.
The nurse is caring for an Asian patient who is being admitted to the hospital. Which action would be most appropriate for the nurse to take when interviewing this patient?
A. Avoid eye contact with the patient
B. Observe the patient's use of eye contact
C. Look directly at the patient when interacting
D. Ask the patient's family member about the patient's cultural beliefs
Correct answer:
Observing the patient's use of eye contact will be most useful in determining the best way to communicate effectively with the patient. Different cultures have varying norms regarding eye contact, so by observing the patient, the nurse can adapt their communication style accordingly. Looking directly at the patient or avoiding eye contact may not be universally appropriate and could be misinterpreted. Asking a family member about the patient's cultural beliefs is not ideal as cultural beliefs can vary among individuals within the same cultural group. It is best to assess the patient directly to provide culturally sensitive care.
A client undergoing presurgical testing before a total abdominal hysterectomy says to the nurse, 'After I have this surgery I know my husband will never come near me again.' Which response would the nurse give?
A. You're underestimating how your husband will respond to your surgery.
B. You're concerned about the effect on your sexual relations.
C. You're worried that the surgery will change how others see you.
D. You're concerned about how your husband will respond to your surgery.
Correct answer:
The correct response acknowledges the client's expressed concern about her husband's reaction to the surgery, encouraging further discussion without imposing the nurse's assumptions. Choice A reframes the client's concern to focus on the husband's response, aligning more closely with the client's stated worry. Choice B makes an assumption about the client's concerns regarding sexual relations, which may not be the primary focus of her statement. Choice C shifts the attention to how others perceive the client, deviating from the client's specific reference to her husband's reaction, thus not addressing the client's main concern.
For a client with obsessive-compulsive disorder, which reaction is most likely to occur when the performance of a ritual is interrupted?
A. Anxiety
B. Hostility
C. Aggression
D. Withdrawal
Correct answer:
When a client with obsessive-compulsive disorder is interrupted while performing a ritual, the most likely reaction is anxiety. The compulsive ritual serves as a coping mechanism to control anxiety, so any disruption to this ritual can heighten the individual's anxiety levels. Hostility is typically part of the disorder itself and not a direct reaction to the interruption of the ritual. Aggression may occur only if anxiety escalates to a panic level, leading to overt anger expression. Withdrawal is not a common behavioral pattern associated with obsessive-compulsive disorder and is not a typical reaction to ritual interruption.
A male client is laughing at a television program with his wife when the evening nurse enters the room. He says his foot is hurting and he would like a pain pill. How should the nurse respond?
A. Ask him to rate his pain on a scale of 1 to 10.
B. Encourage him to wait until bedtime so the pill can help him sleep.
C. Attend to the acutely ill client's needs first because this client is laughing.
D. Instruct him in the use of deep breathing exercises for pain control.
Correct answer:
Obtaining a subjective estimate of the pain experience by asking the client to rate his pain helps the nurse determine which pain medication should be administered and also provides a baseline for evaluating the effectiveness of the medication. Medicating for pain should not be delayed to use it as a sleep medication, so encouraging him to wait until bedtime is incorrect. Option C is judgmental and inappropriate as all clients deserve prompt attention. Option D should be used as an adjunct to pain medication, not instead of medication, so instructing him in deep breathing exercises alone is not the priority in this situation.
NCLEX-RN mental health practice questions, set 15 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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