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
A daughter of a Chinese-speaking client approaches the nurse and asks multiple questions while maintaining direct eye contact. Which culturally related concept would the daughter's behavior reflect?
A. Prejudice
B. Stereotyping
C. Assimilation
D. Ethnocentrism
Show answer and rationale
Correct answer: C — Assimilation
The correct answer is assimilation. Assimilation involves incorporating the behaviors of a dominant culture. In this scenario, maintaining eye contact is characteristic of the American or Canadian culture and not of Asian cultures. Prejudice is a negative belief about another person or group and does not characterize this behavior. Stereotyping is the perception that all members of a group are alike, which is not demonstrated by the daughter's behavior. Ethnocentrism is the perception that one's beliefs are superior to those of others, which is not evident in this situation.
Question 2
What is a priority goal of involuntary hospitalization of the severely mentally ill client?
A. Re-orientation to reality
B. Elimination of symptoms
C. Protection from harm to self or others
D. Return to independent functioning
Show answer and rationale
Correct answer: C — Protection from harm to self or others
The priority goal of involuntary hospitalization of severely mentally ill clients is to ensure protection from harm to self or others. Involuntary hospitalization is often necessary for individuals who are deemed dangerous to themselves or others or who are considered gravely disabled. Re-orientation to reality, elimination of symptoms, and return to independent functioning are important aspects of mental health care but are not the primary goals of involuntary hospitalization. The main focus during involuntary hospitalization is to address safety concerns and prevent harm.
Question 3
While planning care for a 2-year-old hospitalized child, which situation would the nurse most likely expect to affect the behavior?
A. Strange bed and surroundings.
B. Separation from parents.
C. Presence of other toddlers.
D. Unfamiliar toys and games.
Show answer and rationale
Correct answer: B — Separation from parents.
The correct answer is 'Separation from parents.' Separation anxiety is most evident from 6 months to 30 months of age. It is the greatest stress imposed on a toddler by hospitalization. If separation is avoided, young children have a tremendous capacity to withstand other stress. Choices A, C, and D are incorrect because while strange bed and surroundings, presence of other toddlers, and unfamiliar toys and games may contribute to some level of stress or discomfort, the separation from parents is the primary factor affecting the behavior of a 2-year-old hospitalized child.
Question 4
The healthcare provider is assessing several clients before surgery. Which factor in a client's history poses the greatest threat for complications during surgery?
A. Taking birth control pills for the past 2 years
B. Taking anticoagulants for the past year
C. Recently completing antibiotic therapy
D. Having taken laxatives PRN for the last 6 months
Show answer and rationale
Correct answer: B — Taking anticoagulants for the past year
The correct answer is taking anticoagulants for the past year. Anticoagulants increase the risk of bleeding during surgery, which can lead to complications. It is crucial for the healthcare provider to be aware of this medication. While clients taking birth control pills (option A) may be more prone to developing blood clots, these issues typically arise after surgery. Clients who recently completed antibiotic therapy (option C) or have taken laxatives PRN for the last 6 months (option D) are at lower risk compared to those taking anticoagulants (option B) during surgery.
Question 5
The nurse notes bruises on the pregnant client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm which condition?
A. Domestic abuse
B. Hydatidiform mole
C. Excessive exercise
D. Thrombocytopenic purpura
Show answer and rationale
Correct answer: A — Domestic abuse
Domestic abuse is a serious concern during pregnancy as it can escalate, and the bruises on the face and abdomen may indicate physical violence towards the pregnant woman. Hydatidiform mole presents with symptoms like an enlarged uterus for gestational age, hypertension, nausea, vomiting, and vaginal bleeding, not bruises. Excessive exercise typically leads to cardiovascular or pulmonary issues, not bruising. Thrombocytopenic purpura and other bleeding disorders usually present with bruises and petechiae on various body surfaces, not just limited to the face and abdomen.
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Question 6
The client admitted for uncontrolled diabetes is worried about how to pay bills for the family while hospitalized. Which statement by the nurse is therapeutic?
A. "You are worried about paying your bills?"
B. "Don't worry; your bills will get paid eventually."
C. "When was the last time you were admitted for hyperglycemia?"
D. "You really shouldn't be drinking alcohol because of your diagnosis of diabetes."
Correct answer:
The therapeutic communication technique used in this scenario is reflection. By repeating the client's concern, the nurse acknowledges the client's feelings and encourages further exploration of the topic. Choice A is correct as it reflects the client's worry without offering false assurance, advice, or using professional jargon. Choice B dismisses the client's concerns with false reassurance. Choice C introduces professional jargon, which may hinder effective communication. Choice D provides advice, which can limit the client's expression of feelings and concerns.
Which term or description would the nurse use for a client who repeatedly performs ritualistic behaviors throughout the day to limit anxious feelings?
A. Obsessions
B. Compulsions
C. Under personal control
D. Related to rebelliousness
Correct answer:
The correct answer is 'Compulsions.' A compulsion is an uncontrollable, persistent urge to perform an act repetitively to relieve anxiety. In this scenario, the client's repetitive ritualistic behaviors are indicative of compulsions. Obsessions, on the other hand, are persistent ideas, thoughts, or impulses that cannot be eliminated with logical reasoning. The behavior is not under personal control because avoiding it increases anxiety, making it a defense mechanism. It is not related to rebelliousness; instead, clients engage in these behaviors to reduce anxiety.
A 30-year-old woman is scheduled for a total abdominal hysterectomy due to noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. Which concern would be the cause of this anticipated difficulty?
A. Change in femininity
B. Body image changes
C. Diminished sexual desire
D. Slow recovery
Correct answer:
The correct answer is 'Change in femininity.' The removal of the uterus can lead to changes in how some women perceive themselves sexually as it is a reproductive organ. In this young client, there may be heightened feelings of loss of femininity and reproductive potential. Body image changes could occur but are more likely with surgeries involving obvious external changes. Diminished sexual desire is unlikely in a premenopausal woman unless she has specific concerns. Slow recovery is not expected in an otherwise healthy 30-year-old woman undergoing this surgery.
The client believes that the illness is a punishment for sins. Which cultural health belief is the client communicating?
A. Yin/Yang balance
B. Biomedical belief
C. Determinism belief
D. Magicoreligious belief
Correct answer:
The client is communicating a magicoreligious belief by attributing the illness to punishment for sins. In this belief system, illness is seen as caused by supernatural forces or hexes, often related to spiritual or religious beliefs. The yin/yang balance belief system does not view illness as punishment but rather as an imbalance of opposing forces. Biomedical belief focuses on physical and biochemical processes as the cause of health and illness. Determinism belief revolves around outcomes being preordained and unchangeable, not related to punishment for sins.
What would be the first step for a nurse in efficiently addressing a situation of moral dilemma?
A. Helping the client make a moral decision
B. Recognizing one's own moral development level
C. Abiding by the decision of the hospital authority
D. Having one's own opinion that differs from the health care team
Correct answer:
The correct first step for a nurse in efficiently addressing a moral dilemma is to recognize their own moral development level. By understanding their own moral reasoning, a nurse can effectively navigate moral challenges. Helping clients make moral decisions comes after the nurse has assessed their own moral standpoint. Abiding by hospital authority decisions may not always align with a nurse's ethical beliefs, so it's crucial for a nurse to form their own opinions and communicate concerns with the healthcare team to ensure ethical practice and decision-making.
For which condition would electroconvulsive therapy (ECT) be used?
A. Severe clinical depression
B. Substance abuse disorders
C. Antisocial personality disorder
D. Psychosis occurring in schizophrenia
Correct answer:
Electroconvulsive therapy (ECT) is indicated for severe clinical depression, especially in cases where clients do not respond well to psychotropic medications or require immediate intervention due to the severity of their depression. ECT is not typically used as a primary treatment for substance abuse disorders, antisocial personality disorder, or psychosis occurring in schizophrenia. While ECT is an effective intervention for severe depression, it is important to consider individual client needs and response to other treatment options before resorting to ECT.
A staff nurse expresses frustration that a Native American patient always has several family members at the bedside. Which action by the charge nurse is most appropriate?
A. Remind the nurse that family support is important to this family and patient.
B. Have the nurse explain to the family that too many visitors will tire the patient.
C. Suggest that the nurse ask family members to leave the room during patient care.
D. Ask about the nurse's personal beliefs about family support during hospitalization.
Correct answer:
The first step in providing culturally competent care is to understand one's own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help achieve this step. Reminding the nurse that this cultural practice is important to the family and patient will not decrease the nurse's frustration. The remaining responses, such as suggesting that the nurse ask family members to leave the room or having the nurse explain to the family that too many visitors will tire the patient, are not culturally appropriate for this patient.
After a needle stick occurs while removing the cap from a sterile needle, which action should the nurse take?
A. Complete an incident report.
B. Select another sterile needle.
C. Disinfect the needle with an alcohol swab.
D. Notify the supervisor of the department immediately.
Correct answer:
After a needle stick, the needle is considered contaminated and should be discarded. The nurse should select another sterile needle to use. Completing an incident report is not necessary in this situation because the needle was sterile when the nurse was stuck and not in contact with any other person's body fluids. Notifying the supervisor immediately is not required as the situation can be managed by selecting a new needle. Disinfecting the needle with an alcohol swab is not recommended as it does not meet the standards of safe practice and infection control.
The nurse is teaching an obese client, newly diagnosed with arteriosclerosis, about reducing the risk of a heart attack or stroke. Which health promotion brochure is most important for the nurse to provide to this client?
A. Monitoring Your Blood Pressure at Home
B. Smoking Cessation as a Lifelong Commitment
C. Decreasing Cholesterol Levels Through Diet
D. Stress Management for a Healthier You
Correct answer:
The most important health promotion brochure to provide to an obese client newly diagnosed with arteriosclerosis is one focused on decreasing cholesterol levels through diet. Arteriosclerosis is significantly influenced by excess dietary fat, especially saturated fat and cholesterol. Monitoring blood pressure at home, while important, does not directly address the underlying cause of arteriosclerosis. Smoking cessation and stress management are crucial for overall cardiovascular health, but lowering cholesterol through diet takes precedence in this scenario.
On her first visit to the neonatal intensive care unit to see her preterm newborn, the mother's only comment to the nurse is, 'My baby looks so fragile. Do you think my child will make it?' Which is the most appropriate response by the nurse?
A. "Many infants born as small as yours have done just fine."
B. "The staff is confident in your child's prognosis because preterm babies do look like this at first."
C. "It's understandable that your baby looks fragile to you. What have you learned about the condition?"
D. "Your baby is not as fragile as it appears. Do you find it so frightening that you can't touch your child?"
Correct answer:
The nurse's response should aim to convey acceptance and encourage the mother to express her concerns. By saying, "It's understandable that your baby looks fragile to you. What have you learned about the condition?", the nurse acknowledges the mother's feelings and prompts her to share her understanding, fostering further communication and addressing any misconceptions. Choices A and B dismiss the mother's concerns by making general statements and do not encourage dialogue. Choice D implies judgment and may deter the mother from opening up about her fears.
NCLEX-RN mental health practice questions, set 19 for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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