This NCLEX-RN practice test for psychiatric nursing includes questions for patients with varied mental health problems, as well as the addition of several items related to issues due to COVID infection and the pandemic situation. Mental health issues like depression, phobias, therapeutic communication and drug therapy make up a majority of the questions.
In taking this practice test, it is recommended that you time yourself while answering each question, ensuring that 1 minute is allocated to answer each item. After all the questions are answered, take some time to review them and check the answers and rationales for this practice test in the next page.
Practice Questions Set 2
1. A female client who’s at high risk for suicide needs close supervision. To best ensure the client’s safety, the nurse should:
A. Check on the client frequently at irregular intervals throughout the night
B. Assure the client that the nurse will hold in confidence anything the client says
C. Repeatedly discuss previous suicide attempts with the client
D. Disregard decreased communication by the client because this is common in suicidal clients
2. She tearfully tells the nurse “I can’t take it when she accuses me of stealing her things.” Which response by the nurse will be most therapeutic?
A. ”Don’t take it personally. Your mother does not mean it.”
B. “Have you tried discussing this with your mother?”
C. “This must be difficult for you and your mother.”
D. “Next time ask your mother where her things were last seen.”
3. A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, “It felt so wonderful to get high.” Which of the following is the most appropriate response?
A. “If you continue to talk like that, I’m going to stop speaking to you.”
B. “You told me you got fired from your past job for missing too may days after taking drugs all night.”
C. “Tell me more about how it felt to get high.”
D. “Don’t you know it’s illegal to use drugs?”
4. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food
B. Control eating impulses
C. Identify anxiety-causing situations
D. Eat only three meals per day
5. A 14-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter’s weight loss and constant dieting. The nurse conducts health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?
A. “I like the way I look. I just need to keep my weight down because I’nm a cheerleader.”
B. “I don’t like the food my mother cooks. I eat plenty of fast food when I’m out with my friends.”
C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to other girls.”
D. “I do diet around my periods; otherwise, I just get so bloated.”
6. A patient’s spouse died three months ago. The patient says “I would like my friend Tom to have my collection of artwork because I don’t need to look at them anymore”. Which of the following responses by the nurse would be proper?
A. Did Tom ask for the artwork?
B. Are you planning to commit suicide?
C. Does Tom know you want to give him the artwork?
D. Why do you want to give the artwork away?
7. A patient with a history of schizophrenia says “The medical staff is secretly employed by the CIA to take me out.” The nurse should respond as follows:
A. The CIA protects us and is not out to hurt you.
B. No other patient thinks that.
C. I want to help you, not harm you. It must be frightening thinking people want to hurt you.
D. When did you first start having these thoughts?
8. Kevin is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since. His history suggests maladaptive coping, which is associated with:
A. Antisocial personality disorder
B. Borderline personality disorder
C. Obsessive-compulsive personality disorder
D. Narcissistic personality disorder
9. A patient with a diagnosis of major depression who has attempted suicide says to the nurse, “I should have died. I’ve always been a failure. Nothing ever goes right for me.” Which response demonstrates therapeutic communication?
A. “You have everything to live for”
B. “Why do you see yourself as a failure?”
C. “Feeling like this is all part of being depressed.”
D. “You’ve been feeling like a failure for a while?”
10. A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat
A. Using open-ended questions and silence
B. Sharing personal preference regarding food choices
C. Documenting reasons why the patient does not want to eat
D. Offering opinions about the necessity of adequate nutrition
11. A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. “Let me out. There’s nothing wrong with me. I don’t belong here.” What defense mechanism is the patient implementing?
12. On review of the patients record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior?
A. Fearfulness regarding treatment measures.
B. Anger and aggressiveness directed toward others.
C. An understanding of the pathology and symptoms of the diagnosis
D. A willingness to participate in the planning of the care and treatment plan
13. A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially?
A. Contact the patients health care provider (HCP)
B. Call the patients family to arrange for transportations.
C. Attempt to persuade the patient to stay “for only a few more days”
D. Tell the patient the leaving would likely result in an involuntary commitment
14. The nurse is working with a patient who despite making a heroic effort was unable to rescue a neighbor trapped in a house fire. Which patient focused action should the nurse engage in during the working phase of the nurse-patient relationship.
A. Exploring the patient’s ability to function
B. Exploring the patients potential for self-harm
C. Inquiring about the patients perception or appraisal of why the rescue was
D. Inquiring about and examining the patient’s feelings for any that may block adaptive coping
15. The patient says, “My marriage is just great. My spouse and I always agree.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient’s communication is:
16. Which technique will best communicate to a patient that the nurse is interested in listening?
A. Restating a feeling or thought the patient has expressed.
B. Asking a direct question, such as “Did you feel angry?”
C. Making a judgment about the patient’s problem.
D. Saying, “I understand what you’re saying.”
17. A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient’s self-esteem, but after 3 weeks, the patient’s eye contact did not improve. What is the most accurate analysis of this scenario?
A. The patient’s eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
B. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
C. The patient’s poor eye contact is indicative of anger and hostility that were unaddressed.
D. The nurse should have assessed the patient’s culture before making this diagnosis and plan.
18. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?
A. A nurse is responsible for breaking silences.
B. Patients withdraw if silences are prolonged.
C. Silence can provide meaningful moments for reflection.
D. Silence helps patients know that what they said was understood.
19. Select all that apply.
A patient cries as the nurse explores the patient’s feelings about the death of a close friend. The patient sobs, “I shouldn’t be crying like this. It happened a long time ago.” Which responses by the nurse facilitate communication?
A. “Why do you think you are so upset?”
B. “I can see that you feel sad about this situation.”
C. “The loss of a close friend is very painful for you.”
D. “Crying is a way of expressing the hurt you are experiencing.”
E. “Let’s talk about something else because this subject is upsetting you.”
20. A patient says, “Please don’t share information about me with the other people.” How should the nurse respond?
A. “I will not share information with your family or friends without your permission, but I share information about you with other staff.”
B. “A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know.”
C. “It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others.”
D. “I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us.”
21. As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, “Thank you for helping mend my broken heart.” Which is the nurse’s best response?
A. “Accepting gifts violates the policies and procedures of the facility.”
B. “I’m glad you feel so much better now. Thank you for the beautiful necklace.”
C. “I’m glad I could help you, but I can’t accept the gift. My reward is seeing you with a renewed sense of hope.”
C. “Helping people is what nursing is all about. It’s rewarding to me when patients recognize how hard we work.”
22. A nurse wants to enhance growth of a patient by showing positive regard. The nurse’s action most likely to achieve this goal is:
A. Making rounds daily.
B. Staying with a tearful patient.
C. Administering medication as prescribed.
D. Examining personal feelings about a patient.
23. A patient says, “People should be allowed to commit suicide without interference from others.” A nurse replies, “You’re wrong. Nothing is bad enough to justify death.” What is the best analysis of this interchange?
A. The patient is correct.
B. The nurse is correct.
C. Neither person is correct.
D. Differing values are reflected in the two statements.
24. As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse’s best action?
A. Recognize the effectiveness of the relationship and patient’s thoughtfulness. Accept the card.
B. Inform the patient that accepting gifts violates policies of the facility. Decline the card.
C. Acknowledge the patient’s transition through the termination phase but decline the card.
D. Accept the card and invite the patient to return to participate in other arts and crafts groups.
25. A patient says, “I’m still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?” What is the nurse’s best response?
A. “Why are you asking me when you’re able to speak for yourself?”
B. “I will be glad to address it when I see your doctor later today.”
C. “That’s a good topic for you to discuss with your doctor.”
D. “Do you think you can’t speak to a doctor?”
26. A nurse says, “I am the only one who truly understands this patient. Other staff members are too critical.” The nurse’s statement indicates:
A. Boundary blurring.
B. Sexual harassment.
C. Positive regard.
27. Select all that apply.
A novice psychiatric nurse has a parent with bipolar disorder. This nurse angrily recalls feelings of embarrassment about the parent’s behavior in the community. Select the best ways for this nurse to cope with these feelings.
A. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses.
B. Recognize that these feelings are unhealthy. The nurse should try to suppress them when working with patients.
C. Recognize that psychiatric nursing is not an appropriate career choice. Explore other nursing specialties.
D. The nurse should begin new patient relationships by saying, “My own parent had mental illness, so I accept it without stigma.”
E. Recognize that the feelings may add sensitivity to the nurse’s practice, but supervision is important.
28. A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager’s most appropriate action.
A. Postpone the patient’s discharge from the hospital.
B. Contact the landlord who evicted the patient to further discuss the situation.
C. Arrange a temporary place for the patient to stay until new housing can be arranged.
D. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.
29. A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patient’s thoughts are now more organized, and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will just go through all this again.” The nurse should:
A. ask the case manager to arrange a transfer to a long-term care facility
B. notify hospital security to handle the disturbance and escort the family off the unit.
C. explain that the patient will continue to improve if the medication is taken regularly.
D. contact the health care provider to meet with the family and explain the discharge rationale.
30. A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse’s best initial action.
A. Explore ways to help the patient stop smoking.
B. Report the situation to the manager of the shelter.
C. Assess the patient’s weight; determine foods and amounts eaten.
D. Arrange hospitalization for the patient in order to formulate a new treatment plan.
31. The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. He has been previously diagnosed to be COVID-19 positive and expresses fear of what can happen to him. He was reported to have difficulty sleeping and cannot eat well. The nurse is becoming concerned about how it can affect his response to treatment. What question should the nurse ask initially when attempting to help the patient deescalate their anxiety?
A. “Do you know what will help you manage your anxiety?”
B. “Do you need help to manage your anxiety?”
C. “Can you identify what was happening when your anxiety began to increase?” D. “Are you feeling anxious right now?”
32. The nurse is discharging a patient who was treated for depression after losing a loved one from COVID-19. Which of the following statements by the patient indicates to the nurse that he is coping adaptively?
A. “He will do well if I keep him engaged in his favorite activities.”
B. “My focus is learning how to live my life.”
C. “I am glad that our problems are behind us.”
D. “I’ll make sure that the children don’t give him any problems.”
33. The nurse is caring for a patient diagnosed terminal stage coronavirus infection and has been intubated due to rapidly declining oxygen saturation levels. A couple of days into the treatment, the spouse was informed that the patient has very poor prognosis and may die in the next couple of hours. The spouse of the patient says, “We have been married for so long. I am not sure how I can go on now.” What is the most appropriate response by the nurse?
A. It sounds like your children will be there to help during your time of grieving.
B. I know this is difficult. Tell me more about what you are feeling now.
C. Think about the pain and suffering your spouse has endured lately.
D. I will call the hospice nurse to discuss your spouse’s condition with you.
34. The nurse is caring for a patient hospitalized for observation due to suspected COVID-19 infection. The patient states, “My friend went out a few days ago and forgot his mask. A couple of days later, he was complaining of chest pains and coughing. No one thought anything was wrong. He died 2 days later!” Which of the following responses by the nurse would be the best to make?
A. “This happens to quite a few people.”
B. “We are monitoring you, so you’ll be okay.”
C. “Don’t you think I’m taking good care of you?”
D. “You’re concerned that it might happen to you?”
35. A patient who was admitted for exacerbation of his asthma due a recent bout with coronavirus infection was endorsed to the incoming shift because of panic attacks. The patient is due for a nasopharyngeal swab. He was seen crying and told the nurse, “I can’t do this anymore! I thought I was already recovered from the infection. Why do they have to swab me? Are you telling me that I am going to die soon?” What would be the best response the nurse should make?
A. “I know it is frightening. Tell me what is it about the swab test that frightens you?”
B. “It is just a routinary test. No need to worry about it.”
C. “All patients with suspected symptoms are required to undergo with the swab test.”
D. “Maybe you can be prescribed another test. I will check with the physician.”