This NCLEX-RN practice test for psychiatric nursing includes questions for caring for patients with varied mental health problems. Concepts such as depression, suicidal ideation and tendencies, therapeutic communication and drug therapy make up a majority of the questions. There are also items that talks about abuses, eating disorders and crisis interventions.
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.
1. The nurse is planning care with a Mexican-American client who is diagnosed with depression. The client believes in “mal ojo” (the evil eye), and uses treatment by a root healer. The nurse should do which of the following?
A. Avoid talking to the client about the root healer.
B. Explain to the client that Western medicine has a scientific, not mystical, basis.
C. Explain that such beliefs are superstitious and should be forgotten.
D. Involve the root healer in a consultation with the client, physician and nurse.
2. After a period of unsuccessful treatment with Elavil (amitriptyline), a woman diagnosed with depression is switched to Parnate (tranylcypromine). Which statement by the client indicates the client understands the side effects of Parnate?
A. “I need to increase my intake of sodium.”
B. “I must refrain from strenuous exercise.”
C. “I must refrain from eating aged cheese or yeast products.”
D. “I should decrease my intake of foods containing sugar.”
3. A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The physician prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerfully greets the nurse. He appears to be relaxed and joins the group for community meeting before supper. What should the nurse interpret as the most likely cause of the client’s behavior?
A. The Effexor is helping the client’s symptoms of depression significantly.
B. The client’s sudden improvement calls for close observation by the staff.
C. The staff can decrease their observation of the client.
D. The client is nearing discharge due to the improvement of his symptoms.
4. A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member’s statement indicates a need for additional teaching?
A. “My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks.”
B. “My wife will need to take her antidepressant medicine and go to group to stay well.”
C. “My son will only need to attend outpatient appointments when he starts to feel depressed again.”
D. “My mother might need help with grocery shopping, cooking, and cleaning for a while.”
5. A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, “I want to know why I’m so depressed.” Which of the following statements by the nurse is most helpful?
A. “I know you’ll get better with the right medication.”
B. “Let’s discuss possible reasons underlying your depression.”
C. “Your depression is most likely caused by a brain chemical imbalance.”
D. “Members of your family seem very supportive of you.”
6. A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client’s daughter asks the nurse, “How painful will the treatment be for Mom?” The nurse should respond by saying which of the following?
A. “Your mother will be given something for pain before the treatment.”
B. “The physician will make sure your mother doesn’t suffer needlessly.”
C. “Your mother will be asleep during the treatment and will not be in pain.”
D. “Your mother will be able talk to us and tell us if she’s in pain.”
7. A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, “My boss was wonderful! He was understanding and a really nice man.” The nurse interprets the client’s statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse?
A. “But, I don’t understand, wasn’t he the one who fired you?”
B. “Tell me more about having to work while not being able to sleep or concentrate.”
C. “It must have been hard to leave a boss like that.”
D. “It sounds like he would hire you back if you asked.”
8. A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which of the following nursing actions is most appropriate?
A. Explaining the importance of hygiene to the client.
B. Asking the client if he is ready to shower.
C. Waiting until the client’s family can participate in the client’s care.
D. Stating to the client that it’s time for him to take a shower.
9. The nurse overhears a client with acute mania who is euphoric and flirtatious attempting to be sexually inappropriate with other clients by talking about a sexual exploit to a group of clients seated at a table. Which of the following should the nurse do next?
A. Continue walking down the hall, ignoring the conversation.
B. Speak to the client later in private while saying nothing at this time.
C. Tell the client others may not want to hear about sex, and invite him to play a game of
D. Inform the client that if he continues to talk about sex no one will want to be around him.
10. The client with acute mania states to the nurse, “I’m the prince of peace and can save the world. Those against me will find me and take me to another world. They will come. I know it.” The client is beginning to scan the room and starts to repeat his delusion. Which of the following responses by the nurse is most therapeutic?
A. “Describe the people who will come.”
B. “The staff and I will protect you.”
C. “You are not the prince of peace. Your name is Joe.”
D. “Let’s walk around the unit for a while.”
11. A client exhibiting euphoria, hyperactivity, and distractibility cannot remain seated at mealtimes long enough to eat an adequate amount of food. When developing the client’s plan of care, the nurse anticipates providing the client with “finger food” to eat while moving about the unit. Which of the following foods should the nurse include in the client’s plan of care?
A. Bacon, lettuce, and tomato sandwich.
C. Ice cream cone.
D. Cut-up vegetables.
12. A client admitted to the nursing unit with bipolar disorder, manic phase, is accompanied by his wife. The wife states that her husband has been overly energetic and happy, talking constantly, purchasing many unneeded items, and sleeping about 4 hours a night for the past 5 days. When completing the client’s daily assessment, the nurse should be especially alert for which of the following findings?
13. The wife of a client with bipolar disorder, manic phase, states to the nurse, “He’s acting so crazy. What did he do to get this way?” The nurse bases the response on the understanding of which of the following about this disorder?
A. It is caused by underlying psychological difficulties.
B. It is caused by disturbed family dynamics in the client’s early life.
C. It is the result of an imbalance of chemicals in the brain.
D. It is the result of a genetic inheritance from someone in the family.
14. The physician orders valproic acid (Depakene) for a client with bipolar disorder who has achieved limited success with lithium carbonate (Lithane). Which of the following should the nurse include in the client’s medication teaching plan?
A. Follow-up blood tests are unnecessary.
B. The tablet can be crushed if necessary.
C. Drowsiness and upset stomach are common side effects.
D. Consumption of a moderate amount of alcohol is safe.
15. A client’s wife states, “I don’t know what to do sometimes. It’s so hard having a husband with a mental illness like bipolar disorder.” After talking with the client’s wife about her feelings and difficulties, which of the following actions is most appropriate?
A. Suggest that the wife see her physician.
B. Give the wife information about a support group.
C. Recommend that the wife talk with her close friend.
D. Have the wife share her feelings with her husband.
16. A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat?
A. Using open-ended questions and silence
B. Sharing personal preference regarding food choices
C. Documenting reasons why the client does not want to eat
D. Offering opinions about the necessity of adequate nutrition
17. The nurse should plan which goals of the termination stage of group development? Select all that apply.
A. The group evaluates the experience.
B. The real work of the group is accomplished.
C. Group interaction involves superficial conversation.
D. Group members become acquainted with one another.
E. Some structuring of group norms, roles, and responsibilities takes place.
F. The group explores members’ feelings about the group and the impending separation.
18. When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach?
A. Providing a supportive environment
B. Examining intrapsychic conflicts and past issues
C. Emphasizing social interaction with clients who withdraw
D. Helping the client to examine dysfunctional thoughts and beliefs
19. A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program?
A. Admitting to having a problem
B. Substituting other activities for gambling
C. Stating that the gambling will be stopped
D. Discontinuing relationships with people who gamble
20. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, “How is Carol doing? She is my best friend and is seen at your clinic every week.” Which is the most appropriate nursing response?
A. “I cannot discuss any client situation with you.”
B. “If you want to know about Carol, you need to ask her yourself.”
C. “Only because you’re worried about a friend, I’ll tell you that she is improving.”
D. “Being her friend, you know she is having a difficult time and deserves her privacy.”
21. A client diagnosed with delirium becomes disoriented and confused at night. Which intervention should the nurse implement initially?
A. Move the client next to the nurses’ station.
B. Use an indirect light source and turn off the television.
C. Keep the television and a soft light on during the night.
D. Play soft music during the night, and maintain a well-lit room.
22. A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention?
A. Encouraging quiet reading and writing for the first few days
B. Identification of physical activities that will provide exercise
C. No socializing activities, until the client asks to participate in milieu
D. A structured program of activities in which the client can participate
23. A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement?
A. Place the client in seclusion for 30 minutes.
B. Tell the client that the behavior is inappropriate.
C. Escort the client to their room, with the assistance of other staff.
D. Tell the client that their telephone privileges are revoked for 24 hours.
24. Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply.
A. Communicate expected behaviors to the client.
B. Ensure that the client knows that they are not in charge of the nursing unit.
C. Assist the client in identifying ways of setting limits on personal behaviors.
D. Follow through about the consequences of behavior in a nonpunitive manner.
E. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups.
F. Have the client state the consequences for behaving in ways that are viewed as unacceptable.
25. The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client?
C. Ping pong
26. The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings should the nurse expect to note? Select all that apply.
A. Dental decay
B. Moist, oily skin
C. Loss of tooth enamel
D. Electrolyte imbalances
E. Body weight well below ideal range
27. The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client’s room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate?
A. Interrupt the client and weigh her immediately.
B. Interrupt the client and offer to take her for a walk.
C. Allow the client to complete her exercise program.
D. Tell the client that she is not allowed to exercise rigorously.
28. The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event?
A. Witnessing a murder
B. The death of a loved one
C. A fire that destroyed the client’s home
D. A recent rape episode experienced by the client
29. The nurse is conducting an initial assessment of a client in crisis. When assessing the client’s perception of the precipitating event that led to the crisis, which is the most appropriate question?
A. “With whom do you live?”
B. “Who is available to help you?”
C. “What leads you to seek help now?”
D. “What do you usually do to feel better?”
30. The police arrive at the emergency department with a client who has lacerated both wrists. Which is the initial nursing action?
A. Administer an antianxiety agent.
B. Assess and treat the wound sites.
C. Secure and record a detailed history.
D. Encourage and assist the client to ventilate feelings.