Mental health disorders and therapeutic communication

64 NCLEX-RN practice questions on Mental health disorders and therapeutic communication, part of Psychosocial Integrity. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium · Select all that apply

   A client with borderline personality disorder has been admitted after cutting her forearms. Which interventions should the nurse include in the plan?

   1. AAssign the client a favorite nurse who makes exceptions to the rules
   2. BTeach distress-tolerance skills such as using ice in the hand
   3. CAsk the client to sign a no-self-harm contract instead of observing her
   4. DGive extra attention to the client after each self-harm episode
   5. ESet clear limits that every staff member enforces the same way

   Show answerHide answer

   Answer: B, E

   Generate solutions: borderline care rests on consistent team limits and DBT coping skills; rewarding self-harm, special exceptions and no-harm contracts are unsafe.

   • A: Special exceptions feed splitting between staff.
   • C: Contracts do not prevent self-harm and never replace observation.
   • D: Reward after self-harm reinforces the behaviour.

2. Question 2 · Hard · Select all that apply

   A 15-year-old client with major depression is starting fluoxetine. Which instructions should the nurse give the parents?

   1. AStop the drug if there is no improvement after the first week
   2. BExpect mood to improve within 2 to 4 weeks or more
   3. CKeep the medication in a locked place and give each dose
   4. DWatch for new or worsening thoughts of suicide, especially in the first weeks
   5. EReport new agitation, restlessness or trouble sleeping
   6. FAvoid starting other drugs without asking the provider

   Show answerHide answer

   Answer: B, C, D, E, F

   Generate solutions: teaching for a young person on an SSRI covers the boxed suicidality warning, close watching early and after dose changes, delayed benefit, safe storage and drug interactions.

   • A: Effects take weeks; stopping early prevents benefit and should be decided by the provider.

3. Question 3 · Medium · Matrix

   For each finding, indicate whether it is more consistent with anorexia nervosa or bulimia nervosa.

   For each row, choose: Anorexia nervosa / Bulimia nervosa

   1. Normal body weight with eroded tooth enamel
   2. Swelling of the glands at the angles of the jaw
   3. Calluses on the backs of the fingers
   4. BMI of 15.5 with fine body hair on the arms
   5. Absent menstrual periods and a heart rate of 46/min

   Show answerHide answer

   Answer:

   • Normal body weight with eroded tooth enamel: Bulimia nervosa
   • Swelling of the glands at the angles of the jaw: Bulimia nervosa
   • Calluses on the backs of the fingers: Bulimia nervosa
   • BMI of 15.5 with fine body hair on the arms: Anorexia nervosa
   • Absent menstrual periods and a heart rate of 46/min: Anorexia nervosa

   Analyze cues: anorexia shows starvation signs (very low BMI, lanugo, bradycardia, amenorrhea); bulimia shows purging signs at a normal weight (enamel erosion, Russell sign, parotid swelling).

   • Normal body weight with eroded tooth enamel: Repeated vomiting at a normal weight suggests bulimia.
   • Swelling of the glands at the angles of the jaw: Parotid enlargement follows repeated purging.
   • Calluses on the backs of the fingers: Russell sign comes from self-induced vomiting.
   • BMI of 15.5 with fine body hair on the arms: Very low weight with lanugo points to anorexia.
   • Absent menstrual periods and a heart rate of 46/min: Starvation causes amenorrhea and bradycardia.

4. Question 4 · Medium · Matrix

   A client has started haloperidol. For each finding, indicate the extrapyramidal effect it represents.

   For each row, choose: Acute dystonia / Akathisia / Tardive dyskinesia

   1. Neck twisted to one side on the second day of treatment
   2. Lip smacking after several years of treatment
   3. Tongue darting in and out of the mouth
   4. Eyes fixed upward and unable to look down
   5. Paces and says his legs feel jittery
   6. Cannot stay seated through a meal

   Show answerHide answer

   Answer:

   • Neck twisted to one side on the second day of treatment: Acute dystonia
   • Lip smacking after several years of treatment: Tardive dyskinesia
   • Tongue darting in and out of the mouth: Tardive dyskinesia
   • Eyes fixed upward and unable to look down: Acute dystonia
   • Paces and says his legs feel jittery: Akathisia
   • Cannot stay seated through a meal: Akathisia

   Analyze cues: acute dystonia appears within days and is treated urgently with an anticholinergic; akathisia is often mistaken for agitation; tardive dyskinesia appears late and may be permanent.

   • Neck twisted to one side on the second day of treatment: Sudden muscle spasm early in therapy is acute dystonia.
   • Lip smacking after several years of treatment: Late involuntary mouth movements are tardive dyskinesia.
   • Tongue darting in and out of the mouth: Tongue protrusion is a typical sign of tardive dyskinesia.
   • Eyes fixed upward and unable to look down: An oculogyric crisis is a form of acute dystonia.
   • Paces and says his legs feel jittery: Inner restlessness with constant movement is akathisia.
   • Cannot stay seated through a meal: Inability to sit still is a hallmark of akathisia.

5. Question 5 · Hard · Select all that apply

   The nurse is teaching the husband of a client with moderate Alzheimer disease who becomes agitated in the late afternoon. Which statements by the husband indicate the teaching was effective?

   1. A"I'll remind her firmly that her mother died years ago."
   2. B"I'll turn the lights on before dusk and keep a night-light in the hall."
   3. C"I'll let her nap for most of the afternoon so she is rested."
   4. D"When she says her mother is coming, I'll talk about her mother and then offer a snack."
   5. E"I'll keep her meals, bath and bedtime at the same times each day."
   6. F"I'll take her for a walk in the late morning."

   Show answerHide answer

   Answer: B, D, E, F

   Evaluate outcomes: sundowning is managed with routine, daytime activity, good lighting and validation with redirection; long naps and reality confrontation make it worse.

   • A: Repeated confrontation with painful facts causes fresh grief and agitation.
   • C: Long daytime naps disturb night sleep and can worsen evening agitation.

6. Question 6 · Medium · Select all that apply

   The nurse is planning care for a client admitted with bulimia nervosa. Which interventions should be included?

   1. AAllow the client to skip meals when not hungry
   2. BDiscuss calorie counts with the client at each meal
   3. CAsk the client to keep a journal of feelings before binges
   4. DObserve the client for 1 to 2 hours after each meal
   5. EMonitor serum potassium

   Answer and explanation in LearnFree account

7. Question 7 · Hard · Matrix

   The nurse is assessing older clients with memory or thinking changes. For each finding, indicate the condition it most likely suggests.

   For each row, choose: Delirium / Dementia / Depression

   1. Complains at length about losing her memory
   2. Confusion began over a few hours and attention drifts in and out
   3. Sees insects on the wall since a urinary infection began
   4. Tries hard to answer and covers gaps with made-up details
   5. Gets lost in her own neighborhood, worsening over 2 years
   6. Answers "I don't know" to most questions without trying

   Answer and explanation in LearnFree account

8. Question 8 · Hard · Select all that apply

   The nurse is screening a 79-year-old client for suicide risk. Which factors increase his risk?

   1. AHe was widowed 4 months ago
   2. BHe drinks four beers each evening
   3. CHe keeps a hunting rifle in his home
   4. DHis daughter lives with him and checks on him daily
   5. EHe attends religious services weekly with friends
   6. FHe has severe pain from spinal stenosis

   Answer and explanation in LearnFree account

9. Question 9 · Medium · Select all that apply

   A client is having a panic attack in the dayroom. Which actions should the nurse take?

   1. AMove the client to a quieter area
   2. BStay with the client
   3. CGuide slow breathing by breathing with the client
   4. DLeave the client alone to regain control
   5. ESpeak in short, simple sentences
   6. FAsk the client to explain what caused the attack

   Answer and explanation in LearnFree account

10. Question 10 · Hard · Matrix

    The RN on a mental health unit works with assistive personnel (AP). For each task, indicate whether it can be delegated to the AP or must be done by the RN.

    For each row, choose: Delegate to AP / RN must perform

    1. Take vital signs of a stable client the day after ECT
    2. Teach a family about early signs of relapse
    3. Record meal intake for a client with anorexia nervosa
    4. Assess a newly admitted client's suicide risk
    5. Stay within arm's length of a client on one-to-one observation
    6. Evaluate a client's response to a PRN dose of haloperidol

    Answer and explanation in LearnFree account

11. Question 11 · Easy · Matrix

    For each finding, indicate whether it is more typical of a manic episode or a depressive episode of bipolar disorder.

    For each row, choose: Manic episode / Depressive episode

    1. Flight of ideas
    2. Sleeping 14 hours a day
    3. Pressured, loud speech
    4. Spending savings on impulse purchases
    5. Feelings of worthlessness

    Answer and explanation in LearnFree account

12. Question 12 · Medium · Select all that apply

    A client with obsessive-compulsive disorder washes his hands for long periods before every meal. Which actions should the nurse take during the first days of admission?

    1. AApply moisturizer to cracked skin on his hands
    2. BPoint out that the washing makes no sense
    3. CAllow time for the ritual in the daily schedule
    4. DPlan to limit the ritual gradually as anxiety decreases
    5. EPrevent the client from washing until he can explain why

    Answer and explanation in LearnFree account

13. Question 13 · Hard · Matrix

    A client with depression says, "I don't think I'll ever be happy again." For each nurse response, indicate whether it is therapeutic or non-therapeutic.

    For each row, choose: Therapeutic / Non-therapeutic

    1. "Are you having thoughts of killing yourself?"
    2. "Everyone feels down sometimes; you'll feel better soon."
    3. "I'll sit with you for a while."
    4. "You feel that nothing will ever get better."
    5. "Why do you feel that way?"
    6. "Let's talk about your discharge plans instead."

    Answer and explanation in LearnFree account

14. Question 14 · Medium · Matrix

    For each behaviour, indicate the personality disorder it most closely suggests.

    For each row, choose: Borderline / Antisocial / Avoidant

    1. Praises one nurse as perfect, then calls her cruel the next day
    2. Wants friends but avoids group therapy for fear of criticism
    3. Has a record of fights and theft beginning in early adolescence
    4. Makes frantic calls to her partner when he is late, then cuts herself
    5. Lies to staff without remorse to get extra cigarettes

    Answer and explanation in LearnFree account

15. Question 15 · Easy · Matrix

    A client says, "I can't stop worrying about losing my job." For each nurse response, indicate whether it is therapeutic or non-therapeutic.

    For each row, choose: Therapeutic / Non-therapeutic

    1. "You seem tense as you talk about work."
    2. "Don't worry, things will work out."
    3. "You should start looking for another job."
    4. "Tell me more about what worries you."

    Answer and explanation in LearnFree account

16. Question 16 · Medium · Select all that apply

    A client with major depression started sertraline 10 days ago. Which findings require follow-up for suicide risk?

    1. AEats about half of each meal
    2. BAppears suddenly calm and cheerful after weeks of distress
    3. CAttends the morning community meeting
    4. DReports mild nausea since starting the drug
    5. EHas given her favorite watch to a roommate
    6. FAsks how many pills are in a full bottle

    Answer and explanation in LearnFree account

17. Question 17 · Medium · Select all that apply

    A client with schizophrenia has taken clozapine for 2 months. Which findings require follow-up?

    1. ASore throat and a temperature of 101.2 °F (38.4 °C)
    2. BNo bowel movement for 5 days with abdominal distension
    3. CMild drowsiness after the bedtime dose
    4. DWeight gain of 2 lb (0.9 kg) in a month
    5. EChest pain and a resting heart rate of 122/min
    6. FExcess saliva on the pillow at night

    Answer and explanation in LearnFree account

18. Question 18 · Medium · Select all that apply

    A client with schizophrenia is pacing and appears to be listening to voices. Which actions are appropriate?

    1. AArgue that the voices are not real
    2. BLeave the client alone in a quiet room for several hours
    3. CAsk whether the voices are telling the client to do anything
    4. DEngage the client in a simple reality-based task
    5. ESay that the nurse does not hear the voices but understands they seem real to the client

    Answer and explanation in LearnFree account

19. Question 19 · Hard · Select all that apply

    A client receiving haloperidol is confused and diaphoretic. Which findings support neuroleptic malignant syndrome and require immediate follow-up?

    1. ATemperature of 104.2 °F (40.1 °C)
    2. BBlood pressure swinging from 168/98 to 98/60 mm Hg
    3. CDry mouth
    4. DRigid, lead-pipe muscle tone in the arms
    5. ENew stupor with reduced response to voice
    6. FCreatine kinase of 4,800 units/L

    Answer and explanation in LearnFree account

20. Question 20 · Medium · Select all that apply

    A client has returned to the unit after electroconvulsive therapy (ECT). Which actions should the nurse take?

    1. ACheck vital signs until they are stable
    2. BCheck the gag reflex before offering oral fluids
    3. CReorient the client to time and place
    4. DPlace the client side-lying until fully awake
    5. ETell the client memory loss after ECT is usually permanent
    6. FEncourage the client to walk alone to the dayroom right away

    Answer and explanation in LearnFree account

21. Question 21 · Medium · Matrix

    For each finding in a client with anxiety, indicate the level of anxiety it represents.

    For each row, choose: Mild / Moderate / Severe

    1. Voice trembles and pulse rises; can still talk through the problem
    2. Cannot solve a simple problem and fixates on small details
    3. Focuses on his immediate worry but follows directions when guided
    4. Feels restless and notices more around him; learns readily
    5. Reports a sense of dread, nausea and headache, and moves aimlessly

    Answer and explanation in LearnFree account

22. Question 22 · Easy · Select all that apply

    The nurse is admitting a client with major depressive disorder. Which findings are consistent with this diagnosis?

    1. AInflated self-esteem and grand plans
    2. BLoss of interest in activities once enjoyed
    3. CExcessive guilt over minor past mistakes
    4. DWaking at 0400 and being unable to fall back asleep
    5. EDifficulty concentrating on reading
    6. FSlowed speech and movement

    Answer and explanation in LearnFree account

23. Question 23 · Easy · Select all that apply

    A client with major depression is placed on suicide precautions in a private room. Which items should the nurse remove from the room?

    1. AA phone charger cord
    2. BA cotton blanket
    3. CA leather belt
    4. DA paperback book
    5. EA glass picture frame
    6. FShoelaces from sneakers

    Answer and explanation in LearnFree account

24. Question 24 · Hard · Select all that apply

    A client with anorexia nervosa is on day 3 of a nutritional rehabilitation program. Which findings suggest refeeding syndrome?

    1. AWeight gain of 0.4 lb (0.2 kg) since admission
    2. BSerum phosphorus of 1.7 mg/dL
    3. CNew ankle edema and fine crackles
    4. DSerum magnesium of 1.2 mEq/L
    5. EFasting blood glucose of 88 mg/dL
    6. FSerum potassium of 3.0 mEq/L

    Answer and explanation in LearnFree account

25. Question 25 · Hard · Select all that apply

    A client with schizophrenia says, "The government put a chip in my tooth to listen to my thoughts." Which responses by the nurse are therapeutic?

    1. A"Why do you think the government chose you?"
    2. B"Let's talk about something more pleasant."
    3. C"Tell me more about how the chip works."
    4. D"That isn't possible. No one can do that."
    5. E"I don't see any evidence of that, but you seem worried."
    6. F"That sounds frightening for you."

    Answer and explanation in LearnFree account