As the field of nursing continues to evolve, it becomes increasingly important for nursing professionals to stay updated and proficient in their knowledge and skills. One crucial aspect of nursing is mental health and psychiatric nursing, which deals with understanding and managing mental health disorders in patients.
The NCLEX (National Council Licensure Examination) plays a significant role in testing the proficiency of nursing candidates, and in this article, we will explore mental health NCLEX questions for nursing proficiency in 2023.
What is mental health/ psychiatric nursing?
Mental health and psychiatric nursing are crucial aspects of patient care, focusing on the emotional, psychological, and behavioral well-being of individuals. Nurses in this field play a vital role in supporting patients with mental health disorders, promoting mental wellness, and ensuring safe, effective care.
The Importance of mental health NCLEX questions
Before delving into specific NCLEX practice questions for mental health and psychiatric nursing, it's essential to understand the importance and purpose of these questions.
The importance of NCLEX mental health questions and NCLEX psych questions lies in their ability to enhance the knowledge, skills, and competence of nursing students and registered nurses in the field of mental health and psychiatric nursing. These practice questions serve as valuable tools for preparing individuals to succeed in the NCLEX and, more importantly, in providing quality care to patients with mental health conditions throughout their nursing careers.
NCLEX practice questions specifically designed for mental health nursing allow students and nurses to comprehensively review and consolidate their understanding of essential concepts, assessment techniques, interventions, and therapeutic approaches related to mental health care.
Mental health NCLEX questions
There are many NCLEX test banks for mental health nursing. Smart’n also offers one of the best NCLEX practice question banks. With over 2500 NCLEX practice questions with rationales, and more than 60 hours of NGN case studies, Smart’n helps nursing students get prepared for this nursing license exam.
Here are some mental health test questions and answers from Smart’n:
Question 1:
A client with schizoaffective disorder is being seen for recurrent swallowing issues as a result of consuming non-food items. Which of the following would this client be at the highest risk for?
A. Breakdown of the oral mucosa
B. Injury to the muscles of the neck
C. Choking from eating non-food items
D. Gastroesophageal reflux
A. Incorrect Answer
Breakdown of the oral mucosa
Rationale: The highest risk for this client is the issue of choking.
B. Incorrect Answer
Injury to the muscles of the neck
Rationale: Swallowing does not cause neck muscle injury.
C. Correct Answer
Choking from eating non-food items
Rationale: Some clients develop pica, which is the ingestion of non-food substances. A client with pica may crave certain items or may be unaware that he or she is eating abnormal items. The client, in this case, is at risk of choking if he tries to consume something that could become lodged in his throat.
D. Incorrect Answer
Gastroesophageal reflux
Rationale: Eating non-food items may cause this, but the highest risk is the risk of choking on these types of items.
Question 2:
A client has been brought into the emergency department suffering from symptoms of a panic attack. The client has a heart rate of 110 bpm and is shaking, sweating, and feels short of breath. Which action should the nurse perform first?
A. Provide a calm environment and speak to the client in a calm manner
B. Perform an anxiety screening using the Modified Speilberger State Anxiety Scale
C. Administer oxygen and an antidepressant medication such as sertraline (Zoloft)
D. Perform an EEG to determine if the client's brain waves are affected by the panic
A. Correct Answer
Provide a calm environment and speak to the client in a calm manner
Rationale: When a client is brought in because of a panic attack, the nurse must first attend to the airway, breathing, and circulation. Following this assessment, the nurse then may try to calm the client, if possible. Although speaking to a client in a calm voice may not always help the situation, the nurse should at least provide a quiet and calm environment in order to perform other tasks.
B. Incorrect Answer
Perform an anxiety screening using the Modified Speilberger State Anxiety Scale
Rationale: There is an anxiety screening tool that the nurse can use to assess the client called The State-Trait Anxiety Inventory (STAI). However, this should be done in a calm manner by the nurse.
C. Incorrect Answer
Administer oxygen and an antidepressant medication such as sertraline (Zoloft)
Rationale: If the client feels short of breath, a set of vital signs should be obtained before administering oxygen. Often, the client is hyperventilating and does not need oxygen.
D. Incorrect Answer
Perform an EEG to determine if the client's brain waves are affected by the panic
Rationale: A client who is suffering from a panic attack does not need an EEG.
Question 3:
A client with obsessive-compulsive disorder (OCD) has been cleaning a bathroom for most of the morning. When the roommate demands that the client leave the bathroom so that the roommate can shower, the client becomes angry and says, "You can't make me leave, everything is still dirty." What is the best nursing action?
A. Engage other staff members to remove the client from the bathroom
B. Give a reminder that the client has been cleaning the bathroom for 1½ hours and it is time to take a break
C. Tell the client that the bathroom is very clean and that this behavior is unreasonable
D. Tell the roommate to use the shower in another room
A. Incorrect Answer
Engage other staff members to remove the client from the bathroom
Rationale: Engaging other staff members to remove the client from the bathroom is confrontational and will increase the client's and roommate's anxiety; this approach is not necessary or therapeutic.
B. Correct Answer
Give a reminder that the client has been cleaning the bathroom for 1½ hours and it is time to take a break
Rationale: Clients with OCD engage in rituals and behaviors that help reduce the anxiety or stress rooted in their obsessions (recurrent thoughts, impulses, or images that cause notable distress). If the ritual is interrupted, the client will experience increased anxiety.
A client with compulsive behavior often does not realize the amount of time or how many times the same activity has been performed. By providing reflective feedback about the client's behavior, the nurse is acknowledging the behavior in a nonjudgmental manner. The nurse should also help the client become involved in other activities and problem-solving skills.
C. Incorrect Answer
Tell the client that the bathroom is very clean and that this behavior is unreasonable
Rationale: Pointing out that the bathroom is clean does not change the client's obsessive thoughts. Saying that the client's behavior is unreasonable conveys a message of disapproval and would increase the client's anxiety.
D. Incorrect Answer
Tell the roommate to use the shower in another room
Rationale: Telling the roommate to use a different bathroom allows the client to continue the ritualistic behavior, is non-therapeutic, reinforces the behavior, and avoids the issue.
Question 4:
A client is receiving nasogastric tube feedings as nutritional rehabilitation for anorexia nervosa. After a weigh-in, the client learns of gaining 2 lb (0.9 kg) and says to the nurse, "See what your force-feeding has done to me? I'm fatter and uglier than ever." What is the best action by the nurse?
A. Have the client keep a journal and write about feelings
B. Initiate one-on-one supervision of the client during feedings
C. Remind the client that gaining weight means being able to go home
D. Say that the client is not fat and ugly
A. Incorrect Answer
Have the client keep a journal and write about feelings
Rationale: This is an appropriate intervention for a client with anorexia nervosa. Feelings related to lack of control are an underlying problem for these clients, who use food as a way to deal with them. Keeping a diary or journal of feelings will help the client recognize and express them more clearly. However, this is not the priority nursing action.
B. Correct Answer
Initiate one-on-one supervision of the client during feedings
Rationale: Nutrition support (enteral tube feedings and total parenteral nutrition) is usually reserved for clients with anorexia nervosa who are severely ill and/or have not responded to oral nutritional therapy. Such clients are at high risk for medical complications from anorexia nervosa, including death. Criteria for nutrition support include:
Severe weight loss that is life-threatening
Client's unwillingness to adhere to a treatment plan of oral feedings
The priority nursing actions for this high-risk client include interventions to meet physiological and safety needs. Providing one-on-one supervision during the tube feeding will ensure that the client is actually receiving the feeding and prevent the client from stopping the feeding and/or pulling out the nasogastric tube. During the one-on-one contact with the client, the nurse can promote a therapeutic and trusting relationship with the client by:
Being honest and accepting of the client
Presenting the reality of the condition
Acknowledging the client's feelings of loss of control and anger
Encouraging the client to express feelings and fears
C. Incorrect Answer
Remind the client that gaining weight means being able to go home
Rationale: This may be a true statement; clients with anorexia nervosa are usually discharged to outpatient follow-up and treatment or to a residential treatment facility once an acceptable weight gain has been achieved and maintained. However, this is not the priority nursing action.
D. Incorrect Answer
Say that the client is not fat and ugly
Rationale: Clients with anorexia nervosa have a distorted body image and a morbid fear of being overweight; they perceive themselves as "fat and ugly" even when they are emaciated. Saying that the client is not "fat and ugly" will not change this perception.
Question 5:
The nurse is caring for a client admitted with abdominal pain, who has been diagnosed with somatic symptom disorder after a thorough evaluation finds no medical cause for the symptoms. Which intervention should the nurse include in the plan of care?
A. Advocate for an elimination diet to identify the cause of the symptoms
B. Limit time spent discussing physical symptoms with the client
C. Reinforce negative examination results when pain medication is requested
D. When abdominal pain is mentioned, remind the client that it is not real
A. Incorrect Answer
Advocate for an elimination diet to identify the cause of the symptoms
Rationale: An elimination diet would increase the client's focus on the symptoms and is inappropriate, as physiological causes have already been ruled out.
B. Correct Answer
Limit time spent discussing physical symptoms with the client
Rationale: Somatic symptom disorder (SSD) is a psychological disorder that develops from stress, resulting in medically unexplainable physical symptoms (eg, abdominal pain) that disrupt daily life. Clients with SSD focus an excessive amount of time, thought, and energy on the symptoms, often seeking medical care from multiple health care providers. Nursing interventions focus on minimizing indirect benefits and developing client insight. To minimize the indirect benefits from being "sick" (secondary gains), the nurse should:
Redirect somatic complaints to unrelated, neutral topics
Limit time spent discussing physical symptoms (Option 2)
To promote insight and healthy coping mechanisms, the nurse should assist the client to:
Identify secondary gains (eg, increased attention, freedom from responsibilities)
Recognize factors that intensify symptoms (eg, increased stress, reminders of a deceased family member)
Incorporate appropriate coping strategies (eg, relaxation training, physical activity)
C. Incorrect Answer
Reinforce negative examination results when pain medication is requested
Rationale: The client's symptoms are real despite the lack of diagnostic findings. The nurse should administer analgesics as prescribed.
D. Incorrect Answer
When abdominal pain is mentioned, remind the client that it is not real
Rationale: Disputing the validity of the client's symptoms may increase the client's stress level and exacerbate symptoms.
Question 6:
The nurse is educating a client in preparation for discharge from the hospital when the client begins crying and states, "I was diagnosed with a conversion disorder, so the health care provider must think I'm crazy." Which statement would be the best reply to this client?
A. "Conversion disorder is a diagnosis that acknowledges that your symptoms are real, even if there isn't a physical cause."
B. "I am very sorry to hear this, but are you sure that's what the provider meant? Maybe you misunderstood."
C. "The health care provider is probably wrong. I'll give you the information my health care provider used."
D. "Why do you think the health care provider diagnosed you with a conversion disorder?"
A. Correct Answer
"Conversion disorder is a diagnosis that acknowledges that your symptoms are real, even if there isn't a physical cause."
Rationale: Conversion disorder (functional neurological symptom disorder)
Clinical features:
Neurological symptoms (eg, weakness/paralysis, nonepileptic seizures, sensory disturbances)
Not intentionally produced (contrary to factitious disorder or malingering)
Findings incompatible with recognized neurological conditions
Symptoms cause significant functional impairment
Often precipitated by psychological stressors
Treatment options:
Education about the disorder
Cognitive-behavioral therapy
Physical therapy for motor symptoms
Conversion disorder (ie, functional neurological system disorder), refers to the presence of neurological symptoms brought on by psychological stress, without a clear physical cause. Despite being medically unexplainable, these symptoms can lead to significant deficits in neurological functioning (eg, paralysis, blindness). A distinctive feature of conversion disorder is la belle indifference, or "the grand" indifference, which describes a client's lack of an emotional response to varying deficits.
These symptoms are not intentionally produced by the client, or a result of a factitious disorder, malingering, or attention-seeking behavior. The symptoms are real to the client despite the lack of diagnostic findings. It is important to validate the client's experiences and educate the client on the diagnosis using therapeutic communication (Option 1).
B. Incorrect Answer
"I am very sorry to hear this, but are you sure that's what the provider meant? Maybe you misunderstood."
Rationale: Expressing an apology is acceptable if it is genuine; however, invalidating the client's experience without educating or addressing the client's feelings is nontherapeutic.
C. Incorrect Answer
"The health care provider is probably wrong. I'll give you the information my health care provider used."
Rationale: This response is nontherapeutic and unprofessional and does not increase the client's understanding of the diagnosis.
D. Incorrect Answer
"Why do you think the health care provider diagnosed you with a conversion disorder?"
Rationale: Although it is important to explore the client's feelings, asking "why" questions can feel accusatory and cause the client to become defensive, increasing the overall stress level.
Question 7:
A client who was suddenly overwhelmed with an intense fear that something terrible was going to happen is brought to the emergency department by the spouse after they were out at dinner. The client is now shaking, hyperventilating, and having heart palpitations. What is the priority nursing action?
A. Encourage the client to perform deep breathing exercises
B. Explore possible reasons for the episode
C. Place the client in a private room and tell the client to relax
D. Remain in the room with the client
A. Incorrect Answer
Encourage the client to perform deep breathing exercises
Rationale: Deep breathing exercises can relieve hyperventilation, but the priority is to remain with the client to ensure safety.
B. Incorrect Answer
Explore possible reasons for the episode
Rationale: Discussing the reasons for the panic attack is not appropriate while the client is still symptomatic. Once the client has calmed down, the nurse can discuss reasons for the attacks, evaluate stressors in the client's life, and assist the client in developing prevention strategies.
C. Incorrect Answer
Place the client in a private room and tell the client to relax
Rationale: A private room is appropriate; however, just telling a client to relax is not helpful.
D. Correct Answer
Remain in the room with the client
Rationale: This client is experiencing the symptoms of a panic attack and should not be left alone. The priority nursing action is to stay with the client to ensure the client's safety and offer support. Additional nursing actions while the client is experiencing panic symptoms include:
Maintaining a calm, matter-of-fact approach
Speaking calmly and using simple, clear words and phrases when providing information on emergency department procedures
Placing the client in a room with as few stimuli as possible
Administering an anti-anxiety medication such as a benzodiazepine (per health care provider prescription)
Having the client take slow, deep breaths if hyperventilation is a problem
Question 8:
The nurse is caring for a client with a history of heroin use. Which clinical finding may indicate withdrawal?
A. Constipation
B. Constricted pupils
C. Drowsiness
D. Tachycardia
A. Incorrect Answer
Constipation
Rationale: Opioid use typically causes constipation, constricted pupils, and drowsiness due to its central nervous system depressant effects.
B. Incorrect Answer
Constricted pupils
Rationale: Opioid use typically causes constipation, constricted pupils, and drowsiness due to its central nervous system depressant effects.
C. Incorrect Answer
Drowsiness
Rationale: Opioid use typically causes constipation, constricted pupils, and drowsiness due to its central nervous system depressant effects.
D. Correct Answer
Tachycardia
Rationale: Opioid withdrawal
Time course:
4 to 48 hr after opioid cessation
Immediately after opioid antagonist (life-threatening)
Clinical Presentation:
Gastrointestinal: nausea, vomiting, cramping, diarrhea, ↑ bowel sounds
Cardiac: ↑ pulse, ↑ blood pressure, diaphoresis
Psychologic: insomnia, yawning, dysphoric mood
Other: myalgia, arthralgia, mydriasis, lacrimation, rhinorrhea, piloerection
Diagnosis:
History & examination alone (clinical diagnosis)
Management:
Opioid agonist: methadone or buprenorphine
Nonopioid: clonidine or adjunctive medications (antiemetics, antidiarrheals, benzodiazepines)
Clients with opioid dependence (eg, oxycodone, hydrocodone, heroin) may develop acute withdrawal if opioids are abruptly stopped, the dosage is reduced, or a reversal agent (ie, naloxone) is administered. Withdrawal symptoms (eg, anxiety/restlessness, nausea/vomiting, pupillary dilation, tachycardia) are related to increased sympathetic nervous system activity as the depressant effect of the opioid wanes (Option 4).
Although opioid withdrawal is seldom life-threatening, clients who demonstrate signs of acute withdrawal may be given medications, such as methadone, to alleviate discomfort. The nurse should alert the healthcare provider of suspected withdrawal to facilitate appropriate opioid weaning or maintenance interventions.
Question 9:
The nurse is caring for a client with mild to moderate dementia in a residential facility. The client is exhibiting sundowning behavior and is found wandering throughout the hallway in the middle of the night. When communicating with the client, what statement by the nurse is most appropriate?
A. "If you continue wandering in the dark by yourself you might fall."
B. "What are you doing in the hallway? It is not time to wake up yet."
C. "You are in the residential home. Let us go back to your room together."
D. "You should not leave your room without assistance."
A. Incorrect Answer
"If you continue wandering in the dark by yourself you might fall."
Rationale: Communicating disapproval of the client's actions (eg, "You might fall…") does not assist in reality orientation.
B. Incorrect Answer
"What are you doing in the hallway? It is not time to wake up yet."
Rationale: Probing the client who is disorientated (eg, "What are you doing in the hallway?") is not therapeutic and does not promote reality orientation.
C. Correct Answer
"You are in the residential home. Let us go back to your room together."
Rationale: Sundowning (sundown syndrome) is characterized by acute behavioral disturbances experienced by clients with dementia. Sundowning typically occurs in the late afternoon or evening and is linked to a disruption in circadian rhythm. These clients often remain awake during the night and experience increased confusion, wandering, and/or aggression. Risk factors include decreased exposure to light and a disturbed sleep pattern.
When caring for clients experiencing sundowning, the nurse should first listen to their concerns to identify their source of fear or agitation and reorient them to the present time and environment (eg, "You are in the residential home. Let us go back to your room together.") (Option 3).
D. Incorrect Answer
"You should not leave your room without assistance."
Rationale: Penalizing the client (eg, "You should not leave your room without assistance.") can be interpreted as paternalistic and may further escalate the client's behavior.
Question 10:
A client with schizophrenia is started on clozapine. Which periodic measurements take priority in this client?
A. Complete blood count and absolute neutrophil count
B. ECG and blood pressure
C. Fasting blood glucose and fasting lipid panel
D. Height, weight, and waist circumference
A. Correct Answer
Complete blood count and absolute neutrophil count
Rationale: Clozapine (Clozaril) is an atypical antipsychotic medication used to treat schizophrenia that has not responded to standard, more traditional treatment. Clozapine is associated with a risk for agranulocytosis (a potentially fatal blood disorder causing a dangerously low WBC count) and is therefore used only in clients with treatment-resistant schizophrenia.
A client must have a WBC count of ≥3500/mm3 (3.5 × 109/L) and an absolute neutrophil count (ANC) of ≥2000/mm3 (2 × 109/L) before starting clozapine, so it is critical to obtain a baseline complete blood count and ANC. Because agranulocytosis is reversible if caught early, the client's WBC count and ANC must also be monitored regularly throughout the course of clozapine therapy (initially once a week) (Option 1). Clients should also contact the health care provider immediately if they develop fever or sore throat, which can indicate infection due to neutropenia.
B. Incorrect Answer
ECG and blood pressure
Rationale: ECG and blood pressure monitoring is performed before therapy initiation and periodically during therapy because prolonged QT interval and orthostatic hypotension are potential side effects of clozapine; however, agranulocytosis poses a more significant danger to the client.
C. Incorrect Answer
Fasting blood glucose and fasting lipid panel
Rationale: Hyperglycemia, dyslipidemia, and weight gain are potential side effects of clozapine therapy but are not as serious as agranulocytosis.
D. Incorrect Answer
Height, weight, and waist circumference
Rationale: Hyperglycemia, dyslipidemia, and weight gain are potential side effects of clozapine therapy but are not as serious as agranulocytosis.
You can find more mental health NCLEX questions or even NCLEX depression questions or NCLEX anxiety questions by signing up on Smart’n for FREE.
The Benefits of NCLEX Practice Questions
Engaging in mental health nursing practice questions offers several advantages to NCLEX candidates:
1. Self-assessment
Mental health nursing question banks allow candidates to gauge their understanding of mental health and psychiatric nursing concepts, identifying areas that may require further study.
2. Familiarization with the exam format
Practicing with NCLEX-style questions familiarizes candidates with the format and structure of the actual exam, reducing test anxiety.
3. Content reinforcement
Repetitive practice reinforces essential concepts and improves the retention of information.
4. Improving time management
Through practice, candidates learn to manage their time efficiently, which is crucial during the actual NCLEX exam.
5. Building confidence
Regular practice boosts candidates' confidence, leading to better performance during the examination.
Conclusion
Mental health NCLEX questions or psych NCLEX questions for nursing proficiency in 2023 are indispensable for nursing candidates preparing for the NCLEX examination. Engaging in practice questions and quizzes helps candidates assess their knowledge, identify weak areas, and build confidence.
Mental health and psychiatric nursing are vital components of patient care, and nursing professionals must stay updated and proficient in these areas to provide the best possible care to their patients.
FAQs
1. What is the NCLEX exam?
The NCLEX (National Council Licensure Examination) is a standardized examination that assesses the competency of nursing graduates for licensure. It is a crucial step for nurses to become licensed and practice in their respective jurisdictions.
2. What topics does the NCLEX exam cover?
The NCLEX exam covers various areas of nursing, including mental health and psychiatric nursing, medical-surgical nursing, maternal and child health, and more.
3. Why are NCLEX practice questions important?
NCLEX practice questions are essential because they allow nursing candidates to self-assess their knowledge, familiarize themselves with the exam format, reinforce content, and build confidence.
4. Is there a time limit for NCLEX practice quizzes?
Most NCLEX practice quizzes are not timed, allowing candidates to answer questions at their own pace and thoroughly comprehend each item.
