NCLEX-PN mental health practice questions

Question 1

At a 6-week well-baby visit at a pediatric clinic, the father of a healthy infant tells the nurse, "He cries for hours every evening, and nothing works. Last night I got so angry I was afraid of what I might do." The nurse reinforces the teaching the registered nurse (RN) gave the parents about coping with crying. Which statement by the father indicates that the teaching has been understood?

Accepted Answer

C: "If I feel I am losing control, I will lay him on his back in his crib, close the door, and take a break.". Crying peaks at around 6 to 8 weeks of age and is worst in the late afternoon and evening, even in healthy infants. Long periods of inconsolable crying are the most common trigger for abusive head trauma, when a frustrated caregiver shakes the baby. An infant's head is heavy, the neck muscles are weak and the brain moves inside the skull, so shaking can tear blood vessels and cause bleeding, brain injury, blindness or death.

The key teaching is that it is safe to walk away. A baby crying in a safe crib for a few minutes is not in danger; a caregiver at the end of their tether is. The father who plans to put the baby down on his back in the crib, close the door and calm down has learned the most protective message.

Question 2

A 34-year-old client with severe anxiety who is on a medical unit for dehydration has vomited twice and cannot keep oral medication down. The health care provider prescribes lorazepam 1 mg IM once. The vial is labeled lorazepam 2 mg/mL. How many mL should the nurse administer? Record your answer using 1 decimal place.

Accepted Answer

0.5 or .5. Lorazepam is a benzodiazepine that calms severe anxiety within minutes to an hour. It enhances the effect of GABA, the brain's main calming neurotransmitter. Given IM, it is injected deep into a large muscle, and the nurse monitors the respiratory rate, the level of sedation, and the blood pressure afterward and keeps the client on fall precautions.

The volume comes from the dose wanted divided by the concentration on hand. The dose wanted is 1 mg and the vial holds 2 mg in every mL, so half a milliliter delivers the dose.

Question 3

On the third day after a colostomy, a client says, "I'm so embarrassed by the noises it makes." Which response by the nurse is most appropriate?

Accepted Answer

A: "That's a common worry. The noises usually lessen over the next few weeks.". A new stoma is often noisy as peristalsis returns and gas passes, and the client cannot control it. Acknowledging the feeling and giving accurate information, that the noises usually lessen over the next few weeks as the bowel settles and diet is adjusted, supports body image and helps the client begin to accept the stoma.

Question 4

A 31-year-old client who was admitted 6 days ago with suicidal thoughts is being discharged tomorrow. The client has written a safety plan with the registered nurse (RN), and the nurse is reviewing it with the client. Which of the following information should the nurse expect the safety plan to include?

Accepted Answer

A: Steps to make the home safer, such as a friend keeping the client's extra medications; B: Activities the client can do alone to calm down, such as listening to music or walking; C: The thoughts, moods, and situations that usually come before a crisis for the client; E: Names and phone numbers of people to call for help, plus the 988 Suicide and Crisis Lifeline. A safety plan is a short written list the client builds with a clinician and keeps where it can be found quickly in a crisis. It works step by step: recognize the personal warning signs, use coping strategies alone, go to people and places that distract, reach out to people who can help, contact professionals and crisis lines, and make the surroundings safer.

Personal warning signs come first, because the client cannot use the plan without knowing when to start it. Activities the client can do alone, such as music or a walk, help the client ride out a wave of distress before reaching out. Names and numbers of people to call, with 988 and the outpatient clinic, give the client someone to reach at any hour. Limiting access to lethal means is one of the most effective parts of the plan, since a suicidal crisis often passes within minutes to hours, and a client who cannot reach the means in that window often survives it.

The client and the RN write the plan in the client's own words. The nurse reviews it with the client, makes sure the client knows where it is kept, and reports anything missing to the RN.

Question 5

A 52-year-old client with metastatic breast cancer is receiving hospice care at home. During a visit she says to the nurse, "My grandchildren are so young. They won't even remember me." Which of the following actions by the nurse would support the client?

Accepted Answer

B: Ask her what she would most like her grandchildren to know about her; C: Offer to help her record a video or write letters for the grandchildren to have later; E: Ask whether she would like a hospice volunteer to help her put together a photo album of her life. A common worry for dying parents and grandparents is being forgotten. Leaving something behind, often called a legacy project, answers that worry directly and gives the last weeks of life a purpose that matters to the client.

Asking what she wants her grandchildren to know helps her put her values and her story into words, which is part of reviewing her life. Videos, letters for future birthdays and photo albums give the children something real of her own words and face. Hospice volunteers often help with these projects so that the client can do as much as her energy allows.

Question 6

A client with acute mania is speaking so quickly that the nurse can barely follow, jumping from the weather to a business plan to a childhood story, each loosely connected to the last. Which of the following describes this finding?

Accepted Answer

C: Flight of ideas. Flight of ideas is thought running faster than speech can keep up with. The topics change constantly and each one is loosely connected to the one before, so a listener who concentrates can usually see the thread even while it gets away from them.

It is the classic finding in acute mania, and it comes with the rest of that picture: little sleep, enormous energy, grandiose plans, and a client who is often delighted with themselves. Acute mania is also when a bipolar client becomes psychotic, usually with grandiose delusions.

Word salad is the one to hold it against. In flight of ideas the connections are loose. In word salad there are no connections at all, and the client is sicker.

Question 7

A client at a community mental health clinic has been talking about stress at work. He says, "Should I move back in with my parents? What would you do?" Which of the following responses by the nurse is most appropriate?

Accepted Answer

C: "What do you think you should do? Tell me the choices you see.". Giving advice is a nontherapeutic response, even when a client asks for it directly. Advice puts the nurse's values and choices in place of the client's, and it takes the decision away from the person who has to live with it. If things go badly, the client can blame the nurse, and if things go well, the client has learned to depend on someone else rather than on himself.

The therapeutic response hands the question back. Asking "What do you think you should do?" tells him the nurse believes he can think this through, and it invites him to talk about the options, what he wants, and what worries him. The nurse can then help him weigh them without choosing for him.

Question 8

At a primary care clinic, the nurse is reinforcing teaching with a 70-year-old client with hypertension and type 2 diabetes who has had two transient ischemic attacks and was recently found to have early vascular dementia. The client smokes 1 pack of cigarettes a day. Which of the following information should the nurse reinforce to slow the progression of the client's memory loss?

Accepted Answer

A: "Walk for about 30 minutes on most days, at a pace your provider approves."; B: "Keep your blood glucose within the target range your provider set."; D: "Take your blood pressure medication every day, even when you feel well."; E: "Stop smoking, and ask about a program that can help you quit.". Vascular dementia is a decline in thinking caused by damage to the blood vessels of the brain, through many small strokes or long-standing narrowing of small arteries. Its course often moves in steps, with a drop after each new event. The damage already done does not heal, but the next stroke can often be prevented.

Prevention means controlling the same risk factors that cause stroke. Taking antihypertensive medication every day keeps the pressure on the small brain arteries down. Stopping smoking removes a major cause of vessel damage and clotting. Keeping blood glucose in range protects the small vessels from diabetic damage. Regular moderate exercise, such as walking on most days, lowers blood pressure over time and improves blood flow to the brain. A heart-healthy diet and any prescribed antiplatelet or cholesterol medication help as well.

Question 9

On admission to the adolescent unit, a 16-year-old client with anorexia nervosa has a body mass index of 15.2. Which of the following findings should the nurse expect while collecting admission data?

Accepted Answer

A: Resting heart rate of 46/min; B: Fine, soft hair over the arms and back; D: Temperature of 96.3 F (35.7 C). Anorexia nervosa is an eating disorder in which a person severely limits food because of an intense fear of gaining weight and a distorted view of body size.

Severe starvation makes the body conserve energy wherever it can. The heart slows, often to below 50 beats a minute, and the blood pressure falls, especially on standing. Body temperature drops because there is little fat for insulation and little fuel to burn for heat, and the hands and feet are often cold and bluish.

Lanugo, fine downy hair on the arms, back and face, grows as the body's attempt to hold in heat. Menstrual periods often stop because the hormones that drive them shut down when the body has too little energy.

Question 10

The nurse in a skilled nursing facility plans one-to-one time with four residents who are disoriented at times. For which resident would reality orientation be the most appropriate approach?

Accepted Answer

B: A 76-year-old who is recovering from delirium after pneumonia and woke today unsure of the date and the facility name. Reality orientation means giving the person the date, the place and the names of the people around them, and using clocks, calendars and signs so they can check for themselves. It works only when the brain can take in the correction and hold on to it.

A resident who is recovering from delirium can do that. Delirium is a temporary failure of brain function caused by an illness such as pneumonia, and as it clears, frequent, calm orientation helps the resident make sense of the surroundings and lowers fear. This resident's confusion is about the date and place, which orientation cues can fix.

In moderate and severe dementia, the brain can no longer store the correction. Telling a resident that her mother died long ago, or that the farm is gone, is forgotten within minutes but causes fresh distress each time. For these residents, validation, which responds to the feeling behind the words and then gently redirects, is the better approach.

NCLEX-PN mental health practice questions.