NR 292 / NR292 NURSING Mental Health NCLEX QUESTIONS AND ANSWERS

1. The home care nurse is visiting an older client whose spouse died 6 months ago.
Which behavior by the client indicates ineffective coping?
1. Neglecting personal grooming
2. Looking at old snapshots of family
3. Participating in a senior citizens' program
4. Visiting their spouse's grave once a month

1. Neglecting personal grooming

2. A client 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?
1. "You have everything to live for."
2. "Why do you see yourself as a failure?"
3. "Feeling like this is all part of being depressed."
4. "You've been feeling like a failure for a while?"

4. "You've been feeling like a failure for a while?"

3. When the mental health nurse visits a client at home, the client states, "I haven't slept
at all the last couple of nights." Which response by the nurse illustrates a therapeutic
communication response to this client?
1. "I see."
2. "Really?"
3. "You're having difficulty sleeping?"
4. "Sometimes, I have trouble sleeping too."

3. "You're having difficulty sleeping?"

4. 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?
1. Using open-ended questions and silence
2. Sharing personal preference regarding food choices
3. Documenting reasons why the client does not want to eat
4. Offering opinions about the necessity of adequate nutrition

1. Using open-ended questions and silence

5. A client 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 client implementing?
1. Denial
2. Projection
3. Regression
4. Rationalization

1. Denial

6. A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish
my family would stop hoping for a cure! I get so angry when they carry on like this. After
all, I'm the one who's dying." Which response by the nurse is therapeutic?
1. "Have you shared your feelings with your family?"
2. "I think we should talk more about your anger with your family."
3. "You're feeling angry that your family continues to hope for you to be cured?"
4. "You are probably very depressed, which is understandable with such a diagnosis."

3. "You're feeling angry that your family continues to hope for you to be cured?"

7. On review of the client's record, the nurse notes that the mental health admission
was voluntary. Based on this information, the nurse anticipates which client
behavior?
1. Fearfulness regarding treatment measures.
2. Anger and aggressiveness directed toward others.
3. An understanding of the pathology and symptoms of the diagnosis.
4. A willingness to participate in the planning of the care and treatment plan.

4. A willingness to participate in the planning of the care and treatment plan.

8. When reviewing the admission assessment, the nurse notes that a client was admitted
to the mental health unit involuntarily. Based on this type of admission, the nurse
should provide which intervention for this client?
1. Monitor closely for harm to self or others.
2. Assist in completing an application for admission.
3. Supply the client with written information about their mental illness.
4. Provide an opportunity for the family to discuss why they felt the admission was
needed.

1. Monitor closely for harm to self or others.

9. The nurse is preparing a client for the termination phase of the nurse-client
relationship. The nurse prepares to implement which nursing task that is most
appropriate for this phase?
1. Planning short-term goals
2. Making appropriate referrals
 3. Developing realistic solutions
4. Identifying expected outcomes

2. Making appropriate referrals

10. The nurse in the mental health unit recognizes which as being therapeutic
communication techniques? Select all that apply.
1. Restating
2. Listening
3. Asking the client, "Why?"
4. Maintaining neutral responses
5. Providing acknowledgment and feedback
6. Giving advice and approval or disapproval

o 1. Restating

o 2. Listening

o 4. Maintaining neutral responses

o 5. Providing acknowledgment and feedback

11. A client being seen in the emergency department immediately after being sexually
assaulted appears calm and controlled. The nurse analyzes this behavior as
indicating which defense mechanism?
1. Denial
2. Projection
3. Rationalization
4. Intellectualization

1. Denial

12. A client's unresolved feelings related to loss would be most likely observed during which
phase of the therapeutic nurse-client relationship?
1. Trusting
2. Working
3. Orientation
4. Termination

4. Termination

13. The nurse is working with a client who despite making a heroic effort was unable to
rescue a neighbor trapped in a house fire. Which client-focused action should the
nurse engage in during the working phase of the nurse-client relationship?
1. Exploring the client's ability to function
2. Exploring the client's potential for self-harm
 3. Inquiring about the client's perception or appraisal of why the rescue was unsuccessful
4. Inquiring about and examining the client's feelings for any that may block
adaptive coping

4. Inquiring about and examining the client's feelings for any that may block
adaptive coping

14. The nurse employed in a mental health unit of a hospital is the leader of a group
psychotherapy session. What is the nurse's role during the termination stage of
group development?
1. Acknowledging that the group has identified goals
2. Encouraging the accomplishment of the group's work
3. Acknowledging the contributions of each group member
4. Encouraging members to become acquainted with one another

3. Acknowledging the contributions of each group member

15. Which are characteristics of the termination stage of group development? Select all
that apply.
1. The group evaluates the experience.
2. The real work of the group is accomplished.
3. Group interaction involves superficial conversation.
4. Group members become acquainted with each other.
5. Some structuring of group norms, roles, and responsibilities takes place.
6. The group explores members' feelings about the group and the impending separation.

o 1. The group evaluates the experience.

o 6. The group explores members' feelings about the group and the
impending separation.

16. 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 understands that which is the purpose of this approach?
1. Providing a supportive environment
2. Examining intrapsychic conflicts and past issues
3. Emphasizing social interaction with clients who withdraw
4. Helping the client to examine dysfunctional thoughts and beliefs

4. Helping the client to examine dysfunctional thoughts and beliefs

17. The nurse understands that which best describes Gestalt therapy?
1. It emphasizes self-expression, self-exploration, and self-awareness in the present.
2. It promotes the individual's comfort in the group, which then transfers to
other relationships.
3. The therapist focuses on how irrational beliefs and thoughts contribute to
 psychological distress.
4. The therapist's goal is to help others express their feelings toward one another
during group sessions.

1. It emphasizes self-expression, self-exploration, and self-awareness in the present.

18. 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?
1. Admitting to having a problem
2. Substituting other activities for gambling
3. Stating that the gambling will be stopped
4. Discontinuing relationships with people who gamble

1. Admitting to having a problem

19. Which describes the primary focus of milieu therapy?

1. A form of behavior modification therapy
2. A cognitive approach to changing behavior
3. A living, learning, or working environment
4. A behavioral approach to changing behavior

3. A living, learning, or working environment

20. While being treated, a client is introduced to short periods of exposure to the
phobic object while in a relaxed state. What term is used to describe this form of
behavior modification?
1. Milieu therapy
2. Aversion therapy
3. Self-control therapy
4. Systematic desensitization

4. Systematic desensitization

21. A client is planning to attend Overeaters Anonymous. Which statement by the client
indicates a need for additional information regarding this self-help group?
1. "The leader is a nurse or psychiatrist."
2. "The members provide support to each other."
3. "People who have a similar problem are able to help others."
4. "It is designed to serve people who have a common problem."

1. "The leader is a nurse or psychiatrist."

22. What is the most appropriate nursing action to help manage a manic client who is
monopolizing a group therapy session?
1. Ask the client to leave the group for this session only.
2. Refer the client to another group that includes other manic clients.
 3. Tell the client to stop monopolizing in a firm but compassionate manner.
4. Thank the client for the input, but inform the client that now others need a chance
to contribute.

4. Thank the client for the input, but inform the client that now others need a chance to
contribute.

23. Which type of therapeutic approach has the characteristic that all team members are
seen as equally important in helping clients meet their goals?
1. Milieu therapy
2. Interpersonal therapy
3. Behavior modification
4. Rational emotive therapy

1. Milieu therapy

24. A client says to the nurse, "The federal guards were sent to kill me." What
is the best nursing response to the client's concern?
1. "I don't believe this is true."
2. "The guards are not out to kill you."
3. "Do you feel afraid that people are trying to hurt you?"
4. "What makes you think the guards were sent to hurt you?"

3. "Do you feel afraid that people are trying to hurt you?"

25. A client diagnosed with delirium becomes disoriented and confused at night. Which
intervention should the nurse implement initially?
1. Move the client next to the nurse's station.
2. Use an indirect light source and turn off the television.
3. Keep the television and a soft light on during the night.
4. Play soft music during the night, and maintain a well-lit room.

2. Use an indirect light source and turn off the television.

26. 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?
1. Encouraging quiet reading and writing for the first few days
2. Identification of physical activities that will provide exercise
3. No socializing activities, until the client asks to participate in milieu
4. A structured program of activities in which the client can participate

4. A structured program of activities in which the client can participate

27. When planning the discharge of a client with chronic anxiety, the nurse directs the
goals at promoting a safe environment at home. Which is the most appropriate
maintenance goal?
 1. Suppressing feelings of anxiety
2. Identifying anxiety-producing situations
3. Continued contact with a crisis counselor
4. Eliminating all anxiety from daily situations

2. Identifying anxiety-producing situations

28. A client is unwilling to go out of the house for fear of "making a fool of myself in
public." Because of this fear, the client remains homebound. Based on these data,
which mental health disorder is the client experiencing?
1. Agoraphobia
2. Social phobia
3. Claustrophobia
4. Hypochondriasis

2. Social phobia

29. The nurse is conducting a group therapy session. During the session, a client
diagnosed with mania consistently disrupts the group's interactions. Which
intervention should the nurse initially implement?
1. Setting limits on the client's behavior
2. Asking the client to leave the group session
3. Asking another nurse to escort the client out of the group session
4. Telling the client that they will not be able to attend any future group sessions

1. Setting limits on the client's behavior

30. A client is admitted to a medical nursing unit with a diagnosis of acute blindness after
being involved in a hit-and-run accident. When diagnostic testing cannot identify any
organic reason why this client cannot see, a mental health consult is prescribed.
Which condition will be the focus of this consult?
1. Psychosis
2. Repression
3. Conversion disorder
4. Dissociative disorder

3. Conversion disorder

31. A manic client begins to make sexual advance towards 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?
1. Place the client in seclusion for 30 minutes.
2. Tell the client that the behavior is inappropriate.
3. Escort the client to their room, with the assistance of other staff.
4. Tell the client that their telephone privileges are revoked for 24 hours.
 3. Escort the client to their room, with the assistance of other staff.

32. Which nursing interventions are appropriate for a hospitalized client with mania who
is exhibiting manipulative behavior? Select all that apply.
1. Communicate expected behaviors to the client.
2. Ensure that the client knows that they are not in charge of the nursing unit.
3. Assist the client in identifying ways of setting limits on personal behaviors.
4. Follow through about the consequences of behavior in a nonpunitive manner.
5. Enforce rules by informing the client that they will not be allowed to attend
therapy groups.
6. Have the client state the consequences for behaving in ways that are viewed
as unacceptable.

o 1. Communicate expected behaviors to the client.

o 3. Assist the client in identifying ways of setting limits on personal behaviors.

o 4. Follow through about the consequences of behavior in a nonpunitive manner.

o 6. Have the client state the consequences for behaving in ways that are viewed
as unacceptable.

33. The nurse observes that a client is pacing, agitated, and presenting aggressive gestures.
The client's speech pattern is rapid, and affect is belligerent. Based on these
observations, what is the nurse's immediate priority of care?
1. Provide safety for the client and other clients on the unit.
2. Provide the clients on the unit with a sense of comfort and safety.
3. Assist the staff in caring for the client in a controlled environment.
4. Offer the client a less stimulating area to calm down in and gain control.

1. Provide safety for the client and other clients on the unit.

34. The nurse is preparing a client with a history of command hallucinations for discharge
by providing instructions on interventions for managing hallucinations and anxiety.
Which statement in response to these instructions suggests to the nurse that the client
understands the instructions?
1. "My medications aren't likely to make me anxious."
2. "I'll go to support group and talk so that I don't hurt anyone."
3. "It's not likely that I'll get anxious or hear things if I get enough sleep and eat well."
4. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."

4. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."

35. The nurse is caring for a client diagnosed with catatonic stupor who is lying on the bed
in a fetal position. What is the most appropriate nursing intervention?
1. Ask direct questions to encourage talking.
 2. Leave the client alone so as to minimize external stimuli.
3. Sit beside the client in silence with occasional open-ended questions.
4. Take the client into the dayroom with other clients so that they can help watch
him.

3. Sit beside the client in silence with occasional open-ended questions.

36. The nurse is caring for a client who is experiencing disturbed thought processes
as a result of paranoia. In formulating nursing interventions with the members
of the health care team, what best instruction should the nurse provide to the
staff?
1. Increase socialization of the client with peers.
2. Avoid laughing or whispering in front of the client.
3. Begin to educate the client about social supports in the community.
4. Have the client sign a release of information to appropriate parties for
assessment purposes.

2. Avoid laughing or whispering in front of the client.

37. 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?
1. Chess
2. Writing
3. Ping pong
4. Basketball

2. Writing

38. The home health nurse visits a client at home and determines that the client is
dependent on drugs. During the assessment, which action should the nurse take to
plan appropriate nursing care?
1. Ask the client why he started taking illegal drugs.
2. Ask the client about the amount of drug use and its effect.
3. Ask the client how long he thought that he could take drugs without someone
finding out.
4. Not ask any questions for fear that the client is in denial and will throw the nurse
out of the home.

2. Ask the client about the amount of drug use and its effect.