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Mental Health NCLEX practice questions
Psychosocial Integrity is 6 to 12% of the NCLEX-RN. These questions cover therapeutic communication, psychiatric medications, safety and withdrawal.
Question 1 · Physiological Adaptation
An older adult with a history of mild Alzheimer's disease is brought to the emergency department after family reports the patient became suddenly confused and agitated over the past day, is unable to focus attention, and has been seeing things that are not there. The family states the patient's baseline was only mild forgetfulness. The nurse recognizes these findings are most consistent with which condition?
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Answer: A. Sudden onset, fluctuating attention, and new hallucinations occurring over hours to a day are hallmark signs of delirium, an acute and often reversible confusional state that can occur on top of existing dementia; the underlying cause must be identified and treated. Dementia is a gradual, progressive decline over months to years, not something that appears suddenly. Normal aging does not cause acute confusion or hallucinations. A depressive episode does not typically present with sudden hallucinations and fluctuating level of consciousness.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 14.3
Question 2 · Safety and Infection Control
A patient has been placed in restraints after all less restrictive measures failed. Which nursing actions are appropriate? Select all that apply.
Select all that apply.
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Answer: A, B, E. Correct nursing care during restraint use includes documenting the behaviors and alternatives tried, performing circulation and needs checks on a tight, scheduled basis, and ensuring the order is time-limited, all of which protect the patient and provide the necessary chart-based defense. Restraint orders must never be PRN because each episode requires a new time-limited order and reassessment. Skipping documentation of rationale is unsafe and inappropriate because thorough documentation is the primary legal and clinical protection when restraints are used.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 10.2
Question 3 · Pharmacological and Parenteral Therapies
A patient's serum lithium level is reported as 1.8 mEq/L. Which findings should the nurse recognize as signs of lithium toxicity? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, F. Lithium toxicity, which occurs at levels over 1.5 mEq/L, presents with tremor, diarrhea, ataxia, and confusion. Weight gain and constipation are not acute signs of lithium toxicity and are more associated with other chronic effects or unrelated conditions, so they should not be prioritized as toxicity indicators in this scenario.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 4.2
Question 4 · Safety and Infection Control
A client becomes violently aggressive and attempts to strike staff after all de-escalation techniques and less restrictive interventions have failed. Restraints are applied. Within what timeframe must a provider or specially trained RN see the client face-to-face to evaluate the need for continued restraint?
Show answer and rationale
Answer: B. For restraint used to manage violent or self-destructive behavior, a physician or other licensed practitioner, or a specially trained RN, must see the client face-to-face within 1 hour after the restraint starts to evaluate the client's condition, reaction to the intervention and need for continued restraint. Fifteen minutes is not the regulatory deadline; it is closer to the interval many facilities use for circulation, skin and needs checks. Four hours is the longest a single adult order can run before it must be renewed, not the deadline for this evaluation. Eight hours is not a time frame in the rule and would leave the client restrained far too long without the required evaluation.
Checked against: OpenStax Clinical Nursing Skills, 9.5; OpenStax Psychiatric-Mental Health Nursing, 10.2
Question 5 · Psychosocial Integrity
A patient states, 'I feel like nothing I do matters anymore.' Which nurse response uses the best therapeutic communication technique?
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Answer: B. Reflecting the feeling back to the patient is a core therapeutic communication technique that validates emotion and encourages the patient to continue expressing themselves. Asking 'why' is always an incorrect choice because it can sound accusatory and puts the patient on the defensive. Offering false reassurance such as 'I'm sure things will get better' is also automatically wrong because it minimizes the patient's experience without basis. Changing the subject to discharge planning avoids addressing the patient's emotional cue and blocks therapeutic communication.
Checked against: OpenStax Fundamentals of Nursing, 35.1
Question 6 · Psychosocial Integrity
A patient says, 'I won't be a burden much longer.' What is the nurse's most appropriate response?
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Answer: C. This statement is a covert expression of suicidal ideation, and covert statements require the nurse to ask an overt, direct question to assess risk accurately. Reassuring the patient that family loves having them dismisses the underlying feeling and avoids the real issue. Asking 'why' is a therapeutic communication error that can make the patient feel interrogated rather than supported. Redirecting to something positive avoids the critical assessment needed and could miss an at-risk patient.
Checked against: OpenStax Clinical Nursing Skills, 3.1
Question 7 · Psychosocial Integrity
A patient hospitalized for major depression has been withdrawn and tearful for a week. Today the nurse notes the patient is calm, smiling, and giving away a favorite necklace to a roommate. What is the nurse's priority action?
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Answer: D. A sudden lift in mood combined with giving away possessions is a classic red flag that the patient may have made a decision to end their life, so the nurse must directly and immediately assess suicide risk. Documenting the mood as simply 'improved' without further assessment misses a critical warning sign and could allow a suicide attempt to occur. Encouraging group therapy does not address the urgent safety concern that needs to be assessed first. Notifying the family before assessing risk delays the priority action of ensuring the patient's immediate safety.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 16.2
Question 8 · Psychosocial Integrity
A nurse wants to encourage a patient to talk more about feelings after a suicide attempt. Which statement is most therapeutic?
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Answer: A. "Tell me more about what led up to this" is an open-ended statement that invites the patient to elaborate and explore feelings, which is the goal of therapeutic communication. "Why" questions sound accusatory and put the patient on the defensive. "Everything is going to be fine" is false reassurance that dismisses real feelings. "Did you take too many pills?" is a closed yes/no question that limits the patient's response and does not encourage exploration.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 3.1
Question 9 · Physiological Adaptation
A patient withdrawing from long-term benzodiazepine use is most likely to exhibit which cluster of symptoms?
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Answer: D. Withdrawal from a depressant like a benzodiazepine produces the opposite effect of the drug, causing signs of central nervous system stimulation such as agitation, tachycardia, and sweating. Sedation, bradycardia, and hypotension describe the effects of the drug itself, not withdrawal from it. Flat affect and psychomotor retardation are more typical of stimulant withdrawal, not depressant withdrawal. Euphoria and hyperactivity would be expected with stimulant intoxication, not withdrawal from a depressant.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 19.5
Question 10 · Psychosocial Integrity
On an inpatient psychiatric unit, the nurse structures the day with community meetings, group activities, and a predictable schedule to promote patient recovery. This approach is best described as which therapeutic modality?
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Answer: D. Milieu therapy uses the structured, safe therapeutic environment itself, including scheduled activities and community meetings, to promote healing. Cognitive behavioral therapy is an individual or group talk therapy focused on changing thoughts and behaviors rather than structuring the whole environment. Electroconvulsive therapy is a biological/somatic treatment, not an environmental approach. Aversion therapy pairs an unwanted behavior with an unpleasant stimulus and is unrelated to structuring a unit's daily environment.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 2.3; OpenStax Psychiatric-Mental Health Nursing, 5.3
Question 11 · Physiological Adaptation
A patient who recently stopped using cocaine is being assessed by the nurse. Which findings are consistent with stimulant withdrawal? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, B, C, D. Withdrawal from a stimulant produces the opposite of the drug's effect, so the patient 'crashes' into depression, increased appetite, fatigue/hypersomnia, and vivid unpleasant dreams. Tachycardia and hypertension are signs of stimulant intoxication or use, not withdrawal, since the body is no longer being stimulated once the drug clears. Recognizing that withdrawal mirrors the opposite of the substance's effect helps the nurse correctly identify the syndrome and avoid mistaking it for ongoing drug use.
Checked against: OpenStax Clinical Nursing Skills, 20.2; OpenStax Psychiatric-Mental Health Nursing, 19.3
Question 12 · Safety and Infection Control
A patient is admitted to the inpatient psychiatric unit after a suicide attempt with a plan and available means. Which interventions should the nurse implement? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, F. Suicide precautions for a high-risk patient include continuous 1:1 observation, removal of hazardous items such as sharps, belts, and shoelaces, direct assessment of current suicidal ideation, and frequent safety checks per protocol. Allowing the patient to keep all personal belongings is unsafe because items could be used for self-harm. Placing the patient in a private room away from staff isolates them and reduces the level of monitoring needed to keep them safe.
Checked against: OpenStax Psychiatric-Mental Health Nursing, 16.3
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Frequently asked questions
What mental health topics are on the NCLEX?
Therapeutic communication, psychiatric medications and their side effects, suicide and safety, and substance withdrawal are common. Psychosocial Integrity is 6 to 12% of the NCLEX-RN test plan.
About these questions
Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.