Mental NCLEX

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Sample questions from Mental NCLEX

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 24-year-old client in the emergency department reports feeling hopeless after a relationship breakup. The client says, "I have a gun at home and know when I would use it." The client is calm, with BP 128/76 mm Hg, pulse 82/min, and respirations 16/min. What should the nurse do first?

   • A.Ask the client to sign a no-suicide contract and return to the waiting area
   • B.Maintain continuous observation and arrange immediate safety precautions
   • C.Ask the client's partner to take the client home and remove the gun later
   • D.Begin teaching the client relaxation techniques

   Rationale: The client has a specific suicide plan and access to a lethal means, so continuous observation and immediate safety measures are priorities. A no-suicide contract does not ensure safety, and discharge with a partner leaves the client at risk. Relaxation teaching is not an adequate response to imminent danger.

2. 2.A 31-year-old client with schizophrenia is admitted to an inpatient unit. The client reports hearing a voice say, "You are worthless," but denies commands to act and is not agitated. Vital signs are stable. Which response by the nurse is best?

   • A."The voice is not real, so try to ignore it."
   • B."What does the voice say, and how is it affecting you?"
   • C."I hear the voice too, and it sounds frightening."
   • D."You should stay in your room until the voice stops."

   Rationale: Exploring the hallucination assesses its content, including potential commands, while acknowledging the client's experience without reinforcing it. Telling the client the voice is not real dismisses the distress, and claiming to hear it reinforces the hallucination. Isolation does not address safety or therapeutic engagement.

3. 3.A 46-year-old client with bipolar disorder takes lithium carbonate. At a clinic visit, the client reports vomiting, worsening hand tremors, and difficulty walking. The lithium level is 1.8 mEq/L; the client is alert, BP 116/72 mm Hg, and pulse 88/min. What is the nurse's priority action?

   • A.Give the scheduled lithium with food
   • B.Hold lithium and notify the health care provider promptly
   • C.Encourage the client to restrict fluids for the day
   • D.Reassure the client that these are expected effects during treatment

   Rationale: A lithium level of 1.8 mEq/L with gastrointestinal symptoms, coarse tremor, and ataxia suggests toxicity, so the medication should be held and the provider notified. Giving the dose or dismissing the symptoms could worsen toxicity. Fluid restriction can increase lithium concentration; the client needs prompt evaluation and appropriate hydration management.

4. 4.A 39-year-old client with major depressive disorder started sertraline 10 days ago. The client says, "I have more energy now, and I have decided to end my life tonight." The client has no visible injuries; vital signs are stable. What should the nurse do first?

   • A.Ask the client to promise not to self-harm
   • B.Initiate immediate suicide precautions and remain with the client
   • C.Tell the client that the medication will improve mood soon
   • D.Arrange a routine follow-up appointment for next week

   Answer and rationale are in the full material.

5. 5.A 72-year-old client with dementia is admitted to the hospital for pneumonia. At 0200, the client is newly disoriented, tries to climb out of bed, and has an oxygen saturation of 89% on room air, compared with 95% earlier. What should the nurse do first?

   • A.Apply wrist restraints to prevent a fall
   • B.Assess oxygenation and other acute causes of the change
   • C.Document that the behavior is expected with dementia
   • D.Administer a sedative so the client can sleep

   Answer and rationale are in the full material.