NCLEX-PN Psychosocial Integrity Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Medium

   A 52-year-old client visits the primary care clinic and states, "My youngest child just moved away to college, and the house feels completely empty. I spent twenty-four years being a full-time mother, and now I do not know who I am anymore." Which response by the practical nurse is most appropriate?

   1. AA. You must be relieved to finally have quiet time and freedom for yourself.
   2. BB. Your child will be back home for school breaks before you even realize it.
   3. CC. Why do you not look into adopting a pet to keep you company at home?
   4. DD. Losing that daily hands-on parenting role can feel like a significant loss.
   Show answer to question 1

   Answer: D. Losing that daily hands-on parenting role can feel like a significant loss.

   Acknowledging the empty nest transition as a meaningful loss validates the client's identity disruption without offering platitudes. Assuming the client should feel relieved or suggesting a pet discounts the profound grief associated with maternal role reorganization.

2. Question 2 of 25Medium

   A client on an inpatient psychiatric unit is seated in a crowded, noisy dayroom. The client suddenly clasps their hands over their ears and screams, "Stop shouting at me!" Which action should the practical nurse take first?

   1. AA. Turn up the television volume to help drown out the sounds.
   2. BB. Escort the client to a quiet, low-stimulus environment.
   3. CC. Request an immediate prescription for physical restraints.
   4. DD. Ask the other clients in the dayroom to apologize to the client.
   Show answer to question 2

   Answer: B. Escort the client to a quiet, low-stimulus environment.

   High-stimulus environments can trigger or exacerbate hallucinations and agitation; moving the client to a calm, low-stimulus area helps de-escalate anxiety and sensory overload. Physical restraints are a last resort and are not indicated for verbal distress. Increasing the television volume adds further sensory confusion, and asking others to apologize wrongly implies that fellow clients were actually shouting at the client.

3. Question 3 of 25Medium

   A client with posttraumatic stress disorder is hospitalized for pneumonia. After a loud crash in the hallway, the client crouches by the bed, appears terrified, and shouts, "Get down, they are shooting!" Which action should the nurse take?

   1. AA. Place a hand on the client's shoulder to offer reassurance
   2. BB. Tell the client that the sound was not real and to stop reliving the event
   3. CC. Ask the client to describe the event in detail to release the emotions
   4. DD. Call the client by name, state the location, and say the client is safe now
   Show answer to question 3

   Answer: D. Call the client by name, state the location, and say the client is safe now

   During a flashback the client is reacting to the past. Calm orientation to name, place, and safety helps ground the client in the present without startling the client.

   Why the other options are wrong

   • AUnexpected touch may be perceived as a threat and could provoke a defensive or violent reaction.
   • BCommanding the client to stop and dismissing the experience is invalidating and does not orient the client.
   • CAsking for detailed retelling during a flashback may deepen the distress and is not the immediate need.

4. Question 4 of 25Easy

   A client's husband died suddenly in the emergency department an hour ago. The client states, "No, that can't be right. They must have mixed up his chart with someone else's." The nurse identifies this statement as which reaction to loss?

   1. AA. Anger
   2. BB. Denial
   3. CC. Bargaining
   4. DD. Acceptance
   Show answer to question 4

   Answer: B. Denial

   Refusing to believe that the death occurred is denial. It is a common, protective early reaction to sudden loss and gives the client time to absorb the news.

   Why the other options are wrong

   • AAnger would be shown by hostility or blame toward staff or others, not by disbelief that the death happened.
   • CBargaining involves attempts to make deals or promises to reverse or postpone the loss, and the client made none.
   • DAcceptance means acknowledging the death and beginning to adjust, which is the opposite of this statement.

5. Question 5 of 25Medium

   A 70-year-old man who had a stroke has expressive aphasia and becomes frustrated when he tries to tell the nurse about his pain. Which approach best helps him communicate his needs?

   1. AA. Ask simple yes-or-no questions, offer a picture board, and allow time.
   2. BB. Finish his sentences for him quickly so that he feels less frustrated now.
   3. CC. Speak very loudly and slowly so that he can hear each word clearly.
   4. DD. Wait to discuss his pain until the speech therapist is able to visit.
   Show answer to question 5

   Answer: A. Ask simple yes-or-no questions, offer a picture board, and allow time.

   With expressive aphasia the client understands speech but struggles to produce it. Simple closed questions, visual aids, and patience let him share needs without added pressure.

   Why the other options are wrong

   • BFinishing his sentences can lead to errors, undermines his dignity, and often increases his frustration.
   • CHis hearing is not impaired, so very loud speech is unnecessary and may seem demeaning.
   • DDelaying communication about his pain leaves his needs unmet and is unsafe, since the nurse can assess pain now.

6. Question 6 of 25Easy

   A nurse in a long-term care facility notes that an 82-year-old woman with dementia becomes restless and agitated each late afternoon in a busy, noisy dayroom. Which intervention best promotes a therapeutic environment for her?

   1. AA. Seat her near the television so she stays occupied and calm.
   2. BB. Add more group activities to the late afternoon schedule.
   3. CC. Move her to a quiet, softly lit area with a steady routine.
   4. DD. Keep her in her room with the door closed and no visitors.
   Show answer to question 6

   Answer: C. Move her to a quiet, softly lit area with a steady routine.

   Clients with dementia become more agitated with excess noise and stimulation. A calm, quiet, predictable setting reduces agitation and supports safety.

   Why the other options are wrong

   • ATelevision adds noise and visual stimulation that can worsen confusion and agitation.
   • BMore activities increase stimulation at the time of day when she is already overwhelmed.
   • DIsolation with no contact can increase fear and disorientation and is not therapeutic.

7. Question 7 of 25Medium

   A client with opioid use disorder was last using 12 hours ago. The client reports muscle aches and abdominal cramping, and the nurse observes yawning, a runny nose, dilated pupils, and goosebumps. The nurse recognizes these findings as consistent with which condition?

   1. AA. Opioid overdose
   2. BB. Opioid withdrawal
   3. CC. Stimulant intoxication
   4. DD. Sedative overdose
   Show answer to question 7

   Answer: B. Opioid withdrawal

   Yawning, rhinorrhea, piloerection, dilated pupils, muscle aches, and cramping are classic signs of opioid withdrawal. They are uncomfortable but typically not life-threatening.

   Why the other options are wrong

   • AOverdose causes pinpoint pupils, slow breathing, and decreased level of consciousness.
   • CStimulant intoxication causes agitation, a rapid pulse, and high temperature, not yawning and a runny nose.
   • DSedative overdose causes drowsiness and slowed breathing, not the hyperarousal seen here.

8. Question 8 of 25Medium

   A female client who practices Islam is admitted to the medical unit. Which nursing intervention best demonstrates culturally and spiritually sensitive care for this client?

   1. AA. Providing regular hospital gelatin and broths prepared with commercial animal extracts.
   2. BB. Performing non-urgent vital signs and assessments during the client's scheduled daily prayer times.
   3. CC. Assigning female nursing staff to assist with bathing and physical care whenever feasible.
   4. DD. Removing the client's traditional head covering during hospital stays to maintain hygiene standards.
   Show answer to question 8

   Answer: C. Assigning female nursing staff to assist with bathing and physical care whenever feasible.

   Modesty is deeply valued in Islamic tradition, and clients typically prefer healthcare providers of the same gender for personal hygiene, physical examinations, and intimate care. Daily prayer is a vital spiritual obligation and routine care should be planned around these times rather than interrupting them. Removing the head covering without permission violates modesty, and common gelatin products often contain pork by-products that are prohibited (haram).

9. Question 9 of 25Hard

   A client with bipolar disorder who takes prescribed daily lithium is observing a religious fast that requires abstaining from all food and fluids from sunrise to sunset. Which action should the licensed practical nurse (LPN) take first?

   1. AA. Administer double the evening dose of lithium to compensate for daytime fasting.
   2. BB. Encourage the client to drink water secretly during daylight hours to stay hydrated.
   3. CC. Consult with the healthcare provider and client regarding fluid balance and drug levels.
   4. DD. Advise the client that religious fasting is forbidden while taking mood stabilizers.
   Show answer to question 9

   Answer: C. Consult with the healthcare provider and client regarding fluid balance and drug levels.

   Lithium has a narrow therapeutic range, and daytime fluid deprivation significantly increases the risk of dehydration and lithium toxicity. Consulting the healthcare provider while collaborating with the client allows the team to explore medical safety strategies, monitor serum levels, or discuss acceptable religious dispensations.

10. Question 10 of 25Medium

    A client who takes lithium carbonate for bipolar disorder tells the nurse about a coarse hand tremor, vomiting, diarrhea, and an unsteady gait since yesterday. Which action is most appropriate?

    1. AA. Hold the next dose and notify the provider about these findings
    2. BB. Explain that these are expected early effects that will fade soon
    3. CC. Advise the client to limit fluids and salt to reduce the diarrhea
    4. DD. Give the dose with an antidiarrheal and recheck the client tomorrow
    Show answer to question 10

    Answer: A. Hold the next dose and notify the provider about these findings

    Coarse tremor, vomiting, diarrhea, and ataxia are signs of lithium toxicity, which can cause seizures and death. The nurse should hold the dose and report promptly so a serum level can be obtained.

    Why the other options are wrong

    • BA coarse tremor with gastrointestinal symptoms and ataxia is toxicity, not a mild early effect.
    • CRestricting sodium and fluids raises lithium levels and worsens toxicity.
    • DGiving another dose risks more toxicity, and waiting a day delays needed evaluation.

11. Question 11 of 25Medium

    The licensed practical nurse (LPN) visits an older adult client whose spouse died 14 months ago. Which finding indicates to the nurse that the client may be experiencing complicated grief?

    1. AA. Refusing to leave the house or dispose of any personal belongings
    2. BB. Expressing deep sadness during the deceased spouse's birthday
    3. CC. Attending a weekly bereavement support group at a local community center
    4. DD. Looking at old photographs while crying occasionally
    Show answer to question 11

    Answer: A. Refusing to leave the house or dispose of any personal belongings

    Complicated grief is characterized by persistent, maladaptive behaviors such as severe social withdrawal, functional impairment, and an inability to accept the loss more than a year after the death. Experiencing sadness on significant dates or crying while viewing photographs are typical components of normal grief.

12. Question 12 of 25Hard

    An adolescent male on a residential unit has a behavior plan with a defined consequence for verbal aggression. He curses at a peer while staff are present. Which action by the nurse is most appropriate?

    1. AA. Overlook it this time since his behavior has been improving
    2. BB. Calmly name the behavior and apply the agreed consequence
    3. CC. Create a stricter consequence than the plan to deter him
    4. DD. Spend time reviewing his earlier conflicts with him at length
    Show answer to question 12

    Answer: B. Calmly name the behavior and apply the agreed consequence

    Behavior modification works best when expectations and consequences are applied consistently and calmly as written. Naming the behavior and following the plan reinforces limits without punishment.

    Why the other options are wrong

    • AInconsistent enforcement weakens the plan and may reinforce the unwanted behavior.
    • CChanging the consequence without the team is punitive and breaks the agreed plan.
    • DLengthy lectures about past conflicts delay the consequence and do not help him gain self-control.

13. Question 13 of 25Hard

    A nurse in a long-term care facility finds an 82-year-old client with mild dementia newly restless, picking at the bed linens, and unable to focus on conversation. She says she sees children in her room. She is usually oriented to person and place. The change began last evening, and her temperature is 99.8 F (37.7 C). Which action should the nurse take first?

    1. AA. Report the sudden change to the RN or provider, as it may be delirium
    2. BB. Document it as expected progression of dementia and continue to monitor
    3. CC. Ask assistive personnel to apply restraints so the client stays safe
    4. DD. Reorient the client gently and reassess her at the start of the next shift
    Show answer to question 13

    Answer: A. Report the sudden change to the RN or provider, as it may be delirium

    Abrupt onset, inattention, fluctuating course and hallucinations suggest delirium, often caused by infection or medication, and it is a medical problem needing prompt evaluation. The nurse monitors and reports changes.

    Why the other options are wrong

    • BDementia progresses gradually, so a sudden change should not be blamed on it and left unreported.
    • CRestraints can worsen agitation and cause injury, and they are not a first-line response to a possibly reversible cause.
    • DWaiting until the next shift delays treatment of a potentially serious underlying condition such as infection.

14. Question 14 of 25Easy

    A client tells the nurse that in the client's culture, direct eye contact with a person in authority is considered disrespectful. How should the nurse use this information when providing care?

    1. AA. Interpret the lack of eye contact as a sign the client is lying
    2. BB. Document the lack of eye contact as a symptom of depression
    3. CC. Repeat the teaching until the client makes direct eye contact
    4. DD. Accept the practice as respect and adapt communication to it
    Show answer to question 14

    Answer: D. Accept the practice as respect and adapt communication to it

    The client has self-reported a cultural practice. Respecting it and adapting communication supports trust and culturally appropriate care.

    Why the other options are wrong

    • AAssuming the client is lying reflects a cultural bias and ignores what the client explained about the behavior.
    • BThe client explained the behavior, so labeling it a symptom of depression is an unsupported assumption.
    • CRequiring eye contact disrespects the client's beliefs and may hinder rapport and learning.

15. Question 15 of 25Medium

    A client is 2 days postoperative from a below-the-knee amputation. During a dressing change the client turns away from the residual limb and says, "I am not a whole person anymore." Which response by the nurse is best?

    1. AA. "This sounds very hard. Would you tell me more about how you are feeling?"
    2. BB. "Many people adjust to an amputation well within a few weeks."
    3. CC. "You need to look at it now so you can start learning to care for it."
    4. DD. "Once you have a prosthesis, your leg will look almost normal again."
    Show answer to question 15

    Answer: A. "This sounds very hard. Would you tell me more about how you are feeling?"

    Reflecting the feeling and inviting the client to talk acknowledges the loss and begins healthy adjustment. The client can look at the limb when ready.

    Why the other options are wrong

    • BOffering generalized reassurance dismisses the client's present feelings and closes communication.
    • CForcing the client to look is not therapeutic and can increase distress and resistance.
    • DPromising the limb will look normal is false reassurance and avoids the client's grief.

16. Question 16 of 25Medium

    A 52-year-old client admitted for an elective hysterectomy tells the nurse that her faith does not allow blood transfusions. The surgical consent form includes blood administration. Which action should the nurse take?

    1. AA. Reassure her that a transfusion is unlikely, so she need not worry
    2. BB. Encourage her to reconsider because surgery always carries some risks
    3. CC. Report her statement to the RN and the surgeon before surgery begins
    4. DD. Cross out the transfusion section on the consent form for her
    Show answer to question 16

    Answer: C. Report her statement to the RN and the surgeon before surgery begins

    The client's beliefs affect the plan of care, and the surgeon and RN must know them so that consent, alternatives and preparation can be addressed before surgery. The nurse respects her right to decide.

    Why the other options are wrong

    • AReassuring her that a transfusion is unlikely may be untrue and leaves her beliefs and the consent issue unaddressed.
    • BPressuring her to reconsider disrespects her autonomy and religious beliefs.
    • DAltering a consent form is outside the nurse's role; changes to consent must be handled by the provider with the client.

17. Question 17 of 25Easy

    A nurse is caring for a 16-year-old female client who is hospitalized with anorexia nervosa. Which intervention is most appropriate at mealtimes?

    1. AA. Allow the client to eat alone in her room to reduce pressure
    2. BB. Permit the client to use the bathroom alone right after each meal
    3. CC. Discuss the client's weight and body shape with her during each meal
    4. DD. Stay with the client during meals and for a set period afterward
    Show answer to question 17

    Answer: D. Stay with the client during meals and for a set period afterward

    Supervision during and after meals confirms intake and prevents purging or hiding food, while keeping the focus off food and weight.

    Why the other options are wrong

    • AEating alone allows the client to discard or hide food and does not support intake.
    • BUnsupervised bathroom use after meals gives the client an opportunity to purge.
    • CTalking about weight and body shape at meals increases anxiety and reinforces preoccupation with food and appearance.

18. Question 18 of 25Medium

    A client on an acute psychiatric unit is pacing in the dayroom with clenched fists and a rising voice. Other clients are nearby. Which action should the nurse take first?

    1. AA. Stand close to the client and firmly order the client to calm down
    2. BB. Speak calmly from a safe distance and offer to talk somewhere quiet
    3. CC. Apply physical restraints right away to protect the other clients
    4. DD. Wait at the nurses' station until the client's behavior settles down
    Show answer to question 18

    Answer: B. Speak calmly from a safe distance and offer to talk somewhere quiet

    Verbal de-escalation using a calm tone, a safe distance, and a low-stimulation setting is the least restrictive first intervention for an agitated client.

    Why the other options are wrong

    • AStanding close and giving orders invades personal space and can increase agitation and the risk of violence.
    • CRestraints are a last resort after less restrictive measures fail and require an order and facility procedure.
    • DWaiting at the station delays intervention, allows the agitation to escalate, and leaves the client and others at risk.

19. Question 19 of 25Hard

    A 29-year-old client admitted with pneumonia tells the nurse, "I am a man, and I go by Marcus." The armband and chart list a different, traditionally female name. Which nurse action is most appropriate?

    1. AA. Use the name on the armband until the legal name is officially changed
    2. BB. Avoid using any name or pronoun when speaking to or about the client
    3. CC. Use the stated name and pronouns, and ask with whom to share this
    4. DD. Ask the client to explain gender identity so the staff can learn
    Show answer to question 19

    Answer: C. Use the stated name and pronouns, and ask with whom to share this

    Respecting the client's self-identified name and pronouns, while asking about privacy preferences, supports dignity and a trusting relationship. Identification safeguards still follow facility policy.

    Why the other options are wrong

    • AWaiting for a legal name change disregards the client's stated identity and can cause distress and reluctance to seek care.
    • BAvoiding names and pronouns is awkward and does not acknowledge the client's identity.
    • DMaking the client educate staff is inappropriate and places an unfair burden on a client who is ill.

20. Question 20 of 25Easy

    A 45-year-old client tells the nurse at a clinic that he was reprimanded by his supervisor at work. That evening he came home and yelled at his wife over a minor matter. Which defense mechanism is the client using?

    1. AA. Projection
    2. BB. Reaction formation
    3. CC. Regression
    4. DD. Displacement
    Show answer to question 20

    Answer: D. Displacement

    Displacement is shifting feelings from the person who caused them to a safer, less threatening target. The client directs anger meant for his supervisor toward his wife.

    Why the other options are wrong

    • AProjection means attributing one's own unacceptable feelings to another person, which the client did not describe.
    • BReaction formation means behaving opposite to one's true feelings, such as acting overly friendly toward someone resented.
    • CRegression means returning to an earlier developmental level of behavior, such as childlike dependence.

21. Question 21 of 25Hard

    A 45-year-old client with type 2 diabetes who takes insulin tells the nurse at a clinic that he will fast from dawn to sunset every day during Ramadan and plans to skip his insulin on those days. Which action should the nurse take?

    1. AA. Tell him fasting is unsafe and he must not observe Ramadan
    2. BB. Agree that skipping insulin is reasonable and record his plan
    3. CC. Report his plan to the provider so insulin can be adjusted
    4. DD. Suggest he skip insulin only on fasting days as he will not eat
    Show answer to question 21

    Answer: C. Report his plan to the provider so insulin can be adjusted

    His religious practice affects the plan of care. The provider must know so the insulin schedule and glucose monitoring can be changed collaboratively, respecting his beliefs while lowering the risk of complications.

    Why the other options are wrong

    • AForbidding the fast disregards his religious needs and may lead him to hide his plans from the health care team.
    • BEndorsing skipped insulin is unsafe and outside the nurse's role, since stopping insulin can cause serious hyperglycemia.
    • DAdvising him to skip insulin is a medication change the nurse cannot make, and it is unsafe without provider guidance.

22. Question 22 of 25Hard

    A practical nurse is documenting findings for an adult client who reports physical harm caused by a spouse. Which documentation method is most appropriate?

    1. AA. Use generalized summaries of injuries to protect the privacy of the client
    2. BB. Document the nurse's professional opinion that domestic violence occurred
    3. CC. Omit the alleged perpetrator's identity until criminal charges are filed
    4. DD. Record verbatim statements from the client enclosed in quotation marks
    Show answer to question 22

    Answer: D. Record verbatim statements from the client enclosed in quotation marks

    Documentation in suspected abuse cases must be strictly factual, detailed, and objective, including exact quotes from the client and precise anatomical descriptions of injuries. Entering personal interpretations or subjective conclusions is inappropriate and can weaken the legal record.

23. Question 23 of 25Hard

    A home health nurse visits a 78-year-old male client who cares for his wife, who has advanced Alzheimer's disease. He has lost weight, has stopped attending church and says, "No one can care for her the way I do." What is the nurse's best action?

    1. AA. Praise his dedication and encourage him to continue providing all of the care himself
    2. BB. Report signs of caregiver strain to the RN so respite and support services can be arranged
    3. CC. Tell him that it would be best to place his wife in a long-term care facility right away
    4. DD. Explain that feeling tired and losing weight are expected parts of growing older
    Show answer to question 23

    Answer: B. Report signs of caregiver strain to the RN so respite and support services can be arranged

    Weight loss, social withdrawal and refusal to share care are cues of caregiver role strain. The nurse reports these findings so the care team can connect him with respite care and support resources.

    Why the other options are wrong

    • AEncouraging him to continue alone ignores the cues of strain and risks his health and his wife's safety.
    • CDirecting placement is not the nurse's role and the decision should follow assessment of options and wishes.
    • DAttributing the findings to aging dismisses cues of stress and delays needed support.

24. Question 24 of 25Easy

    Which statement by a client admitted to an inpatient unit for depression should alert the nurse to the highest risk for suicide?

    1. AA. "I have been feeling sad and tearful most days lately."
    2. BB. "I wish I could sleep through the night without waking."
    3. CC. "I get nervous when I have to speak in front of groups."
    4. DD. "I gave away my things and wrote letters to my family."
    Show answer to question 24

    Answer: D. "I gave away my things and wrote letters to my family."

    Giving away possessions and writing letters to family are warning signs of a suicide plan. The nurse should report this immediately and implement suicide precautions as ordered.

    Why the other options are wrong

    • ASadness and tearfulness are expected with depression and do not by themselves indicate an imminent plan.
    • BSleep disturbance is a common symptom of depression, not a specific sign of intent to die.
    • CNervousness about speaking to groups reflects ordinary anxiety and is unrelated to suicide risk.

25. Question 25 of 25Easy

    The nurse in a clinic is collecting data from a 67-year-old man who has newly diagnosed heart failure. Which question is best for identifying his support systems?

    1. AA. Who helps you with daily tasks or listens when you worry?
    2. BB. Do you have any family members who live close to your home?
    3. CC. Why don't you have more people helping you out at home?
    4. DD. Is there anyone you could call if you needed a ride today?
    Show answer to question 25

    Answer: A. Who helps you with daily tasks or listens when you worry?

    An open-ended question about both practical and emotional help gives the broadest picture of the client's support systems and resources.

    Why the other options are wrong

    • BThis closed question covers only family and proximity, and it misses friends, faith groups, and emotional support.
    • CA "why" question sounds judgmental and may make the client feel defensive instead of sharing openly.
    • DThis closed question covers only transportation and does not explore the client's overall practical or emotional support.

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