NCLEX-RN Psychosocial Integrity Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Easy

   A client experiencing moderate alcohol withdrawal is agitated, sweating profusely, and reporting a crawling sensation on the skin. Which nonpharmacological environmental intervention should the nurse implement?

   1. AA. Encourage frequent visitors to orient and comfort the client.
   2. BB. Keep the client's room completely dark to promote sleep.
   3. CC. Place the client in a quiet, well-lit room with minimal shadows.
   4. DD. Turn on a television at low volume to provide distraction.
   Show answer to question 1

   Answer: C. Place the client in a quiet, well-lit room with minimal shadows.

   Providing a quiet, well-lit room helps minimize visual misinterpretations, illusions, and sensory overload while reducing fear and agitation in a withdrawing client. Darkening the room should be avoided because shadows can be misperceived as frightening figures or insects, exacerbating tactile or visual illusions.

2. Question 2 of 25Easy

   A nurse provides discharge teaching to the family member of a client with an opioid use disorder regarding the administration of take-home intranasal naloxone. Which instruction should the nurse emphasize?

   1. AA. Place the client in the lateral recovery position after giving the medication.
   2. BB. Prime the nasal spray device twice into the air before inserting it into the nostril.
   3. CC. Administer the nasal spray only while holding the client upright in a sitting position.
   4. DD. Withhold rescue ventilations and chest compressions for ten minutes to assess response.
   Show answer to question 2

   Answer: A. Place the client in the lateral recovery position after giving the medication.

   Placing the client in the lateral recovery position prevents airway occlusion and reduces the risk of aspiration if the client vomits upon awakening or remains sedated. The intranasal naloxone device is single-use and pre-primed, so attempting to prime it beforehand would discharge and waste the medication.

3. Question 3 of 25Medium

   A firefighter who recently responded to a mass casualty event experiences intrusive memories and hypervigilance but avoids using the department's confidential employee assistance program (EAP). The firefighter tells the occupational health nurse, 'If the other crew members find out, they will think I am unreliable in an emergency.' Which barrier to care is the client describing?

   1. AA. Structural deficit in organizational behavioral healthcare options
   2. BB. Lack of mental health literacy regarding post-traumatic stress
   3. CC. Anticipated stigma regarding professional competence and peer trust
   4. DD. Financial distress caused by out-of-pocket behavioral health costs
   Show answer to question 3

   Answer: C. Anticipated stigma regarding professional competence and peer trust

   Anticipated stigma involves the expectation that others will judge, reject, or devalue an individual if their mental health condition or treatment becomes known, which is especially prevalent among first responders and military personnel. The client is worried that peers will perceive them as incompetent or untrustworthy on duty. Because the firefighter recognizes the connection between the trauma and the need for support, and an EAP is readily available, this issue does not stem from low mental health literacy or a structural deficit.

4. Question 4 of 25Hard

   A client whose spouse died unexpectedly two weeks ago tells the nurse, "I cannot believe this happened. I should have recognized the signs and made my spouse go to the emergency room sooner." Which response by the nurse is most therapeutic?

   1. AA. Grief is a slow process, but your pain will lessen as time goes by.
   2. BB. Many people have these same thoughts when experiencing a sudden loss.
   3. CC. You did everything you could, so you should not feel guilty.
   4. DD. You feel responsible for what happened to your spouse.
   Show answer to question 4

   Answer: D. You feel responsible for what happened to your spouse.

   Reflecting the client's stated feeling acknowledges perceived guilt and encourages deeper exploration of the acute grief reaction without judgment. Telling the client that they did everything possible constitutes false reassurance and minimizes the reality of their current emotional experience. Generalizing the reaction or offering clichés about time healing pain diverts attention away from the client's immediate, individual distress.

5. Question 5 of 25Easy

   A client in the emergency department who was involved in a minor motor vehicle collision is hyperventilating, trembling, and stating, "I cannot catch my breath, and my chest feels tight." Vital signs show heart rate 116 beats/min, respiratory rate 32 breaths/min, and oxygen saturation 99% on room air. Which action should the nurse implement first to assist the client?

   1. AA. Ask the client to describe past experiences with motor vehicle accidents.
   2. BB. Coach the client to take slow, controlled diaphragmatic breaths.
   3. CC. Leave the client alone in a private room to decrease external stimuli.
   4. DD. Instruct the client to breathe in and out of a small paper bag.
   Show answer to question 5

   Answer: B. Coach the client to take slow, controlled diaphragmatic breaths.

   Coaching the client to take slow, deep diaphragmatic breaths activates the parasympathetic nervous system, curbs hyperventilation, and restores respiratory control during acute stress. Breathing into a paper bag is an obsolete and unsafe practice because it can cause hypoxemia or mask serious underlying cardiopulmonary pathology. Leaving an acutely panicked client alone increases anxiety and risks safety, while exploring past events is inappropriate while the client is experiencing acute physiological distress.

6. Question 6 of 25Medium

   A 34-year-old client with bipolar I disorder who is in an acute manic episode paces the unit constantly and leaves the dining room after one or two bites at each meal. The client has lost 5 lb in 6 days. Which action by the nurse is most appropriate?

   1. AA. Provide high-calorie finger foods and fluids the client can take while moving.
   2. BB. Require the client to remain seated at the table until the tray is finished.
   3. CC. Serve three large meals each day with extra portions on the client's tray.
   4. DD. Limit the client's fluid intake so there is more room for solid food at meals.
   Show answer to question 6

   Answer: A. Provide high-calorie finger foods and fluids the client can take while moving.

   A client in acute mania is too hyperactive and distractible to sit through a meal. Nutrient-dense foods and fluids that can be eaten on the move help prevent further weight loss and dehydration.

   Why the other options are wrong

   • BInsisting that the client stay seated creates a power struggle the client cannot win and may escalate agitation.
   • CLarge meals still require the client to sit and focus, so a bigger portion size does not solve the problem.
   • DRestricting fluids increases the risk of dehydration in a hyperactive client who is already losing weight.

7. Question 7 of 25Easy

   A home health nurse assesses an 84-year-old client who lives alone, has severe osteoarthritis of both knees, and has lost 7 pounds over the past month. The client explains, "I can no longer stand at the stove long enough to prepare hot meals, and I have stopped driving to buy groceries." Which community resource should the nurse arrange first to address the client's weight loss?

   1. AA. A neighborhood food pantry distribution
   2. BB. A local congregate soup kitchen
   3. CC. A residential assisted living facility
   4. DD. A home-delivered meal program
   Show answer to question 7

   Answer: D. A home-delivered meal program

   A home-delivered meal program, such as Meals on Wheels, delivers prepared, ready-to-eat, nutritious meals directly to homebound individuals who are physically unable to shop or cook for themselves. A neighborhood food pantry provides unprepared groceries that still require transportation and cooking, which this client cannot manage. A local congregate soup kitchen requires independent transportation and mobility that the client lacks.

8. Question 8 of 25Easy

   A nurse develops a care plan for an adolescent client admitted to an inpatient unit who avoids peer interactions and remains secluded in the room. Which client outcome represents the most objective, measurable evidence of progress toward resolving social isolation?

   1. AA. The client eats all daily meals alone in the bedroom without displaying distress.
   2. BB. The client states an understanding that interacting with peers is beneficial.
   3. CC. The client expresses hope that peer friendships will improve over the next year.
   4. DD. The client attends and participates in a 30-minute structured peer craft group.
   Show answer to question 8

   Answer: D. The client attends and participates in a 30-minute structured peer craft group.

   Participating in a scheduled 30-minute peer craft session provides a concrete, observable, and measurable behavioral indicator that the client is overcoming social isolation. Stating an understanding of the benefits of social interaction reflects cognitive insight rather than actual behavioral engagement with peers.

9. Question 9 of 25Medium

   A home health nurse conducts an initial home visit for an 82-year-old client who lives with an adult child caregiver. Which observation most strongly suggests elder neglect?

   1. AA. The client wears mismatched clothing and has unstyled hair.
   2. BB. Prescribed daily antihypertensive medications remain unopened from three months ago.
   3. CC. The client expresses sadness regarding the inability to drive a motor vehicle.
   4. DD. The refrigerator contains mostly frozen, prepackaged meals.
   Show answer to question 9

   Answer: B. Prescribed daily antihypertensive medications remain unopened from three months ago.

   Failing to provide necessary medications or withholding treatment for chronic medical conditions is a core indicator of physical neglect. While unkempt appearance or reliance on frozen convenience meals may warrant further assessment, they do not directly prove harm or deprivation of essential care. Expressing grief over lost independence is a normal emotional response to aging rather than a sign of abuse.

10. Question 10 of 25Easy

    A client with bipolar I disorder in the manic phase becomes increasingly loud, paces rapidly in the dayroom, and clenches their fists while demanding immediate discharge. Which initial action should the nurse take?

    1. AA. Inform the client that shouting will result in the immediate loss of unit privileges
    2. BB. Assemble a team of security staff to physically hold the client in a chair
    3. CC. Escort the client to a quiet, low-stimulation area and speak in a calm, firm tone
    4. DD. Direct the client to enter seclusion until full behavioral control is regained
    Show answer to question 10

    Answer: C. Escort the client to a quiet, low-stimulation area and speak in a calm, firm tone

    Moving the escalating client to a low-stimulation environment and speaking calmly uses least-restrictive de-escalation techniques to decrease sensory overload and defuse aggression. Restraints or seclusion are interventions of last resort and are indicated only when imminent danger of physical harm exists. Threatening loss of privileges serves as an adversarial confrontation that typically escalates the client's agitation.

11. Question 11 of 25Medium

    A client with recurrent major depression and a history of suicidal behavior is preparing for discharge to home. Which assessment finding is most critical for the nurse to evaluate before the client leaves the facility?

    1. AA. The client's ability to recall coping strategies taught in group therapy.
    2. BB. The client's attendance record at scheduled therapeutic unit meetings.
    3. CC. The client's willingness to sign a formal no-suicide contract.
    4. DD. The presence of unsecured firearms or lethal medications at home.
    Show answer to question 11

    Answer: D. The presence of unsecured firearms or lethal medications at home.

    Lethal means safety, specifically restricting access to firearms, toxic chemicals, and prescription medications, is the single most effective environmental intervention for preventing completed suicide. No-suicide contracts are not evidence-based and provide a false sense of security. While coping skills and group engagement are valuable, eliminating access to lethal mechanisms in the home environment is the priority safety evaluation.

12. Question 12 of 25Medium

    The nurse is collaborating with a client to develop an evidence-based suicide safety plan before discharge. Which component should the nurse identify as the first step of this safety plan?

    1. AA. Recognizing personal warning signs that a crisis is developing.
    2. BB. Identifying trusted family members who can offer support.
    3. CC. Listing social settings that provide a healthy distraction.
    4. DD. Contacting mental health professionals or crisis hotlines.
    Show answer to question 12

    Answer: A. Recognizing personal warning signs that a crisis is developing.

    According to the Stanley-Brown Safety Planning Intervention, Step 1 is identifying the client's personal warning signs (such as specific thoughts, moods, or behaviors) that indicate a crisis is emerging. Distraction techniques, reaching out to social contacts, and calling professional resources are subsequent steps that the client utilizes after recognizing these initial warning signs.

13. Question 13 of 25Easy

    A nurse is caring for a client who had an ischemic stroke resulting in right-sided hemiplegia and expressive aphasia. The client was previously the primary decision-maker and provider for the household. During a multidisciplinary care conference, the client begins weeping. Which nursing action best promotes the client's adaptation to these sudden role changes?

    1. AA. Encourage family members to assume all decision-making to alleviate the client's stress.
    2. BB. Reassure the client that all previous household duties will be resumed after discharge.
    3. CC. Involve the client in setting daily rehabilitation goals using adaptive communication tools.
    4. DD. Advise the client to focus solely on physical recovery rather than previous life roles.
    Show answer to question 13

    Answer: C. Involve the client in setting daily rehabilitation goals using adaptive communication tools.

    Involving the client in personal care planning using alternative communication methods preserves autonomy, fosters a sense of purpose, and assists the client in adapting to functional limitations. Allowing the family to assume total control reinforces helplessness and dependency, which impedes the client's psychological adjustment to illness.

14. Question 14 of 25Medium

    A 66-year-old client who lives alone is seen at an orthopedic clinic 2 weeks after fractures of the right wrist and ankle and cannot drive for 6 weeks. The nurse evaluates how the client is adapting to temporary dependence on others. Which statement indicates successful adaptation?

    1. AA. "My neighbor drives me to appointments, and I pay my bills online."
    2. BB. "I plan to drive to the store anyway, since it is only a few blocks away."
    3. CC. "I've told my friends not to visit until I'm back on my feet again."
    4. DD. "From now on, my son will be making my decisions for me."
    Show answer to question 14

    Answer: A. "My neighbor drives me to appointments, and I pay my bills online."

    Accepting help with tasks the client cannot safely do while keeping control of tasks the client can still manage reflects a balanced, healthy adaptation to a temporary role change.

    Why the other options are wrong

    • BPlanning to drive against restrictions shows denial of the limitation and creates a safety risk.
    • CWithdrawing from friends suggests embarrassment or poor coping and removes needed support.
    • DHanding over decision-making is excessive dependence that a temporary injury does not warrant.

15. Question 15 of 25Hard

    A client admitted with acute alcohol withdrawal points to a jacket hanging on a wall hook in the dimly lit room and screams, 'There is a man standing in the corner waiting to attack me!' Which action should the nurse take first?

    1. AA. Place the client in soft bilateral wrist restraints to prevent injury.
    2. BB. Agree that shadows are scary and transfer the client to another room.
    3. CC. Administer an extra dose of a prescribed antipsychotic medication.
    4. DD. Turn on the room lights and clarify that the object is a hanging coat.
    Show answer to question 15

    Answer: D. Turn on the room lights and clarify that the object is a hanging coat.

    The client is experiencing an illusion, which is a misinterpretation of an actual external sensory stimulus. Improving ambient lighting eliminates shadows and clarifies reality, which frequently resolves the perceptual error without escalating interventions. Restraints and antipsychotics are inappropriate initial responses when simple environmental adjustments can restore perception.

16. Question 16 of 25Hard

    An 81-year-old client who practices Orthodox Judaism is hospitalized after a fall. On Friday afternoon, he tells the nurse that from sundown Friday until Saturday night he does not operate electrical devices, including the call light. He is at moderate risk for falls. Which intervention should the nurse plan?

    1. AA. Tell the client that religious restrictions do not apply in the hospital.
    2. BB. Explain that he must use the call light or he will be placed in restraints.
    3. CC. Arrange for staff to check on him at frequent, scheduled intervals.
    4. DD. Ask the client to stay in bed until the Sabbath ends on Saturday.
    Show answer to question 16

    Answer: C. Arrange for staff to check on him at frequent, scheduled intervals.

    Frequent, scheduled rounding respects the client's religious practice while still meeting his safety and toileting needs. The nurse can also ask whether another way of signaling for help is acceptable to him.

    Why the other options are wrong

    • ADismissing a stated religious practice disrespects the client and damages trust.
    • BThreatening restraints is coercive, and restraints are not a substitute for fall prevention.
    • DProlonged bed rest increases weakness and fall risk and is not needed to honor his practice.

17. Question 17 of 25Medium

    A client diagnosed with advanced lung cancer is told by the oncologist that further curative treatment is no longer effective. Shortly after the physician leaves, the client yells loudly at the unlicensed assistive personnel (UAP) for delivering the lunch tray five minutes late. Which defense mechanism is the client exhibiting?

    1. AA. Displacement
    2. BB. Splitting
    3. CC. Projection
    4. DD. Intellectualization
    Show answer to question 17

    Answer: A. Displacement

    Displacement is the redirection of emotions or impulses from their original source to a less threatening person or object. The client cannot express helplessness and anger toward the disease or physician, so the anger is transferred to the UAP. Projection occurs when an individual attributes their own unacknowledged feelings or traits onto others. Intellectualization involves analyzing a distressing event through cold, abstract logic to avoid emotional distress.

18. Question 18 of 25Medium

    An 82-year-old hospice client spends considerable time sharing stories from childhood, discussing career achievements, and expressing regret over estranged relationships. Which nursing intervention best supports the client's psychosocial needs?

    1. AA. Limit conversations about the past to prevent worsening of depressive feelings.
    2. BB. Listen actively to the client's stories to facilitate the life review process.
    3. CC. Provide reassurance that past mistakes have likely been forgotten by relatives.
    4. DD. Redirect the client to present hobbies whenever past regrets are mentioned.
    Show answer to question 18

    Answer: B. Listen actively to the client's stories to facilitate the life review process.

    Life review is a normal, therapeutic developmental task in late life that facilitates achieving ego integrity and resolving unfinished emotional business. The nurse supports this process by being an attentive, nonjudgmental listener as the client finds meaning and coherence in life events. Redirecting or limiting these discussions shuts down an essential developmental process and invalidates the client's need for reflection.

19. Question 19 of 25Hard

    A 28-year-old client admitted to the inpatient psychiatric unit after a suicide attempt by overdose tells the nurse, 'I'm feeling much better now. I think I can go home tomorrow.' Which nursing response is most important?

    1. AA. Document the client's statement and continue with the daily routine
    2. BB. Ask the client directly if they still have thoughts of harming themselves
    3. CC. Remind the client that discharge decisions are made by the treatment team
    4. DD. Praise the client for feeling better and encourage continued progress
    Show answer to question 19

    Answer: B. Ask the client directly if they still have thoughts of harming themselves

    A sudden improvement in mood soon after a suicide attempt can mean the client has decided to attempt again. Asking directly about thoughts of self-harm is the priority because safety must be assessed before any other step.

    Why the other options are wrong

    • ADocumenting without assessing misses a possible warning sign and leaves the client's current suicide risk unknown.
    • CExplaining who makes discharge decisions is accurate but does not assess the client's immediate safety.
    • DPraise may discourage the client from sharing ongoing suicidal thoughts and does not evaluate risk.

20. Question 20 of 25Medium

    A client who underwent an abdominoperineal resection with creation of a permanent colostomy 3 days ago turns the head away whenever the nurse provides stoma care. Which nursing action is most appropriate?

    1. AA. Delegate stoma pouch emptying to assistive personnel to reduce performance pressure.
    2. BB. Insist that the client observe the pouch change before discharge tomorrow.
    3. CC. Cover the stoma immediately and avoid discussing it until the client brings it up.
    4. DD. Acknowledge the client's reluctance and encourage gradual participation in care.
    Show answer to question 20

    Answer: D. Acknowledge the client's reluctance and encourage gradual participation in care.

    Turning away from a newly formed stoma indicates an altered body image and difficulty integrating the physical change; acknowledging reluctance while inviting incremental involvement fosters adaptive coping. Insisting on immediate participation triggers excessive distress, whereas completely avoiding the topic reinforces avoidance and delays rehabilitation.

21. Question 21 of 25Medium

    A client hospitalized with severe major depressive disorder asks the nurse, 'Have you ever felt completely hopeless and thought about giving up?' Which response by the nurse best maintains therapeutic boundaries?

    1. AA. Nurses are trained to manage their feelings, so I focus entirely on my clients.
    2. BB. Yes, I went through a painful divorce last year, but things eventually got better.
    3. CC. It sounds like you are feeling overwhelmed. Tell me more about what hopelessness feels like for you right now.
    4. DD. Most people experience deep sadness at times, but suicide is never a good solution.
    Show answer to question 21

    Answer: C. It sounds like you are feeling overwhelmed. Tell me more about what hopelessness feels like for you right now.

    Therapeutic communication requires redirecting the focus back to the client's immediate feelings and experiences rather than sharing personal struggles. Self-disclosure is nontherapeutic when it shifts the focus of care onto the nurse's personal life. Dismissing the question by asserting professional emotional invulnerability ignores the client's distress and inhibits open dialogue.

22. Question 22 of 25Medium

    An adult client who became physically aggressive toward staff has been placed in four-point physical restraints. Which intervention must the nurse carry out to ensure client safety during restraint use?

    1. AA. Keep the room fully darkened and avoid entering to minimize sensory stimulation
    2. BB. Assess peripheral neurovascular status and skin integrity at least every 15 to 30 minutes
    3. CC. Withhold all oral fluids and nutritional intake until the restraints are discontinued
    4. DD. Obtain a verbal prescription renewal from the health care provider every 24 hours
    Show answer to question 22

    Answer: B. Assess peripheral neurovascular status and skin integrity at least every 15 to 30 minutes

    Frequent assessment of circulation, skin condition, and vital signs is essential to prevent nerve damage, ischemia, and positional injury in a physically restrained client. For violent or self-destructive behavior in an adult, restraint orders must be renewed every 4 hours rather than every 24 hours. Basic physical needs such as hydration and toileting must be offered regularly, not withheld.

23. Question 23 of 25Hard

    A client with chronic alcohol dependence is admitted for severe malnutrition. On examination, the nurse notes confusion, horizontal nystagmus, bilateral lateral rectus palsy, and an unsteady, wide-based gait. The nurse should recognize that these findings are most indicative of which nutritional complication?

    1. AA. Niacin deficiency resulting in pellagra encephalopathy
    2. BB. Pyridoxine deficiency precipitating peripheral polyneuropathy
    3. CC. Thiamine deficiency leading to Wernicke encephalopathy
    4. DD. Cobalamin deficiency causing subacute combined degeneration
    Show answer to question 23

    Answer: C. Thiamine deficiency leading to Wernicke encephalopathy

    The classic clinical triad of Wernicke encephalopathy includes encephalopathy (altered mental status/confusion), oculomotor dysfunction (nystagmus, conjugate gaze palsies), and gait ataxia, caused by acute thiamine (vitamin B1) deficiency common in chronic alcohol use disorder. Cobalamin (vitamin B12) deficiency causes paresthesias and loss of vibratory and position sense due to posterior and lateral column spinal cord degeneration, but it does not produce the acute oculomotor palsy seen in Wernicke encephalopathy.

24. Question 24 of 25Hard

    A 46-year-old client is admitted to the surgical unit the evening before an elective knee replacement. During the admission interview, the client reports drinking "about a six-pack of beer every night" for several years. Which information is most important for the nurse to obtain next?

    1. AA. The date and time of the client's last alcoholic drink
    2. BB. The reasons the client gives for drinking every night
    3. CC. The age at which the client first began drinking alcohol
    4. DD. Whether any family members have problems with alcohol
    Show answer to question 24

    Answer: A. The date and time of the client's last alcoholic drink

    Alcohol withdrawal usually begins 6 to 24 hours after the last drink, so this information helps the nurse anticipate when symptoms may start and plan monitoring with a withdrawal assessment scale.

    Why the other options are wrong

    • BExploring reasons for drinking supports later counseling but does not help predict the onset of a potentially dangerous withdrawal.
    • CThe age drinking began is part of a full substance history but does not affect immediate safety planning.
    • DFamily history adds to overall risk assessment but does not indicate when this client may begin to withdraw.

25. Question 25 of 25Hard

    A psychiatric nurse is preparing to administer haloperidol to an adult client of East Asian descent experiencing acute psychosis. The nurse is aware that individuals of East Asian ancestry have a higher prevalence of reduced CYP2D6 enzyme activity. Which nursing action is most important?

    1. AA. Administer the medication with a high-fat meal to enhance gastrointestinal absorption.
    2. BB. Monitor closely for extrapyramidal symptoms even at standard or lower dosage ranges.
    3. CC. Request a prescription to replace the medication with an atypical antipsychotic immediately.
    4. DD. Anticipate an order for dosages higher than the standard therapeutic range.
    Show answer to question 25

    Answer: B. Monitor closely for extrapyramidal symptoms even at standard or lower dosage ranges.

    Clients who are poor metabolizers of the cytochrome P450 2D6 enzyme clear certain psychotropic medications, including haloperidol, more slowly, leading to higher plasma concentrations and heightened vulnerability to adverse effects such as extrapyramidal symptoms. Anticipating higher dosages is dangerous because reduced clearance would increase drug accumulation and toxicity risk. Monitoring for adverse effects and advocating for lower starting doses is the safest evidence-based approach.

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