NCLEX-RN
NCLEX-RN Mental Health Questions
Extract:
Question 1 of 5
A client has been admitted to the emergency department with alcohol withdrawal delirium. At 9 a.m. on 10/25, the nurse notes that the client is confused. His vital signs are T=99°F, P=50, R=10, and BP=100/60. The nurse compares these findings to the nurses' progress notes from admission 24 hours ago. What should the nurse do first?
Correct Answer: C
Rationale: Attempting to arouse the client is the first action, as it assesses the level of consciousness and responsiveness, critical in determining the severity of delirium and guiding further interventions.
Question 2 of 5
A client has been in the critical care unit for 3 days following a severe myocardial infarction. Although he is medically stable, he has begun to have fluctuating episodes of consciousness, illogical thinking, and anxiety. He is picking at the air to 'catch these baby angels flying around my head.' While waiting for medical and psychiatric results, the nurse must intervene with the client's needs. Which of the following needs have the highest priority? Select all that apply.
Correct Answer: A,B,D
Rationale: Reducing stimuli (
A) minimizes confusion, avoiding challenges to hallucinations (
B) prevents agitation, and gently presenting reality (
D) supports orientation without confrontation. Assuming dementia (E) is premature, and orienting to medical condition (
C) may overwhelm the client.
Question 3 of 5
When comparing the signs and symptoms of depression found in children with those found in adults, which of the following should the nurse expect?
Correct Answer: A
Rationale: Children with depression often present with somatic complaints and behavioral issues, unlike adults who show more overt sadness.
Question 4 of 5
The wife of a client diagnosed with paranoid schizophrenia visits 2 days after her husband's admission and states to the nurse, 'Why isn't he eating? He's still talking about his food being poisoned.' Which of the following appraisals by the nurse is most accurate?
Correct Answer: A
Rationale: The wife's concern about her husband's refusal to eat due to delusions is reasonable, as it reflects a common symptom of paranoid schizophrenia that persists early in treatment.
Question 5 of 5
The physician orders fluoxetine (Prozac) orally every morning for a 72-year-old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse?
Correct Answer: B
Rationale: Dizziness in an elderly client increases fall risk, requiring immediate action to ensure safety.