NCLEX Mental Health Questions

Extract:

Question 1 of 5

The client taking disulfiram has a throbbing headache diaphoresis and sudden vomiting. Which possible conclusions by the nurse should be explored first?

Correct Answer: B

Rationale: Alcohol ingestion (
B) causes disulfiram reaction (headache diaphoresis vomiting). Influenza (
A) cough suppressants (
C)

Question 2 of 5

The nurse is teaching home health aides about monitoring for alcohol abuse in older adults. Which response by a home health aide indicates a need for further teaching?

A. “Alcohol abuse is the largest category of substance abuse problems in older adults.” B. “I should monitor more closely for alcohol abuse in single male clients who smoke.” C. “Retirement and freedom from work and family pressures tend to decrease alcohol use.” D. “Confusion malnutrition and self-neglect may be signs of alcohol abuse in the elderly.”

Correct Answer: C

Rationale: Retirement can increase alcohol use due to isolation (C is incorrect). Alcohol is a major issue (
A) risk factors include male smokers (
B) and signs include confusion (
D).

Question 3 of 5

The nurse explains to the client's family the alcoholic's recovery process. What is the first step in recovering from alcohol?

A. Admitting an inability to control drinking B. Forming a close support network C. Relying on some form of religious belief D. Checking into an inpatient rehabilitation unit

Correct Answer: A

Rationale: Admitting powerlessness over alcohol is the foundational step in recovery models like Alcoholics Anonymous, as it acknowledges the problem and initiates the commitment to change.

Question 4 of 5

The client is being admitted to the ICU with drug overdose that resulted in extreme hypertension and an unstable cardiac rhythm. The client suddenly becomes physically combative and is kicking shoving throwing items in the room and threatening staff. The charge nurse calls a behavioral situation code and 4-point restraints are applied by the team. Which intervention is most important for the nurse to implement next?

A. Have staff members who were harmed complete an incident report. B. Contact the health care provider to obtain an order for restraint use. C. Document the client’s behavior and action taken in the nurse’s notes. D. Check that the client’s wrist restraints are tightly secured to the HOB.

Correct Answer: B

Rationale: A physician or licensed independent practitioner must prescribe restraints and assess the client within 1 hour of restraint placement for client and staff safety. Incident reports (
A) follow treatment documentation (
C) follows HCP contact and securing restraints to the HOB (
D) risks circulation impairment.

Question 5 of 5

Which nursing action is most appropriate for determining whether domestic abuse is occurring?

A. Ask directly if domestic abuse is occurring. B. Arrange a second visit to validate suspicions. C. Assess the young children for signs of injury. D. Make inquiries among relatives or neighbors.

Correct Answer: A

Rationale: Directly asking about abuse in a safe, private setting encourages honest disclosure and is the most effective initial step to confirm suspicions.

NCLEX Mental Health Questions | Nurselytic

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