Mental Health NCLEX Questions with Rationale

Extract:

Question 1 of 5

The nurse is caring for an unresponsive toddler in a PICU. The child’s parent was arrested for alleged child abuse but released on bail. The parent is pounding at the door belligerent and demanding to visit the child. Which is the most appropriate nursing plan of action?

Correct Answer: D

Rationale: Initiating the emergency response (
D) ensures safety. Allowing entry (
A) deferring to HCP (
B) or reporting to Social Services (C likely already done) are inappropriate.

Question 2 of 5

The client experiencing severe withdrawal symptoms due to alcohol dependence is prescribed chlordiazepoxide 100 mg oral x 1 then 50 mg every 2 hours until symptoms are controlled. The medication is supplied in 50-mg tablets. The nurse administered the initial dose 2 hours ago and the client is still agitated and tremulous. How many tablets should the nurse prepare to administer at this time?_ tablet(s) (Record your answer as a whole number.)

Your Answer:

Correct Answer: 1

Rationale: Proportion: 50 mg/1 tablet = 50 mg/X tablets; X = 1 tablet.

Question 3 of 5

The nurse is caring for an unresponsive toddler in a PICU. The child’s parent was arrested for alleged child abuse but released on bail. The parent is pounding at the door belligerent and demanding to visit the child. Which is the most appropriate nursing plan of action?

A. Allow the parent to enter the room and see the child. B. Tell the parent that the HCP wants to speak with the parent first. C. Contact Social Services to report the parent’s abusive behavior. D. Initiate the emergency response system for behavioral situations.

Correct Answer: D

Rationale: Initiating the emergency response (
D) ensures safety. Allowing entry (
A) deferring to HCP (
B) or reporting to Social Services (C likely already done) are inappropriate.

Question 4 of 5

The client with a history of aggressive behavior toward staff and peers states to the nurse “Everyone is just so touchy; I don’t see where I’m being too aggressive.” Which nursing action should be included in the therapeutic plan of care to best effect a difference in perceptions?

A. Refamiliarize the client with the rules of the unit. B. Introduce nonaggressive interpersonal behaviors to the client. C. Promote dialogue between the staff and client to discuss the staff’s perceptions of aggressive behavior. D. Encourage the staff to show patience to the client because the client may have poor aggression control.

Correct Answer: C

Rationale: Dialogue (
C) clarifies differing perceptions of aggression. Rules (
A) or behaviors (
B) are less effective without addressing perceptions and patience (
D) risks safety.

Question 5 of 5

The nurse is counseling the client with a substance abuse disorder. Which defense mechanism is the nurse most likely to observe the client using in response to a stressful event?

A. Repression B. Regression C. Sublimation D. Reaction formation

Correct Answer: B

Rationale: Regression (
B) is common in substance abuse showing childlike behaviors. Repression (
A) sublimation (
C) and reaction formation (
D) are less typical.

Mental Health NCLEX Questions with Rationale | Nurselytic

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