NCLEX RN Psychosocial Integrity Exam 3
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A client with major depressive disorder states, "I am a complete failure.
Everyone would be better off without me." Which response by the nurse is
the most therapeutic?
A. "You have so much to live for. Let's focus on your strengths."
B. "I understand you are feeling hopeless right now, but you are not a
failure."
C. "Tell me more about what makes you feel like a failure."
D. "You should not talk that way. It is not true."
Answer: C
Rationale: Option C uses open-ended exploration, encouraging the client to
elaborate on their feelings, which is a core therapeutic communication
technique. Option A offers false reassurance and negates the client's feelings.
Option B, while empathetic, closes off further exploration by providing a
correction. Option D is confrontational and dismissive, which will damage the
therapeutic alliance. Exploring the client's perception provides valuable
assessment data and shows genuine interest.
2. During a group therapy session, a client with borderline personality disorder
becomes verbally aggressive toward another member. What is the nurse's
priority action?
A. Remove the aggressive client from the group immediately.
B. Redirect the group's focus to a neutral topic.
C. Set limits by stating, "This behavior is unacceptable. Please sit down and
, calm down."
D. Ask the other group members how they feel about the outburst.
Answer: C
Rationale: The priority is to maintain safety and set clear, firm limits on
unacceptable behavior. Option C addresses the behavior directly and gives a
clear expectation. Option A may be necessary if escalation continues, but it is
not the first step and may be seen as punitive. Option B avoids the conflict and
does not address the aggression. Option D is inappropriate while the client is
actively escalating; safety must be secured first.
3. The nurse is assessing a client who presents with a flat affect, alogia, and
avolition. These symptoms are most consistent with which psychiatric
disorder?
A. Major depressive disorder
B. Schizophrenia, negative symptoms
C. Bipolar I disorder, manic phase
D. Generalized anxiety disorder
Answer: B
Rationale: Flat affect (lack of emotional expression), alogia (poverty of speech),
and avolition (lack of motivation) are classic negative symptoms of
schizophrenia. Major depressive disorder typically presents with sad mood,
anhedonia, and sleep disturbances, though avolition can occur, the combination
with flat affect and alogia points directly to the negative symptom cluster of
schizophrenia. Mania presents with grandiosity and hyperactivity. GAD presents
with excessive worry and somatic symptoms.
4. A client who recently lost a spouse to cancer states, "I keep hearing his
voice telling me to lock the doors." Which nursing action is most
appropriate?
A. Administer a PRN antipsychotic medication.
B. Ask the client if he has been hearing voices since the death.
C. Explain that hearing a deceased loved one is a common part of the
, grieving process.
D. Schedule an immediate psychiatric consult for possible psychosis.
Answer: C
Rationale: Auditory hallucinations of a deceased loved one are a normal, non-
psychotic phenomenon during acute grief. The nurse should provide
normalization and reassurance that this experience is expected. Option A is
premature and unnecessary. Option B is a closed question that does not offer
therapeutic education. Option D is an overreaction and indicates a
misunderstanding of normal grief responses.
5. The nurse is caring for a client with alcohol use disorder who is experiencing
withdrawal. Which vital sign finding requires immediate intervention?
A. Heart rate 92 bpm, respiratory rate 18
B. Blood pressure 150/90 mm Hg, heart rate 110 bpm
C. Temperature 37.1°C, blood pressure 128/76
D. Oxygen saturation 98%, heart rate 88 bpm
Answer: B
Rationale: Alcohol withdrawal can lead to autonomic hyperactivity. A blood
pressure of 150/90 and tachycardia of 110 indicate significant autonomic
instability, which can progress to delirium tremens, seizures, or cardiovascular
collapse. This requires immediate pharmacological intervention (e.g.,
benzodiazepines) and close monitoring. The other options are within normal
limits or show only mild elevation.
6. A mother brings her 4-year-old child to the clinic because the child has
started wetting the bed at night after being dry for 6 months. The mother
reports the child recently started preschool. What is the nurse's best
explanation to the mother?
A. "This is likely a urinary tract infection; we should do a urinalysis."
B. "Your child is regressing due to the stress of starting preschool. This is a
normal temporary response."
C. "You should restrict fluids after 5 PM to stop the bedwetting."
D. "This is a sign of a developmental delay and requires further testing."
, Answer: B
Rationale: Regression is a common defense mechanism in young children
experiencing developmental transitions, such as starting school. Loss of a
previously achieved milestone (bowel/bladder control) is a classic sign of
regression under stress. The nurse should reassure the parents that this is
typically temporary. Option A is premature without other signs of infection.
Option C is a behavioral intervention that may help but does not address the
cause. Option D is incorrect as this is not indicative of a permanent delay.
7. A client with post-traumatic stress disorder (PTSD) is experiencing a
flashback. The client is sweating, hyperventilating, and staring blankly. What
is the nurse's priority intervention?
A. Gently touch the client's shoulder to ground them.
B. Speak in a calm, firm voice and say, "You are safe now. You are in the
hospital. Look at me."
C. Administer an anxiolytic medication immediately.
D. Leave the client alone to let the episode pass.
Answer: B
Rationale: During a flashback, the client is dissociating from reality and reliving
the trauma. The priority is to reorient the client to the present environment in a
calm, clear, and assertive manner. Option B provides sensory grounding and
reality orientation. Option A may be unsafe if the client is startled; touch should
be avoided unless the nurse has established permission. Option C is not the
immediate first step; reorientation should be attempted first. Option D is unsafe
and neglectful.
8. The nurse is conducting a mental status exam on a client. Which question
best assesses the client's abstract thinking?
A. "What is your name and date of birth?"
B. "Can you count backward from 100 by 7s?"
C. "What does the saying 'People who live in glass houses shouldn't throw
stones' mean to you?"
D. "Can you repeat these three words: apple, table, penny?"
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A client with major depressive disorder states, "I am a complete failure.
Everyone would be better off without me." Which response by the nurse is
the most therapeutic?
A. "You have so much to live for. Let's focus on your strengths."
B. "I understand you are feeling hopeless right now, but you are not a
failure."
C. "Tell me more about what makes you feel like a failure."
D. "You should not talk that way. It is not true."
Answer: C
Rationale: Option C uses open-ended exploration, encouraging the client to
elaborate on their feelings, which is a core therapeutic communication
technique. Option A offers false reassurance and negates the client's feelings.
Option B, while empathetic, closes off further exploration by providing a
correction. Option D is confrontational and dismissive, which will damage the
therapeutic alliance. Exploring the client's perception provides valuable
assessment data and shows genuine interest.
2. During a group therapy session, a client with borderline personality disorder
becomes verbally aggressive toward another member. What is the nurse's
priority action?
A. Remove the aggressive client from the group immediately.
B. Redirect the group's focus to a neutral topic.
C. Set limits by stating, "This behavior is unacceptable. Please sit down and
, calm down."
D. Ask the other group members how they feel about the outburst.
Answer: C
Rationale: The priority is to maintain safety and set clear, firm limits on
unacceptable behavior. Option C addresses the behavior directly and gives a
clear expectation. Option A may be necessary if escalation continues, but it is
not the first step and may be seen as punitive. Option B avoids the conflict and
does not address the aggression. Option D is inappropriate while the client is
actively escalating; safety must be secured first.
3. The nurse is assessing a client who presents with a flat affect, alogia, and
avolition. These symptoms are most consistent with which psychiatric
disorder?
A. Major depressive disorder
B. Schizophrenia, negative symptoms
C. Bipolar I disorder, manic phase
D. Generalized anxiety disorder
Answer: B
Rationale: Flat affect (lack of emotional expression), alogia (poverty of speech),
and avolition (lack of motivation) are classic negative symptoms of
schizophrenia. Major depressive disorder typically presents with sad mood,
anhedonia, and sleep disturbances, though avolition can occur, the combination
with flat affect and alogia points directly to the negative symptom cluster of
schizophrenia. Mania presents with grandiosity and hyperactivity. GAD presents
with excessive worry and somatic symptoms.
4. A client who recently lost a spouse to cancer states, "I keep hearing his
voice telling me to lock the doors." Which nursing action is most
appropriate?
A. Administer a PRN antipsychotic medication.
B. Ask the client if he has been hearing voices since the death.
C. Explain that hearing a deceased loved one is a common part of the
, grieving process.
D. Schedule an immediate psychiatric consult for possible psychosis.
Answer: C
Rationale: Auditory hallucinations of a deceased loved one are a normal, non-
psychotic phenomenon during acute grief. The nurse should provide
normalization and reassurance that this experience is expected. Option A is
premature and unnecessary. Option B is a closed question that does not offer
therapeutic education. Option D is an overreaction and indicates a
misunderstanding of normal grief responses.
5. The nurse is caring for a client with alcohol use disorder who is experiencing
withdrawal. Which vital sign finding requires immediate intervention?
A. Heart rate 92 bpm, respiratory rate 18
B. Blood pressure 150/90 mm Hg, heart rate 110 bpm
C. Temperature 37.1°C, blood pressure 128/76
D. Oxygen saturation 98%, heart rate 88 bpm
Answer: B
Rationale: Alcohol withdrawal can lead to autonomic hyperactivity. A blood
pressure of 150/90 and tachycardia of 110 indicate significant autonomic
instability, which can progress to delirium tremens, seizures, or cardiovascular
collapse. This requires immediate pharmacological intervention (e.g.,
benzodiazepines) and close monitoring. The other options are within normal
limits or show only mild elevation.
6. A mother brings her 4-year-old child to the clinic because the child has
started wetting the bed at night after being dry for 6 months. The mother
reports the child recently started preschool. What is the nurse's best
explanation to the mother?
A. "This is likely a urinary tract infection; we should do a urinalysis."
B. "Your child is regressing due to the stress of starting preschool. This is a
normal temporary response."
C. "You should restrict fluids after 5 PM to stop the bedwetting."
D. "This is a sign of a developmental delay and requires further testing."
, Answer: B
Rationale: Regression is a common defense mechanism in young children
experiencing developmental transitions, such as starting school. Loss of a
previously achieved milestone (bowel/bladder control) is a classic sign of
regression under stress. The nurse should reassure the parents that this is
typically temporary. Option A is premature without other signs of infection.
Option C is a behavioral intervention that may help but does not address the
cause. Option D is incorrect as this is not indicative of a permanent delay.
7. A client with post-traumatic stress disorder (PTSD) is experiencing a
flashback. The client is sweating, hyperventilating, and staring blankly. What
is the nurse's priority intervention?
A. Gently touch the client's shoulder to ground them.
B. Speak in a calm, firm voice and say, "You are safe now. You are in the
hospital. Look at me."
C. Administer an anxiolytic medication immediately.
D. Leave the client alone to let the episode pass.
Answer: B
Rationale: During a flashback, the client is dissociating from reality and reliving
the trauma. The priority is to reorient the client to the present environment in a
calm, clear, and assertive manner. Option B provides sensory grounding and
reality orientation. Option A may be unsafe if the client is startled; touch should
be avoided unless the nurse has established permission. Option C is not the
immediate first step; reorientation should be attempted first. Option D is unsafe
and neglectful.
8. The nurse is conducting a mental status exam on a client. Which question
best assesses the client's abstract thinking?
A. "What is your name and date of birth?"
B. "Can you count backward from 100 by 7s?"
C. "What does the saying 'People who live in glass houses shouldn't throw
stones' mean to you?"
D. "Can you repeat these three words: apple, table, penny?"
