**Psychiatric Mental Health Nursing Exam Prep: NCLEX-
Style Questions with Clinical Judgment & Therapeutic
Communication**
---
**Question 1**
A nurse is assessing a client with major depressive disorder. Which of the following findings is most
critical to report to the healthcare provider immediately?
A. The client reports feeling sad and hopeless
B. The client has a 5-pound weight loss over the past month
C. The client states, “I have a plan to overdose on my sleeping pills tonight”
D. The client reports difficulty falling asleep
💫ANSWER✔️✔️: C. Active suicidal ideation with a specific plan, intent, and means is a psychiatric
emergency requiring immediate intervention (1:1 observation, removal of means, provider notification).
💫RATIONALE✔️✔️: Sadness (A), weight loss (B), and insomnia (D) are expected in depression but do not
present the same immediate life threat as active suicidal plan.
---
**Question 2**
A nurse is caring for a client with bipolar disorder who is in the manic phase. The client is pacing, talking
rapidly, and has not slept for 2 days. Which of the following is the priority nursing intervention?
,A. Encourage the client to join a group therapy session
B. Provide high-calorie finger foods and fluids to prevent dehydration and malnutrition
C. Restrict the client to their room to reduce stimulation
D. Challenge the client’s grandiose beliefs
💫ANSWER✔️✔️: B. During mania, clients are hyperactive, often skip meals, and become dehydrated.
Providing easy-to-eat finger foods and fluids maintains physical health. Restricting (C) may escalate
agitation.
💫RATIONALE✔️✔️: Group therapy (A) is too stimulating. Challenging grandiose beliefs (D) is ineffective
and damages rapport; focus on safety and physical needs first.
---
**Question 3**
A nurse is caring for a client with borderline personality disorder who has just been informed of a
change in the unit schedule. The client becomes angry and states, “You all hate me and want to control
me.” Which of the following is the most therapeutic response?
A. “You are being manipulative. Stop it.”
B. “Why would you think we hate you?”
C. “It sounds like you are feeling frustrated about the change. I am here to help.”
D. “If you cannot control your anger, I will have to put you in seclusion.”
💫ANSWER✔️✔️: C. This response validates the client’s emotion (frustration) without agreeing with the
distorted belief, uses reflection, and offers support. This de-escalates.
💫RATIONALE✔️✔️: Accusations (A) and “why” questions (B) escalate. Threats (D) are a last resort. Clients
with BPD need validation and boundary setting, not punishment.
,---
**Question 4**
A nurse is assessing a client with schizophrenia who is taking clozapine (Clozaril). The client reports a
sore throat and fever. Which of the following is the priority action?
A. Administer acetaminophen for fever
B. Obtain a stat complete blood count (CBC) with differential
C. Reassure the client that this is a common side effect
D. Increase fluid intake
💫ANSWER✔️✔️: B. Clozapine causes agranulocytosis (severe neutropenia) in up to 2% of clients. Sore
throat and fever may be early signs of infection due to low white blood cells. Immediate CBC is critical.
💫RATIONALE✔️✔️: The medication should be stopped if ANC is low. Acetaminophen (A) and fluids (D)
address symptoms but delay diagnosis. Reassurance (C) is dangerous.
---
**Question 5**
A nurse is providing education to the family of a client with Alzheimer’s disease who is starting
memantine (Namenda). Which of the following statements by a family member indicates
understanding?
A. “This medication will cure my mother’s Alzheimer’s.”
B. “Memantine is for moderate to severe Alzheimer’s and may help slow symptom progression.”
C. “My mother should take this medication only when she becomes agitated.”
, D. “Memantine works immediately to improve memory.”
💫ANSWER✔️✔️: B. Memantine (NMDA antagonist) is indicated for moderate to severe Alzheimer’s
disease and may slow cognitive decline. It does not cure (A), is not PRN (C), and takes weeks to show
effect (D).
💫RATIONALE✔️✔️: Donepezil and rivastigmine are for mild to moderate stages.
---
**Question 6**
A nurse is caring for a client with alcohol withdrawal delirium. The client is diaphoretic, has a heart rate
of 130 bpm, blood pressure 160/100 mm Hg, and is hallucinating. Which of the following medications
does the nurse anticipate administering first?
A. Haloperidol (Haldol)
B. Lorazepam (Ativan)
C. Thiamine (Vitamin B1)
D. Naltrexone (ReVia)
💫ANSWER✔️✔️: B. Benzodiazepines (lorazepam, chlordiazepoxide, diazepam) are first-line treatment
for alcohol withdrawal to prevent seizures and delirium. Thiamine (C) is given to prevent Wernicke’s
encephalopathy but is not the first priority for acute agitation.
💫RATIONALE✔️✔️: Haloperidol (A) may lower seizure threshold and is not first-line. Naltrexone (D) is for
relapse prevention, not acute withdrawal.
---
**Question 7**
Style Questions with Clinical Judgment & Therapeutic
Communication**
---
**Question 1**
A nurse is assessing a client with major depressive disorder. Which of the following findings is most
critical to report to the healthcare provider immediately?
A. The client reports feeling sad and hopeless
B. The client has a 5-pound weight loss over the past month
C. The client states, “I have a plan to overdose on my sleeping pills tonight”
D. The client reports difficulty falling asleep
💫ANSWER✔️✔️: C. Active suicidal ideation with a specific plan, intent, and means is a psychiatric
emergency requiring immediate intervention (1:1 observation, removal of means, provider notification).
💫RATIONALE✔️✔️: Sadness (A), weight loss (B), and insomnia (D) are expected in depression but do not
present the same immediate life threat as active suicidal plan.
---
**Question 2**
A nurse is caring for a client with bipolar disorder who is in the manic phase. The client is pacing, talking
rapidly, and has not slept for 2 days. Which of the following is the priority nursing intervention?
,A. Encourage the client to join a group therapy session
B. Provide high-calorie finger foods and fluids to prevent dehydration and malnutrition
C. Restrict the client to their room to reduce stimulation
D. Challenge the client’s grandiose beliefs
💫ANSWER✔️✔️: B. During mania, clients are hyperactive, often skip meals, and become dehydrated.
Providing easy-to-eat finger foods and fluids maintains physical health. Restricting (C) may escalate
agitation.
💫RATIONALE✔️✔️: Group therapy (A) is too stimulating. Challenging grandiose beliefs (D) is ineffective
and damages rapport; focus on safety and physical needs first.
---
**Question 3**
A nurse is caring for a client with borderline personality disorder who has just been informed of a
change in the unit schedule. The client becomes angry and states, “You all hate me and want to control
me.” Which of the following is the most therapeutic response?
A. “You are being manipulative. Stop it.”
B. “Why would you think we hate you?”
C. “It sounds like you are feeling frustrated about the change. I am here to help.”
D. “If you cannot control your anger, I will have to put you in seclusion.”
💫ANSWER✔️✔️: C. This response validates the client’s emotion (frustration) without agreeing with the
distorted belief, uses reflection, and offers support. This de-escalates.
💫RATIONALE✔️✔️: Accusations (A) and “why” questions (B) escalate. Threats (D) are a last resort. Clients
with BPD need validation and boundary setting, not punishment.
,---
**Question 4**
A nurse is assessing a client with schizophrenia who is taking clozapine (Clozaril). The client reports a
sore throat and fever. Which of the following is the priority action?
A. Administer acetaminophen for fever
B. Obtain a stat complete blood count (CBC) with differential
C. Reassure the client that this is a common side effect
D. Increase fluid intake
💫ANSWER✔️✔️: B. Clozapine causes agranulocytosis (severe neutropenia) in up to 2% of clients. Sore
throat and fever may be early signs of infection due to low white blood cells. Immediate CBC is critical.
💫RATIONALE✔️✔️: The medication should be stopped if ANC is low. Acetaminophen (A) and fluids (D)
address symptoms but delay diagnosis. Reassurance (C) is dangerous.
---
**Question 5**
A nurse is providing education to the family of a client with Alzheimer’s disease who is starting
memantine (Namenda). Which of the following statements by a family member indicates
understanding?
A. “This medication will cure my mother’s Alzheimer’s.”
B. “Memantine is for moderate to severe Alzheimer’s and may help slow symptom progression.”
C. “My mother should take this medication only when she becomes agitated.”
, D. “Memantine works immediately to improve memory.”
💫ANSWER✔️✔️: B. Memantine (NMDA antagonist) is indicated for moderate to severe Alzheimer’s
disease and may slow cognitive decline. It does not cure (A), is not PRN (C), and takes weeks to show
effect (D).
💫RATIONALE✔️✔️: Donepezil and rivastigmine are for mild to moderate stages.
---
**Question 6**
A nurse is caring for a client with alcohol withdrawal delirium. The client is diaphoretic, has a heart rate
of 130 bpm, blood pressure 160/100 mm Hg, and is hallucinating. Which of the following medications
does the nurse anticipate administering first?
A. Haloperidol (Haldol)
B. Lorazepam (Ativan)
C. Thiamine (Vitamin B1)
D. Naltrexone (ReVia)
💫ANSWER✔️✔️: B. Benzodiazepines (lorazepam, chlordiazepoxide, diazepam) are first-line treatment
for alcohol withdrawal to prevent seizures and delirium. Thiamine (C) is given to prevent Wernicke’s
encephalopathy but is not the first priority for acute agitation.
💫RATIONALE✔️✔️: Haloperidol (A) may lower seizure threshold and is not first-line. Naltrexone (D) is for
relapse prevention, not acute withdrawal.
---
**Question 7**
