NCLEX RN Psychiatric Questions
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Question 1 of 5.
A 21-year-old female was arrested on charges of solicitation. Jail staff asked for a mental health evaluation when the woman used a fork to stab herself. She also had an episode of rage after waking up from a nightmare and screamed repeatedly to 'let her out of the locked room.' After she was admitted to the psychiatric unit, she admitted to being kidnapped and held from ages 8 to 16 by a convicted child pornographer. She said she never contacted her family after her release from captivity. The nurse should do the following in what order of priority from first to last?
- A. Initiate suicide precautions and a no harm contract.
- B. Ask the client if she wishes to contact her family while hospitalized.
- C. Offer empathy and support and be non-judgmental and honest with her.
- D. Encourage safe verbalizations of her emotions, especially anger.
- A. Initiate suicide precautions and a no harm contract.
- C. Offer empathy and support and be non-judgmental and honest with her.
- B. Ask the client if she wishes to contact her family while hospitalized.
- D. Encourage safe verbalizations of her emotions, especially anger.
Correct arrangement
Explanation: The nurse should prioritize: 1) Suicide precautions and no harm contract (A) due to self-harm; 2) Offer empathy and support (C) to build trust; 3) Ask about contacting family (B) to explore reconnection; 4) Encourage verbalizing emotions (D) to process trauma.
Question 2 of 5.
A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The physician prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerfully greets the nurse. He appears to be relaxed and joins the group for community meeting before supper. What should the nurse interpret as the most likely cause of the client's behavior?
A. The author is helping the client's symptoms of depression significantly.
B. The client's sudden improvement calls for close observation by the staff.
C. The staff can decrease their observation of the client.
D. The client is nearing discharge due to the improvement of his symptoms.
Explanation: Sudden improvement in a suicidal client may indicate a resolved decision to act on suicidal thoughts, requiring close observation.
Question 3 of 5.
A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, 'I want to know why I'm so depressed.' Which of the following statements by the nurse is most helpful?
A. I know you'll get better with the right medication.'
B. Let's discuss possible reasons underlying your depression.'
C. Your depression is most likely caused by a brain chemical imbalance.'
D. Members of your family seem very supportive of you.'
Explanation: Discussing possible reasons encourages exploration of triggers and fosters therapeutic engagement.
Question 4 of 5.
A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, 'My boss was wonderful! He was understanding and a really nice man.' The nurse interprets the client's statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse?
A. But, I don't understand, wasn't he the one who fired you?'
B. Tell me more about having to work while not being able to sleep or concentrate.'
C. It must have been hard to leave a boss like that.'
D. It sounds like he would hire you back if you asked.'
Explanation: Encouraging the client to discuss difficulties at work may uncover underlying feelings masked by reaction formation.
Question 5 of 5.
A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client?
A. Future plans for going back to work.
B. A conflict encountered with another client.
C. Results of psychological testing.
D. Medication management with outpatient follow-up.
Explanation: Medication adherence and outpatient follow-up are critical to prevent relapse in major depression.
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