Mental Health NCLEX Questions with Rationale
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Question 1 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.
Explanation: Dialogue (C) clarifies differing perceptions of aggression. Rules (A) or behaviors (B) are less effective without addressing perceptions and patience (D) risks safety.
Question 2 of 5.
Which emotional responses are the parents most likely to experience immediately after the sudden death of their infant?
A. Anger
B. Guilt
C. Fear
D. Depression
Explanation: Guilt is a common immediate response as parents often question their actions or feel responsible for the infant's death, reflecting early grief processing.
Question 3 of 5.
The emergency department nurse describes procedures and their purposes to the rape victim before they are implemented. What is the rationale for the nurse's action?
A. It diminishes feelings of powerlessness.
B. It tends to reduce the client's anxiety.
C. It is a policy of the emergency department.
D. It meets the client's need for teaching.
Explanation: Explaining procedures empowers the victim by restoring some control, counteracting the powerlessness experienced during the assault.
Question 4 of 5.
Which nursing actions will best protect the client's safety? Select all that apply.
A. Station a security guard outside the client's room at all times.
B. Remove all cords, wires, and strings in the room.
C. Provide paper dishes and plastic utensils.
D. Assess whether the client has swallowed all medications.
E. Ask a family member to stay with the client during the night.
F. Check in on the client every 30 minutes.
Explanation: Removing potential hazards, using safe utensils, ensuring medication compliance, and frequent checks minimize suicide risk by reducing means and monitoring behavior.
Question 5 of 5.
If the client snorts cocaine on a regular basis, which physical assessment findings will the nurse most likely find? Select all that apply.
A. Dry, stuffy nose
B. Perforated nasal septum
C. Hoarseness and cough
D. Sinus pain under the eyes
E. Elevated blood pressure
F. Inability to sleep
Explanation: Regular cocaine snorting causes nasal irritation, septal damage, sinus pain, hypertension, and insomnia due to its stimulant effects.