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NCLEX Psych / Mental Health Practice Questions

Mental health nursing practice questions: therapeutic communication, psych disorders, and crisis interventions — free with full rationales.

PharmacologyMed-SurgFundamentalsPediatricsMaternity
Question 1Multiple choicePsych

A client prescribed phenelzine (an MAOI) must avoid which food to prevent hypertensive crisis?

  1. Fresh apples
  2. Aged cheese
  3. White rice
  4. Grilled chicken
Show answer & rationale

Correct: Aged cheese

Why: MAOIs block the enzyme that breaks down tyramine; tyramine-rich foods (aged cheese, cured/fermented meats, tap beer, red wine, soy sauce) let tyramine surge and trigger hypertensive crisis. Fresh foods like apples, rice, and plain chicken are safe. Memory aid: aged cheese + MAOI = 'cheese crisis' — tyramine triggers hypertensive crisis.

📚 Basis: MAOIs impair tyramine metabolism; tyramine-rich (aged/fermented) foods can precipitate hypertensive crisis. · FDA MAOI labeling

Question 2Select all that applyPsych

Which responses demonstrate therapeutic communication with an anxious client? Select all that apply.

  1. "Tell me more about what you're feeling."
  2. Sitting quietly with the client
  3. "It sounds like you're worried about the surgery."
  4. "What specifically concerns you most?"
  5. "Don't worry, everything will be fine."
  6. "You should just try to relax."
Show answer & rationale

Correct: "Tell me more about what you're feeling."; Sitting quietly with the client; "It sounds like you're worried about the surgery."; "What specifically concerns you most?"

Why: Therapeutic techniques — open-ended questions, silence, reflection, clarifying — keep the focus on the client. False reassurance ('everything will be fine') and giving advice ('just relax') shut down communication and are non-therapeutic. Memory aid: 'open, silent, reflect' — open-ended questions, therapeutic silence, reflection.

📚 Basis: Therapeutic communication: open-ended questions, silence, reflection, clarifying vs. non-therapeutic blocks (false reassurance, advice-giving). · ANA psychiatric-mental health nursing standards

Question 3Multiple choicePsych

A client whose spouse died 2 months ago tells the nurse, 'I still set a plate for him at dinner every night.' The nurse recognizes this behavior as:

  1. Denial.
  2. Acceptance.
  3. Complicated grief.
  4. Depression.
Show answer & rationale

Correct: Denial.

Why: (1) Clinical principle: in Kubler-Ross's stages of grief, denial is the initial unconscious refusal to accept the reality of the loss, and it is a normal early grief response. (2) Behaving as though the deceased spouse were still alive reflects denial of the loss. (3) Acceptance involves acknowledging the reality of the loss; complicated grief is prolonged, impairing grief beyond cultural norms, typically persisting beyond 6 to 12 months; depression involves pervasive sadness and anhedonia rather than this specific behavior. (4) Memory aid: denial behaves as if the loss has not happened.

📚 Basis: Denial is the initial stage of grief in which the reality of the loss is not accepted. · Kubler-Ross grief theory; Varcarolis' Foundations of Psychiatric-Mental Health Nursing

Question 4Multiple choicePsych

A client with major depressive disorder states, 'I have a plan to kill myself tonight.' The nurse's priority action is to:

  1. Have the client sign a no-suicide contract and continue routine checks.
  2. Place the client on continuous one-to-one observation.
  3. Explain that suicide violates facility policy.
  4. Document the statement and reassess in one hour.
Show answer & rationale

Correct: Place the client on continuous one-to-one observation.

Why: (1) Clinical principle: a stated suicide plan with intent is a psychiatric emergency — the nurse ensures safety first through continuous one-to-one observation, removal of harmful objects, and prompt provider notification, per The Joint Commission's suicide-prevention National Patient Safety Goal. (2) Continuous one-to-one observation directly protects the client from acting on the plan. (3) No-suicide contracts are not reliable safety measures; lecturing about policy is nontherapeutic and punitive; documenting and waiting an hour leaves the client unprotected. (4) Memory aid: plan plus intent means eyes on, no delay.

📚 Basis: A client expressing suicidal plan and intent requires continuous observation and a safe environment. · The Joint Commission NPSG 15.01.01; APA

Question 5Multiple choicePsych

A client has bruises in various stages of healing and says her partner 'has a temper.' The nurse's best initial action is to:

  1. Interview the client alone in a private, safe setting using nonjudgmental language.
  2. Call law enforcement to report the suspected abuse immediately.
  3. Advise the client that she must leave her partner.
  4. Document the findings without discussing them with the client.
Show answer & rationale

Correct: Interview the client alone in a private, safe setting using nonjudgmental language.

Why: (1) Clinical principle: intimate partner violence assessment requires a private, safe setting with nonjudgmental, direct questioning; the nurse screens, supports, documents objectively, and offers resources while respecting the competent adult's autonomy. (2) Interviewing the client alone protects her safety and encourages honest disclosure. (3) Police reporting requirements vary by jurisdiction and the competent adult generally decides; ordering her to leave removes autonomy and can increase danger; silent documentation misses the opportunity to assess safety and offer help. (4) Memory aid: private, nonjudgmental, client-led.

📚 Basis: Intimate partner violence screening should occur privately with nonjudgmental, direct questions. · CDC Intimate Partner Violence guidance; ANA

Question 6Multiple choicePsych

A client with moderate anxiety is pacing and has difficulty concentrating. The nurse understands that at a moderate anxiety level, the client:

  1. Has sharpened senses and increased learning ability.
  2. Has a narrowed perceptual field but can refocus with direction.
  3. Fixates on details and cannot be redirected.
  4. Is unable to process any environmental stimuli.
Show answer & rationale

Correct: Has a narrowed perceptual field but can refocus with direction.

Why: (1) Clinical principle: Peplau's anxiety levels describe progressive perceptual narrowing — mild anxiety sharpens senses and enhances learning; moderate anxiety narrows the perceptual field with selective inattention, though the client can refocus with guidance; severe anxiety greatly reduces focus; panic causes disorganized inability to process stimuli. (2) A narrowed perceptual field with retained ability to refocus with direction defines moderate anxiety. (3) Sharpened senses describe mild anxiety; fixation that cannot be redirected describes severe anxiety; inability to process stimuli describes panic. (4) Memory aid: mild means more aware, moderate needs a guide, severe is scattered, panic is lost.

📚 Basis: At moderate anxiety the perceptual field narrows, but the person can focus with direction. · Peplau's theory of anxiety; Varcarolis' Foundations of Psychiatric-Mental Health Nursing

Question 7Multiple choicePsych

A client arrives at the emergency department after losing their home in a fire, trembling and unable to state their name. Applying crisis intervention principles, the nurse's priority is to:

  1. Ensure the client's physical safety and meet immediate basic needs.
  2. Explore the client's feelings about the loss.
  3. Teach coping strategies for long-term recovery.
  4. Contact the client's family for collateral information.
Show answer & rationale

Correct: Ensure the client's physical safety and meet immediate basic needs.

Why: (1) Clinical principle: crisis intervention follows Maslow's hierarchy — physical safety and physiological needs must be secured before psychological processing, coping instruction, or information gathering can be effective. (2) Ensuring safety, warmth, and basic needs stabilizes the client so later interventions can work. (3) Exploring feelings about the loss and teaching long-term coping strategies come after stabilization; contacting family for collateral information is secondary to the client's immediate safety. (4) Memory aid: in crisis care, safe first and feelings later.

📚 Basis: Crisis intervention prioritizes safety and basic needs before psychological processing. · Aguilera's crisis theory; Maslow's hierarchy of needs

Question 8Multiple choicePsych

A client with borderline personality disorder tells the nurse, 'You are the only one who cares. The night nurse is terrible.' The nurse's best response is to:

  1. Agree with the client to build rapport.
  2. Confront the client about manipulating staff.
  3. Maintain consistent boundaries and reinforce that all staff provide the same quality care.
  4. Request reassignment to avoid conflict with the night nurse.
Show answer & rationale

Correct: Maintain consistent boundaries and reinforce that all staff provide the same quality care.

Why: (1) Clinical principle: splitting — alternating idealization and devaluation of staff — is a defense mechanism common in borderline personality disorder; the therapeutic response is consistent limits, clear expectations, and uniform team behavior. (2) Maintaining consistent boundaries and reinforcing that all staff provide the same quality care directly counters splitting without punishing the client. (3) Agreeing with the client reinforces the split and undermines the team; confrontational labeling of the client as manipulative is nontherapeutic; requesting reassignment avoids the therapeutic work and disrupts continuity of care. (4) Memory aid: splitting splits staff, so stay consistent.

📚 Basis: Consistent boundaries and team-wide consistency are the therapeutic response to splitting behavior. · Varcarolis' Foundations of Psychiatric-Mental Health Nursing; APA practice guidelines for borderline personality disorder

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PharmacologyMed-SurgFundamentalsPediatricsMaternity

NCLEX Drill offers practice questions for study purposes only — not medical advice, and not a substitute for professional judgment or official study materials. Question bank grows daily; last updated 2026-10-09.