NCLEX mental health practice questions

Choose the response that keeps the client talking about feelings, avoid false reassurance and 'why' questions, and put safety first.

1. Question 1

   A client with severe depression is sitting alone in the dayroom. When the nurse approaches, the client looks down and says, "I don't feel like talking." Which response by the nurse is best?

   • A."Okay. Come find me when you're ready to talk."
   • B."You'll feel better if you join the group activity."
   • C."Why don't you want to talk today?"
   • D."That's all right. I'll sit here with you for a while."
   Show answer and explanation

   Answer: D

   Clients with severe depression often feel worthless and lack energy to interact. Spending quiet time with them shows they are valued and builds trust, so they may talk later.

   • A. A client with severe depression rarely has the energy to start contact; this places the burden on the client.
   • B. This gives advice and false reassurance and ignores what the client just said.
   • C. A 'why' question demands an explanation and can make the client feel defensive.
   • D. Offering self shows acceptance and care without pressuring the client to talk.

   Key concept: Offering self ('I'll sit with you') is a therapeutic technique that conveys acceptance without demands.

   Tip: Depressed and silent? Don't leave, don't push: just be present.

2. Question 2

   A home health nurse visits an 80-year-old client whose spouse died 1 year ago. The client lives alone, rarely leaves home and says, "The days are long and empty." Which interventions should the nurse suggest? Select all that apply.

   Select all that apply.

   • A.Information about activities at a local senior center
   • B.A home-delivered meal program that includes a daily visit
   • C.A daily telephone check-in program
   • D.Moving into a nursing home as soon as possible
   • E.Staying home more to avoid the risk of falling
   • F.Reconnecting with friends, neighbors or a faith community the client used to see
   Show answer and explanation

   Answer: A, B, C, F

   Social isolation in older adults raises the risk of depression, poor nutrition and early death. The nurse connects the client with community programs and helps rebuild personal relationships.

   • A. Senior centers offer social contact, meals and activities that reduce isolation.
   • B. Meal delivery provides nutrition and a regular friendly contact.
   • C. Regular calls provide connection and a safety check for an older adult living alone.
   • D. The client has no care needs that require placement; this is not appropriate for loneliness alone.
   • E. This would increase isolation and loss of strength.
   • F. Rebuilding existing relationships strengthens the client's natural support system.

   Key concept: Support systems include family, friends, faith communities and formal community services. Isolation after loss of a spouse is common and should be actively addressed. Screening for depression is also important.

   Tip: Lonely older adult? Connect: center, calls, meals, old friends.

3. Question 3

   The nurse is admitting an 81-year-old client with moderate hearing loss who does not have hearing aids. Which communication techniques should the nurse use? Select all that apply.

   Select all that apply.

   • A.Face the client directly in good light
   • B.Speak clearly in a normal to slightly lower pitch
   • C.Turn off the television and close the door
   • D.Shout so the client can hear every word
   • E.Rephrase a sentence the client did not understand
   • F.Exaggerate lip movements while speaking
   Show answer and explanation

   Answer: A, B, C, E

   Good communication with clients who have hearing loss uses face-to-face contact, good lighting, low background noise, clear speech at a lower pitch and rephrasing when needed.

   • A. Seeing the nurse's face helps the client lip-read and read expressions.
   • B. Age-related hearing loss affects high pitches first, so a lower pitch is easier to hear.
   • C. Reducing background noise makes speech easier to understand.
   • D. Shouting distorts speech and raises pitch, which makes it harder to understand and can seem aggressive.
   • E. Different words may contain sounds that are easier to hear.
   • F. Exaggerated lip movements distort normal mouth shapes and make lip-reading harder.

   Key concept: Adapting communication to sensory deficits is part of a therapeutic environment. Ask about and offer hearing devices such as pocket amplifiers.

   Tip: Face, lower, quiet, rephrase. Don't shout.

4. Question 4

   The nurse is preparing to give discharge teaching to a client who speaks only Vietnamese. Which actions are appropriate? Select all that apply.

   Select all that apply.

   • A.Use a qualified medical interpreter, in person or by video or phone
   • B.Look at and speak directly to the client rather than the interpreter
   • C.Ask the client's 12-year-old grandson to interpret because he is fluent
   • D.Use short sentences and pause often for the interpreter
   • E.Speak more loudly so the client understands better
   • F.Use teach-back through the interpreter to confirm understanding
   Show answer and explanation

   Answer: A, B, D, F

   Clients with limited English proficiency have a right to a qualified interpreter at no cost. The nurse speaks to the client, uses short phrases and confirms understanding with teach-back.

   • A. Trained medical interpreters give accurate interpretation and follow confidentiality rules.
   • B. Speaking to the client keeps the relationship between nurse and client.
   • C. Children and family members may not know medical terms, may filter information and are placed in an unfair role.
   • D. Short segments make accurate interpretation easier.
   • E. Volume does not help a language barrier and can seem disrespectful.
   • F. Asking the client to explain the instructions in their own words checks real understanding.

   Key concept: Use trained medical interpreters, not family members, especially children. Address the client directly and verify understanding.

   Tip: Talk TO the client, THROUGH the interpreter.

5. Question 5

   A 31-year-old veteran is being evaluated in an outpatient clinic for posttraumatic stress disorder (PTSD). Which findings are consistent with this diagnosis? Select all that apply.

   Select all that apply.

   • A.Repeated nightmares about the combat event
   • B.Jumps and feels on guard when a door slams
   • C.Avoids crowded places that remind the client of the event
   • D.Talks rapidly, jumping quickly from one topic to another
   • E.Feels detached and distant from family members
   • F.Believes he has special powers to control the weather
   Show answer and explanation

   Answer: A, B, C, E

   PTSD has four symptom groups: intrusion (nightmares, flashbacks), avoidance, negative changes in mood and thinking (detachment), and increased arousal (hypervigilance, startle). Flight of ideas and grandiose delusions belong to other disorders.

   • A. Intrusive memories and nightmares are core re-experiencing symptoms of PTSD.
   • B. An exaggerated startle response and hypervigilance reflect increased arousal in PTSD.
   • C. Avoidance of reminders is a defining symptom cluster of PTSD.
   • D. Flight of ideas and pressured speech are features of mania, not PTSD.
   • E. Negative changes in mood and feeling cut off from others are common in PTSD.
   • F. This is a grandiose delusion, seen in psychosis or mania, not PTSD.

   Key concept: PTSD symptoms last more than 1 month after a traumatic event and include re-experiencing, avoidance, negative mood changes and hyperarousal.

   Tip: PTSD = Relive, Avoid, Numb, On guard.