Free NCLEX-RN practice
Free NCLEX-RN Psychosocial Integrity Questions
Free NCLEX-RN psychosocial integrity practice questions with rationales — coping, therapeutic communication, and mental health care.
10 psychosocial integrity practice questions with rationales
A client is admitted with anorexia nervosa. Which nursing interventions are appropriate? Select all that apply.
Correct answers: o1, o2, o3
Care supervises meals and the period after to prevent purging or hiding food, monitors electrolytes for the dangerous shifts of refeeding, and keeps a neutral tone that avoids power struggles over food and weight. Leaving eating optional, allowing free exercise, and praising weight gained all feed the disorder or add danger.
Why the other options are wrong
- o4. Making meals optional lets the eating disorder control intake.
- o5. Free exercise burns needed calories and can be used to counteract eating.
- o6. Praising weight focuses on the number and can increase the client's distress and resistance.
Key takeaway
Supervise meals and the time after, watch refeeding electrolytes, and stay matter-of-fact. Do not make eating optional, allow free exercise, or praise the weight.
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A client with schizophrenia says, 'The voices are telling me that I am in danger.' Which response by the nurse is most appropriate?
Correct answer: D
The nurse validates the client's feeling (fear) while being honest that the nurse does not hear the voices, which builds trust without reinforcing the hallucination. Arguing that the voices are not real tends to increase distress, dismissing them ('just tell them to stop') is not helpful, and the nurse does assess for command hallucinations but not by focusing on harming others in this phrasing.
Why the other options are wrong
- A. Flatly denying the voices puts you in an argument the client cannot win from inside the experience, which usually deepens distress and erodes trust. Key distinction: be honest about your own perception without declaring the client wrong.
- B. Leading with what the voices say about harming others centers other people instead of the client's fear and safety, and the abrupt focus can feel threatening. Key distinction: assess command hallucinations, but open with the client's emotion, not with harm to others.
- C. Telling the client to just dismiss the voices minimizes an experience they cannot switch off and offers no real support. Key distinction: acknowledge the distress rather than instruct the client to override it.
Key takeaway
With hallucinations, acknowledge the client's feeling and state you do not share the perception, without arguing.
A client appears frightened and says, 'The voices are telling me people want to hurt me.' What is the nurse's best response?
Correct answer: C
The nurse acknowledges the client's reality without confirming the hallucination ('I don't hear them') and, most importantly, assesses for command hallucinations that direct harm, which is the immediate safety concern. Denying the voices argues with the client, exploring their content in detail can reinforce them, and telling the client to ignore them dismisses the experience.
Why the other options are wrong
- A. Flatly denying the voices argues with the client's experience and does not build trust or assess safety.
- B. Exploring the content in detail can reinforce the hallucination and misses the safety question.
- D. Telling the client to ignore the voices dismisses a frightening experience and assesses nothing.
Key takeaway
For hallucinations, do not confirm or argue. Acknowledge the client's experience and assess for command hallucinations that direct harm.
A client stopped drinking alcohol about 24 hours ago. Which findings are consistent with alcohol withdrawal? Select all that apply.
Correct answers: o4, o1, o3, o2
Alcohol withdrawal is a state of nervous-system overactivity, so it produces tremors, a fast heart rate, high blood pressure, and sweating, along with anxiety and a risk of seizures, and the pupils dilate. Pinpoint pupils suggest opioid effect, slurred speech with an unsteady gait describes intoxication rather than withdrawal, and diaphoresis means the skin is sweaty rather than flushed and dry.
Why the other options are wrong
- o5. Alcohol withdrawal dilates the pupils as part of autonomic overactivity; pinpoint pupils instead point to opioid effect and do not fit withdrawal.
- o6. Slurred speech and an unsteady gait describe acute intoxication. As alcohol clears, the nervous system becomes overactive rather than sedated and uncoordinated.
- o7. Withdrawal produces diaphoresis, so the skin is sweaty, not dry. Flushed, dry skin suggests another cause such as an anticholinergic effect or heat exposure.
Key takeaway
Alcohol withdrawal is sympathetic overdrive: tremor, tachycardia, hypertension, diaphoresis, and dilated pupils. Pinpoint pupils, slurred speech with an unsteady gait, and dry skin point elsewhere.
A client with schizophrenia states firmly, "The government planted a tracking chip in my arm." Which response by the nurse is most appropriate?
Correct answer: C
The nurse neither argues with nor reinforces a delusion. The best response presents reality without debating it ("I do not see a chip") while acknowledging the client's feeling ("this is frightening for you"). Directly arguing the delusion puts the client on the defensive, asking for more detail explores and reinforces the delusional content, and offering an x-ray to disprove it engages the delusion as if it were testable, which also reinforces it.
Why the other options are wrong
- A. Arguing the delusion makes the client defensive and does not build trust.
- B. Even when paired with empathy, asking about the chip explores and reinforces the delusional content.
- D. Trying to disprove the delusion with a test engages and reinforces it.
Key takeaway
With a delusion, do not argue it, explore its content, or try to disprove it. Acknowledge the underlying feeling and calmly present reality.
A client in an acute manic episode has been pacing the unit almost nonstop, has slept only about 2 hours over the past 3 days, and has eaten only a few bites at meals. The client has lost 4 lb (1.8 kg) since admission, has dry mucous membranes and dark, scant urine, is speaking rapidly, is intrusive with others, and cannot sit still to eat or rest. Which intervention is the priority?
Correct answer: D
In acute mania the client is too active to sit and eat, drink, or sleep, so exhaustion, dehydration, and weight loss become the first physical threats. This client already shows weight loss, dry mucous membranes, and dark, scant urine, so meeting physiologic needs comes before behavioral or environmental goals. High-calorie finger foods and fluids the client can consume on the move get calories and hydration in without a power struggle. Limit-setting and reducing stimulation matter, but they address behavior and environment, not the body's immediate deficits.
Why the other options are wrong
- A. Limit-setting is a real and necessary manic intervention, which is why it is tempting, but it manages behavior. It does nothing about the near-sleeplessness, poor intake, and dehydration that threaten this client physically right now.
- B. Reducing stimulation is a legitimate manic intervention, so students often pick it as the priority. It calms the environment and can help the client rest, but it still leaves the urgent nutrition and hydration deficits unaddressed.
- C. A group session would flood an already overstimulated client with more input and could escalate the mania. It also fails to meet the physical needs that come first.
Key takeaway
In acute mania, physiologic needs win. A client with weight loss, dehydration, and near-sleeplessness who cannot sit still is prioritized for nutrition and hydration (portable finger foods and fluids) before behavioral or environmental interventions.
A woman comes to the emergency department with a wrist injury. While the nurse is assessing her alone, she says quietly, 'My partner grabbed me and twisted my arm during an argument.' Which response by the nurse is most appropriate?
Correct answer: C
When a client discloses intimate-partner violence, all four responses are respectful and preserve her autonomy, so the item turns on sequence, not warmth. The immediate priority is to affirm that the abuse is not her fault and to assess her immediate safety, which then shapes everything that follows. Offering to contact police or an advocate, discussing shelter options, and collaborative safety planning are all appropriate interventions, but each is a resource or a plan that comes after the non-blaming safety assessment and remains the client's choice.
Why the other options are wrong
- A. Offering to contact the police or an advocate respects her choice and is a reasonable next step, but it reaches for a specific resource before the nurse has affirmed non-blame and screened immediate safety; that assessment comes first and guides whether and when she wants that call.
- B. Talking through shelter options is appropriate resource-sharing, but jumping to where she will go skips the immediate step of validating that the abuse is not her fault and confirming she is safe right now, which is what safety planning should be built on.
- D. Collaborative safety planning is a core intimate-partner-violence intervention and respects autonomy, but it is future-focused; the nurse first affirms non-blame and assesses immediate danger, then plans with her.
Key takeaway
In IPV, the priority response validates that the abuse is not the client's fault and assesses immediate safety; offering police, shelter, or a safety plan are all appropriate but come after that step and stay in the client's control.
A nurse is preparing a client for discharge after a new diagnosis of heart failure. The client sighs and says, "I don't know how I'm going to manage all of this once I get home." Which is the nurse's best initial response?
Correct answer: B
When a client names a feeling, reflecting that feeling back shows you heard them and keeps the door open, and it comes before focused questioning, assessment, or reassurance. This client's cue is worry about coping at home, so naming the overwhelmed feeling first invites them to say more before the nurse narrows in on specifics, checks supports, or reassures. That is what makes reflecting the feeling the best initial response.
Why the other options are wrong
- A. Asking what worries the client most is genuinely exploratory and useful, but it moves to the content of the worry before acknowledging the feeling the client just named; reflecting the emotion first tells the client they were heard and makes focused exploration land better.
- C. Assessing who is available to help is important discharge information and sounds caring, but it gathers data before acknowledging the feeling; a client who feels overwhelmed needs the emotion named before an assessment question.
- D. Reassuring the client they won't be alone and offering to go step by step is warm and partnering, but it reassures and moves toward problem-solving before the feeling is acknowledged, which can leave the client feeling their worry was smoothed over rather than heard.
Key takeaway
Reflect a stated feeling before you question, assess, or reassure; naming the emotion invites the client to say more.
A client on the mental health unit suddenly begins pacing and breathing rapidly and says, 'I can't breathe, something terrible is happening, I am going to die.' The heart rate is 122, the hands are trembling, and the client cannot focus on the nurse's questions. Which nursing action is the priority?
Correct answer: C
Rule: at the peak of a panic attack the client's perceptual field is severely narrowed, so the person cannot learn new skills or process complex questions. The nurse lowers stimulation and provides external control by staying present, speaking calmly, and giving short, simple, directive statements. Applying that here, the client is at panic-level anxiety (heart rate 122, air hunger, trembling, unable to focus), so remaining with the client and giving brief calm directions meets the immediate need and prevents escalation.
Why the other options are wrong
- A. Progressive muscle relaxation is a genuine anxiety tool, which makes it tempting, but it is taught and rehearsed when anxiety is mild to moderate. A client who cannot focus at panic level cannot follow a multi-step script, so the attempt adds demand and can worsen distress.
- B. Exploring triggers sounds therapeutic, but insight work needs cognitive processing the client does not have during peak panic. Asking what set this off now overloads a narrowed perceptual field and delays the calming the client needs first.
- D. Peer reassurance seems supportive, but moving to the group room adds noise, people, and stimulation, the opposite of what a panicking client needs, and escalation is the likely result.
Key takeaway
During a panic attack, reduce stimulation and use short, calm, directive statements. Save teaching and insight work for when anxiety drops to a learnable level.
Which principles guide crisis intervention? Select all that apply.
Correct answers: o1, o2, o3, o5
Crisis intervention focuses on the immediate problem, ensures safety, mobilizes coping and support, and uses an active, directive approach because time is short. Deep exploration of the past and long-term personality change are goals of ongoing therapy, not acute crisis work.
Why the other options are wrong
- o4. Exploring the distant past is a goal of long-term insight-oriented therapy. Key distinction: Crisis intervention is brief and focuses exclusively on the immediate precipitating stressor.
- o6. Long-term personality reconstruction requires months or years of psychotherapy. Key distinction: The objective of crisis intervention is to restore the client to their pre-crisis baseline, not to alter their personality.
Key takeaway
Crisis intervention: present-focused, safety, mobilize support, and active/directive.