NCLEX Psychosocial Integrity Practice Test
What is in this test
| Topic | Focus | Items |
|---|---|---|
| Anxiety and Mood Disorders | Panic, depression, bipolar disorder and suicide risk | 5 |
| Therapeutic Communication | What to say, and what never to say | 4 |
| Schizophrenia and Psychotic Disorders | Hallucinations, delusions and antipsychotic effects | 4 |
| Substance Use and Withdrawal | Alcohol, opioid and stimulant withdrawal | 3 |
| Grief, Loss and End-of-Life Care | Palliative priorities and supporting the family | 2 |
| Abuse, Neglect and Violence | Recognition, reporting and safety planning | 2 |
Item formats in this test: Multiple choice, Select all that apply, Ordered response. This is test 4 of 9 — there is one for every client-need category.
The 20 questions
A client scheduled for surgery says, "I am really scared about tomorrow." Which response by the nurse is most therapeutic?
Show answer and rationale
Correct answer: B. "Tell me what worries you most about tomorrow."
An open-ended invitation to explore keeps the focus on the client and gives them room to name the specific fear, which is what allows it to be addressed.
Why the other options are wrong
- A. This is false reassurance and dismisses the client’s feeling.
- C. Asking why puts the client on the defensive, and calling it routine minimises their experience.
- D. Generalising moves the focus away from this client and shuts down the conversation.
A client whose spouse died two months ago says, "I still set two places at the table sometimes." Which response by the nurse is most therapeutic?
Show answer and rationale
Correct answer: B. "That sounds like a difficult moment. What is it like when you notice?"
Grief has no fixed timetable, and this behaviour is a common part of adjusting. Acknowledging the experience and inviting the client to explore it supports normal grieving.
Why the other options are wrong
- A. Telling a grieving person to accept a loss is dismissive and pushes them toward a stage.
- C. Referral may be appropriate later, but leading with it implies the response is abnormal.
- D. Comparing to others invalidates the client’s individual grief.
During a conversation about a new diagnosis, a client falls silent and looks down. Which action by the nurse is most therapeutic?
Show answer and rationale
Correct answer: B. Remain quietly present and allow the silence
Silence is an active therapeutic technique. It gives the client time to process difficult information and signals that the nurse can tolerate the emotion without rushing past it.
Why the other options are wrong
- A. Filling the silence serves the nurse’s discomfort, not the client’s need.
- C. Leaving abandons the client at an emotionally significant moment.
- D. Changing the subject is a communication block.
Which nurse responses are non-therapeutic? Select all that apply.
- A"If I were you, I would agree to the surgery."
- B"You seem upset. Can you tell me more?"
- C"Do not worry, everything will work out fine."
- D"Let us talk about something more cheerful."
- E"You mentioned feeling alone. What has that been like?"
Show answer and rationale
Correct answers: A. "If I were you, I would agree to the surgery."; C. "Do not worry, everything will work out fine."; D. "Let us talk about something more cheerful."
Giving advice, offering false reassurance and changing the subject are all communication blocks. They move the focus away from the client and close down exploration.
Why the other options are wrong
- B. Making an observation and inviting elaboration is therapeutic.
- E. Reflecting the client’s own words and exploring is therapeutic.
A client experiencing a panic attack is pacing, breathing rapidly and unable to follow instructions. Which nursing action is most appropriate?
Show answer and rationale
Correct answer: B. Stay with the client and speak calmly in short simple sentences
At panic level, rational thought and learning are unavailable. A calm presence with short directive statements provides the external control the client cannot supply, and reduces stimulation.
Why the other options are wrong
- A. Leaving a client in panic increases fear and risk of injury.
- C. Teaching is impossible above moderate anxiety.
- D. Detailed exploration requires cognitive capacity the client does not currently have.
A client with schizophrenia says, "The voices are telling me to hurt myself." Which response by the nurse is best?
Show answer and rationale
Correct answer: B. "What exactly are the voices telling you to do?"
Command hallucinations to self-harm are a safety emergency. The nurse asks directly what the voices are saying so that risk can be assessed and appropriate observation started.
Why the other options are wrong
- A. Arguing about reality damages trust and does not assess safety.
- C. Distraction may help mild hallucinations but ignores an active safety threat.
- D. Validating the hallucination as real reinforces it and is dishonest.
A client states with conviction that the staff are poisoning the food. Which response by the nurse is most appropriate?
Show answer and rationale
Correct answer: B. "I understand that feels real and frightening. Would you like a sealed carton of milk instead?"
Acknowledging the feeling without confirming the delusional content maintains trust, while offering sealed food is a practical accommodation that protects nutrition without endorsing the belief.
Why the other options are wrong
- A. Direct contradiction of a fixed belief entrenches it and damages the relationship.
- C. Agreeing with a delusion reinforces it.
- D. Challenging the client to prove it is confrontational and increases paranoia.
A client admitted 30 hours ago reports the last alcoholic drink was the morning of admission. The client is now tremulous, diaphoretic, has a heart rate of 118 and reports seeing insects on the wall. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Notify the provider and prepare to administer a prescribed benzodiazepine
These findings are moderate to severe alcohol withdrawal, and this timeline places the client at risk for withdrawal seizures and delirium tremens. Benzodiazepines are the mainstay of treatment and reduce mortality.
Why the other options are wrong
- A. Alcohol withdrawal is potentially fatal and is never dismissed as harmless.
- C. Clients in withdrawal are frequently dehydrated and need fluid, not restriction.
- D. Withdrawal escalates without treatment; waiting risks seizures and delirium tremens.
An older adult arrives with bruising at various stages of healing. The accompanying adult child answers all questions on the client’s behalf. Which action should the nurse take first?
Show answer and rationale
Correct answer: B. Arrange to interview the client alone
A client cannot disclose abuse in front of a possible abuser. Interviewing the client alone is the essential first step, and it allows accurate assessment before any reporting decision.
Why the other options are wrong
- A. Confronting a suspected abuser can escalate danger to the client and is never the nurse’s role.
- C. The nurse documents objective findings and the client’s own words, not a conclusion that abuse occurred.
- D. Discharging without assessment returns the client to a potentially unsafe situation.
A family member of a dying, unresponsive client asks whether their loved one can hear them. Which response by the nurse is most accurate?
Show answer and rationale
Correct answer: B. "Hearing is often the last sense to go, so please do keep talking to him."
Hearing is generally believed to persist longer than other senses at the end of life. Encouraging the family to speak supports the client and gives the family a meaningful way to be present.
Why the other options are wrong
- A. This is inaccurate and takes away a source of comfort for both client and family.
- C. Discouraging speech isolates the client and denies the family an important part of saying goodbye.
- D. Dismissing the question fails the family at a moment when presence matters most.
A client in an acute manic episode has not eaten in 12 hours and cannot sit still. Which nursing action is most appropriate?
Show answer and rationale
Correct answer: B. Offer high-calorie finger foods and drinks the client can carry
A client in mania cannot remain seated long enough to eat a meal. Portable, high-calorie foods work with the hyperactivity rather than against it and prevent nutritional depletion and dehydration.
Why the other options are wrong
- A. A stimulating dining room increases distractibility, and a sit-down meal is unrealistic.
- C. Withholding food as leverage is coercive and worsens the nutritional deficit.
- D. Tube feeding is far too invasive when a simple environmental adaptation will work.
A client repeatedly shouts at staff in the day room. Which response by the nurse best sets a limit?
Show answer and rationale
Correct answer: B. "Shouting is not acceptable here. Let us go to the quiet room and talk about what is bothering you."
An effective limit names the behaviour, states the expectation and offers an acceptable alternative. It addresses the behaviour rather than the feeling and preserves the client’s dignity.
Why the other options are wrong
- A. Labelling the client as rude is a judgement, not a limit.
- C. A punitive threat is not a therapeutic limit and often escalates behaviour.
- D. Telling a client not to feel something invalidates the emotion and sets a limit on feeling rather than behaviour.
A client started a selective serotonin reuptake inhibitor 10 days ago and says, "This is not working. I still feel awful." Which response by the nurse is best?
Show answer and rationale
Correct answer: B. "These medications usually take four to six weeks for the full effect. Tell me how you have been feeling day to day."
Accurate information about the therapeutic lag addresses the client’s concern, and the open invitation continues assessment. This period also carries elevated suicide risk as energy returns before mood lifts, so exploration matters.
Why the other options are wrong
- A. Stopping an antidepressant is a prescribing decision and abrupt discontinuation causes discontinuation symptoms.
- C. Nurses do not advise dose changes.
- D. This is accurate but dismissive and closes the conversation without assessing risk.
A client is becoming increasingly agitated and is pacing and shouting. Place the nursing interventions in the order they should be attempted, from first to last.
- AUse a calm voice, maintain a safe distance and offer choices
- BMove other clients away and reduce environmental stimulation
- COffer a prescribed as-needed medication
- DInitiate seclusion or restraint as prescribed
Show answer and rationale
Correct order: 1) A. Use a calm voice, maintain a safe distance and offer choices 2) B. Move other clients away and reduce environmental stimulation 3) C. Offer a prescribed as-needed medication 4) D. Initiate seclusion or restraint as prescribed
De-escalation moves from least to most restrictive. Verbal techniques come first, then environmental control, then medication, and physical intervention only when everything else has failed and safety is at stake.
A nurse plans to teach a client about a new medication. The client is pacing, speaking rapidly and unable to focus on the conversation. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Postpone teaching and first help the client reduce anxiety
Learning is impaired above moderate anxiety. Reducing the anxiety first is what makes teaching possible, and attempting to teach at severe anxiety wastes the opportunity.
Why the other options are wrong
- A. Written material given to a client who cannot focus is unlikely to be read or understood.
- C. Teaching the family may supplement but does not replace teaching the client.
- D. Raising the voice increases arousal and worsens the anxiety.
A client taking clozapine calls the clinic reporting a fever and sore throat. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Arrange for an urgent absolute neutrophil count and provider evaluation
Clozapine can cause severe neutropenia. Fever and sore throat may be the first sign of a dangerously low neutrophil count, so urgent blood testing and evaluation are required.
Why the other options are wrong
- A. Symptomatic advice without testing risks missing life-threatening agranulocytosis.
- C. Increasing the dose increases the haematological risk.
- D. Stopping and restarting clozapine without medical direction is unsafe and can cause rebound psychosis.
A client is found unresponsive with pinpoint pupils and a respiratory rate of 6 breaths per minute. Which action should the nurse take first?
Show answer and rationale
Correct answer: A. Administer naloxone and support ventilation
Pinpoint pupils with profound respiratory depression is opioid toxicity. Naloxone reverses it within minutes, and ventilatory support addresses the immediate threat to life.
Why the other options are wrong
- B. A drug screen confirms later; the client will not survive the wait.
- C. Access and laboratory studies follow the life-saving intervention.
- D. Restraining an unresponsive client does not address the respiratory failure.
Which client statement indicates the highest immediate suicide risk?
Show answer and rationale
Correct answer: C. "I have saved my tablets and I am going to take them on Friday when my family is away."
This statement contains a specific method, available means, a set time and deliberate isolation from rescue. That combination represents the highest level of immediate risk and requires one-to-one observation and immediate escalation.
Why the other options are wrong
- A. Passive ideation is concerning and requires assessment, but there is no plan or means.
- B. Hopelessness is a significant risk factor but is not an immediate plan.
- D. Anhedonia is a symptom of depression and a risk factor rather than an imminent plan.
A client with a long history of heavy alcohol use arrives with hypoglycaemia. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Give thiamine before or with the dextrose
Chronic alcohol use depletes thiamine. Giving glucose first consumes the remaining thiamine in carbohydrate metabolism and can precipitate Wernicke encephalopathy, so thiamine is given before or alongside the dextrose.
Why the other options are wrong
- A. Delaying thiamine is precisely the sequence that causes the problem.
- C. Withholding treatment for symptomatic hypoglycaemia is unsafe.
- D. Oral carbohydrate is inappropriate for significant hypoglycaemia in a client who may not be able to protect their airway, and it does not address the thiamine deficit.
Two hours after the first dose of an antipsychotic, a client develops a sudden painful spasm with the neck twisted to one side and the eyes rolled upward. Which prescribed medication should the nurse anticipate?
Show answer and rationale
Correct answer: A. Benztropine
This is acute dystonia, an early extrapyramidal reaction. An anticholinergic such as benztropine, or diphenhydramine, reverses it. If the spasm involves the laryngeal muscles it becomes an airway emergency.
Why the other options are wrong
- B. Haloperidol is an antipsychotic and would worsen the dystonia.
- C. Lithium is a mood stabiliser with no role in acute dystonia.
- D. Naloxone reverses opioids.
What to do with your score
A single 20-item set is too short to predict a pass, so treat the number as a pointer rather than a verdict. What is worth acting on is the pattern: go back through every item you missed, and write down whether you lacked the fact, misread what the item asked for, or knew the fact and still picked second-best. Those three failures need three different fixes — more content review, slower reading, or priority-framework drilling.
Read the rationale on the items you got right too. On a well-written item you can arrive at the correct option for the wrong reason, and that will not survive a harder version of the same question.
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