NCLEX Practice Exam for Psychosocial Adaptation

1. A man is admitted to the nursing care unit with a diagnosis of cirrhosis. He has a long history of alcohol dependence. During the late evening following his admission, he becomes increasingly disoriented and agitated. Which of the following would the client be least likely to experience?

  1. Diaphoresis and tremors.
  2. Increased blood pressure and heart rate.
  3. Illusions.
  4. Delusions of grandeur.

2. Mr. Wilson, 35, is admitted for bipolar illness, manic phase, after assaulting his landlord in an argument over Mr. Wilson’s staying up all night playing loud music. Mr. Wilson’s is hyperactive, intrusive, and has rapid, pressured speech. He has not slept in three days and appears thin and disheveled. Which of the following is the most essential nursing action at this time?

  1. Providing a meal and beverage for Mr. Wilson to eat in the dining room.
  2. Providing linens and toiletries for Mr. Wilson to attend to his hygiene.
  3. Consulting with the psychiatrist to order a hypnotic to promote sleep.
  4. Providing for client safety by limiting his privileges.

3. Which of the following would best indicate to the nurse that a depressed client is improving?

  1. Reduced levels of anxiety.
  2. Changes in vegetative signs.
  3. Compliance with medications.
  4. Requests to talk to the nurse.

4. An elderly man is admitted to the hospital. He was alert and oriented during the admission interview. However, his family states that he becomes disruptive and disoriented around dinnertime. One night he was shouting furiously and didn’t know where he was. He was sedated and the next morning he was fine. At dinnertime the disruptive behavior returned. The client is diagnosed as having sundown syndrome. The client’s son asks the nurse what causes sundown syndrome. The nurse’s best response is that it is attributed to

  1. an underlying depression.
  2. inadequate cerebral flow.
  3. changes in the sensory environment.
  4. fluctuating levels of oxygen exchange.

5. The nurse is discussing electroconvulsive therapy (ECT) with a client who asks how long it will be before she feels better. The nurse explains that the beneficial effects of ECT usually occur within

  1. one week.
  2. three weeks.
  3. four weeks.
  4. six weeks.

6. The nurse is assessing a 17-year-old female who is admitted to the eating disorders unit with a history of weight fluctuation, abdominal pain, teeth erosion, receding gums, and bad breath. She states that her health has been a problem but there are no other concerns in her life. Which of the following assessments will be the least useful as the nurse develops the care plan?

  1. Information regarding recent mood changes.
  2. Family functioning using a genogram.
  3. Ability to socialize with peers.
  4. Whether she has a sexual relationship with a boyfriend.

7. A 34-year-old woman is admitted for treatment of depression. Which of these symptoms would the nurse be least likely to find in the initial assessment?

  1. inability to make decisions.
  2. feelings of hopelessness.
  3. family history of depression.
  4. increased interest in sex.

8. The nurse is planning care for a client who has a phobic disorder manifested by a fear of elevators. Which goal would need to be accomplished first? The client

  1. demonstrates the relaxation response when asked.
  2. verbalizes the underlying cause of the disorder.
  3. rides the elevator in the company of the nurse.
  4. role plays the use of an elevator.

9. A teenage female is admitted with the diagnosis of anorexia nervosa. Upon admission, the nurse finds a bottle of assorted pills in the client’s drawer. The client tells the nurse that they are antacids for stomach pains. The best response by the nurse would be

  1. “These pills aren’t antacids since they are all different.”
  2. “Some teenagers use pills to lose weight.”
  3. “Tell me about your week prior to being admitted.”
  4. “Are you taking pills to change your weight?”

10. A mother with a Roman Catholic belief has given birth in an ambulance on the way to the hospital. The neonate is in very critical condition with little expectation of surviving the trip to the hospital. Which of these requests should the nurse in the ambulance anticipate and be prepared to do?

  1. The refusal of any treatment for self and the neonate until she talks to a reader
  2. The placement of a rosary necklace around the neonate’s neck and not to remove it unless absolutely necessary
  3. Arrange for a church elder to be at the emergency department when the ambulance arrives so a “laying on hands” can be done
  4. Pour fluid over the forehead backwards towards the back of the head and say “I baptize you in the name of the father, the son and the holy spirit. Amen.”

11. Which statement by the client during the initial assessment in the the emergency department is most indicative for suspected domestic violence?

  1. “I am determined to leave my house in a week.”
  2. “No one else in the family has been treated like this.”
  3. “I have only been married for 2 months.”
  4. “I have tried leaving, but have always gone back.”

12. Which of these statements by the nurse reflects the best use of therapeutic interaction techniques?

  1. “You look upset. Would you like to talk about it?”
  2. “I’d like to know more about your family. Tell me about them.”
  3. “I understand that you lost your partner. I don’t think I could go on if that happened to me.”
  4. “You look very sad. How long have you been this way?”

13. When planning the therapeutic milieu, it is MOST important to select group activities which

  1. Match the clients’ preferences
  2. Are consistent with clients’ skills
  3. Achieve clients’ therapeutic goals
  4. Build skills of group participation

14. A client was admitted to the psychiatric unit for severe depression. After several days, the client continues to withdraw from other clients. Which of the following would be the MOST appropriate statement by the nurse to promote interaction with other clients?

  1. “Your doctor thinks its good for you to spend time with others.”
  2. “It is important for you to participate in group activities.”
  3. “Painting this picture will help you feel better.”
  4. “Come play Chinese Checkers with Gerry and me.”

15. The nurse can BEST ensure the safety of a demented client who wanders from the room by

  1. Repeatedly reminding the client of time and place
  2. Explaining the risks of becoming lost
  3. Using soft restraints
  4. Attaching a wander-guard sensor band to the client’s wrist

16. A client with paranoid thoughts refuses to eat because he believes the food is poisoned. The MOST appropriate initial action is to

  1. Taste the food in the client’s presence
  2. Suggest that food be brought from home
  3. Simply state the food is not poisoned
  4. Inform the client he will be tube fed if he does not eat

17. The nurse is caring for a severely depressed client who has just been admitted to the in-client psychiatric unit. Which of the following is a PRIORITY of care?

  1. Nutrition
  2. Elimination
  3. Rest
  4. Safety

18. A nurse is teaching a stress-management program for client. Which of the following beliefs will the nurse advocate as a method of coping with stressful life events?

  1. Avoidance of stress is an important goal for living.
  2. Control over one’s response to stress is possible.
  3. Most people have no control over their level of stress.
  4. Significant others are important to provide care and concern.

19. A student nurse is caring for a 75-year-old client who is very confused. The student’s communication tools should include:

  1. written directions for bathing.
  2. speaking very loudly.
  3. gentle touch while guiding ADLs (activities of daily living).
  4. flat facial expression.

20. When a husband takes out his work frustrations and anger by abusing his wife at home, the nurse would identify this crisis as which type?

  1. psychiatric emergency crisis
  2. developmental crisis
  3. anticipated life transition
  4. dispositional crisis
Answers and Rationales
  1. Answer D. Diaphoresis and tremors occur in the first phase of alcohol withdrawal. The blood pressure and heart rate increase in the first phase of alcohol withdrawal. Illusions are common in persons withdrawing from alcohol. Illusions occur most often in dim artificial lighting where the environment is not perceived accurately. Delusions of grandeur are symptomatic of manic clients, not clients withdrawing from alcohol. The symptoms and history of alcohol abuse suggest this client is in alcohol withdrawal.
  2. Answer D. Food and fluids are necessary. However, Mr. Wilson’s hyperactivity does not allow him to sit quietly to eat. Finger foods “on the run” will provide needed nourishment. When hyperactivity decreases, then approach Mr. Wilson’s. regarding hygiene and grooming needs. Medications will be ordered. However, a thorough evaluation must be done first. Mr. Wilson has been assaultive with the landlord and it is reasonable to expect that he may be with peers and staff. His mental illness produces a hyperactive state and poor judgment and impulse control. External controls such as limiting of unit privileges will assist in feelings of security and safety.
  3. Answer B. Reduced levels of anxiety do not indicate an improvement in depressive symptoms. Vegetative signs such as insomnia, anorexia, psychomotor retardation, constipation, diminished libido, and poor concentration are biological responses to depression. Improvement in these signs indicates a lifting of the depression. Compliance with medications does not indicate improvement in depression. Requests to talk to the nurse vary. Requests may show trust in the nurse but are not a sign that depression has diminished.
  4. Answer C. An underlying depression does not cause sundown syndrome. There is not sufficient evidence to suggest he has inadequate cerebral blood flow. Because the confusion occurs at sundown, the cause is probably changes in the sensory environment. Sundown syndrome is related to environmental and sensory abnormalities that lead to acute confusion. Fluctuating levels of oxygen exchange do not cause sundown syndrome.
  5. Answer A. Beneficial effects of ECT usually are evident after the first several treatments. Since treatments are administered at intervals of 48 hours, these effects are apparent after one week of therapy. Beneficial effects of ECT therapy are usually seen before three weeks. It takes three to four weeks for tricyclic antidepressants to take effect. Beneficial effects of ECT therapy are usually seen before four weeks. It takes three to four weeks for tricyclic antidepressants to take effect. Beneficial effects of ECT therapy are usually seen after the first few treatments.
  6. Answer D. Information about mood changes is important to assess, as bulimia is often associated with affective disorders. Family functioning is the most essential point to assess, as it reveals if binge eating is triggered by conflict within the family. Information about ability to socialize with peers is important to assess, as it is possible the problem initiated with peer relationships. It is inappropriate to ask about her sexual relationships.
  7. Answer D. Indecisiveness and fear of being wrong are common in depression. Depression creates feelings that nothing will ever improve. The risk of depression is increased when there is a family history. Interest in sex is markedly decreased in depression.
  8. Answer A. The ability to use relaxation is basic to treatment of phobia. Clients with phobias are resistant to insight therapy. Riding the elevator accompanied by the nurse is an appropriate long-term goal. Role playing may be appropriate after the client has learned relaxation.
  9. Answer C. This is an open-ended question which is nonjudgemental and allows for further discussion. The topic is also nonthreatening yet will give the nurse insight into the client”s view of events leading up to admission. It is the only option that is client centered. The other options focus on the pills.
  10. Answer D. Infant baptism is madatory in the Roman Catholic belief especially if a neonate is not expected to live. Anyone may perform this if an infant or child is gravely ill. Option A refers to the Christian Science belief. Option B is a belief of Russian Orthodoxy. Mormons believe of devine healing with the laying on of hands, as represented in option C.
  11. Answer D. Victims develop a high tolerance for abuse. They blame themselves for being victimized. All members in the family suffer from the effects of abuse, even if they are not the actual victims. For these reasons, victims often have an extensive history of abuse and struggle for a long time before they can leave permanently.
  12. Answer A. Giving broad opening statements and making observations are examples of therapeutic communication. The other options are too specific or focused to be therapeutic.
  13. Answer C. Activity groups are used to enhance the therapeutic milieu and to meet the clinical and social needs of clients, e.g., to minimize withdrawal and regression, to develop self care skills, etc.
  14. Answer D. This gradually engages the client in interactions with others and uses positive behavioral expectation.
  15. Answer D. This type of identification band easily tracks the client’s movements and ensures safety while wandering on the unit.
  16. Answer C. This actions presents reality.
  17. Answer D. Safety is a priority of care for the depressed client. Precautions to prevent suicide must be a part of the plan.
  18. Answer B. When learning to manage stress, it is helpful to believe that one has the ability to control one’s response to stress. It is impossible to avoid stress, which is a normal experience. Stress can be positive and growth enhancing as well as harmful. The belief that one has some control can minimize the stress response.
  19. Answer C. Nonverbal, gentle touch is an important tool here. Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals, families, and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self.
  20. Answer D. A dispositional crisis is a response to an external situational crisis. External anger at work is the dispositional crisis displaced to his wife through abuse. An anticipated life transition crisis is a crisis that is normal in the life cycle; transitional is one over which the person has no control. Developmental crisis occurs in response to triggering emotions related to unresolved conflict in one’s life. This is called a developmental crisis based on Freudian psychology. Psychiatric emergency crisis is when the individual’s general functioning has been severely impaired, and the individual has been rendered incompetent.