The Ultimate Guide to Mental Health Nursing NCLEX Questions

The Ultimate Guide to Mental Health Nursing NCLEX Questions. Mental health nursing is a rewarding yet challenging field that requires nurses to have expertise in psychiatric and mental health conditions, treatments, and care. Passing the NCLEX-RN exam is essential for becoming a licensed mental health nurse.

This comprehensive guide will provide an overview of mental health nursing concepts and disorders frequently tested on the NCLEX, followed by 25 practice NCLEX questions to help prepare you for the licensure examination.

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An Introduction to Mental Health Nursing

Mental health nurses work with patients suffering from mental illnesses and psychiatric issues in hospitals, clinics, and other healthcare settings. Their duties include assessing mental status, identifying disorders, creating patient care plans, administering medications, and providing therapy. Excelling as a mental health nurse requires specialized knowledge and skills such as:

• Psychopathology – Understanding mental health disorders, their causes, symptoms, and treatments.
• Patient Education – Teaching patients and families about illnesses, treatment plans, coping techniques, medication management, and more.
• Psychopharmacology – Having expertise with psychotropic medications, side effects, and drug interactions.
• Communication Skills – Using therapeutic communication techniques to interact with patients and build rapport.
• Crisis Intervention – Assessing risk of harm, de-escalating agitated patients, and connecting patients with emergency services.

The NCLEX-RN exam thoroughly tests these competencies and the various disorders seen in mental health nursing.

Common Mental Health Conditions on the NCLEX

Here is an overview of some of the most prevalent psychiatric disorders and issues addressed on the NCLEX:

Schizophrenia

Schizophrenia is a severe chronic condition characterized by hallucinations, delusions, disorganized speech and behavior, social withdrawal, lack of motivation, and more. Questions may cover schizophrenia subtypes, positive and negative symptoms, antipsychotic medications, and nursing interventions for acute psychotic episodes.

Bipolar Disorder

Bipolar disorder causes extreme shifts in mood and energy levels, resulting in manic and depressive episodes. You may get questions on the manic and depressive phases, risk factors, lithium and anticonvulsant medications, and suicide prevention.

Depression

Depression questions can cover symptoms, risk factors, suicide risk assessment, selective serotonin reuptake inhibitors (SSRIs), electroconvulsive therapy, and therapeutic communication strategies.

Anxiety Disorders

There are many types of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, phobias, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). NCLEX questions may address signs and symptoms, anti-anxiety medications, cognitive behavioral therapy (CBT), and teaching relaxation techniques.

Substance Abuse

You must know signs and symptoms of substance intoxication and withdrawal, complications, lab tests, 12-step programs, use of disulfiram and methadone, and motivational interviewing techniques.

Personality Disorders

Questions on personality disorders like antisocial, borderline, histrionic, narcissistic, avoidant, paranoid, and schizoid personalities can cover symptoms, challenging behaviors, therapeutic communication approaches, boundaries, and treatment plans.This covers some of the major mental health nursing topics on the NCLEX. Let’s now go through 25 practice NCLEX questions to apply this knowledge.

Mental Health Nursing NCLEX Practice Questions

Here are 25 multiple choice NCLEX practice questions on various mental health disorders and psychiatric nursing concepts. Try to answer each question before looking at the correct answer and rationale.

1. A patient exhibiting grandiose delusions, reckless behavior, reduced need for sleep, and rapid speech is experiencing symptoms of which bipolar disorder mood state?

A. Depressed phase

B. Manic phase

C. Mixed episode

D. Hypomanic phase

Correct Answer: B

Rationale: The symptoms described of grandiose delusions, reckless behavior, decreased sleep need, and rapid speech are characteristic of the manic phase in bipolar disorder.

1. A patient with borderline personality disorder repeatedly makes suicidal threats and engages in self-harm behaviors. What is the nurse’s most appropriate response?

A. Inform the patient you will not tolerate threats.

B. Place the patient in seclusion for safety.

C. Establish clear boundaries with consequences.

D. Order a psychiatric evaluation.

Correct Answer: C

Rationale: Patients with borderline personality disorder often test boundaries. Establishing clear limits with defined consequences for unacceptable behavior while maintaining a therapeutic alliance is the priority.

1. A patient exhibiting signs of substance intoxication. What clinical manifestation requires immediate medical intervention?

A. Constricted pupils

B. Agitation

C. Tremors

D. Hypothermia

Correct Answer: D

Rationale: Hypothermia caused by substance intoxication can quickly become life-threatening. The other options would not necessarily require emergent medical care.

1. A patient with schizophrenia has delusions that the hospital staff are trying to poison her. She refuses to eat or take medications. What is the best nursing intervention?

A. Set clear limits on refusing food and medications.

B. Reassure her the staff is trying to help her.

C. Restrain her and administer injections.

D. Explore reasons why she believes staff would try to hurt her.

Correct Answer: D

Rationale: Attempting to orient the patient to reality may increase paranoia. Restraints should only be used as a last resort. Exploring the delusion in a non-judgmental way builds trust needed to provide care.

1. A patient with depression scores 25 on the Beck Depression Inventory. How does the nurse interpret this score?

A. Mild depression

B. Moderate depression

C. Severe depression

D. Manic episode

Correct Answer: C

Rationale: Scores on the Beck Depression Inventory range from 0-63. A score of 0-13 indicates minimal depression, 14-19 mild depression, 20-28 moderate depression, and 29-63 severe depression.

1. A patient is involuntarily admitted after making threats to kill his neighbor. On assessment, he is agitated, yelling, threatening, and refuses medications. What is the priority nursing intervention?

A. Establish rapport through therapeutic communication.

B. Determine criteria for discharge.

C. Administer PRN antipsychotic medications.

D. Apply 4-point restraints for safety.

Correct Answer: A

Rationale: Despite agitation, involuntarily committed patients retain patient rights. Restraints and forced medications should only be used as a last resort when a patient poses an immediate safety risk to self or others. Addressing symptoms first with de-escalation techniques should be the priority.

1. Which class of medications used for depression takes up to 4 weeks to achieve a full therapeutic effect?

A. Monoamine oxidase inhibitors (MAOIs)

B. Selective serotonin reuptake inhibitors (SSRIs)

C. Tricyclic antidepressants (TCAs)

D. Atypical antidepressants

Correct Answer: B

Rationale: SSRIs like fluoxetine and sertraline are commonly prescribed first-line for depression. However, they require at least 2-4 weeks for optimal therapeutic blood levels, making patient education on medication adherence vital.

1. A patient with panic disorder experiences sudden episodes of intense fear with physical symptoms like chest pain, dizziness, and shortness of breath. What medication does the nurse anticipate being prescribed?

A. Chlorpromazine (Thorazine)

B. Valproic acid (Depakote)

C. Sertraline (Zoloft)

D. Alprazolam (Xanax)

Correct Answer: D

Rationale: Benzodiazepines like alprazolam are fast-acting anti-anxiety medications used to treat panic attacks for quick symptom relief. The other options would not be appropriate.

1. A patient with OCD compulsively washes his hands over 200 times per day. What is the priority nursing intervention?

A. Ensure skin integrity is maintained.

B. Set limits on hand washing.

C. Recommend behavioral psychotherapy.

D. Teach coping strategies for anxiety.

Correct Answer: C

Rationale: Behavioral psychotherapy like exposure and response prevention (ERP) is considered first-line treatment for OCD to help patients confront fears and resist rituals. The other interventions may be appropriate but are secondary to addressing the underlying OCD.

1. A patient with PTSD starts shouting, diving under the bed, and reporting hearing combat noises. What is the nurse’s best response?

A. Reorient the patient to the hospital setting.

B. Request an order for PRN lorazepam.

C. Turn down lights and minimize stimulation.

D. Apply restraints as needed for safety.

Correct Answer: C

Rationale: Turning down lights, speaking softly, removing extra staff, and minimizing stimulation can help de-escalate PTSD flashback episodes without restraints which may re-traumatize.

1. Which symptom is most indicative of the depressed phase of bipolar disorder?

A. Impulsivity

B. Insomnia

C. Racing thoughts

D. Poor concentration

Correct Answer: D

Rationale: While insomnia and agitation can occur in the depressed phase, poor concentration is most specific to a major depressive episode in bipolar disorder.

1. A patient abruptly stops taking lorazepam prescribed for generalized anxiety. What withdrawal symptom does the nurse most closely monitor for?

A. Headaches

B. Insomnia

C. Abdominal pain

D. Seizures

Correct Answer: D

Rationale: Benzodiazepine withdrawal can cause life-threatening seizures. Thus, vital signs, neurological checks, and seizure precautions are essential for a patient stopping an anti-anxiety benzodiazepine medication.

1. Which symptom would distinguish borderline personality disorder from bipolar disorder?

A. Impulsivity

B. Mood lability

C. Paranoia

D. Chronic emptinessCorrect Answer: DRationale: While borderline and bipolar disorders share affective instability, chronic feelings of emptiness specifically indicates borderline personality disorder.

1. A patient with schizophrenia has a new prescription for fluphenazine (Prolixin). What adverse effect does the nurse monitor for?

A. Urinary retention

B. Respiratory depression

C. Cardiac arrhythmias

D. Extrapyramidal symptoms (EPS)

Correct Answer: D

Rationale: Antipsychotics like fluphenazine frequently cause EPS like akathisia, dystonia, and tardive dyskinesia. Schizophrenia patients require ongoing monitoring for these adverse medication effects.

1. Which statement by a patient hospitalized with major depression is most concerning?

A. “I deserve to feel this way.”

B. “I should give all my money away.”

C. “Life is hopeless.”

D. “I’ll lose my job for missing work.

”Correct Answer: BRationale: Giving away possessions can indicate suicidal planning, making this statement the most concerning. Statements about deserving depression, having a hopeless outlook, and worrying about work are expected with this disorder.

1. A patient with paranoid personality disorder refuses to leave his house out of fear the government is spying on him. What intervention does the nurse recommend?

A. Challenging irrational beliefs

B. Teaching coping techniques

C. Setting clear expectations

D. Encouraging independence

Correct Answer: B

Rationale: Paranoid personality disorders have pervasive mistrust. Avoid directly challenging fears, but provide empathy while teaching anxiety and stress coping techniques.

1. A patient with alcohol withdrawal is oriented but jittery with dilated pupils. What medication does the nurse anticipate administering?

A. Disulfiram (Antabuse)

B. Chlordiazepoxide (Librium)

C. Methadone

D. Naltrexone

Correct Answer: B

Rationale: Chlordiazepoxide is the drug of choice for alcohol detoxification to prevent progression to delirium tremens. Disulfiram, methadone, and naltrexone are not used for acute alcohol withdrawal management.

1. A patient with schizophrenia has delusions of parasites crawling under his skin. He scratches his arms until bleeding. What is the priority nursing intervention?

A. Place the patient in restraints.

B. Investigate reasons for the false belief.

C. Apply antibiotic cream to skin wounds.

D. Redirect the patient and clean injuries.

Correct Answer: D

Rationale: Restraints can worsen psychosis and should only be used as a last resort. Exploring reasons for delusions can increase suspiciousness. The priority is redirecting the safety risk behavior and treating wounds.

Mental Health NCLEX Questions by Disorder

Mental health questions on the NCLEX are typically centered around common disorders like depression, schizophrenia, and anxiety. Questions will test your knowledge of these disorders along with the nursing care of patients experiencing mental health issues.

Depression

1. A nurse is caring for a patient who reports feeling depressed with suicidal ideations. Which of the following medications does the nurse anticipate administering?

A. Propranolol

B. Diazepam

C. Fluoxetine

D. Phenobarbital

The correct answer is C.

Fluoxetine is an SSRI antidepressant medication that can be used to treat depression and decrease suicidal thoughts. Propranolol is a beta blocker, diazepam is a benzodiazepine antianxiety medication, and phenobarbital is a barbiturate anticonvulsant.

2. A patient is prescribed sertraline to treat new-onset depression. What symptom will the nurse teach the patient to report immediately?A. Fatigue

B. Nausea

C. Insomnia

D. Worsening depression

The correct answer is D.

Worsening depression or emergence of suicidal thoughts is the most concerning potential side effect of antidepressant therapy that should be immediately reported. The other options would be bothersome but not emergent.

Schizophrenia

1. A patient with schizophrenia becomes aggressive and begins shouting while playing a board game with other patients on the unit. Which nursing intervention takes priority?

A. Restrain the patient for safety

B. Provide PRN haloperidol IM

C. Remove stimuli from the environment

D. Place the patient in seclusion

The correct answer is C.

Removing extra stimuli from the environment is the least restrictive intervention that should be attempted first. Restraints, seclusion, and involuntary medication administration should only be used as a last resort.

2. A nurse is providing teaching to the family member of a patient recently diagnosed with schizophrenia. Which statement by the family member indicates an understanding of the teaching?

A. “I will make sure he takes zinc supplements to improve his symptoms.”

B. “I’m going to help her eliminate gluten from her diet to reduce psychosis.”

C. “It’s important that she takes her medication regularly as prescribed.”

D. “I’ll be sure to play lots of loud music to distract him from his delusions.

”The correct answer is C.

Antipsychotic medications are essential in managing schizophrenia symptoms. Diet modifications, supplements, and music therapy do not treat the underlying disease process.

Anxiety

1. A patient with generalized anxiety disorder who takes buspirone daily is preparing for discharge. What instruction should the nurse provide about this medication?

A. Take only when feeling anxious

B. Expect immediate symptom relief

C. Continue even if anxious feelings persist

D. Discontinue after 1 week if not effective

The correct answer is C.

Buspirone can take up to 6 weeks to have an anti-anxiety effect. Patients should be instructed to continue taking it regularly even if anxiety persists initially.

2. A nurse is triaging patients in the emergency department. Which symptom reported by a patient over the phone should prompt the nurse to assign the patient a high triage acuity score?

A. Nervousness, panic attacks

B. Persistent worrying

C. Feeling tense while driving

D. Difficulty falling asleep

The correct answer is A.

Symptoms of an acute panic attack with nervousness warrants urgent evaluation, while the other responses represent chronic generalized anxiety. By knowing the key features of common mental health conditions, you can begin to analyze and eliminate answer options on NCLEX questions. Now let’s look at some specific question types you may encounter.

Types of Mental Health NCLEX Questions

There are a variety of question types on the NCLEX that could cover mental health nursing concepts. Below are some of the most common:

Prioritization Questions

These questions will provide several patient symptoms or scenarios and ask you to order them based on what requires the most urgent nursing action. For example:

Place the following patients in order of which one the nurse should assess first:

1. A depressed patient who has not eaten in 2 days
2. An anxious patient with chest pain and shortness of breath
3. A patient with schizophrenia who is pacing and shouting loudly on the unit
4. A patient who reports feeling sad after recently losing a family member

The correct order is: 2, 1, 3, 4

The patient with anxiety and cardiopulmonary symptoms should be assessed first to rule out a potential medical emergency. Refusing food for 2 days and acting disruptively on the unit also require prompt nursing action. Feeling sad after a loss would be appropriate.

Select All That Apply Questions

For these questions, you will be asked to select all correct answer choices out of 5 or 6 options. There may be just 1 or 2 correct options, or there may be more. For example:A nurse is providing care for a patient with depression who begins taking paroxetine. Which side effects require further assessment by the nurse over the next few weeks?

Select all that apply.

• Headache
• Excessive worrying
• Suicidal thoughts
• Blurred vision
• Constipation
• Fatigue

The correct answers are: Suicidal thoughts, Headache, Constipation, FatigueThe other options are not associated side effects of paroxetine.

Ordered Response Questions

These questions will provide several actions for a nursing scenario and ask you to order them sequentially from first to last.

For example: A nurse on an inpatient psychiatric unit discovers an empty package of pills in a patient’s room. Place the following actions in order of what the nurse should do:

1. Notify the physician
2. Check the medication administration record
3. Assess the patient’s vital signs
4. Induce vomiting

The correct order is: 3, 2, 1, 4

Initial assessment takes priority over contacting the physician in potential overdose situations. Vomiting should only be induced if pills were ingested within the last hour, so this action would come last.

Delegation Questions

Delegation questions describe a task or scenario and ask you to determine which member of the healthcare team it would be most appropriate to delegate to. Options often include licensed practical nurse (LPN), registered nurse (RN), nurse practitioner (NP), physician assistant (PA), doctor/physician (MD), social worker (SW), etc. For example:Which member of the mental health team should the RN delegate to reinforce teaching with a depressed patient about their new antidepressant prescription?

A. LPN

B. Mental health technician

C. Psychiatrist

D. Occupational therapist

The correct answer is A.

Reinforcing education about medications falls within the LPN scope of practice and could be delegated to an LPN by an RN. The other options exceed the expertise or scope of those team members. Now that you’re familiar with mental health nursing concepts and the types of NCLEX questions you may receive, let’s review some key tips for success on exam day.

Crucial Tips for Answering Mental Health NCLEX Questions

• Read each question stem carefully. Underline or highlight key details that provide clues about the patient’s diagnosis and the context for the scenario. Don’t make assumptions beyond what is stated.
• Watch for negative phrasing. Terms like “what intervention should the nurse avoid” or “which action requires further clarification from the provider” mean you should select the worst choice or unsafe response.
• Familiarize yourself with standard precautions for suicidal patients. Options like removing sharps, placing patient close to nurse’s station, and instituting one-to-one observation are correct answers for protecting patient safety.
• Consider Maslow’s hierarchy of needs when prioritizing. Focus first on issues impacting basic physiologic functioning before addressing higher-level deficits like self-esteem or self-actualization.
• Recognize emergent presentations of anxiety requiring immediate intervention. Panic attacks, crushing chest pain, sensations of choking, suicidal intent, and psychosis are just some examples.

With consistent NCLEX prep, you will be well equipped to tackle any mental health question that crosses your path. Now get out there and show what an exceptional mental health nurse you’re going to be!