NCLEX-RN: Mental Health practice questions

Answer: A. Arousal and Reactivity

Topic: PTSD Symptom Categories

Alterations in arousal and reactivity in PTSD include irritable behavior, angry outbursts, and aggressive actions toward others. Namita's yelling at teachers and bullying peers directly demonstrate these hyperarousal and reactive symptoms following her childhood trauma.

Why the others are wrong

• B – Involves intrusive memories, flashbacks, or nightmares about the traumatic event, not externalized anger.
• C – Involves staying away from people, places, or thoughts that remind them of the trauma.
• D – Involves negative beliefs, distorted blame, feelings of detachment, or inability to experience positive emotions.

Remember: Angry outbursts and aggression equal hyperarousal and reactivity.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Provide access to decision making options

Topic: Mental Health Client Dignity

Providing access to decision‑making options respects autonomy, promotes dignity, and empowers clients to participate in their own care, aligning with person‑centered mental health practice and supporting recovery.

Why the others are wrong

• A – Encouraging decision making only when it matches clinical preferences limits client choice.
• B – Making decisions for the client undermines autonomy and violates dignity.
• C – Technical language can confuse clients and hinder respectful communication.

Remember: Offer choices, preserve dignity.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Avoid wearing necklaces and earrings

Topic: Mental Health Safety

Nurses should avoid wearing necklaces and earrings because these items can be grabbed, used as weapons, or become entangled during a client’s aggressive behavior, increasing risk of injury to both nurse and client.

Why the others are wrong

• B – Ignoring feelings compromises therapeutic rapport and safety.
• C – Long hair down can be grabbed during agitation.
• D – Identification lanyards can be seized and used as a weapon.

Remember: No jewelry, no hazards.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Underweight

Topic: Body Mass Index Classification

A BMI of 17.1 falls below the underweight threshold of 18.5 kg/m², indicating underweight status, which is typical in anorexia nervosa and raises cardiac risk.

Why the others are wrong

• A – BMI 17.1 is below healthy range.
• C – BMI 17.1 is far below overweight cutoff.
• D – BMI 17.1 does not meet obesity criteria.

Remember: BMI <18.5 = underweight.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Agranulocytosis

Topic: Clozapine Monitoring

Clozapine is an atypical antipsychotic that carries a black box warning for agranulocytosis, a severe and potentially life-threatening reduction in white blood cells. Regular monitoring of the absolute neutrophil count (ANC) is mandatory to ensure patient safety.

Why the others are wrong

• A – Hypocalcemia is not a typical adverse effect of clozapine requiring routine laboratory surveillance.
• B – Hypomagnesemia is not a standard risk or monitoring requirement associated with clozapine therapy.
• D – Hyponatremia is not a primary, life-threatening side effect of clozapine requiring mandatory blood monitoring.

Remember: Clozapine: watch the WBCs close-ly to prevent agranulocytosis.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Acknowledging one's personal beliefs

Topic: Stigma Reduction Process

Resolving stigma begins with self‑reflection; recognizing and acknowledging one's own attitudes and biases creates the foundation for change and informed interaction with others and guides subsequent education, discussion, and advocacy.

Why the others are wrong

• A – Historical review informs context but does not address personal bias first.
• B – Evidence guides interventions after personal attitudes are recognized.
• D – Dialogue is useful later; it presupposes personal bias awareness.

Remember: Stigma stops when you own your own bias.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Bipolar I

Topic: Bipolar Disorder Severity

Bipolar I disorder is the most severe form because it involves at least one full manic episode. These episodes cause severe functional impairment, often require hospitalization, and can include psychotic features, unlike milder forms of the illness.

Why the others are wrong

• A – Hypomanic episodes are a symptom of bipolar II, not a distinct diagnostic category.
• B – Cyclothymia is a milder, chronic form of bipolar disorder with less intense mood shifts.
• D – Bipolar II involves hypomania and depression, which are less severe than full mania.

Remember: Bipolar I is number one in severity because of full mania.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Monomamine Oxidase Inhibitors (MAOIs)

Topic: Antidepressant Side Effects

MAOIs inhibit monoamine oxidase, preventing breakdown of tyramine from foods; excess tyramine causes massive norepinephrine release, leading to hypertensive crisis. This risk is unique to MAOIs among antidepressants.

Why the others are wrong

• B – TCAs may cause orthostatic hypotension, not hypertensive crisis.
• C – SARIs have minimal dietary restrictions and do not precipitate hypertensive crisis.
• D – SSRIs affect serotonin, not tyramine, and do not cause hypertensive crisis.

Remember: MAOIs + tyramine = hypertensive crisis

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Side-lying

Topic: Acute Alcohol Intoxication

When a patient is unresponsive from alcohol intoxication, the recovery (side‑lying) position keeps the airway open and allows any vomitus to drain, reducing aspiration risk while maintaining circulation.

Why the others are wrong

• B – Supine blocks airway, increases aspiration of vomit.
• C – Trendelenburg promotes gastric contents moving toward airway.
• D – Prone makes airway access difficult and hinders drainage.

Remember: Unconscious? Use recovery side‑lying to protect airway.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Post Traumatic Stress Disorder

Topic: Post-Traumatic Stress Disorder Symptoms

Toni experienced a traumatic event and is now demonstrating avoidance behaviors, such as skipping evening classes to avoid being out at night. Avoidance of trauma-related stimuli is a hallmark symptom of Post-Traumatic Stress Disorder.

Why the others are wrong

• A – While trauma causes distress, her specific avoidance of night classes points directly to PTSD.
• B – Involves a loss of contact with reality, such as hallucinations, which is not described.
• D – Characterized by alternating episodes of mania and depression, not trauma-induced avoidance.

Remember: Trauma triggers avoidance; think PTSD when they steer clear.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Mood Stabilizer

Topic: Bipolar Disorder Management

Mood stabilizers are first‑line pharmacologic treatment for bipolar disorder because they reduce both manic and depressive episodes and help maintain long‑term mood equilibrium and improve overall functioning.

Why the others are wrong

• A – TCAs have high toxicity and can trigger mania.
• C – SSRIs treat depression, not primary bipolar symptom control.
• D – MAOIs interact dangerously with many foods and are not first‑line.

Remember: Bipolar meds = mood stabilizers, not antidepressants.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. "Do you feel safe in your living situation?"

Topic: Elder Abuse Assessment

Asking the client, “Do you feel safe in your living situation?” is a direct, non‑judgmental safety question that encourages disclosure and helps the nurse assess for possible abuse without blaming or assuming.

Why the others are wrong

• A – Self‑disclosure shifts focus; violates therapeutic boundaries.
• C – Assumes other victims; may intimidate and is not a safety assessment.
• D – Puts pressure on client; not a neutral safety question.

Remember: Ask safety, not blame.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Has a high potential for abuse and may lead to psychological or physical dependence

Topic: Opioid Analgesic Abuse

Hydrocodone is a Schedule II opioid analgesic; it produces euphoria and tolerance, leading to a high risk of both psychological and physical dependence, making abuse potential high.

Why the others are wrong

• A – It is an FDA‑approved medication; not true that it lacks medical use.
• C – Moderate potential for abuse is inaccurate; hydrocodone is classified as high abuse risk.
• D – Low potential is false; opioids like hydrocodone have significant abuse risk.

Remember: Hydrocodone = high‑abuse opioid, Schedule II.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Veracity

Topic: Ethical Principles in Nursing

Providing a thorough, honest explanation of ECT benefits and risks exemplifies the nurse’s duty to tell the truth and ensure the patient receives accurate information, which is the principle of veracity.

Why the others are wrong

• A – Autonomy concerns respecting the patient’s choices, not the act of truthful disclosure.
• C – Justice relates to fairness and equitable care, not to truthful communication.
• D – Beneficence involves acting in the patient’s best interest, not specifically providing honest information.

Remember: Honest disclosure equals veracity.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. “ I am taking this medication to help with my depression.”

Topic: Sertraline Patient Education

Sertraline is an SSRI prescribed to alleviate depressive symptoms; recognizing its purpose shows the client understands the medication’s therapeutic goal and that it is intended to treat depression, not other conditions.

Why the others are wrong

• A – SSRIs reduce depressive symptoms but do not guarantee suicide prevention.
• B – Sertraline is usually taken in the morning; nighttime dosing may cause insomnia.
• D – Stopping abruptly can cause discontinuation syndrome; dosage changes require provider guidance.

Remember: Sertraline treats depression, not a bedtime or suicide fix.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Nonmaleficence

Topic: Lithium Toxicity Monitoring

Assessing vision, tremors, GI upset, and mentation before giving lithium is intended to detect early toxicity and prevent patient harm, which exemplifies the ethical principle of nonmaleficence.

Why the others are wrong

• B – Autonomy concerns respecting patient choices, not safety monitoring.
• C – Beneficence focuses on doing good, not specifically preventing injury.
• D – Justice relates to fairness in care distribution, not toxicity checks.

Remember: Check labs, stop harm—nonmaleficence.

Question adapted from Nursing Mental Health and Community Concepts 2e, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.