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NCLEX-RN Psychosocial Integrity practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

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Topics come from the tags on our own items, so this list reflects what the bank actually covers in Psychosocial Integrity rather than a generic syllabus.

Therapeutic communication 33 in the bank

Psychosocial Integrity sample questions

Question 1

A 45-year-old client from a traditional East Asian culture is admitted for a cardiac catheterization. The client avoids eye contact and responds with brief answers. Which nursing action best demonstrates cultural awareness?

  1. A Continue the assessment using a respectful, indirect approach.
  2. B Explain that eye contact is expected in this health care setting.
  3. C Request a cultural mediator to confront the client about the behavior.
  4. D Ask the client directly why they are avoiding eye contact.
Show the answer and explanation

Correct answer: A

In many East Asian cultures, avoiding direct eye contact signals respect, especially toward health professionals. Continuing the assessment with a respectful, less direct approach honors the client's norms and preserves trust.

Why the other options are wrong:
B: Insisting on eye contact imposes the nurse's cultural norm on the client.
C: Confronting the client is disrespectful, and cultural mediators bridge communication rather than enforce behavior.
D: Questioning the client about eye contact can cause embarrassment and damage rapport.

Question 2

In the emergency department, a 22-year-old client with bipolar disorder is brought in by police after being found shouting on a street corner. The client is pacing, cursing loudly, and making threats. Which action should the nurse take first?

  1. A Escort the client to a quiet, low-stimulus room.
  2. B Call the psychiatric consult liaison immediately.
  3. C Administer haloperidol 5 mg intramuscularly as ordered.
  4. D Place the client in four-point restraints for safety.
Show the answer and explanation

Correct answer: A

Moving the agitated client to a quiet, low-stimulus area is the least restrictive first step and can de-escalate behavior before medication or restraints are considered.

Why the other options are wrong:
B: Calling a consultant delays action and does not manage the immediate agitation.
C: Medication is used if verbal and environmental de-escalation fail, so it is not the first action.
D: Restraints are a last resort after less restrictive measures fail, and using them first can escalate the crisis.

Question 3

A 28-year-old client admitted to the inpatient psychiatric unit after a suicide attempt by overdose tells the nurse, 'I'm feeling much better now. I think I can go home tomorrow.' Which nursing response is most important?

  1. A Document the client's statement and continue with the daily routine
  2. B Ask the client directly if they still have thoughts of harming themselves
  3. C Remind the client that discharge decisions are made by the treatment team
  4. D Praise the client for feeling better and encourage continued progress
Show the answer and explanation

Correct answer: B

Clients who have recently attempted suicide may feel relief after making a decision to try again, and statements about feeling suddenly better can indicate a hidden plan. The nurse must directly assess current suicidal ideation to ensure safety. Reminding the client about the treatment team (the option "Remind the client that discharge decisions are made by the treatment team" is factual but does not assess immediate risk. Praising the client (the option "Praise the client for feeling better and encourage continued progress" may inadvertently reinforce concealment of ongoing suicidal thoughts. Documenting and continuing the routine (the option "Document the client's statement and continue with the daily routine" misses the opportunity to evaluate the client's current mental state and could lead to a missed warning sign. Direct questioning about suicidal ideation is the standard of care.

Question 4

A 72-year-old client whose spouse died 3 months ago says, 'I keep setting the table for two. Sometimes I forget he's gone.' Which stage of grief according to Kübler-Ross is the client most likely experiencing?

  1. A Denial, because the client is unable to accept the reality of the loss
  2. B Bargaining, because the client wishes the death had not happened
  3. C Depression, because the client is overwhelmed by sadness
  4. D Acceptance, because the client is beginning to adjust to the new reality
Show the answer and explanation

Correct answer: A

Denial is a common early grief stage where the individual has difficulty accepting the permanence of the loss, often shown by behaviors that act as if the deceased is still present, such as setting a place at the table. Bargaining (the option "Bargaining, because the client wishes the death had not happened" involves making deals with a higher power to reverse the loss, not forgetting the loss. Depression (the option "Depression, because the client is overwhelmed by sadness" is characterized by profound sadness and withdrawal, not by actions that assume the person is still alive. Acceptance (the option "Acceptance, because the client is beginning to adjust to the new reality" involves coming to terms with the loss and moving forward, which is inconsistent with forgetting the spouse has died.

Question 5

A 70-year-old client whose spouse died 3 months ago says, "I still set a place for him at the dinner table every night. I know he's gone, but I can't stop." Which response by the nurse is most appropriate?

  1. A "This behavior is a sign that you are not accepting the loss."
  2. B "It is common for people to keep rituals after a loss, but you should try to stop."
  3. C "Have you considered talking to a grief counselor about this?"
  4. D "Continuing rituals can be a normal part of grieving for some people."
Show the answer and explanation

Correct answer: D

Three months after a spouse's death, keeping familiar rituals such as setting a place at the table can be part of normal grieving. Normalizing the behavior validates the client's experience without judgment and keeps communication open.

Why the other options are wrong:
A: Labeling the behavior as nonacceptance is judgmental and can increase guilt.
B: Telling the client to stop dismisses a coping behavior that is not harmful.
C: Referral is not needed for a normal grief response at 3 months and implies something is wrong.

Question 6

A 72-year-old client with macular degeneration is admitted to a long-term care facility. The client states, 'I see shadows and wavy lines that aren't there, and it's making me nervous.' Which response by the nurse is most appropriate?

  1. A "Let me check your eyes for any visible changes."
  2. B "I will dim the lights to make the room darker."
  3. C "Tell me more about the shadows and wavy lines you see."
  4. D "These images are not real; try to ignore them."
Show the answer and explanation

Correct answer: C

Inviting the client to describe what they see acknowledges the distress and gathers assessment data. Shadows and wavy lines can reflect distortion from macular degeneration or images that are common with vision loss, and details about onset and change show whether the provider should be notified.

Why the other options are wrong:
A: Macular changes cannot be seen on a simple eye inspection, and this response skips over the client's anxiety.
B: Dim lighting reduces usable vision for a client with low vision and can make visual disturbances worse.
D: Dismissing the experience increases anxiety and closes communication, and new distortion may need evaluation.

Question 7

A 74-year-old client whose spouse died 3 months ago says, 'I still set the table for two every night. I can't accept that she's gone.' Which stage of grief according to Kübler-Ross is the client experiencing?

  1. A Acceptance
  2. B Depression
  3. C Bargaining
  4. D Denial
Show the answer and explanation

Correct answer: D

Denial is the stage in which the person acts as if the loss has not occurred, as demonstrated by setting the table for two. Bargaining involves making deals or promises in an attempt to reverse the loss. Depression is characterized by profound sadness and withdrawal from daily activities. Acceptance is when the person acknowledges the reality of the loss and begins to move forward. The client's behavior clearly reflects an inability to accept the spouse's death, which is characteristic of denial.

Question 8

A 24-year-old client with a history of panic disorder is brought to the emergency department with heart rate 122 beats/min, respiratory rate 28 breaths/min, and blood pressure 148/92 mm Hg. The client is hyperventilating and says, 'I think I'm dying.' Which action should the nurse take first?

  1. A Position the client supine with legs elevated to improve cerebral flow.
  2. B Coach the client in slow, pursed-lip breathing to reduce respiratory rate.
  3. C Administer 2 mg of lorazepam intramuscularly as ordered stat.
  4. D Apply supplemental oxygen at 2 liters per minute via nasal cannula.
Show the answer and explanation

Correct answer: B

The client is hyperventilating during a panic attack. Coaching slow, controlled breathing with prolonged exhalation reduces the respiratory rate, corrects the low carbon dioxide that causes many of the frightening sensations, and gives the client a sense of control right away.

Why the other options are wrong:
A: Supine positioning with legs elevated is for hypotension; this client is hypertensive, and lying flat can worsen breathlessness.
C: Lorazepam may be needed later, but an IM injection takes time to work and coaching can begin immediately.
D: Hyperventilation is not caused by low oxygen, so oxygen does not treat the problem.

Question 9

A 45-year-old client with newly diagnosed hypertension states, 'I can't stop worrying about my blood pressure; it's all I think about.' The nurse teaches the client a relaxation technique. Which client statement indicates the technique is understood?

  1. A "I will increase my physical activity to at least two hours daily."
  2. B "I will avoid thinking about my blood pressure during meals."
  3. C "I will practice deep breathing three times a day for 10 minutes."
  4. D "I will take my blood pressure reading every hour when I am anxious."
Show the answer and explanation

Correct answer: C

Deep breathing is a relaxation technique that activates the parasympathetic nervous system and reduces stress. Planning regular 10-minute practice sessions three times a day shows the client understands how to use it.

Why the other options are wrong:
A: Two hours of daily activity is excessive for a new routine and is not the relaxation technique that was taught.
B: Trying not to think about blood pressure is thought suppression, not a relaxation technique.
D: Hourly blood pressure checks feed the worry and increase anxiety.

Question 10

A 78-year-old client with terminal heart failure is receiving palliative care. The client's daughter asks the nurse, "How will I know when my mother is comfortable?" Which response by the nurse is most appropriate?

  1. A "She will be comfortable as long as her heart rate stays below 100."
  2. B "We check her oxygen level every four hours to ensure comfort."
  3. C "I will watch for grimacing, moaning, or restlessness as signs of pain."
  4. D "The doctor will increase her morphine when her breathing becomes labored."
Show the answer and explanation

Correct answer: C

Grimacing, moaning and restlessness are observable signs of discomfort that the daughter can also recognize and report. Focusing on these behaviors answers her question directly.

Why the other options are wrong:
A: Heart rate changes for many reasons and is not a reliable measure of comfort.
B: Oxygen saturation measures oxygenation, not comfort, and routine checks are often stopped in palliative care.
D: Comfort is managed proactively, and this reply defers to the doctor without telling her what to watch for.

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