NCLEX-PN Psychosocial Integrity Practice Questions

Emotional, mental, and social well-being — therapeutic communication, coping, abuse, and crisis care. It sits under Psychosocial Integrity on the NCLEX-PN test plan and carries an approximate weight of 12% of the exam.

Below are 10 practice questions for this domain — 6 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Select all that apply

1. Dementia — evening agitation care approaches

A nurse in a memory-care unit is caring for a client with moderate Alzheimer disease. Each evening the client becomes restless and repeatedly asks to go home to a parent who died many years ago.

Which approaches should the nurse use? Select all that apply.

  1. Use short, simple sentences and give one direction at a time.
  2. Keep the daily routine and the assigned caregivers as consistent as possible.
  3. Redirect the client to a familiar activity, such as folding towels or looking through a photo album.
  4. Explain in detail that the parent died years ago so the client can accept reality.
  5. Quiz the client about the date and recent events each evening to exercise memory.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Dementia impairs the ability to process complex or multi-step language. Brief, single-step communication is the standard approach and reduces frustration for the client.
  • B. Correct . A predictable routine and familiar faces reduce confusion and agitation in clients with dementia, who rely on environmental consistency as memory declines.
  • C. Correct . Redirection acknowledges the client's restlessness and channels it into a calming, familiar task. It is more effective than arguing with a belief the client cannot correct.
  • D. Incorrect . Repeatedly confronting a client who has moderate dementia with a loved one's death forces fresh grief each time and increases distress, because the client cannot retain the correction. Redirect and respond to the underlying feeling instead.
  • E. Incorrect . Drilling a client with dementia on facts they can no longer retrieve produces frustration and agitation without slowing the disease, which is progressive and irreversible.

Reference: Alzheimer's Association communication and dementia-care guidance; National Institute on Aging caregiver guidance

Easy Multiple choice

2. Panic-level anxiety after a house fire

A client whose home was destroyed by a fire the previous night is brought to the clinic by a neighbor. The client is pacing, hyperventilating, and wringing the hands, and cannot answer simple questions or follow the conversation.

Which action should the nurse take first?

  1. Stay with the client and give short, simple directions in a calm voice.
  2. Leave the client alone in a quiet room to regain composure.
  3. Begin teaching the client about community resources for fire victims.
  4. Ask the client to describe the fire in detail to begin processing the event.
Show the answer and rationales

Correct answer: A

  • A. Correct . This client shows panic-level anxiety during an acute crisis. Perception is severely narrowed, so the nurse stays with the client for safety, lowers stimulation, and uses brief, concrete directions — the only kind of communication a panicking person can process.
  • B. Incorrect . A client in severe or panic-level anxiety must never be left alone — judgment and safety awareness are impaired, and isolation can intensify the panic.
  • C. Incorrect . Severe and panic-level anxiety block learning. Teaching and concrete problem-solving belong later in crisis intervention, after the anxiety is reduced to a workable level.
  • D. Incorrect . Asking for a detailed account during panic escalates distress, and the client cannot organize thoughts well enough to respond. Exploring the event is appropriate only once anxiety has decreased.

Reference: SAMHSA crisis counseling guidance; NCSBN NCLEX-PN test plan (psychosocial integrity)

Medium Multiple choice

3. Angry client — de-escalation first step

In an outpatient clinic, a client who has been told that the provider must reschedule the appointment begins shouting at the nurse, clenching both fists, and stepping closer.

Which action should the nurse take first?

  1. Speak in a calm, low voice, acknowledge the client's anger, and keep a clear path to the door.
  2. Place a reassuring hand on the client's shoulder.
  3. Tell the client the shouting is unacceptable, then turn and walk into the back office.
  4. Explain point by point why the provider had to reschedule, correcting the client's misstatements.
Show the answer and rationales

Correct answer: A

  • A. Correct . De-escalation starts with the nurse staying calm, naming the emotion — for example, telling the client they sound very angry — and protecting personal safety by maintaining distance and an exit route. Acknowledging the feeling without endorsing the behavior defuses most escalations.
  • B. Incorrect . Touching a person who is escalating invades personal space and is easily perceived as a threat or restraint attempt — it can trigger the very violence the nurse is trying to prevent.
  • C. Incorrect . Limit-setting is appropriate, but delivering an ultimatum and turning away abandons the interaction, leaves the situation unresolved, and turning the back on an escalating client is unsafe.
  • D. Incorrect . Arguing facts with an angry person fuels the escalation. The emotion must be acknowledged and the situation made safe before any explanation can be heard.

Reference: OSHA guidelines for preventing workplace violence in healthcare; standard de-escalation practice

Medium Multiple choice

4. Delirium — new confusion in long-term care

A nurse in a long-term care facility is caring for a 78-year-old client who is usually alert and oriented. Today the client is intermittently drowsy, inattentive, and confused about the place and the date. Vital signs are temperature 99.8 F (37.7 C), heart rate 102/min, respirations 18/min, and blood pressure 134/82 mm Hg. The urine in the drainage bag is cloudy with a strong odor.

Which action should the nurse take?

  1. Report the acute change in mental status and the findings to the registered nurse immediately.
  2. Reorient the client and plan to recheck mental status at the end of the shift.
  3. Ask the provider for a PRN sedative so the client can rest until morning.
  4. Reassure the family that gradual memory loss is expected at the client's age.
Show the answer and rationales

Correct answer: A

  • A. Correct . Sudden, fluctuating confusion in an older adult is delirium until proven otherwise, and a urinary tract infection is one of the most common triggers — cloudy, foul-smelling urine with low-grade fever and tachycardia supports that here. Delirium can signal developing sepsis, so the nurse reports immediately rather than waiting.
  • B. Incorrect . Reorientation alone delays evaluation of a reversible and potentially serious cause. An acute mental status change with signs of infection needs escalation now, not at the end of the shift.
  • C. Incorrect . Sedating medications can deepen delirium and mask the underlying cause. The priority is identifying and treating the trigger, not chemically quieting the symptoms.
  • D. Incorrect . This change is acute and fluctuating, not gradual — the pattern of delirium, not dementia or normal aging. Mislabeling it as expected decline delays treatment of a reversible condition.

Reference: Systematic review of UTI-induced delirium in older adults (PMC 2023); Northwestern Medicine clinical guidance on UTI and confusion

Medium Multiple choice

5. Grief at four months — therapeutic response

At a follow-up clinic visit four months after the death of a spouse, a client begins to cry and says, 'I thought I would be over this by now. Some days I still cannot make myself get out of bed.'

Which response by the nurse is most appropriate?

  1. This sounds very painful. Tell me more about how the days have been for you.
  2. Why are you still grieving this hard after four months?
  3. You will feel better soon — your spouse would not want you to be sad.
  4. Most people finish grieving within six weeks, so the medication may need adjusting.
Show the answer and rationales

Correct answer: A

  • A. Correct . This response names the feeling with empathy and follows it with an open-ended invitation, which encourages the client to express the grief. Grief has no fixed timeline, and the nurse's role is to support the process rather than rush it.
  • B. Incorrect . Why-questions sound accusatory and imply the client's grief is wrong or abnormal, which shuts down communication and damages rapport.
  • C. Incorrect . This is false reassurance combined with a cliché. It dismisses what the client is feeling now and signals that the nurse is not willing to hear the painful parts.
  • D. Incorrect . Grief follows no set schedule, so the six-week claim is simply inaccurate, and jumping to medication frames a normal grief response as a pharmacologic problem before the client has even been heard.

Reference: MedlinePlus (grief and bereavement); NCSBN NCLEX-PN test plan (psychosocial integrity)

Medium Select all that apply

6. Professional boundaries — gift and social media

A client nearing discharge from a rehabilitation unit offers the nurse an expensive bracelet, asks to connect on the nurse's personal social media account, and invites the nurse to a family barbecue. The nurse also recalls having recently told this client about the nurse's own marital problems.

Which behaviors would indicate that professional boundaries are at risk? Select all that apply.

  1. Accepting the expensive bracelet as a keepsake of the relationship.
  2. Connecting with the client on a personal social media account.
  3. Attending the client's family barbecue after discharge.
  4. Sharing detailed accounts of the nurse's own marital problems with the client.
  5. Thanking the client and explaining that facility policy does not allow accepting valuable gifts.
  6. Keeping conversations focused on the client's recovery goals.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Accepting a gift of significant value shifts the relationship from therapeutic to personal and can create a sense of obligation. The nurse declines politely and follows facility policy.
  • B. Correct . Personal online relationships with clients blur the line between professional and private life and risk confidentiality breaches — a boundary concern specifically addressed in NCSBN guidance.
  • C. Correct . Socializing with a client outside of care moves the relationship into personal territory and compromises the objectivity the therapeutic relationship depends on.
  • D. Correct . Excessive self-disclosure reverses the roles, shifting the focus from the client's needs to the nurse's. Brief, purposeful disclosure can be therapeutic, but detailed personal problems are not.
  • E. Incorrect . This response maintains the boundary while preserving the relationship — it acknowledges the client's gratitude without accepting an inappropriate gift.
  • F. Incorrect . A client-centered focus is the defining feature of a therapeutic relationship, not a boundary violation.

Reference: NCSBN A Nurse's Guide to Professional Boundaries

Medium Select all that apply

7. Suicide precautions — carrying out the plan

A client admitted after describing a plan to overdose on a stockpile of medication tells the nurse that the intent to die is still present. The registered nurse initiates suicide precautions, and the nurse is assisting with carrying them out.

Which actions by the nurse are appropriate? Select all that apply.

  1. Ensure continuous one-to-one observation, including while the client uses the bathroom.
  2. Remove razors, cords, plastic bags, and any medication left at the bedside from the room.
  3. Check items brought by visitors so that nothing harmful is left with the client.
  4. Agree to keep the client's suicidal statements confidential to preserve trust.
  5. Replace the one-to-one observation with checks every 15 minutes while the client sleeps.
  6. Ask the client to sign a no-suicide contract in place of close observation.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . A client with a plan, access to means, and current intent is at the highest risk level and requires constant one-to-one observation with no gaps — including bathroom use, where many inpatient suicides occur.
  • B. Correct . Restricting access to lethal means is a core element of inpatient suicide precautions and directly counters this client's stated method of overdose.
  • C. Correct . Visitors can unknowingly supply means of self-harm such as medications, sharp objects, or cords, so screening belongings is part of maintaining a safe environment.
  • D. Incorrect . Safety overrides confidentiality. All statements about suicidal thoughts or plans must be shared with the RN and the care team — promising secrecy endangers the client.
  • E. Incorrect . Intermittent checks leave dangerous unobserved intervals. A client at the highest risk level requires continuous observation around the clock until the provider or RN changes the level of precaution.
  • F. Incorrect . No-suicide contracts have no demonstrated protective effect and must never substitute for continuous observation and a means-restricted environment.

Reference: The Joint Commission NPSG 15.01.01; SAMHSA suicide prevention guidance

Hard Multiple choice

8. Depression — sudden mood improvement

A nurse on a behavioral health unit is collecting data on a client hospitalized for major depressive disorder. For the past week the client has been withdrawn, tearful, and refusing all unit activities. This morning the client appears calm and cheerful, tells the nurse that everything is finally settled, and gives a roommate a treasured family photograph.

Which action should the nurse take first?

  1. Ask the client directly whether the client is having thoughts of suicide.
  2. Document the improved mood as a positive response to the antidepressant.
  3. Encourage the client to share the positive feelings in the morning group session.
  4. Return the photograph and remind the client that exchanging gifts between clients is not allowed.
Show the answer and rationales

Correct answer: A

  • A. Correct . An abrupt shift from severe depression to calm cheerfulness, paired with giving away a valued possession, is a classic warning sign that the client may have decided on a suicide plan and now has the energy to act. Asking directly does not plant the idea — it is the essential first data-collection step, and the findings are then reported to the RN so precautions can be increased.
  • B. Incorrect . Antidepressants typically take 2 to 6 weeks for full effect, and a sudden mood lift with giving away belongings suggests a decision to die rather than recovery. Documenting without acting misses a critical safety warning.
  • C. Incorrect . This treats a red-flag presentation as genuine improvement and delays the direct suicide inquiry and escalation that the situation requires.
  • D. Incorrect . Enforcing a unit rule addresses the surface behavior but ignores its meaning — giving away treasured possessions is a recognized suicide warning sign that demands direct follow-up, not a rules reminder.

Reference: NIMH Warning Signs of Suicide; SAMHSA suicide warning signs

Hard Multiple choice

9. Substance withdrawal — which client first

A nurse on a medical unit receives report on four clients with substance-use disorders.

Which client should the nurse collect data on first?

  1. A client whose last alcoholic drink was 36 hours ago and who now has tremors, a heart rate of 118/min, blood pressure 162/94 mm Hg, diaphoresis, and reports seeing insects on the wall.
  2. A client in opioid withdrawal who has yawning, a runny nose, muscle aches, nausea, and abdominal cramping.
  3. A client who stopped smoking two days ago, is irritable, and is asking when the prescribed nicotine patch will arrive.
  4. A client receiving scheduled methadone maintenance who is asking what time the next dose is due.
Show the answer and rationales

Correct answer: A

  • A. Correct . Tremors, marked autonomic hyperactivity, and visual hallucinations 12 to 48 hours after the last drink signal severe alcohol withdrawal that can progress to delirium tremens, which typically begins 48 to 96 hours after the last drink and is life-threatening. This client is seen first and the findings reported to the RN immediately.
  • B. Incorrect . Opioid withdrawal is intensely uncomfortable but rarely life-threatening in an otherwise healthy adult. Comfort measures and prescribed medications can follow the higher-priority client.
  • C. Incorrect . Nicotine withdrawal causes irritability and craving but poses no physiologic danger. Following up on the patch is appropriate after unstable clients are seen.
  • D. Incorrect . This client is stable and asking a routine medication question — there is no withdrawal emergency or data suggesting deterioration.

Reference: StatPearls Alcohol Withdrawal Syndrome (NCBI Bookshelf); MedlinePlus (delirium tremens; opiate and opioid withdrawal)

Hard Select all that apply

10. Suspected elder abuse — home visit actions

During a home visit, a nurse notes that an 82-year-old client has bruises in several stages of healing on both upper arms and appears fearful. The adult child who serves as caregiver answers every question directed at the client, then briefly leaves the room to take a phone call.

Which actions should the nurse take? Select all that apply.

  1. Use the time alone to interview the client privately about safety at home.
  2. Document the findings objectively, including the size and location of the bruises and the client's exact words.
  3. Report the suspected abuse according to agency policy and state law.
  4. Confront the caregiver with the suspicion of abuse before leaving the home.
  5. Promise the client that nothing discussed will be shared without permission.
  6. Delay reporting until the bruising is photographed and abuse is confirmed.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . A suspected victim must be interviewed away from the possible abuser, who often answers for the client or monitors what is said. The caregiver's absence is the moment to collect data privately.
  • B. Correct . Objective, quoted documentation preserves evidence and avoids the nurse's interpretation contaminating the record — both essential if protective services investigate.
  • C. Correct . Nurses, including LPNs, are mandatory reporters of suspected elder abuse. Reasonable suspicion — not proof — is the threshold that triggers the report.
  • D. Incorrect . Confronting a suspected abuser can escalate the danger to the client and to the nurse. The concern is routed through the reporting agency, which investigates safely.
  • E. Incorrect . Mandatory reporting cannot be promised away. The nurse can offer support and explain who must be told, but must not guarantee secrecy that the law does not allow.
  • F. Incorrect . Reports are made on suspicion; confirmation and investigation are the responsibility of adult protective services. Waiting for proof leaves the client in danger and may violate the law.

Reference: National Center on Elder Abuse (Administration for Community Living); state mandatory-reporter laws for nurses

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

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