NCLEX-RN Psychosocial Integrity Practice Questions

Emotional, mental, and social well-being — therapeutic communication, coping, and crisis care. It sits under Psychosocial Integrity on the NCLEX-RN test plan and carries an approximate weight of 9% of the exam.

Below are 13 practice questions for this domain — 8 multiple-choice and 5 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-RN 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 Multiple choice

1. Grief at two months — therapeutic response

At a wellness visit two months after the death of a spouse, a client tells the nurse about crying most days and asks whether it is normal to still feel this way.

Which response by the nurse is most appropriate?

  1. Grief has no set timetable. Tell me more about what these two months have been like for you.
  2. Most people finish grieving within six weeks, so you should ask your provider about starting an antidepressant.
  3. Try to keep yourself busy so you have less time to think about the loss.
  4. At least your spouse is no longer suffering.
Show the answer and rationales

Correct answer: A

  • A. Correct . This response normalizes the client's experience, conveys empathy, and uses an open-ended invitation that encourages the client to keep talking. Grief is an individual process with no fixed timeline, and the nurse's role is to support it, not rush it.
  • B. Incorrect . Grief has no fixed endpoint, and crying at two months after a major loss is within the expected range of normal grieving. This response pathologizes a normal process and offers premature medical advice.
  • C. Incorrect . Giving advice and encouraging avoidance are nontherapeutic. Suppressing grief rather than expressing it can delay healthy adjustment to the loss.
  • D. Incorrect . Cliched reassurance minimizes the client's pain and shuts down communication. It directs the client toward how the nurse thinks they should feel instead of validating what they actually feel.

Reference: MedlinePlus bereavement resources; psychiatric-mental health nursing standards for grief support and therapeutic communication

Easy Multiple choice

2. Professional boundaries — behavior requiring intervention

A charge nurse on an inpatient mental health unit is observing the interactions of a newly licensed nurse with clients.

Which behavior by the newly licensed nurse requires the charge nurse to intervene?

  1. Giving a client a personal cell phone number to stay in touch after discharge.
  2. Sitting in silence beside a tearful client.
  3. Declining a client's gift of an expensive watch and explaining the unit policy on gifts.
  4. Redirecting the conversation back to the client's discharge goals when asked about the nurse's own family life.
Show the answer and rationales

Correct answer: A

  • A. Correct . Continuing a personal connection outside the professional relationship is a boundary violation. It shifts the relationship from therapeutic to personal and must be addressed by the charge nurse.
  • B. Incorrect . Silence is a core therapeutic communication technique. Quiet presence communicates acceptance and gives the client space to gather thoughts and feelings.
  • C. Incorrect . Politely refusing a valuable gift maintains professional boundaries. Accepting it could blur the relationship and create a sense of obligation.
  • D. Incorrect . Limiting self-disclosure and keeping the focus on the client is exactly how professional boundaries are maintained. Brief redirection preserves the therapeutic purpose of the relationship.

Reference: NCSBN professional boundaries guidance for nurses

Medium Multiple choice

3. Auditory hallucinations — priority action

A client with schizophrenia on an inpatient mental health unit approaches the nurse, appearing tense and distracted, and states that the voices are much louder today.

Which action should the nurse take first?

  1. Ask the client directly what the voices are saying.
  2. Tell the client that the voices are not real and should be ignored.
  3. Guide the client to a group activity in the dayroom for distraction.
  4. Administer the PRN antipsychotic medication right away.
Show the answer and rationales

Correct answer: A

  • A. Correct . The priority is to assess the content of the hallucinations, because command hallucinations may direct the client to harm self or others. Safety assessment must come before any other intervention.
  • B. Incorrect . Dismissing the voices invalidates an experience that is very real to the client and damages trust. The nurse should acknowledge the experience without reinforcing it, not argue it away.
  • C. Incorrect . Distraction can be a useful strategy for managing hallucinations, but using it before assessing the content of the voices could leave a dangerous command hallucination undetected.
  • D. Incorrect . A PRN medication may well be appropriate, but assessment precedes intervention. The nurse must first determine what the voices are saying and evaluate the safety risk before medicating.

Reference: Open RN Nursing Mental Health and Community Concepts (NCBI Bookshelf) chapter on psychosis and schizophrenia; psychiatric-mental health nursing standards for command hallucination assessment

Medium Select all that apply

4. Escalating aggression — de-escalation actions

After a phone call, a client on an inpatient mental health unit begins pacing the dayroom, speaking in a raised voice with clenched fists, and moving closer to other clients.

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

  1. Speak in a calm, low voice using short, simple sentences.
  2. Maintain several feet of distance and keep a clear path to the door for both the nurse and the client.
  3. Offer the client choices, such as moving to a quieter area or taking a PRN medication.
  4. Ask other clients to leave the dayroom to reduce stimulation and protect their safety.
  5. Apply physical restraints now to prevent the situation from getting worse.
  6. Place a reassuring hand on the client's shoulder.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . A calm tone and brief, clear statements are foundational de-escalation techniques. An agitated client cannot process long or complex communication, and matching the client's volume escalates the situation.
  • B. Correct . Respecting personal space reduces the perceived threat, and an unobstructed exit protects everyone. Cornering an agitated client, or letting the nurse be cornered, increases the risk of violence.
  • C. Correct . Offering realistic choices restores a sense of control, which is often what an escalating client has lost. It is a core element of verbal de-escalation.
  • D. Correct . Clearing the area lowers environmental stimulation, removes an audience that can fuel escalation, and keeps bystanders safe — all part of managing the therapeutic milieu.
  • E. Incorrect . Restraint is a last resort used only after less restrictive measures fail, and it requires a provider's order with a face-to-face evaluation. Applying restraints preemptively violates regulatory standards and the client's rights.
  • F. Incorrect . Touching an agitated client invades personal space and is easily perceived as an attack, which can trigger a violent response. Touch should be avoided during escalation.

Reference: Project BETA consensus statement on verbal de-escalation (American Association for Emergency Psychiatry); CMS and Joint Commission restraint and seclusion standards

Medium Select all that apply

5. House fire — crisis intervention

Two days after losing their home in a fire, a client comes to a community clinic visibly shaken and states they cannot think straight or decide what to do next. The client has no injuries and denies thoughts of self-harm.

Which interventions by the nurse are appropriate during crisis intervention? Select all that apply.

  1. Address the client's immediate safety and basic needs, such as shelter and food, first.
  2. Help the client identify coping strategies that have worked during past stressful events.
  3. Assist the client to break the situation into small, concrete next steps, such as contacting the insurance company and arranging temporary housing.
  4. Explore unresolved conflicts from the client's childhood that may be intensifying the response.
  5. Encourage the client to decide now whether to relocate permanently to another city.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Crisis intervention always begins with safety and survival needs. Until basic needs are secured, the client cannot engage in problem-solving.
  • B. Correct . Reinforcing the client's own previously successful coping mechanisms is central to crisis work, because familiar strategies are the most accessible when usual functioning is overwhelmed.
  • C. Correct . Crisis intervention is reality-focused and practical. Concrete, short-term problem-solving restores a sense of control when the client feels unable to function.
  • D. Incorrect . Crisis intervention is short-term and focused on the here and now. Exploring developmental or psychodynamic issues belongs to long-term therapy, not to the acute crisis period.
  • E. Incorrect . Major, irreversible life decisions should be deferred during a crisis, when judgment and concentration are impaired. The focus is on immediate, manageable steps.

Reference: SAMHSA disaster behavioral health and crisis counseling resources; psychiatric-mental health nursing standards for crisis intervention

Medium Multiple choice

6. Panic-level anxiety — first action

A client in the emergency department is pacing, trembling, and breathing rapidly at 30/min. The client cannot follow a simple conversation, gestures wildly, and states that something terrible is about to happen. The cardiac workup is negative.

Which action should the nurse take first?

  1. Stay with the client and give short, simple directions in a calm voice.
  2. Begin teaching diaphragmatic breathing and progressive muscle relaxation.
  3. Leave the client alone in a quiet room to decrease stimulation.
  4. Ask the client to describe what triggered these feelings.
Show the answer and rationales

Correct answer: A

  • A. Correct . Panic-level anxiety narrows perception and impairs processing, and the client is at risk for harm. Remaining with the client provides safety, and a calm voice with brief, simple directions is the only communication the client can absorb at this level of anxiety.
  • B. Incorrect . Learning is not possible during panic-level anxiety because perception and concentration are severely impaired. Teaching coping techniques is appropriate only after the anxiety has decreased to a mild or moderate level.
  • C. Incorrect . Reducing environmental stimuli is appropriate, but a client in panic-level anxiety must never be left alone — the risk of injury and escalating terror makes the nurse's continuous presence a safety priority.
  • D. Incorrect . Exploring triggers requires reflection and insight that the client cannot access during panic. This intervention belongs later, once the anxiety has subsided enough for the client to think and communicate clearly.

Reference: NIMH anxiety and panic disorder resources; psychiatric-mental health nursing standards for severe and panic-level anxiety

Medium Multiple choice

7. Paranoid delusion — best response

A client admitted with a psychotic disorder refuses the lunch tray and tells the nurse that the staff have been putting poison in the food.

Which response by the nurse is most appropriate?

  1. That sounds frightening. I have not seen anything to suggest the food here is unsafe.
  2. Why would the staff want to poison you?
  3. No one is poisoning your food. That belief is a symptom of your illness.
  4. I will arrange for you to watch the kitchen staff prepare every one of your meals.
Show the answer and rationales

Correct answer: A

  • A. Correct . This response acknowledges the fear behind the delusion and gently presents reality without arguing about the belief itself. Focusing on the feeling rather than debating the content is the recommended approach to delusional thinking.
  • B. Incorrect . A why question sounds accusatory and invites the client to elaborate and defend the delusion, which can entrench it further. It also does not address the fear the client is experiencing.
  • C. Incorrect . Directly challenging a delusion does not change a fixed false belief and is likely to provoke defensiveness and damage trust. Logical argument is ineffective against delusional thinking.
  • D. Incorrect . Acting as though the delusion might be true reinforces it. The nurse should neither agree with nor elaborately accommodate the false belief, but instead address the underlying feeling and ensure nutrition through reasonable measures.

Reference: Open RN Nursing Mental Health and Community Concepts (NCBI Bookshelf); psychiatric-mental health nursing standards for therapeutic communication with delusional clients

Medium Select all that apply

8. Suicide precautions — plan of care

A client with major depressive disorder is admitted to an inpatient mental health unit after telling the provider about a plan to overdose on prescription medications.

Which actions should the nurse include in the plan of care? Select all that apply.

  1. Ask the client directly about current suicidal thoughts, the specific plan, and access to means.
  2. Remove potentially harmful items such as cords, glass, and razors from the client's environment.
  3. Initiate continuous one-to-one observation according to facility protocol.
  4. Collaborate with the client to develop a safety plan that identifies warning signs and sources of support.
  5. Avoid using the word suicide in conversation so the client does not get new ideas.
  6. Reassure the client that everything will work out fine.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Direct, specific questioning is the standard of care for suicide risk assessment. Research shows that asking about suicide does not plant the idea or increase risk.
  • B. Correct . Restricting access to lethal means is one of the most effective suicide-prevention interventions and is a core component of inpatient suicide precautions.
  • C. Correct . A client admitted with a plan and intent is at high acute risk, and constant observation provides the level of supervision needed to keep the client safe.
  • D. Correct . Collaborative safety planning is an evidence-based intervention that gives the client concrete steps to use when suicidal thoughts intensify and engages the client in their own care.
  • E. Incorrect . Avoiding the topic is a myth-based practice. Talking openly about suicide does not increase risk; it is the best way to identify risk and communicates that the subject is safe to discuss.
  • F. Incorrect . False reassurance dismisses the client's feelings and blocks therapeutic communication. It offers no safety benefit and can make the client feel unheard.

Reference: NIMH suicide prevention FAQ and warning signs; SAMHSA and 988 Suicide and Crisis Lifeline safety planning guidance

Medium Multiple choice

9. Systematic desensitization — teaching evaluation

A client whose fear of flying has caused them to miss important family events is beginning systematic desensitization with a therapist. The nurse reinforces teaching about the treatment.

Which statement by the client indicates understanding of the treatment?

  1. I will learn relaxation techniques first, then face situations related to flying one step at a time, starting with the least frightening.
  2. I will be put on an airplane right away and stay there until my fear goes away.
  3. I will need to take a sedative before every flight for the rest of my life.
  4. I should avoid thinking or talking about airplanes between my therapy sessions.
Show the answer and rationales

Correct answer: A

  • A. Correct . Systematic desensitization pairs relaxation training with gradual exposure up a fear hierarchy, beginning with the least anxiety-provoking situation. The client advances a step only after staying relaxed at the current one.
  • B. Incorrect . Immediate prolonged exposure to the most feared situation describes flooding, a different technique. Systematic desensitization is gradual and hierarchical, not all at once.
  • C. Incorrect . Medication may occasionally be used short-term as an adjunct, but the goal of systematic desensitization is for the client to manage the feared situation using learned relaxation skills, not lifelong sedation.
  • D. Incorrect . Avoidance is what maintains a phobia. Treatment depends on controlled, repeated engagement with the feared stimulus, often including practice between sessions.

Reference: Systematic desensitization literature (Wolpe method) including EBSCO Research Starters and academic psychology references on graded exposure versus flooding

Medium Select all that apply

10. Trauma-informed care — admission actions

A nurse is admitting a client with post-traumatic stress disorder related to a past physical assault. The client appears guarded and startles when the door opens.

Which actions by the nurse reflect trauma-informed care? Select all that apply.

  1. Explain each part of the assessment before starting and ask permission before touching the client.
  2. Offer choices when possible, such as the timing of care activities and a preference for the gender of caregivers.
  3. Help the client identify personal strengths and supports that have helped them get through difficult times before.
  4. Knock and announce yourself before entering the room.
  5. Require the client to describe the assault in detail to complete the admission history.
  6. Withhold information about upcoming procedures so the client does not become anxious ahead of time.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Predictability and consent support the trauma-informed principles of safety and trustworthiness. Unexpected touch can trigger intense fear responses in a client with a trauma history.
  • B. Correct . Empowerment, voice, and choice are core trauma-informed principles. Restoring control to the client counters the powerlessness that defines traumatic experience.
  • C. Correct . Building on existing strengths fosters resilience and reflects the collaborative, empowerment-focused approach of trauma-informed care.
  • D. Correct . Announcing entry prevents startling a hypervigilant client and supports a predictable, physically and psychologically safe environment.
  • E. Incorrect . Forcing a detailed retelling of trauma can re-traumatize the client and is not required for safe care. The nurse needs to know how the trauma affects current care, not a full narrative of the event.
  • F. Incorrect . Withholding information violates the principle of trustworthiness and transparency. For trauma survivors, the unknown is more frightening than clear, honest preparation.

Reference: SAMHSA concept of trauma and guidance for a trauma-informed approach (six key principles); CDC infographic on the six guiding principles of a trauma-informed approach

Hard Multiple choice

11. Alcohol withdrawal — finding to report immediately

A client with a 15-year history of heavy daily alcohol use was admitted 2 days ago for cellulitis. The client has not had a drink for approximately 56 hours and is on a symptom-triggered CIWA-Ar protocol.

Which finding should the nurse report to the provider immediately?

  1. New disorientation to place and time with visual hallucinations, heart rate 126/min, blood pressure 168/98 mm Hg, and temperature 38.3 C (100.9 F).
  2. Bilateral hand tremors and reports of feeling anxious.
  3. Reports of craving alcohol and difficulty falling asleep.
  4. Mild diaphoresis with a heart rate of 92/min.
Show the answer and rationales

Correct answer: A

  • A. Correct . New disorientation, hallucinations, marked tachycardia, hypertension, and fever appearing 48 to 96 hours after the last drink are hallmarks of delirium tremens, a medical emergency with significant mortality if untreated. The provider must be notified immediately so treatment can be escalated.
  • B. Incorrect . Tremulousness and anxiety are expected early withdrawal findings that are managed with scheduled CIWA-Ar scoring and symptom-triggered benzodiazepines. They warrant monitoring and protocol dosing, not an emergency call to the provider.
  • C. Incorrect . Craving and insomnia are common, anticipated features of alcohol withdrawal. They should be documented and addressed in the plan of care but do not signal an immediate threat to life.
  • D. Incorrect . Mild sweating with a heart rate near the upper end of normal reflects mild withdrawal that the CIWA-Ar protocol is designed to manage. It does not indicate the autonomic storm and altered sensorium that define delirium tremens.

Reference: StatPearls Alcohol Withdrawal Syndrome (NCBI Bookshelf); American Family Physician alcohol withdrawal review; Medscape delirium tremens clinical presentation

Hard Select all that apply

12. Alcohol withdrawal — nursing interventions

A client with a 10-year history of heavy daily alcohol use is admitted to a medical unit 36 hours after the last drink. The client is tremulous and diaphoretic with blood pressure 156/94 mm Hg and heart rate 112/min, and the CIWA-Ar score is 14.

Which interventions should the nurse implement? Select all that apply.

  1. Administer a benzodiazepine as prescribed per the symptom-triggered CIWA-Ar protocol.
  2. Implement seizure precautions.
  3. Provide a quiet room with reduced stimulation.
  4. Administer thiamine as prescribed before infusing dextrose-containing IV fluids.
  5. Begin disulfiram now to reduce the client's craving for alcohol.
  6. Limit assessments to once per shift so the client can rest without interruption.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Benzodiazepines are first-line treatment for alcohol withdrawal, and a CIWA-Ar score of 14 indicates moderate withdrawal that meets the typical symptom-triggered dosing threshold of 8 to 10.
  • B. Correct . Withdrawal seizures most often occur 12 to 48 hours after the last drink, so this client is squarely within the highest-risk window and needs padded rails, suction, and oxygen available.
  • C. Correct . Excess noise and stimulation aggravate autonomic arousal, anxiety, and perceptual disturbances during withdrawal. A calm, low-stimulation environment is a standard supportive measure.
  • D. Correct . Giving a glucose load to a thiamine-deficient client can precipitate Wernicke encephalopathy because glucose metabolism consumes thiamine. Thiamine is given first or concurrently to prevent this neurologic emergency.
  • E. Incorrect . Disulfiram does not reduce craving; it causes a toxic aversive reaction if alcohol is consumed and must never be started until the client has been abstinent and is past acute withdrawal. It has no role in withdrawal management.
  • F. Incorrect . Symptom-triggered protocols require CIWA-Ar reassessment as often as every 1 to 4 hours in active withdrawal. Once-per-shift assessment could miss rapid progression toward seizures or delirium tremens.

Reference: StatPearls Alcohol Withdrawal Syndrome (NCBI Bookshelf); American Family Physician alcohol withdrawal review; FDA prescribing information (disulfiram); Medscape Wernicke encephalopathy treatment

Hard Multiple choice

13. Depression with sudden calm — which client first

A nurse on an inpatient mental health unit receives the morning report on four clients.

Which client should the nurse assess first?

  1. A client with major depression who was withdrawn and tearful all week and this morning appears calm, smiling, and is giving away personal belongings.
  2. A client with generalized anxiety disorder who is pacing the hallway and asking for a PRN medication.
  3. A client who is crying after a difficult family visit and asks to talk with the nurse.
  4. A client with depression who refused breakfast and is still in bed at mid-morning.
Show the answer and rationales

Correct answer: A

  • A. Correct . A sudden lift in mood after severe depression, especially combined with giving away possessions, is a classic warning sign that the client may have decided to attempt suicide and now has the energy and resolve to act. This client is at imminent risk and must be assessed first.
  • B. Incorrect . Pacing and requesting a PRN reflect moderate anxiety that needs timely attention, but this client is communicating needs directly and is not showing signs of imminent danger to self or others.
  • C. Incorrect . Crying after a stressful visit is an expected emotional response, and the client is appropriately seeking support. This need is real but does not outrank an imminent safety risk.
  • D. Incorrect . Poor appetite and low energy are consistent, expected findings in depression. They require follow-up and care planning but do not signal the acute change in risk that a sudden unexplained calm does.

Reference: NIMH Warning Signs of Suicide; American Foundation for Suicide Prevention warning signs

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.

Study sets in this domain