Mental health disorders (anxiety, depression, bipolar, schizophrenia) NCLEX-RN Practice Questions

Mental health disorders (anxiety, depression, bipolar, schizophrenia) NCLEX-RN Practice Questions help you master high-yield nursing priorities in the Psychosocial Integrity domain. This topic-wise set is designed to sharpen clinical reasoning, safety prioritization, therapeutic communication, and pharmacologic management for complex psychiatric presentations. You’ll practice triaging panic attacks, responding to suicidal ideation, intervening for mania, and managing psychotic symptoms—all while integrating medication teaching and adverse effect recognition (e.g., lithium toxicity, serotonin syndrome, NMS, EPS, and clozapine agranulocytosis). Tailored for rigorous exam prep and ideal for advanced learners such as M. Pharma students, these questions mirror real NCLEX-RN decision-making scenarios. Use them to build confidence in applying evidence-based interventions and safeguarding patient safety across inpatient and community mental health settings.

Q1. A client presents with a panic attack: trembling, hyperventilation, and “I’m dying.” What is the nurse’s priority action?

• Teach progressive muscle relaxation in detail
• Guide slow, diaphragmatic breathing and speak in short, calm sentences while remaining with the client
• Leave briefly to obtain a benzodiazepine PRN
• Discuss long-term cognitive restructuring techniques

Correct Answer: Guide slow, diaphragmatic breathing and speak in short, calm sentences while remaining with the client

Q2. A client with major depressive disorder states, “I’m a burden. I can’t do this anymore.” Which assessment is most important to ask next?

• “Have you tried meditation or journaling?”
• “Do you have a plan to harm yourself?”
• “When did these feelings start?”
• “Have you taken your antidepressant today?”

Correct Answer: “Do you have a plan to harm yourself?”

Q3. A client taking sertraline arrives with agitation, fever, diaphoresis, hyperreflexia, and tremor. What is the nurse’s first action?

• Administer propranolol to reduce tremor
• Hold sertraline and notify the provider immediately
• Encourage oral fluids and rest
• Give benztropine for extrapyramidal symptoms

Correct Answer: Hold sertraline and notify the provider immediately

Q4. A client prescribed phenelzine asks about diet. Which statement indicates correct understanding?

• “I can have aged cheddar and red wine in moderation.”
• “I will avoid aged cheeses, cured meats, and fermented products.”
• “I can take any OTC cold medicine with this medication.”
• “I will increase my intake of kimchi and soy sauce for flavor.”

Correct Answer: “I will avoid aged cheeses, cured meats, and fermented products.”

Q5. A client on lithium for bipolar disorder calls with diarrhea, coarse tremor, and ataxia after a weekend of hiking in heat. What is the priority action?

• Advise taking the next scheduled dose with food
• Instruct to increase water intake and monitor symptoms
• Hold lithium and arrange for an urgent serum lithium level
• Recommend acetaminophen for tremor

Correct Answer: Hold lithium and arrange for an urgent serum lithium level

Q6. An inpatient with acute mania is pacing, euphoric, and hasn’t eaten in 24 hours. Which intervention is priority?

• Invite the client to a seated, formal meal
• Provide high-calorie, high-protein finger foods frequently
• Assign the client as group leader to channel energy
• Initiate deep psychoeducation on sleep hygiene

Correct Answer: Provide high-calorie, high-protein finger foods frequently

Q7. A client with schizophrenia reports, “Voices are telling me to hurt someone.” What is the nurse’s first response?

• “Ignore the voices; they aren’t real.”
• “What are the voices saying, and can you resist following them?”
• “Let’s turn on the TV to distract you.”
• “You’ll get in trouble if you act on that.”

Correct Answer: “What are the voices saying, and can you resist following them?”

Q8. A client on clozapine reports sore throat and a fever of 101.5°F (38.6°C). What is the best action?

• Administer acetaminophen and recheck in 4 hours
• Continue clozapine and schedule a wellness check
• Hold the medication and obtain a STAT CBC with ANC
• Encourage oral fluids and rest

Correct Answer: Hold the medication and obtain a STAT CBC with ANC

Q9. A client on haloperidol develops torticollis, oculogyric crisis, and severe neck stiffness. What is the immediate nursing action?

• Administer IM benztropine or diphenhydramine
• Apply heat packs and massage neck
• Encourage relaxation techniques
• Give lorazepam PO

Correct Answer: Administer IM benztropine or diphenhydramine

Q10. Two days after starting a high-potency antipsychotic, a client develops 104°F fever, severe rigidity, diaphoresis, and confusion. What is the priority?

• Administer ondansetron and monitor
• Continue antipsychotic and provide hydration
• Stop antipsychotic, notify provider, initiate cooling and supportive care
• Give propranolol for rigidity

Correct Answer: Stop antipsychotic, notify provider, initiate cooling and supportive care

Q11. A client with obsessive-compulsive disorder washes hands repeatedly, causing skin breakdown. Which initial nursing approach is most therapeutic?

• Prohibit all rituals to stop reinforcement
• Allow time for rituals initially while gradually introducing limits and skin care
• Use distraction and refuse to discuss obsessions
• Encourage family to confront the client

Correct Answer: Allow time for rituals initially while gradually introducing limits and skin care

Q12. During a PTSD flashback, a client crouches in the corner shouting, “They’re coming!” What is the nurse’s best response?

• “Stop it. You’re safe here.”
• Gently touch the client’s shoulder to comfort
• “You’re in the hospital. Look around and tell me three things you see.”
• “If you ignore this, it will pass.”

Correct Answer: “You’re in the hospital. Look around and tell me three things you see.”

Q13. A client newly prescribed an SSRI for depression says, “I’ll feel better by the end of the week.” Which response indicates teaching is needed?

• “Improvement may take 2–4 weeks.”
• “Call if you have worsening mood or suicidal thoughts.”
• “I’ll feel better by the end of the week.”
• “Sexual side effects can occur; tell your provider.”

Correct Answer: “I’ll feel better by the end of the week.”

Q14. Teaching about alprazolam for generalized anxiety should include which statement?

• “Stop it abruptly if you feel better.”
• “Avoid alcohol and don’t drive until you know how it affects you.”
• “It is non-sedating and non-addictive.”
• “You can take extra doses if anxiety increases.”

Correct Answer: “Avoid alcohol and don’t drive until you know how it affects you.”

Q15. A client starting buspirone asks what to expect. Which teaching is correct?

• “You can take it PRN for panic attacks.”
• “It may take 2–4 weeks to reach full effect.”
• “It causes sedation similar to benzodiazepines.”
• “Stop immediately if you feel better after 3 days.”

Correct Answer: “It may take 2–4 weeks to reach full effect.”

Q16. Pre-ECT care for severe depression includes which priority action?

• Ensure NPO status and verify informed consent
• Encourage a large breakfast for energy
• Administer long-acting benzodiazepine pre-procedure
• Hold all antihypertensives the morning of ECT

Correct Answer: Ensure NPO status and verify informed consent

Q17. A client on lamotrigine for bipolar maintenance reports a new, widespread rash. What should the nurse advise?

• Apply moisturizer and continue medication
• Stop the medication and seek immediate evaluation
• Reduce the dose by half
• Use antihistamines and observe

Correct Answer: Stop the medication and seek immediate evaluation

Q18. A client taking valproate for bipolar disorder returns with labs: AST 160 U/L, ALT 175 U/L, platelets 95,000/µL. What is the priority action?

• Continue therapy; these values are expected
• Hold valproate and notify the provider
• Encourage high-protein diet
• Administer vitamin K

Correct Answer: Hold valproate and notify the provider

Q19. An inpatient with severe depression isolates and speaks minimally. Which therapeutic communication is best?

• “You need to join group now.”
• “Why won’t you talk to me?”
• “I’ll sit with you for a while if that’s okay.”
• “Cheer up; things will improve.”

Correct Answer: “I’ll sit with you for a while if that’s okay.”

Q20. A client says, “There are cameras in the vents watching me.” Which response is most appropriate?

• “That’s not true; stop thinking that.”
• “I don’t see cameras, but I understand you feel afraid. You’re safe here.”
• “Show me where the cameras are.”
• “Ignore it and it will go away.”

Correct Answer: “I don’t see cameras, but I understand you feel afraid. You’re safe here.”

Q21. Which situation most justifies immediate use of restraints according to least-restrictive principles?

• Client refuses scheduled medication
• Client paces and mutters to self
• Client throws chairs, attempts to strike staff, and de-escalation has failed
• Client declines to attend group therapy

Correct Answer: Client throws chairs, attempts to strike staff, and de-escalation has failed

Q22. A postpartum client with severe depression says, “Sometimes I think my baby would be better off without me.” What is the priority?

• Teach sleep hygiene and nutrition
• Initiate 1:1 observation and notify the provider immediately
• Schedule outpatient counseling next week
• Encourage attending a peer support group

Correct Answer: Initiate 1:1 observation and notify the provider immediately

Q23. A client on phenelzine asks about OTC medications. Which teaching is correct?

• “Most decongestants are safe.”
• “Avoid OTC cold remedies and decongestants due to hypertensive crisis risk.”
• “Take St. John’s wort for added benefit.”
• “Use any cough suppressant without concern.”

Correct Answer: “Avoid OTC cold remedies and decongestants due to hypertensive crisis risk.”

Q24. A client with panic disorder is hyperventilating, dizzy, and tingling in fingers. What is the best immediate intervention?

• Encourage slow, diaphragmatic breathing with prolonged exhalation
• Discuss long-term CBT techniques
• Provide a detailed explanation of panic physiology
• Begin progressive muscle training

Correct Answer: Encourage slow, diaphragmatic breathing with prolonged exhalation

Q25. Which is a negative symptom of schizophrenia?

• Auditory hallucinations
• Grandiose delusions
• Flat affect and avolition
• Disorganized speech

Correct Answer: Flat affect and avolition

Q26. A client with schizophrenia repeatedly stops taking oral antipsychotics after discharge. Which prescription should the nurse anticipate discussing?

• Haloperidol 5 mg PO BID
• Risperidone long-acting injection every 2 weeks
• Clozapine PO with weekly pickup
• Quetiapine 25 mg PRN

Correct Answer: Risperidone long-acting injection every 2 weeks

Q27. Before starting ziprasidone, which finding is most concerning?

• Potassium 3.0 mEq/L
• Blood pressure 138/86 mm Hg
• Fasting glucose 102 mg/dL
• BMI 26 kg/m²

Correct Answer: Potassium 3.0 mEq/L

Q28. A client admitted after a suicide attempt now denies suicidal thoughts. Which order is the priority to implement?

• Provide brochures on coping skills
• Assign room at end of hall
• Initiate 1:1 observation and remove potentially harmful items
• Schedule discharge planning

Correct Answer: Initiate 1:1 observation and remove potentially harmful items

Q29. A client on lithium had vomiting and diarrhea for two days and now has nausea and coarse tremor. What should the nurse do first?

• Administer the next lithium dose with food
• Hold lithium and obtain a stat lithium level
• Encourage sports drinks and continue dosing
• Give ibuprofen for discomfort

Correct Answer: Hold lithium and obtain a stat lithium level

Q30. A client with schizophrenia says, “I hear voices but they don’t tell me to do anything.” Which response is best?

• “Those voices aren’t real; ignore them.”
• “Tell me more about the voices. I don’t hear them, and we can walk together to the day room.”
• “You must stop listening immediately.”
• “We’ll increase your dose today.”

Correct Answer: “Tell me more about the voices. I don’t hear them, and we can walk together to the day room.”

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