Coping mechanisms NCLEX-RN Practice Questions

Coping mechanisms NCLEX-RN Practice Questions help you master how clients respond to stress, illness, and life transitions within the Psychosocial Integrity domain. This topic demands clinical judgment: distinguishing adaptive from maladaptive coping, recognizing defense mechanisms, and choosing interventions that promote effective stress management and safety. In these practice items, you’ll assess statements and behaviors, prioritize therapeutic communication strategies, initiate crisis interventions, and evaluate client outcomes. Scenarios include grief, chronic illness, substance use, caregiver burden, and cultural considerations. For M. Pharma students and nursing candidates alike, these questions go beyond memorization to application—helping you identify which action offers the most immediate, ethical, and evidence-based support for clients navigating internal and external stressors.

Q1. A client recently diagnosed with multiple sclerosis says, “The MRI must be wrong; I feel completely fine.” Which defense mechanism is the client most likely using?

• Denial
• Rationalization
• Projection
• Sublimation

Correct Answer: Denial

Q2. A nurse cares for an ICU client exhibiting agitation and verbal aggression after a traumatic accident. Which initial nursing action best supports adaptive coping?

• Provide detailed pathophysiology about the injuries
• Offer brief, clear information and ensure a calm, safe environment
• Encourage the client to write a comprehensive journal immediately
• Confront the client about inappropriate behavior to set firm limits

Correct Answer: Offer brief, clear information and ensure a calm, safe environment

Q3. A client who lost a job says, “It doesn’t matter; that company never deserved me.” The nurse identifies this as which coping or defense mechanism?

• Compensation
• Rationalization
• Suppression
• Dissociation

Correct Answer: Rationalization

Q4. A postoperative client reports severe anxiety about pain and requests specific relaxation techniques. Which intervention is most appropriate first?

• Teach paced diaphragmatic breathing with guided imagery
• Refer to a psychiatrist for medication management
• Suggest the client “push through” the anxiety without aids
• Delay teaching until discharge to reduce cognitive load

Correct Answer: Teach paced diaphragmatic breathing with guided imagery

Q5. A teenager caught shoplifting blames friends for “pressuring” them, despite planning the theft. Which defense mechanism is primarily displayed?

• Projection
• Regression
• Displacement
• Reaction formation

Correct Answer: Projection

Q6. A caregiver of a client with dementia reports exhaustion, insomnia, and irritability. Which nursing action best promotes adaptive coping?

• Reinforce commitment to full-time caregiving to maintain consistency
• Encourage respite services and connect to a caregiver support group
• Advise discontinuing all social activities to maximize rest
• Teach advanced neurocognitive pathophysiology to reduce uncertainty

Correct Answer: Encourage respite services and connect to a caregiver support group

Q7. A client with alcohol use disorder reports drinking only after arguments with their partner and says, “It helps me calm down.” Which nurse response best supports adaptive coping?

• “You should stop drinking immediately; it’s not acceptable.”
• “Let’s explore stress-management alternatives you can use during conflict.”
• “If your partner changes, you likely won’t need alcohol.”
• “We will discharge you once you promise not to drink.”

Correct Answer: “Let’s explore stress-management alternatives you can use during conflict.”

Q8. A client with generalized anxiety disorder spends hours cleaning to avoid thinking about an upcoming MRI. Which coping mechanism is this behavior most consistent with?

• Sublimation
• Suppression
• Compensation
• Undoing

Correct Answer: Suppression

Q9. A client says, “I keep snapping at my children when I’m mad at my boss.” Which defense mechanism is the client describing?

• Displacement
• Conversion
• Identification
• Intellectualization

Correct Answer: Displacement

Q10. Following a disaster, a client is tearful, reports insomnia, and feels “numb.” What is the nurse’s priority action?

• Teach advanced cognitive-behavioral strategies
• Assess for suicidal ideation and safety risk
• Encourage immediate return to work routines
• Provide detailed disaster debriefing about events

Correct Answer: Assess for suicidal ideation and safety risk

Q11. A client recently diagnosed with cancer says, “I’m going to start a patient support blog to help others navigate this.” This statement reflects which coping process?

• Reaction formation
• Sublimation
• Regression
• Rationalization

Correct Answer: Sublimation

Q12. A client consistently minimizes symptoms and refuses follow-up, stating, “I’m too busy to be sick.” Which is the best nursing intervention?

• Confront the client’s avoidance until they agree to care
• Use motivational interviewing to elicit values and ambivalence
• Schedule mandatory appointments without discussion
• Provide a lengthy lecture on disease complications

Correct Answer: Use motivational interviewing to elicit values and ambivalence

Q13. During grief counseling, a client states, “If I had taken him to the hospital sooner, he’d still be alive.” This statement best represents:

• Denial
• Bargaining
• Guilt as part of normal grieving
• Maladaptive fixation

Correct Answer: Guilt as part of normal grieving

Q14. A client with PTSD avoids crowded places and experiences hyperarousal. Which nursing intervention best supports coping in early treatment?

• Encourage prolonged exposure therapy during acute crisis
• Teach grounding techniques and controlled breathing
• Advise complete avoidance of all triggers indefinitely
• Recommend detailed trauma recounting in the first session

Correct Answer: Teach grounding techniques and controlled breathing

Q15. The nurse notes that a client laughs while describing physical abuse. Which defense mechanism is most likely involved?

• Intellectualization
• Reaction formation
• Humor as adaptive coping
• Incongruent affect indicating possible dissociation

Correct Answer: Incongruent affect indicating possible dissociation

Q16. A client repeatedly washes hands to reduce distress after intrusive thoughts. Which nursing intervention best promotes coping while respecting safety?

• Prohibit all handwashing to extinguish the behavior
• Introduce scheduled handwashing intervals and relaxation
• Encourage family to provide constant reassurance
• Allow unlimited handwashing without boundaries

Correct Answer: Introduce scheduled handwashing intervals and relaxation

Q17. A nurse teaches a client with chronic pain to use the “ABCDE” approach (Acknowledge pain, Breathe, Choose focus, Do relaxation, Evaluate). Which outcome indicates effective coping?

• Reports pain is “gone forever”
• Reports better control during flares and less catastrophizing
• Stops using any analgesics
• Sleeps 12 hours daily

Correct Answer: Reports better control during flares and less catastrophizing

Q18. A client with diabetes overeats after receiving criticism at work. The nurse recognizes this as which mechanism?

• Compensation
• Regression
• Sublimation
• Undoing

Correct Answer: Regression

Q19. In a family session, a parent says, “My child fails because teachers are unfair,” despite multiple missed assignments. Which defense mechanism is primarily used?

• Projection
• Rationalization
• Displacement
• Identification

Correct Answer: Rationalization

Q20. A client requests information on mindfulness for stress. Which teaching is most accurate?

• Mindfulness requires transcendental meditation training
• Mindfulness focuses on present-moment awareness without judgment
• Mindfulness emphasizes analyzing the past to prevent future stress
• Mindfulness is incompatible with cognitive-behavioral therapy

Correct Answer: Mindfulness focuses on present-moment awareness without judgment

Q21. A client coping with infertility says, “I’ve started mentoring students after school; it gives me purpose.” The nurse interprets this as:

• Displacement
• Sublimation
• Reaction formation
• Compensation

Correct Answer: Sublimation

Q22. A client with newly diagnosed heart failure becomes preoccupied with lab values and asks highly technical questions without discussing feelings. Which mechanism is most likely?

• Intellectualization
• Suppression
• Conversion
• Dissociation

Correct Answer: Intellectualization

Q23. During a crisis call, the client states, “I can’t cope and have thought about ending it.” What is the nurse’s priority?

• Explore long-term coping goals
• Assess lethality, access to means, and initiate safety plan
• Suggest journaling and call back tomorrow
• Redirect to discuss positive events

Correct Answer: Assess lethality, access to means, and initiate safety plan

Q24. A hospitalized adolescent begins wetting the bed after parental divorce. This behavior best represents:

• Regression
• Denial
• Projection
• Introjection

Correct Answer: Regression

Q25. A client in anger management says, “When I feel rage, I go for a run before talking.” The nurse evaluates this as:

• Maladaptive avoidance
• Displacement
• Adaptive coping and self-regulation
• Suppression with rebound

Correct Answer: Adaptive coping and self-regulation

Q26. A client with panic disorder fears leaving home. Which initial intervention best supports coping before exposure therapy?

• Teach interoceptive exposure and diaphragmatic breathing
• Encourage immediate public transportation rides alone
• Reassure repeatedly that panic is harmless
• Start open-ended group therapy focused on storytelling

Correct Answer: Teach interoceptive exposure and diaphragmatic breathing

Q27. A nurse notes a client has developed pseudoneurological symptoms after a stressful event with no organic cause. Which mechanism is most consistent with this presentation?

• Conversion
• Repression
• Compensation
• Undoing

Correct Answer: Conversion

Q28. A client says, “I yelled at my sister, so I bought her a gift to make up for it.” This response indicates which mechanism?

• Undoing
• Reaction formation
• Identification
• Rationalization

Correct Answer: Undoing

Q29. A nurse implements stress inoculation training. Which sequence reflects correct steps?

• Generalization, rehearsal, education
• Education, skill acquisition/rehearsal, application
• Rehearsal, application, evaluation only
• Assessment only, followed by discharge

Correct Answer: Education, skill acquisition/rehearsal, application

Q30. A client from a collectivist culture relies on extended family for caregiving decisions and coping. Which nursing action best supports culturally congruent care?

• Insist the client make decisions independently to build autonomy
• Invite identified family decision-makers to planning while preserving client consent
• Limit family involvement to avoid HIPAA violations automatically
• Provide written instructions only to the client

Correct Answer: Invite identified family decision-makers to planning while preserving client consent

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