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NCLEX mental health practice questions

20 free NCLEX-style psychosocial questions: suicide risk, therapeutic communication, psychiatric medications, substance withdrawal and crisis care, with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A nursing student is talking with a client whose father died last week. Which statement by the student requires the nurse to intervene?

  1. 'I'm not sure what to say, but I'd like to stay here with you a while.'
  2. 'My dad died last year, and I still cry about it most nights.'
  3. 'What has been the hardest part of this week for you?'
  4. 'Can you tell me about your father? What do you miss most about him?'
Show the answer and rationale

Answer: B

Sharing the student's own unresolved grief shifts the focus from the client to the student and may leave the client feeling that they must comfort the student. Brief, purposeful self-disclosure can sometimes help, but only when it serves the client's needs. Admitting not knowing what to say may sound unprofessional, but pairing that honesty with an offer to stay is a genuine form of therapeutic presence. Asking what the hardest part of the week has been and inviting the client to talk about what they miss most are open-ended and help the client express grief.

📚 Learn it: Never Ask Why: Therapeutic Communication That Passes

Question 2 of 20

A nurse staffing a telephone advice line answers a call from a man who says, 'I just took the whole bottle of my blood pressure pills. I wanted someone to know.' His speech is slow and slurred. Which action should the nurse take first?

  1. Have him call a nearby family member to drive him to the nearest emergency department
  2. Ask him the name of the medication, how many pills he took, and when he took them
  3. Ask where he is, and keep him talking on the line while a coworker calls 911
  4. Stay on the line, assess his intent and plan, and ask if anyone is home with him
Show the answer and rationale

Answer: C

A caller who has already taken a large overdose and sounds drowsy needs emergency help at once, so the nurse learns where he is and keeps him talking while a coworker calls 911; if he hangs up or loses consciousness, help is already on the way. The runner-up is asking the medication name, amount and timing: poison control needs them, but they can be gathered while help is dispatched. Staying on the line only to assess intent and who is home delays rescue for a man who is already fading, and sending him by family car leaves a drowsy, unstable man without monitoring or treatment en route.

📚 Learn it: Ask the Question Directly

Question 3 of 20

A client takes immediate-release lithium carbonate 600 mg by mouth at 0800 and 2000 for bipolar disorder. Last month's level, drawn before the morning dose, was 0.9 mEq/L. Today the client took the 0800 dose, and blood for a lithium level was drawn at 1000; the result is 1.6 mEq/L. The client has no tremor, nausea, diarrhea or confusion. Which action should the nurse take?

  1. Give the 2000 dose with an extra 1,000 mL of fluid to dilute the level
  2. Give the 2000 dose as scheduled and document that there are no symptoms
  3. Report that the blood was drawn 2 hours after a dose and ask about a 12-hour level
  4. Hold tonight's 2000 dose and report a toxic lithium level to the provider right away
Show the answer and rationale

Answer: C

Lithium levels are compared with the therapeutic range only when drawn about 12 hours after the last dose, just before the next one; an immediate-release dose peaks within about 3 hours, so a sample at 1000 shows a peak. The nurse reports the timing error and asks about a correctly timed level. Holding the dose for toxicity is the runner-up, but a peak of 1.6 mEq/L in a client with no symptoms and a trough of 0.9 mEq/L last month does not show toxicity, and acting on it can lead to an unneeded dose cut. Extra fluid does not fix a mistimed sample, and giving the dose without reporting leaves a misleading result in the record.

📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause

Question 4 of 20

While the nurse is applying a bandage, a 6-year-old says quietly, 'My uncle does bad touching when he babysits me, but it's a secret.' Which response by the nurse is most appropriate?

  1. 'Can you tell me what you mean by bad touching, using your own words?'
  2. 'Thank you for telling me. You did the right thing.'
  3. 'Before I can help you, I need to ask your uncle what happened.'
  4. 'I'll tell your mom what you said, but I won't mention it to anyone else.'
Show the answer and rationale

Answer: B

When a child discloses abuse, the nurse stays calm, believes the child, says the child was right to tell and is not to blame, and then reports the disclosure to child protective services as a mandated reporter, documenting the child's exact words. The runner-up is asking the child to explain in her own words: open-ended listening is well meant, but drawing out details can upset the child and compromise the forensic interview that trained interviewers will conduct. Confronting the uncle first can endanger the child and the investigation, and promising to tell no one but her mother is a promise the nurse cannot keep, because the report to child protective services is required.

📚 Learn it: Recognizing Abuse: What You Document and Whom You Tell

Question 5 of 20

The spouse of a client with alcohol use disorder tells the nurse, 'When he's too hungover to work, I call his boss and say he has the flu so he won't get fired.' How should the nurse interpret this statement?

  1. The spouse is in denial about how serious his drinking has become
  2. The spouse is using rationalization to explain away his absences
  3. The spouse is enabling the drinking by shielding him from consequences
  4. The spouse is protecting the family income in a reasonable way
Show the answer and rationale

Answer: C

Covering for a person's drinking by calling in sick for him is enabling, because it shields him from the consequences that might motivate change and keeps the family organized around the drinking. Denial is common in families affected by alcohol use, but this spouse openly names the hangovers and is covering for them, not denying them. It may look like protecting the family income, but it is not effective problem-solving, and rationalization is justifying one's own behavior, not knowingly giving an employer a false excuse. The nurse can refer the spouse to a family support group such as Al-Anon.

📚 Learn it: Which Withdrawal Can Kill: Alcohol, Benzos, and the Ones That Just Hurt

Question 6 of 20 · Select all that apply

A 78-year-old client with end-stage COPD who is receiving comfort care has become unresponsive. He has periods of apnea lasting up to 20 seconds, and his knees are mottled. His wife and two adult children are at the bedside. Which actions should the nurse take? Select all that apply.

  1. Encourage the family to keep talking to him and to say what they want to say
  2. Limit visitors to two at a time so that the room stays calm and quiet
  3. Tell the family that he can no longer hear them now that he is unresponsive
  4. Encourage the family to give him sips of water so that he does not feel thirsty
  5. Ask whether they would like the chaplain or their own spiritual leader to visit
  6. Explain that pauses in his breathing are expected as death approaches
Show the answer and rationale

Answer: A, E, F

Hearing appears to persist in dying clients who no longer respond, so the family is encouraged to keep talking to him and say what they want to say, and telling them he cannot hear is a misconception that takes that chance away. Periods of apnea and mottling are expected signs that death is near, and explaining them lessens fear. Offering the chaplain or the family's own spiritual leader meets spiritual needs at the end of life. An unresponsive client cannot swallow safely, so oral swabs and mouth care relieve dryness instead of sips of water, and families are usually welcome to stay together at the bedside rather than being held to visitor limits.

📚 Learn it: Never Ask Why: Therapeutic Communication That Passes

Question 7 of 20

A nurse is teaching the parents of a client with schizophrenia who is being discharged after his first relapse. Which statement by a parent indicates understanding of the early warning signs of relapse?

  1. 'If he gets irritable, we'll give him extra space for a while.'
  2. 'We'll call his team as soon as he starts hearing voices again.'
  3. 'Relapse mostly follows missed doses, so we'll focus on checking his pills.'
  4. 'If he sleeps poorly and pulls away from us, we'll call his team.'
Show the answer and rationale

Answer: D

Early warning signs often appear days to weeks before psychotic symptoms return and include trouble sleeping, social withdrawal, rising suspiciousness, irritability, and neglect of self-care; calling the treatment team then allows early intervention. Calling as soon as voices return sounds prompt, but it means waiting for a full relapse. Missed doses are a common cause of relapse, so supporting adherence matters, but it does not replace watching for warning signs, and new irritability is a reason to call, not just to give him space. Relapse usually builds gradually, which is exactly why families are taught what to watch for.

📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis

Question 8 of 20

A 23-year-old client who had a spinal cord injury at the C6 level 3 weeks ago turns his head away when the nurse arrives for morning care and shouts, 'Just leave me alone! I'm sick of people doing everything for me!' Which response by the nurse is best?

  1. 'I won't stay while you shout at me. I'll come back a little later.'
  2. 'You're tired of needing so much help. Would you like to choose what we do first?'
  3. 'Your care has to be done now, or your skin could start to break down.'
  4. 'Most people with a new injury go through an angry stage. It will pass.'
Show the answer and rationale

Answer: B

Anger after a sudden, disabling injury is common and often grows out of losing control over the body and daily life. Naming the feeling and then offering real choices, such as the order or timing of care, gives back some control and usually lowers the anger. Insisting that care must happen now to protect his skin is the runner-up because the reason is valid, but it turns care into a power struggle when choices within safe limits are possible. Leaving because he raised his voice withdraws support from a client who is not threatening anyone, and calling his anger a stage that will pass dismisses it.

📚 Learn it: Never Ask Why: Therapeutic Communication That Passes

Question 9 of 20

A 14-year-old client is in the emergency department for an asthma exacerbation. On the Ask Suicide-Screening Questions (ASQ), the client answers yes to 'In the past few weeks, have you wished you were dead?' and no to the other three questions, then answers no when asked, 'Are you having thoughts of killing yourself right now?' Which action should the nurse take?

  1. Alert the provider that the client needs a brief suicide safety assessment
  2. Keep the client in sight at all times until a full psychiatric evaluation is done
  3. Give the parent a list of outpatient counselors and the 988 number at discharge
  4. Record the screen as negative, since the client denies current thoughts
Show the answer and rationale

Answer: A

On the ASQ, a yes to any of the four screening questions is a positive screen, and the acuity question sorts it: a yes means an acute positive screen, while a no, as here, is a non-acute positive screen. The nurse alerts the clinician responsible for the client's care, and a brief suicide safety assessment decides whether and when a full mental health evaluation is needed. Keeping the client in sight until a full evaluation is the runner-up, but that is the pathway for an acute positive screen. Handing out resources without the assessment skips a required step, and a denial of current thoughts does not turn a positive screen negative.

📚 Learn it: Ask the Question Directly

Question 10 of 20

A nurse at an outpatient mental health clinic is returning phone messages. Which client should the nurse call back first?

  1. A 41-year-old taking escitalopram for 3 weeks who says that her mood is only slightly better so far
  2. A 52-year-old taking venlafaxine for 2 years whose home blood pressure this morning was 146/92 mm Hg
  3. A 19-year-old who started fluoxetine 12 days ago whose mother says he paces at night and barely sleeps
  4. A 34-year-old who started sertraline 6 days ago and reports mild nausea and loose stools since starting
Show the answer and rationale

Answer: C

Antidepressants carry a boxed warning for increased suicidal thinking and behavior in children, adolescents and young adults through age 24, especially in the first few months and after dose changes, and new agitation, insomnia and restlessness such as akathisia can come before it, so the 19-year-old is called first to assess for suicidal thoughts and involve the prescriber. The venlafaxine reading is the runner-up, because the drug can raise blood pressure and this reading needs follow-up, but it is not an immediate danger. Nausea and loose stools in the first week of an SSRI usually fade, and partial improvement at 3 weeks is expected.

📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause

Practice 10 more Mental health questions free →

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

Question 11 of 20

A 29-year-old client is treated in the emergency department for a laceration of the forearm. Interviewed alone, she says her boyfriend has been abusing her for about a year. Which statement by the client indicates the greatest risk that the abuse will become lethal?

  1. 'When he drinks on weekends, he screams and throws things at me.'
  2. 'He reads all my texts and tracks my phone so he knows where I am.'
  3. 'Last week he squeezed my neck until everything went black.'
  4. 'He shoved me into a wall last spring, and I hit my head.'
Show the answer and rationale

Answer: C

Nonfatal strangulation is one of the strongest predictors of intimate partner homicide: women strangled by a partner are about seven times more likely to be killed later, and blacking out means her brain went without oxygen. She also needs a medical evaluation, because airway swelling can appear up to 36 hours later and neck vessels can be injured without visible marks. Drunken rages with thrown objects are the runner-up because they are frequent and frightening, but strangulation is the far stronger signal. Phone tracking and a past shove are abuse that belongs in her safety plan, but they predict homicide less strongly.

📚 Learn it: Recognizing Abuse: What You Document and Whom You Tell

Question 12 of 20

A 57-year-old client with alcohol-related cirrhosis is admitted 10 hours after the last drink with a CIWA-Ar score of 14. Laboratory results: total bilirubin 4.2 mg/dL, albumin 2.6 g/dL, INR 1.9, magnesium 1.2 mEq/L. The nurse reviews the admission prescriptions. Which prescription should the nurse clarify with the provider?

  1. Magnesium sulfate IV to correct the low magnesium level
  2. Chlordiazepoxide by mouth every 6 hours on a fixed schedule
  3. Thiamine IV once daily, given before any dextrose infusion
  4. Folic acid by mouth once daily
Show the answer and rationale

Answer: B

Chlordiazepoxide is a long-acting benzodiazepine with active metabolites that the liver must clear, so in severe liver disease, shown here by the high bilirubin and INR and low albumin, it can build up and cause oversedation that looks like hepatic encephalopathy; a shorter-acting drug such as lorazepam is preferred. IV magnesium is the runner-up because it is a high-alert IV electrolyte, but a level of 1.2 mEq/L needs replacing, since low magnesium lowers the seizure threshold during withdrawal. Thiamine before dextrose and folic acid treat the deficiencies common with heavy drinking.

📚 Learn it: Which Withdrawal Can Kill: Alcohol, Benzos, and the Ones That Just Hurt

Question 13 of 20

A nurse on an eating disorders unit is caring for four adult clients who start nutritional rehabilitation today. Which client is at highest risk for refeeding syndrome?

  1. A 30-year-old with binge-eating disorder, BMI 38, who is starting a structured meal plan
  2. A 19-year-old with anorexia nervosa, BMI 15.2, who has barely eaten in 12 days
  3. A 25-year-old with anorexia nervosa, BMI 17.6, who has eaten small meals every day this month
  4. A 22-year-old with bulimia nervosa, BMI 21, who vomits after most of her evening meals
Show the answer and rationale

Answer: B

Refeeding syndrome is most likely when feeding resumes in a severely malnourished client. NICE criteria for high risk include a BMI under 16 kg/m², very little or no intake for more than 10 days, or low potassium, phosphate or magnesium before feeding, and this client meets two of them. The client with a BMI of 17.6 is the runner-up because she has anorexia nervosa, but she is eating every day. Purging can lower potassium, which would add risk if present, but that client has a normal BMI and keeps eating, and the client with binge-eating disorder is not starved.

📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis

Question 14 of 20 · Select all that apply

A nurse on a medical unit is orienting a newly hired nurse. Their client is a 39-year-old woman with major depressive disorder who was admitted with pneumonia and started an antidepressant 10 days ago. Which statements by the new nurse indicate a need for further teaching? Select all that apply.

  1. 'If she denies suicidal thoughts today, I'll still watch for warning signs.'
  2. 'People who talk about suicide usually aren't the ones who go through with it.'
  3. 'She has more energy since starting the antidepressant, so her risk is lower now.'
  4. 'Asking her directly about suicide might put the idea in her head.'
  5. 'If she says she has thought about suicide, I'll ask whether she has a plan.'
  6. 'A past suicide attempt would raise her risk, so I'll ask about her history.'
Show the answer and rationale

Answer: B, C, D

Asking directly about suicide does not plant the idea; research shows it does not increase suicidal thinking and may ease distress. Energy often returns in the first weeks of antidepressant treatment before mood lifts, which can give a depressed client the energy to act, so rising energy is not a sign of lower risk. Talk of suicide is a warning sign to take seriously, not proof that the person will not act. Asking about a plan after a yes, asking about past attempts, the strongest single risk factor, and watching for warning signs after a denial are all correct and need no teaching.

📚 Learn it: Ask the Question Directly

Question 15 of 20

A client has just given birth to a stillborn infant at 34 weeks of gestation. Which action by the nurse best supports the parents' grief?

  1. Explain how an autopsy may help find the cause of the baby's death
  2. Arrange a visit from the hospital chaplain to offer the parents spiritual support
  3. Suggest that they remember the baby as they had imagined
  4. Offer the parents a chance to see and hold the baby and keep mementos
Show the answer and rationale

Answer: D

Offering parents the choice to see and hold their baby and to keep mementos such as footprints, a lock of hair, or photographs helps make the loss real and supports healthy grieving; the nurse respects whatever they decide and asks how their beliefs shape their wishes. A chaplain visit can comfort many families, but it assumes a spiritual need and does not by itself give the parents time with their baby. Suggesting they remember the baby as they imagined takes away an opportunity many parents value, and information about an autopsy matters later but does not address their grief now.

📚 Learn it: Never Ask Why: Therapeutic Communication That Passes

Question 16 of 20

During an annual visit, a 47-year-old client with chronic low back pain tells the clinic nurse that she has thought about ending her life 'almost every day this past month.' Which question should the nurse ask next?

  1. 'Would you be willing to see a counselor later this week?'
  2. 'Have you thought about how you would do it?'
  3. 'Who at home can you talk to when you feel this way?'
  4. 'Will you promise to call us if the thoughts get stronger?'
Show the answer and rationale

Answer: B

Once a client confirms suicidal thoughts, the nurse asks next about a method or plan, then about intent, access to the means, and past attempts, because a specific plan with means at hand signals the highest risk and decides whether she can safely leave the clinic. Asking who she can talk to is the runner-up: supports are protective and belong in the assessment, but they come after the plan and means are known. A counseling visit later this week may be far too late if she has a plan, and a promise to call is a no-suicide contract, which does not keep a client safe.

📚 Learn it: Ask the Question Directly

Question 17 of 20

A client with schizophrenia has taken clozapine for 4 months. Today's weekly absolute neutrophil count (ANC) is 1,300/µL; last week's was 2,100/µL. The client has no fever, sore throat or other sign of infection and says she feels well. Which action should the nurse take?

  1. Give today's dose, report the result, and expect ANC checks three times a week
  2. Hold the dose and start protective isolation until the ANC is 1,500/µL or higher
  3. Hold today's dose, notify the provider, and recheck the ANC in 48 hours
  4. Give today's dose, report the result, and repeat the ANC at the next weekly check
Show the answer and rationale

Answer: A

An ANC of 1,000 to 1,499/µL is mild neutropenia, and clozapine labeling says to continue treatment and check the ANC three times a week until it is back to 1,500/µL or higher, so the nurse gives the dose, reports the drop and reminds the client to report fever or sore throat at once. The runner-up is holding the dose, notifying the provider and rechecking in 48 hours, but interruption is for moderate or severe neutropenia (below 1,000/µL) or a temperature of 101.3°F (38.5°C) or higher, not one mild result in a client who feels well. Giving the dose on the usual weekly schedule misses the closer monitoring this drop requires, and protective isolation is not needed for mild neutropenia.

📚 Learn it: Lithium, SSRIs, MAOIs and the Emergencies They Cause

Question 18 of 20

A client admitted with a fractured jaw tells the nurse that her husband caused the injury, and she asks that the hospital not confirm she is there. That evening a man calls the unit, says he is her husband, and asks for her room number. Which response by the nurse is most appropriate?

  1. 'I'm not able to share any information about who is or isn't staying here.'
  2. 'I can give out that information only if you come to the unit with photo ID.'
  3. 'Let me transfer you to her room, and she can decide whether to talk with you.'
  4. 'She is resting right now, but I will let her know that you called.'
Show the answer and rationale

Answer: A

A client who opts out of the facility directory is not listed, so staff neither confirm nor deny that she is in the hospital; any answer that admits she is there can lead an abusive partner to her. Transferring the call is the runner-up because it seems to let her choose, but putting the call through tells him she is here and where. Saying she is resting confirms her presence, and asking for identification implies the information is available to the right person. The nurse then tells the client and security about the call per policy and updates her safety plan.

📚 Learn it: Recognizing Abuse: What You Document and Whom You Tell

Question 19 of 20

A nurse is screening a client who reports gambling often. Which statement by the client is most consistent with gambling disorder?

  1. 'When I lose, I go back the next day to win my money back.'
  2. 'I once spent my whole paycheck in one night, but that was back in college.'
  3. 'I get a rush from placing a big bet, so I save up for one casino weekend a year.'
  4. 'After a stressful week at work, gambling is how I unwind with my friends.'
Show the answer and rationale

Answer: A

Returning after a loss to win the money back, called chasing losses, is a core feature of gambling disorder, along with needing larger bets for the same excitement, failed attempts to cut back, lying to hide gambling, and relying on others to pay debts; it is grouped with the substance-related and addictive disorders because of this loss of control. The runner-up is spending a whole paycheck in one night: it was a serious episode, but it happened once, years ago, with no current pattern of loss of control. Saving up for one planned casino weekend a year and gambling socially to unwind after work are recreational patterns, however often the client enjoys them, because the spending stays planned and controlled.

📚 Learn it: Which Withdrawal Can Kill: Alcohol, Benzos, and the Ones That Just Hurt

Question 20 of 20

An adolescent on a mental health unit has a token economy plan that awards one token each time he completes morning hygiene without reminders. Which action by the nurse is consistent with the plan?

  1. Gives the token at lunch after reviewing his morning with him
  2. Takes back the token if he is rude to staff later that morning
  3. Gives a token after one reminder, since he finished the task
  4. Gives the token as soon as the client finishes hygiene on his own
Show the answer and rationale

Answer: D

Token economies rely on positive reinforcement that is immediate, consistent, and tied to the specific target behavior, so the token is given right after the client completes hygiene without reminders. Giving a token after one reminder seems fair because he finished, but it rewards a different behavior than the plan targets and weakens the contingency. Waiting until lunch weakens the link between behavior and reward, and taking back an earned token for rudeness adds a penalty the plan does not include.

📚 Learn it: Don't Argue With the Delusion, and Other Rules for Psychosis

Practice 10 more Mental health questions free →

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