National Council Licensure Examination: Psychosocial Integrity

1.Ms. Ortega sits in silence and then says, 'I don't know if I can keep going.' Which response is most therapeutic?

2.After hearing a cancer diagnosis, Mr. Feldman says nothing and looks at the floor. Which nursing action is most therapeutic?

3.Ms. Cho cries after a miscarriage and says, 'I lost my baby.' Which response is most therapeutic?

4.Mr. Brooks says, 'The test is wrong. I do not have heart failure.' He has just seen the results. Which response is most therapeutic?

5.A nurse tells a depressed client, 'My divorce was worse than this, so I know how you feel.' Which judgment is correct?

6.Mr. Alvarez asks, 'You're not going to tell anyone I said I want to die, right?' He describes a plan. Which response is correct?

7.Ms. Rahman says she feels hopeless. Which question is the best suicide assessment?

8.Mr. Klein has major depression and suddenly gives away his watch, seems calmer, and says his affairs are 'settled.' Which understanding is correct?

9.Ms. Blake is on one-to-one observation for suicidal intent. The observer wants to leave for a meal break while she showers alone. Which action is correct?

10.Mr. Petrova says a voice is telling him to hurt a named coworker tonight. Which action is the priority?

11.Ms. Haddad says, 'The FBI put a transmitter in my tooth.' She is frightened but not violent. Which response is most therapeutic?

12.Mr. Young whispers that other clients are plotting against him and becomes wary when two staff talk softly in the hall. Which action is correct?

13.During a panic attack, Ms. Levy is breathing fast, cannot follow a long explanation, and says she is dying. Which action is best?

14.Mr. Santos is in a manic episode, has not slept in two nights, and is interrupting every group. Which plan is best?

15.Ms. Duarte is shouting and pacing, fists clenched, after another client bumped her. Which action is the priority?

16.Mr. Ibrahim, who has mild memory loss, asks repeatedly what day it is and becomes less anxious when told. Which approach is best?

17.Ms. Friedman has late dementia, asks for her long-dead mother every evening, and sobs harder each time she is told her mother is dead. Which approach is best?

18.80-year-old Mr. Holt was clear yesterday and is now picking at the air, sleepy, then agitated. His oxygen saturation is 88 percent. Which understanding is correct?

19.Ms. Nowak wears a hearing aid and seems confused by a long question. Which communication is best?

20.Mr. Costa has aphasia after a stroke and becomes angry when the nurse finishes his sentences. Which plan is best?

21.5-year-old Grace says her grandfather 'went to sleep' and asks if he will wake up. Her family used that phrase after his death. Which response is best?

22.Three weeks after birth, Ms. Cho says her family would be safer if she were gone and she has a plan. Which action is the priority?

23.Ms. Kapoor believes her newborn is dangerous and says she must 'send the baby away forever' tonight. She does not see this thought as odd. Which action is correct?

24.Ms. Navarro is terrified of unwanted thoughts of harming her baby, says she would never act on them, and is asking for help. Which response is best?

25.Mr. Bauer, on day 2 without alcohol, is tremulous, sweating, and has a heart rate of 130. He wants to go to a group on 'life goals.' Which priority is correct?

26.Ms. Ellison has taken lorazepam daily for a year and stopped it yesterday because the bottle ran out. She is anxious and has not slept. Which teaching is correct?

27.Mr. Mensah has an alcohol use disorder and is about to receive intravenous dextrose for low glucose. Which accompanying order is the safety priority?

28.Mr. Dalal, who takes lithium, has been vomiting from a stomach illness and now has a coarse tremor and new confusion. Which action is correct?

29.Ms. Adebayo takes clozapine and calls to report a fever and a very sore throat. Which instruction is correct?

30.Mr. Reed started sertraline last week and was given an MAOI this morning by mistake in a new order. He is agitated, shivering, and has overactive reflexes. Which action is the priority?

31.Ms. Perry takes an MAOI and arrives with a severe headache after a dinner of aged cheese and cured meat. Which action is correct?

32.Mr. Cohen is prescribed disulfiram and uses alcohol-based mouthwash each morning. Which teaching is correct?

33.Ms. Wright has lost a large amount of weight, her heart rate is 38, and she wants to attend a cooking group before being seen by the provider. Which priority is correct?

34.The team is planning meals for Ms. Romano, who has anorexia nervosa and hides food. Which approach is best?

35.Mr. Lange has bulimia and asks to use the bathroom alone right after a large meal. Which action is correct?

36.Ms. Vogel has a superficial self-inflicted cut and says, 'Don't tell the team; you are the only nurse who cares.' Which action is correct?

37.Two staff members disagree, and Mr. Novak tells Nurse A that Nurse B is cruel and only Nurse A understands him. Which response is best?

38.Ms. Ortiz says, 'If I were attractive, people would stay.' She was just left by a partner. Which response is most therapeutic?

39.Mr. Gallagher's adult child died yesterday. He tells the nurse, 'This is your fault for not checking sooner,' although the death was expected. Which response is best?

40.Ms. Brennan's partner died a year ago. She still cannot return to work and says life has no point. Which action is correct?

41.Mr. Okonkwo's coworkers do not know he miscarried with his partner, and he says no one at work thinks he lost anything. Which response is best?

42.A family wants a prayer ritual at the bedside of a dying client. The unit routine would skip it. Which action is correct?

43.8-year-old Diego says the car crash was his fault because he was mad at his brother that morning. His brother died. Which response is best?

44.Ms. Farooq is in the bargaining stage, saying she will be a better person if her spouse recovers. Which response is best?

45.Mr. Pike has just been told his partner died in the emergency department. He stares and does not cry. Which action is best?

46.The nurse feels like crying while sitting with parents whose child has died. Which use of that feeling is appropriate?

47.Mr. Solano says, 'I failed at everything' two days after starting an antidepressant, and he still cannot sleep. Which teaching is correct?

48.16-year-old Noor has been on an antidepressant for 10 days, has new energy, and has quietly given away her art supplies. Which action is correct?

49.Mr. Bernard is placed in seclusion after throwing a chair and trying to hit staff. He is now sitting. Which requirement is correct?

50.Mr. Clark is on a legal hold and refuses his morning vitamin. He is calm. Which action is correct?

51.Ms. Johnson is about to hit another client and refuses oral medication. A provider orders emergency medication to prevent injury. Which action is correct?

52.Mr. Adeyemi tells the nurse he will kill a specific neighbor at a specific time and says he has what he needs to do it. Which duty applies?

53.During group, a client starts to describe another client's trauma in the hallway afterward. Which response is correct?

54.Ms. Khan says, 'You look just like my father, and I hate you for it,' after a limit is set. Which response is best?

55.A nurse realizes a growing wish to punish a sarcastic client by delaying care. Which action is professional?

56.Mr. Silva asks the nurse for a personal phone number 'so we can be friends after discharge.' Which response is correct?

57.A grateful family offers the nurse an expensive watch. Which response is correct?

58.Before a holiday, Mr. Rossi, who has depression, says he has no plan to die but feels more alone. Which plan is best?

59.Ms. Abebe wakes from a nightmare, sweating, and does not know the year. She has post-traumatic stress disorder. Which action is best?

60.A veteran startles and swings an arm when the nurse approaches quietly from behind. Which change is correct?

61.Mr. Owens has schizophrenia and is packing to leave because 'the television said the unit is poisoned.' He is calm. Which response is best?

62.Ms. Haddad hears a voice but cannot describe it. Which assessment question is the priority?

63.Mr. Diaz has major depression and refuses a community outing, saying he has no energy. Which invitation is best?

64.Ms. Laurent is pacing and says she will 'explode' if she cannot wash her hands again, and her hands are raw and bleeding. Which balance is correct?

65.Mr. Cole drinks a pint of liquor nightly and says, 'I can stop whenever I want.' The blood alcohol level is high and he is missing work. Which response is best?

66.Ms. Vogel says she drinks because it is the only way she sleeps, and she is not sure she wants to stop. Which question is most therapeutic?

67.The caregiver of a client with dementia says, 'Some days I resent him, and then I feel guilty.' Which response is best?

68.Mr. Ibrahim usually becomes frightened and tries to leave each evening. Which plan best reduces sundowning?

69.After electroconvulsive therapy, Mr. Bennett is sleepy, confused about the year, and has a weak cough. Which action is the priority?

70.Ms. Reyes is scheduled for electroconvulsive therapy and tells the nurse she does not know what will happen and has not talked with the psychiatrist. Which action is correct?

71.A client on the inpatient unit is voluntarily admitted and now says, 'I want to leave.' He is calm and denies suicidal ideas. Which action is correct?

72.15-year-old Malik tells the nurse he wants to be called by a chosen name and is afraid his parent will hear it. Which action is correct?

73.Mr. Goldberg says, 'I yelled at you because my boss humiliated me this morning.' He is calm now. Which defense is he describing?

74.Ms. Carter, who was just told to limit salt, says, 'I only eat chips because my job is stressful, so it is not a real problem.' Which defense is this?

75.An angry client says, 'I'm not hostile. You are the hostile one,' while slamming a table. Which defense is this?

76.After an outburst, Mr. Hugo says he will volunteer at a shelter because helping others turns his anger into something useful. Which defense is he using in a healthy way?

77.A usually independent adult, newly admitted, asks the nurse to decide every small choice and wants a childhood blanket. Which defense is most likely?

78.Mr. Lange has akathisia from an antipsychotic and cannot stop moving. A new order doubles the same drug 'for worsening psychosis.' Which action is correct?

79.Ms. Duarte develops a high fever, rigid muscles, sweating, and a changing blood pressure two days after an antipsychotic injection. Which action is the priority?

80.Mr. Sato's neck twists painfully and his eyes roll upward an hour after haloperidol. He can still speak. Which action is correct?

81.Ms. Ortega has repeated lip-smacking and tongue movements after years on an antipsychotic. Which teaching is correct?

82.Mr. Klein takes lithium and plans a summer construction job with heavy sweating. Which teaching is correct?

83.The lithium level for Ms. Grant, drawn 12 hours after her dose, is 2.1 mEq/L. She is drowsy. Which action is correct?

84.Mr. Cole is starting an antipsychotic known for weight gain and higher glucose. Which teaching is correct?

85.17-year-old Noor is prescribed a stimulant for attention deficit and her parent asks about giving it at 9 p.m. Which teaching is correct?

86.Ms. Blake takes valproate and says she wants to become pregnant next month. Which teaching is correct?

87.Mr. Alvarez has not slept, believes he owns the hospital, and is trying to give his credit card to other clients. Which priority is correct?

88.Ms. Cho, who has depression, says, 'Nothing helps. I am a burden.' She denies a plan today. Which response is most therapeutic?

89.A client recovering from depression says the nurse's visit is the only good part of the day and asks the nurse not to take vacations. Which response is best?

90.Mr. Holt is intoxicated, smelling of alcohol, and says he will drive home. Which action is correct?

91.Ms. Wright is in opioid withdrawal with yawning, dilated pupils, and diarrhea. Her vital signs are stable, while another client is in severe alcohol withdrawal. Which priority is correct?

92.Mr. Mensah says he uses opioids and asks the nurse not to tell the surgeon before his operation. Which response is correct?

93.A school nurse sees 14-year-old Maya with fresh parallel cuts on her forearm. She asks the nurse not to tell anyone. Which action is correct?

94.Mr. Costa says he stopped his antidepressant because of sexual side effects and felt he could not mention them. Which response is best?

95.Ms. Perry is grieving a death and also has asthma with new shortness of breath and wheezing. Which need is the priority?

96.During a crisis call, Ms. Khan says she lost her job an hour ago and cannot think. Which approach is best?

97.Mr. Novak, who has paranoia, will not take a sealed medication cup. Which action is best?

98.A client with depression is ready for discharge and has a follow-up visit in one week. He lives alone and his only number for the nurse was the unit desk. Which plan is best?

99.Ms. Romano says, 'I cut myself to feel something, not to die,' and denies a plan to die. Which action is still required?

100.Mr. Young has severe anxiety and is scheduled for teaching about a new home medication. He cannot repeat a sentence. Which decision is correct?

101.The family of a dying client asks the nurse to tell the client a false story that the scans are normal. The client has asked for the truth. Which response is correct?

102.Mr. Dalal prays five times a day and is worried the psychiatric unit will not allow it. Which response is correct?

103.A client does not speak English and is describing abuse in a family session. A relative offers to interpret. Which action is correct?

104.4-year-old Camille is about to have blood drawn and hides her hands, saying the needle will make her empty. Which response is best?

105.Mr. Bennett completes a drinking screen and says, 'I guess you think I am a bad person.' Which response is best?

106.Ms. Levy has been restrained after an assault. The provider's renewal is due, and she is now lying quietly and following directions. Which action is correct?

107.A client says, 'I hear a voice telling me I am worthless, but it is not telling me to hurt myself.' Which response is best?

108.Mr. Solano is being discharged after a depressive episode. He agrees to lock up leftover opioid tablets from an old injury and to give a friend the key. Which understanding is correct?