Mental Health NCLEX Practice Questions

NCLEX frequently tests correct vs incorrect communication. Always therapeutic: open-ended questions, active listening, silence, restating, reflecting feelings. Never therapeutic: giving unsolicited advice, changing the subject, false reassurance ('everything will be fine'), 'why' questions, and minimizing feelings. When selecting an answer, choose the response that acknowledges and reflects the client's feelings.

Typical antipsychotics cause extrapyramidal symptoms (EPS): akathisia (restlessness), dystonia, pseudoparkinsonism, and tardive dyskinesia. Neuroleptic Malignant Syndrome (NMS): high fever, muscle rigidity, altered LOC — medical emergency. Clozapine (atypical): agranulocytosis risk — monitor CBC weekly. Lithium toxicity (mood stabilizer): nausea, tremors, ataxia — therapeutic range 0.6-1.2 mEq/L.

Assess every client with depression or mental health crisis for suicidal ideation — ask directly (asking does NOT increase risk). Evaluate: plan specificity, access to means, previous attempts, and protective factors. Highest risk: specific plan with access to lethal means and history of prior attempts. Priority nursing actions: one-to-one observation, remove dangerous objects (sharps, belts, cords), maintain a safe environment, and establish a therapeutic relationship. Document assessment findings and interventions. Never leave a high-risk client alone.

Anorexia nervosa: severely restricted intake, distorted body image, BMI <18.5. Medical complications: bradycardia, hypothermia, electrolyte imbalances (especially hypokalemia), amenorrhea, and osteoporosis. Refeeding syndrome risk when nutrition is restored too quickly (monitor phosphorus). Bulimia nervosa: binge-purge cycles, may have normal weight, dental erosion, parotid gland swelling, and metabolic alkalosis from vomiting. Priority: monitor electrolytes, especially potassium, and assess cardiac status. Avoid power struggles around food.

Involuntary commitment requires the client to be a danger to self or others, or gravely disabled and unable to meet basic needs. Even involuntarily committed clients retain rights: right to treatment, right to refuse treatment (except in emergencies), right to communicate with people outside the facility, right to informed consent, and right to confidentiality. Emergency medication administration (chemical restraint) requires imminent danger and must be documented with justification. Know your state-specific mental health laws.

Mature defenses: sublimation (channeling unacceptable impulses into socially acceptable activities), humor, and suppression. Immature defenses: denial (refusing to accept reality), projection (attributing own feelings to others), regression (reverting to earlier developmental behavior), displacement (redirecting emotions to a safer target), and rationalization (making excuses to justify behavior). NCLEX tests the ability to identify which defense mechanism a client is using based on a clinical scenario and respond therapeutically.