NCLEX Psychosocial Integrity Practice Test

Question 1

A nurse is assessing a 6-year-old Asian child with injuries sustained after “falling from a bicycle.” The child’s injuries are inconsistent with the provided history. He is brought in by his mother, a physician, who also has resolving facial injuries. When questioned, the mother cannot recall how she received her injuries. Which of the following factors supports the nurse’s suspicion of child abuse?

Accepted Answer

suspicion of spousal abuse. Child abuse (even suspected cases) in many states must be reported by a healthcare worker. The risk factors include: parental perception of stress, life changes in a family, young age at the birth of the first child, low education level, low income or unemployment, little or no prenatal care, no phone or unlisted number, evidence of harsh discipline, and/or current or past spousal abuse. Therefore, in this scenario, the mother’s injuries along with those of the child raise the suspicion of an abusive situation in the home.

Question 2

A nurse is caring for a 19-year-old female admitted for psychosis. The patient tells the nurse that she sees numerous people in the room speaking to her. The nurse and the patient are the only two people in the room. Which of the following statements by the nurse would be most appropriate?

Accepted Answer

“I understand that you hear and see other people with us, but I do not. We are alone in the room together.”. A patient experiencing altered mental processes benefits most from nursing interventions that reinforce normalcy, safety, and promote self-control and responsibility with an open and honest relationship. The nurse should demonstrate acceptance of the patient’s hallucinations by verbalizing it, but then provide reorientation to reality. The nurse should not encourage the patient to discuss the hallucinations more or give a harsh rejection of what the patient is experiencing.

Question 3

A nurse is taking care of an intoxicated male patient who has been involved in a motor vehicle accident. Although not critically injured, the patient refuses to remain on his gurney, continuously gets up to leave the ED, and is unsteady on his feet. The nurse is given a written order by the physician to use wrists restraints on the patient. When the nurse tells the patient this, he refuses. Which of these is the correct action for the nurse to take?

Accepted Answer

Place the patient in restraints in accordance with the policies of the facility. The nurse’s first responsibility, when taking care of an intoxicated patient, is to ensure his or her safety. In this case, the nurse should follow the physician’s order and place the patient in restraints in accordance with the facility’s policies. Intoxicated patients cannot make the informed decision to refuse care, nor can they participate in responsible and mutually respectful conversations about behavior expectations. Although further intervention by the physician may be necessary, the nurse should first place the patient in restraints before asking for further orders.

Question 4

A nurse is caring for a 37-year-old male diabetic patient admitted post operatively below-knee amputation as a result of poor wound healing after a motor vehicle accident. Which of the following comments by the patient indicates ineffective coping with his post-operative recovery?
Select all that apply.
A. “When can I start physical therapy so I learn how to move around again?”
B. “I am going to work with a prosthetics specialist to fit a new lower limb.”
C. “Just order me a wheelchair, it’s not like I’m going to walk with one leg.”
D. “I will ensure that my blood sugars are appropriately managed.”
E. “I don’t want to see my leg. This is just a bad dream.”

Accepted Answer

C and E. Coping mechanisms are essential to a patient’s recovery. Poor coping mechanisms may inhibit recovery by decreasing patient participation in therapies. The nurse must understand that many patients will grieve throughout their illness as they let go of their previous normal life and transition into their new normal. In the event of limb amputation, many physical and emotional barriers will present. Comments by the patient to be more involved in his care will likely improve his outcomes. The patient will need to manage his other chronic health issues to optimize recovery. Support systems are also essential in this process to improve patient outcomes.

Question 5

A nurse is taking care of a patient who is exhibiting signs of severe stress. Which of these nursing interventions is least helpful for the nurse to use to minimize the patient’s stress in this situation?

Accepted Answer

Identify the patient’s weaknesses. Nursing interventions in this situation should always focus on ways to minimize a patient’s stress. Rather than pointing out a patient’s weaknesses, identify and discuss the patient’s strengths. Help him or her locate and utilize all existing resources and coping mechanisms instead of focusing on what’s lacking. In addition to the other choices listed, nurses in this situation should also allow verbalization of the effects of stress from a patient, listen to and support him or her in the process, and teach new coping strategies or identify resources that will be helpful in learning.

Question 6

A nurse is discussing the diagnosis of a terminal disease with a patient. When the nurse asks the patient about how he is feeling about all of the information she’s giving him, he states,”I don’t think there’s anything wrong with me…I’m not worried at all.” This statement is an example of what kind of defense mechanism?

Accepted Answer

denial. Defense mechanisms are unconscious reactions or behaviors to stressors or stressful situations. In this example, the patient is not recognizing or acknowledging his thoughts or feelings about being told he has a terminal condition, so he is in denial. Suppression is when a patient recognizes a thought or feeling, but then tries to hide or ignore it. Projection is when a patient believes that someone else has the same thoughts or feelings. Displacement occurs when a patient directs a thought or feeling to another, usually helpless, person or target.

Question 7

A nurse sees a 12-year-old female for a well-child visit. The child’s mother is concerned that since a recent car accident, the child wants to co-sleep with the mother and is afraid of the dark. The nurse explains that this is representative of which defense mechanism?

Accepted Answer

regression. Defense mechanisms are unconscious behaviors or reactions to stressors or stressful situations. In this example, the patient is using immature reactions and behaviors to deal with the thoughts and feelings about the recent car accident. This is an example of regression. Acting out is when a patient uses disruptive or extreme behaviors to express thoughts or feelings that he or she is otherwise incapable of expressing. Reaction formation is when a patient changes a thought or feeling to its exact opposite and adopts that stance. Dissociation occurs when a patient (in part) detaches him or herself from his or her current reality to avoid certain thoughts or feelings.

Question 8

A nurse is caring for a patient who has just undergone a major life-changing event. The patient exhibits signs of near complete detachment from her surroundings and appears disoriented. She expresses thoughts and feelings of being completely overwhelmed by her current situation. When caring for a patient in a crisis such as this, which of the following is the first priority of the nurse?

Accepted Answer

Assess the patient for the potential for harm (to self and others) and take appropriate safety precautions. While all of the answer choices are correct in terms of the nurse’s role in caring for a patient in crisis, the highest nursing priority is to assess the patient’s potential for violence and take the appropriate safety measures.

Question 9

Which of these interventions are congruent with cultural competence?
Select all that apply.
A. Listen with respect.
B. Integrate caregivers into the patient’s care.
C. Use family members as interpreters for medically sensitive information.
D. Evaluate the effectiveness of the care plan.
E. Project personal views upon patients.

Accepted Answer

A, B, and D. A culturally competent nurse will listen with respect, use appropriate resources to surmount any language barriers, provide culturally appropriate care, allow caregiver support, and evaluate the effectiveness of the patient’s care plan. It is always best to use a professional medical interpreter to translate medical information. The nurse should never project their personal views to the patient, but rather be open and understanding to the patient’s views.

Question 10

A hospice nurse is caring for a patient who has made the decision to pass away at home. The patient is refusing to eat or drink. During a visit, one of the patient’s adult children asks the following question, “Why is my mom not eating or drinking? Can’t we give her something to help her get her strength back?” Which of these is the most appropriate response to this question?

Accepted Answer

“I understand this is difficult. We are going to make sure your mom is comfortable and will provide anything that she asks for.”. Nurses who are caring for patients at the end of life must respect and honor their patients’ wishes including the right to refuse care. They must also prepare the family for the physical, emotional, and psychological changes and decline of their loved one. This will include helping them with increasing anxiety as the time of death approaches. This question demonstrates this anxiety as well as a lack of understanding of the normal process of dying. Expressing understanding and giving reassurance that everything is being done to keep their loved one comfortable through the process. Educating the family about the dying process here would also be appropriate. The nurse cannot force the patient to eat or drink. Telling the family that the process can go back and forth or is “normal” in any way is not a competent, empathetic or proper answer to give in this situation.

Question 11

While caring for a chronically ill, hospitalized male, the nurse notes that he and his wife are often hostile and angry with each other when she visits him. The nurse notes that the patient’s physical, emotional, and mental health is suffering as a result. Which of these is the correct course of action for the nurse to take at this time?

Accepted Answer

Discuss the observations and concerns with the patient and his wife. Discuss and explore family therapy to help them develop better patterns and methods of communication. This patient and his wife are displaying dysfunctional family communication. While most family members will support a loved one during an illness, displaying milder degrees of dysfunction, severe family dysfunction can be an impairment to the patient. The nurse should discuss her observations and concerns with both the patient and his wife and help them find the appropriate resources, such as family counseling, and encourage their participation. Because the relationship is dysfunctional, both the patient and his wife will need intervention, not just the patient. Psychological consultation may be appropriate at some point, but it is not the correct first step in this scenario.

Question 12

Which of these are stages of grief as described by Elizabeth Kubler-Ross?
Select all that apply.
A. depression
B. elation
C. acceptance
D. anger
E. denial

Accepted Answer

A, C, D, and E. The Stages of Grieving described by Elizabeth Kubler-Ross include denial, anger, bargaining, depression, and acceptance. While most patients will follow the stages in order, many patients will fluctuate between stages of grief.

Question 13

A newly graduated nursing student accepts a position with a company that provides hospice care. Which of these is the most important thing that this nurse needs to do before he begins this position?

Accepted Answer

Analyze his own feelings about death and dying. While all of these are appropriate for this nurse to do prior to entering hospice work, the most important thing is for him to examine and analyze his own feelings about death and dying. All nurses need to do this before they can effectively assist either patients or their families with end of life grief and loss.

Question 14

A home health nurse visits a pleasant, independent 89-year-old female. At her appointment, the patient appears confused and agitated and has difficulty answering questions. The patient’s vital signs are normal. Which of the following is the most appropriate nursing action?

Accepted Answer

Make arrangements for the patient to be evaluated by her primary healthcare provider, and stay with her until she is seen to ensure her safety. Since this patient is exhibiting signs of altered cognition, the correct course of action is to seek further evaluation and ensure her safety. Taking a detailed history may be helpful, but in the patient’s current mental state, she is unable to give one. Although her vitals are normal, she should not be left alone as her condition may further deteriorate and/or she may injure or harm herself. As her condition at this point is not life-threatening, using EMS is not appropriate.

Question 15

A nurse is caring for a hospitalized Hindu client who is served a Salisbury steak dinner. Which of these is the most appropriate action for the nurse to take?

Accepted Answer

She should be aware that many Hindus do not eat beef and ask the client if they would like an alternative meal. The nurse should make every effort to accommodate and incorporate the religious and spiritual beliefs and practices into the client’s care, as this is crucial for the client’s overall health and well-being. The only acceptable answer choice is to make an effort to find an acceptable alternative meal. The other choices demonstrate a lack of respect for the religious dietary restrictions of her client.

Question 16

A nurse is caring for four patients on a med/surg floor of a hospital. Based on what the nurse knows about risk factors for sensory and/or perceptual alterations, which of these patients would least likely be at risk of potentially developing this problem?

Accepted Answer

an elderly patient who is recovering from a hysterectomy whose pain is well controlled. Sensory and perceptual alterations can distort the view of one’s surroundings as well as one’s interactions with others. Ultimately, they can lead to a loss of the ability to function. Risk factors include: being confined in a low-stimulation environment, having vision or hearing problems, restricted mobility, having emotional problems, patients with limited social contacts, being in pain and discomfort, having acute illnesses (fever, seizure, etc.), close or frequent monitoring, and cognitive ability issues (i.e., head trauma). In this example, the only answer choice that does not contain one of these risk factors is the elderly patient recovering from a hysterectomy whose pain is well controlled.

Note: If you had difficulty with this question, please note that it is of a typical style and difficulty level as the actual questions on this test. Many questions will challenge you to use critical thinking skills and address all aspects of potential situations.

Question 17

A nurse is caring for a patient who has limited social contacts and family during her convalescence. The nurse knows that she needs to incorporate support systems into this patient’s care plan. Which of these is a reason for the helpfulness of support systems in a patient’s recovery?

Accepted Answer

Support systems keep patients accountable for maintaining any changes in lifestyle that are a result of their condition and/or treatment. Support systems are the network of people a patient uses when emotional, moral, or other types of practical support are needed. Support systems benefit patients in these ways: they help patients better understand their conditions and treatments, they keep patients accountable for maintaining new lifestyle changes that are a result of their condition or treatment, and they help the patient learn necessary new skills related to their treatment or condition. Lastly, support systems may offer other types of practical support such as physical care, but they are never used as a substitute for nursing care or as a distraction to keep a patient busy. While support systems are helpful and beneficial to patients’ recovery, there are no scientific studies showing that they speed recovery time.

Question 18

A nurse taking care of a patient needs to have a lengthy discussion about a sensitive aspect of the patient’s care. To have therapeutic communication with this patient, the nurse should do which of these?

Accepted Answer

Plan a conversation that is patient- and goal-directed, being mindful of nonverbal communication. Therapeutic communication is, by definition, a planned, goal-oriented conversation that is interactive between the nurse and patient. The message is patient-directed and tailored to fit his or her needs (developmental, cognitive, etc.). It serves to promote a better working relationship and incorporates listening while providing both clarification and insight when necessary. It involves the use of both verbal and nonverbal communication.

Question 19

A nurse is working at a pregnancy crisis clinic. She is caring for a 15-year-old girl who is there for a pregnancy test. When the nurse gives her the positive result, the girl becomes distraught and seems overwhelmed. The nurse begins to discuss the patient’s situation with her and shares that she too was once an unwed mother at the age of 16. In terms of therapeutic communication, this example most specifically demonstrates which of its essential conditions?

Accepted Answer

self-disclosure. There are six essential conditions for therapeutic communication: empathy, respect, genuineness, self-disclosure, concreteness and specificity, and confrontation. Self-disclosure is when your own personal views or experiences are shared in order to improve the mental/emotional state of another. Empathy is an understanding and sharing of one’s feelings. Respect is acceptance or regard for another, even someone with a differing viewpoint. Genuineness is is showing and expressing sincere and honest concern for the concerns and problems of another.

Question 20

Which of these patients is correctly matched with the proper therapeutic environment?

Accepted Answer

an angry, intoxicated patient in a private room with restraints on. A therapeutic environment is one in which a patient’s spoken and unspoken needs are met, proper safety precautions and measures are taken, and all extraneous stressors and stimuli are removed. A therapeutic environment should help patients better adapt to their surroundings and provide all the necessary components that encourage and support a full recovery. An angry, intoxicated patient should not be placed with other patients as a safety concern. Restraints may be necessary to keep the patient from wandering and/or hurting themselves or others. Manic patients need less stimulatory environments and depressed ones should have more stimulation. Patients that require close monitoring, such as those with suicidal ideation, should be as close to the nurses’ station as possible.

NCLEX Psychosocial Integrity Practice Test

Test Details

Psychosocial Practice That Builds Better Judgment

Michele J. McCarthy

Molly W.

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Common Psychosocial Integrity Practice Test Questions with Their Answers

What types of scenarios usually fall under Psychosocial Integrity?

Why do psychosocial questions feel like multiple answers could work?

What is the most common trap in therapeutic communication questions?

How do I choose between setting limits and showing empathy?

How do I handle questions where a patient says something alarming

Are family members and visitors part of this category too?

Should I pick “notify the provider” for most psychosocial issues?

Can I pause the quiz and return later?

Do I need an email to view the results screen?

What should I do if the quiz does not load correctly?