Mental health nursing is an essential part of the NCLEX, covering topics like therapeutic communication, crisis intervention, psychiatric disorders, and patient safety. Many test-takers struggle with these questions because they require critical thinking and an understanding of psychiatric nursing principles.

In this guide, we will review the most common NCLEX mental health scenarios, key concepts, and strategies to help you select the best answers.

1. Therapeutic Communication Scenarios

Scenario:

A patient with schizophrenia tells you, “The voices are telling me to hurt myself.” What is the most appropriate response?

Key Nursing Approach:

• Prioritize patient safety. The correct response should assess the risk of self-harm and ensure immediate intervention.
• Use open-ended, therapeutic communication. Avoid responses that dismiss the patient’s feelings.
• Example of a correct response: “I understand that the voices are distressing. Can you tell me more about what they are saying?”

Common Wrong Answer Choices:

• “Those voices aren’t real.” (Invalidates the patient’s experience.)
• “Try to ignore them.” (Minimizes the distress.)

2. Managing a Patient with Anxiety

Scenario:

A patient experiencing a panic attack is breathing rapidly and says, “I feel like I’m dying.” What is your priority intervention?

Key Nursing Approach:

• Encourage slow, deep breathing. This helps reduce hyperventilation and restores oxygen balance.
• Provide reassurance and remain calm.
• Use simple, short statements. A patient in panic may struggle to process long explanations.
• Example of a correct response: “Take a slow, deep breath with me. Breathe in through your nose and out through your mouth.”

Common Wrong Answer Choices:

• “You’re fine; there’s nothing wrong.” (Dismisses the patient’s experience.)
• “Try to calm down.” (Not specific enough to be helpful.)

3. Suicide Risk Assessment

Scenario:

A patient with major depression states, “I have nothing to live for anymore.” What is your first action?

Key Nursing Approach:

• Assess for suicide risk immediately. Ask direct questions about thoughts of self-harm.
• Example of a correct response: “Are you having thoughts of harming yourself?”
• If the patient expresses a plan, ensure safety. Remove harmful objects, initiate one-on-one observation, and notify the healthcare provider.

Common Wrong Answer Choices:

• “You should think about the good things in life.” (Minimizes the patient’s distress.)
• “I’m sure you don’t mean that.” (Invalidates feelings and discourages communication.)

4. Handling Aggressive or Violent Patients

Scenario:

A patient with bipolar disorder is pacing, shouting, and throwing objects. What is your priority nursing intervention?

Key Nursing Approach:

• Ensure safety for the patient and others.
• Use a calm, non-threatening approach. Avoid confrontation.
• Provide a quiet, low-stimulation environment.
• Example of a correct response: “Let’s move to a quieter space where we can talk.”

Common Wrong Answer Choices:

• “You need to calm down right now.” (May escalate aggression.)
• “If you don’t stop, I will call security.” (Threats can increase agitation.)

5. Schizophrenia and Hallucinations

Scenario:

A patient with schizophrenia tells you, “The CIA is spying on me through the lights.” How should you respond?

Key Nursing Approach:

• Do not argue or reinforce the delusion. Instead, acknowledge the patient’s feelings and redirect.
• Example of a correct response: “I understand that this is very real to you, but I do not see any cameras in the lights. Let’s talk about how you’re feeling.”

Common Wrong Answer Choices:

• “That’s not true.” (Directly confronting delusions is not therapeutic.)
• “Tell me more about the cameras.” (Encourages the delusion.)

6. Alcohol Withdrawal Management

Scenario:

A patient admitted for alcohol withdrawal is experiencing tremors, sweating, and agitation. What is the priority nursing intervention?

Key Nursing Approach:

• Prevent complications like seizures and delirium tremens (DTs).
• Administer benzodiazepines as prescribed. (e.g., lorazepam, diazepam)
• Monitor vital signs and hydration status.
• Example of a correct response: “I will administer lorazepam as ordered to help with withdrawal symptoms.”

Common Wrong Answer Choices:

• “You just need to relax.” (Ignores the medical need for intervention.)
• “We can’t give you any medications for withdrawal.” (Incorrect, as benzodiazepines are commonly used.)

7. Eating Disorders and Refeeding Syndrome

Scenario:

A patient with anorexia nervosa has just started nutritional rehabilitation. What is the priority assessment?

Key Nursing Approach:

• Monitor for refeeding syndrome, a life-threatening complication.
• Check electrolytes, especially phosphorus, potassium, and magnesium.
• Gradually increase caloric intake to prevent cardiac issues.
• Example of a correct response: “I will closely monitor your electrolytes and cardiac status as we start refeeding.”

Common Wrong Answer Choices:

• “You should eat as much as possible to regain weight quickly.” (Too rapid refeeding can cause complications.)

NCLEX Tips for Mental Health Nursing Questions

1. Always prioritize safety. If a question involves self-harm, aggression, or suicide risk, ensure the patient’s immediate safety first.
2. Use therapeutic communication. Avoid dismissive, judgmental, or minimizing statements.
3. Know psychiatric medications. Be familiar with antidepressants, antipsychotics, mood stabilizers, and anxiolytics.
4. Recognize withdrawal symptoms. Alcohol, benzodiazepine, and opioid withdrawal require close monitoring.
5. Understand common disorders. Depression, schizophrenia, anxiety, bipolar disorder, and eating disorders frequently appear on the NCLEX.

By mastering these mental health scenarios, you can confidently approach psychiatric nursing questions on the NCLEX and provide safe, effective care in real-world practice.