Mental Health
NCLEX® practice.

Free practice set · 7 questions

7 more free mental health NCLEX-RN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 7 · Mental Health & Psychosocial Care

   A primigravida client at 28 weeks of gestation presents for a routine prenatal visit. Vital signs are: BP 118/76 mmHg, heart rate 84, temperature 37.1°C. She denies headache, visual changes, vaginal bleeding, or fluid leakage. Fetal movement is normal. Prenatal labs from 20 weeks show: blood type O-positive, rubella immune, glucose tolerance test (1-hour) pending from today's draw, negative for infection. She is employed, lives with her partner, and reports a planned pregnancy with strong family support. Which action best reflects the nurse's next priority?

   1. ADefer prenatal education to the client's partner and family members, who can provide guidance on diet and activity based on their own pregnancy experiences.
   2. BSchedule the follow-up glucose tolerance test result review and provide education on second-trimester nutrition, fetal development, and warning signs appropriate to 28 weeks.
   3. CInstruct the client to begin monitoring fetal kick counts daily and to avoid all caffeine and strenuous exercise for the remainder of pregnancy.
   4. DReassure the client that mild headache and visual changes are normal in the third trimester and advise rest and increased hydration.
   Show the answer and rationale

   Correct answer: B. Schedule the follow-up glucose tolerance test result review and provide education on second-trimester nutrition, fetal development, and warning signs appropriate to 28 weeks.

   At 28 weeks, the client is in the third trimester and presents with normal vital signs and no red-flag symptoms. However, the glucose tolerance test (1-hour) result is pending from today's draw, a time-sensitive screening due at 24–28 weeks to rule out gestational diabetes mellitus. According to evidence-based prenatal guidelines (ACOG, ADA), the 1-hour GTT must be completed and results reviewed; if abnormal, a 3-hour GTT is required. Simultaneously, third-trimester education includes fetal movement awareness (kick counts), warning signs (headache, visual changes, vaginal bleeding, fluid leakage, regular contractions), nutrition, and fetal development. The nursing priority integrates both: ensuring the screening result is reviewed (the "match prenatal teaching to trimester and individual risk" rule) and delivering education matched to the gestational week and risk profile. The client has no warning signs and strong psychosocial support, so routine teaching is appropriate; she is Rh-positive, so no Rho(A) immune globulin is indicated at this visit. Recommending blanket avoidance of caffeine and strenuous exercise imposes a restriction not supported by current evidence without indication; current evidence supports moderate activity and individualized counseling (150 minutes/week of moderate aerobic activity is safe in low-risk pregnancy). Dismissing headache and visual changes as 'normal in the third trimester' would fail to escalate red-flag prenatal warning signs over routine teaching; these are red-flag symptoms (potential preeclampsia) that require immediate assessment and provider notification, not reassurance. Deferring clinical prenatal education to unverified family sources would fail to provide evidence-based prenatal guidance; the RN is responsible for providing evidence-based prenatal guidance using validated patient-education materials.

   A. Defer prenatal education to the client's partner and family members, who can provide guidance on diet and activity based on their own pregnancy experiences.

   This option expands the "defer to a non-clinical or unverified source for prenatal education" error pattern and violates the "match prenatal teaching to trimester and individual risk" rule. Prenatal education is the RN's responsibility and must be delivered using validated, evidence-based patient materials. Deferring clinical guidance (e.g., diet safety, activity recommendations, warning signs) to family members or unverified sources introduces inconsistency, misinformation, and undermines the RN's role in supporting informed decision-making during pregnancy.

   B. Schedule the follow-up glucose tolerance test result review and provide education on second-trimester nutrition, fetal development, and warning signs appropriate to 28 weeks.

   This option satisfies the "match prenatal teaching to trimester and individual risk" rule. At 28 weeks, the 1-hour glucose tolerance test is a time-sensitive screening (due at 24–28 weeks per ACOG guidelines); reviewing the result is the immediate priority to rule out gestational diabetes. Simultaneously, third-trimester education on nutrition, fetal development, and red-flag warning signs (headache, visual changes, vaginal bleeding, fluid leakage, contractions) is appropriate for this gestational age and the client's low-risk profile.

   C. Instruct the client to begin monitoring fetal kick counts daily and to avoid all caffeine and strenuous exercise for the remainder of pregnancy.

   This option expands the "impose a restriction not supported by current evidence" error pattern and violates the "match prenatal teaching to trimester and individual risk" rule. Blanket avoidance of caffeine and elimination of strenuous exercise without clinical indication contradicts current evidence; ACOG recommends moderate aerobic activity (150 minutes/week) in low-risk pregnancy. While kick-count awareness at 28 weeks is appropriate, the restriction advice is not evidence-based and does not individualize counseling to this client's risk profile.

   D. Reassure the client that mild headache and visual changes are normal in the third trimester and advise rest and increased hydration.

   This option expands the "reframe a red-flag symptom as 'normal pregnancy'" error pattern and violates the "escalate red-flag prenatal warning signs over routine teaching" rule. Headache and visual changes are red-flag symptoms suggestive of preeclampsia and require immediate assessment and provider notification. Although the client did not report these symptoms in this stem, the option falsely normalizes them as 'part of the third trimester,' which would delay critical intervention if they occurred. Reassurance without evaluation is unsafe.

2. Question 2 of 7 · Mental Health & Psychosocial Care

   A 72-year-old client presents for a routine annual wellness visit. During the visit, the client's adult daughter mentions that her mother has become withdrawn, expresses no interest in her usual activities, and frequently says "I don't see the point anymore." The client has a past medical history of hypertension and type 2 diabetes, and her mother died by suicide 10 years ago. The client denies current suicidal thoughts but appears flat in mood. The nurse recognizes this as a depression screening indication based on age, symptoms, and family history. Which action should the nurse take?

   1. ADocument the client's reported withdrawn behavior in the chart and plan to conduct a formal depression screen at the next visit if symptoms persist.
   2. BAdminister the PHQ-9, score it, and if the score is ≥10, diagnose the client with major depressive disorder and initiate antidepressant therapy immediately.
   3. CAdminister the Geriatric Depression Scale (GDS-15), score it against the validated threshold, and if the score is ≥5, perform a direct suicide-risk assessment and notify the provider for further evaluation.
   4. DAsk the client directly, 'Are you feeling depressed?' If she says no, document that depression screening is negative and continue with the visit.
   Show the answer and rationale

   Correct answer: C. Administer the Geriatric Depression Scale (GDS-15), score it against the validated threshold, and if the score is ≥5, perform a direct suicide-risk assessment and notify the provider for further evaluation.

   The correct answer applies the evidence-based principle of matching the screening tool to the client's age and risk profile, using a validated threshold, and triggering a defined safety-focused next step. The client is a 72-year-old with clear risk factors, anhedonia, social withdrawal, and a family history of suicide, making depression screening indicated today. The Geriatric Depression Scale (GDS-15) is the validated tool for older adults; it has a published threshold of ≥5 points indicating probable depression. A positive screen requires both suicide-risk assessment (critical given the family history) and immediate provider notification to determine if further diagnostic workup or intervention is needed. Screening identifies risk and guides action; it is not diagnostic in itself. Option D violates the the "use a validated tool and act on a positive screen" rule rule by relying on an informal, non-validated question ("Are you feeling depressed?") rather than administering the GDS-15. This approach lacks reliability and sensitivity, misses the opportunity to quantify risk, and incorrectly reassures the nurse if the client denies depression despite presenting symptoms. Option B violates the the "treat a positive screen as a diagnosis" error pattern rule by interpreting a positive PHQ-9 score as a diagnosis of major depressive disorder and justifying immediate pharmacotherapy. Screening tools identify individuals at risk; they do not establish a psychiatric diagnosis, which requires clinical interview, differential diagnosis, and health care provider assessment. Additionally, the PHQ-9 (designed for adults, not geriatric populations) is not the best tool for a 72-year-old, violating the "match the screening tool to the indication and the client's age/risk" rule. Option A violates the the "document but take no action on a positive screen" error pattern rule by documenting the client's symptoms but deferring the formal depression screen to a future visit. The indication is present now, the client is showing clear signs of depression and has significant family history, and the screen should be conducted at this encounter to enable timely safety assessment and intervention planning.

   A. Document the client's reported withdrawn behavior in the chart and plan to conduct a formal depression screen at the next visit if symptoms persist.

   Incorrect. Violates the "document but take no action on a positive screen" error pattern. The client presents with clear indication for depression screening today (withdrawn mood, anhedonia, family history of suicide). Delaying the formal screen to a future visit defers the safety assessment and misses the opportunity to intervene when risk factors are evident. Screening is performed when the indication is present, not postponed.

   B. Administer the PHQ-9, score it, and if the score is ≥10, diagnose the client with major depressive disorder and initiate antidepressant therapy immediately.

   Incorrect. Violates the "treat a positive screen as a diagnosis" error pattern and the "match the screening tool to the indication and the client's age/risk" rule. The PHQ-9 is validated for general adults, not older adults, and a positive score on any screening tool is not sufficient to diagnose depression or initiate treatment. Diagnosis requires comprehensive clinical assessment by the health care provider. Screening identifies risk; it does not authorize therapeutic action.

   C. Administer the Geriatric Depression Scale (GDS-15), score it against the validated threshold, and if the score is ≥5, perform a direct suicide-risk assessment and notify the provider for further evaluation.

   Correct. This option satisfies both key rules: it uses the Geriatric Depression Scale (GDS-15), the validated tool designed for older adults ≥65 years, applies the published threshold (≥5 points), and mandates a defined next step, suicide-risk assessment and provider notification. The safety question is non-negotiable given the family history.

   D. Ask the client directly, 'Are you feeling depressed?' If she says no, document that depression screening is negative and continue with the visit.

   Incorrect. Violates the "use a validated tool and act on a positive screen" rule. The option uses an informal, non-validated screening question rather than the GDS-15. This approach lacks sensitivity, may miss depression, and does not quantify risk against published thresholds. Screening requires a validated tool to produce reliable, actionable results.

3. Question 3 of 7 · Mental Health & Psychosocial Care

   A 52-year-old client with a history of chronic pain and recent loss of employment presents for a routine primary care visit. During the health history, the client reports feeling "tired all the time" and "not interested in much anymore." The nurse notes the client has no prior psychiatric history and is not currently on any antidepressant medications. The client is alert and oriented, and consents to screening. The nurse recognizes the need to screen for depression given the disclosed symptoms and risk factors. Which action should the nurse take?

   1. AAdminister the Geriatric Depression Scale (GDS) because the client is over 50, score it, and if elevated, record the result as confirmed depression and schedule a specialist referral.
   2. BDocument the client's reported fatigue and anhedonia in the progress note, recognize these are possible depression symptoms, and plan to administer a validated screening tool at the next visit.
   3. CAsk the client directly, 'Are you feeling depressed?' and if the response is 'yes,' document this in the chart as a depression diagnosis and continue with routine care.
   4. DAdminister the PHQ-9, score it against the published threshold of ≥10, and if positive, perform further assessment including suicidal ideation screening and notify the health care provider for evaluation and next-step planning.
   Show the answer and rationale

   Correct answer: D. Administer the PHQ-9, score it against the published threshold of ≥10, and if positive, perform further assessment including suicidal ideation screening and notify the health care provider for evaluation and next-step planning.

   Depression screening is indicated by the client's symptoms and risk factors. The PHQ-9 is a validated 9-item instrument scored 0–27, with a published threshold of ≥10 indicating possible depressive disorder in adolescents and adults, including this 52-year-old client. A positive screen, defined as a score ≥10, requires a defined next-step pathway: (1) further assessment through suicidal ideation screening (PHQ-9 Q9), (2) notification of the health care provider, and (3) collaborative evaluation and clinical decision-making. The tool is validated and age-appropriate, reflecting the need to match the screening tool to the indication and the client's age/risk. The positive result must also be acted on through a safety and referral protocol, using a validated tool and acting on a positive screen. Deferring screening until a future visit is inappropriate when the client has current depressive symptoms and risk factors. The symptoms are an active screening indication that should be addressed today with a validated tool rather than postponed. Asking only, "Are you feeling depressed?" is an informal, non-validated question. A response of "yes" is a screening cue requiring further evaluation, not a depression diagnosis. Applying the GDS to a 52-year-old adult is also inappropriate because it is validated for older adults, typically ≥65, and has different cutoffs. A high GDS score would not confirm depression without further diagnostic workup.

   A. Administer the Geriatric Depression Scale (GDS) because the client is over 50, score it, and if elevated, record the result as confirmed depression and schedule a specialist referral.

   Violates the "match the screening tool to the indication and the client's age/risk" rule by using the GDS, validated for older adults ≥65 years, on a 52-year-old adult where the PHQ-9 is the evidence-based tool. Also violates the "treat a positive screen as a diagnosis" rule by treating a positive GDS as confirmed depression without diagnostic workup.

   B. Document the client's reported fatigue and anhedonia in the progress note, recognize these are possible depression symptoms, and plan to administer a validated screening tool at the next visit.

   Violates the "delay a clearly indicated screen until a later visit" rule by deferring validated screening to the next visit despite the client's current disclosure of fatigue, anhedonia, and risk factors. Screening indication is present today; action should occur now, not postponed.

   C. Ask the client directly, 'Are you feeling depressed?' and if the response is 'yes,' document this in the chart as a depression diagnosis and continue with routine care.

   Violates the "use a validated tool and act on a positive screen" rule by replacing a validated tool with a single informal question. Also violates the "treat a positive screen as a diagnosis" rule by documenting the client's response as a clinical diagnosis rather than a screening signal requiring further evaluation.

   D. Administer the PHQ-9, score it against the published threshold of ≥10, and if positive, perform further assessment including suicidal ideation screening and notify the health care provider for evaluation and next-step planning.

   Correct. Uses the PHQ-9, a validated tool for adults, scored against the threshold of ≥10, and implements the required next-step protocol: further assessment including suicide risk and provider notification. Satisfies both key rules: tool matched to age/population and positive screen actioned with defined clinical steps.

4. Question 4 of 7 · Mental Health & Psychosocial Care

   A 16-year-old girl comes to the school nurse's office after her history teacher raised concerns about her withdrawn behavior and poor academic performance over the past month. The client reports feeling "down and hopeless" most days. The nurse learns that her maternal grandmother has a history of depression treated with medication. The client has not been screened for depression before. The nurse now performs a targeted depression screening to evaluate her risk and determine the need for referral. Which action should the nurse take to evaluate the adolescent’s depression and determine appropriate follow-up?

   1. AUse the Geriatric Depression Scale because the client has a family history of depression, score it, and if the result is positive, inform her parents that she has clinical depression.
   2. BDocument that the client endorses feeling down and hopeless in the chart; schedule a follow-up visit for depression screening at the next quarterly health visit in three months.
   3. CAdminister the PHQ-9, score it against the validated threshold of ≥10 for further evaluation, and if positive, perform suicide-risk screening including Q9; notify the health care provider and arrange a mental health referral.
   4. DAsk the client, 'Are you feeling sad or depressed?' and document her response; if she says yes, document this as depression and advise her to see a counselor.
   Show the answer and rationale

   Correct answer: C. Administer the PHQ-9, score it against the validated threshold of ≥10 for further evaluation, and if positive, perform suicide-risk screening including Q9; notify the health care provider and arrange a mental health referral.

   Using a validated, age-appropriate screening tool and acting on a positive result provides a defined safety and referral pathway. The PHQ-9 is the gold-standard depression screening instrument for adolescents and adults; a score of ≥10 indicates clinically significant depressive symptoms warranting further evaluation. A positive screen triggers two critical next steps: first, direct assessment of suicidal ideation (PHQ-9 item Q9) to evaluate imminent safety risk, and second, notification of the health care provider and referral to mental health services for diagnostic evaluation. This approach honors the screening-to-action pipeline: the tool identifies risk, the safety question addresses harm, and the referral pathway ensures proper diagnosis and treatment. Asking an informal, clinician-generated question ("Are you sad?") violates the "use a validated tool and act on a positive screen" rule rather than using a validated instrument, and labeling the client with a diagnosis based on screening alone compounds the error by conflating screening with diagnosis, which violates the "treat a positive screen as a diagnosis" error pattern. Using the Geriatric Depression Scale violates the "match the screening tool to the indication and the client's age/risk" rule because it is validated for adults aged ≥65 years and uses different item thresholds; applying it to a 16-year-old produces unreliable results outside the tool's evidence base. Informing the parents of a clinical depression diagnosis after a positive result also violates the "treat a positive screen as a diagnosis" error pattern, because diagnostic evaluation should be arranged instead. Documenting the client's distress without taking action violates the "document but take no action on a positive screen" error pattern, and deferring screening violates the "delay a clearly indicated screen until a later visit" error pattern. Screening is indicated because client symptoms and risk factors are present today, so delaying care and failing to initiate any action on her disclosed distress places the client at risk of harm during the three-month interval.

   A. Use the Geriatric Depression Scale because the client has a family history of depression, score it, and if the result is positive, inform her parents that she has clinical depression.

   This option violates the "match the screening tool to the indication and the client's age/risk" rule by applying the Geriatric Depression Scale, which is validated only for older adults (≥65 years), not adolescents; this mismatch produces unreliable results. It also violates the "treat a positive screen as a diagnosis" error pattern by informing parents of a clinical diagnosis rather than arranging diagnostic referral.

   B. Document that the client endorses feeling down and hopeless in the chart; schedule a follow-up visit for depression screening at the next quarterly health visit in three months.

   This option violates the "delay a clearly indicated screen until a later visit" error pattern by deferring screening despite clear indication (client symptoms and family risk present today). It also violates the "document but take no action on a positive screen" error pattern by taking no action on the client's disclosed distress, leaving her at risk during the three-month interval without safety assessment or provider notification.

   C. Administer the PHQ-9, score it against the validated threshold of ≥10 for further evaluation, and if positive, perform suicide-risk screening including Q9; notify the health care provider and arrange a mental health referral.

   This option correctly applies the the "use a validated tool and act on a positive screen" rule rule: the PHQ-9 is the validated instrument for adolescents and adults; scoring ≥10 triggers further evaluation, including the mandatory Q9 suicide-risk assessment, followed by provider notification and mental health referral, a protocol-driven pathway that ensures screening findings lead to diagnostic workup and safety intervention, not diagnosis.

   D. Ask the client, 'Are you feeling sad or depressed?' and document her response; if she says yes, document this as depression and advise her to see a counselor.

   This option violates the "use a validated tool and act on a positive screen" rule by replacing the PHQ-9 with an informal, non-validated question ('Are you sad?'). It also violates the "treat a positive screen as a diagnosis" error pattern by labeling the client with depression based on screening alone, bypassing the need for diagnostic evaluation and treatment planning.

5. Question 5 of 7 · Mental Health & Psychosocial Care

   A 16-year-old client with no prior psychiatric history presents for a routine annual health visit. During the interview, the client reports persistent sadness, difficulty concentrating in school, and feeling "hopeless about the future" for the past 3 weeks. The client denies current suicidal thoughts. The health care provider decides a depression screening is indicated. The client consents and understands the screening will help identify any concerns and guide next steps if needed. Which action best demonstrates evidence-based targeted screening?

   1. AAsk the client directly, 'Do you feel sad or hopeless?' and document the response; if yes, diagnose depression and initiate antidepressant therapy.
   2. BNote the client's reported mood symptoms during the visit, defer the formal depression screening until the next appointment to avoid rushing, and reassess at that time.
   3. CAdminister the PHQ-9, score it against the published threshold (≥10 indicates depression risk), and if positive, conduct a detailed safety assessment including suicidal ideation question Q9 and notify the health care provider.
   4. DAdminister the Geriatric Depression Scale because it is the most reliable depression screening tool, score it, and if elevated, document findings without further action.
   Show the answer and rationale

   Correct answer: C. Administer the PHQ-9, score it against the published threshold (≥10 indicates depression risk), and if positive, conduct a detailed safety assessment including suicidal ideation question Q9 and notify the health care provider.

   The PHQ-9 is a validated depression screening tool appropriate for this client's age group and presenting concern, including persistent sadness, hopelessness, and concentration difficulty. Scoring against the published threshold (PHQ-9 ≥10 indicates significant depressive symptoms requiring further evaluation) and performing a mandatory safety assessment, including Q9 (suicidal ideation), before notifying the provider demonstrates evidence-based targeted screening. The next-step pathway, safety assessment and provider notification, is what makes the screen clinically actionable. Asking the client informally, "Do you feel sad?" violates the "use a validated tool and act on a positive screen" rule and the "match the screening tool to the indication and the client's age/risk" rule because it uses an informal question instead of a validated tool. Treating the response as a diagnosis and initiating treatment without formal assessment also violates the "use a validated tool and act on a positive screen" rule. Applying the Geriatric Depression Scale violates the "match the screening tool to the indication and the client's age/risk" rule because this tool is validated for older adults (typically 65+), not a 16-year-old, producing unreliable results outside the tool's population. Documenting findings without acting on a positive result also violates the "use a validated tool and act on a positive screen" rule. Delaying a clearly indicated screen violates the "use a validated tool and act on a positive screen" rule and the spirit of targeted screening, despite the client volunteering cardinal depression symptoms today. Screening is performed when the indication is present.

   A. Ask the client directly, 'Do you feel sad or hopeless?' and document the response; if yes, diagnose depression and initiate antidepressant therapy.

   This option violates the "use a validated tool and act on a positive screen" rule by using an informal, non-validated question ('Do you feel sad?') instead of the PHQ-9, and by treating a positive screen as a clinical diagnosis requiring treatment initiation. It also violates the "match the screening tool to the indication and the client's age/risk" rule by not applying an evidence-based tool appropriate to the adolescent's age and presenting concern.

   B. Note the client's reported mood symptoms during the visit, defer the formal depression screening until the next appointment to avoid rushing, and reassess at that time.

   This option violates the "use a validated tool and act on a positive screen" rule by deferring a formal, validated screening despite clear current indication (the client is reporting cardinal depression symptoms today). Targeted screening is performed when the indication is present, not delayed until the next visit. The pattern also violates the action phase of screening: capturing risk when the client is in the encounter.

   C. Administer the PHQ-9, score it against the published threshold (≥10 indicates depression risk), and if positive, conduct a detailed safety assessment including suicidal ideation question Q9 and notify the health care provider.

   This option satisfies the "use a validated tool and act on a positive screen" rule by administering the PHQ-9, applying its validated threshold (≥10), and triggering the required next step: detailed safety assessment and provider notification. It satisfies the "match the screening tool to the indication and the client's age/risk" rule by selecting a tool validated for adolescents and adults with reported depressive symptoms.

   D. Administer the Geriatric Depression Scale because it is the most reliable depression screening tool, score it, and if elevated, document findings without further action.

   This option violates the "match the screening tool to the indication and the client's age/risk" rule by applying the Geriatric Depression Scale, which is validated for older adults (≥65), to a 16-year-old, producing unreliable results outside the tool's population. It also violates the "use a validated tool and act on a positive screen" rule by documenting findings without performing the required safety assessment or provider notification on a positive screen.

6. Question 6 of 7 · Mental Health & Psychosocial Care

   A 32-year-old client with a 10-year history of tobacco use presents to the clinic with persistent nonproductive cough and mild dyspnea on exertion. Recent spirometry shows a 20% decline in FEV1. When asked about quitting, the client states, "I know smoking is bad, but I'm not really thinking about quitting right now. Maybe eventually." The client works full-time with limited break time and states that previous quit attempts failed because of stress at work. The health care provider recognizes the client is in the contemplation stage of change regarding tobacco cessation. Which intervention should the nurse use to address the client's readiness for tobacco cessation?

   1. ASchedule a separate appointment in 3 months for comprehensive tobacco-cessation counseling; discuss smoking cessation only at that future visit.
   2. BPrescribe varenicline and provide detailed quit-date instructions, encouraging the client to choose a date within the next week to begin the medication and achieve cessation.
   3. CExplain to the client that continued smoking will result in severe lung disease and early death, emphasizing the moral failure of addiction to reinforce the urgency of stopping.
   4. DExplore the client's ambivalence about smoking using open-ended questions, acknowledge the barriers to quitting, and provide brief information about nicotine replacement therapy and counseling resources available when the client is ready.
   Show the answer and rationale

   Correct answer: D. Explore the client's ambivalence about smoking using open-ended questions, acknowledge the barriers to quitting, and provide brief information about nicotine replacement therapy and counseling resources available when the client is ready.

   The client is in the contemplation stage of change, aware of the problem but not yet committed to action. Using the transtheoretical stage-of-change model, motivational interviewing techniques such as open-ended exploration help the client work through ambivalence, acknowledge real barriers such as work stress, and learn about evidence-based options such as nicotine replacement therapy and counseling referral without pushing premature action. This approach builds readiness without overwhelming the client. Prescribing an action-stage intervention such as varenicline with a set quit date does not match a contemplative client's readiness. Contemplativeness requires building motivation first; providing medication and quit-date worksheets before readiness exists increases resistance and relapse risk. Judgmental, fear-based language ('moral failure,' scare tactics about death) damages the therapeutic relationship, contradicts motivational interviewing principles, and is unlikely to move a contemplative client toward genuine commitment. Shame-based teaching is not evidence-based for behavior change. Deferring all education to a future visit misses the current encounter as an opportunistic moment for brief intervention. Evidence-based practice includes brief, motivational counseling at every visit, particularly when the client discloses ambivalence, not only at scheduled specialty appointments.

   A. Schedule a separate appointment in 3 months for comprehensive tobacco-cessation counseling; discuss smoking cessation only at that future visit.

   This option violates the evidence-based timing rule by deferring all education to a future appointment. Brief intervention and motivational counseling at the current visit are evidence-based practices, especially when the client discloses ambivalence. Skipping opportunistic intervention reduces the chance of moving toward action.

   B. Prescribe varenicline and provide detailed quit-date instructions, encouraging the client to choose a date within the next week to begin the medication and achieve cessation.

   This option violates the stage-of-change rule by pushing action-stage teaching (medication prescription, quit-date setting) at a contemplative client. Varenicline with a deadline assumes readiness the client has not yet stated. Premature action-stage interventions increase resistance and relapse; contemplation requires building motivation first.

   C. Explain to the client that continued smoking will result in severe lung disease and early death, emphasizing the moral failure of addiction to reinforce the urgency of stopping.

   This option violates the evidence-based teaching rule by using judgmental, fear-based framing ('moral failure,' scare tactics). Shaming language damages therapeutic relationship and contradicts motivational interviewing principles. It does not match the client's stage and reduces engagement with behavior change.

   D. Explore the client's ambivalence about smoking using open-ended questions, acknowledge the barriers to quitting, and provide brief information about nicotine replacement therapy and counseling resources available when the client is ready.

   This option correctly applies motivational interviewing and stage-of-change matching. The client is in contemplation (aware but uncommitted), so open-ended exploration of ambivalence, acknowledgment of disclosed barriers (work stress), and introduction of evidence-based options (NRT, counseling) without premature action align with the transtheoretical model. The approach meets the client where they are while keeping safety information available.

7. Question 7 of 7 · Mental Health & Psychosocial Care

   A 42-year-old client presents for a routine follow-up visit. The nurse's health history review reveals the client has been smoking one pack of cigarettes daily for 20 years. When asked about quitting, the client states, "I know smoking is bad for me, but I'm not really thinking about quitting right now. I've tried before and it didn't work." Current vital signs are stable; however, the client reports occasional morning cough and mild dyspnea on exertion. The client's family members smoke, and the client frequently socializes in environments where smoking is common. Based on the client's readiness stage and current health status, what is the most appropriate nursing response?

   1. AAcknowledge the client's failed quit attempts and inform them that smoking cessation education is best addressed during a scheduled appointment with a pulmonologist.
   2. BAsk open-ended questions to explore the client's ambivalence about smoking and raise awareness of personal smoking triggers and health consequences.
   3. CProvide a quit-date calendar and a prescription for nicotine patches, then schedule a follow-up in 2 weeks to monitor progress.
   4. DTell the client that continued smoking will lead to lung cancer and early death, and emphasize the harm to family members exposed to secondhand smoke.
   Show the answer and rationale

   Correct answer: B. Ask open-ended questions to explore the client's ambivalence about smoking and raise awareness of personal smoking triggers and health consequences.

   The client is in the precontemplation stage of change, the client acknowledges smoking is harmful but is not actively considering quitting and has internalized prior failure. According to the transtheoretical model and motivational interviewing principles, the appropriate nursing intervention at this stage is to raise awareness, explore ambivalence, and identify personal triggers without pushing toward action. Asking open-ended questions helps the client recognize their own reasons for change and understand connections between behavior and health consequences, meeting the client where they are and building intrinsic motivation. This satisfies both key rules: it tailors teaching to the precontemplation stage and incorporates evidence-based motivational interviewing. Offering action-stage tools, such as a quit-date and pharmacotherapy, to a precontemplative client increases resistance and is premature before readiness is established. Fear-based and shaming language ("lung cancer," "early death") damages the therapeutic relationship and is ineffective for behavior change at any stage, especially precontemplation. Deferring all teaching to a future appointment misses the opportunistic moment for brief intervention and implies that this nursing action is outside the nurse's scope during routine encounters, when in fact brief, tailored counseling is a core nursing responsibility in health promotion.

   A. Acknowledge the client's failed quit attempts and inform them that smoking cessation education is best addressed during a scheduled appointment with a pulmonologist.

   Incorrect. This option violates the rule that brief intervention is part of nursing scope and evidence-based practice at every encounter. Deferring all education to a future specialist visit misses the opportunistic moment and implies this teaching is not the nurse's responsibility during routine care, when in fact the nurse can establish motivation and awareness now.

   B. Ask open-ended questions to explore the client's ambivalence about smoking and raise awareness of personal smoking triggers and health consequences.

   Correct. This option matches the client's precontemplation stage by using open-ended, motivational interviewing questions to explore ambivalence and build awareness of personal triggers and health consequences. This is the evidence-based entry point for behavior change when readiness is absent, establishing the therapeutic foundation for later action.

   C. Provide a quit-date calendar and a prescription for nicotine patches, then schedule a follow-up in 2 weeks to monitor progress.

   Incorrect. This option violates the stage-of-change rule by offering action-stage pharmacotherapy and structured quit-planning to a precontemplative client. Pushing quit dates and patches before the client is ready increases resistance and sets up another perceived failure, rather than building readiness first.

   D. Tell the client that continued smoking will lead to lung cancer and early death, and emphasize the harm to family members exposed to secondhand smoke.

   Incorrect. This option violates the key rule on therapeutic engagement by using fear-based language and moral framing ('lung cancer,' 'harm to family'). Scare tactics and shame damage the therapeutic relationship and are ineffective, especially at the precontemplation stage, where the client is already defensive about past failed attempts.