Psychosocial Integrity Questions
What It Tests
Psychosocial Integrity is 6 to 12 percent of the exam. NCSBN puts in it therapeutic communication, coping and grief, crisis intervention, abuse and neglect, substance use and withdrawal, mental health concepts, cultural and spiritual influences, and end-of-life care. On screen most items are a quoted client statement, four quoted nurse responses, and "Which response by the nurse is best?"; the rest are safety items about a plan to harm, withdrawal, or injuries that do not match the story.
Rule 1
Safety first, then feelings. Any risk of harm to self or others makes the answer the safety action, and no therapeutic sentence outranks it. Worked: "A client says, 'I have been saving my pills; I know how many I need.' Which does the nurse do first?" → ask directly about suicide and remove the pills; the reflecting sentence comes after.
Rule 2
The best response names the feeling and keeps the client talking: no reassurance, no why, no advice, no I. Three of the four quoted responses fail for a nameable reason, so strike them and keep the survivor. Worked: "A widow says, 'I should have made him see the doctor sooner.'" → "You feel you could have changed what happened."; not don't blame yourself, not why, not my father died too.
Rule 3
Physical need comes before psychosocial only when the stem has a physical problem. A client in pain or short of breath gets that first; a stem with no physical problem is asking the psychosocial question. Worked: "A stable client two days after a heart attack says, 'I am afraid it will happen again.'" → reflect the fear; checking the blood pressure answers a question the stem never asked.
What to Review
Clinical Pearl
Safety first, then feelings; name the feeling and keep them talking; the body wins only when the stem puts it there.