HESI Mental Health NGN Exam
2026/2027 – Version B: Actual Exam
Questions with Verified Answers – Next
Generation NCLEX Aligned
SECTION 1: THERAPEUTIC COMMUNICATION & MILIEU MANAGEMENT
(Questions 1-5)
Question 1 (Standard Multiple Choice)
A nurse is caring for a client diagnosed with borderline personality disorder who states,
"You're the only nurse who understands me. The others are terrible and don't care about
me at all." Which response demonstrates the most therapeutic communication?
A. "I'm glad you feel I understand you. Let's focus on your treatment goals."
B. "You shouldn't compare nurses. We all care about your recovery."
C. "It sounds like you're experiencing some strong feelings about the staff. Can you tell
me more about that?"
D. "I think you're splitting the staff into good and bad. That's a defense mechanism you
need to work on."
Correct Answer: C
,Rationale: This response uses the therapeutic technique of
exploration/validation—acknowledging the client's feelings without reinforcing splitting
(a primitive defense mechanism common in BPD). Option A reinforces the splitting by
agreeing with the "good nurse/bad nurse" dichotomy. Option B is defensive and blocks
communication. Option D uses psychological jargon and confrontational language that
increases shame and defensiveness. The nurse must remain neutral while encouraging
the client to explore emotions.
Cognitive Level: Application
Client Need: Psychosocial Integrity
NGN Competency: Generate Solutions (therapeutic response)
Question 2 (Standard Multiple Choice)
A client on an inpatient psychiatric unit becomes increasingly agitated, pacing the
hallway and clenching fists. Which nursing intervention is the priority?
A. Offer PRN anxiolytic medication as ordered
B. Escort the client to a quiet area with decreased stimulation
C. Implement one-to-one observation immediately
D. Use therapeutic communication to de-escalate the situation
Correct Answer: B
Rationale: The priority is environmental management to prevent escalation. Moving to a
quiet area reduces stimuli that may contribute to agitation (milieu management). Option
A may be appropriate but requires assessment first. Option C (1:1) is excessive at this
,stage and may increase agitation. Option D is important but secondary to environmental
safety. The least restrictive intervention principle applies—modify environment before
using higher-level interventions.
Cognitive Level: Analysis
Client Need: Safe and Effective Care Environment
NGN Competency: Prioritize (hierarchy of interventions)
Question 3 (Multiple Response - Select All That Apply)
A nurse is establishing a therapeutic relationship with a newly admitted client. Which
actions demonstrate the foundational components of a therapeutic nurse-client
relationship? Select all that apply.
☐ A. Sharing personal experiences to demonstrate empathy
☐ B. Maintaining professional boundaries while showing genuine concern
☐ C. Collaborating with the client to establish mutual goals
☐ D. Ensuring confidentiality within legal and ethical limits
☐ E. Providing advice based on the nurse's life experience
☐ F. Using self-disclosure to build rapid rapport
Correct Answers: B, C, D
Rationale: The therapeutic relationship (Peplau's model) requires trust, respect,
empathy, and professional boundaries. Option B demonstrates genuineness with
boundaries. Option C reflects the working phase collaboration. Option D establishes
, trust through confidentiality (with mandated reporter exceptions). Options A, E, and F
represent inappropriate self-disclosure that shifts focus to the nurse, blurs boundaries,
and can create dependency or transference complications.
Cognitive Level: Application
Client Need: Psychosocial Integrity
NGN Competency: Generate Solutions (therapeutic relationship building)
Question 4 (Standard Multiple Choice)
Which statement by a nursing student indicates understanding of milieu therapy?
A. "The milieu is just the physical environment where treatment occurs."
B. "Milieu therapy uses the total environment as a therapeutic tool, including structured
activities and peer interactions."
C. "Milieu therapy focuses primarily on individual psychotherapy sessions."
D. "The nurse's role in milieu therapy is to maintain safety through seclusion and
restraint."
Correct Answer: B
Rationale: Milieu therapy (therapeutic community) involves the total
environment—physical setting, social interactions, daily routines, and therapeutic
activities—all designed to support recovery. Option A is incomplete (ignores
social/therapeutic components). Option C describes individual therapy, not milieu.
Option D focuses only on safety/restraint, which contradicts the therapeutic,
least-restrictive philosophy of milieu therapy.
2026/2027 – Version B: Actual Exam
Questions with Verified Answers – Next
Generation NCLEX Aligned
SECTION 1: THERAPEUTIC COMMUNICATION & MILIEU MANAGEMENT
(Questions 1-5)
Question 1 (Standard Multiple Choice)
A nurse is caring for a client diagnosed with borderline personality disorder who states,
"You're the only nurse who understands me. The others are terrible and don't care about
me at all." Which response demonstrates the most therapeutic communication?
A. "I'm glad you feel I understand you. Let's focus on your treatment goals."
B. "You shouldn't compare nurses. We all care about your recovery."
C. "It sounds like you're experiencing some strong feelings about the staff. Can you tell
me more about that?"
D. "I think you're splitting the staff into good and bad. That's a defense mechanism you
need to work on."
Correct Answer: C
,Rationale: This response uses the therapeutic technique of
exploration/validation—acknowledging the client's feelings without reinforcing splitting
(a primitive defense mechanism common in BPD). Option A reinforces the splitting by
agreeing with the "good nurse/bad nurse" dichotomy. Option B is defensive and blocks
communication. Option D uses psychological jargon and confrontational language that
increases shame and defensiveness. The nurse must remain neutral while encouraging
the client to explore emotions.
Cognitive Level: Application
Client Need: Psychosocial Integrity
NGN Competency: Generate Solutions (therapeutic response)
Question 2 (Standard Multiple Choice)
A client on an inpatient psychiatric unit becomes increasingly agitated, pacing the
hallway and clenching fists. Which nursing intervention is the priority?
A. Offer PRN anxiolytic medication as ordered
B. Escort the client to a quiet area with decreased stimulation
C. Implement one-to-one observation immediately
D. Use therapeutic communication to de-escalate the situation
Correct Answer: B
Rationale: The priority is environmental management to prevent escalation. Moving to a
quiet area reduces stimuli that may contribute to agitation (milieu management). Option
A may be appropriate but requires assessment first. Option C (1:1) is excessive at this
,stage and may increase agitation. Option D is important but secondary to environmental
safety. The least restrictive intervention principle applies—modify environment before
using higher-level interventions.
Cognitive Level: Analysis
Client Need: Safe and Effective Care Environment
NGN Competency: Prioritize (hierarchy of interventions)
Question 3 (Multiple Response - Select All That Apply)
A nurse is establishing a therapeutic relationship with a newly admitted client. Which
actions demonstrate the foundational components of a therapeutic nurse-client
relationship? Select all that apply.
☐ A. Sharing personal experiences to demonstrate empathy
☐ B. Maintaining professional boundaries while showing genuine concern
☐ C. Collaborating with the client to establish mutual goals
☐ D. Ensuring confidentiality within legal and ethical limits
☐ E. Providing advice based on the nurse's life experience
☐ F. Using self-disclosure to build rapid rapport
Correct Answers: B, C, D
Rationale: The therapeutic relationship (Peplau's model) requires trust, respect,
empathy, and professional boundaries. Option B demonstrates genuineness with
boundaries. Option C reflects the working phase collaboration. Option D establishes
, trust through confidentiality (with mandated reporter exceptions). Options A, E, and F
represent inappropriate self-disclosure that shifts focus to the nurse, blurs boundaries,
and can create dependency or transference complications.
Cognitive Level: Application
Client Need: Psychosocial Integrity
NGN Competency: Generate Solutions (therapeutic relationship building)
Question 4 (Standard Multiple Choice)
Which statement by a nursing student indicates understanding of milieu therapy?
A. "The milieu is just the physical environment where treatment occurs."
B. "Milieu therapy uses the total environment as a therapeutic tool, including structured
activities and peer interactions."
C. "Milieu therapy focuses primarily on individual psychotherapy sessions."
D. "The nurse's role in milieu therapy is to maintain safety through seclusion and
restraint."
Correct Answer: B
Rationale: Milieu therapy (therapeutic community) involves the total
environment—physical setting, social interactions, daily routines, and therapeutic
activities—all designed to support recovery. Option A is incomplete (ignores
social/therapeutic components). Option C describes individual therapy, not milieu.
Option D focuses only on safety/restraint, which contradicts the therapeutic,
least-restrictive philosophy of milieu therapy.
