HESI RN Mental Health Exam | Actual
Questions & Verified Answers | A+ Graded
Study Guide100+Detailed Rationale!!
Section 1: Therapeutic Communication & Relationship (Questions 1–15)
1. A client with schizophrenia tells the nurse, “I am the king of the universe.” Which
response by the nurse is most therapeutic?
A. “No, you’re not a king. You’re a client in the hospital.”
B. “It must feel powerful to be a king, but I see you as a person who needs rest.”
C. “Why do you think you are the king?”
D. “That’s a delusion. Let’s talk about something real.”
Answer: B
Rationale: Option B acknowledges the client’s feeling without reinforcing the delusion. It
uses validation and redirection. A and D are confrontational; C asks “why,” which can
increase paranoia.
2. A nurse is caring for a client with major depressive disorder who states, “Nothing
matters anymore.” Which response demonstrates empathy?
A. “You have so much to live for. Look at your family.”
B. “I understand how you feel. I’ve been sad before too.”
C. “It sounds like you’re feeling hopeless. That must be very painful.”
D. “Have you thought about what makes you happy?”
Answer: C
Rationale: C reflects the client’s feeling (hopelessness) and shows understanding without
comparing or minimizing. A is invalidating; B shifts focus to the nurse; D is a closed question.
3. A client with borderline personality disorder says, “You’re the only nurse who really
cares. The others are all mean.” How should the nurse respond?
A. “I’m glad you trust me. Let’s talk about how you feel about the others.”
B. “Thank you, but the other nurses are very competent.”
C. “I see you’re splitting. Let’s discuss this behavior.”
D. “It concerns me that you see people as all good or all bad. Let’s look at this pattern.”
,Answer: D
Rationale: D addresses the splitting defense mechanism without judgment. A may reinforce
splitting; B avoids the issue; C is too confrontational and labels the behavior.
4. A client tells the nurse, “I want to die.” Which initial response is most appropriate?
A. “Don’t say that. You have so much to live for.”
B. “Are you thinking of killing yourself?”
C. “Everyone feels sad sometimes. This will pass.”
D. “I’ll call your doctor right away.”
Answer: B
Rationale: B directly assesses suicide risk. Safety is priority. A and C minimize; D bypasses
assessment.
5. A nurse is sitting with a client who is mute and withdrawn. The best therapeutic action
is to:
A. Sit quietly with the client for short periods.
B. Ask open-ended questions to encourage speech.
C. Leave the client alone until they are ready to talk.
D. Talk about the nurse’s own experiences to model sharing.
Answer: A
Rationale: A provides presence without pressure. B may increase anxiety; C implies
abandonment; D shifts focus to the nurse.
6. Which statement by the nurse best demonstrates active listening?
A. “I see. Go on.”
B. “That must have been very difficult for you.”
C. “Why did you react that way?”
D. “Let me tell you what worked for me.”
Answer: B
Rationale: B reflects feeling and content. A is neutral but less specific; C is probing; D is
advice-giving.
7. A client with PTSD says, “I can’t stop thinking about the accident.” The nurse responds:
A. “Try to focus on the present.”
B. “What do you think triggered this memory?”
C. “It sounds like you’re having a flashback. Let’s use grounding techniques.”
D. “You need to let go of the past.”
Answer: C
Rationale: C validates the experience and offers a coping strategy. A and D dismiss; B may
worsen anxiety.
, 8. A nurse notices a client pacing and muttering. Which statement is most therapeutic?
A. “You need to calm down.”
B. “I can see you’re upset. Can you tell me what’s happening?”
C. “Stop pacing and sit down.”
D. “Would you like some medication to relax?”
Answer: B
Rationale: B acknowledges behavior and invites communication. A and C are controlling; D
jumps to intervention.
9. A client says, “I’m worthless. I should just disappear.” The nurse’s best response is:
A. “You’re not worthless. You’re a good person.”
B. “Tell me more about why you feel that way.”
C. “Do you have a plan to hurt yourself?”
D. “Let’s list your positive qualities.”
Answer: C
Rationale: C assesses immediate safety. B may be appropriate after safety is established; A
and D are invalidating.
10. A client with bipolar disorder (manic phase) is talking rapidly and jumping topics. The
nurse should:
A. Ask the client to speak more slowly.
B. Ignore the pressured speech.
C. Use short, concrete statements.
D. Challenge the illogical thoughts.
Answer: C
Rationale: C reduces stimulation and improves comprehension. A may be impossible for the
client; B neglects therapeutic interaction; D increases agitation.
11. A client with social anxiety disorder avoids eye contact. The nurse should:
A. Gently ask the client to look at the nurse.
B. Sit at a 90-degree angle and avoid forcing eye contact.
C. Stand directly in front of the client.
D. Tell the client it’s rude to look away.
Answer: B
Rationale: B reduces threat and respects boundaries. A and C increase anxiety; D is shaming.
12. A client says, “My doctor doesn’t care about me. He never listens.” The nurse
responds:
A. “I’m sure he cares. He’s very busy.”
B. “You feel unheard. Let’s talk about how to communicate that to him.”
Questions & Verified Answers | A+ Graded
Study Guide100+Detailed Rationale!!
Section 1: Therapeutic Communication & Relationship (Questions 1–15)
1. A client with schizophrenia tells the nurse, “I am the king of the universe.” Which
response by the nurse is most therapeutic?
A. “No, you’re not a king. You’re a client in the hospital.”
B. “It must feel powerful to be a king, but I see you as a person who needs rest.”
C. “Why do you think you are the king?”
D. “That’s a delusion. Let’s talk about something real.”
Answer: B
Rationale: Option B acknowledges the client’s feeling without reinforcing the delusion. It
uses validation and redirection. A and D are confrontational; C asks “why,” which can
increase paranoia.
2. A nurse is caring for a client with major depressive disorder who states, “Nothing
matters anymore.” Which response demonstrates empathy?
A. “You have so much to live for. Look at your family.”
B. “I understand how you feel. I’ve been sad before too.”
C. “It sounds like you’re feeling hopeless. That must be very painful.”
D. “Have you thought about what makes you happy?”
Answer: C
Rationale: C reflects the client’s feeling (hopelessness) and shows understanding without
comparing or minimizing. A is invalidating; B shifts focus to the nurse; D is a closed question.
3. A client with borderline personality disorder says, “You’re the only nurse who really
cares. The others are all mean.” How should the nurse respond?
A. “I’m glad you trust me. Let’s talk about how you feel about the others.”
B. “Thank you, but the other nurses are very competent.”
C. “I see you’re splitting. Let’s discuss this behavior.”
D. “It concerns me that you see people as all good or all bad. Let’s look at this pattern.”
,Answer: D
Rationale: D addresses the splitting defense mechanism without judgment. A may reinforce
splitting; B avoids the issue; C is too confrontational and labels the behavior.
4. A client tells the nurse, “I want to die.” Which initial response is most appropriate?
A. “Don’t say that. You have so much to live for.”
B. “Are you thinking of killing yourself?”
C. “Everyone feels sad sometimes. This will pass.”
D. “I’ll call your doctor right away.”
Answer: B
Rationale: B directly assesses suicide risk. Safety is priority. A and C minimize; D bypasses
assessment.
5. A nurse is sitting with a client who is mute and withdrawn. The best therapeutic action
is to:
A. Sit quietly with the client for short periods.
B. Ask open-ended questions to encourage speech.
C. Leave the client alone until they are ready to talk.
D. Talk about the nurse’s own experiences to model sharing.
Answer: A
Rationale: A provides presence without pressure. B may increase anxiety; C implies
abandonment; D shifts focus to the nurse.
6. Which statement by the nurse best demonstrates active listening?
A. “I see. Go on.”
B. “That must have been very difficult for you.”
C. “Why did you react that way?”
D. “Let me tell you what worked for me.”
Answer: B
Rationale: B reflects feeling and content. A is neutral but less specific; C is probing; D is
advice-giving.
7. A client with PTSD says, “I can’t stop thinking about the accident.” The nurse responds:
A. “Try to focus on the present.”
B. “What do you think triggered this memory?”
C. “It sounds like you’re having a flashback. Let’s use grounding techniques.”
D. “You need to let go of the past.”
Answer: C
Rationale: C validates the experience and offers a coping strategy. A and D dismiss; B may
worsen anxiety.
, 8. A nurse notices a client pacing and muttering. Which statement is most therapeutic?
A. “You need to calm down.”
B. “I can see you’re upset. Can you tell me what’s happening?”
C. “Stop pacing and sit down.”
D. “Would you like some medication to relax?”
Answer: B
Rationale: B acknowledges behavior and invites communication. A and C are controlling; D
jumps to intervention.
9. A client says, “I’m worthless. I should just disappear.” The nurse’s best response is:
A. “You’re not worthless. You’re a good person.”
B. “Tell me more about why you feel that way.”
C. “Do you have a plan to hurt yourself?”
D. “Let’s list your positive qualities.”
Answer: C
Rationale: C assesses immediate safety. B may be appropriate after safety is established; A
and D are invalidating.
10. A client with bipolar disorder (manic phase) is talking rapidly and jumping topics. The
nurse should:
A. Ask the client to speak more slowly.
B. Ignore the pressured speech.
C. Use short, concrete statements.
D. Challenge the illogical thoughts.
Answer: C
Rationale: C reduces stimulation and improves comprehension. A may be impossible for the
client; B neglects therapeutic interaction; D increases agitation.
11. A client with social anxiety disorder avoids eye contact. The nurse should:
A. Gently ask the client to look at the nurse.
B. Sit at a 90-degree angle and avoid forcing eye contact.
C. Stand directly in front of the client.
D. Tell the client it’s rude to look away.
Answer: B
Rationale: B reduces threat and respects boundaries. A and C increase anxiety; D is shaming.
12. A client says, “My doctor doesn’t care about me. He never listens.” The nurse
responds:
A. “I’m sure he cares. He’s very busy.”
B. “You feel unheard. Let’s talk about how to communicate that to him.”
