Mental Health Nursing Examination Paper
2026/2027 | 140 NCLEX-Style Questions
with Rationales | DSM-5-TR Aligned for
Nursing Students
Description:
Master mental health nursing with 140 NCLEX-style questions for 2026/2027. Includes
DSM-5-TR updates, evidence-based rationales, and 45 topic sections. Pass your
psychiatric nursing exam on the first try.
Download the complete 2026/2027 exam paper today.
, Mental Health Nursing Exam 2026/2027: 140 NCLEX Questions
Section 1: Mental Status Assessment and Diagnostic Tools
Question 1
A charge nurse is discussing mental status examinations with a newly licensed nurse. Which
of the following statements by the newly licensed nurse indicates an understanding of the
teaching? (Select all that apply)
A) To assess cognitive ability, I should ask the client to count backward by sevens.
B) To assess affect, I should observe the client's facial expression.
C) To assess language ability, I should instruct the client to write a sentence.
D) To assess remote memory, I should have the client repeat a list of objects.
E) To assess abstract thinking, I should ask the client to identify our most recent presidents.
Answer: A, B, C
Explanation: Counting backward by sevens assesses attention and concentration, which are
cognitive functions. Observing facial expression is the correct method for assessing affect.
Writing a sentence evaluates language ability and expressive communication. Repeating a list
of objects assesses immediate or short-term memory, not remote memory. Identifying recent
presidents assesses recent memory and general knowledge, not abstract thinking (which
requires interpreting proverbs or identifying similarities).
Question 2
A nurse is planning a peer group discussion about the DSM-5. Which of the following
information is appropriate to include in the discussion? (Select all that apply)
A) The DSM-5 includes client education handouts for mental health disorders.
B) The DSM-5 establishes diagnostic criteria for individual mental health disorders.
C) The DSM-5 indicates recommended pharmacological treatment for mental health
disorders.
D) The DSM-5 assists nurses in planning care for clients who have mental health disorders.
E) The DSM-5 indicates expected assessment findings of mental health disorders.
Answer: B, D, E
Explanation: The DSM-5 provides standardized diagnostic criteria for mental health
disorders. It assists nurses in care planning by identifying expected findings and symptoms.
The DSM-5 describes expected assessment findings associated with each disorder. It does not
include client education handouts (these are found in other resources). It does not prescribe
pharmacological treatments (treatment guidelines are separate).
,Section 2: Therapeutic Communication and Nurse-Client Relationship
Question 3
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview.
When conducting the interview, which of the following actions should the nurse identify as
the priority?
A) Coordinate holistic care with social services.
B) Identify the client's perception of her mental health status.
C) Include the client's family in the interview.
D) Teach the client about her current mental health disorder.
Answer: B
Explanation: The priority during an initial interview is to establish therapeutic rapport and
understand the client's perspective of their mental health status. This provides the foundation
for all subsequent assessment and treatment planning. Coordinating care, involving family,
and teaching occur after the initial assessment is complete.
Question 4
A nurse is caring for the parents of a child who has demonstrated changes in behavior and
mood. When the mother asks the nurse for reassurance about her son's condition, which of
the following responses should the nurse make?
A) "I think your son is getting better. What have you noticed?"
B) "I'm sure everything will be okay. It just takes time to heal."
C) "I'm not sure what's wrong. Have you asked the doctor about your concerns?"
D) "I understand you're concerned. Let's discuss what concerns you specifically."
Answer: D
Explanation: This response validates the mother's feelings and opens communication for
further exploration. It demonstrates empathy without offering false reassurance. False
reassurance (options A and B) is nontherapeutic and dismisses the mother's legitimate
concerns. Option C abdicates the nurse's responsibility to address the family's concerns.
Question 5
A nurse is in the working phase of a therapeutic relationship with a client who has
methamphetamine use disorder. Which of the following actions indicates transference
behavior?
A) The client asks the nurse whether she will go out to dinner with him.
, B) The client accuses the nurse of telling him what to do just like his ex-girlfriend.
C) The client reminds the nurse of a friend who died from a substance overdose.
D) The client becomes angry and threatens to harm himself.
Answer: B
Explanation: Transference occurs when a client unconsciously redirects feelings and
expectations from past significant relationships onto the nurse. Accusing the nurse of
behaving like his ex-girlfriend is a classic example of transference. Option A represents a
boundary violation request. Option C describes countertransference (nurse's reaction to
client). Option D represents escalating behavior requiring intervention.
Question 6
A charge nurse is discussing the characteristics of a nurse-client relationship with a newly
licensed nurse. Which of the following characteristics should the nurse include in the
discussion? (Select all that apply)
A) The needs of both participants are met.
B) An emotional commitment exists between the participants.
C) It is goal-directed.
D) Behavioral change is encouraged.
E) A termination date is established.
Answer: C, D, E
Explanation: The therapeutic relationship is goal-directed, focusing on client outcomes. It
encourages behavioral change through therapeutic interventions. A termination date or phase
is established from the beginning. The needs of the client, not both participants, are the focus.
Emotional commitment is characteristic of social relationships, not therapeutic ones.
Question 7
A nurse is planning care for the termination phase of a nurse-client relationship. Which of the
following actions should the nurse include in the plan of care?
A) Discussing ways to use new behaviors.
B) Practicing new problem-solving skills.
C) Developing goals.
D) Establishing boundaries.
Answer: A
Explanation: During the termination phase, the nurse helps the client consolidate learning
and discuss how to apply new behaviors independently. Practicing problem-solving skills
2026/2027 | 140 NCLEX-Style Questions
with Rationales | DSM-5-TR Aligned for
Nursing Students
Description:
Master mental health nursing with 140 NCLEX-style questions for 2026/2027. Includes
DSM-5-TR updates, evidence-based rationales, and 45 topic sections. Pass your
psychiatric nursing exam on the first try.
Download the complete 2026/2027 exam paper today.
, Mental Health Nursing Exam 2026/2027: 140 NCLEX Questions
Section 1: Mental Status Assessment and Diagnostic Tools
Question 1
A charge nurse is discussing mental status examinations with a newly licensed nurse. Which
of the following statements by the newly licensed nurse indicates an understanding of the
teaching? (Select all that apply)
A) To assess cognitive ability, I should ask the client to count backward by sevens.
B) To assess affect, I should observe the client's facial expression.
C) To assess language ability, I should instruct the client to write a sentence.
D) To assess remote memory, I should have the client repeat a list of objects.
E) To assess abstract thinking, I should ask the client to identify our most recent presidents.
Answer: A, B, C
Explanation: Counting backward by sevens assesses attention and concentration, which are
cognitive functions. Observing facial expression is the correct method for assessing affect.
Writing a sentence evaluates language ability and expressive communication. Repeating a list
of objects assesses immediate or short-term memory, not remote memory. Identifying recent
presidents assesses recent memory and general knowledge, not abstract thinking (which
requires interpreting proverbs or identifying similarities).
Question 2
A nurse is planning a peer group discussion about the DSM-5. Which of the following
information is appropriate to include in the discussion? (Select all that apply)
A) The DSM-5 includes client education handouts for mental health disorders.
B) The DSM-5 establishes diagnostic criteria for individual mental health disorders.
C) The DSM-5 indicates recommended pharmacological treatment for mental health
disorders.
D) The DSM-5 assists nurses in planning care for clients who have mental health disorders.
E) The DSM-5 indicates expected assessment findings of mental health disorders.
Answer: B, D, E
Explanation: The DSM-5 provides standardized diagnostic criteria for mental health
disorders. It assists nurses in care planning by identifying expected findings and symptoms.
The DSM-5 describes expected assessment findings associated with each disorder. It does not
include client education handouts (these are found in other resources). It does not prescribe
pharmacological treatments (treatment guidelines are separate).
,Section 2: Therapeutic Communication and Nurse-Client Relationship
Question 3
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview.
When conducting the interview, which of the following actions should the nurse identify as
the priority?
A) Coordinate holistic care with social services.
B) Identify the client's perception of her mental health status.
C) Include the client's family in the interview.
D) Teach the client about her current mental health disorder.
Answer: B
Explanation: The priority during an initial interview is to establish therapeutic rapport and
understand the client's perspective of their mental health status. This provides the foundation
for all subsequent assessment and treatment planning. Coordinating care, involving family,
and teaching occur after the initial assessment is complete.
Question 4
A nurse is caring for the parents of a child who has demonstrated changes in behavior and
mood. When the mother asks the nurse for reassurance about her son's condition, which of
the following responses should the nurse make?
A) "I think your son is getting better. What have you noticed?"
B) "I'm sure everything will be okay. It just takes time to heal."
C) "I'm not sure what's wrong. Have you asked the doctor about your concerns?"
D) "I understand you're concerned. Let's discuss what concerns you specifically."
Answer: D
Explanation: This response validates the mother's feelings and opens communication for
further exploration. It demonstrates empathy without offering false reassurance. False
reassurance (options A and B) is nontherapeutic and dismisses the mother's legitimate
concerns. Option C abdicates the nurse's responsibility to address the family's concerns.
Question 5
A nurse is in the working phase of a therapeutic relationship with a client who has
methamphetamine use disorder. Which of the following actions indicates transference
behavior?
A) The client asks the nurse whether she will go out to dinner with him.
, B) The client accuses the nurse of telling him what to do just like his ex-girlfriend.
C) The client reminds the nurse of a friend who died from a substance overdose.
D) The client becomes angry and threatens to harm himself.
Answer: B
Explanation: Transference occurs when a client unconsciously redirects feelings and
expectations from past significant relationships onto the nurse. Accusing the nurse of
behaving like his ex-girlfriend is a classic example of transference. Option A represents a
boundary violation request. Option C describes countertransference (nurse's reaction to
client). Option D represents escalating behavior requiring intervention.
Question 6
A charge nurse is discussing the characteristics of a nurse-client relationship with a newly
licensed nurse. Which of the following characteristics should the nurse include in the
discussion? (Select all that apply)
A) The needs of both participants are met.
B) An emotional commitment exists between the participants.
C) It is goal-directed.
D) Behavioral change is encouraged.
E) A termination date is established.
Answer: C, D, E
Explanation: The therapeutic relationship is goal-directed, focusing on client outcomes. It
encourages behavioral change through therapeutic interventions. A termination date or phase
is established from the beginning. The needs of the client, not both participants, are the focus.
Emotional commitment is characteristic of social relationships, not therapeutic ones.
Question 7
A nurse is planning care for the termination phase of a nurse-client relationship. Which of the
following actions should the nurse include in the plan of care?
A) Discussing ways to use new behaviors.
B) Practicing new problem-solving skills.
C) Developing goals.
D) Establishing boundaries.
Answer: A
Explanation: During the termination phase, the nurse helps the client consolidate learning
and discuss how to apply new behaviors independently. Practicing problem-solving skills
