HESI MEntal HEaltH ExaM MEd Surg
[2026/2027] updatEd VErSIon |
VErIfIEd QuEStIonS & dEtaIlEd
ratIonalES alrEadY gradEd a+
1. A client with major depressive disorder tells the nurse, "There's no point in going on.
Everyone would be better off without me." Which response by the nurse is most therapeutic?
A) "You have so much to live for."
B) "Are you thinking of harming yourself?"
C) "Don't say that; you'll feel better tomorrow."
D) "Why would you say that?"
Answer: B
Rationale: The nurse must directly assess for suicidal ideation. Asking "Are you thinking of
harming yourself?" is essential and does not increase suicide risk. False reassurance (A, C)
dismisses the patient's feelings, and "why" questions (D) can be accusatory. Direct, non-
judgmental assessment is the priority in mental health nursing .
2. A client with schizophrenia tells the nurse, "The FBI is monitoring my room." The nurse's
best response is:
A) "That's not true; you are imagining things."
B) "I understand you feel very frightened. I do not see any evidence of monitoring, but you are
safe here."
C) "You should take your medication, and those thoughts will go away."
D) "Tell me more about the FBI."
1
, Answer: B
Rationale: Validate the underlying emotion (fear) without validating the delusion. Do not argue,
dismiss, or reinforce the delusion by asking for details (D). Arguing (A) damages the therapeutic
relationship; dismissing (C) is non-therapeutic. The nurse should acknowledge the client's
feelings while gently offering reality orientation .
3. A client with bipolar disorder in the manic phase is pacing and talking rapidly. The nurse
should:
A) Provide a stimulating environment with many activities
B) Set firm, consistent limits and provide a quiet, low-stimulation environment
C) Encourage the client to stay awake all night to tire them out
D) Place the client in restraints immediately
Answer: B
Rationale: Clients in manic episodes need a calm, low-stimulation environment to reduce
agitation. Consistent limits help with safety. Restraints are a last resort for dangerous behavior.
A stimulating environment (A) would exacerbate symptoms. The client should be encouraged to
rest, not stay awake (C) .
4. A client is crying after receiving a new diagnosis of cancer. The nurse sits quietly at the
bedside without speaking. This is an example of:
A) False reassurance
B) Therapeutic use of silence
C) Changing the subject
D) Giving advice
Answer: B
Rationale: Silence allows the patient to process emotions and provides a supportive presence
without pressure to speak. False reassurance (A) and giving advice (D) are nontherapeutic. The
nurse should allow the client to initiate conversation when ready. Silence can be a powerful
therapeutic tool when used appropriately .
5. A client tells the nurse, "I don't think I can manage my diabetes at home." The nurse
responds, "You feel overwhelmed by your diabetes care plan." This is an example of:
2
, A) Restating
B) Reflection of feeling
C) Clarifying
D) Summarizing
Answer: B
Rationale: Reflection of feeling identifies and validates the client's emotional state. Restating
repeats words; clarifying asks for more detail; summarizing reviews the main points. Reflection
of feeling is a key therapeutic communication technique that helps clients feel understood and
encourages further expression .
6. A client with borderline personality disorder tells the nurse, "You're the only one who
understands me. The other nurses are mean." The nurse's best response is:
A) "Thank you. I try to be a good nurse."
B) "I will talk to the other nurses about their behavior."
C) "It sounds like you see people as all good or all bad."
D) "You shouldn't talk about your other nurses that way."
Answer: C
Rationale: This response reflects splitting (a common defense in BPD) and helps the client gain
insight. It is non-judgmental and therapeutic. Options A and B reinforce the splitting behavior; D
is judgmental. The nurse should help the client recognize patterns in their relationships and
work toward more integrated thinking .
7. A client refuses to take medication, stating "It's poison." Which is the best initial nursing
action?
A) Call the provider to obtain a different order.
B) Tell the client they will lose privileges.
C) Explore the client's reasons for believing the medication is poison.
D) Administer the medication by injection.
Answer: C
Rationale: Exploring the client's belief shows respect and may uncover a treatable issue (e.g.,
paranoia, side effects). Coercion (B, D) damages trust; changing meds without assessment (A) is
premature. The nurse should use therapeutic communication to understand the client's
perspective and address concerns .
3
, 8. A nurse is caring for a client who reports hearing voices. Which nursing response is
therapeutic?
A) "You shouldn't listen to those voices."
B) "Those voices aren't real."
C) "I don't hear any voices, but I understand that you do."
D) "Try to ignore them."
Answer: C
Rationale: Acknowledges the client's experience without reinforcing hallucinations. Arguing (B)
or telling the client to ignore the voices (A, D) is not therapeutic. The nurse should validate the
client's experience while gently reality-testing. Focus on the client's feelings rather than the
content of the hallucinations .
9. A client tells the nurse, "My boss yelled at me, so I came home and yelled at my dog." This
demonstrates which defense mechanism?
A) Rationalization
B) Displacement
C) Projection
D) Sublimation
Answer: B
Rationale: Displacement involves transferring feelings from one target to a less threatening one.
The client redirected anger from the boss to the dog. Rationalization (A) involves making
excuses; projection (C) involves attributing one's feelings to others; sublimation (D) involves
channeling impulses into acceptable activities .
10. A client states, "I'm worthless and nobody cares about me." The most therapeutic
response is:
A) "You shouldn't feel that way."
B) "I care about you, and we are here to help."
C) "You feel like you have no value right now."
D) "That's not true; you have many good qualities."
Answer: C
Rationale: Reflects feelings and invites expression without offering false reassurance. It
4
[2026/2027] updatEd VErSIon |
VErIfIEd QuEStIonS & dEtaIlEd
ratIonalES alrEadY gradEd a+
1. A client with major depressive disorder tells the nurse, "There's no point in going on.
Everyone would be better off without me." Which response by the nurse is most therapeutic?
A) "You have so much to live for."
B) "Are you thinking of harming yourself?"
C) "Don't say that; you'll feel better tomorrow."
D) "Why would you say that?"
Answer: B
Rationale: The nurse must directly assess for suicidal ideation. Asking "Are you thinking of
harming yourself?" is essential and does not increase suicide risk. False reassurance (A, C)
dismisses the patient's feelings, and "why" questions (D) can be accusatory. Direct, non-
judgmental assessment is the priority in mental health nursing .
2. A client with schizophrenia tells the nurse, "The FBI is monitoring my room." The nurse's
best response is:
A) "That's not true; you are imagining things."
B) "I understand you feel very frightened. I do not see any evidence of monitoring, but you are
safe here."
C) "You should take your medication, and those thoughts will go away."
D) "Tell me more about the FBI."
1
, Answer: B
Rationale: Validate the underlying emotion (fear) without validating the delusion. Do not argue,
dismiss, or reinforce the delusion by asking for details (D). Arguing (A) damages the therapeutic
relationship; dismissing (C) is non-therapeutic. The nurse should acknowledge the client's
feelings while gently offering reality orientation .
3. A client with bipolar disorder in the manic phase is pacing and talking rapidly. The nurse
should:
A) Provide a stimulating environment with many activities
B) Set firm, consistent limits and provide a quiet, low-stimulation environment
C) Encourage the client to stay awake all night to tire them out
D) Place the client in restraints immediately
Answer: B
Rationale: Clients in manic episodes need a calm, low-stimulation environment to reduce
agitation. Consistent limits help with safety. Restraints are a last resort for dangerous behavior.
A stimulating environment (A) would exacerbate symptoms. The client should be encouraged to
rest, not stay awake (C) .
4. A client is crying after receiving a new diagnosis of cancer. The nurse sits quietly at the
bedside without speaking. This is an example of:
A) False reassurance
B) Therapeutic use of silence
C) Changing the subject
D) Giving advice
Answer: B
Rationale: Silence allows the patient to process emotions and provides a supportive presence
without pressure to speak. False reassurance (A) and giving advice (D) are nontherapeutic. The
nurse should allow the client to initiate conversation when ready. Silence can be a powerful
therapeutic tool when used appropriately .
5. A client tells the nurse, "I don't think I can manage my diabetes at home." The nurse
responds, "You feel overwhelmed by your diabetes care plan." This is an example of:
2
, A) Restating
B) Reflection of feeling
C) Clarifying
D) Summarizing
Answer: B
Rationale: Reflection of feeling identifies and validates the client's emotional state. Restating
repeats words; clarifying asks for more detail; summarizing reviews the main points. Reflection
of feeling is a key therapeutic communication technique that helps clients feel understood and
encourages further expression .
6. A client with borderline personality disorder tells the nurse, "You're the only one who
understands me. The other nurses are mean." The nurse's best response is:
A) "Thank you. I try to be a good nurse."
B) "I will talk to the other nurses about their behavior."
C) "It sounds like you see people as all good or all bad."
D) "You shouldn't talk about your other nurses that way."
Answer: C
Rationale: This response reflects splitting (a common defense in BPD) and helps the client gain
insight. It is non-judgmental and therapeutic. Options A and B reinforce the splitting behavior; D
is judgmental. The nurse should help the client recognize patterns in their relationships and
work toward more integrated thinking .
7. A client refuses to take medication, stating "It's poison." Which is the best initial nursing
action?
A) Call the provider to obtain a different order.
B) Tell the client they will lose privileges.
C) Explore the client's reasons for believing the medication is poison.
D) Administer the medication by injection.
Answer: C
Rationale: Exploring the client's belief shows respect and may uncover a treatable issue (e.g.,
paranoia, side effects). Coercion (B, D) damages trust; changing meds without assessment (A) is
premature. The nurse should use therapeutic communication to understand the client's
perspective and address concerns .
3
, 8. A nurse is caring for a client who reports hearing voices. Which nursing response is
therapeutic?
A) "You shouldn't listen to those voices."
B) "Those voices aren't real."
C) "I don't hear any voices, but I understand that you do."
D) "Try to ignore them."
Answer: C
Rationale: Acknowledges the client's experience without reinforcing hallucinations. Arguing (B)
or telling the client to ignore the voices (A, D) is not therapeutic. The nurse should validate the
client's experience while gently reality-testing. Focus on the client's feelings rather than the
content of the hallucinations .
9. A client tells the nurse, "My boss yelled at me, so I came home and yelled at my dog." This
demonstrates which defense mechanism?
A) Rationalization
B) Displacement
C) Projection
D) Sublimation
Answer: B
Rationale: Displacement involves transferring feelings from one target to a less threatening one.
The client redirected anger from the boss to the dog. Rationalization (A) involves making
excuses; projection (C) involves attributing one's feelings to others; sublimation (D) involves
channeling impulses into acceptable activities .
10. A client states, "I'm worthless and nobody cares about me." The most therapeutic
response is:
A) "You shouldn't feel that way."
B) "I care about you, and we are here to help."
C) "You feel like you have no value right now."
D) "That's not true; you have many good qualities."
Answer: C
Rationale: Reflects feelings and invites expression without offering false reassurance. It
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