HESI RN MENTAL HEALTH NGN ULTIMATE PRACTICE EXAM: 200 HIGH-YIELD QUESTIONS WITH DETAILED RATIONALES COVERING PSYCHOPHARMACOLOGY, THERAPEUTIC COMMUNICATION, PERSONALITY DISORDERS, CRISIS INTERVENTION, & DSM-5-TR CRITERIA

HESI RN MENTAL HEALTH NGN ULTIMATE PRACTICE EXAM: 200 HIGH-YIELD QUESTIONS WITH DETAILED RATIONALES COVERING PSYCHOPHARMACOLOGY, THERAPEUTIC COMMUNICATION, PERSONALITY DISORDERS, CRISIS INTERVENTION, & DSM-5-TR CRITERIA 1. A client with bipolar disorder is experiencing acute mania. Which nursing intervention is most appropriate during this phase? A. Encourage participation in group therapy sessions B. Provide a structured environment with minimal stimulation C. Allow the client to make all decisions regarding daily activities D. Encourage the client to write in a journal about their feelings Answer: B. Provide a structured environment with minimal stimulation Rationale: During acute mania, clients experience heightened sensory input and racing thoughts. A structured environment with minimal stimulation helps reduce anxiety and prevent escalating agitation. Group therapy would be overwhelming, and allowing full decision-making could lead to poor choices. Journaling requires concentration that may not be possible during acute mania. ________________________________________ 2. The RN is caring for a client prescribed clozapine (Clozaril). Which laboratory value requires immediate notification of the healthcare provider? A. White blood cell count of 2,500/mm³ B. Hemoglobin of 12.5 g/dL C. Platelet count of 150,000/mm³ D. Serum sodium of 138 mEq/L Answer: A. White blood cell count of 2,500/mm³ Rationale: Clozapine carries a black box warning for agranulocytosis. A WBC count below 3,000/mm³ requires immediate intervention. The other values are within normal limits and do not require immediate notification. ________________________________________ 3. A client with major depressive disorder tells the RN, "Nothing matters anymore. I just want to end it all." Which action should the RN take first? A. Ask the client if they have a specific plan to harm themselves B. Tell the client that suicide is not the answer C. Contact the client's family for support D. Place the client in seclusion for safety Answer: A. Ask the client if they have a specific plan to harm themselves Rationale: When a client expresses suicidal ideation, the RN must immediately assess the lethality of the plan. Asking about specific plans, means, and timing is essential for determining the level of risk and implementing appropriate precautions. ________________________________________ 4. A client is prescribed sertraline (Zoloft) for depression. Which statement indicates the client understands the medication teaching? A. "I can stop taking this medication once I feel better" B. "It may take 4 to 6 weeks before I notice improvement" C. "I should take this medication with grapefruit juice" D. "This medication works immediately to improve my mood" Answer: B. "It may take 4 to 6 weeks before I notice improvement" Rationale: SSRIs like sertraline typically take 4-6 weeks to reach therapeutic effect. Clients must understand this to maintain adherence. The medication should not be stopped abruptly, grapefruit juice should be avoided, and immediate effects are not expected. ________________________________________ 5. The RN is assessing a client with Alzheimer's disease who is exhibiting sundowning syndrome. Which intervention is most appropriate? A. Keep the client awake during the day to ensure nighttime sleep B. Provide a quiet, well-lit environment in the evening C. Administer a sedative at bedtime as prescribed D. Encourage the client to watch television until falling asleep Answer: B. Provide a quiet, well-lit environment in the evening Rationale: Sundowning involves increased confusion and agitation in the late afternoon and evening. Providing a quiet environment with adequate lighting and a structured routine helps reduce anxiety. Sedatives should be used cautiously, and television may overstimulate the client. ________________________________________ 6. A client with borderline personality disorder exhibits self-mutilating behavior. Which nursing intervention is most appropriate? A. Ignore the behavior to avoid reinforcing it B. Establish a safety contract and provide alternative coping strategies C. Place the client in seclusion for safety D. Restrict the client's visitors to reduce stress Answer: B. Establish a safety contract and provide alternative coping strategies Rationale: Clients with borderline personality disorder need to learn alternative coping mechanisms for managing intense emotions. A safety contract helps establish boundaries, and teaching alternatives to self-harm is essential. Ignoring the behavior, seclusion, or restricting visitors does not address the underlying issues. ________________________________________ 7. The RN is caring for a client experiencing alcohol withdrawal. Which assessment finding requires immediate intervention? A. Heart rate of 100 beats per minute B. Blood pressure of 140/90 mmHg C. Temperature of 100.2°F D. Seizure activity Answer: D. Seizure activity Rationale: Seizures during alcohol withdrawal indicate severe withdrawal and can be life-threatening. Immediate intervention including airway management and administration of benzodiazepines is required. The other findings are elevated but expected during withdrawal and should be monitored. ________________________________________ 8. A client with paranoid schizophrenia tells the RN, "The FBI is monitoring my thoughts through the television." Which response by the RN is most therapeutic? A. "That's impossible. The FBI doesn't monitor thoughts." B. "I understand you believe that. Tell me more about your feelings." C. "Let's turn off the television so they can't monitor you." D. "You need to take your medication to stop these thoughts." Answer: B. "I understand you believe that. Tell me more about your feelings." Rationale: This response acknowledges the client's perception without validating the delusion. It focuses on the client's feelings and maintains therapeutic communication. Arguing with delusions or reinforcing them is not therapeutic. ________________________________________ 9. A client is taking lithium carbonate (Eskalith). Which serum lithium level is within therapeutic range? A. 0.4 mEq/L B. 0.8 mEq/L C. 1.5 mEq/L D. 2.0 mEq/L Answer: B. 0.8 mEq/L Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for acute mania and 0.6-0.8 mEq/L for maintenance. A level of 0.8 mEq/L is within therapeutic range. Levels below 0.6 are subtherapeutic, and levels above 1.5 indicate toxicity. ________________________________________