2026 ATI RN Mental Health Practice Exam
Questions with Answers and Detailed
Rationales
1. A nurse is assessing a client who has major depressive
disorder and reports, "My family would be better off
without me." Which response by the nurse is most
appropriate?
A. "You have a lot to live for, so you should focus on your
family."
B. "Why do you think your family would be better off without
you?"
C. "Are you thinking about killing yourself?"
D. "You should tell your family how you are feeling."
Rationale: Directly asking about suicidal thoughts does not
increase suicide risk and is necessary for accurate assessment.
The nurse should assess suicidal ideation, intent, plan, access
to means, and protective factors. Avoiding the topic or using
reassuring statements can minimize the client's feelings and
delay necessary intervention.
2. A client admitted with severe depression has a flat affect,
minimal eye contact, and reports having no energy. Which
nursing intervention is the priority?
,A. Encourage the client to participate in group therapy for 1
hr.
B. Ask the client to identify three personal strengths.
C. Encourage the client to make independent decisions about
daily activities.
D. Assess the client for suicidal ideation and intent.
Rationale: Severe depression combined with hopelessness
and withdrawal requires immediate suicide-risk assessment.
The nurse must determine whether the client has suicidal
thoughts, a plan, intent, and access to lethal means. Other
interventions may be appropriate later but do not take
priority over immediate safety assessment.
3. A nurse is caring for a client experiencing acute mania.
Which finding requires the nurse to intervene first?
A. The client refuses to attend group therapy.
B. The client reports sleeping 3 hr during the previous night.
C. The client has consumed only 10% of meals for 2 days.
D. The client repeatedly interrupts other clients.
Rationale: Clients experiencing mania have increased activity
and energy but often neglect nutritional needs. Inadequate
food intake can rapidly lead to dehydration, electrolyte
disturbances, and physical exhaustion. The nurse should
provide high-calorie, high-protein finger foods and fluids that
can be consumed while the client remains active.
,4. A client with bipolar disorder is prescribed lithium. Which
finding should the nurse identify as an early manifestation
of lithium toxicity?
A. Increased appetite
B. Mild thirst
C. Fine hand tremor
D. Persistent vomiting and diarrhea
Rationale: Gastrointestinal disturbances such as persistent
vomiting and diarrhea can indicate lithium toxicity and
require prompt evaluation. Lithium toxicity can progress to
coarse tremors, confusion, ataxia, seizures, and potentially
life-threatening neurologic complications. Mild thirst and fine
tremors can occur as adverse effects but are not necessarily
signs of severe toxicity.
5. A client taking lithium reports beginning a low-sodium
diet. Which response by the nurse is appropriate?
A. "A low-sodium diet will increase the effectiveness of
lithium."
B. "A sudden reduction in sodium intake can increase your
lithium level."
C. "You should eliminate sodium completely while taking
lithium."
D. "Sodium intake has no effect on lithium therapy."
, Rationale: Lithium and sodium are handled by the kidneys in
related ways. A significant reduction in sodium intake can
decrease lithium excretion and increase serum lithium
concentrations, potentially causing toxicity. Clients should
maintain a consistent sodium intake and adequate hydration.
6. A nurse is caring for a client who is experiencing
command auditory hallucinations. The client states, "The
voices are telling me to stab my roommate." Which action
should the nurse take first?
A. Ask the client to attend reality-orientation group.
B. Tell the client the voices are not real.
C. Determine whether the client intends to act on the
command.
D. Place the client in a room with another client for
distraction.
Rationale: Command hallucinations involving harm require
immediate assessment of the client's intent, plan, access to
means, and ability to resist the commands. The nurse should
prioritize safety of the client and others. Simply challenging
the hallucination or providing distraction without assessing
risk is insufficient.
Difficulty: Hard
Questions with Answers and Detailed
Rationales
1. A nurse is assessing a client who has major depressive
disorder and reports, "My family would be better off
without me." Which response by the nurse is most
appropriate?
A. "You have a lot to live for, so you should focus on your
family."
B. "Why do you think your family would be better off without
you?"
C. "Are you thinking about killing yourself?"
D. "You should tell your family how you are feeling."
Rationale: Directly asking about suicidal thoughts does not
increase suicide risk and is necessary for accurate assessment.
The nurse should assess suicidal ideation, intent, plan, access
to means, and protective factors. Avoiding the topic or using
reassuring statements can minimize the client's feelings and
delay necessary intervention.
2. A client admitted with severe depression has a flat affect,
minimal eye contact, and reports having no energy. Which
nursing intervention is the priority?
,A. Encourage the client to participate in group therapy for 1
hr.
B. Ask the client to identify three personal strengths.
C. Encourage the client to make independent decisions about
daily activities.
D. Assess the client for suicidal ideation and intent.
Rationale: Severe depression combined with hopelessness
and withdrawal requires immediate suicide-risk assessment.
The nurse must determine whether the client has suicidal
thoughts, a plan, intent, and access to lethal means. Other
interventions may be appropriate later but do not take
priority over immediate safety assessment.
3. A nurse is caring for a client experiencing acute mania.
Which finding requires the nurse to intervene first?
A. The client refuses to attend group therapy.
B. The client reports sleeping 3 hr during the previous night.
C. The client has consumed only 10% of meals for 2 days.
D. The client repeatedly interrupts other clients.
Rationale: Clients experiencing mania have increased activity
and energy but often neglect nutritional needs. Inadequate
food intake can rapidly lead to dehydration, electrolyte
disturbances, and physical exhaustion. The nurse should
provide high-calorie, high-protein finger foods and fluids that
can be consumed while the client remains active.
,4. A client with bipolar disorder is prescribed lithium. Which
finding should the nurse identify as an early manifestation
of lithium toxicity?
A. Increased appetite
B. Mild thirst
C. Fine hand tremor
D. Persistent vomiting and diarrhea
Rationale: Gastrointestinal disturbances such as persistent
vomiting and diarrhea can indicate lithium toxicity and
require prompt evaluation. Lithium toxicity can progress to
coarse tremors, confusion, ataxia, seizures, and potentially
life-threatening neurologic complications. Mild thirst and fine
tremors can occur as adverse effects but are not necessarily
signs of severe toxicity.
5. A client taking lithium reports beginning a low-sodium
diet. Which response by the nurse is appropriate?
A. "A low-sodium diet will increase the effectiveness of
lithium."
B. "A sudden reduction in sodium intake can increase your
lithium level."
C. "You should eliminate sodium completely while taking
lithium."
D. "Sodium intake has no effect on lithium therapy."
, Rationale: Lithium and sodium are handled by the kidneys in
related ways. A significant reduction in sodium intake can
decrease lithium excretion and increase serum lithium
concentrations, potentially causing toxicity. Clients should
maintain a consistent sodium intake and adequate hydration.
6. A nurse is caring for a client who is experiencing
command auditory hallucinations. The client states, "The
voices are telling me to stab my roommate." Which action
should the nurse take first?
A. Ask the client to attend reality-orientation group.
B. Tell the client the voices are not real.
C. Determine whether the client intends to act on the
command.
D. Place the client in a room with another client for
distraction.
Rationale: Command hallucinations involving harm require
immediate assessment of the client's intent, plan, access to
means, and ability to resist the commands. The nurse should
prioritize safety of the client and others. Simply challenging
the hallucination or providing distraction without assessing
risk is insufficient.
Difficulty: Hard
