Elsevier HESI RN Mental Health Exit
Exam 2026/2027: The Definitive
Question Mastery Test Bank with
Integrated Clinical Rationales for NCLEX
Success.
---
SECTION 1: Therapeutic Communication & Nurse-Client Relationship
**1. A client diagnosed with paranoid schizophrenia approaches the nurse and
whispers, "The government has planted a microchip in my brain through the
water supply. They are tracking every move I make." Which response by the nurse
is most therapeutic?**
A. "That is completely impossible; the government is not tracking you."
B. "Why do you think the government would want to track you specifically?"
C. "It sounds like you are feeling very frightened and overwhelmed right now.
Let's talk about what is happening on the unit today."
D. "Let's go to your room so we can discuss who might have put the microchip in
your water."
**Correct Answer: C**
**Rationale:** A therapeutic response acknowledges the client's underlying
feelings (fear and anxiety) without validating or reinforcing the delusion. Arguing
against the delusion or trying to prove it false increases anxiety and
,defensiveness, while exploring the delusion further reinforces it. Shifting the
focus to reality-based topics or unit activities helps ground the client.
---
**2. A nurse is assessing a client diagnosed with major depressive disorder. Which
statement requires immediate intervention?**
A. "I have trouble sleeping at night."
B. "I don't enjoy my hobbies anymore."
C. "My family would be better off without me."
D. "I feel tired all the time."
**Correct Answer: C**
**Rationale:** Statements suggesting hopelessness and worthlessness ("My
family would be better off without me") may indicate suicidal ideation and
require immediate assessment and intervention. The other symptoms are
common manifestations of depression but are not as urgent as potential self-
harm risk.
---
**3. A client with schizophrenia reports hearing voices telling him to hurt himself.
What is the nurse's priority action?**
A. Tell the client the voices are not real
,B. Assess the content of the hallucinations
C. Distract the client with activities
D. Administer a sedative immediately
**Correct Answer: B**
**Rationale:** The nurse must first assess the content and severity of command
hallucinations to determine the risk of harm. Telling the client the voices are not
real may increase distrust, and interventions should follow assessment.
---
**4. On admission assessment, the nurse is obtaining subjective data about a
client's sexual and reproductive status. The client states, "I don't want to discuss
this; it's private and personal." Which response by the nurse is the most
therapeutic?**
A. "I'd hate being asked these sorts of questions too, but it's a necessary part of
providing you with the best care."
B. "This is difficult for you to speak about, but I need this information from you in
order to perform a complete assessment."
C. "I am a professional registered nurse, and, as such, I'll have you know that all
your information is certainly kept confidential."
D. "I know that some of these questions are difficult for you, but, as a professional
nurse, I am obligated to respect your confidentiality."
**Correct Answer: D**
, **Rationale:** This response validates the client's feelings while affirming the
nurse's professional obligation to maintain confidentiality. It respects the client's
autonomy and privacy while gently addressing the need for the assessment.
---
**5. A nurse is preparing to care for a dying client, and several family members
are at the client's bedside. Select the therapeutic techniques that the nurse would
use when communicating with the family. (Select all that apply.)**
A. Discourage reminiscing
B. Make decisions for the family
C. Encourage expression of feelings, concerns, and fears
D. Explain everything that is happening to all family members
E. Touch and hold the client's or family member's hands if appropriate
F. Be honest and let the client and family know that they will not be abandoned
by the nurse
**Correct Answer: C, E, F**
**Rationale:** Encouraging expression of feelings facilitates healthy grieving.
Touch, when appropriate, conveys caring and support. Honesty and reassurance
about not being abandoned are essential therapeutic interventions. Discouraging
reminiscing blocks healthy grieving, and making decisions for the family removes
autonomy.
---
Exam 2026/2027: The Definitive
Question Mastery Test Bank with
Integrated Clinical Rationales for NCLEX
Success.
---
SECTION 1: Therapeutic Communication & Nurse-Client Relationship
**1. A client diagnosed with paranoid schizophrenia approaches the nurse and
whispers, "The government has planted a microchip in my brain through the
water supply. They are tracking every move I make." Which response by the nurse
is most therapeutic?**
A. "That is completely impossible; the government is not tracking you."
B. "Why do you think the government would want to track you specifically?"
C. "It sounds like you are feeling very frightened and overwhelmed right now.
Let's talk about what is happening on the unit today."
D. "Let's go to your room so we can discuss who might have put the microchip in
your water."
**Correct Answer: C**
**Rationale:** A therapeutic response acknowledges the client's underlying
feelings (fear and anxiety) without validating or reinforcing the delusion. Arguing
against the delusion or trying to prove it false increases anxiety and
,defensiveness, while exploring the delusion further reinforces it. Shifting the
focus to reality-based topics or unit activities helps ground the client.
---
**2. A nurse is assessing a client diagnosed with major depressive disorder. Which
statement requires immediate intervention?**
A. "I have trouble sleeping at night."
B. "I don't enjoy my hobbies anymore."
C. "My family would be better off without me."
D. "I feel tired all the time."
**Correct Answer: C**
**Rationale:** Statements suggesting hopelessness and worthlessness ("My
family would be better off without me") may indicate suicidal ideation and
require immediate assessment and intervention. The other symptoms are
common manifestations of depression but are not as urgent as potential self-
harm risk.
---
**3. A client with schizophrenia reports hearing voices telling him to hurt himself.
What is the nurse's priority action?**
A. Tell the client the voices are not real
,B. Assess the content of the hallucinations
C. Distract the client with activities
D. Administer a sedative immediately
**Correct Answer: B**
**Rationale:** The nurse must first assess the content and severity of command
hallucinations to determine the risk of harm. Telling the client the voices are not
real may increase distrust, and interventions should follow assessment.
---
**4. On admission assessment, the nurse is obtaining subjective data about a
client's sexual and reproductive status. The client states, "I don't want to discuss
this; it's private and personal." Which response by the nurse is the most
therapeutic?**
A. "I'd hate being asked these sorts of questions too, but it's a necessary part of
providing you with the best care."
B. "This is difficult for you to speak about, but I need this information from you in
order to perform a complete assessment."
C. "I am a professional registered nurse, and, as such, I'll have you know that all
your information is certainly kept confidential."
D. "I know that some of these questions are difficult for you, but, as a professional
nurse, I am obligated to respect your confidentiality."
**Correct Answer: D**
, **Rationale:** This response validates the client's feelings while affirming the
nurse's professional obligation to maintain confidentiality. It respects the client's
autonomy and privacy while gently addressing the need for the assessment.
---
**5. A nurse is preparing to care for a dying client, and several family members
are at the client's bedside. Select the therapeutic techniques that the nurse would
use when communicating with the family. (Select all that apply.)**
A. Discourage reminiscing
B. Make decisions for the family
C. Encourage expression of feelings, concerns, and fears
D. Explain everything that is happening to all family members
E. Touch and hold the client's or family member's hands if appropriate
F. Be honest and let the client and family know that they will not be abandoned
by the nurse
**Correct Answer: C, E, F**
**Rationale:** Encouraging expression of feelings facilitates healthy grieving.
Touch, when appropriate, conveys caring and support. Honesty and reassurance
about not being abandoned are essential therapeutic interventions. Discouraging
reminiscing blocks healthy grieving, and making decisions for the family removes
autonomy.
---
