ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
ATI RN Mental Health 2026
Upgraded NGN Exam
70 Questions with Answers and Rationales
Instructions: Read each question carefully. For standard multiple-choice questions, select the one best answer. For
questions marked Select All That Apply (SATA), select all correct answers. Each question is followed by the correct
Format: Single-answer and Select All That Apply
answer(s) and a detailed rationale to support your learning.
(SATA) items | Study Guide Edition
Question 1
A nurse is interacting with a client who has schizophrenia and is experiencing
auditory hallucinations. Which of the following is the most appropriate response
by the nurse?
A. "I don't hear any voices, so they aren't real."
B. "I understand that the voices are real to you, but I don't hear them."
C. "You should try to ignore the voices and focus on me."
D. "What are the voices telling you to do?"
Correct Answer B
Rationale: The most therapeutic response acknowledges the client's
experience without reinforcing the hallucination. Stating 'I understand that the
voices are real to you, but I don't hear them' validates the client's feelings while
maintaining reality. This approach builds trust and opens communication
without arguing about the existence of the hallucination. Telling the client the
voices aren't real is argumentative and dismissive, which damages the
therapeutic relationship. Telling the client to ignore the voices is overly directive
and unrealistic. While asking what the voices are saying may be necessary for
safety assessment, it is not the initial therapeutic response and can reinforce
the hallucination if done before establishing a reality-based connection.
Question 2
A nurse is providing care to a client who has major depressive disorder. Which
Page 1
, ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
of the following therapeutic communication techniques is the nurse using when
saying, 'It sounds like you've been feeling very sad and hopeless lately'?
A. Restating
B. Reflecting
C. Clarifying
D. Summarizing
Correct Answer B
Rationale: Reflecting is a therapeutic communication technique in which the
nurse directs back to the client the feelings or thoughts that have been
expressed. The phrase 'It sounds like you've been feeling very sad and
hopeless lately' mirrors the client's emotions and demonstrates that the nurse is
listening and understands the client's emotional state. Restating involves
repeating the client's main idea using different words, not focusing on emotions.
Clarifying involves asking questions to help make the client's message clearer.
Summarizing involves reviewing the key points of a longer conversation.
Reflecting is particularly valuable in mental health nursing because it helps clients
feel heard and understood.
Page 2
, ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
Question 3
A nurse is caring for a client who states, 'I'm worthless and no one would care if
I disappeared.' Which of the following actions should the nurse take first?
A. Encourage the client to participate in a group activity
B. Ask the client if they are thinking about harming themselves
C. Provide reassurance that the client has value and people care
D. Document the statement and continue routine care
Correct Answer B
Rationale: When a client expresses feelings of worthlessness or
hopelessness, the nurse's first priority is to assess for suicidal ideation by
directly asking the client if they are thinking about harming themselves. This is
a critical safety assessment that must not be delayed. While reassurance,
group involvement, and documentation are all important aspects of care, safety
takes priority. Direct questioning about suicidal thoughts does not increase the
risk of suicide; rather, it provides an opportunity for the client to discuss their
feelings openly. The nurse should use a calm, nonjudgmental tone and follow
up with a more detailed suicide risk assessment including specific plans,
means, and intent.
Question 4
A nurse is interacting with a client who has anxiety disorder and is pacing the
hallway. Which of the following nursing interventions is most appropriate?
A. Tell
the client to sit down and take deep breaths
B. Walk with the client at a slower pace and use a calm voice
C. Redirect the client to a quiet room and close the door
D. Administer a prescribed anxiolytic medication immediately
Correct Answer B
Rationale: Walking with the client at a slower pace and using a calm voice is
the most appropriate initial intervention because it provides a therapeutic
presence and models calm behavior without being coercive. Pacing is a
common coping mechanism for anxiety, and the nurse can help reduce the
client's arousal level by gradually slowing the pace. Telling the client to sit down
may increase anxiety by removing their coping mechanism. Isolating the client in
Page 3
, ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
a quiet room may increase feelings of being trapped and escalate anxiety.
While medication may be needed if anxiety is severe, nursing interventions
should be attempted first unless the client is in acute distress.
Question 5
A nurse is establishing a therapeutic relationship with a client who has
borderline personality disorder. Which of the following behaviors should the
nurse expect?
A. Consistent, stable mood throughout the day
B. Intense fear of abandonment and split-staff relationships
C. Delusions and visual hallucinations
D. Social withdrawal and flat affect
Correct Answer B
Rationale: Borderline personality disorder is characterized by a pervasive
pattern of instability in interpersonal relationships, self-image, and affect. The
hallmark behaviors include an intense fear of abandonment, splitting (viewing
others as all good or all bad), impulsivity, self-harm, and emotional lability.
Clients with borderline personality disorder may attempt to split staff by pitting
one caregiver against another, testing the consistency of the therapeutic
relationship. Consistent, stable mood is not characteristic; these clients
experience rapid mood shifts. Delusions and hallucinations are features of
psychotic disorders, not personality disorders. Social withdrawal and flat affect
are more characteristic of schizoid personality disorder or negative symptoms
of schizophrenia.
Page 4
ATI RN Mental Health 2026
Upgraded NGN Exam
70 Questions with Answers and Rationales
Instructions: Read each question carefully. For standard multiple-choice questions, select the one best answer. For
questions marked Select All That Apply (SATA), select all correct answers. Each question is followed by the correct
Format: Single-answer and Select All That Apply
answer(s) and a detailed rationale to support your learning.
(SATA) items | Study Guide Edition
Question 1
A nurse is interacting with a client who has schizophrenia and is experiencing
auditory hallucinations. Which of the following is the most appropriate response
by the nurse?
A. "I don't hear any voices, so they aren't real."
B. "I understand that the voices are real to you, but I don't hear them."
C. "You should try to ignore the voices and focus on me."
D. "What are the voices telling you to do?"
Correct Answer B
Rationale: The most therapeutic response acknowledges the client's
experience without reinforcing the hallucination. Stating 'I understand that the
voices are real to you, but I don't hear them' validates the client's feelings while
maintaining reality. This approach builds trust and opens communication
without arguing about the existence of the hallucination. Telling the client the
voices aren't real is argumentative and dismissive, which damages the
therapeutic relationship. Telling the client to ignore the voices is overly directive
and unrealistic. While asking what the voices are saying may be necessary for
safety assessment, it is not the initial therapeutic response and can reinforce
the hallucination if done before establishing a reality-based connection.
Question 2
A nurse is providing care to a client who has major depressive disorder. Which
Page 1
, ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
of the following therapeutic communication techniques is the nurse using when
saying, 'It sounds like you've been feeling very sad and hopeless lately'?
A. Restating
B. Reflecting
C. Clarifying
D. Summarizing
Correct Answer B
Rationale: Reflecting is a therapeutic communication technique in which the
nurse directs back to the client the feelings or thoughts that have been
expressed. The phrase 'It sounds like you've been feeling very sad and
hopeless lately' mirrors the client's emotions and demonstrates that the nurse is
listening and understands the client's emotional state. Restating involves
repeating the client's main idea using different words, not focusing on emotions.
Clarifying involves asking questions to help make the client's message clearer.
Summarizing involves reviewing the key points of a longer conversation.
Reflecting is particularly valuable in mental health nursing because it helps clients
feel heard and understood.
Page 2
, ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
Question 3
A nurse is caring for a client who states, 'I'm worthless and no one would care if
I disappeared.' Which of the following actions should the nurse take first?
A. Encourage the client to participate in a group activity
B. Ask the client if they are thinking about harming themselves
C. Provide reassurance that the client has value and people care
D. Document the statement and continue routine care
Correct Answer B
Rationale: When a client expresses feelings of worthlessness or
hopelessness, the nurse's first priority is to assess for suicidal ideation by
directly asking the client if they are thinking about harming themselves. This is
a critical safety assessment that must not be delayed. While reassurance,
group involvement, and documentation are all important aspects of care, safety
takes priority. Direct questioning about suicidal thoughts does not increase the
risk of suicide; rather, it provides an opportunity for the client to discuss their
feelings openly. The nurse should use a calm, nonjudgmental tone and follow
up with a more detailed suicide risk assessment including specific plans,
means, and intent.
Question 4
A nurse is interacting with a client who has anxiety disorder and is pacing the
hallway. Which of the following nursing interventions is most appropriate?
A. Tell
the client to sit down and take deep breaths
B. Walk with the client at a slower pace and use a calm voice
C. Redirect the client to a quiet room and close the door
D. Administer a prescribed anxiolytic medication immediately
Correct Answer B
Rationale: Walking with the client at a slower pace and using a calm voice is
the most appropriate initial intervention because it provides a therapeutic
presence and models calm behavior without being coercive. Pacing is a
common coping mechanism for anxiety, and the nurse can help reduce the
client's arousal level by gradually slowing the pace. Telling the client to sit down
may increase anxiety by removing their coping mechanism. Isolating the client in
Page 3
, ATI RN Mental Health 2026 | Upgraded NGN Exam | 70 Questions
a quiet room may increase feelings of being trapped and escalate anxiety.
While medication may be needed if anxiety is severe, nursing interventions
should be attempted first unless the client is in acute distress.
Question 5
A nurse is establishing a therapeutic relationship with a client who has
borderline personality disorder. Which of the following behaviors should the
nurse expect?
A. Consistent, stable mood throughout the day
B. Intense fear of abandonment and split-staff relationships
C. Delusions and visual hallucinations
D. Social withdrawal and flat affect
Correct Answer B
Rationale: Borderline personality disorder is characterized by a pervasive
pattern of instability in interpersonal relationships, self-image, and affect. The
hallmark behaviors include an intense fear of abandonment, splitting (viewing
others as all good or all bad), impulsivity, self-harm, and emotional lability.
Clients with borderline personality disorder may attempt to split staff by pitting
one caregiver against another, testing the consistency of the therapeutic
relationship. Consistent, stable mood is not characteristic; these clients
experience rapid mood shifts. Delusions and hallucinations are features of
psychotic disorders, not personality disorders. Social withdrawal and flat affect
are more characteristic of schizoid personality disorder or negative symptoms
of schizophrenia.
Page 4
