Page 1 of 61
MENTAL HEALTH NURSING REVIEW EXAM-
NCLEX-RN -QUESTIONS (100) WITH LOGICAL
RATIONALES
Nursing / clinical
Exam coverage:
I. Section 1 (Q1-25): Therapeutic Communication &
Professional Boundaries - covers therapeutic techniques,
defense mechanisms, and establishing the nurse-client
relationship.
II. Section 2 (Q26-50): Anxiety, Mood, & Trauma Disorders -
addresses PTSD, panic disorder, depression, bipolar disorder,
and suicide risk assessment.
III. Section 3 (Q51-75): Psychotic Disorders, Personality
Disorders, & Crisis - covers schizophrenia, personality
disorders, and crisis intervention strategies.
IV. Section 4 (Q76-100): Psychopharmacology, Substance
Use, & NGN Cases - includes medication management,
substance withdrawal, and Next Generation NCLEX-style
clinical judgment scenarios
Section 1: Therapeutic Communication & Professional
Boundaries (Questions 1-25)
Question 1: A nurse is beginning a therapeutic relationship with
a client diagnosed with major depressive disorder. According to
, Page 2 of 61
Peplau's interpersonal theory, which statement best reflects
the nurse's role during the orientation phase?
A. "I will focus on solving your problems for you so you can feel
better quickly."
B. "We will work together to establish goals and define the
parameters of our relationship."
C. "It's best if you share everything about your past so we can
identify the root cause of your depression."
D. "I will decide what interventions are appropriate based on
your diagnosis."
CORRECT: B
RATIONALE: During the orientation phase of the therapeutic
relationship, the nurse and client establish goals, define roles,
build trust, and set the parameters of their work together. This
collaborative approach forms the foundation for therapeutic
work. Solving problems for the client (A) undermines autonomy,
focusing solely on the past (C) is premature, and unilateral
decision-making (D) contradicts the collaborative nature of
psychiatric nursing.
Question 2: A client tells the nurse, "I'm worthless. I can't do
anything right." Which nursing response demonstrates the
therapeutic communication technique of presenting reality?
A. "That's not true. You have many good qualities."
B. "I notice you completed your morning hygiene independently
today."
C. "You shouldn't say things like that about yourself."
D. "I understand you feel that way right now."
, Page 3 of 61
CORRECT: B
RATIONALE: Presenting reality involves offering factual,
objective observations without directly challenging the client's
perception. By stating a concrete observation about the client's
achievement, the nurse provides a reality-based perspective.
Offering reassurance (A) dismisses feelings, giving advice (C) is
nontherapeutic, and validating feelings without reality
orientation (D) may reinforce distorted thinking.
Question 3: During a therapy session, a client with borderline
personality disorder tells the nurse, "You're the only one who
understands me. My other nurse never listens." The nurse
recognizes this statement as:
A. Transference
B. Splitting
C. Projection
D. Displacement
CORRECT: B
RATIONALE: Splitting is a defense mechanism in which the
client views people as all-good or all-bad and often pits staff
against one another. This is a hallmark of borderline personality
disorder. Transference (A) involves redirecting feelings about
one person onto another, projection (C) involves attributing
one's own feelings to others, and displacement (D) involves
shifting feelings from the original target to a safer one.
, Page 4 of 61
Question 4: A nurse is caring for a client with schizophrenia
who states, "The FBI is monitoring my thoughts through the
television." Which response is most therapeutic?
A. "That's a delusion. The FBI doesn't monitor television
signals."
B. "I understand you're feeling frightened. Let's talk more about
what you're experiencing."
C. "Why would the FBI be interested in you?"
D. "The television is just a machine; it can't monitor your
thoughts."
CORRECT: B
RATIONALE: Acknowledging the client's fear and validating the
emotional experience without agreeing with the delusional
content is therapeutic. This approach builds trust and maintains
the therapeutic relationship. Challenging the delusion (A, D) can
increase anxiety and damage rapport, and asking "why" (C) can
reinforce the delusional thinking .
Question 5: A client who is anxious about an upcoming
procedure speaks rapidly and jumps from topic to topic. Which
communication technique should the nurse use to address
this?
A. Focusing
B. Restating
C. Broad openings
D. Silence
MENTAL HEALTH NURSING REVIEW EXAM-
NCLEX-RN -QUESTIONS (100) WITH LOGICAL
RATIONALES
Nursing / clinical
Exam coverage:
I. Section 1 (Q1-25): Therapeutic Communication &
Professional Boundaries - covers therapeutic techniques,
defense mechanisms, and establishing the nurse-client
relationship.
II. Section 2 (Q26-50): Anxiety, Mood, & Trauma Disorders -
addresses PTSD, panic disorder, depression, bipolar disorder,
and suicide risk assessment.
III. Section 3 (Q51-75): Psychotic Disorders, Personality
Disorders, & Crisis - covers schizophrenia, personality
disorders, and crisis intervention strategies.
IV. Section 4 (Q76-100): Psychopharmacology, Substance
Use, & NGN Cases - includes medication management,
substance withdrawal, and Next Generation NCLEX-style
clinical judgment scenarios
Section 1: Therapeutic Communication & Professional
Boundaries (Questions 1-25)
Question 1: A nurse is beginning a therapeutic relationship with
a client diagnosed with major depressive disorder. According to
, Page 2 of 61
Peplau's interpersonal theory, which statement best reflects
the nurse's role during the orientation phase?
A. "I will focus on solving your problems for you so you can feel
better quickly."
B. "We will work together to establish goals and define the
parameters of our relationship."
C. "It's best if you share everything about your past so we can
identify the root cause of your depression."
D. "I will decide what interventions are appropriate based on
your diagnosis."
CORRECT: B
RATIONALE: During the orientation phase of the therapeutic
relationship, the nurse and client establish goals, define roles,
build trust, and set the parameters of their work together. This
collaborative approach forms the foundation for therapeutic
work. Solving problems for the client (A) undermines autonomy,
focusing solely on the past (C) is premature, and unilateral
decision-making (D) contradicts the collaborative nature of
psychiatric nursing.
Question 2: A client tells the nurse, "I'm worthless. I can't do
anything right." Which nursing response demonstrates the
therapeutic communication technique of presenting reality?
A. "That's not true. You have many good qualities."
B. "I notice you completed your morning hygiene independently
today."
C. "You shouldn't say things like that about yourself."
D. "I understand you feel that way right now."
, Page 3 of 61
CORRECT: B
RATIONALE: Presenting reality involves offering factual,
objective observations without directly challenging the client's
perception. By stating a concrete observation about the client's
achievement, the nurse provides a reality-based perspective.
Offering reassurance (A) dismisses feelings, giving advice (C) is
nontherapeutic, and validating feelings without reality
orientation (D) may reinforce distorted thinking.
Question 3: During a therapy session, a client with borderline
personality disorder tells the nurse, "You're the only one who
understands me. My other nurse never listens." The nurse
recognizes this statement as:
A. Transference
B. Splitting
C. Projection
D. Displacement
CORRECT: B
RATIONALE: Splitting is a defense mechanism in which the
client views people as all-good or all-bad and often pits staff
against one another. This is a hallmark of borderline personality
disorder. Transference (A) involves redirecting feelings about
one person onto another, projection (C) involves attributing
one's own feelings to others, and displacement (D) involves
shifting feelings from the original target to a safer one.
, Page 4 of 61
Question 4: A nurse is caring for a client with schizophrenia
who states, "The FBI is monitoring my thoughts through the
television." Which response is most therapeutic?
A. "That's a delusion. The FBI doesn't monitor television
signals."
B. "I understand you're feeling frightened. Let's talk more about
what you're experiencing."
C. "Why would the FBI be interested in you?"
D. "The television is just a machine; it can't monitor your
thoughts."
CORRECT: B
RATIONALE: Acknowledging the client's fear and validating the
emotional experience without agreeing with the delusional
content is therapeutic. This approach builds trust and maintains
the therapeutic relationship. Challenging the delusion (A, D) can
increase anxiety and damage rapport, and asking "why" (C) can
reinforce the delusional thinking .
Question 5: A client who is anxious about an upcoming
procedure speaks rapidly and jumps from topic to topic. Which
communication technique should the nurse use to address
this?
A. Focusing
B. Restating
C. Broad openings
D. Silence
