Evolve HESI Mental Health Nursing 2026 | Most Tested Questions &
Verified Answers with Bold Italic Explanations | Updated Psychiatric
Nursing Exam Study Guide
SECTION I: THERAPEUTIC COMMUNICATION & THE NURSE-CLIENT RELATIONSHIP
(Questions 1–60)
1. A nurse is caring for a client who is experiencing acute anxiety. Which nursing action is most
appropriate initially?
A) Encourage the client to identify the source of anxiety
B) Stay with the client and use a calm, reassuring approach
C) Teach the client relaxation techniques
D) Administer a PRN anti-anxiety medication
Answer: B) Stay with the client and use a calm, reassuring approach
Explanation: For acute anxiety, the priority is to stay with the client and provide a calm presence
to reduce anxiety. Teaching and identifying triggers occur after the anxiety is reduced.
Medication may be used but is not the initial nursing action.
2. A client tells the nurse, "I'm worthless. My family would be better off without me." Which
response by the nurse is most therapeutic?
A) "You shouldn't feel that way. Your family loves you."
B) "Are you thinking about hurting yourself?"
C) "Let's focus on your discharge plans instead."
D) "Why do you feel that way?"
Answer: B) "Are you thinking about hurting yourself?"
Explanation: Directly asking about suicidal ideation is essential when a client expresses
worthlessness and thoughts of being a burden. This allows for immediate safety assessment.
The other responses minimize the client's feelings or avoid the issue.
,3. A nurse is using active listening with a client. Which behavior demonstrates this technique?
A) Taking notes while the client speaks
B) Maintaining eye contact and nodding occasionally
C) Interrupting to ask clarifying questions
D) Changing the subject when the client becomes emotional
Answer: B) Maintaining eye contact and nodding occasionally
Explanation: Active listening involves giving full attention, maintaining eye contact, and using
nonverbal cues like nodding. Interrupting and changing the subject are barriers to
communication.
4. A client states, "I can't go to group today. I'm too tired." Which response uses the
therapeutic technique of reflection?
A) "You feel too tired to attend group today."
B) "You should try to go anyway; it will help you."
C) "Why are you tired?"
D) "Everyone gets tired sometimes."
Answer: A) "You feel too tired to attend group today."
Explanation: Reflection involves restating the client's feelings to demonstrate understanding.
This encourages the client to explore their feelings further.
5. A nurse is caring for a client with borderline personality disorder who says, "You're the only
nurse who understands me. The others don't care." Which response is most appropriate?
A) "I'm glad you feel that way. I do care about you."
B) "All the nurses here care about you. Let's talk about your feelings."
C) "You shouldn't say that about the other nurses."
D) "Why do you think the others don't care?"
Answer: B) "All the nurses here care about you. Let's talk about your feelings."
Explanation: Clients with borderline personality disorder may use splitting. The nurse should
avoid reinforcing this by maintaining a neutral, consistent approach and redirecting to the
client's feelings.
,6. A nurse is caring for a client who is manipulative. Which nursing intervention is most
appropriate?
A) Set clear, consistent limits and consequences
B) Allow the client to make decisions to build trust
C) Ignore the manipulative behavior
D) Confront the client aggressively
Answer: A) Set clear, consistent limits and consequences
Explanation: Setting clear, consistent limits helps the client feel safe and establishes appropriate
boundaries. Ignoring the behavior or confronting aggressively is counterproductive.
7. A nurse is caring for a client with depression who states, "I just want to sleep forever."
Which is the nurse's priority action?
A) Encourage the client to attend group therapy.
B) Assess the client's suicidal ideation and plan.
C) Tell the client that sleep is important for recovery.
D) Administer the prescribed antidepressant.
Answer: B) Assess the client's suicidal ideation and plan.
Explanation: Any statement suggesting a desire to die or sleep forever requires immediate
assessment of suicidal ideation and safety. This takes priority over other interventions.
8. A nurse is communicating with a client who has schizophrenia and is experiencing auditory
hallucinations. The client says, "The voices are telling me to hurt myself." Which response is
most therapeutic?
A) "There are no voices. It's just your imagination."
B) "What are the voices saying to you right now?"
C) "Try to ignore the voices and focus on me."
D) "Why do you think you are hearing voices?"
Answer: B) "What are the voices saying to you right now?"
Explanation: The nurse should assess the content of the hallucinations, especially if they are
command hallucinations telling the client to hurt themselves. Arguing with the hallucination or
telling the client to ignore it is non-therapeutic.
, 9. A nurse is caring for a client who is angry and yelling. Which is the most appropriate initial
nursing action?
A) Tell the client to lower their voice.
B) Stay calm and move the client to a quiet, safe area.
C) Administer a PRN medication for agitation.
D) Leave the client alone until they calm down.
Answer: B) Stay calm and move the client to a quiet, safe area.
Explanation: The initial priority is safety. Moving the client to a quieter area and maintaining a
calm demeanor helps de-escalate the situation. Leaving the client alone may increase anxiety,
and administering medication is not the first step unless safety is immediately compromised.
10. A client says to the nurse, "I feel like I'm going crazy." Which response uses the
therapeutic technique of clarification?
A) "You shouldn't feel that way."
B) "Tell me more about what you mean by 'going crazy'."
C) "I'm sure everything will be fine."
D) "Why do you think you're going crazy?"
Answer: B) "Tell me more about what you mean by 'going crazy'."
Explanation: Clarification helps the nurse understand the client's subjective experience. Asking
the client to elaborate on vague terms is a core therapeutic communication technique.
11. A nurse is caring for a client who is terminally ill and states, "I'm not ready to die." Which
response is most therapeutic?
A) "You have to be strong for your family."
B) "I'm here to listen if you want to talk about your fears."
C) "Everyone feels that way at the end."
D) "Let's focus on your pain management instead."
Answer: B) "I'm here to listen if you want to talk about your fears."
Explanation: Offering self and acknowledging the client's feelings without providing false
reassurance or dismissing their fears is therapeutic. The nurse should provide a supportive
presence.
Verified Answers with Bold Italic Explanations | Updated Psychiatric
Nursing Exam Study Guide
SECTION I: THERAPEUTIC COMMUNICATION & THE NURSE-CLIENT RELATIONSHIP
(Questions 1–60)
1. A nurse is caring for a client who is experiencing acute anxiety. Which nursing action is most
appropriate initially?
A) Encourage the client to identify the source of anxiety
B) Stay with the client and use a calm, reassuring approach
C) Teach the client relaxation techniques
D) Administer a PRN anti-anxiety medication
Answer: B) Stay with the client and use a calm, reassuring approach
Explanation: For acute anxiety, the priority is to stay with the client and provide a calm presence
to reduce anxiety. Teaching and identifying triggers occur after the anxiety is reduced.
Medication may be used but is not the initial nursing action.
2. A client tells the nurse, "I'm worthless. My family would be better off without me." Which
response by the nurse is most therapeutic?
A) "You shouldn't feel that way. Your family loves you."
B) "Are you thinking about hurting yourself?"
C) "Let's focus on your discharge plans instead."
D) "Why do you feel that way?"
Answer: B) "Are you thinking about hurting yourself?"
Explanation: Directly asking about suicidal ideation is essential when a client expresses
worthlessness and thoughts of being a burden. This allows for immediate safety assessment.
The other responses minimize the client's feelings or avoid the issue.
,3. A nurse is using active listening with a client. Which behavior demonstrates this technique?
A) Taking notes while the client speaks
B) Maintaining eye contact and nodding occasionally
C) Interrupting to ask clarifying questions
D) Changing the subject when the client becomes emotional
Answer: B) Maintaining eye contact and nodding occasionally
Explanation: Active listening involves giving full attention, maintaining eye contact, and using
nonverbal cues like nodding. Interrupting and changing the subject are barriers to
communication.
4. A client states, "I can't go to group today. I'm too tired." Which response uses the
therapeutic technique of reflection?
A) "You feel too tired to attend group today."
B) "You should try to go anyway; it will help you."
C) "Why are you tired?"
D) "Everyone gets tired sometimes."
Answer: A) "You feel too tired to attend group today."
Explanation: Reflection involves restating the client's feelings to demonstrate understanding.
This encourages the client to explore their feelings further.
5. A nurse is caring for a client with borderline personality disorder who says, "You're the only
nurse who understands me. The others don't care." Which response is most appropriate?
A) "I'm glad you feel that way. I do care about you."
B) "All the nurses here care about you. Let's talk about your feelings."
C) "You shouldn't say that about the other nurses."
D) "Why do you think the others don't care?"
Answer: B) "All the nurses here care about you. Let's talk about your feelings."
Explanation: Clients with borderline personality disorder may use splitting. The nurse should
avoid reinforcing this by maintaining a neutral, consistent approach and redirecting to the
client's feelings.
,6. A nurse is caring for a client who is manipulative. Which nursing intervention is most
appropriate?
A) Set clear, consistent limits and consequences
B) Allow the client to make decisions to build trust
C) Ignore the manipulative behavior
D) Confront the client aggressively
Answer: A) Set clear, consistent limits and consequences
Explanation: Setting clear, consistent limits helps the client feel safe and establishes appropriate
boundaries. Ignoring the behavior or confronting aggressively is counterproductive.
7. A nurse is caring for a client with depression who states, "I just want to sleep forever."
Which is the nurse's priority action?
A) Encourage the client to attend group therapy.
B) Assess the client's suicidal ideation and plan.
C) Tell the client that sleep is important for recovery.
D) Administer the prescribed antidepressant.
Answer: B) Assess the client's suicidal ideation and plan.
Explanation: Any statement suggesting a desire to die or sleep forever requires immediate
assessment of suicidal ideation and safety. This takes priority over other interventions.
8. A nurse is communicating with a client who has schizophrenia and is experiencing auditory
hallucinations. The client says, "The voices are telling me to hurt myself." Which response is
most therapeutic?
A) "There are no voices. It's just your imagination."
B) "What are the voices saying to you right now?"
C) "Try to ignore the voices and focus on me."
D) "Why do you think you are hearing voices?"
Answer: B) "What are the voices saying to you right now?"
Explanation: The nurse should assess the content of the hallucinations, especially if they are
command hallucinations telling the client to hurt themselves. Arguing with the hallucination or
telling the client to ignore it is non-therapeutic.
, 9. A nurse is caring for a client who is angry and yelling. Which is the most appropriate initial
nursing action?
A) Tell the client to lower their voice.
B) Stay calm and move the client to a quiet, safe area.
C) Administer a PRN medication for agitation.
D) Leave the client alone until they calm down.
Answer: B) Stay calm and move the client to a quiet, safe area.
Explanation: The initial priority is safety. Moving the client to a quieter area and maintaining a
calm demeanor helps de-escalate the situation. Leaving the client alone may increase anxiety,
and administering medication is not the first step unless safety is immediately compromised.
10. A client says to the nurse, "I feel like I'm going crazy." Which response uses the
therapeutic technique of clarification?
A) "You shouldn't feel that way."
B) "Tell me more about what you mean by 'going crazy'."
C) "I'm sure everything will be fine."
D) "Why do you think you're going crazy?"
Answer: B) "Tell me more about what you mean by 'going crazy'."
Explanation: Clarification helps the nurse understand the client's subjective experience. Asking
the client to elaborate on vague terms is a core therapeutic communication technique.
11. A nurse is caring for a client who is terminally ill and states, "I'm not ready to die." Which
response is most therapeutic?
A) "You have to be strong for your family."
B) "I'm here to listen if you want to talk about your fears."
C) "Everyone feels that way at the end."
D) "Let's focus on your pain management instead."
Answer: B) "I'm here to listen if you want to talk about your fears."
Explanation: Offering self and acknowledging the client's feelings without providing false
reassurance or dismissing their fears is therapeutic. The nurse should provide a supportive
presence.
