PMHN Psychiatric Mental Health Nursing Practice Exam 100 Multiple
Choice Questions with Answers and Rationales
Practice Questions
1. A patient says, 'I do not want to live.' What should the RN do first?
A. Avoid the topic
B. Promise secrecy
C. Directly assess thoughts, intent, plan, and means
D. Assume figurative speech
Correct answer: C. Directly assess thoughts, intent, plan, and means
Rationale: Direct nonjudgmental questions clarify risk. Assessment must lead to
protective action when indicated rather than avoidance or promises that prevent
necessary disclosure.
2. A patient hears commands to self-harm. What is the priority?
A. Agree with the command
B. Change topic without assessment
C. Assess content, intent, ability to resist, and safety
D. Assume all voices create identical risk
Correct answer: C. Assess content, intent, ability to resist, and safety
Rationale: Command content and the person's response affect urgency.
Individualized assessment guides supervision and intervention rather than the
presence of hallucinations alone.
3. A patient has a suicide plan and available means. What is appropriate?
A. Leave alone to reflect
B. Wait until the next group
C. Use only a no-harm promise
D. Ensure immediate safety and urgent evaluation
Correct answer: D. Ensure immediate safety and urgent evaluation
Rationale: A feasible plan with access creates substantial concern. Protective
supervision and urgent review take priority; a promise alone is insufficient.
4. What belongs in a collaborative safety plan?
A. A guarantee of no distress
B. Only a no-harm signature
C. Warning signs, coping steps, supports, and emergency actions
D. Instructions to conceal symptoms
PMHN Practice Exam | Page 1
,Correct answer: C. Warning signs, coping steps, supports, and emergency actions
Rationale: A safety plan provides practical actions for escalating distress. It
complements assessment and treatment but does not guarantee safety or replace
indicated emergency care.
5. A severely depressed patient suddenly has more energy after treatment
begins. What is important?
A. Assume risk ended
B. Stop all observation
C. Declare complete recovery
D. Reassess activation, mood, and suicide risk
Correct answer: D. Reassess activation, mood, and suicide risk
Rationale: Energy can improve before hopelessness resolves or may represent
activation. One improved feature does not establish that risk has disappeared.
6. Which finding suggests delirium?
A. Unchanged quiet preference
B. New fluctuating attention and awareness
C. Stable lifelong personality
D. Remote history without symptoms
Correct answer: B. New fluctuating attention and awareness
Rationale: Delirium is acute and fluctuating and may reflect illness, drugs,
intoxication, or withdrawal. Prompt evaluation of causes is necessary.
7. An older patient becomes inattentive after a medication change. What is
appropriate?
A. Call it normal aging
B. Ignore it without aggression
C. Diagnose dementia without review
D. Assess and report medication or medical contributors
Correct answer: D. Assess and report medication or medical contributors
Rationale: New confusion is not ordinary aging. A calm patient can still have
serious reversible illness or medication toxicity requiring evaluation.
8. What is part of the mental status examination?
A. Only insurance details
B. Only a historical diagnosis
C. Only old school results
D. Current behavior, speech, thought, perception, and cognition
Correct answer: D. Current behavior, speech, thought, perception, and cognition
PMHN Practice Exam | Page 2
, Rationale: The mental status examination describes present functioning. History
provides context but cannot substitute for observation and assessment of the
current state.
9. A patient rapidly shifts between loosely related ideas. What should be
documented?
A. Observed speech and thought examples
B. Unverified motives
C. A judgment of annoyance
D. Only noncompliance
Correct answer: A. Observed speech and thought examples
Rationale: Specific examples communicate the actual clinical pattern. Character
judgments and unsupported explanations are less useful for assessment and
continuity.
10. How should substance use be assessed?
A. Assume prescriptions cannot be misused
B. Directly and nonjudgmentally, including patterns and consequences
C. With moral criticism
D. Only illegal drugs
Correct answer: B. Directly and nonjudgmentally, including patterns and
consequences
Rationale: Broad respectful inquiry identifies intoxication, withdrawal,
interactions, and treatment needs. Alcohol, prescription drugs, and nonprescription
substances also matter.
11. A substance-using patient is obtunded with slow breathing. What is the
priority?
A. Group orientation
B. A long social history
C. Airway and ventilation support with emergency help
D. Routine meal planning
Correct answer: C. Airway and ventilation support with emergency help
Rationale: Respiratory depression is a medical emergency. Stabilization precedes
detailed psychiatric interviewing while the underlying causes are evaluated.
12. Tremor, sweating, and agitation follow cessation of heavy alcohol use.
What is appropriate?
A. Assume only anxiety
B. Leave unobserved
PMHN Practice Exam | Page 3
Choice Questions with Answers and Rationales
Practice Questions
1. A patient says, 'I do not want to live.' What should the RN do first?
A. Avoid the topic
B. Promise secrecy
C. Directly assess thoughts, intent, plan, and means
D. Assume figurative speech
Correct answer: C. Directly assess thoughts, intent, plan, and means
Rationale: Direct nonjudgmental questions clarify risk. Assessment must lead to
protective action when indicated rather than avoidance or promises that prevent
necessary disclosure.
2. A patient hears commands to self-harm. What is the priority?
A. Agree with the command
B. Change topic without assessment
C. Assess content, intent, ability to resist, and safety
D. Assume all voices create identical risk
Correct answer: C. Assess content, intent, ability to resist, and safety
Rationale: Command content and the person's response affect urgency.
Individualized assessment guides supervision and intervention rather than the
presence of hallucinations alone.
3. A patient has a suicide plan and available means. What is appropriate?
A. Leave alone to reflect
B. Wait until the next group
C. Use only a no-harm promise
D. Ensure immediate safety and urgent evaluation
Correct answer: D. Ensure immediate safety and urgent evaluation
Rationale: A feasible plan with access creates substantial concern. Protective
supervision and urgent review take priority; a promise alone is insufficient.
4. What belongs in a collaborative safety plan?
A. A guarantee of no distress
B. Only a no-harm signature
C. Warning signs, coping steps, supports, and emergency actions
D. Instructions to conceal symptoms
PMHN Practice Exam | Page 1
,Correct answer: C. Warning signs, coping steps, supports, and emergency actions
Rationale: A safety plan provides practical actions for escalating distress. It
complements assessment and treatment but does not guarantee safety or replace
indicated emergency care.
5. A severely depressed patient suddenly has more energy after treatment
begins. What is important?
A. Assume risk ended
B. Stop all observation
C. Declare complete recovery
D. Reassess activation, mood, and suicide risk
Correct answer: D. Reassess activation, mood, and suicide risk
Rationale: Energy can improve before hopelessness resolves or may represent
activation. One improved feature does not establish that risk has disappeared.
6. Which finding suggests delirium?
A. Unchanged quiet preference
B. New fluctuating attention and awareness
C. Stable lifelong personality
D. Remote history without symptoms
Correct answer: B. New fluctuating attention and awareness
Rationale: Delirium is acute and fluctuating and may reflect illness, drugs,
intoxication, or withdrawal. Prompt evaluation of causes is necessary.
7. An older patient becomes inattentive after a medication change. What is
appropriate?
A. Call it normal aging
B. Ignore it without aggression
C. Diagnose dementia without review
D. Assess and report medication or medical contributors
Correct answer: D. Assess and report medication or medical contributors
Rationale: New confusion is not ordinary aging. A calm patient can still have
serious reversible illness or medication toxicity requiring evaluation.
8. What is part of the mental status examination?
A. Only insurance details
B. Only a historical diagnosis
C. Only old school results
D. Current behavior, speech, thought, perception, and cognition
Correct answer: D. Current behavior, speech, thought, perception, and cognition
PMHN Practice Exam | Page 2
, Rationale: The mental status examination describes present functioning. History
provides context but cannot substitute for observation and assessment of the
current state.
9. A patient rapidly shifts between loosely related ideas. What should be
documented?
A. Observed speech and thought examples
B. Unverified motives
C. A judgment of annoyance
D. Only noncompliance
Correct answer: A. Observed speech and thought examples
Rationale: Specific examples communicate the actual clinical pattern. Character
judgments and unsupported explanations are less useful for assessment and
continuity.
10. How should substance use be assessed?
A. Assume prescriptions cannot be misused
B. Directly and nonjudgmentally, including patterns and consequences
C. With moral criticism
D. Only illegal drugs
Correct answer: B. Directly and nonjudgmentally, including patterns and
consequences
Rationale: Broad respectful inquiry identifies intoxication, withdrawal,
interactions, and treatment needs. Alcohol, prescription drugs, and nonprescription
substances also matter.
11. A substance-using patient is obtunded with slow breathing. What is the
priority?
A. Group orientation
B. A long social history
C. Airway and ventilation support with emergency help
D. Routine meal planning
Correct answer: C. Airway and ventilation support with emergency help
Rationale: Respiratory depression is a medical emergency. Stabilization precedes
detailed psychiatric interviewing while the underlying causes are evaluated.
12. Tremor, sweating, and agitation follow cessation of heavy alcohol use.
What is appropriate?
A. Assume only anxiety
B. Leave unobserved
PMHN Practice Exam | Page 3
