HESI RN Psychiatric / Mental Health Nursing Exam
2026/2027 | Newly Released
Actual 75 questions with Correct Answers and Expert
Explanations
Q1: A patient with schizophrenia tells the nurse, "The FBI is listening to my thoughts through the
smoke detectors." What is the best nursing response?
A. "That is a delusion. The smoke detectors are just electric."
B. "I can hear how frightening that must be for you." [CORRECT]
C. "Let's go to a room without smoke detectors so you feel better."
D. "Why would the FBI want to listen to your thoughts?"
Correct Answer: B
Rationale: The best answer is acknowledging the patient's feelings without validating the
delusion, which builds trust while avoiding an argument about reality.
Q2: A nurse is interacting with a patient who is crying silently after receiving a terminal
diagnosis. Which therapeutic communication technique is the nurse using by sitting quietly and
handing the patient a tissue?
A. Reflecting
B. Offering self
C. Using silence [CORRECT]
D. Clarifying
Correct Answer: C
Rationale: The best answer is using silence because it gives the patient time to process their
emotions and communicates that the nurse is present and supportive without rushing them to
speak.
,Q3: A patient is started on lithium for bipolar disorder. The nurse teaches the patient to maintain
an adequate intake of which substance to help prevent lithium toxicity?
A. Potassium
B. Sodium [CORRECT]
C. Calcium
D. Magnesium
Correct Answer: B
Rationale: The best answer is sodium because lithium and sodium compete for reabsorption in
the kidneys, so low sodium levels can cause lithium to build up to toxic levels in the blood.
Q4: During a suicide risk assessment, which question is the most direct and appropriate for the
nurse to ask?
A. "You aren't thinking about hurting yourself, are you?"
B. "Are you having thoughts of killing yourself?" [CORRECT]
C. "Why would you want to end your life?"
D. "How would your family feel if you died?"
Correct Answer: B
Rationale: The best answer is asking directly about suicidal ideation because research shows that
direct, clear questioning does not plant the idea of suicide and is necessary for accurate risk
assessment.
Q5: A patient on an involuntary psychiatric hold attempts to leave the unit. What is the nurse's
primary legal obligation?
A. Call the police to have the patient arrested for trespassing.
B. Physically block the door to prevent the patient from exiting.
C. Use therapeutic communication to convince the patient to stay.
D. Prevent the patient from leaving by using the least restrictive interventions possible.
[CORRECT]
Correct Answer: D
,Rationale: The best answer is using the least restrictive interventions because patients on
involuntary holds have lost their right to leave, but the nurse must still uphold their other rights
by avoiding unnecessary physical force when de-escalation or redirection is possible.
NGN Case Study 1
[Electronic Health Record]
History: A 42-year-old patient is admitted with severe major depressive disorder. They have a
history of two prior suicide attempts by overdose. The patient reports sleeping only 2 hours a
night, significant weight loss, and overwhelming feelings of worthlessness.
Vital Signs: BP 110/70, HR 62, RR 16, Temp 98.6°F.
Mental Status Exam: Appearance is disheveled with poor hygiene. Mood is depressed and
anxious. Affect is constricted. Speech is slow with delayed responses. The patient states, "I just
can't keep living like this, but I don't have the energy to do anything about it."
Nurse's Notes: Patient refuses to eat lunch and remains in bed with the blanket over their head.
Patient agreed to a 1:1 sitter but states, "It doesn't matter anyway."
Q6: Based on the mental status exam, which cue is the most critical for the nurse to analyze
regarding the patient's immediate safety?
A. Disheveled appearance and poor hygiene
B. Slow speech with delayed responses
C. Statement of worthlessness combined with a history of prior suicide attempts [CORRECT]
D. Constricted affect
Correct Answer: C
Rationale: The best answer is the statement of worthlessness combined with prior attempts
because this specific data indicates a high risk for suicide, making it the priority safety concern
over general depression symptoms.
, Q7: The nurse is planning care for this patient. Which interventions should the nurse implement
to ensure a safe environment? Select all that apply.
A. Assign the patient to a room at the end of the hallway [CORRECT]
B. Remove all sharps, cords, and potential hazards from the room [CORRECT]
C. Allow the patient to keep their prescribed medications at the bedside for independence
D. Maintain continuous 1:1 observation as ordered [CORRECT]
E. Encourage the patient to spend time alone in their room to rest
Correct Answer: A, B, D
Rationale: The best answers are placing the patient where they can be easily observed, removing
lethal means, and maintaining continuous observation, as these are standard suicide precautions;
keeping meds at the bedside and isolation increase risk.
Q8: The provider prescribes sertraline (Zoloft). What is the priority teaching the nurse must
provide regarding this medication?
A. "You may feel much better within the first 48 hours of taking this."
B. "It is important to report any worsening depression or thoughts of suicide, especially in
the first few weeks." [CORRECT]
C. "You must avoid eating foods containing tyramine while on this medication."
D. "This medication will make you feel very drowsy, so take it at night."
Correct Answer: B
Rationale: The best answer is warning about the risk of increased suicidal ideation because the
FDA requires a black box warning for antidepressants regarding this risk, particularly in the early
stages of treatment or dose changes.
Q9: The patient says to the nurse, "I'm so worthless. My kids are better off without me." What is
the best therapeutic response?
A. "You have a wonderful family who loves you very much."
B. "You feel worthless right now, but things will get better."
C. "Can you tell me more about what makes you feel worthless?" [CORRECT]
D. "Why would you say that? You have a great job."
2026/2027 | Newly Released
Actual 75 questions with Correct Answers and Expert
Explanations
Q1: A patient with schizophrenia tells the nurse, "The FBI is listening to my thoughts through the
smoke detectors." What is the best nursing response?
A. "That is a delusion. The smoke detectors are just electric."
B. "I can hear how frightening that must be for you." [CORRECT]
C. "Let's go to a room without smoke detectors so you feel better."
D. "Why would the FBI want to listen to your thoughts?"
Correct Answer: B
Rationale: The best answer is acknowledging the patient's feelings without validating the
delusion, which builds trust while avoiding an argument about reality.
Q2: A nurse is interacting with a patient who is crying silently after receiving a terminal
diagnosis. Which therapeutic communication technique is the nurse using by sitting quietly and
handing the patient a tissue?
A. Reflecting
B. Offering self
C. Using silence [CORRECT]
D. Clarifying
Correct Answer: C
Rationale: The best answer is using silence because it gives the patient time to process their
emotions and communicates that the nurse is present and supportive without rushing them to
speak.
,Q3: A patient is started on lithium for bipolar disorder. The nurse teaches the patient to maintain
an adequate intake of which substance to help prevent lithium toxicity?
A. Potassium
B. Sodium [CORRECT]
C. Calcium
D. Magnesium
Correct Answer: B
Rationale: The best answer is sodium because lithium and sodium compete for reabsorption in
the kidneys, so low sodium levels can cause lithium to build up to toxic levels in the blood.
Q4: During a suicide risk assessment, which question is the most direct and appropriate for the
nurse to ask?
A. "You aren't thinking about hurting yourself, are you?"
B. "Are you having thoughts of killing yourself?" [CORRECT]
C. "Why would you want to end your life?"
D. "How would your family feel if you died?"
Correct Answer: B
Rationale: The best answer is asking directly about suicidal ideation because research shows that
direct, clear questioning does not plant the idea of suicide and is necessary for accurate risk
assessment.
Q5: A patient on an involuntary psychiatric hold attempts to leave the unit. What is the nurse's
primary legal obligation?
A. Call the police to have the patient arrested for trespassing.
B. Physically block the door to prevent the patient from exiting.
C. Use therapeutic communication to convince the patient to stay.
D. Prevent the patient from leaving by using the least restrictive interventions possible.
[CORRECT]
Correct Answer: D
,Rationale: The best answer is using the least restrictive interventions because patients on
involuntary holds have lost their right to leave, but the nurse must still uphold their other rights
by avoiding unnecessary physical force when de-escalation or redirection is possible.
NGN Case Study 1
[Electronic Health Record]
History: A 42-year-old patient is admitted with severe major depressive disorder. They have a
history of two prior suicide attempts by overdose. The patient reports sleeping only 2 hours a
night, significant weight loss, and overwhelming feelings of worthlessness.
Vital Signs: BP 110/70, HR 62, RR 16, Temp 98.6°F.
Mental Status Exam: Appearance is disheveled with poor hygiene. Mood is depressed and
anxious. Affect is constricted. Speech is slow with delayed responses. The patient states, "I just
can't keep living like this, but I don't have the energy to do anything about it."
Nurse's Notes: Patient refuses to eat lunch and remains in bed with the blanket over their head.
Patient agreed to a 1:1 sitter but states, "It doesn't matter anyway."
Q6: Based on the mental status exam, which cue is the most critical for the nurse to analyze
regarding the patient's immediate safety?
A. Disheveled appearance and poor hygiene
B. Slow speech with delayed responses
C. Statement of worthlessness combined with a history of prior suicide attempts [CORRECT]
D. Constricted affect
Correct Answer: C
Rationale: The best answer is the statement of worthlessness combined with prior attempts
because this specific data indicates a high risk for suicide, making it the priority safety concern
over general depression symptoms.
, Q7: The nurse is planning care for this patient. Which interventions should the nurse implement
to ensure a safe environment? Select all that apply.
A. Assign the patient to a room at the end of the hallway [CORRECT]
B. Remove all sharps, cords, and potential hazards from the room [CORRECT]
C. Allow the patient to keep their prescribed medications at the bedside for independence
D. Maintain continuous 1:1 observation as ordered [CORRECT]
E. Encourage the patient to spend time alone in their room to rest
Correct Answer: A, B, D
Rationale: The best answers are placing the patient where they can be easily observed, removing
lethal means, and maintaining continuous observation, as these are standard suicide precautions;
keeping meds at the bedside and isolation increase risk.
Q8: The provider prescribes sertraline (Zoloft). What is the priority teaching the nurse must
provide regarding this medication?
A. "You may feel much better within the first 48 hours of taking this."
B. "It is important to report any worsening depression or thoughts of suicide, especially in
the first few weeks." [CORRECT]
C. "You must avoid eating foods containing tyramine while on this medication."
D. "This medication will make you feel very drowsy, so take it at night."
Correct Answer: B
Rationale: The best answer is warning about the risk of increased suicidal ideation because the
FDA requires a black box warning for antidepressants regarding this risk, particularly in the early
stages of treatment or dose changes.
Q9: The patient says to the nurse, "I'm so worthless. My kids are better off without me." What is
the best therapeutic response?
A. "You have a wonderful family who loves you very much."
B. "You feel worthless right now, but things will get better."
C. "Can you tell me more about what makes you feel worthless?" [CORRECT]
D. "Why would you say that? You have a great job."
