NGN Mental Health HESI Exams Versions A &
B Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed – A+
Graded
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SECTION 1: MOOD DISORDERS, SUICIDE & SELF-HARM Q1 – Q12
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Question 1 of 60
A 42-year-old woman diagnosed with major depressive disorder, recurrent, moderate, is admitted to
the psychiatric unit after her husband found her unable to get out of bed for three days. She reports
anhedonia, fatigue, psychomotor retardation, and passive suicidal ideation without a plan. Her
current medications include sertraline 100 mg daily, which she started four weeks ago. During the
morning assessment, she states, "I just feel numb — like I'm watching my life from outside." The nurse
recognizes this symptom as most consistent with which DSM-5-TR criterion?
A. Depressed mood most of the day, nearly every day
B. Markedly diminished interest or pleasure in activities
C. Feelings of worthlessness or excessive guilt
D. Depersonalization/derealization experiences ✓ CORRECT
Correct Answer: D
Rationale: Depersonalization involves a persistent feeling of being detached from one's mental
processes or body, which aligns with the patient's description of feeling "numb" and "watching my life
from outside." While anhedonia (choice B) is present, it specifically refers to loss of interest or
pleasure rather than this detached, out-of-body quality. Depersonalization can occur during severe
depressive episodes and warrants careful assessment as it may indicate increased severity or
dissociative features.
Question 2 of 60
A 28-year-old man with bipolar I disorder is brought to the emergency department by police after he
was found running through traffic, claiming he has been chosen to deliver a message from God. He
has not slept in four days, is hyperverbal, and has spent $8,000 on electronic equipment in the past
,48 hours. His lithium level is subtherapeutic at 0.4 mEq/L. The psychiatrist orders lithium carbonate
600 mg three times daily to achieve a therapeutic level. The nurse should prioritize which assessment
before administering the first dose?
A. Assess the patient's current mood and energy level
B. Verify the patient's renal function and hydration status ✓ CORRECT
C. Check the patient's thyroid-stimulating hormone level
D. Evaluate the patient's current sleep pattern
Correct Answer: B
Rationale: Lithium is primarily excreted unchanged by the kidneys, and renal impairment significantly
increases the risk of lithium toxicity, making baseline renal function and hydration status the priority
assessment before initiating or increasing lithium therapy. While thyroid function (choice C) is
important for long-term lithium monitoring, it is not the priority before the first dose in an acute manic
presentation where renal clearance directly impacts safety.
Question 3 of 60
A 19-year-old college student is admitted to the psychiatric unit after her roommate found her cutting
her forearms with a razor blade following a breakup. The patient has multiple superficial parallel
lacerations on her left forearm and states, "The cutting helps me feel something when I'm empty
inside. I don't want to die — I just need the pain to stop." She has a history of three previous self-harm
episodes over the past year. Which nursing intervention is the priority during the first 24 hours of
admission?
A. Encourage the patient to journal about her feelings of emptiness
B. Remove all sharps and implement continuous visual observation ✓ CORRECT
C. Administer a PRN anxiolytic to reduce emotional distress
D. Facilitate a family meeting to discuss relationship stressors
Correct Answer: B
Rationale: Safety is the foundational priority in psychiatric nursing, and removing all potential
self-harm implements while maintaining continuous visual observation directly addresses the
immediate risk of further self-injury or escalation to suicidal behavior. Journaling (choice A) is a
valuable therapeutic intervention but is inappropriate until safety is established, as writing
instruments could be used for self-harm and the patient requires stabilization first.
Question 4 of 60
A 55-year-old man with treatment-resistant major depressive disorder is scheduled for his fourth
electroconvulsive therapy (ECT) session tomorrow morning. During the evening assessment, he tells
the nurse, "I'm terrified they'll shock my brain and I'll forget everything — my kids' names, my job, who I
,am." Which therapeutic response by the nurse best addresses his anxiety while remaining clinically
accurate?
A. "ECT doesn't cause any memory problems, so you have nothing to worry about."
B. "Some people experience temporary confusion and short-term memory gaps around the time of
treatment, but these typically improve within weeks." ✓ CORRECT
C. "Memory loss is permanent, but most patients say the depression relief is worth it."
D. "Your doctor wouldn't recommend this if it wasn't completely safe for your memory."
Correct Answer: B
Rationale: This response is therapeutically honest and accurate, validating the patient's fear while
providing realistic information that retrograde amnesia for events surrounding ECT is common but
typically transient, which builds trust through transparency. Choice A is incorrect because it
dismisses a legitimate side effect and violates therapeutic communication principles by providing
false reassurance, which undermines the nurse-patient relationship when the patient discovers the
truth.
Question 5 of 60
A 34-year-old woman with postpartum depression is being evaluated in the outpatient clinic six
weeks after delivery. She reports persistent sadness, difficulty bonding with her infant, overwhelming
fatigue, and intrusive thoughts that she might accidentally harm her baby by dropping him. She has
no plan or intent to harm the infant and is distressed by these thoughts. Her Edinburgh Postnatal
Depression Scale score is 18. Which nursing action is most appropriate?
A. Immediately contact child protective services to ensure infant safety
B. Reassure the patient that intrusive thoughts are common and do not mean she will act on them,
while initiating treatment ✓ CORRECT
C. Recommend that the patient avoid being alone with the infant until thoughts resolve
D. Advise the patient that these thoughts indicate postpartum psychosis requiring inpatient
admission
Correct Answer: B
Rationale: Intrusive thoughts of infant harm in postpartum depression are ego-dystonic, meaning the
patient is distressed by them and has no intent to act, which distinguishes this from postpartum
psychosis where thoughts are ego-syntonic and accompanied by delusions or command
hallucinations. Calling child protective services (choice A) is inappropriate and harmful when there is
no actual risk to the infant, as it would increase the mother's shame and potentially deter her from
seeking essential mental health care.
Question 6 of 60
, A 67-year-old man with a new diagnosis of major neurocognitive disorder due to Alzheimer's disease
is started on donepezil 5 mg daily. His daughter, who is his primary caregiver, calls the clinic and
reports that her father has become increasingly irritable, is sleeping poorly, and made statements like
"I don't want to be a burden anymore" after watching a news story about assisted dying. Which
response by the nurse demonstrates the best clinical judgment?
A. "These mood changes are expected with Alzheimer's — just monitor him closely."
B. "We need to evaluate him immediately for depression and suicidal ideation, as older adults with
dementia have elevated suicide risk." ✓ CORRECT
C. "Donepezil commonly causes irritability and sleep disturbance — let's stop the medication."
D. "He probably just needs more social activities to improve his mood."
Correct Answer: B
Rationale: Older adults with neurocognitive disorders face significantly elevated suicide risk,
particularly in early stages when insight is preserved, and any statements about being a burden
combined with mood changes require immediate comprehensive assessment rather than dismissal
or attribution solely to medication. Choice A minimizes potentially life-threatening symptoms and
reflects ageist assumptions that depression is a normal part of dementia, which violates standards
of geropsychiatric care.
Question 7 of 60
A 31-year-old woman with bipolar II disorder presents to the clinic in a hypomanic state. She reports
sleeping only three hours nightly for the past week, has started three new business ventures, and is
spending excessive amounts of money on cryptocurrency. Her current medication is lamotrigine 200
mg daily. The psychiatrist adds quetiapine 100 mg at bedtime. The nurse should include which
teaching point as the highest priority?
A. "Take this medication with food to improve absorption."
B. "Rise slowly from sitting or lying positions to prevent dizziness from orthostatic hypotension." ✓
CORRECT
C. "You may experience increased appetite and weight gain over time."
D. "Avoid driving until you know how this medication affects you."
Correct Answer: B
Rationale: Quetiapine causes significant alpha-1 adrenergic blockade leading to orthostatic
hypotension, which poses an immediate safety risk for falls and injury, making it the highest priority
teaching point before the patient leaves the clinic. While weight gain (choice C) is a valid long-term
concern with quetiapine, it does not represent an immediate safety threat compared to the risk of
syncope and injury from orthostatic hypotension, especially in an energized hypomanic patient.
Question 8 of 60
B Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed – A+
Graded
══════════════════════════════════════
SECTION 1: MOOD DISORDERS, SUICIDE & SELF-HARM Q1 – Q12
══════════════════════════════════════
Question 1 of 60
A 42-year-old woman diagnosed with major depressive disorder, recurrent, moderate, is admitted to
the psychiatric unit after her husband found her unable to get out of bed for three days. She reports
anhedonia, fatigue, psychomotor retardation, and passive suicidal ideation without a plan. Her
current medications include sertraline 100 mg daily, which she started four weeks ago. During the
morning assessment, she states, "I just feel numb — like I'm watching my life from outside." The nurse
recognizes this symptom as most consistent with which DSM-5-TR criterion?
A. Depressed mood most of the day, nearly every day
B. Markedly diminished interest or pleasure in activities
C. Feelings of worthlessness or excessive guilt
D. Depersonalization/derealization experiences ✓ CORRECT
Correct Answer: D
Rationale: Depersonalization involves a persistent feeling of being detached from one's mental
processes or body, which aligns with the patient's description of feeling "numb" and "watching my life
from outside." While anhedonia (choice B) is present, it specifically refers to loss of interest or
pleasure rather than this detached, out-of-body quality. Depersonalization can occur during severe
depressive episodes and warrants careful assessment as it may indicate increased severity or
dissociative features.
Question 2 of 60
A 28-year-old man with bipolar I disorder is brought to the emergency department by police after he
was found running through traffic, claiming he has been chosen to deliver a message from God. He
has not slept in four days, is hyperverbal, and has spent $8,000 on electronic equipment in the past
,48 hours. His lithium level is subtherapeutic at 0.4 mEq/L. The psychiatrist orders lithium carbonate
600 mg three times daily to achieve a therapeutic level. The nurse should prioritize which assessment
before administering the first dose?
A. Assess the patient's current mood and energy level
B. Verify the patient's renal function and hydration status ✓ CORRECT
C. Check the patient's thyroid-stimulating hormone level
D. Evaluate the patient's current sleep pattern
Correct Answer: B
Rationale: Lithium is primarily excreted unchanged by the kidneys, and renal impairment significantly
increases the risk of lithium toxicity, making baseline renal function and hydration status the priority
assessment before initiating or increasing lithium therapy. While thyroid function (choice C) is
important for long-term lithium monitoring, it is not the priority before the first dose in an acute manic
presentation where renal clearance directly impacts safety.
Question 3 of 60
A 19-year-old college student is admitted to the psychiatric unit after her roommate found her cutting
her forearms with a razor blade following a breakup. The patient has multiple superficial parallel
lacerations on her left forearm and states, "The cutting helps me feel something when I'm empty
inside. I don't want to die — I just need the pain to stop." She has a history of three previous self-harm
episodes over the past year. Which nursing intervention is the priority during the first 24 hours of
admission?
A. Encourage the patient to journal about her feelings of emptiness
B. Remove all sharps and implement continuous visual observation ✓ CORRECT
C. Administer a PRN anxiolytic to reduce emotional distress
D. Facilitate a family meeting to discuss relationship stressors
Correct Answer: B
Rationale: Safety is the foundational priority in psychiatric nursing, and removing all potential
self-harm implements while maintaining continuous visual observation directly addresses the
immediate risk of further self-injury or escalation to suicidal behavior. Journaling (choice A) is a
valuable therapeutic intervention but is inappropriate until safety is established, as writing
instruments could be used for self-harm and the patient requires stabilization first.
Question 4 of 60
A 55-year-old man with treatment-resistant major depressive disorder is scheduled for his fourth
electroconvulsive therapy (ECT) session tomorrow morning. During the evening assessment, he tells
the nurse, "I'm terrified they'll shock my brain and I'll forget everything — my kids' names, my job, who I
,am." Which therapeutic response by the nurse best addresses his anxiety while remaining clinically
accurate?
A. "ECT doesn't cause any memory problems, so you have nothing to worry about."
B. "Some people experience temporary confusion and short-term memory gaps around the time of
treatment, but these typically improve within weeks." ✓ CORRECT
C. "Memory loss is permanent, but most patients say the depression relief is worth it."
D. "Your doctor wouldn't recommend this if it wasn't completely safe for your memory."
Correct Answer: B
Rationale: This response is therapeutically honest and accurate, validating the patient's fear while
providing realistic information that retrograde amnesia for events surrounding ECT is common but
typically transient, which builds trust through transparency. Choice A is incorrect because it
dismisses a legitimate side effect and violates therapeutic communication principles by providing
false reassurance, which undermines the nurse-patient relationship when the patient discovers the
truth.
Question 5 of 60
A 34-year-old woman with postpartum depression is being evaluated in the outpatient clinic six
weeks after delivery. She reports persistent sadness, difficulty bonding with her infant, overwhelming
fatigue, and intrusive thoughts that she might accidentally harm her baby by dropping him. She has
no plan or intent to harm the infant and is distressed by these thoughts. Her Edinburgh Postnatal
Depression Scale score is 18. Which nursing action is most appropriate?
A. Immediately contact child protective services to ensure infant safety
B. Reassure the patient that intrusive thoughts are common and do not mean she will act on them,
while initiating treatment ✓ CORRECT
C. Recommend that the patient avoid being alone with the infant until thoughts resolve
D. Advise the patient that these thoughts indicate postpartum psychosis requiring inpatient
admission
Correct Answer: B
Rationale: Intrusive thoughts of infant harm in postpartum depression are ego-dystonic, meaning the
patient is distressed by them and has no intent to act, which distinguishes this from postpartum
psychosis where thoughts are ego-syntonic and accompanied by delusions or command
hallucinations. Calling child protective services (choice A) is inappropriate and harmful when there is
no actual risk to the infant, as it would increase the mother's shame and potentially deter her from
seeking essential mental health care.
Question 6 of 60
, A 67-year-old man with a new diagnosis of major neurocognitive disorder due to Alzheimer's disease
is started on donepezil 5 mg daily. His daughter, who is his primary caregiver, calls the clinic and
reports that her father has become increasingly irritable, is sleeping poorly, and made statements like
"I don't want to be a burden anymore" after watching a news story about assisted dying. Which
response by the nurse demonstrates the best clinical judgment?
A. "These mood changes are expected with Alzheimer's — just monitor him closely."
B. "We need to evaluate him immediately for depression and suicidal ideation, as older adults with
dementia have elevated suicide risk." ✓ CORRECT
C. "Donepezil commonly causes irritability and sleep disturbance — let's stop the medication."
D. "He probably just needs more social activities to improve his mood."
Correct Answer: B
Rationale: Older adults with neurocognitive disorders face significantly elevated suicide risk,
particularly in early stages when insight is preserved, and any statements about being a burden
combined with mood changes require immediate comprehensive assessment rather than dismissal
or attribution solely to medication. Choice A minimizes potentially life-threatening symptoms and
reflects ageist assumptions that depression is a normal part of dementia, which violates standards
of geropsychiatric care.
Question 7 of 60
A 31-year-old woman with bipolar II disorder presents to the clinic in a hypomanic state. She reports
sleeping only three hours nightly for the past week, has started three new business ventures, and is
spending excessive amounts of money on cryptocurrency. Her current medication is lamotrigine 200
mg daily. The psychiatrist adds quetiapine 100 mg at bedtime. The nurse should include which
teaching point as the highest priority?
A. "Take this medication with food to improve absorption."
B. "Rise slowly from sitting or lying positions to prevent dizziness from orthostatic hypotension." ✓
CORRECT
C. "You may experience increased appetite and weight gain over time."
D. "Avoid driving until you know how this medication affects you."
Correct Answer: B
Rationale: Quetiapine causes significant alpha-1 adrenergic blockade leading to orthostatic
hypotension, which poses an immediate safety risk for falls and injury, making it the highest priority
teaching point before the patient leaves the clinic. While weight gain (choice C) is a valid long-term
concern with quetiapine, it does not represent an immediate safety threat compared to the risk of
syncope and injury from orthostatic hypotension, especially in an energized hypomanic patient.
Question 8 of 60
