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
══════════════════════════════════════
SECTION 1: MOOD DISORDERS, SUICIDE & SELF-HARM Q1 – Q12
══════════════════════════════════════
Question 1 of 60
A 19-year-old college freshman is brought to the emergency department by her roommate
after writing a goodbye note and giving away prized possessions. She has a history of major
depressive disorder and was started on sertraline 50 mg three weeks ago by her primary care
provider. Her vital signs are stable, but she refuses to answer direct questions about a
suicide plan. Her parents are demanding she be discharged immediately so she can attend
her midterm exams tomorrow.
A. Honor the parents' request and discharge the patient with a follow-up appointment in one
week
B. Initiate one-to-one continuous observation and place the patient on suicide precautions ✓
CORRECT
C. Increase the sertraline dose to 100 mg immediately to achieve therapeutic effect sooner
D. Ask the roommate to sign out the patient against medical advice and drive her home
Correct Answer: B
Rationale: Any patient who has written a goodbye note and given away possessions has
demonstrated suicidal intent and requires immediate one-to-one observation and suicide
precautions per The Joint Commission standards. Discharging the patient to attend midterm
exams ignores the acute risk and violates the duty to protect a vulnerable patient from
self-harm. On the NGN exam, always prioritize patient safety over family demands when
suicide risk is present.
Question 2 of 60
A 34-year-old woman with bipolar I disorder is admitted to the inpatient psychiatric unit during
a manic episode. She has not slept in four days, is spending excessively on online shopping,
,and believes she is a famous inventor. Her current medications include lithium carbonate 600
mg BID, but her most recent lithium level was 0.4 mEq/L. She refuses to take her evening
lithium dose and insists she must leave to attend a business meeting with NASA.
A. Allow her to leave the unit for one hour to reduce her agitation and build trust
B. Restrain her in four-point leather restraints to prevent elopement
C. Administer her lithium via intramuscular injection against her will
D. Offer a PRN dose of haloperidol 5 mg PO and redirect her to a low-stimulation environment
✓ CORRECT
Correct Answer: D
Rationale: During acute mania, offering an antipsychotic such as haloperidol addresses
agitation and psychotic features while protecting patient dignity, and redirecting to a
low-stimulation environment supports sensory modulation. Allowing elopement risks patient
safety and violates the duty to protect, while restraints should only be used when less
restrictive interventions have failed and the patient is an imminent danger. Forced lithium
administration is inappropriate when the patient has capacity to refuse, and her
subtherapeutic level explains her continued symptoms.
Question 3 of 60
A 28-year-old woman delivered a healthy baby girl three weeks ago and presents to the
maternal mental health clinic with her husband. She reports feeling numb, unable to bond with
her infant, and consumed by intrusive thoughts that she might accidentally drop the baby
down the stairs. She sleeps only two hours per night because she repeatedly checks the crib
to ensure the baby is breathing. Her husband states she has not eaten a full meal in five days.
A. Recognize these symptoms as consistent with postpartum obsessive-compulsive disorder
and initiate SSRI therapy with exposure-based CBT ✓ CORRECT
B. Reassure the husband that all new mothers experience baby blues and recommend
increased rest
C. Immediately file a report with child protective services due to the mother's intrusive
thoughts
D. Prescribe zolpidem 10 mg nightly to improve her sleep and reduce nighttime anxiety
Correct Answer: A
Rationale: Intrusive thoughts of harm toward the infant accompanied by compulsive checking
behaviors in the postpartum period are hallmark features of postpartum OCD, not psychosis,
and require SSRI therapy combined with exposure and response prevention. Labeling these
symptoms as typical baby blues delays necessary treatment and increases maternal
suffering, while filing a CPS report inappropriately pathologizes ego-dystonic thoughts that
the mother finds distressing and is actively trying to prevent. Zolpidem addresses only
insomnia and ignores the underlying obsessive-compulsive pathology that places both
mother and infant at risk for attachment disruption.
,Question 4 of 60
A 52-year-old man with recurrent major depressive disorder has failed trials of sertraline,
venlafaxine, and bupropion over the past 18 months. His psychiatrist is recommending
electroconvulsive therapy (ECT). The patient tells the psychiatric nurse, "My neighbor said
ECT is barbaric and will fry my brain like in the movies. I'm terrified to consent." He asks the
nurse what he should do.
A. Validate his fear by agreeing that ECT carries a high risk of permanent brain damage
B. Tell him to refuse ECT and demand another medication trial with a tricyclic antidepressant
C. Explain that modern ECT uses anesthesia and controlled electrical stimuli with temporary
memory side effects as the primary risk ✓ CORRECT
D. Suggest he watch online videos of ECT procedures to help him make an informed decision
Correct Answer: C
Rationale: The psychiatric nurse must provide accurate, evidence-based education about ECT,
which is performed under general anesthesia with muscle relaxation and uses brief-pulse
electrical stimulation that typically causes temporary retrograde amnesia rather than brain
damage. Agreeing that ECT causes permanent brain damage reinforces stigma and
constitutes misinformation that violates the ethical duty of veracity. Refusing a potentially
life-saving treatment based on cinematic stereotypes denies the patient a therapy with
documented efficacy for treatment-resistant depression.
Question 5 of 60
A 41-year-old woman with bipolar II disorder has been stable on lamotrigine 200 mg daily for
two years. She arrives at the clinic complaining of a mildly itchy rash on her chest that began
yesterday. She denies fever, mucosal involvement, or systemic symptoms, but mentions she
recently started taking over-the-counter ibuprofen daily for knee pain.
A. Instruct her to continue lamotrigine and apply topical hydrocortisone for the rash
B. Hold lamotrigine immediately and have the patient evaluated for Stevens-Johnson
syndrome ✓ CORRECT
C. Switch her to carbamazepine to maintain mood stability while the rash resolves
D. Advise her to stop the ibuprofen and continue lamotrigine since NSAIDs do not interact
Correct Answer: B
Rationale: Any rash occurring during lamotrigine therapy must be evaluated immediately for
Stevens-Johnson syndrome or toxic epidermal necrolysis, as these potentially fatal
dermatologic reactions can progress rapidly even when initial symptoms appear benign.
Continuing lamotrigine while applying topical steroids delays critical assessment and places
the patient at risk for mucosal involvement and systemic complications. Switching to
carbamazepine without assessing the rash is premature and introduces another medication
with its own serious adverse effect profile, including its own risk of severe rash.
, Question 6 of 60
A 23-year-old male veteran is admitted to the psychiatric unit after his girlfriend found him
unconscious in the garage with the car running and the door closed. He regained
consciousness in the emergency department and states, "I just wanted the pain to stop. I
didn't mean for anyone to find me." He has a history of PTSD and recently stopped taking his
prescribed paroxetine because he felt "numb and disconnected." He is now alert, oriented, and
cooperative.
A. Document his statement as a parasuicide gesture and downgrade his observation level to
every fifteen minutes
B. Discharge him with a safety plan because he denies current suicidal intent and is
cooperative
C. Place him on one-to-one observation only during the night shift when suicide risk is
highest
D. Maintain continuous one-to-one observation and initiate a psychiatric safety assessment
including means restriction counseling ✓ CORRECT
Correct Answer: D
Rationale: A suicide attempt by carbon monoxide poisoning represents high-lethality intent
regardless of the patient's current denial of suicidal ideation, and continuous observation
combined with safety assessment including means restriction is mandatory. Downgrading
observation based on superficial cooperation ignores the fluctuating nature of suicidal intent
and the patient's recent medication nonadherence, which has destabilized his mood.
Discharging a patient who attempted suicide by a highly lethal method within hours of
admission would constitute gross negligence and place the patient at imminent risk for a
fatal reattempt.
Question 7 of 60
A 37-year-old woman with treatment-resistant major depressive disorder is started on
phenelzine 15 mg TID after failing multiple SSRI trials. During medication education, she asks
the psychiatric nurse whether she can continue drinking her usual two glasses of red wine
with dinner and whether she needs to avoid any foods.
A. Instruct her to avoid all aged cheeses, cured meats, red wine, and fermented soy products
to prevent hypertensive crisis ✓ CORRECT
B. Tell her that moderate red wine consumption is acceptable because only hard liquor
interacts with MAOIs
C. Advise her to avoid only cheddar cheese and continue all other dietary habits without
restriction
D. Explain that dietary restrictions are outdated and modern MAOIs no longer require
tyramine avoidance
& 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 19-year-old college freshman is brought to the emergency department by her roommate
after writing a goodbye note and giving away prized possessions. She has a history of major
depressive disorder and was started on sertraline 50 mg three weeks ago by her primary care
provider. Her vital signs are stable, but she refuses to answer direct questions about a
suicide plan. Her parents are demanding she be discharged immediately so she can attend
her midterm exams tomorrow.
A. Honor the parents' request and discharge the patient with a follow-up appointment in one
week
B. Initiate one-to-one continuous observation and place the patient on suicide precautions ✓
CORRECT
C. Increase the sertraline dose to 100 mg immediately to achieve therapeutic effect sooner
D. Ask the roommate to sign out the patient against medical advice and drive her home
Correct Answer: B
Rationale: Any patient who has written a goodbye note and given away possessions has
demonstrated suicidal intent and requires immediate one-to-one observation and suicide
precautions per The Joint Commission standards. Discharging the patient to attend midterm
exams ignores the acute risk and violates the duty to protect a vulnerable patient from
self-harm. On the NGN exam, always prioritize patient safety over family demands when
suicide risk is present.
Question 2 of 60
A 34-year-old woman with bipolar I disorder is admitted to the inpatient psychiatric unit during
a manic episode. She has not slept in four days, is spending excessively on online shopping,
,and believes she is a famous inventor. Her current medications include lithium carbonate 600
mg BID, but her most recent lithium level was 0.4 mEq/L. She refuses to take her evening
lithium dose and insists she must leave to attend a business meeting with NASA.
A. Allow her to leave the unit for one hour to reduce her agitation and build trust
B. Restrain her in four-point leather restraints to prevent elopement
C. Administer her lithium via intramuscular injection against her will
D. Offer a PRN dose of haloperidol 5 mg PO and redirect her to a low-stimulation environment
✓ CORRECT
Correct Answer: D
Rationale: During acute mania, offering an antipsychotic such as haloperidol addresses
agitation and psychotic features while protecting patient dignity, and redirecting to a
low-stimulation environment supports sensory modulation. Allowing elopement risks patient
safety and violates the duty to protect, while restraints should only be used when less
restrictive interventions have failed and the patient is an imminent danger. Forced lithium
administration is inappropriate when the patient has capacity to refuse, and her
subtherapeutic level explains her continued symptoms.
Question 3 of 60
A 28-year-old woman delivered a healthy baby girl three weeks ago and presents to the
maternal mental health clinic with her husband. She reports feeling numb, unable to bond with
her infant, and consumed by intrusive thoughts that she might accidentally drop the baby
down the stairs. She sleeps only two hours per night because she repeatedly checks the crib
to ensure the baby is breathing. Her husband states she has not eaten a full meal in five days.
A. Recognize these symptoms as consistent with postpartum obsessive-compulsive disorder
and initiate SSRI therapy with exposure-based CBT ✓ CORRECT
B. Reassure the husband that all new mothers experience baby blues and recommend
increased rest
C. Immediately file a report with child protective services due to the mother's intrusive
thoughts
D. Prescribe zolpidem 10 mg nightly to improve her sleep and reduce nighttime anxiety
Correct Answer: A
Rationale: Intrusive thoughts of harm toward the infant accompanied by compulsive checking
behaviors in the postpartum period are hallmark features of postpartum OCD, not psychosis,
and require SSRI therapy combined with exposure and response prevention. Labeling these
symptoms as typical baby blues delays necessary treatment and increases maternal
suffering, while filing a CPS report inappropriately pathologizes ego-dystonic thoughts that
the mother finds distressing and is actively trying to prevent. Zolpidem addresses only
insomnia and ignores the underlying obsessive-compulsive pathology that places both
mother and infant at risk for attachment disruption.
,Question 4 of 60
A 52-year-old man with recurrent major depressive disorder has failed trials of sertraline,
venlafaxine, and bupropion over the past 18 months. His psychiatrist is recommending
electroconvulsive therapy (ECT). The patient tells the psychiatric nurse, "My neighbor said
ECT is barbaric and will fry my brain like in the movies. I'm terrified to consent." He asks the
nurse what he should do.
A. Validate his fear by agreeing that ECT carries a high risk of permanent brain damage
B. Tell him to refuse ECT and demand another medication trial with a tricyclic antidepressant
C. Explain that modern ECT uses anesthesia and controlled electrical stimuli with temporary
memory side effects as the primary risk ✓ CORRECT
D. Suggest he watch online videos of ECT procedures to help him make an informed decision
Correct Answer: C
Rationale: The psychiatric nurse must provide accurate, evidence-based education about ECT,
which is performed under general anesthesia with muscle relaxation and uses brief-pulse
electrical stimulation that typically causes temporary retrograde amnesia rather than brain
damage. Agreeing that ECT causes permanent brain damage reinforces stigma and
constitutes misinformation that violates the ethical duty of veracity. Refusing a potentially
life-saving treatment based on cinematic stereotypes denies the patient a therapy with
documented efficacy for treatment-resistant depression.
Question 5 of 60
A 41-year-old woman with bipolar II disorder has been stable on lamotrigine 200 mg daily for
two years. She arrives at the clinic complaining of a mildly itchy rash on her chest that began
yesterday. She denies fever, mucosal involvement, or systemic symptoms, but mentions she
recently started taking over-the-counter ibuprofen daily for knee pain.
A. Instruct her to continue lamotrigine and apply topical hydrocortisone for the rash
B. Hold lamotrigine immediately and have the patient evaluated for Stevens-Johnson
syndrome ✓ CORRECT
C. Switch her to carbamazepine to maintain mood stability while the rash resolves
D. Advise her to stop the ibuprofen and continue lamotrigine since NSAIDs do not interact
Correct Answer: B
Rationale: Any rash occurring during lamotrigine therapy must be evaluated immediately for
Stevens-Johnson syndrome or toxic epidermal necrolysis, as these potentially fatal
dermatologic reactions can progress rapidly even when initial symptoms appear benign.
Continuing lamotrigine while applying topical steroids delays critical assessment and places
the patient at risk for mucosal involvement and systemic complications. Switching to
carbamazepine without assessing the rash is premature and introduces another medication
with its own serious adverse effect profile, including its own risk of severe rash.
, Question 6 of 60
A 23-year-old male veteran is admitted to the psychiatric unit after his girlfriend found him
unconscious in the garage with the car running and the door closed. He regained
consciousness in the emergency department and states, "I just wanted the pain to stop. I
didn't mean for anyone to find me." He has a history of PTSD and recently stopped taking his
prescribed paroxetine because he felt "numb and disconnected." He is now alert, oriented, and
cooperative.
A. Document his statement as a parasuicide gesture and downgrade his observation level to
every fifteen minutes
B. Discharge him with a safety plan because he denies current suicidal intent and is
cooperative
C. Place him on one-to-one observation only during the night shift when suicide risk is
highest
D. Maintain continuous one-to-one observation and initiate a psychiatric safety assessment
including means restriction counseling ✓ CORRECT
Correct Answer: D
Rationale: A suicide attempt by carbon monoxide poisoning represents high-lethality intent
regardless of the patient's current denial of suicidal ideation, and continuous observation
combined with safety assessment including means restriction is mandatory. Downgrading
observation based on superficial cooperation ignores the fluctuating nature of suicidal intent
and the patient's recent medication nonadherence, which has destabilized his mood.
Discharging a patient who attempted suicide by a highly lethal method within hours of
admission would constitute gross negligence and place the patient at imminent risk for a
fatal reattempt.
Question 7 of 60
A 37-year-old woman with treatment-resistant major depressive disorder is started on
phenelzine 15 mg TID after failing multiple SSRI trials. During medication education, she asks
the psychiatric nurse whether she can continue drinking her usual two glasses of red wine
with dinner and whether she needs to avoid any foods.
A. Instruct her to avoid all aged cheeses, cured meats, red wine, and fermented soy products
to prevent hypertensive crisis ✓ CORRECT
B. Tell her that moderate red wine consumption is acceptable because only hard liquor
interacts with MAOIs
C. Advise her to avoid only cheddar cheese and continue all other dietary habits without
restriction
D. Explain that dietary restrictions are outdated and modern MAOIs no longer require
tyramine avoidance
