ATI PN MENTAL HEALTH
PROCTORED ACTUAL EXAM
With NGN Questions, Case Studies, and SATA
Updated Edition
Aligned with the ATI PN Mental Health Blueprint &
NCSBN Clinical Judgment Measurement Model (NCJMM)
Total Questions 150
NGN Case Studies 7 Comprehensive Cases (Q1-Q35)
Standard Multiple Choice 100 Questions (Q36-Q135)
Select-All-That-Apply (SATA) 15 Questions (Q136-Q150)
Question Style 70% Scenario / 20% Direct / 10% NGN
Cognitive Level Mix 25% Recall / 50% Application / 25% Analysis
Rationales A+ Graded with Full Clinical Reasoning
Content Coverage
Section 1: NGN Case Studies (Q1-Q35) | Section 2: Therapeutic Communication (Q36-Q50)
Section 3: Psychiatric Disorders & DSM-5-TR Criteria (Q51-Q75)
Section 4: Psychopharmacology & Medication Management (Q76-Q95)
Section 5: Crisis Intervention & Suicide Prevention (Q96-Q110)
Section 6: Legal, Ethical & Professional Issues (Q111-Q125)
Section 7: Substance Use Disorders & Withdrawal (Q126-Q135)
Section 8: Select-All-That-Apply (SATA) (Q136-Q150)
,ATI PN Mental Health Proctored Exam - 2026/2027 NGN Edition 150 Questions
For Practical Nursing (PN) students preparing for the ATI Mental Health Proctored Exam.
Includes Next Generation NCLEX (NGN) clinical judgment scenarios and comprehensive rationales.
Page 2
,ATI PN Mental Health Proctored Exam - 2026/2027 NGN Edition 150 Questions
SECTION 1: NGN Case Studies with Extended Mental Health
Scenarios
NCSBN Clinical Judgment Measurement Model (NCJMM) - Questions 1-35 (7 Comprehensive Cases)
CASE STUDY 1: Major Depressive Disorder with Suicidal Ideation
A 38-year-old female client is admitted to the inpatient psychiatric unit after a suicide attempt in which she ingested
20 tablets of acetaminophen. On admission, she states, "I just want to die. I'm a burden to everyone." She has a
6-month history of depressed mood, anhedonia, insomnia (waking at 3 AM daily), 15-pound weight loss, fatigue, and
feelings of worthlessness. She lost her job 7 months ago and recently separated from her spouse. Her score on the
Columbia-Suicide Severity Rating Scale (C-SSRS) indicates severe ideation with a plan. Vital signs are stable;
acetaminophen level is being monitored.
[NCJMM: Recognize Cues]
Q1: Which of the following assessment findings is the MOST reliable indicator that this client is at imminent
risk for suicide?
A. She has a 6-month history of depressed mood and anhedonia.
B. She has a recent suicide attempt by overdose and a stated plan to die. [CORRECT]
C. She lost her job and recently separated from her spouse.
D. She scores high on the C-SSRS scale with severe ideation.
Correct Answer: B
Rationale: A recent suicide attempt combined with a stated plan to die is the single strongest predictor of imminent
suicide risk. While depression, anhedonia, and recent losses are risk factors (A, C), they do not by themselves
indicate imminent danger. A high C-SSRS score (D) reflects ideation severity but a recent attempt and ongoing intent
(B) most directly signals immediate danger and dictates 1:1 observation. The nurse must prioritize this cue above all
others when formulating the safety plan.
Q2: Using the NCJMM Analyze Cues step, the nurse links the client's early-morning awakening (3 AM),
weight loss, and psychomotor slowing to which DSM-5-TR diagnostic category?
A. Melancholic features of Major Depressive Disorder [CORRECT]
B. Atypical features of Persistent Depressive Disorder
C. Mixed features of Bipolar I Disorder
D. Catatonic features of Schizophrenia
Correct Answer: A
Rationale: Early-morning terminal insomnia, significant weight loss, and psychomotor slowing are classic
melancholic features of Major Depressive Disorder (MDD) per DSM-5-TR. Atypical depression (B) presents with
hypersomnia, weight gain, and leaden paralysis. Bipolar mixed features (C) require concurrent manic/hypomanic
symptoms such as pressured speech or grandiosity. Catatonic schizophrenia (D) presents with mutism, posturing, or
waxy flexibility, not the vegetative signs seen here. Accurate diagnosis informs both pharmacologic and behavioral
interventions.
Page 3
, ATI PN Mental Health Proctored Exam - 2026/2027 NGN Edition 150 Questions
Q3: In the Prioritize Hypotheses step, which nursing concern must the team address FIRST?
A. Risk for self-directed violence related to hopelessness [CORRECT]
B. Sleep deprivation related to early-morning awakening
C. Imbalanced nutrition: less than body requirements
D. Ineffective coping related to job loss and marital separation
Correct Answer: A
Rationale: Per Maslow's hierarchy and crisis-intervention principles, safety always supersedes physiological comfort
and psychosocial concerns. Risk for self-directed violence (A) is life-threatening and must be addressed first with 1:1
observation, removal of lethal means, and a no-suicide contract as appropriate. Sleep (B), nutrition (C), and coping
(D) are valid concerns but follow stabilization of suicide risk. Prioritization errors are the most common cause of ATI
exam failure; always choose the life-threatening option first.
Q4: In the Generate Solutions/Take Action step, which intervention is MOST appropriate to implement
immediately upon admission?
A. Initiate 1:1 continuous observation and remove all harmful objects from the room. [CORRECT]
B. Begin cognitive behavioral therapy to challenge distorted thoughts of worthlessness.
C. Encourage attendance at group therapy to reduce social isolation.
D. Administer a prescribed SSRI and monitor for therapeutic effects in 2 weeks.
Correct Answer: A
Rationale: Continuous 1:1 observation and environmental safety (removal of belts, sheets, sharp objects, plastic
bags, and medications) are the highest-priority nursing actions for a client with active suicidal intent. CBT (B) and
group therapy (C) are appropriate in the working phase of treatment but not before safety is established. SSRI
administration (D) is part of the treatment plan but onset is 2-4 weeks; it does not address imminent risk. Safety
always precedes therapeutic and pharmacologic interventions in crisis.
Q5: In the Evaluate Outcomes step, which finding BEST indicates that the safety plan is effective 72 hours
after admission?
A. The client denies suicidal ideation and engages in unit activities with peers. [CORRECT]
B. The client sleeps 8 hours per night with the aid of a PRN sedative.
C. The client eats 75% of meals and gains 1 pound during the shift.
D. The client asks to be discharged because she feels better now.
Correct Answer: A
Rationale: Denial of suicidal ideation combined with voluntary engagement in unit activities is the strongest
evidence that acute suicide risk is decreasing and the safety plan is effective. Improved sleep (B) and nutrition (C) are
positive physiological signs but do not by themselves reflect reduced suicide risk. Requesting discharge (D) can be a
manipulation to access means; it requires careful assessment rather than assumption of improvement. Evaluation must
focus on the original priority (safety) before considering step-down in level of care.
CASE STUDY 2: Schizophrenia - Acute Psychotic Episode
A 24-year-old male client is brought to the emergency department by police after being found disoriented in a public
park. He states, "The government implanted a chip in my brain and they're broadcasting my thoughts on the radio."
He has not eaten or slept in 4 days. He is diagnosed with schizophrenia, paranoid subtype, and admitted to the
inpatient psychiatric unit. Vital signs: T 37.2 C, HR 102, BP 138/88, RR 20. He is started on risperidone 2 mg PO
Page 4
PROCTORED ACTUAL EXAM
With NGN Questions, Case Studies, and SATA
Updated Edition
Aligned with the ATI PN Mental Health Blueprint &
NCSBN Clinical Judgment Measurement Model (NCJMM)
Total Questions 150
NGN Case Studies 7 Comprehensive Cases (Q1-Q35)
Standard Multiple Choice 100 Questions (Q36-Q135)
Select-All-That-Apply (SATA) 15 Questions (Q136-Q150)
Question Style 70% Scenario / 20% Direct / 10% NGN
Cognitive Level Mix 25% Recall / 50% Application / 25% Analysis
Rationales A+ Graded with Full Clinical Reasoning
Content Coverage
Section 1: NGN Case Studies (Q1-Q35) | Section 2: Therapeutic Communication (Q36-Q50)
Section 3: Psychiatric Disorders & DSM-5-TR Criteria (Q51-Q75)
Section 4: Psychopharmacology & Medication Management (Q76-Q95)
Section 5: Crisis Intervention & Suicide Prevention (Q96-Q110)
Section 6: Legal, Ethical & Professional Issues (Q111-Q125)
Section 7: Substance Use Disorders & Withdrawal (Q126-Q135)
Section 8: Select-All-That-Apply (SATA) (Q136-Q150)
,ATI PN Mental Health Proctored Exam - 2026/2027 NGN Edition 150 Questions
For Practical Nursing (PN) students preparing for the ATI Mental Health Proctored Exam.
Includes Next Generation NCLEX (NGN) clinical judgment scenarios and comprehensive rationales.
Page 2
,ATI PN Mental Health Proctored Exam - 2026/2027 NGN Edition 150 Questions
SECTION 1: NGN Case Studies with Extended Mental Health
Scenarios
NCSBN Clinical Judgment Measurement Model (NCJMM) - Questions 1-35 (7 Comprehensive Cases)
CASE STUDY 1: Major Depressive Disorder with Suicidal Ideation
A 38-year-old female client is admitted to the inpatient psychiatric unit after a suicide attempt in which she ingested
20 tablets of acetaminophen. On admission, she states, "I just want to die. I'm a burden to everyone." She has a
6-month history of depressed mood, anhedonia, insomnia (waking at 3 AM daily), 15-pound weight loss, fatigue, and
feelings of worthlessness. She lost her job 7 months ago and recently separated from her spouse. Her score on the
Columbia-Suicide Severity Rating Scale (C-SSRS) indicates severe ideation with a plan. Vital signs are stable;
acetaminophen level is being monitored.
[NCJMM: Recognize Cues]
Q1: Which of the following assessment findings is the MOST reliable indicator that this client is at imminent
risk for suicide?
A. She has a 6-month history of depressed mood and anhedonia.
B. She has a recent suicide attempt by overdose and a stated plan to die. [CORRECT]
C. She lost her job and recently separated from her spouse.
D. She scores high on the C-SSRS scale with severe ideation.
Correct Answer: B
Rationale: A recent suicide attempt combined with a stated plan to die is the single strongest predictor of imminent
suicide risk. While depression, anhedonia, and recent losses are risk factors (A, C), they do not by themselves
indicate imminent danger. A high C-SSRS score (D) reflects ideation severity but a recent attempt and ongoing intent
(B) most directly signals immediate danger and dictates 1:1 observation. The nurse must prioritize this cue above all
others when formulating the safety plan.
Q2: Using the NCJMM Analyze Cues step, the nurse links the client's early-morning awakening (3 AM),
weight loss, and psychomotor slowing to which DSM-5-TR diagnostic category?
A. Melancholic features of Major Depressive Disorder [CORRECT]
B. Atypical features of Persistent Depressive Disorder
C. Mixed features of Bipolar I Disorder
D. Catatonic features of Schizophrenia
Correct Answer: A
Rationale: Early-morning terminal insomnia, significant weight loss, and psychomotor slowing are classic
melancholic features of Major Depressive Disorder (MDD) per DSM-5-TR. Atypical depression (B) presents with
hypersomnia, weight gain, and leaden paralysis. Bipolar mixed features (C) require concurrent manic/hypomanic
symptoms such as pressured speech or grandiosity. Catatonic schizophrenia (D) presents with mutism, posturing, or
waxy flexibility, not the vegetative signs seen here. Accurate diagnosis informs both pharmacologic and behavioral
interventions.
Page 3
, ATI PN Mental Health Proctored Exam - 2026/2027 NGN Edition 150 Questions
Q3: In the Prioritize Hypotheses step, which nursing concern must the team address FIRST?
A. Risk for self-directed violence related to hopelessness [CORRECT]
B. Sleep deprivation related to early-morning awakening
C. Imbalanced nutrition: less than body requirements
D. Ineffective coping related to job loss and marital separation
Correct Answer: A
Rationale: Per Maslow's hierarchy and crisis-intervention principles, safety always supersedes physiological comfort
and psychosocial concerns. Risk for self-directed violence (A) is life-threatening and must be addressed first with 1:1
observation, removal of lethal means, and a no-suicide contract as appropriate. Sleep (B), nutrition (C), and coping
(D) are valid concerns but follow stabilization of suicide risk. Prioritization errors are the most common cause of ATI
exam failure; always choose the life-threatening option first.
Q4: In the Generate Solutions/Take Action step, which intervention is MOST appropriate to implement
immediately upon admission?
A. Initiate 1:1 continuous observation and remove all harmful objects from the room. [CORRECT]
B. Begin cognitive behavioral therapy to challenge distorted thoughts of worthlessness.
C. Encourage attendance at group therapy to reduce social isolation.
D. Administer a prescribed SSRI and monitor for therapeutic effects in 2 weeks.
Correct Answer: A
Rationale: Continuous 1:1 observation and environmental safety (removal of belts, sheets, sharp objects, plastic
bags, and medications) are the highest-priority nursing actions for a client with active suicidal intent. CBT (B) and
group therapy (C) are appropriate in the working phase of treatment but not before safety is established. SSRI
administration (D) is part of the treatment plan but onset is 2-4 weeks; it does not address imminent risk. Safety
always precedes therapeutic and pharmacologic interventions in crisis.
Q5: In the Evaluate Outcomes step, which finding BEST indicates that the safety plan is effective 72 hours
after admission?
A. The client denies suicidal ideation and engages in unit activities with peers. [CORRECT]
B. The client sleeps 8 hours per night with the aid of a PRN sedative.
C. The client eats 75% of meals and gains 1 pound during the shift.
D. The client asks to be discharged because she feels better now.
Correct Answer: A
Rationale: Denial of suicidal ideation combined with voluntary engagement in unit activities is the strongest
evidence that acute suicide risk is decreasing and the safety plan is effective. Improved sleep (B) and nutrition (C) are
positive physiological signs but do not by themselves reflect reduced suicide risk. Requesting discharge (D) can be a
manipulation to access means; it requires careful assessment rather than assumption of improvement. Evaluation must
focus on the original priority (safety) before considering step-down in level of care.
CASE STUDY 2: Schizophrenia - Acute Psychotic Episode
A 24-year-old male client is brought to the emergency department by police after being found disoriented in a public
park. He states, "The government implanted a chip in my brain and they're broadcasting my thoughts on the radio."
He has not eaten or slept in 4 days. He is diagnosed with schizophrenia, paranoid subtype, and admitted to the
inpatient psychiatric unit. Vital signs: T 37.2 C, HR 102, BP 138/88, RR 20. He is started on risperidone 2 mg PO
Page 4
