RN HESI MENTAL HEALTH EXIT EXAM
NEWEST 2026/ 2027 TEST BANK| ELSEVIER
HESI RN MENTAL
1. A client with major depressive disorder tells the nurse, "There's no point in
going on. Everyone would be better off without me." Which is the most
therapeutic initial response?
A) "You have so much to live for. Think about your family."
B) "Why would you say something like that?"
C) "It sounds like you're feeling hopeless. Are you thinking about harming
yourself?"
D) "I understand how you feel. I've been there too."
Answer: C
Rationale: This response validates the client's feeling of hopelessness and directly
assesses for suicidal ideation, which is the priority safety concern. Option A offers
false reassurance. Option B is a "why" question that can put the client on the
defensive. Option D is inappropriate self-disclosure that shifts focus to the nurse .
2. A client with schizophrenia tells the nurse, "The FBI is monitoring my thoughts
through a chip in my tooth." Which is the most therapeutic response?
A) "That sounds frightening. I don't believe the FBI is monitoring you, but I
understand you believe that."
B) "You're being paranoid. Nobody is monitoring you."
C) "The FBI has no interest in you."
D) "Let's talk about something else."
Answer: A
Rationale: This response validates the client's emotional experience (frightening)
without reinforcing the delusion. It acknowledges the client's belief while stating
,the nurse's different reality. Option B is confrontational and judgmental. Option C
dismisses the client's experience. Option D avoids the issue .
3. A client tells the nurse, "I don't think I want to take my medication anymore.
It makes me feel like a zombie." Which is the most therapeutic response?
A) "You must take your medication as prescribed."
B) "Tell me more about how the medication makes you feel like a zombie."
C) "That's a common side effect. You'll get used to it."
D) "If you don't take your medication, you'll end up back in the hospital."
Answer: B
Rationale: This response uses an open-ended statement to explore the client's
concerns and side effects, which may be addressed with dosage adjustment or
medication change. Option A is authoritarian. Option C dismisses the client's
concern. Option D uses a threat .
4. A client with anxiety disorder states, "I can't go to the grocery store. I'm
terrified I'll have a panic attack." Which response demonstrates empathy?
A) "Everyone gets nervous sometimes. You just need to push through it."
B) "I understand you're scared. Many people with anxiety feel that way. Let's talk
about coping strategies."
C) "There's nothing to be afraid of at the grocery store."
D) "You need to take your PRN medication before you go."
Answer: B
Rationale: Empathy involves understanding and validating the client's feelings
without judgment. Option B acknowledges the fear and offers support. Option A
minimizes the client's experience. Option C offers false reassurance. Option D
focuses only on medication .
,5. A client with borderline personality disorder tells the nurse, "You're the only
staff member who actually cares about me. Everyone else is horrible." Which is
the most therapeutic response?
A) "Thank you. I try to care about all my clients."
B) "I can see you feel strongly about this. Let's talk about your relationships with
the staff."
C) "You're right. Some staff members aren't as caring as others."
D) "That's not true. All the staff members care about you."
Answer: B
Rationale: This response addresses the splitting behavior (idealizing one staff
member while devaluing others) without reinforcing it. It opens discussion about
relationship patterns. Option A may reinforce splitting. Option C validates the
distorted perception. Option D argues with the client .
6. A client tells the nurse, "You're the only one who understands me. I wish you
were my mother." Which is the most therapeutic response?
A) "I'm flattered, but I'm not your mother."
B) "It sounds like you're looking for a maternal connection. I'm your nurse, and I'm
here to support you in that role."
C) "I can be whatever you need me to be."
D) "That's inappropriate. Let's stay focused on your treatment."
Answer: B
Rationale: This response acknowledges the client's emotional need (maternal
connection) while maintaining appropriate therapeutic boundaries and clarifying
the nurse's role. Option A is dismissive. Option C blurs boundaries. Option D is
judgmental .
, 7. A client with alcohol use disorder states, "I only drink because my job is so
stressful. If I had a different job, I wouldn't need to drink." Which defense
mechanism is the client using?
A) Denial
B) Rationalization
C) Projection
D) Displacement
Answer: B
Rationale: Rationalization involves creating logical excuses to justify unacceptable
behavior. The client is rationalizing drinking by blaming job stress. Denial would be
refusing to acknowledge drinking. Projection attributes one's own feelings to
others. Displacement redirects emotions to a safer target .
8. A client tells the nurse, "The voices are telling me to hurt myself." Which is
the nurse's priority action?
A) Ask the client what the voices are saying specifically
B) Place the client on one-to-one observation
C) Administer PRN antipsychotic medication
D) Document the statement and notify the provider
Answer: B
Rationale: Command hallucinations to self-harm require immediate safety
intervention. One-to-one observation (constant supervision) is the priority while
further assessment and intervention occur. Safety always comes first .
9. A patient with schizophrenia tells the nurse, "Aliens are controlling my
thoughts." Which therapeutic response is most appropriate?
A) "That's not true; no aliens are here."
B) "I don't see any aliens, but I understand you feel controlled."
NEWEST 2026/ 2027 TEST BANK| ELSEVIER
HESI RN MENTAL
1. A client with major depressive disorder tells the nurse, "There's no point in
going on. Everyone would be better off without me." Which is the most
therapeutic initial response?
A) "You have so much to live for. Think about your family."
B) "Why would you say something like that?"
C) "It sounds like you're feeling hopeless. Are you thinking about harming
yourself?"
D) "I understand how you feel. I've been there too."
Answer: C
Rationale: This response validates the client's feeling of hopelessness and directly
assesses for suicidal ideation, which is the priority safety concern. Option A offers
false reassurance. Option B is a "why" question that can put the client on the
defensive. Option D is inappropriate self-disclosure that shifts focus to the nurse .
2. A client with schizophrenia tells the nurse, "The FBI is monitoring my thoughts
through a chip in my tooth." Which is the most therapeutic response?
A) "That sounds frightening. I don't believe the FBI is monitoring you, but I
understand you believe that."
B) "You're being paranoid. Nobody is monitoring you."
C) "The FBI has no interest in you."
D) "Let's talk about something else."
Answer: A
Rationale: This response validates the client's emotional experience (frightening)
without reinforcing the delusion. It acknowledges the client's belief while stating
,the nurse's different reality. Option B is confrontational and judgmental. Option C
dismisses the client's experience. Option D avoids the issue .
3. A client tells the nurse, "I don't think I want to take my medication anymore.
It makes me feel like a zombie." Which is the most therapeutic response?
A) "You must take your medication as prescribed."
B) "Tell me more about how the medication makes you feel like a zombie."
C) "That's a common side effect. You'll get used to it."
D) "If you don't take your medication, you'll end up back in the hospital."
Answer: B
Rationale: This response uses an open-ended statement to explore the client's
concerns and side effects, which may be addressed with dosage adjustment or
medication change. Option A is authoritarian. Option C dismisses the client's
concern. Option D uses a threat .
4. A client with anxiety disorder states, "I can't go to the grocery store. I'm
terrified I'll have a panic attack." Which response demonstrates empathy?
A) "Everyone gets nervous sometimes. You just need to push through it."
B) "I understand you're scared. Many people with anxiety feel that way. Let's talk
about coping strategies."
C) "There's nothing to be afraid of at the grocery store."
D) "You need to take your PRN medication before you go."
Answer: B
Rationale: Empathy involves understanding and validating the client's feelings
without judgment. Option B acknowledges the fear and offers support. Option A
minimizes the client's experience. Option C offers false reassurance. Option D
focuses only on medication .
,5. A client with borderline personality disorder tells the nurse, "You're the only
staff member who actually cares about me. Everyone else is horrible." Which is
the most therapeutic response?
A) "Thank you. I try to care about all my clients."
B) "I can see you feel strongly about this. Let's talk about your relationships with
the staff."
C) "You're right. Some staff members aren't as caring as others."
D) "That's not true. All the staff members care about you."
Answer: B
Rationale: This response addresses the splitting behavior (idealizing one staff
member while devaluing others) without reinforcing it. It opens discussion about
relationship patterns. Option A may reinforce splitting. Option C validates the
distorted perception. Option D argues with the client .
6. A client tells the nurse, "You're the only one who understands me. I wish you
were my mother." Which is the most therapeutic response?
A) "I'm flattered, but I'm not your mother."
B) "It sounds like you're looking for a maternal connection. I'm your nurse, and I'm
here to support you in that role."
C) "I can be whatever you need me to be."
D) "That's inappropriate. Let's stay focused on your treatment."
Answer: B
Rationale: This response acknowledges the client's emotional need (maternal
connection) while maintaining appropriate therapeutic boundaries and clarifying
the nurse's role. Option A is dismissive. Option C blurs boundaries. Option D is
judgmental .
, 7. A client with alcohol use disorder states, "I only drink because my job is so
stressful. If I had a different job, I wouldn't need to drink." Which defense
mechanism is the client using?
A) Denial
B) Rationalization
C) Projection
D) Displacement
Answer: B
Rationale: Rationalization involves creating logical excuses to justify unacceptable
behavior. The client is rationalizing drinking by blaming job stress. Denial would be
refusing to acknowledge drinking. Projection attributes one's own feelings to
others. Displacement redirects emotions to a safer target .
8. A client tells the nurse, "The voices are telling me to hurt myself." Which is
the nurse's priority action?
A) Ask the client what the voices are saying specifically
B) Place the client on one-to-one observation
C) Administer PRN antipsychotic medication
D) Document the statement and notify the provider
Answer: B
Rationale: Command hallucinations to self-harm require immediate safety
intervention. One-to-one observation (constant supervision) is the priority while
further assessment and intervention occur. Safety always comes first .
9. A patient with schizophrenia tells the nurse, "Aliens are controlling my
thoughts." Which therapeutic response is most appropriate?
A) "That's not true; no aliens are here."
B) "I don't see any aliens, but I understand you feel controlled."
