, HESI Exit Exam Mental Health Nursing Questions
and Answers with Rationale 2026/2027
Question 1
A client diagnosed with major depressive disorder is prescribed
sertraline. Which symptom reported by the client indicates an adverse
effect that requires immediate medical evaluation?
A. Mild dry mouth and occasional mild nausea
B. Agitation, confusion, diaphoresis, and tachycardia
C. Occasional drowsiness in the evening
D. Mild transient headache
Correct Answer: B. Agitation, confusion, diaphoresis, and tachycardia
Rationale: These findings are classic manifestations of serotonin
syndrome, a potentially life-threatening condition caused by
excessive serotonergic activity. Sertraline is an SSRI, and
combining it with other agents or experiencing individual
hypersensitivity can trigger this emergency, requiring immediate
cessation of the medication and supportive care.
Question 2
A nurse is assessing a client admitted with acute mania associated with
bipolar I disorder. Which behavior is the nurse most likely to observe?
A. Psychomotor retardation and social withdrawal
B. Grandiose delusions, flight of ideas, and decreased need for sleep
C. Flat affect and prolonged periods of mutism
, D. Extreme suspiciousness and auditory hallucinations of a
persecutory nature
Correct Answer: B. Grandiose delusions, flight of ideas, and decreased
need for sleep
Rationale: Acute mania is characterized by elevated, expansive, or
irritable mood accompanied by inflated self-esteem or grandiosity,
rapid speech with flight of ideas, distractibility, psychomotor
agitation, and a drastically decreased need for sleep.
Question 3
A client is brought to the emergency department experiencing an acute
panic attack, reporting severe shortness of breath, chest palpitations,
dizziness, and a profound fear of impending doom. What is the priority
nursing intervention?
A. Leave the client alone in a quiet, darkened room to rest.
B. Remain with the client, speak in a calm, concise, reassuring
manner, and maintain a safe environment.
C. Administer a complex psychosocial lecture on the origins of
anxiety.
D. Encourage rapid deep breathing exercises.
Correct Answer: B. Remain with the client, speak in a calm, concise,
reassuring manner, and maintain a safe environment.
Rationale: During a severe panic attack, a client's cognitive
functioning is severely impaired. Staying with the client ensures
physical safety, and using calm, simple, and reassuring
communication helps reduce feelings of isolation and escalates
grounding.
, Question 4
A nurse is caring for a client diagnosed with schizophrenia who exhibits
negative symptoms. Which clinical manifestation should the nurse
anticipate?
A. Auditory hallucinations and paranoid delusions
B. Bizarre posturing and unprovoked agitation
C. Apathy, avolition, flat affect, and social withdrawal
D. Pressured speech and loose associations
Correct Answer: C. Apathy, avolition, flat affect, and social withdrawal
Rationale: Negative symptoms of schizophrenia reflect a loss or
diminution of normal functions, including flat affect, avolition
(lack of motivation), alogia (poverty of speech), anhedonia, and
asociality. Hallucinations and delusions are positive symptoms.
Question 5
A client diagnosed with obsessive-compulsive disorder (OCD) spends
hours each day performing elaborate hand-washing rituals. What is the
most appropriate initial nursing intervention regarding these compulsive
behaviors?
A. Immediately prohibit the client from performing the rituals to stop
the behavior.
B. Allow time for the client to perform the ritual, then gradually
structure the schedule to limit time spent on compulsions while
supporting alternative coping mechanisms.
C. Ridicule the rituals to show the client how irrational they are.
and Answers with Rationale 2026/2027
Question 1
A client diagnosed with major depressive disorder is prescribed
sertraline. Which symptom reported by the client indicates an adverse
effect that requires immediate medical evaluation?
A. Mild dry mouth and occasional mild nausea
B. Agitation, confusion, diaphoresis, and tachycardia
C. Occasional drowsiness in the evening
D. Mild transient headache
Correct Answer: B. Agitation, confusion, diaphoresis, and tachycardia
Rationale: These findings are classic manifestations of serotonin
syndrome, a potentially life-threatening condition caused by
excessive serotonergic activity. Sertraline is an SSRI, and
combining it with other agents or experiencing individual
hypersensitivity can trigger this emergency, requiring immediate
cessation of the medication and supportive care.
Question 2
A nurse is assessing a client admitted with acute mania associated with
bipolar I disorder. Which behavior is the nurse most likely to observe?
A. Psychomotor retardation and social withdrawal
B. Grandiose delusions, flight of ideas, and decreased need for sleep
C. Flat affect and prolonged periods of mutism
, D. Extreme suspiciousness and auditory hallucinations of a
persecutory nature
Correct Answer: B. Grandiose delusions, flight of ideas, and decreased
need for sleep
Rationale: Acute mania is characterized by elevated, expansive, or
irritable mood accompanied by inflated self-esteem or grandiosity,
rapid speech with flight of ideas, distractibility, psychomotor
agitation, and a drastically decreased need for sleep.
Question 3
A client is brought to the emergency department experiencing an acute
panic attack, reporting severe shortness of breath, chest palpitations,
dizziness, and a profound fear of impending doom. What is the priority
nursing intervention?
A. Leave the client alone in a quiet, darkened room to rest.
B. Remain with the client, speak in a calm, concise, reassuring
manner, and maintain a safe environment.
C. Administer a complex psychosocial lecture on the origins of
anxiety.
D. Encourage rapid deep breathing exercises.
Correct Answer: B. Remain with the client, speak in a calm, concise,
reassuring manner, and maintain a safe environment.
Rationale: During a severe panic attack, a client's cognitive
functioning is severely impaired. Staying with the client ensures
physical safety, and using calm, simple, and reassuring
communication helps reduce feelings of isolation and escalates
grounding.
, Question 4
A nurse is caring for a client diagnosed with schizophrenia who exhibits
negative symptoms. Which clinical manifestation should the nurse
anticipate?
A. Auditory hallucinations and paranoid delusions
B. Bizarre posturing and unprovoked agitation
C. Apathy, avolition, flat affect, and social withdrawal
D. Pressured speech and loose associations
Correct Answer: C. Apathy, avolition, flat affect, and social withdrawal
Rationale: Negative symptoms of schizophrenia reflect a loss or
diminution of normal functions, including flat affect, avolition
(lack of motivation), alogia (poverty of speech), anhedonia, and
asociality. Hallucinations and delusions are positive symptoms.
Question 5
A client diagnosed with obsessive-compulsive disorder (OCD) spends
hours each day performing elaborate hand-washing rituals. What is the
most appropriate initial nursing intervention regarding these compulsive
behaviors?
A. Immediately prohibit the client from performing the rituals to stop
the behavior.
B. Allow time for the client to perform the ritual, then gradually
structure the schedule to limit time spent on compulsions while
supporting alternative coping mechanisms.
C. Ridicule the rituals to show the client how irrational they are.
