RN MENTAL HEALTH NURSING EXAM 2026/2027
ACTUAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS WITH RATIONALES GRADED A+ LATEST
1. A client with major depressive disorder tells the nurse, “My family would be
better off without me. I have already decided how I am going to do it.” Which
action should the nurse take first?
A. Ask the client to describe the reasons for feeling hopeless.
B. Determine whether the client currently has access to the planned method.
C. Encourage the client to identify positive reasons for living.
D. Notify the client's family that the client is experiencing suicidal thoughts.
Answer: B
Rationale: A specific suicide plan indicates a high level of risk. The nurse should
immediately determine access to the intended method and implement appropriate
safety precautions. Exploring feelings and protective factors is important, but
immediate assessment of access and environmental safety takes priority.
2. A client taking lithium carbonate for bipolar disorder reports vomiting, diarrhea,
coarse hand tremors, and difficulty walking. The client's serum lithium level is 2.1
mEq/L. Which action should the nurse take?
A. Administer the next dose with food.
B. Encourage the client to increase sodium intake.
C. Hold the lithium and notify the provider.
D. Recheck the lithium level in 24 hours.
Answer: C
Rationale: A lithium level of 2.1 mEq/L is above the therapeutic range and,
together with gastrointestinal symptoms, coarse tremor, and ataxia, indicates
lithium toxicity. Lithium should be withheld and the provider notified promptly.
,Severe toxicity can progress to neurologic impairment, seizures, and cardiac
complications.
3. A client experiencing auditory hallucinations says, “The voices are telling me
that the nurses are poisoning my food.” Which response by the nurse is most
therapeutic?
A. “The voices are not real, so you should ignore them.”
B. “Why do you think the nurses want to poison you?”
C. “I understand that the voices are frightening. I do not hear them.”
D. “You should tell the voices that you are not going to listen.”
Answer: C
Rationale: The nurse acknowledges the client's emotional experience without
validating the hallucination as reality. Saying that the nurse does not hear the
voices provides reality-based feedback while demonstrating empathy.
4. A client taking phenelzine asks which meal would be safest to select.
A. Pepperoni pizza and red wine
B. Aged cheddar cheese with smoked sausage
C. Grilled chicken, rice, and fresh vegetables
D. Pickled herring and fermented vegetables
Answer: C
Rationale: Monoamine oxidase inhibitors (MAOIs) require avoidance of foods
high in tyramine because excessive tyramine can precipitate severe hypertension.
Aged cheeses, cured meats, fermented foods, and certain alcoholic beverages are
common concerns. Fresh chicken, rice, and vegetables are generally appropriate
choices.
,5. The nurse is caring for four clients on an inpatient psychiatric unit. Which client
should the nurse assess first?
A. A client with generalized anxiety disorder who reports difficulty sleeping
B. A client with schizophrenia who reports hearing one familiar voice
C. A client with bipolar disorder who has stopped sleeping and is pacing rapidly
D. A client with depression who refuses breakfast but denies suicidal thoughts
Answer: C
Rationale: Decreased need for sleep combined with rapidly increasing activity
may indicate escalating mania. A client with severe mania can become
increasingly impulsive, aggressive, exhausted, or unable to maintain adequate
nutrition and hydration. The client's escalating behavior requires the most
immediate assessment.
6. A client with panic disorder suddenly becomes pale, tremulous, and tachypneic
and says, “I can't breathe. I'm going to die.” Which nursing intervention is most
appropriate initially?
A. Ask the client to explain the source of the anxiety.
B. Remain with the client and use short, calm statements.
C. Encourage the client to discuss previous panic attacks.
D. Leave the client alone in a quiet room.
Answer: B
Rationale: During an acute panic attack, the client's ability to process complex
information is reduced. Remaining with the client communicates safety. Short,
simple, calm statements help decrease stimulation and support the client until the
intensity of the panic decreases.
, 7. A client prescribed amitriptyline reports dry mouth, constipation, blurred vision,
and difficulty urinating. Which interpretation by the nurse is most appropriate?
A. These findings suggest serotonin syndrome.
B. These findings are expected anticholinergic effects.
C. These findings indicate lithium toxicity.
D. These findings suggest extrapyramidal symptoms.
Answer: B
Rationale: Tricyclic antidepressants such as amitriptyline have significant
anticholinergic effects, including dry mouth, blurred vision, constipation, urinary
retention, and tachycardia. The nurse should monitor severity, particularly urinary
retention and cardiac effects.
8. A client with schizophrenia has received haloperidol for several days. The client
develops neck stiffness, upward deviation of the eyes, and difficulty swallowing.
Which action should the nurse take?
A. Administer the next scheduled dose of haloperidol.
B. Encourage increased oral fluid intake.
C. Recognize an acute dystonic reaction and obtain treatment promptly.
D. Place the client in seclusion because the symptoms indicate psychosis.
Answer: C
Rationale: Acute dystonia is an extrapyramidal adverse effect associated with
antipsychotic medications. Neck and eye muscle spasms and difficulty swallowing
can occur. Prompt treatment, commonly with an anticholinergic medication such
as benztropine or diphenhydramine, is necessary.
ACTUAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS WITH RATIONALES GRADED A+ LATEST
1. A client with major depressive disorder tells the nurse, “My family would be
better off without me. I have already decided how I am going to do it.” Which
action should the nurse take first?
A. Ask the client to describe the reasons for feeling hopeless.
B. Determine whether the client currently has access to the planned method.
C. Encourage the client to identify positive reasons for living.
D. Notify the client's family that the client is experiencing suicidal thoughts.
Answer: B
Rationale: A specific suicide plan indicates a high level of risk. The nurse should
immediately determine access to the intended method and implement appropriate
safety precautions. Exploring feelings and protective factors is important, but
immediate assessment of access and environmental safety takes priority.
2. A client taking lithium carbonate for bipolar disorder reports vomiting, diarrhea,
coarse hand tremors, and difficulty walking. The client's serum lithium level is 2.1
mEq/L. Which action should the nurse take?
A. Administer the next dose with food.
B. Encourage the client to increase sodium intake.
C. Hold the lithium and notify the provider.
D. Recheck the lithium level in 24 hours.
Answer: C
Rationale: A lithium level of 2.1 mEq/L is above the therapeutic range and,
together with gastrointestinal symptoms, coarse tremor, and ataxia, indicates
lithium toxicity. Lithium should be withheld and the provider notified promptly.
,Severe toxicity can progress to neurologic impairment, seizures, and cardiac
complications.
3. A client experiencing auditory hallucinations says, “The voices are telling me
that the nurses are poisoning my food.” Which response by the nurse is most
therapeutic?
A. “The voices are not real, so you should ignore them.”
B. “Why do you think the nurses want to poison you?”
C. “I understand that the voices are frightening. I do not hear them.”
D. “You should tell the voices that you are not going to listen.”
Answer: C
Rationale: The nurse acknowledges the client's emotional experience without
validating the hallucination as reality. Saying that the nurse does not hear the
voices provides reality-based feedback while demonstrating empathy.
4. A client taking phenelzine asks which meal would be safest to select.
A. Pepperoni pizza and red wine
B. Aged cheddar cheese with smoked sausage
C. Grilled chicken, rice, and fresh vegetables
D. Pickled herring and fermented vegetables
Answer: C
Rationale: Monoamine oxidase inhibitors (MAOIs) require avoidance of foods
high in tyramine because excessive tyramine can precipitate severe hypertension.
Aged cheeses, cured meats, fermented foods, and certain alcoholic beverages are
common concerns. Fresh chicken, rice, and vegetables are generally appropriate
choices.
,5. The nurse is caring for four clients on an inpatient psychiatric unit. Which client
should the nurse assess first?
A. A client with generalized anxiety disorder who reports difficulty sleeping
B. A client with schizophrenia who reports hearing one familiar voice
C. A client with bipolar disorder who has stopped sleeping and is pacing rapidly
D. A client with depression who refuses breakfast but denies suicidal thoughts
Answer: C
Rationale: Decreased need for sleep combined with rapidly increasing activity
may indicate escalating mania. A client with severe mania can become
increasingly impulsive, aggressive, exhausted, or unable to maintain adequate
nutrition and hydration. The client's escalating behavior requires the most
immediate assessment.
6. A client with panic disorder suddenly becomes pale, tremulous, and tachypneic
and says, “I can't breathe. I'm going to die.” Which nursing intervention is most
appropriate initially?
A. Ask the client to explain the source of the anxiety.
B. Remain with the client and use short, calm statements.
C. Encourage the client to discuss previous panic attacks.
D. Leave the client alone in a quiet room.
Answer: B
Rationale: During an acute panic attack, the client's ability to process complex
information is reduced. Remaining with the client communicates safety. Short,
simple, calm statements help decrease stimulation and support the client until the
intensity of the panic decreases.
, 7. A client prescribed amitriptyline reports dry mouth, constipation, blurred vision,
and difficulty urinating. Which interpretation by the nurse is most appropriate?
A. These findings suggest serotonin syndrome.
B. These findings are expected anticholinergic effects.
C. These findings indicate lithium toxicity.
D. These findings suggest extrapyramidal symptoms.
Answer: B
Rationale: Tricyclic antidepressants such as amitriptyline have significant
anticholinergic effects, including dry mouth, blurred vision, constipation, urinary
retention, and tachycardia. The nurse should monitor severity, particularly urinary
retention and cardiac effects.
8. A client with schizophrenia has received haloperidol for several days. The client
develops neck stiffness, upward deviation of the eyes, and difficulty swallowing.
Which action should the nurse take?
A. Administer the next scheduled dose of haloperidol.
B. Encourage increased oral fluid intake.
C. Recognize an acute dystonic reaction and obtain treatment promptly.
D. Place the client in seclusion because the symptoms indicate psychosis.
Answer: C
Rationale: Acute dystonia is an extrapyramidal adverse effect associated with
antipsychotic medications. Neck and eye muscle spasms and difficulty swallowing
can occur. Prompt treatment, commonly with an anticholinergic medication such
as benztropine or diphenhydramine, is necessary.
