2026/2027 HESI MENTAL HEALTH NURSING EXAMINATION
Actual Exam | 100 Questions With Correct Answers and Rationales
Section 1: Therapeutic Communication and the Nurse-Client Relationship
Q1: A nurse is caring for a client diagnosed with major depressive disorder who says, 'Nobody cares about me. I
am completely alone in this world.' Which response by the nurse demonstrates the therapeutic communication
technique of reflection?
A. 'Do not say that. You have family who loves you very much.'
B. 'You are feeling like no one cares about you and that you are completely alone.' [CORRECT]
C. 'Can you tell me more about why you feel this way?'
D. 'Everyone feels alone sometimes. It will get better.'
Correct Answer: B
Rationale: Reflection directs the client's feelings, thoughts, or content back to them so they can examine their own
expressions. The nurse mirrors the client's message to promote further exploration. Options A and D are non-therapeutic
by offering reassurance and giving false reassurance. Option C uses open-ended questioning rather than reflection.
Q2: A client with schizophrenia tells the nurse, 'The CIA is monitoring my thoughts through the television set.'
Which is the MOST appropriate nursing response?
A. 'That is not true. The CIA does not monitor people's thoughts.'
B. 'You believe the CIA is monitoring your thoughts through the television?' [CORRECT]
C. 'Why would the CIA be interested in your thoughts?'
D. 'Let me turn off the television for you so you feel better.'
Correct Answer: B
Rationale: When a client expresses a delusion, the nurse should acknowledge the client's feelings without reinforcing the
false belief or arguing. This therapeutic technique validates the client's experience without confirming the delusion's
reality. Arguing (A) or exploring the logic (C) increases defensiveness, and distracting (D) avoids the underlying issue.
Q3: During a therapeutic interaction, a client suddenly becomes silent and looks down at the floor. Which
nursing action is MOST appropriate?
A. Ask the client, 'Why did you stop talking?'
B. Sit quietly and allow the client time to process thoughts [CORRECT]
C. Change the subject to something less uncomfortable
D. Tell the client that silence makes you uncomfortable
Correct Answer: B
Rationale: Therapeutic silence is a powerful communication tool that allows the client time to organize thoughts, reflect
on feelings, and decide how to proceed. The nurse should remain present and attentive without pressuring the client.
Asking why (A) puts the client on the defensive, changing the subject (C) avoids the client's needs, and sharing the nurse's
discomfort (D) redirects focus from the client to the nurse.
,Q4: A nurse is establishing a therapeutic relationship with a new client on the psychiatric unit. Which statement
by the nurse BEST demonstrates the technique of offering self?
A. 'I will be your primary nurse for this shift and I will check on you every hour.'
B. 'I understand how you are feeling because I have experienced something similar.'
C. 'I am here with you, and I would like to help you work through this.' [CORRECT]
D. 'You should feel better soon because we have excellent treatments here.'
Correct Answer: C
Rationale: Offering self involves making the nurse available on an emotional and physical level to support the client. It
conveys genuine interest and commitment without making promises or assumptions. Option A focuses on task-oriented
care rather than therapeutic presence. Option B uses the non-therapeutic technique of sharing personal experiences.
Option D gives false reassurance.
Q5: A client diagnosed with borderline personality disorder tells the nurse, 'You are the only one who
understands me. The other nurses are terrible.' Which response is MOST therapeutic?
A. 'I appreciate that you feel comfortable with me. Let us talk about what is concerning you.'
[CORRECT]
B. 'The other nurses are very skilled and caring professionals.'
C. 'I will make sure I am always assigned to be your nurse.'
D. 'Why do you think the other nurses are terrible?'
Correct Answer: A
Rationale: Clients with borderline personality disorder often use splitting, viewing individuals as all-good or all-bad. The
therapeutic response acknowledges the client's feelings without reinforcing the split or making promises that cannot be
kept. Defending other nurses (B) or promising exclusive care (C) are non-therapeutic. Exploring why (D) may reinforce
the splitting dynamic rather than redirecting to the client's needs.
Q6: Which nursing statement exemplifies the non-therapeutic communication technique of giving advice?
A. 'What do you think would be the best thing to do in this situation?'
B. 'If I were you, I would call your mother and apologize to her.' [CORRECT]
C. 'It sounds like you are struggling with a difficult decision.'
D. 'How have you handled similar situations in the past?'
Correct Answer: B
Rationale: Giving advice tells the client what to do and removes the client's autonomy and decision-making ability. In
therapeutic communication, the nurse should help the client explore options and arrive at their own decisions. Options A,
C, and D are therapeutic: A encourages self-reflection, C uses paraphrasing, and D encourages the client to draw on
their own strengths and past experiences.
Q7: A nurse is interacting with a client who has been admitted for alcohol withdrawal. The client says, 'I do not
have a drinking problem. I can stop anytime I want.' Which response uses the therapeutic technique of
confrontation?
A. 'I hear that you believe you can stop anytime, but your admission for withdrawal suggests the
situation may be more serious than you recognize.' [CORRECT]
B. 'It is okay. Many people do not think they have a problem at first.'
C. 'Your doctor says you have a severe alcohol use disorder.'
, D. 'Let us talk about something else to take your mind off it.'
Correct Answer: A
Rationale: Therapeutic confrontation involves presenting reality to the client when there is a discrepancy between the
client's perception and objective reality. It is done with empathy and without judgment to help the client recognize
inconsistencies in their thinking. Option B minimizes the situation, C shifts responsibility to the doctor, and D uses
avoidance, all of which are non-therapeutic.
Q8: A psychiatric nurse receives a friend request on social media from a former client who was discharged six
months ago. Which is the MOST appropriate action?
A. Accept the request since the client has been discharged for six months
B. Decline the request and discuss the boundary violation at the next clinical supervision meeting
[CORRECT]
C. Accept the request but restrict what the client can see on the profile
D. Ignore the request and take no further action
Correct Answer: B
Rationale: Professional boundaries in psychiatric nursing extend beyond discharge. Social media contact with former
clients constitutes a boundary violation that can undermine the therapeutic relationship and create dual relationships. The
nurse should decline the request and seek guidance from a supervisor. Even with time elapsed, accepting (A) or partially
accepting (C) the request blurs professional lines. Simply ignoring (D) fails to address the ethical issue properly.
Q9: A nurse is conducting an admission assessment on a client who states, 'I am here because my wife made me
come. I do not need to be in a psychiatric hospital.' Which response by the nurse BEST uses the technique of
clarification?
A. 'Could you help me understand what you mean when you say you do not need to be here?'
[CORRECT]
B. 'Your wife probably knows what is best for you.'
C. 'Everyone who comes here says that at first, but they usually end up being glad they came.'
D. 'The doctor will determine if you need to be admitted.'
Correct Answer: A
Rationale: Clarification is used when the nurse needs the client to provide more detail or explain ambiguous statements
more fully. It helps the nurse understand the client's perspective more accurately and invites the client to elaborate. Option
B is non-therapeutic by siding with the wife, C offers false reassurance, and D avoids the client's concern entirely by
deflecting to the physician.
Q10: A client with anxiety disorder is pacing the hallway and speaking rapidly. The nurse says, 'I notice you are
pacing and talking very quickly. Are you feeling anxious right now?' Which therapeutic communication
technique is the nurse using?
A. Making observations [CORRECT]
B. Verbalizing the implied
C. Restating
D. Summarizing
Correct Answer: A
Rationale: Making observations involves verbalizing what the nurse observes about the client's behavior, appearance, or
affect without making judgments. This technique helps the client become aware of their own behavior and can serve as a
, starting point for exploring underlying feelings. Verbalizing the implied (B) would address unspoken thoughts, restating
(C) repeats the client's main message, and summarizing (D) condenses a longer conversation.
Q11: During a group therapy session, a client with social anxiety disorder remains silent throughout the entire
meeting. After the session, the nurse says, 'I noticed you did not share during group today.' This is an example of
which therapeutic communication technique?
A. Exploring
B. Making observations [CORRECT]
C. Focusing
D. Presenting reality
Correct Answer: B
Rationale: The nurse is making an observation about the client's behavior during the session. This non-threatening
approach can open the door for the client to discuss barriers to participation such as anxiety, fear of judgment, or
uncertainty about the group process. Exploring (A) would delve deeper into the reasons, focusing (C) would direct
attention to a specific topic, and presenting reality (D) would address distortions in thinking.
Q12: A nurse is providing discharge teaching to a client with generalized anxiety disorder. The client says, 'I just
want to take a pill to fix everything.' Which nursing response is MOST therapeutic?
A. 'Medication can be helpful, and we can discuss that with your provider. Can you also tell me
about what coping strategies you have tried?' [CORRECT]
B. 'Pills are not the answer. You need to learn to handle your anxiety without medication.'
C. 'Your provider will probably prescribe something for you before you leave.'
D. 'I understand. Medication is the most effective treatment for anxiety.'
Correct Answer: A
Rationale: This response acknowledges the client's desire for relief while also introducing the concept of complementary
coping strategies. It balances validation with psychoeducation and encourages active participation in the treatment plan.
Option B is judgmental and dismissive of medication's role, C makes assumptions about the provider's plan, and D
reinforces the client's passive approach without promoting self-management skills.
Q13: A client says to the nurse, 'My life has no meaning since my husband died. I wish I were dead.' Which
initial nursing response is MOST appropriate?
A. 'You have so much to live for. Your children need you.'
B. 'Are you thinking about hurting yourself?' [CORRECT]
C. 'It takes time, but you will eventually feel better.'
D. 'Tell me more about what has been happening since your husband died.'
Correct Answer: B
Rationale: When a client expresses suicidal ideation, the nurse's priority is to conduct a direct suicide risk assessment.
Asking directly about self-harm does not increase suicide risk; rather, it opens communication and allows the nurse to
assess the severity and develop a safety plan. Options A and C provide false reassurance, and D, while therapeutic in
other contexts, does not take priority over assessing immediate safety.
Q14: Which statement by a nurse demonstrates the non-therapeutic technique of stereotyping?
A. 'Clients with schizophrenia often have difficulty with social interactions.'
Actual Exam | 100 Questions With Correct Answers and Rationales
Section 1: Therapeutic Communication and the Nurse-Client Relationship
Q1: A nurse is caring for a client diagnosed with major depressive disorder who says, 'Nobody cares about me. I
am completely alone in this world.' Which response by the nurse demonstrates the therapeutic communication
technique of reflection?
A. 'Do not say that. You have family who loves you very much.'
B. 'You are feeling like no one cares about you and that you are completely alone.' [CORRECT]
C. 'Can you tell me more about why you feel this way?'
D. 'Everyone feels alone sometimes. It will get better.'
Correct Answer: B
Rationale: Reflection directs the client's feelings, thoughts, or content back to them so they can examine their own
expressions. The nurse mirrors the client's message to promote further exploration. Options A and D are non-therapeutic
by offering reassurance and giving false reassurance. Option C uses open-ended questioning rather than reflection.
Q2: A client with schizophrenia tells the nurse, 'The CIA is monitoring my thoughts through the television set.'
Which is the MOST appropriate nursing response?
A. 'That is not true. The CIA does not monitor people's thoughts.'
B. 'You believe the CIA is monitoring your thoughts through the television?' [CORRECT]
C. 'Why would the CIA be interested in your thoughts?'
D. 'Let me turn off the television for you so you feel better.'
Correct Answer: B
Rationale: When a client expresses a delusion, the nurse should acknowledge the client's feelings without reinforcing the
false belief or arguing. This therapeutic technique validates the client's experience without confirming the delusion's
reality. Arguing (A) or exploring the logic (C) increases defensiveness, and distracting (D) avoids the underlying issue.
Q3: During a therapeutic interaction, a client suddenly becomes silent and looks down at the floor. Which
nursing action is MOST appropriate?
A. Ask the client, 'Why did you stop talking?'
B. Sit quietly and allow the client time to process thoughts [CORRECT]
C. Change the subject to something less uncomfortable
D. Tell the client that silence makes you uncomfortable
Correct Answer: B
Rationale: Therapeutic silence is a powerful communication tool that allows the client time to organize thoughts, reflect
on feelings, and decide how to proceed. The nurse should remain present and attentive without pressuring the client.
Asking why (A) puts the client on the defensive, changing the subject (C) avoids the client's needs, and sharing the nurse's
discomfort (D) redirects focus from the client to the nurse.
,Q4: A nurse is establishing a therapeutic relationship with a new client on the psychiatric unit. Which statement
by the nurse BEST demonstrates the technique of offering self?
A. 'I will be your primary nurse for this shift and I will check on you every hour.'
B. 'I understand how you are feeling because I have experienced something similar.'
C. 'I am here with you, and I would like to help you work through this.' [CORRECT]
D. 'You should feel better soon because we have excellent treatments here.'
Correct Answer: C
Rationale: Offering self involves making the nurse available on an emotional and physical level to support the client. It
conveys genuine interest and commitment without making promises or assumptions. Option A focuses on task-oriented
care rather than therapeutic presence. Option B uses the non-therapeutic technique of sharing personal experiences.
Option D gives false reassurance.
Q5: A client diagnosed with borderline personality disorder tells the nurse, 'You are the only one who
understands me. The other nurses are terrible.' Which response is MOST therapeutic?
A. 'I appreciate that you feel comfortable with me. Let us talk about what is concerning you.'
[CORRECT]
B. 'The other nurses are very skilled and caring professionals.'
C. 'I will make sure I am always assigned to be your nurse.'
D. 'Why do you think the other nurses are terrible?'
Correct Answer: A
Rationale: Clients with borderline personality disorder often use splitting, viewing individuals as all-good or all-bad. The
therapeutic response acknowledges the client's feelings without reinforcing the split or making promises that cannot be
kept. Defending other nurses (B) or promising exclusive care (C) are non-therapeutic. Exploring why (D) may reinforce
the splitting dynamic rather than redirecting to the client's needs.
Q6: Which nursing statement exemplifies the non-therapeutic communication technique of giving advice?
A. 'What do you think would be the best thing to do in this situation?'
B. 'If I were you, I would call your mother and apologize to her.' [CORRECT]
C. 'It sounds like you are struggling with a difficult decision.'
D. 'How have you handled similar situations in the past?'
Correct Answer: B
Rationale: Giving advice tells the client what to do and removes the client's autonomy and decision-making ability. In
therapeutic communication, the nurse should help the client explore options and arrive at their own decisions. Options A,
C, and D are therapeutic: A encourages self-reflection, C uses paraphrasing, and D encourages the client to draw on
their own strengths and past experiences.
Q7: A nurse is interacting with a client who has been admitted for alcohol withdrawal. The client says, 'I do not
have a drinking problem. I can stop anytime I want.' Which response uses the therapeutic technique of
confrontation?
A. 'I hear that you believe you can stop anytime, but your admission for withdrawal suggests the
situation may be more serious than you recognize.' [CORRECT]
B. 'It is okay. Many people do not think they have a problem at first.'
C. 'Your doctor says you have a severe alcohol use disorder.'
, D. 'Let us talk about something else to take your mind off it.'
Correct Answer: A
Rationale: Therapeutic confrontation involves presenting reality to the client when there is a discrepancy between the
client's perception and objective reality. It is done with empathy and without judgment to help the client recognize
inconsistencies in their thinking. Option B minimizes the situation, C shifts responsibility to the doctor, and D uses
avoidance, all of which are non-therapeutic.
Q8: A psychiatric nurse receives a friend request on social media from a former client who was discharged six
months ago. Which is the MOST appropriate action?
A. Accept the request since the client has been discharged for six months
B. Decline the request and discuss the boundary violation at the next clinical supervision meeting
[CORRECT]
C. Accept the request but restrict what the client can see on the profile
D. Ignore the request and take no further action
Correct Answer: B
Rationale: Professional boundaries in psychiatric nursing extend beyond discharge. Social media contact with former
clients constitutes a boundary violation that can undermine the therapeutic relationship and create dual relationships. The
nurse should decline the request and seek guidance from a supervisor. Even with time elapsed, accepting (A) or partially
accepting (C) the request blurs professional lines. Simply ignoring (D) fails to address the ethical issue properly.
Q9: A nurse is conducting an admission assessment on a client who states, 'I am here because my wife made me
come. I do not need to be in a psychiatric hospital.' Which response by the nurse BEST uses the technique of
clarification?
A. 'Could you help me understand what you mean when you say you do not need to be here?'
[CORRECT]
B. 'Your wife probably knows what is best for you.'
C. 'Everyone who comes here says that at first, but they usually end up being glad they came.'
D. 'The doctor will determine if you need to be admitted.'
Correct Answer: A
Rationale: Clarification is used when the nurse needs the client to provide more detail or explain ambiguous statements
more fully. It helps the nurse understand the client's perspective more accurately and invites the client to elaborate. Option
B is non-therapeutic by siding with the wife, C offers false reassurance, and D avoids the client's concern entirely by
deflecting to the physician.
Q10: A client with anxiety disorder is pacing the hallway and speaking rapidly. The nurse says, 'I notice you are
pacing and talking very quickly. Are you feeling anxious right now?' Which therapeutic communication
technique is the nurse using?
A. Making observations [CORRECT]
B. Verbalizing the implied
C. Restating
D. Summarizing
Correct Answer: A
Rationale: Making observations involves verbalizing what the nurse observes about the client's behavior, appearance, or
affect without making judgments. This technique helps the client become aware of their own behavior and can serve as a
, starting point for exploring underlying feelings. Verbalizing the implied (B) would address unspoken thoughts, restating
(C) repeats the client's main message, and summarizing (D) condenses a longer conversation.
Q11: During a group therapy session, a client with social anxiety disorder remains silent throughout the entire
meeting. After the session, the nurse says, 'I noticed you did not share during group today.' This is an example of
which therapeutic communication technique?
A. Exploring
B. Making observations [CORRECT]
C. Focusing
D. Presenting reality
Correct Answer: B
Rationale: The nurse is making an observation about the client's behavior during the session. This non-threatening
approach can open the door for the client to discuss barriers to participation such as anxiety, fear of judgment, or
uncertainty about the group process. Exploring (A) would delve deeper into the reasons, focusing (C) would direct
attention to a specific topic, and presenting reality (D) would address distortions in thinking.
Q12: A nurse is providing discharge teaching to a client with generalized anxiety disorder. The client says, 'I just
want to take a pill to fix everything.' Which nursing response is MOST therapeutic?
A. 'Medication can be helpful, and we can discuss that with your provider. Can you also tell me
about what coping strategies you have tried?' [CORRECT]
B. 'Pills are not the answer. You need to learn to handle your anxiety without medication.'
C. 'Your provider will probably prescribe something for you before you leave.'
D. 'I understand. Medication is the most effective treatment for anxiety.'
Correct Answer: A
Rationale: This response acknowledges the client's desire for relief while also introducing the concept of complementary
coping strategies. It balances validation with psychoeducation and encourages active participation in the treatment plan.
Option B is judgmental and dismissive of medication's role, C makes assumptions about the provider's plan, and D
reinforces the client's passive approach without promoting self-management skills.
Q13: A client says to the nurse, 'My life has no meaning since my husband died. I wish I were dead.' Which
initial nursing response is MOST appropriate?
A. 'You have so much to live for. Your children need you.'
B. 'Are you thinking about hurting yourself?' [CORRECT]
C. 'It takes time, but you will eventually feel better.'
D. 'Tell me more about what has been happening since your husband died.'
Correct Answer: B
Rationale: When a client expresses suicidal ideation, the nurse's priority is to conduct a direct suicide risk assessment.
Asking directly about self-harm does not increase suicide risk; rather, it opens communication and allows the nurse to
assess the severity and develop a safety plan. Options A and C provide false reassurance, and D, while therapeutic in
other contexts, does not take priority over assessing immediate safety.
Q14: Which statement by a nurse demonstrates the non-therapeutic technique of stereotyping?
A. 'Clients with schizophrenia often have difficulty with social interactions.'
