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LPN/LVN Mental Health Nursing
Competency Exam — Code: LPN-PMH-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A client with major depressive disorder says, “My family would be better
off without me.” Which response by the LPN/LVN is the priority?
A. “Your family needs you, so try to think positively.”
B. “Why do you believe your family would be better off?”
C. “Are you thinking about killing yourself?”
D. “Let’s talk about something that makes you happy.”
Answer: C. “Are you thinking about killing yourself?”
Rationale: Directly assessing suicidal thoughts is essential when a client makes a
statement suggesting hopelessness or perceived burdensomeness. Asking about
suicide does not cause suicidal behavior and helps determine immediate safety
needs.
, 2. A client prescribed lithium reports severe diarrhea, vomiting, coarse hand
tremors, and difficulty walking. What should the nurse do first?
A. Encourage the client to increase sodium intake.
B. Administer the next lithium dose with food.
C. Hold the lithium and notify the healthcare provider.
D. Reassure the client that mild tremors are expected.
Answer: C. Hold the lithium and notify the healthcare provider.
Rationale: Severe gastrointestinal symptoms, coarse tremor, and ataxia suggest
lithium toxicity. The medication should be withheld and the provider notified
promptly for evaluation and serum lithium testing.
3. A client experiencing acute mania is pacing rapidly, speaking loudly, and
attempting to enter other clients’ rooms. Which intervention is most
appropriate?
A. Encourage participation in a group therapy session.
B. Provide a quiet, low-stimulation environment.
C. Ask the client to remain alone in the bedroom.
D. Explain the consequences of continued disruptive behavior.
Answer: B. Provide a quiet, low-stimulation environment.
Rationale: Mania is worsened by environmental stimulation. Reducing noise,
activity, and interpersonal demands helps decrease agitation and supports
behavioral control.
4. A client taking clozapine develops fever, sore throat, and malaise. Which
laboratory test is most important?
A. Serum sodium
B. Hemoglobin A1c
C. Absolute neutrophil count
D. Serum creatinine
Answer: C. Absolute neutrophil count
,Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and
sore throat may indicate infection associated with dangerously low neutrophils
and require prompt evaluation.
5. A client with schizophrenia says, “The voices are telling me that the staff
are planning to poison me.” Which response is most therapeutic?
A. “The staff would never poison you.”
B. “I don't hear the voices, but I understand that they are frightening to you.”
C. “You need to ignore those voices.”
D. “What did the voices tell you about each staff member?”
Answer: B. “I don't hear the voices, but I understand that they are frightening to
you.”
Rationale: The nurse acknowledges the client’s emotional experience without
validating the hallucination. Presenting reality calmly while avoiding argument
is therapeutic.
6. A client receiving haloperidol develops severe muscle rigidity, high fever,
altered consciousness, and unstable blood pressure. Which complication
should the nurse suspect?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Acute dystonia
Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a life-threatening reaction to
antipsychotics characterized by hyperthermia, severe rigidity, autonomic
instability, and altered mental status.
7. A client taking an SSRI says, “I suddenly have much more energy, but I still
feel hopeless.” Why is this report particularly concerning?
, A. Increased energy indicates the medication is working normally.
B. Improved energy eliminates suicide risk.
C. Increased energy may allow the client to act on suicidal thoughts.
D. SSRIs routinely cause violent behavior.
Answer: C. Increased energy may allow the client to act on suicidal thoughts.
Rationale: During early antidepressant treatment, energy may improve before
mood and hopelessness. A client who remains suicidal but becomes more
energetic may have increased capacity to act on suicidal thoughts.
8. A client with panic disorder suddenly reports chest tightness, trembling,
and shortness of breath. Which nursing intervention is most appropriate
initially?
A. Ask the client to describe childhood stressors.
B. Encourage slow, controlled breathing and remain with the client.
C. Leave the client alone to reduce stimulation.
D. Explain that the symptoms are imaginary.
Answer: B. Encourage slow, controlled breathing and remain with the client.
Rationale: During acute panic, the nurse should remain with the client, provide
reassurance, reduce stimuli, and use simple interventions such as controlled
breathing. Complex discussion should wait until anxiety decreases.
9. A client with obsessive-compulsive disorder repeatedly washes their hands
until the skin becomes excoriated. Which intervention is most appropriate?
A. Immediately prohibit all handwashing.
B. Encourage gradual reduction of compulsive behavior.
C. Tell the client the behavior is irrational.
D. Reinforce the ritual to decrease anxiety.
Answer: B. Encourage gradual reduction of compulsive behavior.
LPN/LVN Mental Health Nursing
Competency Exam — Code: LPN-PMH-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A client with major depressive disorder says, “My family would be better
off without me.” Which response by the LPN/LVN is the priority?
A. “Your family needs you, so try to think positively.”
B. “Why do you believe your family would be better off?”
C. “Are you thinking about killing yourself?”
D. “Let’s talk about something that makes you happy.”
Answer: C. “Are you thinking about killing yourself?”
Rationale: Directly assessing suicidal thoughts is essential when a client makes a
statement suggesting hopelessness or perceived burdensomeness. Asking about
suicide does not cause suicidal behavior and helps determine immediate safety
needs.
, 2. A client prescribed lithium reports severe diarrhea, vomiting, coarse hand
tremors, and difficulty walking. What should the nurse do first?
A. Encourage the client to increase sodium intake.
B. Administer the next lithium dose with food.
C. Hold the lithium and notify the healthcare provider.
D. Reassure the client that mild tremors are expected.
Answer: C. Hold the lithium and notify the healthcare provider.
Rationale: Severe gastrointestinal symptoms, coarse tremor, and ataxia suggest
lithium toxicity. The medication should be withheld and the provider notified
promptly for evaluation and serum lithium testing.
3. A client experiencing acute mania is pacing rapidly, speaking loudly, and
attempting to enter other clients’ rooms. Which intervention is most
appropriate?
A. Encourage participation in a group therapy session.
B. Provide a quiet, low-stimulation environment.
C. Ask the client to remain alone in the bedroom.
D. Explain the consequences of continued disruptive behavior.
Answer: B. Provide a quiet, low-stimulation environment.
Rationale: Mania is worsened by environmental stimulation. Reducing noise,
activity, and interpersonal demands helps decrease agitation and supports
behavioral control.
4. A client taking clozapine develops fever, sore throat, and malaise. Which
laboratory test is most important?
A. Serum sodium
B. Hemoglobin A1c
C. Absolute neutrophil count
D. Serum creatinine
Answer: C. Absolute neutrophil count
,Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and
sore throat may indicate infection associated with dangerously low neutrophils
and require prompt evaluation.
5. A client with schizophrenia says, “The voices are telling me that the staff
are planning to poison me.” Which response is most therapeutic?
A. “The staff would never poison you.”
B. “I don't hear the voices, but I understand that they are frightening to you.”
C. “You need to ignore those voices.”
D. “What did the voices tell you about each staff member?”
Answer: B. “I don't hear the voices, but I understand that they are frightening to
you.”
Rationale: The nurse acknowledges the client’s emotional experience without
validating the hallucination. Presenting reality calmly while avoiding argument
is therapeutic.
6. A client receiving haloperidol develops severe muscle rigidity, high fever,
altered consciousness, and unstable blood pressure. Which complication
should the nurse suspect?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Acute dystonia
Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a life-threatening reaction to
antipsychotics characterized by hyperthermia, severe rigidity, autonomic
instability, and altered mental status.
7. A client taking an SSRI says, “I suddenly have much more energy, but I still
feel hopeless.” Why is this report particularly concerning?
, A. Increased energy indicates the medication is working normally.
B. Improved energy eliminates suicide risk.
C. Increased energy may allow the client to act on suicidal thoughts.
D. SSRIs routinely cause violent behavior.
Answer: C. Increased energy may allow the client to act on suicidal thoughts.
Rationale: During early antidepressant treatment, energy may improve before
mood and hopelessness. A client who remains suicidal but becomes more
energetic may have increased capacity to act on suicidal thoughts.
8. A client with panic disorder suddenly reports chest tightness, trembling,
and shortness of breath. Which nursing intervention is most appropriate
initially?
A. Ask the client to describe childhood stressors.
B. Encourage slow, controlled breathing and remain with the client.
C. Leave the client alone to reduce stimulation.
D. Explain that the symptoms are imaginary.
Answer: B. Encourage slow, controlled breathing and remain with the client.
Rationale: During acute panic, the nurse should remain with the client, provide
reassurance, reduce stimuli, and use simple interventions such as controlled
breathing. Complex discussion should wait until anxiety decreases.
9. A client with obsessive-compulsive disorder repeatedly washes their hands
until the skin becomes excoriated. Which intervention is most appropriate?
A. Immediately prohibit all handwashing.
B. Encourage gradual reduction of compulsive behavior.
C. Tell the client the behavior is irrational.
D. Reinforce the ritual to decrease anxiety.
Answer: B. Encourage gradual reduction of compulsive behavior.
