RN Mental Health Nursing Competency
Exam — Code: RN-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 tells the nurse, “My family would be
better off without me. I have finally figured out how to end all of this.”
What is the nurse’s priority action?
A. Encourage the client to discuss positive aspects of life.
B. Ask whether the client has a specific suicide plan, access to means, and intent.
C. Place the client in a quiet room to decrease stimulation.
D. Notify the family that the client is feeling depressed.
Answer: B. Ask whether the client has a specific suicide plan, access to means,
and intent.
,Rationale: Directly assessing suicide plan, means, and intent is essential for
determining immediate risk. Asking about suicide does not increase suicidal
behavior and allows the nurse to implement appropriate safety precautions.
2. A client taking lithium reports vomiting, coarse hand tremors, severe
diarrhea, and difficulty walking. Which action should the nurse take first?
A. Administer the next lithium dose with food.
B. Encourage increased sodium restriction.
C. Hold lithium and notify the healthcare provider immediately.
D. Reassure the client that mild tremors are expected.
Answer: C. Hold lithium and notify the healthcare provider immediately.
Rationale: Severe gastrointestinal symptoms, coarse tremors, and ataxia
suggest lithium toxicity. Lithium should be withheld and the provider notified
promptly because toxicity can progress to neurologic impairment, seizures, and
potentially life-threatening complications.
3. A client experiencing acute mania has been awake for 48 hours, repeatedly
interrupts other clients, and becomes increasingly irritable when limits are
imposed. Which nursing intervention is most appropriate?
A. Encourage participation in group therapy for several hours.
B. Provide lengthy explanations about behavioral expectations.
C. Reduce environmental stimulation and establish concise, consistent limits.
D. Allow unrestricted activity to prevent confrontation.
Answer: C. Reduce environmental stimulation and establish concise, consistent
limits.
Rationale: A manic client benefits from a low-stimulation environment, clear
boundaries, brief communication, and consistent limit setting. Excessive
stimulation can worsen agitation and impulsivity.
, 4. A client taking clozapine reports fever, sore throat, and profound weakness.
Which laboratory test is the priority?
A. Serum sodium
B. Absolute neutrophil count
C. Serum lithium level
D. Liver enzyme level
Answer: B. Absolute neutrophil count
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and
sore throat may indicate infection associated with dangerously low neutrophil
levels, requiring urgent evaluation.
5. A client with schizophrenia states, “The voices are telling me that the
government is monitoring my thoughts.” Which response by the nurse is
best?
A. “Those voices are not real, so you need to ignore them.”
B. “Why do you think the government is monitoring you?”
C. “I understand that you hear the voices, but I do not hear them.”
D. “You should listen carefully to determine whether they are giving you useful
information.”
Answer: C. “I understand that you hear the voices, but I do not hear them.”
Rationale: The nurse acknowledges the client’s experience without validating
the hallucination or delusion. Presenting reality in a calm manner promotes
therapeutic communication.
, 6. A client with obsessive-compulsive disorder spends several hours washing
their hands because of contamination fears. Which nursing intervention is
most appropriate?
A. Immediately prohibit all handwashing rituals.
B. Participate in the ritual to decrease anxiety.
C. Establish gradual limits while helping the client develop alternative anxiety-
management strategies.
D. Tell the client that contamination fears are irrational.
Answer: C. Establish gradual limits while helping the client develop alternative
anxiety-management strategies.
Rationale: Abruptly preventing compulsions can cause severe anxiety.
Treatment focuses on gradually reducing compulsive behavior while developing
healthier coping mechanisms, commonly through exposure and response
prevention.
7. A client with post-traumatic stress disorder becomes visibly distressed after
hearing a loud crash. Which nursing intervention is best?
A. Ask the client to describe every detail of the trauma immediately.
B. Encourage grounding techniques and orient the client to the present
environment.
C. Tell the client to suppress memories of the trauma.
D. Leave the client alone until the reaction resolves.
Answer: B. Encourage grounding techniques and orient the client to the present
environment.
Rationale: Grounding helps the client distinguish the present environment from
trauma-related memories or flashbacks. Immediate detailed processing of the
trauma is not appropriate during acute distress.
Exam — Code: RN-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 tells the nurse, “My family would be
better off without me. I have finally figured out how to end all of this.”
What is the nurse’s priority action?
A. Encourage the client to discuss positive aspects of life.
B. Ask whether the client has a specific suicide plan, access to means, and intent.
C. Place the client in a quiet room to decrease stimulation.
D. Notify the family that the client is feeling depressed.
Answer: B. Ask whether the client has a specific suicide plan, access to means,
and intent.
,Rationale: Directly assessing suicide plan, means, and intent is essential for
determining immediate risk. Asking about suicide does not increase suicidal
behavior and allows the nurse to implement appropriate safety precautions.
2. A client taking lithium reports vomiting, coarse hand tremors, severe
diarrhea, and difficulty walking. Which action should the nurse take first?
A. Administer the next lithium dose with food.
B. Encourage increased sodium restriction.
C. Hold lithium and notify the healthcare provider immediately.
D. Reassure the client that mild tremors are expected.
Answer: C. Hold lithium and notify the healthcare provider immediately.
Rationale: Severe gastrointestinal symptoms, coarse tremors, and ataxia
suggest lithium toxicity. Lithium should be withheld and the provider notified
promptly because toxicity can progress to neurologic impairment, seizures, and
potentially life-threatening complications.
3. A client experiencing acute mania has been awake for 48 hours, repeatedly
interrupts other clients, and becomes increasingly irritable when limits are
imposed. Which nursing intervention is most appropriate?
A. Encourage participation in group therapy for several hours.
B. Provide lengthy explanations about behavioral expectations.
C. Reduce environmental stimulation and establish concise, consistent limits.
D. Allow unrestricted activity to prevent confrontation.
Answer: C. Reduce environmental stimulation and establish concise, consistent
limits.
Rationale: A manic client benefits from a low-stimulation environment, clear
boundaries, brief communication, and consistent limit setting. Excessive
stimulation can worsen agitation and impulsivity.
, 4. A client taking clozapine reports fever, sore throat, and profound weakness.
Which laboratory test is the priority?
A. Serum sodium
B. Absolute neutrophil count
C. Serum lithium level
D. Liver enzyme level
Answer: B. Absolute neutrophil count
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and
sore throat may indicate infection associated with dangerously low neutrophil
levels, requiring urgent evaluation.
5. A client with schizophrenia states, “The voices are telling me that the
government is monitoring my thoughts.” Which response by the nurse is
best?
A. “Those voices are not real, so you need to ignore them.”
B. “Why do you think the government is monitoring you?”
C. “I understand that you hear the voices, but I do not hear them.”
D. “You should listen carefully to determine whether they are giving you useful
information.”
Answer: C. “I understand that you hear the voices, but I do not hear them.”
Rationale: The nurse acknowledges the client’s experience without validating
the hallucination or delusion. Presenting reality in a calm manner promotes
therapeutic communication.
, 6. A client with obsessive-compulsive disorder spends several hours washing
their hands because of contamination fears. Which nursing intervention is
most appropriate?
A. Immediately prohibit all handwashing rituals.
B. Participate in the ritual to decrease anxiety.
C. Establish gradual limits while helping the client develop alternative anxiety-
management strategies.
D. Tell the client that contamination fears are irrational.
Answer: C. Establish gradual limits while helping the client develop alternative
anxiety-management strategies.
Rationale: Abruptly preventing compulsions can cause severe anxiety.
Treatment focuses on gradually reducing compulsive behavior while developing
healthier coping mechanisms, commonly through exposure and response
prevention.
7. A client with post-traumatic stress disorder becomes visibly distressed after
hearing a loud crash. Which nursing intervention is best?
A. Ask the client to describe every detail of the trauma immediately.
B. Encourage grounding techniques and orient the client to the present
environment.
C. Tell the client to suppress memories of the trauma.
D. Leave the client alone until the reaction resolves.
Answer: B. Encourage grounding techniques and orient the client to the present
environment.
Rationale: Grounding helps the client distinguish the present environment from
trauma-related memories or flashbacks. Immediate detailed processing of the
trauma is not appropriate during acute distress.
