Psychiatric-Mental Health Nursing Certification Practice
Exam | Videbeck 9th Edition | 2025/2026 Verified Q&A
Pack with Comprehensive Rationales | Aligned with
Latest NCLEX-RN Test Plan
Instructions: This practice exam contains 90 multiple-choice questions covering the full spectrum of
psychiatric-mental health nursing. Each question is followed by the correct answer and a detailed
rationale in italicized format. Work through systematically, selecting your answer before reviewing the
rationale.
1. A client with schizophrenia is experiencing auditory hallucinations telling him to hurt himself.
Which response by the nurse is most appropriate?
A. "Tell the voices to stop."
B. "I know the voices are real to you, but I want you to be safe. Let's work together to keep you from
harm."
C. "Those voices aren't real. You need to ignore them."
D. "Why do you think you're hearing voices?"
Correct Answer: B
Rationale: The nurse should acknowledge the client's experience without reinforcing the
hallucination, while prioritizing safety. Option B validates the client's experience and establishes
a therapeutic alliance focused on safety. Option A dismisses the client's experience. Option C
denies the client's reality and can damage trust. Option D challenges the client and may
increase anxiety.
2. A nurse is assessing a client with major depressive disorder. Which symptom would the nurse
expect to find?
A. Grandiosity
B. Decreased need for sleep
C. Anhedonia
D. Flight of ideas
Correct Answer: C
Rationale: Anhedonia, the inability to experience pleasure in previously enjoyable activities, is a
cardinal symptom of major depressive disorder. Grandiosity, decreased need for sleep, and
flight of ideas are symptoms of mania, not depression.
3. A client with bipolar disorder is in the manic phase and has not slept for 3 days. Which nursing
intervention is the priority?
,A. Encourage the client to participate in group therapy
B. Provide a quiet environment and promote rest
C. Administer a PRN antipsychotic
D. Monitor for suicidal ideation
Correct Answer: B
Rationale: The priority for a client in the manic phase who is sleep-deprived is to provide a quiet,
low-stimulation environment and promote rest. Mania increases metabolic demands, and sleep
deprivation can worsen symptoms. While monitoring for suicidal ideation is important,
immediate physiological needs take priority. PRN medication may be necessary but is not the
first intervention.
4. A nurse is caring for a client with anorexia nervosa. Which behavior indicates the client is making
progress?
A. The client consumes 75% of meals
B. The client weighs herself daily
C. The client exercises for 2 hours daily
D. The client hides food in her pockets
Correct Answer: A
Rationale: Consuming 75% of meals indicates the client is beginning to normalize eating
behaviors and is a measurable sign of progress. Weighing daily and excessive exercise are
symptoms of the disorder. Hiding food indicates continued resistance to treatment.
5. A client with obsessive-compulsive disorder (OCD) performs handwashing rituals for 2 hours each
day. Which nursing intervention is most appropriate?
A. Interrupt the ritual immediately and redirect the client
B. Allow the ritual but set limits on duration
C. Teach the client to substitute a less harmful ritual
D. Administer a PRN anxiolytic before the ritual
Correct Answer: B
Rationale: Initially, the nurse should allow the ritual but set limits on duration to prevent
exhaustion and skin breakdown. Interrupting rituals abruptly increases anxiety. Substituting
rituals reinforces the disorder. PRN medication may be used but does not address the underlying
behavior.
6. A nurse is assessing a client for signs of alcohol withdrawal. Which symptom would the nurse
expect to see first?
A. Seizures
B. Delirium tremens
C. Tremors and anxiety
D. Hallucinations
, Correct Answer: C
Rationale: Early alcohol withdrawal typically begins 6-12 hours after the last drink and includes
tremors, anxiety, nausea, and diaphoresis. Seizures, hallucinations, and delirium tremens occur
later (24-72 hours). Early recognition and treatment prevent progression.
7. A client with post-traumatic stress disorder (PTSD) is experiencing a flashback. Which nursing
intervention is most appropriate?
A. Touch the client gently to orient him
B. Speak loudly to get his attention
C. Remain calm and tell the client he is in a safe place
D. Leave the client alone until the flashback passes
Correct Answer: C
Rationale: During a flashback, the client is reliving a traumatic event and needs gentle, calm
reorientation to the present. Touching may be misinterpreted as an assault. Loud speech may
increase agitation. Leaving the client alone is unsafe.
8. A nurse is caring for a client with borderline personality disorder who is demanding and
manipulative. Which nursing approach is most appropriate?
A. Set firm, consistent limits and maintain boundaries
B. Allow the client to have special privileges to prevent acting out
C. Rotate staff assignments frequently
D. Ignore manipulative behaviors
Correct Answer: A
Rationale: Clients with borderline personality disorder benefit from consistent, firm limits and
clear boundaries. This provides structure and safety. Special privileges reinforce manipulation.
Rotating staff may increase anxiety. Ignoring behaviors does not address them.
9. A client with schizophrenia is started on risperidone. Which adverse effect should the nurse
monitor for?
A. Hypothyroidism
B. Metabolic syndrome
C. Hypertension
D. Bradycardia
Correct Answer: B
Rationale: Atypical antipsychotics like risperidone are associated with metabolic syndrome,
including weight gain, hyperglycemia, and dyslipidemia. Monitoring weight, glucose, and lipids
is essential. Hypothyroidism, hypertension, and bradycardia are not typical adverse effects.
10. A nurse is conducting a suicide risk assessment. Which question is most appropriate to ask?
Exam | Videbeck 9th Edition | 2025/2026 Verified Q&A
Pack with Comprehensive Rationales | Aligned with
Latest NCLEX-RN Test Plan
Instructions: This practice exam contains 90 multiple-choice questions covering the full spectrum of
psychiatric-mental health nursing. Each question is followed by the correct answer and a detailed
rationale in italicized format. Work through systematically, selecting your answer before reviewing the
rationale.
1. A client with schizophrenia is experiencing auditory hallucinations telling him to hurt himself.
Which response by the nurse is most appropriate?
A. "Tell the voices to stop."
B. "I know the voices are real to you, but I want you to be safe. Let's work together to keep you from
harm."
C. "Those voices aren't real. You need to ignore them."
D. "Why do you think you're hearing voices?"
Correct Answer: B
Rationale: The nurse should acknowledge the client's experience without reinforcing the
hallucination, while prioritizing safety. Option B validates the client's experience and establishes
a therapeutic alliance focused on safety. Option A dismisses the client's experience. Option C
denies the client's reality and can damage trust. Option D challenges the client and may
increase anxiety.
2. A nurse is assessing a client with major depressive disorder. Which symptom would the nurse
expect to find?
A. Grandiosity
B. Decreased need for sleep
C. Anhedonia
D. Flight of ideas
Correct Answer: C
Rationale: Anhedonia, the inability to experience pleasure in previously enjoyable activities, is a
cardinal symptom of major depressive disorder. Grandiosity, decreased need for sleep, and
flight of ideas are symptoms of mania, not depression.
3. A client with bipolar disorder is in the manic phase and has not slept for 3 days. Which nursing
intervention is the priority?
,A. Encourage the client to participate in group therapy
B. Provide a quiet environment and promote rest
C. Administer a PRN antipsychotic
D. Monitor for suicidal ideation
Correct Answer: B
Rationale: The priority for a client in the manic phase who is sleep-deprived is to provide a quiet,
low-stimulation environment and promote rest. Mania increases metabolic demands, and sleep
deprivation can worsen symptoms. While monitoring for suicidal ideation is important,
immediate physiological needs take priority. PRN medication may be necessary but is not the
first intervention.
4. A nurse is caring for a client with anorexia nervosa. Which behavior indicates the client is making
progress?
A. The client consumes 75% of meals
B. The client weighs herself daily
C. The client exercises for 2 hours daily
D. The client hides food in her pockets
Correct Answer: A
Rationale: Consuming 75% of meals indicates the client is beginning to normalize eating
behaviors and is a measurable sign of progress. Weighing daily and excessive exercise are
symptoms of the disorder. Hiding food indicates continued resistance to treatment.
5. A client with obsessive-compulsive disorder (OCD) performs handwashing rituals for 2 hours each
day. Which nursing intervention is most appropriate?
A. Interrupt the ritual immediately and redirect the client
B. Allow the ritual but set limits on duration
C. Teach the client to substitute a less harmful ritual
D. Administer a PRN anxiolytic before the ritual
Correct Answer: B
Rationale: Initially, the nurse should allow the ritual but set limits on duration to prevent
exhaustion and skin breakdown. Interrupting rituals abruptly increases anxiety. Substituting
rituals reinforces the disorder. PRN medication may be used but does not address the underlying
behavior.
6. A nurse is assessing a client for signs of alcohol withdrawal. Which symptom would the nurse
expect to see first?
A. Seizures
B. Delirium tremens
C. Tremors and anxiety
D. Hallucinations
, Correct Answer: C
Rationale: Early alcohol withdrawal typically begins 6-12 hours after the last drink and includes
tremors, anxiety, nausea, and diaphoresis. Seizures, hallucinations, and delirium tremens occur
later (24-72 hours). Early recognition and treatment prevent progression.
7. A client with post-traumatic stress disorder (PTSD) is experiencing a flashback. Which nursing
intervention is most appropriate?
A. Touch the client gently to orient him
B. Speak loudly to get his attention
C. Remain calm and tell the client he is in a safe place
D. Leave the client alone until the flashback passes
Correct Answer: C
Rationale: During a flashback, the client is reliving a traumatic event and needs gentle, calm
reorientation to the present. Touching may be misinterpreted as an assault. Loud speech may
increase agitation. Leaving the client alone is unsafe.
8. A nurse is caring for a client with borderline personality disorder who is demanding and
manipulative. Which nursing approach is most appropriate?
A. Set firm, consistent limits and maintain boundaries
B. Allow the client to have special privileges to prevent acting out
C. Rotate staff assignments frequently
D. Ignore manipulative behaviors
Correct Answer: A
Rationale: Clients with borderline personality disorder benefit from consistent, firm limits and
clear boundaries. This provides structure and safety. Special privileges reinforce manipulation.
Rotating staff may increase anxiety. Ignoring behaviors does not address them.
9. A client with schizophrenia is started on risperidone. Which adverse effect should the nurse
monitor for?
A. Hypothyroidism
B. Metabolic syndrome
C. Hypertension
D. Bradycardia
Correct Answer: B
Rationale: Atypical antipsychotics like risperidone are associated with metabolic syndrome,
including weight gain, hyperglycemia, and dyslipidemia. Monitoring weight, glucose, and lipids
is essential. Hypothyroidism, hypertension, and bradycardia are not typical adverse effects.
10. A nurse is conducting a suicide risk assessment. Which question is most appropriate to ask?
