ATI Mental Health Nursing 2026–2027 | ATI RN
Mental Health Nursing Review & Proctored Exam
Study Guide | Psychiatric Nursing, Mental Health
Assessment, Therapeutic Communication, Anxiety &
Trauma Disorders, Depression & Suicide
Prevention, Bipolar Disorder, Schizophrenia &
Psychotic Disorders, Personality Disorders,
Substance Use & Addictive Disorders, Eating
Disorders, Neurocognitive Disorders,
Psychopharmacology, Crisis Intervention, Legal &
Ethical Nursing, Patient Safety, Clinical Judgment,
NGN-Style Practice Questions & Detailed Rationales
Question 1: A nurse is assessing a client who repeatedly uses the defense
mechanism of projection. Which of the following client statements should the
nurse expect?
A. "I don't remember saying that to my wife."
B. "The staff members are the ones who don't like me."
C. "I became angry because my boss provoked me."
D. "I enjoy helping others because it makes me feel good."
CORRECT ANSWER: B. "The staff members are the ones who don't like me."
Rationale: Projection involves attributing one's own unacceptable thoughts or feelings to
others. The client who feels disliked by staff but actually harbors negative feelings
toward them is projecting. Option A reflects repression or denial, Option C reflects
rationalization, and Option D reflects altruism, a mature defense mechanism.
Question 2: A nurse is caring for a client with major depressive disorder who
states, "Nothing matters anymore." Which of the following responses by the
nurse is the priority?
A. "You have so much to live for."
B. "Are you thinking of harming yourself ?"
C. "I understand exactly how you feel."
D. "Why do you feel that way?"
CORRECT ANSWER: B. "Are you thinking of harming yourself ?"
Rationale: The priority nursing action is to assess for suicidal ideation, as the statement
suggests hopelessness and potential risk for self-harm. Direct questioning about suicidal
thoughts is essential for safety. Option A minimizes the client's feelings, Option C is
nontherapeutic by assuming understanding, and Option D asks "why," which can seem
judgmental and may increase defensiveness.
,Question 3: A nurse is providing teaching to a client prescribed phenelzine
(Nardil). Which of the following dietary instructions is essential?
A. "Increase your intake of leafy green vegetables."
B. "Avoid foods high in tyramine, such as aged cheese and cured meats."
C. "Take this medication with grapefruit juice."
D. "Increase your potassium intake significantly."
CORRECT ANSWER: B. "Avoid foods high in tyramine, such as aged cheese and
cured meats."
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Tyramine-rich foods
can precipitate a hypertensive crisis when consumed with MAOIs. Clients must follow a
low-tyramine diet. Grapefruit juice interactions are not the primary concern with
MAOIs, and potassium or leafy green vegetables are unrelated to this specific dietary
restriction.
Question 4: A client with schizophrenia tells the nurse, "The CIA is poisoning
my food." Which of the following responses by the nurse is most therapeutic?
A. "That's not true. No one is poisoning your food."
B. "Why do you think the CIA is poisoning your food?"
C. "I understand you feel that way, but the food is safe."
D. "Let's go to the dining room together and I'll eat with you."
CORRECT ANSWER: D. "Let's go to the dining room together and I'll eat with
you."
Rationale: This response validates the client's experience without arguing about the
delusion and provides reality-based support by offering to eat with the client. Option A
challenges the delusion directly, which may increase agitation. Option B asks "why,"
which reinforces the delusional content. Option C acknowledges feelings but then
dismisses the concern without offering a therapeutic action.
Question 5: A nurse is caring for a client experiencing command
hallucinations. Which of the following actions is the priority?
A. Tell the client to ignore the voices.
B. Assess the content and intent of the hallucinations.
C. Administer PRN antipsychotic medication immediately.
D. Place the client in seclusion for safety.
CORRECT ANSWER: B. Assess the content and intent of the hallucinations.
Rationale: Command hallucinations involving harm require immediate assessment of the
content, intent, the client's ability to resist the command, and the potential target.
Assessment precedes intervention. Telling the client to ignore the voices is not helpful,
and while medication or seclusion may be necessary, assessment comes first to
determine the level of risk.
,Question 6: A client with bipolar disorder is prescribed valproic acid
(Depakote). Which of the following laboratory values should the nurse monitor
most closely?
A. Serum sodium
B. Liver function tests
C. Serum potassium
D. Thyroid function
CORRECT ANSWER: B. Liver function tests
Rationale: Valproic acid can cause hepatotoxicity and pancreatitis. Liver function tests
should be monitored at baseline and periodically. It can also cause thrombocytopenia,
so platelet counts should be monitored. Sodium, potassium, and thyroid function are not
primary concerns with valproic acid therapy.
Question 7: A nurse is teaching a client about sertraline (Zoloft). Which of the
following client statements indicates a need for further teaching?
A. "I should take this medication at the same time each day."
B. "I will feel better within 24 hours of starting this medication."
C. "I should not stop this medication abruptly."
D. "I may experience some nausea when I first start taking this."
CORRECT ANSWER: B. "I will feel better within 24 hours of starting this
medication."
Rationale: SSRIs like sertraline typically take 2 to 4 weeks to achieve therapeutic effects.
Setting realistic expectations improves adherence. Taking the medication consistently,
not stopping abruptly, and anticipating possible GI upset are all accurate statements that
indicate correct understanding.
Question 8: A nurse is assessing a client for serotonin syndrome. Which of the
following findings is most concerning?
A. Mild nausea
B. Hyperthermia and muscle rigidity
C. Constipation
D. Dry mouth
CORRECT ANSWER: B. Hyperthermia and muscle rigidity
Rationale: Serotonin syndrome is a life-threatening condition characterized by
hyperthermia, muscle rigidity, altered mental status, and autonomic instability. It
requires immediate medical intervention. Mild nausea, constipation, and dry mouth are
common SSRI side effects but are not indicative of this emergency.
Question 9: A nurse is caring for a client with schizophrenia who exhibits
concrete thinking. Which of the following client statements supports this
finding?
, A. "I am aware that each problem has only one solution."
B. "I am a prophet of God."
C. "The voices tell me that I must avoid large crowds."
D. "I know that you are trying to poison me."
CORRECT ANSWER: A. "I am aware that each problem has only one solution."
Rationale: Concrete thinking is the inability to think abstractly. A client who believes
every problem has only one solution demonstrates literal, inflexible thinking. Option B
reflects a grandiose delusion, Option C reflects an auditory hallucination, and Option D
reflects a persecutory delusion.
Question 10: A nurse is admitting a client who is exhibiting manic behavior.
Which of the following is the priority nursing action?
A. Identifying support systems
B. Assisting the client in identifying coping behaviors
C. Encouraging self-care
D. Preventing self-directed violence
CORRECT ANSWER: D. Preventing self-directed violence
Rationale: Safety is always the priority in nursing care. Clients in a manic state are at risk
for self-directed violence due to impulsivity, poor judgment, and excessive energy.
Identifying support systems, exploring coping behaviors, and encouraging self-care are
important but secondary to immediate safety.
Question 11: A nurse is assessing a client with alcohol use disorder who
exhibits signs of Wernicke-Korsakoff syndrome. Which of the following
findings is most characteristic?
A. Fine tremors of the hands
B. Confusion and ataxia
C. Visual hallucinations
D. Seizure activity
CORRECT ANSWER: B. Confusion and ataxia
Rationale: Wernicke-Korsakoff syndrome results from thiamine (vitamin B1) deficiency
and is characterized by confusion, ataxia, and ophthalmoplegia. Fine tremors,
hallucinations, and seizures are more associated with acute alcohol withdrawal rather
than this specific neurological complication.
Question 12: A nurse is providing education to a client prescribed clozapine.
Which of the following client statements indicates correct understanding?
A. "I need to have my white blood cell count checked regularly."
B. "I can stop this medication if I feel dizzy."
C. "This medication is safe to take during pregnancy."
D. "I can continue drinking grapefruit juice."
Mental Health Nursing Review & Proctored Exam
Study Guide | Psychiatric Nursing, Mental Health
Assessment, Therapeutic Communication, Anxiety &
Trauma Disorders, Depression & Suicide
Prevention, Bipolar Disorder, Schizophrenia &
Psychotic Disorders, Personality Disorders,
Substance Use & Addictive Disorders, Eating
Disorders, Neurocognitive Disorders,
Psychopharmacology, Crisis Intervention, Legal &
Ethical Nursing, Patient Safety, Clinical Judgment,
NGN-Style Practice Questions & Detailed Rationales
Question 1: A nurse is assessing a client who repeatedly uses the defense
mechanism of projection. Which of the following client statements should the
nurse expect?
A. "I don't remember saying that to my wife."
B. "The staff members are the ones who don't like me."
C. "I became angry because my boss provoked me."
D. "I enjoy helping others because it makes me feel good."
CORRECT ANSWER: B. "The staff members are the ones who don't like me."
Rationale: Projection involves attributing one's own unacceptable thoughts or feelings to
others. The client who feels disliked by staff but actually harbors negative feelings
toward them is projecting. Option A reflects repression or denial, Option C reflects
rationalization, and Option D reflects altruism, a mature defense mechanism.
Question 2: A nurse is caring for a client with major depressive disorder who
states, "Nothing matters anymore." Which of the following responses by the
nurse is the priority?
A. "You have so much to live for."
B. "Are you thinking of harming yourself ?"
C. "I understand exactly how you feel."
D. "Why do you feel that way?"
CORRECT ANSWER: B. "Are you thinking of harming yourself ?"
Rationale: The priority nursing action is to assess for suicidal ideation, as the statement
suggests hopelessness and potential risk for self-harm. Direct questioning about suicidal
thoughts is essential for safety. Option A minimizes the client's feelings, Option C is
nontherapeutic by assuming understanding, and Option D asks "why," which can seem
judgmental and may increase defensiveness.
,Question 3: A nurse is providing teaching to a client prescribed phenelzine
(Nardil). Which of the following dietary instructions is essential?
A. "Increase your intake of leafy green vegetables."
B. "Avoid foods high in tyramine, such as aged cheese and cured meats."
C. "Take this medication with grapefruit juice."
D. "Increase your potassium intake significantly."
CORRECT ANSWER: B. "Avoid foods high in tyramine, such as aged cheese and
cured meats."
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Tyramine-rich foods
can precipitate a hypertensive crisis when consumed with MAOIs. Clients must follow a
low-tyramine diet. Grapefruit juice interactions are not the primary concern with
MAOIs, and potassium or leafy green vegetables are unrelated to this specific dietary
restriction.
Question 4: A client with schizophrenia tells the nurse, "The CIA is poisoning
my food." Which of the following responses by the nurse is most therapeutic?
A. "That's not true. No one is poisoning your food."
B. "Why do you think the CIA is poisoning your food?"
C. "I understand you feel that way, but the food is safe."
D. "Let's go to the dining room together and I'll eat with you."
CORRECT ANSWER: D. "Let's go to the dining room together and I'll eat with
you."
Rationale: This response validates the client's experience without arguing about the
delusion and provides reality-based support by offering to eat with the client. Option A
challenges the delusion directly, which may increase agitation. Option B asks "why,"
which reinforces the delusional content. Option C acknowledges feelings but then
dismisses the concern without offering a therapeutic action.
Question 5: A nurse is caring for a client experiencing command
hallucinations. Which of the following actions is the priority?
A. Tell the client to ignore the voices.
B. Assess the content and intent of the hallucinations.
C. Administer PRN antipsychotic medication immediately.
D. Place the client in seclusion for safety.
CORRECT ANSWER: B. Assess the content and intent of the hallucinations.
Rationale: Command hallucinations involving harm require immediate assessment of the
content, intent, the client's ability to resist the command, and the potential target.
Assessment precedes intervention. Telling the client to ignore the voices is not helpful,
and while medication or seclusion may be necessary, assessment comes first to
determine the level of risk.
,Question 6: A client with bipolar disorder is prescribed valproic acid
(Depakote). Which of the following laboratory values should the nurse monitor
most closely?
A. Serum sodium
B. Liver function tests
C. Serum potassium
D. Thyroid function
CORRECT ANSWER: B. Liver function tests
Rationale: Valproic acid can cause hepatotoxicity and pancreatitis. Liver function tests
should be monitored at baseline and periodically. It can also cause thrombocytopenia,
so platelet counts should be monitored. Sodium, potassium, and thyroid function are not
primary concerns with valproic acid therapy.
Question 7: A nurse is teaching a client about sertraline (Zoloft). Which of the
following client statements indicates a need for further teaching?
A. "I should take this medication at the same time each day."
B. "I will feel better within 24 hours of starting this medication."
C. "I should not stop this medication abruptly."
D. "I may experience some nausea when I first start taking this."
CORRECT ANSWER: B. "I will feel better within 24 hours of starting this
medication."
Rationale: SSRIs like sertraline typically take 2 to 4 weeks to achieve therapeutic effects.
Setting realistic expectations improves adherence. Taking the medication consistently,
not stopping abruptly, and anticipating possible GI upset are all accurate statements that
indicate correct understanding.
Question 8: A nurse is assessing a client for serotonin syndrome. Which of the
following findings is most concerning?
A. Mild nausea
B. Hyperthermia and muscle rigidity
C. Constipation
D. Dry mouth
CORRECT ANSWER: B. Hyperthermia and muscle rigidity
Rationale: Serotonin syndrome is a life-threatening condition characterized by
hyperthermia, muscle rigidity, altered mental status, and autonomic instability. It
requires immediate medical intervention. Mild nausea, constipation, and dry mouth are
common SSRI side effects but are not indicative of this emergency.
Question 9: A nurse is caring for a client with schizophrenia who exhibits
concrete thinking. Which of the following client statements supports this
finding?
, A. "I am aware that each problem has only one solution."
B. "I am a prophet of God."
C. "The voices tell me that I must avoid large crowds."
D. "I know that you are trying to poison me."
CORRECT ANSWER: A. "I am aware that each problem has only one solution."
Rationale: Concrete thinking is the inability to think abstractly. A client who believes
every problem has only one solution demonstrates literal, inflexible thinking. Option B
reflects a grandiose delusion, Option C reflects an auditory hallucination, and Option D
reflects a persecutory delusion.
Question 10: A nurse is admitting a client who is exhibiting manic behavior.
Which of the following is the priority nursing action?
A. Identifying support systems
B. Assisting the client in identifying coping behaviors
C. Encouraging self-care
D. Preventing self-directed violence
CORRECT ANSWER: D. Preventing self-directed violence
Rationale: Safety is always the priority in nursing care. Clients in a manic state are at risk
for self-directed violence due to impulsivity, poor judgment, and excessive energy.
Identifying support systems, exploring coping behaviors, and encouraging self-care are
important but secondary to immediate safety.
Question 11: A nurse is assessing a client with alcohol use disorder who
exhibits signs of Wernicke-Korsakoff syndrome. Which of the following
findings is most characteristic?
A. Fine tremors of the hands
B. Confusion and ataxia
C. Visual hallucinations
D. Seizure activity
CORRECT ANSWER: B. Confusion and ataxia
Rationale: Wernicke-Korsakoff syndrome results from thiamine (vitamin B1) deficiency
and is characterized by confusion, ataxia, and ophthalmoplegia. Fine tremors,
hallucinations, and seizures are more associated with acute alcohol withdrawal rather
than this specific neurological complication.
Question 12: A nurse is providing education to a client prescribed clozapine.
Which of the following client statements indicates correct understanding?
A. "I need to have my white blood cell count checked regularly."
B. "I can stop this medication if I feel dizzy."
C. "This medication is safe to take during pregnancy."
D. "I can continue drinking grapefruit juice."
