Page |1
HESI RN MENTAL HEALTH EXIT EXAMINATION
STUDY GUIDE | LATEST UPDATE 2026/2027 |
PRACTICE QUESTIONS AND ANSWERS |
EXAM REVIEW.
TABLE OF CONTENTS
1. Foundations of Psychiatric-Mental Health Nursing
2. Therapeutic Communication and Relationships
3. Legal and Ethical Issues in Mental Health
4. Anxiety, OCD, and Trauma-Related Disorders
5. Mood Disorders and Suicide
6. Schizophrenia and Psychotic Disorders
7. Personality Disorders
8. Substance Use Disorders
9. Eating Disorders
10. Somatic Symptom and Dissociative Disorders
11. Neurocognitive Disorders
12. Child and Adolescent Psychiatric Disorders
13. Psychopharmacology
14. Milieu Therapy and Crisis Intervention
15. Community Mental Health and Disaster Response
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Question 1: A nurse is establishing a therapeutic relationship with a newly admitted
patient with paranoid schizophrenia. Which action should the nurse take first?
A) Encourage the patient to attend all group activities
B) Introduce self and explain the purpose of the interaction
C) Set firm limits on suspicious behavior
D) Administer prescribed antipsychotic medication
Correct Answer: B) Introduce self and explain the purpose of the interaction
The orientation phase of the therapeutic relationship begins with introductions,
establishing trust, and explaining the purpose of the interaction. This is especially
important for a patient with paranoia, as it establishes predictability and reduces
suspicion. Encouraging group attendance and setting limits are premature before
trust is established.
Question 2: A patient says to the nurse, "I feel like nobody cares whether I live or
die." Which response by the nurse is most therapeutic?
A) "You shouldn't feel that way; many people care about you."
B) "Are you thinking about hurting yourself?"
C) "Let's talk about something more pleasant."
D) "Why do you feel that way?"
Correct Answer: B) "Are you thinking about hurting yourself?"
When a patient expresses feelings of hopelessness or worthlessness, the priority is
to directly assess for suicidal ideation. This direct, nonjudgmental questioning
provides critical safety information. Dismissing the feeling, changing the subject, or
asking "why" are not therapeutic responses.
Question 3: Which finding indicates that a patient with anorexia nervosa is
experiencing a life-threatening complication?
A) Body mass index of 16.5
B) Serum potassium of 2.8 mEq/L
C) Heart rate of 88 beats/min
D) Preoccupation with food
Correct Answer: B) Serum potassium of 2.8 mEq/L
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Hypokalemia (normal: 3.5-5.0 mEq/L) is a life-threatening complication of anorexia
nervosa, especially with purging behaviors, and can cause cardiac dysrhythmias. A
BMI of 16.5 is concerning but not immediately life-threatening. Preoccupation with
food is a characteristic feature, not a complication.
Question 4: A patient with bipolar disorder is in the manic phase and has not slept for
3 days. Which nursing intervention is priority?
A) Administer a PRN sleep aid
B) Provide a quiet, low-stimulation environment
C) Encourage the patient to attend group therapy
D) Allow the patient to engage in physical activity
Correct Answer: B) Provide a quiet, low-stimulation environment
During a manic episode, the priority is to reduce environmental stimulation to
promote rest and decrease agitation. A quiet environment helps prevent escalation of
manic behavior. Administering sleep aids requires an order, and group therapy and
physical activity may increase stimulation.
Question 5: A patient receiving haloperidol develops muscle rigidity, fever, and
altered mental status. Which condition should the nurse suspect?
A) Tardive dyskinesia
B) Acute dystonia
C) Neuroleptic malignant syndrome
D) Serotonin syndrome
Correct Answer: C) Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotic
medications characterized by severe muscle rigidity, hyperthermia, autonomic
instability, and altered mental status. Immediate discontinuation of the offending
agent and supportive care are essential. Tardive dyskinesia involves involuntary
movements. Acute dystonia involves muscle spasms. Serotonin syndrome occurs
with serotonergic agents.
Question 6: A nurse is teaching a patient about lithium therapy. Which statement by
the patient indicates correct understanding?
, Page |4
A) "I should maintain consistent sodium and fluid intake."
B) "I should avoid all fluids to prevent toxicity."
C) "I can stop the medication when I feel better."
D) "I should take lithium only when I feel manic."
Correct Answer: A) "I should maintain consistent sodium and fluid intake."
Lithium levels are affected by sodium and fluid balance. Patients should maintain
consistent sodium and fluid intake and avoid drastic changes. Dehydration and low
sodium can increase lithium levels and toxicity risk. Lithium must be taken
consistently, not as needed.
Question 7: A patient with major depressive disorder is started on sertraline. Which
teaching point is most important?
A) "The medication works immediately."
B) "Full therapeutic effect may take 4-6 weeks."
C) "Stop the medication if you feel better."
D) "Take the medication only when you feel sad."
Correct Answer: B) "Full therapeutic effect may take 4-6 weeks."
SSRIs typically take 4-6 weeks to achieve full therapeutic effect. Patients should be
counseled to continue taking the medication as prescribed and not to expect
immediate results. Abrupt discontinuation can cause withdrawal symptoms.
Question 8: A patient with schizophrenia is experiencing auditory hallucinations
telling them to harm themselves. Which nursing intervention is priority?
A) Tell the patient the voices are not real
B) Ask the patient what the voices are saying
C) Ignore the hallucinations
D) Increase the patient's medication without an order
Correct Answer: B) Ask the patient what the voices are saying
Assessing the content of hallucinations is essential to determine if they are
command hallucinations (which may pose a safety risk) and to guide appropriate
interventions. Telling the patient the voices are not real may increase distress.
Increasing medication requires a provider order.
HESI RN MENTAL HEALTH EXIT EXAMINATION
STUDY GUIDE | LATEST UPDATE 2026/2027 |
PRACTICE QUESTIONS AND ANSWERS |
EXAM REVIEW.
TABLE OF CONTENTS
1. Foundations of Psychiatric-Mental Health Nursing
2. Therapeutic Communication and Relationships
3. Legal and Ethical Issues in Mental Health
4. Anxiety, OCD, and Trauma-Related Disorders
5. Mood Disorders and Suicide
6. Schizophrenia and Psychotic Disorders
7. Personality Disorders
8. Substance Use Disorders
9. Eating Disorders
10. Somatic Symptom and Dissociative Disorders
11. Neurocognitive Disorders
12. Child and Adolescent Psychiatric Disorders
13. Psychopharmacology
14. Milieu Therapy and Crisis Intervention
15. Community Mental Health and Disaster Response
, Page |2
Question 1: A nurse is establishing a therapeutic relationship with a newly admitted
patient with paranoid schizophrenia. Which action should the nurse take first?
A) Encourage the patient to attend all group activities
B) Introduce self and explain the purpose of the interaction
C) Set firm limits on suspicious behavior
D) Administer prescribed antipsychotic medication
Correct Answer: B) Introduce self and explain the purpose of the interaction
The orientation phase of the therapeutic relationship begins with introductions,
establishing trust, and explaining the purpose of the interaction. This is especially
important for a patient with paranoia, as it establishes predictability and reduces
suspicion. Encouraging group attendance and setting limits are premature before
trust is established.
Question 2: A patient says to the nurse, "I feel like nobody cares whether I live or
die." Which response by the nurse is most therapeutic?
A) "You shouldn't feel that way; many people care about you."
B) "Are you thinking about hurting yourself?"
C) "Let's talk about something more pleasant."
D) "Why do you feel that way?"
Correct Answer: B) "Are you thinking about hurting yourself?"
When a patient expresses feelings of hopelessness or worthlessness, the priority is
to directly assess for suicidal ideation. This direct, nonjudgmental questioning
provides critical safety information. Dismissing the feeling, changing the subject, or
asking "why" are not therapeutic responses.
Question 3: Which finding indicates that a patient with anorexia nervosa is
experiencing a life-threatening complication?
A) Body mass index of 16.5
B) Serum potassium of 2.8 mEq/L
C) Heart rate of 88 beats/min
D) Preoccupation with food
Correct Answer: B) Serum potassium of 2.8 mEq/L
, Page |3
Hypokalemia (normal: 3.5-5.0 mEq/L) is a life-threatening complication of anorexia
nervosa, especially with purging behaviors, and can cause cardiac dysrhythmias. A
BMI of 16.5 is concerning but not immediately life-threatening. Preoccupation with
food is a characteristic feature, not a complication.
Question 4: A patient with bipolar disorder is in the manic phase and has not slept for
3 days. Which nursing intervention is priority?
A) Administer a PRN sleep aid
B) Provide a quiet, low-stimulation environment
C) Encourage the patient to attend group therapy
D) Allow the patient to engage in physical activity
Correct Answer: B) Provide a quiet, low-stimulation environment
During a manic episode, the priority is to reduce environmental stimulation to
promote rest and decrease agitation. A quiet environment helps prevent escalation of
manic behavior. Administering sleep aids requires an order, and group therapy and
physical activity may increase stimulation.
Question 5: A patient receiving haloperidol develops muscle rigidity, fever, and
altered mental status. Which condition should the nurse suspect?
A) Tardive dyskinesia
B) Acute dystonia
C) Neuroleptic malignant syndrome
D) Serotonin syndrome
Correct Answer: C) Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotic
medications characterized by severe muscle rigidity, hyperthermia, autonomic
instability, and altered mental status. Immediate discontinuation of the offending
agent and supportive care are essential. Tardive dyskinesia involves involuntary
movements. Acute dystonia involves muscle spasms. Serotonin syndrome occurs
with serotonergic agents.
Question 6: A nurse is teaching a patient about lithium therapy. Which statement by
the patient indicates correct understanding?
, Page |4
A) "I should maintain consistent sodium and fluid intake."
B) "I should avoid all fluids to prevent toxicity."
C) "I can stop the medication when I feel better."
D) "I should take lithium only when I feel manic."
Correct Answer: A) "I should maintain consistent sodium and fluid intake."
Lithium levels are affected by sodium and fluid balance. Patients should maintain
consistent sodium and fluid intake and avoid drastic changes. Dehydration and low
sodium can increase lithium levels and toxicity risk. Lithium must be taken
consistently, not as needed.
Question 7: A patient with major depressive disorder is started on sertraline. Which
teaching point is most important?
A) "The medication works immediately."
B) "Full therapeutic effect may take 4-6 weeks."
C) "Stop the medication if you feel better."
D) "Take the medication only when you feel sad."
Correct Answer: B) "Full therapeutic effect may take 4-6 weeks."
SSRIs typically take 4-6 weeks to achieve full therapeutic effect. Patients should be
counseled to continue taking the medication as prescribed and not to expect
immediate results. Abrupt discontinuation can cause withdrawal symptoms.
Question 8: A patient with schizophrenia is experiencing auditory hallucinations
telling them to harm themselves. Which nursing intervention is priority?
A) Tell the patient the voices are not real
B) Ask the patient what the voices are saying
C) Ignore the hallucinations
D) Increase the patient's medication without an order
Correct Answer: B) Ask the patient what the voices are saying
Assessing the content of hallucinations is essential to determine if they are
command hallucinations (which may pose a safety risk) and to guide appropriate
interventions. Telling the patient the voices are not real may increase distress.
Increasing medication requires a provider order.
