TEST BANK
NGN RN HESI EXIT PSYCHIATRIC MENTAL HEALTH EXAM STUDY GUIDE
Questions, Correct answers and Rationales
PERFECT STUDY GUIDE FOR 2025
1. A client on the mental health unit is becoming more agitated, shouting at the staff, and pacing in
the hallway. When the PRN medication is offered, the client refuses the medication and defiantly
sits on the floor in the middle of the unit hallway. What nursing intervention should the RN
implement first?
A. Transport of the client to the seclusion room.
B. Quietly approach the client with additional staff members.
C. Take other clients in the area to the client lounge.
D. Administer medication to chemically restrain the patient.
Rationale: Prioritizing the safety of other clients is essential in a potentially volatile situation. Removing
other clients from the area reduces the risk of harm and minimizes stimulation, which could further
escalate the agitated client's behavior. This intervention addresses the immediate safety concerns
before attempting to de-escalate or manage the client’s behavior directly.
2. A client is admitted to the mental health unit and reports taking extra antianxiety medication
because, “I’m so stressed out. I just want to go to sleep.” The RN should plan one-on-one
observation of the client based on which statement?
A. “What should I do? Nothing seems to help.”
B. “I have been so tired lately and needed to sleep.”
C. “I really think that I don’t need to be here.”
D. “I don’t want to walk. Nothing matters anymore.”
Rationale: The statement “I don’t want to walk. Nothing matters anymore” indicates hopelessness and
potential suicidal ideation, which are red flags for self-harm risk. One-on-one observation is critical to
ensure the client’s safety and monitor for any signs of worsening depression or suicidal behavior.
, 3. A male hospital employee is pushed out of the way by a female employee because of an
oncoming gurney. The pushed employee becomes very angry and swings at the female
employee. Both employees are referred for counseling with the staff psychiatric RN. Which factor
in the pushed employee’s history is most related to the reaction that occurred?
A. Is worried about losing his job to a woman.
B. Tortured animals as a child.
C. Was physically abused by his mother.
D. Hates to be touched by anyone.
Rationale: A history of physical abuse by his mother is most likely to contribute to the employee’s
aggressive reaction to being pushed, as it may trigger unresolved trauma or heightened sensitivity to
physical contact, leading to an exaggerated response. Past trauma can significantly influence emotional
regulation and interpersonal interactions.
4. The RN documents the mental status of a female client who has been hospitalized for several
days by court order. The client states, “I don’t need to be here” and tells the RN that she believes
the television talks to her. The RN should document these assessment findings in which section
of the mental status exam?
A. Level of concentration.
B. Insight and judgement.
C. Remote memory.
D. Mood and affect.
Rationale: The client’s statements reflect impaired insight (denying the need for hospitalization) and
poor judgment (believing the television talks to her), which are appropriately documented in the insight
and judgment section of the mental status exam. These findings indicate delusional thinking and lack of
awareness of her condition.
5. A client is admitted to the mental health unit and reports shortness of breath and dizziness. The
client tells the RN, “I feel like I’m going to die.” Which nursing problem should the RN include in
this client’s plan of care?
A. Mood disturbance.
B. Moderate anxiety.
C. Altered thoughts.
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, D. Social isolation.
Rationale: The client’s symptoms of shortness of breath, dizziness, and fear of dying are characteristic
of moderate anxiety. Including this in the care plan prioritizes addressing the acute physiological and
psychological symptoms, which can be managed through interventions like relaxation techniques or
medication.
6. A female client who is wearing dirty clothes and has foul body odor comes to the clinic reporting
feeling scared because she is being stalked. What action is most important for the RN to take?
A. Offer the client a safe place to relax before interviewing her.
B. Ask the client to describe why she is being stalked.
C. Recommend that the client talk with a social worker.
D. Assure the client that the HCP will see her today.
Rationale: Providing a safe, calming environment is the priority to reduce the client’s fear and anxiety,
which may be exacerbated by the perception of being stalked. This action helps establish trust and
facilitates a more effective interview, ensuring the client feels secure before further assessment.
7. The RN leading a group session of adolescent clients gives the members a handout about anger
management. One of the male clients is fidgety, interrupts peers when they try to talk, and talks
about his pets at home. What nursing action is best for the RN to take?
A. Explore the client’s feelings about his pets and home life.
B. Encourage his peers to help involve him in the activity.
C. Give the client permission to leave and return in 10 minutes.
D. Redirect him by encouraging him to read from the handout.
Rationale: Redirecting the client to focus on the handout helps maintain the group’s focus and structure
while addressing the client’s disruptive behavior. This intervention keeps the client engaged in the
therapeutic activity without reinforcing off-topic behavior or isolating him from the group.
8. A male adolescent was admitted to the unit two days ago for depression. When the mental
health RN tries to interview the client to establish rapport, he becomes very irritated and
sarcastic. Which action is best for the RN to take?
A. Report the behavior to the next shift.
B. Offer to play a game of cards with the client.
3|Page
, C. Document the behavior in the chart.
D. Plan to talk with the client the next day.
Rationale: Offering to play a game of cards is a non-threatening way to build rapport with an
adolescent who may be resistant to direct conversation. This approach can reduce defensiveness and
foster a therapeutic relationship, making the client more comfortable engaging with the RN.
9. A male adult is admitted because of an acetaminophen (Tylenol) overdose. After transfer to the
mental health unit, the client is told he has liver damage. Which information is most important for
the nurse to include in the client’s discharge plan?
A. Do not take any over-the-counter meds.
B. Eat a high carb, low fat, low protein diet.
C. Call the crisis hotline if feeling lonely.
D. Avoid exposure to large crowds.
Rationale: Due to liver damage from the acetaminophen overdose, avoiding over-the-counter
medications is critical, as many contain substances that could further harm the liver. This instruction is
vital to prevent additional hepatotoxicity and ensure the client’s safety post-discharge.
10. After receiving treatment for anorexia, a student asks the school RN for permission to work in the
school cafeteria as part of the school’s work study program. What action should the RN take?
A. Refer the student to a psychiatrist for further discussion.
B. Recommend assignment to the receptionist’s office.
C. Suggest that student work in the athletic department.
D. Determine the parent’s opinion of the work assignment.
Rationale: Working in the cafeteria could expose the student to food-related triggers, potentially
exacerbating anorexia symptoms. Recommending a non-food-related role, like the receptionist’s office,
supports recovery by minimizing stress and temptation while allowing participation in the work study
program.
11. The RN accepts a transfer to the mental health unit and understands that the client is distractible
and is exhibiting a decreased ability to concentrate. The RN only has 15 minutes to talk to the
client. To develop a treatment plan for this client, which assessment is most important for the RN
to obtain?
4|Page
NGN RN HESI EXIT PSYCHIATRIC MENTAL HEALTH EXAM STUDY GUIDE
Questions, Correct answers and Rationales
PERFECT STUDY GUIDE FOR 2025
1. A client on the mental health unit is becoming more agitated, shouting at the staff, and pacing in
the hallway. When the PRN medication is offered, the client refuses the medication and defiantly
sits on the floor in the middle of the unit hallway. What nursing intervention should the RN
implement first?
A. Transport of the client to the seclusion room.
B. Quietly approach the client with additional staff members.
C. Take other clients in the area to the client lounge.
D. Administer medication to chemically restrain the patient.
Rationale: Prioritizing the safety of other clients is essential in a potentially volatile situation. Removing
other clients from the area reduces the risk of harm and minimizes stimulation, which could further
escalate the agitated client's behavior. This intervention addresses the immediate safety concerns
before attempting to de-escalate or manage the client’s behavior directly.
2. A client is admitted to the mental health unit and reports taking extra antianxiety medication
because, “I’m so stressed out. I just want to go to sleep.” The RN should plan one-on-one
observation of the client based on which statement?
A. “What should I do? Nothing seems to help.”
B. “I have been so tired lately and needed to sleep.”
C. “I really think that I don’t need to be here.”
D. “I don’t want to walk. Nothing matters anymore.”
Rationale: The statement “I don’t want to walk. Nothing matters anymore” indicates hopelessness and
potential suicidal ideation, which are red flags for self-harm risk. One-on-one observation is critical to
ensure the client’s safety and monitor for any signs of worsening depression or suicidal behavior.
, 3. A male hospital employee is pushed out of the way by a female employee because of an
oncoming gurney. The pushed employee becomes very angry and swings at the female
employee. Both employees are referred for counseling with the staff psychiatric RN. Which factor
in the pushed employee’s history is most related to the reaction that occurred?
A. Is worried about losing his job to a woman.
B. Tortured animals as a child.
C. Was physically abused by his mother.
D. Hates to be touched by anyone.
Rationale: A history of physical abuse by his mother is most likely to contribute to the employee’s
aggressive reaction to being pushed, as it may trigger unresolved trauma or heightened sensitivity to
physical contact, leading to an exaggerated response. Past trauma can significantly influence emotional
regulation and interpersonal interactions.
4. The RN documents the mental status of a female client who has been hospitalized for several
days by court order. The client states, “I don’t need to be here” and tells the RN that she believes
the television talks to her. The RN should document these assessment findings in which section
of the mental status exam?
A. Level of concentration.
B. Insight and judgement.
C. Remote memory.
D. Mood and affect.
Rationale: The client’s statements reflect impaired insight (denying the need for hospitalization) and
poor judgment (believing the television talks to her), which are appropriately documented in the insight
and judgment section of the mental status exam. These findings indicate delusional thinking and lack of
awareness of her condition.
5. A client is admitted to the mental health unit and reports shortness of breath and dizziness. The
client tells the RN, “I feel like I’m going to die.” Which nursing problem should the RN include in
this client’s plan of care?
A. Mood disturbance.
B. Moderate anxiety.
C. Altered thoughts.
2|Page
, D. Social isolation.
Rationale: The client’s symptoms of shortness of breath, dizziness, and fear of dying are characteristic
of moderate anxiety. Including this in the care plan prioritizes addressing the acute physiological and
psychological symptoms, which can be managed through interventions like relaxation techniques or
medication.
6. A female client who is wearing dirty clothes and has foul body odor comes to the clinic reporting
feeling scared because she is being stalked. What action is most important for the RN to take?
A. Offer the client a safe place to relax before interviewing her.
B. Ask the client to describe why she is being stalked.
C. Recommend that the client talk with a social worker.
D. Assure the client that the HCP will see her today.
Rationale: Providing a safe, calming environment is the priority to reduce the client’s fear and anxiety,
which may be exacerbated by the perception of being stalked. This action helps establish trust and
facilitates a more effective interview, ensuring the client feels secure before further assessment.
7. The RN leading a group session of adolescent clients gives the members a handout about anger
management. One of the male clients is fidgety, interrupts peers when they try to talk, and talks
about his pets at home. What nursing action is best for the RN to take?
A. Explore the client’s feelings about his pets and home life.
B. Encourage his peers to help involve him in the activity.
C. Give the client permission to leave and return in 10 minutes.
D. Redirect him by encouraging him to read from the handout.
Rationale: Redirecting the client to focus on the handout helps maintain the group’s focus and structure
while addressing the client’s disruptive behavior. This intervention keeps the client engaged in the
therapeutic activity without reinforcing off-topic behavior or isolating him from the group.
8. A male adolescent was admitted to the unit two days ago for depression. When the mental
health RN tries to interview the client to establish rapport, he becomes very irritated and
sarcastic. Which action is best for the RN to take?
A. Report the behavior to the next shift.
B. Offer to play a game of cards with the client.
3|Page
, C. Document the behavior in the chart.
D. Plan to talk with the client the next day.
Rationale: Offering to play a game of cards is a non-threatening way to build rapport with an
adolescent who may be resistant to direct conversation. This approach can reduce defensiveness and
foster a therapeutic relationship, making the client more comfortable engaging with the RN.
9. A male adult is admitted because of an acetaminophen (Tylenol) overdose. After transfer to the
mental health unit, the client is told he has liver damage. Which information is most important for
the nurse to include in the client’s discharge plan?
A. Do not take any over-the-counter meds.
B. Eat a high carb, low fat, low protein diet.
C. Call the crisis hotline if feeling lonely.
D. Avoid exposure to large crowds.
Rationale: Due to liver damage from the acetaminophen overdose, avoiding over-the-counter
medications is critical, as many contain substances that could further harm the liver. This instruction is
vital to prevent additional hepatotoxicity and ensure the client’s safety post-discharge.
10. After receiving treatment for anorexia, a student asks the school RN for permission to work in the
school cafeteria as part of the school’s work study program. What action should the RN take?
A. Refer the student to a psychiatrist for further discussion.
B. Recommend assignment to the receptionist’s office.
C. Suggest that student work in the athletic department.
D. Determine the parent’s opinion of the work assignment.
Rationale: Working in the cafeteria could expose the student to food-related triggers, potentially
exacerbating anorexia symptoms. Recommending a non-food-related role, like the receptionist’s office,
supports recovery by minimizing stress and temptation while allowing participation in the work study
program.
11. The RN accepts a transfer to the mental health unit and understands that the client is distractible
and is exhibiting a decreased ability to concentrate. The RN only has 15 minutes to talk to the
client. To develop a treatment plan for this client, which assessment is most important for the RN
to obtain?
4|Page
