HESI RN Psychiatric Mental Health Exit
Exam 2025/2026 – Clinical Case Study
Questions & Answers in Full with Rationales
Bundle | 100% Verified
Question 1: Therapeutic Communication
Case Study: A client with major depressive disorder says to the nurse, “I’m a complete failure,
and nothing I do is ever good enough.”
Which response by the nurse demonstrates therapeutic communication?
A. “You’re not a failure; you have so much to live for.”
B. “Can you tell me more about why you feel this way?”
C. “Everyone feels like that sometimes; it’s normal.”
D. “You’ll feel better once your medication starts working.”
Correct Answer: B. Can you tell me more about why you feel this way?
Rationale: Therapeutic communication encourages the client to express feelings and explore
their thoughts, promoting self-awareness. Option B uses an open-ended question to facilitate
discussion. Option A is dismissive, C minimizes the client’s feelings, and D offers false
reassurance.
Question 2: Safety
Case Study: A client with schizophrenia is pacing the unit and shouting, “They’re coming for
me!”
What is the nurse’s priority action?
A. Administer an antipsychotic medication as prescribed
B. Place the client in seclusion immediately
C. Assess the client’s level of agitation and safety risk
D. Instruct the client to sit down and be quiet
Correct Answer: C. Assess the client’s level of agitation and safety risk
Rationale: Assessing the client’s agitation and potential for harm to self or others is the priority
to guide interventions. Administering medication (A) or seclusion (B) may be appropriate after
assessment, and instructing the client to sit (D) may escalate agitation.
,Question 3: Psychopharmacology
Case Study: A client with bipolar disorder is prescribed lithium. The client reports nausea and
tremors.
What is the nurse’s first action?
A. Administer an antiemetic as prescribed
B. Check the client’s lithium level
C. Encourage the client to drink more water
D. Notify the healthcare provider
Correct Answer: B. Check the client’s lithium level
Rationale: Nausea and tremors may indicate lithium toxicity, requiring immediate assessment of
serum lithium levels (therapeutic range: 0.6–1.2 mEq/L). Administering an antiemetic (A) or
encouraging fluids (C) may be secondary, and notifying the provider (D) follows assessment.
Question 4: Crisis Intervention
Case Study: A client with borderline personality disorder threatens to cut themselves during a
group therapy session.
What is the nurse’s priority action?
A. Remove the client from the group session
B. Ask the client to discuss their feelings in private
C. Restrain the client to prevent self-harm
D. Administer a PRN anxiolytic medication
Correct Answer: B. Ask the client to discuss their feelings in private
Rationale: Addressing the client’s emotions in a private, safe setting de-escalates the situation
and promotes therapeutic communication. Removing the client (A) may feel punitive, restraining
(C) is a last resort, and medication (D) requires assessment first.
Question 5: Therapeutic Communication (Select All That Apply)
Case Study: A client with generalized anxiety disorder expresses fear about an upcoming
surgery.
Which responses by the nurse are therapeutic? (Select all that apply.)
A. “You seem really worried about this surgery.”
B. “Surgery is routine; you’ll be fine.”
C. “Can you describe what scares you the most?”
, D. “Let’s focus on something positive instead.”
E. “I’ll stay with you to discuss your concerns.”
Correct Answers: A, C, E
Rationale: Reflecting feelings (A), using open-ended questions (C), and offering presence (E)
are therapeutic techniques that validate the client’s emotions. Reassurance (B) minimizes
concerns, and redirecting (D) avoids addressing the client’s anxiety.
Question 6: Safety
Case Study: A client with alcohol withdrawal exhibits tremors and confusion.
Which intervention is most important?
A. Administer thiamine as prescribed
B. Place the client in a quiet, low-stimulus room
C. Apply soft restraints to prevent injury
D. Monitor the client’s blood alcohol level
Correct Answer: B. Place the client in a quiet, low-stimulus room
Rationale: A quiet environment reduces sensory overload and agitation in alcohol withdrawal,
promoting safety. Thiamine (A) prevents Wernicke’s encephalopathy but is not the priority,
restraints (C) are a last resort, and blood alcohol levels (D) are less relevant during withdrawal.
Question 7: Psychopharmacology
Case Study: A client taking fluoxetine for depression reports insomnia and agitation.
What is the nurse’s best action?
A. Advise the client to take the medication at bedtime
B. Assess for signs of serotonin syndrome
C. Encourage the client to reduce caffeine intake
D. Instruct the client to stop the medication
Correct Answer: B. Assess for signs of serotonin syndrome
Rationale: Insomnia and agitation may indicate serotonin syndrome, a potentially life-
threatening condition. Assessing for symptoms (e.g., fever, rigidity) is critical. Fluoxetine is
typically taken in the morning (A), caffeine reduction (C) is secondary, and stopping the
medication (D) requires provider guidance.
Question 8: Prioritization
Exam 2025/2026 – Clinical Case Study
Questions & Answers in Full with Rationales
Bundle | 100% Verified
Question 1: Therapeutic Communication
Case Study: A client with major depressive disorder says to the nurse, “I’m a complete failure,
and nothing I do is ever good enough.”
Which response by the nurse demonstrates therapeutic communication?
A. “You’re not a failure; you have so much to live for.”
B. “Can you tell me more about why you feel this way?”
C. “Everyone feels like that sometimes; it’s normal.”
D. “You’ll feel better once your medication starts working.”
Correct Answer: B. Can you tell me more about why you feel this way?
Rationale: Therapeutic communication encourages the client to express feelings and explore
their thoughts, promoting self-awareness. Option B uses an open-ended question to facilitate
discussion. Option A is dismissive, C minimizes the client’s feelings, and D offers false
reassurance.
Question 2: Safety
Case Study: A client with schizophrenia is pacing the unit and shouting, “They’re coming for
me!”
What is the nurse’s priority action?
A. Administer an antipsychotic medication as prescribed
B. Place the client in seclusion immediately
C. Assess the client’s level of agitation and safety risk
D. Instruct the client to sit down and be quiet
Correct Answer: C. Assess the client’s level of agitation and safety risk
Rationale: Assessing the client’s agitation and potential for harm to self or others is the priority
to guide interventions. Administering medication (A) or seclusion (B) may be appropriate after
assessment, and instructing the client to sit (D) may escalate agitation.
,Question 3: Psychopharmacology
Case Study: A client with bipolar disorder is prescribed lithium. The client reports nausea and
tremors.
What is the nurse’s first action?
A. Administer an antiemetic as prescribed
B. Check the client’s lithium level
C. Encourage the client to drink more water
D. Notify the healthcare provider
Correct Answer: B. Check the client’s lithium level
Rationale: Nausea and tremors may indicate lithium toxicity, requiring immediate assessment of
serum lithium levels (therapeutic range: 0.6–1.2 mEq/L). Administering an antiemetic (A) or
encouraging fluids (C) may be secondary, and notifying the provider (D) follows assessment.
Question 4: Crisis Intervention
Case Study: A client with borderline personality disorder threatens to cut themselves during a
group therapy session.
What is the nurse’s priority action?
A. Remove the client from the group session
B. Ask the client to discuss their feelings in private
C. Restrain the client to prevent self-harm
D. Administer a PRN anxiolytic medication
Correct Answer: B. Ask the client to discuss their feelings in private
Rationale: Addressing the client’s emotions in a private, safe setting de-escalates the situation
and promotes therapeutic communication. Removing the client (A) may feel punitive, restraining
(C) is a last resort, and medication (D) requires assessment first.
Question 5: Therapeutic Communication (Select All That Apply)
Case Study: A client with generalized anxiety disorder expresses fear about an upcoming
surgery.
Which responses by the nurse are therapeutic? (Select all that apply.)
A. “You seem really worried about this surgery.”
B. “Surgery is routine; you’ll be fine.”
C. “Can you describe what scares you the most?”
, D. “Let’s focus on something positive instead.”
E. “I’ll stay with you to discuss your concerns.”
Correct Answers: A, C, E
Rationale: Reflecting feelings (A), using open-ended questions (C), and offering presence (E)
are therapeutic techniques that validate the client’s emotions. Reassurance (B) minimizes
concerns, and redirecting (D) avoids addressing the client’s anxiety.
Question 6: Safety
Case Study: A client with alcohol withdrawal exhibits tremors and confusion.
Which intervention is most important?
A. Administer thiamine as prescribed
B. Place the client in a quiet, low-stimulus room
C. Apply soft restraints to prevent injury
D. Monitor the client’s blood alcohol level
Correct Answer: B. Place the client in a quiet, low-stimulus room
Rationale: A quiet environment reduces sensory overload and agitation in alcohol withdrawal,
promoting safety. Thiamine (A) prevents Wernicke’s encephalopathy but is not the priority,
restraints (C) are a last resort, and blood alcohol levels (D) are less relevant during withdrawal.
Question 7: Psychopharmacology
Case Study: A client taking fluoxetine for depression reports insomnia and agitation.
What is the nurse’s best action?
A. Advise the client to take the medication at bedtime
B. Assess for signs of serotonin syndrome
C. Encourage the client to reduce caffeine intake
D. Instruct the client to stop the medication
Correct Answer: B. Assess for signs of serotonin syndrome
Rationale: Insomnia and agitation may indicate serotonin syndrome, a potentially life-
threatening condition. Assessing for symptoms (e.g., fever, rigidity) is critical. Fluoxetine is
typically taken in the morning (A), caffeine reduction (C) is secondary, and stopping the
medication (D) requires provider guidance.
Question 8: Prioritization
