HESI RN Psychiatric Nursing Exam |
Updated 2025/2026 Verified Mental Health
Questions and Aswers
1. A client with major depression says, “I’m a burden to everyone. I should just end it.” The
nurse’s best therapeutic response is: “You’re feeling like a burden right now. Can you
tell me more about that?”Rationale: Reflecting and using open-ended questions
validates feelings and encourages exploration without minimizing suicidal ideation
(HESI 2025 Therapeutic Communication).
2. The nurse observes a manic client giving away possessions and flirting inappropriately.
Priority nursing diagnosis: Risk for injuryRationale: Impulsivity and poor judgment
place the client at high risk for financial, sexual, and physical harm (HESI 2025 Bipolar
Disorders).
3. Therapeutic serum level for lithium (acute mania): 0.8–1.2 mEq/LRationale: Acute
phase requires higher end; maintenance 0.6–1.0 mEq/L. Levels >1.5 = toxicity (HESI
Psychopharmacology 2025).
4. A client with schizophrenia hears command hallucinations telling him to harm others.
Priority action: Assess lethality and place on 1:1 observationRationale: Command
hallucinations with violent content are a psychiatric emergency requiring immediate
safety measures (HESI 2025 Psychosis).
5. First sign of lithium toxicity the nurse should teach the client to report: Fine hand
tremor progressing to coarse tremorRationale: Early toxicity presents with GI upset
and fine tremor; coarse tremor, ataxia, and confusion indicate severe toxicity (HESI
2025).
6. A client with anorexia nervosa (BMI 14.8) refuses to eat. The nurse should: Establish a
behavioral contract with gradual weight gain goalsRationale: Refeeding must be
gradual to prevent refeeding syndrome; contracts promote autonomy (HESI Eating
Disorders 2025).
7. The nurse is teaching a client about sertraline. Which statement requires immediate
intervention? “I’ll take it at bedtime because it makes me sleepy.”Rationale:
Sertraline is activating and should be taken in the morning to avoid insomnia (HESI
Antidepressants 2025).
8. A client experiencing panic attack (HR 130, trembling, feeling of doom). Most effective
immediate intervention: Guide slow breathing using 4-7-8 techniqueRationale:
Interrupts hyperventilation and activates parasympathetic response faster than medication
(HESI Crisis Intervention 2025).
, 9. Clozapine monitoring requirement: Weekly ANC for first 6 months, then
biweeklyRationale: REMS program due to 1% risk of agranulocytosis; ANC <500 =
discontinue (HESI Atypical Antipsychotics 2025).
10.A client with PTSD avoids driving after a car accident. Best evidence-based therapy:
Prolonged Exposure Therapy (PE)Rationale: Gold standard; systematic
desensitization via imaginal and in-vivo exposure (VA/DoD 2025 PTSD Guidelines).
11.Client states, “I’m going to kill myself with my gun tonight.” Nurse’s legal
responsibility: Break confidentiality and warn authorities/intended victim if
applicableRationale: Duty to warn/protect (Tarasoff ruling); suicidal ideation with plan
and means requires involuntary hold (HESI Legal/Ethical 2025).
12.Side effect of risperidone requiring immediate reporting in adolescents: Gynecomastia
and galactorrheaRationale: Hyperprolactinemia; may be irreversible (HESI Pediatric
Psychopharmacology 2025).
13.A client with borderline personality disorder self-harms after an argument. Therapeutic
response: “I can see you’re really upset. Let’s work on some distress tolerance skills
together.”Rationale: DBT-based; validates emotion without reinforcing self-harm (HESI
Personality Disorders 2025).
14.Haloperidol 5 mg IM given for acute agitation. Most serious adverse effect to monitor:
Laryngeal dystonia or laryngospasmRationale: Acute dystonic reaction can be
life-threatening; treat with benztropine or diphenhydramine IM (HESI EPS 2025).
15.A client with alcohol withdrawal has CIWA-Ar score 22. Medication and dose:
Lorazepam 2–4 mg IV/IM now, may repeat q15–30 minRationale: Severe
withdrawal; symptom-triggered regimen preferred (HESI Substance Use 2025).
16.Neuroleptic malignant syndrome (NMS) hallmark signs: Hyperthermia, severe
rigidity, elevated CPK, autonomic instabilityRationale: Medical emergency; mortality
10–20% if untreated (HESI 2025).
17.Client diagnosed with somatic symptom disorder reports new paralysis. Best response:
“That sounds frightening. Let’s talk about what’s been stressful lately.”Rationale:
Acknowledges symptom while redirecting to psychosocial triggers (HESI Somatoform
Disorders 2025).
18.A client with bipolar I stops lithium and becomes manic. Best long-term strategy to
prevent relapse: Long-acting injectable antipsychotic (e.g., aripiprazole
monohydrate)Rationale: Improves adherence >70% in non-adherent patients (HESI
2025 Adherence).
19.Postpartum psychosis onset typically: Within first 2 weeks postpartumRationale:
Psychiatric emergency; high risk of infanticide/suicide; requires immediate
hospitalization (HESI Perinatal MH 2025).
20.Client with delirium tremens sees bugs crawling on walls. Best initial medication:
Lorazepam 2–4 mg IVRationale: Controls agitation and prevents seizures; thiamine
500 mg IV given concurrently (HESI 2025).
Updated 2025/2026 Verified Mental Health
Questions and Aswers
1. A client with major depression says, “I’m a burden to everyone. I should just end it.” The
nurse’s best therapeutic response is: “You’re feeling like a burden right now. Can you
tell me more about that?”Rationale: Reflecting and using open-ended questions
validates feelings and encourages exploration without minimizing suicidal ideation
(HESI 2025 Therapeutic Communication).
2. The nurse observes a manic client giving away possessions and flirting inappropriately.
Priority nursing diagnosis: Risk for injuryRationale: Impulsivity and poor judgment
place the client at high risk for financial, sexual, and physical harm (HESI 2025 Bipolar
Disorders).
3. Therapeutic serum level for lithium (acute mania): 0.8–1.2 mEq/LRationale: Acute
phase requires higher end; maintenance 0.6–1.0 mEq/L. Levels >1.5 = toxicity (HESI
Psychopharmacology 2025).
4. A client with schizophrenia hears command hallucinations telling him to harm others.
Priority action: Assess lethality and place on 1:1 observationRationale: Command
hallucinations with violent content are a psychiatric emergency requiring immediate
safety measures (HESI 2025 Psychosis).
5. First sign of lithium toxicity the nurse should teach the client to report: Fine hand
tremor progressing to coarse tremorRationale: Early toxicity presents with GI upset
and fine tremor; coarse tremor, ataxia, and confusion indicate severe toxicity (HESI
2025).
6. A client with anorexia nervosa (BMI 14.8) refuses to eat. The nurse should: Establish a
behavioral contract with gradual weight gain goalsRationale: Refeeding must be
gradual to prevent refeeding syndrome; contracts promote autonomy (HESI Eating
Disorders 2025).
7. The nurse is teaching a client about sertraline. Which statement requires immediate
intervention? “I’ll take it at bedtime because it makes me sleepy.”Rationale:
Sertraline is activating and should be taken in the morning to avoid insomnia (HESI
Antidepressants 2025).
8. A client experiencing panic attack (HR 130, trembling, feeling of doom). Most effective
immediate intervention: Guide slow breathing using 4-7-8 techniqueRationale:
Interrupts hyperventilation and activates parasympathetic response faster than medication
(HESI Crisis Intervention 2025).
, 9. Clozapine monitoring requirement: Weekly ANC for first 6 months, then
biweeklyRationale: REMS program due to 1% risk of agranulocytosis; ANC <500 =
discontinue (HESI Atypical Antipsychotics 2025).
10.A client with PTSD avoids driving after a car accident. Best evidence-based therapy:
Prolonged Exposure Therapy (PE)Rationale: Gold standard; systematic
desensitization via imaginal and in-vivo exposure (VA/DoD 2025 PTSD Guidelines).
11.Client states, “I’m going to kill myself with my gun tonight.” Nurse’s legal
responsibility: Break confidentiality and warn authorities/intended victim if
applicableRationale: Duty to warn/protect (Tarasoff ruling); suicidal ideation with plan
and means requires involuntary hold (HESI Legal/Ethical 2025).
12.Side effect of risperidone requiring immediate reporting in adolescents: Gynecomastia
and galactorrheaRationale: Hyperprolactinemia; may be irreversible (HESI Pediatric
Psychopharmacology 2025).
13.A client with borderline personality disorder self-harms after an argument. Therapeutic
response: “I can see you’re really upset. Let’s work on some distress tolerance skills
together.”Rationale: DBT-based; validates emotion without reinforcing self-harm (HESI
Personality Disorders 2025).
14.Haloperidol 5 mg IM given for acute agitation. Most serious adverse effect to monitor:
Laryngeal dystonia or laryngospasmRationale: Acute dystonic reaction can be
life-threatening; treat with benztropine or diphenhydramine IM (HESI EPS 2025).
15.A client with alcohol withdrawal has CIWA-Ar score 22. Medication and dose:
Lorazepam 2–4 mg IV/IM now, may repeat q15–30 minRationale: Severe
withdrawal; symptom-triggered regimen preferred (HESI Substance Use 2025).
16.Neuroleptic malignant syndrome (NMS) hallmark signs: Hyperthermia, severe
rigidity, elevated CPK, autonomic instabilityRationale: Medical emergency; mortality
10–20% if untreated (HESI 2025).
17.Client diagnosed with somatic symptom disorder reports new paralysis. Best response:
“That sounds frightening. Let’s talk about what’s been stressful lately.”Rationale:
Acknowledges symptom while redirecting to psychosocial triggers (HESI Somatoform
Disorders 2025).
18.A client with bipolar I stops lithium and becomes manic. Best long-term strategy to
prevent relapse: Long-acting injectable antipsychotic (e.g., aripiprazole
monohydrate)Rationale: Improves adherence >70% in non-adherent patients (HESI
2025 Adherence).
19.Postpartum psychosis onset typically: Within first 2 weeks postpartumRationale:
Psychiatric emergency; high risk of infanticide/suicide; requires immediate
hospitalization (HESI Perinatal MH 2025).
20.Client with delirium tremens sees bugs crawling on walls. Best initial medication:
Lorazepam 2–4 mg IVRationale: Controls agitation and prevents seizures; thiamine
500 mg IV given concurrently (HESI 2025).
