BoardVitals NCLEX-RN Mental Health 2026/2027
Comprehensive Exam Prep: 100 High-Yield Practice Questions
Covering Psychiatric Disorders, Therapeutic Communication,
Mental Status Assessment, Anxiety & Trauma, Mood
Disorders, Schizophrenia, Personality Disorders, Substance
Use, Crisis Intervention, Suicide Risk, Psychopharmacology,
Patient Safety, Prioritization, Clinical Judgment, and NGN-Style
Case Studies
1. A nurse is conducting a mental status assessment on a newly
admitted client. Which of the following findings should the nurse
document as part of the client's cognitive assessment?
A. The client's grooming and hygiene
B. The client's ability to recall recent events
C. The client's facial expressions
D. The client's current mood
CORRECT ANSWER: B. The client's ability to recall recent events
Rationale: Cognitive assessment evaluates orientation, memory,
attention, and abstract reasoning. Grooming, facial expressions, and
mood are part of the general appearance, behavior, and affect
assessment, not cognition.
2. A client with major depressive disorder states, "I just can't go on
anymore." What is the nurse's priority action?
A. Reassure the client that things will improve with time.
B. Ask the client directly about suicidal thoughts and intent.
,C. Document the statement and continue with the assessment.
D. Encourage the client to attend a group therapy session.
CORRECT ANSWER: B. Ask the client directly about suicidal thoughts
and intent.
Rationale: When a client expresses hopelessness or a desire to give up,
the nurse must directly assess for suicidal ideation, plan, means, and
intent. This is the priority safety intervention. Reassurance minimizes
the client's feelings, documentation alone does not address immediate
risk, and group therapy is inappropriate during an acute safety concern.
3. A client with schizophrenia tells the nurse, "The voices are telling
me to hurt myself." What is the nurse's initial response?
A. "Those voices aren't real. Try to ignore them."
B. "What are the voices saying to you right now?"
C. "I will give you medication to make the voices stop."
D. "You know you shouldn't listen to the voices."
CORRECT ANSWER: B. "What are the voices saying to you right now?"
Rationale: When a client reports command hallucinations, the nurse
must first assess the content of the hallucinations to determine the risk
of harm. Arguing with the delusion or hallucination is non-therapeutic.
Medication may be administered, but assessment comes first.
4. A nurse is assessing a client who has been taking lithium carbonate
for bipolar disorder. Which of the following findings indicates early
lithium toxicity?
A. Fine hand tremors
B. Coarse hand tremors
C. Tinnitus
D. Blurred vision
,CORRECT ANSWER: B. Coarse hand tremors
Rationale: Fine hand tremors are a common side effect of lithium
therapy. Coarse hand tremors, along with vomiting, diarrhea, and
ataxia, are signs of early lithium toxicity. Tinnitus and blurred vision are
signs of severe toxicity.
5. A client with borderline personality disorder is admitted to the unit.
The client tells the nurse, "You are the only one who understands me.
The other nurses are terrible." Which of the following defense
mechanisms is the client using?
A. Projection
B. Splitting
C. Denial
D. Rationalization
CORRECT ANSWER: B. Splitting
Rationale: Splitting is a primitive defense mechanism often seen in
clients with borderline personality disorder, where they view people as
either all good or all bad. The nurse should set consistent limits and
avoid participating in the splitting.
6. A nurse is caring for a client experiencing acute alcohol withdrawal.
Which of the following medications should the nurse anticipate
administering?
A. Naltrexone
B. Lorazepam
C. Disulfiram
D. Acamprosate
CORRECT ANSWER: B. Lorazepam
Rationale: Benzodiazepines, such as lorazepam, are the first-line
, treatment for acute alcohol withdrawal to prevent seizures and delirium
tremens. Naltrexone, disulfiram, and acamprosate are used for long-
term maintenance to prevent relapse.
7. A client is admitted with post-traumatic stress disorder (PTSD)
following a motor vehicle accident. The client reports experiencing
flashbacks. Which of the following interventions should the nurse
implement?
A. Encourage the client to watch television to distract from the
flashbacks.
B. Teach the client grounding techniques to use during a flashback.
C. Ask the client to describe the accident in detail immediately.
D. Administer a PRN antipsychotic medication.
CORRECT ANSWER: B. Teach the client grounding techniques to use
during a flashback.
Rationale: Grounding techniques, such as focusing on the present
environment or deep breathing, help clients with PTSD manage
flashbacks. Encouraging detailed description of the trauma immediately
can retraumatize the client. Television may trigger further distress.
8. A nurse is assessing a client who has generalized anxiety disorder
(GAD). Which of the following physical symptoms should the nurse
expect?
A. Bradycardia
B. Hypotension
C. Muscle tension
D. Hypothermia
CORRECT ANSWER: C. Muscle tension
Rationale: Generalized anxiety disorder is characterized by excessive
Comprehensive Exam Prep: 100 High-Yield Practice Questions
Covering Psychiatric Disorders, Therapeutic Communication,
Mental Status Assessment, Anxiety & Trauma, Mood
Disorders, Schizophrenia, Personality Disorders, Substance
Use, Crisis Intervention, Suicide Risk, Psychopharmacology,
Patient Safety, Prioritization, Clinical Judgment, and NGN-Style
Case Studies
1. A nurse is conducting a mental status assessment on a newly
admitted client. Which of the following findings should the nurse
document as part of the client's cognitive assessment?
A. The client's grooming and hygiene
B. The client's ability to recall recent events
C. The client's facial expressions
D. The client's current mood
CORRECT ANSWER: B. The client's ability to recall recent events
Rationale: Cognitive assessment evaluates orientation, memory,
attention, and abstract reasoning. Grooming, facial expressions, and
mood are part of the general appearance, behavior, and affect
assessment, not cognition.
2. A client with major depressive disorder states, "I just can't go on
anymore." What is the nurse's priority action?
A. Reassure the client that things will improve with time.
B. Ask the client directly about suicidal thoughts and intent.
,C. Document the statement and continue with the assessment.
D. Encourage the client to attend a group therapy session.
CORRECT ANSWER: B. Ask the client directly about suicidal thoughts
and intent.
Rationale: When a client expresses hopelessness or a desire to give up,
the nurse must directly assess for suicidal ideation, plan, means, and
intent. This is the priority safety intervention. Reassurance minimizes
the client's feelings, documentation alone does not address immediate
risk, and group therapy is inappropriate during an acute safety concern.
3. A client with schizophrenia tells the nurse, "The voices are telling
me to hurt myself." What is the nurse's initial response?
A. "Those voices aren't real. Try to ignore them."
B. "What are the voices saying to you right now?"
C. "I will give you medication to make the voices stop."
D. "You know you shouldn't listen to the voices."
CORRECT ANSWER: B. "What are the voices saying to you right now?"
Rationale: When a client reports command hallucinations, the nurse
must first assess the content of the hallucinations to determine the risk
of harm. Arguing with the delusion or hallucination is non-therapeutic.
Medication may be administered, but assessment comes first.
4. A nurse is assessing a client who has been taking lithium carbonate
for bipolar disorder. Which of the following findings indicates early
lithium toxicity?
A. Fine hand tremors
B. Coarse hand tremors
C. Tinnitus
D. Blurred vision
,CORRECT ANSWER: B. Coarse hand tremors
Rationale: Fine hand tremors are a common side effect of lithium
therapy. Coarse hand tremors, along with vomiting, diarrhea, and
ataxia, are signs of early lithium toxicity. Tinnitus and blurred vision are
signs of severe toxicity.
5. A client with borderline personality disorder is admitted to the unit.
The client tells the nurse, "You are the only one who understands me.
The other nurses are terrible." Which of the following defense
mechanisms is the client using?
A. Projection
B. Splitting
C. Denial
D. Rationalization
CORRECT ANSWER: B. Splitting
Rationale: Splitting is a primitive defense mechanism often seen in
clients with borderline personality disorder, where they view people as
either all good or all bad. The nurse should set consistent limits and
avoid participating in the splitting.
6. A nurse is caring for a client experiencing acute alcohol withdrawal.
Which of the following medications should the nurse anticipate
administering?
A. Naltrexone
B. Lorazepam
C. Disulfiram
D. Acamprosate
CORRECT ANSWER: B. Lorazepam
Rationale: Benzodiazepines, such as lorazepam, are the first-line
, treatment for acute alcohol withdrawal to prevent seizures and delirium
tremens. Naltrexone, disulfiram, and acamprosate are used for long-
term maintenance to prevent relapse.
7. A client is admitted with post-traumatic stress disorder (PTSD)
following a motor vehicle accident. The client reports experiencing
flashbacks. Which of the following interventions should the nurse
implement?
A. Encourage the client to watch television to distract from the
flashbacks.
B. Teach the client grounding techniques to use during a flashback.
C. Ask the client to describe the accident in detail immediately.
D. Administer a PRN antipsychotic medication.
CORRECT ANSWER: B. Teach the client grounding techniques to use
during a flashback.
Rationale: Grounding techniques, such as focusing on the present
environment or deep breathing, help clients with PTSD manage
flashbacks. Encouraging detailed description of the trauma immediately
can retraumatize the client. Television may trigger further distress.
8. A nurse is assessing a client who has generalized anxiety disorder
(GAD). Which of the following physical symptoms should the nurse
expect?
A. Bradycardia
B. Hypotension
C. Muscle tension
D. Hypothermia
CORRECT ANSWER: C. Muscle tension
Rationale: Generalized anxiety disorder is characterized by excessive
