Psych HESI Questions QUESTIONS AND
ANSWERS 2026-2027
PSYCH HESI
MOST TESTED & HARDEST PRACTICE QUESTIONS (1–10)
QUESTION 1 — Suicide Risk (VERY HIGHLY TESTED)
A 22-year-old client diagnosed with major depressive disorder tells the nurse, “I finally feel calm. I’ve
decided everything will be okay soon.” Which action should the nurse take FIRST?
A. Encourage the client to attend group therapy
B. Document the improvement in mood
C. Ask the client directly about suicidal thoughts
D. Reduce observation because anxiety has decreased
✅ Correct Answer: C
Rationale:
A sudden calmness may indicate the client has decided to commit suicide. Direct assessment of suicidal
intent is the priority. Never assume improvement.
QUESTION 2 — Therapeutic Communication (HESI FAVORITE)
A client with schizophrenia says, “The FBI planted cameras in my room.” Which nurse response is MOST
therapeutic?
A. “That’s not true. You’re imagining things.”
B. “Why do you think the FBI is watching you?”
C. “I don’t see any cameras, but I know this feels real to you.”
D. “You should stop thinking about that.”
✅ Correct Answer: C
,Rationale:
Acknowledge the client’s feelings without reinforcing the delusion. Do not argue or validate false
beliefs.
QUESTION 3 — Anxiety Disorders (COMMONLY TESTED)
Which symptom best differentiates panic disorder from generalized anxiety disorder?
A. Muscle tension
B. Excessive worry
C. Sudden onset of intense fear
D. Difficulty concentrating
✅ Correct Answer: C
Rationale:
Panic disorder involves abrupt episodes of overwhelming fear, often with physical symptoms.
QUESTION 4 — Mania vs Hypomania (HIGH DIFFICULTY)
Which behavior is MOST characteristic of mania rather than hypomania?
A. Increased productivity
B. Elevated mood
C. Severe impairment in social or occupational functioning
D. Decreased need for sleep
✅ Correct Answer: C
Rationale:
Mania causes marked impairment and may require hospitalization; hypomania does not.
QUESTION 5 — Defense Mechanisms (HESI CLASSIC)
A client who failed a nursing exam states, “The instructor hates me—that’s why I failed.” This is an
example of:
A. Projection
B. Rationalization
C. Regression
D. Denial
✅ Correct Answer: A
Rationale:
The client is attributing their own feelings or shortcomings to another person.
,QUESTION 6 — Antipsychotic Medications (VERY TESTED)
Which assessment finding in a client taking haloperidol requires IMMEDIATE nursing action?
A. Dry mouth
B. Muscle rigidity and high fever
C. Weight gain
D. Sedation
✅ Correct Answer: B
Rationale:
This suggests Neuroleptic Malignant Syndrome (NMS) — a medical emergency.
QUESTION 7 — Substance Use Disorders (HIGH-YIELD)
Which withdrawal symptom places a client with alcohol dependence at greatest risk for death?
A. Tremors
B. Nausea
C. Anxiety
D. Seizures
✅ Correct Answer: D
Rationale:
Alcohol withdrawal seizures and delirium tremens are life-threatening.
QUESTION 8 — Legal/Ethical Issues (HESI FAVORITE)
A client states, “I plan to kill my coworker tomorrow.” What is the nurse’s legal obligation?
A. Maintain confidentiality
B. Notify the client’s family
C. Warn the potential victim and authorities
D. Document and continue monitoring
✅ Correct Answer: C
Rationale:
This is the duty to warn (Tarasoff ruling) — safety overrides confidentiality.
QUESTION 9 — Eating Disorders (COMMON TRAP)
Which finding in a client with anorexia nervosa is MOST concerning?
, A. Body image distortion
B. Bradycardia
C. Fear of weight gain
D. Excessive exercise
✅ Correct Answer: B
Rationale:
Bradycardia indicates cardiac compromise, a leading cause of death in anorexia.
QUESTION 10 — Priority & Safety (VERY HIGHLY TESTED)
Four clients are on a psychiatric unit. Which client should the nurse assess FIRST?
A. A client with OCD who is washing hands repeatedly
B. A client with depression refusing breakfast
C. A client with bipolar disorder pacing and yelling
D. A client with schizophrenia experiencing command hallucinations to self-harm
✅ Correct Answer: D
Rationale:
Command hallucinations to self-harm = immediate danger. Safety is always priority.
QUESTION 11 — Suicide Precautions (VERY HIGH-YIELD)
A client admitted for major depressive disorder denies suicidal ideation on admission. On day 3, the
client gives personal belongings to peers and writes letters to family. Which nursing action is MOST
appropriate?
A. Continue routine safety checks
B. Notify the provider and initiate suicide precautions
C. Encourage journaling and group therapy
D. Praise the client for improved coping skills
✅ Correct Answer: B
Rationale:
Giving away possessions and writing letters are classic signs of imminent suicide. Suicide precautions
must be initiated immediately, even if the client denies ideation.
QUESTION 12 — Mood Disorders & Medications (HIGHLY TESTED)
A client with bipolar disorder is prescribed lithium. Which laboratory value is MOST important to
monitor for toxicity?
ANSWERS 2026-2027
PSYCH HESI
MOST TESTED & HARDEST PRACTICE QUESTIONS (1–10)
QUESTION 1 — Suicide Risk (VERY HIGHLY TESTED)
A 22-year-old client diagnosed with major depressive disorder tells the nurse, “I finally feel calm. I’ve
decided everything will be okay soon.” Which action should the nurse take FIRST?
A. Encourage the client to attend group therapy
B. Document the improvement in mood
C. Ask the client directly about suicidal thoughts
D. Reduce observation because anxiety has decreased
✅ Correct Answer: C
Rationale:
A sudden calmness may indicate the client has decided to commit suicide. Direct assessment of suicidal
intent is the priority. Never assume improvement.
QUESTION 2 — Therapeutic Communication (HESI FAVORITE)
A client with schizophrenia says, “The FBI planted cameras in my room.” Which nurse response is MOST
therapeutic?
A. “That’s not true. You’re imagining things.”
B. “Why do you think the FBI is watching you?”
C. “I don’t see any cameras, but I know this feels real to you.”
D. “You should stop thinking about that.”
✅ Correct Answer: C
,Rationale:
Acknowledge the client’s feelings without reinforcing the delusion. Do not argue or validate false
beliefs.
QUESTION 3 — Anxiety Disorders (COMMONLY TESTED)
Which symptom best differentiates panic disorder from generalized anxiety disorder?
A. Muscle tension
B. Excessive worry
C. Sudden onset of intense fear
D. Difficulty concentrating
✅ Correct Answer: C
Rationale:
Panic disorder involves abrupt episodes of overwhelming fear, often with physical symptoms.
QUESTION 4 — Mania vs Hypomania (HIGH DIFFICULTY)
Which behavior is MOST characteristic of mania rather than hypomania?
A. Increased productivity
B. Elevated mood
C. Severe impairment in social or occupational functioning
D. Decreased need for sleep
✅ Correct Answer: C
Rationale:
Mania causes marked impairment and may require hospitalization; hypomania does not.
QUESTION 5 — Defense Mechanisms (HESI CLASSIC)
A client who failed a nursing exam states, “The instructor hates me—that’s why I failed.” This is an
example of:
A. Projection
B. Rationalization
C. Regression
D. Denial
✅ Correct Answer: A
Rationale:
The client is attributing their own feelings or shortcomings to another person.
,QUESTION 6 — Antipsychotic Medications (VERY TESTED)
Which assessment finding in a client taking haloperidol requires IMMEDIATE nursing action?
A. Dry mouth
B. Muscle rigidity and high fever
C. Weight gain
D. Sedation
✅ Correct Answer: B
Rationale:
This suggests Neuroleptic Malignant Syndrome (NMS) — a medical emergency.
QUESTION 7 — Substance Use Disorders (HIGH-YIELD)
Which withdrawal symptom places a client with alcohol dependence at greatest risk for death?
A. Tremors
B. Nausea
C. Anxiety
D. Seizures
✅ Correct Answer: D
Rationale:
Alcohol withdrawal seizures and delirium tremens are life-threatening.
QUESTION 8 — Legal/Ethical Issues (HESI FAVORITE)
A client states, “I plan to kill my coworker tomorrow.” What is the nurse’s legal obligation?
A. Maintain confidentiality
B. Notify the client’s family
C. Warn the potential victim and authorities
D. Document and continue monitoring
✅ Correct Answer: C
Rationale:
This is the duty to warn (Tarasoff ruling) — safety overrides confidentiality.
QUESTION 9 — Eating Disorders (COMMON TRAP)
Which finding in a client with anorexia nervosa is MOST concerning?
, A. Body image distortion
B. Bradycardia
C. Fear of weight gain
D. Excessive exercise
✅ Correct Answer: B
Rationale:
Bradycardia indicates cardiac compromise, a leading cause of death in anorexia.
QUESTION 10 — Priority & Safety (VERY HIGHLY TESTED)
Four clients are on a psychiatric unit. Which client should the nurse assess FIRST?
A. A client with OCD who is washing hands repeatedly
B. A client with depression refusing breakfast
C. A client with bipolar disorder pacing and yelling
D. A client with schizophrenia experiencing command hallucinations to self-harm
✅ Correct Answer: D
Rationale:
Command hallucinations to self-harm = immediate danger. Safety is always priority.
QUESTION 11 — Suicide Precautions (VERY HIGH-YIELD)
A client admitted for major depressive disorder denies suicidal ideation on admission. On day 3, the
client gives personal belongings to peers and writes letters to family. Which nursing action is MOST
appropriate?
A. Continue routine safety checks
B. Notify the provider and initiate suicide precautions
C. Encourage journaling and group therapy
D. Praise the client for improved coping skills
✅ Correct Answer: B
Rationale:
Giving away possessions and writing letters are classic signs of imminent suicide. Suicide precautions
must be initiated immediately, even if the client denies ideation.
QUESTION 12 — Mood Disorders & Medications (HIGHLY TESTED)
A client with bipolar disorder is prescribed lithium. Which laboratory value is MOST important to
monitor for toxicity?
