NCLEX-RN 2026 Mental Health Nursing practice exam. This resource contains 200+ questions covering
therapeutic communication, depression, anxiety disorders, schizophrenia, bipolar disorder, substance abuse,
suicide precautions, psychiatric medications, and other key mental health topics. Each question includes the
correct answer and rationale. Use this exam to strengthen your psychiatric nursing knowledge and prepare
for the NCLEX.
Key Topics Covered
1. Therapeutic Communication – Active listening, empathy, clarifying, reflecting, setting limits, non-verbal
communication, therapeutic vs non-therapeutic responses
2. Mood Disorders – Major depressive disorder, persistent depressive disorder, bipolar I and II, mania,
hypomania, treatment (SSRIs, SNRIs, lithium, anticonvulsants), suicide risk assessment and precautions
3. Anxiety Disorders – Generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety,
obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), treatment (SSRIs,
benzodiazepines, CBT)
4. Psychotic Disorders – Schizophrenia, schizoaffective disorder, delusional disorder, positive/negative
symptoms, antipsychotics (typical vs atypical), side effects (EPS, NMS, agranulocytosis)
5. Personality Disorders – Borderline, antisocial, narcissistic, histrionic, avoidant, dependent; treatment
approaches, boundary setting
6. Substance Use Disorders – Alcohol, opioids, stimulants, benzodiazepines; withdrawal syndromes,
detoxification, relapse prevention, harm reduction, medications (naltrexone, methadone, buprenorphine,
disulfiram)
7. Eating Disorders – Anorexia nervosa, bulimia nervosa, binge-eating disorder; medical complications,
refeeding syndrome, treatment
8. Suicide & Self-Harm – Risk factors, assessment (SAFE-T, SAD PERSONS), precautions (one-to-one
observation, environment safety), post-suicide care
9. Crisis Intervention & De-escalation – Crisis theory, anger management, de-escalation techniques,
restraints (seclusion, physical restraints), legal and ethical issues
10. Psychopharmacology – Mechanism of action, side effects, nursing monitoring, patient education, drug
interactions
,Questions 1–215
1. A client with major depressive disorder tells the nurse, “I’m a complete failure. Nothing I do ever
works out.” Which response by the nurse is most therapeutic?
A) “You shouldn’t feel that way. You’ve accomplished many things.”
B) “It sounds like you’re feeling really down about yourself right now.”
C) “Let’s list some of your recent successes.”
D) “Why do you think you feel like a failure?”
Answer B: “It sounds like you’re feeling really down about yourself right now.”
Rationale: This response reflects the client’s feeling (reflection/validation) without arguing or offering false
reassurance. Therapeutic communication focuses on the feeling, not the content.
2. A client with bipolar disorder in a manic episode is pacing rapidly, talking loudly, and making
grandiose statements. Which nursing intervention is most appropriate initially?
A) Place the client in seclusion
B) Provide a quiet, low-stimulation environment
C) Confront the client about the grandiose statements
D) Assign a group of staff to restrain the client
Answer B: Provide a quiet, low-stimulation environment
Rationale: Reducing environmental stimuli helps decrease agitation and manic behavior. Seclusion and
restraints are last resorts after de-escalation fails.
3. A client with schizophrenia tells the nurse, “The CIA is poisoning my food with radioactive waves.”
What is the most therapeutic response?
A) “That is not true. The CIA has no reason to harm you.”
B) “I understand that you believe that, but I don’t hear the voices. Let’s talk about something else.”
C) “Tell me more about why you think that.”
D) “You need to take your medication to stop the voices.”
Answer B: “I understand that you believe that, but I don’t hear the voices. Let’s talk about something
else.”
Rationale: This response acknowledges the client’s feeling without reinforcing the delusion (“I understand
you believe that”), then redirects to reality.
,4. A client with borderline personality disorder has a history of self-mutilation (cutting). The client
says, “I feel so empty, I want to cut myself.” Which intervention should the nurse implement first?
A) Restrict the client to her room
B) Assess the intensity of the urge and review the safety plan
C) Apply soft wrist restraints
D) Administer a PRN sedative
Answer B: Assess the intensity of the urge and review the safety plan
Rationale: First, assess the risk and use de-escalation techniques, including reviewing alternative coping
strategies. Restraints are a last resort.
5. A client with alcohol use disorder is admitted for detoxification. The client’s last drink was 8 hours
ago. Which assessment finding is the nurse most likely to see first?
A) Seizure activity
B) Anxiety, tremors, and diaphoresis
C) Delirium tremens (DTs)
D) Hallucinations
Answer B: Anxiety, tremors, and diaphoresis
Rationale: Early alcohol withdrawal (6-12 hours) includes tremors, anxiety, sweating, and tachycardia.
Seizures occur at 12-24 hours; DTs at 48-72 hours.
6. A client on a psychiatric unit tells the nurse, “I’m going to kill myself tonight after you go off shift.”
What is the nurse’s priority action?
A) Document the statement and tell the next shift
B) Place the client on one-to-one observation and notify the provider
C) Tell the client that this behavior will not be tolerated
D) Remove all sharp objects from the unit
Answer B: Place the client on one-to-one observation and notify the provider
Rationale: Immediate safety interventions include constant observation, removing means, and notifying the
provider for a suicide risk assessment.
7. A client with social anxiety disorder is prescribed paroxetine (an SSRI). Which statement by the
client indicates understanding of the medication?
A) “I should feel better within 24 hours.”
, B) “It may take 4-6 weeks for the full effect.”
C) “I can stop the medication once I feel less anxious.”
D) “This medication is addictive like Xanax.”
Answer B: “It may take 4-6 weeks for the full effect.”
Rationale: SSRIs have delayed onset; full therapeutic effect takes several weeks. They are not addictive like
benzodiazepines.
8. A client with schizophrenia has been taking haloperidol for 2 weeks and now presents with a stiff
neck, fever, and confusion. Which condition does the nurse suspect?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome (NMS)
C) Acute dystonia
D) Serotonin syndrome
Answer B: Neuroleptic malignant syndrome (NMS)
Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic instability. It is a medical
emergency requiring discontinuation of the antipsychotic.
9. A client with major depressive disorder has been started on fluoxetine. The client says, “I feel even
more tired and nauseous now.” Which response is most appropriate?
A) “The medication is not working; we need to switch it.”
B) “These side effects often improve after the first week or two. Try taking it with food.”
C) “You should stop taking it immediately.”
D) “That means the medication is not right for you.”
Answer B: “These side effects often improve after the first week or two. Try taking it with food.”
Rationale: Early side effects (nausea, fatigue) are common and often transient; encourage adherence while
monitoring.
10. A client with bipolar disorder is taking lithium. The client reports hand tremors and increased
thirst. What should the nurse do first?
A) Hold the next dose of lithium
B) Check the client’s lithium level
C) Administer a beta-blocker for tremors
D) Increase the client’s fluid intake
therapeutic communication, depression, anxiety disorders, schizophrenia, bipolar disorder, substance abuse,
suicide precautions, psychiatric medications, and other key mental health topics. Each question includes the
correct answer and rationale. Use this exam to strengthen your psychiatric nursing knowledge and prepare
for the NCLEX.
Key Topics Covered
1. Therapeutic Communication – Active listening, empathy, clarifying, reflecting, setting limits, non-verbal
communication, therapeutic vs non-therapeutic responses
2. Mood Disorders – Major depressive disorder, persistent depressive disorder, bipolar I and II, mania,
hypomania, treatment (SSRIs, SNRIs, lithium, anticonvulsants), suicide risk assessment and precautions
3. Anxiety Disorders – Generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety,
obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), treatment (SSRIs,
benzodiazepines, CBT)
4. Psychotic Disorders – Schizophrenia, schizoaffective disorder, delusional disorder, positive/negative
symptoms, antipsychotics (typical vs atypical), side effects (EPS, NMS, agranulocytosis)
5. Personality Disorders – Borderline, antisocial, narcissistic, histrionic, avoidant, dependent; treatment
approaches, boundary setting
6. Substance Use Disorders – Alcohol, opioids, stimulants, benzodiazepines; withdrawal syndromes,
detoxification, relapse prevention, harm reduction, medications (naltrexone, methadone, buprenorphine,
disulfiram)
7. Eating Disorders – Anorexia nervosa, bulimia nervosa, binge-eating disorder; medical complications,
refeeding syndrome, treatment
8. Suicide & Self-Harm – Risk factors, assessment (SAFE-T, SAD PERSONS), precautions (one-to-one
observation, environment safety), post-suicide care
9. Crisis Intervention & De-escalation – Crisis theory, anger management, de-escalation techniques,
restraints (seclusion, physical restraints), legal and ethical issues
10. Psychopharmacology – Mechanism of action, side effects, nursing monitoring, patient education, drug
interactions
,Questions 1–215
1. A client with major depressive disorder tells the nurse, “I’m a complete failure. Nothing I do ever
works out.” Which response by the nurse is most therapeutic?
A) “You shouldn’t feel that way. You’ve accomplished many things.”
B) “It sounds like you’re feeling really down about yourself right now.”
C) “Let’s list some of your recent successes.”
D) “Why do you think you feel like a failure?”
Answer B: “It sounds like you’re feeling really down about yourself right now.”
Rationale: This response reflects the client’s feeling (reflection/validation) without arguing or offering false
reassurance. Therapeutic communication focuses on the feeling, not the content.
2. A client with bipolar disorder in a manic episode is pacing rapidly, talking loudly, and making
grandiose statements. Which nursing intervention is most appropriate initially?
A) Place the client in seclusion
B) Provide a quiet, low-stimulation environment
C) Confront the client about the grandiose statements
D) Assign a group of staff to restrain the client
Answer B: Provide a quiet, low-stimulation environment
Rationale: Reducing environmental stimuli helps decrease agitation and manic behavior. Seclusion and
restraints are last resorts after de-escalation fails.
3. A client with schizophrenia tells the nurse, “The CIA is poisoning my food with radioactive waves.”
What is the most therapeutic response?
A) “That is not true. The CIA has no reason to harm you.”
B) “I understand that you believe that, but I don’t hear the voices. Let’s talk about something else.”
C) “Tell me more about why you think that.”
D) “You need to take your medication to stop the voices.”
Answer B: “I understand that you believe that, but I don’t hear the voices. Let’s talk about something
else.”
Rationale: This response acknowledges the client’s feeling without reinforcing the delusion (“I understand
you believe that”), then redirects to reality.
,4. A client with borderline personality disorder has a history of self-mutilation (cutting). The client
says, “I feel so empty, I want to cut myself.” Which intervention should the nurse implement first?
A) Restrict the client to her room
B) Assess the intensity of the urge and review the safety plan
C) Apply soft wrist restraints
D) Administer a PRN sedative
Answer B: Assess the intensity of the urge and review the safety plan
Rationale: First, assess the risk and use de-escalation techniques, including reviewing alternative coping
strategies. Restraints are a last resort.
5. A client with alcohol use disorder is admitted for detoxification. The client’s last drink was 8 hours
ago. Which assessment finding is the nurse most likely to see first?
A) Seizure activity
B) Anxiety, tremors, and diaphoresis
C) Delirium tremens (DTs)
D) Hallucinations
Answer B: Anxiety, tremors, and diaphoresis
Rationale: Early alcohol withdrawal (6-12 hours) includes tremors, anxiety, sweating, and tachycardia.
Seizures occur at 12-24 hours; DTs at 48-72 hours.
6. A client on a psychiatric unit tells the nurse, “I’m going to kill myself tonight after you go off shift.”
What is the nurse’s priority action?
A) Document the statement and tell the next shift
B) Place the client on one-to-one observation and notify the provider
C) Tell the client that this behavior will not be tolerated
D) Remove all sharp objects from the unit
Answer B: Place the client on one-to-one observation and notify the provider
Rationale: Immediate safety interventions include constant observation, removing means, and notifying the
provider for a suicide risk assessment.
7. A client with social anxiety disorder is prescribed paroxetine (an SSRI). Which statement by the
client indicates understanding of the medication?
A) “I should feel better within 24 hours.”
, B) “It may take 4-6 weeks for the full effect.”
C) “I can stop the medication once I feel less anxious.”
D) “This medication is addictive like Xanax.”
Answer B: “It may take 4-6 weeks for the full effect.”
Rationale: SSRIs have delayed onset; full therapeutic effect takes several weeks. They are not addictive like
benzodiazepines.
8. A client with schizophrenia has been taking haloperidol for 2 weeks and now presents with a stiff
neck, fever, and confusion. Which condition does the nurse suspect?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome (NMS)
C) Acute dystonia
D) Serotonin syndrome
Answer B: Neuroleptic malignant syndrome (NMS)
Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic instability. It is a medical
emergency requiring discontinuation of the antipsychotic.
9. A client with major depressive disorder has been started on fluoxetine. The client says, “I feel even
more tired and nauseous now.” Which response is most appropriate?
A) “The medication is not working; we need to switch it.”
B) “These side effects often improve after the first week or two. Try taking it with food.”
C) “You should stop taking it immediately.”
D) “That means the medication is not right for you.”
Answer B: “These side effects often improve after the first week or two. Try taking it with food.”
Rationale: Early side effects (nausea, fatigue) are common and often transient; encourage adherence while
monitoring.
10. A client with bipolar disorder is taking lithium. The client reports hand tremors and increased
thirst. What should the nurse do first?
A) Hold the next dose of lithium
B) Check the client’s lithium level
C) Administer a beta-blocker for tremors
D) Increase the client’s fluid intake
