NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
1. Therapeutic Communication & Assessment Priorities
Question 1
A client diagnosed with schizophrenia says to the nurse, "The voices are telling me that the
food on this tray is poisoned by the government." Which response by the nurse is
therapeutic? A) "Don't be silly, the government has no interest in your food tray."
B) "I understand that you hear those voices, but I do not hear them. Your food is safe to eat."
C) "Why would the government want to poison a student like you?"
D) "Let me taste the food first to prove to you that it isn't poisoned."
Correct Answer: B — "I understand that you hear those voices, but I do not hear them.
Your food is safe to eat."
Rationale: This response presents reality gently while acknowledging the client’s experience.
It avoids arguing or validating the delusion, and it provides reassurance. Never argue with a
delusion, never ask "why" (Option C), and never play along with the delusion (Option D).
Question 2
A nurse is caring for a client admitted with severe major depressive disorder. Which
statement by the client requires the nurse's immediate, highest-priority intervention? A) "I
just don't feel like participating in group therapy sessions today."
B) "Everything will be much better for my family once I am gone."
C) "I haven't slept more than two hours a night for the past week."
D) "The antidepressant medication is making my mouth feel very dry."
Correct Answer: B — "Everything will be much better for my family once I am gone."
Rationale: This statement strongly implies suicidal ideation. Client safety is always the
highest priority in mental health nursing. The nurse must immediately perform a direct
suicide risk assessment and initiate safety precautions.
Question 3
An adolescent client is admitted to an eating disorder unit with a diagnosis of Anorexia
Nervosa. Which nursing intervention is a priority during the immediate post-meal period? A)
Allow the client to rest quietly alone in their room for 60 minutes to promote digestion.
B) Accompany and observe the client for 60 minutes after meals to prevent vomiting or
discarding hidden food.
C) Weigh the client immediately after they finish eating to track caloric retention.
,NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
D) Review the client's laboratory values for signs of hyperkalemia.
Correct Answer: B — Accompany and observe the client for 60 minutes after meals to
prevent vomiting or discarding hidden food.
Rationale: Clients with anorexia or bulimia are at high risk for purging or exercising secretly
immediately after meals. Direct observation for 1 hour post-meal is standard structural
protocol. Weighing should occur in the morning before eating, not right after meals.
2. Psychopharmacology & Critical Side Effects
Question 4
A client taking Haloperidol (a typical antipsychotic) develops a high fever ($40^\circ\text{C}$
/ $104^\circ\text{F}$), severe muscle rigidity, altered mental status, and autonomic
instability. The nurse recognizes these findings as indicative of: A) Serotonin Syndrome
B) Neuroleptic Malignant Syndrome (NMS)
C) Acute Dystonic Reaction
D) Tardive Dyskinesia
Correct Answer: B — Neuroleptic Malignant Syndrome (NMS)
Rationale: NMS is a life-threatening complication of antipsychotic medications characterized
by hyperpyrexia (high fever), severe "lead-pipe" muscle rigidity, and cardiovascular
instability. Immediate actions include stopping the medication and cooling the patient.
Question 5
A client is prescribed Phenelzine, a Monoamine Oxidase Inhibitor (MAOI). Which food
selection on the client's lunch tray requires immediate intervention by the nurse? A) Fresh
grilled chicken breast with steamed white rice
B) A turkey sandwich with processed cheddar cheese slices
C) Aged pepperoni pizza with a side of red wine or tap beer
D) Scrambled eggs with sliced fresh tomatoes
Correct Answer: C — Aged pepperoni pizza with a side of red wine or tap beer
Rationale: MAOIs interact severely with foods high in tyramine (aged cheeses, cured/aged
meats like pepperoni, red wine, tap beers, and fermented products). Consuming tyramine
while on an MAOI can trigger a fatal hypertensive crisis.
Question 6
,NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
A client stabilized on Lithium Carbonate for Bipolar Disorder reports vomiting, severe
diarrhea, blurred vision, and a gross hand tremor. The nurse should suspect: A) Expected
initial side effects of therapeutic lithium use
B) Lithium toxicity
C) An acute manic breakthrough episode
D) Extrapyramidal symptoms (EPS)
Correct Answer: B — Lithium toxicity
Rationale: Gastrointestinal distress (vomiting/diarrhea), coarse tremors, blurred vision, and
ataxia are classic signs of lithium toxicity (typically when blood levels exceed $1.5\text{
mEq/L}$). The nurse must hold the dose and request a serum lithium level.
Question 7
A client is initiated on Sertraline, an SSRI, for anxiety. The nurse should instruct the client to
monitor for which early, transient side effects? A) Agranulocytosis and sore throat
B) Nausea, headache, and temporary sleep disturbances
C) Severe urinary retention and extreme dry mouth
D) Hypertensive crisis and rigid muscles
Correct Answer: B — Nausea, headache, and temporary sleep disturbances
Rationale: SSRIs commonly cause mild, temporary gastrointestinal upset and headaches
during the first 1 to 2 weeks of therapy. Options A and C are associated with other classes
(clozapine and tricyclics).
3. Anxiety, Mood, and Personality Disorders
Question 8
A client experiencing a severe panic attack presents to the emergency department. The
client is hyperventilating, pacing rapidly, and screaming, "I’m dying! I can't breathe!" Which
action should the nurse take first? A) Leave the client alone in a quiet room so they can calm
down safely.
B) Give a detailed educational lecture on the physiology of anxiety responses.
C) Stay with the client, use short, simple sentences, and instruct them to take slow breaths
with you.
D) Ask the client to complete a 5-page retrospective anxiety intake assessment form.
, NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
Correct Answer: C — Stay with the client, use short, simple sentences, and instruct them
to take slow breaths with you.
Rationale: During severe or panic-level anxiety, a client cannot process complex information
or abstract instructions. The nurse must provide a calm, safe presence and clear, simple
instructions to reduce hyperventilation.
Question 9
A nurse on an inpatient unit observes a client diagnosed with Borderline Personality
Disorder attempting to convince the night shift nurse that the day shift nurse is "terrible and
cruel," while praising the night shift nurse as "the only one who truly cares." The nurse
recognizes this behavior as: A) Splitting
B) Malingering
C) Rationalization
D) Confabulation
Correct Answer: A — Splitting
Rationale: Splitting is a primary defense mechanism used by individuals with Borderline
Personality Disorder, where they view people or situations as entirely good or entirely bad.
The nursing team must maintain consistent, clear boundaries to manage this.
Question 10
A client is admitted to the psychiatric unit in an acute manic state. They are wearing bright,
revealing clothing, pacing aggressively, and interrupting other clients. Which environment is
most appropriate for this client's lunch? A) At a large communal table in the main dining
area with all other clients
B) In a quiet, low-stimulation environment or their own room with simple finger foods
C) At the nurse's desk under close multi-staff monitoring
D) In a dark room with no windows or lights turned on
Correct Answer: B — In a quiet, low-stimulation environment or their own room with
simple finger foods
Rationale: Acute mania requires a reduction in environmental stimuli to decrease
hyperactivity. High-calorie finger foods are prioritized because manic clients rarely sit down
long enough to eat a full meal using utensils.
4. Substance Use & Crisis Management
Answers. Graded A+ (2026/2027)
1. Therapeutic Communication & Assessment Priorities
Question 1
A client diagnosed with schizophrenia says to the nurse, "The voices are telling me that the
food on this tray is poisoned by the government." Which response by the nurse is
therapeutic? A) "Don't be silly, the government has no interest in your food tray."
B) "I understand that you hear those voices, but I do not hear them. Your food is safe to eat."
C) "Why would the government want to poison a student like you?"
D) "Let me taste the food first to prove to you that it isn't poisoned."
Correct Answer: B — "I understand that you hear those voices, but I do not hear them.
Your food is safe to eat."
Rationale: This response presents reality gently while acknowledging the client’s experience.
It avoids arguing or validating the delusion, and it provides reassurance. Never argue with a
delusion, never ask "why" (Option C), and never play along with the delusion (Option D).
Question 2
A nurse is caring for a client admitted with severe major depressive disorder. Which
statement by the client requires the nurse's immediate, highest-priority intervention? A) "I
just don't feel like participating in group therapy sessions today."
B) "Everything will be much better for my family once I am gone."
C) "I haven't slept more than two hours a night for the past week."
D) "The antidepressant medication is making my mouth feel very dry."
Correct Answer: B — "Everything will be much better for my family once I am gone."
Rationale: This statement strongly implies suicidal ideation. Client safety is always the
highest priority in mental health nursing. The nurse must immediately perform a direct
suicide risk assessment and initiate safety precautions.
Question 3
An adolescent client is admitted to an eating disorder unit with a diagnosis of Anorexia
Nervosa. Which nursing intervention is a priority during the immediate post-meal period? A)
Allow the client to rest quietly alone in their room for 60 minutes to promote digestion.
B) Accompany and observe the client for 60 minutes after meals to prevent vomiting or
discarding hidden food.
C) Weigh the client immediately after they finish eating to track caloric retention.
,NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
D) Review the client's laboratory values for signs of hyperkalemia.
Correct Answer: B — Accompany and observe the client for 60 minutes after meals to
prevent vomiting or discarding hidden food.
Rationale: Clients with anorexia or bulimia are at high risk for purging or exercising secretly
immediately after meals. Direct observation for 1 hour post-meal is standard structural
protocol. Weighing should occur in the morning before eating, not right after meals.
2. Psychopharmacology & Critical Side Effects
Question 4
A client taking Haloperidol (a typical antipsychotic) develops a high fever ($40^\circ\text{C}$
/ $104^\circ\text{F}$), severe muscle rigidity, altered mental status, and autonomic
instability. The nurse recognizes these findings as indicative of: A) Serotonin Syndrome
B) Neuroleptic Malignant Syndrome (NMS)
C) Acute Dystonic Reaction
D) Tardive Dyskinesia
Correct Answer: B — Neuroleptic Malignant Syndrome (NMS)
Rationale: NMS is a life-threatening complication of antipsychotic medications characterized
by hyperpyrexia (high fever), severe "lead-pipe" muscle rigidity, and cardiovascular
instability. Immediate actions include stopping the medication and cooling the patient.
Question 5
A client is prescribed Phenelzine, a Monoamine Oxidase Inhibitor (MAOI). Which food
selection on the client's lunch tray requires immediate intervention by the nurse? A) Fresh
grilled chicken breast with steamed white rice
B) A turkey sandwich with processed cheddar cheese slices
C) Aged pepperoni pizza with a side of red wine or tap beer
D) Scrambled eggs with sliced fresh tomatoes
Correct Answer: C — Aged pepperoni pizza with a side of red wine or tap beer
Rationale: MAOIs interact severely with foods high in tyramine (aged cheeses, cured/aged
meats like pepperoni, red wine, tap beers, and fermented products). Consuming tyramine
while on an MAOI can trigger a fatal hypertensive crisis.
Question 6
,NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
A client stabilized on Lithium Carbonate for Bipolar Disorder reports vomiting, severe
diarrhea, blurred vision, and a gross hand tremor. The nurse should suspect: A) Expected
initial side effects of therapeutic lithium use
B) Lithium toxicity
C) An acute manic breakthrough episode
D) Extrapyramidal symptoms (EPS)
Correct Answer: B — Lithium toxicity
Rationale: Gastrointestinal distress (vomiting/diarrhea), coarse tremors, blurred vision, and
ataxia are classic signs of lithium toxicity (typically when blood levels exceed $1.5\text{
mEq/L}$). The nurse must hold the dose and request a serum lithium level.
Question 7
A client is initiated on Sertraline, an SSRI, for anxiety. The nurse should instruct the client to
monitor for which early, transient side effects? A) Agranulocytosis and sore throat
B) Nausea, headache, and temporary sleep disturbances
C) Severe urinary retention and extreme dry mouth
D) Hypertensive crisis and rigid muscles
Correct Answer: B — Nausea, headache, and temporary sleep disturbances
Rationale: SSRIs commonly cause mild, temporary gastrointestinal upset and headaches
during the first 1 to 2 weeks of therapy. Options A and C are associated with other classes
(clozapine and tricyclics).
3. Anxiety, Mood, and Personality Disorders
Question 8
A client experiencing a severe panic attack presents to the emergency department. The
client is hyperventilating, pacing rapidly, and screaming, "I’m dying! I can't breathe!" Which
action should the nurse take first? A) Leave the client alone in a quiet room so they can calm
down safely.
B) Give a detailed educational lecture on the physiology of anxiety responses.
C) Stay with the client, use short, simple sentences, and instruct them to take slow breaths
with you.
D) Ask the client to complete a 5-page retrospective anxiety intake assessment form.
, NSG 221 Mental Health Nursing HESI Questions and
Answers. Graded A+ (2026/2027)
Correct Answer: C — Stay with the client, use short, simple sentences, and instruct them
to take slow breaths with you.
Rationale: During severe or panic-level anxiety, a client cannot process complex information
or abstract instructions. The nurse must provide a calm, safe presence and clear, simple
instructions to reduce hyperventilation.
Question 9
A nurse on an inpatient unit observes a client diagnosed with Borderline Personality
Disorder attempting to convince the night shift nurse that the day shift nurse is "terrible and
cruel," while praising the night shift nurse as "the only one who truly cares." The nurse
recognizes this behavior as: A) Splitting
B) Malingering
C) Rationalization
D) Confabulation
Correct Answer: A — Splitting
Rationale: Splitting is a primary defense mechanism used by individuals with Borderline
Personality Disorder, where they view people or situations as entirely good or entirely bad.
The nursing team must maintain consistent, clear boundaries to manage this.
Question 10
A client is admitted to the psychiatric unit in an acute manic state. They are wearing bright,
revealing clothing, pacing aggressively, and interrupting other clients. Which environment is
most appropriate for this client's lunch? A) At a large communal table in the main dining
area with all other clients
B) In a quiet, low-stimulation environment or their own room with simple finger foods
C) At the nurse's desk under close multi-staff monitoring
D) In a dark room with no windows or lights turned on
Correct Answer: B — In a quiet, low-stimulation environment or their own room with
simple finger foods
Rationale: Acute mania requires a reduction in environmental stimuli to decrease
hyperactivity. High-calorie finger foods are prioritized because manic clients rarely sit down
long enough to eat a full meal using utensils.
4. Substance Use & Crisis Management
