RN ATI 2023 MENTAL HEALTH PROCTORED
EXAM NGN 2023: 240 Detailed Questions with Answers
and Rationales
Summary of Key Content Areas
Content Area Question Numbers
Therapeutic Communication 1-20
Schizophrenia & Psychotic Disorders 21-35
Bipolar Disorder 36-45
Depressive Disorders 46-60
Anxiety, OCD, PTSD 61-75
Eating Disorders 76-80
Substance Use Disorders 81-100
Personality Disorders 101-115
Psychopharmacology 116-140
Therapies & ECT 141-155
Childhood/Adolescent Disorders 156-170
Neurocognitive Disorders 171-180
Crisis & Suicide Prevention 181-195
Legal/Ethical Issues 196-210
NGN Case Studies 211-240
,SECTION 1: THERAPEUTIC COMMUNICATION & THE NURSE-CLIENT
RELATIONSHIP
Question 1:
A nurse is sitting with a client diagnosed with major depressive disorder. The client suddenly
says, "I'm just a burden to everyone. No one would care if I were gone." Which of the
following is the nurse's priority response?
A. "You have so much to live for. Think about your children."
B. "I care about you, and I want to help you feel better."
C. "Are you thinking about hurting yourself or ending your life?"
D. "Why would you say something like that when you know it's not true?"
Answer: C
Rationale: The nurse's priority is to assess for suicidal ideation, plan, and intent. The client's
statement ("no one would care if I were gone") is a red flag for possible suicidality. Option C
directly assesses safety, which is always the priority. Option A provides false reassurance.
Option B, while caring, does not address the immediate safety concern. Option D is non-
therapeutic ("why" questions can sound judgmental) and dismisses the client's feelings .
Question 2:
A nurse is caring for a client with schizophrenia who states, "The FBI is monitoring my room
through the television set." Which of the following responses by the nurse is most
therapeutic?
A. "That's not true. No one is monitoring you. You are safe here."
B. "I understand you believe that, but I don't see any cameras."
C. "That sounds frightening. Tell me more about what you're experiencing."
D. "Let's focus on something else instead of talking about the FBI."
Answer: C
Rationale: Option C acknowledges the client's feelings without reinforcing the delusion,
which is a therapeutic communication technique. Option A challenges the client's belief
directly, which may increase distrust and anxiety. Option B, while not directly argumentative,
still challenges the delusion and may lead to further entrenchment. Option D changes the
subject and avoids addressing the client's emotional distress .
Question 3:
A nurse is working with a client who has borderline personality disorder. The client tells the
nurse, "You're the only one who understands me. The other nurses don't care about me at
all." The nurse should recognize this statement as an example of which of the following?
A. Splitting
B. Projection
C. Reaction formation
D. Rationalization
,Answer: A
Rationale: Splitting is a primitive defense mechanism common in borderline personality
disorder where the client views people as all-good or all-bad, unable to integrate positive
and negative qualities. The client idealizes the nurse while devaluing the other staff
members. Projection involves attributing one's own unacceptable feelings to others.
Reaction formation involves behaving opposite to one's true feelings. Rationalization
involves creating logical excuses for irrational behavior.
Question 4:
A nurse is assessing a client who was physically assaulted. The client states, "I can't
remember anything about what happened to me." The nurse should recognize this as which
of the following defense mechanisms?
A. Suppression
B. Repression
C. Denial
D. Dissociation
Answer: B
Rationale: Repression is the involuntary blocking of unpleasant memories from conscious
awareness. The client's inability to remember the traumatic event is a classic example.
Suppression is a conscious effort to forget. Denial involves refusing to acknowledge reality.
Dissociation involves a disruption in consciousness, memory, or identity .
Question 5:
A nurse is caring for a client whose partner died 8 months ago. The client states, "I still don't
feel up to returning to work. I can't concentrate and I just don't care about anything
anymore." Which of the following responses by the nurse is most appropriate?
A. "It's been 8 months. Don't you think it's time to move on?"
B. "You need to push yourself to go back to work. It will help you feel better."
C. "Tell me more about how your grief has been affecting your daily life."
D. "Your partner would want you to be happy and get back to normal."
Answer: C
Rationale: Option C uses an open-ended statement to explore the client's experience
further, demonstrating therapeutic communication and assessment. Option A is judgmental
and dismissive. Option B gives advice, which is non-therapeutic. Option D uses a "should"
statement and makes assumptions about what the deceased would want .
Question 6:
A nurse is preparing to discharge a client who has been treated for depression. The client
states, "I'm really scared I'm going to feel depressed again once I go home." Which of the
following responses by the nurse is most therapeutic?
A. "Don't worry. You've learned coping skills here, so you'll be fine."
B. "Let's talk about what you're worried about and make a plan for when you go home."
, C. "Why are you worried? You've made so much progress."
D. "Maybe you're not ready for discharge yet. I'll talk to the provider."
Answer: B
Rationale: Option B validates the client's concern and collaboratively problem-solves,
promoting self-efficacy and discharge planning. Option A offers false reassurance. Option C
uses a "why" question that can sound judgmental. Option D undermines the client's
confidence and the discharge plan unnecessarily.
Question 7:
A nurse is caring for a client who is angry and yelling, "You never listen to me! Everyone here
is incompetent!" Which of the following is the nurse's best response?
A. "I can see that you're upset. Let's go somewhere private and talk about what's bothering
you."
B. "You need to lower your voice right now or I will have to call for help."
C. "I do listen to you. That's not fair. I've spent a lot of time with you today."
D. "Everyone here is trying their best. You should be more grateful."
Answer: A
Rationale: Option A acknowledges the client's emotion, offers a private setting (which can
de-escalate anger), and invites discussion. Option B uses a threatening tone that may
escalate anger. Option C becomes defensive and argumentative. Option D uses "should"
statements and shames the client, which is non-therapeutic.
Question 8:
A nurse is caring for a client with social anxiety disorder. The client states, "I can't go to the
group therapy session. Everyone will stare at me and think I'm stupid." Which of the
following responses by the nurse is most therapeutic?
A. "No one is going to stare at you. You're being paranoid."
B. "You don't have to go if you're not ready. You can stay in your room."
C. "I understand you're feeling anxious. Let's walk to the group together, and you can just
listen at first."
D. "You have to go to group. It's part of your treatment plan."
Answer: C
Rationale: Option C validates the client's anxiety while providing support and a graded
approach (just listening at first) to increase the likelihood of participation. Option A
dismisses the client's fear. Option B reinforces avoidance behavior. Option D is authoritarian
and does not address the underlying anxiety.
Question 9:
A nurse is caring for a client who is crying after receiving a difficult diagnosis. The nurse sits
quietly with the client without speaking. This action by the nurse demonstrates which of the
following therapeutic techniques?
EXAM NGN 2023: 240 Detailed Questions with Answers
and Rationales
Summary of Key Content Areas
Content Area Question Numbers
Therapeutic Communication 1-20
Schizophrenia & Psychotic Disorders 21-35
Bipolar Disorder 36-45
Depressive Disorders 46-60
Anxiety, OCD, PTSD 61-75
Eating Disorders 76-80
Substance Use Disorders 81-100
Personality Disorders 101-115
Psychopharmacology 116-140
Therapies & ECT 141-155
Childhood/Adolescent Disorders 156-170
Neurocognitive Disorders 171-180
Crisis & Suicide Prevention 181-195
Legal/Ethical Issues 196-210
NGN Case Studies 211-240
,SECTION 1: THERAPEUTIC COMMUNICATION & THE NURSE-CLIENT
RELATIONSHIP
Question 1:
A nurse is sitting with a client diagnosed with major depressive disorder. The client suddenly
says, "I'm just a burden to everyone. No one would care if I were gone." Which of the
following is the nurse's priority response?
A. "You have so much to live for. Think about your children."
B. "I care about you, and I want to help you feel better."
C. "Are you thinking about hurting yourself or ending your life?"
D. "Why would you say something like that when you know it's not true?"
Answer: C
Rationale: The nurse's priority is to assess for suicidal ideation, plan, and intent. The client's
statement ("no one would care if I were gone") is a red flag for possible suicidality. Option C
directly assesses safety, which is always the priority. Option A provides false reassurance.
Option B, while caring, does not address the immediate safety concern. Option D is non-
therapeutic ("why" questions can sound judgmental) and dismisses the client's feelings .
Question 2:
A nurse is caring for a client with schizophrenia who states, "The FBI is monitoring my room
through the television set." Which of the following responses by the nurse is most
therapeutic?
A. "That's not true. No one is monitoring you. You are safe here."
B. "I understand you believe that, but I don't see any cameras."
C. "That sounds frightening. Tell me more about what you're experiencing."
D. "Let's focus on something else instead of talking about the FBI."
Answer: C
Rationale: Option C acknowledges the client's feelings without reinforcing the delusion,
which is a therapeutic communication technique. Option A challenges the client's belief
directly, which may increase distrust and anxiety. Option B, while not directly argumentative,
still challenges the delusion and may lead to further entrenchment. Option D changes the
subject and avoids addressing the client's emotional distress .
Question 3:
A nurse is working with a client who has borderline personality disorder. The client tells the
nurse, "You're the only one who understands me. The other nurses don't care about me at
all." The nurse should recognize this statement as an example of which of the following?
A. Splitting
B. Projection
C. Reaction formation
D. Rationalization
,Answer: A
Rationale: Splitting is a primitive defense mechanism common in borderline personality
disorder where the client views people as all-good or all-bad, unable to integrate positive
and negative qualities. The client idealizes the nurse while devaluing the other staff
members. Projection involves attributing one's own unacceptable feelings to others.
Reaction formation involves behaving opposite to one's true feelings. Rationalization
involves creating logical excuses for irrational behavior.
Question 4:
A nurse is assessing a client who was physically assaulted. The client states, "I can't
remember anything about what happened to me." The nurse should recognize this as which
of the following defense mechanisms?
A. Suppression
B. Repression
C. Denial
D. Dissociation
Answer: B
Rationale: Repression is the involuntary blocking of unpleasant memories from conscious
awareness. The client's inability to remember the traumatic event is a classic example.
Suppression is a conscious effort to forget. Denial involves refusing to acknowledge reality.
Dissociation involves a disruption in consciousness, memory, or identity .
Question 5:
A nurse is caring for a client whose partner died 8 months ago. The client states, "I still don't
feel up to returning to work. I can't concentrate and I just don't care about anything
anymore." Which of the following responses by the nurse is most appropriate?
A. "It's been 8 months. Don't you think it's time to move on?"
B. "You need to push yourself to go back to work. It will help you feel better."
C. "Tell me more about how your grief has been affecting your daily life."
D. "Your partner would want you to be happy and get back to normal."
Answer: C
Rationale: Option C uses an open-ended statement to explore the client's experience
further, demonstrating therapeutic communication and assessment. Option A is judgmental
and dismissive. Option B gives advice, which is non-therapeutic. Option D uses a "should"
statement and makes assumptions about what the deceased would want .
Question 6:
A nurse is preparing to discharge a client who has been treated for depression. The client
states, "I'm really scared I'm going to feel depressed again once I go home." Which of the
following responses by the nurse is most therapeutic?
A. "Don't worry. You've learned coping skills here, so you'll be fine."
B. "Let's talk about what you're worried about and make a plan for when you go home."
, C. "Why are you worried? You've made so much progress."
D. "Maybe you're not ready for discharge yet. I'll talk to the provider."
Answer: B
Rationale: Option B validates the client's concern and collaboratively problem-solves,
promoting self-efficacy and discharge planning. Option A offers false reassurance. Option C
uses a "why" question that can sound judgmental. Option D undermines the client's
confidence and the discharge plan unnecessarily.
Question 7:
A nurse is caring for a client who is angry and yelling, "You never listen to me! Everyone here
is incompetent!" Which of the following is the nurse's best response?
A. "I can see that you're upset. Let's go somewhere private and talk about what's bothering
you."
B. "You need to lower your voice right now or I will have to call for help."
C. "I do listen to you. That's not fair. I've spent a lot of time with you today."
D. "Everyone here is trying their best. You should be more grateful."
Answer: A
Rationale: Option A acknowledges the client's emotion, offers a private setting (which can
de-escalate anger), and invites discussion. Option B uses a threatening tone that may
escalate anger. Option C becomes defensive and argumentative. Option D uses "should"
statements and shames the client, which is non-therapeutic.
Question 8:
A nurse is caring for a client with social anxiety disorder. The client states, "I can't go to the
group therapy session. Everyone will stare at me and think I'm stupid." Which of the
following responses by the nurse is most therapeutic?
A. "No one is going to stare at you. You're being paranoid."
B. "You don't have to go if you're not ready. You can stay in your room."
C. "I understand you're feeling anxious. Let's walk to the group together, and you can just
listen at first."
D. "You have to go to group. It's part of your treatment plan."
Answer: C
Rationale: Option C validates the client's anxiety while providing support and a graded
approach (just listening at first) to increase the likelihood of participation. Option A
dismisses the client's fear. Option B reinforces avoidance behavior. Option D is authoritarian
and does not address the underlying anxiety.
Question 9:
A nurse is caring for a client who is crying after receiving a difficult diagnosis. The nurse sits
quietly with the client without speaking. This action by the nurse demonstrates which of the
following therapeutic techniques?
