Psychiatric Mental Health Nursing Examination
2026/2027 Academic Year | 75 Questions with Correct Answers & Rationales
This examination consists of 75 multiple-choice questions covering essential psychiatric mental health nursing content.
Select the single best answer for each question. Correct answers are indicated in bold cyan, followed by evidence-based
rationales. Total time: 2 hours 30 minutes.
Section I: Therapeutic Communication & Nurse-Patient Relationship
1. A patient diagnosed with major depressive disorder says, 'Nobody cares about me. I'm completely alone in
this world.' Which response by the nurse is the most therapeutic?
B. I can hear that you are feeling very alone right
A. You shouldn't feel that way. Many people care
now. Can you tell me more about what you are
about you, including your family and the staff here.
experiencing?
C. Everyone feels lonely sometimes. You just need D. I understand how you feel. I felt the same way
to focus on the positive things in your life. when I went through a difficult time.
Correct Answer: B. I can hear that you are feeling very alone right now. Can you tell me more about
what you are experiencing?
Rationale: This response uses reflective listening and an open-ended question to validate the patient's feelings without
offering false reassurance. Therapeutic communication techniques such as reflection, restatement, and open-ended
questions encourage the patient to explore feelings and promote a trusting relationship. The ANA Psychiatric-Mental
Health Nursing Standards emphasize that false reassurance ('You shouldn't feel that way') and universalizing
statements ('Everyone feels lonely') invalidate the patient's experience. Self-disclosure ('I felt the same way') shifts focus
from the patient to the nurse (Varcarolis, 2022; ANA, 2022).
2. A nurse has been caring for a patient with borderline personality disorder for three weeks. The patient tells
the nurse, 'You are the only person who truly understands me. You are so much better than all the other
nurses here.' Which concept best describes this dynamic?
B. Transference, in which the patient
A. Countertransference, in which the nurse develops
unconsciously redirects feelings from a
an emotional attachment to the patient
significant past relationship onto the nurse
C. Splitting, in which the patient idealizes one staff
D. Therapeutic alliance, representing a healthy and
member and devalues others as a defense
collaborative nurse-patient relationship
mechanism
Correct Answer: B. Transference, in which the patient unconsciously redirects feelings from a
significant past relationship onto the nurse
Rationale: Transference occurs when a patient unconsciously displaces feelings, expectations, and attitudes from a
significant person in their past onto the nurse. This is a common and expected phenomenon in psychiatric nursing,
particularly with patients who have experienced disrupted early relationships. The nurse must recognize transference,
maintain professional boundaries, and use the experience therapeutically rather than acting on it. While splitting
(idealization/devaluation) can also occur in BPD, the description of redirecting relational feelings onto the nurse is the
hallmark of transference. Countertransference refers to the nurse's emotional reactions to the patient (APA, 2023;
Varcarolis, 2022).
1
,3. A nurse is conducting an initial psychiatric assessment of a patient admitted for depression. Which
question is an open-ended therapeutic question that will yield the most information?
A. Have you been feeling sad lately? B. Are you having any thoughts of suicide?
C. Tell me about what has been happening in
D. Do you have a family history of mental illness?
your life recently.
Correct Answer: C. Tell me about what has been happening in your life recently.
Rationale: Open-ended questions encourage patients to share information in their own words and provide richer, more
comprehensive data. 'Tell me about...' is the classic open-ended format. Closed-ended questions (yes/no answers) such
as 'Have you been feeling sad lately?' are useful for specific data gathering but do not facilitate therapeutic
exploration. The Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA/APNA, 2022) recommend
beginning assessments with open-ended questions and using closed-ended questions for clarification and specific
clinical data (Varcarolis, 2022; Stuart, 2022).
4. A patient with a history of stalking behavior repeatedly asks a psychiatric nurse for her personal phone
number and tries to find her on social media. Which action by the nurse is most appropriate?
A. Give the patient a fake phone number to avoid B. Explain clearly and firmly that personal
confrontation and maintain the therapeutic contact is not appropriate, and maintain
relationship consistent professional boundaries
C. Report the patient's behavior to law enforcement D. Avoid the patient entirely and assign another
immediately and request a transfer to another unit nurse to provide all future care
Correct Answer: B. Explain clearly and firmly that personal contact is not appropriate, and maintain
consistent professional boundaries
Rationale: Setting and maintaining professional boundaries is essential in psychiatric nursing. The nurse should
clearly, directly, and without hostility explain that personal contact outside the therapeutic relationship is not
appropriate. Consistent boundary-setting helps maintain a safe therapeutic environment for both patient and nurse.
Giving false information or completely avoiding the patient undermines trust and therapeutic rapport. Reporting to law
enforcement is premature unless there is an active threat to safety. The ANA Code of Ethics and the APNA position
statement on boundary management emphasize that boundary violations can harm patients and compromise care (ANA,
2022; APNA, 2023).
5. A nurse enters a patient's room and observes the patient sitting curled in the corner of the bed with arms
wrapped around the knees, avoiding eye contact, and speaking in a barely audible whisper. The patient was
admitted yesterday for acute anxiety. Which interpretation of this nonverbal communication is most
accurate?
B. The patient is exhibiting signs of fear,
A. The patient is relaxed and resting comfortably
withdrawal, and a need for a sense of safety and
after receiving an anxiolytic medication
protection
C. The patient is demonstrating manipulative D. The patient is showing hostility and anger toward
behavior to gain attention from the nursing staff the treatment team
Correct Answer: B. The patient is exhibiting signs of fear, withdrawal, and a need for a sense of safety
and protection
Rationale: The described nonverbal cues — fetal position (curled in corner), protective posture (arms around knees),
avoidance of eye contact, and barely audible speech — are classic indicators of fear, anxiety, and emotional
withdrawal. These behaviors signal that the patient feels unsafe and vulnerable. The nurse should approach calmly,
introduce themselves, speak softly, and ask permission before entering the patient's personal space. Research in
psychiatric nursing shows that nonverbal communication accounts for the majority of interpersonal messages, and
accurate interpretation is critical for therapeutic intervention (Varcarolis, 2022; Peplau, 2022).
2
,6. A psychiatric nurse becomes aware that she feels frustrated and angry when caring for a patient with
antisocial personality disorder who repeatedly manipulates staff. After reflection, the nurse recognizes that
the patient reminds her of an abusive family member. Which concept does this scenario best illustrate?
B. The need for therapeutic use of self through
A. Burnout, resulting from chronic workplace stress
self-awareness and recognition of
and inadequate professional support
countertransference reactions
C. Compassion fatigue, caused by over-
D. Impaired clinical judgment due to inadequate
identification with the patient's traumatic
psychiatric nursing education
experiences
Correct Answer: B. The need for therapeutic use of self through self-awareness and recognition of
countertransference reactions
Rationale: Therapeutic use of self is a core intervention in psychiatric nursing that requires the nurse to develop self-
awareness and recognize how personal experiences and emotions influence the therapeutic relationship. The nurse's
frustration and anger, triggered by the patient's resemblance to an abusive family member, is a classic example of
countertransference. Through self-reflection and supervision, the nurse can manage these reactions and prevent them
from affecting patient care. The ANA/APNA Psychiatric-Mental Health Nursing Standards identify therapeutic use of
self as a foundational competency requiring ongoing self-assessment and supervision (ANA/APNA, 2022; Varcarolis,
2022).
7. A nurse has been working with a patient with depression for 8 weeks in an outpatient setting. The patient
has shown significant improvement and the treatment goals have been met. Which nursing action is most
appropriate during the termination phase of the therapeutic relationship?
A. Gradually reduce the frequency of sessions,
B. Abruptly end the therapeutic relationship to
review progress and achievements, discuss
avoid the patient developing dependency on the
feelings about ending therapy, and develop a
nurse
relapse prevention plan
D. Refer the patient to a different therapist without
C. Extend the therapy indefinitely to ensure the
discussing the termination to minimize emotional
patient does not relapse after termination
distress
Correct Answer: A. Gradually reduce the frequency of sessions, review progress and achievements,
discuss feelings about ending therapy, and develop a relapse prevention plan
Rationale: The termination phase of the therapeutic relationship should be planned, gradual, and collaborative.
Peplau's Interpersonal Relations Theory identifies termination as a critical phase where the nurse and patient review
progress, summarize achievements, explore feelings about separation, and plan for continued wellness. Abrupt
termination can cause feelings of abandonment, while overly prolonged therapy fosters dependency. A relapse
prevention plan equips the patient with coping strategies and resources for maintaining gains. The ANA Psychiatric-
Mental Health Nursing Standards recommend structured termination processes that promote patient autonomy and
continuity of care (Peplau, 2022; ANA, 2022).
Section II: Mental Status Examination & DSM-5-TR
8. A nurse is conducting a mental status examination and documents the following observation: 'The patient's
speech flows rapidly from one topic to another with no logical connection between ideas. When asked about
3
, breakfast, the patient begins discussing a television program, then shifts to a childhood memory, and ends by
talking about politics.' Which mental status finding is this?
A. Flight of ideas, characterized by a continuous
B. Loose associations, characterized by a lack of
flow of accelerated speech with abrupt topic
logical connection between thoughts or topics
changes
C. Neologisms, characterized by the invention of D. Circumstantiality, characterized by excessive and
new words that have meaning only to the patient irrelevant detail before reaching the point
Correct Answer: B. Loose associations, characterized by a lack of logical connection between thoughts
or topics
Rationale: Loose associations (also called derailment) are a disorder of thought form in which ideas shift from one
topic to another with no logical or meaningful connection. This is a hallmark finding in schizophrenia and other
psychotic disorders. Flight of ideas involves a rapid, continuous flow of speech in which the topics are connected,
though the connections may be difficult to follow (often seen in mania). Neologisms are invented words, and
circumstantiality involves delayed but eventual arrival at the point. The DSM-5-TR categorizes loose associations
under 'disorganized thinking' and it is a criterion for the diagnosis of schizophrenia (APA, 2022; Varcarolis, 2022).
9. A nurse is reviewing a patient's chart and notes that the patient reports persistent depressed mood,
anhedonia, significant weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness,
diminished concentration, and recurrent thoughts of death for the past 5 weeks. According to the DSM-5-TR
criteria for major depressive disorder (MDD), which statement is correct?
A. The patient meets criteria for MDD because at B. The patient does not meet criteria for MDD
least 5 symptoms are present for at least 2 weeks, because psychomotor retardation is not an
including depressed mood or anhedonia acceptable symptom
D. The patient does not meet criteria for MDD
C. The patient meets criteria for MDD but requires a
because the symptoms must be present for at least 6
minimum of 7 symptoms for the diagnosis
months
Correct Answer: A. The patient meets criteria for MDD because at least 5 symptoms are present for at
least 2 weeks, including depressed mood or anhedonia
Rationale: The DSM-5-TR diagnostic criteria for MDD require at least five of nine specified symptoms present during
the same 2-week period, representing a change from previous functioning. At least one of the symptoms must be either
depressed mood or anhedonia (loss of interest or pleasure). This patient exhibits eight of the nine criteria (depressed
mood, anhedonia, weight loss, insomnia, psychomotor retardation, fatigue, worthlessness, diminished concentration,
and recurrent thoughts of death) for 5 weeks, fully meeting the diagnostic threshold. The symptoms must cause
clinically significant distress or functional impairment and not be attributable to substance use or another medical
condition (APA, 2022; Varcarolis, 2022).
10. A nurse is assessing two patients. Patient A reports persistent worry and anxiety about multiple areas of
life (work, health, finances) for the past 9 months, muscle tension, restlessness, and difficulty concentrating.
Patient B reports recurrent, unexpected panic attacks with sudden onset of palpitations, sweating, trembling,
shortness of breath, and fear of dying, occurring 2-3 times per week for the past month. Which
differentiation is most accurate?
B. Patient A meets criteria for generalized
A. Both patients meet DSM-5-TR criteria for panic
anxiety disorder; Patient B meets criteria for
disorder
panic disorder
4
2026/2027 Academic Year | 75 Questions with Correct Answers & Rationales
This examination consists of 75 multiple-choice questions covering essential psychiatric mental health nursing content.
Select the single best answer for each question. Correct answers are indicated in bold cyan, followed by evidence-based
rationales. Total time: 2 hours 30 minutes.
Section I: Therapeutic Communication & Nurse-Patient Relationship
1. A patient diagnosed with major depressive disorder says, 'Nobody cares about me. I'm completely alone in
this world.' Which response by the nurse is the most therapeutic?
B. I can hear that you are feeling very alone right
A. You shouldn't feel that way. Many people care
now. Can you tell me more about what you are
about you, including your family and the staff here.
experiencing?
C. Everyone feels lonely sometimes. You just need D. I understand how you feel. I felt the same way
to focus on the positive things in your life. when I went through a difficult time.
Correct Answer: B. I can hear that you are feeling very alone right now. Can you tell me more about
what you are experiencing?
Rationale: This response uses reflective listening and an open-ended question to validate the patient's feelings without
offering false reassurance. Therapeutic communication techniques such as reflection, restatement, and open-ended
questions encourage the patient to explore feelings and promote a trusting relationship. The ANA Psychiatric-Mental
Health Nursing Standards emphasize that false reassurance ('You shouldn't feel that way') and universalizing
statements ('Everyone feels lonely') invalidate the patient's experience. Self-disclosure ('I felt the same way') shifts focus
from the patient to the nurse (Varcarolis, 2022; ANA, 2022).
2. A nurse has been caring for a patient with borderline personality disorder for three weeks. The patient tells
the nurse, 'You are the only person who truly understands me. You are so much better than all the other
nurses here.' Which concept best describes this dynamic?
B. Transference, in which the patient
A. Countertransference, in which the nurse develops
unconsciously redirects feelings from a
an emotional attachment to the patient
significant past relationship onto the nurse
C. Splitting, in which the patient idealizes one staff
D. Therapeutic alliance, representing a healthy and
member and devalues others as a defense
collaborative nurse-patient relationship
mechanism
Correct Answer: B. Transference, in which the patient unconsciously redirects feelings from a
significant past relationship onto the nurse
Rationale: Transference occurs when a patient unconsciously displaces feelings, expectations, and attitudes from a
significant person in their past onto the nurse. This is a common and expected phenomenon in psychiatric nursing,
particularly with patients who have experienced disrupted early relationships. The nurse must recognize transference,
maintain professional boundaries, and use the experience therapeutically rather than acting on it. While splitting
(idealization/devaluation) can also occur in BPD, the description of redirecting relational feelings onto the nurse is the
hallmark of transference. Countertransference refers to the nurse's emotional reactions to the patient (APA, 2023;
Varcarolis, 2022).
1
,3. A nurse is conducting an initial psychiatric assessment of a patient admitted for depression. Which
question is an open-ended therapeutic question that will yield the most information?
A. Have you been feeling sad lately? B. Are you having any thoughts of suicide?
C. Tell me about what has been happening in
D. Do you have a family history of mental illness?
your life recently.
Correct Answer: C. Tell me about what has been happening in your life recently.
Rationale: Open-ended questions encourage patients to share information in their own words and provide richer, more
comprehensive data. 'Tell me about...' is the classic open-ended format. Closed-ended questions (yes/no answers) such
as 'Have you been feeling sad lately?' are useful for specific data gathering but do not facilitate therapeutic
exploration. The Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA/APNA, 2022) recommend
beginning assessments with open-ended questions and using closed-ended questions for clarification and specific
clinical data (Varcarolis, 2022; Stuart, 2022).
4. A patient with a history of stalking behavior repeatedly asks a psychiatric nurse for her personal phone
number and tries to find her on social media. Which action by the nurse is most appropriate?
A. Give the patient a fake phone number to avoid B. Explain clearly and firmly that personal
confrontation and maintain the therapeutic contact is not appropriate, and maintain
relationship consistent professional boundaries
C. Report the patient's behavior to law enforcement D. Avoid the patient entirely and assign another
immediately and request a transfer to another unit nurse to provide all future care
Correct Answer: B. Explain clearly and firmly that personal contact is not appropriate, and maintain
consistent professional boundaries
Rationale: Setting and maintaining professional boundaries is essential in psychiatric nursing. The nurse should
clearly, directly, and without hostility explain that personal contact outside the therapeutic relationship is not
appropriate. Consistent boundary-setting helps maintain a safe therapeutic environment for both patient and nurse.
Giving false information or completely avoiding the patient undermines trust and therapeutic rapport. Reporting to law
enforcement is premature unless there is an active threat to safety. The ANA Code of Ethics and the APNA position
statement on boundary management emphasize that boundary violations can harm patients and compromise care (ANA,
2022; APNA, 2023).
5. A nurse enters a patient's room and observes the patient sitting curled in the corner of the bed with arms
wrapped around the knees, avoiding eye contact, and speaking in a barely audible whisper. The patient was
admitted yesterday for acute anxiety. Which interpretation of this nonverbal communication is most
accurate?
B. The patient is exhibiting signs of fear,
A. The patient is relaxed and resting comfortably
withdrawal, and a need for a sense of safety and
after receiving an anxiolytic medication
protection
C. The patient is demonstrating manipulative D. The patient is showing hostility and anger toward
behavior to gain attention from the nursing staff the treatment team
Correct Answer: B. The patient is exhibiting signs of fear, withdrawal, and a need for a sense of safety
and protection
Rationale: The described nonverbal cues — fetal position (curled in corner), protective posture (arms around knees),
avoidance of eye contact, and barely audible speech — are classic indicators of fear, anxiety, and emotional
withdrawal. These behaviors signal that the patient feels unsafe and vulnerable. The nurse should approach calmly,
introduce themselves, speak softly, and ask permission before entering the patient's personal space. Research in
psychiatric nursing shows that nonverbal communication accounts for the majority of interpersonal messages, and
accurate interpretation is critical for therapeutic intervention (Varcarolis, 2022; Peplau, 2022).
2
,6. A psychiatric nurse becomes aware that she feels frustrated and angry when caring for a patient with
antisocial personality disorder who repeatedly manipulates staff. After reflection, the nurse recognizes that
the patient reminds her of an abusive family member. Which concept does this scenario best illustrate?
B. The need for therapeutic use of self through
A. Burnout, resulting from chronic workplace stress
self-awareness and recognition of
and inadequate professional support
countertransference reactions
C. Compassion fatigue, caused by over-
D. Impaired clinical judgment due to inadequate
identification with the patient's traumatic
psychiatric nursing education
experiences
Correct Answer: B. The need for therapeutic use of self through self-awareness and recognition of
countertransference reactions
Rationale: Therapeutic use of self is a core intervention in psychiatric nursing that requires the nurse to develop self-
awareness and recognize how personal experiences and emotions influence the therapeutic relationship. The nurse's
frustration and anger, triggered by the patient's resemblance to an abusive family member, is a classic example of
countertransference. Through self-reflection and supervision, the nurse can manage these reactions and prevent them
from affecting patient care. The ANA/APNA Psychiatric-Mental Health Nursing Standards identify therapeutic use of
self as a foundational competency requiring ongoing self-assessment and supervision (ANA/APNA, 2022; Varcarolis,
2022).
7. A nurse has been working with a patient with depression for 8 weeks in an outpatient setting. The patient
has shown significant improvement and the treatment goals have been met. Which nursing action is most
appropriate during the termination phase of the therapeutic relationship?
A. Gradually reduce the frequency of sessions,
B. Abruptly end the therapeutic relationship to
review progress and achievements, discuss
avoid the patient developing dependency on the
feelings about ending therapy, and develop a
nurse
relapse prevention plan
D. Refer the patient to a different therapist without
C. Extend the therapy indefinitely to ensure the
discussing the termination to minimize emotional
patient does not relapse after termination
distress
Correct Answer: A. Gradually reduce the frequency of sessions, review progress and achievements,
discuss feelings about ending therapy, and develop a relapse prevention plan
Rationale: The termination phase of the therapeutic relationship should be planned, gradual, and collaborative.
Peplau's Interpersonal Relations Theory identifies termination as a critical phase where the nurse and patient review
progress, summarize achievements, explore feelings about separation, and plan for continued wellness. Abrupt
termination can cause feelings of abandonment, while overly prolonged therapy fosters dependency. A relapse
prevention plan equips the patient with coping strategies and resources for maintaining gains. The ANA Psychiatric-
Mental Health Nursing Standards recommend structured termination processes that promote patient autonomy and
continuity of care (Peplau, 2022; ANA, 2022).
Section II: Mental Status Examination & DSM-5-TR
8. A nurse is conducting a mental status examination and documents the following observation: 'The patient's
speech flows rapidly from one topic to another with no logical connection between ideas. When asked about
3
, breakfast, the patient begins discussing a television program, then shifts to a childhood memory, and ends by
talking about politics.' Which mental status finding is this?
A. Flight of ideas, characterized by a continuous
B. Loose associations, characterized by a lack of
flow of accelerated speech with abrupt topic
logical connection between thoughts or topics
changes
C. Neologisms, characterized by the invention of D. Circumstantiality, characterized by excessive and
new words that have meaning only to the patient irrelevant detail before reaching the point
Correct Answer: B. Loose associations, characterized by a lack of logical connection between thoughts
or topics
Rationale: Loose associations (also called derailment) are a disorder of thought form in which ideas shift from one
topic to another with no logical or meaningful connection. This is a hallmark finding in schizophrenia and other
psychotic disorders. Flight of ideas involves a rapid, continuous flow of speech in which the topics are connected,
though the connections may be difficult to follow (often seen in mania). Neologisms are invented words, and
circumstantiality involves delayed but eventual arrival at the point. The DSM-5-TR categorizes loose associations
under 'disorganized thinking' and it is a criterion for the diagnosis of schizophrenia (APA, 2022; Varcarolis, 2022).
9. A nurse is reviewing a patient's chart and notes that the patient reports persistent depressed mood,
anhedonia, significant weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness,
diminished concentration, and recurrent thoughts of death for the past 5 weeks. According to the DSM-5-TR
criteria for major depressive disorder (MDD), which statement is correct?
A. The patient meets criteria for MDD because at B. The patient does not meet criteria for MDD
least 5 symptoms are present for at least 2 weeks, because psychomotor retardation is not an
including depressed mood or anhedonia acceptable symptom
D. The patient does not meet criteria for MDD
C. The patient meets criteria for MDD but requires a
because the symptoms must be present for at least 6
minimum of 7 symptoms for the diagnosis
months
Correct Answer: A. The patient meets criteria for MDD because at least 5 symptoms are present for at
least 2 weeks, including depressed mood or anhedonia
Rationale: The DSM-5-TR diagnostic criteria for MDD require at least five of nine specified symptoms present during
the same 2-week period, representing a change from previous functioning. At least one of the symptoms must be either
depressed mood or anhedonia (loss of interest or pleasure). This patient exhibits eight of the nine criteria (depressed
mood, anhedonia, weight loss, insomnia, psychomotor retardation, fatigue, worthlessness, diminished concentration,
and recurrent thoughts of death) for 5 weeks, fully meeting the diagnostic threshold. The symptoms must cause
clinically significant distress or functional impairment and not be attributable to substance use or another medical
condition (APA, 2022; Varcarolis, 2022).
10. A nurse is assessing two patients. Patient A reports persistent worry and anxiety about multiple areas of
life (work, health, finances) for the past 9 months, muscle tension, restlessness, and difficulty concentrating.
Patient B reports recurrent, unexpected panic attacks with sudden onset of palpitations, sweating, trembling,
shortness of breath, and fear of dying, occurring 2-3 times per week for the past month. Which
differentiation is most accurate?
B. Patient A meets criteria for generalized
A. Both patients meet DSM-5-TR criteria for panic
anxiety disorder; Patient B meets criteria for
disorder
panic disorder
4
