ASN 100 Mental Health HESI Comprehensive Exam
Preparation: Questions, Answers, and Detailed
Rationales – The Essential Guide to Passing on Your
First Attempt and Avoiding Resits
1. A patient with a history of bipolar I disorder, currently in a manic episode, presents with
pressured speech, grandiosity, and decreased need for sleep. The patient refuses oral medications.
The provider orders intramuscular haloperidol 5 mg and lorazepam 2 mg. Which
neurotransmitter system is primarily targeted by the haloperidol to achieve acute symptom
control?
A. Dopamine D2 receptor blockade in the mesolimbic pathway
B. GABA-A receptor potentiation in the amygdala
C. Serotonin 5-HT2A receptor antagonism in the prefrontal cortex
D. Norepinephrine alpha-2 receptor agonism in the locus coeruleus
Answer: A
Rationale: Haloperidol is a typical antipsychotic that exerts its primary effect via dopamine D2 receptor
blockade in the mesolimbic pathway, reducing positive symptoms of mania. Lorazepam potentiates
GABA-A receptors, but haloperidol's mechanism is D2 blockade. Options B and C describe
benzodiazepine and atypical antipsychotic mechanisms, respectively. Option D is incorrect as alpha-2
agonism is not the primary action of haloperidol.
2. A nurse is conducting a suicide risk assessment for a patient who recently disclosed suicidal
ideation with a plan. The patient states, 'I have the pills at home, but I would never do that to my
family.' Which of the following is the most critical factor indicating imminent risk?
A. Presence of a specific plan and means
B. Ambivalence about the impact on family
C. History of previous suicide attempts
D. Lack of social support
Answer: A
Rationale: Imminent suicide risk is highest when a specific plan and means are present, as this indicates
preparation and intent. While ambivalence (B) may suggest some protective factors, it does not negate
the risk. History of attempts (C) is a risk factor but not as immediate. Lack of social support (D) is a
distal risk factor. The combination of plan and means requires immediate intervention.
3. A patient with a diagnosis of schizophrenia has been taking clozapine for 6 months. The patient
now presents with a sore throat, fever, and malaise. Which laboratory value is most critical to
assess immediately?
Page 1
,A. Absolute neutrophil count (ANC)
B. Serum creatinine
C. Liver function tests (ALT/AST)
D. Hemoglobin A1c
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis, necessitating regular ANC monitoring. Symptoms
of infection (sore throat, fever) may indicate neutropenia, and immediate ANC is essential. Serum
creatinine (B) and liver function (C) are important but not the priority. Hemoglobin A1c (D) is for
monitoring metabolic side effects, not acute infection.
4. During a group therapy session, a patient with borderline personality disorder becomes verbally
aggressive, accusing another member of 'stealing' the therapist's attention. The therapist states, 'I
notice you are feeling angry right now. Can you describe what you are experiencing without
blaming others?' This intervention is an example of which therapeutic technique?
A. Confrontation
B. Validation
C. Reframing
D. Process illumination
Answer: B
Rationale: Validation acknowledges the patient's emotion (anger) without reinforcing maladaptive
behavior. Confrontation (A) would challenge the patient's accusation directly. Reframing (C) offers a
different perspective but does not initially acknowledge the feeling. Process illumination (D) draws
attention to group dynamics, which may be premature. Validation helps de-escalate and fosters
therapeutic alliance.
5. A patient with major depressive disorder has been on escitalopram 20 mg daily for 8 weeks with
minimal improvement. The provider considers augmenting with aripiprazole. Which receptor
profile of aripiprazole underlies its augmentation effect in treatment-resistant depression?
A. Partial agonism at D2 and 5-HT1A receptors
B. Antagonism at 5-HT2A and D2 receptors
C. Reuptake inhibition of serotonin and norepinephrine
D. Irreversible inhibition of monoamine oxidase A
Answer: A
Rationale: Aripiprazole is a partial agonist at D2 and 5-HT1A receptors, which modulates dopamine and
serotonin activity to enhance antidepressant response. Option B describes atypical antipsychotics like
risperidone. Option C describes SNRIs. Option D describes MAOIs. The partial agonist activity
stabilizes neurotransmitter systems, reducing side effects while augmenting efficacy.
6. A nurse is caring for a patient admitted after a suicide attempt by overdose. The patient is
medically stable but refuses to speak and avoids eye contact. Which nursing intervention is most
appropriate initially?
A. Sit quietly with the patient for short periods without demanding conversation
B. Encourage the patient to verbalize feelings by asking open-ended questions
Page 2
,C. Inform the patient that silence will delay discharge
D. Refer the patient to a psychiatrist for immediate medication adjustment
Answer: A
Rationale: Silent presence conveys acceptance and safety, allowing the patient to control the pace of
interaction. Forcing verbalization (B) may increase anxiety. Coercion (C) is countertherapeutic. While
psychiatric consultation may be needed, it is not the initial nursing intervention. Building trust through
nonverbal presence is foundational.
7. A patient with anorexia nervosa, restricting type, is admitted with bradycardia (heart rate 44
bpm), hypotension, and hypokalemia. Which laboratory finding would most indicate the need for
cardiac monitoring?
A. QTc interval prolongation on ECG
B. Elevated BUN-to-creatinine ratio
C. Decreased serum albumin
D. Increased liver transaminases
Answer: A
Rationale: QTc prolongation is a direct marker of cardiac risk in anorexia due to electrolyte disturbances
and malnutrition, predisposing to arrhythmias. Elevated BUN/creatinine (B) indicates dehydration,
which is important but not the most immediate cardiac risk. Albumin (C) reflects nutritional status. Liver
enzymes (D) may be elevated in refeeding syndrome but are not the primary indicator for cardiac
monitoring.
8. A patient with posttraumatic stress disorder (PTSD) reports recurrent nightmares and
hypervigilance. The provider prescribes prazosin. Which mechanism of action explains prazosin's
efficacy for nightmares?
A. Central alpha-1 adrenergic receptor blockade
B. Selective serotonin reuptake inhibition
C. Antagonism of NMDA glutamate receptors
D. Activation of GABA-A chloride channels
Answer: A
Rationale: Prazosin is an alpha-1 adrenergic antagonist that reduces norepinephrine-mediated arousal,
thereby decreasing nightmares and hypervigilance in PTSD. SSRIs (B) are first-line for PTSD but do not
directly target nightmares. NMDA antagonism (C) is associated with ketamine. GABA-A activation (D)
is the mechanism of benzodiazepines, which are not recommended for PTSD.
9. A patient with substance use disorder, currently in withdrawal from alcohol, develops
tachycardia, hypertension, tremors, and diaphoresis. The nurse administers lorazepam per
protocol. Which nursing assessment is most critical to monitor for potential complication?
A. Respiratory rate and oxygen saturation
B. Blood glucose level
C. Urine output
D. Bowel sounds
Page 3
, Answer: A
Rationale: Benzodiazepines like lorazepam can cause respiratory depression, especially in patients with
compromised liver function or concurrent substances. Monitoring respiratory rate and oxygen
saturation is essential. Blood glucose (B) is important but not the priority during acute withdrawal.
Urine output (C) and bowel sounds (D) are less critical in the immediate period.
10. A patient with obsessive-compulsive disorder (OCD) has been on fluoxetine 80 mg daily for 12
weeks with partial response. The patient continues to spend 3 hours per day washing hands. Which
of the following is the most appropriate next step?
A. Augment with an atypical antipsychotic such as risperidone
B. Switch to a different SSRI at therapeutic dose
C. Add clomipramine and monitor for side effects
D. Refer for exposure and response prevention (ERP) therapy
Answer: D
Rationale: First-line treatment for OCD includes SSRIs and ERP therapy. Since the patient has partial
response to an adequate SSRI trial, adding ERP is the most evidence-based intervention. Augmentation
with antipsychotics (A) is reserved for refractory cases. Switching SSRIs (B) is an option but less
effective than ERP. Clomipramine (C) is a second-line TCA with more side effects.
11. A client with chronic schizophrenia who has been stable on clozapine for 6 months develops
new-onset sialorrhea, sedation, and a white blood cell count of 4,000/mm³. The nurse reviews the
medication administration record. Which action is most appropriate?
A. Administer the next dose as scheduled and monitor vital signs.
B. Hold the clozapine and notify the prescriber immediately.
C. Increase the dose of clozapine to counteract tolerance.
D. Administer benztropine to manage extrapyramidal symptoms.
Answer: B
Rationale: A WBC count of 4,000 is below the threshold for clozapine therapy (typically <3,500 requires
discontinuation, but a drop to 4,000 warrants immediate notification and holding the drug to prevent
agranulocytosis). Sialorrhea is a common side effect, but the priority is the hematologic risk. Options A,
C, and D ignore the critical lab finding.
12. A research study examines the neural correlates of emotion regulation in individuals with
borderline personality disorder (BPD) compared to healthy controls using fMRI during a
reappraisal task. Which finding would most likely differentiate the BPD group?
A. Increased activation of the dorsolateral prefrontal cortex and decreased amygdala reactivity.
B. Reduced activation of the prefrontal cortex and heightened amygdala reactivity.
C. Equivalent activation patterns but slower reaction times in BPD.
D. Increased activation of the hippocampus and reduced insula activity.
Answer: B
Rationale: BPD is associated with emotional dysregulation, characterized by reduced prefrontal control
over limbic regions, especially the amygdala, leading to heightened emotional responses. Option A
describes effective regulation seen in healthy controls. Option C is not well-supported; option D
contradicts known findings of increased insula activity in BPD.
Page 4
Preparation: Questions, Answers, and Detailed
Rationales – The Essential Guide to Passing on Your
First Attempt and Avoiding Resits
1. A patient with a history of bipolar I disorder, currently in a manic episode, presents with
pressured speech, grandiosity, and decreased need for sleep. The patient refuses oral medications.
The provider orders intramuscular haloperidol 5 mg and lorazepam 2 mg. Which
neurotransmitter system is primarily targeted by the haloperidol to achieve acute symptom
control?
A. Dopamine D2 receptor blockade in the mesolimbic pathway
B. GABA-A receptor potentiation in the amygdala
C. Serotonin 5-HT2A receptor antagonism in the prefrontal cortex
D. Norepinephrine alpha-2 receptor agonism in the locus coeruleus
Answer: A
Rationale: Haloperidol is a typical antipsychotic that exerts its primary effect via dopamine D2 receptor
blockade in the mesolimbic pathway, reducing positive symptoms of mania. Lorazepam potentiates
GABA-A receptors, but haloperidol's mechanism is D2 blockade. Options B and C describe
benzodiazepine and atypical antipsychotic mechanisms, respectively. Option D is incorrect as alpha-2
agonism is not the primary action of haloperidol.
2. A nurse is conducting a suicide risk assessment for a patient who recently disclosed suicidal
ideation with a plan. The patient states, 'I have the pills at home, but I would never do that to my
family.' Which of the following is the most critical factor indicating imminent risk?
A. Presence of a specific plan and means
B. Ambivalence about the impact on family
C. History of previous suicide attempts
D. Lack of social support
Answer: A
Rationale: Imminent suicide risk is highest when a specific plan and means are present, as this indicates
preparation and intent. While ambivalence (B) may suggest some protective factors, it does not negate
the risk. History of attempts (C) is a risk factor but not as immediate. Lack of social support (D) is a
distal risk factor. The combination of plan and means requires immediate intervention.
3. A patient with a diagnosis of schizophrenia has been taking clozapine for 6 months. The patient
now presents with a sore throat, fever, and malaise. Which laboratory value is most critical to
assess immediately?
Page 1
,A. Absolute neutrophil count (ANC)
B. Serum creatinine
C. Liver function tests (ALT/AST)
D. Hemoglobin A1c
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis, necessitating regular ANC monitoring. Symptoms
of infection (sore throat, fever) may indicate neutropenia, and immediate ANC is essential. Serum
creatinine (B) and liver function (C) are important but not the priority. Hemoglobin A1c (D) is for
monitoring metabolic side effects, not acute infection.
4. During a group therapy session, a patient with borderline personality disorder becomes verbally
aggressive, accusing another member of 'stealing' the therapist's attention. The therapist states, 'I
notice you are feeling angry right now. Can you describe what you are experiencing without
blaming others?' This intervention is an example of which therapeutic technique?
A. Confrontation
B. Validation
C. Reframing
D. Process illumination
Answer: B
Rationale: Validation acknowledges the patient's emotion (anger) without reinforcing maladaptive
behavior. Confrontation (A) would challenge the patient's accusation directly. Reframing (C) offers a
different perspective but does not initially acknowledge the feeling. Process illumination (D) draws
attention to group dynamics, which may be premature. Validation helps de-escalate and fosters
therapeutic alliance.
5. A patient with major depressive disorder has been on escitalopram 20 mg daily for 8 weeks with
minimal improvement. The provider considers augmenting with aripiprazole. Which receptor
profile of aripiprazole underlies its augmentation effect in treatment-resistant depression?
A. Partial agonism at D2 and 5-HT1A receptors
B. Antagonism at 5-HT2A and D2 receptors
C. Reuptake inhibition of serotonin and norepinephrine
D. Irreversible inhibition of monoamine oxidase A
Answer: A
Rationale: Aripiprazole is a partial agonist at D2 and 5-HT1A receptors, which modulates dopamine and
serotonin activity to enhance antidepressant response. Option B describes atypical antipsychotics like
risperidone. Option C describes SNRIs. Option D describes MAOIs. The partial agonist activity
stabilizes neurotransmitter systems, reducing side effects while augmenting efficacy.
6. A nurse is caring for a patient admitted after a suicide attempt by overdose. The patient is
medically stable but refuses to speak and avoids eye contact. Which nursing intervention is most
appropriate initially?
A. Sit quietly with the patient for short periods without demanding conversation
B. Encourage the patient to verbalize feelings by asking open-ended questions
Page 2
,C. Inform the patient that silence will delay discharge
D. Refer the patient to a psychiatrist for immediate medication adjustment
Answer: A
Rationale: Silent presence conveys acceptance and safety, allowing the patient to control the pace of
interaction. Forcing verbalization (B) may increase anxiety. Coercion (C) is countertherapeutic. While
psychiatric consultation may be needed, it is not the initial nursing intervention. Building trust through
nonverbal presence is foundational.
7. A patient with anorexia nervosa, restricting type, is admitted with bradycardia (heart rate 44
bpm), hypotension, and hypokalemia. Which laboratory finding would most indicate the need for
cardiac monitoring?
A. QTc interval prolongation on ECG
B. Elevated BUN-to-creatinine ratio
C. Decreased serum albumin
D. Increased liver transaminases
Answer: A
Rationale: QTc prolongation is a direct marker of cardiac risk in anorexia due to electrolyte disturbances
and malnutrition, predisposing to arrhythmias. Elevated BUN/creatinine (B) indicates dehydration,
which is important but not the most immediate cardiac risk. Albumin (C) reflects nutritional status. Liver
enzymes (D) may be elevated in refeeding syndrome but are not the primary indicator for cardiac
monitoring.
8. A patient with posttraumatic stress disorder (PTSD) reports recurrent nightmares and
hypervigilance. The provider prescribes prazosin. Which mechanism of action explains prazosin's
efficacy for nightmares?
A. Central alpha-1 adrenergic receptor blockade
B. Selective serotonin reuptake inhibition
C. Antagonism of NMDA glutamate receptors
D. Activation of GABA-A chloride channels
Answer: A
Rationale: Prazosin is an alpha-1 adrenergic antagonist that reduces norepinephrine-mediated arousal,
thereby decreasing nightmares and hypervigilance in PTSD. SSRIs (B) are first-line for PTSD but do not
directly target nightmares. NMDA antagonism (C) is associated with ketamine. GABA-A activation (D)
is the mechanism of benzodiazepines, which are not recommended for PTSD.
9. A patient with substance use disorder, currently in withdrawal from alcohol, develops
tachycardia, hypertension, tremors, and diaphoresis. The nurse administers lorazepam per
protocol. Which nursing assessment is most critical to monitor for potential complication?
A. Respiratory rate and oxygen saturation
B. Blood glucose level
C. Urine output
D. Bowel sounds
Page 3
, Answer: A
Rationale: Benzodiazepines like lorazepam can cause respiratory depression, especially in patients with
compromised liver function or concurrent substances. Monitoring respiratory rate and oxygen
saturation is essential. Blood glucose (B) is important but not the priority during acute withdrawal.
Urine output (C) and bowel sounds (D) are less critical in the immediate period.
10. A patient with obsessive-compulsive disorder (OCD) has been on fluoxetine 80 mg daily for 12
weeks with partial response. The patient continues to spend 3 hours per day washing hands. Which
of the following is the most appropriate next step?
A. Augment with an atypical antipsychotic such as risperidone
B. Switch to a different SSRI at therapeutic dose
C. Add clomipramine and monitor for side effects
D. Refer for exposure and response prevention (ERP) therapy
Answer: D
Rationale: First-line treatment for OCD includes SSRIs and ERP therapy. Since the patient has partial
response to an adequate SSRI trial, adding ERP is the most evidence-based intervention. Augmentation
with antipsychotics (A) is reserved for refractory cases. Switching SSRIs (B) is an option but less
effective than ERP. Clomipramine (C) is a second-line TCA with more side effects.
11. A client with chronic schizophrenia who has been stable on clozapine for 6 months develops
new-onset sialorrhea, sedation, and a white blood cell count of 4,000/mm³. The nurse reviews the
medication administration record. Which action is most appropriate?
A. Administer the next dose as scheduled and monitor vital signs.
B. Hold the clozapine and notify the prescriber immediately.
C. Increase the dose of clozapine to counteract tolerance.
D. Administer benztropine to manage extrapyramidal symptoms.
Answer: B
Rationale: A WBC count of 4,000 is below the threshold for clozapine therapy (typically <3,500 requires
discontinuation, but a drop to 4,000 warrants immediate notification and holding the drug to prevent
agranulocytosis). Sialorrhea is a common side effect, but the priority is the hematologic risk. Options A,
C, and D ignore the critical lab finding.
12. A research study examines the neural correlates of emotion regulation in individuals with
borderline personality disorder (BPD) compared to healthy controls using fMRI during a
reappraisal task. Which finding would most likely differentiate the BPD group?
A. Increased activation of the dorsolateral prefrontal cortex and decreased amygdala reactivity.
B. Reduced activation of the prefrontal cortex and heightened amygdala reactivity.
C. Equivalent activation patterns but slower reaction times in BPD.
D. Increased activation of the hippocampus and reduced insula activity.
Answer: B
Rationale: BPD is associated with emotional dysregulation, characterized by reduced prefrontal control
over limbic regions, especially the amygdala, leading to heightened emotional responses. Option A
describes effective regulation seen in healthy controls. Option C is not well-supported; option D
contradicts known findings of increased insula activity in BPD.
Page 4
