ATI Mental Health Proctored Exam Practice Questions and Answers
Updated 2026 | Complete Psychiatric Nursing Study Guide with Verified
Questions, Detailed Rationales, Therapeutic Communication, Mood
Disorders, Anxiety Disorders, Schizophrenia, Substance Use, Crisis
Intervention, Psychopharmacology, Patient Safety, Prioritization & NGN
NCLEX-PN/RN Exam Prep
Question 1: A nurse is caring for a client diagnosed with major depressive disorder
who states, "I don't see the point in living anymore." Which action should the nurse
take first?
A. Ask the client if they have a specific plan to harm themselves
B. Encourage the client to verbalize feelings of hopelessness
C. Notify the health care provider immediately
D. Place the client on one-to-one suicide observation
CORRECT ANSWER: A. Ask the client if they have a specific plan to harm
themselves
Rationale: When a client expresses suicidal ideation, the nurse's first priority is to
assess the immediacy and severity of risk by determining if the client has a specific
plan, means, and intent. This assessment guides subsequent interventions such as
initiating suicide precautions, notifying the provider, or providing emotional support.
Jumping to interventions without thorough assessment may miss critical risk factors or
escalate client anxiety.
Question 2: A nurse is teaching a client about the side effects of clozapine. Which
statement by the client indicates understanding of the teaching?
A. "I will report any sore throat or fever immediately."
B. "I should expect my urine to turn orange while taking this medication."
C. "I can stop taking this medication once my hallucinations improve."
D. "I will need to avoid foods high in tyramine while on this drug."
CORRECT ANSWER: A. "I will report any sore throat or fever immediately."
Rationale: Clozapine carries a black box warning for agranulocytosis, a life-threatening
drop in white blood cell count. Early signs include sore throat, fever, and malaise.
Clients must be taught to report these symptoms immediately for prompt laboratory
evaluation. Orange urine is associated with phenazopyridine, not clozapine.
Antipsychotics should never be abruptly discontinued due to risk of relapse or
withdrawal. Tyramine restriction applies to MAOIs, not clozapine.
Question 3: A nurse is using therapeutic communication with a client experiencing
anxiety. Which response by the nurse is most appropriate?
A. "Everything will be fine; try not to worry."
B. "Tell me more about what you are feeling right now."
,C. "You should practice deep breathing exercises."
D. "I know exactly how you feel; I get anxious too."
CORRECT ANSWER: B. "Tell me more about what you are feeling right now."
Rationale: Therapeutic communication focuses on exploring the client's feelings and
experiences without minimizing, advising prematurely, or shifting focus to the nurse.
Open-ended questions encourage expression and build trust. Reassurance ("everything
will be fine") dismisses the client's experience. Offering advice before assessment is
nontherapeutic. Self-disclosure by the nurse shifts focus away from the client and is
generally avoided unless strategically used later in the therapeutic relationship.
Question 4: A client with bipolar disorder is prescribed lithium carbonate. Which
laboratory value requires immediate notification of the provider?
A. Sodium 138 mEq/L
B. Potassium 4.0 mEq/L
C. Lithium level 1.8 mEq/L
D. Creatinine 0.9 mg/dL
CORRECT ANSWER: C. Lithium level 1.8 mEq/L
Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L for maintenance and up to
1.5 mEq/L for acute mania. A level of 1.8 mEq/L indicates toxicity, which can cause
tremors, confusion, ataxia, seizures, or renal failure. Immediate intervention is required.
Sodium, potassium, and creatinine values listed are within normal limits; however,
sodium imbalances can affect lithium levels, so monitoring is essential but not
immediately critical at 138 mEq/L.
Question 5: A nurse is caring for a client with schizophrenia who is experiencing
auditory hallucinations. Which intervention is most therapeutic?
A. Confront the client by stating the voices are not real
B. Ask the client to describe what the voices are saying
C. Ignore the behavior to avoid reinforcing the hallucinations
D. Redirect the client to a structured activity immediately
CORRECT ANSWER: B. Ask the client to describe what the voices are saying
Rationale: Assessing the content of hallucinations is critical to determine if the client is
at risk for harm (e.g., command hallucinations to hurt self or others). Confronting the
reality of the hallucinations can increase anxiety and damage rapport. Ignoring the
experience invalidates the client's perception. While redirection is useful, assessment
must precede intervention to ensure safety. Understanding content guides appropriate
nursing actions and safety planning.
Question 6: A nurse is preparing to administer haloperidol intramuscularly to an
agitated client. Which action should the nurse take first?
,A. Ensure the medication order is verified with a second nurse
B. Assess the client's airway, breathing, and circulation
C. Explain the procedure to the client in simple terms
D. Position the client in a side-lying position for injection
CORRECT ANSWER: B. Assess the client's airway, breathing, and circulation
Rationale: Safety is the priority. Before administering any medication, especially to an
agitated client, the nurse must ensure physiological stability using the ABCs (airway,
breathing, circulation). Agitation can compromise respiratory status or indicate
underlying medical conditions. While verification, explanation, and positioning are
important, they follow initial safety assessment. This aligns with the nursing process:
assess before intervening.
Question 7: A client with borderline personality disorder states, "You're the only
nurse who cares; the others are all useless." Which response by the nurse
demonstrates appropriate boundary maintenance?
A. "Thank you; I do try my best to help you."
B. "I'm glad you feel that way, but all staff are here to support you."
C. "That's not fair to the other nurses; they work hard too."
D. "Let's focus on your treatment goals rather than comparing staff."
CORRECT ANSWER: B. "I'm glad you feel that way, but all staff are here to support
you."
Rationale: Clients with borderline personality disorder may use splitting (viewing people
as all good or all bad). The nurse should acknowledge the client's feeling without
reinforcing splitting or accepting excessive praise. Option B validates the client while
promoting a unified treatment team approach. Accepting special praise (A) reinforces
splitting. Defending staff (C) is argumentative. While focusing on goals (D) is useful, it
dismisses the client's current emotional expression without first addressing the
interpersonal dynamic.
Question 8: A nurse is assessing a client for signs of neuroleptic malignant
syndrome (NMS). Which finding is most indicative of this condition?
A. Mild tremor and restlessness
B. Fever, muscle rigidity, and altered mental status
C. Dry mouth and blurred vision
D. Orthostatic hypotension and dizziness
CORRECT ANSWER: B. Fever, muscle rigidity, and altered mental status
Rationale: Neuroleptic malignant syndrome is a rare but life-threatening reaction to
antipsychotic medications. Classic signs include hyperthermia (fever), severe muscle
rigidity, altered mental status (confusion, agitation), autonomic instability (tachycardia,
blood pressure fluctuations), and elevated creatine kinase. Mild tremor and
restlessness suggest akathisia. Dry mouth and blurred vision are anticholinergic side
, effects. Orthostatic hypotension is common with many psychotropics but not specific
to NMS. Immediate discontinuation of the antipsychotic and emergency treatment are
required.
Question 9: A client with generalized anxiety disorder is learning cognitive-
behavioral techniques. Which statement by the client reflects use of cognitive
restructuring?
A. "When I feel anxious, I will take a walk to calm down."
B. "I notice I'm thinking 'I'll fail,' so I challenge that thought with evidence."
C. "I practice deep breathing for five minutes when my heart races."
D. "I avoid situations that make me feel overwhelmed."
CORRECT ANSWER: B. "I notice I'm thinking 'I'll fail,' so I challenge that thought
with evidence."
Rationale: Cognitive restructuring, a core component of CBT, involves identifying
distorted or maladaptive thoughts and replacing them with more balanced, evidence-
based thoughts. Option B demonstrates this process. Options A and C describe
behavioral relaxation techniques. Option D describes avoidance, which is a
maladaptive coping strategy that maintains anxiety long-term and is not a CBT goal.
Question 10: A nurse is caring for a client who is involuntarily committed. Which
statement by the client indicates a need for further education about their rights?
A. "I have the right to refuse all medications at any time."
B. "I can request a hearing to contest my commitment."
C. "I should be treated with dignity and respect while hospitalized."
D. "I have the right to communicate with my attorney."
CORRECT ANSWER: A. "I have the right to refuse all medications at any time."
Rationale: While clients retain many rights during involuntary commitment, the right to
refuse medication is not absolute. In emergencies or with specific legal procedures
(e.g., court order), medication may be administered over objection. Clients do have the
right to a hearing, to humane treatment, and to legal counsel. Clarifying medication
refusal rights prevents misunderstanding and promotes informed participation in care.
Question 11: A nurse is developing a care plan for a client with anorexia nervosa.
Which goal is the priority during the initial phase of treatment?
A. Client will verbalize three personal strengths
B. Client will achieve a weight gain of 1–2 pounds per week
C. Client will identify two triggers for restrictive eating
D. Client will attend all group therapy sessions
CORRECT ANSWER: B. Client will achieve a weight gain of 1–2 pounds per week
Rationale: In anorexia nervosa, physiological stabilization is the priority due to risks of
cardiac complications, electrolyte imbalances, and refeeding syndrome. Weight
Updated 2026 | Complete Psychiatric Nursing Study Guide with Verified
Questions, Detailed Rationales, Therapeutic Communication, Mood
Disorders, Anxiety Disorders, Schizophrenia, Substance Use, Crisis
Intervention, Psychopharmacology, Patient Safety, Prioritization & NGN
NCLEX-PN/RN Exam Prep
Question 1: A nurse is caring for a client diagnosed with major depressive disorder
who states, "I don't see the point in living anymore." Which action should the nurse
take first?
A. Ask the client if they have a specific plan to harm themselves
B. Encourage the client to verbalize feelings of hopelessness
C. Notify the health care provider immediately
D. Place the client on one-to-one suicide observation
CORRECT ANSWER: A. Ask the client if they have a specific plan to harm
themselves
Rationale: When a client expresses suicidal ideation, the nurse's first priority is to
assess the immediacy and severity of risk by determining if the client has a specific
plan, means, and intent. This assessment guides subsequent interventions such as
initiating suicide precautions, notifying the provider, or providing emotional support.
Jumping to interventions without thorough assessment may miss critical risk factors or
escalate client anxiety.
Question 2: A nurse is teaching a client about the side effects of clozapine. Which
statement by the client indicates understanding of the teaching?
A. "I will report any sore throat or fever immediately."
B. "I should expect my urine to turn orange while taking this medication."
C. "I can stop taking this medication once my hallucinations improve."
D. "I will need to avoid foods high in tyramine while on this drug."
CORRECT ANSWER: A. "I will report any sore throat or fever immediately."
Rationale: Clozapine carries a black box warning for agranulocytosis, a life-threatening
drop in white blood cell count. Early signs include sore throat, fever, and malaise.
Clients must be taught to report these symptoms immediately for prompt laboratory
evaluation. Orange urine is associated with phenazopyridine, not clozapine.
Antipsychotics should never be abruptly discontinued due to risk of relapse or
withdrawal. Tyramine restriction applies to MAOIs, not clozapine.
Question 3: A nurse is using therapeutic communication with a client experiencing
anxiety. Which response by the nurse is most appropriate?
A. "Everything will be fine; try not to worry."
B. "Tell me more about what you are feeling right now."
,C. "You should practice deep breathing exercises."
D. "I know exactly how you feel; I get anxious too."
CORRECT ANSWER: B. "Tell me more about what you are feeling right now."
Rationale: Therapeutic communication focuses on exploring the client's feelings and
experiences without minimizing, advising prematurely, or shifting focus to the nurse.
Open-ended questions encourage expression and build trust. Reassurance ("everything
will be fine") dismisses the client's experience. Offering advice before assessment is
nontherapeutic. Self-disclosure by the nurse shifts focus away from the client and is
generally avoided unless strategically used later in the therapeutic relationship.
Question 4: A client with bipolar disorder is prescribed lithium carbonate. Which
laboratory value requires immediate notification of the provider?
A. Sodium 138 mEq/L
B. Potassium 4.0 mEq/L
C. Lithium level 1.8 mEq/L
D. Creatinine 0.9 mg/dL
CORRECT ANSWER: C. Lithium level 1.8 mEq/L
Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L for maintenance and up to
1.5 mEq/L for acute mania. A level of 1.8 mEq/L indicates toxicity, which can cause
tremors, confusion, ataxia, seizures, or renal failure. Immediate intervention is required.
Sodium, potassium, and creatinine values listed are within normal limits; however,
sodium imbalances can affect lithium levels, so monitoring is essential but not
immediately critical at 138 mEq/L.
Question 5: A nurse is caring for a client with schizophrenia who is experiencing
auditory hallucinations. Which intervention is most therapeutic?
A. Confront the client by stating the voices are not real
B. Ask the client to describe what the voices are saying
C. Ignore the behavior to avoid reinforcing the hallucinations
D. Redirect the client to a structured activity immediately
CORRECT ANSWER: B. Ask the client to describe what the voices are saying
Rationale: Assessing the content of hallucinations is critical to determine if the client is
at risk for harm (e.g., command hallucinations to hurt self or others). Confronting the
reality of the hallucinations can increase anxiety and damage rapport. Ignoring the
experience invalidates the client's perception. While redirection is useful, assessment
must precede intervention to ensure safety. Understanding content guides appropriate
nursing actions and safety planning.
Question 6: A nurse is preparing to administer haloperidol intramuscularly to an
agitated client. Which action should the nurse take first?
,A. Ensure the medication order is verified with a second nurse
B. Assess the client's airway, breathing, and circulation
C. Explain the procedure to the client in simple terms
D. Position the client in a side-lying position for injection
CORRECT ANSWER: B. Assess the client's airway, breathing, and circulation
Rationale: Safety is the priority. Before administering any medication, especially to an
agitated client, the nurse must ensure physiological stability using the ABCs (airway,
breathing, circulation). Agitation can compromise respiratory status or indicate
underlying medical conditions. While verification, explanation, and positioning are
important, they follow initial safety assessment. This aligns with the nursing process:
assess before intervening.
Question 7: A client with borderline personality disorder states, "You're the only
nurse who cares; the others are all useless." Which response by the nurse
demonstrates appropriate boundary maintenance?
A. "Thank you; I do try my best to help you."
B. "I'm glad you feel that way, but all staff are here to support you."
C. "That's not fair to the other nurses; they work hard too."
D. "Let's focus on your treatment goals rather than comparing staff."
CORRECT ANSWER: B. "I'm glad you feel that way, but all staff are here to support
you."
Rationale: Clients with borderline personality disorder may use splitting (viewing people
as all good or all bad). The nurse should acknowledge the client's feeling without
reinforcing splitting or accepting excessive praise. Option B validates the client while
promoting a unified treatment team approach. Accepting special praise (A) reinforces
splitting. Defending staff (C) is argumentative. While focusing on goals (D) is useful, it
dismisses the client's current emotional expression without first addressing the
interpersonal dynamic.
Question 8: A nurse is assessing a client for signs of neuroleptic malignant
syndrome (NMS). Which finding is most indicative of this condition?
A. Mild tremor and restlessness
B. Fever, muscle rigidity, and altered mental status
C. Dry mouth and blurred vision
D. Orthostatic hypotension and dizziness
CORRECT ANSWER: B. Fever, muscle rigidity, and altered mental status
Rationale: Neuroleptic malignant syndrome is a rare but life-threatening reaction to
antipsychotic medications. Classic signs include hyperthermia (fever), severe muscle
rigidity, altered mental status (confusion, agitation), autonomic instability (tachycardia,
blood pressure fluctuations), and elevated creatine kinase. Mild tremor and
restlessness suggest akathisia. Dry mouth and blurred vision are anticholinergic side
, effects. Orthostatic hypotension is common with many psychotropics but not specific
to NMS. Immediate discontinuation of the antipsychotic and emergency treatment are
required.
Question 9: A client with generalized anxiety disorder is learning cognitive-
behavioral techniques. Which statement by the client reflects use of cognitive
restructuring?
A. "When I feel anxious, I will take a walk to calm down."
B. "I notice I'm thinking 'I'll fail,' so I challenge that thought with evidence."
C. "I practice deep breathing for five minutes when my heart races."
D. "I avoid situations that make me feel overwhelmed."
CORRECT ANSWER: B. "I notice I'm thinking 'I'll fail,' so I challenge that thought
with evidence."
Rationale: Cognitive restructuring, a core component of CBT, involves identifying
distorted or maladaptive thoughts and replacing them with more balanced, evidence-
based thoughts. Option B demonstrates this process. Options A and C describe
behavioral relaxation techniques. Option D describes avoidance, which is a
maladaptive coping strategy that maintains anxiety long-term and is not a CBT goal.
Question 10: A nurse is caring for a client who is involuntarily committed. Which
statement by the client indicates a need for further education about their rights?
A. "I have the right to refuse all medications at any time."
B. "I can request a hearing to contest my commitment."
C. "I should be treated with dignity and respect while hospitalized."
D. "I have the right to communicate with my attorney."
CORRECT ANSWER: A. "I have the right to refuse all medications at any time."
Rationale: While clients retain many rights during involuntary commitment, the right to
refuse medication is not absolute. In emergencies or with specific legal procedures
(e.g., court order), medication may be administered over objection. Clients do have the
right to a hearing, to humane treatment, and to legal counsel. Clarifying medication
refusal rights prevents misunderstanding and promotes informed participation in care.
Question 11: A nurse is developing a care plan for a client with anorexia nervosa.
Which goal is the priority during the initial phase of treatment?
A. Client will verbalize three personal strengths
B. Client will achieve a weight gain of 1–2 pounds per week
C. Client will identify two triggers for restrictive eating
D. Client will attend all group therapy sessions
CORRECT ANSWER: B. Client will achieve a weight gain of 1–2 pounds per week
Rationale: In anorexia nervosa, physiological stabilization is the priority due to risks of
cardiac complications, electrolyte imbalances, and refeeding syndrome. Weight
