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2026 ATI Mental Health CMS Comprehensive Review |
100+ Practice Questions, NGN Clinical Judgment Case
Studies, and Verified Answers
SECTION 1 – NGN CLINICAL JUDGMENT CASE STUDIES (Questions 1–30)
Case Study 1: Major Depressive Disorder with Suicidal Ideation
Scenario: A 32-year-old female is brought to the emergency department by her
roommate, who found her crying and stating she "can't go on anymore." The
patient reports feeling depressed for the past 6 weeks, with loss of appetite,
insomnia, and fatigue. She states, "I've been thinking about taking all my pills."
She has a history of one prior suicide attempt 3 years ago. She is alert, oriented,
and cooperative but tearful. Vital signs are stable. The provider admits her to the
inpatient psychiatric unit with a diagnosis of major depressive disorder with
suicidal ideation.
1. Recognize Cues – Which findings in the scenario are most concerning for
immediate suicide risk? (Select all that apply)
A. Feeling depressed for 6 weeks
B. Statement "I've been thinking about taking all my pills"
C. History of a prior suicide attempt
D. Loss of appetite and insomnia
E. The patient is cooperative
Answer: B, C
Rationale: A specific plan (taking all pills) and a history of prior attempt are strong
predictors of suicide. Depressed mood and neurovegetative symptoms (A, D)
support the diagnosis of depression but are not the most acute risk indicators.
Cooperation (E) does not eliminate risk.
2. Analyze Cues – The patient reveals she has a bottle of acetaminophen at
home and has been saving it. She states she planned to take it tonight. How
pg. 1
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should the nurse interpret this information?
A. The patient is seeking attention
B. The patient has a lethal plan and high intent, requiring immediate safety
measures
C. The patient is not at risk because she disclosed the plan
D. The patient is testing the staff's trustworthiness
Answer: B
Rationale: Disclosure of a specific plan with accessible means and a timeframe
indicates high lethality and intent. This requires immediate intervention, including
one-to-one observation and removal of all potentially harmful items. The nurse
must not dismiss the threat.
3. Prioritize Hypotheses – The patient is admitted. What is the priority nursing
action?
A. Administer a prescribed antidepressant
B. Initiate one-to-one constant observation and remove all potentially harmful
items
C. Schedule a family therapy session
D. Encourage the patient to attend group therapy
Answer: B
Rationale: Safety is the highest priority. The nurse must ensure the patient's
immediate safety by removing dangerous objects (belts, shoelaces, glass,
medications) and placing the patient on constant observation until a full risk
assessment is completed and safety is established. Medications (A) are secondary
to safety.
4. Generate Solutions – The patient is started on sertraline 50 mg daily. The
nurse should plan to monitor for which early adverse effects? (Select all that
apply)
A. Increased energy with persistent suicidal ideation
B. Gastrointestinal upset
C. Hypertensive crisis
pg. 2
,3
D. Activation and jitteriness
E. Weight gain
Answer: A, B, D
Rationale: SSRIs can cause initial activation, anxiety, and GI upset. Increased
energy before mood improvement can increase the risk of acting on suicidal
thoughts. Hypertensive crisis (C) is associated with MAOIs. Weight gain (E) is more
common with long-term use and atypical antipsychotics.
5. Take Actions – The patient has been on sertraline for 5 days and now reports
feeling "a little better" but still has occasional passive thoughts of death. What
is the most appropriate nursing action?
A. Discontinue suicide precautions because she is improving
B. Continue suicide precautions and reassess risk frequently
C. Increase the sertraline dose
D. Discharge the patient with outpatient follow-up
Answer: B
Rationale: Partial improvement with ongoing passive ideation still warrants close
monitoring. Suicide risk can fluctuate, and it is premature to discontinue
precautions. Dose adjustments should be made by the provider.
6. Evaluate Outcomes – After 2 weeks, the patient's PHQ-9 score decreases from
22 to 12, she denies suicidal ideation, and she is participating in group therapy.
Which statement indicates the patient is ready for discharge planning?
A. "I will stop taking my medication once I feel completely better."
B. "I will attend my outpatient therapy appointments and take my medication
every day."
C. "I don't need any follow-up; I feel fine now."
D. "I only need to take my medication when I feel depressed."
Answer: B
Rationale: The patient demonstrates understanding of the need for continued
medication adherence and follow-up therapy, which are essential for relapse
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, 4
prevention. Stopping medication (A, D) or skipping follow-up (C) increases the risk
of recurrence.
Case Study 2: Schizophrenia with Auditory Hallucinations
Scenario: A 24-year-old male with a 2-year history of schizophrenia is admitted to
the inpatient unit after stopping his risperidone 3 weeks ago. He is pacing the
hallway, mumbling to himself, and appears agitated. He tells the nurse, "The
voices are telling me they are going to poison my food." He refuses to eat his
breakfast tray.
7. Recognize Cues – Which of the following findings require immediate
intervention? (Select all that apply)
A. Pacing and agitation
B. Auditory hallucinations telling him his food is poisoned
C. Refusal to eat
D. History of schizophrenia
E. Stopping risperidone
Answer: A, B, C
Rationale: Agitation, command-type hallucinations involving harm, and refusal to
eat (risk of malnutrition and dehydration) are immediate concerns. History and
medication nonadherence are contributing factors but not the immediate safety
priorities.
8. Analyze Cues – The patient's auditory hallucinations are telling him his food is
poisoned. What is the most likely reason he is refusing to eat?
A. He is not hungry
B. He has a delusion that the food is contaminated
C. He is protesting the unit rules
D. He has a physical illness
Answer: B
Rationale: The hallucinations are directly influencing his behavior, causing a
pg. 4
2026 ATI Mental Health CMS Comprehensive Review |
100+ Practice Questions, NGN Clinical Judgment Case
Studies, and Verified Answers
SECTION 1 – NGN CLINICAL JUDGMENT CASE STUDIES (Questions 1–30)
Case Study 1: Major Depressive Disorder with Suicidal Ideation
Scenario: A 32-year-old female is brought to the emergency department by her
roommate, who found her crying and stating she "can't go on anymore." The
patient reports feeling depressed for the past 6 weeks, with loss of appetite,
insomnia, and fatigue. She states, "I've been thinking about taking all my pills."
She has a history of one prior suicide attempt 3 years ago. She is alert, oriented,
and cooperative but tearful. Vital signs are stable. The provider admits her to the
inpatient psychiatric unit with a diagnosis of major depressive disorder with
suicidal ideation.
1. Recognize Cues – Which findings in the scenario are most concerning for
immediate suicide risk? (Select all that apply)
A. Feeling depressed for 6 weeks
B. Statement "I've been thinking about taking all my pills"
C. History of a prior suicide attempt
D. Loss of appetite and insomnia
E. The patient is cooperative
Answer: B, C
Rationale: A specific plan (taking all pills) and a history of prior attempt are strong
predictors of suicide. Depressed mood and neurovegetative symptoms (A, D)
support the diagnosis of depression but are not the most acute risk indicators.
Cooperation (E) does not eliminate risk.
2. Analyze Cues – The patient reveals she has a bottle of acetaminophen at
home and has been saving it. She states she planned to take it tonight. How
pg. 1
,2
should the nurse interpret this information?
A. The patient is seeking attention
B. The patient has a lethal plan and high intent, requiring immediate safety
measures
C. The patient is not at risk because she disclosed the plan
D. The patient is testing the staff's trustworthiness
Answer: B
Rationale: Disclosure of a specific plan with accessible means and a timeframe
indicates high lethality and intent. This requires immediate intervention, including
one-to-one observation and removal of all potentially harmful items. The nurse
must not dismiss the threat.
3. Prioritize Hypotheses – The patient is admitted. What is the priority nursing
action?
A. Administer a prescribed antidepressant
B. Initiate one-to-one constant observation and remove all potentially harmful
items
C. Schedule a family therapy session
D. Encourage the patient to attend group therapy
Answer: B
Rationale: Safety is the highest priority. The nurse must ensure the patient's
immediate safety by removing dangerous objects (belts, shoelaces, glass,
medications) and placing the patient on constant observation until a full risk
assessment is completed and safety is established. Medications (A) are secondary
to safety.
4. Generate Solutions – The patient is started on sertraline 50 mg daily. The
nurse should plan to monitor for which early adverse effects? (Select all that
apply)
A. Increased energy with persistent suicidal ideation
B. Gastrointestinal upset
C. Hypertensive crisis
pg. 2
,3
D. Activation and jitteriness
E. Weight gain
Answer: A, B, D
Rationale: SSRIs can cause initial activation, anxiety, and GI upset. Increased
energy before mood improvement can increase the risk of acting on suicidal
thoughts. Hypertensive crisis (C) is associated with MAOIs. Weight gain (E) is more
common with long-term use and atypical antipsychotics.
5. Take Actions – The patient has been on sertraline for 5 days and now reports
feeling "a little better" but still has occasional passive thoughts of death. What
is the most appropriate nursing action?
A. Discontinue suicide precautions because she is improving
B. Continue suicide precautions and reassess risk frequently
C. Increase the sertraline dose
D. Discharge the patient with outpatient follow-up
Answer: B
Rationale: Partial improvement with ongoing passive ideation still warrants close
monitoring. Suicide risk can fluctuate, and it is premature to discontinue
precautions. Dose adjustments should be made by the provider.
6. Evaluate Outcomes – After 2 weeks, the patient's PHQ-9 score decreases from
22 to 12, she denies suicidal ideation, and she is participating in group therapy.
Which statement indicates the patient is ready for discharge planning?
A. "I will stop taking my medication once I feel completely better."
B. "I will attend my outpatient therapy appointments and take my medication
every day."
C. "I don't need any follow-up; I feel fine now."
D. "I only need to take my medication when I feel depressed."
Answer: B
Rationale: The patient demonstrates understanding of the need for continued
medication adherence and follow-up therapy, which are essential for relapse
pg. 3
, 4
prevention. Stopping medication (A, D) or skipping follow-up (C) increases the risk
of recurrence.
Case Study 2: Schizophrenia with Auditory Hallucinations
Scenario: A 24-year-old male with a 2-year history of schizophrenia is admitted to
the inpatient unit after stopping his risperidone 3 weeks ago. He is pacing the
hallway, mumbling to himself, and appears agitated. He tells the nurse, "The
voices are telling me they are going to poison my food." He refuses to eat his
breakfast tray.
7. Recognize Cues – Which of the following findings require immediate
intervention? (Select all that apply)
A. Pacing and agitation
B. Auditory hallucinations telling him his food is poisoned
C. Refusal to eat
D. History of schizophrenia
E. Stopping risperidone
Answer: A, B, C
Rationale: Agitation, command-type hallucinations involving harm, and refusal to
eat (risk of malnutrition and dehydration) are immediate concerns. History and
medication nonadherence are contributing factors but not the immediate safety
priorities.
8. Analyze Cues – The patient's auditory hallucinations are telling him his food is
poisoned. What is the most likely reason he is refusing to eat?
A. He is not hungry
B. He has a delusion that the food is contaminated
C. He is protesting the unit rules
D. He has a physical illness
Answer: B
Rationale: The hallucinations are directly influencing his behavior, causing a
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