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2026 ATI Mental Health CMS Exam Version B | 90
Comprehensive Questions and Rationales
SECTION 1: THERAPEUTIC COMMUNICATION & MILIEU (1–10)
1. A patient tells the nurse, “Everyone would be better off if I weren’t
here.” What is the nurse’s most therapeutic response?
A. “You have so much to live for.”
B. “Why do you feel that way?”
C. “It sounds like you’re feeling hopeless right now. Tell me more.”
D. “You shouldn’t talk like that.”
Answer: C
Rationale: This response uses reflection and open-ended exploration,
validating the patient’s feelings without judgment. Option A gives false
reassurance, B asks “why” which can be probing and nontherapeutic,
and D is dismissive.
2. A patient with schizophrenia is admitted. The patient says, “The FBI
is watching me through the television.” What is the nurse’s best
response?
A. “That’s not true; the FBI isn’t watching you.”
B. “I believe you must be very frightened by that thought.”
C. “Why do you think the FBI is watching you?”
D. “Let’s change the subject to something more pleasant.”
Answer: B
Rationale: This acknowledges the patient’s fear without reinforcing the
delusion. Directly challenging the delusion or asking “why” is
pg. 1
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nontherapeutic, and changing the subject dismisses the patient’s
distress.
3. During a group therapy session, a patient becomes angry and starts
yelling at other members. What is the nurse’s priority intervention?
A. Ask the patient to leave the group immediately.
B. Acknowledge the patient’s anger and set limits on behavior.
C. Ignore the outburst and continue the session.
D. Call security to remove the patient.
Answer: B
Rationale: Acknowledging the emotion validates the patient, while
setting limits maintains a safe environment. Removal is a last resort if
de-escalation fails.
4. A nurse has been caring for a patient for several weeks and begins
to feel overly protective and spends extra time with the patient. This
is an example of:
A. Transference
B. Countertransference
C. Professional boundaries
D. Therapeutic rapport
Answer: B
Rationale: Countertransference is the nurse’s emotional reaction to a
patient based on personal experiences or needs. Feeling overly
protective may indicate blurred boundaries. The nurse should process
these feelings in clinical supervision.
pg. 2
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5. A patient with borderline personality disorder repeatedly calls the
nurse a “hero” and later says the nurse is “useless.” The nurse
recognizes this as:
A. Projection
B. Splitting
C. Denial
D. Regression
Answer: B
Rationale: Splitting is a primitive defense mechanism where people are
viewed as all good or all bad. It is common in borderline personality
disorder. The nurse must maintain consistent, non-reactive boundaries.
6. A patient is admitted after a suicide attempt. The patient says, “I
feel much better now. I don’t want to talk about it.” The nurse should:
A. Discontinue suicide precautions.
B. Recognize that a sudden improvement may indicate the patient has
decided to act on suicidal thoughts; maintain precautions and assess
further.
C. Discharge the patient.
D. Leave the patient alone to rest.
Answer: B
Rationale: A sudden, unexplained improvement in mood can
paradoxically signal an increased risk of suicide, as the patient may feel
relief after making a decision to act. Vigilance must be maintained.
7. A patient says, “I don’t want to talk to you because you remind me
of my mother.” This is an example of:
A. Transference
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B. Countertransference
C. Projection
D. Dissociation
Answer: A
Rationale: Transference occurs when a patient unconsciously displaces
feelings about a significant person onto the nurse. Countertransference
is the nurse’s emotional response to the patient.
8. A patient is pacing, wringing hands, and breathing rapidly. The
nurse identifies these as signs of which level of anxiety?
A. Mild
B. Moderate
C. Severe
D. Panic
Answer: C
Rationale: Severe anxiety manifests with significant motor tension,
autonomic hyperactivity, and narrowed perception. In panic, the
person is overwhelmed and may be unable to communicate.
9. A patient with severe anxiety is unable to problem-solve. The nurse
recognizes that the patient is at which level of anxiety?
A. Mild
B. Moderate
C. Severe
D. Panic
Answer: C
Rationale: In severe anxiety, the perceptual field is greatly reduced, and
pg. 4
2026 ATI Mental Health CMS Exam Version B | 90
Comprehensive Questions and Rationales
SECTION 1: THERAPEUTIC COMMUNICATION & MILIEU (1–10)
1. A patient tells the nurse, “Everyone would be better off if I weren’t
here.” What is the nurse’s most therapeutic response?
A. “You have so much to live for.”
B. “Why do you feel that way?”
C. “It sounds like you’re feeling hopeless right now. Tell me more.”
D. “You shouldn’t talk like that.”
Answer: C
Rationale: This response uses reflection and open-ended exploration,
validating the patient’s feelings without judgment. Option A gives false
reassurance, B asks “why” which can be probing and nontherapeutic,
and D is dismissive.
2. A patient with schizophrenia is admitted. The patient says, “The FBI
is watching me through the television.” What is the nurse’s best
response?
A. “That’s not true; the FBI isn’t watching you.”
B. “I believe you must be very frightened by that thought.”
C. “Why do you think the FBI is watching you?”
D. “Let’s change the subject to something more pleasant.”
Answer: B
Rationale: This acknowledges the patient’s fear without reinforcing the
delusion. Directly challenging the delusion or asking “why” is
pg. 1
,2
nontherapeutic, and changing the subject dismisses the patient’s
distress.
3. During a group therapy session, a patient becomes angry and starts
yelling at other members. What is the nurse’s priority intervention?
A. Ask the patient to leave the group immediately.
B. Acknowledge the patient’s anger and set limits on behavior.
C. Ignore the outburst and continue the session.
D. Call security to remove the patient.
Answer: B
Rationale: Acknowledging the emotion validates the patient, while
setting limits maintains a safe environment. Removal is a last resort if
de-escalation fails.
4. A nurse has been caring for a patient for several weeks and begins
to feel overly protective and spends extra time with the patient. This
is an example of:
A. Transference
B. Countertransference
C. Professional boundaries
D. Therapeutic rapport
Answer: B
Rationale: Countertransference is the nurse’s emotional reaction to a
patient based on personal experiences or needs. Feeling overly
protective may indicate blurred boundaries. The nurse should process
these feelings in clinical supervision.
pg. 2
,3
5. A patient with borderline personality disorder repeatedly calls the
nurse a “hero” and later says the nurse is “useless.” The nurse
recognizes this as:
A. Projection
B. Splitting
C. Denial
D. Regression
Answer: B
Rationale: Splitting is a primitive defense mechanism where people are
viewed as all good or all bad. It is common in borderline personality
disorder. The nurse must maintain consistent, non-reactive boundaries.
6. A patient is admitted after a suicide attempt. The patient says, “I
feel much better now. I don’t want to talk about it.” The nurse should:
A. Discontinue suicide precautions.
B. Recognize that a sudden improvement may indicate the patient has
decided to act on suicidal thoughts; maintain precautions and assess
further.
C. Discharge the patient.
D. Leave the patient alone to rest.
Answer: B
Rationale: A sudden, unexplained improvement in mood can
paradoxically signal an increased risk of suicide, as the patient may feel
relief after making a decision to act. Vigilance must be maintained.
7. A patient says, “I don’t want to talk to you because you remind me
of my mother.” This is an example of:
A. Transference
pg. 3
, 4
B. Countertransference
C. Projection
D. Dissociation
Answer: A
Rationale: Transference occurs when a patient unconsciously displaces
feelings about a significant person onto the nurse. Countertransference
is the nurse’s emotional response to the patient.
8. A patient is pacing, wringing hands, and breathing rapidly. The
nurse identifies these as signs of which level of anxiety?
A. Mild
B. Moderate
C. Severe
D. Panic
Answer: C
Rationale: Severe anxiety manifests with significant motor tension,
autonomic hyperactivity, and narrowed perception. In panic, the
person is overwhelmed and may be unable to communicate.
9. A patient with severe anxiety is unable to problem-solve. The nurse
recognizes that the patient is at which level of anxiety?
A. Mild
B. Moderate
C. Severe
D. Panic
Answer: C
Rationale: In severe anxiety, the perceptual field is greatly reduced, and
pg. 4
