HESI NCLEX-RN Comprehensive Psychiatric Nursing
Review – Mental Health Disorders, Therapeutic
Communication, Abuse, and Crisis Intervention
(2025/2026)/HESI Comprehensive Review for
NCLEX-RN Exam Psychiatric.
A client in the critical care unit who has been oriented suddenly becomes disoriented and
fearful. Assessment of vital signs and other physical parameters reveals no significant changes,
and the nurse formulates the diagnosis of confusion related to ICU psychosis. Which nursing
action is best for this client's behavior?
A. Move all medical equipment away from the client's bedside.
B. Allay fears by teaching the client about the causes of the disease.
C. Cluster care to allow for brief rest periods during the day.
D. Encourage visitation by the client's family members, including the client's young children.
C. Cluster care to allow for brief rest periods during the day.
The best intervention is to organize care so that the client can experience rest periods. The
critical care unit contains many lifesaving treatment modalities that offer clients an array of
auditory, visual, and even painful stimuli. These stressors can result in isolation and confusion.
The nurse is reviewing techniques of therapeutic communication with a student nurse. Which of
the student's statements will the nurse indicate as therapeutic? (Select all that apply.)
A. "Am I correct in restating that you are feeling less anxious today?"
B. "In looking back at what you said, you stated you are feeling better."
C. "Why do you think you are feeling better today?"
D. "Surely you did not mean that you are feeling better today."
E. "Help me understand what you are feeling today?"
A. "Am I correct in restating that you are feeling less anxious today?"
B. "In looking back at what you said, you stated you are feeling better."
E. "Help me understand what you are feeling today?"
While in group therapy, a client who is diagnosed with posttraumatic stress disorder (PTSD) is
processing an experience from the war in Iraq when another client tips over a chair. What action
should the nurse take when the client with PTSD falls to the floor in a fetal position?
A. Confront the client who tipped over the chair about the inconsiderate behavior.
,B. Dismiss the other clients from the group therapy session for a 10-minute break.
C. Reinforce reality to the client on the floor and remove him to a quiet space.
D. Call a security code and medicate both clients with an antianxiety drug.
C. Reinforce reality to the client on the floor and remove him to a quiet space.
The client who is diagnosed with PTSD is re-experiencing the traumatic experience and needs
reality reassurance (confirmation that there is no danger at this time) and reduced stimuli.
The parent and a 6-year-old present to the clinic for routine well-child care. The child weighs 35
pounds 15.9 kg; is wearing torn and dirty clothing; and, sits quietly with an apparent subtle
rocking motion. What are the nurse's next actions? (Select all that apply.)
A. Take the child's height, and vital signs.
B. Check the clothing closet at the clinic for size appropriate clothing.
C. Assess the child for any bruising, or lacerations.
D. Ask the accompanying parent to leave the room.
E. Ask the child about attendance at school.
F. Stay with the child during the healthcare provider's assessment.
A. Take the child's height, and vital signs.
C. Assess the child for any bruising, or lacerations.
D. Ask the accompanying parent to leave the room.
E. Ask the child about attendance at school.
F. Stay with the child during the healthcare provider's assessment.
Checking for appropriate clothing is a nice gesture, but that action does nothing to protect the
child or assess for further signs of neglect. The remaining assessments will help validate for
neglect. The normal height and weight for this child should be 45 pounds/20.4 kg and 45
inches/114 cm. This child is underweight for its age, but a height and comparison of stature to
the parents will help confirm those findings. The subtle rocking motion may be an indication of
emotional abuse. The goal of the nurse is to provide a safe and secure environment for the
child. Nurses are mandatory reporters for suspected abuse.
A client states to the new nurse, "I can't tell you something important because you will tell the
other nurses." What is a therapeutic response by the new nurse? (Select all that apply.)
A. "I promise not to tell anyone what is on your mind; your concerns are safe with me."
B. "What you share with me is confidential; I guarantee I will not say a word to anyone."
C. "You can trust me not to tell your concerns to the other nurses."
D. "Since the information you have is important to you; I encourage you to share."
E. "I urge you to tell me what is on your mind; you have something to disclose."
,D. "Since the information you have is important to you; I encourage you to share."
E. "I urge you to tell me what is on your mind; you have something to disclose."
The nurse cannot promise not to tell/share information. That is never appropriate in a
therapeutic relationship. It is therapeutic to encourage the client to share important
information.
The therapy nurse is working with a client admitted with an erratic type of personality disorder.
Which client behaviors indicate to the nurse that the therapy is beginning to be effective?
(Select all that apply.)
A. The client no longer wishes to do self-harm.
B. A happy and bright affect is evident in the client's face.
C. The client no longer displayed manipulative behaviors.
D. Attention seeking behaviors are no longer evident.
E. The client is no longer hearing voices that are not present.
A. The client no longer wishes to do self-harm.
C. The client no longer displayed manipulative behaviors.
D. Attention seeking behaviors are no longer evident.
The client with depression would display a bright affect. When a client is talking to voices, that
client is having auditory hallucinations. The remaining behaviors are signs that a client with a
personality disorder is improving.
A woman brings her 48-year-old husband to the outpatient psychiatric unit and tells the nurse
that he is being treated for dissociative disorder. Which data are consistent with this diagnosis?
(Select all that apply.)
A. Sleepwalking
B. Unable to remember who he is
C. Has recurrent intrusive obsessions
D. Acute attack of anxiety
E. Exhibits multiple personalities
A. Sleepwalking
B. Unable to remember who he is
E. Exhibits multiple personalities
Sleepwalking, amnesia, and multiple personalities are examples of detaching emotional conflict
from one's consciousness and are consistent with a diagnosis of dissociative disorder (A, B, E).
, (C) is consistent with obsessive-compulsive disorder. (D) is associated with neuro-cognitive
disorders.
A client who recently retired is admitted to the psychiatric inpatient unit with a diagnosis of
major depression. The initial nursing care plan includes the goal "Assist client to express feelings
of guilt." What is true about the goal statement referring to the client's depression?
A. Implementation of the goal should be deferred until further data can be gathered.
B. The depression will dissipate once the client becomes accustomed to retirement.
C. Depressed clients may be unaware of guilt feelings and should be encouraged to increase
self-awareness.
D. Nursing goals should be approved by the treatment team before they are initiated.
C. Depressed clients may be unaware of guilt feelings and should be encouraged to increase
self-awareness.
Depression is associated with feelings of guilt, and clients are often not aware of these feelings.
Awareness is the first step in dealing with guilt (or any other feeling), so the nurse's efforts
should be directed toward increasing the client's awareness of feelings. Although a goal may be
changed based on an evaluation of interventions to meet the goal, a goal should never be
ignored. Option B dismisses the client's symptoms as age-related. Setting goals for the nursing
care plan is a function of the nurse, although the nurse can collaborate with the treatment
team.
What is the priority nursing action three days after the admission of a client diagnosed with
obsessive-compulsive disorder?
A. Establish a written contract with the client to gradually decrease the compulsive behaviors.
B. Sit with the client quietly for 15 minutes every day and not discuss the ritualistic behaviors.
C. Include the client's spouse in the 1:1 therapy sessions.
D. Refer the client to an obsessive-compulsive outpatient support group.
A. Establish a written contract with the client to gradually decrease the compulsive behaviors.
After a time when a trusting nurse-client relationship is established, the goal is to decrease the
compulsive behaviors. A written contract has a high rate of compliance as long as the behaviors
are not abruptly stopped. Sitting with the client quietly does nothing but spend time with the
client, and does not address the reason for the admissions. The therapy is not 1:1 if the client's
spouse is included. The client needs time to safely develop trust with the nurse in 1:1 sessions.
Separate time for the spouse and family needs to be identified. After three days, the client is not
likely ready for discharge.
Review – Mental Health Disorders, Therapeutic
Communication, Abuse, and Crisis Intervention
(2025/2026)/HESI Comprehensive Review for
NCLEX-RN Exam Psychiatric.
A client in the critical care unit who has been oriented suddenly becomes disoriented and
fearful. Assessment of vital signs and other physical parameters reveals no significant changes,
and the nurse formulates the diagnosis of confusion related to ICU psychosis. Which nursing
action is best for this client's behavior?
A. Move all medical equipment away from the client's bedside.
B. Allay fears by teaching the client about the causes of the disease.
C. Cluster care to allow for brief rest periods during the day.
D. Encourage visitation by the client's family members, including the client's young children.
C. Cluster care to allow for brief rest periods during the day.
The best intervention is to organize care so that the client can experience rest periods. The
critical care unit contains many lifesaving treatment modalities that offer clients an array of
auditory, visual, and even painful stimuli. These stressors can result in isolation and confusion.
The nurse is reviewing techniques of therapeutic communication with a student nurse. Which of
the student's statements will the nurse indicate as therapeutic? (Select all that apply.)
A. "Am I correct in restating that you are feeling less anxious today?"
B. "In looking back at what you said, you stated you are feeling better."
C. "Why do you think you are feeling better today?"
D. "Surely you did not mean that you are feeling better today."
E. "Help me understand what you are feeling today?"
A. "Am I correct in restating that you are feeling less anxious today?"
B. "In looking back at what you said, you stated you are feeling better."
E. "Help me understand what you are feeling today?"
While in group therapy, a client who is diagnosed with posttraumatic stress disorder (PTSD) is
processing an experience from the war in Iraq when another client tips over a chair. What action
should the nurse take when the client with PTSD falls to the floor in a fetal position?
A. Confront the client who tipped over the chair about the inconsiderate behavior.
,B. Dismiss the other clients from the group therapy session for a 10-minute break.
C. Reinforce reality to the client on the floor and remove him to a quiet space.
D. Call a security code and medicate both clients with an antianxiety drug.
C. Reinforce reality to the client on the floor and remove him to a quiet space.
The client who is diagnosed with PTSD is re-experiencing the traumatic experience and needs
reality reassurance (confirmation that there is no danger at this time) and reduced stimuli.
The parent and a 6-year-old present to the clinic for routine well-child care. The child weighs 35
pounds 15.9 kg; is wearing torn and dirty clothing; and, sits quietly with an apparent subtle
rocking motion. What are the nurse's next actions? (Select all that apply.)
A. Take the child's height, and vital signs.
B. Check the clothing closet at the clinic for size appropriate clothing.
C. Assess the child for any bruising, or lacerations.
D. Ask the accompanying parent to leave the room.
E. Ask the child about attendance at school.
F. Stay with the child during the healthcare provider's assessment.
A. Take the child's height, and vital signs.
C. Assess the child for any bruising, or lacerations.
D. Ask the accompanying parent to leave the room.
E. Ask the child about attendance at school.
F. Stay with the child during the healthcare provider's assessment.
Checking for appropriate clothing is a nice gesture, but that action does nothing to protect the
child or assess for further signs of neglect. The remaining assessments will help validate for
neglect. The normal height and weight for this child should be 45 pounds/20.4 kg and 45
inches/114 cm. This child is underweight for its age, but a height and comparison of stature to
the parents will help confirm those findings. The subtle rocking motion may be an indication of
emotional abuse. The goal of the nurse is to provide a safe and secure environment for the
child. Nurses are mandatory reporters for suspected abuse.
A client states to the new nurse, "I can't tell you something important because you will tell the
other nurses." What is a therapeutic response by the new nurse? (Select all that apply.)
A. "I promise not to tell anyone what is on your mind; your concerns are safe with me."
B. "What you share with me is confidential; I guarantee I will not say a word to anyone."
C. "You can trust me not to tell your concerns to the other nurses."
D. "Since the information you have is important to you; I encourage you to share."
E. "I urge you to tell me what is on your mind; you have something to disclose."
,D. "Since the information you have is important to you; I encourage you to share."
E. "I urge you to tell me what is on your mind; you have something to disclose."
The nurse cannot promise not to tell/share information. That is never appropriate in a
therapeutic relationship. It is therapeutic to encourage the client to share important
information.
The therapy nurse is working with a client admitted with an erratic type of personality disorder.
Which client behaviors indicate to the nurse that the therapy is beginning to be effective?
(Select all that apply.)
A. The client no longer wishes to do self-harm.
B. A happy and bright affect is evident in the client's face.
C. The client no longer displayed manipulative behaviors.
D. Attention seeking behaviors are no longer evident.
E. The client is no longer hearing voices that are not present.
A. The client no longer wishes to do self-harm.
C. The client no longer displayed manipulative behaviors.
D. Attention seeking behaviors are no longer evident.
The client with depression would display a bright affect. When a client is talking to voices, that
client is having auditory hallucinations. The remaining behaviors are signs that a client with a
personality disorder is improving.
A woman brings her 48-year-old husband to the outpatient psychiatric unit and tells the nurse
that he is being treated for dissociative disorder. Which data are consistent with this diagnosis?
(Select all that apply.)
A. Sleepwalking
B. Unable to remember who he is
C. Has recurrent intrusive obsessions
D. Acute attack of anxiety
E. Exhibits multiple personalities
A. Sleepwalking
B. Unable to remember who he is
E. Exhibits multiple personalities
Sleepwalking, amnesia, and multiple personalities are examples of detaching emotional conflict
from one's consciousness and are consistent with a diagnosis of dissociative disorder (A, B, E).
, (C) is consistent with obsessive-compulsive disorder. (D) is associated with neuro-cognitive
disorders.
A client who recently retired is admitted to the psychiatric inpatient unit with a diagnosis of
major depression. The initial nursing care plan includes the goal "Assist client to express feelings
of guilt." What is true about the goal statement referring to the client's depression?
A. Implementation of the goal should be deferred until further data can be gathered.
B. The depression will dissipate once the client becomes accustomed to retirement.
C. Depressed clients may be unaware of guilt feelings and should be encouraged to increase
self-awareness.
D. Nursing goals should be approved by the treatment team before they are initiated.
C. Depressed clients may be unaware of guilt feelings and should be encouraged to increase
self-awareness.
Depression is associated with feelings of guilt, and clients are often not aware of these feelings.
Awareness is the first step in dealing with guilt (or any other feeling), so the nurse's efforts
should be directed toward increasing the client's awareness of feelings. Although a goal may be
changed based on an evaluation of interventions to meet the goal, a goal should never be
ignored. Option B dismisses the client's symptoms as age-related. Setting goals for the nursing
care plan is a function of the nurse, although the nurse can collaborate with the treatment
team.
What is the priority nursing action three days after the admission of a client diagnosed with
obsessive-compulsive disorder?
A. Establish a written contract with the client to gradually decrease the compulsive behaviors.
B. Sit with the client quietly for 15 minutes every day and not discuss the ritualistic behaviors.
C. Include the client's spouse in the 1:1 therapy sessions.
D. Refer the client to an obsessive-compulsive outpatient support group.
A. Establish a written contract with the client to gradually decrease the compulsive behaviors.
After a time when a trusting nurse-client relationship is established, the goal is to decrease the
compulsive behaviors. A written contract has a high rate of compliance as long as the behaviors
are not abruptly stopped. Sitting with the client quietly does nothing but spend time with the
client, and does not address the reason for the admissions. The therapy is not 1:1 if the client's
spouse is included. The client needs time to safely develop trust with the nurse in 1:1 sessions.
Separate time for the spouse and family needs to be identified. After three days, the client is not
likely ready for discharge.
