NCLEX-RN Mental Health Exam
2025/2026 – Verified Questions, Correct
Answers, and Rationales
Question 1: Case Study – Client with Major Depressive
Disorder
A 32-year-old client presents to the mental health clinic reporting feelings of worthlessness,
fatigue, and loss of interest in activities for 3 months. The client has a history of major
depressive disorder and is prescribed sertraline 100 mg daily. The nurse observes the client
appears withdrawn with poor eye contact.
Select the priority nursing intervention. A. Encourage the client to join a group therapy
session immediately. B. Assess the client for suicidal ideation and risk. C. Teach the client
about the side effects of sertraline. D. Develop a daily activity schedule for the client.
Rationale: B. Assess the client for suicidal ideation and risk. Clients with major depressive
disorder are at high risk for suicide, especially with symptoms like worthlessness and
withdrawal. Assessing for suicidal ideation ensures safety, which is the priority.
• A: Group therapy is beneficial but not the priority until safety is established.
• C: Medication education is important but secondary to safety.
• D: Activity scheduling is therapeutic but not the immediate priority.
Question 2: Unfolding Scenario – Client with Schizophrenia
A 25-year-old client with schizophrenia is admitted after experiencing auditory hallucinations
and paranoia. The client is prescribed risperidone 2 mg twice daily. On day 2, the client is pacing
and refuses medication, stating, “The voices are telling me it’s poison.”
Which action should the nurse take first? A. Administer the medication as prescribed. B. Use
therapeutic communication to explore the client’s concerns. C. Place the client in seclusion to
reduce stimulation. D. Notify the healthcare provider immediately.
Rationale: B. Use therapeutic communication to explore the client’s concerns. Therapeutic
communication builds trust and addresses the client’s fears, potentially improving medication
adherence.
• A: Forcing medication may increase agitation and mistrust.
• C: Seclusion is not indicated unless the client poses an immediate risk.
• D: Notifying the provider is premature before assessing the client’s concerns.
,Question 3: Multiple Choice – Bipolar Disorder
A nurse is caring for a client with bipolar disorder in the manic phase. The client is pacing,
talking rapidly, and refusing to sleep.
Which nursing intervention is most appropriate? A. Encourage the client to participate in a
high-energy group activity. B. Provide a calm, structured environment with minimal stimuli.
C. Administer a PRN dose of lorazepam without assessing the client. D. Allow the client to make
decisions about their daily schedule.
Rationale: B. Provide a calm, structured environment with minimal stimuli. A calm
environment reduces overstimulation, which can exacerbate manic symptoms.
• A: High-energy activities may worsen agitation.
• C: Administering medication without assessment is unsafe.
• D: Unrestricted decision-making can lead to impulsive behaviors.
Question 4: Select All That Apply – Client with Anxiety
Disorder
A 40-year-old client with generalized anxiety disorder reports chest tightness, palpitations, and
difficulty breathing during a panic attack. The client has a PRN prescription for lorazepam 0.5
mg.
Which interventions should the nurse implement? (Select all that apply.) A. Teach the
client deep breathing techniques. B. Administer lorazepam 0.5 mg as prescribed. C. Place
the client in a seclusion room. D. Stay with the client to provide reassurance. E. Encourage the
client to walk briskly to reduce anxiety.
Rationale: A, B, D. Teach the client deep breathing techniques, administer lorazepam 0.5
mg as prescribed, stay with the client to provide reassurance. Deep breathing manages acute
anxiety, lorazepam addresses severe symptoms, and staying with the client provides support.
• C: Seclusion is inappropriate unless the client is a danger to self or others.
• E: Brisk walking may increase physical symptoms during a panic attack.
Question 5: Unfolding Scenario – Client with Substance Use
Disorder
A 28-year-old client is admitted for alcohol withdrawal. The client is tremulous, agitated, and
reports seeing “bugs crawling on the walls.” The nurse notes a CIWA-Ar score of 15.
, What is the priority nursing action? A. Administer a PRN dose of haloperidol. B. Administer
lorazepam as per the CIWA-Ar protocol. C. Encourage the client to drink oral fluids. D. Place
the client in restraints to prevent injury.
Rationale: B. Administer lorazepam as per the CIWA-Ar protocol. A CIWA-Ar score of 15
indicates moderate to severe withdrawal, requiring benzodiazepines to prevent seizures.
• A: Haloperidol may lower the seizure threshold and is not indicated.
• C: Fluids are important but not the priority.
• D: Restraints are a last resort and not indicated here.
Question 6: Multiple Choice – Therapeutic Communication
A nurse is speaking with a client who expresses hopelessness about their future.
Which response demonstrates therapeutic communication? A. “You shouldn’t feel that way;
things will get better.” B. “Why do you feel so hopeless?” C. “It sounds like you’re feeling
overwhelmed. Can you share more?” D. “Other clients have felt this way and they got through
it.”
Rationale: C. “It sounds like you’re feeling overwhelmed. Can you share more?” This
response uses reflection and open-ended questioning to encourage expression.
• A: Dismisses the client’s feelings.
• B: “Why” questions can feel confrontational.
• D: Comparing minimizes the client’s experience.
Question 7: Case Study – Client with Post-Traumatic Stress
Disorder (PTSD)
A 35-year-old veteran with PTSD reports nightmares and hypervigilance. The client becomes
agitated when discussing a recent trigger event.
What is the nurse’s best response? A. Use a calm tone and ask, “Would it help to talk about
what makes you feel safe?” B. Change the topic to avoid agitation. C. Encourage the client to
confront the trigger immediately. D. Administer a PRN anxiolytic without assessment.
Rationale: A. Use a calm tone and ask, “Would it help to talk about what makes you feel
safe?” This promotes safety and redirects to a coping-focused topic.
• B: Changing the topic avoids addressing needs.
• C: Confronting triggers prematurely may worsen symptoms.
• D: Medication without assessment is unsafe.
2025/2026 – Verified Questions, Correct
Answers, and Rationales
Question 1: Case Study – Client with Major Depressive
Disorder
A 32-year-old client presents to the mental health clinic reporting feelings of worthlessness,
fatigue, and loss of interest in activities for 3 months. The client has a history of major
depressive disorder and is prescribed sertraline 100 mg daily. The nurse observes the client
appears withdrawn with poor eye contact.
Select the priority nursing intervention. A. Encourage the client to join a group therapy
session immediately. B. Assess the client for suicidal ideation and risk. C. Teach the client
about the side effects of sertraline. D. Develop a daily activity schedule for the client.
Rationale: B. Assess the client for suicidal ideation and risk. Clients with major depressive
disorder are at high risk for suicide, especially with symptoms like worthlessness and
withdrawal. Assessing for suicidal ideation ensures safety, which is the priority.
• A: Group therapy is beneficial but not the priority until safety is established.
• C: Medication education is important but secondary to safety.
• D: Activity scheduling is therapeutic but not the immediate priority.
Question 2: Unfolding Scenario – Client with Schizophrenia
A 25-year-old client with schizophrenia is admitted after experiencing auditory hallucinations
and paranoia. The client is prescribed risperidone 2 mg twice daily. On day 2, the client is pacing
and refuses medication, stating, “The voices are telling me it’s poison.”
Which action should the nurse take first? A. Administer the medication as prescribed. B. Use
therapeutic communication to explore the client’s concerns. C. Place the client in seclusion to
reduce stimulation. D. Notify the healthcare provider immediately.
Rationale: B. Use therapeutic communication to explore the client’s concerns. Therapeutic
communication builds trust and addresses the client’s fears, potentially improving medication
adherence.
• A: Forcing medication may increase agitation and mistrust.
• C: Seclusion is not indicated unless the client poses an immediate risk.
• D: Notifying the provider is premature before assessing the client’s concerns.
,Question 3: Multiple Choice – Bipolar Disorder
A nurse is caring for a client with bipolar disorder in the manic phase. The client is pacing,
talking rapidly, and refusing to sleep.
Which nursing intervention is most appropriate? A. Encourage the client to participate in a
high-energy group activity. B. Provide a calm, structured environment with minimal stimuli.
C. Administer a PRN dose of lorazepam without assessing the client. D. Allow the client to make
decisions about their daily schedule.
Rationale: B. Provide a calm, structured environment with minimal stimuli. A calm
environment reduces overstimulation, which can exacerbate manic symptoms.
• A: High-energy activities may worsen agitation.
• C: Administering medication without assessment is unsafe.
• D: Unrestricted decision-making can lead to impulsive behaviors.
Question 4: Select All That Apply – Client with Anxiety
Disorder
A 40-year-old client with generalized anxiety disorder reports chest tightness, palpitations, and
difficulty breathing during a panic attack. The client has a PRN prescription for lorazepam 0.5
mg.
Which interventions should the nurse implement? (Select all that apply.) A. Teach the
client deep breathing techniques. B. Administer lorazepam 0.5 mg as prescribed. C. Place
the client in a seclusion room. D. Stay with the client to provide reassurance. E. Encourage the
client to walk briskly to reduce anxiety.
Rationale: A, B, D. Teach the client deep breathing techniques, administer lorazepam 0.5
mg as prescribed, stay with the client to provide reassurance. Deep breathing manages acute
anxiety, lorazepam addresses severe symptoms, and staying with the client provides support.
• C: Seclusion is inappropriate unless the client is a danger to self or others.
• E: Brisk walking may increase physical symptoms during a panic attack.
Question 5: Unfolding Scenario – Client with Substance Use
Disorder
A 28-year-old client is admitted for alcohol withdrawal. The client is tremulous, agitated, and
reports seeing “bugs crawling on the walls.” The nurse notes a CIWA-Ar score of 15.
, What is the priority nursing action? A. Administer a PRN dose of haloperidol. B. Administer
lorazepam as per the CIWA-Ar protocol. C. Encourage the client to drink oral fluids. D. Place
the client in restraints to prevent injury.
Rationale: B. Administer lorazepam as per the CIWA-Ar protocol. A CIWA-Ar score of 15
indicates moderate to severe withdrawal, requiring benzodiazepines to prevent seizures.
• A: Haloperidol may lower the seizure threshold and is not indicated.
• C: Fluids are important but not the priority.
• D: Restraints are a last resort and not indicated here.
Question 6: Multiple Choice – Therapeutic Communication
A nurse is speaking with a client who expresses hopelessness about their future.
Which response demonstrates therapeutic communication? A. “You shouldn’t feel that way;
things will get better.” B. “Why do you feel so hopeless?” C. “It sounds like you’re feeling
overwhelmed. Can you share more?” D. “Other clients have felt this way and they got through
it.”
Rationale: C. “It sounds like you’re feeling overwhelmed. Can you share more?” This
response uses reflection and open-ended questioning to encourage expression.
• A: Dismisses the client’s feelings.
• B: “Why” questions can feel confrontational.
• D: Comparing minimizes the client’s experience.
Question 7: Case Study – Client with Post-Traumatic Stress
Disorder (PTSD)
A 35-year-old veteran with PTSD reports nightmares and hypervigilance. The client becomes
agitated when discussing a recent trigger event.
What is the nurse’s best response? A. Use a calm tone and ask, “Would it help to talk about
what makes you feel safe?” B. Change the topic to avoid agitation. C. Encourage the client to
confront the trigger immediately. D. Administer a PRN anxiolytic without assessment.
Rationale: A. Use a calm tone and ask, “Would it help to talk about what makes you feel
safe?” This promotes safety and redirects to a coping-focused topic.
• B: Changing the topic avoids addressing needs.
• C: Confronting triggers prematurely may worsen symptoms.
• D: Medication without assessment is unsafe.
