HESI RN Psychiatric Mental
Health Exam 2025/2026 –
Verified Q&A with Full
Rationales | Free Practice
Questions
A nurse is using therapeutic communication with a client who has major depressive disorder
(MDD) per DSM-5 criteria. Which of the following responses best encourages expression of
feelings?
o A. "Why do you feel that way?"
o B. "Tell me more about how you're feeling."
o C. "You shouldn't feel sad."
o D. "Things will get better soon." Rationale: Open-ended prompts foster trust and
validate emotions in MDD (DSM-5: persistent low mood >2 weeks), enhancing
therapeutic alliance per APA communication guidelines.
2. A nurse is assessing a client starting sertraline for generalized anxiety disorder (GAD).
Which of the following should the nurse monitor for in the first 2 weeks?
o A. Weight gain
o B. Increased suicidal ideation
o C. Sedation
o D. Tachycardia Rationale: SSRIs like sertraline carry a black-box warning for
suicidality in young adults during initial treatment (DSM-5 GAD: excessive
worry >6 months), requiring close monitoring per FDA psychopharmacology.
3. A nurse is caring for a client with schizophrenia exhibiting auditory hallucinations
(DSM-5 positive symptom). Which of the following is the most appropriate initial
intervention?
o A. Administer haloperidol PRN
o B. Encourage reality orientation
o C. Isolate the client
o D. Restrain during episodes Rationale: Gentle reality testing reduces delusion
intensity without confrontation, promoting ego integrity stability per APA
schizophrenia care.
4. A nurse is teaching a client about benzodiazepines for panic disorder (DSM-5: recurrent
attacks). Which of the following should the nurse emphasize?
o A. "Use as needed indefinitely."
, o B. "Short-term use due to dependence risk."
o C. "Combine with alcohol."
o D. "Increase dose during stress." Rationale: Benzos like alprazolam risk
tolerance/withdrawal (GABA enhancement), limiting to 2-4 weeks per APA
anxiety pharmacotherapy for safety.
5. A nurse is using the mental status exam on a client with bipolar I disorder in manic phase
(DSM-5: elevated mood >1 week). Which of the following findings should the nurse
document?
o A. Flat affect
o B. Flight of ideas
o C. Slow speech
o D. Poor insight absent Rationale: Rapid, tangential speech reflects pressured
thinking, guiding lithium initiation for mood stabilization per APA bipolar
assessment.
6. A nurse is caring for a client with borderline personality disorder (DSM-5: instability in
relationships). Which of the following therapeutic boundaries should the nurse maintain?
o A. Share personal phone number
o B. Consistent session times
o C. Gift exchange
o D. Self-disclosure Rationale: Predictable structure reduces splitting, fostering
trust per APA personality disorder therapy.
7. A nurse is assessing a client for alcohol use disorder (DSM-5: tolerance/craving). Which
of the following screening tools should the nurse use?
o A. GAD-7
o B. CAGE questionnaire
o C. PHQ-9
o D. MMSE Rationale: CAGE identifies dependence patterns, guiding disulfiram
or naltrexone for relapse prevention per ASAM substance use.
8. A nurse is administering risperidone to a client with schizoaffective disorder. Which of
the following side effects should the nurse monitor?
o A. Hypertension
o B. Extrapyramidal symptoms
o C. Weight loss
o D. Insomnia Rationale: D2 blockade causes dystonia/akathisia, anticholinergics
PRN for motor stability per APA antipsychotic management.
9. A nurse is using motivational interviewing with a client resistant to PTSD treatment
(DSM-5: trauma re-experiencing). Which of the following is an example of reflective
listening?
o A. "You need to face your fears."
o B. "It sounds like the trauma still affects you daily."
o C. "Have you tried therapy before?"
o D. "Change is possible if you try." Rationale: Reflection evokes ambivalence
resolution, enhancing engagement per APA trauma-informed care.
10. A nurse is caring for a client on lithium for bipolar disorder. Which of the following lab
values should the nurse monitor?
o A. TSH
, o B. Lithium level 0.6-1.2 mEq/L
o C. BUN
o D. Glucose Rationale: Therapeutic range prevents toxicity (tremor,
nephrotoxicity), mood stability per APA lithium monitoring.
11. A nurse is assessing a client with obsessive-compulsive disorder (DSM-5: rituals >1
hour/day). Which of the following should the nurse prioritize?
o A. Insight-oriented therapy
o B. Exposure and response prevention
o C. Group support
o D. Hypnosis Rationale: ERP extinguishes compulsions, anxiety habituation
stability per APA OCD treatment.
12. A nurse is teaching a client about SSRIs for social anxiety disorder. Which of the
following should the nurse include?
o A. "Onset in 1 week."
o B. "Sexual side effects possible."
o C. "No interactions."
o D. "Discontinue abruptly." Rationale: Serotonin modulation causes dysfunction,
bupropion adjunct for tolerability per APA anxiety pharmacotherapy.
13. A nurse is caring for a client with delusional disorder (DSM-5: fixed false beliefs).
Which of the following is the most therapeutic response?
o A. "That's not true."
o B. "I see this is important to you."
o C. "Let's focus on reality."
o D. "You need medication." Rationale: Validation avoids confrontation, alliance
building per APA psychotic disorders.
14. A nurse is monitoring a client on clozapine for treatment-resistant schizophrenia. Which
of the following should the nurse check weekly?
o A. Weight
o B. WBC count
o C. Blood glucose
o D. Lipids Rationale: Agranulocytosis risk requires ANC >1500, immune stability
per APA clozapine.
15. A nurse is using cognitive behavioral therapy (CBT) with a client who has phobias
(DSM-5: irrational fear). Which of the following techniques should the nurse employ?
o A. Free association
o B. Systematic desensitization
o C. Interpretation
o D. Transference Rationale: Gradual exposure reduces avoidance, fear extinction
stability per APA CBT for anxiety.
16. A nurse is caring for a client with ADHD on methylphenidate. Which of the following
should the nurse monitor?
o A. Appetite suppression
o B. Growth parameters
o C. Insomnia
o D. Tics worsening Rationale: Stimulants affect stature, quarterly checks for
developmental stability per AACAP ADHD.
Health Exam 2025/2026 –
Verified Q&A with Full
Rationales | Free Practice
Questions
A nurse is using therapeutic communication with a client who has major depressive disorder
(MDD) per DSM-5 criteria. Which of the following responses best encourages expression of
feelings?
o A. "Why do you feel that way?"
o B. "Tell me more about how you're feeling."
o C. "You shouldn't feel sad."
o D. "Things will get better soon." Rationale: Open-ended prompts foster trust and
validate emotions in MDD (DSM-5: persistent low mood >2 weeks), enhancing
therapeutic alliance per APA communication guidelines.
2. A nurse is assessing a client starting sertraline for generalized anxiety disorder (GAD).
Which of the following should the nurse monitor for in the first 2 weeks?
o A. Weight gain
o B. Increased suicidal ideation
o C. Sedation
o D. Tachycardia Rationale: SSRIs like sertraline carry a black-box warning for
suicidality in young adults during initial treatment (DSM-5 GAD: excessive
worry >6 months), requiring close monitoring per FDA psychopharmacology.
3. A nurse is caring for a client with schizophrenia exhibiting auditory hallucinations
(DSM-5 positive symptom). Which of the following is the most appropriate initial
intervention?
o A. Administer haloperidol PRN
o B. Encourage reality orientation
o C. Isolate the client
o D. Restrain during episodes Rationale: Gentle reality testing reduces delusion
intensity without confrontation, promoting ego integrity stability per APA
schizophrenia care.
4. A nurse is teaching a client about benzodiazepines for panic disorder (DSM-5: recurrent
attacks). Which of the following should the nurse emphasize?
o A. "Use as needed indefinitely."
, o B. "Short-term use due to dependence risk."
o C. "Combine with alcohol."
o D. "Increase dose during stress." Rationale: Benzos like alprazolam risk
tolerance/withdrawal (GABA enhancement), limiting to 2-4 weeks per APA
anxiety pharmacotherapy for safety.
5. A nurse is using the mental status exam on a client with bipolar I disorder in manic phase
(DSM-5: elevated mood >1 week). Which of the following findings should the nurse
document?
o A. Flat affect
o B. Flight of ideas
o C. Slow speech
o D. Poor insight absent Rationale: Rapid, tangential speech reflects pressured
thinking, guiding lithium initiation for mood stabilization per APA bipolar
assessment.
6. A nurse is caring for a client with borderline personality disorder (DSM-5: instability in
relationships). Which of the following therapeutic boundaries should the nurse maintain?
o A. Share personal phone number
o B. Consistent session times
o C. Gift exchange
o D. Self-disclosure Rationale: Predictable structure reduces splitting, fostering
trust per APA personality disorder therapy.
7. A nurse is assessing a client for alcohol use disorder (DSM-5: tolerance/craving). Which
of the following screening tools should the nurse use?
o A. GAD-7
o B. CAGE questionnaire
o C. PHQ-9
o D. MMSE Rationale: CAGE identifies dependence patterns, guiding disulfiram
or naltrexone for relapse prevention per ASAM substance use.
8. A nurse is administering risperidone to a client with schizoaffective disorder. Which of
the following side effects should the nurse monitor?
o A. Hypertension
o B. Extrapyramidal symptoms
o C. Weight loss
o D. Insomnia Rationale: D2 blockade causes dystonia/akathisia, anticholinergics
PRN for motor stability per APA antipsychotic management.
9. A nurse is using motivational interviewing with a client resistant to PTSD treatment
(DSM-5: trauma re-experiencing). Which of the following is an example of reflective
listening?
o A. "You need to face your fears."
o B. "It sounds like the trauma still affects you daily."
o C. "Have you tried therapy before?"
o D. "Change is possible if you try." Rationale: Reflection evokes ambivalence
resolution, enhancing engagement per APA trauma-informed care.
10. A nurse is caring for a client on lithium for bipolar disorder. Which of the following lab
values should the nurse monitor?
o A. TSH
, o B. Lithium level 0.6-1.2 mEq/L
o C. BUN
o D. Glucose Rationale: Therapeutic range prevents toxicity (tremor,
nephrotoxicity), mood stability per APA lithium monitoring.
11. A nurse is assessing a client with obsessive-compulsive disorder (DSM-5: rituals >1
hour/day). Which of the following should the nurse prioritize?
o A. Insight-oriented therapy
o B. Exposure and response prevention
o C. Group support
o D. Hypnosis Rationale: ERP extinguishes compulsions, anxiety habituation
stability per APA OCD treatment.
12. A nurse is teaching a client about SSRIs for social anxiety disorder. Which of the
following should the nurse include?
o A. "Onset in 1 week."
o B. "Sexual side effects possible."
o C. "No interactions."
o D. "Discontinue abruptly." Rationale: Serotonin modulation causes dysfunction,
bupropion adjunct for tolerability per APA anxiety pharmacotherapy.
13. A nurse is caring for a client with delusional disorder (DSM-5: fixed false beliefs).
Which of the following is the most therapeutic response?
o A. "That's not true."
o B. "I see this is important to you."
o C. "Let's focus on reality."
o D. "You need medication." Rationale: Validation avoids confrontation, alliance
building per APA psychotic disorders.
14. A nurse is monitoring a client on clozapine for treatment-resistant schizophrenia. Which
of the following should the nurse check weekly?
o A. Weight
o B. WBC count
o C. Blood glucose
o D. Lipids Rationale: Agranulocytosis risk requires ANC >1500, immune stability
per APA clozapine.
15. A nurse is using cognitive behavioral therapy (CBT) with a client who has phobias
(DSM-5: irrational fear). Which of the following techniques should the nurse employ?
o A. Free association
o B. Systematic desensitization
o C. Interpretation
o D. Transference Rationale: Gradual exposure reduces avoidance, fear extinction
stability per APA CBT for anxiety.
16. A nurse is caring for a client with ADHD on methylphenidate. Which of the following
should the nurse monitor?
o A. Appetite suppression
o B. Growth parameters
o C. Insomnia
o D. Tics worsening Rationale: Stimulants affect stature, quarterly checks for
developmental stability per AACAP ADHD.
