Psychiatric Nursing Practice Questions with Rationales
A free set of original clinical-judgment questions written for nursing students studying psychiatric mental health nursing. Each question has four options, the correct answer, a concise rationale, and a note on why the main distractors are less appropriate. Every topic links to the Nursivelle article that explains it. These are study questions written by Nursivelle; they are not official examination items.
Updated 29 September 2026 · Educational content written and internally reviewed by Nursivelle; not independently reviewed by an outside clinician or organisation. Sources are listed at the end of the article.
How to use these questions
Read the stem, decide on the safety priority before looking at the options, choose, then read the rationale even when you are right. If the rationale contains a word you could not define, that is the topic to review — open the linked article. Distractors in psychiatric questions are usually responses that are kind but not therapeutic, or actions that are correct but not first.
Browse by psychiatric nursing theme
Every question is on this page, grouped by topic; the theme index groups the topics the way courses and exams do. Each section links to the article that explains its rationales.
Therapeutic communication
Review: Therapeutic communication techniques and examples.
A patient on the unit says, 'The nurses are putting something in my food.' Which response is most therapeutic?
- 'Nobody here would do that — you're safe with us.'
- 'That sounds frightening. I'll sit with you while you eat something sealed.'
- 'Why do you think that?'
- 'Let's talk about something more pleasant.'
Answer: B. It acknowledges the feeling, does not argue with the delusion, and meets the physical need (nutrition) safely. A argues and reassures, C asks the patient to justify a delusion, D dismisses the concern.
A patient who has been tearful says, 'I'm fine, really.' The nurse notices the patient's hands are shaking. The most therapeutic response is:
- 'Good — I'm glad you're feeling better.'
- 'You say you're fine, and I notice your hands are shaking.'
- 'Why are you pretending to be fine?'
- 'Everyone has bad days; try not to dwell on it.'
Answer: B. Making an observation names the mismatch between words and body without judgement and invites the patient to say more. A accepts the words alone, C asks 'why' and accuses, D belittles the feeling.
Mania
Review: Mania nursing interventions and priorities.
A patient admitted in acute mania has been awake for four days, is pacing constantly and has eaten almost nothing. Which nursing action is the priority?
- Schedule the patient for the afternoon group discussion
- Offer high-calorie finger foods and fluids the patient can carry
- Explore the patient's feelings about the admission
- Set a limit that the patient must sit at the table for meals
Answer: B. Physiological needs and safety come first in mania; portable food meets the need without demanding stillness the patient cannot manage. A adds stimulation, C is insight work the patient cannot use yet, D sets an unrealistic limit that invites conflict.
A patient with bipolar disorder says the nurse is 'the only competent person on this unit' and asks for special visiting hours. The best response is:
- Grant the request to maintain rapport
- Explain that the same visiting rules apply to everyone, calmly and briefly
- Tell the patient that flattery will not work
- Ask the charge nurse to speak to the patient about manipulation
Answer: B. Consistent limits delivered calmly and briefly are the therapeutic response to manipulative or splitting behaviour in mania. A rewards the behaviour, C confronts harshly, D passes the interaction on and labels the patient.
Suicide risk
Review: Suicide risk assessment and nursing interventions.
Which change in a patient with depression should the nurse treat as an increase in suicide risk rather than improvement?
- Sleeping through the night for the first time
- Sudden calm and giving away belongings after weeks of hopelessness
- Asking to attend group therapy
- Eating a full breakfast
Answer: B. Sudden peace after prolonged hopelessness, together with giving away possessions, is a recognised warning sign that a decision may have been made. The other options are ordinary signs of recovery.
A patient admitted after a suicide attempt says, 'I have a plan and I'll do it as soon as I get out of here.' Which nursing action is most important?
- Ask the patient to sign a no-suicide contract
- Ensure continuous observation and remove potential means per policy, then notify the team
- Encourage the patient to attend the morning community meeting
- Document the statement and reassess at the end of the shift
Answer: B. A stated plan with intent is the highest-risk picture; immediate physical safety comes first. A contract is not protective, C ignores the risk, D delays action for hours.
Hallucinations
Review: Hallucinations: nursing interventions and therapeutic responses.
A patient is seen turning toward an empty corner and whispering. When approached, he says, 'They told me to stop taking my pills.' What should the nurse ask first?
- 'How long have you been hearing voices?'
- 'Do the voices tell you to do anything else, such as harm yourself or anyone?'
- 'Why do you think the voices don't want you to take medication?'
- 'Would you like to go to the dayroom for a distraction?'
Answer: B. A command hallucination is present; the priority is to assess the full content for danger to self or others. A gathers history after safety, C explores the hallucination as if rational, D skips assessment.
A patient with schizophrenia says, 'Can't you hear them laughing at me?' The most therapeutic response is:
- 'Yes, I can hear something too.'
- 'There's no one laughing — you're imagining it.'
- 'I don't hear anything, but I can see this is upsetting you.'
- 'Just ignore them and they'll stop.'
Answer: C. Presents reality once, without arguing, and acknowledges the feeling. A colludes, B argues and dismisses, D gives advice that does not work.
Lithium
Review: Lithium nursing considerations and patient teaching.
A patient stable on lithium starts a new fitness programme and reports sweating heavily during long runs, plus recent nausea and a shaky hand. The nurse's best action is:
- Advise the patient to drink sports drinks and continue training
- Recognise possible rising lithium levels, hold the dose per protocol and arrange a level
- Reassure the patient that a fine tremor is expected
- Suggest reducing salt intake to prevent fluid retention
Answer: B. Heavy sweating loses sodium and water, raising the lithium level; nausea with tremor is an early toxicity cue. A and C miss the cue; D would raise the level further.
Which statement by a patient starting lithium indicates correct understanding of monitoring?
- 'I only need blood tests if I feel unwell.'
- 'I'll have my level drawn before my morning dose, not after it.'
- 'Once my level is right, the tests can stop.'
- 'I'll take an extra dose on the day of the test so it reads correctly.'
Answer: B. Levels are trough values drawn before the next dose. A and C abandon scheduled monitoring; D falsifies the result and risks toxicity.
Clozapine
Review: Clozapine nursing considerations and ANC monitoring.
A patient who started clozapine three weeks ago reports feeling feverish with a sore throat and a 'racing heart' since yesterday. Which action should the nurse take first?
- Advise paracetamol and fluids and review at the next scheduled visit
- Arrange an urgent absolute neutrophil count and medical assessment for possible infection and myocarditis
- Reassure the patient that flu-like symptoms are common when starting antipsychotics
- Recommend the patient skip today's dose and see how they feel tomorrow
Answer: B. Fever and sore throat may signal neutropenia and, with palpitations early in treatment, possible myocarditis; both need same-day assessment. A, C and D delay detection of two potentially life-threatening reactions.
A patient restarting clozapine after missing four days of doses says, 'I'll just take my usual dose tonight.' The nurse should:
- Agree, since the patient knows the dose well
- Explain that the prescriber must direct a reduced restart dose and re-titration
- Tell the patient to take a double dose to catch up
- Advise waiting until the next blood test before restarting
Answer: B. After missed doses the prescribing information directs a reduced restart dose to avoid serious hypotension, syncope and seizures. A and C are unsafe; D delays treatment without addressing the dosing issue.
Antipsychotic adverse effects
Review: Antipsychotic side effects: EPS vs NMS vs tardive dyskinesia.
A patient started an antipsychotic recently and now has a high temperature, rigid muscles and a fluctuating level of consciousness. What is the nurse's priority?
- Reassess in one hour
- Encourage oral fluids and rest
- Withhold the next dose as directed and notify the provider immediately
- Offer a PRN anxiolytic
Answer: C. Fever, rigidity and altered consciousness after antipsychotic exposure are the classic picture of neuroleptic malignant syndrome, a medical emergency. The medication is held and the provider notified urgently; the other options delay treatment.
An hour after a first dose of a first-generation antipsychotic, a patient's jaw locks and his eyes roll upward. He is frightened and drooling. What should the nurse do first?
- Explain that this is tardive dyskinesia and usually permanent
- Stay with him, assess his airway and swallowing, and obtain urgent treatment as ordered
- Encourage deep breathing and reassess in 30 minutes
- Document the reaction and hold the next dose
Answer: B. This is acute dystonia, which can threaten the airway; it needs immediate assessment and treatment. A is the wrong diagnosis, C and D delay care.
During a routine movement screening, the nurse notices a patient on long-term antipsychotic therapy has begun making repetitive chewing and tongue-thrusting movements he is unaware of. The most appropriate action is to:
- Tell the patient to try to control the movements
- Record and report the findings promptly as possible tardive dyskinesia
- Increase the dose of the antipsychotic to suppress the movements
- Stop the antipsychotic immediately without informing the prescriber
Answer: B. Early recognition and reporting of tardive dyskinesia preserves the chance of recovery. A blames the patient, C may worsen it, D risks relapse and is outside the nurse's role.
Schizophrenia
Review: Schizophrenia nursing interventions and priorities.
A patient with schizophrenia sits alone all day, speaks in short phrases, shows little facial expression and has not showered in a week. The nurse understands these findings represent:
- Positive symptoms that will respond quickly to medication
- Negative symptoms that need structure, small goals and patience
- Manipulative behaviour to avoid unit activities
- Signs of lithium toxicity
Answer: B. Withdrawal, alogia, flat affect and poor self-care are negative symptoms, which respond less to medication and more to consistent structured nursing. A misclassifies them, C is a judgement, D is the wrong drug and picture.
A newly admitted patient believes the staff are impostors and flinches when approached. Which nursing approach is best?
- Approach quickly and firmly to establish authority
- Approach slowly from the front, introduce yourself each time, and keep interactions brief
- Explain in detail why the staff cannot be impostors
- Avoid the patient until the medication has taken effect
Answer: B. A calm, predictable, non-threatening approach reduces fear and the risk of defensive aggression. A and C increase threat and argue with the delusion; D abandons the patient's needs.
Bipolar disorder
Review: Bipolar disorder nursing care.
A patient with bipolar disorder whose mania has settled over the past week now says, 'I've ruined everything — my family will never trust me again.' Which nursing action is the priority?
- Reassure the patient that families usually forgive
- Ask directly about thoughts of suicide, plan and intent
- Encourage the patient to write an apology letter
- Document improved insight
Answer: B. The depressive swing after mania, with returning insight and shame, is a recognised high-risk period; suicide risk is assessed directly. A is false reassurance, C and D treat a warning sign as progress.
Before an antidepressant is started for a patient with depression, which nursing assessment question is most important for identifying bipolar disorder?
- 'How many hours do you usually sleep?'
- 'Have you ever had a period of several days when you needed very little sleep and felt full of energy?'
- 'Do you drink coffee in the evening?'
- 'Has anyone in your family had depression?'
Answer: B. A history of elevated-energy, reduced-sleep episodes points to bipolar disorder, in which an antidepressant alone can precipitate mania. The other questions are useful but do not screen for past mania.
Depression
Review: Depression nursing interventions.
A patient with severe depression started an antidepressant twelve days ago. He is now showering and eating but says he still 'can't see a future'. The nurse's priority is to:
- Reduce the observation level because self-care has improved
- Reassess suicide risk directly, since energy has returned before mood
- Praise the improvement and encourage group attendance
- Ask the prescriber to increase the dose
Answer: B. Returning energy with persisting hopelessness is the early-treatment window of raised risk. A lowers safety, C treats a warning sign as recovery, D is not the nurse's decision and does not address safety.
Which nursing approach is most therapeutic for a patient with depression who has not spoken during a one-to-one?
- Sitting quietly with the patient and allowing silence
- Telling the patient about other people who recovered
- Suggesting the patient try harder to talk
- Ending the session early to avoid pressure
Answer: A. Presence and deliberate silence communicate acceptance without demand. B shifts the focus, C pressures, D withdraws.
Anxiety
Review: Anxiety nursing interventions: levels of anxiety and nursing priorities.
A patient is trembling, hyperventilating and unable to answer questions, saying only 'I can't breathe.' Vital signs are being obtained. Which nursing action is most appropriate now?
- Ask what caused the episode
- Stay with the patient, speak in short calm sentences and guide slow breathing
- Teach the patient about panic disorder
- Leave the room to reduce stimulation
Answer: B. At the severe-to-panic level the patient cannot process questions or teaching; presence, simplicity and breathing guidance are the response. A and C need a lower level of anxiety; D removes support and observation.
A patient with moderate anxiety is pacing and says she cannot focus on the discharge instructions. The nurse should:
- Give the written instructions and leave
- Help her refocus with slow breathing and go through the instructions one point at a time
- Postpone discharge teaching indefinitely
- Request a sedative before continuing
Answer: B. At the moderate level the patient can follow direction when refocused. A abandons teaching, C is unnecessary, D over-treats.
SSRIs
Review: SSRI nursing considerations.
A patient taking an SSRI who recently started tramadol becomes agitated, sweaty and tremulous with a fever and a racing pulse. The nurse's priority is to:
- Give paracetamol and reassess in an hour
- Recognise possible serotonin syndrome, hold the drugs as directed and obtain urgent medical evaluation
- Encourage fluids and rest
- Reassure the patient that anxiety causes these symptoms
Answer: B. A new serotonergic drug with mental-status change, autonomic instability and neuromuscular signs is serotonin syndrome until proven otherwise — an emergency. The other options delay treatment.
A 20-year-old started an SSRI a week ago. Which report requires the most urgent nursing action?
- Nausea after the morning dose
- Trouble falling asleep
- New thoughts of self-harm and feeling 'wound up'
- A dry mouth
Answer: C. New suicidal thoughts with agitation early in treatment in a young adult is the boxed-warning picture requiring immediate assessment and notification. The others are common early effects to monitor.
Benzodiazepines
Review: Benzodiazepine nursing considerations.
A patient received a benzodiazepine and an opioid an hour apart and is now difficult to rouse, breathing slowly and shallowly. What should the nurse do first?
- Let the patient sleep and recheck at the next rounds
- Stimulate the patient, call for help, monitor respiratory rate and saturation, and prepare naloxone as ordered
- Give the next benzodiazepine dose early
- Document and hand over to the next shift
Answer: B. The opioid–benzodiazepine combination can cause profound sedation and respiratory depression; this is an emergency. The other options delay or worsen it.
A patient who takes a benzodiazepine every night at home is admitted and it is not on the orders. The best nursing action is to:
- Omit it because it is not ordered
- Contact the prescriber so it can be continued or tapered, to avoid withdrawal
- Offer warm milk instead
- Advise the patient to bring in their own supply
Answer: B. Abrupt discontinuation after regular use can precipitate a withdrawal syndrome including seizures; the prescriber must decide. The other options are unsafe.
Safety priorities and first nursing action
Review: Psychiatric nursing safety cluster.
Four patients need the nurse's attention. Whom should the nurse see first?
- A patient on lithium who asks about a low-salt diet
- A patient on clozapine reporting drooling at night
- A patient on an antipsychotic with a temperature of 39.8 °C and stiff limbs
- A patient with depression who wants to discuss discharge plans
Answer: C. Fever with rigidity on an antipsychotic suggests neuroleptic malignant syndrome — an emergency. A needs teaching soon, B is a common manageable effect, D is important but not urgent.
A patient in the dayroom is pacing, clenching his fists and shouting that another patient is 'sending thoughts' into his head. Which nursing action is first?
- Ask the other patient to leave the dayroom
- Calmly move the escalating patient to a quieter space, speaking briefly and keeping distance
- Explain that thought insertion is not possible
- Administer a PRN medication without speaking to the patient
Answer: B. Early de-escalation — reducing stimulation, calm brief communication, personal space — is the first action for rising agitation. A moves the wrong person, C argues with a delusion, D uses medication before verbal de-escalation and without assessment.
Score yourself, then read
Twenty-nine questions. If you missed any in a topic, that topic's article — linked at the top of its section — is the review. The study-method guide explains how to turn a wrong answer into a durable correction rather than a memorised fact.
Nursivelle materials are provided for educational and study purposes only. They are not a substitute for professional clinical judgment, institution-specific policies, instructor guidance, required course materials, or professional medical advice. Always follow your program's current references and your facility's protocols.
