HESI Psychiatric

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Sample questions from HESI Psychiatric

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A client admitted for major depressive disorder says, "My family would be better off if I were gone." Which response should the nurse make first?

   • A.Your family would be very upset if you died.
   • B.Are you thinking about killing yourself?
   • C.Tell me about the conflicts you have with your family.
   • D.Try to identify three reasons your life is valuable.

   Rationale: The statement suggests suicidal thinking and requires direct assessment of suicide risk. Asking about suicide does not cause suicidal behavior and helps clarify immediate safety needs. Emphasizing the family's distress may increase guilt, while exploring family conflict or identifying reasons to live delays the initial risk assessment. The priority is to ask directly, then assess intent, plan, access to means, and protective factors.

2. 2.A client reports hearing a voice that says, "Use your belt to strangle yourself." Which nursing action has the highest priority?

   • A.Ask the client to write down when the voice occurs.
   • B.Explain that the voice is a symptom of schizophrenia.
   • C.Offer headphones to distract the client from the voice.
   • D.Remain with the client and initiate immediate suicide precautions.

   Rationale: A command hallucination directing self-harm represents an immediate safety threat. The nurse should remain with the client, restrict access to potential means of injury, and activate appropriate observation and assessment procedures. Recording symptoms, providing education, and using distraction may be helpful later but do not adequately address the immediate danger. Safety takes priority over symptom-management teaching.

3. 3.A client with schizophrenia states, "The television announcer is sending secret warnings directly to me." Which response is most therapeutic?

   • A.That sounds frightening. I do not receive personal messages from the television.
   • B.The announcer cannot possibly know who you are.
   • C.What secret instructions is the announcer giving you?
   • D.You should stop watching television until these thoughts go away.

   Rationale: The nurse acknowledges the client's distress while briefly presenting reality without endorsing the delusion. Arguing about what is possible can increase defensiveness, and asking for secret instructions may reinforce the belief. Telling the client to stop watching television avoids the underlying concern and unnecessarily restricts activity. Therapeutic responses validate feelings without validating delusional content.

4. 4.Which finding in a client with schizophrenia is classified as a negative symptom?

   • A.Believing that coworkers are poisoning food
   • B.Hearing two voices discussing the client's behavior
   • C.Showing little facial expression and speaking very little
   • D.Using unrelated words that make speech difficult to understand

   Answer and rationale are in the full material.

5. 5.Three days after starting haloperidol, a client develops a temperature of 103.1 F, severe generalized muscle rigidity, confusion, and fluctuating blood pressure. Which action should the nurse take first?

   • A.Administer the next dose with an antipyretic.
   • B.Withhold haloperidol and activate urgent medical evaluation.
   • C.Give a prescribed anticholinergic and reassess in one hour.
   • D.Encourage oral fluids and reduce environmental stimulation.

   Answer and rationale are in the full material.