These 30 psychiatric nursing questions and answers cover the mental health topics that appear most often in NMCN, NCLEX, NMC CBT and Prometric exams: therapeutic communication, schizophrenia, mood disorders, suicide risk, psychotropic medicines, substance withdrawal and legal and ethical care. Try each question before reading the answer.
Therapeutic communication
1. A patient says, “Nobody cares whether I live or die.” The best response is:
A. “Of course people care about you.”
B. “You’re feeling that no one cares. Are you thinking about ending your life?”
C. “Let’s talk about something more positive.”
D. “Why do you feel that way?”
Answer: B. Reflect the feeling and ask directly about suicide. Asking does not plant the idea; it opens the conversation.
2. Which is a non-therapeutic response?
A. “Tell me more.”
B. “I see.”
C. “Don’t worry, everything will be fine.”
D. “You seem upset.”
Answer: C. False reassurance dismisses the patient’s feelings.
3. A patient with schizophrenia says, “The TV is sending me messages.” The best response is:
A. “That’s impossible.”
B. “What are the messages saying?”
C. “I don’t hear any messages, but you seem frightened. Let’s talk about how you’re feeling.”
D. “Let’s turn off the TV so the messages stop.”
Answer: C. Do not argue with or reinforce a delusion; present reality and focus on feelings.
4. The best way to start a therapeutic relationship is to:
A. Share personal problems to build trust
B. Set clear boundaries, introduce yourself and explain the purpose of meetings
C. Avoid silence
D. Give advice early
Answer: B. The orientation phase establishes trust, roles and boundaries.
Schizophrenia and antipsychotics
5. Which is a positive symptom of schizophrenia?
A. Flat affect
B. Alogia
C. Auditory hallucinations
D. Avolition
Answer: C. Positive symptoms are added experiences: hallucinations, delusions, disorganised speech.
6. A patient on haloperidol has a rigid neck and eyes rolled upward. This is:
A. Tardive dyskinesia
B. Acute dystonia
C. Akathisia
D. Neuroleptic malignant syndrome
Answer: B. Acute dystonia appears early and is treated with an anticholinergic such as procyclidine or benztropine as prescribed.
7. High fever, muscle rigidity, confusion and unstable blood pressure in a patient on antipsychotics suggest:
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Answer: B. NMS is an emergency: stop the antipsychotic and escalate immediately.
8. Which blood test is essential for a patient on clozapine?
A. Liver function
B. Full blood count (white cells and neutrophils)
C. Thyroid function
D. Serum lithium
Answer: B. Clozapine can cause agranulocytosis, so neutrophil monitoring is mandatory.
9. Involuntary lip smacking and tongue movements after years on antipsychotics indicate:
A. Tardive dyskinesia
B. Parkinsonism
C. Dystonia
D. Akathisia
Answer: A. Tardive dyskinesia is a late, sometimes permanent side effect.
Mood disorders and lithium
10. The usual therapeutic range for lithium maintenance is about:
A. 0.1–0.3 mmol/L
B. 0.4–1.0 mmol/L
C. 1.5–2.0 mmol/L
D. 2.5–3.0 mmol/L
Answer: B. Local ranges vary, commonly 0.4–1.0 mmol/L. Levels above 1.5 mmol/L risk toxicity.
11. Which sign suggests lithium toxicity?
A. Fine hand tremor only
B. Coarse tremor, vomiting, diarrhoea and confusion
C. Weight gain
D. Thirst
Answer: B. Fine tremor and thirst are common side effects; coarse tremor with GI symptoms and confusion signals toxicity.
12. Which advice is correct for a patient on lithium?
A. Restrict salt strictly
B. Keep fluid and salt intake steady and avoid dehydration
C. Take ibuprofen freely for pain
D. Stop it when you feel well
Answer: B. Dehydration, low salt and NSAIDs raise lithium levels.
13. A depressed patient suddenly seems calm and gives away belongings. The nurse should:
A. Document improvement
B. Reduce observation
C. Assess suicide risk urgently and increase observation
D. Plan discharge
Answer: C. Sudden calm and giving away possessions can mean a decision to die.
14. The priority for a patient in acute mania is:
A. Group therapy
B. Safety, nutrition, hydration and rest
C. Insight-oriented therapy
D. Long discussions
Answer: B. Manic patients may not eat, drink or sleep and can be exhausted or injured.
15. Which food must a patient on a monoamine oxidase inhibitor (MAOI) avoid?
A. Fresh chicken
B. Aged cheese
C. Rice
D. Fresh fruit
Answer: B. Tyramine-rich foods (aged cheese, cured meats, some fermented products) can cause a hypertensive crisis.
16. Agitation, fever, sweating and muscle twitching after adding tramadol to an SSRI suggest:
A. Serotonin syndrome
B. NMS
C. Hypoglycaemia
D. Alcohol withdrawal
Answer: A. Combining serotonergic drugs can cause serotonin syndrome.
Anxiety, personality and eating disorders
17. During a panic attack, the nurse should first:
A. Teach relaxation theory
B. Stay with the patient, speak calmly and guide slow breathing
C. Leave the patient alone
D. Ask why they are anxious
Answer: B. Ensure safety and reduce anxiety before teaching.
18. A patient with borderline personality disorder praises one nurse and criticises all others. This is:
A. Projection
B. Splitting
C. Denial
D. Regression
Answer: B. Respond with consistent team boundaries.
19. A priority risk in the early refeeding of a patient with anorexia nervosa is:
A. Hyperkalaemia
B. Refeeding syndrome with low phosphate
C. Hypertension
D. Weight gain too slowly
Answer: B. Monitor phosphate, potassium and magnesium closely.
Substance use
20. Alcohol withdrawal symptoms typically begin within:
A. 6–24 hours of the last drink
B. 5 days
C. 2 weeks
D. 1 month
Answer: A. Seizures may occur within 48 hours and delirium tremens around 48–72 hours.
21. Which vitamin is given to prevent Wernicke’s encephalopathy?
A. Vitamin C
B. Thiamine (vitamin B1)
C. Vitamin K
D. Folate
Answer: B. Give thiamine, ideally before glucose.
22. The antidote for opioid overdose is:
A. Flumazenil
B. Naloxone
C. Atropine
D. Protamine
Answer: B. Naloxone may wear off before the opioid, so keep observing.
23. Pinpoint pupils, slow breathing and drowsiness suggest:
A. Amphetamine use
B. Opioid overdose
C. Cannabis intoxication
D. Alcohol withdrawal
Answer: B.
Suicide and self-harm
24. Which is the strongest predictor of suicide?
A. Female sex
B. A previous suicide attempt
C. Being married
D. Young age alone
Answer: B. A previous attempt greatly increases risk.
25. A patient has a specific plan and access to means. The nurse should:
A. Promise to keep it secret
B. Remove means, keep the patient under close observation and inform the team immediately
C. Schedule a review next week
D. Ask the family to watch the patient at home
Answer: B. Confidentiality does not apply when life is at risk.
Legal, ethical and other
26. The least restrictive principle means:
A. Using restraint first to prevent harm
B. Choosing the option that limits the patient’s freedom the least while keeping them safe
C. Admitting all patients compulsorily
D. Avoiding medication
Answer: B.
27. The first step in de-escalating an agitated patient is:
A. Call security to restrain
B. Approach calmly, keep a safe distance, use a low voice and listen
C. Give an injection
D. Argue the facts
Answer: B. Restraint and rapid tranquillisation are last resorts.
28. Electroconvulsive therapy (ECT) is most often used for:
A. Mild anxiety
B. Severe, treatment-resistant depression
C. Personality disorder
D. Insomnia
Answer: B. Common short-term side effects include headache and memory loss.
29. A patient believes she is the Queen of England. This is a delusion of:
A. Persecution
B. Grandeur
C. Reference
D. Control
Answer: B.
30. Stigma towards mental illness is best reduced by:
A. Avoiding talking about it
B. Using person-first language and accurate education
C. Calling patients by their diagnosis
D. Separating psychiatric units from communities
Answer: B. Say “a person living with schizophrenia,” not “a schizophrenic.”
Exam tips for psychiatric nursing
- Safety first: suicide risk and violence beat every other priority.
- Choose answers that focus on feelings and do not argue with delusions.
- Learn the side effects that are emergencies: NMS, serotonin syndrome, lithium toxicity, agranulocytosis.
Related reading: Psychosis and schizophrenia nursing care · Suicide risk assessment for nurses · Pharmacology nursing questions and answers
Drug ranges vary by country and hospital. Always follow your local policy.