Mental Health and Psychiatric Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Depression, Suicide Risk, Psychosis, Bipolar Disorder, Anxiety, Delirium, Dementia, Substance Withdrawal, Psychotropic Drugs and Therapeutic Communication

Mental health is 5 to 8% of the registered nurse paper, about 8 to 12 questions, and it is where many medical-surgical nurses lose easy marks because they have not worked in psychiatry since training. The questions are not obscure: suicide risk, antipsychotic side effects, lithium, delirium versus dementia, alcohol withdrawal and therapeutic communication. Psychiatrists sit a different paper (psychiatry specialist questions).

Therapeutic communication and safety

Question 1

A patient says, "There is no point in anything anymore. Everyone would be better off without me." The best nursing response is:

1. "Don't say that, you have so much to live for."
2. "It sounds like you are feeling hopeless. Are you having thoughts of ending your life?" followed by a direct assessment of plan, means, intent and protective factors, and immediate escalation
3. Change the subject to something cheerful
4. "Everyone feels like that sometimes."

Answer: B. Asking directly about suicide does not increase risk; minimising, reassuring and changing the subject are non-therapeutic responses tested as wrong answers.

Question 2

A patient admitted after an overdose is assessed as high risk for suicide. The appropriate nursing safety measures include:

1. Hourly checks and a private room with a bathroom door that locks
2. Continuous one-to-one observation, removal of ligature points, sharps, belts, cords and medications from the environment, checking belongings and visitors' items, and a documented safety plan reviewed each shift
3. Discharge with an outpatient appointment
4. Promising the patient secrecy about the attempt

Answer: B. The period immediately after admission and the days after mood appears to lift (when energy returns) are high-risk times.

Question 3

Which patient has the highest static risk factors for completed suicide?

1. A 22-year-old woman with no psychiatric history
2. A 58-year-old man, recently divorced, unemployed, with alcohol dependence, a previous serious attempt and chronic pain
3. A 30-year-old woman with mild anxiety
4. A 16-year-old with good family support

Answer: B. Male sex, older age, previous attempts, substance use, social isolation, chronic illness and recent loss are the recognised risk factors; a previous attempt is the strongest single predictor.

Question 4

A patient on the ward is pacing, shouting and clenching their fists. The first-line approach is:

1. Immediate physical restraint by security
2. Verbal de-escalation: a calm, non-threatening stance at a safe distance, one staff member speaking, acknowledging the patient's feelings, offering choices and a quieter space, removing bystanders, and oral medication offered before any involuntary measure
3. Threaten the patient with seclusion
4. Ignore the behaviour

Answer: B. Restraint and seclusion are last resorts, time-limited, require a physician order, continuous monitoring of circulation and respiration, and documentation; prone restraint is avoided.

Mood disorders

Question 5

A patient started on sertraline for depression two weeks ago says it is not working. The nurse explains:

1. The drug has failed and should be stopped today
2. Antidepressants usually take 2 to 4 weeks for mood benefit and up to 6 to 8 weeks for full effect; early side effects (nausea, headache, restlessness) often settle, treatment continues at least 6 to 12 months after recovery, and stopping suddenly can cause discontinuation symptoms
3. Double the dose immediately
4. Take the tablet only on bad days

Answer: B. Energy may return before mood improves, which can briefly raise suicide risk, so early follow-up is scheduled.

Question 6

A patient on a monoamine oxidase inhibitor must avoid which foods?

1. Fresh fruit and rice
2. Tyramine-rich foods such as aged cheese, cured and fermented meats, soy sauce, fermented products, tap beer and yeast extracts, because of hypertensive crisis
3. Dairy products of all kinds
4. Bread

Answer: B. MAOIs also interact dangerously with other antidepressants, pethidine and decongestants; a washout period is needed when switching.

Question 7

A patient with bipolar disorder on lithium has coarse tremor, vomiting, diarrhoea, ataxia and confusion after a week of fever and poor fluid intake. The nurse should:

1. Give the next lithium dose and encourage rest
2. Withhold lithium, notify the physician urgently, obtain a lithium level, electrolytes and renal function, and support hydration, because these are signs of lithium toxicity (usually above 1.5 mmol/L; severe above 2.0)
3. Give an antiemetic only
4. Restrict fluids

Answer: B. Dehydration, sodium depletion, NSAIDs, ACE inhibitors and thiazides raise lithium levels. Routine monitoring includes lithium levels, renal and thyroid function, and calcium; the therapeutic range is about 0.6 to 1.0 mmol/L.

Question 8

A patient in acute mania has not slept for three days, is talking rapidly, spending recklessly and is too distractible to eat. Nursing priorities include:

1. Group activities to use up energy
2. A low-stimulation environment, finger foods and high-calorie drinks that can be eaten on the move, brief clear communication, consistent limits, protecting the patient from the consequences of impulsivity, and administering prescribed mood stabilisers or antipsychotics
3. Lengthy discussion of the patient's plans
4. Caffeine to help concentration

Answer: B. Antidepressants are avoided in mania because they can worsen it.

Psychosis and antipsychotics

Question 9

A patient with schizophrenia says, "The television is sending me messages telling me the staff are poisoning my food." The most therapeutic response is:

1. "That is not true; the television cannot send messages."
2. "I understand that this feels very real and frightening to you. I don't hear the messages myself. You are safe here, and I'll stay with you." Then offer sealed or self-selected food if it helps the patient eat
3. Agree that the food may be poisoned
4. Laugh and reassure

Answer: B. Neither argue with nor reinforce delusions; acknowledge the feeling, present reality gently and focus on safety.

Question 10

Two days after starting haloperidol, a young man develops a painful sustained upward deviation of the eyes and twisting of the neck. The nurse recognises and anticipates:

1. Tardive dyskinesia; no treatment
2. Acute dystonia (oculogyric crisis, torticollis); an anticholinergic such as intramuscular or intravenous procyclidine or benztropine, which relieves it within minutes
3. A seizure; diazepam
4. Malingering

Answer: B. Extrapyramidal effects: acute dystonia (hours to days), akathisia (restlessness, weeks), parkinsonism (weeks) and tardive dyskinesia (months to years, often irreversible).

Question 11

A patient on an antipsychotic has a temperature of 40 °C, severe muscle rigidity, fluctuating consciousness, sweating, a labile blood pressure and a creatine kinase of 9,000 U/L. The nurse should:

1. Give the next antipsychotic dose
2. Stop the antipsychotic, call for urgent medical help and prepare for ICU care with cooling, intravenous fluids, and dantrolene or bromocriptine, because this is neuroleptic malignant syndrome
3. Give paracetamol and recheck in four hours
4. Apply restraints for the rigidity

Answer: B. Serotonin syndrome, by contrast, follows serotonergic drugs and shows hyperreflexia, clonus and diarrhoea with a faster onset.

Question 12

A patient is started on clozapine for treatment-resistant schizophrenia. The essential monitoring is:

1. Annual blood tests
2. Regular white cell and neutrophil counts (weekly initially, then less often) because of agranulocytosis, plus monitoring for myocarditis in the first weeks, constipation and bowel obstruction, hypersalivation, seizures, weight and metabolic parameters; any fever or sore throat is reported immediately
3. Lithium levels
4. Thyroid function only

Answer: B. Clozapine is dispensed only with a satisfactory blood result; smoking cessation raises clozapine levels.

Question 13

A patient on olanzapine has gained 12 kg in six months. The nurse should:

1. Tell the patient to stop the drug
2. Monitor weight, waist circumference, blood pressure, fasting glucose or HbA1c and lipids per protocol, offer dietary and activity support, and inform the prescriber so metabolic risk can be reviewed and a switch considered
3. Ignore it; weight gain is unavoidable
4. Prescribe a diuretic

Answer: B. Metabolic syndrome is common with second-generation antipsychotics, a concern in a region with high diabetes prevalence.

Anxiety, trauma and eating disorders

Question 14

A patient is hyperventilating, trembling, has palpitations and says they are dying. Cardiac causes have been excluded. The best initial nursing intervention is:

1. Leave the patient alone to calm down
2. Stay with the patient, speak calmly in short sentences, guide slow controlled breathing, reduce stimulation, and once the attack passes teach that panic peaks within about 10 minutes and is not dangerous; benzodiazepines are short-term only, with SSRIs and cognitive behavioural therapy for long-term treatment
3. Give a paper bag to breathe into
4. Tell the patient it is all in their head

Answer: B. Paper-bag rebreathing is no longer recommended; benzodiazepine dependence develops within weeks.

Question 15

A 17-year-old girl weighs 38 kg at 165 cm (BMI 14), has a heart rate of 42, blood pressure 80/50, a potassium of 2.8 mmol/L and denies that anything is wrong. The nurse's priorities are:

1. Encourage a large meal immediately
2. Recognise medical instability from anorexia nervosa requiring admission, cardiac monitoring, electrolyte correction, and cautious graded refeeding with phosphate monitoring to prevent refeeding syndrome, with supervised meals and a non-judgemental approach
3. Discharge with diet advice
4. Confront the patient about lying

Answer: B. Bradycardia below 40 to 50, hypotension, hypothermia, hypokalaemia and hypophosphataemia are admission criteria; refeeding syndrome can be fatal in the first week.

Organic and substance-related conditions

Question 16

An 80-year-old admitted with a urinary tract infection becomes acutely confused overnight, pulling at lines, seeing insects on the wall, with fluctuating alertness. The most likely diagnosis and nursing management are:

1. Dementia; refer to a nursing home
2. Delirium; treat the cause, review medications, ensure glasses and hearing aids, orientation cues (clock, calendar, daylight), familiar faces, sleep hygiene, hydration, mobilisation, avoiding restraints and catheters, with low-dose antipsychotic only for severe distress or danger
3. Schizophrenia; start antipsychotics long term
4. Depression; antidepressants

Answer: B. Delirium is acute, fluctuating and reversible; dementia is gradual and progressive with clear consciousness. Benzodiazepines worsen delirium except in alcohol withdrawal.

Question 17

A patient with Alzheimer's dementia becomes agitated every evening and tries to leave the ward to "go home to cook for the children." The best approach is:

1. Correct the patient firmly that the children are adults
2. Recognise sundowning; use a calm reassuring approach, redirect to a meaningful activity, reduce evening noise and lighting changes, meet needs such as toileting, pain or hunger, and avoid arguing or restraint
3. Sedate with diazepam each evening
4. Lock the patient in the room

Answer: B. Validation and redirection work better than reality orientation in moderate to severe dementia.

Question 18

A patient admitted for surgery discloses heavy daily alcohol use. Forty-eight hours later they are tremulous, sweating, tachycardic, anxious and seeing things. The nurse anticipates:

1. No treatment; it will pass
2. Alcohol withdrawal progressing towards delirium tremens; symptom-triggered benzodiazepines (for example chlordiazepoxide or diazepam using the CIWA-Ar scale), thiamine before any glucose to prevent Wernicke's encephalopathy, fluids and electrolytes, and seizure precautions
3. Antipsychotics alone
4. Giving alcohol

Answer: B. Withdrawal seizures occur at 6 to 48 hours and delirium tremens at 48 to 96 hours. In Gulf countries alcohol use is sensitive and sometimes concealed; a non-judgemental history matters.

Perinatal mental health and ethics

Question 19

Two weeks after delivery, a mother is tearful, not sleeping even when the baby sleeps, feels worthless, and says she is a bad mother who does not deserve the baby. The nurse recognises:

1. Normal "baby blues," which need no action
2. Probable postnatal depression requiring screening (for example the Edinburgh Postnatal Depression Scale), assessment of thoughts of harming herself or the baby, and referral; any confusion, hallucinations or delusions would suggest postpartum psychosis, a psychiatric emergency
3. Postpartum psychosis; immediate sedation
4. Anaemia

Answer: B. Baby blues peak at day 3 to 5 and resolve within two weeks; depression persists and impairs function.

Question 20

A competent adult patient with depression refuses a prescribed medication. The nurse should:

1. Hide the medication in food
2. Respect the refusal, explore the reasons, provide information, document the refusal and inform the prescriber, because a competent patient has the right to refuse; covert medication is unethical and unlawful unless a formal incapacity and best-interest process applies
3. Threaten to withhold visits
4. Give it by injection

Answer: B. Gulf mental health laws (for example the UAE Mental Health Law of 2023) set rules for involuntary admission, treatment, confidentiality and patient rights; involuntary treatment requires the legal process, not a nurse's decision.

How to practise

• Learn therapeutic versus non-therapeutic responses: the exam rewards acknowledging feelings, open questions and presenting reality, and penalises false reassurance, arguing and giving advice.
• Know the drug safety: lithium range and toxicity, antipsychotic side effects by onset, clozapine monitoring, MAOI foods, serotonin syndrome versus neuroleptic malignant syndrome.
• Distinguish the organic conditions: delirium, dementia, alcohol withdrawal, and the emergencies within them.

Mental health chapters with explanations are in the Registered Nurse bank; related sets are the pharmacology questions, medical-surgical questions and general nursing questions. Psychiatric nurses looking at Gulf posts should also read mental health careers in the Gulf.

Frequently asked questions

How many mental health questions are in the Prometric nursing exam?

About 8 to 12 of 150, within the mental health and psychosocial domain.

Which mental health topics come up most?

Therapeutic communication, suicide risk and safety, antipsychotic side effects, lithium, delirium versus dementia and alcohol withdrawal.

Are questions on Gulf mental health laws included?

Occasionally, at the level of principles: consent, confidentiality, the right to refuse treatment and the legal basis for involuntary treatment.

Do medical-surgical nurses need to study psychiatry?

Yes. The registered nurse paper covers the whole blueprint, and these are among the most predictable marks on it.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.