Clinical Nurse Specialist Psychiatric & Mental Health Nursing 1 — Questions and Answers
Question 1: According to the DSM-5, how many symptoms of a major depressive episode must be present for at least two weeks to meet diagnostic criteria?
- At least 3 symptoms including depressed mood
- At least 5 symptoms, including depressed mood or anhedonia (Correct answer)
- At least 4 symptoms including sleep disturbance
- At least 6 symptoms including suicidal ideation
Correct answer: At least 5 symptoms, including depressed mood or anhedonia
DSM-5 requires at least 5 of 9 criteria symptoms present nearly every day for ≥2 weeks, and must include either depressed mood or anhedonia (loss of interest/pleasure).
Question 2: A CNS is assessing a patient for suicide risk. Which mnemonic is most commonly used in structured suicide risk assessment?
- SBAR
- IS PATH WARM (Correct answer)
- CIWA-Ar
- CAGE-AID
Correct answer: IS PATH WARM
IS PATH WARM (Ideation, Substance abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood changes) is an American Association of Suicidology mnemonic for assessing suicide warning signs.
Question 3: A patient with schizophrenia reports that the television is sending them special messages. This symptom is best classified as:
- Auditory hallucination
- Idea of reference (Correct answer)
- Thought broadcasting
- Persecutory delusion
Correct answer: Idea of reference
An idea of reference is a delusional belief that external events (such as TV broadcasts) have special personal meaning directed specifically at the individual.
Question 4: Which therapeutic communication technique is most appropriate when a patient with depression says, 'Nobody cares if I live or die'?
- Reassurance: 'Of course people care about you'
- Reflection: 'It sounds like you're feeling very alone and uncared for' (Correct answer)
- Redirection: 'Let's talk about something more positive'
- Information giving: 'Depression causes these types of thoughts'
Correct answer: Reflection: 'It sounds like you're feeling very alone and uncared for'
Reflection acknowledges and mirrors the patient's feelings without dismissing or deflecting, encouraging further expression and demonstrating empathic understanding.
Question 5: A patient on haloperidol develops muscle rigidity, fever of 104°F, altered consciousness, and autonomic instability. The CNS should suspect:
- Tardive dyskinesia
- Akathisia
- Neuroleptic malignant syndrome (Correct answer)
- Acute dystonia
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotics characterized by the tetrad of hyperthermia, muscle rigidity, altered mental status, and autonomic instability.
Question 6: In the mental status examination (MSE), a patient who describes their thoughts jumping from topic to topic with loose connections between ideas demonstrates which finding?
- Flight of ideas
- Loose associations (Correct answer)
- Tangentiality
- Circumstantiality
Correct answer: Loose associations
Loose associations (also called derailment) refers to a pattern of thinking where the connections between ideas are unclear or illogical, characteristic of psychotic disorders such as schizophrenia.
Question 7: A CNS applying the recovery model to a patient with bipolar disorder would prioritize which intervention?
- Ensuring medication compliance through close monitoring
- Empowering the patient to identify personal strengths and set their own recovery goals (Correct answer)
- Educating family members on how to supervise the patient's behavior
- Focusing treatment on symptom elimination before addressing quality of life
Correct answer: Empowering the patient to identify personal strengths and set their own recovery goals
The recovery model emphasizes patient empowerment, self-determination, and hope, focusing on the individual's strengths and ability to pursue meaningful life goals beyond symptom management.
Clinical Nurse Specialist Psychiatric & Mental Health Nursing 1
According to the DSM-5, how many symptoms of a major depressive episode must be present for at least two weeks to meet diagnostic criteria?