Clinical Nurse Specialist Psychiatric & Mental Health Nursing 2

Question 1

A patient with borderline personality disorder engages in splitting by telling the night nurse that the day nurse is 'incompetent and cruel.' The most therapeutic CNS response to the team is to:

Accepted Answer

Implement consistent limit-setting and unified team communication strategies

Answer

Investigate whether the day nurse was actually harmful

Answer

Allow the patient to vent feelings without team involvement

Answer

Reassign the patient to a nurse they prefer

Question 2

Which of the following is the FIRST priority intervention when de-escalating a verbally aggressive patient in an inpatient psychiatric unit?

Accepted Answer

Ensure personal safety and position yourself near the exit

Answer

Administer an oral PRN benzodiazepine

Answer

Establish a therapeutic alliance through verbal intervention

Answer

Call for additional staff to stand nearby as a show of force

Question 3

A patient with post-traumatic stress disorder (PTSD) is experiencing hypervigilance, nightmares, and avoidance of trauma reminders. Which first-line evidence-based psychotherapy is recommended by VA/DoD clinical practice guidelines?

Accepted Answer

Prolonged Exposure (PE) therapy

Answer

Psychodynamic therapy

Answer

Dialectical Behavior Therapy (DBT)

Answer

Interpersonal therapy (IPT)

Question 4

A CNS assessing a patient for alcohol use disorder uses the CIWA-Ar scale. A score of 15 on this scale indicates:

Accepted Answer

Moderate withdrawal requiring pharmacological intervention

Answer

Mild withdrawal requiring observation only

Answer

Severe withdrawal with imminent seizure risk requiring ICU transfer

Answer

No withdrawal symptoms; patient is stable for discharge

Question 5

The use of physical restraints in an inpatient psychiatric setting requires which of the following per The Joint Commission standards?

Accepted Answer

Face-to-face evaluation within one hour of restraint initiation

Answer

Standing order from the attending physician

Answer

Nursing supervisor approval before application

Answer

Patient consent documented in the chart

Question 6

A patient taking lithium for bipolar disorder presents with coarse tremor, confusion, and ataxia. The serum lithium level is 2.1 mEq/L. The CNS should anticipate:

Accepted Answer

Immediate discontinuation and supportive treatment for toxicity

Answer

Increasing the lithium dose to achieve therapeutic effect

Answer

Holding the next lithium dose and monitoring symptoms closely

Answer

Administering flumazenil as an antidote

Question 7

Cognitive Behavioral Therapy (CBT) for depression primarily targets which mechanism to reduce depressive symptoms?

Accepted Answer

Maladaptive thought patterns and their influence on behavior and emotions

Answer

Unconscious conflicts from early childhood experiences

Answer

Interpersonal role disputes and transitions affecting mood

Answer

Neurochemical imbalances corrected through behavioral activation alone