Clinical Nurse Specialist Psychiatric & Mental Health Nursing 3

Question 1

A CNS must differentiate between delirium and dementia in an older adult patient. Which feature most strongly suggests delirium rather than dementia?

Accepted Answer

Acute onset with fluctuating level of consciousness

Answer

Gradual onset over months to years

Answer

Impaired long-term memory as the primary deficit

Answer

Preserved orientation with personality changes

Question 2

A patient with anorexia nervosa has a serum potassium of 2.8 mEq/L and QTc interval of 490 ms on ECG. The CNS should immediately prioritize:

Accepted Answer

Cardiac monitoring and electrolyte replacement to prevent life-threatening arrhythmias

Answer

Initiating oral nutritional supplementation and re-checking labs in 24 hours

Answer

Psychiatric consultation for involuntary hospitalization

Answer

Initiating an SSRI to address underlying anxiety and OCD traits

Question 3

Which of the following best describes the primary goal of Dialectical Behavior Therapy (DBT)?

Accepted Answer

Developing biosocial coping skills balancing acceptance and change for emotionally dysregulated patients

Answer

Exploring childhood trauma to resolve unconscious conflicts

Answer

Exposing patients to feared stimuli to reduce anxiety through habituation

Answer

Correcting irrational beliefs using Socratic questioning

Question 4

A CNS is caring for a patient scheduled for electroconvulsive therapy (ECT). Which nursing intervention is essential immediately BEFORE the procedure?

Accepted Answer

Ensure the patient has been NPO for the required fasting period

Answer

Administer a prophylactic anticonvulsant medication

Answer

Obtain a new informed consent immediately before each treatment

Answer

Apply bilateral EEG leads and confirm the electrical dose

Question 5

A patient with schizophrenia who is stabilized on clozapine requires which mandatory monitoring due to a potentially fatal adverse effect?

Accepted Answer

Weekly to biweekly absolute neutrophil count (ANC) to monitor for agranulocytosis

Answer

Monthly liver function tests to screen for hepatotoxicity

Answer

Biannual renal function panels to assess nephrotoxicity

Answer

Daily blood pressure checks to monitor for hypertensive crisis

Question 6

Under the concept of duty to warn (Tarasoff ruling), a CNS is legally and ethically obligated to act when a patient:

Accepted Answer

Makes a specific, credible threat of serious harm to an identifiable third party

Answer

Expresses general frustration and anger toward a family member

Answer

Has a history of violence documented in prior medical records

Answer

Refuses to take prescribed medications that manage aggressive impulses

Question 7

A CNS implementing trauma-informed care on an inpatient psychiatric unit should emphasize which of the following core principles?

Accepted Answer

Safety, trustworthiness, peer support, collaboration, empowerment, and cultural sensitivity

Answer

Strict behavioral contracts to establish clear consequences for rule violations

Answer

Focusing treatment on trauma processing before addressing current symptoms

Answer

Maintaining professional distance to prevent transference issues