CPEN Psychosocial Emergencies 2 — Questions and Answers
Question 1: A 14-year-old presents after ingesting 20 acetaminophen tablets. She states she 'just wanted to sleep.' Which initial nursing action is the priority?
- Administer activated charcoal immediately
- Obtain a psychiatric consult
- Assess suicide intent using a validated tool such as the Columbia Suicide Severity Rating Scale (Correct answer)
- Notify child protective services
Correct answer: Assess suicide intent using a validated tool such as the Columbia Suicide Severity Rating Scale
A structured suicide risk assessment using a validated tool is the priority to determine immediate safety needs and guide management.
Question 2: Which behavior in a 10-year-old brought to the ED after a house fire is MOST consistent with acute stress disorder?
- Crying and clinging to a parent
- Repeatedly re-enacting the fire in play (Correct answer)
- Complaining of stomach pain
- Refusing to answer questions
Correct answer: Repeatedly re-enacting the fire in play
Repetitive trauma re-enactment in play is a hallmark dissociative/intrusive symptom of acute stress disorder in school-age children.
Question 3: A 7-year-old with autism spectrum disorder arrives in the ED in behavioral crisis, screaming and hitting staff. The FIRST intervention should be:
- Administer lorazepam IM
- Place the child in a quiet, low-stimulation room (Correct answer)
- Apply physical restraints to prevent injury
- Perform a full neurological assessment
Correct answer: Place the child in a quiet, low-stimulation room
Reducing environmental sensory stimuli is the first non-pharmacological intervention for children with ASD in behavioral crisis.
Question 4: During triage, a mother states her 5-year-old 'has not been the same' since witnessing domestic violence last month. The nurse recognizes this as a potential sign of:
- Oppositional defiant disorder
- Post-traumatic stress disorder (Correct answer)
- Separation anxiety disorder
- Attention deficit hyperactivity disorder
Correct answer: Post-traumatic stress disorder
Behavioral change following a traumatic event such as witnessing domestic violence is a classic presentation of PTSD in young children.
Question 5: A 16-year-old male with depression is being discharged after a suicidal ideation evaluation. Which discharge instruction is MOST important for lethal means reduction?
- Schedule a follow-up appointment within two weeks
- Ensure all firearms and medications are secured or removed from the home (Correct answer)
- Provide a list of crisis hotline numbers
- Instruct the patient to call 911 if symptoms worsen
Correct answer: Ensure all firearms and medications are secured or removed from the home
Lethal means counseling, specifically securing or removing firearms and medications, is the most evidence-based strategy to reduce suicide risk at home.
Question 6: A 3-year-old is brought in by a caregiver with bruises in various stages of healing. The child is withdrawn and does not make eye contact. The nurse should FIRST:
- Ask the caregiver directly if abuse occurred
- Document observations and notify the provider and social worker (Correct answer)
- Photograph the injuries and discharge the patient
- Separate the child from the caregiver for a private interview
Correct answer: Document observations and notify the provider and social worker
Documenting objective findings and involving the multidisciplinary team (provider and social worker) is the appropriate first nursing action when child abuse is suspected.
Question 7: Which of the following is the MOST appropriate de-escalation technique for an agitated 12-year-old in the ED?
- Speak in a loud, firm voice to establish authority
- Use open-ended questions and a calm, low tone while maintaining personal space (Correct answer)
- Involve multiple staff members to show control of the situation
- Immediately offer oral medication to reduce agitation
Correct answer: Use open-ended questions and a calm, low tone while maintaining personal space
Verbal de-escalation using a calm tone, open-ended questions, and respecting personal space reduces agitation without escalating the situation.
CPEN Psychosocial Emergencies 2
A 14-year-old presents after ingesting 20 acetaminophen tablets.
She states she 'just wanted to sleep.' Which initial nursing action is the priority?