CPNRE Mental Health Nursing Concepts 2 — Questions and Answers
Question 1: A client with schizophrenia insists that the television is sending them personal messages. Which type of symptom is this?
- Negative symptom (flat affect)
- Negative symptom (alogia)
- Positive symptom (delusion of reference) (Correct answer)
- Positive symptom (hallucination)
Correct answer: Positive symptom (delusion of reference)
A delusion of reference is a positive symptom of schizophrenia where the client believes external stimuli are directed personally at them.
Schizophrenia symptoms. Positive symptoms (add abnormal experiences): delusions (false fixed beliefs) including delusions of reference (believing media/events reference you personally), persecutory delusions, grandiose delusions; hallucinations (auditory most common); disorganized thinking. Negative symptoms (reduction of normal functions): flat affect; alogia (poverty of speech); avolition; anhedonia; asociality. Positive symptoms typically respond better to antipsychotic medications. Practical nurses in Canadian mental health settings must accurately identify and document symptom type to assist in treatment planning.
Question 2: A client with major depressive disorder expresses that things will never get better. Which therapeutic communication technique best addresses this hopelessness?
- Tell the client to think positively and focus on what they have to live for
- Acknowledge the client's pain while offering realistic hope: 'I hear how painful this is. Many people with depression find that treatment helps.' (Correct answer)
- Change the subject to avoid reinforcing negative thinking
- Agree that their situation is very difficult
Correct answer: Acknowledge the client's pain while offering realistic hope: 'I hear how painful this is. Many people with depression find that treatment helps.'
Acknowledging feelings while offering realistic hope validates the experience without dismissing it and provides therapeutic support.
Therapeutic communication with depressed clients: validate the current experience with empathy ('I hear how painful this is'); offer realistic hope without false promises ('treatment helps many people'); avoid false reassurance ('everything will be fine') which clients find dismissive; avoid toxic positivity ('think positive') which invalidates experience; don't change the subject; don't agree with hopelessness (reinforces the cognitive distortion). This approach is consistent with recovery-oriented mental health care principles endorsed by the Mental Health Commission of Canada (MHCC) and evidence-based depression care guidelines.
Question 3: A client on lithium carbonate has serum lithium level 1.8 mEq/L with nausea, tremor, and polyuria. How should the practical nurse interpret this?
- Therapeutic range, these are normal side effects
- Subtherapeutic level, dose needs to be increased
- Toxic level, notify physician and withhold next dose (Correct answer)
- Mildly elevated, monitor more frequently
Correct answer: Toxic level, notify physician and withhold next dose
Lithium therapeutic range is 0.6-1.2 mEq/L maintenance. A level of 1.8 mEq/L is above therapeutic range indicating toxicity.
Lithium therapeutic monitoring: maintenance range 0.6-1.2 mEq/L (up to 1.4 for acute mania). Levels >1.5 mEq/L indicate early toxicity. Levels >2.0 mEq/L indicate severe toxicity with risk of seizures, cardiac dysrhythmias, and death. Early toxicity signs: coarse tremor, nausea/vomiting, diarrhea, polyuria/polydipsia, slurred speech, confusion. Management: withhold lithium; notify physician immediately; assess hydration; monitor serum levels, renal function, electrolytes. Lithium toxicity is exacerbated by dehydration, sodium depletion, NSAIDs. Practical nurses in Canadian settings must know lithium toxicity signs and the narrow therapeutic index.
Question 4: Under provincial Mental Health Act legislation, what criterion must be met for a physician to sign an involuntary admission order?
- The client is refusing all medications
- The client is a risk of serious harm to themselves or others due to mental disorder (Correct answer)
- The client's family requests involuntary treatment
- The client has been previously hospitalized for mental illness
Correct answer: The client is a risk of serious harm to themselves or others due to mental disorder
Involuntary admission requires that the client is a risk of serious harm to themselves or others as a direct result of a mental disorder.
All Canadian provincial Mental Health Acts permit involuntary hospitalization when specific criteria are met. Common criteria: the person has a mental disorder; as a result, there is serious risk of harm to themselves or others; the person needs hospital treatment; less restrictive means are insufficient. Criteria do NOT include: refusing medication alone, previous hospitalization, family request alone, or simply having a mental illness. Provincial acts vary (Mental Health Act BC, Mental Health Act Ontario, Mental Health Services Act Alberta). Practical nurses must understand the legal basis for involuntary status to protect client rights in mental health settings.
Question 5: A client with anorexia nervosa has BMI 14.5 and is medically unstable. What is the priority focus of nursing care?
- Promoting insight into distorted body image through therapeutic conversations
- Medical stabilization: monitoring vital signs, electrolytes, and cardiac function (Correct answer)
- Discussing meal planning to increase caloric intake
- Encouraging immediate group therapy participation
Correct answer: Medical stabilization: monitoring vital signs, electrolytes, and cardiac function
Medical stabilization is the priority when a client with anorexia is medically unstable. Life-threatening cardiac dysrhythmias and refeeding syndrome must be addressed first.
Anorexia nervosa with BMI 14.5 and medical instability requires: continuous cardiac monitoring (QTc prolongation, dysrhythmias are leading causes of death); electrolyte monitoring (hypokalemia, hypophosphatemia, hypomagnesemia); blood glucose monitoring; careful refeeding to prevent refeeding syndrome (potentially fatal electrolyte shifts during nutritional rehabilitation); orthostatic vital signs; warming measures for hypothermia. Refeeding syndrome is a potentially fatal complication of too-rapid caloric introduction. Psychotherapy and group therapy are important but secondary to medical stabilization. Canadian eating disorder guidelines (NEDIC, provincial standards) prioritize medical stability.
Question 6: Which response demonstrates motivational interviewing (MI) techniques with a client ambivalent about taking antidepressants?
- 'These medications are very effective. You really should try them.'
- 'What are your concerns about the medication, and what might be some potential benefits for you?' (Correct answer)
- 'You will not get better without medication. Your doctor knows best.'
- 'Let's talk about something else until you feel ready.'
Correct answer: 'What are your concerns about the medication, and what might be some potential benefits for you?'
Asking about both concerns and potential benefits elicits the client's ambivalence and engages their own motivation, a core MI technique.
Motivational interviewing (MI) is evidence-based for ambivalence: OARS (Open questions, Affirmations, Reflections, Summaries); explore ambivalence by asking about both sides (concerns and potential benefits); evoke change talk from the client; roll with resistance rather than confronting; support client's autonomy. 'What are your concerns... and what might be some potential benefits?' evokes ambivalent exploration, is non-confrontational, and supports autonomy. Telling the client they should take medication or that the doctor knows best violates MI spirit. Avoidance misses the therapeutic opportunity. MI is used in mental health, addictions, and chronic disease management in Canadian healthcare.
CPNRE Mental Health Nursing Concepts 2
A client with schizophrenia insists that the television is sending them personal messages.
Which type of symptom is this?