DOH Nursing Psychiatric Nursing 2 — Questions and Answers
Question 1: What is the distinguishing feature between delirium and dementia?
- Delirium has acute onset and fluctuating course; dementia is gradual and progressive (Correct answer)
- Both have identical acute onset and fluctuating course
- Dementia is always reversible; delirium is not
- Delirium affects only elderly patients; dementia can occur at any age
Correct answer: Delirium has acute onset and fluctuating course; dementia is gradual and progressive
Delirium is characterized by acute onset (hours to days), fluctuating consciousness and attention, and is usually reversible when the cause is treated. Dementia has an insidious onset and progressive course without fluctuating consciousness. Both can coexist.
Question 2: A patient with bipolar disorder is experiencing a manic episode. Which behavior is most consistent with this phase?
- Grandiosity, decreased need for sleep, pressured speech, and reckless behavior (Correct answer)
- Profound sadness, hypersomnia, and psychomotor retardation
- Flat affect, social withdrawal, and poverty of thought
- Paranoid delusions with auditory hallucinations only
Correct answer: Grandiosity, decreased need for sleep, pressured speech, and reckless behavior
Manic episodes feature elevated/expansive or irritable mood, grandiosity, decreased need for sleep (not insomnia — they feel rested with 3 hours of sleep), pressured speech, racing thoughts, distractibility, goal-directed activity, and risky behavior. Psychotic features may occur in severe mania.
Question 3: Which intervention is priority when a patient with anorexia nervosa is medically hospitalized?
- Nutritional rehabilitation and medical stabilization (electrolyte monitoring, refeeding protocol) (Correct answer)
- Initiate cognitive behavioral therapy sessions immediately
- Weigh the patient multiple times daily and share results
- Encourage unlimited exercise to manage anxiety
Correct answer: Nutritional rehabilitation and medical stabilization (electrolyte monitoring, refeeding protocol)
Medical priorities in anorexia include correcting electrolyte imbalances (especially hypokalemia, hypophosphatemia — refeeding syndrome), cardiac monitoring, and gradual nutritional rehabilitation. Refeeding syndrome (dangerous phosphate drop) can occur when feeding resumes too rapidly.
Question 4: A patient taking lithium carbonate reports coarse tremor, confusion, and vomiting. Lithium level is 2.8 mEq/L. What is the priority action?
- Stop lithium immediately, establish IV access, and initiate hydration and monitoring (Correct answer)
- Administer the next scheduled lithium dose and monitor closely
- Reduce the lithium dose by half and recheck levels in 1 week
- Give anti-tremor medication and document the findings
Correct answer: Stop lithium immediately, establish IV access, and initiate hydration and monitoring
Lithium toxicity at levels >2.0 mEq/L (therapeutic: 0.6–1.2 mEq/L) causes neurotoxicity (tremor, confusion, ataxia), GI symptoms, and in severe cases, seizures and cardiac arrhythmias. Lithium must be stopped, IV fluids administered to enhance renal excretion, and dialysis considered for severe toxicity.
Question 5: Which action best maintains the therapeutic milieu in an inpatient psychiatric unit?
- Consistent routine, clear limit-setting, and involving patients in their care planning (Correct answer)
- Unlimited individual freedom without any structure
- Strict isolation of patients from peers for safety
- Allowing only family-initiated conversations about treatment
Correct answer: Consistent routine, clear limit-setting, and involving patients in their care planning
A therapeutic milieu provides safety through predictable structure (consistent daily routine), clear boundaries (limit-setting), and empowers patients through participation in care. Peer interaction and group activities are therapeutic components. Isolation is counter-therapeutic.
Question 6: A patient with PTSD describes experiencing vivid re-experiencing of the traumatic event as if it is happening now. What is this phenomenon called?
- A flashback (Correct answer)
- A delusion
- A pseudohallucination
- An illusion
Correct answer: A flashback
Flashbacks are dissociative episodes in PTSD where the person mentally re-experiences the traumatic event with full sensory vividness, temporarily losing contact with the present. Unlike hallucinations, the patient usually recognizes it as a memory once the episode passes.
DOH Nursing Psychiatric Nursing 2
What is the distinguishing feature between delirium and dementia?