DOH Nursing Psychiatric Nursing 2

Question 1

What is the distinguishing feature between delirium and dementia?

Accepted Answer

Delirium has acute onset and fluctuating course; dementia is gradual and progressive

Answer

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?

Accepted Answer

Grandiosity, decreased need for sleep, pressured speech, and reckless behavior

Answer

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?

Accepted Answer

Nutritional rehabilitation and medical stabilization (electrolyte monitoring, refeeding protocol)

Answer

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?

Accepted Answer

Stop lithium immediately, establish IV access, and initiate hydration and monitoring

Answer

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?

Accepted Answer

Consistent routine, clear limit-setting, and involving patients in their care planning

Answer

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.

DOH Nursing Practice Test

DOH Nursing Practice Test

DOH Nursing Psychiatric Nursing 2