DOH Nursing Psychiatric Nursing 3 — Questions and Answers
Question 1: What is the correct nursing response to a patient in the psychiatric unit who is about to hit another patient?
- Step between them, use a calm firm voice, direct the agitated patient to a quiet area, and call for assistance (Correct answer)
- Physically restrain the patient without warning
- Ignore the behavior to avoid escalation
- Lock the other patient in their room and walk away
Correct answer: Step between them, use a calm firm voice, direct the agitated patient to a quiet area, and call for assistance
De-escalation is the first-line response: use a calm, firm voice, maintain safe distance, redirect to a quiet space, and call for backup. Physical intervention (restraint) is a last resort when de-escalation fails and safety is at risk. Follow facility policy on team response.
Question 2: A patient with alcohol use disorder who stopped drinking 48 hours ago develops tremors, tachycardia, and visual hallucinations. What condition is occurring?
- Alcohol withdrawal delirium (delirium tremens) (Correct answer)
- Korsakoff's psychosis
- Wernicke's encephalopathy
- Acute alcohol intoxication
Correct answer: Alcohol withdrawal delirium (delirium tremens)
Delirium tremens (DT) typically peaks at 48–72 hours after last drink. Features: severe autonomic hyperactivity, confusion, hallucinations (visual/tactile), tremors, and seizure risk. Without treatment (benzodiazepines, thiamine), DTs carry up to 5% mortality. It is a medical emergency.
Question 3: Which side effect of antipsychotic medications is characterized by an inner feeling of restlessness and inability to sit still?
- Akathisia (Correct answer)
- Tardive dyskinesia
- Dystonia
- Parkinsonism
Correct answer: Akathisia
Akathisia is a distressing subjective sense of inner restlessness with an irresistible urge to move, often manifesting as pacing. It is a common cause of non-adherence. It differs from dystonia (acute muscle spasm), tardive dyskinesia (late involuntary movements), and drug-induced Parkinsonism.
Question 4: A nurse implements a 'no-suicide contract' with a patient. What is the most important limitation of this approach?
- Research shows no-suicide contracts do not reliably prevent suicide and should not replace a comprehensive safety plan (Correct answer)
- They are legally binding documents that protect the hospital from liability
- They are universally effective and replace the need for constant observation
- They work best when signed without therapeutic discussion
Correct answer: Research shows no-suicide contracts do not reliably prevent suicide and should not replace a comprehensive safety plan
No-suicide contracts lack evidence of effectiveness. Patients in crisis may sign contracts to avoid hospitalization or closer monitoring. Evidence-based practice favors collaborative safety planning (Stanley-Brown Safety Planning Intervention), which identifies warning signs, coping strategies, and resources.
Question 5: What is the primary goal of motivational interviewing (MI) in addiction nursing?
- Elicit the patient's own motivation for change by exploring ambivalence without confrontation (Correct answer)
- Convince the patient to stop using substances through direct advice
- Use confrontational techniques to break through denial
- Educate the patient about the dangers of their substance use only
Correct answer: Elicit the patient's own motivation for change by exploring ambivalence without confrontation
MI is a collaborative, patient-centered approach that explores and resolves ambivalence. The nurse uses open-ended questions, affirmations, reflective listening, and summaries (OARS) to help patients identify their own reasons for change. Confrontation is explicitly avoided.
Question 6: Which medication requires regular monitoring of absolute neutrophil count (ANC)?
- Clozapine (Correct answer)
- Haloperidol
- Lithium carbonate
- Olanzapine
Correct answer: Clozapine
Clozapine carries a risk of agranulocytosis (0.5–2%) — a life-threatening drop in neutrophils. Mandatory ANC monitoring is required before initiation and at regular intervals (weekly for 6 months, then bi-weekly for 6 months, then monthly thereafter) through the REMS program.
DOH Nursing Psychiatric Nursing 3
What is the correct nursing response to a patient in the psychiatric unit who is about to hit another patient?