DOH Nursing Psychiatric Nursing 4 — Questions and Answers
Question 1: A patient with obsessive-compulsive disorder (OCD) is spending 4 hours daily washing their hands. What is the recommended evidence-based therapy?
- Exposure and response prevention (ERP) (Correct answer)
- Long-term cognitive therapy without behavioral component
- Hypnotherapy as first-line treatment
- Strict behavioral contracts prohibiting all compulsions immediately
Correct answer: Exposure and response prevention (ERP)
ERP is the gold-standard psychological treatment for OCD. The patient is gradually exposed to feared stimuli (dirty hands) while preventing the compulsive response (hand washing). Over time, anxiety extinguishes without the compulsion. SSRIs are combined with ERP for moderate-severe OCD.
Question 2: Which feature differentiates a panic attack from a cardiac event in a clinical setting?
- History of panic disorder, situational triggers, normal ECG, rapid resolution with cognitive/breathing techniques (Correct answer)
- Panic attacks always cause ST changes on ECG
- Cardiac events never cause chest pain in young patients
- Normal cardiac enzymes alone rule out panic attack
Correct answer: History of panic disorder, situational triggers, normal ECG, rapid resolution with cognitive/breathing techniques
Clinically, a cardiac event must be ruled out first. Features suggesting panic: known anxiety history, situational trigger, normal ECG and cardiac enzymes, symptom peak within 10 minutes, and resolution with reassurance and breathing techniques. Thorough evaluation is always required.
Question 3: A patient is placed in mechanical restraints after all alternatives have been exhausted. What is the nurse's ongoing responsibility?
- Assess circulation, breathing, skin integrity, and offer release every 15 minutes; document every 15–30 minutes (Correct answer)
- Apply restraints and reassess at the end of the shift
- Restrain all four limbs simultaneously and leave until agitation resolves
- Only one nurse needs to be present for the initial restraint application
Correct answer: Assess circulation, breathing, skin integrity, and offer release every 15 minutes; document every 15–30 minutes
Restraint use requires continuous monitoring: circulation checks (CMS), respiratory assessment, skin integrity, behavioral status, and offers of release every 15 minutes. Documentation must occur every 15–30 minutes. Restraints must be released, one limb at a time, for range of motion regularly.
Question 4: Which nursing diagnosis is the highest priority for a patient with severe depression who is refusing to eat or drink?
- Risk for self-harm and imbalanced nutrition: less than body requirements (Correct answer)
- Impaired social interaction
- Ineffective coping
- Disturbed sleep pattern
Correct answer: Risk for self-harm and imbalanced nutrition: less than body requirements
Severe depression with refusal to eat and drink presents immediate physical safety risks (dehydration, malnutrition, medical deterioration) alongside the psychiatric risk of self-harm. Both must be addressed urgently. Physical safety and nutrition take priority over social or sleep-related diagnoses.
Question 5: What is the primary purpose of group therapy in an inpatient psychiatric setting?
- Provide peer support, reduce isolation, develop social skills, and promote insight through shared experiences (Correct answer)
- Reduce workload for individual therapists only
- Provide medication education exclusively
- Separate high-risk patients from the general milieu
Correct answer: Provide peer support, reduce isolation, develop social skills, and promote insight through shared experiences
Group therapy in inpatient psychiatry serves multiple therapeutic functions: universality (not alone in suffering), peer support, social skill development, interpersonal learning, and behavioral rehearsal. Group dynamics under a skilled facilitator are therapeutic in themselves.
Question 6: A patient with borderline personality disorder (BPD) tells one nurse they are 'the best nurse ever' while telling another they are 'terrible.' What defense mechanism is this?
- Splitting (black-and-white thinking) (Correct answer)
- Projection
- Rationalization
- Sublimation
Correct answer: Splitting (black-and-white thinking)
Splitting is the core defense mechanism in BPD — people and situations are viewed as all good or all bad, never mixed. It causes significant team conflict. Consistent, firm, non-punitive responses across all staff members help manage this pattern.
DOH Nursing Psychiatric Nursing 4
A patient with obsessive-compulsive disorder (OCD) is spending 4 hours daily washing their hands.
What is the recommended evidence-based therapy?