DOH Nursing Psychiatric Nursing 1 — Questions and Answers
Question 1: Which therapeutic communication technique is most appropriate when a patient says 'I feel like no one understands me'?
- Reflect and validate: 'It sounds like you're feeling very alone and misunderstood.' (Correct answer)
- Offer false reassurance: 'I'm sure everyone understands you'
- Change the subject to reduce patient distress
- Give advice: 'You should talk to your family'
Correct answer: Reflect and validate: 'It sounds like you're feeling very alone and misunderstood.'
Reflection and validation acknowledge the patient's feelings without judgment, fostering therapeutic alliance. False reassurance dismisses feelings and erodes trust. Changing the subject avoids the therapeutic relationship. Giving unsolicited advice undermines autonomy.
Question 2: A patient with schizophrenia reports hearing voices that command them to harm others. What is the priority nursing action?
- Assess for immediate danger to self or others and initiate safety measures (Correct answer)
- Administer PRN antipsychotic medication only and document
- Reassure the patient that the voices are not real
- Isolate the patient until the voices stop
Correct answer: Assess for immediate danger to self or others and initiate safety measures
Command hallucinations to harm others require immediate risk assessment (intent, plan, means, target) and safety measures including constant observation, removal of means, and notification of the treatment team. Patient and public safety is the priority in psychiatric emergencies.
Question 3: Which finding is a positive symptom of schizophrenia?
- Hallucinations, delusions, and disorganized speech (Correct answer)
- Flat affect and social withdrawal
- Alogia (poverty of speech)
- Avolition (lack of motivation)
Correct answer: Hallucinations, delusions, and disorganized speech
Positive symptoms represent an excess or distortion of normal function: hallucinations, delusions, disorganized thinking/speech, and disorganized or catatonic behavior. Negative symptoms (flat affect, alogia, avolition, anhedonia) represent loss of normal function.
Question 4: What is the priority assessment for a patient admitted following a suicide attempt?
- Assess current suicidal ideation, intent, plan, lethality of method, and means access (Correct answer)
- Obtain a complete medical history before any psychiatric assessment
- Administer standardized depression scale questionnaire first
- Contact family for collateral history before speaking with the patient
Correct answer: Assess current suicidal ideation, intent, plan, lethality of method, and means access
Immediate risk assessment after a suicide attempt includes: current SI (ideation, intent), plan (specificity), lethality of previous attempt, access to means, and protective factors. This guides the level of observation and safety planning. Medical stability is assessed simultaneously.
Question 5: Which medication class is the first-line pharmacological treatment for generalized anxiety disorder (GAD)?
- SSRIs (selective serotonin reuptake inhibitors) (Correct answer)
- Benzodiazepines as long-term therapy
- Antipsychotics for all anxiety disorders
- Tricyclic antidepressants as first choice
Correct answer: SSRIs (selective serotonin reuptake inhibitors)
SSRIs (e.g., escitalopram, sertraline) are first-line for GAD due to efficacy and favorable side effect profile. Benzodiazepines are appropriate for short-term acute anxiety but not long-term due to dependence risk. SNRIs (venlafaxine) are also first-line.
Question 6: A patient with depression is started on an SSRI. What is the most important safety teaching for the first 1–2 weeks?
- Energy and motivation may improve before mood does, increasing suicide risk — monitor closely (Correct answer)
- The medication works immediately and they will feel better within 48 hours
- Sedation is the primary concern; do not drive
- SSRIs cause immediate mood elevation that lasts only 3 days
Correct answer: Energy and motivation may improve before mood does, increasing suicide risk — monitor closely
In the first 1–4 weeks of SSRI therapy, a dangerous window exists where psychomotor energy returns before mood elevation. A previously lethargic patient may now have the energy to act on suicidal ideation. Close monitoring, follow-up, and safety planning are critical.
DOH Nursing Psychiatric Nursing 1
Which therapeutic communication technique is most appropriate when a patient says 'I feel like no one understands me'?