NMBI Mental Health Nursing and Evidence-Based Practice 2 — Questions and Answers
Question 1: A nurse is caring for a patient experiencing an acute psychotic episode. What is the most important immediate safety consideration?
- The safety of the patient and others — de-escalate calmly, minimise stimuli, and call for support if needed (Correct answer)
- Administering antipsychotic medication immediately without assessment
- Leaving the patient alone to calm down
- Restraining the patient as a precaution
Correct answer: The safety of the patient and others — de-escalate calmly, minimise stimuli, and call for support if needed
During acute psychosis, safety of both the patient and staff is paramount. De-escalation, environmental management, and summoning support are priorities. Restraint is a last resort and medication requires assessment.
Question 2: What is the purpose of a 'risk assessment' in mental health nursing?
- To identify, evaluate, and document a patient's risk of harm to themselves or others, to guide care planning (Correct answer)
- To determine the patient's insurance status
- To decide whether to discharge the patient from hospital
- To rate the hospital ward for Joint Commission accreditation
Correct answer: To identify, evaluate, and document a patient's risk of harm to themselves or others, to guide care planning
Mental health risk assessment evaluates risk of suicide, self-harm, violence, and vulnerability. It informs care planning, level of observation, and safety interventions. It must be dynamic — updated as the patient's condition changes.
Question 3: Which nursing intervention is consistent with trauma-informed care?
- Asking permission before touching a patient and explaining all procedures beforehand (Correct answer)
- Proceeding with all care without explanation to prevent anxiety
- Limiting patient choices to reduce decision fatigue
- Avoiding any discussion of a patient's past experiences
Correct answer: Asking permission before touching a patient and explaining all procedures beforehand
Trauma-informed care recognises the widespread impact of trauma and ensures care practices do not re-traumatise patients. Key principles include safety, choice, collaboration, and empowerment.
Question 4: What is the hierarchy of evidence in evidence-based practice, from strongest to weakest?
- Systematic reviews/meta-analysis → RCTs → cohort studies → case studies → expert opinion (Correct answer)
- Expert opinion → case studies → RCTs → systematic reviews
- Case studies → RCTs → expert opinion → systematic reviews
- RCTs → meta-analysis → expert opinion → case studies
Correct answer: Systematic reviews/meta-analysis → RCTs → cohort studies → case studies → expert opinion
The evidence hierarchy places systematic reviews and meta-analyses at the top (synthesising many studies), followed by RCTs (randomised controlled trials), then observational studies, case reports, and expert opinion at the base.
Question 5: A patient refuses a prescribed medication. What is the nurse's most appropriate response?
- Respect the refusal, explore reasons, document it, and inform the prescriber (Correct answer)
- Administer the medication anyway as it is prescribed
- Ignore the refusal and try again later without documentation
- Immediately involve the next of kin to persuade the patient
Correct answer: Respect the refusal, explore reasons, document it, and inform the prescriber
A competent patient has the right to refuse any treatment. The nurse must respect autonomy, explore reasons (which may reveal side effects, fears, or misunderstanding), document the refusal, and inform the prescriber.
Question 6: What does 'critical reflection' mean in nursing practice?
- Actively analysing and questioning one's own practice, assumptions, and values to improve patient care (Correct answer)
- Criticising colleagues' nursing practice in team meetings
- Completing annual performance reviews
- Reviewing nursing literature only
Correct answer: Actively analysing and questioning one's own practice, assumptions, and values to improve patient care
Critical reflection is an active, professional process of examining your own actions, beliefs, and the evidence behind your decisions to continually improve practice. It is fundamental to lifelong learning in nursing.
NMBI Mental Health Nursing and Evidence-Based Practice 2
A nurse is caring for a patient experiencing an acute psychotic episode.
What is the most important immediate safety consideration?