PCCN Psychosocial and Behavioral Health 1 — Questions and Answers
Question 1: A progressive care patient who has been hospitalized for 5 days becomes confused at night, attempts to pull out his IV, and reports seeing insects on the ceiling. Which condition does this presentation most likely indicate?
- Hyponatremia
- ICU/hospital-acquired delirium (Correct answer)
- New-onset dementia
- Psychotic depression
Correct answer: ICU/hospital-acquired delirium
Hospital-acquired delirium is characterized by acute onset of fluctuating confusion, disorientation, and perceptual disturbances, and is extremely common in progressive care patients.
Question 2: The nurse is assessing a patient for alcohol withdrawal using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Which finding would indicate the most severe level of withdrawal?
- Mild diaphoresis and anxiety with a score of 8
- Moderate tremor and nausea with a score of 15
- Severe agitation, hallucinations, and seizures with a score of 22 (Correct answer)
- Tachycardia and hypertension only with a score of 10
Correct answer: Severe agitation, hallucinations, and seizures with a score of 22
A CIWA-Ar score ≥20 indicates severe withdrawal requiring aggressive pharmacologic intervention; scores with seizures and hallucinations represent the highest risk category.
Question 3: A patient admitted for cardiac monitoring discloses feelings of hopelessness and that life is not worth living. What is the nurse's priority action?
- Document the statement and notify the physician at the next scheduled rounding
- Administer an as-needed anxiolytic medication
- Perform a structured suicidal ideation assessment and notify the care team immediately (Correct answer)
- Reassure the patient that these feelings are normal after a cardiac event
Correct answer: Perform a structured suicidal ideation assessment and notify the care team immediately
Statements indicating hopelessness and passive suicidal ideation require immediate structured risk assessment and prompt notification of the multidisciplinary team to ensure patient safety.
Question 4: Which intervention is MOST effective in preventing delirium in a progressive care patient?
- Administering prophylactic haloperidol nightly
- Providing continuous physical restraints to prevent falls
- Promoting sleep hygiene, early mobility, and reorientation strategies (Correct answer)
- Keeping the room darkened and quiet at all times
Correct answer: Promoting sleep hygiene, early mobility, and reorientation strategies
Non-pharmacologic bundles including sleep promotion, early mobilization, cognitive stimulation, and reorientation (e.g., ABCDEF bundle) are the most evidence-based approach to delirium prevention.
Question 5: A nurse is caring for a patient experiencing opioid withdrawal. Which cluster of symptoms should the nurse expect?
- Bradycardia, hypotension, miosis, and sedation
- Tachycardia, diaphoresis, piloerection, and yawning (Correct answer)
- Hypertension, fever, hallucinations, and seizures
- Bradypnea, hypothermia, constipation, and euphoria
Correct answer: Tachycardia, diaphoresis, piloerection, and yawning
Opioid withdrawal produces a hyperadrenergic state characterized by tachycardia, diaphoresis, piloerection (goosebumps), yawning, lacrimation, and muscle aches.
Question 6: When using therapeutic communication with a patient who is anxious about an upcoming procedure, which nurse response is MOST appropriate?
- "Don't worry — this procedure is done all the time and is perfectly safe."
- "I understand you're concerned. Can you tell me more about what's worrying you?" (Correct answer)
- "You should focus on the positive outcome and not think about the risks."
- "The physician already explained everything; is there anything specific you didn't understand?"
Correct answer: "I understand you're concerned. Can you tell me more about what's worrying you?"
Open-ended questions that acknowledge the patient's feelings and invite elaboration are the hallmark of therapeutic communication and help identify specific concerns.
Question 7: A family member of a dying patient asks the nurse, 'Is my mother suffering?' The patient is unconscious and receiving palliative sedation. Which response best reflects palliative care principles?
- "We cannot know for certain what she is experiencing."
- "She is not suffering; the medications are keeping her comfortable and peaceful." (Correct answer)
- "You should speak with the physician about your concerns."
- "It's hard to say — she may still be aware of pain at some level."
Correct answer: "She is not suffering; the medications are keeping her comfortable and peaceful."
Palliative sedation is titrated to ensure comfort; reassuring the family that the patient is comfortable is accurate, compassionate, and consistent with palliative care goals.
PCCN Psychosocial and Behavioral Health 1
A progressive care patient who has been hospitalized for 5 days becomes confused at night, attempts to pull out his IV, and reports seeing insects on the ceiling.
Which condition does this presentation most likely indicate?