PCCN Psychosocial and Behavioral Health 2 — Questions and Answers
Question 1: The nurse is differentiating between delirium, dementia, and depression ('the 3 Ds') in a progressive care patient. Which feature is MOST characteristic of delirium compared to the other two?
- Gradual onset over months to years
- Persistent low mood with anhedonia
- Acute onset with fluctuating level of consciousness (Correct answer)
- Intact short-term memory with personality changes
Correct answer: Acute onset with fluctuating level of consciousness
Delirium is distinguished by its acute onset (hours to days), fluctuating course, and impaired consciousness, distinguishing it from the gradual progression of dementia and the mood-focused presentation of depression.
Question 2: A patient with acute coronary syndrome is found to have comorbid major depression. The nurse understands that depression in cardiac patients is significant because it:
- Decreases pain perception and therefore reduces analgesic requirements
- Is associated with increased mortality, poor medication adherence, and worse cardiac outcomes (Correct answer)
- Is a normal adjustment reaction that typically resolves without intervention within 6 months
- Primarily affects quality of life but has no impact on physiologic cardiac function
Correct answer: Is associated with increased mortality, poor medication adherence, and worse cardiac outcomes
Depression is an independent risk factor for adverse cardiac outcomes; it is associated with increased mortality, poor adherence to cardiac medications and lifestyle changes, and higher rates of recurrent cardiac events.
Question 3: A progressive care nurse is supporting the family of a patient who has just been told the prognosis is terminal. The family members are arguing among themselves and appear angry. The nurse should recognize this behavior as:
- A dysfunctional family dynamic requiring immediate social work referral
- A normal grief response that may reflect denial, fear, and helplessness (Correct answer)
- Evidence that the family has not been adequately informed of the diagnosis
- A sign that family members require psychiatric evaluation
Correct answer: A normal grief response that may reflect denial, fear, and helplessness
Anger and conflict among family members in crisis situations are common manifestations of grief and reflect normal emotional responses including helplessness, fear, and denial.
Question 4: Which assessment tool is specifically validated for measuring delirium in acute care settings?
- Glasgow Coma Scale (GCS)
- Mini-Mental State Examination (MMSE)
- Confusion Assessment Method (CAM) (Correct answer)
- Montreal Cognitive Assessment (MoCA)
Correct answer: Confusion Assessment Method (CAM)
The Confusion Assessment Method (CAM) is the gold-standard validated tool for delirium assessment in acute/progressive care; the CAM-ICU is adapted for non-verbal/intubated patients.
Question 5: A patient with a history of benzodiazepine dependence is admitted for a non-related procedure. The nurse anticipates withdrawal symptoms will most likely begin:
- Within 1–2 hours of last dose
- 12–24 hours after the last dose for short-acting agents and up to 5–7 days for long-acting agents (Correct answer)
- Only if the patient has been using benzodiazepines for more than 10 years
- After 72 hours regardless of the benzodiazepine used
Correct answer: 12–24 hours after the last dose for short-acting agents and up to 5–7 days for long-acting agents
Benzodiazepine withdrawal timing depends on the drug's half-life; short-acting agents (e.g., lorazepam) produce symptoms within 12–24 hours, while long-acting agents (e.g., diazepam) may not produce symptoms for several days.
Question 6: A nurse is providing culturally competent care to a patient from a culture where direct eye contact is considered disrespectful. Which approach should the nurse take?
- Insist on eye contact to ensure the patient is engaged and understands instructions
- Avoid all eye contact and communicate only through written materials
- Adapt communication style to avoid prolonged direct eye contact while continuing to provide complete care (Correct answer)
- Defer all communication to a family member who acts as a cultural intermediary
Correct answer: Adapt communication style to avoid prolonged direct eye contact while continuing to provide complete care
Culturally competent care requires adapting communication practices — including non-verbal behaviors like eye contact — to respect cultural norms while still providing complete, individualized patient care.
Question 7: Which intervention best addresses sleep deprivation in a progressive care patient?
- Administering nightly sedative-hypnotics routinely for all patients
- Clustering care activities, minimizing nighttime interruptions, and reducing lighting and noise at night (Correct answer)
- Encouraging napping throughout the day to make up for nighttime disruptions
- Restricting family visitation during evening hours only
Correct answer: Clustering care activities, minimizing nighttime interruptions, and reducing lighting and noise at night
Evidence-based sleep promotion bundles in the PCU include clustering care to reduce overnight interruptions, lowering light and noise levels at night, and minimizing unnecessary monitoring, which prevents delirium and promotes recovery.
PCCN Psychosocial and Behavioral Health 2
The nurse is differentiating between delirium, dementia, and depression ('the 3 Ds') in a progressive care patient.
Which feature is MOST characteristic of delirium compared to the other two?