Psychiatric-Mental Health Nurse Practitioner Exam Crisis Intervention and Emergency Psychiatry 2 — Questions and Answers
Question 1: Which protective factor most strongly reduces suicide risk during crisis assessment?
- Financial stability
- Reasons for living and strong social support (Correct answer)
- Previous psychiatric hospitalizations
- Current antidepressant use
Correct answer: Reasons for living and strong social support
Strong reasons for living and robust social support networks are among the most consistently identified protective factors against suicide.
Question 2: A patient experiencing a serotonin syndrome crisis would most likely present with which triad of symptoms?
- Bradycardia, hypothermia, miosis
- Neuromuscular abnormalities, autonomic instability, altered mental status (Correct answer)
- Rigidity, fever, elevated CK from neuroleptic malignant syndrome only
- Sedation, respiratory depression, pinpoint pupils
Correct answer: Neuromuscular abnormalities, autonomic instability, altered mental status
Serotonin syndrome's classic triad includes neuromuscular findings (clonus, hyperreflexia), autonomic instability, and altered mental status.
Question 3: Which crisis intervention model focuses on assessing the patient's perception of the event, available supports, and coping mechanisms?
- Roberts' Seven-Stage Crisis Intervention Model
- The ABC Model of Crisis Intervention
- Caplan's Crisis Theory
- Aguilera and Messick's Balancing Factors Model (Correct answer)
Correct answer: Aguilera and Messick's Balancing Factors Model
Aguilera and Messick's model identifies three balancing factors—perception of the event, situational supports, and coping mechanisms—that determine crisis resolution.
Question 4: A PMHNP is completing a psychiatric hold. Which document must be completed to initiate involuntary evaluation in most US states?
- Advance directive
- 5150 or equivalent emergency detention certificate (Correct answer)
- HIPAA release form
- Competency evaluation
Correct answer: 5150 or equivalent emergency detention certificate
Most US states use a form similar to California's 5150 (or equivalent emergency detention certificate) to legally authorize involuntary psychiatric holds.
Question 5: During a manic crisis, a patient refuses medication and is destroying property. Which intervention is the MOST appropriate next step?
- Wait for the episode to resolve naturally
- Initiate a least restrictive intervention and document behaviors (Correct answer)
- Discharge the patient immediately
- Ignore the behavior to avoid reinforcing it
Correct answer: Initiate a least restrictive intervention and document behaviors
Least restrictive intervention with thorough documentation is required before escalating to more coercive measures.
Question 6: A PMHNP identifies a patient as having homicidal ideation toward a specific person. Under Tarasoff duty, the clinician must:
- Maintain confidentiality and document only
- Warn the identified victim and notify law enforcement (Correct answer)
- Refer the patient to social work only
- Increase medication doses and monitor
Correct answer: Warn the identified victim and notify law enforcement
The Tarasoff ruling established the duty to protect identifiable potential victims, including warning them and notifying law enforcement.
Psychiatric-Mental Health Nurse Practitioner Exam Crisis Intervention and Emergency Psychiatry 2
Which protective factor most strongly reduces suicide risk during crisis assessment?