Saudi Prometric Nursing Psychiatric and Mental Health Nursing 3 — Questions and Answers
Question 1: A patient with obsessive-compulsive disorder (OCD) spends 3 hours daily washing their hands. Which nursing response is most therapeutic?
- Allow the ritual initially while working on gradual reduction with a structured ERP plan (Correct answer)
- Physically prevent the ritual to break the cycle
- Tell the patient the behavior is irrational and they should stop
- Ignore the behavior completely
Correct answer: Allow the ritual initially while working on gradual reduction with a structured ERP plan
Exposure and Response Prevention (ERP) is the gold-standard therapy for OCD. Abruptly stopping rituals increases anxiety severely. A structured plan of gradual exposure to anxiety triggers while preventing the ritual (with patient agreement) is the most effective approach.
Question 2: The nurse is performing a suicide risk assessment. Which factor places the patient at HIGHEST risk?
- Specific plan with access to means and previous attempt (Correct answer)
- Passive suicidal ideation without a plan
- Social support and strong religious beliefs
- Recent initiation of antidepressant therapy without other risk factors
Correct answer: Specific plan with access to means and previous attempt
The highest risk factors for completed suicide are: specific plan, access to lethal means, and previous suicide attempt (the strongest predictor). Protective factors include social support and religious beliefs. The combination of plan + means + history represents imminent risk.
Question 3: A patient with post-traumatic stress disorder (PTSD) is describing a flashback to the nurse. Which nursing response is most appropriate?
- Speak calmly, use grounding techniques, and orient the patient to the present (Correct answer)
- Ask the patient to describe the traumatic event in detail
- Leave the patient alone to process the experience
- Administer a sedative immediately
Correct answer: Speak calmly, use grounding techniques, and orient the patient to the present
During a flashback, the patient experiences the trauma as if it is happening now. Calm, grounding interventions (e.g., 5-4-3-2-1 sensory technique, stating the date/location) help re-orient the patient to the present reality. Forcing trauma recall worsens PTSD.
Question 4: A patient is admitted involuntarily to a psychiatric unit. The nurse explains that the patient retains which right?
- The right to refuse specific medications (with capacity assessment) (Correct answer)
- No rights, as involuntary admission overrides all rights
- The right to leave at any time
- The right to refuse all assessments
Correct answer: The right to refuse specific medications (with capacity assessment)
Involuntary psychiatric admission restricts freedom of movement but does not eliminate all rights. Patients retain rights including: confidentiality, humane treatment, communication with an attorney, and the right to refuse medications in most jurisdictions (unless capacity is deemed absent by a court).
Question 5: A patient with dementia is becoming increasingly agitated at sunset. The nurse identifies this as 'sundowning.' Which intervention is most effective?
- Maintain consistent routines, increase lighting in the evening, and use calming activities (Correct answer)
- Administer a sedative at noon to prevent evening agitation
- Restrain the patient during evening hours
- Avoid all stimulation including television throughout the day
Correct answer: Maintain consistent routines, increase lighting in the evening, and use calming activities
Sundowning in dementia is managed through environmental and behavioral strategies: consistent daily routines, bright lighting during the day (especially in the evening to delay circadian shift), calming familiar music, and orientation cues. Pharmacological restraint should be minimized.
Question 6: The nurse is caring for a patient experiencing alcohol withdrawal. Which medication is most commonly used to prevent seizures?
- Lorazepam (Ativan) (Correct answer)
- Haloperidol (Haldol)
- Disulfiram (Antabuse)
- Naltrexone
Correct answer: Lorazepam (Ativan)
Benzodiazepines (e.g., lorazepam, diazepam, chlordiazepoxide) are the first-line treatment for alcohol withdrawal because they enhance GABA inhibition and prevent withdrawal seizures and DTs. Haloperidol may be added for psychosis but does not prevent seizures.
Saudi Prometric Nursing Psychiatric and Mental Health Nursing 3
A patient with obsessive-compulsive disorder (OCD) spends 3 hours daily washing their hands.
Which nursing response is most therapeutic?