Saudi Prometric Nursing Psychiatric and Mental Health Nursing 4 — Questions and Answers
Question 1: A patient with borderline personality disorder self-harms by cutting. Which nursing response is most therapeutic?
- Respond calmly without increased attention to the cutting, explore underlying feelings (Correct answer)
- Express strong disapproval to discourage the behavior
- Place the patient in isolation to prevent future self-harm
- Ignore the behavior to avoid reinforcing it
Correct answer: Respond calmly without increased attention to the cutting, explore underlying feelings
Dialectical Behavior Therapy (DBT) is the evidence-based treatment for BPD. Nurses should avoid reinforcing self-harm through excessive attention (which can perpetuate behavior) while acknowledging distress, maintaining safety, and exploring the emotional trigger underlying the act.
Question 2: A patient is started on clozapine for treatment-resistant schizophrenia. Which potentially fatal side effect requires regular monitoring?
- Agranulocytosis — requires weekly CBC monitoring (Correct answer)
- Tardive dyskinesia — irreversible movement disorder
- Neuroleptic malignant syndrome — requires immediate discontinuation
- Serotonin syndrome — requires dose reduction
Correct answer: Agranulocytosis — requires weekly CBC monitoring
Clozapine causes agranulocytosis in approximately 1–2% of patients, which can be fatal if undetected. A mandatory REMS program requires weekly CBC for the first 6 months, then biweekly. Patients must be enrolled in the registry before dispensing.
Question 3: The nurse notes that a patient with schizophrenia speaks with long pauses and difficulty expressing thoughts. This symptom is called:
- Alogia (poverty of speech) (Correct answer)
- Tangentiality
- Flight of ideas
- Word salad
Correct answer: Alogia (poverty of speech)
Alogia refers to poverty of speech or thought — reduced verbal output and difficulty expressing ideas. It is a negative symptom of schizophrenia. Tangentiality and flight of ideas involve excessive but disconnected speech (positive symptoms). Word salad is incoherent speech.
Question 4: A nurse is administering olanzapine to a patient with schizophrenia. Which metabolic side effects should be monitored?
- Weight gain, hyperglycemia, and dyslipidemia (metabolic syndrome) (Correct answer)
- Hypotension and bradycardia
- Hypothyroidism and hair loss
- Renal failure and electrolyte imbalances
Correct answer: Weight gain, hyperglycemia, and dyslipidemia (metabolic syndrome)
Second-generation (atypical) antipsychotics, especially olanzapine and clozapine, are associated with metabolic syndrome: significant weight gain, diabetes (hyperglycemia), and dyslipidemia. Regular monitoring of weight, glucose, and lipids is essential.
Question 5: A patient states: 'I am going to kill my roommate tonight.' The nurse has a duty to:
- Warn the identified potential victim and take steps to protect them (Tarasoff duty) (Correct answer)
- Maintain strict confidentiality as the patient has not taken action
- Document the statement and monitor the patient only
- Report only to the treatment team, not law enforcement
Correct answer: Warn the identified potential victim and take steps to protect them (Tarasoff duty)
The Tarasoff ruling established the 'duty to protect' — when a patient makes a specific, credible threat against an identifiable person, the clinician must take reasonable steps to protect the intended victim (warning them, notifying police, hospitalization). This overrides confidentiality.
Question 6: A nurse is assessing a patient with generalized anxiety disorder (GAD). Which symptom is characteristic?
- Excessive, uncontrollable worry about multiple areas of life for more than 6 months (Correct answer)
- Brief, intense panic attacks with chest pain
- Anxiety triggered only by specific objects
- Avoidance of social situations due to fear of embarrassment
Correct answer: Excessive, uncontrollable worry about multiple areas of life for more than 6 months
GAD is characterized by excessive, uncontrollable worry about multiple life areas (work, health, family) that is difficult to control and present most days for at least 6 months, accompanied by physical symptoms (fatigue, muscle tension, poor concentration, sleep disturbance).
Saudi Prometric Nursing Psychiatric and Mental Health Nursing 4
A patient with borderline personality disorder self-harms by cutting.
Which nursing response is most therapeutic?