Saudi Prometric Nursing Psychiatric and Mental Health Nursing 5 — Questions and Answers
Question 1: The nurse is developing a care plan for a patient with major depressive disorder. Which nursing diagnosis has the highest priority?
- Risk for suicide related to hopelessness (Correct answer)
- Impaired social interaction related to withdrawal
- Disturbed sleep pattern related to depression
- Imbalanced nutrition: less than body requirements
Correct answer: Risk for suicide related to hopelessness
In psychiatric nursing, Maslow's hierarchy guides priority. Risk for suicide is a life-threatening priority that supersedes all other nursing diagnoses. Safety is always the first priority regardless of other identified problems in a patient with depression.
Question 2: A patient with paranoid schizophrenia refuses to eat, stating 'the food is poisoned.' Which nursing intervention is most appropriate?
- Offer sealed, commercially packaged food the patient can open themselves (Correct answer)
- Force the patient to eat using the nasogastric route
- Assure the patient the food is safe and insist they eat
- Skip meals until the patient consents to eat normally
Correct answer: Offer sealed, commercially packaged food the patient can open themselves
Offering sealed, unopened commercially packaged food allows the patient with paranoid delusions to verify the food has not been tampered with, thereby improving safety and nutritional intake. This respects the patient's paranoid belief while meeting a physiological need.
Question 3: The nurse is assessing a patient's affect. The patient discusses a recent death in the family with no change in facial expression or emotional tone. This is described as:
- Flat affect (Correct answer)
- Blunted affect
- Labile affect
- Restricted affect
Correct answer: Flat affect
Flat affect describes the complete absence of emotional expression in voice and face, regardless of the subject matter. Blunted affect is reduced (not absent) emotional expression. Labile affect involves rapid, unpredictable emotional shifts. Both flat and blunted are negative symptoms of schizophrenia.
Question 4: A patient with dementia is repeatedly asking where their deceased spouse is. What is the most therapeutic response?
- Redirect the patient to a pleasant activity without confirming or dwelling on the death (Correct answer)
- Repeatedly explain that the spouse has died each time they ask
- Tell the patient the spouse is 'just out shopping' to avoid distress
- Confront the patient with reality firmly each time
Correct answer: Redirect the patient to a pleasant activity without confirming or dwelling on the death
In dementia care, repeatedly confirming the death causes repeated grief without memory consolidation. Therapeutic fibbing or gentle redirection to pleasant activities is preferred over repeated reality orientation that causes distress. Lying ('just shopping') may occasionally be used with careful judgment.
Question 5: The nurse is preparing to apply physical restraints to an agitated patient. Which action is most important?
- Explore all less restrictive alternatives before applying restraints (Correct answer)
- Apply restraints immediately to ensure staff safety
- Apply restraints and then contact the physician for an order
- Document restraint use but no physician order is needed
Correct answer: Explore all less restrictive alternatives before applying restraints
Restraints are a last resort and must be used only when all less restrictive alternatives have been tried and failed. A physician order is required (retroactively in emergencies). Restraints carry risks including injury, aspiration, and psychological harm.
Question 6: A nurse is administering lithium to a patient with bipolar disorder. Which instruction about diet and hydration is most important?
- Maintain consistent sodium intake and adequate hydration — avoid low-sodium diets (Correct answer)
- Consume a high-sodium diet to prevent toxicity
- Restrict fluid intake to less than 1 liter daily
- Avoid all caffeine and tyramine-containing foods
Correct answer: Maintain consistent sodium intake and adequate hydration — avoid low-sodium diets
Lithium is reabsorbed in the renal tubules alongside sodium. Low sodium intake (dehydration, low-salt diet, excessive sweating) causes the kidneys to reabsorb more lithium, raising serum levels to toxic range. Consistent sodium and fluid intake maintains stable lithium levels.
Saudi Prometric Nursing Psychiatric and Mental Health Nursing 5
The nurse is developing a care plan for a patient with major depressive disorder.
Which nursing diagnosis has the highest priority?