Saudi Prometric Nursing Psychiatric and Mental Health Nursing 6 — Questions and Answers
Question 1: The nurse is planning care for a patient with an eating disorder who is medically cleared. Which therapy is the primary evidence-based treatment for bulimia nervosa?
- Cognitive Behavioral Therapy (CBT) (Correct answer)
- Psychoanalysis
- Systematic desensitization
- Electroconvulsive therapy
Correct answer: Cognitive Behavioral Therapy (CBT)
CBT is the gold-standard treatment for bulimia nervosa, targeting the distorted thoughts about body image and food, as well as breaking the binge-purge cycle. SSRIs (especially fluoxetine at higher doses) are the adjunctive pharmacological treatment.
Question 2: A nurse is assessing a patient with suspected ADHD in a school-age child. Which finding is most consistent with inattentive-type ADHD?
- Frequently loses items, forgetful, easily distracted, fails to finish tasks (Correct answer)
- Runs and climbs excessively, cannot sit still
- Interrupts others constantly, blurts out answers
- Impulsive risk-taking and difficulty waiting in turn
Correct answer: Frequently loses items, forgetful, easily distracted, fails to finish tasks
Inattentive-type ADHD presents with poor attention to detail, losing items, forgetfulness, distractibility, and failure to complete tasks — without hyperactivity/impulsivity. Hyperactive-impulsive type presents with the motor and impulse control symptoms.
Question 3: A nurse is caring for a patient in the ICU who develops ICU psychosis. Which intervention is most effective?
- Reorient the patient frequently, maintain day-night cycles, and reduce sleep disruptions (Correct answer)
- Administer high-dose antipsychotics immediately
- Place the patient in isolation to reduce stimulation
- Restrain the patient to prevent self-harm
Correct answer: Reorient the patient frequently, maintain day-night cycles, and reduce sleep disruptions
ICU psychosis (delirium) is best managed non-pharmacologically: frequent reorientation, maintaining circadian rhythms (lights on during day, dim at night), minimizing sleep disruption, early mobility, removing unnecessary catheters/lines, and involving family. This is evidence-based through ABCDEF bundle.
Question 4: The nurse is reviewing the chart of a patient prescribed tranylcypromine (an MAOI). Which dietary restriction is critical?
- Avoid tyramine-rich foods (aged cheese, cured meats, red wine) (Correct answer)
- Avoid high-sodium foods
- Avoid vitamin K-rich foods like leafy greens
- Avoid dairy products
Correct answer: Avoid tyramine-rich foods (aged cheese, cured meats, red wine)
MAOIs inhibit monoamine oxidase, which normally breaks down tyramine in the gut. Consuming tyramine-rich foods (aged cheese, cured meats, fermented foods, red wine) while on MAOIs causes tyramine accumulation, leading to potentially fatal hypertensive crisis.
Question 5: A patient with depression is started on an SSRI and also takes St. John's Wort. The nurse identifies risk for:
- Serotonin syndrome — agitation, hyperthermia, muscle twitching, and diarrhea (Correct answer)
- Hypertensive crisis — severe headache and visual changes
- Neuroleptic malignant syndrome — rigidity and hyperthermia
- Anticholinergic toxicity — dry skin, confusion, and urinary retention
Correct answer: Serotonin syndrome — agitation, hyperthermia, muscle twitching, and diarrhea
St. John's Wort has serotonergic activity and, combined with SSRIs, significantly increases the risk of serotonin syndrome — an excess of serotonin causing agitation, hyperthermia, muscle hyperreflexia/clonus, diarrhea, and diaphoresis.
Question 6: The nurse is assessing a patient with borderline personality disorder. Which defense mechanism is most characteristic?
- Splitting — viewing people as entirely good or entirely bad (Correct answer)
- Sublimation — channeling negative impulses into positive activities
- Rationalization — providing logical explanations for behavior
- Repression — pushing painful memories to the unconscious
Correct answer: Splitting — viewing people as entirely good or entirely bad
Splitting is the hallmark defense mechanism in borderline personality disorder, where individuals see people (and themselves) as either all-good or all-bad, with no integration of both qualities. This leads to idealization followed by sudden devaluation of others.
Saudi Prometric Nursing Psychiatric and Mental Health Nursing 6
The nurse is planning care for a patient with an eating disorder who is medically cleared.
Which therapy is the primary evidence-based treatment for bulimia nervosa?