Psychiatric and Mental Health Nursing Flashcards

A patient with borderline personality disorder self-harms by cutting. Which nursing response is most therapeutic?

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.

A patient is started on clozapine for treatment-resistant schizophrenia. Which potentially fatal side effect requires regular monitoring?

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.

The nurse notes that a patient with schizophrenia speaks with long pauses and difficulty expressing thoughts. This symptom is called:

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.

A nurse is administering olanzapine to a patient with schizophrenia. Which metabolic side effects should be monitored?

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.

A patient states: 'I am going to kill my roommate tonight.' The nurse has a duty to:

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.

A nurse is assessing a patient with generalized anxiety disorder (GAD). Which symptom is characteristic?

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).