SNLE Psychiatric Nursing 2 — Questions and Answers
Question 1: What does 'therapeutic milieu' mean in a psychiatric setting?
- A safe, structured environment designed to promote therapeutic change through social interactions (Correct answer)
- Medication management only
- Isolation of patients with behavioral problems
- A reward-and-punishment behavior modification system
Correct answer: A safe, structured environment designed to promote therapeutic change through social interactions
Therapeutic milieu refers to the planned, structured, safe environment of a psychiatric unit where all aspects — physical layout, rules, staff interactions, group activities — are used as therapeutic tools to promote healing and behavioral change.
Question 2: A patient with bipolar disorder is in a manic phase. Which nursing intervention is the priority?
- Ensure safety, provide a low-stimulation environment, and meet physical needs (Correct answer)
- Encourage social activities to channel excess energy
- Engage the patient in lengthy discussions
- Allow the patient to make all decisions independently
Correct answer: Ensure safety, provide a low-stimulation environment, and meet physical needs
During mania, patients are at risk for injury (from impulsivity and poor judgment), dehydration (forgetting to eat/drink), and exhaustion. A low-stimulation environment reduces escalation. Safety and physical needs are the priority.
Question 3: Which medication is the first-line mood stabilizer for bipolar disorder?
- Lithium carbonate (Correct answer)
- Haloperidol
- Fluoxetine
- Clonazepam
Correct answer: Lithium carbonate
Lithium is the gold standard mood stabilizer for bipolar disorder with strong evidence for preventing both manic and depressive episodes and reducing suicide risk. It requires regular serum level monitoring (therapeutic range: 0.6–1.2 mEq/L for maintenance).
Question 4: A patient with obsessive-compulsive disorder (OCD) insists on washing their hands 50 times per day. What is the most therapeutic nursing approach?
- Allow the ritual initially while building therapeutic alliance, then gradually work on reducing it (Correct answer)
- Prevent the ritual immediately and completely
- Ignore the behavior entirely
- Mock the behavior to highlight its irrationality
Correct answer: Allow the ritual initially while building therapeutic alliance, then gradually work on reducing it
Abruptly stopping OCD rituals causes extreme anxiety. The therapeutic approach involves building trust, psychoeducation, and gradually implementing exposure and response prevention (ERP) therapy. Forcing immediate cessation is counterproductive and harmful.
Question 5: What is the correct nursing response to a patient experiencing a panic attack?
- Stay with the patient, speak calmly, guide slow controlled breathing, reassure they are safe (Correct answer)
- Leave the patient in a quiet room alone
- Administer antipsychotic medication
- Restrain the patient to prevent injury
Correct answer: Stay with the patient, speak calmly, guide slow controlled breathing, reassure they are safe
During a panic attack, the nurse's presence, calm demeanor, and controlled breathing guidance reduce sympathetic stimulation. Reassurance that the symptoms are the panic attack itself (not a heart attack) and that it will pass helps de-escalate the physiological response.
Question 6: Which term describes a patient's false belief that is firmly held despite evidence to the contrary?
- Delusion (Correct answer)
- Hallucination
- Illusion
- Confabulation
Correct answer: Delusion
A delusion is a fixed, false belief not consistent with cultural norms, maintained despite clear evidence to the contrary. Hallucinations are sensory perceptions without external stimuli. Illusions are misinterpretations of real stimuli. Confabulation is unconscious fabrication of memories.
SNLE Psychiatric Nursing 2
What does 'therapeutic milieu' mean in a psychiatric setting?