SNLE Psychiatric Nursing 3 — Questions and Answers
Question 1: A patient with major depressive disorder refuses to get out of bed and states 'What is the point?' Which nursing diagnosis is the priority?
- Risk for self-directed violence related to hopelessness (Correct answer)
- Impaired physical mobility
- Deficient knowledge
- Ineffective health maintenance
Correct answer: Risk for self-directed violence related to hopelessness
Hopelessness is a significant risk factor for suicidal ideation. 'What is the point?' may indicate passive suicidal ideation. Safety assessment and risk for self-directed violence are the priority nursing concerns before addressing mobility or other issues.
Question 2: What is the therapeutic serum level of lithium for maintenance therapy?
- 0.6–1.2 mEq/L (Correct answer)
- 2.0–2.5 mEq/L
- 0.1–0.5 mEq/L
- 1.5–2.0 mEq/L
Correct answer: 0.6–1.2 mEq/L
Therapeutic lithium levels for maintenance are 0.6–1.2 mEq/L. During acute mania, levels of 0.8–1.2 mEq/L are targeted. Toxicity begins around 1.5 mEq/L and is life-threatening above 2.0 mEq/L. Signs of toxicity include tremor, ataxia, nausea, and confusion.
Question 3: Which finding suggests neuroleptic malignant syndrome (NMS) in a patient taking antipsychotics?
- High fever, muscle rigidity, altered consciousness, and autonomic instability (Correct answer)
- Low-grade fever, mild tremor, and increased appetite
- Hypotension, bradycardia, and hypothermia
- Rash, angioedema, and bronchospasm
Correct answer: High fever, muscle rigidity, altered consciousness, and autonomic instability
NMS is a rare, potentially fatal reaction to antipsychotics characterized by the tetrad: hyperthermia (often >40°C), severe muscle rigidity ('lead-pipe' rigidity), altered consciousness, and autonomic instability (diaphoresis, tachycardia, BP fluctuations). Immediate discontinuation and supportive treatment are required.
Question 4: What type of therapy is most evidence-based for PTSD?
- Trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR (Correct answer)
- Psychoanalytic therapy only
- Medication alone without psychotherapy
- Group exercise therapy
Correct answer: Trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR
Trauma-focused CBT and Eye Movement Desensitization and Reprocessing (EMDR) have the strongest evidence base for PTSD treatment. They help patients process traumatic memories, modify negative thought patterns, and reduce hyperarousal and avoidance behaviors.
Question 5: A patient with anorexia nervosa is admitted with a weight of 35 kg at 165 cm height (BMI 12.9). What is the immediate priority?
- Medical stabilization: electrolyte management and nutritional rehabilitation (Correct answer)
- Psychotherapy sessions immediately
- Family therapy only
- Discharge to outpatient care
Correct answer: Medical stabilization: electrolyte management and nutritional rehabilitation
Severe anorexia (BMI <15) is a medical emergency. Life-threatening complications include cardiac arrhythmias (from hypokalemia and hypomagnesemia), refeeding syndrome, and multi-organ failure. Medical stabilization, electrolyte monitoring, and controlled nutritional rehabilitation precede psychological interventions.
Question 6: Which statement by a patient taking MAO inhibitors requires immediate intervention?
- 'I had red wine and cheese with dinner tonight.' (Correct answer)
- 'I took my medication with water this morning.'
- 'I have been sleeping better since I started this medication.'
- 'I feel less sad this week.'
Correct answer: 'I had red wine and cheese with dinner tonight.'
MAO inhibitors combined with tyramine-rich foods (aged cheese, red wine, cured meats, fermented foods) cause hypertensive crisis — a dangerous, potentially fatal surge in blood pressure. Patients must strictly avoid all tyramine-containing foods.
SNLE Psychiatric Nursing 3
A patient with major depressive disorder refuses to get out of bed and states 'What is the point?' Which nursing diagnosis is the priority?