SNLE Psychiatric Nursing 4 — Questions and Answers
Question 1: What is the purpose of a 'no-suicide contract' in psychiatric care?
- To reinforce therapeutic alliance and communication, not as a standalone safety measure (Correct answer)
- To legally prevent the patient from attempting suicide
- To replace regular risk assessments
- To discharge the patient safely without further monitoring
Correct answer: To reinforce therapeutic alliance and communication, not as a standalone safety measure
No-suicide contracts have limited evidence as standalone safety measures. Their value lies in reinforcing the therapeutic relationship, establishing a communication agreement, and reinforcing the patient's commitment to safety. They do not replace comprehensive risk assessment and monitoring.
Question 2: A patient is exhibiting escalating agitation on the psychiatric unit. What is the least restrictive first intervention?
- Verbal de-escalation: calm voice, non-threatening posture, offer choices (Correct answer)
- Immediate physical restraint
- Immediate chemical restraint
- Seclusion
Correct answer: Verbal de-escalation: calm voice, non-threatening posture, offer choices
The hierarchy of least to most restrictive interventions starts with verbal de-escalation (preferred), followed by medication (chemical restraint), seclusion, and finally physical restraint as a last resort. Least restrictive intervention must always be tried first.
Question 3: Which drug class is used to treat acute extrapyramidal side effects (EPS) caused by antipsychotics?
- Anticholinergic agents such as benztropine (Cogentin) (Correct answer)
- Benzodiazepines
- Beta-blockers
- SSRIs
Correct answer: Anticholinergic agents such as benztropine (Cogentin)
Acute EPS (dystonia, akathisia, parkinsonism) from antipsychotic dopamine blockade are treated with anticholinergic agents (benztropine, diphenhydramine) which restore the dopamine-acetylcholine balance in the extrapyramidal system.
Question 4: A patient describes hearing voices that comment on their actions throughout the day. This is:
- Auditory hallucinations — a positive symptom of schizophrenia (Correct answer)
- A normal stress response
- A delusion
- Negative symptom of schizophrenia
Correct answer: Auditory hallucinations — a positive symptom of schizophrenia
Auditory hallucinations — hearing sounds, voices, or commands without an external stimulus — are positive (added) symptoms of schizophrenia. Running commentary type hallucinations are a classic first-rank (Schneiderian) symptom of schizophrenia.
Question 5: What is the best nursing response when a patient expresses anger toward the nurse?
- Remain calm, set limits on the behavior, and explore the underlying feelings (Correct answer)
- Become defensive and walk away
- Apologize regardless of whether you did anything wrong
- Match the patient's emotional intensity
Correct answer: Remain calm, set limits on the behavior, and explore the underlying feelings
A non-defensive, calm response acknowledges the patient's anger, models self-regulation, and opens communication. Setting limits on abusive behavior while exploring its source (often displaced from other frustrations) is therapeutic and maintains professional boundaries.
Question 6: Which term describes a patient's inability to feel pleasure in activities they previously enjoyed?
- Anhedonia (Correct answer)
- Anergia
- Aphasia
- Agoraphobia
Correct answer: Anhedonia
Anhedonia is the inability to experience pleasure from previously enjoyable activities and is a core symptom of major depressive disorder and a negative symptom of schizophrenia. Anergia is lack of energy; aphasia is language impairment; agoraphobia is fear of open spaces.
SNLE Psychiatric Nursing 4
What is the purpose of a 'no-suicide contract' in psychiatric care?