SNLE Psychiatric Nursing 1 — Questions and Answers
Question 1: Which therapeutic communication technique is most appropriate when a patient states 'I feel like nobody cares about me'?
- Reflect feelings: 'It sounds like you are feeling very alone right now.' (Correct answer)
- Offer advice: 'You should talk to your family.'
- Minimize: 'I am sure that is not true.'
- Change the subject to distract the patient.
Correct answer: Reflect feelings: 'It sounds like you are feeling very alone right now.'
Reflecting feelings validates the patient's emotional experience and encourages them to explore their feelings further. Offering unsolicited advice, minimizing, or changing the subject are non-therapeutic techniques that block communication.
Question 2: What is the priority nursing assessment for a patient admitted with suicidal ideation?
- Assess the lethality of the plan, means, intent, and timeline (Correct answer)
- Check vital signs only
- Administer medication first
- Leave the patient alone to calm down
Correct answer: Assess the lethality of the plan, means, intent, and timeline
Suicide risk assessment must include plan (is there a specific method?), means (access to the method), intent (determination to carry it out), and timeline (when). Higher lethality, accessible means, and clear intent indicate imminent risk requiring immediate intervention.
Question 3: A patient with schizophrenia states 'The TV is sending me secret messages.' This is an example of:
- Ideas of reference (Correct answer)
- Auditory hallucinations
- Delusion of grandeur
- Thought insertion
Correct answer: Ideas of reference
Ideas of reference are a type of delusion in which the patient believes that external events or objects (TV, radio, strangers) are specifically directed at them with special meaning. This is a positive symptom of schizophrenia.
Question 4: Which medication requires regular monitoring of white blood cell count?
- Clozapine (Clozaril) (Correct answer)
- Haloperidol (Haldol)
- Lithium
- Fluoxetine (Prozac)
Correct answer: Clozapine (Clozaril)
Clozapine carries a risk of agranulocytosis (dangerous reduction in white blood cells) in approximately 1% of patients. Mandatory WBC and absolute neutrophil count (ANC) monitoring is required weekly for 6 months, then bi-weekly, then monthly.
Question 5: What is the correct nursing response when a patient experiencing command hallucinations says the voices are telling them to hurt someone?
- Ensure immediate safety, remove potential weapons, notify the treatment team immediately (Correct answer)
- Tell the patient to ignore the voices
- Continue the current care plan without changes
- Document it for the next shift only
Correct answer: Ensure immediate safety, remove potential weapons, notify the treatment team immediately
Command hallucinations with violent content represent an imminent safety risk to the patient and others. Immediate safety measures (environmental safety, 1:1 observation), notification of the treatment team, and potentially initiating involuntary hold procedures are required.
Question 6: Which nursing intervention is most important during alcohol withdrawal?
- Monitor for seizures, administer benzodiazepines as ordered, and ensure hydration (Correct answer)
- Encourage alcohol use to prevent severe withdrawal
- Administer antipsychotics as first-line treatment
- Place the patient in seclusion
Correct answer: Monitor for seizures, administer benzodiazepines as ordered, and ensure hydration
Alcohol withdrawal can be life-threatening (delirium tremens, Wernicke encephalopathy, seizures). Benzodiazepines are the standard of care to prevent withdrawal seizures. Monitoring with the CIWA-Ar scale guides dosing. Hydration and thiamine replacement are also critical.
SNLE Psychiatric Nursing 1
Which therapeutic communication technique is most appropriate when a patient states 'I feel like nobody cares about me'?