Psychiatric Nursing Flashcards

What is the purpose of a 'no-suicide contract' in psychiatric care?

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.

A patient is exhibiting escalating agitation on the psychiatric unit. What is the least restrictive first intervention?

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.

Which drug class is used to treat acute extrapyramidal side effects (EPS) caused by antipsychotics?

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.

A patient describes hearing voices that comment on their actions throughout the day. This is:

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.

What is the best nursing response when a patient expresses anger toward the nurse?

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.

Which term describes a patient's inability to feel pleasure in activities they previously enjoyed?

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.