NR 548 EXAM PREP LATEST Psychiatric Assessment for Psychiatric-Mental Health Nurse Practit, Exams of Nursing

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NR 548 EXAM PREP LATEST Psychiatric

Assessment for Psychiatric-Mental Health Nurse

Practitioner ANSWERED 2024-2025 Questions

with correct answers

1,What are the four main components of a psychiatric

assessment? (4 marks) Answer: The four main

components of a psychiatric assessment are:

• History: This includes the patient's personal, family, medical, and psychiatric history, as well as their current symptoms, stressors, coping skills, and goals.
• Mental status examination: This is a systematic observation of the patient's appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.
• Physical examination: This is a general examination of the patient's vital signs, organ systems, and neurological functions to rule out any medical causes or complications of their mental condition.
• Diagnostic tests: These are laboratory tests, imaging studies, or psychological tests that may help to confirm or rule out a specific diagnosis or to monitor the patient's response to treatment.

1. What are the three main types of psychiatric interviews and

when are they used? (6 marks) Answer: The three main types of

psychiatric interviews are:

• Screening interview: This is a brief interview that aims to identify the presence or absence of a mental disorder or a need for further evaluation. It is usually used in primary care settings or in emergency situations.
• Diagnostic interview: This is a comprehensive interview that aims to establish a diagnosis or a differential diagnosis based on the criteria of a diagnostic manual such as the DSM-5 or the ICD-10. It is usually used in specialty mental health settings or in research settings.
• Therapeutic interview: This is an ongoing interview that aims to establish a

therapeutic alliance, explore the patient's problems and feelings, and facilitate change and recovery. It is usually used in psychotherapy or counseling settings.

2. What are some of the advantages and disadvantages of using structured or semi-structured interviews versus unstructured interviews for psychiatric diagnosis? (10 marks)

Answer: Some of the advantages and disadvantages of using structured or

semi-structured interviews versus unstructured interviews for psychiatric diagnosis are:

• Advantages of structured or semi-structured interviews: They are more reliable, valid, and standardized than unstructured interviews. They ensure that all relevant information is covered and that no important details are missed. They reduce the influence of interviewer bias or subjectivity. They facilitate communication and documentation among clinicians and researchers.
• Disadvantages of structured or semi-structured interviews: They are more time-consuming, rigid, and artificial than unstructured interviews. They may limit the rapport and flexibility between the interviewer and the patient. They may overlook some aspects of the patient's individuality, context, or complexity. They may not capture the nuances or subtleties of the patient's experience.

3. What are some of the common rating scales or instruments that are used to measure the severity or outcome of psychiatric disorders? Give an example for each of the following categories: mood disorders, anxiety disorders, psychotic disorders, substance use disorders, and personality disorders. (10 marks)

Answer: Some of the common rating scales or instruments that are used to measure

the severity or outcome of psychiatric disorders are:

• Mood disorders: Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Montgomery- Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Altman Self-Rating Mania Scale (ASRM).

Anxiety Disorder 7-item scale (GAD-7), Panic Disorder Severity Scale (PDSS), Social Phobia Inventory (SPIN).

• Psychotic disorders: Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH).
• Substance use disorders: Addiction Severity Index (ASI), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), Severity of Dependence Scale (SDS), Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar).
• Personality disorders: Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2), Millon Clinical Multiaxial Inventory 3rd edition (MCMI- III), Personality Assessment Inventory (PAI), Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), Personality Disorder Questionnaire 4th edition (PDQ-4). 1. A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate? a. You look nice this morning. b. You are wearing a new shirt. c. I like the shirt youre wearing. d. You must be feeling better today. 2. An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a. Social skills training b. Relaxation training classes c. Use of complementary therapy d. Learning desensitization techniques 3. A priority nursing intervention for a patient diagnosed with major depressive disorder is: a. distracting the patient from self-absorption. b. carefully and inconspicuously observing the patient around the clock. c. allowing the patient to spend long periods alone in self-reflection. d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu. 4. When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by

using: a. psychoanalytic therapy. b. desensitization therapy. c. cognitive behavioral therapy. d. alternative and complementary therapies.

5. A patient says to the nurse, My life does not have any happiness in it anymore. I once enjoyed holidays, but now theyre just another day. How would the nurse document the complaint? a. Vegetative symptom b. Anhedonia c. Euphoria d. Anergia

a. Mashed potatoes, ground beef patty, corn, green beans, apple pie b. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake c. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

12. What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment? a. Supporting physiologic stability b. Reducing disorientation and confusion c. Monitoring pupillary responses d. Assisting the patient to identify and test negative thoughts 13. A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which behavior indicates effective learning? The patient: a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting.

c. consults the pharmacist when selecting over-the-counter medications. d. can identify foods with high selenium content, which should be avoided.

14. A patients employment is terminated and major depressive disorder results. The patient says to the nurse, Im not worth the time you spend with me. Im the most useless person in the world. Which nursing diagnosis applies? a. Powerlessness b. Defensive coping c. Situational low self-esteem d. Disturbed personal identity 15. A patient diagnosed with major depressive disorder does not interact with others except when addressed and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Select the nurses most effective approach to communication. a. Make observations. b. Ask the patient direct questions.

c. Phrase questions to require yes or no Answers.

d. Frequently reassure the patient to reduce guilt feelings.

16. A patient being treated for major depressive disorder has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse should advise the patient: a. Go to the nearest emergency department immediately. b. Do not to be alarmed. Take two aspirin and drink plenty of fluids. c. Take one dose of the antidepressant. Come to the clinic to see the health care provider. d. Resume taking the antidepressant for 2 more weeks, and then discontinue it again. 17. Which documentation indicates the treatment plan of a patient diagnosed with major depressive disorder was effective? a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. b. Slept 10 hours uninterrupted. Attended craft group; stated project was a failure, just like me. c. Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. d. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, I feel tired all the time. 18. A woman gave birth to a healthy newborn 1 month ago. The patient now reports she cannot cope and is unable to sleep or eat. She says, I feel like a failure. This baby is the root of my problems. The priority nursing diagnosis

c. Hot tea d. Milk

21. During a psychiatric assessment, the nurse observes a patients facial expressions that are without emotion. The patient says, Life feels so hopeless to me. Ive been feeling sad for several months. How should the nurse document the patients affect and mood? a. Affect depressed; mood flat b. Affect flat; mood depressed c. Affect labile; mood euphoric d. Affect and mood are incongruent 22. A disheveled patient with severe depression and psychomotor retardation has not bathed for several days. The nurse should: a. avoid forcing the issue. b. bring up the issue at the community meeting. c. calmly tell the patient, You must bathe daily. d. firmly and neutrally assist the patient with showering. 23. A patient was started on escitalopram (Lexapro) 5 days ago and now says, This medicine isnt working. The nurses best intervention would be to: a. discuss with the health care provider the need to change medications. b. reassure the patient that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. d. critically assess the patient for symptom relief. 24. A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate? a. Arms crossed b. Staring at the nurse c. Smiling inappropriately d. Eyes pointed downward 25. A patient diagnosed with major depressive disorder was hospitalized for 8 days. Treatment included six electroconvulsive therapy sessions and aggressive dose adjustments of antidepressant medications. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. a. Temporary memory impairments and confusion can be associated with electroconvulsive therapy. b. Antidepressant medications alter catecholamine levels, which impair decision- making abilities. c. Antidepressant medications may cause confusion related to a limitation of tyramine in the diet. d. The patient needs time to reorient himself or herself to a pressured work schedule.

26. A nurse instructs a patient taking a drug that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. hypotensive shock. b. hypertensive crisis. c. cardiac dysrhythmia. d. cardiogenic shock.

A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficit and sad mood

provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin (Dilantin) b. clonidine (Catapres) c. carbamazepine (Tegretol) d. chlorpromazine (Thorazine)

The cause of bipolar disorder has not been determined, but: a. several factors, including genetics, are implicated. b. brain structures were altered by stresses early in life. c. excess norepinephrine is probably a major factor. d. excess sensitivity in dopamine receptors may exist.

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurse's best response. a. "A high proportion of patients diagnosed with bipolar disorders are found among creative writers." b. "A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder." c. "Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to

daily stresses." d. "More individuals diagnosed with bipolar disorder come from high socioeconomic and educational backgrounds."

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse. a. Distraction: "Let's go to the dining room for a snack." b. Humor: "How much are you paying servants these days?" c. Limit setting: "You must stop ordering other patients around." d. Honest feedback: "Your controlling behavior is annoying others."

A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. incorrect because of inaccurate testing

Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which drug also belongs to this group? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (Lamictal) d. aripiprazole (Abilify)

When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority? a. Allow the patient to act out his or her feelings. b. Set limits on the patient's behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity and aggression.

At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. Select the best option. a. Extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery

A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and fought all morning. Staff members are feeling defensive and fatigued. Which is the best action? a. Confer with the health care provider regarding use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches.

the nurse's most appropriate intervention. a. Suggest to the patient to ask a friend do the shopping and bring purchases to the unit. b. Invite the patient to sit with the nurse and look at new fashion magazines. c. Tell the patient that computer use is not allowed until self-control improves. d. Ask whether the patient has enough money to pay for the purchases.

A patient diagnosed with bipolar disorder is being treated on an outpatient basis with lithium carbonate 300 mg three times daily. The patient complains of nausea. To reduce the nausea, the nurse can suggest that the lithium be taken with: a. meals. b. an antacid. c. a large glass of juice. d. an antiemetic medication.

A health teaching plan for a patient taking lithium should include instructions to: a. maintain normal salt and fluids in the diet. b. drink twice the usual daily amount of fluids. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats, and red wine

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depressive disorder (MDD) as well as one experiencing acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania? a. Spaghetti and meatballs, salad, a banana b. Beef and vegetable stew, a roll, chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, apple d. Chicken casserole, green beans, flavored gelatin with whipped cream

Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on: a. maintaining an interest in the environment. b. developing an optimistic outlook. c. self-control of distorted thinking. d. stabilizing the sleep pattern.

Which documentation indicates that the treatment plan for a patient

experiencing acute mania has been effective? a. "Converses without interrupting; clothing matches; participates in activities." b. "Irritable, suggestible, distractible; napped for 10 minutes in afternoon." c. "Attention span short; writing copious notes; intrudes in conversations." d. "Heavy makeup; seductive toward staff; pressured speech."

A patient experiencing mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation? a. Monitor physiologic functioning b. Provide a subdued environment c. Supervise personal hygiene d. Observe for mood changes

A patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken lithium 600 mg three times daily. Staff members observe increased agitation, pressured speech, poor personal hygiene,

c. "Usually patients take this medication for approximately 6 months after discharge." d. "It's unusual that the health care provider has not already stopped your medication."

A patient diagnosed with bipolar disorder and who takes lithium telephones the nurse at the clinic to say, "I've had severe diarrhea 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse should advise the patient: a. "Restrict oral fluids for 24 hours and stay in bed." b. "Have someone bring you to the clinic immediately." c. "Drink a large glass of water with 1 teaspoon of salt added." d. "Take an over-the-counter antidiarrheal medication hourly until the diarrhea subsides."

Lithium is prescribed for a new patient. Which information from the patient's history indicates that monitoring serum concentrations of the drug will be especially challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Congestive heart failure

A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's best response. a. "Why are you laughing?" b. "Please share the joke with me." c. "I don't think I said anything funny." d. "You are laughing. Tell me what's happening."

A person diagnosed with schizophrenia has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me." Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help if you will let them." d. "Staff members are health care professionals who are qualified to help you."

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as: a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.

A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to overdose me." How does this patient perceive the environment? a. Disorganized b. Unpredictable c. Dangerous d. Bizarre

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What common side effects should the nurse validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose

A nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, "I don't