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PMH –BC – SAMPLE QUESTIONS WITH
SOLUTIONS
A "state of optimum anxiety" refers to: A. readiness for learning B. Psychological well-being C. Readiness for therapy D. Response to treatment - answer -A. Readiness for learning A "state of optimum anxiety" refers to readiness for learning. Studies have indicated that learning is best achieved when the patient is experiencing mild to moderate anxiety, which may be related to anticipation or concerns about learning. This optimum anxiety enhances the ability to concentrate and the process of information. However, when this level of anxiety is exceeded, learning is impaired and the patient becomes defensive. The psychiatric and mental health nurse may need to assist the patient with anxiety-reducing techniques before teaching. A "state of optimum anxiety" refers to:
A. Readiness for learning B. Psychological wellbeing C. Readiness for therapy D. Response to treatment - answer -A. Readiness for learning A "state of optimum anxiety" prefers to readiness for learning. Studies have indicated that learning is best achieved when the patient is experiencing mild to moderate anxiety, which may be related to anticipation her concerns about learning. This optimum anxiety enhances the ability to concentrate and process information. However, when this level of anxiety is exceeded, learning is impaired and the patient becomes defensive. The psychiatric and mental health nurse may need to assist the patient with anxiety reducing techniques before teaching. A 15-year-old patient with autism spectrum disorder and obsessive compulsive disorder rarely verbalizes except for occasional words that seem random, and the patient often becomes very agitated when the psychiatric and mental health nurse attempts to interact or communicate with him. The most appropriate method to improve communication is to: A. Keep interactions to a minimum to avoid agitating the patient. B. Have the patient evaluated by speech therapist. C. Observe the patient carefully to note any communication strategies. D. Meet with the parents/caregivers to discuss the patient's communication. - answer -D. Meet with the parents/caregivers to discuss the patient's communication. Even patients who are essentially nonverbal with autism spectrum disorder have usually developed some methods of communication-such as becoming agitated or
A. "You will die if you dont' eat." B. "You will be fed by nasogastric tube if you don't eat." C. "We can't help you if you don't help yourself." D. "I can't force you to eat." - answer -B. "you will be fed by nasogastric tube if you don't eat." An adult can refuse food and nutrition, but a 16-year-old is a minor and under parental control, so the parents/caregivers make the decisions about health. In this case, because the patient's life is in danger, the nurse should respond with what is true and necessary: "You will be fed by nasogastric tube if you do not eat." The patient should be monitored during meals and for at least an hour after meals to prevent purging. Her goal for weight gain (usually 2 to 3 pounds per week) should be established and calories/nutrition calculated based on that goal. A 60 -year old female patient has been treated for depression with an SSRI for four months but reports no improvement in feelings of depression. The patient reports weight gain, lethargy, and feeling constantly "chilled." The patient probably needs: A. An increased dosage of medication B. Thyroid function tests C. A change to a different medication D. Renal function tests - answer -B. Thyroid function tests The patient is exhibiting possible signs of hypothyroidism. Weight gain, lethargy, and feeling "chilled" or having increased sensitivity to cold - and should have thyroid function tests. Patients may also complain of poor concentration, constipation, dry hair, and somnolence and may exhibit bradycardia and joint or
muscle pain. Hypothyroidism is a common cause of depression; it is often one of the first signs, and is typically overlooked. Hyperthyroidism may result in anxiety and emotional lability with some patients developing acute episodes of mania. a 78 year old female patient has been alert and oriented but has sudden onset of confusion. She has no physical complaints but the psychiatric and mental health nurse finds a low-grade elevation of temperature on examination, leading the psychiatric and mental health nurse to suspect: A. A respiratory tract infection B. Onset of influenza C. Dehydration and malnutrition D. A urinary tract infaction - answer -D. A urinary tract infection The psychiatric and mental health nurse should suspect that the patient has a urinary tract infection. In older adults, one of the first signs of a urinary tract infection may be sudden onset of confusion, as other usual signs (urinary frequency, burning) may be absent. The cause of the confusion is not clear but may relate to a combination of mild dehydration and fever. The patient should have a urinalyses and urine culture. The confusion usually clears rapidly with treatment for the infection. A male patient who is very short in stature has abused steroids in an attempt to build muscle mass. He excels in martial arts and he is very aggressive with other males. This behavior most likely reflects the ego defense mechanism of: A. Identification B. Repression C. Introjection
reinforcement, showing an accepting attitude to help increase the patient's feelings of self-worth and emotional security. A patient at risk for self-directed violence tells the psychiatric and mental health nurse that she wants to die and has nothing to live for. The most appropriate response is: A. "Do you have a suicide plan?" B. "Your family loves you very much." C. "You will feel better when the medication starts to work." D. "I'm so sorry to hear that, but I can help you." - answer -A. "Do you have a suicide plan?" The most appropriate response to a patient stating that she wants to die and has nothing to live for is "Do you have a suicide plan?" The psychiatric and mental health nurse should confront the issue directly in a matter-of-fact manner because this helps to convey to the patient that the nurse is willing to hear truthful response, and when confronted in this way, patients are more likely to share plans. Patients who have actually developed a suicide plan are at increased risk. A patient exhibits disturbed thought processes and delusional thinking, insisting his room is "bugged by the CIA." The most appropriate response to the patient is: A. "Thats not true. The CIA has no access to this facility." B. "OK, Let's see if we can find the bug and remove it." C. "I understand you believe your room is bugged, but I don't believe it's possible."
D. "Remember what you learned about hallucinations and delusions not being real."
- answer -C. "I understand you believe your room is bugged, but I don't believe it's possible The most appropriate response is the one that expressed acceptance of the person's belief along with reasonable doubt: "I understand you believe your room is bugged, but I don't believe it's possible." It's important to avoid denying outright that delusions are real ("that's not true...") or arguing with the patient ("remember what you learned...") as this is not likely to change the person's beliefs and will likely interfere with the therapeutic relationship. However, it's also important to avoid supporting the delusion ("Ok, lets see if we can find the bug..."). A patient experiences a sudden and severe panic attack and is almost paralyzed with fear, believing her life is in danger. In addition to providing an anti-anxiety medication, the most appropriate response for the psychiatric and mental health nurse is to: A. Leave the patient alone in a quiet space to recover. B. Ask the patient what would help relieve her anxiety. C. Stay with the patient and offer reassurance of safety. D. Remind the patient that her fears are not real. - answer -C. Stay with the patient and offer reassurance of safety. The most appropriate response to a patient experiencing a sudden panic attack is to stay with the patient and offer reassurance of safety, speaking in a calm and non- threatening manner. Reducing stimuli (noise, light, people) in the immediate area may help to reduce the patient's fears. Once the patient has regained control and the panic attack subsides, the psychiatric and mental health nurse should explore with the patient the cause of the attack to help the patient recognize precipitating factors.
Intellectual disabilities
- Mild (IQ 60-70): Achieves academic skills to sixth grade level and is able to learn some vocational skills and to live independently with some assistance
- Moderate (35-49 iQ): Achieves academic skills to second-grade level and may be able to work in sheltered workshop, but requires supervision in living situations
- Severe (IQ 20-34): Learns through systematic habit forming, but cannot benefit from vocational training or work or live independently.
- Profound (IQ <20): responds to minimal training in self-help and needs constant care and supervision. A patient has signed the consent form for ECT under pressure from her spouse but confides in the psychiatric and mental health nurse that she does not want the treatment and is terrified but afraid to stand up to her spouse. The psychiatric and mental nurse should: A.) Ask the patient if she wants to rescind the content form. B.) Tell the patient that she must tell her spouse she does not want the treatment. C.) Tell the patient she must go through with the treatment since she signed the consent. D.) Notify the physician of the patient's feelings about the treatment. - answer -(D.) Notify the physician of the patients feelings about the treatment. Because the patient is intimidated by her spouse and has stated she is afraid to stand up to him, as an advocate for the patient, the nurse should notify the physician of the patient's feelings about the treatment. Being coerced into signing a consent form is not the same is not the same as giving informed consent, which is required by law. Because patients are vulnerable to manipulation, the nurse must ensure that the actual wishes of the patient are respected.
A patient in the emergency department with multiple injuries (bruises, split lip, facial laceration, head contusion) reports that her boyfriend got high on amphetamines and alcohol and beat her, so she drove herself to the hospital for treatment. The priority intervention is: A. Asking the patient if she wants to call the police B. Providing information about a women's shelter C. Providing information about domestic abuse services D. Providing wound care to the injuries - answer -D. Providing wound care to the injuries The priority intervention for a patient who presents with multiple injuries to provide wound care and assess the degree of injury; especially since a head injury is involved. Once the patient's condition is stable, the psychiatric and mental health nurse should ask the patient if she wants to call the police and provide information about domestic abuse services and women's shelters. The nurse should also ascertain that the abuser is not present in the facility because, if that is the case, then security should be notified. A patient was able to slowly read aloud an information sheet but when asked to state what she had read in her own words was unable to do so. The most likely reason is: A.) Low self-esteem B.) Poor hearing C.) Low health literacy D.) Anxiety - answer -(C.) Low health literacy
A. Providing smoking cessation classes B. Allowing scheduled smoking C. Providing emotional support D. Providing nicotine patches. - answer -D. Providing nicotine patches Patients usually exhibit symptoms of abrupt withdrawal from nicotine within 24 hours. Symptoms can include difficulty concentrating, dysphoric or depressed mood, difficulty sleeping, agitation, irritation, anger, frustration, bradycardia, and increased appetite. These symptoms may add to those the patient is already experiencing, making treatment more difficult, so the patient may benefit from the use of nicotine patches to avoid withdrawal symptoms A patient with a long history of schizophrenia and alcohol and drug addiction with repeated institutionalizations is stabilized after the current hospitalization and is ready for discharge. Which of the following community resource referrals is most likely to be effective? A. Community mental health center B. Psychiatric home health care C. Assertive community treatment (ACT) D. Partial hospitalization program - answer -C. Assertive Community Treatment (ACT) Assertive Community Treatment (ACT) is a comprehensive interdisciplinary case- management approach to providing treatment for patients with severe and persistent mental illness. ACT provides services from psychiatry, nursing, social work, and rehabilitation (substance abuse, vocational) around the clock to help patients:
- decrease / eliminate symptoms
- minimize recurrent / acute exacerbations
- improve functioning (social, voc.)
- Live independently Another goal of the program is to help relieve family members of the burden of caring for patients with serious mental illnesses. A patient with anxiety disorder wants to utilize complementary therapy as an adjunct to anti-anxiety medications. The complementary therapy that is likely to be the most effective in providing relief from anxiety is: A. Imagery/self-relaxation B. Acupuncture C. Massage D. Aromatherapy - answer -A. Imagery/Self-relaxation Imagery and self-relaxation techniques are likely to be the most effective in providing relief from anxiety because these techniques can be learned easily and utilized whenever the patient feels stressed. Massage also has benefits in reducing anxiety but is expensive and not readily available during times of stress. Some people feel that aromatherapy (orange, bergamot, lavender) is beneficial. Studies regarding the use of acupuncture to relieve anxiety have been inconclusive, although some people feel it helps reduce anxiety. A patient with bipolar disorder is extremely manipulative and often behaves in a sexually provocative and inappropriate manner with staff members and other
senses. For example, a patient may be asked to smell a particular food and then be asked questions about the food. Another type of SST uses a rapid sequence of nerve stimulation through a device in a part of the body, such as an arm, to promote neural regeneration. A patient with schizophrenia has delusions and believes that his family members cannot be trusted. According to Maslow's hierarchy of needs, the patient's delusions are interfering with the development at the level of: A. Physiological needs B. Love/belongings needs C. Safety needs D. Self-esteem needs - answer -B.) Love/Belongings needs The patient's delusions are interfering with the development at the level of love/belonging needs. Maslow's hierarchy of needs is based on the premise that 1 must satisfy one type of need before 1 can obtain the next. The hierarchy of need includes: Physiological: Basic needs such as air, food, water, shelter. Safety and security: Freedom from fear: Safety comfort: Physical comfort
Love and belonging: Companionship, caring/giving receiving love, group identification, satisfying interpersonal relationships. Self-esteem: Working for success, desiring respecting prestige, seeking self respect. Self-actualization: Feeling of self-fulfillment, satisfaction with achievement. A rape victim with multiple injuries has been brought to the emergency department for evaluation and treatment. The first thing that the psychiatric and mental health nurse should communicate is: A. "I am so sorry this happened to you" B. "You are safe here. No one can hurt you." C. "This was not your fault" D. "I'm thankful you survived this attack." - answer -B. "you are safe here. No one can hurt you." Patients who have been raped are often severely traumatized emotionally and physically, and are commonly very fearful and panicked, so the first thing that the mental health nurse should communicate is "you are safe here, no one can hurt you". The psychiatric and mental health nurse may need to repeat this a number of times because traumatized patients may block out what people are saying. The nurse should also reassure the patient that the attack was not the patient's fault and that the nurse is sorry for what the patient has gone through. According to Erickson's stages of psychosocial development, which are the following best characterizes the developmental task of adulthood and the generativity versus stagnation stage?
C. They have very low health literacy. D. They are ashamed that their child has a psychiatric condition. - answer -D. They are ashamed their child has a psychiatric condition. The most likely reason that Asian American parents would insist that their child's condition was caused by an "infection" and refused outpatient care or follow-up is because they are ashamed that their child has a psychiatric condition. It is common among Asian cultures to believe that psychiatric illness is caused by poor behavior, and this behavior is viewed as bringing shame on the patient and the family. Asians often ascribe psychiatric symptoms to physical illnesses, such as infection, because these types of illnesses are more socially acceptable. An Asian-American adolescent is to be discharged from a psychiatric unit after psychotic episode, but the parents, who are immigrants from China, are adamant that the patient cannot receive any outpatient treatment or follow-up care, stating that his illness was caused by an "infection". The probably reason for this is: A. They are unfamiliar with the Western treatment for mental illness. B. They have poor language skills and misunderstand the diagnosis. C. They have very low health literacy. D. They are ashamed their child has a psychiatric condition. - answer -D. They are shamed their child has a psychiatric condition. The most likely reason that Asian-American parents would insist that their child's condition was caused by an "infection" and refuse outpatient care or follow-up is because they are ashamed that their child has a psychiatric condition. It is common among Asian cultures to believe that psychiatric illness is caused by poor behavior, and this behavior is viewed as bringing shame on the patient and the family. Asians often ascribe psychiatric symptoms to physical illnesses, such as infection, because these types of illnesses are more socially acceptable.
An elderly patient scored 18 out of the possible maximum score of 30 on the mini mental status examination MMSE this score usually indicates: A. Severe cognitive impairment B. Mild cognitive impairment C. Moderate cognitive impairment D. Normal cognition - answer -C. Moderate cognitive impairment Score of 18 out of 30 MMSS usually indicates a moderate cognitive impairment. Scores of 24-38 indicate normal cognition while 10-18 indicate moderate cognitive impairment. Scores may be affected by numerous variables (age, hearing, intelligence, vision, physical condition), so the MMSE score alone is not adequate for diagnosis of dementia. However, it is a good guide, and those with very low scores (<9) usually demonstrates severe cognitive impairment. As part of milieu therapy, the psychiatric and mental health nurse should expect to: A. Provide weekly patient feedback. B. Attend regular community meetings. C. Direct patient participation. D. Established rules of patient behavior. - answer -B. Attend regular community meetings. With milieu therapy, all aspects of the patient's environment are considered therapeutic, and patients are expected to be active participants and planning their own treatment. Criteria for milieu therapy include fulfilling basic physiological needs, establishing an environment that is conductive to achieving therapeutic
