Synopsis of Psychiatry Test Bank

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A new nurse asks the mentor, “How can I be sure I’m developing a therapeutic environment for my unit?” The mentor uses as a basis for the response the fact that a therapeutic milieu is characterized by:

  • A. Rigid adherence to timelines and unit routine
  • B. Relaxation of boundaries when doing so is accepted by all
  • C. Working with a member to help improve their communication skill
  • D. The focus of the staff is directed to the most critically disturbed patients
Correct Answer: D

Rationale: A therapeutic milieu is characterized by focusing on the needs and goals of the patients. By establishing specific patient-centered goals that are agreed upon mutually by the patient and the staff, it ensures that the care provided is individualized and tailored to the patient's needs. This approach fosters a collaborative and empowering environment where the patient feels heard and supported in their recovery journey. It also promotes a sense of ownership and accountability for both the patient and the staff in working towards these goals together. In contrast, rigid adherence to timelines and unit routine (option A) may not always take into account the unique needs of each patient, and relaxation of boundaries (option B) can potentially compromise the therapeutic process by blurring professional boundaries. Therefore, establishing patient-centered goals is a key component of creating a therapeutic environment on a nursing unit.

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An outcome for a patient experiencing anticipatory grieving for a spouse diagnosed with
terminal cancer would be that the patient will:

  • A. Continue to be emotionally involved with the dying spouse
  • B. Develop protective mental mechanisms to allay the pain of spousal loss
  • C. Not voice threats of physical violence that is either self or others directed
  • D. Agree to stay at home and care for the spouse with appropriate assistance
Correct Answer: D

Rationale: Anticipatory grieving involves preparing emotionally for the upcoming loss. The patient may begin to focus on caregiving and emotional preparation. Agreeing to care for the spouse with assistance reflects an adaptive coping mechanism during this period.

A 19-year-old patient with undifferentiated schizophrenia is acutely psychotic. The nurse assesses the primary deficit as:

  • A. Social isolation
  • B. Disturbed thinking
  • C. Altered mood states
  • D. Poor impulse control
Correct Answer: B

Rationale: Acute psychosis primarily affects thought processes, evidenced by delusions or disorganized thinking.

A novice mental health nurse shares that, “I’ll never get used to playing cards or other games with patients. It seems like a poor use of scarce nursing time.” The best response for the nurse’s mentor would be:

  • A. “Perhaps you’ll want to rethink your transfer to this unit if you’re really uncomfortable.”
  • B. “Your comments make a point about scarce resources. I’ll ask the treatment team to review our position on activities.”
  • C. “Activity co-leadership puts us in a position to help patients develop social skills and support them as they take small risks.”
  • D. “Managed care has cost us activities therapists. Activities are
Correct Answer: C

Rationale: The best response for the nurse’s mentor would be to highlight the importance of activities in mental health nursing. Participating in activities such as playing cards or games with patients is not just about passing time, but it also serves a therapeutic purpose. Engaging in activities helps patients to develop social skills, build relationships, and take small risks in a safe environment. As mental health nurses, it is crucial to understand that these activities are not a waste of time but rather an essential part of the therapeutic process. By participating in activities with patients, nurses can actively support their mental well-being and contribute to their overall treatment and recovery.

For which patient is the nurse most likely to need to schedule a pre-ECT workup and teaching?

  • A. Patient A, who is newly diagnosed with dysthymic disorder
  • B. Patient B, who has melancholic depression that responded well to ECT 2 years ago
  • C. Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant therapy
  • D. Patient D, who has depression associated with diagnosis of inoperable
Correct Answer: D

Rationale: The nurse is most likely to need to schedule a pre-electroconvulsive therapy (ECT) workup and teaching for Patient D, who has depression associated with the diagnosis of an inoperable brain tumor. In such cases, ECT may be considered as a treatment option due to the severity of the depression and the limitations in using other treatments. Before ECT can be initiated in a patient with such complex medical conditions, it is crucial to conduct a thorough evaluation and preparation process, which includes obtaining informed consent, assessing the patient's medical history, conducting pre-ECT laboratory tests, and providing patient and family education about the procedure. Given the unique circumstances of Patient D's inoperable brain tumor, the nurse must ensure all necessary steps are taken to ensure the safety and efficacy of ECT as a treatment option.

A patient returned from attending the service memorializing his wife, who died after a sudden illness. Although those around him were visibly saddened, he smiled and remained in control. He refused support from friends, stating, “I can handle anything that comes my way.” The patient’s behavior is an example of grief.

  • A. Inhibited
  • B. Distorted
  • C. Conflicted
  • D. Normal
Correct Answer: B

Rationale: The patient's behavior of smiling and remaining in control while refusing support from friends, despite attending a service memorializing his wife's death, is indicative of distorted grief. In distorted grief, individuals may show seemingly inappropriate reactions or behaviors that do not align with the typical grieving process. The patient's avoidance of accepting support and expression of excessive self-reliance in the face of a significant loss suggest a distorted way of coping with grief. In normal grief, individuals may experience a range of emotions and accept support from others as they navigate through the grieving process.

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