PSYCH

Question 1

What is Anhedonia in relation to depression?

Answer 1

Loss of pleasure in activities that used to bring pleasure. AKA - a general loss of enjoyment

Question 2

What happens to a client’s weight in mild and severe depression?

Answer 2

Mild = weight gain (Lack of activity)
Severe = Weight Loss (Anorexia)

Question 3

What causes irritability in a client with depression?

Answer 3

Decreased serotonin levels

Serotonin is a mood elevator

Question 4

You’re working the day shift on an inpatient psych ward. Your clients are playing a group game of Monopoly, but you noticed one of your clients with severe depression is still in their room, sitting quietly. Which is the most appropriate action?
A/ Close their door to prevent excess noise and anxiety
B/ Tell them that they need to partake in the afternoon activities
C/ Encourage them to join the rest of the group by keeping score
D/ Routinely check in on them every 20 minutes

Answer 4

C/ Encourage them to join the rest of the group by keeping score

Depression causes people to withdraw and isolate themselves from others. Interaction with others will improve their mood; however, this cannot be forced upon them (B).

Leaving them alone with increase their isolation and decrease their mood further.

Question 5

A client on the psych floor has isolated himself in his room since yesterday afternoon. He suffers from severe depression since the loss of his wife and refuses to interact with others. Which of the following action is most appropriate?
A/ Encourage him to sit out in the common area with the others
B/ Tell him that exercise will improve his mood and offer to take him on a walk around the floor
C/ Ask him if you can sit with him in his room for a few minutes
D/ Ask him if he would like to talk about what is bothering him and if he would like to talk about his wife.

Answer 5

C/ Ask him if you can sit with him in his room for a few minutes

In severely depressed clients sometimes the best thing nurses can do is simply sit with the client and be in their presence. Making demands or trying to push them outside their boundaries may decrease their mood or create further isolation.

Asking him to talk about his dead wife may not go over smoothly unless he is willing to do so. Remember don’t make demands, no matter how innocent.

Question 6

Which of the following might be challenging for a person with depression?
SELECT ALL THAT APPLY

A/ Choosing which clothes to wear for the day
B/ Participating in a game of checkers
C/ Reading a book
D/ Deciding on which movie to watch that evening
E/ Drawing a picture with pencils

Answer 6

A/ Choosing which clothes to wear for the day
D/ Deciding on which movie to watch that evening

Typically, depression makes it challenging for people to make simple decisions. It impedes their ability to decide and stick with their choices.

Question 7

Which of the following clients are at the greatest risk for suicide?
A/ 57 year-old-mother who suffers from depression and recently lost her husband to ALS
B/ 69-year-old male recovering from severe depression in an outpatient service
C/ 15-year-old female in therapy for Bulimia Nervosa and depression
D/ 44-year-old male who has recently been diagnosed with pancreatic cancer and suffers from Generalized Anxiety Disorder.

Answer 7

B/ 69-year-old male recovering from severe depression in an outpatient service

As depressive symptoms start to lift, the risk for suicide increases, especially in older clients. Elderly men tend to be the most successful due to their choice of lethal methods.

Although all clients should be assessed, the client (B) is at greatest risk due to their decreasing symptoms, age, and gender.

Question 8

Which of the following clients is most likely to develop hypersomnia?
A/ 18-year-old with mild depression
B/ 55-year-old with depression and OCD
C/ 38-year-old with severe depression
D/ 61-year-old with severe depression and suicidal ideation

Answer 8

A/ 18-year-old with mild depression

Hypersomnia is someone who is sleepy most of the time and tends to oversleep. This is most common in mild depression. Age is not a factor.

Moderate-Severe depression is more likely to present with insomnia

Question 9

What are some symptoms is Mania?

Answer 9

1. Continuous High
2. Emotions-labile (likely to change)
3. Flight of ideas
4. Delusions
5. Constant motor activity
6. Inappropriate dress
7. Too busy to eat
8. Altered sleep patterns
9. Spending sprees
10. Poor judgment
11. No inhibitions (limits or social norms)
12. Hypersexual and may exploit others
13. Manipulates others
14. Decreased attention span
15. Hallucinations

Question 10

Your client with Mania develops a delusion that they are Queen Victoria and all other clients must bow to her. Which is the most appropriate response by the nurse?
A/ “I understand that you feel you are Queen Victoria, but this needs to stop”
B/ “You are not the Queen, you need to understand that this is a delusion and I am here to help you”
C/ “Your Majesty, would you like to have a seat here with me and we can chat?”
D/ “I understand that you need to feel as if you are Queen Victoria, but I do not believe that you are.”

Answer 10

D/ “I understand that you need to feel as if you are Queen Victoria, but I do not believe that you are.”

It is important to acknowledge that they need this delusion, however; acknowledge that you do not share this delusion.

Clients with mania will develop delusions to serve a purpose.

Question 11

Why might a client develop a delusion of Grandeur or a delusion of persecution?

Answer 11

Delusions of grandeur often fulfills the need for the client to feel good about themselves or meet their self-esteem needs

Delusions of persecution are often linked to the need to feel safe.

Question 12

What does manipulation do for a client with mania?

Answer 12

Provides them with a sense of power, control, and security.

Question 13

Which of the following are appropriate nursing consideration for a client with Mania? SELECT ALL THAT APPLY

A/ Limit Group activities
B/ Provide a structured schedule
C/ Set up their meals with appropriate cutlery
D/ Provide free time to prevent anxiety
E/ Decrease stimulation
F/ Avoid lengthy conversation

Answer 13

A/ Limit Group activities
B/ Provide a structured schedule
E/ Decrease stimulation
F/ Avoid lengthy conversation

They should be given finger foods as they rarely sit still to eat, therefore setting up their meals will most likely not work. Providing them with free time will give them the opportunity to engage in an inappropriate or purposeless activity. A structured schedule is important. A lengthy conversation with Staff will increase their stimulation and feed into their mania.

Question 14

What is Echolalia associated with schizophrenia?

Answer 14

Repeating words over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over

Question 15

What is Neologism associated with Schizophrenia?

Answer 15

Creation of new words

“Halaflapocka”
“Dinkaflicka”
“Porjicate”

Question 16

What is a command hallucination?

Answer 16

Auditory hallucinations that command the client to hurt themselves or others. They can be frightening for the client and others and are psychiatric emergencies.

Can occur with schizophrenia

Question 17

When caring for a client with schizophrenia, it is important for the nurse to remember:
SELECT ALL THAT APPLY

A/ Decrease their stimuli
B/ Observe them cautiously every hour
C/ Keep conversations to a minimum
D/ Orientate the client frequently
E/ Provide them with a radio or television to decrease hallucinations

Answer 17

A/ Decrease their stimuli
D/ Orientate the client frequently

Orientation is required, even though they may know person, place, and time, they may still have delusions.

Observation of the client is important, but ensure you do not provoke feelings of suspicion, fear, or anger in the client. Observation should be done every 20 minutes.

Conversations are appropriate, but they must be reality based. Do not accept hallucinations, but try to ground the person in reality.

Radios and television will overstimulate the client. Perhaps writing activities or colouring

Question 18

What are 4 important questions to ask if suicidal ideation is expected?

Answer 18

1. Do they have a plan? What is the plan?
2. How lethal is the plan?
3. Do they have access to the means of their plan?
4. Have they had previous attempts in the past?

Question 19

What are some precursor signs of potential suicide?

Answer 19

1. Isolating themselves
2. Writing a will or note
3. Collecting harmful objects
4. Giving away possessions (no matter how trivial or insignificant)

Question 20

What is a contract to postpone?

Answer 20

A contract between nurse/HCP and client who is suicidal that states the client agrees not to end their life for 24 hours.

The hope is that this written agreement will postpone their plan and in those 24 hours the client may have a change of heart or come to a logical realization.

*Ensure you renew the contract after 24 hours or your up shit creek.

Question 21

You’re a graduate nurse working at a psychiatric hospital. Your task is to plan a group activity for 6 clients admitted with suicidal ideation. Which task is the most appropriate?
A/ Walking around the grounds for 30 minutes
B/ Organizing a game of 3-on-3 basketball
C/ A group scavenger hunt
D/ A painting class

Answer 21

B/ Organizing a game of 3-on-3 basketball

Physical activity helps refocus negative emotions, whether they be anger, frustration, sadness, hopelessness, etc. Physical activity releases endorphins and improves mood. Always chose activities that exert the most energy!

Question 22

A 53-year-old client suffering from severe depression states that “it has been so hard to go on since my wife died, I can barely eat anything, or enjoy activities I used to enjoy. What’s the point?” The most appropriate response from the nurse would be:
A/ “I can imagine that the loss of your wife has been very difficult for you, how have you managed to cope with her passing?”
B/ “I understand that this is a difficult time for you, perhaps we could find activities that could help improve your mood.”
C/ “Have you ever felt like ending your life, or that life is not worth living anymore?”
D/ “What do you think would help you to feel better?”

Answer 22

C/ “Have you ever felt like ending your life, or that life is not worth living anymore?”

The client is hinting that they may have suicidal ideation. their statement “It has been so hard to go on… What’s the point?” Eludes to their displeasure with life and possible suicide. It is important to be direct and blunt in confronting suicidal thoughts; especially to know if they have a plan and a means or previous attempts.

Question 23

How often should you check restraints?

Answer 23

every 15 minutes

Remember hydration, nutrition, and elimination

ALWAYS A LAST RESORT

Question 24

People who have paranoia tend to have pathologic ____ that consumes their thoughts

Answer 24

Jealousy

Question 25

When caring for a person with Paranoia, what is the most important factor of treatment?

Answer 25

Following through with promises. This builds trust

BE RELIABLE

Question 26

Which of the following is inappropriate for nurses to do when providing care to a paranoid client?
A/ Providing personal space
B/ Providing medications one at a time
C/ Using touch to build rapport and therapeutic communication
D/ Ensuring the use of a matter-of-fact tone and avoiding sarcasm.

Answer 26

C/ Using touch to build rapport and therapeutic communication

This violates their personal bubble which may be much larger than the average person. They can perceive these actions as a threat to their safety.

Question 27

Which client is most likely to require medications to be labeled? A client with...
A/ Schizophrenia
B/ Mania
C/ Paranoia
D/ Severe depression

Answer 27

C/ Paranoia

They do not trust others and may be suspicious about taking their medications.

Question 28

What are some signs and symptoms of generalized anxiety disorder?

Answer 28

1. Chronic anxiety that occurs daily
2. Fatigue due to symptoms and muscle tension
3. Uncomfortable/malaise
4. They often seek help due to poor quality of life

Question 29

Aside from Anxiolytics and relaxation techniques, what other method has shown to help clients with generalized anxiety disorder?

Answer 29

Journaling

Over time it may provide insight into anxiety, their peaks and valleys, and triggers.

Question 30

You are assigned to a patient diagnosed with PTSD on the psychiatric unit. Prior to entering their room, you expect the client to:
A/ Be emotionally detached and expressionless
B/ Be cautious of you and hesitant
C/ Be visibly upset and apprehensive
D/ Be defensive and eager to isolate themselves from others

Answer 30

A/ Be emotionally detached and expressionless

They do this to push away negative emotions associated with the illness.

Question 31

What is an Obsession and what is a Compulsion?

Answer 31

Obsession = Recurrent Thought
Compulsion = Recurrent Act

Question 32

A client with OCD on the floor as been continuously brushing their teeth to the point that their gums are becoming severely irritated and breaking down. Which of the following actions is most appropriate for the client?
A/ Provide them with a soft bristle toothbrush to reduce irritation
B/ Remove their toothbrush and only provide it after meals
C/ Remove their toothbrush and provide them with a stack of laundry that needs folding
D/ Alter their schedule to reduce the amount of free time they have in order to reduce their time for oral hygiene rituals

Answer 32

C/ Remove their toothbrush and provide them with a stack of laundry that needs folding

It is appropriate to remove the ritual, ONLY if you provide them with another ritual. It is important to give them time to complete their rituals as this will reduce their stress and anxiety. Removing the ritual is not appropriate. But enabling them to continue a ritual that is harmful to themselves or others is also not appropriate.

Question 33

What are dissociative disorders?

Answer 33

The client uses dissociation as a coping mechanism to protect themselves from severe physical and or psychological trauma. Often seen in clients with sexual abuse. They may not be aware of a problem because they may not remember any events or periods of time associated with the events.

Question 34

What occurs during the 3 stages of alcohol withdrawal?

Answer 34

Stage I: Mild tremors, nervousness, nausea

Stage II: Increased tremors, hyperactive, nightmares, disorientation, hallucinations, tachycardia, increased BP

Stage III: Severe hallucinations, Grand Mal Seizures (MOST SERIOUS)

Question 35

What is the detox protocol for a client with Alcohol withdrawal?

Answer 35

Thiamine Injections (B1)
Multivitamins
Magnesium (somtimes)

Alcoholics are often deficient in various nutrients, which can cause severe complications during alcohol withdrawal such as the development of Wernicke syndrome. To help to prevent Wernicke syndrome, alcoholics should be administered a multivitamin preparation with sufficient quantities of thiamine and folic acid.

Some alcoholics have low Magnesium in their blood and this should be replaced if they are deficient

Question 36

What type of medications are appropriate during alcohol withdrawal

Answer 36

Anxiolytics

The client may be frightened during withdrawal, especially if they are in their third stage and experiencing severe hallucinations.

Question 37

What is Korsakoff’s and Wernicke’s Syndrome?

Answer 37

Korsakoff’s Syndrome = Disorientation, cannot remember details or events.

Wernicke’s Syndrome = Emotionally labile or moody, tire easily.

Both are associated with alcohol withdrawal.

Question 38

Why might a client who suffers from alcoholism experience peripheral neuritis?

Answer 38

They are severely deficient in B vitamins which affect the nerves

Question 39

What happens to magnesium and potassium during alcohol intake?

Answer 39

Alcohol causes the excretion of water and sodium which causes a shift of Mg and K into the cells causing hypomagnesemia and hypokalemia. Emesis associated with alcoholism along-with poor diet can also affect these levels.

Therefore monitor electrolytes (especially Mg and K) in patients with alcohol withdrawal

Question 40

Which of the following are expected findings in a client with Anorexia Nervosa?
SELECT ALL THAT APPLY

A/ Amenorrhea
B/ Inactivity
C/ Development of Lanugo
D/ Perfectionist behaviour
E/ Thin Hair
F/ Hypersomnia

Answer 40

A/ Amenorrhea
C/ Development of Lanugo
D/ Perfectionist behaviour
E/ Thin Hair

Instead of inactivity, people with this disorder will likely exercise excessively, and instead of oversleeping, they are more likely to develop insomnia.

Question 41

The interprofessional team is working on a care plan for a 27-year-old client suffering from Anorexia Nervosa who weighs 38 kg. Which of the following is the most appropriate priority intervention?
A/ Teaching the client healthy eating and exercise
B/ Increasing their body weight
C/ Allowing the client input into the food choices for meals
D/ Limiting their activity and providing Nasogastric feeding until weight is improved

Answer 41

D/ Limiting their activity and providing Nasogastric feeding until weight is improved

Although all other options are appropriate, ensuring this client gains weight is most important due to their incredibly low weight. At 38 kg, they are at risk for life-threatening consequences and this becomes an issue of safety rather than control and teaching. Once sufficient weight is obtained, the other options should be exercised.

Question 42

Which of the following clients is likely to have Bulimia?
A/ 18-year-old who weighs 58 kg and is engaged in vigorous sports and have episodic amenorrhea
B/ 21-year-old who weighs 48 kg with tooth decay and follows a strict diet
C/ 26-year-old who weighs 43 kg is a ballet dancer and follows a strict vegan diet
D/ 15-year-old who weighs 61 kg is socially withdrawn at school and has Oligomenorrhea

Answer 42

B/ 21-year-old who weighs 48 kg with tooth decay and follows a strict diet

Tooth decay is a tell-tale sign of bulimia as frequent vomiting with degrade tooth enamel. The client is also at the very low end of acceptable weight for her age, and she follows a strict diet, which is another sign.

Veganism is not directly associated, and amenorrhea is associated with Anorexia

Question 43

A person with a personality disorder is likely to have which of the following traits?
SELECT ALL THAT APPLY

A/ Be Manipulative
B/ Be Preoccupied with the actions of others
C/ Exhibit paranoid behaviours
D/ Engage in self-mutilation
E/ Maybe sexually promiscuous  
F/ May abuse substances

Answer 43

A/ Be Manipulative
D/ Engage in self-mutilation
E/ Maybe sexually promiscuous
F/ May abuse substances

People with this disorder are likely to engage in relationships with others based solely on the idea that it is better to be with someone than being alone. They are likely to abuse substances and engage in self-mutilation, along with making suicidal gestures.

Question 44

Which disorder is it crucial to reinforce strict limits and rules on behaviour and relationships?
A/ OCD
B/ Borderline Personality Disorder
C/ Severe Depression
D/ Bulimia

Answer 44

B/ Borderline Personality Disorder

Although these apply to these disorders, it is crucial for Borderline personality disorder to have rules to inhibit their manipulation and sexual exploitation of others.

Question 45

What is the key to recovery for persons with phobias?

Answer 45

Gradual exposure to phobia over time. Desensitization occurs gradually!

Question 46

You’re working the night shift at a psych hospital and one of your long-time patients with panic disorder begins having a panic attack. Which of the following is the most appropriate response?
A/ “It’s going to be okay, we can go for a walk and try to calm down together”
B/ “I know you’re worked up, but let’s take a deep breath and move on from this”
C/ “I’m here, it is going to be okay”
D/ “You need to have a seat and take some deep breaths, we are going to get through this together”

Answer 46

C/ “I’m here, it is going to be okay”

People with panic disorders cannot understand complex sentences during a panic attack. Ensure that you provide the patient with adequate space as they may be likely to become aggressive if people enter their personal bubble.

Statement C is reassuring but simple to understand.

Question 47

Which of the following is the most appropriate activity for a person with a panic disorder?
A/ Leading a group discussion
B/ Reading a book
C/ Journalling
D/ Colouring in an adult colouring book

Answer 47

C/ Journalling

Journalling is an effective tool in anxiety disorders that helps gain insight into the root causes on anxiety and track the patient’s activities, thoughts, and actions over a period of time.

Although reading and colouring may be relaxing activities that are appropriate, journalling will provide insight into their disorder over time.

Question 48

A client begins visually hallucinating a scene from WWII on the ward and is causing a scene in front of the other clients who are eating. Which of the following is the most appropriate action of the nurse to take?
A/ “I see the Germans coming, we need to get back to your room where we can be safe”
B/ “I know you see the enemy coming, but we do not see them. Let me help you back to your room”
C/ “Holy Shit! They are throwing Grenades at us!”
D/ “Take my hand, I will get you out of here where you are safe”

Answer 48

B/ “I know you see the enemy coming, but we do not see them. Let me help you back to your room”

This acknowledges that they are having a hallucination, but directly states that you do not share this perception. This fails to validate their experience and reinforce their hallucination.

(D) acknowledges their ahllucination, but does not challenge its reality. Whereas (A) and (C) validates the hallucination

Question 49

It is 0300 during a long shift, and the nurse comes across a patient shouting in their bed. They recognize they are having a hallucination and they respond to the situation appropriately by:
A/ Rasing the head of their bed
B/ Helping them change position
C/ Asking them to be quiet
D/ Offer them a glass of water and some psychotropic meds

Answer 49

A/ Rasing the head of their bed

Studies show that the supine position can elicit hallucinations, and a simple change of position may alleviate the symptoms.