Clinical Management in Psychiatric Nursing
Exam Answer Key
Course Introduction
Clinical Management in Psychiatric Nursing explores the principles and practices involved in the care of individuals with mental health disorders across the lifespan. This course emphasizes assessment, diagnosis, treatment planning, and evidence-based interventions, with a focus on therapeutic communication, crisis intervention, and psychopharmacology. Students will learn to collaborate effectively within multidisciplinary teams, advocate for clients' rights, and address ethical and legal considerations in psychiatric settings. Through case studies and clinical scenarios, the course aims to develop skills in managing acute and chronic psychiatric conditions, promoting mental health, and supporting recovery and resilience among diverse populations.
Recommended Textbook
Psychiatric Advanced Practice Nursing 1st Edition by Perese
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19 Chapters
203 Verified Questions
203 Flashcards
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Chapter 1: Theoretical Framework of Practice
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Sample Questions
Q1) Temperament-a genetically influenced early form of personality-describes an infant's pattern of central nervous system responses and behaviors. Among the different types of temperament, which one is associated with more impairment of brain functioning and, in the absence of positive, nurturing parenting, is a risk factor for later development of psychiatric disorders?
A) Easy
B) Slow-to-warm-up/inhibited
C) Mixed
D) Difficult
Answer: D
Q2) Freud's drive theory proposes that individuals are motivated by A) Basic drives for survival and reproduction.
B) Need to reduce anxiety.
C) Need to resolve interpersonal conflicts.
D) Basic drives for altruism.
Answer: A
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Chapter 2: Neurobiological Theory of Psychiatric Disorders:
Brain Functioning, Brain Development and Prenatal and
Perinatal Factors Disrupting Brain Development
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Sample Questions
Q1) This area of the brain is called a system and is made up of the rim of the medial (innermost) portions of the frontal, parietal, and temporal lobes and overlies the brainstem. It is involved with emotions and is referred to as the
A) Ventricular system
B) Limbic system
C) Reticular activating system
D) Blood-brain barrier system
Answer: B
Q2) The function of this brain structure was formerly believed to be limited to maintaining balance and learning motor skills but is now believed to be involved in learning and emotions and may be involved in autism. It is the
A) Cerebellum
B) Insula
C) Corpus callosum
D) Pons
Answer: A
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Chapter 3: Postnatal Influences on Development of
Psychopathology
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Sample Questions
Q1) In considering fetal exposure to prenatal risk factors, it is known that
A) Damage due to maternal stress is greatest during the third trimester.
B) Nutritional deficits can damage the brain as well as the spinal cord.
C) Radiation exposure has no effect on brain development during the first trimester.
D) There are safe periods of time for maternal consumption of alcohol.
Answer: B
Q2) Among children who use an accommodating response to maltreatment, there is increased likelihood of impaired capacity for
A) Controlling impulsivity
B) Knowing their own feelings and emotions
C) Showing regressive behaviors
D) Integrating memories of pain and fear
Answer: B
Q3) It is known that childhood exposure to maltreatment
A) Is associated with increased rates of physical and psychiatric disorders
B) Occurs in 10% of U.S. children
C) Is most often exposure to sexual abuse
D) Usually involves a perpetrator who is unknown to the child
Answer: A
Page 5
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Chapter 4: Communicating, Interviewing and Assessing
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Sample Questions
Q1) Validation is a communication strategy used to
A) Let the patient know that his or her feelings are reasonable.
B) Evaluate change in symptoms or behaviors.
C) Prompt the patient to continue talking.
D) Elicit more information about a response.
Q2) The purposes of the psychiatric interview include all except
A) Gaining an understanding of the patient's illness
B) Obtaining information efficiently
C) Providing education about psychiatric disorders
D) Establishing a therapeutic alliance
Q3) To encourage the patient to talk freely during the interview, the clinician
A) Uses direct questioning
B) Explains behavior/brain interaction theory
C) Takes notes conscientiously
D) Provides empathetic response.
Q4) Open-ended questions
A) Are useful in obtaining direct responses
B) Define the focus of interest
C) Are useful in the beginning of an interview
D) Define the boundaries of the therapeutic alliance
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Chapter 5: Case Formulation and Diagnosis, Differential
Diagnoses and Developing a Biopsychosocial Plan of Care
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Q1) A precipitating event might be
A) Financial losses or loss of housing
B) Chronic health problems
C) Childhood separations and anxiety disorders
D) Genetic influences and premature birth
Q2) A predisposing event would be all of the following except
A) Early prolonged separation from the mother
B) Having been born unwanted
C) Recent arrests or incarcerations
D) History of childhood neglect or abuse
Q3) In the problem-oriented method of case formulation, the patient's problems are defined as a solvable target of treatment. Which of the following is an example of a problem-oriented case formulation description?
A) "Lack of interpersonal communication skills"
B) "Due to early childhood conflicts"
C) "Due to use of immature defense mechanisms"
D) "Caused by stigma and discrimination"
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Page 7
Chapter 6: Psychopharmacotherapy
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Sample Questions
Q1) Antidepressants are used with caution in which of the following disorders?
A) Major depression with atypical features
B) Adjustment disorder with depression
C) Bipolar disorders
D) Dysthymia
Q2) A patient with bipolar disorder who has been on lithium for 3 months has a blood lithium level of 0.3 mEq/L when tested. You anticipate
A) Improvement of manic symptoms
B) No improvement of manic symptoms
C) Improvement of depressive symptoms
D) Symptoms of moderate lithium toxicity
Q3) The tricyclic antidepressant class of medications can be characterized by all of the following properties except
A) Long half-life
B) Inexpensive cost
C) Safety in overdose
D) High rate of side effects
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8
Chapter 7: Psychotherapies
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Q1) Psychotherapy is a form of learning that has the potential to do all of the following except
A) Alter gene expression
B) Influence production of neurotransmitters
C) Promote creation of new synaptic connections
D) Eradicate traumatic memories
Q2) In supportive therapy, the focus is on
A) Strengthening self-esteem and ego functioning
B) Promoting insight
C) Remediating cognitive functioning
D) Exposure and response prevention
Q3) Among the following disorders, which one would most likely be amenable to brief dynamic therapy?
A) Bipolar disorder
B) Substance dependence
C) Psychotic disorder
D) Avoidant personality disorder
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Chapter 8: Psychosocial Interventions
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Sample Questions
Q1) It can be said of social rhythms therapy that
A) It is involved in establishing regular patterns of sleep.
B) It has been found to be effective for major depressive disorder but not for bipolar disorder.
C) It is involved in establishing regular patterns of sleeping, eating, exercising, and engaging in other daily activities.
D) It has not been found to be effective as adjunctive treatment in obesity.
Q2) Family psychoeducation is designed to do all of the following except
A) Provide information about the illness
B) Reduce criticism of the patient by the family
C) Promote problem-solving skills of the family
D) Advocate for vocational rehabilitation
Q3) Support groups differ from self-help groups by
A) Use of a drop-in approach
B) Professional leadership
C) Theory of empowerment
D) Emphasis on mastery
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Chapter 9: Response to Stressors: Bridging Normal
Responses and Psychiatric Disorders
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Q1) An important evidence-based finding about adjustment disorder among adolescents and young adults is that
A) Pharmacotherapy is the frontline for treatment.
B) The course of adjustment disorder is brief, with good outcomes.
C) There is a short time between thoughts of suicide and carrying out suicide.
D) Academic functioning is well preserved.
Q2) Patients who use direct methods of coping strategies when confronted with a stressful event would likely engage in
A) Seeking to understand the value to be extracted from negative experiences
B) Following the steps of problem-solving
C) Increasing their sense of control over the situation
D) Asking other people to manage the situation
Q3) Adjustment disorder is often associated with
A) Symptoms of dissociation
B) Time lost from work
C) Flashbacks and nightmares
D) Delusions of persecution
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Page 11
Chapter 10: Phobias, Generalized Anxiety Disorder, Social
Anxiety Disorder and Panic Disorder
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Sample Questions
Q1) It can be said that in the fear system, the amygdala
A) Serves as a response center for danger and fear
B) Imprints the time and place of an event
C) Evaluates the event in relation to memories of previous experiences
D) Releases hormones that start a cascade of neurohormones and neurotransmitters that prepare the body to respond to a threat
Q2) Regarding generalized anxiety disorder (GAD), which of the following is true?
A) GAD is rare in older adults.
B) Comorbidity for major depression and other anxiety disorders is not common.
C) GAD is considered to be a chronic condition.
D) GAD is characterized by seasonal cycles.
Q3) Leonard avoids going out to eat with his family at restaurants. He is concerned that others may watch him and criticize his table manners. Which is the most likely diagnosis?
A) Agoraphobia
B) Specific situational phobia
C) Social anxiety disorder
D) Generalized anxiety disorder
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Chapter 11: Acute Stress Disorder and Posttraumatic Stress Disorder
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Q1) Which mental status variation are you most likely to expect for a client diagnosed as having post-traumatic stress disorder?
A) Thought: delusions of grandeur
B) Perceptual: derealization and depersonalization
C) Memory: impaired recent memory
D) Mood: inappropriate, silly
Q2) Ninety percent of Americans experience a trauma in their lifetime that is severe enough to cause post-traumatic stress disorder. What percent develop post-traumatic stress disorder?
A) 10%
B) 20%
C) 30%
D) 40%
Q3) The current frontline treatment for acute stress disorder is
A) Mood stabilizer medications
B) Interpersonal psychotherapy
C) Antianxiety medications
D) Trauma-focused cognitive behavioral therapy
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Obsessive-Compulsive
Spectrum Disorders
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Sample Questions
Q1) Which of the following tricyclic antidepressants is most effective in the treatment of OCD?
A) Imipramine
B) Amitriptyline
C) Desipramine
D) Clomipramine
Q2) In selecting treatment for a patient with trichotillomania, which of the following evidence-based treatment options would be a logical first choice?
A) Reminiscence therapy
B) Monotherapy with clomipramine (Anafranil)
C) Habit reversal therapy
D) Exposure and ritual prevention therapy
Q3) Nonpharmacological treatment of obsessive-compulsive disorder (OCD) would most likely include which of the following?
A) Electroconvulsive therapy
B) Cognitive behavioral therapy
C) Milieu therapy
D) Dialectical behavioral therapy
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Chapter 13: Depressive Disorders
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12 Verified Questions
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Sample Questions
Q1) A patient who has been taking venlafaxine (Effexor) for major depressive disorder with melancholic features says that suddenly he can't sleep and spends hours writing to his congressman with his ideas of how to reduce the national debt. The psychiatric advanced practice nurse considers all of the following but selects which one as the most likely explanation for the change in his clinical presentation:
A) Nonadherence with venlafaxine
B) Emergence of symptoms of hypomania
C) Emergence of symptoms of a personality disorder
D) Increasing severity of symptoms of depression
Q2) The patient says that for the last 5 years, she has begun to feel depressed around the time the golf season ends in November and begins to feel better when she is able to get outdoors to play again in April. When she is depressed, she craves carbohydrates, overeats, and gains weight. She has no energy and wants to sleep all the time and she is irritable and snaps at people. The psychiatric advanced practice nurse considers which of the following diagnoses?
A) Dysthymia
B) Major depressive disorder with seasonal pattern
C) Adjustment disorder with depressed mood
D) Major depressive disorder with atypical features
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Page 15
Chapter 14: Bipolar Disorder
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Sample Questions
Q1) The course of bipolar disorder is characterized by
A) Difficulty achieving good vocational functioning
B) Patient adherence to treatment
C) Infrequent recurrences
D) Good interpersonal and social functioning
Q2) Negative life events such as losses have been found to be associated with all of the following except
A) Development of depressive symptoms of bipolar disorder
B) History of childhood abuse
C) Development of manic symptoms of bipolar disorder
D) Comorbid psychiatric disorders
Q3) Disruptions of social rhythms
A) Are related to changes of zeitgerbers (time givers)
B) Occur after the onset of bipolar disorder
C) Are related to anticipation
D) Occur rarely in the general population
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Chapter 15: Schizophrenia and Schizoaffective Disorder
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Sample Questions
Q1) A patient who has just been started on Haldol 5 mg po bid is complaining of a sudden painful stiff neck and jaw muscles. This is most likely
A) Akinesia
B) Akathisia
C) Dystonia
D) Somatization
Q2) A patient states that she hears voices telling her that she should kill herself. The psychiatric advanced practice nurse states that the patient is
A) Experiencing delusions
B) Experiencing hallucinations
C) Experiencing an aura
D) Experiencing a dissociative state
Q3) When used for treatment of a patient with schizophrenia, typical antipsychotics could be expected to be most effective for which of the following symptoms?
A) Social isolation
B) Ineffective individual coping
C) Hallucinations
D) Lack of ability to make decisions
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Chapter 16: Delirium and Dementia
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Sample Questions
Q1) Medications that are frequently used for patients with dementia are
A) Selective serotonin reuptake inhibitors
B) Selective norepinephrine reuptake inhibitors
C) Acetylcholinesterase inhibitors
D) Monoamine oxidase inhibitors
Q2) Among patients with dementia, early impairment of functioning is frequently seen in
A) Managing finances
B) Self-care deficits such as feeding themselves
C) Limitations of physical activities
D) Recognizing loved ones
Q3) In the early stages of dementia, frontal-temporal dementia is more likely than Alzheimer's-type dementia to be characterized by
A) Deficits in executive functioning
B) Problems with memory
C) Personality changes
D) Losing things
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18
Chapter 17: Dual Diagnosis
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Q1) Current treatment approaches for dual diagnosis or co-occurring disorders focuses on
A) Identifying primary disorders and treating them first
B) Treating psychiatric disorders and substance-related disorders separately
C) Treating all co-occurring disorders as primary disorders
D) Treating psychiatric disorders first
Q2) Which of the following medications used to decrease alcohol consumption interferes with the metabolism of alcohol?
A) Naltrexone (ReVia)
B) Disulfiram (Antabuse)
C) Acamprosate (Campral)
D) Extended-release naltrexone injection
Q3) Symptoms of alcohol withdrawal
A) Are most severe 8 to 10 hours after last drink
B) Are most severe 24 to 28 hours after last drink
C) Include hallucinations among 50% of individuals
D) Are evidenced as delirium tremens 2 weeks after the last drink
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19
Chapter 18: Personality Disorders
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Sample Questions
Q1) The personality disorder that is the most socially sensitive to the influence of culture is
A) Paranoid
B) Narcissistic
C) Schizotypal
D) Schizoid
Q2) Patients with histrionic personality disorder frequently manifest which of the following?
A) Use of their appearance to be the center of attention
B) Belief that they have clairvoyance
C) Perfectionism
D) Fear of criticism and rejection by others
Q3) Temperament, which is one component of personality,
A) Has a 50% heritability
B) Achieves stability by age 16 years
C) Includes the trait of spirituality
D) Is associated with insight learning
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Chapter 19: Prevention of Psychiatric Disorders
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Q1) At this time, in the prevention of schizophrenia, the focus is on
A) Preventing adverse circumstances of birth
B) Promoting childhood resilience
C) Preventing prodromal symptoms from converting to schizophrenia
D) Preventing late-onset schizophrenia
Q2) Among older adults, evidence suggests that the risk for developing dementia can be reduced by which of the following interventions?
A) Cognitive remediation
B) Identifying and treating hearing loss
C) Cognitive restructuring
D) Identifying and treating symptoms of depression
Q3) In prevention of suicide among adults, the most effective intervention is
A) Screening of all patients for suicidal ideation by primary care clinicians
B) Providing debriefing after traumatic events
C) Restricting access to lethal means such as handguns and pesticides
D) Increasing public education programs about suicide
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