Clinical Management in Psychiatric Nursing Exam Preparation Guide
Course Introduction
Clinical Management in Psychiatric Nursing focuses on the development of skills and knowledge essential for the effective assessment, planning, implementation, and evaluation of care for individuals with psychiatric disorders. This course covers topics such as crisis intervention, therapeutic communication, pharmacological and non-pharmacological treatments, patient advocacy, interdisciplinary collaboration, and evidence-based approaches in psychiatric nursing practice. Students will gain an understanding of legal and ethical issues, cultural considerations, and the importance of individualized care plans to address the complex needs of patients in a variety of clinical settings.
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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Page 2
Chapter 1: Theoretical Framework of Practice
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Sample Questions
Q1) The primary focus of the biopsychosocial model is
A) Heritability of psychiatric disorders
B) Domains of functioning
C) Abnormalities of neurotransmission
D) Abnormalities of systems and circuits
Answer: B
Q2) The primary relevance of Bowlby's attachment theory for psychiatric advanced practice nurses is that
A) Toddlers develop primitive defense mechanisms such as denial.
B) Toddlers develop an inner working model of how adults will respond to them.
C) Toddlers face the psychosocial task of autonomy versus shame.
D) Toddlers develop a fear of engulfment and enmeshment.
Answer: B
Q3) Brain plasticity, which refers to the brain's capacity to change in response to an event,
A) Is the same for all individuals
B) Involves physical changes of the brain
C) Is absent in older adults
D) Is independent of genetic influence
Answer: B
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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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Q1) Which area of the brain is a very primitive in terms of evolution and is involved in swallowing, arousal, and breathing?
A) Parietal lobe
B) Insula
C) Cerebellum
D) Brainstem
Answer: D
Q2) On evaluation, the patient appears to be having difficulty with working memory, planning, and insight into his problems. The psychiatric advanced practice nurse recognizes that these symptoms are associated with problems with the A) Frontal lobe
B) Temporal lobe
C) Parietal lobe
D) Occipital lobe
Answer: A
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Chapter 3: Postnatal Influences on Development of
Psychopathology
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Sample Questions
Q1) Among children who have experienced chronic exposure to family violence, it has been found that
A) The children may lack capacity for emotional self-regulation.
B) Most of the children are able to integrate their experiences into a positive inner model of the world.
C) As adolescents, they have lower rates of aggressive behavior problems.
D) The rate of adult psychopathology is the same as that of the general population.
Answer: A
Q2) 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
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Chapter 4: Communicating, Interviewing and Assessing
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Sample Questions
Q1) For a patient who is overinclusive or rambling, the clinician
A) Asks the patient to tell his story
B) Uses direction and redirection
C) Increases the amount of eye contact
D) Interviews the person accompanying the patient
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) In using the communication technique of reflection, the clinician
A) Interprets the difference between a patient's thoughts and his or her behaviors
B) Repeats something that the patient has said to encourage the patient to give more information
C) Provides prompts such as "tell me more"
D) Seeks more information in order to have a more clear understanding
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Chapter 5: Case Formulation and Diagnosis, Differential
Diagnoses and Developing a Biopsychosocial Plan of Care
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Q1) Mechanisms that maintain a problem are biopsychosocial causes or sources of the problem. Psychological causes might include
A) Poverty and social isolation
B) Impaired neural circuitry
C) Impaired ability to regulation emotions
D) Abnormalities of neurotransmission
Q2) 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"
Q3) 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
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Chapter 6: Psychopharmacotherapy
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Q1) In treating a patient with depression for whom you want to increase norepinephrine, which of the following antidepressants would you choose because it specifically increases levels of norepinephrine?
A) Reboxetine (Vestra)
B) Fluoxetine (Prozac)
C) Phenelzine (Nardil)
D) Venlafaxine (Effexor)
Q2) 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
Q3) Neuroleptic malignant syndrome is a serious complication of the use of antipsychotic medications. One of the first indicators of this complication is
A) Increased motor activity
B) Rapid temperature elevation to 103°F
C) Increase of aggressive behavior
D) Nose twitching and abnormal tongue movements
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Chapter 7: Psychotherapies
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Q1) 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
Q2) Which of the following criteria would preclude the use of brief dynamic therapy?
A) Adequate ego strengths
B) Psychological problems in multiple domains
C) Use of mature defense mechanisms
D) Adequate ability to process information
Q3) The primary purpose of psychotherapy is to facilitate changes by the patient in order to
A) Reduce symptoms of distress
B) Address identified problems
C) Reduce burden on the family
D) Improve vocational functioning
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Chapter 8: Psychosocial Interventions
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Sample Questions
Q1) Research has found that sleep therapy is effective in reducing symptoms of which of the following disorders?
A) Social anxiety disorder (nongeneralized)
B) Agoraphobia
C) Depression
D) Obsessive-compulsive disorder
Q2) When considering how to increase a patient's social network, which of the following interventions provides training for volunteers in working with people with mental illnesses?
A) Self-help groups
B) Compeer
C) Mutual-help groups
D) Drop-in centers
Q3) The primary goal of compensatory interventions is to help patients improve coping through the use of all of the following except
A) Brief dynamic therapy
B) Social skills training
C) Stress management
D) Problem-solving therapy
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Page 10
Chapter 9: Response to Stressors: Bridging Normal
Responses and Psychiatric Disorders
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Sample Questions
Q1) The response of exposure to stressors
A) Is the same response in all humans
B) Is the same for males and females
C) Is followed by homeostasis
D) Is buffered by the presence of three or more social contacts
Q2) Complicated grief differs from normal grief by the presence of
A) Emotions of anger and regret
B) Persistent longing and yearning for the deceased
C) Physical symptoms of headaches and indigestion
D) Problems with concentration and planning
Q3) 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
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Chapter 10: Phobias, Generalized Anxiety Disorder, Social
Anxiety Disorder and Panic Disorder
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Sample Questions
Q1) In GAD, which of the following is true?
A) GAD is rare in older adults.
B) Worrying may be associated with the belief that it keeps the family safe.
C) Worrying is usually limited to one type of worry, such as locking doors.
D) Worrying is usually accompanied by ritualistic behaviors.
Q2) Chris, a successful music major, is preparing for his recital next week. He has experienced severe stage fright in the past. Which of the following classes of medication would most likely be recommended?
A) Monoamine oxidase inhibitor
B) Tricyclic antidepressant
C) Norepinephrine reuptake inhibitor
D) Beta blocker
Q3) Medical disorders that should be considered as differential diagnoses of panic disorder include all of the following except
A) Hyperthyroidism
B) Hypothyroidism
C) Mitral valve prolapse
D) Hyperparathyroidism
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Chapter 11: Acute Stress Disorder and Posttraumatic Stress Disorder
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Sample Questions
Q1) 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
Q2) The model of psychotherapy that is most effective for acute post-traumatic stress disorder is
A) Supportive psychotherapy
B) Exposure therapy
C) Stress inoculation therapy
D) Debriefing therapy
Q3) Which one of the following exposure treatments for post-traumatic stress disorder has been found to be effective among veterans with chronic post-traumatic stress disorder that has not responded to other forms of treatment?
A) Cognitive behavioral therapy
B) Eye movement desensitization and reprocessing therapy
C) Structured writing therapy
D) Virtual reality exposure therapy
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Obsessive-Compulsive Spectrum Disorders
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Q1) In obsessive-compulsive disorder, patients are likely to experience
A) Obsessions as ego-syntonic
B) Extreme worrying about everyday concerns such as being late
C) Specific worries about the sight of blood
D) Obsessions of symmetry and need to have things just right
Q2) Obsessions are often accompanied by compulsive behaviors. Which of the following is not true?
A) Obsession of contamination is linked with excessive cleaning.
B) Obsession of pathological doubt is linked with hoarding.
C) Obsession of symmetry is linked with arranging things until they are perfect.
D) Somatic obsession is linked with checking the body for signs of illness.
Q3) On clinical presentation, patients with OCD tend to
A) Be eager to discuss their symptoms
B) Have good insight into their obsessions and compulsions
C) Describe a sudden intrusion of unwanted distressful thoughts and the need to do something to reduce their distress
D) Be aware of the influence of their symptoms on their families
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Page 14
Chapter 13: Depressive Disorders
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Sample Questions
Q1) Post's theory of depression states that early experience may make the brain more sensitive to future stressors and to recurrence of depressive episodes. This theory is often referred to as
A) Kindling theory
B) Dysregulation theory
C) Anger turned inward theory
D) Learned helplessness theory
Q2) Which of the following is a frontline treatment for insomnia in depressed elderly individuals?
A) Sleep hygiene
B) Benzodiazepines
C) Zolpidem
D) Trazodone
Q3) Which one of the following somatic therapies is no longer used to treat depression?
A) Transcranial magnetic stimulation
B) Electroconvulsive therapy
C) Insulin shock therapy
D) Phototherapy (light therapy)
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Chapter 14: Bipolar Disorder
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Sample Questions
Q1) In the prodromal phase of bipolar disorder, patients' behaviors often include
A) Putting their affairs in order
B) Sleeping more than usual
C) Increased talkativeness
D) A decrease of social activities
Q2) 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
Q3) Compared with unipolar depression, the depressed phase of bipolar disorder is associated with
A) A greater degree of insomnia
B) More melancholic features
C) Greater weight loss
D) More symptoms of anxiety and tearfulness
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Chapter 15: Schizophrenia and Schizoaffective Disorder
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Sample Questions
Q1) Which of the following features is associated with positive outcome among patients with schizophrenia?
A) Younger age of onset
B) Male gender
C) Living in an industrialized country
D) Having positive symptoms
Q2) It has been suggested that reduced volume of the temporal lobe is related to
A) Persistence of negative symptoms
B) Severity of auditory hallucinations
C) Deficits in working memory
D) Impairment of motor coordination
Q3) 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
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17
Chapter 16: Delirium and Dementia
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Q1) Which of the following is classified as a subcortical dementia?
A) Dementia of Alzheimer's type
B) Dementia due to Pick's disease
C) Dementia due to Parkinson's disease
D) Dementia due to vascular dementia
Q2) 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
Q3) 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
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18
Chapter 17: Dual Diagnosis
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Sample Questions
Q1) The action produced by cocaine that can cause symptoms of paranoia and hallucinations similar to symptoms of schizophrenia is related to
A) Increase of dopamine
B) Decrease of dopamine
C) Increase of norepinephrine
D) Decrease of glutamate
Q2) 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
Q3) Which of the following brain nuclei is involved with pleasure and addiction?
A) Red nucleus
B) Hypothalamus
C) Substantia nigra
D) Nucleus accumbens
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Chapter 18: Personality Disorders
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Q1) Impulsivity and suicidality are often associated with borderline personality disorder. Which of the following pharmacological interventions is frequently used to reduce impulsivity and suicidality?
A) Tricyclic antidepressants
B) Benzodiazepines
C) Selective serotonin reuptake inhibitors
D) Monoamine oxidase inhibitors
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) Preventive interventions that have been found to be associated with a sustained reduction of late-life depression include
A) Life review and reminiscence therapy
B) Exposure and response prevention therapy
C) Social skills training
D) Problem-solving therapy
Q2) In considering suicide among older adults, it has been found that they are more likely than younger adults to
A) Have made previous suicide attempts
B) Confide their plan to others
C) Act impulsively
D) Plan carefully
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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