Test Questions for Psychiatry Program

Item Writing 1: General Knowledge for Psychiatric-Mental Health Nurse Practitioner (PMHNP)

1. Psychiatric nursing staff have approached an adult psychiatric and mental health clinical nurse concerning challenges within the unit’s work setting. The complaints include shortage of staff and burnout, among others. The nurses express feelings of frustration, helplessness, and hopelessness. The clinical nurse’s first step is to:

• Carry out stress management for the group.
• Educate the staff on how to manage workplace stress.
• Establish a committee to look into the nurses’ complaints.
• Establish an approach to understand the nurses’ problems.

The question tests the nurse leaders’ problem-solving skills, which begin by identifying and understanding the problem.

2. A 56-year old patient has been receiving therapy under the care of an adult psychiatric mental health nurse for two months now. The patient’s husband is an alcohol addict and has declined treatment. Tuesday night, before the next appointment as scheduled, the patient called the nurse on the phone, stating that the husband was drunk and hostile and threatening to rape and kill her. The nurse priority intervention is to:

• Arrange for the patient’s safety.
• Arrange for the patient’s emergency psychiatric assessment.
• Request to speak with the patient’s husband.
• Request for a restraining/restrictive order.

This question assesses the nurses’ ability to respond to emergency cases and ensure their patient’s safety. 

3. A 43-year-old patient with depression complained of feeling overwhelmed by her environment and mood. The adult psychiatric and mental health nurse adopts a cognitive-behavioral therapy, which is designed to:

• Improve the patient’s self-awareness while providing repeated reassurance.
• Adjust the patient’s behaviors while improving her social skills.
• Adjust the patient’s thoughts while increasing her sense of self-esteem and control.
• Shift the patient from self-preoccupation to making change.

This question tests the nurse understanding of the role of different psychotherapy approaches when applied to the patients. In this particular one, cognitive-behavioral therapy mainly helps the patients to identify harmful thought arrangements and how such thoughts lead to destructive beliefs and behavior. The therapist then works with the patients to think more constructively once the harmful thoughts are identified.

4. Applying cognitive-behavioral therapy to treat the patient’s anxiety, psychiatric-mental health nurse professionals design the intervention on the principle that:

• Anxiety mostly occur because of previously unmet needs
• Anxiety mostly occurs because of the distortion in the patients thinking.
• Medication can enhance desensitization to anxiety.
• Learned responses can also be unlearned.

This question also tests the nurses understanding of the role of psychotherapy approaches on psychiatric patients. Cognitive-behavioral therapy mainly focuses on the patient’s thoughts and perceptions; hence our key.

5. Psychiatric-mental health nurse professional works with a 54-year-old patient complaining of sadness, weight loss, and insomnia, and wants to be left alone. The nurse formulates a treatment plan for the patient based on the understanding that:

• The patient’s symptoms and complications are consistent with circadian rhythm problems, particularly seasonal affective/emotional disorders.
• Dexamethasone suppression tests are more reliable indicators of depression.
• Increasing the level of dopamine can treat the patient’s symptoms.
• Reduced activity in the norepinephrine-serotonin part of the neurotransmitter systems is linked to depression.

The question tests whether the nurse can point out symptoms of depression at a glance and is aware of possible neurotransmitters linked to depression and how they cause depression. Low serotonin and norepinephrine neurotransmitters increase the odds of experiencing depressive symptoms (Köhler, Cierpinsky, Kronenberg & Adli, 2016).

6. A psychiatric and mental health nurse educating parents how to apply a positive reinforcement approach with their kid recommends:

• Accepting any statement made by the child, whether positive or negative and restating the kid’s statement with any comment.
• Controlling the kid’s behavior to ensure no chance for negative behaviors.
• Eliminating any negative consequences to generate a positive result.
• Rewarding any positive behavior exhibited to encourage recurrence.

The question tests the psychiatric nurse’s understanding and application of reinforcement theory to shape behavior. Reinforcement theory operates on the idea that their consequences shape behavior. A reward encourages the kid’s good behaviors, and can improve the positive relationship between the parent and the child.

7. To assess if the patient education for coping skills is operational, the psychiatric nurse requests the adolescent patient to:

• Objectively look at the outcomes.
• Maintain a written journal.
• Set goals that are measurable
• Do a return demonstration.

This question tests if the nurses have the skills to assess if they have explained what they need to know to their patients in a comprehensible way. Return demonstrations or teach-back are strategies nurses use to aid in patient understanding. The patients demonstrate what they have learnt.

8. A patient who has been under antidepressants for one week complains of blurred vision and constipation, with no signs of improvement in mood. As a psychiatric-mental health nurse, you should inform the client:

• To immediately stop the antidepressants visit your primary care doctor.
• To visit his doctor to have the medication changed.
• To schedule an appointment with his ophthalmologist.
• It takes about 2-4 weeks for depression to reduce, and side effects lessen over time.

The question tests if the nurse understands the side effects of antidepressants and how to respond when the client complains of side effects. Usually, it takes time for symptoms of depression to lessen, and the client should be made aware of that.

9. Psychiatric-mental health nurses planning for inpatient psychotherapy for patients with antisocial personality disorders should:

• Focus on group therapy instead of individual therapy.
• Create a permissive atmosphere that allows their patients to feel a sense of control.
• Provide a structured and organized therapeutic environment.
• Should recognize that antisocial personality disorders are occasioned by social withdrawal.

An optimal environment is important to eliminate or reduce environmental stress during the therapy sessions.

10. Screening people for post-traumatic stress disorders after a natural disaster is practising which form of disease prevention as a psychiatric-mental health nurse?

• Secondary.
• Primary.
• Universal.
• Tertiary.

Secondary PTSD can result from indirect exposure to life-threatening natural events such as natural disasters.

Item Writing 2:

1. In an initial interview with the patient, the mental health nurse should start by requesting the patients to describe their:

• Present situation.
• Personal history.
• Feelings concerning the present situation.
• Thoughts concerning the present situation.

The nurse must first understand the patient’s current situation, which the patient can only describe.

2. What is the short-term goal for patients with Alzheimer’s syndrome?

• Enhanced functioning is a less restrictive setting.
• Enhanced problem-solving in everyday activities.
• Improved self-consent and self-esteem.
• Regain cognitive function and sensory perception.

Studies show that people with Alzheimer’s syndrome are less likely to be distressed or agitated if they have steady access to quiet space, fresh air, and exercise. This improves functioning, including cognitive, problem solving, and other functioning (Keren-Shaul et al., 2017).

3. Which selective serotonin reuptake inhibitors target part of the brain?

• Putamen.
• Frontal cortex.
• Basal ganglia.
• Hippocampus.

The question tests the nurse understanding of medications used to treat mental illness. Study shows that SSRI targets prefrontal circuits in emotional behavior and modulating synaptic connectivity development (Soiza-Reilly et al. 2019).

4. A severe sense of restlessness due to psychotropic medicines, which patients often misunderstand to mean reappearance of psychiatric symptoms or anxiety disorder, is known as:

• Dystonia
• Akinesia
• Akathisia
• Bradykinesia 

Akathisia is the lack of ability to remain calm. The condition depicts a neuropsychiatric syndrome often characterized by psychomotor restlessness (Saboowala, 2020). 

5. Nurse is caring for a patient experiencing false sensory perception with no basis in real-life. This kind of perception is called:

• Hallucinations.
• Loose associations.
• Delusions.
• Neologisms.

The question tests the nurse’s understanding of different behaviors exhibited by psychiatric patients to develop a response mechanism. False perceptions are due to hallucination, which is often characterized by visual, olfactory, or auditory perceptions with no basis in reality.

6. Which of the following should be the initial action for an adult psychiatric-mental health nurse upon receiving a request to act as a consultant?

• Negotiate payable fee for the service.
• Establish stakeholders.
• Establish their suitability for the work.
• Clarify possible role expectations.

When requested to carry out a task, the first thing as a professional is to know the expectations, which would help you judge your suitability for the task and expected fee.

7. A couple under counselling therapy reports starting a fight with their son when they feel annoyed with each other. Such kind of behavior represents:

• Triangulation.
• Coalition.
• Indirect communication.
• Transference.

Triangulation is a manipulation method where one uses exclusion or threats or bringing a third party to the relationship to remain in control; hence best suits this case.

8. A recently graduated PMHNP nurse is assigned as a case manager for a patient with acute mental illness. The nurse is required to maintain accurate and in-depth patient records of:

• Imaging results.
• Appointment records.
• Insurance coverage.
• Treatment plan.

The treatment plan includes all the patient’s data, diagnoses, treatment outline, and many other components; hence best answer for this case.

9. A PMHNP nurse bases their evaluation of continuing community-based psychological health program on the principle that valuation:

• It is part of the planning process for the program.
• It is based on fiscal needs.
• Comprises of a participant survey.
• It is dependent on administrative expectations.

Evaluation is the last phase of program planning, assessing the program’s outcomes and recommending further action; hence the most suitable answer for this case.

10. The nursing diagnosis for patients with antisocial personality disorder considers:

• Anxiety as associated with social situations, leading to social isolation.
• Impaired social interaction as a result of manipulative behaviors.
• Sensory-perceptual alterations caused by disturbing thought processes.
• Extreme fear of failure and poor self-image lead to chronic self-esteem.

ASPD is often characterized by patterns of disregard for other people’s rights, which also include being manipulative (Johnson, 2019), and the nurse should observe such signs during diagnosis.