Completing a full set of CEN Test Questions can simulate a real exam experience.
Psychosocial Emergencies CEN Practical Questions - CEN Questions On Psychosocial Emergencies
Question 1.
Which of the following is the most important action to ensure patient safety before rooming a patient who is suicidal?
(a) Ensure there are no items present that could be used to harm themselves.
(b) Talk with family members regarding patient statements and actions.
(c) Ask the patient to commit to no self-harm while in the ED.
(d) Thoroughly review the patient’s history for past suicide attempts.
Answer:
(a) Ensure there are no items present that could be used to harm themselves.
Rationale:
Ensuring patient safety is a primary responsibility of the nurse. Although establishing rapport (committing to no self-harm) is typically the first step in nursing care, clearing the room of potential hazards after the patient is present could impede rapport while also allowing the patient a means and opportunity to harm self or others. Reviewing the history is an appropriate step of the patient assessment after patient privacy is secured. Talking to family members regarding their presenting actions and statements is also important; however, the priority is patient safety in the initial stages of care.
Verifying means to ensure personal safety is also a concern for emergency nurses when caring for patients experiencing psychosocial issues. This is usually done at the same time when the initial care is in progress. Always make sure that you the nurse are safe from harm! Have an escape out of the room available and never situate yourself in a position in which the patient is between you and the door!
Question 2.
Anxiety is a manifestation of:
(a) Increased parasympathetic nervous system stimulation.
(b) Decreased parasympathetic nervous system stimulation.
(c) Increased sympathetic nervous system stimulation.
(d) Decreased sympathetic nervous system stimulation.
Answer:
(c) Increased sympathetic nervous system stimulation.
Rationale:
Anxiety is the result of increased sympathetic nervous system stimulation (fight or flight)? Increased parasympathetic stimulation (rest and digest) would counter sympathetic stimulation. Both decreased sympathetic and decreased parasympathetic stimulation would allow a return to baseline.
Question 3.
The level of anxiety at which a patient loses their ability to think logically is:
(a) Level I: mild.
(b) Level II: moderate.
(c) Level III: severe.
(d) Level IV: panic.
Answer:
(d) Level IV: panic.
Rationale:
Level IV anxiety is typified by an inability to solve problems or think logically and obligates the nurse to identify safety plans for the patient and others as the patient may experience changes in their personality. Patients with level I anxiety are aware of their environmental stimuli and can rationally problem-solve. Level II anxiety is associated with a heightened focus on immediate concerns while the patient remains cooperative with care providers. Level III anxiety patients do not engage with the full spectrum of their situation and demonstrate regressive behaviors while often needing repetitive Level IV: While a level 5 triage acuity patient may express anxiety over a long lobby wait, this dysfunctional expectation is a situational anxiety response, not an anxiety disorder.
Question 4.
During a manic episode, a patient with bipolar disorder may:
(a) Present withdrawn and depressed.
(b) Present unkempt with poor hygiene.
(c) Display poor social judgment.
(d) Refuse to answer questions.
Answer:
(c) Display poor social judgment.
Rationale:
During a manic phase, the patient with bipolar disorder often has poor social judgment, which can manifest as sexual inappropriateness, becomes hypersocial, with rapid, verbose speech without allowing opportunity for reciprocal communication, and/or displays grandiosity of thought and ideas. The manic phase is the opposite of the depressed phase, which may manifest with social withdrawal. The manic patient is more likely to display flamboyant personal styl4 and dress rather than be unkempt. Patients in a manic episode will usually be more than willing to answer questions by providing long and rambling explanations to questions. It will be difficult to keep them on task and to elicit appropriate answers from them.
When patients are in the manic phase, be sure to provide a safe environment for them. They may need to pace or move about. They must be closely observed at all times.
Question 5.
The postpartum patient with a history of bipolar disorder has an increased risk of:
(a) Eclampsia.
(b) Psychosis.
(c) Hemorrhage.
(d) Fatigue.
Answer:
(b) Psychosis.
Rationale:
Although postpartum psychosis occurs in only 1 to 2 per 1,000 births, the bipolar patient is at increased risk for this process. The psychotic patient typically has difficulty sleeping rather than increased fa-tigue. Eclampsia has no known correlation with bipolar disorder. There is no known risk of hemorrhage due to bipolar disorder; however, there may be risk related to the medication profile of each patient.
The desire for pickles and ice cream is not a symptom of abnormal behavior or suggestive of developing psychosis. This is normal in pregnancy! Health care professionals should watch closely, however, for manifestations of mental health issues that might exacerbate or escalate in the pregnant and postpar-tum patient.
Question 6.
Human trafficking victims are unlikely to solicit assistance from the emergency nurse because:
(a) They are psychologically abused and manipulated.
(b) They are voluntary participants in their circumstances.
(c) Their psychological needs are being fulfilled.
(d) They are safe in their home environment.
Answer:
(a) They are psychologically abused and manipulated.
Rationale:
Victims of human trafficking are held captive through psychological manipulation using threats and fear of reprisal against themselves and others by their captors. Although they may feel they entered the circumstances voluntarily initially, their physical and psychological needs are not being appropriately met and their safety and possibly the safety of others is at risk if they pursue escape.
Question 7.
Lithium, a drug used to treat bipolar disorder, is known to have which of the following characteristics?
(a) Wide therapeutic window
(b) Little risk for overdose
(c) Potentially dangerous in the dehydrated patient
(d) Used to treat many nonpsychological diagnoses
Answer:
(c) Potentially dangerous in the dehydrated patient
Rationale:
Lithium hemoconcentrates when patients become dehydrated, resulting in a relative elevation in the blood level. Given the narrow therapeutic window, these relative elevations can result in symptoms of over-dose-spanning nausea, muscle twitching, convulsions, and coma. Although no longer a first-line treatment, lithium is used primarily in the treatment of bipolar disorders and less frequently for schizophrenia and major depressive disorders.
Question 8.
Atypical antipsychotic drugs affect the dopamine and serotonin receptors and are lower compared with typical antipsychotic medications.
(a) Daily compliance
(b) Extrapyramidal syndromes
(c) Financial burden
(d) Therapeutic benefits
Answer:
(b) Extrapyramidal syndromes
Rationale:
Extrapyramidal side effects are diminished compared with typical antipsychotics and therefore have increased compliance. The atypicals also demonstrate benefits in reducing symptoms associated with psychosis such as hostility, violence, and suicidal behavior. This class of drug is relatively more expensive when compared with typical antipsychotic medications.
Atypical versus Typical Antipsychotics: Atypical antipsychotics are also known as second generation. This group of antipsychotics cause less extrapyramidal symptoms than the first-generation or typical antipsychotics. Examples of atypical (second generation) antipsychotic medications includes clozapine (Clozaril), lurasidone (Latuda), olanzapine
Question 9.
A family member who has immediately and unexpectedly experienced the death of a loved one in the emergency department may manifest all of the following EXCEPT:
(a) Depression.
(b) Grief.
(c) Denial.
(d) Anger.
Answer:
(a) Depression.
Rationale:
A diagnosis of depression is not indicated until a compilation of at least five persistent symptoms such as loss of interest, depressed mood, appetite changes with weight change, sleep disturbances, decreased cognition, fatigue, psychomotor changes, and recurrent thoughts of death or feelings of worthlessness persist distinctly from an event such as a family death. Denial, as well as anger, are normal phases of grief, as is depression, but defining a response as depression immediately is not appropriate.
Question 10.
The majority of completed suicides are in which of the following populations?
(a) Men
(b) Women
(c) Nonveterans
(d) Children
Answer:
(a) Men
Rationale:
Although women attempt suicide more frequently than men, 80% of all suicides are completed by men. Older adult rrlales who are widowed or divorced are at highest risk of successful suicide. Veterans are recognized as being high risk for suicide. Child suicide attempts, although significant, are uncommon.
Question 11.
Common physical manifestations of eating disorders include all of the following EXCEPT:
(a) Dehydration/Nutjritional Imbalances.
(b) Cardiac Arrhythnlias/Electrolyte Imbalances.
(c) Acute Renal Or Hepatic Failure.
(d) Progressive Vision Loss/Diplopia.
Answer:
(d) Progressive Vision Loss/Diplopia.
Rationale:
Dehydration and nutritional abnormalities are present in 47% of admissions, followed by electrolyte imbalances for 34%, cardiac dysrhythmias in 24%, and 4% presenting with renal or hepatic failure.
Visual impairment is not a complication.
The emergency nurse should be suspicious for eating disorders in order to help in the identification of this psychosocial disorder. The other major component for emergency nurses is to be aware of pathophysi¬ologic complications that may cause life-threatening issues. Be suspicious!
Question 12.
When assisting someone who has just experienced the death of their family member and is in a state of acute grief, which of the following is NOT an appropriate statement by the emergency nurse?
(a) “I’m so sorry for your loss.”
(b) “We gave all the care one could hope for.”
(c) “You are a strong person and will get through this.”
(d) “I’m sorry your husband died.”
Answer:
(c) “You are a strong person and will get through this.”
Rationale:
Encouraging the grieving person does not acknowledge the significance of the loss and grief that is normal. Although it is important to demonstrate support of the survivor, during the acute event, it is a time to focus on assimilating the event reality. Now is not the time to try to list their vision beyond the current
Question 13.
When assessing for medical clearance {medical stability), which of the following should NOT prevent transfer to psychiatric services?
(a) Hypoglycemia
(b) Adverse drug event
(c) Dehydration
(d) Homelessness
Answer:
(d) Homelessness
Rationale:
Homelessness is a social determinant of health that may contribute to mental illness. It is not a medical condition that can be definitively treated in the emergency department (ED). All other conditions provided are within the scope and duties of ED treatment and therefore must be resolved before transfer to definitive psychiatric care.
Question 14.
When first-generation antipsychotic medications are used in the medication naive patient, which of the following may be used to prevent/reverse dystonic reactions?
(a) Haloperidol (Haldol)
(b) Diphenhydramine (Benadryl)
(c) Droperidol (Inapsine)
(d) Lorazepam (Ativan)
Answer:
(b) Diphenhydramine (Benadryl)
Rationale:
Diphenhydramine (Benadryl) is therapeutic in preventing and treating dystonic reactions. Haloperi-dol (Haldol) and droperidol (Inapsine) can cause dystonic reactions. Lorazepam (Ativan) may be palliative for a patient experiencing the effect, but does not reverse it.
Dystonic reactions are very scary for patients! Be calm! A little Benadryl will fix them right up! This reaction involves extremely strong muscular ' contractions to the neck or torso, which causes the patient’s head and body to be held in contorted and abnormal positions. The eyes are also often affected (known as oculogyric crisis), causing the patient to not be able to look downward or they may maintain a deviated gaze. The mouth is unable to be closed and the tongue may protrude involuntarily. These reactions are a type of extrapyramidal symptoms.
Question 15.
Which of the following does NOT call for a high index of suspicion for child maltreatment?
(a) Bruising on a child who is less than 4 months of age
(b) Bruises on the ears, neck, or thorax on a child of any age
(c) Discolorations on the back/buttocks on a child less than 3 years old
(d) Patterned bruises on the backs of the legs of a toddler
Answer:
(c) Discolorations on the back/buttocks on a child less than 3 years old
Rationale:
Blue/green discolorations on the back/but-tocks, situation. Acknowledging their loss is a genuine empathy, which acknowledges and reinforces the permanence of the event. Stating you did all you could assists with ques-tions or doubts about what may have been done differ-ently. Words such as “death” and “died” provide concrete meaning and are to be used in place of descriptions such as “passed” or “have gone to a better place.”
Question 16.
The psychiatric condition with the highest mortality rate is:
(a) Anorexia nervosa.
(b) Bipolar disorder.
(c) Dementia.
(d) Psychotic depression.
Answer:
(a) Anorexia nervosa.
Rationale:
Anorexia Nervosa has the highest mortality rate due to metabolic complications and concomitant risk of suicidal ideation. Although all other mentioned diagnoses have mortality risks, anorexia has the highest risk of all psychiatric diagnoses.
Question 17.
When discharging the depressed patient from the emergency department, the most important intervention is:
(a) Administering a first dose of a selective serotonin reuptake inhibitor (SSRI).
(b) Verifying social contacts are present outside of the emergency department.
(c) Encouraging that nutritional needs are met.
(d) Assessing the home environment for weapons.
Answer:
(b) Verifying social contacts are present outside of the emergency department.
Rationale:
Social interaction in the most effective and urgent need for the depressed patient. Selective serotonin reuptake inhibitor (SSRI) medications are not acutely effective and may take weeks to reach a therapeutic effect. Nutritional care is important in the long-term recovery plan and may require ongoing intervention, but that is not the most urgent need. A depressed patient is at risk for becoming suicidal, in which case access to weapons may be indicated, but the timeliest means of preventing such escalation is to connect the patient with social resources.
Question 18.
The suicidal patient is at greater risk of attempting suicide in all of the following situations EXCEPT:
(a) Access to weapons.
(b) Intoxication.
(c) Recent social stressors.
(d) Friend/family presence.
Answer:
(d) Friend/family presence.
Rationale:
Engaging friends/family in care diminishes risk of suicide. Ensuring the removal of access to weap-ons, resolving/preventing intoxication, and diminishing social stressors are all appropriate interventions to de-crease suicidal risk.
Question 19.
Potential nonpsychiatric causes of acute agitation and behavior changes include all of the following EXCEPT:
(a) Hypoxia.
(b) Thyroid disorders.
(c) Stroke.
(d) Dementia.
Answer:
(d) Dementia.
Rationale:
Dementia can result in acute agitation re-lated to confusion and amplified sensory stimulation
Question 20.
After identifying an adult victim of human trafficking, the emergency nurse should do all of the following EXCEPT:
(a) Force The Victim To Remain In The Ed Against Their Will.
(b) Collaborate With Police And Other Community Aid Resources.
(c) Discretely offer assistance resources to victim.
(d) Appropriately treat all medical needs of the patient.
Answer:
(a) Force The Victim To Remain In The Ed Against Their Will.
Rationale:
The adult victim of human trafficking can-not be detained against their will and attempting to do so hyperthyroidism are causes of behavioral issues that can appear to be psychiatric in nature. May be harmful to them or others. It is appropriate to access adult protective services and other regional re-sources. Discretely offering resources can be helpful, but the key to success is in not putting the patient at risk by delivering the aid in a way that alerts the captor. Treating all medical needs is of primary importance.
Always be concerned about medications that the patient is on or is supposed to be taking—and the dos¬ing regimen when determining potential medical reasons for psychosocial presentations. Sometimes interactions between medications or side effects can be a cause of the behavior!
Question 21.
Which of the following would NOT be an expected outcome following the administration of ketamine?
(a) Decrease in chronic depressive behaviors and thoughts
(b) Relief of suicidal ideation thoughts and actions
(c) Reduction of symptoms in patients with excited delirium
(d) Diminished aggressive behavior in the acute grieving process
Answer:
(d) Diminished aggressive behavior in the acute grieving process
Rationale:
Ketamine is an old medication with new uses in the mental health field. It does not have properties that help when an individual is in a situational crisis causing them to utilize defensive and aggressive mechanisms instead of their usual coping mechanisms. It is now being used and explored in this field to treat depression, suicidal ideation, and excited delirium.
Question 22.
When discussing the potential risks and benefits of caring for a victim of sexual assault, all of the following are true statements EXCEPT:
(a) There are risks and benefits to all medications that may be appropriately offered.
(b) There is potential need for follow-up care and treatment if prophylactic care is refused.
(c) The patient has the right to accept or refuse all or parts of the offered care.
(d) Refusal of treatments will prevent prosecution of the crime.
Answer:
(d) Refusal of treatments will prevent prosecution of the crime.
Rationale:
Refusing treatment has no implication to the ability to prosecute the crime, but refusal of the collection of evidence can impede prosecution. Example: Refusal of prophylactic antibiotics is incon-sequential to prosecution, whereas refusal to collect a swabbed fluid specimen may complicate prosecutorial efforts. All other answer options are appropriate nursing care.
Question 23.
The dementia patient is most likely at risk of receiving suboptimal emergency care for an acute hip fracture because:
(a) Their vascular sufficiency may be compromised and impede healing.
(b) Their ability to interpret and communicate pain may be compromised.
(c) They are not competent to consent to a surgical treatment.
(d) It is impossible to keep them in the bed for a thorough evaluation.
Answer:
(b) Their ability to interpret and communicate pain may be compromised.
Rationale:
The dementia patient may have impaired ability to assess their own pain and communicate their symptoms. It is incumbent upon the nurse to dedicate adequate attention to objective signs of discomfort such as body posture and vital sign changes. Chronic vascular pathology will not impact emergency care, but attentive monitoring of distal circulation may be a heightened concern due to communication challenges with the patient. If the patient is incompetent to consent to treatment themselves, a surrogate decision maker is indicated. Sedation and/or a bedside sitter may be necessary to ensure patient safety, and adequate pain control will facilitate safe care.
Question 24.
The peak frequency of onset and diagnosis of schizophrenia is in which of the following age groups?
(a) 5 to 14 years
(b) 15 to 24 years
(c) 25 to 34 years
(d) 35 to 44 years
Answer:
(b) 15 to 24 years
Rationale:
The highest frequency of onset/diagnosis of schizophrenia is in the age group of 15 to 24 years.
All patients presenting to the emergency department with psychiatric symptoms should have a Mental Status Examination (MSE) performed. The pieces and parts of this examination include the following: General Appearance/Rate and Tone of Speech/Sub¬jective Mood/Objective Affect/lntellect/Short-Term or Long-Term Memory Loss/Abnormal Thought Processes (flight of ideas/thought blocking)/Halluci¬nations or Illusions/Insight and Judgment. (Do they know they are ill or need help?)
Question 25.
When caring for a patient who is acutely agitated and presenting a risk to self and others, which of the following is an appropriate intervention?
(a) Administer enough medication to get them to sleep.
(b) Place them in a seclusion room with a sitter or status checks evbry 15 minutes.
(c) Immediately implement four-point leather restraints. ,
(d) Begin with the least restrictive means necessary to keep them and others safe.
Answer:
(d) Begin with the least restrictive means necessary to keep them and others safe.
Rationale:
Keeping the patient and others safe during a period of crisis is the priority and should be achieved using the least restrictive yet effective means. This may include a combination of medications and changes to the physical environment and their mobility, but it must be implemented in a measured fashion that may involve escalating restriction and medication modalities with the goal of being effective, not excessive and never punitive or because it is just too hard to care for them short of se¬dation until asleep.
Question 26.
Which of the following is a true statement regarding restraining a patient when necessary?
(a) Utilize a trained and coordinated team approach.
(b) Have the strongest members of the staff overpower the patient.
(c) Direct the patient to cooperate or law enforcement will be called.
(d) Engage family members to physically assist.
Answer:
(a) Utilize a trained and coordinated team approach.
Rationale:
This is a high-risk situation for both the patient and staff. A trained team approach, which has been practiced outside of emergent circumstances, is indicated. Attempting to use the strongest staff ap-proach is likely to harm both the patient and the pro-vider. Threatening the patient with police intervention is abusive and not likely to result in a therapeutic result. Family should not be allowed to participate in such an intervention.
It is no longer appropriate to refer to a therapeutic intervention of restraint as a “takedown. ”
Question 27.
Acute Stress Disorder (ASD) differs from Post- Traumatic Stress Disorder (PTSD) because the:
(a) Triggering events are of a different magnitude.
(b) Length of time since the life-changing event is different.
(c) Emergent needs of patients during each crisis differ.
(d) Pathophysiologic stress response is different.
Answer:
(b) Length of time since the life-changing event is different.
Rationale:
Acute stress disorder (ASD) is the condition that occurs within the first 30 days after the life-changing event. During this phase, the patient is still working through the actual event experience. After 30 days, if the social and physiologic stress persists, the condition becomes post-traumatic stress disorder (PTSD) and symp¬toms result from triggering of the memory of the event. The needs of the patient for reassurance and safety remain unchanged in the emergency department.
Question 28.
Schizoaffective disorder involves at least one schizophrenic-like episode lasting more than 2 weeks plus a diagnosis of during
a nonschizophrenic-like period.
(a) Post-Traumatic stress disorder
(b) An Episode of dementia
(c) A Major Mood disorder
(d) Suicidal Ideation
Answer:
(c) A Major Mood disorder
Rationale:
Schizoaffective disorder involves the pres-ence of two conditions: A major mood disorder (ma¬nia or major depression) occurring independent of a schizophrenic-like psychosis lasting more than 2 weeks. Although serious, the other choices are unrelated to the diagnosis of schizoaffective disorder.
Question 29.
Delusional Disorder involves the presence of delusions, often nonbizarre and potentially plausible while not actual, that persists for:
(a) A few days.
(b) At least 1 month.
(c) More than 1 month.
(d) At least 1 year.
Answer:
(b) At least 1 month.
Rationale:
Delusions must be present for more than 1 month to qualify for diagnosis as Delusional Disorder.
Although the emergency nurse may feel the patient’s request for three hydrocodone (Norco) refills may be delusional, it does not reflect the gravity of psychiatric delusion. Delusions can take many forms such as being persecutory, grandiose, romantic, catastrophic, or somatic. Examples of these false beliefs would be believing that some horrible event was im-minent or that someone was being followed. These delusions are built around the concept that they could be a reality and are potentially believable.
Question 30.
During the initial treatment of a patient with a medication overdose, the priority assessment is identification of:
(a) The ingested substance.
(b) The motivating trigger.
(c) The time of the ingestion.
(d) Life-threatening conditions.
Answer:
(d) Life-threatening conditions.
Rationale:
The priority assessment should be the identification of the need for immediate lifesaving interventions (that is, airway, breathing, and circula-tion) . The timing and type of ingestion are important for anticipating potential changes in the patient’s condition, but life-threatening symptomatology and concerns must be addressed first. Motivation behind the ingestion (at-tempted suicide or accidental overdose) will be a priority for care before discharge or inpatient care planning.
Question 31.
A priority in caring for a family member grieving the acute loss of a loved one includes:
(a) Determining where to disposition the body.
(b) Assisting with making family notifications.
(c) Expressing acknowledgment of the reality of the death.
(d) Securing social support for the grieving person.
Answer:
(c) Expressing acknowledgment of the reality of the death.
Rationale:
Ensuring the family member accepts the real¬ity of the circumstances is the first step toward healing.
Disposition of the deceased is an administrative necessity, which can proceed after care of the family. Urgently making notifications is not time-sensitive and can distract the fam¬ily from internalizing the reality. Securing social support is important before discharge but is not an immediate need.
Question 32.
The emergency nurse’s priority for a patient in police custody who are seeking medical clearance after alleged bizarre and criminal behavior is to:
(a) Facilitate rapid disposition so there is no emergency department disruption.
(b) Delay history gathering until the officer is present to take notes.
(c) Accept the patient’s request to refuse care without any examination.
(d) Thoroughly assess the patient for signs of illness or injury.
Answer:
(d) Thoroughly assess the patient for signs of illness or injury.
Rationale:
Due to the reported bizarre behavior, it is incumbent upon the nurse to assess for medical and psychiatric illness. History gathering is a critical part of the patient assessment and should be a priority regardless of officer attention. The potential of cognitive impairment may preclude the patient’s right to refuse care. Seeking rapid disposition can be a therapeutic priority after medical needs are ruled out.
Good relationships with law enforcement are com¬mon in emergency departments in general, and such relationships can be sustained through collegial communications without compromising our professional commitment to the patient.
Question 33.
Emergency department operational efficiency that minimizes waits for triage and bedding and shortens length of stay does all the following EXCEPT:
(a) Decreases workplace stress.
(b) Decreases patient anxiety.
(c) Makes patients feel care was less thorough.
(d) Helps staff establjsh trust with patients.
Answer:
(c) Makes patients feel care was less thorough.
Rationale:
Decreased operational efficiency, not positive operational efficiency, can make patients feel that they are not being cared for properly. Effective operations are valuable contributors to nursing self-care. Long waits increase frustrations of patients, which can diminish trust and prolong the process of establishing rapport with the patient. Proper functioning of the emergency department will decrease patient anxiety and help to create a positive experience for the patient and significant others.
Little else can be more straining on a career in the service of emergency department patients than poorly managed operations. Your local grocery store has figured out how to keep waiting tolerable. The profes¬sional nurse should recognize there is more to good operations than adding more staff. Challenge your department to figure out better ideas than adding people at what could be a process design problem.
Question 34.
When assessing a victim of domestic violence, a priority for the emergency nurse should be:
(a) Gaining access to the patient without the presence of family.
(b) Asking the family if the patient is safe at home.
(c) Discussing with the family concerns for patient safety.
(d) Ensuring a safe discharge environment.
Answer:
(a) Gaining access to the patient without the presence of family.
Rationale:
It may not be possible to gather an accurate history and physical examination with a potential per-petrator present. The patient, not the family, should be the subject of questions regarding their personal safety.- Ensuring a safe discharge is of critical importance, but, is an aspect of care later in the visit.
Question 35.
The parent most likely to experience a child death due to Sudden Infant Death Syndrome (SIDS) has a child of what age?
(a) 1 to 7 days
(b) 1 to 16 weeks
(c) 4 to 12 months
(d) 1 to IV2 years
Answer:
(b) 1 to 16 weeks
Rationale:
Although sudden infant death syndrome (SIDS) may occur anytime between 1 week and 1 year of birth, the peak incidence is before 4 months. These parents will need coping resources before release from the emergency department.
Question 36.
Discharge teaching after a dystonic reaction includes ensuring the patient recognizes that:
(a) Symptoms may return for several days as medication wears off.
(b) The emergency department medications are all that is needed to prevent reoccurrence.
(c) The next time they receive the causative drug, they may not have a reaction.
(d) They do not need to include the causing drug on their allergy list.
Answer:
(a) Symptoms may return for several days as medication wears off.
Rationale:
Due to the long duration of action of most medications that can cause dystonia, symptoms may recur. Redosing of treatment is likely needed as the emergency dosing may not be adequate to prevent these reoccurrences. Once the patient experiences the reaction, the recurrent use of the causative agent will result in the same reaction. Although not a true allergic reaction, plac¬ing this medication, which causes significant negative reactions on the “allergy” list, is appropriate.
Question 37.
When treating an acutely psychotic patient, all of the following are appropriate EXCEPT:
(a) Reorienting them back to reality as frequently as necessary.
(b) Policy requirement of mandatory seclusion or four- point restraints.
(c) Comprehensive assessment for potential medical causes to their psychosis.
(d) Escalation of restrictive intervention to protect the patient and others from harm.
Answer:
(b) Policy requirement of mandatory seclusion or four- point restraints.
Rationale:
Policy requirement of mandatory seclusion or restraints for a diagnosis is not appropriate. The
acutely psychotic patient may require frequent reorienta¬tion to reality. Ruling out medical causes of psychosis is a standard of care. The decision for the level of restraint necessary should be borne in assessment of the patient and should progress from the least restrictive to the level necessary to protect the patient and others.
When you think seclusion is the answer, consider if the patient needs it or if you may just be well past a reasonable opportunity to reorient yourself to reality with a break.
Question 38.
Which of the following is NOT a typical intervention for a patient demonstrating manifestations of mania?
(a) Evaluate for a therapeutic lithium level
(b) Assess for a panel of drugs of abuse
(c) Reorient them to their physical limitations
(d) Report their condition to family without their consent
Answer:
(d) Report their condition to family without their consent
Rationale:
In general, unless patients are being held and admitted under a “hold,” they maintain all their civil rights, including their right to patient privacy. A subtherapeutic lithium level may be the cause of their manic episode. Toxicity of drugs of abuse may masquer¬ade as mania. The manic patient may perceive powers and abilities that exceed reality.
When answering questions on the test, remember that situations and circumstances are discussed in general terms because nurses from all parts of the country are being tested. Different aspects of care can be termed differently in different regions; for instance, a psychiatric hold may be called a “96-hour hold” in one part of the nation but called a “5150 hold” in another, and there may be nuances particu¬lar to different areas and jurisdictions. Be careful to not get caught answering questions "just as we do it."
Question 39.
Which of the following classes of medications would most likely NOT be prescribed in an emergency care environment due to their slow onset of effectiveness?
(a) Typical antipsychotic
(b) Atypical antipsychotic
(c) Benzodiazepine
(d) Selective serotonin reuptake inhibitor (SSRI)
Answer:
(d) Selective serotonin reuptake inhibitor (SSRI)
Rationale:
While frequently effective after days or weeks of use, the SSRI (selective serotonin reuptake inhibitor) medications are not an acutely beneficial emergency department intervention. All the other drugs have an onset, which may be beneficial during a typical emergency department stay.
Question 40.
In the event of an intentional overdose of lorazepam (Ativan), which concomitant condition would prompt you to question an order to administer a reversal agent?
(a) Seizure history
(b) Bipolar disorder
(c) Opioid allergy
(d) History of angioedema
Answer:
(a) Seizure history
Rationale:
Seizures cannot be effectively treated with benzodiazepines after administration of a benzodiaz-epine reversal agent. The patient may best be cared for using supportive respiratory care until the overdose wears off. Another appropriate intervention would be explor¬ing for therapeutic levels of antiseizure medications. The other conditions are not associated with increased risk from a reversal agent.
Question 41.
A patient with a history of alcoholism presents to the emergency department with agitation and hallucinations after reportedly abstaining from alcohol for 48 hours. Appropriate interventions include all the following EXCEPT:
(a) Benzodiazepines.
(b) Continued abstinence from alcohol.
(c) Vitamin B,.
(d) Watchful waiting.
Answer:
(d) Watchful waiting.
Rationale:
Watchful waiting is not a typical treatment for acute alcohol withdrawal syndrome resulting in delirium tremens. All the other interventions are within the standard of care. Benzodiazepines are helpful in decreasing the severity of the withdrawal and in preventing potential sei¬zure activity. Thiamine (vitamin B,) is useful in preventing Wernicke’s encephalopathy/Wernicke-Korsakoff syndrome. Thiamine is necessary for the successful metabolism of glucose in the brain. Alcohol should not be taken during the course of treatment for alcohol withdrawal,
Patients in alcohol withdrawal can progress to delir¬ium tremens (DT). This can be a dangerous situation and should not be considered to be an uncomplicated process. Act early to begin true therapy so this patient does not become a boarder because the floor feels they cannot handle a disruptive sobering patient.
Question 42.
Delirium unrelated to alcohol withdrawal is NOT typically treated with which of the following pharmacologic interventions?
(a) Haloperidol (Haldol)
(b) Atypical antipsychotic medications
(c) Benzodiazepines
(d) Ziprasidone (Geodon)
Answer:
(c) Benzodiazepines
Rationale:
Benzodiazepine administration is not appropri¬ate for nonalcohol-related delirium and may exacerbate the symptoms. The most common cause of delirium is due to drug ingestion. Haloperidol (Haldol) and. atypical antipsy-chotics such as Ziprasodone (Geodon) may prove effective.
Question 43.
Which of the following would indicate an improvement in a patient with a diagnosis of Serotonin Syndrome?
(a) Increased heart rate
(b) Normothermia
(c) Mydriasis
(d) Dry mucous membranes
Answer:
(b) Normothermia
Rationale:
Hyperthermia is a trademark symptom of Serotonin Syndrome, therefore, normothermia would indicate an improvement in this’patient. Other mani-festations include tachycardia, dilated pupils (mydriasis), and dry mucous membranes as well as agitation, hyper- reflexia, diaphoresis, and flushed skin.
Always make sure providers are aware of all medications a patient is taking! Serotonin Syndrome occurs when too much serotonin is dumped out into the body. This can happen when patients are taking two medications that produce the same results an increase in serotonin production. It can also happen with one of these medications in a patient who has hypersensitivity to serotonin. These medications include SSRIs Selective Serotonin Reuptake Inhibitors (SSRIs). Taking a monoamine oxidase inhibitor (MAOI) with an SSRI can have disastrous results. Another serotonin-releasing drug is St. John’s Won. Be careful with seemingly “simple” herbal remedies!
Question 44.
The most significant side effect of tricyclic antidepressants (TCAs) is:
(a) Cardiac toxicity in overdose.
(b) High abuse potential when taken recreationally.
(c) Withdrawal syndromes when stopped abruptly.
(d) Sedation in overdose situations.
Answer:
(a) Cardiac toxicity in overdose.
Rationale:
Life-threatenihg cardiac arrhythmias can occur in TCA overdose. These are not commonly abused, except as a means in attempted suicide. Withdrawal syndromes can occur with abrupt cessation, but symptoms are not life-threatening and are prevented with tapering over a few days. Sedation in overdose is a known side effect, but it is not as significant a concern as the cardiotoxic effects.
Patients with tricyclic antidepressant overdoses as a suicidal gesture are candidates for a high success rate. Recognize the significant risk of success from these overdoses and ensure aggressive management.
Question 45.
A dangerous side effect of Monoamine Oxidase Inhibitor (MAOI) antidepressant overdose is:
(a) Hypotension.
(b) Hypertension.
(c) Sedation.
(d) Severe Agitation.
Answer:
(b) Hypertension.
Rationale:
Severe hypertension can result from monoamine oxidase inhibitors (MAOIs) overdoses, which blocks the metabolism of norepinephrine. Hypotension, sedation, and severe agitation are not associated with MAOI overdose.
Question 46.
Treatment of Monoamine Oxidase Inhibitor (MAOI) accidental overdose includes all of the following EXCEPT:
(a) Administration of phentolamine.
(b) Cooling measures.
(c) Dietary cautions.
(d) Lying supine.
Answer:
(d) Lying supine.
Rationale:
Overdoses of monoamine oxidase inhibitors (MAOIs) cause severe hypertension, and lying flat in-creases cerebral blood pressure. Cooling measures may be required as the overdose can elevate temperature. Many foods, such as cured, pickled or fermented food and drink (especially red wine), can potentiate the effect of MAOIs. Phentolamine blocks the action of norepinephrine, the caus¬ative agent behind the overdose-associated hypertension.
An example of an monoamine oxidase inhibitor (MAOI) is phenelzine (Nardil). This class of medication are older drugs and are not the first-line medications for antidepressant use. These were some of the first antidepressants utilized.
Question 47.
Neuroleptic Malignant Syndrome (NMS), a rare but potentially fatal side effect of antipsychotic drugs, is associated with all of the following EXCEPT:
(a) Fever.
(b) Muscle rigidity.
(c) Tremors.
(d) Urinary retention.
Answer:
(d) Urinary retention.
Rationale:
Neuroleptic malignant syndrome (NMS) is the result of autonomic nervous system dysfunction, and bowel and bladder sphincters may relax causing incontinence rather than retention. The body’s ability to regulate primarily unconsciously controlled functions such as muscle and temperature control occur. Tempera-ture elevation is due to an increase in muscle activity.
Question 48.
The most common time of onset of neuroleptic malignant syndrome (NMS) is associated with which of the following regarding the prescription use of Monoamine Oxidase Inhibitors (MAOIs)?
(a) Within the first 2 weeks of starting an MAOI
(b) After abrupt cessation of an MAOI
(c) After decreasing a patient’s MAOI dose
(d) After taking an MAOI for many years
Answer:
(a) Within the first 2 weeks of starting an MAOI
Rationale:
The most common onset of neuroleptic ma-lignant syndrome is between 4 and 14 days after start-ing the medication. Cessation and decreasing the dose is associated with decreased risk of NMS. The risks of NMS after a therapeutic dose has been achieved are low, but dehydration can result in increased risk due to relative concentration of the drug level.
Find out your facility policy for procurement of medications to treat this condition. Many facilities have a strong process backed by policy between the Operating Room and the Pharmacy because these treat¬ments are very high-cost drugs. The policy should include the ED, and practicing the request/delivery process is well worth the effort.
Question 49.
In which of the following circumstances does a psychiatric patient have the right to refuse treatment?
(a) They are under conservatorship and the decision maker agrees to the treatment.
(b) The patient is below 18 years of age and the parent consents to treatment.
(c) They are voluntarily receiving care, but they are refusing a medication.
(d) An injury is reasonably believed to have impaired their ability to consent.
Answer:
(c) They are voluntarily receiving care, but they are refusing a medication.
Rationale:
A patient who is not under involuntary hold has the right to refuse aspects of or all of care. Conser-vatorship appoints another to make decisions for the pa-tient. The parent is the legal decision maker for a patient under the age of 18, but the nurse should be aware that a therapeutic rapport is critical in working with a patient who is resistant to care. Care may be administered in the event of an injury, which can be reasonably believed to
impair the ability of the patient to decide for themselves; however, those administering the treatment must reason-ably believe the treatment will benefit the patient. In other words, if the nurse does not feel it is appropriate, they should not administer the order.
Question 50.
Which of the following is NOT a predisposing factor influencing psychosocial health?
(a) Sociocultural influences
(b) Developmental factors
(c) Biologic components
(d) Social stressors
Answer:
(d) Social stressors
Rationale:
Social stressors are precipitating factors that are related to psychosocial health, not predisposing factors. Precipitating factors cause a person to experience disruption from their norms or trigger a maladaptive response. Predisposing factors occur early in life and contribute to the potential for development of a psychological disorder.
Question 51.
If a patient presents a significant threat to others, the nurse has a duty to do which of the following?
(a) Warn the at-risk individual
(b) Protect the at-risk individual
(c) Protect patient confidentiality
(d) Violate confidentiality law
Answer:
(b) Protect the at-risk individual
Rationale:
The nurse has the duty to protect those at risk, which may include assisting with transfer to in-patient care of the psychiatric patient. This standard is frequently misunderstood as simply a duty to warn those at risk. The rights of the patient do not include confidenti¬ality when they are posing a genuine risk to others. Such disclosures and actions to protect others are not a violation of confidentiality law. This is referred to as Tarasoff’s law.
Few Emergency Departments have timely access to inpatient psychiatric resources, so our profes¬sion needs to build skills in this expertise. At one point in time, we were not always as exceptional as we are now in the treatment of Acute Myocar¬dial Infarction and Stroke, but once we accepted it as our interest, we became very good at delivering great outcomes. We must all step up to this new challenge.
Question 52.
Secondary traumatic stress is a form of Post- Traumatic Stress Disorder (PTSD) seen in what percentage of emergency nurses?
(a) Less than 10%
(b) Approximately 25 %
(c) Up to 50%
(d) More than 50%
Answer:
(d) More than 50%
Rationale:
Significant symptoms of stress have been found in 64% of studied Emergency Department nurses. Symptoms are understood to be the result of repeated exposure to traumatic and stressful care events common to the emergency care environment. Attention to self-care as well as recognition of symptoms and prompt intervention is key to the long-term health of the emer¬gency department nurse.
Question 53.
Notification to a child of the death of their sibling is most therapeutically delivered by:
(a) The on-duty physician.
(b) The patient’s nurse.
(c) A chaplain or social worker.
(d) A trusted family member.
Answer:
(d) A trusted family member.
Rationale:
Such a traumatic message is best received from a trusted friend or family member who can sustain interaction with the sibling. The other indi-viduals are very important in the process, but the best person to deliver this information is the trusted friend or family member.
Question 54.
Which of the following statements made by the wife of a patient who was an unsuccessful resuscitation attempt would most indicate that her presence during the attempt was a positive experience?
(a) “I wonder if more medicine would have helped?”
(b) “I will never get over seeing the screen show that flat line. ”
(c) “I feel like nothing more could have been done. ”
(d) “I wish I had had someone to explain things to me.”
Answer:
(c) “I feel like nothing more could have been done. ”
Rationale:
The Emergency Nurses Association (ENA) as well as other international emergency nurse asso-ciations (and national emergency care organizations) support family presence during resuscitation. Family members who are in the room can see all of the things that are being done for their loved one. This is a positive outcome for those who are left behind. It is difficult for them to see the reality of the death, but it can help the grieving process to begin. Staff mem¬bers should always be present when this is done. That staff member’s total responsibility is the family member. Family members should have this support or they should not be allowed into the resuscitation room.
Question 55.
A patient with acute onset of visual hallucinations is most likely experiencing which of the following situations?
(a) Acute delirium
(b) Chronic fatigue
(c) Chronic psychosis
(d) Psychotic break
Answer:
(a) Acute delirium
Rationale:
Visual hallucinations are most commonly associated with acute delirium. Chronic fatigueds not associated with acute visual hallucinations. Both acute and chronic psychosis are more commonly associated with auditory rather than visual hallucinations. This sort of detailed knowledge may be the first step in leading your psychiatric patients to the types of outcomes we strive to deliver.
Question 56.
Which of the following is NOT associated with opiate withdrawal?
(a) Yawning
(b) Bradycardia
(c) Piloerection
(d) Nausea
Answer:
(b) Bradycardia
Rationale:
Tachycardia, not bradycardia, is associated with opiate withdrawal. All other options are associated with opiate withdrawal. Piloerection is “goose bumps. ’’ This is caused by a sympathetic response that allows small muscles, ar- rector pili muscles, to contract, which then pulls the hair in an upright position. This goes along with the “Fight or Flight” reaction
Question 57.
Acute toxicity of hallucinogenic substances is manifested with all of the following symptoms EXCEPT:
(a) Central Nervous system (CNS) depression.
(b) Central nervous system (CNS) stimulation.
(c) General excitation.
(d) General agitation.
Answer:
(b) Central nervous system (CNS) stimulation.
Rationale:
A common effect of hallucinogenic sub-stances includes central nervous system (CNS) depres-sion as well as general social excitability and agitation. Symptoms of CNS stimulation are uncommon.
Question 58.
Upon initial interaction with the agitated patient, the most appropriate response would include which of the
following?
(a) Medication intervention
(b) Isolation initiation
(c) Restraint preparation
(d) Verbal de-escalation
Answer:
(d) Verbal de-escalation
Rationale:
It is appropriate to initiate interventions with the agitated patient with the least invasive means. It is appropriate to escalate the level of intervention in response to ineffective therapeutic effect through isolation, medication, or as a last resort restraint. Working with law enforcement is an important aspect of care of the psychosocial patient in the emergency department. Be sure to utilize this group of professionals in the best way possible for a positive outcome for your patients. Work together not against each other.
Question 59.
Compulsive bathing is associated with chronic use of which of the following drugs?
(a) Marijuana
(b) Opiates
(c) Benzodiazepines
(d) Methamphetamines
Answer:
(a) Marijuana
Rationale:
Cannabinoid Hyperemesis Syndrome is an increasingly common condition associated with chronic consumption of modern marijuana and prod-ucts of marijuana origin. Patients typically present with abdominal pain, nausea, and vomiting and have a com-pulsion to bathe multiple times a day with hot water be-cause it helps to relieve the symptoms. The other choices are not associated with this combination of symptoms.
Question 60.
Pediatric psychiatric patients are at high risk for which of the following?
(a) Completed suicide
(b) Maltreatment/abuse
(c) Acute drug intoxication
(d) Therapeutic drug toxicity
Answer:
(b) Maltreatment/abuse
Rationale:
Pediatric psychiatric patients have high incidences of maltreatment. Although suicide attempts can be common in this population, completion is uncommon. Drug intoxication and therapeutic toxicity can be acute; however, the larger, more often missed concern is the need to assess for signs of maltreatment.
It cannot be stated enough times that the emergency department nurse must be suspicious for child abuse. There are many red flags including the care giver paying more attention to the behavior of the child rather than the injury itself and the bypassing of closer emergency departments. This should raise suspicion.
Question 61.
Which of the following is NOT a detrimental social determinant of care?
(a) Homelessness
(b) Unemployment
(c) Addiction
(d) Obesity
Answer:
(d) Obesity
Rationale:
Obesity is not identified as a social deter-minate of care, although it is associated as a risk factor for many medical conditions. All of the other options are considered social determinants that should be evaluated.
Question 62.
After the death of a child, the probability of divorce:
(a) Increases slightly.
(b) Increases significantly.
(c) Decreases slightly.
(d) Decreases significantly.
Answer:
(b) Increases significantly.
Rationale:
The death of a child has profound implica-tions for the dynamics of individuals and the family unit and is associated with significant increases in divorce rates.
Question 63.
Which of the following processes does NOT typically present during childhood?
(a) Autism
(b) Tourette’s disorder
(c) Schizophrenia
(d) Pica
Answer:
(c) Schizophrenia
Rationale:
A diagnosis of schizophrenia most commonly occurs in early adulthood. All the other choices typically present before adulthood. Pica is the act of eating or chewing on something that has no nutritional value such as ice, dirt, or clay. This is sometimes a culturally accepted norm in some groups of people.
Question 64.
Which of the following is one of the strongest risk factors for the abuse of spouses in adulthood?
(a) Parental violence during childhood
(b) Low socioeconomic status
(c) High socioeconomic status
(d) Alcohol use in the home
Answer:
(a) Parental violence during childhood
Rationale:
Abuse is considered a cyclical problem because the dysfunctional coping activity is often a learned response gained through observation in child-hood. The dysfunction knows no socioeconomic bound-aries. Although alcohol use is commonly involved, it is not a causative factor.
It is always best practice to ask every person who comes to the ED for care if they are safe at home. One of the best clues that something may be amiss is a moment of hesitation before responding to the nurse.
Question 65.
The adolescent patient may manifest feelings of depression in which of the following manners?
(a) Regressive behavior
(b) Use of alcohol/drugs
(c) Hyperactivity
(d) “I don’t know” answers
Answer:
(b) Use of alcohol/drugs
Rationale:
The adolescent may manifest depression in a variety of ways, including the use of alcohol or drugs, delinquency, traumatic injuries (from risk-taking behaviors) , sexual promiscuity, or other manners of acting out type of behavior. Children may show regressive or hyperactive type of behavior as well as enuresis. The older adult may answer orientation questions without difficulty, but when asked how things are in general, for instance, may reply with “I don’t know,” which can translate to “I don’t care.”
Question 66.
A patient appears younger than her stated age. She looks to the person with her before answering any assessment questions. Which of the following does NOT increase the emergency nurse’s suspicion this patient is being trafficked?
(a) She does not make eye contact with the nurse.
(b) She has a small symbol tattooed on her wrist.
(c) She has a large tattoo on her lower back.
(d) She is not able to state her address.
Answer:
(c) She has a large tattoo on her lower back.
Rationale:
Large tattooing of the lower back is most commonly associated with a patient’s independent choice. However, tattooing may be used to “brand” a trafficked individual to an abductor and is usually found on the wrist. Refusal to make eye contact could be a so-ciocultural norm, but it could also be suggestive that the patient is looking to their captor for acceptable answers. Not knowing or refusal to disclose their address may be a signal that they are held against their will and either do not know the answer or are forbidden to disclose the answer by their captor.
Question 67.
Which of the following is most likely to be a complication of physical restraints in an agitated patient?
(a) Pulmonary embolus
(b) Heart failure
(c) Bowel obstruction
(d) Femoral dislocation
Answer:
(a) Pulmonary embolus
Rationale:
Individuals who are physically restrained for periods of time have the potential to develop deep vein thrombosis, which can then escalate to a pulmonary embolus. Always be aware of this possibility. The other potential options are not usual complications from the restraining process.
Question 68.
Approximately half of all people diagnosed with Post-Traumatic Stress Disorder (PTSD) also suffer from which of the following processes?
(a) Major depression
(b) Schizophrenia
(c) Narcissism
(d) Agoraphobia
Answer:
(a) Major depression
Rationale:
Major Depression is a common concomitant diagnosis for patients with post-traumatic stress dis¬order (PTSD). The other choices, while possible, are not noted in the literature as being strongly correlated.
Agoraphobia is a condition of anxiety causing avoidance of certain places or situations that might create a feeling of helplessness or of feeling trapped. Many different fears can be involved, including in¬creased anxiety in crowds or being around any type of large groups of people, but, it can also be associ¬ated with both open and enclosed areas.
Question 69.
Approximately one of four people in America will experience which of the following disorders?
(a) Depression
(b) Anxiety
(c) Eating
(d) Bipolar
Answer:
(b) Anxiety
Rationale:
Approximately 25 % of Americans experi-ence clinically diagnosable anxiety during their life span. Depression, eating disorders, and bipolar disorder are far less common.
Question 70.
During the acute phase of crisis, specifically, the first 72 hours, therapeutic actions should focus on all the following EXCEPT:
(a) Patient safety.
(b) Increased isolation.
(c) Situational support.
(d) Symptom management.
Answer:
(b) Increased isolation.
Rationale:
Isolation is not a strong therapy for the duration of an acute psychiatric manifestation. The other options are all strong contributors to successful outcomes during the early phase of the psychosocial nursing intervention.
Crisis Stabilization Facilities emphasize safety, support, and symptom management during the first 72 hours of a psychosocial patient’s need. By front-loading these therapies, these care milieus are often able to prevent the need for inpatient psychiatric care.
Question 71.
Which of the following is NOT a balancing factor for resolution of psychosocial crisis?
(a) The precipitating event
(b) Adequate coping mechanisms
(c) Ample situational support
(d) Realistic perception of the event
Answer:
(a) The precipitating event
Rationale:
The precipitating event is a causative factor associated with a mental health crisis. All the other answers are considered balancing factors, which facilitate resolution or prevention of a crisis.
Question 72.
Which of the following is a true statement regarding the catharsis technique of crisis intervention?
(a) It begins with medication.
(b) It is initiated after a period of isolation.
(c) It delivers positive responses to adaptive behaviors.
(d) It emphasizes active listening.
Answer:
(d) It emphasizes active listening.
Rationale:
Catharsis involves active listening to the patient as they “tell their story” and is identified as a therapeutic intervention. Medication as a therapeutic adjunct to care may be indicated, but it is not a precursor to catharsis. Isolation is the inverse of catharsis. Positive reinforcement of adaptive behaviors is appropriate but is independent of catharsis.
Question 73.
Which of the following is the appropriate therapeutic response in a threatening situation?
(a) Aggression
(b) Passivity
(c) Assertiveness
(d) Indifference
Answer:
(c) Assertiveness
Rationale:
Professional assertiveness is an appropriate and often effective response. Aggression is not a profes¬sional response and can escalate the circumstances. Passivity is not effective and can result in increased risk for the nurse. Indifference does not facilitate a therapeutic relationship.
When dealing with aggressive individuals, for what-ever reason, speak in a low tone of voice and do assume a power position over them too quickly. This can put them in a defense mode. The health care provider may indeed need to assume this at some point; however, do not rush to this play. Use slow movements, provide limits that are held to, and use simple, concrete expressions.
Question 74.
Which of the following is NOT a predictor for aggressive behavior?
(a) Active psychotic symptoms
(b) Low socioeconomic status
(c) Substance abuse disorders
(d) History of violence
Answer:
(b) Low socioeconomic status
Rationale:
There is no socioeconomic status that is predictive of aggressive behavior. The other choices are known to be predictive for increased aggressive potential.
Question 75.
A patient with an anxiety disorder asks about complementary and alternative therapies during discharge. Evidence-based recommendations includes which of the following?
(a) Eye movement desensitization and reprocessing
(b) The practice of yoga
(c) The utilization of acupuncture
(d) The addition of therapeutic touch
Answer:
(c) The utilization of acupuncture
Rationale:
Acupuncture is an evidence-based treatment for anxiety, depression, and substance use disorders. Eye Movement Desensitization is an evidence-based treat¬ment for post-traumatic stress disorder (PTSD). Yoga and therapeutic touch may hold therapeutic benefit but do not have adequate research to be identified as evidence-based options.