Answer each of the
following questions (there is only one correct answer to each question).
1
As a result of changing health care patterns in the
United States:
A. more people with psychiatric problems are
being hospitalized
B. the average length of stay in psychiatric
hospitals has increased
C. treatment programs are being consolidated
into large regional facilities
D. people with psychiatric problems turn to emergency
rooms for care
2
The interaction of complex biological and psychosocial
factors in human beings results in:
A. reliance on lab work to diagnose mental illness
B. physical disorders masking underlying anxiety
and depression
C. clear differential diagnoses of psychiatric
and medical problems
D. the need to use medication to treat all emotional
problems
3
A psychiatric emergency is characterized by all of the
following except:
A. sudden, serious behavior disturbance
B. an event that seems overwhelming to the individual
C. adequate coping abilities
D. sense of urgency
4
The common denominator in all psychiatric emergencies
is:
A. helplessness
B. anxiety
C. anger
D. depression
5
Stressors connected with illness that may lead to depression
and suicide include all of the following except:
A. the prospect of chronic illness and incapacitation
B. chronic pain
C. death of a loved one
D. availability of adequate insurance and specialized
care
6
Any behavior that over a period of time significantly
shortens or threatens a person's life span can be considered:
A. self-destructive
B. psychotic
C. neurotic
D. immature
7
Factors placing the elderly at risk for psychiatric
emergencies include:
A. reduced problem solving ability
B. loss of support systems
C. increased financial pressures
D. all of the above
8
According to Caplan, the definition of crisis is a:
A. state provoked when a person faces an insurmountable
obstacle to important life goals
B. severe state of anxiety and psychosis
C. perceived need which cannot be met by friends,
family, or self
D. trauma or tragedy which leaves the person
or significant others injured or dead
9
The definition of a stressor is:
A. a problem that lasts for a year or more
B. a situation where the outcome is unknown
C. an unresolved problem from childhood
D. an event or combination of events that leads
to crisis
10
According to Caplan's crisis theory, the constructive
resolution of a crisis can lead to:
A. greater personality integration
B. less need for close personal relationships
C. reliance on ineffective coping strategies
D. all of the above
11
The individual's habitual patterns of dealing with stress
and other problems are commonly referred to as:
A. personality traits
B. coping mechanisms
C. subconscious motives
D. behavioral preferences
12
Individuals often obtain relief from tension through
all of the following except:
A. physical movement
B. repetitive vocalizations
C. prolonged inactivity
D. reaction formation
13
The four stages of crisis intervention are:
A. restraint, sedation, counseling, follow-up
B. suppression, compensation, rationalization,
reaction formation
C. physical examination, hospitalization or treatment
center entry, counseling, social rehabilitation
D. assessment, determination of therapeutic intervention,
intervention, resolution
14
The first step in crisis intervention is to:
A. determine if a crisis exists
B. engage the cooperation of family and significant
others
C. explore the availability of coping resources
D. assess the need for medication
15
The style of interviewing used in crisis intervention
differs from traditional psychotherapy in that it is:
A. more direct, empathic and active
B. more likely to incorporate silence as a technique
C. focused on long term feelings rather than
problem resolution
D. dependent on the patient to set the framework
for the interaction
16
According to Aguilera and Messick, a crisis has been
resolved when:
A. emotional equilibrium is re-established
B. adequate situational support is achieved
C. realistic perceptions of the event are provided
D. effective coping mechanisms are developed
17
The most important factor in successful resolution of
a crisis is:
A. good physical health
B. avoidance of negative consequences
C. availability of help from others
D. acknowledgement of dependence on the crisis
worker
18
A four-fold increase in frequency of attempted suicide
has been documented in patients diagnosed with:
A. asthma
B. congestive heart failure
C. diabetes
D. hyperthyroidism
19
All of the following have been associated with increased
risk for suicidal behavior except:
A. family history of suicide
B. stresses arising from life transitions
C. a history of stable relationships
D. chronic, unexplained medical symptoms
20
Common myths regarding suicidal behavior include:
A. If a person talks about suicide, he won't
do it.
B. People who are considering suicide usually
give multiple warnings.
C. Suicide potential increases as persons come
out of deep depression.
D. The intuition of family members can pick up
on suicidal intent.
21
The degrees of intent for suicidal behavior are:
A. mild, dangerous, destructive
B. moderate, dangerous, lethal
C. mild, moderate, lethal
D. nondestructive, destructive, lethal
22
After taking an overdose of barbiturates, a woman calls
a crisis center. Her behavior represents:
A. reaction formation
B. frustration
C. ambivalence
D. undoing
23
Which one of the following statements is not
true:
A. probability of successful suicide increases
with age
B. one risk factor for suicide is poor impulse
control
C. alcohol use decreases the risk of suicide
D. chronic and/or debilitating illness can be
a factor in elderly suicide
24
Which one of the following presents the greatest risk
in a suicidal patient?
A. expressions of helplessness
B. increased or excessive alcohol intake
C. depressive signs and symptoms
D. disturbed family network
25
Persons with lethal intent to commit suicide are characterized
by:
A. ambivalence about ending their lives
B. gestures which may appear attention seeking
C. use of suicidal behavior to manipulate others
D. expectation of death as a result of their
actions
26
Which of the following would be considered a direct
verbal warning of suicidal intent?
A. "I feel just like I did when my husband
first left me."
B. "I can't concentrate on anything lately."
C. "I just wanted to say goodbye and thank
you for all your kindness."
D. "I wish I could cry but I can't anymore."
27
One of the danger signals in a depressed patient that
would point to the decision to commit suicide is:
A. refusal to eat
B. inability to get out of bed and dress
C. lamenting and wringing of hands
D. sudden change from agitation to calmness
28
The most immediate goal in treating suicide is:
A. stress relief
B. emotional or physical restraint
C. preservation of life
D. self-protection
29
Patients may not follow through with psychiatric treatment
once the emergency is over for all the following reasons except:
A. They are afraid to change.
B. They are not ready to face difficult interpersonal
problems.
C. They are unaware of the need for follow-up
care.
D. They fear the stigma of mental illness.
30
Suicide precautions require the removal from the immediate
environment of items that could be used for self harm for patients at:
A. Level One
B. Level Two
C. Level Three
D. All of the above
31
The vast majority of violent crimes and other incidents
of violent behavior are related to:
A. substance abuse
B. mental illness
C. poverty
D. lack of education
32
Which of the following behavioral characteristics is
most suggestive of significant anger?
A. controlled, precise speech
B. flat, unanimated facial expression
C. excessive smoking
D. trembling lips and chin
33
The learning process for anger management includes all
of the following steps except:
A. describing fully the situation in which anger
occurs
B. confronting the object of the anger
C. discussing alternatives to violent or negative
behavior
D. using a more positive alternative the next
time the situation occurs
34
The many parallels between patients who are suicidal
and those who are violent or homicidal include all of the following
except:
A. both have difficulty with impulse control.
B. both present potentially life-threatening
situations.
C. both have impulses that are time-limited and
may respond to appropriate help.
D. both require sedating medication upon arrival
at the emergency room.
35
Characteristics of "overcontrolled" individuals
include:
A. areputation of being easy to anger, having
a "short fuse"
B. anger that is turned inward
C. toleration of a chronically frustrating situation
D. history of violent behavior as a child
36
Anxiety and agitation may be expressed in angry, violent
behavior by an individual who:
A. is confused and lashes out in panic
B. fears assault due to psychosis or intoxication
C. misperceives hospital procedures and strikes
back in self defense
D. all of the above
37
If a patient is angry to the point of violence in response
to realistic external problems, the nurse should:
A. use the situation to teach anger management
skills
B. encourage use of community resources to resolve
disputes
C. ignore the patient's behavior
D. attempt to correct the problems
38
A subacute level of psychiatric emergency exists when
the patient:
A. is actively violent, combative and dangerous
B. has had recurrent episodes of violence but
is currently in reasonably good control
C. is threatening and agitated, but violence
has not occurred
D. has requested assistance to prevent future
violent outbursts
39
Elements that have been identified in the profiles of
individuals who commit murder include all of the following except:
A. deep seated feelings of inadequacy
B. frequent participation in contact sports
C. limited relationships with peers
D. great need for acceptance and approval
40
The most significant factors in assessment of violence
include all of the following except:
A. presence of diagnosed physical illness
B. previous history of violent behavior
C. type of violence expressed or expected
D. degree of impulse control
41
All of the following elements of personal history are
important indicators of violence potential except:
A. multiple losses of significant others
B. emotional deprivation and abuse in childhood
C. previous violence
D. association with significant other who is
violent
42
The initial treatment of an agitated, potentially violent
patient in the emergency room includes all the following except:
A. alert staff and security guards
B. use medication to keep patient under control
C. place the patient in isolation and restraints
D. arrange for a safe, private interview room
43
What factors determine nursing action with angry and/or
violent people?
A. degree of danger, treatment setting, cause
of anger, individual nursing skills
B. availability of restraints and other persons
who can help
C. history of drug abuse, physiological complications,
family support
D. underlying reason for the anger, physical
restraint policy, support of other personnel, pharmacological agents
available
44
A nursing action which interferes with helping a patient
deal with anger is to:
A. encourage discussion of previous violent outbursts
B. attempt to joke or humor the person
C. divert into physical activity
D. separate from disturbing situation
45
The feeling of apprehension, tension, and uneasiness
that stems from the anticipation of danger from some unknown source
is:
A. terror
B. anxiety
C. agitation
D. fear
46
Medical conditions that present with prominent features
of anxiety include all of the following except:
A. hypoglycemia
B. obstructive pulmonary disease
C. narcolepsy
D. caffeinism
47
Those individuals who are unusually susceptible to the
effects of alcohol include:
A. the very young and the elderly
B. the obese
C. ethnic groups from the United Kingdom and
Scandinavia
D. people who started drinking alcohol at a very
early age
48
Signs and symptoms of acute alcohol withdrawal:
A. generally begin about fifteen days after the
onset of abstinence
B. are indicators of the need for immediate hospitalization
C. occur only when the withdrawal was unplanned
D. include autonomic hyperactivity
49
Thiamine is administered to alcoholic patients admitted
to the hospital with altered mental status in order to:
A. ease the shakiness and nausea associated with
withdrawal.
B. prevent the permanent brain damage of Wernicke's
syndrome
C. sedate the patient and prevent bad dreams
D. avoid the need for minor tranquilizers in
patients susceptible to drug abuse
50
Nursing actions in treatment of delirium tremens include
all of the following except:
A. provision of a well lit room with minimal
external stimulation
B. repeated reassurance and reorientation
C. administration of prescribed medication to
decrease agitation and promote rest
D. routine use of mechanical restraints to prevent
injury
51
Frequent drugs of abuse including cocaine, amphetamines,
and Ritalin represent the class of substances known as:
A. hallucinogens
B. opiates
C. central nervous system stimulants
D. central nervous system depressants
52
The serious complications of acute drug overdose include:
A. coma
B. respiratory failure
C. circulatory collapse
D. all of the above
53
A particularly powerful hallucinogen which can produce
extreme agitation or a state resembling a catatonic reaction is:
A. psilocibin
B. phencyclidine
C. hashish
D. scopolamine
54
Withdrawal from barbiturates is most safely managed
on an inpatient unit because:
A. as an outpatient, the person is likely to
keep using drugs
B. the person needs to be separated from the
stresses leading to drug abuse
C. self-help groups have little to offer these
individuals
D. barbiturate withdrawal is potentially a serious
medical problem
55
Which of the following actions would be correct to help
manage a patient who is experiencing a "bad trip?"
A. administer phenothiazine
B. refer for outpatient therapy
C. keep friends and other drug-experienced people
around
D. separate from companions and family
56
Damage to the axons of individual nerve cells in the
brain, accompanied by punctate hemorrhages and swelling, is characteristic
of injuries resulting from:
A. head trauma in a motor vehicle accident
B. bacterial or viral infection
C. brain tumors
D. drug overdose
57
In determining whether to use medication in a psychiatric
emergency, the severity of the symptoms is evaluated by:
A. the degree of psychomotor disturbance
B. presence of psychosis or extreme conceptual
disorganization
C. marked symptoms of anxiety
D. all of the above
58
Aggression in psychiatric patients is currently treated
with all of the following except:
A. clozapine
B. atropine
C. risperidone
D. olanzapine
59
Benzodiazepines are contraindicated in the treatment
of impulsivity because:
A. they may actually increase impulsivity
B. they have potentially dangerous effects on
cardiac function
C. they are considered too expensive for long
term use
D. they interfere with sleep
60
Neuroleptic malignant syndrome:
A. is a rare but serious reaction to antipsychotic
drugs
B. is a medical emergency only for patients with
pre-existing cardiovascular disease
C. occurs most frequently in patients who have
been on the same medication for years
D. all of the above
61
In the assessment stage, the factors governing hospitalization
include:
A. degree of anxiety or depression
B. ability or inability to maintain impulse control
C. the availability of other people who can help
D. all of the above
62
Psychiatric hospitalization is contraindicated when
the person:
A. threatens violence
B. requires medical workups before starting psychotropic
drugs
C. demonstrates bizarre and socially intolerable
behavior
D. seeks to evade responsibilities
63
If a patient verbally threatens to strike another patient
or a staff member:
A. he is considered a danger to self or others,
and a restraint may be applied
B. the nurse should cue and redirect him to more
appropriate behavior
C. the requirement for a physician's order for
restraint is waived
D. seclusion is the intervention of choice
64
Bed restraints should be attached to:
A. the mattress
B. the bed rails
C. the bed frame
D. any of the above
65
The most frequent rationale for use of restraints in
the elderly is:
A. prevention of injury due to falls
B. reduction of wandering due to dementia
C. control of aggressive behavior
D. lessening of the need for psychotropic medication
66
Studies have indicated that changes in patterns of restraint
use in nursing homes:
A. are more easily accepted by younger, less
experienced staff
B. tend to occur immediately after relevant in-service
training
C. depend on the average level of nursing care
the patients require
D. all of the above
67
Restoration of impulse control is an important nursing
goal in the treatment of:
A. suicidal behavior
B. violent behavior
C. substance abuse
D. all of the above
68
Which of the following is not a medical emergency?
A. delirium tremens
B. neuroleptic malignant syndrome
C. psychotic terror
D. acute alcohol intoxication
69
A psychiatric patient has the right to all of the following
except:
A. access to his own medical and legal counsel
B. uncensored communication with visitors
C. use of over the counter medications to treat
general medical problems
D. refusal to give fingerprints and photographs
70
According to the Holmes/Rahe Scale, which of the following
events is most stressful?
A. marriage
B. pregnancy
