Barkley PMHNP Chapter Quiz 2: Safety
Needs, Therapeutic Alliance, and Frame of
Care Comprehensive 150-Question
Multiple-Choice Examination a well
detailed one written and
graded A+ upgraded
Instructions to the Examinee:
This examination consists of 150 multiple-choice questions designed to assess advanced
knowledge of safety needs, therapeutic alliance, and framework of care in psychiatric-mental
health nursing practice. Each question has one best answer. Select the single best response.
Questions are written at an advanced/professional level and include conceptual, application-
based, and clinical scenario items.
SECTION A: SAFETY NEEDS AND RISK ASSESSMENT (Questions 1–40)
1. A 32-year-old male patient with major depressive disorder reports passive suicidal ideation
without a plan. He states, "Sometimes I wish I wouldn't wake up." Which of the following
represents the MOST appropriate initial response?
A. "Let's discuss your medication adherence and treatment response."
B. "Have you thought about how you would end your life?"
,C. "I understand you're feeling hopeless. Let's focus on coping strategies."
D. "You need to sign a no-harm contract before we continue."
Correct Answer: B
Rationale: Direct questioning about suicidal ideation, including plan, intent, and means, is
essential for accurate risk assessment. Asking explicitly about method does not increase suicidal
behavior and provides critical safety information. No-harm contracts are not recommended as
standalone safety interventions.
2. A 45-year-old female with bipolar I disorder is brought to the emergency department by
police after being found wandering in traffic. She is agitated, yelling, and unable to sit still.
She endorses auditory hallucinations commanding her to "run." What is the PRIORITY
intervention?
A. Administer haloperidol 5 mg IM immediately
B. Obtain a detailed psychiatric history from family members
C. Ensure immediate physical safety and initiate de-escalation
D. Place the patient in seclusion for protection
Correct Answer: C
Rationale: The priority in any psychiatric emergency is ensuring physical safety for the patient
and staff. De-escalation techniques should be attempted before chemical or physical restraints.
Safety needs must be addressed before diagnostic or historical information can be obtained.
3. Which of the following assessment findings carries the HIGHEST risk for imminent suicide
completion?
A. Female gender with history of childhood trauma
B. Male gender, age 45, with recent job loss and access to firearms
C. History of two prior suicide attempts by self-cutting
D. Endorsement of passive suicidal ideation with no plan
Correct Answer: B
Rationale: Male gender, middle age, recent psychosocial stressors, and access to lethal means
(firearms) constitute a high-risk profile for suicide completion. Access to lethal means is one of
the strongest predictors of completed suicide.
,4. A 28-year-old female with borderline personality disorder reports chronic suicidal ideation.
She has made multiple superficial wrist-cutting episodes in the past. Which approach BEST
reflects evidence-based management of this patient's safety?
A. Repeated hospitalizations for each suicidal statement
B. Development of a crisis safety plan with specific coping strategies
C. Continuous 1:1 observation during all outpatient visits
D. Requiring the patient to sign a no-harm contract at each visit
Correct Answer: B
Rationale: For patients with chronic suicidal ideation, particularly in borderline personality
disorder, crisis safety planning with specific coping strategies, social supports, and emergency
contacts is more effective than repeated hospitalizations or no-harm contracts. Safety planning
is an evidence-based intervention that empowers patients.
5. A 72-year-old male with major neurocognitive disorder is found wandering outside his
assisted living facility in winter wearing only a hospital gown. His core body temperature is
34.5°C (94.1°F). What is the MOST immediate safety concern?
A. Risk of aspiration pneumonia
B. Hypothermia and risk of cardiac arrhythmias
C. Dehydration and electrolyte imbalance
D. Worsening of cognitive symptoms
Correct Answer: B
Rationale: Hypothermia (core temperature <35°C) is a life-threatening emergency that can lead
to cardiac arrhythmias and death. Physiologic safety needs must be addressed before
psychiatric assessment. This patient's cognitive impairment placed him at risk for environmental
hazards.
6. In conducting a suicide risk assessment, which of the following questions is MOST
important to ask after a patient endorses suicidal ideation?
A. "How long have you been feeling this way?"
B. "Do you have a specific plan for how you would kill yourself?"
C. "Have you been taking your medications as prescribed?"
D. "Do you have a history of substance use?"
, Correct Answer: B
Rationale: After establishing the presence of suicidal ideation, assessing for plan, intent, and
means is the critical next step in risk stratification. The presence of a specific, lethal plan
significantly increases imminent risk.
7. A 19-year-old college student presents with acute anxiety after witnessing a mass shooting
on campus one week ago. She reports difficulty sleeping, hypervigilance, and intrusive
images. Which safety assessment is MOST appropriate at this time?
A. Assess for suicidal ideation and access to lethal means
B. Refer for long-term psychotherapy only
C. Prescribe a benzodiazepine for acute symptom relief
D. Recommend avoidance of all campus activities
Correct Answer: A
Rationale: Any patient presenting with trauma-related symptoms should be screened for
suicidal ideation and access to lethal means. Acute stress reactions can include suicidal
thoughts, and safety assessment is a fundamental component of any psychiatric evaluation.
8. A 55-year-old male with alcohol use disorder is being discharged from inpatient
detoxification. Which intervention BEST addresses his safety needs upon discharge?
A. Providing a prescription for naltrexone
B. Referring to a 12-step program
C. Developing a relapse prevention and crisis plan
D. Scheduling a follow-up appointment in 4 weeks
Correct Answer: C
Rationale: Discharge planning must include a comprehensive relapse prevention and crisis plan
that addresses triggers, coping strategies, social supports, and emergency resources. Safety
needs extend beyond the inpatient setting.
9. Which of the following is a modifiable risk factor for suicide that should be specifically
targeted in treatment planning?
A. Family history of suicide
B. Male gender
Needs, Therapeutic Alliance, and Frame of
Care Comprehensive 150-Question
Multiple-Choice Examination a well
detailed one written and
graded A+ upgraded
Instructions to the Examinee:
This examination consists of 150 multiple-choice questions designed to assess advanced
knowledge of safety needs, therapeutic alliance, and framework of care in psychiatric-mental
health nursing practice. Each question has one best answer. Select the single best response.
Questions are written at an advanced/professional level and include conceptual, application-
based, and clinical scenario items.
SECTION A: SAFETY NEEDS AND RISK ASSESSMENT (Questions 1–40)
1. A 32-year-old male patient with major depressive disorder reports passive suicidal ideation
without a plan. He states, "Sometimes I wish I wouldn't wake up." Which of the following
represents the MOST appropriate initial response?
A. "Let's discuss your medication adherence and treatment response."
B. "Have you thought about how you would end your life?"
,C. "I understand you're feeling hopeless. Let's focus on coping strategies."
D. "You need to sign a no-harm contract before we continue."
Correct Answer: B
Rationale: Direct questioning about suicidal ideation, including plan, intent, and means, is
essential for accurate risk assessment. Asking explicitly about method does not increase suicidal
behavior and provides critical safety information. No-harm contracts are not recommended as
standalone safety interventions.
2. A 45-year-old female with bipolar I disorder is brought to the emergency department by
police after being found wandering in traffic. She is agitated, yelling, and unable to sit still.
She endorses auditory hallucinations commanding her to "run." What is the PRIORITY
intervention?
A. Administer haloperidol 5 mg IM immediately
B. Obtain a detailed psychiatric history from family members
C. Ensure immediate physical safety and initiate de-escalation
D. Place the patient in seclusion for protection
Correct Answer: C
Rationale: The priority in any psychiatric emergency is ensuring physical safety for the patient
and staff. De-escalation techniques should be attempted before chemical or physical restraints.
Safety needs must be addressed before diagnostic or historical information can be obtained.
3. Which of the following assessment findings carries the HIGHEST risk for imminent suicide
completion?
A. Female gender with history of childhood trauma
B. Male gender, age 45, with recent job loss and access to firearms
C. History of two prior suicide attempts by self-cutting
D. Endorsement of passive suicidal ideation with no plan
Correct Answer: B
Rationale: Male gender, middle age, recent psychosocial stressors, and access to lethal means
(firearms) constitute a high-risk profile for suicide completion. Access to lethal means is one of
the strongest predictors of completed suicide.
,4. A 28-year-old female with borderline personality disorder reports chronic suicidal ideation.
She has made multiple superficial wrist-cutting episodes in the past. Which approach BEST
reflects evidence-based management of this patient's safety?
A. Repeated hospitalizations for each suicidal statement
B. Development of a crisis safety plan with specific coping strategies
C. Continuous 1:1 observation during all outpatient visits
D. Requiring the patient to sign a no-harm contract at each visit
Correct Answer: B
Rationale: For patients with chronic suicidal ideation, particularly in borderline personality
disorder, crisis safety planning with specific coping strategies, social supports, and emergency
contacts is more effective than repeated hospitalizations or no-harm contracts. Safety planning
is an evidence-based intervention that empowers patients.
5. A 72-year-old male with major neurocognitive disorder is found wandering outside his
assisted living facility in winter wearing only a hospital gown. His core body temperature is
34.5°C (94.1°F). What is the MOST immediate safety concern?
A. Risk of aspiration pneumonia
B. Hypothermia and risk of cardiac arrhythmias
C. Dehydration and electrolyte imbalance
D. Worsening of cognitive symptoms
Correct Answer: B
Rationale: Hypothermia (core temperature <35°C) is a life-threatening emergency that can lead
to cardiac arrhythmias and death. Physiologic safety needs must be addressed before
psychiatric assessment. This patient's cognitive impairment placed him at risk for environmental
hazards.
6. In conducting a suicide risk assessment, which of the following questions is MOST
important to ask after a patient endorses suicidal ideation?
A. "How long have you been feeling this way?"
B. "Do you have a specific plan for how you would kill yourself?"
C. "Have you been taking your medications as prescribed?"
D. "Do you have a history of substance use?"
, Correct Answer: B
Rationale: After establishing the presence of suicidal ideation, assessing for plan, intent, and
means is the critical next step in risk stratification. The presence of a specific, lethal plan
significantly increases imminent risk.
7. A 19-year-old college student presents with acute anxiety after witnessing a mass shooting
on campus one week ago. She reports difficulty sleeping, hypervigilance, and intrusive
images. Which safety assessment is MOST appropriate at this time?
A. Assess for suicidal ideation and access to lethal means
B. Refer for long-term psychotherapy only
C. Prescribe a benzodiazepine for acute symptom relief
D. Recommend avoidance of all campus activities
Correct Answer: A
Rationale: Any patient presenting with trauma-related symptoms should be screened for
suicidal ideation and access to lethal means. Acute stress reactions can include suicidal
thoughts, and safety assessment is a fundamental component of any psychiatric evaluation.
8. A 55-year-old male with alcohol use disorder is being discharged from inpatient
detoxification. Which intervention BEST addresses his safety needs upon discharge?
A. Providing a prescription for naltrexone
B. Referring to a 12-step program
C. Developing a relapse prevention and crisis plan
D. Scheduling a follow-up appointment in 4 weeks
Correct Answer: C
Rationale: Discharge planning must include a comprehensive relapse prevention and crisis plan
that addresses triggers, coping strategies, social supports, and emergency resources. Safety
needs extend beyond the inpatient setting.
9. Which of the following is a modifiable risk factor for suicide that should be specifically
targeted in treatment planning?
A. Family history of suicide
B. Male gender
