NR 548 EXAM PREP 1. What are the four main components of a psychiatric assessment? (4 marks)
Answer: The four main components of a psychiatric assessment are:
- History: This includes the patient's personal, family, medical, and psychiatric history, as well as their current
LATEST
symptoms, stressors, coping skills, and goals.
- Mental status examination: This is a systematic observation of the patient's appearance, behavior, mood, affect,
speech, thought process, thought content, perception, cognition, insight, and judgment.
- Physical examination: This is a general examination of the patient's vital signs, organ systems, and neurological
functions to rule out any medical causes or complications of their mental condition.
- Diagnostic tests: These are laboratory tests, imaging studies, or psychological tests that may help to confirm or
rule out a specific diagnosis or to monitor the patient's response to treatment.
Psychiatric Assessment for
Psychiatric-Mental Health
2. What are the three main types of psychiatric interviews and when are they used? (6 marks)
Answer: The three main types of psychiatric interviews are:
- Screening interview: This is a brief interview that aims to identify the presence or absence of a mental disorder
or a need for further evaluation. It is usually used in primary care settings or in emergency situations.
Nurse Practitioner - Diagnostic interview: This is a comprehensive interview that aims to establish a diagnosis or a differential
diagnosis based on the criteria of a diagnostic manual such as the DSM-5 or the ICD-10. It is usually used in
specialty mental health settings or in research settings.
- Therapeutic interview: This is an ongoing interview that aims to establish a therapeutic alliance, explore the
patient's problems and feelings, and facilitate change and recovery. It is usually used in psychotherapy or
counseling settings.
3. What are some of the advantages and disadvantages of using structured or semi-structured interviews versus
ANSWERED unstructured interviews for psychiatric diagnosis? (10 marks)
Answer: Some of the advantages and disadvantages of using structured or semi-structured interviews versus
unstructured interviews for psychiatric diagnosis are:
- Advantages of structured or semi-structured interviews: They are more reliable, valid, and standardized than
unstructured interviews. They ensure that all relevant information is covered and that no important details are
missed. They reduce the influence of interviewer bias or subjectivity. They facilitate communication and
documentation among clinicians and researchers.
- Disadvantages of structured or semi-structured interviews: They are more time-consuming, rigid, and artificial
2023/2024
than unstructured interviews. They may limit the rapport and flexibility between the interviewer and the
patient. They may overlook some aspects of the patient's individuality, context, or complexity. They may not
capture the nuances or subtleties of the patient's experience.
4. What are some of the common rating scales or instruments that are used to measure the severity or outcome of
psychiatric disorders? Give an example for each of the following categories: mood disorders, anxiety
disorders, psychotic disorders, substance use disorders, and personality disorders. (10 marks)
Answer: Some of the common rating scales or instruments that are used to measure the severity or outcome of
psychiatric disorders are:
- Mood disorders: Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Montgomery-
Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Altman Self-Rating Mania
Scale (ASRM).
- Anxiety disorders: Hamilton Anxiety Rating Scale (HARS), Beck Anxiety Inventory (BAI), Generalized
, 6. A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says, I
Anxiety Disorder 7-item scale (GAD-7), Panic Disorder Severity Scale (PDSS), Social Phobia Inventory dont think I can keep taking these pills. They make me so, especially when I stand up. The nurse should:
(SPIN). a. explain how to manage postural hypotension, and educate the patient that side effects go away after several
- Psychotic disorders: Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), weeks.
Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms b. tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
(SANS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH). c. withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
- Substance use disorders: Addiction Severity Index (ASI), Alcohol Use Disorders Identification Test (AUDIT), d. teach the patient how to use pursed-lip breathing.
Drug Abuse Screening Test (DAST), Severity of Dependence Scale (SDS), Clinical Institute Withdrawal
Assessment for Alcohol (CIWA-Ar). 7. A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every night
- Personality disorders: Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2), Millon Clinical at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider
Multiaxial Inventory 3rd edition (MCMI-III), Personality Assessment Inventory (PAI), Structured Clinical regarding potentially hazardous side effects of this drug?
Interview for DSM-5 Personality Disorders (SCID-5-PD), Personality Disorder Questionnaire 4th edition a. Dry mouth
(PDQ-4). b. Blurred vision
c. Nasal congestion
1. A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. d. Urinary retention
Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt. 8. A patient diagnosed with major depressive disorder tells the nurse, Bad things that happen are always my
c. I like the shirt youre wearing. fault. To assist the patient in reframing this overgeneralization, the nurse should respond:
d. You must be feeling better today. a. I really doubt that one person can be blamed for all the bad things that happen.
b. Lets look at one bad thing that happened to see if another explanation exists.
c. You are being exceptionally hard on yourself when you say those things.
2. An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral d. How does your belief in fate relate to your cultural heritage?
therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should
the nurse suggest?
a. Social skills training 9. A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and
b. Relaxation training classes dependent on others. After 3 weeks, the patient did not improve. The nurse is at risk for feelings of:
a. overinvolvement.
c. Use of complementary therapy
d. Learning desensitization techniques b. guilt and despair.
c. interest and pleasure.
d. ineffectiveness and frustration.
3. A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
10. A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI)
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection. antidepressant therapy. Priority information given to the patient and family should include a directive to:
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu. a. avoid exposure to bright sunlight.
b. report increased suicidal thoughts.
c. restrict sodium intake to 1 g daily.
4. When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will d. maintain a tyramine-free diet.
address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy. 11. A nurse teaching a patient about a tyramine-restricted diet would approve which meal?
c. cognitive behavioral therapy. a. Mashed potatoes, ground beef patty, corn, green beans, apple pie
b. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
d. alternative and complementary therapies.
c. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
5. A patient says to the nurse, My life does not have any happiness in it anymore. I once enjoyed holidays, but
now theyre just another day. How would the nurse document the complaint?
a. Vegetative symptom 12. What is the focus of priority nursing interventions for the period immediately after electroconvulsive
b. Anhedonia therapy treatment?
a. Supporting physiologic stability
c. Euphoria
d. Anergia b. Reducing disorientation and confusion
c. Monitoring pupillary responses
d. Assisting the patient to identify and test negative thoughts
13. A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which
behavior indicates effective learning? The patient:
a. monitors sodium intake and weight daily.
b. wears support stockings and elevates the legs when sitting.
Answer: The four main components of a psychiatric assessment are:
- History: This includes the patient's personal, family, medical, and psychiatric history, as well as their current
LATEST
symptoms, stressors, coping skills, and goals.
- Mental status examination: This is a systematic observation of the patient's appearance, behavior, mood, affect,
speech, thought process, thought content, perception, cognition, insight, and judgment.
- Physical examination: This is a general examination of the patient's vital signs, organ systems, and neurological
functions to rule out any medical causes or complications of their mental condition.
- Diagnostic tests: These are laboratory tests, imaging studies, or psychological tests that may help to confirm or
rule out a specific diagnosis or to monitor the patient's response to treatment.
Psychiatric Assessment for
Psychiatric-Mental Health
2. What are the three main types of psychiatric interviews and when are they used? (6 marks)
Answer: The three main types of psychiatric interviews are:
- Screening interview: This is a brief interview that aims to identify the presence or absence of a mental disorder
or a need for further evaluation. It is usually used in primary care settings or in emergency situations.
Nurse Practitioner - Diagnostic interview: This is a comprehensive interview that aims to establish a diagnosis or a differential
diagnosis based on the criteria of a diagnostic manual such as the DSM-5 or the ICD-10. It is usually used in
specialty mental health settings or in research settings.
- Therapeutic interview: This is an ongoing interview that aims to establish a therapeutic alliance, explore the
patient's problems and feelings, and facilitate change and recovery. It is usually used in psychotherapy or
counseling settings.
3. What are some of the advantages and disadvantages of using structured or semi-structured interviews versus
ANSWERED unstructured interviews for psychiatric diagnosis? (10 marks)
Answer: Some of the advantages and disadvantages of using structured or semi-structured interviews versus
unstructured interviews for psychiatric diagnosis are:
- Advantages of structured or semi-structured interviews: They are more reliable, valid, and standardized than
unstructured interviews. They ensure that all relevant information is covered and that no important details are
missed. They reduce the influence of interviewer bias or subjectivity. They facilitate communication and
documentation among clinicians and researchers.
- Disadvantages of structured or semi-structured interviews: They are more time-consuming, rigid, and artificial
2023/2024
than unstructured interviews. They may limit the rapport and flexibility between the interviewer and the
patient. They may overlook some aspects of the patient's individuality, context, or complexity. They may not
capture the nuances or subtleties of the patient's experience.
4. What are some of the common rating scales or instruments that are used to measure the severity or outcome of
psychiatric disorders? Give an example for each of the following categories: mood disorders, anxiety
disorders, psychotic disorders, substance use disorders, and personality disorders. (10 marks)
Answer: Some of the common rating scales or instruments that are used to measure the severity or outcome of
psychiatric disorders are:
- Mood disorders: Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), Montgomery-
Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Altman Self-Rating Mania
Scale (ASRM).
- Anxiety disorders: Hamilton Anxiety Rating Scale (HARS), Beck Anxiety Inventory (BAI), Generalized
, 6. A patient diagnosed with major depressive disorder is taking a tricyclic antidepressant. The patient says, I
Anxiety Disorder 7-item scale (GAD-7), Panic Disorder Severity Scale (PDSS), Social Phobia Inventory dont think I can keep taking these pills. They make me so, especially when I stand up. The nurse should:
(SPIN). a. explain how to manage postural hypotension, and educate the patient that side effects go away after several
- Psychotic disorders: Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), weeks.
Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms b. tell the patient that the side effects are a minor inconvenience compared with the feelings of depression.
(SANS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH). c. withhold the drug, force oral fluids, and notify the health care provider to examine the patient.
- Substance use disorders: Addiction Severity Index (ASI), Alcohol Use Disorders Identification Test (AUDIT), d. teach the patient how to use pursed-lip breathing.
Drug Abuse Screening Test (DAST), Severity of Dependence Scale (SDS), Clinical Institute Withdrawal
Assessment for Alcohol (CIWA-Ar). 7. A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every night
- Personality disorders: Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2), Millon Clinical at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider
Multiaxial Inventory 3rd edition (MCMI-III), Personality Assessment Inventory (PAI), Structured Clinical regarding potentially hazardous side effects of this drug?
Interview for DSM-5 Personality Disorders (SCID-5-PD), Personality Disorder Questionnaire 4th edition a. Dry mouth
(PDQ-4). b. Blurred vision
c. Nasal congestion
1. A nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. d. Urinary retention
Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt. 8. A patient diagnosed with major depressive disorder tells the nurse, Bad things that happen are always my
c. I like the shirt youre wearing. fault. To assist the patient in reframing this overgeneralization, the nurse should respond:
d. You must be feeling better today. a. I really doubt that one person can be blamed for all the bad things that happen.
b. Lets look at one bad thing that happened to see if another explanation exists.
c. You are being exceptionally hard on yourself when you say those things.
2. An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral d. How does your belief in fate relate to your cultural heritage?
therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should
the nurse suggest?
a. Social skills training 9. A nurse worked with a patient diagnosed with major depressive disorder who was severely withdrawn and
b. Relaxation training classes dependent on others. After 3 weeks, the patient did not improve. The nurse is at risk for feelings of:
a. overinvolvement.
c. Use of complementary therapy
d. Learning desensitization techniques b. guilt and despair.
c. interest and pleasure.
d. ineffectiveness and frustration.
3. A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
10. A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI)
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection. antidepressant therapy. Priority information given to the patient and family should include a directive to:
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu. a. avoid exposure to bright sunlight.
b. report increased suicidal thoughts.
c. restrict sodium intake to 1 g daily.
4. When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will d. maintain a tyramine-free diet.
address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy. 11. A nurse teaching a patient about a tyramine-restricted diet would approve which meal?
c. cognitive behavioral therapy. a. Mashed potatoes, ground beef patty, corn, green beans, apple pie
b. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
d. alternative and complementary therapies.
c. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
5. A patient says to the nurse, My life does not have any happiness in it anymore. I once enjoyed holidays, but
now theyre just another day. How would the nurse document the complaint?
a. Vegetative symptom 12. What is the focus of priority nursing interventions for the period immediately after electroconvulsive
b. Anhedonia therapy treatment?
a. Supporting physiologic stability
c. Euphoria
d. Anergia b. Reducing disorientation and confusion
c. Monitoring pupillary responses
d. Assisting the patient to identify and test negative thoughts
13. A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which
behavior indicates effective learning? The patient:
a. monitors sodium intake and weight daily.
b. wears support stockings and elevates the legs when sitting.
