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MENTAL HEALTH SELF ASSESSMENTS
QUESTIONS WITH DETAILED VERIFIED
ANSWERS
The nurse is sitting with a patient diagnosed as having schizophrenia,
disorganized type, who starts to laugh uncontrollably, although nothing
funny has occurred. The nurse should say:
"Please share the joke with me"
"Why are you laughing?"
"I don't think I said anything funny"
"You are laughing. Tell me what's happening" Ans: "You are laughing.
Tell me what's happening"
The use of reflecting the patient's behavior helps to promote reality
testing. It also conveys to the patient that the nurse wants to understand
the behavior.
The wife of a patient with schizophrenia is worried about her 17 year old
daughter. She asks the nurse what symptoms mark the prodromal stage
of schizophrenia. The nurse should respond by listing the behaviors as:
Withdrawal, poor concentration, erratic sleep patterns, and possibility of
auditory hallucinations
Auditory hallucinations, ideas of reference, thought insertion, and
broadcasting
Stereotyped behavior, echopraxia, echolalia, waxy flexibility, and thought
blocking
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Looseness of association, concrete thinking, echolalia, paranoid delusions
Ans: Withdrawal, poor concentration, erratic sleep patterns, and
possibility of auditory hallucinations
This list of symptoms describe some of the preliminary symptoms of
schizophrenia that occur before the first psychotic episode. The other
distracters list actual positive symptoms of the disorder.
A patient with schizophrenia has received typical antipsychotics (e.g.
haldol) for a year. His hallucinations are less intrusive, but he remains
apathetic, has poverty of thoughts, cannot work, and is socially isolated.
To address these symptoms, the nurse might consult with the prescribing
health care provider to suggest a change to an atypical antipsychotic
such as:
Ativan
Olanzapine (Zyprexa)
Diphenhydramine (Benadryl)
Chlorpromazine (Thorazine) Ans: Olanzapine (Zyprexa)
The atypical antipsychotics are thought to help with the negative
symptoms of schizophrenia (avolition, apathy, poverty of thoughts, etc)
A man with severe depression is admitted to the partial hospitalization
program for mood disorders after exhibiting unintentional weight loss and
refusal to go to work. He does not bathe or shave, sleeps poorly, and
repeatedly states: "I'm useless, I'm no good to anyone." Which
intervention would be best to include in the patient's initial care plan?
Involve patient in activities akin to those at his work to restore comfort.
Reinforce his interest in resuming work attendance when it returns.
Provide patient with nutrient-dense finger foods and weigh daily.
Provide activities that involve concentration and fine motor skills. Ans:
Provide patient with nutrient-dense finger foods and weigh daily.
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In this patient's initial treatment, it is important to focus on basic
physiological functioning and safety concerns such as ensuring adequate
nutrition. Therefore, interventions focused on basic functioning should be
stressed in his initial care plan. Providing finger foods enables easier
intake, and nutrient-dense foods require that the patient ingest less food
while still maintaining his weight. Severely depressed persons have
impaired cognition and would have difficulty with tasks involving
concentration or fine motor skills. It is important to choose activities for
which the patient would have a high likelihood of success (or a positive
experience) in order to reduce failure and reinforcement of negative self-
image. Reinforcing an interest in work is desirable but unrealistic for his
initial care plan.
A recently divorced man with severe depression exhibits poor sleep and
impaired concentration, leading him to function poorly at work.
Inattention to hygiene and irritability with others aggravate problems at
work. Co-workers do not recognize that he is depressed and instead
assume his behavioral changes are due to drug abuse. One day he is
fired. Work had been his one remaining source of self-worth. The man
presents at the emergency room seeking medication to help him sleep.
Which of the following responses would be most important for the triage
nurse to take at this time?
"Have you considered seeking treatment for the depression itself?"
"Tell me what you have already been trying to help improve your sleep."
"We usually don't prescribe sleep medications in the emergency room."
"You said you are depressed; have you thought about harming yourself?"
Ans: "You said you are depressed; have you thought about harming
yourself?"
Approximately two-thirds of depressed people contemplate suicide.
Depressed patients who exhibit feelings of worthlessness are at higher
risk. Significant losses (divorce and loss of job) and depressed mood are
major risk factors for suicide. Suicide should be directly assessed.
Seeking further information about his sleep habits and exploring
treatment options related to depression are desirable but are not as high
a priority at this time as assessing possible risk to self. Advising him that
, Page | 4
sleep medications are not provided by the emergency room could be seen
as further rejection and could lead the patient to terminate the
assessment prematurely.
A student in the Mood Disorders Clinic states that everything he does is
wrong and that nothing he tries ever works. Although he has never failed
an exam, he believes he will fail the next one. Based on evidence-based
research, which of the following interventions would best address a
presentation of this type?
Psychoanalytic therapy
Desensitization therapy
Cognitive-behavioral therapy
Alternative and complementary therapies Ans: Cognitive-behavioral
therapy
Cognitive-behavioral therapy attempts to alter the patient's dysfunctional
beliefs by identifying automatic and/or distorted thinking and then
questioning it. This is then followed by rewording or reframing the
thought in a more realistic manner. The patient is also taught the
connection between thoughts and mood. Research shows that cognitive-
behavioral therapy involves the formation of new connections between
nerve cells in the brain and is at least as effective as medication.
Evidence does not support similar effectiveness for the other
psychotherapeutic modalities mentioned.
Information given to a depressed patient and family when the patient
begins selective serotonin reuptake inhibitor (SSRI) antidepressant
therapy should include the directive to:
avoid exposure to bright sunlight.
report increased suicidal thoughts.
restrict sodium intake to 1 gm daily.
maintain a tyramine-free diet. Ans: report increased suicidal thoughts.
MENTAL HEALTH SELF ASSESSMENTS
QUESTIONS WITH DETAILED VERIFIED
ANSWERS
The nurse is sitting with a patient diagnosed as having schizophrenia,
disorganized type, who starts to laugh uncontrollably, although nothing
funny has occurred. The nurse should say:
"Please share the joke with me"
"Why are you laughing?"
"I don't think I said anything funny"
"You are laughing. Tell me what's happening" Ans: "You are laughing.
Tell me what's happening"
The use of reflecting the patient's behavior helps to promote reality
testing. It also conveys to the patient that the nurse wants to understand
the behavior.
The wife of a patient with schizophrenia is worried about her 17 year old
daughter. She asks the nurse what symptoms mark the prodromal stage
of schizophrenia. The nurse should respond by listing the behaviors as:
Withdrawal, poor concentration, erratic sleep patterns, and possibility of
auditory hallucinations
Auditory hallucinations, ideas of reference, thought insertion, and
broadcasting
Stereotyped behavior, echopraxia, echolalia, waxy flexibility, and thought
blocking
, Page | 2
Looseness of association, concrete thinking, echolalia, paranoid delusions
Ans: Withdrawal, poor concentration, erratic sleep patterns, and
possibility of auditory hallucinations
This list of symptoms describe some of the preliminary symptoms of
schizophrenia that occur before the first psychotic episode. The other
distracters list actual positive symptoms of the disorder.
A patient with schizophrenia has received typical antipsychotics (e.g.
haldol) for a year. His hallucinations are less intrusive, but he remains
apathetic, has poverty of thoughts, cannot work, and is socially isolated.
To address these symptoms, the nurse might consult with the prescribing
health care provider to suggest a change to an atypical antipsychotic
such as:
Ativan
Olanzapine (Zyprexa)
Diphenhydramine (Benadryl)
Chlorpromazine (Thorazine) Ans: Olanzapine (Zyprexa)
The atypical antipsychotics are thought to help with the negative
symptoms of schizophrenia (avolition, apathy, poverty of thoughts, etc)
A man with severe depression is admitted to the partial hospitalization
program for mood disorders after exhibiting unintentional weight loss and
refusal to go to work. He does not bathe or shave, sleeps poorly, and
repeatedly states: "I'm useless, I'm no good to anyone." Which
intervention would be best to include in the patient's initial care plan?
Involve patient in activities akin to those at his work to restore comfort.
Reinforce his interest in resuming work attendance when it returns.
Provide patient with nutrient-dense finger foods and weigh daily.
Provide activities that involve concentration and fine motor skills. Ans:
Provide patient with nutrient-dense finger foods and weigh daily.
, Page | 3
In this patient's initial treatment, it is important to focus on basic
physiological functioning and safety concerns such as ensuring adequate
nutrition. Therefore, interventions focused on basic functioning should be
stressed in his initial care plan. Providing finger foods enables easier
intake, and nutrient-dense foods require that the patient ingest less food
while still maintaining his weight. Severely depressed persons have
impaired cognition and would have difficulty with tasks involving
concentration or fine motor skills. It is important to choose activities for
which the patient would have a high likelihood of success (or a positive
experience) in order to reduce failure and reinforcement of negative self-
image. Reinforcing an interest in work is desirable but unrealistic for his
initial care plan.
A recently divorced man with severe depression exhibits poor sleep and
impaired concentration, leading him to function poorly at work.
Inattention to hygiene and irritability with others aggravate problems at
work. Co-workers do not recognize that he is depressed and instead
assume his behavioral changes are due to drug abuse. One day he is
fired. Work had been his one remaining source of self-worth. The man
presents at the emergency room seeking medication to help him sleep.
Which of the following responses would be most important for the triage
nurse to take at this time?
"Have you considered seeking treatment for the depression itself?"
"Tell me what you have already been trying to help improve your sleep."
"We usually don't prescribe sleep medications in the emergency room."
"You said you are depressed; have you thought about harming yourself?"
Ans: "You said you are depressed; have you thought about harming
yourself?"
Approximately two-thirds of depressed people contemplate suicide.
Depressed patients who exhibit feelings of worthlessness are at higher
risk. Significant losses (divorce and loss of job) and depressed mood are
major risk factors for suicide. Suicide should be directly assessed.
Seeking further information about his sleep habits and exploring
treatment options related to depression are desirable but are not as high
a priority at this time as assessing possible risk to self. Advising him that
, Page | 4
sleep medications are not provided by the emergency room could be seen
as further rejection and could lead the patient to terminate the
assessment prematurely.
A student in the Mood Disorders Clinic states that everything he does is
wrong and that nothing he tries ever works. Although he has never failed
an exam, he believes he will fail the next one. Based on evidence-based
research, which of the following interventions would best address a
presentation of this type?
Psychoanalytic therapy
Desensitization therapy
Cognitive-behavioral therapy
Alternative and complementary therapies Ans: Cognitive-behavioral
therapy
Cognitive-behavioral therapy attempts to alter the patient's dysfunctional
beliefs by identifying automatic and/or distorted thinking and then
questioning it. This is then followed by rewording or reframing the
thought in a more realistic manner. The patient is also taught the
connection between thoughts and mood. Research shows that cognitive-
behavioral therapy involves the formation of new connections between
nerve cells in the brain and is at least as effective as medication.
Evidence does not support similar effectiveness for the other
psychotherapeutic modalities mentioned.
Information given to a depressed patient and family when the patient
begins selective serotonin reuptake inhibitor (SSRI) antidepressant
therapy should include the directive to:
avoid exposure to bright sunlight.
report increased suicidal thoughts.
restrict sodium intake to 1 gm daily.
maintain a tyramine-free diet. Ans: report increased suicidal thoughts.
