and Psychiatric Nursing Exam and

NCLEX RN Comprehensive Mental Health and Psychiatric Nursing Exam and Rationale (Set 1)

• Ivy, who is in the psychiatric unit is copying and imitating the movements of her primary nurse.

During recovery, she says, “I thought the nurse was my mirror. I felt connected only when I saw my nurse.” This behavior is known by which of the following terms?

• Modeling

• Echopraxia
• Ego-syntonicity
• Ritualism

Correct Answer: B. Echopraxia

Echopraxia is the copying of another’s behaviors and is the result of the loss of ego boundaries. The involuntary imitation of the movements of another person. Echopraxia is a feature of schizophrenia (especially the catatonic form), Tourette syndrome, and some other neurologic diseases. From echo + the Greek praxia meaning action.Option A: Modeling is the conscious copying of someone’s behaviors. Modeling is one way in which behavior is learned. When a person observes the behavior of another and then imitates that behavior, he or she is modeling the behavior. This is sometimes known as observational learning or social learning. Modeling is a kind of vicarious learning in which direct instruction need not occur.Option C: Ego-syntonicity refers to behaviors that correspond with the individual’s sense of self.Thoughts, wishes, impulses, and behavior are said to be ego-syntonic when they form no threat to the ego and can be acted upon without interference from the superego.Option D: Ritualism behaviors are repetitive and compulsive. Ritualism is a concept developed by American sociologist Robert K. Merton as a part of his structural strain theory. It refers to the common practice of going through the motions of daily life even though one does not accept the goals or values that align with those practices.

• Charina, a college student who frequently visited the health center during the past year with

multiple vague complaints of GI symptoms before course examinations. Although physical causes have been eliminated, the student continues to express her belief that she has a serious illness. These symptoms are typically of which of the following disorders?

• Conversion disorder
• Depersonalization

• Hypochondriasis 1 / 4

• Somatization disorder

Correct Answer: C. Hypochondriasis

Hypochondriasis, in this case, is shown by the client’s belief that she has a serious illness, although pathologic causes have been eliminated. The disturbance usually lasts at least 6 with identifiable life stressor such as, in this case, course examinations. Hypochondriasis, which is now known as illness anxiety disorder, and the other somatic symptom disorders (e.g., factitious disorder, conversion disorder) are among the most difficult and most complex psychiatric disorders to treat in the general medical setting. On the basis of many new developments in this field, the DMS-5 has revised diagnostic criteria to facilitate clinical care and research. While illness anxiety disorder is included in the category of “somatic symptom and related disorders” it continues to have much overlap with obsessive-compulsive disorder and related illness.Option A: Conversion disorders are characterized by one or more neurologic symptoms.Hypochondriasis, which is now known as illness anxiety disorder, and the other somatic symptom disorders (e.g., factitious disorder, conversion disorder) are among the most difficult and most complex psychiatric disorders to treat in the general medical setting. On the basis of many new developments in this field, the DMS-5 has revised diagnostic criteria to facilitate clinical care and research. While illness anxiety disorder is included in the category of “somatic symptom and related disorders” it continues to have much overlap with obsessive-compulsive disorder and related illness.Option B: Depersonalization refers to persistent recurrent episodes of feeling detached from one’s self or body. Depersonalization is described as feeling disconnected or detached from one’s self.Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions.Option D: Somatoform disorders generally have a chronic course with few remissions. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) category of Somatic Symptom Disorders and Other Related Disorders represents a group of disorders characterized by thoughts, feelings, or behaviors related to somatic symptoms. This category represents psychiatric conditions because the somatic symptoms are excessive for any medical disorder that may be present.

• Which client outcome is most appropriately achieved in a community approach setting in

psychiatric nursing?

• The client performs activities of daily living and learns about crafts.
• The client is able to prevent aggressive behavior and monitors his use of medications.

• The client demonstrates self-reliance and social adaptation.
• The client experiences anxiety relief and learns about his symptoms.

Correct Answer: C. The client demonstrates self-reliance and social adaptation.

A therapeutic community is designed to help individuals assume responsibility for themselves, to learn how to respect and communicate with others, and to interact in a positive manner. The therapeutic 2 / 4

community (TC) is an intensive and comprehensive treatment model developed for use with adults that has been modified successfully to treat adolescents with substance use disorders.Option A: The core goal of TCs has always been to promote a more holistic lifestyle and to identify areas for change such as negative personal behaviors–social, psychological, and emotional–that can lead to substance use. Residents make these changes by learning from fellow residents, staff members, and other figures of authority.Option B: The theoretical framework for the TC model considers substance use a symptom of much broader problems and, in a residential setting, uses a holistic treatment approach that has an impact on every aspect of a resident’s life. Residents are distinguished along dimensions of psychological dysfunction and social deficits. The community provides habilitation, in which some TC residents develop socially productive lifestyles for the first time in their lives, and rehabilitation, in which other residents are helped to return to a previously known and practiced or rejected healthy lifestyle (De Leon, 1994).Option D: The remaining answer choices may be outcomes of psychiatric treatment, but the use of a therapeutic community approach is concerned with the promotion of self-reliance and cooperative adaptation to being with others. Part of the ecological approach to treatment in the TC is the creation of a safe and nurturing environment, within which adolescents can begin to experience healthy living. It is important for the staff of the TC to understand what type of home, neighborhood, and social environment from which each adolescent comes. Many adolescents enrolled in the TC come from unsafe physical and psychological environments; the characteristics of the home and neighborhood do not facilitate healthy living, and many risk factors may be environmental.

• The emergency department nurse is assigned to provide care for a victim of a sexual assault.

When following legal and agency guidelines, which intervention is most important?

• Determine the assailant’s identity
• Preserve the client’s privacy
• Identify the extent of an injury

• Ensure an unbroken chain of evidence

Correct Answer: D. Ensure an unbroken chain of evidence

Establishing an unbroken chain of evidence is essential in order to ensure that the prosecution of the perpetrator can occur. Explain the forensic specimens you plan to collect; inform the client that they can be used for identification and prosecution of the rapist, for example blood, combing pubic hairs, semen samples, skin from underneath nails.Option A: Arrange for support follow-up: crisis counseling, group therapy, individual therapy, rape counselor, or a support group. Many individuals carry with them constant emotional distress and trauma. Depression and suicidal ideation are frequent sequelae of rape. As soon as the intervention is carried out, the less complicated the recovery may be. 3 / 4

Option B: The nurse will also need to preserve the client’s privacy and identify the extent of an injury. However, it is essential that the nurse follows legal and agency guidelines for preserving evidence. Provide strict confidentiality. The client’s situation is not to be talked over with anyone other than the medical staff involved unless the client gives consent to it.Option C: Identifying the assailant is the job of law enforcement, not the nurse. Approach the client in a nonjudgmental manner. Nurses’ attitudes can have an important therapeutic impact. Displays of shock, horror, disgust, or disbelief are not appropriate. Never use judgmental language.

• Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia lives in a

rooming house that has a weekly nursing clinic. She scratches while she tells the nurse she feels creatures eating away at her skin. Which of the following interventions should be done first?

• Talk about his hallucinations and fears.
• Refer him for anticholinergic adverse reactions.

• Assess for possible physical problems such as rash.
• Call his physician to get his medication increased to control his psychosis.

Correct Answer: C. Assess for possible physical problems such as rash

Clients with schizophrenia generally have poor visceral recognition because they live so fully in their fantasy world. They need to have an in-depth assessment of physical complaints that may spill over into their delusional symptoms. Over half of the patients have significant comorbidities, both psychiatric and medical, making it one of the leading causes of disability worldwide. The diagnosis correlates with a 20% reduction in life expectancy, with up to 40% of deaths attributed to suicide.Option A: Talking with the client won’t provide an assessment of his itching. A thorough risk assessment must also be undertaken to determine the risk of harm to self and others. The first schizophrenic episode usually occurs during early adulthood or late adolescence. Individuals often lack insight at this stage; therefore few will present directly to seek help for their psychotic symptoms.Option B: Itching isn’t an adverse reaction of antipsychotic drugs. Common presentations include a relative noticing social withdrawal, personality changes or uncharacteristic behavior; deliberate self- harm or suicide attempts; calling the police to report their delusional symptoms or referral via the criminal justice system. The use of screening tools such as COPS (Criteria of Prodromal Syndromes), SIPS (Structured Interview for Prodromal Syndromes) and PACE (Personal Assessment and Crisis Evaluation Clinic) has been shown to increase the detection rate of schizophrenia in premorbid states although there is controversy surrounding indicating treatment at this stage.Option D: Calling the physician to get the client’s medication increased doesn’t address his physical complaints. After conducting a full psychiatric history, it is imperative to conduct a thorough systems review and a mental state examination where appearance, behavior, mood, speech, cognition, and insight need to be assessed, alongside determining evidence of perceptual delusions or formal thought disorders.

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