Psychiatric Mental Health Nurse Practitioner Clinical Internship III (D350)

Correct Answer

B. Healing from the effects of racial trauma

Explanation

The radical healing framework is centered on healing from racial trauma by fostering resilience, empowerment, and collective well-being within marginalized communities. It emphasizes social justice, cultural affirmation, and community-based strategies to address the psychological and emotional impact of racism. Rather than solely focusing on coping mechanisms, it promotes systemic change and holistic healing.

Why other options are wrong

A. Coping strategies for managing stress – While coping strategies play a role in healing, the radical healing framework is broader. It not only helps individuals manage stress but also focuses on community empowerment, activism, and systemic change.

C. Pharmacological interventions for mental health – The radical healing framework does not prioritize medication-based interventions. Instead, it emphasizes culturally relevant healing practices and community engagement.

D. Cognitive behavioral therapy techniques – Although cognitive behavioral therapy (CBT) can be a tool in addressing racial trauma, radical healing is not centered on a single therapeutic approach. It incorporates multiple strategies, including activism, cultural identity, and collective resilience.

Correct Answer

B. Flight of ideas

Explanation

Flight of ideas is a thought disorder commonly observed in individuals experiencing mania, particularly in bipolar disorder. It is characterized by rapid shifts from one topic to another, often based on loose associations, rhyming, or wordplay, making it difficult for others to follow the speaker’s logic. The thoughts appear fragmented and lack a coherent narrative, though they may still contain some logical connections.

Why other options are wrong

A. Circumstantial thinking – In circumstantial thinking, the person provides excessive, unnecessary details before eventually returning to the main point. Unlike flight of ideas, the train of thought is not completely lost, just overly detailed.

C. Tangential thinking – This occurs when a person goes off on tangents and never returns to the main topic, unlike flight of ideas, where there are rapid shifts in thought without a clear derailment from the original topic.

D. Logical thought process – Logical thinking follows a clear, rational, and goal-directed sequence. This is the opposite of the flight of ideas, where thought patterns are disorganized and difficult to follow.

Correct Answer

A. Persistent repetition of the same word or idea in response to different questions ("stuck" on a topic)

Explanation

Perseveration is a symptom commonly seen in conditions such as obsessive-compulsive disorder (OCD), schizophrenia, traumatic brain injuries, and dementia. It involves involuntary repetition of words, phrases, or ideas, even when they are no longer relevant to the conversation. Individuals with cognitive impairments or frontal lobe damage may struggle to shift their focus from one idea to another, leading to rigid and repetitive speech patterns.

Why other options are wrong

B. Creation of false memories in the absence of intentions of deception. – This describes confabulation, which is different from perseveration. Confabulation occurs when a person unintentionally fabricates or distorts memories, often seen in dementia or brain injuries.

C. Grouping of words (usually rhyming) that are based on similar sounds, even though the words themselves have no logical reason to be grouped together. – This is clang association, a symptom of schizophrenia and manic episodes where individuals speak in rhyming or alliterative words without logical connections.

D. Meaningless repetition of another person's spoken words as a symptom of psychiatric disorder. – This describes echolalia, which is common in autism spectrum disorder, schizophrenia, and neurological conditions. In echolalia, the individual repeats what they hear rather than producing spontaneous speech.

Correct Answer

B. It serves as the moral compass, guiding behavior based on ideals and societal standards.

Explanation

The superego, according to Sigmund Freud’s psychoanalytic theory, is the moral component of personality that develops during early childhood. It internalizes societal norms, parental guidance, and ethical values, shaping an individual's sense of right and wrong. The superego restrains the id’s impulses and guides behavior toward socially acceptable actions based on an individual’s moral principles and conscience.

Why other options are wrong

A. It governs the pleasure-seeking impulses and desires. – This describes the id, which operates on the pleasure principle, seeking instant gratification without considering morality or consequences.

C. It is responsible for the unconscious drives and instincts. – The id controls basic biological instincts like hunger, aggression, and sexual desires, while the superego focuses on moral reasoning and ethical conduct.

D. It regulates emotional responses to external stimuli. – Emotional regulation is primarily associated with the ego, which balances the demands of the id and superego while responding to external realities.

Correct Answer:

B. Assisting clients in regaining or improving previous coping abilities and preventing further disability

Explanation:

The Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA, 2007) outlines the role of psychiatric nurses in assessing, diagnosing, and treating mental health conditions within their scope of practice. A key responsibility is to help clients improve coping mechanisms, maintain mental health, and prevent relapse or further disability.

Why other options are wrong:

A. Diagnosing disorders using the Diagnostic and Statistical Manual III-R published by the American Psychiatric Association.

Psychiatric nurses can assess and identify symptoms, but the formal diagnosis of psychiatric disorders is typically made by psychiatrists or other licensed clinicians (e.g., psychiatric nurse practitioners or psychologists). Also, DSM-III-R is outdated; the DSM-5 is the current version.

C. Providing psychoanalysis to unravel psychoneuroses common to clients with schizophrenia.

Psychoanalysis is a specialized therapy usually conducted by trained psychoanalysts (e.g., psychologists or psychiatrists). It is not the primary role of a psychiatric nurse, especially for clients with schizophrenia, who typically require medication management and structured therapy.

D. Applying somatic therapies, such as electroconvulsive therapy, to severely depressed clients.

While psychiatric nurses assist in ECT procedures, they do not independently apply somatic therapies. ECT is administered by psychiatrists or specialized medical professionals under controlled conditions.

Correct Answer: D. Is unresponsive to even noxious stimuli

Explanation:

A comatose patient is in a state of deep unconsciousness where they do not respond to any external stimuli, including painful or noxious stimuli. This condition typically results from severe brain injury, metabolic disturbances, or neurological disease. Unlike other altered states of consciousness, coma represents a complete lack of awareness and responsiveness to external stimuli.

Why other options are wrong:

A. Is normally reactive to its environment is incorrect because a comatose patient lacks normal reactivity and does not interact with their surroundings. They exhibit no voluntary movements or responses.

B. Is responsive to stimulus, but seems otherwise quiet describes a stuporous patient rather than a comatose one. A stuporous patient may respond to strong stimuli, but their responsiveness is minimal and inconsistent.

C. Is responsive to noxious stimuli only applies more to a semi-comatose or stuporous state. In coma, the patient does not react even to painful stimuli such as a sternal rub or deep nail-bed pressure.

Correct Answer:

A. Repeating words, phrases, questions, or actions

Explanation:

Perseveration is a condition in which a person repeats words, phrases, or behaviors excessively, often without realizing it. This repetitive behavior is commonly associated with neurological disorders, such as autism, traumatic brain injury, and obsessive-compulsive disorder (OCD). In psychiatric settings, perseveration can also be observed in individuals with schizophrenia or dementia. It often occurs due to difficulty in shifting thoughts or actions from one response to another.

Why other options are wrong:

B. Suggesting words that sound correct

This describes paraphasia, a language disturbance often seen in individuals with aphasia or other speech disorders. Paraphasia occurs when a person unintentionally substitutes similar-sounding words (e.g., saying "table" instead of "chair"), but it is not the same as perseveration, which involves compulsive repetition rather than substitution of words.

C. Hallucinating

Hallucinations are sensory perceptions that occur without an external stimulus, such as hearing voices or seeing things that aren’t there. Perseveration, on the other hand, involves repetition of speech or actions rather than sensory disturbances. While perseveration can occur in some psychiatric conditions that involve hallucinations, the two phenomena are distinct.

D. Gesturing instead of speaking to you

Using gestures instead of speech is characteristic of nonverbal communication or a condition such as aphasia, where individuals struggle with verbal expression. Perseveration specifically involves repetitive verbal or motor behavior, rather than a preference for gestures over speech.

Correct Answer

C. It directs conscious thoughts and monitors both preconscious and unconscious thoughts.

Explanation

According to Freud’s psychoanalytic theory, the ego acts as the rational mediator between the id (instincts) and the superego (moral standards). It functions at multiple levels of consciousness:

Conscious level: Directs thoughts and makes rational decisions.

Preconscious level: Retrieves stored information that is not immediately in awareness.

Unconscious level: Monitors impulses from the id and suppresses inappropriate desires.

The ego's primary function is to balance reality with internal desires and moral constraints, ensuring appropriate behavior in social contexts.

Why other options are wrong

A. It only operates at the conscious level. – While the ego does function in conscious thought, it also manages unconscious and preconscious processes, such as defense mechanisms and impulse control.

B. It primarily operates at the preconscious level. – The ego does not function primarily in one level of consciousness; instead, it works across all levels to maintain psychological balance.

D. It operates solely at the unconscious level. – The id is the component that is fully unconscious, while the ego spans all three levels of consciousness to regulate thoughts and behavior.

Correct Answer: D. Tangential thinking

Explanation:

Tangential thinking occurs when a person drifts away from the topic and never returns to answering the original question. While their thoughts may be loosely related, they fail to reach a conclusion or direct response. This pattern is commonly observed in schizophrenia, mania, and some neurological disorders.

Why other options are wrong:

A. Loose association – In loose associations, thoughts are disconnected or only minimally connected, making it difficult for listeners to follow the train of thought. However, in tangential thinking, the patient’s response may still have some logical connection, but it fails to answer the question directly.

B. Word salad – Word salad refers to a completely disorganized, incoherent jumble of words that lacks logical structure or meaning. This is different from tangential thinking, where the patient’s words still form meaningful sentences, just not relevant to the question.

C. Flight of ideas – This occurs when a person’s speech is rapid and jumps from one topic to another without clear connections, often seen in mania. Unlike tangential thinking, flight of ideas includes rapid, pressured speech with frequent topic shifts.