PNC Licensing Examination Mental Health and Psychiatric Nursing Syllabus

Differentiate Bipolar I from Bipolar II disorder.

Bipolar I requires at least one full manic episode (with or without depression); Bipolar II requires at least one hypomanic episode plus at least one major depressive episode, with no full manic episode.

What is the priority nursing concern during a manic episode regarding nutrition?

The patient may not sit still to eat, so provide high-calorie, high-protein finger foods and fluids that can be consumed on the move to prevent exhaustion and malnutrition.

What is schizophrenia?

A chronic psychotic disorder characterized by disturbances in thought, perception, emotion, and behavior, with positive and negative symptoms, typically lasting at least 6 months.

Differentiate positive and negative symptoms of schizophrenia.

Positive symptoms are added/exaggerated behaviors (delusions, hallucinations, disorganized speech). Negative symptoms are deficits (flat affect, alogia, avolition, anhedonia, social withdrawal).

Define delusion and name three common types.

A delusion is a fixed false belief not amenable to reason. Types: persecutory (paranoid), grandiose, somatic, religious, and delusions of reference.

What is the most common type of hallucination in schizophrenia?

Auditory hallucinations (hearing voices).

What are the '4 A's' of Bleuler describing schizophrenia?

Associative looseness, Affect (inappropriate/blunted), Ambivalence, and Autism.

What is the nursing priority when a patient reports command hallucinations?

Assess the content of the hallucination for harm to self or others; command hallucinations telling the patient to hurt someone require immediate safety measures.

List three clusters of personality disorders and an example of each.

Cluster A (odd/eccentric): paranoid, schizoid, schizotypal; Cluster B (dramatic/erratic): antisocial, borderline, histrionic, narcissistic; Cluster C (anxious/fearful): avoidant, dependent, obsessive-compulsive.

What characterizes borderline personality disorder?

Pervasive instability of relationships, self-image, and affect with marked impulsivity, fear of abandonment, splitting, recurrent self-harm/suicidal behavior, and chronic emptiness.

What is splitting in borderline personality disorder?

A defense mechanism in which the patient views people or things as all good or all bad, unable to integrate positive and negative qualities; nurses must maintain consistency to manage it.

What is a somatoform (somatic symptom) disorder?

A disorder in which the patient has physical symptoms suggesting a medical condition but without an organic cause, accompanied by excessive thoughts, feelings, or behaviors about the symptoms.

Differentiate conversion disorder from malingering.

Conversion disorder produces unconsciously generated neurological symptoms (e.g., paralysis, blindness) with no organic cause; malingering is the conscious, intentional feigning of symptoms for external gain.

What is hypochondriasis (illness anxiety disorder)?

Preoccupation with and fear of having a serious illness based on misinterpretation of body sensations, persisting despite medical reassurance.

Differentiate substance abuse, tolerance, and dependence.

Abuse is maladaptive use causing impairment; tolerance is needing increasing amounts to achieve the same effect; dependence is physiological/psychological need producing withdrawal when the substance is stopped.

What is the most dangerous (potentially fatal) withdrawal syndrome and its features?

Alcohol withdrawal/delirium tremens (DTs): tremors, tachycardia, hypertension, hallucinations, seizures, confusion, and autonomic instability - occurs 48-72 hours after the last drink.

What vitamin is given to alcoholics to prevent Wernicke-Korsakoff syndrome?

Thiamine (Vitamin B1).

What medications are used in alcohol withdrawal and as a deterrent (aversion therapy)?

Benzodiazepines (e.g., chlordiazepoxide, diazepam) for withdrawal; disulfiram (Antabuse) as an aversive deterrent that causes an unpleasant reaction with alcohol.

What is the antidote for opioid overdose?

Naloxone (Narcan).

Define crisis and state how long it typically lasts.

A crisis is an acute state of disequilibrium when usual coping mechanisms fail to resolve a stressful event; it is self-limiting and usually resolves within 4-6 weeks.

Name the three types of crisis (Caplan/Aguilera).

Maturational (developmental) crisis, situational crisis, and adventitious (social/disaster) crisis.

What is the primary goal of crisis intervention?

To return the person to their pre-crisis (baseline) level of functioning, focusing on the immediate problem in the here-and-now.

List risk factors for suicide (SAD PERSONS mnemonic).

Sex (male), Age (<19 or >45), Depression, Previous attempt, Ethanol/substance abuse, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness (chronic illness).

Which patient is at highest immediate risk: one with vague ideas of death or one with a specific plan, means, and a set time?

The patient with a specific plan, available means, and a set time is at highest risk and requires immediate one-to-one observation and a safe environment.

What is the nurse's priority intervention for an actively suicidal patient?

Ensure safety: institute constant (one-to-one) observation, remove harmful objects from the environment, and never leave the patient alone.

Is asking a patient directly about suicide harmful?

No - directly asking about suicidal thoughts does not increase risk; it opens communication and allows accurate assessment of intent and plan.

Name the main classes of psychotropic medications.

Antipsychotics (neuroleptics), antidepressants, mood stabilizers, anxiolytics (antianxiety), and CNS stimulants.

What is the therapeutic serum level of lithium and the toxic level?

Therapeutic level is 0.6-1.2 mEq/L (maintenance); toxicity occurs above 1.5 mEq/L, with severe toxicity above 2.0 mEq/L.

What is neuroleptic malignant syndrome (NMS) and its hallmark signs?

A rare, life-threatening reaction to antipsychotics marked by high fever, severe muscle rigidity ('lead-pipe'), altered consciousness, and autonomic instability; treat by stopping the drug and giving dantrolene/bromocriptine.

What dietary restriction is required with MAOI antidepressants and why?

Avoid tyramine-rich foods (aged cheese, cured meats, red wine, fermented foods) because the combination can cause a hypertensive crisis.

Differentiate systematic desensitization from flooding in behavioral therapy.

Systematic desensitization gradually exposes the patient to a hierarchy of feared stimuli paired with relaxation; flooding exposes the patient to the most feared stimulus immediately and intensely until anxiety subsides.