CPEN Psychosocial Emergencies 3 — Questions and Answers
Question 1: A 15-year-old presents with self-inflicted lacerations to her forearms. She states the cutting 'helps her feel better.' This behavior is BEST characterized as:
- A suicidal gesture requiring immediate psychiatric hospitalization
- Non-suicidal self-injury used as an emotion regulation strategy (Correct answer)
- Factitious disorder imposed on self
- Borderline personality disorder
Correct answer: Non-suicidal self-injury used as an emotion regulation strategy
Non-suicidal self-injury (NSSI) is commonly used by adolescents as a maladaptive coping mechanism to regulate overwhelming emotions, not as a suicide attempt.
Question 2: Which statement by a parent MOST suggests that a child's conversion disorder symptoms are being reinforced?
- 'She seems worse when she is stressed about school.'
- 'I carry her everywhere because she can't walk and I don't want her to fall.' (Correct answer)
- 'We've seen three neurologists and no one can find anything wrong.'
- 'Her symptoms started after her best friend moved away.'
Correct answer: 'I carry her everywhere because she can't walk and I don't want her to fall.'
Carrying a child who has functional neurological symptoms reinforces illness behavior and secondary gain, which perpetuates conversion disorder.
Question 3: A 9-year-old who experienced sexual abuse is brought to the ED. During the forensic exam, he suddenly becomes mute and stares blankly. The nurse recognizes this as:
- Malingering to avoid the examination
- A dissociative response to trauma triggers (Correct answer)
- Absence seizure activity requiring EEG
- Elective mutism unrelated to the trauma
Correct answer: A dissociative response to trauma triggers
Dissociation, including emotional numbing and blank staring during trauma-related examinations, is a protective psychological response to overwhelming stress.
Question 4: When caring for a suicidal adolescent in the ED, which environmental safety measure is ESSENTIAL?
- Placing the patient in a private room with a television
- Removing all potentially harmful objects including IV tubing and gown strings (Correct answer)
- Limiting visitor access to one parent at a time
- Applying a safety vest to prevent the patient from leaving
Correct answer: Removing all potentially harmful objects including IV tubing and gown strings
Environmental risk reduction by removing all potentially harmful objects is mandatory for suicidal patients undergoing psychiatric evaluation in the ED.
Question 5: A caregiver reports that her 4-year-old has been having nightmares, refusing to sleep alone, and is very clingy since a recent car accident. The most appropriate nursing response is:
- Reassure the parent these behaviors will resolve without intervention
- Refer the family for trauma-focused cognitive behavioral therapy evaluation (Correct answer)
- Suggest the parent allow co-sleeping permanently
- Schedule a developmental screening in six months
Correct answer: Refer the family for trauma-focused cognitive behavioral therapy evaluation
Persistent post-traumatic symptoms in young children warrant referral for trauma-focused therapy; early intervention improves outcomes.
Question 6: Which factor MOST increases the risk of completed suicide in an adolescent presenting to the ED?
- Female sex
- Previous suicide attempt (Correct answer)
- Diagnosis of anxiety disorder
- Age under 13
Correct answer: Previous suicide attempt
A prior suicide attempt is the single strongest predictor of completed suicide in adolescents.
Question 7: A 13-year-old with anorexia nervosa presents in the ED with bradycardia and syncope. After medical stabilization, the priority psychosocial nursing intervention is:
- Confront the patient about her distorted body image
- Provide a compassionate, non-judgmental environment and involve the eating disorder team (Correct answer)
- Encourage the patient to eat a full meal before psychiatric evaluation
- Educate the family that anorexia is a choice and recovery requires willpower
Correct answer: Provide a compassionate, non-judgmental environment and involve the eating disorder team
A non-judgmental, supportive approach and multidisciplinary team involvement are essential to therapeutic engagement with patients with eating disorders.
CPEN Psychosocial Emergencies 3
A 15-year-old presents with self-inflicted lacerations to her forearms.
She states the cutting 'helps her feel better.' This behavior is BEST characterized as: