CPEN Psychosocial Emergencies 4 — Questions and Answers
Question 1: A 17-year-old presents with racing thoughts, decreased need for sleep, grandiosity, and risky behavior for the past week. These symptoms are MOST consistent with:
- Stimulant intoxication only
- A manic episode requiring psychiatric evaluation (Correct answer)
- Attention deficit hyperactivity disorder
- Adolescent normative risk-taking
Correct answer: A manic episode requiring psychiatric evaluation
Elevated mood, decreased sleep need, grandiosity, and risky behavior lasting at least a week are hallmark features of a manic episode.
Question 2: A 6-year-old being evaluated for suspected sexual abuse tells the nurse details about the abuse spontaneously. The BEST nursing response is:
- Ask detailed follow-up questions to gather as much information as possible
- Listen without interruption, use open-ended prompts, and document the child's exact words (Correct answer)
- Tell the child to save the details for the forensic interviewer
- Reassure the child that what happened was not their fault and stop the conversation
Correct answer: Listen without interruption, use open-ended prompts, and document the child's exact words
Using open-ended prompts, listening without leading questions, and documenting exact words preserves the integrity of disclosure for forensic purposes.
Question 3: Which of the following statements about pediatric grief in the ED setting is MOST accurate?
- Children under age 5 fully understand death as permanent and universal
- Providing honest, age-appropriate explanations reduces long-term psychological harm (Correct answer)
- Siblings should always be excluded from the resuscitation room
- Grief reactions in children always present as crying and sadness
Correct answer: Providing honest, age-appropriate explanations reduces long-term psychological harm
Age-appropriate honest communication about death supports healthy grief processing and reduces long-term psychological sequelae in children.
Question 4: A nurse suspects that a parent is fabricating symptoms in their 8-year-old, who has had 12 ED visits in the past year for unverifiable complaints. This presentation is concerning for:
- Somatization disorder in the child
- Medical child abuse (formerly Munchausen syndrome by proxy) (Correct answer)
- Hypochondriasis in the parent
- Health anxiety in the child
Correct answer: Medical child abuse (formerly Munchausen syndrome by proxy)
Repeated ED visits for unverifiable symptoms, with a caregiver who appears to induce or fabricate illness, is the classic pattern of medical child abuse.
Question 5: A 16-year-old presents with paranoia, auditory hallucinations, and disorganized speech that began three weeks ago. After ruling out substance use and medical causes, the nurse anticipates collaboration with psychiatry for which diagnosis?
- Major depressive disorder with psychotic features only if mood symptoms are present
- Brief psychotic disorder or first-episode psychosis evaluation (Correct answer)
- Dissociative identity disorder
- Reactive attachment disorder
Correct answer: Brief psychotic disorder or first-episode psychosis evaluation
New-onset psychotic symptoms lasting less than a month after medical and substance causes are excluded point to brief psychotic disorder or first-episode psychosis.
Question 6: When performing a mental status examination on a child in the ED, which domain assesses whether the child knows today's date and where they are?
- Affect
- Orientation (Correct answer)
- Thought content
- Insight
Correct answer: Orientation
Orientation assesses awareness of person, place, and time and is a core component of the mental status examination.
Question 7: A 14-year-old with a known history of ADHD is brought in by police after a violent outburst at school. The nurse should FIRST:
- Administer a stimulant medication to improve impulse control
- Ensure the environment is safe and assess for co-occurring psychiatric disorders or substance use (Correct answer)
- Apply restraints to prevent further violence
- Contact the school for a behavioral report before assessing the patient
Correct answer: Ensure the environment is safe and assess for co-occurring psychiatric disorders or substance use
Ensuring environmental safety and performing a comprehensive assessment for co-occurring conditions is the priority before any intervention.
CPEN Psychosocial Emergencies 4
A 17-year-old presents with racing thoughts, decreased need for sleep, grandiosity, and risky behavior for the past week.
These symptoms are MOST consistent with: