Psychiatric-Mental Health Nurse Practitioner Exam Crisis Intervention and Emergency Psychiatry 1 — Questions and Answers
Question 1: A PMHNP evaluating a patient in crisis should first prioritize which action?
- Initiate pharmacotherapy immediately
- Establish safety and assess risk of harm to self or others (Correct answer)
- Contact the patient's family
- Schedule a follow-up appointment
Correct answer: Establish safety and assess risk of harm to self or others
Safety assessment is always the first priority in any psychiatric crisis situation.
Question 2: Which validated tool is commonly used by PMHNPs to assess suicide risk in emergency settings?
- PHQ-9
- Columbia Suicide Severity Rating Scale (C-SSRS) (Correct answer)
- GAD-7
- CAGE questionnaire
Correct answer: Columbia Suicide Severity Rating Scale (C-SSRS)
The C-SSRS is a standardized, evidence-based tool that quantifies suicidal ideation and behavior severity.
Question 3: A patient in acute psychotic crisis is agitated and threatening violence. What is the PMHNP's safest first intervention?
- Physical restraint immediately
- Verbal de-escalation in a calm, low-stimulation environment (Correct answer)
- Administer IM antipsychotic without consent
- Call police first
Correct answer: Verbal de-escalation in a calm, low-stimulation environment
Verbal de-escalation is the least restrictive, safest first-line intervention for agitated patients.
Question 4: When a patient meets criteria for involuntary psychiatric hospitalization, which legal standard most commonly applies in the US?
- Preponderance of evidence
- Imminent danger to self or others due to mental illness (Correct answer)
- Court order required in all cases
- Physician agreement with family
Correct answer: Imminent danger to self or others due to mental illness
Involuntary holds in the US require evidence of a mental illness causing imminent risk of harm to self or others.
Question 5: Which medication combination is considered first-line for rapid tranquilization of an acutely agitated patient in the ED?
- Lithium + valproate
- Haloperidol + lorazepam (or diphenhydramine) (Correct answer)
- Clozapine + olanzapine
- Quetiapine + lamotrigine
Correct answer: Haloperidol + lorazepam (or diphenhydramine)
Haloperidol combined with lorazepam (or diphenhydramine to prevent EPS) is a widely used, evidence-supported rapid tranquilization regimen.
Question 6: A PMHNP using the SLAP mnemonic to assess lethality of a suicide plan is assessing which four elements?
- Severity, Location, Availability, Proximity to rescue
- Suicidal thoughts, Lethality, Attempt history, Plan specificity
- Seriousness, Lethality, Availability, Proximity (Correct answer)
- Severity, Likelihood, Agitation, Plan
Correct answer: Seriousness, Lethality, Availability, Proximity
The SLAP mnemonic assesses the Seriousness of intent, Lethality of the chosen method, Availability of the means, and Proximity of rescue.
Psychiatric-Mental Health Nurse Practitioner Exam Crisis Intervention and Emergency Psychiatry 1
A PMHNP evaluating a patient in crisis should first prioritize which action?