NUR 4290 MAIN EXAMINATION 2026 SET QUESTIONS AND
ANSWERS RATED A+
✔✔5 categories of psych nursing - ✔✔words, drugs , environment , somatic therapy
(social work, art, and music therapy, behavioral counseling
✔✔3 areas of psych nursing to focus on - ✔✔nurse-pt relationship (words),
psychopharmacology (drugs) and mileu management (environment)
✔✔nurse patient relationship - ✔✔WORDS: VERBAL,WRITTEN &NONVERBAL
2. RN RELIES ON COMMUNICATION AS PIVOTAL TO:- ANALYSIS -
COLLABORATION -DELIVERY OF SERVICES COMMUNICATION SKILLS -
RESPECT & DESIRE TO HELP UNDERSTANDING OF MENTAL MECHANISMS
ADAPTATION STYLES COPING STRATEGIES THERAPEUTIC INTERVENTION
SKILLS CULTURAL CONTEXT
*nurse must have respect for pt! nurse cannot have bias
✔✔for a first time med make sure to.. - ✔✔monitor for first 30 minutes, stay w them
make sure they take it , education and 5 rights of meds
✔✔what is a therapeutic mileu ? - ✔✔where a pt should be expected to go for their
safety, , least restrictive, where they feel they can connect and not be harmed by other
patients. *consistency of unit - if set limits everyone has to follow!
BE PURPOSEFUL & PLANNED TO PROVIDE SAFETY FROM DANGER &
EMOTIONAL TRAUMA
2. PROMOTE INTERACTION & COMMUNICATION AMONG PTS & PERSONNEL
3. PROVIDE TESTING GROUND FOR NEW PATTERNS OF BEHAVIOR WHILE PTS
TAKE RESPONSIBILITY FOR THEIR BEHAVIORS
4. PROVIDE FOR CONSISTENT LIMIT SETTING
5. ENCOURAGE PARTICIPATION IN GROUP ACTIVITIES
6. PROVIDE FOR PT RESPECT & DIGNITY
7. CONVEY AN ATTITUDE OF OVERALL ACCEPTANCE &OPTIMISM
8. ALLOW FOR CONTINUAL ASSESSMENT &EVALUATION OF PT'S PROGRESS
✔✔consequences of an imbalance of nursing care - ✔✔NPR ONLY + WEAK MILEU-
MEDS =DECOMPENSATION WHEN PTS DON'T REC APPROPRIATE MEDS
&MILIEU ISN'T THERAPEUTIC =POSSIBILITY OF DECOMPENSATION TO A PRE
TX STATE
MEDS ONLY IF PTS GIVEN MEDS WITHOUT SUPPORT OF THERAPEUTIC
ENCOUNTERS WITH STAFF & WELL MANAGED MILIEU=CUSTODIAL CARE ONLY
, ✔✔anger is - ✔✔EMOTIONAL RESPONSE TO PERCEIVED: FRUSTRATION SHAME
HUMILIATION
*anxious> anger> aggressive > violent
pay attention to why pt is angry and intervene!
anxiety is a change of behavior !
deescalate w words!
✔✔agression is - ✔✔INTENTIONAL BEHAVIORS WITH THE POTENTIAL TO CAUSE
DESTRUCTION OR HARM VERBAL THREATS/ATTACKS(-) USE OF OBJECTS
PHYSICAL ASSAULTS TOWARDS OTHERS/AGAINST SELF
✔✔violence is - ✔✔an absolute intent and willful to cause harm
✔✔restraint policies are for - ✔✔medical reasons /behavioral health reasons
medical reason 24 hrs in restraints
behavioral 4 hrs for adult , 2 hrs adolescent , 1 hr for child
OMH most stringent
✔✔NURSING CONSIDERATIONS INTERVENING WITH ANGRY/AGGRESSIVE
INTERVENING WITH ANGRY/AGGRESSIVE PTS INPT - ✔✔RN'S WHO =
RESPECTFUL & EMPATHETIC FOR PT'S IMMEDIATE SITUATION MORE LIKELY
TO SUCCEED IN DEFUSING SITUATION INTERPERSONAL PRECURSORS TO
ESCALATING BEHAVIORS:
1. Confusion/anger r/t behavior of other pts[disputes over food/cigs]
2. Aversive stimulation from staff or environment3. Overstimulation or understimulation
✔✔Outpatient- - ✔✔USUALLY PTS SXS ARE STABILIZED SO ANGER/AGGRESSION
AREN'T INCIDENTS NOT COMMON IMPORTANT FOR RN TO STRESS NEED FOR
TREATMENT COMPLIANCE[MEDS, PROGRAM ATTENDANCE, ETC] IN ORDER TO
AVOID:1. Relapses
2. Sxs that may cause behavior to escalate
✔✔IMPORTANT STEPS IN PREVENTING ESCALATION OF AGGRESSIVE
BEHAVIORS ESCALATION OF AGGRESSIVE BEHAVIOR - ✔✔MAKE PERSONAL
CONTACT DISCOVER SOURCE OF DISTRESS RELIEVE THE DISTRESS KEEP
EVERYONE SAFE ASSIST WITH ALTERNATIVE BEHAVIORS AND PROBLEM
SOLVING
✔✔AGGRESSION ESCALATES & PTS DON'T RESPOND TO OTHER METHODS: -
✔✔prn meds admin
ANSWERS RATED A+
✔✔5 categories of psych nursing - ✔✔words, drugs , environment , somatic therapy
(social work, art, and music therapy, behavioral counseling
✔✔3 areas of psych nursing to focus on - ✔✔nurse-pt relationship (words),
psychopharmacology (drugs) and mileu management (environment)
✔✔nurse patient relationship - ✔✔WORDS: VERBAL,WRITTEN &NONVERBAL
2. RN RELIES ON COMMUNICATION AS PIVOTAL TO:- ANALYSIS -
COLLABORATION -DELIVERY OF SERVICES COMMUNICATION SKILLS -
RESPECT & DESIRE TO HELP UNDERSTANDING OF MENTAL MECHANISMS
ADAPTATION STYLES COPING STRATEGIES THERAPEUTIC INTERVENTION
SKILLS CULTURAL CONTEXT
*nurse must have respect for pt! nurse cannot have bias
✔✔for a first time med make sure to.. - ✔✔monitor for first 30 minutes, stay w them
make sure they take it , education and 5 rights of meds
✔✔what is a therapeutic mileu ? - ✔✔where a pt should be expected to go for their
safety, , least restrictive, where they feel they can connect and not be harmed by other
patients. *consistency of unit - if set limits everyone has to follow!
BE PURPOSEFUL & PLANNED TO PROVIDE SAFETY FROM DANGER &
EMOTIONAL TRAUMA
2. PROMOTE INTERACTION & COMMUNICATION AMONG PTS & PERSONNEL
3. PROVIDE TESTING GROUND FOR NEW PATTERNS OF BEHAVIOR WHILE PTS
TAKE RESPONSIBILITY FOR THEIR BEHAVIORS
4. PROVIDE FOR CONSISTENT LIMIT SETTING
5. ENCOURAGE PARTICIPATION IN GROUP ACTIVITIES
6. PROVIDE FOR PT RESPECT & DIGNITY
7. CONVEY AN ATTITUDE OF OVERALL ACCEPTANCE &OPTIMISM
8. ALLOW FOR CONTINUAL ASSESSMENT &EVALUATION OF PT'S PROGRESS
✔✔consequences of an imbalance of nursing care - ✔✔NPR ONLY + WEAK MILEU-
MEDS =DECOMPENSATION WHEN PTS DON'T REC APPROPRIATE MEDS
&MILIEU ISN'T THERAPEUTIC =POSSIBILITY OF DECOMPENSATION TO A PRE
TX STATE
MEDS ONLY IF PTS GIVEN MEDS WITHOUT SUPPORT OF THERAPEUTIC
ENCOUNTERS WITH STAFF & WELL MANAGED MILIEU=CUSTODIAL CARE ONLY
, ✔✔anger is - ✔✔EMOTIONAL RESPONSE TO PERCEIVED: FRUSTRATION SHAME
HUMILIATION
*anxious> anger> aggressive > violent
pay attention to why pt is angry and intervene!
anxiety is a change of behavior !
deescalate w words!
✔✔agression is - ✔✔INTENTIONAL BEHAVIORS WITH THE POTENTIAL TO CAUSE
DESTRUCTION OR HARM VERBAL THREATS/ATTACKS(-) USE OF OBJECTS
PHYSICAL ASSAULTS TOWARDS OTHERS/AGAINST SELF
✔✔violence is - ✔✔an absolute intent and willful to cause harm
✔✔restraint policies are for - ✔✔medical reasons /behavioral health reasons
medical reason 24 hrs in restraints
behavioral 4 hrs for adult , 2 hrs adolescent , 1 hr for child
OMH most stringent
✔✔NURSING CONSIDERATIONS INTERVENING WITH ANGRY/AGGRESSIVE
INTERVENING WITH ANGRY/AGGRESSIVE PTS INPT - ✔✔RN'S WHO =
RESPECTFUL & EMPATHETIC FOR PT'S IMMEDIATE SITUATION MORE LIKELY
TO SUCCEED IN DEFUSING SITUATION INTERPERSONAL PRECURSORS TO
ESCALATING BEHAVIORS:
1. Confusion/anger r/t behavior of other pts[disputes over food/cigs]
2. Aversive stimulation from staff or environment3. Overstimulation or understimulation
✔✔Outpatient- - ✔✔USUALLY PTS SXS ARE STABILIZED SO ANGER/AGGRESSION
AREN'T INCIDENTS NOT COMMON IMPORTANT FOR RN TO STRESS NEED FOR
TREATMENT COMPLIANCE[MEDS, PROGRAM ATTENDANCE, ETC] IN ORDER TO
AVOID:1. Relapses
2. Sxs that may cause behavior to escalate
✔✔IMPORTANT STEPS IN PREVENTING ESCALATION OF AGGRESSIVE
BEHAVIORS ESCALATION OF AGGRESSIVE BEHAVIOR - ✔✔MAKE PERSONAL
CONTACT DISCOVER SOURCE OF DISTRESS RELIEVE THE DISTRESS KEEP
EVERYONE SAFE ASSIST WITH ALTERNATIVE BEHAVIORS AND PROBLEM
SOLVING
✔✔AGGRESSION ESCALATES & PTS DON'T RESPOND TO OTHER METHODS: -
✔✔prn meds admin
