Psychology and Psychiatric Nursing MCQ Quiz - Objective Question with Answer for Psychology and Psychiatric Nursing - Download Free PDF

• Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and is considered a first-line treatment for Obsessive-Compulsive Disorder (OCD). OCD is a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety caused by these thoughts.
• SSRIs, such as fluoxetine, work by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a key role in regulating mood, anxiety, and behavior. By improving serotonin levels, fluoxetine helps reduce the symptoms of OCD.
• Fluoxetine and other SSRIs are preferred for OCD because they are effective in reducing both obsessions and compulsions, have a favorable side effect profile compared to other medications, and are generally well-tolerated by patients.

• Rationale: Benzodiazepines are primarily used for short-term management of acute anxiety or insomnia. While they may provide temporary relief from anxiety symptoms, they are not effective for treating OCD. Additionally, they carry a risk of dependence and withdrawal symptoms, making them unsuitable for long-term treatment.

• Rationale: Antipsychotics are sometimes used as an adjunct (add-on) treatment for OCD, particularly when symptoms are severe or when SSRIs alone are not effective. However, they are not considered first-line treatments due to their limited efficacy for OCD and their potential side effects, such as weight gain, sedation, and extrapyramidal symptoms.

• Rationale: Tricyclic antidepressants (TCAs) such as clomipramine have been used to treat OCD. While clomipramine is effective, it is generally not considered a first-line treatment because of its higher risk of side effects compared to SSRIs. These side effects may include dry mouth, constipation, dizziness, and potential cardiotoxicity in overdose.

• Rationale: There is no fifth option provided in the question, so no explanation is necessary for this.

• Fluoxetine, an SSRI, is the first-line treatment for OCD due to its efficacy, safety, and tolerability. It is important to note that treatment for OCD often involves a combination of medication and cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP), which has been shown to be highly effective in managing OCD symptoms.

• Psychotherapy is an evidence-based treatment modality for depression that can significantly improve outcomes for patients. According to clinical studies, approximately 30-40% of patients with depression benefit from psychotherapy when it is implemented as a priority treatment.
• This percentage reflects the group of patients who experience notable improvement in symptoms and overall functioning due to psychotherapy, compared to other approaches like medication or self-help strategies.
• Psychotherapy approaches, such as Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and psychodynamic therapy, are tailored to address the underlying psychological factors contributing to depression.
• The efficacy of psychotherapy may vary based on individual factors, including the severity of depression, comorbid conditions, and the patient's engagement and adherence to therapy sessions.

• Rationale: This percentage is too low and does not align with the evidence from clinical studies. While some patients may experience only marginal benefits from psychotherapy, the majority of patients achieve more significant improvements.

• Rationale: While psychotherapy is effective, this percentage is slightly higher than what studies typically report. Combining psychotherapy with other treatments like medication may yield benefits for a larger proportion of patients, but psychotherapy alone generally benefits around 30-40%.

• Rationale: This percentage is overly optimistic and does not reflect realistic expectations from psychotherapy as a standalone treatment for depression. Higher success rates may be achieved through combined treatment modalities (e.g., psychotherapy plus pharmacotherapy).

• Psychotherapy is a highly effective treatment for a significant proportion of patients with depression, with clinical studies supporting a benefit rate of approximately 30-40%. It is important to recognize that individual responses to therapy can vary and that combining psychotherapy with other treatment approaches may enhance outcomes for many patients.

• Electroconvulsive Therapy (ECT) is a medical treatment that involves inducing a controlled seizure in patients under general anesthesia. It is used to treat certain severe psychiatric disorders, such as major depression, bipolar disorder, and some forms of schizophrenia.
• Before undergoing ECT, patients are instructed to follow specific preoperative guidelines, including being NPO (nothing by mouth) for a specified period. This is done to reduce the risk of aspiration during the procedure, as patients are under general anesthesia.
• The recommended duration for NPO prior to ECT is typically 6-8 hours. This ensures that the stomach is empty, minimizing the risk of regurgitation and aspiration, which could lead to serious complications such as aspiration pneumonia.

• Rationale: A fasting period of 1-2 hours is insufficient to ensure that the stomach is empty. Food and fluids may still be present in the stomach, increasing the risk of aspiration during anesthesia. This option is not in line with standard medical guidelines.

• Rationale: A fasting period of 2-4 hours is also inadequate for most patients. While this might be acceptable for clear liquids in some surgical guidelines, it is not appropriate for ECT, as it does not provide enough time for the stomach to fully empty solid foods or other substances.

• Rationale: A fasting period of 10-12 hours may be unnecessarily long for most patients undergoing ECT. Extended fasting can cause discomfort, dehydration, or hypoglycemia, which can negatively affect the patient's condition prior to the procedure. Standard guidelines recommend 6-8 hours as sufficient.

• The correct fasting period before ECT is 6-8 hours to minimize the risk of aspiration and ensure patient safety. Other options, such as shorter fasting times (1-2 or 2-4 hours), do not provide enough time for the stomach to empty, while longer fasting periods (10-12 hours) may cause unnecessary discomfort without added benefit.

• The Mini-Mental State Examination (MMSE) is a widely used tool for evaluating cognitive function. It assesses areas such as orientation, memory, attention, language, and visuospatial skills, providing a score out of 30. Higher scores indicate better cognitive function.
• A score of 20 out of 30 typically falls within the range of moderate cognitive impairment. This suggests that the individual has noticeable difficulties with cognitive tasks that may impact their daily life but is not yet in the severe impairment range.
• Moderate cognitive impairment may manifest as significant difficulties in remembering recent events, performing complex tasks (e.g., financial management), or maintaining attention, but the patient may still retain some independence in simpler daily activities.
• It is important to interpret MMSE scores in the context of the patient’s overall clinical presentation, including age, education level, and cultural factors, as these can influence the results.

• Rationale: Normal cognitive function typically corresponds to an MMSE score of 24–30. Scores in this range indicate intact cognitive abilities and minimal to no observable deficits in memory, attention, or other cognitive domains. A score of 20 is below this range, ruling out normal cognitive function.

• Rationale: Mild cognitive impairment usually corresponds to an MMSE score of 21–23. In this range, individuals may experience subtle cognitive deficits, such as occasional forgetfulness or difficulty concentrating, but these deficits do not significantly interfere with daily life. Since the patient scored 20, this is below the threshold for mild impairment.

• Rationale: Severe cognitive impairment is typically associated with MMSE scores below 10–19. Individuals in this range have profound deficits in cognitive function, often requiring assistance with basic activities of daily living, such as eating, dressing, and personal hygiene. A score of 20 is above this range, ruling out severe impairment.

• Based on the MMSE score of 20, the patient’s cognitive function is best classified as moderate cognitive impairment. This level of impairment highlights the need for interventions to support the patient’s cognitive health and daily functioning while considering strategies to slow further cognitive decline.

• Electroconvulsive therapy (ECT) is a medical treatment used primarily for patients with severe depression that has not responded to other therapies. As a preoperative intervention, ensuring NPO (nothing by mouth) status is crucial to prevent aspiration during the procedure.
• NPO status means the patient must refrain from eating or drinking for a specific period before the procedure, usually 6-8 hours. This is done to reduce the risk of vomiting or aspiration during anesthesia induction.
• Aspiration can lead to serious complications such as pneumonia or airway obstruction, making it a critical safety measure in preoperative care for ECT.
• Ensuring NPO status is the nurse's priority intervention because it directly impacts the patient's safety during the procedure.

• ECT involves brief electrical stimulation of the brain while the patient is under anesthesia. The procedure is considered safe and effective, but preoperative care is essential to minimize risks.
• Other preoperative preparations include ensuring the patient is calm, verifying consent, and checking vital signs, but maintaining NPO status is the most critical.

• Rationale: Administering pre-medications is an important step but is not the priority intervention. Pre-medications are typically given to relax the patient or reduce side effects of anesthesia, but ensuring NPO status takes precedence due to the risk of aspiration.

• Rationale: ECG electrodes are applied to monitor heart activity during the procedure. While this is necessary, it is a procedural step that occurs closer to the time of the ECT and does not address the preoperative risk of aspiration.

• Rationale: Removing jewelry is a standard protocol to prevent burns or interference with electrical equipment during ECT. However, this is a secondary task compared to ensuring NPO status, which directly affects patient safety during anesthesia.

• The priority nursing preoperative intervention for a patient undergoing ECT is ensuring NPO status to prevent aspiration during anesthesia induction. While other interventions are important, they do not address immediate safety risks as effectively as maintaining NPO status.

Explanation:

• A phobia is an exaggerated usually inexplicable and illogical fear of a particular object, class of objects, or situation
• The term ‘phobia’ is often used to refer to a fear of one particular trigger.
• There are three types of phobia recognized by the American Psychiatric Association (APA).

1. Specific phobia:
   • This is an intense, irrational fear of a specific trigger.
2. Social phobia, or social anxiety:
   • This is a profound fear of public humiliation and being singled out or judged by others in a social situation.
   • These kinds of people avoid large gatherings because of social anxiety.
   • It is different than shyness.
3. Agoraphobia:
   • This is a fear of situations from which it would be difficult to escape if a person were to experience extreme panic, such as being in a lift or being outside of the home.

The correct answer is mood.

Key Points

• Depression is a mood disorder.
• Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act.
• It is treatable.
• It causes feelings of sadness and a loss of interest in activities you once enjoyed.
•  It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.​

Additional Information

Concept:-

• The concepts of id, ego and superego are proposed by 'Sigmund Freud' in his 'Psychoanalytic Theory of Personality. Freud used these three concepts to describe the three parts of the human personality and to explain the way a human mind works.  

According to Freud, the human personality is made up of three major systems: the id, ego, and superego. 

Important Points

Another concept introduced by Freud was the “unconscious”. He conceived of the mind like an Iceberg, the tip of which is called the conscious, a small portion as subconscious and the remaining large portion as the Unconscious.

Let's Understand in Brief:

• The ID:
  • It is the unconscious part of the human personality that works to fulfil basic desires.
  • It is based on the pleasure principle which aspires for the satisfaction of antisocial desires.
• The Ego:
  • It looks for rules and morals and resides in the unconscious mind. 
  • The Ego always postpones the desire and discharge the tension until it gets the desired object. 
• The Super-Ego:
  • It is the moral part of the personality, which is known as conscience too. It stands for perfection, rather than pleasure.
  • It acts as a balance between id and super-ego, it tries to figure the solution which does not hurt either id or super-ego.
• Unconscious:
  • A reservoir of feelings, thoughts, urges, and memories that are outside of our conscious awareness.
  • Most of the contents of the unconscious are unacceptable or unpleasant, such as feelings of pain, anxiety, or conflict.
  • According to Freud, the unconscious continues to influence the conscious behaviours of the individual.

Key Points

• The deep-seated unconscious mind is the storehouse of all our memories and experiences. It is the centre for emotions and feelings and for all our behaviour and habits.
• Freud proved that through various psychoanalytical techniques which are also partly therapeutic like the free association technique or the dream analysis technique, changes can be brought in the unconscious mind.

The Psychosocial crisis ‘Trust vs Mistrust’ is linked with the stage infancy (0 – 18 months) of Erikson’s theory. There are 8 stages in Erikson’s theory.

Erikson covered human personality development in a series of eight stages that take place from the time of birth and continue throughout an individual’s complete life. Erik Erikson’s Psycho-social Theory focused on the adaptive function of the ego and the development of ego strength. There are some reasons due to which his theory is considered as stage theory:

• Personality develops in stages in a pre-determined order, from infancy to adulthood.
• Each stage has a psychological crisis, which could be positive or negative.
• Each crisis comes with its psychological needs which conflicts with the need of society.
• On completing the stage, a healthy personality comes out along with basic virtues.

Hence, there are four reasons behind Erikson’s theory being a stage theory.

Concept:

Mania

• Mania is a psychological condition that causes a person to experience unreasonable euphoria, very intense moods, hyperactivity, and delusions.
• Mania (or manic episodes) is a common symptom of bipolar disorder.
• A doctor will also likely prescribe a mood stabilizer, also called an “antimanic” medication.
• These help control mood swings and prevent them, and may help to make someone less likely to attempt suicide.
• Patients may need to take medicine for a long time, sometimes indefinitely.
• The doctor may prescribe lithium (Eskalith, Lithobid) and certain anti-seizure drugs like carbamazepine (Tegretol) or valproate (Depakote).
• Patients may need very close medical supervision and blood tests while you take these.

Additional Information

• Glutamate is an excitatory neurotransmitter that is elevated during mania. Lithium acutely stimulates the NMDA receptor, increasing glutamate availability in the postsynaptic neuron.
• It takes about 1 to 3 weeks for lithium to show the effects of symptoms.
• Therapeutic lithium level is somewhere between 0.6 to 1.2 mEq/L

Concept:-

In psychoanalytic theory, given by Sigmund Freud says that the defense mechanism is an unconscious psychological action that functions to protect a person from anxiety-producing thoughts and feelings related to internal conflicts and outer stressors. There are many defense mechanisms enlist which a person uses in his day to day life:

• Sublimation: It is similar to displacement, but takes place when a person manages to displace his unacceptable emotions into behaviors that are constructive and socially acceptable, rather than destructive activities.
• Sublimation is one of Freud's original defense mechanisms in which his deep sexual desires were turned into socially acceptable behavior by his writings and paintings.

Additional Information   1. Regression

• Regression is a defense mechanism proposed by Anna Freud whereby the ego reverts to an earlier stage of development usually in response to stressful situations. Regressions enable a person to psychologically go back in time to a period when the person felt safer.
• Example: When a person is troubled, he behaves most often childish or primitively to cope with the undesirable situation.

    2. Identification: 

• also known as Introjection. Is a defense mechanism when a person not only takes on a belief or voice of another person but also begins to identify with that individual. For example, a father tells his son that women do the household work and the son keeps this thought in his mind and acts in the same manner as his father does.

Concept:

• Anorexia nervosa: it is an eating disorder occurs most often in adolescent girls.
• The problem is found as refusal of food to maintain normal body weight by reducing food intake, especially fats and carbohydrates.
• Sign and symptoms:
  • Extreme weight loss or not making expected developmental weight gains.
  • Thin appearance.
  • Abnormal blood counts.
  • Fatigue.
  • Insomnia.
  • Dizziness or fainting.
  • Bluish discoloration of the fingers.

Explanation:

• Complication in anorexia nervosa:

Osteoporosis: A condition in which bones become weak and brittle.

• The body constantly absorbs and replaces bone tissue. With osteoporosis, new bone creation doesn't keep up with old bone removal.
• Many people have no symptoms until they have a bone fracture.

Myocardial hypertrophy:

• Myocardial hypertrophy is defined as an increase in ventricular myocardial mass.
• In clinical practice and in animal studies, left ventricular (LV) hypertrophy (LVH) is often assessed by measurement of end-diastolic thickness of septal and LV posterior wall and may be associated with normal or dilated LV cavity.

Electrolyte imbalance:

• It occurs when you have too much or not enough of certain minerals in your body.
• This imbalance may be a sign of a problem like kidney disease.

Additional Information 

• Bulimia nervosa: Eating disorder where the person will have binge eating
• Pica: Eating disorder where the child eats non nutritive substances
• Geophagia : Eating mud
• Trichophagia : Eating hair

Concept:-

Erickson's Theory

• Erickson's theory for adolescent- Identity vs confusion.
• Erikson described eight stages of development. Each stage is characterized by a psychosocial crisis, representing a conflict between the individual and society.
• The progression to the next stage depends on the resolution of these conflicts.
• Out of eight stages,​ only five are relating to childhood.

Additional Information

Obsessive-compulsive disorder (OCD) is characterized by the occurrence of unwanted, intrusive obsessive thoughts and distressing images which are usually accompanied by compulsive behaviors. Compulsive behaviors are carried out either to undo or neutralize the obsessions or to prevent the occurrence of some dreadful event.

Key Points

• Anxiety disorders are disorders that decrease the performance or social functioning of an individual due to hyper-anxiety. Anxiety disorder can be of many types such as generalized anxiety disorder, obsessive-compulsive disorder, somatoform disorder, etc.
• Obsessive behavior is the inability to stop thinking about a particular idea or topic. The person involved, often finds these thoughts to be unpleasant and shameful.
• Compulsive behavior is the need to perform certain behaviors over and over again. Many compulsions deal with counting, ordering, checking, touching, and washing.  
• People affected by the obsessive-compulsive disorder are unable to control their preoccupation with specific ideas or are unable to prevent themselves from repeatedly carrying out a particular act or series of acts that affect their ability to carry out normal activities.

Thus, it is concluded that Obsessive-compulsive disorder is an anxiety disorder.

Hint

• Somatoform disorders refer to physical problems which have no organic basis, for example, fatigue, headaches, vague body pains, etc. The persons suffering from this disease remain preoccupied with symptoms.
• Dissociative disorders describe a persistent mental state that is marked by feelings of being detached from reality, being outside of one’s own body, or experiencing memory loss.
• Adjustment disorders are a group of conditions that can occur when you have difficulty in coping with a stressful life event. Example"the death of a loved one, relationship issues, or being fired from work.