1. What are the main components of a mental status examination (MSE)? How would you conduct an
MSE for a patient with schizophrenia?
- The main components of a MSE are appearance, behavior, speech, mood, affect, thought process,
thought content, perception, cognition, insight, and judgment. To conduct an MSE for a patient with
schizophrenia, you would observe their appearance and behavior for signs of dishevelment, agitation,
or catatonia; assess their speech for rate, volume, tone, and coherence; evaluate their mood and
affect for congruence, intensity, and range; examine their thought process for logic, organization, and
coherence; explore their thought content for delusions, obsessions, or suicidal or homicidal ideation;
assess their perception for hallucinations or illusions; test their cognition for orientation, memory,
attention, concentration, and executive functions; and appraise their insight and judgment for their
ability to understand their illness and make appropriate decisions.
2. What are the indications and contraindications for electroconvulsive therapy (ECT)? What are the
common side effects and complications of ECT?
- The indications for ECT are severe or treatment-resistant depression, bipolar disorder with psychotic
or catatonic features, schizophrenia with catatonia or suicidal ideation, and other conditions such as
Parkinson’s disease or neuroleptic malignant syndrome that may benefit from ECT. The
contraindications for ECT are increased intracranial pressure, recent stroke or brain surgery, unstable
cardiovascular disease, severe pulmonary disease, or active substance use. The common side
effects of ECT are headache, nausea, muscle soreness, confusion, memory impairment, and
transient arrhythmias. The complications of ECT are prolonged seizures, status epilepticus, aspiration
pneumonia, cardiac arrest, or death.
3. What are the principles and techniques of motivational interviewing (MI)? How would you use MI to
help a patient with alcohol use disorder who is ambivalent about quitting?
- The principles of MI are expressing empathy, developing discrepancy, rolling with resistance, and
supporting self-efficacy. The techniques of MI are open-ended questions, affirmations, reflections,
and summaries. To use MI to help a patient with alcohol use disorder who is ambivalent about
quitting, you would ask open-ended questions to elicit the patient's reasons for and against drinking;
affirm the patient's strengths and efforts; reflect the patient's feelings and statements; summarize the
patient's ambivalence and discrepancy between their current behavior and their goals; and support
the patient's confidence and ability to change.
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