nle pre board june 2008 npt 5-questions and rationale

7/31/2019 Nle Pre Board June 2008 Npt 5-Questions and Rationale

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Situation 1 - Jimmy developed his goal for hospitalization. "To get a handle on my nervousness." The nurse is going tocollaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned toasphyxiate himself with exhaust from his car but frightened instead. He realized he needed help.

1. The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is:a. help the client find meaning in his experienceb. help the client to plan alternativesc. help the client cope with present problemd. help the client to communicate

CORRECT ANSWER: CRATIONALE: Crisis Intervention is an active but temporary entry into the life situation of an individual, a family or agroup during a period of stress. It includes assessment, planning of therapeutic intervention, implementation of therapeutic intervention and evaluation. Since the client has already conceptualized his own problem, there is noneed for assessment anymore. Helping him cope with present problem is already planning of therapeuticintervention.OPTION A- There is no need helping the client find meaning in his experience because as stated, he is alreadyaware of his own problemOPTION B- Planning of alternatives is wrong because the client hasnt cope with his problem yet. He hasntdeveloped any coping strategies yet.OPTION D- There is no need to let the client verbalize and/or communicate because he has already verbalized thathe needs to handle his nervousness.SOURCE: Shives, Psychiatric-Mental health Nursing, 5 th ed, pp166-168

2. The nurse is guided that Jimmy is aware of his concerns of the "here and now" when he crossed out which itemfrom his "list of what to know"a. anxiety laden unconscious conflictsb. subjective idea of the range of mild to severe anxietyc. early signs of anxietyd. physiological indices of anxiety

CORRECT ANSWER: CRATIONALE: Crisis Intervention deals with the here and now, Gestalt therapy. It emphasizes identifying thepersons feelings and thoughts in the here and now. Therapists often use gestalt therapy to increase clients self-awareness, focusing on the present. Early signs of anxiety dont deal with the here and now because the client is

already manifesting signs of anxiety. An early sign of anxiety is a part of assessment process.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 59

3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that completedisruption of the ability to perceive occurs in:a. panic state of anxietyb. severe anxietyc. moderate anxietyd. mild anxiety

CORRECT ANSWER: BRATIONALE: A severely anxious person has trouble thinking and reasoning. They cant complete a task. The rangeof perception is reduced, anxiety interferes with effective functioning.OPTION A- In panic the ability to concentrate is disrupted, the individual may experience terror or confusion or unable to speak or move. They cant communicate verbally and may be suicidal.OPTION C-In Moderate Anxiety, the perception becomes narrower; concentration is increased and able to ignoredistractions in dealing with problems. Moderately anxious person has difficulty concentrating independently.OPTION D- In Mild anxiety, the client is more alert, more aware of environment. It helps the person focus attentionto learn, solve problems, think, act, feel and protect himself.SOURCE: Videbeck, Psychiatric Mental health Nursing, 3rd ed,

4. Jimmy initiates independence and takes an active part in his self care with the following EXCEPT:a. agreeing to contact the staff when he is anxiousb. becoming aware of the conscious feelingc. assessing need for medication and medicating himself d. writing out a list of behaviors that he identifies as anxious

CORRECT ANSWER: ARATIONALE: Contacting the staff every time he feels anxious is still being dependent to the staff nurses of his self-careOPTION B, C, and Dimplies independence

5. The nurse notes effectiveness of Interventions in using subjective and objective data in the:a. initial plans or order b. databasec. problem listd. progress notes

CORRECT ANSWER: D


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RATIONALE: A progress note is a chart entry made by all health professionals involved in a clients care. It is in theprogress notes that the nurse notes the effectiveness of interventions.OPTION A-OPTION B- includes the nursing assessment, the physicians history, social and family data and the results of thephysical examination and baseline diagnostic tests.OPTION C- derived from database. It is usually kept at the front of the chart and serves as an index to thenumbered entries in the progress notes.SOURCE: Kozier, Fundamentals of Nursing, 7th ed, pp 331-332

Situation 2 - A research study was undertaken in order to identify and analyze a disabled boy's coping reaction patternduring stress.

6. This study which is a depth study of one boy is a:a. case studyb. longitudinal studyc. cross-sectional studyd. evaluative study

CORRECT ANSWER: ARATIONALE: Case study involves an in-depth, longitudinal examination of a single instance or event: a case, rather than using large samples and following a rigid protocol to examine a limited number of variables.OPTION B- Longitudinal study is a correlational research that involves repeated studies observations of the sameitems over a long period of time. It studies developmental ternds over a long period of time. OPTION C-Cross-sectional study is a study design in which data are collected at one point in time; sometimes used to infer changeover time when data are collected from different age or developmental groupsOPTION D- Evaluative study is a research that investigates how well a program, practice or policy is workingSOURCE: Polit and Beck, Nursing Research, 7th ed, pp 712, 715 717, 723

7. The process recording was the principal tool for data collection. Which of the following is NOT a part of a processrecording?a. Non verbal narrative accountb. Audio and interpretationc. Audio-visual recordingd. Verbal narrative account

CORRECT ANSWER: C

RATIONALE: Process recordings are written records of segment from the nurse-client session that reflects closelyas possible the verbal and non-verbal behaviors of both client and nurse. It is usually best of the student can writenotes verbatim in a private area immediately after the interaction has taken place. Nurses record their words andclients words, identify whether the responses are therapeutic, and recall their emotions at that time.OPTIONS A, B & D- all are part of process recordingSOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 245

8. Which of these does NOT happen in a descriptive study?a. Describing relationship among variablesb. Exploration of relationships between two or more phenomenac. Manipulation of phenomenon in real life contextd. Manipulation of a variable

CORRECT ANSWER: DRATIONALE: Descriptive research is a nonexperimental study. The purpose of it is to observe, describe, anddocument aspects of a situation as it naturally occurs and sometimes to serve as a starting point for hypothesisgeneration or theory development. The aim of this study is to describe relationship among variables. Neither of thevariables could be experimentally manipulated.OPTIONS A, B, C- all happens in a descriptive studySOURCE: Polit and Beck, Nursing Research, 7th ed, pp 192, 195

9. The investigator also provided the nursing care of the subject. The investigator is referred to as a/an.a. Participant-observer b. Observer researcher c. Caregiver d. Advocate

CORRECT ANSWER: CRATIONALE: The primary role of caregiver is the primary role of the nurse. The provision of care to patients thatcombines both the art and the science of nursing in meeting all the aspect of well being.OPTION A- the researcher participates as a member of the group and observes the group at the same time in datacollectionOPTION B-the researcher observes a particular group and records behaviors or activitiesOPTION D- in advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. Advocacy is the process of acting in the clients behalf when he or she cannot do so.SOURCE: Polit et al, Nursing Research, 7th ed, pp 726, 727 and Videbeck, Psychiatric Mental Health Nursing, 2nded, p 104

10. To ensure reliability of the study, the investigator analysis and interpretations were:


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a. subjected to statistical treatmentb. correlated with a list coping behaviorsc. subjected to an inter-observe agreementd. scored and compared standard criteria

CORRECT ANSWER: ARATIONALE: Statistical treatment is a process of using statistical tools such as mode of central tendency, mean,median to test the reliability of the study. You need to quantify first the data obtained before you can say that thestudy is reliable.

Situation 3 - During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 5 years old, wasgiven Flurazepam (Dalmane) 15 mg at 10:00pm because she had trouble going to sleep. Before approaching Regina, thenurse read the observation of the night nurse.

11. Which of the following approaches of the nurse validates the data gathered?a. "I learned that you were up till ten last night, tell me what happened before you were finally able to sleep

and how was your sleep?"b. "Hmm...You look like you had a very sound sleep. That pill you were given last night is effective isn't

it?"c. "Regina, did you sleep well?"d. "Regina, how are you?"

CORRECT ANSWER: ARATIONALE: Asking open-ended questions, leads or invite the client to explore (elaborate, clarify, describe,compare or illustrate) thoughts or feelings. It enables the nurse to examine important ideas, experiences andencourages communicationOPTIONS B & C-it is a closed ended question. It closes an interview rapidly.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p 116,118

12. Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needsfor information about her medicine?a. Guided by a medication teaching plan go over with her the purpose, indications and special instructions,

about the medication and provides her a checklistb. Provide a drug literature and explain its contentsc. Have an informal conversation about the medication and its effectsd. Ask her what time she would like to watch the informative video about the medication

CORRECT ANSWER: DRATIONALE: The main purpose is to provide health teaching to the client. Communicating helpful information to theclient about the drug she is taking. Asking her what time she would like to watch the informative video leastcommunicate attention to her needs about her medicine because you are giving the client the option to say no to theactivity. Although it is an informative video, yet as a nurse, health teaching is our primary responsibility. We must beresponsible for the learning of our clients.OPTIONS A,B, CCommunicates attention and care for her needs about her medicine. It is part of health teaching.

13. The nurse engages Regina in the process of mutual inquiry to provide an opportunity for Regina toa. face emerging problems realisticallyb. conceptualize her problemc. cope with her present problemd. perceive her participation in an experience

CORRECT ANSWER: DRATIONALE: In mutual inquiry, the nurse involves the patient in determining the facts of his/her situation whereinthe patient will be able to understand her involvement in a certain experience. Often just helping the client explorehis/her perceptions of a problem stimulates potential solutions in the clients mind. Clients participation is effectivein finding meaningful solutions to problems.OPTIONS A, B, C- pertains to goals of crisis interventionSOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 122

14. Which of these responses indicate that Regina needs further discussion regarding special instructions?a. "I have to take this medicine judiciously."b. "I know I will stop taking the medicine when there is an advice form the doctor for me to discontinue."c. "I will inform you and the doctor any untoward reactions I have."d. "I like taking this sleeping pill. It solves my problem of insomnia. I wish I can take it for life."

CORRECT ANSWER: DRATIONALE: Sleeping pills are hypnotics. Hypnotics are effective in treating transient insomnia, but when used over the long-term, patients run the risk of developing dependence on the drug itself. Hypnotics can worsen existingsleep disturbances when they induce dug dependency insomnia, for once the drug is discontinued, the individualthen have rebound insomnia and nightmares.

OPTION A- taking the medicine with caution is a mustOPTION B and C- shows understanding of the special instructions given to her SOURCE: Varcaloris, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 892


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15. Regina commits to herself that she understood and will observe all the medicine precautions by;a. affixing her signature to the teaching plan that she has understood the nurseb. committing what she learned to her memoryc. verbally agreeing with the nursed. relying on her husband to remember the precautions

CORRECT ANSWER: ARATIONALE: The nurse should make an agreement or contract with the client. Teaching plans are signed by thepatient if she/he is able to understand fully the health teaching given to her. Any documents can also serve legalpurposes.OPTION B- She may not able to recall everythingOPTION C- Written agreement is more formal compared to verbal agreementOPTION D- The husband has nothing to do with the medications. The patient itself must understand the precautionsof her medications

Situation 4 - The nurse-patient relationship is a modality through which the nurse meets the client's needs.

16. The nurse's most unique tool in working with the emotionally ill client is his/her:a. theoretical knowledgeb. personality make upc. emotional reactionsd. communication skills

CORRECT ANSWER: DRATIONALE: Therapists ability to convey an essential interest in the client has been found to be more importantthan position, appearance, reputation, clinical experience, training and theoretical knowledge. Skilled use of communication techniques helps the nurse understand and empathize with the clients experience. It helps infacilitating the clients expression of emotions.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p112

17. The premise that an individuals behavior and affect are largely determined by the attitudes and assumptions onehas developed about the world underlies:a. modelingb. milieu therapyc. cognitive therapyd. psychoanalytic psychotherapy

CORRECT ANSWER: CRATIONALE: Cognitive theory uses cognitive therapy that is an active, directive, time-limited, structured approachused to treat a variety of psychiatric disorders. Cognitive theory believes that individuals affect and behavior arelargely determined by the way in which they are structure the world.OPTION A- In modeling the therapist provides a role model for specific identified behaviors, and the client learnsthrough imitation.OPTION B- Describe the use of the total environment to treat disturbed children. A comfortable, secure environmentis created in which psychotic children were helped to form a new world.OPTION D- Uses many of the tools of psychoanalysis, such as free association, dream analysis, transference andcounter transference, but the therapist is much more involved and interacts with the client more freely.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, pp 38, 39, 42, 43

18. One way to increase objectivity in dealing with one's fears and anxieties is through the process of:a. observationb. interventionc. validationd. collaboration

CORRECT ANSWER: BRATIONALE: Intervention is any act performed to prevent harming of a patient or to improve the mental, emotionalor physical function of a personOPTION A- act of watching carefully and attentivelyOPTION C- an agreement of the listener with certain elements of the patients communicationOPTION D- a structured, recursive process where two or more people work together toward a common goaltypically an intellectual endeavor SOURCE: Mosby, Mosbys Pocket Dictionary, 4th ed, pp 671, 880, 1328

19. All of the following response are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior?a. Responding in a punitive manner to the clientb. Rejecting the client as a unique human beingc. Tolerating all behavior in the clientd. Communicating ambivalent messages to the client

CORRECT ANSWER: DRATIONALE: Congruence signifies genuineness, or self-awareness of ones feelings as they arise within therelationship, and the ability to communicate them when appropriate. It is conveyed by actions such as not hidingbehind the role of nurse, listening to and communicating with others without distorting their message and being clear


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and concrete in communications with clients. Congruence connotes the ability to use therapeutic communicationtools in an appropriately spontaneous manner, rather than rigidly or in a parrot-like fashion.OPTION A- although it is also communicating with clients, it is not the most direct violation of the concept of usingtherapeutic communication in an appropriately spontaneous manner OPTION B- not directly connected with communicating with the clientOPTION C- tolerating behavior is more on behavioral approach rather than communicationSOURCE: Varcaloris, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 223

20. The mentally ill person demonstrating a child-like behavior responds positively to the nurse who is warm and caring.This demonstration of the nurse's role as:a. counselor b. parent surrogatec. therapistd. socializing agent

CORRECT ANSWER: BRATIONALE: When a client exhibits child-like behavior or when a nurse is required to provide personal care, thenurse may be tempted to assume the parental role.OPTION A- deals with human development concerns through support, consultation, evaluation, researchOPTION C- person with special skills. More on a professional level of a relationship between client and

nurseOPTION D- people and groups that influence our self-concept, emotions, attitudes, and behavior SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, p 100

Situation 5 - The nurse engages the client in a nurse-patient interaction.

21. The best time to inform the client about terminating the nurse-patient relationship isa. when the client asks, how long one relationship would beb. during the working phasec. towards the end of the relationshipd. at the start of the relationship

CORRECT ANSWER: DRATIONALE: Termination begins in the orientation phase or at the start of the relationship. The date of thetermination phase should be clear from beginning to keep the client aware, less dependent on the nurse and avoiddeveloping a relationship more than that of a professional relationship. Also, to prevent separation anxiety.

OPTION A- you should not wait for the client to ask you how long your relationship would be. It is your obligation asa nurse to inform him.OPTION B- in the working phase, the nurse and client together identify and explore areas in the clients life that arecausing problemsOPTION C- Feelings are aroused in both the client and the nurse with regard to the experience they have had. If you will tell the client that you will terminate your nurse-patient relationship towards the end of the relationship, itwould be difficult for the client to accept it and you might awaken the unresolved feelings of abandonment or loneliness, or feelings of being rejected by others.SOURCE: Varcaloris, Foundations of Psychiatric Mental Health Nursing, 4th ed, pp 232-235

22. The client says, "I want to tell you something but can you promise that you will keep this, a secret?" A therapeuticresponse of the nurse is:a. "Yes, our interaction is confidential provided the information you tell me is not detrimental to your safety."b. "Of course yes, this is just between you and me. Promise!"c. "Yes, it is my principle to uphold my client's rights."d. "Yes, you have the right to invoke confidentiality of our interaction."

CORRECT ANSWER: ARATIONALE: You are making your patient build a trusting relationship with you. Confidentiality means allowing onlythose involved in the patients care to have access to any information that the patient divulges. The nurse mustdefine the boundaries of confidentiality to the patient. The nurse is clear that only members of the health care teamwill have access to patient data. The team must have the data to care for the patient in the best manner possible.OPTIONS B, C, D- it is non therapeutic to agree with the client. When the nurse agrees with the client, there is noopportunity for the client to change his/her mind without being wrongSOURCE: Videbeck, Psychiatric Mental Health Nursing 2nd ed, p 99

23. When the nurse respects the client's self-disclosure, this is a gauge for the nurse's:a. trustworthinessb. loyaltyc. integrityd. professionalism

CORRECT ANSWER: ARATIONALE: Nurse-client relationship requires trust. Trust builds when the client is confident in the nurse and thenurses presence conveys integrity and reliability. Trust develops when the client believes that the nurse will beconsistent in his/her words and actions and respects the clients self-disclosure, providing confidentiality.OPTION B- it is a feeling of devotion, duty or attachment to somebody or somethingOPTION C- the quality of possessing and steadfastly adhering to high moral principles or professional standardsOPTION D- character expected of a member of a highly trained profession


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SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p 91

24. Building trust is important in:a. orientation phase of the relationshipb. the problem identification subphase of the relationshipc. all phases of the relationshipd. the exploitation phase

CORRECT ANSWER: ARATIONALE: It is during the orientation phase that the nurse begins to build trust with the client. It is the nursesresponsibility to establish a therapeutic environment that fosters trust and understanding. The nurse should shareappropriate information about himself/herself OPTION B- part of the working phase, wherein client identifies the issues or concerns causing theproblemOPTION D- during this phase the nurse guides the client to examine feelings and responses and develop

better coping skills and a more positive self-image; part of the working phaseSOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, pp 93, 97

25. The client has not been visited by relatives for months. He gives a, telephone number and requests the nurseto call. An appropriate action of the nurse would be:a. Inform the attending psychiatric about the request of the clientb. Assist the client to bring his concern to the attention of the social worker c. "Here (gives her mobile phone). You may call this number now."d. Ask the client what is the purpose of contacting his relatives

CORRECT ANSWER: ARATIONALE: Confidentiality is important during nurse-client interaction. No information will be discussed outside thehealth care team. Only if information may be harmful for the client or others, information may be related to the other nurses and the attending physician and only information that will be helpful in assisting the client toward recoverywill be provided to others. The attending psychiatrist or doctor will be informed regarding every concern of thepatient, for he will be the one who will decide about certain things pertaining to the concern of the client.OPTION B- Social workers are secondary workers after the doctors.OPTION C- Nurses must know that every decision is made by the attending physician. Before doing anything aboutthe concern of the patient, consult first.OPTION D- Asking the client what is the purpose is not necessary because you already have the information that hehas not been visited by relatives for almost a month.

SOURCE: Shives, Basic concepts of Psychiatric Mental Health Nursing, 5th

ed, p 133Situation 6 - Camila, 25 years old, was reported to be gradually withdrawing and isolating herself from friends and familymembers. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently.She was diagnosed as schizophrenia

26. The past history of Camila would most probably reveal that her premorbid personality is:a. schizoidb. extrovertc. ambivertd. cycloid

CORRECT ANSWER: ARATIONALE: A schizoid personality is characterized by a persistent pattern of detachment from social relationshipsand a restricted range of emotional expression in interpersonal settings. They are aloof and indifferent, appearingemotionally cold, uncaring or unfeeling (Videbeck, 352).OPTION B- An extrovert is a person who is energized by being around other people. Extroverts tend to "fade" whenalone and can easily become bored without other people around. When given the chance, an extrovert will talk withsomeone else rather than sit alone and think (about.com).OPTION C- Ambiverts are the ones who fall between the two extremes of introversion and extroversion, possessingsome tendencies of each. They have a well-balanced personality (yahoo.com).OPTION D- A cycloid personality is a person who tends to have periods of marked swings of mood, but withinnormal limits.

27. Which of the following are considered the negative sign of schizophrenia?a. Anhedonia, Restricted range of feelings, Catatoniab. Delusions, hallucinations, disordered thinkingc. Ambivalence, Associative looseness, hallucinationsd. Alogia, Echopraxia, Ideas of reference

CORRECT ANSWER: ARATIONALE: Schizophrenia has positive and negative symptoms. Positive or hard symptoms include ambivalence,associative looseness, delusions, echopraxia, flight of ideas, hallucinations, ideas of reference and preservation.Negative symptoms are alogia, anhedonia, apathy, blunted affect, catatonia, flat affect, lack of volitionOPTION B- positive symptomsOPTION C- positive symptomsOPTION D- alogia is a negative symptom, while the other two are positive symptomsSOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 276


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28. Which of the following disturbances in interpersonal relationships MOST often predispose, to the development of schizophrenia?a. Lack of participation in peer groupsb. Faulty family atmosphere and interactionc. Extreme rebellion towards authority figuresd. Solo parenting

CORRECT ANSWER: BRATIONALE: Interpersonal theorists suggested that schizophrenia resulted from dysfunctional relationships in earlylife and adolescence. Therapists also believed that schizophrenia results from dysfunctional parenting or familydynamics.OPTION C- anti social personality disorder SOURCE: Videbeck, Psychiatric Mental Health Nursing 3 rd ed p 278

29. Schizophrenia is best described as a disorder characterized by:a. Disturbed relationship related to an inability to communicate and think clearlyb. Severe mood swings and periods of low to high activityc. Multiple personalities, one of which is more destructive than the othersd. Auditory and visual hallucinations

CORRECT ANSWER: ARATIONALE: Schizophrenia can best be described as one of a group of psychotic reactions characterized bydisturbances in an individuals relationship with people and an inability to communicate and think clearlyOPTION B- Severe mood swings and periods of low to high activity are typical of bipolar disorder OPTION C- Multiple personality, which is sometimes confused with schizophrenia, is a dissociative disorder, not apsychotic illnessOPTION D- Many schizophrenic patients have auditory, not visual hallucinations. Visual hallucinations are morecommon in organic or toxic disorder

30. Schizophrenia is a/an:a. anxiety disorder b. neurosisc. psychosisd. personality disorder

CORRECT ANSWER: C

RATIONALE: Psychosis is a mental disorder of organic and emotional origin, and schizophrenia is an organicdisease with underlying physical brain pathology. Biologic theories of schizophrenia focus on genetic factors,neuroanatomic and neurochemical factorsOPTION A- disorder in which anxiety is the most prominent featureOPTION B- mental disorder in which the symptoms are distressing to the person, reality testing is intactOPTION D- diagnosed when personality traits become inflexible and maladaptive and significantly interfere with howa person functions in society or cause the person emotional distressSOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, pp 299, 375 and Mosby, Mosbys Pocket , 4th ed,pp 93, 856

Situation 7 - Salome, 80 year old widow, has been observed to be irritable, demanding and speaking louder than usual.She would prefer to be alone and take her meals by herself, minimized receiving visitors at home and no longer bothers toanswer telephone calls because of deterioration of her hearing. She was brought by her daughter to, the Geriatric clinic for assessment and treatment.

31. The nurse counsels Salome's daughter that Salome's becoming very loud and tendency to becomeaggressive is a/an:a. beginning indifference to the world around her b. attempt to maintain authoritative rolec. overcompensation for hearing lossd. behavior indicative of unresolved repressed conflict of the part

CORRECT ANSWER: CRATIONALE: It is not easy for older clients to experience a slowing of their mental and physical reactions and beunable to do anything about it or to look on younger people perform their job and assume their role. Variousemotional and behavioral reactions occur as people undergo physiologic changes of the aging process. Thesereactions include anxiety, frustration, fear depression, intolerance, loneliness, decreased independence, decreasedproductivity and low self-esteem.OPTION A- experienced by ages 60-65 during retirement stageOPTION B- a defense mechanism used by elder people in trying to establish a comfortable routine after retirementSOURCE: Shives, Psychiatric-Mental Health Nursing, 5 th ed, pp 593-594

32. A nursing diagnosis for Salome is:a. sensory deprivationb. social isolationc. cognitive impairmentd. ego despair

CORRECT ANSWER: A


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RATIONALE: Salome is observed to be demanding and speaking louder than usual due to deterioration of her hearing.

33. The nurse will assist Salome and her daughter to plan a goal which is:a. adjust to the loss of sensory and perceptual functionb. participate in conversation and other social situationsc. accept the steady loss of hearing that occurs with agingd. increase her self-esteem to maintain her authoritative role

CORRECT ANSWER: ARATIONALE: aging necessitates adjustment to different roles, relationships, responsibilities, changes in self-image,independence and changes in physical, emotional, mental and spiritual aspects of life.OPTION B- let her adjust to the situation first before you make her participate in conversation and other socialsituationsOPTION C- just a matter of acceptance, no action involvedSOURCE: Videbeck, Psychiatric Nursing Care Plans, 7th ed, p 18

34. The daughter understood the following ways to assist Salome meet her needs and avoiding which of the following:a. Using short simple sentencesb. Speaking distinctly and slowlyc. Speaking at eye level and having the client's attentiond. Allowing her to take her meals alone

CORRECT ANSWER: DRATIONALE: Allowing her to take her meals alone is like depriving her of care and treatment she deserves. It willmake her feel more sad and aloneOPTIONS A, B, C- Communicating with the hearing impaired includes: a.) when speaking, always face the persondirectly as possible b.) make sure your face is as clear as possible. Locate yourself so that your face is well lightedc.) speak slowly and distinctly and use short and simple sentencesSOURCE: Smeltzer, S.C. Medical-Surgical Nursing, 9 th ed, p 1588

35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she ways that thebattery should be functional, the device is turned on and adjusted to a:a. therapeutic levelb. comfortable levelc. prescribed level

d. audible level

CORRECT ANSWER: DRATIONALE: Hearing aid programming software and real ear measurement equipment allow the hearing aids to beindividually customized to optimize the hearing aid fitting for the child and to assure the speech signal is delivered atthe most appropriate listening levels. The goal of digital hearing aids is to deliver soft sounds at an audible level.Hearing aids should be turned on to a minimal level to avoid feedback.

Situation 8 - For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if somethingdreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come torescue her just in case something happens to her.

36. Cecilia is demonstrating:a. acrophobiab. claustrophobiac. agoraphobiad. xenophobia

CORRECT ANSWER: CRATIONALE: Agoraphobia involves intense, excessive anxiety or fear about being in places or situations from whichescape might be difficult or embarrassing, or in which help might not be available if a panic attack occurred.OPTION A- Acrophobia is the fear of high places.OPTION B- Claustrophobia is the fear of closed places.OPTION D- Xenophobia is the fear of foreign places or strangers.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, pp 311& 313

37. Cecilia's problem is that she always sees and thinks negative hence she is always fearful. Phobia is a symptomdescribed as:a. organicb. psychosomaticc. psychoticd. neurotic

CORRECT ANSWER: DRATIONALE: pertaining to neurosis, a category of mental disorder in which the symptoms are distressing to theperson, reality testing is intact, behavior does not violate gross social norms and there is no apparent organic cause.The person who is neurotic is said to be emotionally unstableOPTION A- organic disease or condition is any disease associated with detectable or observable changes in one or more body organs


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OPTION B- expression of an emotional conflict through physical symptomsOPTION C- not in contact with realitySOURCE: Mosby, Mosbys Pocket Dictionary,4th ed, pp 856, 900, 1049, 1050

38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her:a. communicationb. cognitionc. observationd. perception CORRECT ANSWER: BRATIONALE: Irrational thoughts refer to the impaired cognition of the person. It is the inability to think properly andreasonably. Cognition is the mental process characterized by knowing, thinking, learning, understanding and

judging. Cognitive Therapy is a treatment of mental and emotional disorders that help a person change attitudes,perceptions and patterns of thinkingOPTION A- has nothing to do with irrational thoughtsOPTION C- observation is an act of watching carefully and attentively, and its not related with treatments for irrational thoughtsOPTION D- perception is the conscious recognition and interpretation of sensory stimuli that serve as a basis for understanding, learning and knowingSOURCE: Mosby, Mosbys Pocket Dictionary, 4th ed, pp 258, 880, 959

39. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of thefollowing should the nurse implement?a. assist her in recognizing irrational beliefs and thoughtsb. help find meaning in her behavior c. provide positive reinforcement for acceptable behavior d. administer anxiolytic drug

CORRECT ANSWER: ARATIONALE: Cognitive Behavior Therapy (CBT) helps improve a persons moods and behavior by examiningconfused or distorted patterns of thinking. During CBT the person learns that thoughts cause feelings and moodswhich can influence behavior.

40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia?a. she read a book in the public library

b. she drives alone along the long expresswayc. she watches television with the family in the recreation roomd. she goes out with a friend

CORRECT ANSWER: ARATIONALE: Reading a book in the public library indicates that the client has overcome her fear of being in an openor public place, knowing that agoraphobics avoids being alone outsideOPTION B- driving alone doesnt involve too much peopleOPTION C- family is the comfort zone of the client

Situation 9 - it is the first day of clinical experience of nursing students at the Psychiatry Ward- During the orientation, thenurse emphasizes that the team members including nursing students are legally responsible to safeguard patient's recordsfrom loss or destruction or from people not authorized to read it.

41. It is unethical to tell one's friends and family member's data bout patients because doing so is violation of patients'rights to:a. Informed consentb. Confidentialityc. Least restrictive environmentd. Civil liberty

CORRECT ANSWER: BRATIONALE: Confidentiality means respecting the clients right to keep private information about his or her mentaland physical health and related careOPTION A- obtained when a client is subjected to surgery, electroconvulsive treatment or the use of experimentaldrugs or proceduresOPTION C- means that a client does not have to be hospitalized if he or she can be treated in an outpatient settingor in a group home. It also means that the client must be free of restraint or seclusion unless it is necessaryOPTION D- curtails the clients right to freedom-the ability to leave the hospital when he or she wishes.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, p170 and Videbeck, PsychiatricMental health Nursing, 3 rd ed, p 169, 170 & 171

42. The nurse must see to it that the written consent of mentally ill patients must be taken from:a. Doctor b. Social worker c. Parents or legal guardiand. Law enforcement authorities

CORRECT ANSWER: C


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RATIONALE: A mentally incompetent person cannot legally consent to medical or surgical treatment. The consentmust be taken from the parents or legal guardian.SOURCE: Venzon, Professional Nursing in the Philippines, 10 th ed. p175

43. In an extreme situation and when no other resident or intern is available, should a nurse receive, telephone orders,the order has to be correctly written and signed by the physician within.a. 24 hoursb. 36 hoursc. 48 hoursd. 12 hours

CORRECT ANSWER: ARATIONALE: Once the order is transcribed on the physicians order sheet, the order must be countersigned by thephysician within a time period described by agency policy, but many acute care hospitals require that this be donewithin 24 hours.SOURCE: Kozier, Fundamentals of Nursing, 7 th ed, p 346

44. The following are SOAP (Subjective - Objective - Analysis -Plan) statements on a problem: Anxiety about diagnosis.What is the objective data?a. Relate patient's feelings to physician initiate and encourage her to verbalize her fears give emotional support

by spending more time with patient, continue to make necessary explanations regarding diagnostic test.b. Has periods of crying, frequently verbalizes fear of what diagnostic tests will revealc. Anxiety due to the unknownd. "I'm so worried about what else they'll find wrong with me"

CORRECT ANSWER: BRATIONALE: Objective Data consist of information that is measured or observed by use of the sensesOPTION A- it is more of planning the care for the clientOPTION C- it is assessment or analysis drawn about the subjective and objective dataOPTION D- subjective datainformation obtained from what the client saysSOURCE: Kozier, Fundamentals of Nursing, 7 th ed, p 332

45. Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the:a. Summary of chronological notations made by individuals health team membersb. Identification of patient's responses to medical diagnosis and treatmentc. Patient's responses to health and illness as a total person in interaction with the environment

d. Step procedures for the management of common problems

CORRECT ANSWER: CRATIONALE: Nursing Care Plan is a plan based on a nursing assessment and a nursing diagnosis carried out by anurse. It has four essential components: a.) identification of the nursing care problems b.) statement of the expectedbenefit to the patient c.) statement of the specific actions by the nurse that reflect the nursing approach and achievethe goals specified d.) evaluation of the patients response to nursing care and readjustment of that care as requiredOPTION A- source-oriented recordeach person or department makes notations in a separate section or sectionsin he clients chartOPTION B- progress notesprovides information about the progress a client is making toward achieving thedesired outcomesOPTION D- nursing interventionpart of the nursing care planSOURCE: Kozier, Fundamentals of Nursing, 7th ed, 330, 339 and Mosbys Pocket Dictionary, 4th ed, p 874

Situation 10 - Marie is 5 years old and described by the mother as bedwetting at night.

46. Which of the following is NOT a common cause of night bedwetting?a. deep sleep factorsb. abnormal bladder development or structure problemsc. infections familial and genetic factorsd. drinking plenty of water before sleep

CORRECT ANSWER: DRATIONALE: Bedwetting or enuresis is the involuntary urination during the day or at night into clothing or bed by achild at least 5 years of age either chronologically or developmentally (Videbeck, 465). Bed-wetting isn't caused bydrinking too much before bedtime. Causes of bedwetting are, genetic factors (it tends to run in families), difficultieswaking up from sleep, slower than normal development of the central nervous system--this reduces the child's abilityto stop the bladder from emptying at night, hormonal factors (not enough antidiuretic hormone--this hormonereduces the amount of urine made by the kidneys), urinary tract infections and inability to hold urine for a long timebecause of small bladder (familydoctor.org).

47. All of the following, EXCEPT one comprise the concepts of behavior therapy program:a. reward and punishmentb. extinctionc. learningd. placebo as a form treatment

CORRECT ANSWER: D


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RATIONALE: Behavior therapy is based on learning theory. It focuses on modifying observable and, at least inprinciple, quantifiable behavior by means of systematic manipulation of the environment and variables thought to befunctionally related to behavior. Behaviorists believed that problem behaviors are learned, and therefore can beeliminated or replaced by desirable behaviors through new learning experiences. Behavior therapy techniquesinclude behavior modification and systematic desensitization, aversion therapy, modeling, operant conditioning.SOURCE: Shives, Psychiatric-Mental health Nursing, 5 th ed, p 153

48. To help Marie who bed wets at night practice acceptable and appropriate behavior, it is important for the parents tobe consistent with the following approaches EXCEPT:a. discipline with a king attitudeb. matter of fact in handling the behavior c. sympathize for the childd. be lowing yet firm

CORRECT ANSWER: ARATIONALE: Bed wetting is modified and/or eliminated through behavior modification. Reinforcing positivebehaviors. Rewarding the desired behavior and withholding rewards for undesirable behaviors. Disciplining the childin a king attitude will intimidate the child and make her feel that everything is her fault. The child might develop a lowself-esteem. Situation must be handled in a matter of fact attitude, sympathizing the child, be lowing yet firm and notbeing too strict and demanding.SOURCE: Shives, Basic concepts of Psychiatric-Mental Health Nursing, 5 th ed, p153

49. Which of the following is used to treat enuresis?a. Imipramine (Tofranil)b. Methylphenidate (Ritalin)c. Olanzapine (Zyprexa)d. Resperidone (Risperdal)

CORRECT ANSWER: ARATIONALE: Enuresis can be treated effectively with Imipramine (Tofranil), an antidepressant with a side effect of urinary retention.OPTION B- CNS stimulant use to treat patients with ADHDOPTION C- Antipsychotic use to treat SchizophreniaOPTION D- Antipsychotic, short-term treatment of schizophreniaSOURCE: Lippincott Williams & Wilkins, Nursing Drug Handbook, 26 th ed, pp 454, 495, 490, 509

50. During your conference, the parent inquires how to motivate Marie to be dry in the morning. Your response which isan immediate intervention would be:a. Give a star each time she wakes up dry and every set of five stars, give a prizeb. Tokens make her materialistic at an early age. Give praise and hugs occasionallyc. What does your child want that you can give every time he/she wakes up dry in the morning?d. Promise him/her a long awaited vacation after school is over.

CORRECT ANSWER: BRATIONALE: Behavior modification is based on the principle that behavior that is rewarded is more likely to berepeated. Developmentally appropriate behaviors are normally rewarded with validation by a significant adult in thechilds life, so modifying behavior in this manner is a standard parenting technique.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, pp 875-876

Situation 11 - The nurse is often met with the following situations when clients become angry and hostile.

51. To maintain a therapeutic eye contact and body posture while interacting with angry and aggressive individual, thenurse should:a. keep an eye contact while staring at the clientb. keep his/her hands behind his/her back or in one's pocketc. fold his/her arms across his/her chestd. keep an "open" posture, e.g. Hands by sides but palms turned outwards

CORRECT ANSWER: DRATIONALE: The nurse should approach the client who is angry and hostile in a nonthreatening, calm manner andnon aggressive posture while maintaining personal safetyOPTION A- its like challenging the behavior of the client which is not therapeuticOPTION B- it may be misinterpreted by the client that you will try to harm him/her, especially if the client is paranoidOPTION C- shows a close, aggressive postureSOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, p 197

52. During the pre-interaction phase of the N-P relationship the nurse recognizes this normal INITIAL reaction to anassaultive or potentially assaultive person.a. To remain and cope with the incidentb. Display empathy towards the patientc. To call for help from the other members of the teamd. To stay and fight or run away

CORRECT ANSWER: B


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RATIONALE: Approach should be nonthreatening and in a calm manner. Conveying empathy for the clients anger or frustration is important. The nurse can encourage the client to express his/her angry feelings verbally, suggestingthat the client is still in control and can maintain that control.

OPTION A- Respond as early as possibleOPTION C-Calling for help is not an initial reaction. It is necessary if the client becomes very physically aggressiveOPTION D- Always maintain control of yourself and the situation; remain calm. Your behavior provides a role modelfor the client and communicates that you can and will provide control.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, pp 197, 198, 203

53. Which of the following is an accurate way of reporting and recording an incident?a. "When asked about his relationship with his father, client became anxious."b. "When asked about his relationship with his father, client clenched his jaw/teeth made a fist and turned

away from the nurse."c. "When asked about his relationship with his father, client was resistant to respond."d. "When asked about his relationship with his father, his anger was suppressed."

CORRECT ANSWER: BRATIONALE: Recording and reporting should be documented descriptively or completely. It should describe everyaction and/or behavior undertaken by the client.OPTION A, C and Dvery vague descriptions. It doesnt show the manifestations of each behavior.

54. To encourage thought. Which of the following approaches is NOT therapeutic?a. "Why do you feel angry?"b. "When do you usually feel angry?"c. "How do you usually express anger?"d. "What situations provoke you to be angry?"

CORRECT ANSWER: ARATIONALE: It is non therapeutic because it requests an explanation from the client. There is a difference betweenasking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a whyquestion is intimidating. In addition, the client is unlikely to know why and may become defensive trying to explainhimself or herself.OPTION B, C, D- Placing event in time or sequenceputting events in proper sequence helps both the nurse andclient to see them in perspective. The client may gain insight into cause-and-effect behaviour and consequences.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, pp 117, 120

55. A patient grabs a chair and about to throw it. The nurse best responds saying.a. "Stop. Put that chair down."b. "Don't be silly."c. "Stop, the security will be here in a minute."d. "Calm down."

CORRECT ANSWER: ARATIONALE: The client is about to loss control of himself. The nurse must take control of the situation and shouldprovide directions to the client in a calm, firm voice. The nurse should tell the client that aggressive behavior is notacceptable and that the nurse is there to help the client regain control.OPTION B- Ignoring the situation and belittling the clients capabilities.OPTION C- Threatening the client can lead to a more aggressive behavior OPTION D- It is true if the client is still in the triggering phase of aggressive behavior.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 184

Situation 12 - Nursing care for the elderly.

56. In planning care for a patient with Parkinson's disease, which of these nursing diagnoses should have priority?a. potential for injuryb. altered nutritional statec. ineffective copingd. altered mood state

CORRECT ANSWER: ARATIONALE: The client has neuromuscular impairment, such as muscle weakness, tremors, bradykinesia andmusculoskeletal impairment as manifested by joint rigidity; therefore the patient is potential for having an injury.OPTION B- Secondary nursing diagnosisOPTION C- not related to parkinsons diseaseOPTION D- not related to parkinsons diseaseSOURCE: Black et al, Medical-Surgical Nursing, 7 th ed, vol. 2, p 2174

57. A healthy adaptation to aging is primarily related to an individual.a. Number of accomplishmentsb. Ability to avoid interpersonal conflictc. Physical health throughout lifed. Personality development in his life span

CORRECT ANSWER: C


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RATIONALE: Physical health also can influence how a person responds to psychosocial stress and illness. Thehealthier a person is, the better he or she can cope with stress and illness.OTHER OPTIONSsecondary reasons for healthy adaptationSOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p132

58. The frequent use of the older client's name by the nurse is MOST effective in alleviating which of the followingresponses to old age?a. Lonelinessb. Suspicionc. Grief d. Confusion

CORRECT ANSWER: DRATIONALE: Clients with delirium cannot focus, sustain or shift attention effectively, and there is impaired recentand immediate memory. To manage clients confusion, the nurse provides orienting cues when talking with clients,such as calling them by name and referring to the time of the day or expected activity.OPTION A- a lot of things causes loneliness to an elderly person, such as death of a spouse or relative, pain,certain times of the day or night. The role f the nurse is to let the client verbalize feelings and grow from theexperienceOPTION B- loss of sight or hearing, sensory deprivation and physical impairment often contribute to suspiciousnessin elderly persons. Aging persons may feel that others are talking about them or conspiring against them. Nursingcare focuses on establishing rapport; enhancing self-esteem; decreasing fears and suspicions; utilizing listening andacceptanceOPTION C- loss of a spouse or loved one is the most stressful event across all ages. The role of the nurse as thefacilitator in grief work is to help the client accept the loss, express feelings about the loss and learn and grow fromthe experience.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, p517; Shives, Psychiatric Mental Health Nursing, 5 th

ed, pp 288, 597, 598, 604

59. An elderly confused client gets out of bed at night to go to the bathroom and tries to go to another bed when shereturns. The MOST appropriate action the nurse would take is to:a. Assign client to a single roomb. Leave a light on all nightc. Remind client to call the nurse when she wants to get upd. put side rails on the bed

CORRECT ANSWER: ARATIONALE: It may be difficult for client to be with other patients and engage them in a conversation because theyare easily distracted and display marked attention deficits. Memory is often impaired. Assigning the client to a singleroom will help prevent the client from wandering; promote safety and decrease confusion.OPTION B- comes after assigning the client into a single room. It also promotes safetyOPTION C- it fosters dependency to the nurse which is not therapeuticOPTION D- clients who are confused have errors in perception of sensory stimuli. They might mistake some objectsinto something dreadful and although putting the side rails up can promote safety, patients need to be oriented firstabout why there is a need for side rails because they might think that they are being held captive. It often becomesthe object of the clients projected fear.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, p 578, 579

60. An elderly who has lots of regrets, unhappy and miserable is experiencing:a. Crisisb. Despair c. Lossd. Ambivalence

CORRECT ANSWER: BRATIONALE: If an individual does not develop as sense of satisfaction with life and its meaning and believe that lifeis not fulfilling and unsuccessful, that person is undergoing despair. They cant adapt to the changing environmentand cant overcome what has been referred to as season of losses.OPTION A- Occurs when a person, family or group is inadequately prepared to handle the event or situation.Normal coping methods fail, tension rises and feelings of anxiety, fear, guilt, anger, shame and helplessness mayoccur.OPTION C- A person experiences a feeling of loss when a spouse or relative diesOPTION D- Presence of two opposing ideas, emotions, feelings at the same time.SOURCE: Shives, Basic concepts of Psychiatric Mental Health Nursing, 5 th ed, pp 161, 596

Situation 13 Graciela, 1 year old is admitted in the hospital from the emergency room with a fracture of the left femur dueto a fall down a flight of stairs. Graciela is placed oh Bryant's traction.

61. While on Bryant's traction, which of these observations of Graciela and her traction apparatus would indicate adecrease in the effectiveness of her traction?a. Graciela's buttocks are resting on the bedb. The traction weights are hanging 10 inches above the floor c. Graciela's legs are suspended at a 90 degree angle to her trunkd. The traction ropes move freely through the pulley


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CORRECT ANSWER: ARATIONALE: Bryants traction is a type of running traction in which the pull is only in one direction. Skin traction isapplied to the legs, which are flexed at a 90-degree angle at hips. The childs trunk provides counter traction.Buttocks are raised slightly off the bed. Traction weights are hanging 10 in above the floor and ropes move freelythrough the pulley.SOURCE: Hockenberry, Wongs Essential of Pediatric Nursing, 7th ed, p 1161

62. The nurse notes that the fall might also cause a possible head injury- She will be observed for signs of increasedintracranial pressure which include:a. Narrowing of the pulse pressureb. Vomitingc. Periorbital edemad. A positive Kernig's sign

CORRECT ANSWER: BRATIONALE: Manifestations of increased ICP are subtle and diligent observation for changes in the clientscondition is necessary. Clinical manifestations include, any alteration in LOC, changes in speech, papillary reactivityheadache, nausea, vomiting, diplopia (blurred or double vision), papilledema,increased systolic blood pressure withwidened pulse pressure and bradycardialate response and indicates severe increased ICPOPTION A- Increased systolic blood pressure with widened pulse pressure not narrowedOPTION C- There is papilledema instead of periorbital edema, due to increased tension in the skull that istransmitted to the optic nerveOPTION D- Kernigs sign is a diagnostic sign for meningitis marked by loss of the ability of a supine patient tocompletely straighten the leg when it is full flexed at the knee and hipSOURCE: Black et al, Medical- Surgical Nursing, 7 th ed, pp 2191-2192

63. Graciela is assessed to have no head injury. The Bryant's traction is removed. A plaster of paris is applied to hisspica. Which of these finding as a concern of immediate attention that must be reported to the physicianimmediately?a. Graciela is scratching the cast over her abdomenb. The toes of Graciela's left foot blanch when the nurse applies pressure on themc. Graciela's cast is still dampd. The nurse is unable to insert a finger under the edge of Graciela's cast on her left foot

CORRECT ANSWER: DRATIONALE: If the nurse is unable to insert a finger under the patients cast it means the client is suffering from

compartment syndrome, brought about by excessive swelling that constricts the enclosed soft tissueOPTION A-OPTION B- Normal capillary refill is about 2-3 seconds. Blanching of the foot when pressure is applied is normal.OPTION C- As the water from newly applied cast eventually evaporates, a mature cast of full strength develops.Plaster casts set quickly but take hours to days to dry completelySOURCE: Black et al, Medical- Surgical Nursing, 7 th ed, pp 631, 633-634

64. Part of discharge plan is for the nurse to give instructions about the care of Graciela's cast to the mother.Which of statement by the mother indicates a need for further instructions?a. The cast may feel warm as the cast dries.b. If the cast becomes wet, a blow drier set on the cool setting may be used to dry cast.c. A small amount of white shoe polish can touch up a soiled white cast.d. I can use lotion or powder around the cast edges to relieve itching.

CORRECT ANSWER: DRATIONALE: The mother must be instructed not to use lotion or powders on the skin around the cast edges or inside the cast, since lotions and powders can become sticky, caked and cause skin irritation.OPTION A- Feeling of warmth is normal when the cast is starting to dry up.OPTION B- If the cast gets wet, it can be dried with a hair dryer set to a cool setting to prevent skin breakdown.OPTION C- White shoe polish is used to touch up the soiled edges of a white cast.SOURCE: Silvestri, Saunders Comprehensive Review for the NCLEX-RN, 3 rd ed, p 1004

65. The nurse counsels Graciela's mother ways to safeguard safety while providing opportunities of Graciela to developa sense of:a. Trustb. Initiativec. Industryd. Autonomy

CORRECT ANSWER: DRATIONALE:

STAGE POSITIVE EFFECT NEGATIVE EFECTInfancy (0-1 yrs)>Trust vs. Mistrust

Sound basis for relatingto other people

General difficultiesrelating to people effectively;

trust-fear conflictToddlerhood (1 -3 yrs)>Autonomy vs. Shame &

Doubt

Sense of self-control andadequacy; free will

Independence-fear conflict; sever feelings of self-

doubt


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Preschool (3-6 yrs)>Initiative vs. Guilt

Ability to initiate onesown activities; sense of purpose

Aggression-fear conflict;sense of inadequacy or guilt

School Age (6-12 yrs)>Industry v. Inferiority

Competence; ability towork

Sense of inferiority;difficulty learning and working

SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 30

Situation 14 - Jolina is an 18 year old beginning college student. Her mother observed that she is having problems relatingwith her friends. She is undecided about her future. She has lost insight, lost interest in anything and complained andcomplained of constant tiredness.

66. Jolina is out on antidepressant drugs. These drugs act on the brain chemistry, therefore they would be useful inwhich type of depression?a. exogenous depressionb. neurotic depressionc. endogenous depressiond. psychotic depression

CORRECT ANSWER: BRATIONALE : Neurotic depression is any state of depression that is not psychotic. Neurotic disorders are mentaldisorders without any demonstrable organic basis in which the patient may have considerable insight and hasunimpaired reality testing, in that he usually does not confuse his morbid subjective experiences and fantasies withexternal reality.OPTION A- Exogenous depression is an inappropriate state of depression that is precipitated by events in theperson's life.OPTION C- Endogenous depression is a severe form of depression usually characterized by insomnia, weight loss,and inability to experience pleasure, thought to be of internal origin and not influenced by external events. Alsocalled melancholia.OPTION D- Psychotic depression is a state of depression so severe that the person loses contact with reality andsuffers a variety of functional impairments.

67. This is a tricyclic antidepressant drug:a. Venlafaxine (Effexor)c. Setraline (Zoloft)b. Flouxetine (Prozac)d. Imipramine (Tofranil)

CORRECT ANSWER: DRATIONALE: TCAs are thought to act primarily by blocking the reuptake of norepinephrine and to a lesser degree,serotonin.OPTION A- it is a novel antidepressant. Venlafaxine blocks the reuptake of both norepinephrine and serotoninOPTION B- it is a SSRI that preferentially block the reuptake and thus the destruction of serotonin, with little or noeffect on the other monoamine transmittersOPTION C- still a SSRI.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, pp 69, 72-73

68. After one week of antidepressant medication, Jolina still manifests depression. The nurse evaluates this as;a. Unusual because action of antidepressant drug is immediateb. Unexpected because therapeutic effectiveness takes within a few daysc. Expected because therapeutic effectiveness takes 2-4 weeks

d. Ineffective result because perhaps the drug's dosage is inadequate

CORRECT ANSWER: CRATIONALE: One drawback to the use of antidepressant medication is that the client may have to take theantidepressant agents for 1-3 weeks before improvement is noticed.OPTION A- antidepressants doesnt take effect immediatelyOPTION B- it is expected because antidepressants take effect 2-3 weeks after ingestionOPTION D- it is not ineffectiveSOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, p 470

69. Jolina continues to verbalize feeling sad and hopeless. She is not mixing well with other clients. One of the nurse's

important consideration for Jolina initially is to:a. Formulate a structured schedule so she is able to channel her energies externally

b. Let her alone until she feels like mingling with othersc. Encourage her to join socialization hour so she will start to relate with othersd. Encourage her to join group therapy with other patients

CORRECT ANSWER: CRATIONALE: Often clients decline to engage in activities because they are too fatigued or have no interest. Thenurse can validate these feelings yet still promote participation. The nurse can let clients know they must becomemore active to feel better rather than waiting passively for improvement.OPTION A- Not applicable for depressed clientOPTION B- The first priority is to determine whether a client is suicidal. Depressed client are more likely to besuicidal. Suicide precautions must be instituted. The client must not be left alone.OPTION D- Group therapy is indicated for schizophrenic clients and personality disorder


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SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, pp 319, 322

70. During the predischarge conference, the nurse suggests vocational guidance because it should help Jolina to:a. Find a good jobb. Make some decision about her futurec. Realistically assess her assets and limitationsd. to solve her own problems

CORRECT ANSWER: CRATIONALE: Vocational guidance aims to determine clients interests and abilities and matching them withvocational choices.OPTION A- comes after the client has assess her assets and limitationsOPTION B- goal of psychotherapyOPTION D- still with psychotherapySOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 78

Situation 15 - Group Approach in Nursing.

71. Membership drop out generally occurs in group therapy after a member:a. Accomplishes his goal in joining the groupb. Discovers that his feelings are shared by the group membersc. Monopolizes the groupd. Discusses personal concerns with group members

CORRECT ANSWER: CRATIONALE: A person who monopolizes the group uses his compulsive speech as an attempt to deal with anxiety.

As the client sees group tension grow, the clients level of anxiety rises and the clients tendency to speak increaseseven more. Therefore no one else gets the chance to be heard, and other group members eventually lose interestand begin to withdraw. Also clients who experiences feelings of frustration in the group drops out from it.OPTIONS A, B and D- shows that the client is interested in the group, happy to be in the group, fulfilled as a personand has overcome her undesirable behaviors.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, p 943

72. Which of the following questions illustrates the group role of encourager?a. What were you saying?b. Who wants to respond next?

c. Where do you go from here?d. Why haven't we heard from you?

CORRECT ANSWER: BRATIONALE: Asking who wants to respond next is encouraging client to express self with out forcing the client to doit.OPTION A- Its like forcing the client to participate. Not therapeuticOPTION C- Testing the client forces the client to respondOPTION D- Why questions are intimidating and makes client defensive.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 115

73. The goal of remotivation therapy is to facilitate:a. Insightb. Productivityc. Socializationd. Intimacy

CORRECT ANSWER: BRATIONALE: Remotivation therapy resocializes regressed and apathetic clients, reawakens interest in their environment, increases participants sense of reality and productivity and realizes more objective self image.OPTION C- is true in reminiscing therapySOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, p 906

74. The treatment of the family as a unit is based on the belief that the family:a.is a social system and all the members are interrelated components of that systemb.as a unit of society needs the opportunity to change its own destinyc. who has therapy together will tend to remain together d.is "contaminated" by the presence of deviant member and all members need treatment

CORRECT ANSWER: ARATIONALE: Family is a group related by heredity, such as parents, children and siblings. It is a social unit and allmembers are interrelated with each other. Although one family member usually is identified initially as the one whohas problems and needs help, it often becomes evident through the therapeutic process that other family membersalso have emotional problems and difficulties.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 63

75. The working phase in therapy group is usually characterized by which of the following?a. Cautionb. Cohesiveness


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c. Confusiond. Competition

CORRECT ANSWER: BRATIONALE: During the working phase, several group characteristics may be seen. Group cohesiveness is thedegree to which members work together cooperatively to accomplish the purpose. Cohesiveness is a desirablegroup characteristic and is associated with positive group outcomes. Cohesiveness is evidenced when membersvalue one anothers contributions to the group.OPTION D- Some groups exhibit competition, or rivalry, among members. This may positively affect the outcome of the group if the competition leads to compromise, improved group performance. Many times, however, competitioncan be destructive for the group.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 62

Situation 16 It is the nurses primary responsibility to ensure a safe environment for the patients at the Psychiatry Ward.

76. All of the following concepts are true, EXCEPT:a. Hostility is destructiveb. Frustration develops in response to unmeet needs, wants and desiresc. Anger is incompatible with loved. Aggression can be expressed in a constructive as well as destructive manner

CORRECT ANSWER: DRATIONALE: Aggression is a threatening behavior or action. It is a behavior in which a person attacks or injuresanother person or involves destruction of property. It is expressed in a destructive manner.OPTION A- Hostility is an emotion expressed through verbal abuse or threatening behavior. It intends to intimidateor cause emotional harm to another. It can lead to aggression.OPTION B- When goals are thwarted or desires are unsatisfied, frustration develops.OPTION C- Anger is the opposite of love. They cant go together due to basic differences.SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, p193

77. Carlo is acting out hostile and aggressive feelings such as yelling, agitated, threatening, clenched fist, threateninggestures, hostility. The MOST effective way to deal with Carlos behavior is initially to:a. set limits on the behavior by verbal commandb. administer prn tranquilizer c. remove the harmful objects from the roomd. restrain the patient and place him in the Isolation Room

CORRECT ANSWER: ARATIONALE: Carlo is in the escalating phase of aggression. The nurse must take control of the situation. The nurseshould provide directions to the client in a calm, firm voice and tell the client that aggressive behavior is notacceptableOPTION B- prn tranquilizers should be offered if ordered by the physician in the triggering phaseOPTION C- removing of harmful objects is not necessary in the escalating phaseOPTION D- Restraining the patient is required in the crisis phase, wherein client loses control emotionally andphysically, throwing objects, kicking, hitting, screaming, etc. The staff must take charge of the situation for the safetyof the client, staff and other clientsSOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, p 196

78. Mrs. Dizon was visiting her son at the Psychiatry Ward. Which of the following items will the nurse not allow to bebrought inside the ward?a. string rosary braceletb. box of cakec. bottle of coked. rubber shoes

CORRECT ANSWER: CRATIONALE: When the patient becomes physically aggressive, he/she can broke the bottle of coke and injurehim/her own self, the staff and even other patients. The environment must be free from potentially harmful objects.Promote safety of patients, other clients and the staff.OPTION A- A bracelet is too small to cause harmOPTION B- No harm at allOPTION D- Although it is painful being hit by a rubber shoes, but the damage is not fatal.

79. Which of the following will probably be most therapeutic for a patient on a behavioral modification ward?a. if the client is agitated, discuss the feelings especially anger b. insist to stop obscene language by verbal reprimandc. give client support and positive feedback for controlling use of obscene languaged. provide a punching bag as an alternative to express upset emotions

CORRECT ANSWER: CRATIONALE: Behavior Modification is a method of attempting to strengthen a desired behavior or response byreinforcement, either positive or negative. The group leader provides positive reinforcement by giving the clientattention and positive feedback. Negative reinforcement involves removing a stimulus immediately after a behavior occurs.


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OPTION A- Although making the client verbalize his/her feelings is therapeutic, but the focus of behavior modification is reinforcing the desired behavior.OPTION B- Insisting the client to stop by verbal reprimand can stir up argument and promote more aggressivebehavior OPTION D- Providing a punching bag can help to reduce upset emotions but you are not confronting the clientdirectly. Nurses must be firm and direct in modifying the aggressive behavior SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, p 58

80. Which of the following must be considered while planning activities for the depressed patient?a. activities which require exertion of energyb. challenging activities to get him out of his depressionc. reading materials to divert his thoughtsd. variety of unstructured activities

CORRECT ANSWER: ARATIONALE: In dealing with depressed clients, one must consider the clients energy level. Activities that requireexertion of energy is best for depressed clients because the more energy the task requires, theless energy the client will have to engage in hostile, aggressive behavior and self inflicted harmOPTIONS B & CDepressed clients have impaired cognition and inability to concentrate. They will not be able tocomprehend or think well if you will engage them in challenging activities and make them read.OPTION D- They should be involved in simple tasks to enhance their self-esteem and encourage concentration.Unstructured activities could bring about more impaired cognition and decrease concentrationSOURCE: Shives, Basic concepts of Psychiatric-Mental Health Nursing, 5 th ed, pp 302, 304, 305

Situation 17 - Nurse's in all practice areas are likely to come in contact with clients suffering from acute or chronic drugabuse.

81. The psychodynamic therapy of substance abuse is based upon the premise that drug abuse is:a. a common problem brought about by socioeconomic deprivationb. caused by multiplicity of factorsc. predisposed by an inability to develop appropriate psychological resources to manage developmental stressesd. due to biochemical factors

CORRECT ANSWER: BRATIONALE: The exact cause of drug use, dependence and addiction are not known, but various factors arethought to contribute to the development of substance-related disorders.

OPTION A- People risk addiction when they lack other capacities, choices, interests or sources of attachment tosomething outside themselves.OPTION C- Some people use prohibited drugs and even alcohol as a coping mechanism or to relieve stress andtension, increase feelings of power and decrease psychological painOPTION D- All drugs of abuse have one thing in commonthe stimulation of dopamine secretion. Dopamine isresponsible for integration of emotions and thoughts and involved in decision makingSOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed p411; Shives, Basic concepts of Psychiatric-MentalHealth Nursing, 5 th ed, pp 427-428

82. Being in contact with reality and the environment is a function of the:a. conscienceb. egoc. idd. super egoCORRECT ANSWER: B RATIONALE:In Freud's theory, the ego mediates among the id, the super-ego and the external world. Its task is to find a balancebetween primitive drives, morals, and reality while satisfying the id and superego. It is the part of the mind whichcontains the consciousness.OPTION A- Conscience is the awareness of a moral or ethical aspect of ones conduct together with the urge toprefer right over wrong.OPTION C-The id stands in direct opposition to the super-ego. It is dominated by the pleasure principle. It isresponsible for our basic drives such as food, sex and aggressive impulses, and demands immediate satisfaction. Itis amoral and egocentric, ruled by the pleasure-pain principle. It does not take social norms into account when'thinking' or 'acting'. The id is the primal, or beastlike, part of the brain.OPTION D- The super-ego acts as the conscience, maintaining our sense of morality and the prohibition of taboos.

83. Substance abuse is different from substance dependence in the sense that substance dependence:a. includes characteristics of adverse consequences and repeated useb. requires long term treatment in a hospital based programc. produces less severe symptoms than that of abused. includes characteristics of tolerance and withdrawal

CORRECT ANSWER: DRATIONALE: Tolerance increasing amount of the substance is required to achieve the desired effect or there is amarkedly diminished effect with repeated use of the same dose. Withdrawal the person following reduction or cessation of intake of the substance experiences a substance-specific syndrome. Such withdrawal signs could bephysiologic or psychologicSOURCE: Sia, Psychiatric Nursing, p361


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84. During the detoxification stage, it is a priority for the nurse to:a. teach skills to recognize and respond to health threatening situationsb. increase the client's awareness of unsatisfactory protective behaviorsc. implement behavior modificationd. promote homeostasis and minimize the client's withdrawal symptoms

CORRECT ANSWER: DRATIONALE: The first and most critical purpose of alcohol treatment or removal of the harmful physical andemotional effects of alcohol usage is to complete process of alcohol detoxification safely and with as few painful anddangerous withdrawal symptoms as possible. There is a very high element of danger that can occur during theprocess of detoxification when those alcohol dependents are made to stop using alcohol. It can result in dangerousside effects during the alcohol withdrawal process. These side effects can be serious enough to cause even death.For this reason, alcohol detoxification should never be attempted alone and be done by medical professionals.SOURCE: www.detox.org.il/alcohol-detoxification.asp

85. Commonly known as "shabu" is:a. Cannabis Sativab. Lysergic add diethylamidec. Methylenedioxy methamphetamined. Methamphetamine hydrochloride

CORRECT ANSWER: DRATIONALE: Methamphetamine hydrochloride is the scientific name of shabu.OPTION A is commonly called marijuana.OPTION B is the most widely used hallucinogenic drug. Hallucinogenic drugs cause a person to see vivid images,hear sounds, and feel sensations that seem real but are not. LSD is also called acid, doses, hits, Microdot, sugar cubes, tabs, and trips. It is odorless and colorless and has a slightly bitter taste. It can be obtained as a coloredtablet, clear liquid, or thin square of gelatin (window panes) or on blotter paper. Most often, LSD is licked off blotter paper or taken by mouth. However, the gelatin and liquid forms can be put in the eyes.OPTION C is most commonly known today by the street name ecstasy (often abbreviated to E, X, or XTC), is asemisynthetic member of the phenethylamine class of psychoactive drugs. The drug is well known for its ability toproduce feelings of overwhelming euphoria, intimacy, and connectedness with others, and is commonly associatedwith the rave culture and its related genres of music.

Situation 18 - It is common that client ask the nurse personal questions.

86. Anticipation of personal questions is given adequate attention during which phase of the nurse patient relationship?a. Orientation phaseb. Working phasec. Pre-interaction phased. Termination phase

CORRECT ANSWER: BRATIONALE: Describing, and often re-experiencing in the working phase, old conflicts generally awakens highlevels of anxiety in the client. Clients may use various defenses against anxiety and displace their feelings onto thenurse. Therefore during the working phase, intense emotions such as anxiety, anger, self-hate, and hopelessnessmay surface. Behaviors such as acting out anger inappropriately withdrawing, intellectualizing, manipulating anddenying are to be expected. Nurses are often manipulated by client to change roles. This keeps the focus off theclient and prevents the building of a relationship. Testing and manipulating behaviors of clients during workingphase, challenges the nurse to stay focused and not to react or be distracted.OPTION A- During the orientation phase, the nurse establishes roles, the purpose of meeting, and the parametersof subsequent meetings; identifies clients problems; and clarifies expectationsOPTION C- Pre interaction is where the nurse or nursing students together with their instructors, discusses thecommon concerns regarding the exposure to a psychiatric unit. It usually revolves around planning the firstinteraction with the client.OPTION D- Final step of the therapeutic relationship. The nurse terminates the relationship when the mutuallyagreed-on goals are reached, the client is transferred or discharged, or the nurse has finished the clinical rotation.

As separation occurs, it is common for the client to exhibit regressive behavior, demonstrate hostility or experiencesadness.SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4 th ed, pp 232, 235, 247 and Shives,Psychiatric-Mental Health Nursing, 5 th ed, p 139

87. The client asks for the nurse's telephone number, which of these responses is NOT appropriate?a. "it is confidential I just don't give it to anyone."b. "What would you do with my number if I give it to you?"c. "If I say no to your request, what are your thoughts about it?"d. "Are you asking for an official number of the hospital/clinic for your reference?"

CORRECT ANSWER: ARATIONALE: Rejectingthis technique closes the possibility of exploration of the clients feelings. In turn, the clientmay feel personally rejected along with his/her ideasOPTION B- Exploringhelps examine the issue more fully. Promotes further discussionOPTION C- Encouraging expressionencourages the client to make his/her own appraisal rather than acceptingthe opinion of others


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OPTION D-Seeking Clarificationhelps the nurse to avoid making assumptions. It helps client to express thoughts,feelings and ideas more clearlySOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, pp 116, 117, 120

88. When the client asks about the family of the nurse the MOST appropriate response is:a. Avoid the situation and redirect the client's attentionb. Give a brief and simple response and focus on the clientc. "Why don't we talk about your family instead?"d. Introduce another topic like the client's interests

CORRECT ANSWER: BRATIONALE: Answer directly and briefly and then go back to the topic you were discussing. Nurses should showunderstanding and acceptance to the client and at the same time setting limits to the behavior. Therapeuticrelationship should be client-centered.OPTION A- Rejectingthis technique closes the possibility of exploration of the clients feelings. In turn, the clientmay feel personally rejected along with his/her ideasOPTION C- Requesting an explanationthis question is intimidating and client may become defensiveOPTION D- Introduction of unrelated topicthe nurse takes the initiative for the interaction away from the clientSOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, p 120

89. When the nurse is asked a personal question, which of these reactions indicates a need for her to introspect?a. The client is simply curiousb. His/her right to privacy is being intrudedc. The client knows no other way to begin a conversationd. Some patients are like children in seeking recognition from the nurse

CORRECT ANSWER: DRATIONALE: The nurse must understand that some clients who are mentally ill feel rejected, seeks attention andneed to be loved and cared for. Sometimes they are like children who constantly seek attention and be recognized.What they havent experienced from their own family, they try to get it from the nurse and other people. They needto feel that somebody cares for them.OPTION A- Mentally ill clients are not curiousOPTION B- The nurse has the option whether to answer or not answer the clients question. If she chooses toanswer then it cant be said that her right to privacy has been intruded.OPTION C- It could be that clients know no other way to start a conversation with the nurse

90. It is 10 o'clock of your watch. The client asks, "What time is it?" The nurse's appropriate response is:a. "Are you bored?"b. "It is 10 o'clock."c. "Why do you ask?"d. "Guess, what time is it?"

CORRECT ANSWER: BRATIONALE: Giving Informationinforming the client of facts increases his or her knowledge about a topic. Thenurse is functioning as a resource person. Giving information also builds trust with the client.OPTION A- Interpreting--the clients thoughts and feelings are his or her own, not to be interpreted by the nurse or for hidden meaning. Only the client can identify or confirm the presence of feelingsOPTION C- Requesting an explanationwhy question is intimidatingOPTION D- Indicating the existence of an external sourceimplies that the client was made or compelled to think ina certain waySOURCE: Videbeck, Psychiatric Mental Health Nursing, 3 rd ed, pp 112-115

Situation 19 Jim, age 25, recalled that his problem began around age 15 or 16. He would count pencils in a mug over andover with the thought that stopping could result in something bad happening.

91. There are many things Jim seems he has to do to keep him from getting:a. confusedb. suspiciousc. excitedd. anxious

CORRECT ANSWER: DRATIONALE: Jim has an obsessive-compulsive disorder. OCD can be manifested through many behaviors that arerepetitive, meaningless and difficult to conquer. The person understands that these rituals are unusual andunreasonable but feels forced to perform them to alleviate anxiety or to prevent terrible thoughts.OPTION A- defined as having impaired psychological capacity to the extent of being forgetful and no longer able tocarry out simple everyday taskOPTION B- believing that something is wrong. A characteristic of paranoid PD.OPTION C- feeling or condition of lively enjoyment or pleasant anticipationSOURCE: Videbeck, Psychiatric Mental Health Nursing, 2 nd ed, p 285

92. He has to change clothes 20 times before work, chew each bite he eats 24 times and go up and down the stairs four to five times before it feels right. He is demonstrating:a. ideas of referenceb. denial and projection


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c. obsession and compulsiond. rationalization and over reaction

CORRECT ANSWER: CRATIONALE: Obsession is a recurrent, persistent, unpleasant and unwanted thoughts, images or impulses thatcause marked anxiety and interfere with interpersonal, social or occupational functions. Compulsion on the other hand is a ritualistic or repetitive behavior or mental acts that a person carries out continuously in an attempt toneutralize anxiety. 285OPTION A- Ideas if reference is the clients in accurate interpretation that general events are personally directed tohim/her 162OPTION B- Denial is a defense mechanism that shows failure to admit reality of a situation; Pr

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