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Psychiatric Nursing questions with rationale

Psychiatric Nursing questions with rationale

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Published by Karol Delagana

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Published by: Karol Delagana on Sep 11, 2010
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Psychiatric nursing
1. Mental health is defined as: A. The ability to distinguish what is real from what is not.B. A state of well-being where a person can realize his own abilities cancope with normal stresses of life and work productively.C. Is the promotion of mental health, prevention of mental disorders,nursing care of patients during illness and rehabilitationD. Absence of mental illness Answer: (B) A state of well-being where a person can realize his ownabilities can cope with normal stresses of life and work productively.Mental health is a state of emotional and psychosocial well being. Amentally healthy individual is self aware and self directive, has the abilityto solve problems, can cope with crisis without assistance beyond thesupport of family and friends fulfill the capacity to love and work andsets goals and realistic limits. A. This describes the ego function realitytesting. C. This is the definition of Mental Health and PsychiatricNursing. D. Mental health is not just the absence of mental illness.2. Which of the following describes the role of a technician? A. Administers medications to a schizophrenic patient.B. The nurse feeds and bathes a catatonic clientC. Coordinates diverse aspects of care rendered to the patientD. Disseminates information about alcohol and its effects. Answer: (A) Administers medications to a schizophrenic patient. Administration of medications and treatments, assessment,documentation are the activities of the nurse as a technician. B. Activities as a parent surrogate. C. Refers to the ward manager role. D.Role as a teacher.3. Liza says, ³Give me 10 minutes to recall the name of our collegeprofessor who failed many students in our anatomy class.´ She isoperating on her: A. SubconsciousB. ConsciousC. UnconsciousD. Ego Answer: (A) SubconsciousSubconscious refers to the materials that are partly remembered partlyforgotten but these can be recalled spontaneously and voluntarily. B.This functions when one is awake. One is aware of his thoughts,feelings actions and what is going on in the environment. C. The largestpotion of the mind that contains the memories of one¶s past particularlythe unpleasant. It is difficult to recall the unconscious content. D. Theconscious self that deals and tests reality.4. The superego is that part of the psyche that: A. Uses defensive function for protection.B. Is impulsive and without morals.C. Determines the circumstances before making decisions.D. The censoring portion of the mind. Answer: (D) The censoring portion of the mind.The critical censoring portion of one¶s personality; the conscience. A.This refers to the ego function that protects itself from anything thatthreatens it.. B. The Id is composed of the untamed, primitive drives andimpulses. C. This refers to the ego that acts as the moderator of thestruggle between the id and the superego.5. Primary level of prevention is exemplified by: A. Helping the client resume self care.B. Ensuring the safety of a suicidal client in the institution.C. Teaching the client stress management techniquesD. Case finding and surveillance in the community Answer: (C) Teaching the client stress management techniquesPrimary level of prevention refers to the promotion of mental health andprevention of mental illness. This can be achieved by rendering healthteachings such as modifying ones responses to stress. A. This is tertiarylevel of prevention that deals with rehabilitation. B and D. Secondarylevel of prevention which involves reduction of actual illness throughearly detection and treatment of illness.6. Situation: In a home visit done by the nurse, she suspects that thewife and her child are victims of abuse.Which of the following is the most appropriate for the nurse to ask? A. ³Are you being threatened or hurt by your partner?B. ³Are you frightened of you partner´C. ³Is something bothering you?´D. ³What happens when you and your partner argue?´ Answer: (A) ³Are you being threatened or hurt by your partner?The nurse validates her observation by asking simple, direct question.This also shows empathy. B, C, and D are indirect questions which maynot lead to the discussion of abuse.7. The wife admits that she is a victim of abuse and opens up about her persistent distaste for sex. This sexual disorder is: A. Sexual desire disorder B. Sexual arousal Disorder C. Orgasm Disorder D. Sexual Pain Disorder  Answer: (A) Sexual desire disorder Has little or no sexual desire or has distaste for sex. B. Failure tomaintain the physiologic requirements for sexual intercourse. C.Persistent and recurrent inability to achieve an orgasm. D. Also calleddyspareunia. Individuals with this disorder suffer genital pain before,during and after sexual intercourse.8. What would be the best approach for a wife who is still living with her abusive husband? A. ³Here¶s the number of a crisis center that you can call for help .´B. ³Its best to leave your husband.´C. ³Did you discuss this with your family?´D. ³ Why do you allow yourself to be treated this way´ Answer: (A) ³Here¶s the number of a crisis center that you can call for help .´Protection is a priority concern in abuse. Help the victim to develop aplan to ensure safety. B. Do not give advice to leave the abuser. Makingdecisions for the victim further erodes her esteem. However discussoptions available. C. The victim tends to isolate from friends and family.D. This is judgmental. Avoid in anyway implying that she is at fault.9. Which comment about a 3 year old child if made by the parent mayindicate child abuse? A. ³Once my child is toilet trained, I can still expect her to have some"B. ³When I tell my child to do something once, I don¶t expect to have totell"C. ³My child is expected to try to do things such as, dress and feed.´D. ³My 3 year old loves to say NO.´ Answer: (B) ³When I tell my child to do something once, I don¶t expect tohave to tell" Abusive parents tend to have unrealistic expectations on the child. A,Band C are realistic expectations on a 3 year old. 10. The primary nursing intervention for a victim of child abuse is: A. Assess the scope of the problemB. Analyze the family dynamicsC. Ensure the safety of the victimD. Teach the victim coping skills Answer: (C) Ensure the safety of the victimThe priority consideration is the safety of the victim. Attend to thephysical injuries to ensure the physiologic safety and integrity of thechild. Reporting suspected case of abuse may deter recurrence of abuse. A,B and D may be addressed later.11. Situation: A 30 year old male employee frequently complains of lowback pain that leads to frequent absences from work. Consultation andtests reveal negative results.The client has which somatoform disorder? A. Somatization Disorder B. HypochondriaisisC. Conversion Disorder D. Somatoform Pain Disorder  Answer: (D) Somatoform Pain Disorder This is characterized by severe and prolonged pain that causessignificant distress. A. This is a chronic syndrome of somatic symptomsthat cannot be explained medically and is associated with psychosocialdistress. B. This is an unrealistic preoccupation with a fear of having aserious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict.12. Freud explains anxiety as: A. Strives to gratify the needs for satisfaction and securityB. Conflict between id and superegoC. A hypothalamic-pituitary-adrenal reaction to stressD. A conditioned response to stressors Answer: (B) Conflict between id and superegoFreud explains anxiety as due to opposing action drives between the idand the superego. A. Sullivan identified 2 types of needs, satisfactionand security. Failure to gratify these needs may result in anxiety. C.Biomedical perspective of anxiety. D. Explanation of anxiety using thebehavioral model.13. The following are appropriate nursing diagnosis for the clientEXCEPT: A. Ineffective individual copingB. Alteration in comfort, painC. Altered role performanceD. Impaired social interaction Answer: (D) Impaired social interactionThe client may not have difficulty in social exchange. The cues do notsupport this diagnosis. A. The client maladaptively uses body symptomsto manage anxiety. B. The client will have discomfort due to pain. C.The client may fail to meet environmental expectations due to pain.14. The following statements describe somatoform disorders: A. Physical symptoms are explained by organic causes
B. It is a voluntary expression of psychological conflictsC. Expression of conflicts through bodily symptomsD. Management entails a specific medical treatment Answer: (C) Expression of conflicts through bodily symptomsBodily symptoms are used to handle conflicts. A. Manifestations do nothave an organic basis. B. This occurs unconsciously. D. Medicaltreatment is not used because the disorder does not have a structural or organic basis.15. What would be the best response to the client¶s repeated complaintsof pain: A. ³I know the feeling is real tests revealed negative results.´B. . ³I think you¶re exaggerating things a little bit.´C. ³Try to forget this feeling and have activities to take it off your mind´D. ³So tell me more about the pain´ Answer: (A) ³I know the feeling is real tests revealed negative results.´Shows empathy and offers information. B. This is a demeaningstatement. C. This belittles the client¶s feelings. D. Giving undueattention to the physical symptom reinforces the complaint.16. Situation: A nurse may encounter children with mental disorders.Her knowledge of these various disorders is vital.When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to: A. provide as much structure as possible for the childB. ignore the child¶s overactivity.C. encourage the child to engage in any play activity to dissipate energyD. remove the child from the classroom when disruptive behavior occurs Answer: (A) provide as much structure as possible for the childDecrease stimuli for behavior control thru an environment that is free of distractions, a calm non ±confrontational approach and setting limit totime allotted for activities. B. The child will not benefit from a lenientapproach. C. Dissipate energy through safe activities. D. This indicatesthat the classroom environment lacks structure.17. The child with conduct disorder will likely demonstrate: A. Easy distractibility to external stimuli.B. Ritualistic behaviorsC. Preference for inanimate objects.D. Serious violations of age related norms. Answer: (D) Serious violations of age related norms.This is a disruptive disorder among children characterized by moreserious violations of social standards such as aggression, vandalism,stealing, lying and truancy. A. This is characteristic of attention deficitdisorder. B and C. These are noted among children with autisticdisorder. 18. Ritalin is the drug of choice for chidren with ADHD. The side effectsof the following may be noted: A. increased attention span and concentrationB. increase in appetiteC. sleepiness and lethargyD. bradycardia and diarrhea Answer: (A) increased attention span and concentrationThe medication has a paradoxic effect that decrease hyperactivity andimpulsivity among children with ADHD. B, C, D. Side effects of Ritalininclude anorexia, insomnia, diarrhea and irritability.19. School phobia is usually treated by: A. Returning the child to the school immediately with family support.B. Calmly explaining why attendance in school is necessaryC. Allowing the child to enter the school before the other childrenD. Allowing the parent to accompany the child in the classroom Answer: (A) Returning the child to the school immediately with familysupport.Exposure to the feared situation can help in overcoming anxiety. A. Thiswill not help in relieving the anxiety due separation from a significantother. C. and C. Anxiety in school phobia is not due to being in schoolbut due to separation from parents/caregivers so these interventions arenot applicable. D. This will not help the child overcome the fear 20. A 10 year old child has very limited vocabulary and interaction skills.She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. ProfoundB. MildC. ModerateD. Severe Answer: (C) ModerateThe child with moderate mental retardation has an I.Q. of 35-50Profound Mental retardation has an I.Q. of below 20; Mild mentalretardation 50-70 and Severe mental retardation has an I.Q. of 20-35.21. The nurse teaches the parents of a mentally retarded child regardingher care. The following guidelines may be taught except: A. overprotection of the childB. patience, routine and repetitionC. assisting the parents set realistic goalsD. giving reasonable compliments Answer: (A) overprotection of the childThe child with mental retardation should not be overprotected but needprotection from injury and the teasing of other children. B,C, and DChildren with mental retardation have learning difficulty. They should betaught with patience and repetition, start from simple to complex, usevisuals and compliment them for motivation. Realistic expectationsshould be set and optimize their capability.22. The parents express apprehensions on their ability to care for their maladaptive child. The nurse identifies what nursing diagnosis: A. hopelessnessB. altered parenting roleC. altered family processD. ineffective coping Answer: (B) altered parenting role Altered parenting role refers to the inability to create an environmentthat promotes optimum growth and development of the child. This isreflected in the parent¶s inability to care for the child. A. This refers tolack of choices or inability to mobilize one¶s resources. C. Refers tochange in family relationship and function. D. Ineffective coping is theinability to form valid appraisal of the stressor or inability to use availableresources23. A 5 year old boy is diagnosed to have autistic disorder.Which of the following manifestations may be noted in a client withautistic disorder? A. argumentativeness, disobedience, angry outburstB. intolerance to change, disturbed relatedness, stereotypesC. distractibility, impulsiveness and overactivityD. aggression, truancy, stealing, lying Answer: (B) intolerance to change, disturbed relatedness, stereotypesThese are manifestations of autistic disorder. A. These manifestationsare noted in Oppositional Defiant Disorder, a disruptive disorder amongchildren. C. These are manifestations of Attention Deficit Disorder D.These are the manifestations of Conduct Disorder 24. The therapeutic approach in the care of an autistic child include thefollowing EXCEPT: A. Engage in diversionary activities when acting -outB. Provide an atmosphere of acceptanceC. Provide safety measuresD. Rearrange the environment to activate the child Answer: (D) Rearrange the environment to activate the childThe child with autistic disorder does not want change. Maintaining aconsistent environment is therapeutic. A. Angry outburst can berechannelled through safe activities. B. Acceptance enhances a trustingrelationship. C. Ensure safety from self-destructive behaviors like headbanging and hair pulling.25. According to Piaget a 5 year old is in what stage of development: A. Sensory motor stageB. Concrete operationsC. Pre-operationalD. Formal operation Answer: (C) Pre-operationalPre-operational stage (2-7 years) is the stage when the use of language, the use of symbols and the concept of time occur. A.Sensory-motor stage (0-2 years) is the stage when the child uses thesenses in learning about the self and the environment throughexploration. B. Concrete operations (7-12 years) when inductivereasoning develops. D. Formal operations (2 till adulthood) is whenabstract thinking and deductive reasoning develop.26. Situation : The nurse assigned in the detoxification unit attends tovarious patients with substance-related disorders. A 45 years old male revealed that he experienced a marked increase inhis intake of alcohol to achieve the desired effect This indicates: A. withdrawalB. toleranceC. intoxicationD. psychological dependence Answer: (B) tolerancetolerance refers to the increase in the amount of the substance toachieve the same effects. A. Withdrawal refers to the physical signs andsymptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependencerefers to the intake of the substance to prevent the onset of withdrawalsymptoms.27. The client admitted for alcohol detoxification develops increasedtremors, irritability, hypertension and fever. The nurse should be alert for impending: A. delirium tremensB. Korsakoff¶s syndromeC. esophageal varices
D. Wernicke¶s syndrome Answer: (A) delirium tremensDelirium Tremens is the most extreme central nervous system irritabilitydue to withdrawal from alcohol B. This refers to an amnestic syndromeassociated with chronic alcoholism due to a deficiency in Vit. B C. Thisis a complication of liver cirrhosis which may be secondary to alcoholism. D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination.28. The care for the client places priority to which of the following: A. Monitoring his vital signs every hour B. Providing a quiet, dim roomC. Encouraging adequate fluids and nutritious foodsD. Administering Librium as ordered Answer: (A) Monitoring his vital signs every hour Pulse and blood pressure are usually elevated during withdrawal,Elevation may indicate impending delirium tremens B. Client needsquiet, well lighted, consistent and secure environment. Excessivestimulation can aggravate anxiety and cause illusions andhallucinations. C. Adequate nutrition with sulpplement of Vit. B shouldbe ensured. D. Sedatives are used to relieve anxiety.29. Another client is brought to the emergency room by friends whostate that he took something an hour ago. He is actively hallucinating,agitated, with irritated nasal septum. A. HeroinB. cocaineC. LSDD. marijuana Answer: (B) cocaineThe manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairmentin judgment, attention and the presence of papillary constriction. C.Intoxication with hallucinogen like LSD is manifested by grandiosity,hallucinations, synesthesia and increase in vital signs D. Intoxicationwith Marijuana, a cannabinoid is manifested by sensation of slowedtime, conjunctival redness, social withdrawal, impaired judgment andhallucinations.30. A client is admitted with needle tracts on his arm, stuporous and withpin point pupil will likely be managed with: A. Naltrexone (Revia)B. Narcan (Naloxone)C. Disulfiram (Antabuse)D. Methadone (Dolophine) Answer: (B) Narcan (Naloxone)Narcan is a narcotic antagonist used to manage the CNS depressiondue to overdose with heroin. A. This is an opiate receptor blocker usedto relieve the craving for heroine C. Disulfiram is used as a deterrent inthe use of alcohol. D. Methadone is used as a substitute in thewithdrawal from heroine31. Situation: An old woman was brought for evaluation due to thehospital for evaluation due to increasing forgetfulness and limitations indaily function.The daughter revealed that the client used her toothbrush to comb her hair. She is manifesting: A. apraxiaB. aphasiaC. agnosiaD. amnesia Answer: (C) agnosiaThis is the inability to recognize objects. A. Apraxia is the inability toexecute motor activities despite intact comprehension. B. Aphasia is theloss of ability to use or understand words. D. Amnesia is loss of memory.32. She tearfully tells the nurse ³I can¶t take it when she accuses me of stealing her things.´ Which response by the nurse will be mosttherapeutic? A. ´Don¶t take it personally. Your mother does not mean it.´B. ³Have you tried discussing this with your mother?´C. ³This must be difficult for you and your mother.´D. ³Next time ask your mother where her things were last seen.´ Answer: (C) ³This must be difficult for you and your mother.´This reflecting the feeling of the daughter that shows empathy. A and D.Giving advise does not encourage verbalization. B. This response doesnot encourage verbalization of feelings.33. The primary nursing intervention in working with a client withmoderate stage dementia is ensuring that the client: A. receives adequate nutrition and hydrationB. will reminisce to decrease isolationC. remains in a safe and secure environmentD. independently performs self care Answer: (C) remains in a safe and secure environmentSafety is a priority consideration as the client¶s cognitive abilitydeteriorates.. A is appropriate interventions because the client¶scognitive impairment can affect the client¶s ability to attend to hisnutritional needs, but it is not the priority B. Patient is allowed toreminisce but it is not the priority. D. The client in the moderate stage of  Alzheimer¶s disease will have difficulty in performing activitiesindependently34. She says to the nurse who offers her breakfast, ³Oh no, I will wait for my husband. We will eat together´ The therapeutic response by thenurse is: A. ³Your husband is dead. Let me serve you your breakfast.´B. ³I¶ve told you several times that he is dead. It¶s time to eat.´C. ³You¶re going to have to wait a long time.´D. ³What made you say that your husband is alive? Answer: (A) ³Your husband is dead. Let me serve you your breakfast.´The client should be reoriented to reality and be focused on the hereand now.. B. This is not a helpful approach because of the short termmemory of the client. C. This indicates a pompous response. D. Thecognitive limitation of the client makes the client incapable of givingexplanation.35. Dementia unlike delirium is characterized by: A. slurred speechB. insidious onsetC. clouding of consciousnessD. sensory perceptual change Answer: (B) insidious onsetDementia has a gradual onset and progressive deterioration. It causespronounced memory and cognitive disturbances. A,C and D are allcharacteristics of delirium.36. Situation: A 17 year old gymnast is admitted to the hospital due toweight loss and dehydration secondary to starvation.Which of the following nursing diagnoses will be given priority for theclient? A. altered self-imageB. fluid volume deficitC. altered nutrition less than body requirementsD. altered family process Answer: (B) fluid volume deficitFluid volume deficit is the priority over altered nutrition (A) since thesituation indicates that the client is dehydrated. A and D arepsychosocial needs of a client with anorexia nervosa but they are notthe priority.37. What is the best intervention to teach the client when she feels theneed to starve? A. Allow her to starve to relieve her anxietyB. Do a short term exercise until the urge passesC. Approach the nurse and talk out her feelingsD. Call her mother on the phone and tell her how she feels Answer: (C) Approach the nurse and talk out her feelingsThe client with anorexia nervosa uses starvation as a way of managinganxiety. Talking out feelings with the nurse is an adaptive coping. A.Starvation should not be encouraged. Physical safety is a priority.Without adequate nutrition, a life threatening situation exists. B. Theclient with anorexia nervosa is preoccupied with losing weight due todisturbed body image. Limits should be set on attempts to lose moreweight. D. The client may have a domineering mother which causes theclient to feel ambivalent. The client will not discuss her feelings with her mother.38. The client with anorexia nervosa is improving if: A. She eats meals in the dining room.B. Weight gainC. She attends ward activities.D. She has a more realistic self concept. Answer: (B) Weight gainWeight gain is the best indication of the client¶s improvement. The goalis for the client to gain 1-2 pounds per week. (A)The client may purgeafter eating. (C) Attending an activity does not indicate improvement innutritional state. (D) Body image is a factor in anorexia nervosa but it isnot an indicator for improvement.39. The characteristic manifestation that will differentiate bulimianervosa from anorexia nervosa is that bulimic individuals A. have episodic binge eating and purgingB. have repeated attempts to stabilize their weightC. have peculiar food handling patternsD. have threatened self-esteem Answer: (A) have episodic binge eating and purgingBulimia is characterized by binge eating which is characterized by takingin a large amount of food over a short period of time. B and C arecharacteristics of a client with anorexia nervosa D. Low esteem is notedin both eating disorders40. A nursing diagnosis for bulimia nervosa is powerlessness related tofeeling not in control of eating habits. The goal for this problem is: A. Patient will learn problem solving skills

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