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 can cope with normal stresses of life and work producti ely. !. "s the promotion of mental health# pre ention of mental disorders# nursing care of patients during illness and rehabilitation $. Absence of mental illness Answer: %B& A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work producti ely. Mental health is a state of emotional and psychosocial well being. A mentally healthy indi idual is self aware and self directi e# has the ability to sol e problems# can cope with crisis without assistance beyond the support of family and friends fulfill the capacity to lo e and work and sets goals and realistic limits. A. This describes the ego function reality testing. !. This is the definition of Mental 'ealth and (sychiatric )ursing. $. Mental health is not *ust the absence of mental illness. +. ,hich of the following describes the role of a technicianA. Administers medications to a schizophrenic patient. B. The nurse feeds and bathes a catatonic client !. !oordinates di erse aspects of care rendered to the patient $. $isseminates information about alcohol and its effects. Answer: %A& Administers medications to a schizophrenic patient. Administration of medications and treatments# assessment# documentation are the acti ities of the nurse as a technician. B. Acti ities as a parent surrogate. !. .efers to the ward manager role. $. .ole as a teacher. /. 0iza says# 12i e me 13 minutes to recall the name of our college professor who failed many students in our anatomy class.4 5he is operating on her: A. 5ubconscious B. !onscious !. 6nconscious $. 7go Answer: %A& 5ubconscious 5ubconscious refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and oluntarily. B. This functions when one is awake. 8ne is aware of his thoughts# feelings actions and what is going on in the en ironment. !. The largest potion of the mind that contains the memories of one9s past particularly the unpleasant. "t is difficult to recall the unconscious content. $. The conscious self that deals and tests reality. :. The superego is that part of the psyche that: A. 6ses defensi e function for protection. B. "s impulsi e and without morals. !. $etermines the circumstances before making decisions. $. The censoring portion of the mind. Answer: %$& The censoring portion of the mind. The critical censoring portion of one9s personality; the conscience. A. This refers to the ego function that protects itself from anything that threatens it.. B. The "d is composed of the untamed# primiti e dri es and impulses. !. This refers to the ego that acts as the moderator of the struggle between the id and the superego. <. (rimary le el of pre ention is e=emplified by: A. 'elping the client resume self care. B. 7nsuring the safety of a suicidal client in the institution. !. Teaching the client stress management techni>ues $. !ase finding and sur eillance in the community Answer: %!& Teaching the client stress management techni>ues (rimary le el of pre ention refers to the promotion of mental health and pre ention of mental illness. This can be achie ed by rendering health teachings such as modifying ones responses to stress. A. This is tertiary le el of pre ention that deals with rehabilitation. B and $. 5econdary le el of pre ention which in ol es reduction of actual illness through early detection and treatment of illness. ?. 5ituation: "n a home isit done by the nurse# she suspects that the wife and her child are ictims of abuse. ,hich of the following is the most appropriate for the nurse to askA. 1Are you being threatened or hurt by your partnerB. 1Are you frightened of you partner4 !. 1"s something bothering you-4 $. 1,hat happens when you and your partner argue-4 Answer: %A& 1Are you being threatened or hurt by your partnerThe nurse alidates her obser ation by asking simple# direct >uestion. This also shows empathy. B# !# and $ are indirect >uestions which may not lead to the discussion of abuse. @. The wife admits that she is a ictim of abuse and opens up about her persistent distaste for se=. This se=ual disorder is: A. 5e=ual desire disorder B. 5e=ual arousal $isorder !. 8rgasm $isorder

$. 5e=ual (ain $isorder Answer: %A& 5e=ual desire disorder 'as little or no se=ual desire or has distaste for se=. B. Aailure to maintain the physiologic re>uirements for se=ual intercourse. !. (ersistent and recurrent inability to achie e an orgasm. $. Also called dyspareunia. "ndi iduals with this disorder suffer genital pain before# during and after se=ual intercourse. B. ,hat would be the best approach for a wife who is still li ing with her abusi e husbandA. 1'ere9s the number of a crisis center that you can call for help .4 B. 1"ts best to lea e your husband.4 !. 1$id you discuss this with your family-4 $. 1 ,hy do you allow yourself to be treated this way4 Answer: %A& 1'ere9s the number of a crisis center that you can call for help .4 (rotection is a priority concern in abuse. 'elp the ictim to de elop a plan to ensure safety. B. $o not gi e ad ice to lea e the abuser. Making decisions for the ictim further erodes her esteem. 'owe er discuss options a ailable. !. The ictim tends to isolate from friends and family. $. This is *udgmental. A oid in anyway implying that she is at fault. C. ,hich comment about a / year old child if made by the parent may indicate child abuseA. 18nce my child is toilet trained# " can still e=pect her to ha e someD B. 1,hen " tell my child to do something once# " don9t e=pect to ha e to tellD !. 1My child is e=pected to try to do things such as# dress and feed.4 $. 1My / year old lo es to say )8.4 Answer: %B& 1,hen " tell my child to do something once# " don9t e=pect to ha e to tellD Abusi e parents tend to ha e unrealistic e=pectations on the child. A#B and ! are realistic e=pectations on a / year old. 13. The primary nursing inter ention for a ictim of child abuse is: A. Assess the scope of the problem B. Analyze the family dynamics !. 7nsure the safety of the ictim $. Teach the ictim coping skills Answer: %!& 7nsure the safety of the ictim The priority consideration is the safety of the ictim. Attend to the physical in*uries to ensure the physiologic safety and integrity of the child. .eporting suspected case of abuse may deter recurrence of abuse. A#B and $ may be addressed later. 11. 5ituation: A /3 year old male employee fre>uently complains of low back pain that leads to fre>uent absences from work. !onsultation and tests re eal negati e results. The client has which somatoform disorderA. 5omatization $isorder B. 'ypochondriaisis !. !on ersion $isorder $. 5omatoform (ain $isorder Answer: %$& 5omatoform (ain $isorder This is characterized by se ere and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be e=plained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of ha ing a serious illness. !. !haracterized by alteration or loss in sensory or motor function resulting from a psychological conflict. 1+. Areud e=plains an=iety as: A. 5tri es to gratify the needs for satisfaction and security B. !onflict between id and superego !. A hypothalamic-pituitary-adrenal reaction to stress $. A conditioned response to stressors Answer: %B& !onflict between id and superego Areud e=plains an=iety as due to opposing action dri es between the id and the superego. A. 5ulli an identified + types of needs# satisfaction and security. Aailure to gratify these needs may result in an=iety. !. Biomedical perspecti e of an=iety. $. 7=planation of an=iety using the beha ioral model. 1/. The following are appropriate nursing diagnosis for the client 7E!7(T: A. "neffecti e indi idual coping B. Alteration in comfort# pain !. Altered role performance $. "mpaired social interaction Answer: %$& "mpaired social interaction The client may not ha e difficulty in social e=change. The cues do not support this diagnosis. A. The client maladapti ely uses body symptoms to manage an=iety. B. The client will ha e discomfort due to pain. !. The client may fail to meet en ironmental e=pectations due to pain. 1:. The following statements describe somatoform disorders: A. (hysical symptoms are e=plained by organic causes

B. "t is a oluntary e=pression of psychological conflicts !. 7=pression of conflicts through bodily symptoms $. Management entails a specific medical treatment Answer: %!& 7=pression of conflicts through bodily symptoms Bodily symptoms are used to handle conflicts. A. Manifestations do not ha e an organic basis. B. This occurs unconsciously. $. Medical treatment is not used because the disorder does not ha e a structural or organic basis. 1<. ,hat would be the best response to the client9s repeated complaints of pain: A. 1" know the feeling is real tests re ealed negati e results.4 B. . 1" think you9re e=aggerating things a little bit.4 !. 1Try to forget this feeling and ha e acti ities to take it off your mind4 $. 15o tell me more about the pain4 Answer: %A& 1" know the feeling is real tests re ealed negati e results.4 5hows empathy and offers information. B. This is a demeaning statement. !. This belittles the client9s feelings. $. 2i ing undue attention to the physical symptom reinforces the complaint. 1?. 5ituation: A nurse may encounter children with mental disorders. 'er knowledge of these arious disorders is ital. ,hen planning school inter entions for a child with a diagnosis of attention deficit hyperacti ity disorder# a guide to remember is to: A. pro ide as much structure as possible for the child B. ignore the child9s o eracti ity. !. encourage the child to engage in any play acti ity to dissipate energy $. remo e the child from the classroom when disrupti e beha ior occurs Answer: %A& pro ide as much structure as possible for the child $ecrease stimuli for beha ior control thru an en ironment that is free of distractions# a calm non Fconfrontational approach and setting limit to time allotted for acti ities. B. The child will not benefit from a lenient approach. !. $issipate energy through safe acti ities. $. This indicates that the classroom en ironment lacks structure. 1@. The child with conduct disorder will likely demonstrate: A. 7asy distractibility to e=ternal stimuli. B. .itualistic beha iors !. (reference for inanimate ob*ects. $. 5erious iolations of age related norms. Answer: %$& 5erious iolations of age related norms. This is a disrupti e disorder among children characterized by more serious iolations of social standards such as aggression# andalism# stealing# lying and truancy. A. This is characteristic of attention deficit disorder. B and !. These are noted among children with autistic disorder. 1B. .italin is the drug of choice for chidren with A$'$. The side effects of the following may be noted: A. increased attention span and concentration B. increase in appetite !. sleepiness and lethargy $. bradycardia and diarrhea Answer: %A& increased attention span and concentration The medication has a parado=ic effect that decrease hyperacti ity and impulsi ity among children with A$'$. B# !# $. 5ide effects of .italin include anore=ia# insomnia# diarrhea and irritability. 1C. 5chool phobia is usually treated by: A. .eturning the child to the school immediately with family support. B. !almly e=plaining why attendance in school is necessary !. Allowing the child to enter the school before the other children $. Allowing the parent to accompany the child in the classroom Answer: %A& .eturning the child to the school immediately with family support. 7=posure to the feared situation can help in o ercoming an=iety. A. This will not help in relie ing the an=iety due separation from a significant other. !. and !. An=iety in school phobia is not due to being in school but due to separation from parentsGcaregi ers so these inter entions are not applicable. $. This will not help the child o ercome the fear +3. A 13 year old child has ery limited ocabulary and interaction skills. 5he has an ".H. of :<. 5he is diagnosed to ha e Mental retardation of this classification: A. (rofound B. Mild !. Moderate $. 5e ere Answer: %!& Moderate The child with moderate mental retardation has an ".H. of /<-<3 (rofound Mental retardation has an ".H. of below +3; Mild mental retardation <3-@3 and 5e ere mental retardation has an ".H. of +3-/<. +1. The nurse teaches the parents of a mentally retarded child regarding her care. The following guidelines may be taught e=cept: A. o erprotection of the child B. patience# routine and repetition

!. assisting the parents set realistic goals $. gi ing reasonable compliments Answer: %A& o erprotection of the child The child with mental retardation should not be o erprotected but need protection from in*ury and the teasing of other children. B#!# and $ !hildren with mental retardation ha e learning difficulty. They should be taught with patience and repetition# start from simple to comple=# use isuals and compliment them for moti ation. .ealistic e=pectations should be set and optimize their capability. ++. The parents e=press apprehensions on their ability to care for their maladapti e child. The nurse identifies what nursing diagnosis: A. hopelessness B. altered parenting role !. altered family process $. ineffecti e coping Answer: %B& altered parenting role Altered parenting role refers to the inability to create an en ironment that promotes optimum growth and de elopment of the child. This is reflected in the parent9s inability to care for the child. A. This refers to lack of choices or inability to mobilize one9s resources. !. .efers to change in family relationship and function. $. "neffecti e coping is the inability to form alid appraisal of the stressor or inability to use a ailable resources +/. A < year old boy is diagnosed to ha e autistic disorder. ,hich of the following manifestations may be noted in a client with autistic disorderA. argumentati eness# disobedience# angry outburst B. intolerance to change# disturbed relatedness# stereotypes !. distractibility# impulsi eness and o eracti ity $. aggression# truancy# stealing# lying Answer: %B& intolerance to change# disturbed relatedness# stereotypes These are manifestations of autistic disorder. A. These manifestations are noted in 8ppositional $efiant $isorder# a disrupti e disorder among children. !. These are manifestations of Attention $eficit $isorder $. These are the manifestations of !onduct $isorder +:. The therapeutic approach in the care of an autistic child include the following 7E!7(T: A. 7ngage in di ersionary acti ities when acting -out B. (ro ide an atmosphere of acceptance !. (ro ide safety measures $. .earrange the en ironment to acti ate the child Answer: %$& .earrange the en ironment to acti ate the child The child with autistic disorder does not want change. Maintaining a consistent en ironment is therapeutic. A. Angry outburst can be rechannelled through safe acti ities. B. Acceptance enhances a trusting relationship. !. 7nsure safety from self-destructi e beha iors like head banging and hair pulling. +<. According to (iaget a < year old is in what stage of de elopment: A. 5ensory motor stage B. !oncrete operations !. (re-operational $. Aormal operation Answer: %!& (re-operational (re-operational stage %+-@ years& is the stage when the use of language# the use of symbols and the concept of time occur. A. 5ensory-motor stage %3-+ years& is the stage when the child uses the senses in learning about the self and the en ironment through e=ploration. B. !oncrete operations %@-1+ years& when inducti e reasoning de elops. $. Aormal operations %+ till adulthood& is when abstract thinking and deducti e reasoning de elop. +?. 5ituation : The nurse assigned in the deto=ification unit attends to arious patients with substance-related disorders. A :< years old male re ealed that he e=perienced a marked increase in his intake of alcohol to achie e the desired effect This indicates: A. withdrawal B. tolerance !. into=ication $. psychological dependence Answer: %B& tolerance tolerance refers to the increase in the amount of the substance to achie e the same effects. A. ,ithdrawal refers to the physical signs and symptoms that occur when the addicti e substance is reduced or withheld. B. "nto=ication refers to the beha ioral changes that occur upon recent ingestion of a substance. $. (sychological dependence refers to the intake of the substance to pre ent the onset of withdrawal symptoms. +@. The client admitted for alcohol deto=ification de elops increased tremors# irritability# hypertension and fe er. The nurse should be alert for impending: A. delirium tremens B. Iorsakoff9s syndrome !. esophageal arices

$. ,ernicke9s syndrome Answer: %A& delirium tremens $elirium Tremens is the most e=treme central ner ous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Jit. B !. This is a complication of li er cirrhosis which may be secondary to alcoholism . $. This is a complication of alcoholism characterized by irregularities of eye mo ements and lack of coordination. +B. The care for the client places priority to which of the following: A. Monitoring his ital signs e ery hour B. (ro iding a >uiet# dim room !. 7ncouraging ade>uate fluids and nutritious foods $. Administering 0ibrium as ordered Answer: %A& Monitoring his ital signs e ery hour (ulse and blood pressure are usually ele ated during withdrawal# 7le ation may indicate impending delirium tremens B. !lient needs >uiet# well lighted# consistent and secure en ironment. 7=cessi e stimulation can aggra ate an=iety and cause illusions and hallucinations. !. Ade>uate nutrition with sulpplement of Jit. B should be ensured. $. 5edati es are used to relie e an=iety. +C. Another client is brought to the emergency room by friends who state that he took something an hour ago. 'e is acti ely hallucinating# agitated# with irritated nasal septum. A. 'eroin B. cocaine !. 05$ $. mari*uana Answer: %B& cocaine The manifestations indicate into=ication with cocaine# a !)5 stimulant. A. "nto=ication with heroine is manifested by euphoria then impairment in *udgment# attention and the presence of papillary constriction. !. "nto=ication with hallucinogen like 05$ is manifested by grandiosity# hallucinations# synesthesia and increase in ital signs $. "nto=ication with Mari*uana# a cannabinoid is manifested by sensation of slowed time# con*uncti al redness# social withdrawal# impaired *udgment and hallucinations. /3. A client is admitted with needle tracts on his arm# stuporous and with pin point pupil will likely be managed with: A. )altre=one %.e ia& B. )arcan %)alo=one& !. $isulfiram %Antabuse& $. Methadone %$olophine& Answer: %B& )arcan %)alo=one& )arcan is a narcotic antagonist used to manage the !)5 depression due to o erdose with heroin. A. This is an opiate receptor blocker used to relie e the cra ing for heroine !. $isulfiram is used as a deterrent in the use of alcohol. $. Methadone is used as a substitute in the withdrawal from heroine /1. 5ituation: An old woman was brought for e aluation due to the hospital for e aluation due to increasing forgetfulness and limitations in daily function. The daughter re ealed that the client used her toothbrush to comb her hair. 5he is manifesting: A. apra=ia B. aphasia !. agnosia $. amnesia Answer: %!& agnosia This is the inability to recognize ob*ects. A. Apra=ia is the inability to e=ecute motor acti ities despite intact comprehension. B. Aphasia is the loss of ability to use or understand words. $. Amnesia is loss of memory. /+. 5he tearfully tells the nurse 1" can9t take it when she accuses me of stealing her things.4 ,hich response by the nurse will be most therapeuticA. 4$on9t take it personally. Kour mother does not mean it.4 B. 1'a e you tried discussing this with your mother-4 !. 1This must be difficult for you and your mother.4 $. 1)e=t time ask your mother where her things were last seen.4 Answer: %!& 1This must be difficult for you and your mother.4 This reflecting the feeling of the daughter that shows empathy. A and $. 2i ing ad ise does not encourage erbalization. B. This response does not encourage erbalization of feelings. //. The primary nursing inter ention in working with a client with moderate stage dementia is ensuring that the client: A. recei es ade>uate nutrition and hydration B. will reminisce to decrease isolation !. remains in a safe and secure en ironment $. independently performs self care Answer: %!& remains in a safe and secure en ironment 5afety is a priority consideration as the client9s cogniti e ability deteriorates.. A is appropriate inter entions because the client9s

cogniti e impairment can affect the client9s ability to attend to his nutritional needs# but it is not the priority B. (atient is allowed to reminisce but it is not the priority. $. The client in the moderate stage of Alzheimer9s disease will ha e difficulty in performing acti ities independently /:. 5he says to the nurse who offers her breakfast# 18h no# " will wait for my husband. ,e will eat together4 The therapeutic response by the nurse is: A. 1Kour husband is dead. 0et me ser e you your breakfast.4 B. 1"9 e told you se eral times that he is dead. "t9s time to eat.4 !. 1Kou9re going to ha e to wait a long time.4 $. 1,hat made you say that your husband is ali eAnswer: %A& 1Kour husband is dead. 0et me ser e you your breakfast.4 The client should be reoriented to reality and be focused on the here and now.. B. This is not a helpful approach because of the short term memory of the client. !. This indicates a pompous response. $. The cogniti e limitation of the client makes the client incapable of gi ing e=planation. /<. $ementia unlike delirium is characterized by: A. slurred speech B. insidious onset !. clouding of consciousness $. sensory perceptual change Answer: %B& insidious onset $ementia has a gradual onset and progressi e deterioration. "t causes pronounced memory and cogniti e disturbances. A#! and $ are all characteristics of delirium. /?. 5ituation: A 1@ year old gymnast is admitted to the hospital due to weight loss and dehydration secondary to star ation. ,hich of the following nursing diagnoses will be gi en priority for the clientA. altered self-image B. fluid olume deficit !. altered nutrition less than body re>uirements $. altered family process Answer: %B& fluid olume deficit Aluid olume deficit is the priority o er altered nutrition %A& since the situation indicates that the client is dehydrated. A and $ are psychosocial needs of a client with anore=ia ner osa but they are not the priority. /@. ,hat is the best inter ention to teach the client when she feels the need to star eA. Allow her to star e to relie e her an=iety B. $o a short term e=ercise until the urge passes !. Approach the nurse and talk out her feelings $. !all her mother on the phone and tell her how she feels Answer: %!& Approach the nurse and talk out her feelings The client with anore=ia ner osa uses star ation as a way of managing an=iety. Talking out feelings with the nurse is an adapti e coping. A. 5tar ation should not be encouraged. (hysical safety is a priority. ,ithout ade>uate nutrition# a life threatening situation e=ists. B. The client with anore=ia ner osa is preoccupied with losing weight due to disturbed body image. 0imits should be set on attempts to lose more weight. $. The client may ha e a domineering mother which causes the client to feel ambi alent. The client will not discuss her feelings with her mother. /B. The client with anore=ia ner osa is impro ing if: A. 5he eats meals in the dining room. B. ,eight gain !. 5he attends ward acti ities. $. 5he has a more realistic self concept. Answer: %B& ,eight gain ,eight gain is the best indication of the client9s impro ement. The goal is for the client to gain 1-+ pounds per week. %A&The client may purge after eating. %!& Attending an acti ity does not indicate impro ement in nutritional state. %$& Body image is a factor in anore=ia ner osa but it is not an indicator for impro ement. /C. The characteristic manifestation that will differentiate bulimia ner osa from anore=ia ner osa is that bulimic indi iduals A. ha e episodic binge eating and purging B. ha e repeated attempts to stabilize their weight !. ha e peculiar food handling patterns $. ha e threatened self-esteem Answer: %A& ha e episodic binge eating and purging Bulimia is characterized by binge eating which is characterized by taking in a large amount of food o er a short period of time. B and ! are characteristics of a client with anore=ia ner osa $. 0ow esteem is noted in both eating disorders :3. A nursing diagnosis for bulimia ner osa is powerlessness related to feeling not in control of eating habits. The goal for this problem is: A. (atient will learn problem sol ing skills

B. (atient will ha e decreased symptoms of an=iety. !. (atient will perform self care acti ities daily. $. (atient will erbalize how to set limits on others. Answer: %A& (atient will learn problem sol ing skills if the client learns problem sol ing skills she will gain a sense of control o er her life. %B& An=iety is caused by powerlessness. %!& (erforming self care acti ities will not decrease ones powerlessness %$& 5etting limits to control imposed by others is a necessary skill but problem sol ing skill is the priority. :1. "n the management of bulimic patients# the following nursing inter entions will promote a therapeutic relationship 7E!7(T: A. 7stablish an atmosphere of trust B. $iscuss their eating beha ior. !. 'elp patients identify feelings associated with binge-purge beha ior $. Teach patient about bulimia ner osa Answer: %B& $iscuss their eating beha ior. The client is often ashamed of her eating beha ior. $iscussion should focus on feelings. A#! and $ promote a therapeutic relationship :+. 5ituation: A /< year old male has intense fear of riding an ele ator. 'e claims 1 As if " will die inside.4 This has affected his studies The client is suffering from: A. agoraphobia B. social phobia !. !laustrophobia $. =enophobia Answer: %!& !laustrophobia !laustrophobia is fear of closed space. A. Agoraphobia is fear of open space or being a situation where escape is difficult. B. 5ocial phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing. $. Eenophobia is fear of strangers. :/. "nitial inter ention for the client should be to: A. 7ncourage to erbalize his fears as much as he wants. B. Assist him to find meaning to his feelings in relation to his past. !. 7stablish trust through a consistent approach. $. Accept her fears without criticizing. Answer: %$& Accept her fears without criticizing. The client cannot control her fears although the client knows its silly and can *oke about it. A. Allow e=pression of the client9s fears but he should focus on other producti e acti ities as well. B and !. These are not the initial inter entions. ::. The nurse de elops a countertransference reaction. This is e idenced by: A. .e ealing personal information to the client B. Aocusing on the feelings of the client. !. !onfronting the client about discrepancies in erbal or non- erbal beha ior $. The client feels angry towards the nurse who resembles his mother. Answer: %A& .e ealing personal information to the client A. !ountertransference is an emotional reaction of the nurse on the client based on her unconscious needs and conflicts. B and !. These are therapeutic approaches. $. This is transference reaction where a client has an emotional reaction towards the nurse based on her past. :<. ,hich is the desired outcome in conducting desensitization: A. The client erbalize his fears about the situation B. The client will oluntarily attend group therapy in the social hall. !. The client will socialize with others willingly $. The client will be able to o ercome his disabling fear. Answer: %$& The client will be able to o ercome his disabling fear. The client will o ercome his disabling fear by gradual e=posure to the feared ob*ect. A#B and ! are not the desired outcome of desensitization. :?. ,hich of the following should be included in the health teachings among clients recei ing Jalium: A. A oid taking !)5 depressant like alcohol. B. There are no restrictions in acti ities. !. 0imit fluid intake. $. Any be erage like coffee may be taken Answer: %A& A oid taking !)5 depressant like alcohol. Jalium is a !)5 depressant. Taking it with other !)5 depressants like alcohol; potentiates its effect. B. The client should be taught to a oid acti ities that re>uire alertness. !. Jalium causes dry mouth so the client must increase her fluid intake. $. 5timulants must not be taken by the client because it can decrease the effect of Jalium. :@. 5ituation: A +3 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. 7=tensi e e=amination re ealed no physical basis for the complaint. The nurse plans inter ention based on which correct statement about con ersion disorder-

A. The symptoms are conscious effort to control an=iety B. The client will e=perience high le el of an=iety in response to the paralysis. !. The con ersion symptom has symbolic meaning to the client $. A confrontational approach will be beneficial for the client. Answer: %!& The con ersion symptom has symbolic meaning to the client the client uses body symptoms to relie e an=iety. A. The condition occurs unconsciously. B. The client is not distressed by the lost or altered body function. $. The client should not be confronted by the underlying cause of his condition because this can aggra ate the client9s an=iety. :B. )ina re eals that the boyfriend has been pressuring her to engage in premarital se=. The most therapeutic response by the nurse is: A. 1" can refer you to a spiritual counselor if you like.4 B. 1Kou shouldn9t allow anyone to pressure you into se=.4 !. 1"t sounds like this problem is related to your paralysis.4 $. 1'ow do you feel about being pressured into se= by your boyfriend-4 Answer: %$& 1'ow do you feel about being pressured into se= by your boyfriend-4 Aocusing on e=pression of feelings is therapeutic. The central force of the client9s condition is an=iety. A. This is not therapeutic because the nurse passes the responsibility to the counselor. B. 2i ing ad ice is not therapeutic. !. This is not therapeutic because it confronts the underlying cause. :C. Malingering is different from somatoform disorder because the former: A. 'as e idence of an organic basis. B. "t is a deliberate effort to handle upsetting e ents !. 2ratification from the en ironment are obtained. $. 5tress is e=pressed through physical symptoms. Answer: %B& "t is a deliberate effort to handle upsetting e ents Malingering is a conscious simulation of an illness while somatoform disorder occurs unconscious. A. Both disorders do not ha e an organic or structural basis. !. Both ha e primary gains. $. This is a characteristic of somatoform disorder. <3. 6nlike psychophysiologic disorder 0inda may be best managed with: A. medical regimen B. milieu therapy !. stress management techni>ues $. psychotherapy Answer: %!& stress management techni>ues 5tree management techni>ues is the best management of somatoform disorder because the disorder is related to stress and it does not ha e a medical basis. A. This disorder is not supported by organic pathology so no medical regimen is re>uired. B and $. Milieu therapy and psychotherapy may be used a therapeutic modalities but these are not the best. <1. ,hich is the best indicator of success in the long term management of the clientA. 'is symptoms are replaced by indifference to his feelings B. 'e participates in di ersionary acti ities. !. 'e learns to erbalize his feelings and concerns $. 'e states that his beha ior is irrational. Answer: %!& 'e learns to erbalize his feelings and concerns !. The client is encouraged to talk about his feelings and concerns instead of using body symptoms to manage his stressors. A. The client is encouraged to acknowledge feelings rather than being indifferent to her feelings. B. (articipation in acti ities di erts the client9s attention away from his bodily concerns but this is not the best indicator of success. $. 'elp the client recognize that his physical symptoms occur because of or are e=acerbated by specific stressor# not as irrational. <+. 5ituation: A young woman is brought to the emergency room appearing depressed. The nurse learned that her child died a year ago due to an accident. The initial nursing diagnosis is dysfunctional grie ing. The statement of the woman that supports this diagnosis is: A. 1" feel en ious of mothers who ha e toddlers4 B. 1" ha en9t been able to open the door and go into my baby9s room 1 !. 1" watch other toddlers and think about their play acti ities and " cry.4 $. 1" often find myself thinking of how " could ha e pre ented the death. Answer: %B& 1" ha en9t been able to open the door and go into my baby9s room 1 This indicates denial. This defense is adapti e as an initial reaction to loss but an e=tended# unsuccessful use of denial is dysfunctional. A. This indicates acknowledgement of the loss. 7=pressing feelings openly is acceptable. !. This indicates the stage of depression in the grie ing process. $. .emembering both positi e and negati e aspects of the deceased lo e one signals successful mourning. </. The client said 1" can9t e en take care of my baby. "9m good for nothing.4 ,hich is the appropriate nursing diagnosisA. "neffecti e indi idual coping related to loss. B. "mpaired erbal communication related to inade>uate social skills.

!. 0ow esteem related to failure in role performance $. "mpaired social interaction related to repressed anger. Answer: %!& 0ow esteem related to failure in role performance This indicates the client9s negati e self e aluation. A sense of worthlessness may accompany depression. A#B and $ are not rele ant. The cues do not indicate inability to use coping resources# decreased ability to transmitGprocess symbols# nor insufficient >uality of social e=change <:. The following medications will likely be prescribed for the client 7E!7(T: A. (rozac B. Tofranil !. (arnate $. Lypre=a Answer: %$& Lypre=a This is an antipsychotic. A. This is a 55." antidepressant. B. This antidepressant belongs to the Tricyclic group. !. This is a MA8" antidepressant. <<. ,hich is the highest priority in the post 7!T careA. 8bser e for confusion B. Monitor respiratory status !. .eorient to time# place and person $. $ocument the client9s response to the treatment Answer: %B& Monitor respiratory status A side effect of 7!T which is life threatening is respiratory arrest. A and !. !onfusion and disorientation are side effects of 7!T but these are not the highest priority. <?. 5ituation: A +@ year old writer is admitted for the second time accompanied by his wife. 'e is demanding# arrogant talked fast and hyperacti e. "nitially the nurse should plan this for a manic client: A. set realistic limits to the client9s beha ior B. repeat erbal instructions as often as needed !. allow the client to get out feelings to relie e tension $. assign a staff to be with the client at all times to help maintain control Answer: %A& set realistic limits to the client9s beha ior The manic client is hyperacti e and may engage in in*urious acti ities. A >uiet en ironment and consistent and firm limits should be set to ensure safety. B. !lear# concise directions are gi en because of the distractibility of the client but this is not the priority. !. The manic client tend to e=ternalize hostile feelings# howe er only non-destructi e methods of e=pression should be allowed $. )urses set limit as needed. Assigning a staff to be with the client at all times is not realistic. <@. An acti ity appropriate for the client is: A. table tennis B. painting !. chess $. cleaning Answer: %$& cleaning The client9s e=cess energy can be rechanelled through physical acti ities that are not competiti e like cleaning. This is also a way to dissipate tension. A. Tennis is a competiti e acti ity which can stimulate the client. <B. The client is arrogant and manipulati e. "n ensuring a therapeutic milieu# the nurse does one of the following: A. Agree on a consistent approach among the staff assigned to the client. B. 5uggest that the client take a leading role in the social acti ities !. (ro ide the client with e=tra time for one on one sessions $. Allow the client to negotiate the plan of care Answer: %A& Agree on a consistent approach among the staff assigned to the client. A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of e=ploiting the weakness in others or create conflicts among the staff. Bargaining should not be allowed. B. This is not therapeutic because the client tends to control and dominate others. !. 0imits are set for interaction time. $. Allowing the client to negotiate may reinforce manipulati e beha ior. <C. The nurse e=emplifies awareness of the rights of a client whose anger is escalating by: A. Taking a directi e role in erbalizing feelings B. 6sing an authoritarian# confrontational approach !. (utting the client in a seclusion room $. Applying mechanical restraints Answer: %A& Taking a directi e role in erbalizing feelings The client has the right to be free from unnecessary restraints. Jerbalization of feelings or 1talking down4 in a non-threatening en ironment is helpful to relie e the client9s anger. B. This is a threatening approach. ! and $. 5eclusion and application restraints are done only when less restricti e measures ha e failed to contain the client9s anger. ?+. The nurse9s therapeutic response is: A. 1" will refer you to a clergy who can help you understand what is happening to you.4 B. 1 "t isn9t fair that an innocent like you will suffer from A"$5.4 !. 1That is a negati e attitude.4 $. 4"t must really be frustrating for you. 'ow can " best help you-4 Answer: %$& 4"t must really be frustrating for you. 'ow can " best help you-4 This response reflects the pain due to loss. A helping relationship can be forged by showing empathy and concern. A. This is not therapeutic since it passes the buck or responsibility to the clergy. B. This response is not therapeutic because it gi es the client the impression that she is right which pre ents the client from reconsidering her thoughts. !. This statement passes *udgment on the client. ?/. 8ne morning the nurse sees the client in a depressed mood. The nurse asks her 1,hat are you thinking about-4 This communication techni>ue is: A. focusing B. alidating !. reflecting $. gi ing broad opening Answer: %$& gi ing broad opening Broad opening techni>ue allows the client to take the initiati e in introducing the topic. A#B and ! are all therapeutic techni>ues but these are not e=emplified by the nurse9s statement. ?:. The client says to the nurse 4 (ray for me4 and entrusts her wedding ring to the nurse. The nurse knows that this may signal which of the following: A. an=iety B. suicidal ideation !. Ma*or depression $. 'opelessness Answer: %B& suicidal ideation The client9s statement is a erbal cue of suicidal ideation not an=iety. ,hile suicide is common among clients with ma*or depression# this occurs when their depression starts to lift. 'opelessness indicates no alternati es a ailable and may lead to suicide# the statement and non erbal cue of the client indicate suicide. ?<. ,hich of the following inter entions should be prioritized in the care of the suicidal clientA. .emo e all potentially harmful items from the client9s room. B. Allow the client to e=press feelings of hopelessness. !. )ote the client9s capabilities to increase self esteem. $. 5et a 1no suicide4 contract with the client. Answer: %A& .emo e all potentially harmful items from the client9s room. Accessibility of the means of suicide increases the lethality. Allowing patient to e=press feelings and setting a no suicide contract are inter entions for suicidal client but blocking the means of suicide is priority. "ncreasing self esteem is an inter ention for depressed clients bur not specifically for suicide. ?3. A client on 0ithium has diarrhea and omiting. ,hat should the nurse do first: A. .ecognize this as a drug interaction B. 2i e the client !ogentin !. .eassure the client that these are common side effects of lithium therapy $. 'old the ne=t dose and obtain an order for a stat serum lithium le el Answer: %$& 'old the ne=t dose and obtain an order for a stat serum lithium le el $iarrhea and omiting are manifestations of 0ithium to=icity. The ne=t dose of lithium should be withheld and test is done to alidate the obser ation. A. The manifestations are not due to drug interaction. B. !ogentin is used to manage the e=tra pyramidal symptom side effects of antipsychotics. !. The common side effects of 0ithium are fine hand tremors# nausea# polyuria and polydipsia. ?1. 5ituation: A widow age +B# whose husband died one year ago due to A"$5# has *ust been told that she has A"$5. (amela says to the nurse# 1,hy me- 'ow could 2od do this to me-4 This reaction is one of: A. $epression B. $enial !. anger $. bargaining Answer: %!& anger Anger is e=perienced as reality sets in. This may either be directed to 2od# the deceased or displaced on others. A. $epression is a painful stage where the indi idual mourns for what was lost. B. $enial is the first stage of the grie ing process e idenced by the statement 1)o# it can9t be true.4 The indi idual does not acknowledge that the loss has occurred to protect self from the psychological pain of the loss. $. "n bargaining the indi idual holds out hope for additional alternati es to forestall the loss# e idenced by the statement 1"f onlyM4

se=uality. ??. 5ituation: A 1: year old male was admitted to a medical ward due to bronchial asthma after learning that his mother was lea ing soon for 6.I. to work as nurse. The client has which of the following de elopmental focus: A. 7stablishing relationship with the opposite se= and career planning. B. (arental and societal responsibilities. !. 7stablishing ones sense of competence in school. $. $e eloping initial commitments and collaboration in work Answer: %A& 7stablishing relationship with the opposite se= and career planning. The client belongs to the adolescent stage. The adolescent establishes his sense of identity by making decisions regarding familial# occupational and social roles. The adolescent emancipates himself from the family and decides what career to pursue# what set of friends to ha e and what alue system to uphold. B. This refers to the middle adulthood stage concerned with transmitting his alues to the ne=t generation to ensure his immortality through the perpetuation of his culture. !. This reflects school age which is concerned with the pursuit of knowledge and skills to deal with the en ironment both in the present and in the future. $. The stage of young adulthood is concerned with de elopment of intimate relationship with the opposite se=# establishment of a safe and congenial family en ironment and building of one9s lifework. ?@. The personality type of .yan is: A. conforming B. dependent !. perfectionist $. masochistic Answer: %B& dependent A client with dependent personality is predisposed to de elop asthma. A. The conforming non-asserti e client is predisposed to de elop hypertension because of the tendency to repress rage. !. The perfectionist and compulsi e tend to de elop migraine. $. The masochistic# self sacrificing type are prone to de elop rheumatoid arthritis. ?B. The nurse ensures a therapeutic en ironment for the client. ,hich of the following best describes a therapeutic milieuA. A therapy that rewards adapti e beha ior B. A cogniti e approach to change beha ior !. A li ing# learning or working en ironment. $. A permissi e and congenial en ironment Answer: %!& A li ing# learning or working en ironment. A therapeutic milieu refers to a broad conceptual approach in which all aspects of the en ironment are channeled to pro ide a therapeutic en ironment for the client. The si= en ironmental elements include structure# safety# norms# limit setting# balance and unit modification. A. Beha ioral approach in psychiatric care is based on the premise that beha ior can be learned or unlearned through the use of reward and punishment. B. !ogniti e approach to change beha ior is done by correcting distorted perceptions and irrational beliefs to correct maladapti e beha iors. $. This is not congruent with therapeutic milieu. ?C. "ncluded as priority of care for the client will be: A. 7ncourage erbalization of concerns instead of demonstrating them through the body B. $i ert attention to ward acti ities !. (lace in semi-fowlers position and render 8+ inhalation as ordered $. 'elp her recognize that her physical condition has an emotional component Answer: %!& (lace in semi-fowlers position and render 8+ inhalation as ordered 5ince psychopysiologic disorder has organic basis# priority inter ention is directed towards disease-specific management. Aailure to address the medical condition of the client may be a life threat. A and B. The client has physical symptom that is ad ersely affected by psychological factors. Jerbalization of feelings in a non threatening en ironment and in ol ement in rela=ing acti ities are adapti e way of dealing with stressors. 'owe er# these are not the priority. $. 'elping the client connect the physical symptoms with the emotional problems can be done when the client is ready. @3. The client is concerned about his coming discharge# manifested by being unusually sad. ,hich is the most therapeutic approach by the nurseA. 1Kou are much better than when you were admitted so there9s no reason to worry.4 B. 1,hat would you like to do now that you9re about to go home-4 !. 1Kou seem to ha e concerns about going home.4 $. 1Aren9t you glad that you9re going home soon-4 Answer: %!& 1Kou seem to ha e concerns about going home.4 . This statement reflects how the client feels. 5howing empathy can encourage the client to talk which is important as an alternati e more adapti e way of coping with stressors.. A. 2i ing false reassurance is not therapeutic. B. ,hile this techni>ue e=plores plans after discharge# it does not focus on e=pression of feelings. $. This close ended >uestion does not encourage erbalization of feelings. @1. 5ituation: The nurse may encounter clients with concerns on The most basic factor in the inter ention with clients in the area of se=uality is: A. Inowledge about se=uality. B. 7=perience in dealing with clients with se=ual problems !. !omfort with one9s se=uality $. Ability to communicate effecti ely Answer: %!& !omfort with one9s se=uality The nurse must be accepting# empathetic and non-*udgmental to patients who disclose concerns regarding se=uality. This can happen only when the nurse has reconciled and accepted her feelings and beliefs related to se=uality. A#B and $ are important considerations but these are not the priority. @+. ,hich of the following statements is true for gender identity disorderA. "t is the se=ual pleasure deri ed from inanimate ob*ects. B. "t is the pleasure deri ed from being humiliated and made to suffer !. "t is the pleasure of shocking the ictim with e=posure of the genitalia $. "t is the desire to li e or in ol e in reactions of the opposite se= Answer: %$& "t is the desire to li e or in ol e in reactions of the opposite se= 2ender identity disorder is a strong and persistent desire to be the other se=. A. This is fetishism. B. This refers to masochism. !. This describes e=hibitionism. @/. The se=ual response cycle in which the se=ual interest continues to build: A. 5e=ual $esire B. 5e=ual arousal !. 8rgasm $. .esolution Answer: %B& 5e=ual arousal 5e=ual arousal or e=citement refers to attaining and maintaining the physiologic re>uirements for se=ual intercourse. A. 5e=ual $esire refers to the ability# interest or willingness for se=ual stimulation. !. 8rgasm refers to the peak of the se=ual response where the female has aginal contractions for the female and e*aculatory contractions for the male. $. .esolution is the final phase of the se=ual response in which the organs and the body systems gradually return to the unaroused state. @:. The inability to maintain the physiologic re>uirements in se=ual intercourse is: A. 5e=ual $esire $isorder B. 5e=ual Arousal $isorder !. 8rgasm $isorder $. 5e=ual (ain disorder Answer: %B& 5e=ual Arousal $isorder This describes se=ual arousal disorder. A. 5e=ual $esire $isorder refers to the persistent and recurrent lack of desire or willingness for se=ual intercourse. !. 8rgasm $isorder is the inability to complete the se=ual response cycle because of the inability to achie e an orgasm. $. 5e=ual (ain $isorder is characterized by genital pain before# during or after se=ual intercourse. @<. The nurse asks a client to roll up his slee es so she can take his blood pressure. The client replies 1"f you want " can go naked for you.4 The most therapeutic response by the nurse is: A. 1Kou9re attracti e but "9m not interested.4 B. 1Kou wouldn9t be the first that " will see naked.4 !. 1" will report you to the guard if you don9t control yourself.4 $. 1" only need access to your arm. (utting up your slee e is fine.4 Answer: %$& 1" only need access to your arm. (utting up your slee e is fine.4 The nurse needs to deal with the client with se=ually connotati e beha ior in a casual# matter of fact way. A and B. These responses are not therapeutic because they are challenging and re*ecting. !. Threatening the client is not therapeutic. @?. 5ituation: Inowledge and skills in the care of iolent clients is ital in the psychiatric unit. A nurse obser es that a client with a potential for iolence is agitated# pacing up and down the hallway and making aggressi e remarks. ,hich of the following statements is most appropriate to make to this patientA. ,hat is causing you to become agitatedB. Kou need to stop that beha ior now. !. Kou will need to be restrained if you do not change your beha ior. $. Kou will need to be placed in seclusion. Answer: %A& ,hat is causing you to become agitated"n a non- iolent aggressi e beha ior# help the client identify the stressor or the true ob*ect of hostility. This helps re eal unresol ed issues so that they may be confronted. B. (acing is a tension relie ing measure for an agitated client. !. This is a threatening statement that can heighten the client9s tension. $. 5eclusion is used when less restricti e measures ha e failed. @@. The nurse closely obser es the client who has been displaying

aggressi e beha ior. The nurse obser es that the client9s anger is escalating. ,hich approach is least helpful for the client at this timeA. Acknowledge the client9s beha ior B. Maintain a safe distance from the client !. Assist the client to an area that is >uiet $. "nitiate confinement measures Answer: %$& "nitiate confinement measures The proper procedure for dealing with harmful beha ior is to first try to calm patient erbally. . ,hen erbal and psychopharmacologic inter entions are not ade>uate to handle the aggressi eness# seclusion or restraints may be applicable. A# B and ! are appropriate approaches during the escalation phase of aggression. @B. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for iolence is which of the following: A. A timid nurse B. A mature e=perienced nurse !. an ine=perienced nurse $. a soft spoken nurse Answer: %B& A mature e=perienced nurse The unstable# aggressi e client should be assigned to the most e=perienced nurse. A# ! and $. A shy# ine=perienced# soft spoken nurse may feel intimidated by the angry patient. @C. The nurse e=emplifies awareness of the rights of a client whose anger is escalating by: A. Taking a directi e role in erbalizing feelings B. 6sing an authoritarian# confrontational approach !. (utting the client in a seclusion room $. Applying mechanical restraints Answer: %A& Taking a directi e role in erbalizing feelings Taking a directi e role in the client9s erbalization of feelings can deescalate the client9s anger. B. A confrontational approach can be threatening and adds to the client9s tension. ! and $. 6se of restraints and isolation may be re>uired if less restricti e inter entions are unsuccessful. B3. The client *umps up and throws a chair out of the window. 'e was restrained after his beha ior can no longer be controlled by the staff. ,hich of these documentations indicates the safeguarding of the patient9s rightsA. There was a doctor9s order for restraintsGseclusion B. The patient9s rights were e=plained to him. !. The staff obser ed confidentiality $. The staff carried out less restricti e measures but were unsuccessful. Answer: %$& The staff carried out less restricti e measures but were unsuccessful. This documentation indicates that the client has been placed on restraints after the least restricti e measures failed in containing the client9s iolent beha ior. B1. 5ituation: !lients with personality disorders ha e difficulties in their social and occupational functions. !lients with personality disorder will most likely: A. reco er with therapeutic inter ention B. respond to antian=iety medication !. manifest enduring patterns of infle=ible beha iors $. 5eek treatment willingly from some personally distressing symptoms Answer: %!& manifest enduring patterns of infle=ible beha iors (ersonality disorders are characterized by infle=ible traits and characteristics that are lifelong. A and $. This disorder is manifested by life-long patterns of beha ior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not reco er from therapeutic inter ention. B. Medications are generally not recommended for personality disorders. B+. A client tends to be insensiti e to others# engages in abusi e beha iors and does not ha e a sense of remorse. ,hich personality disorder is he likely to ha eA. )arcissistic B. (aranoid !. 'istrionic $. Antisocial Answer: %$& Antisocial These are the characteristics of an indi idual with antisocial personality. A. )arcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. B. "ndi iduals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others moti es as threatening. !. "ndi iduals with histrionic ha e e=cessi e emotionality# and attention-seeking beha iors. B/. The client *oins a support group and fre>uently preaches against abuse# is demonstrating the use of: A. denial B. reaction formation !. rationalization $. pro*ection

Answer: %B& reaction formation .eaction formation is the adoption of beha ior or feelings that are e=actly opposite of one9s true emotions. A. $enial is refusal to accept a painful reality. !. .ationalization is attempting to *ustify one9s beha ior by presenting reasons that sounds logical. $. (ro*ection is attributing of one9s beha iors and feelings to another person. B:. A teenage girl is diagnosed to ha e borderline personality disorder. ,hich manifestations support the diagnosisA. 0ack of self esteem# strong dependency needs and impulsi e beha ior B. social withdrawal# inade>uacy# sensiti ity to re*ection and criticism !. 5uspicious# hyper igilance and coldness $. (reoccupation with perfectionism# orderliness and need for control Answer: %A& 0ack of self esteem# strong dependency needs and impulsi e beha ior These are the characteristics of client with borderline personality. B. This describes the a oidant personality. !. These are the characteristics of a client with paranoid personality $. This describes the obsessi e compulsi e personality B<. The plan of care for clients with borderline personality should include: A. 0imit setting and fle=ibility in schedule B. 2i ing medications to pre ent acting out !. .estricting her from other clients $. 7nsuring she adheres to certain restrictions Answer: %$& 7nsuring she adheres to certain restrictions The client is manipulati e. The client must be informed about the policies# e=pectations# rules and regulation upon admission. A. 0imits should be firmly and consistently implemented. Ale=ibility and bargaining are not therapeutic in dealing with a manipulati e client. B. There is no specific medication prescribed for this condition. !. This is not part of the care plan. "nteraction with other clients are allowed but the client should be obser ed and gi en limits in her attempt to manipulate and dominate others. B?. 5ituation: A :+ year old male client# is admitted in the ward because of bizarre beha iors. 'e is gi en a diagnosis of schizophrenia paranoid type. The client should ha e achie ed the de elopmental task of: A. Trust s. mistrust B. "ndustry s. inferiority !. 2enerati ity s. stagnation $. 7go integrity s. despair Answer: %$& 7go integrity s. despair The client belongs to the middle adulthood stage %/3 to ?< yrs.& The de elopmental task generati ity is characterized by concern and care for others. "t is a producti e and creati e stage. %A& "nfancy stage %3 F 1B mos.& is concerned with gratification of oral needs %B& 5chool Age child %? F 1+ yrs.& is characterized by ac>uisition of school competencies and social skills %!& 0ate adulthood % ?3 and abo e& !oncerned with reflection on the past and his contributions to others and face the future. B@. !lients who are suspicious primarily use pro*ection for which purpose: A. deny reality B. to deal with feelings and thoughts that are not acceptable !. to show resentment towards others $. manipulate others Answer: %B& to deal with feelings and thoughts that are not acceptable (ro*ection is a defense mechanism where one attributes ones feelings and inade>uacies to others to reduce an=iety. A. This is not true in all instances of pro*ection ! and $. This focuses on the self rather than others BB. The client says 1 the )B" is out to get me.4 The nurse9s best response is: A. 1The )B" is not out to catch you.4 B. 1" don9t belie e that.4 !. 1" don9t know anything about that. Kou are afraid of being harmed.4 $. 1 ,hat made you think of that.4 Answer: %!& 1" don9t know anything about that. Kou are afraid of being harmed.4 This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses because these disagree with the client9s false belief and makes the client feel challenged $. unnecessary e=ploration of the false BC. The client on 'aldol has pill rolling tremors and muscle rigidity. 'e is likely manifesting: A. tardi e dyskinesia B. (seudoparkinsonism !. akinesia $. dystonia Answer: %B& (seudoparkinsonism (seudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies# pill rolling tremors# muscle rigidity A.

Tardi e dyskinesia is manifested by lip smacking# wormlike mo ement of the tongue !. Akinesia is characterized by feeling of weakness and muscle fatigue $. $ystonia is manifested by torticollis and rolling back of the eyes C3. The client is ery hostile toward one of the staff for no apparent reason. The client is manifesting: A. 5plitting B. Transference !. !ountertransference $. .esistance Answer: %B& Transference Transference is a positi e or negati e feeling associated with a significant person in the client9s past that are unconsciously assigned to another A. 5plitting is a defense mechanism commonly seen in a client with personality disorder in which the world is percei ed as all good or all bad !. !ounterttransference is a phenomenon where the nurse shifts feelings assigned to someone in her past to the patient $. .esistance is the client9s refusal to submit himself to the care of the nurse C1. 5ituation: An 1B year old female was se=ually attacked while on her way home from work. 5he is brought to the hospital by her mother. .ape is an e=ample of which type of crisis: A. 5ituational B. Ad entitious !. $e elopmental $. "nternal Answer: %B& Ad entitious Ad entitious crisis is a crisis in ol ing a traumatic e ent. "t is not part of e eryday life. A. 5ituational crisis is from an e=ternal source that upset ones psychological e>uilibrium ! and $. Are the same. They are transitional or de elopmental periods in life C+. $uring the initial care of rape ictims the following are to be considered 7E!7(T: A. Assure pri acy. B. Touch the client to show acceptance and empathy !. Accompany the client in the e=amination room. $. Maintain a non-*udgmental approach. Answer: %B& Touch the client to show acceptance and empathy The client finds touch intrusi e and therefore should be a oided. A. (ri acy is one of the rights of a ictim of rape. !.The client is an=ious. Accompanying the client in a >uiet room ensures safety and offers emotional support. $. 2uilt feeling is common among rape ictims. They should not be blamed. C/. The nurse acts as a patient ad ocate when she does one of the following: A. 5he encourages the client to e=press her feeling regarding her e=perience. B. 5he assesses the client for in*uries. !. 5he postpones the physical assessment until the client is calm $. 7=plains to the client that her reactions are normal Answer: %!& 5he postpones the physical assessment until the client is calm The nurse acts as a patient ad ocate as she protects the client from psychological harm A. The nurse acts a a counselor B. The nurse acts as a technician $. This e=emplifies the role of a teacher C:. !risis inter ention carried out to the client has this primary goal: A. Assist the client to e=press her feelings B. 'elp her identify her resources !. 5upport her adapti e coping skills $. 'elp her return to her pre-rape le el of function Answer: %$& 'elp her return to her pre-rape le el of function The goal of crisis inter ention to help the client return to her le el of function prior to the crisis. A#B and ! are inter entions or strategies to attain the goal C<. Ai e months after the incident the client complains of difficulty to concentrate# poor appetite# inability to sleep and guilt. 5he is likely suffering from: A. Ad*ustment disorder B. 5omatoform $isorder !. 2eneralized An=iety $isorder $. (ost traumatic disorder Answer: %$& (ost traumatic disorder (ost traumatic stress disorder is characterized by flashback# irritability# difficulty falling asleep and concentrating following an e=tremely traumatic e ent. This lasts for more that one month A. Ad*ustment disorder is the maladapti e reaction to stressful e ents characterized by an=iety# depression and work or social impairments. This occurs within / months after the e ent B. 5omatoform disorders are an=iety related disorders characterized by presence of physical symptoms without demonstrable organic basis !. 2eneralized an=iety disorder is characterized by chronic# e=cessi e an=iety for at least ? months C?. 5ituation: A +C year old client newly diagnosed with breast cancer is

pacing# with rapid speech headache and inability to focus with what the doctor was saying. The nurse assesses the le el of an=iety as: A. Mild B. Moderate !. 5e ere $. (anic Answer: %!& 5e ere The client9s manifestations indicate se ere an=iety. A Mild an=iety is manifested by slight muscle tension# slight fidgeting# alertness# ability to concentrate and capable of problem sol ing. B. Moderate muscle tension# increased ital signs# periodic slow pacing# increased rate of speech and difficulty in concentrating are noted in moderate an=iety. $. (anic le el of an=iety is characterized immobilization# incoherence# feeling of being o erwhelmed and disorganization C@. An=iety is caused by: A. an ob*ecti e threat B. a sub*ecti ely percei ed threat !. hostility turned to the self $. masked depression Answer: %B& a sub*ecti ely percei ed threat An=iety is caused by a sub*ecti ely percei ed threat A. Aear is caused by an ob*ecti e threat !. A depressed client internalizes hostility $. Mania is due to masked depression CB. "t would be most helpful for the nurse to deal with a client with se ere an=iety by: A. 2i e specific instructions using speak in concise statements. B. Ask the client to identify the cause of her an=iety. !. 7=plain in detail the plan of care de eloped $. 6rge the client to focus on what the nurse is saying Answer: %A& 2i e specific instructions using speak in concise statements. The client has narrowed perceptual field. 0engthy e=planations cannot be followed by the client. B. The client will not be able to identify the cause of an=iety ! and $. The client has difficulty concentrating and will not be able to focus. CC. ,hich of the following medications will likely be ordered for the client-4 A. (rozac B. Jalium !. .isperdal $. 0ithium Answer: %B& Jalium Antian=iety A. Antidepressant !. Antipsychotic $. Antimanic 133. ,hich of the following is included in the health teachings among clients recei ing Jalium-: A. A oid foods rich in tyramine. B. Take the medication after meals. !. "t is safe to stop it anytime after long term use. $. $ouble up the dose if the client forgets her medication. Answer: %B& Take the medication after meals. Antian=iety medications cause 2.". upset so it should be taken after meals. A. This is specific for antidepressant MA8". Taking tyramine rich food can cause hypertensi e crisis. !. Jalium causes dependency. "n which case# the medication should be gradually withdrawn to pre ent the occurrence of con ulsion. $ The dose of Jalium should not be doubled if the pre ious dose was not taken. "t can intensify the !)5 depressant effects.