Situation 1 - The following questions refer to nurse's efforts to do collaboration and teamwork. Select the best answer. 1.

The most important role of the nurse as a member of the team is to: A. carry out medical orders B. meet the needs for the physical well being of patients C. coordinate the psychological care and management of clients D. keep a 24 hour watch for the patients CORRECT ANSWER: A RATIONALE: cayying out medical orders is simply a collaboration task. OPTION B – limited only to the physical aspect of care. How about the psychological? And there was no mention of collaboration with other team members OPTION C – Limited to psychological aspect only eventhough it states about coordination with others 2. A biologic/medical approach to patient care utilizes which of the following? A. Million therapy B. Somatic therapy C. Behavioral therapy D. Psychotherapy CORRECT ANSWER: B RATIONALE: page 1071- 1072 saunders A – no such thing as million therapy B - Somatic therapy is a holistically oriented therapy which integrates the mental, emotional, spiritual and physical aspects of each of us. It accomplishes this by helping us to become aware of our bodies and the sensations we experience through them. When our mind can be so busy with worries, schedules and concerns, our body's awareness and breathing can help us to focus on what we are experiencing in the moment. C – Behavioral therapy – an approach to bring about behavioral change D - Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. This usually includes increasing individual sense of well-being and reducing subjective discomforting experience. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change and that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). 3. Which of these nursing actions belong to the secondary level of preventive intervention? A. Providing mental health consultation to health care providers B. Providing emergency psychiatric services C. Being politically active in relation to mental health issues D. Providing mental health education to members of the community CORRECT ANSWER: B RATIONALE: page 121 funda kozier : Secondary level of prevention: emphasizes early detection of disease, prompt intervention and health maintenance for individuals experiencing health problems. Includes prevention of complication and disabilities. Emergency psychiatric services fall under prompt treatment of the seconday prevention. OPTION C – Primary prevention OPTION D – Primary prevention 4. When the nurse identifies a client who has attempt to commit suicide the nurse should: A. call a priest B. counsel the client C. refer the client to the psychiatrist D. refer the matter to the police CORRECT ANSWER: B RATIONALE: page 1057 and page 1115 saunders: Suicide attempt – any willful, self inflicted or life threatening attempt by an individual that has not lead to death. Encourage verbalization of the patient to reason why and how he will commit suicide and if there is still a plan to commit suicide. 5. The community health nurse was invited by the principal of an elementary school and was asked to give a talk to parents. An appropriate topic would be: A. the legal aspects of drug abuse B. disciplining children at home and school C. marital crises D. the problems of out of school youth CORRECT ANSWER: A Reproduction is strictly prohibited… RN International Review Center 1

RATIONALE: A – page 381 saunders : teach the school age child to avoid speaking to strangers and never to accept a ride, toys or gift from strangers B – disciplining child at home can be done by a nurse but not in the school C - talking regarding marital crisis refers to adolescents D - page 375 saunders: problems of out of school youth is never a problem because - a child has fear of missing school and the fear that their friends will forget them. Situation 2 - The nurse visited the Reyes family to check on their two growing children, aged 7 and 4 years. Upon her visit she observed that common areas of arguments between Mr. and Mrs. Reyes are about conflicting ways of bringing up their children. Mrs. Reyes is lax and tolerant while Mr. Reyes often insists strict ways to a point of over protectiveness from what he perceives as unsafe i.e. community and neighbors that cannot be trusted. 6. Mr. Reyes remarked "I am wary about people visiting- with all the media news about child kidnapping and robberies.” The nurse's BEST response would be: A. "Would you rather wish that I don't come and visit you may regard me as a stranger?" B. "I get that.” The nurse diverts the attention to talk about non-threatening topics. C. "It must be distressing to think and feel the way you do." D. "I acknowledge what you are saying. My concern is the health care of your family and information is strictly confidential." CORRECT ANSWER: C RATIONALE: A - a nurse should encourage verbalization not question the belief of the parents B – diverting the topic is non-therapeutic C – nurse is acknowledging the feeling and is encouraging verbalization D – confidentiality is considered in every NPI but should be shared with the other team members 7. Mrs. Reyes expressed that her socializing with neighbors is limited because her husband thinks she is getting overly friendly with a guy next door. Which of the following would the nurse emphasize as basic? A. Keeping trust in the relationship B. Avoid relating with neighbors to minimize conflict C. Be assertive to express her individuality D. Ignore the husband and just be supportive CORRECT ANSWER: A RATIONALE: Taking into consideration that a good relationship will be based on a trusting relationship 8. For the nurse to be effective in developing rapport with the family it is essential that she keeps her appointment on time and stick to a care plan. She is applying the principle of: A. responsibility and accountability B. consistency and predictability C. honesty and integrity D. empathy and compassion CORRECT ANSWER: B Being frequent and consistent shows to the family the nurses care 9. Which of these symptoms if demonstrated by Mr. Reyes would necessitate referral to a doctor? A. Hypervigilance B. Suspicious affect C. Hypersensitive D. Loss of reality contact CORRECT ANSWER: A RATIONALE: Hypervigilance is an "enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats” 10. The paranoid client utilizes which of the following defense mechanisms? A. Sublimation B. Projection C. Rationalization D. Reaction formation CORRECT ANSWER: B Paranoid personality disorder is characterized by a distrust of others and a constant suspicion that people around you have sinister motives. People with this disorder tend to have excessive trust in their own knowledge and abilities and usually avoid close relationships with others. They search for hidden meanings in everything and read hostile intentions into the actions of others. They are quick to challenge the loyalties of friends and loved Reproduction is strictly prohibited… RN International Review Center 2

ones and often appear cold and distant to others. They usually shift blame to others and tend to carry long grudges. Situation 3 - Mr. Sison has been diagnosed as having early chronic glaucoma. He has been admitted to the hospital for treatment. 11. The nurse identified a nursing problem of disturbed sensory perception: visual impairment characterized by: A. Sudden loss of eyesight B. Loss of night vision C. Loss of peripheral vision D. Loss of central vision CORRECT ANSWER: C RATIONALE: page 905 saunders progressive loss of peripheral vision followed by loss of central vision 12. In order to understand the rationale for drug therapy, it is important for the nurse to know that glaucoma is usually caused by: A. opacity in the lens B. gradual diminution of the retina C. damage to the proteins in the lens D. increase production of aqueous fluid CORRECT ANSWER: D RATIONALE: page 905 saunders glaucoma is an increased intraocular pressure results from inadequate drainage of aqueous humor from the canal of Schlemn or overproduction of aqueous fluid. A – cataract C – diminution - the act or process of diminishing; a lessening or reduction. Retinal problem 13. Diamox is a drug used in the treatment of glaucoma. Which of these is the effect of this drug? A. Constricts the pupil B. Acts as osmotic diuretic C. Reduces the production of aqueous humor D. Facilitates outflow of aqueous humor CORRECT ANSWER: C RATIONALE: page 845 nursing2006 drug handbook – Diamox For glaucoma sufferers, the drug decreases fluid formation in the eye resulting in lower intraocular pressure. 14. Public health nurses should Identify which of these patients as a risk group for development of glaucoma, hence the need for annual eye examinations: A. Patient with Parkinson's disease B. Cancer patients C. Diabetic and hypertensive patients D. Patient with COPD CORRECT ANSWER: C RATIONALE: page 945 med-surg black – hypertension, cardiovascular disease, diabetes, and obesity are associated with the development of glaucoma 15. The appropriate method of instilling eye drops is: Instilling into an opened eye with the head held back and with the eye looking: A. to the left B. downward C. to the right D. upward CORRECT ANSWER: D RATIONALE: 841 fundamentals by kozier – the person is less likely to blink if looking up. While the client is looking up, the cornea is partially protected by the upper eyelid. Situation 4 - SEXUAL DISORDER 16. A hospitalized male adolescent flirts with and is sexually provocative toward a female nurse. The nurse can respond MOST therapeutically by doing which of the following? A. Telling him she is married and too old for him B. Introducing him to female clients his own age C. Encouraging him to watch TV in his room D. Ignoring his flirtatious and provocative behaviors CORRECT ANSWER: D Reproduction is strictly prohibited… RN International Review Center 3

RATIONALE: limit and reject clients inappropriate behavior but not rejecting the individual 17. The premorbid personality of a person with a non psychotic maladaptive response to anxiety may most accurately be described as: A. unpredictable, impulsive and aggressive B. rigid, insecure and conforming C. dependent, pessimistic and moody D. anxious, insensitive and self-absorbed CORRECT ANSWER: A RATIONALE: Premorbid personality is most often associated with Schizophrenia, due to the search for these elements - but doesnt always need to occur that way. Among the professionals it is considered a psychosocial factor. Basically it isnt really a personality ... but is looking at the change in personality before the disease (premorbid) compared to after the disease has progressed. There is hope that by identifying early signs of the disease - such as in this case personality changes - that the diseases can better be caught and controlled early 18. An oral-dependent personality is characterized by which of the following? A. Helplessness B. Hopelessness C. Aggressiveness D. Suspiciousness CORRECT ANSWER: A RATIONALE: page 1087 saunders Individuals with DPD (dependent personality disorder) see relationships with significant others as necessary for survival. They do not define themselves as able to function independently; they have to be in supportive relationships to be able to manage their lives. 19. The pedophile's choice of a sex object is primary based on: A. Difficulty relating with adults B. Feelings of tenderness toward children C. Fears of incestuous impulses D. Preferred for a passive sexual rote CORRECT ANSWER: B RATIONALE: Medical diagnosis manuals ICD-10 and DSM IV describe pedophilia as a mental disorder, a form of paraphilia in which a person either has acted on sexual urges towards children, or has sexual urges towards and fantasies about children that cause distress or interpersonal difficulty

20. A young adult male unable to stay put in one job and doesn’t have commitment in his relationship is having
difficulty achieving a sense of: A. autonomy B. trust C. industry D. intimacy CORRECT ANSWER: D RATIONALE: He was able to developed love for his commitment in relationship, but not the industry where he cannot hold on a job longer than expected A. autonomy - toddler B. trust - infant C. industry - schoolager D. intimacy – old adult Situation 5 - Anita is experiencing rape-trauma syndrome in an acute phase. She had been invited to a fraternity party. She had too much drink and she was raped by her date. The day after, she was brought to the hospital. She has feelings of anger, humiliation, helplessness, nausea, vomiting, and nightmare and muscle tension. 21. When the nurse approached Anita, initially she was just crying, felt she was in a nightmare and she was at a loss. The appropriate nursing diagnosis is: A. Situational low self-esteem B. Sexual violence C. Ineffective coping D. Sexual dysfunction CORRECT ANSWER: C RATIONALE: PTSD (Post Traumatic Stress Disorder) is one of the anxiety disorders. Symptoms of PTSD develop in people who have experienced an event that is outside the range of usual human suffering and that would be extremely stressful for nearly anybody. Such an event would impose "a serious harm or threat to one's life or physical integrity, a serious threat to one's children, spouse, or other close relatives or friends. Reproduction is strictly prohibited… RN International Review Center 4

22. Anita expressed to the nurse that she douched, showered for half an hour and still did not feel clean. Anita is experiencing: A. guilt B. anger C. denial D. frustration CORRECT ANSWER: B RATIONALE: persistent symptoms of increased arousal, which involve irritability and outburst of anger, troubled concentrating, hypervigilance, exaggerated startle response; they show physiological reaction to events or situations that symbolize or resemble the trauma; 23. Which of these communicate unconditional acceptance of Anita and her situation? A. "You are safe here and I am ready to listen." B. "Why did you date a guy you hardly knew?" , C. "Tell me when you are ready and I'll come back to you' D. "It would be best of help if you stop crying." CORRECT ANSWER: A RATIONALE: A. "You are safe here and I am ready to listen." – encourage expression of feeling B. "Why did you date a guy you hardly knew?" ---- most non therapeutic , C. "Tell me when you are ready and I'll corne back to you' --- do not leave pt.. offer self D. "I would be best of help if you slop crying." --- hinders pt expression of fellings 24. Anita is experiencing: A. maturational crisis B. developmental crisis C. anticipated crisis D. situational crisis CORRECT ANSWER: D RATIONALE: page 1109 saunders Maturational crisis – relates to developmental stages and associated role changes Situational crisis - arises from an external and is associated with a life event that upsets an individual or a group’s psychological equilibrium. Anticipated crisis – no such thing as to anticipate a crisis Maturational crisis - Developmental: normal bio-psychosocial, spiritual developmental stages 25. Which of these behaviors of Anita signal her readiness to proceed to the working phase of the nurse-patient relationship? A. She states she trusted the nurse B. She wants to talk to a lawyer C. She inquired about personal information about the nurse D. She wants to be told what her rights are CORRECT ANSWER: A The proceed to the working phase, the phase prior to that should be accompished. That stage is the orientation phase. During this stage trust should be accomplished so that the working phase can start. Situation 6 - The psychiatric mental health nurse adheres to standards that ensure quality improvement. The following situations and behaviors are means to achieve this goal. 26. This is the process wherein the clients chart is reviewed to compare criteria for quality care with actual practice. A. Psychiatric Audit B. Nursing Care Process C. Interaction Process Analysis D. Algorithms CORRECT ANSWER: D RATIONALE: Algorithms - algorithm is a sequence of instructions, often used for calculation, data processing. It is formally a type of effective method in which a list of well-defined instructions for completing a task will, when given an initial state, proceed through a well-defined series of successive states, eventually terminating in an end-state. Psychiatric audit - Symptom presentation for both voluntary and involutary admissions were analyzed along with the mode of patient arrival, domicile information and psychiatric hospitalization history; using the Bellevue Psychiatric Audit, Structured Clinical Interview, mental status examination and psychiatric interview. As expected, it was found that symptom presentation upon arrival was the primary basis for admission.

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Nursing process is a process by which nurses deliver care to patients, supported by nursing models or philosophies. The nursing process was originally an adapted form of problem-solving and is classified as a deductive theory. IPA is a method for analyzing the "systems of human interaction" in originally, small face-to-face groups. Bales regarded small groups as "partial" or "microscopic" social systems useful for comparing groups of different kinds with each other and for making inquiries into "full-scale social systems." 27. In order to assess "Reliability" as a behavioral characteristic, the nurse would ask herself which of the following questions regarding her recording: A. Did the history of the present problem correlate with the review of growth and development? B. How long did it take to complete the nursing data base? C. Is the nursing data base complete? D. Are the nursing history and psychosocial assessment accurate? CORRECT ANSWER: C RATIONALE: 28. All of these are the advantages of peer review EXCEPT: A. Demands accountability for nursing actions B. Has the possibility of enhancing intra professional respect C. It requires the development of standards for quality care D. Provide an evaluation of the nurse's abilities CORRECT ANSWER: D RATIONALE: page 726 nursing research polit/beck peer review is a person who reviews and critiques a research report or proposal, who himself/herself is a researcher and who makes a recommendation about publishing or funding the research, it evaluates the research but not demand changes. 29. The nursing team leader wants to involve all the nurses in participating in their own personal and professional growth through a brainstorming session. One of the most important ground rules is: A. follow the problem solving approach B. do not pass judgment on the ideas presented C. ideas must be feasible D. suggestions must be cost effective CORRECT ANSWER: B RATIONALE: Brainstorming is a group creativity technique designed to generate a large number of ideas for the solution to a problem. The method was first popularized in the late 1930s by Alex Faickney Osborn, an advertising executive and one of the founders of BBDO, in a book called Applied Imagination. Osborn proposed that groups could double their creative output by using the method of brainstorming.[1]Although brainstorming has become a popular group technique, researchers have generally failed to find evidence of its effectiveness for enhancing either quantity or quality of ideas generated. Although traditional brainstorming may not increase the productivity of groups, it may still provide benefits, such as enhancing the enjoyment of group work and improving morale. It may also serve as a useful exercise for team building. 30. “Did the nurse perform in the best possible manner without waste?" aims to describe the nurse's: A. thoroughness B. reliability C. efficiency D. analytic sense CORRECT ANSWER: C RATIONALE: Thoroughness - The quality or state of being thorough; completeness. conscientiousness in performing all aspects of a task Reliability - is the ability of a person or system to perform and maintain its functions in routine circumstances, as well as hostile or unexpected circumstances. Efficiency - The quality or property of being efficient. The power or capacity to produce a desired result Situation 7 – A nurse was interested to study the research question: “What are the differences and similarities between aggressive and non-aggressive cognitively impaired, elderly, institutionalized people?” 31. Investigation of cognitively impaired individual presented some ethical dilemmas. Which of the following protocol would be considered unethical? A. Recording interaction with the elderly with their permission B. Verbal permission from the subject is unnecessary C. Data coded and recorded solely by the investigation D. A written consent from the institution and a significant other CORRECT ANSWER: B Reproduction is strictly prohibited… RN International Review Center 6

RATIONALE: Any activity/ interaction/ procedures or interventions going to be performed in a patient will either need a written or a verbal consent. 32. A semi-structured interview was conducted. This means that: A. interview is conducted precisely in the same manner B. interviewer is not held to any specific question C. subject is allowed to express without any suggestion from interviewer D. interviewer is free to probe beyond a number of specific major questions CORRECT ANSWER: D RATIONALE: The SCID-II is a semi-structured interview for making DSM-IV Axis II: Personality Disorder diagnoses. Semi-structured interviews are conducted with a fairly open framework which allow for focused, conversational, two-way communication. They can be used both to give and receive information. Not all questions are designed and phrased ahead of time. The majority of questions are created during the interview, allowing both the interviewer and the person being interviewed the flexibility to probe for details or discuss issues. 33. The type of study conducted is : A. descriptive B. quasi-experimental C. experimental D. case study CORRECT ANSWER: A RATIONALE: page 29 fundamentals kozier A – descriptive statistics– procedures that summarize large volumes of data are used to describe and synthesize data, showing patterns and trends. B – quasi-experimental – the investigator manipulates the independent variable but without either the randomization or control that characterizes true experiments C – experimental - the investigator manipulates the independent variable by administering an experimental treatment to some subjects while withholding it from others D – case study - case study methods involve an in-depth, longitudinal examination of a single instance or event: a case. They provide a systematic way of looking at events, collecting data, analyzing information, and reporting the results. As a result the researcher may gain a sharpened understanding of why the instance happened as it did, and what might become important to look at more extensively in future research. 34. The review of literature included reference to retrospective studies. Such studies have the following advantages EXCEPT: A. data are inexpensive to obtain B. possibility of memory bias and distortion of fact C. there is much material available D. it is easy to get data CORRECT ANSWER: D RATIONALE: A retrospective study is a study that looks backwards in time. For example, we find people that are already dead and try to figure out why they died. A retrospective study is fast. Since the subjects are already dead; we just have to tabulate all the results. The one problem is that it's hard to interview a dead person. Even if the patient is alive, like study on cancer and smoking, we have to rely on them to recall things that may have happened many years ago. Memory is a selective thing, and it can introduce all sorts of biases into our study. 35. The following concepts of liability negligence are true: A. Deviation from standard of care is established. B. Duty is owed to the nurse C. Financial, physical and emotional harm is establish D. Direct cause for failure to meet standard of care clearly established CORRECT ANSWER: A RATIONALE: Situation 8 - Mr. David is brought to the hospital due to pain radiating to the hip and leg. He is diagnosed with a herniated lumbar disk. He is scheduled for myelogram. 36. After the procedure, the nurse must include which of the following nursing action in his care. A. Assess for movement and sensation of the lower extremity B. Place the client in most comfortable position C. Lying supine with heels flexed D. Bed rest with bed elevated at 45 degrees CORRECT ANSWER: A RATIONALE: page 939 saunders – Myelogram – injection of dye or ir into the subarachnoid space to detect abnormalities of the spinal cord and vertebrae. After, assess vital signs and neurological condition frequestly Reproduction is strictly prohibited… RN International Review Center 7

Water based dye – elevate the head 15 to 30 degrees fro 6 to 8 hours Oil based dye – keep client flat 6 to 8 hrs Air based dye – keep head lower than the trunk for up to 48 hrs 37. Mr. David is scheduled for lumbar laminectomy, Post operatively the nurse should: A. logroll the client with the help of another nurse B. inform the client that he should be in supine position C. assess for sensory loss in the legs D. instruct the patient to move from side to side CORRECT ANSWER: A RATIONALE: page 229 saunders – logroll the client, no part of the body should be twisted or turned, nor should the client be allowed to assume a sitting position. 38. Trimethobenzamide Hydrochloride (Tigan) was administered postoperatively. The action of this drug is effective when it: A. controls nausea B. controls pain C. controls muscle spasm D. controls edema CORRECT ANSWER: A RATIONALE: Tigan® is indicated for the treatment of postoperative nausea and vomiting and for nausea associated with gastroenteritis. 39. Mr. David is to ambulate for the first time following surgery. What nursing action should be best when the client begins to faint? A. Get another nurse for help B. Maneuver the client to a sitting position C. Get back to his bed and place in side lying position D. Assist the client to form a wide base of support and lean against the nurse CORRECT ANSWER: D RATIONALE: page 1100 fundamentals kozier: assume a broad stance with one foot in front of the other. Bring the client backwards so that your body supports the person. 40. Mr. David has to wear back brace. Which position is recommended when the brace is applied? A. Sitting position B. Standing position C. Lying on his side in bed D. Supine position in bed CORRECT ANSWER: D RATIONALE: page 2147 med-surge black – after spinal surgery, a brace or corset maybe required temporarily to support the spine. Brace should be used constantly whether client is in or out of bed. Situation 9 - Through the nurse-patient relationship, the nurse intervenes utilizing effective communication techniques. The following are varied situations in a psychiatry ward. 41. The patient verbalizes. "Masama ang pakiramdarn ko. Hindi ako nakatulog kagabi." A therapeutic response of the nurse would be: A. “Baka ini-istorbo ka na naman ng mga boses.” B. “Sinabi mo sana sa nars para nabigyan ka ng sedative drug mo.” C. “Relax lang! Huwag ka masyadong mag-isip ng mga problema mo." D. “Maaari mo bang sabihin sa akin ang mga naiisip at nararamdaman mo?” CORRECT ANSWER: D RATIONALE: Restating – repeating the main thought the pt. expressed, it values and validates that the nurse is listening 42. Soledad is terminally ill of cancer. Looking sad she expresses, "Wala na yata akong pag-asang mabuthay pa.” A response which fosters hope is: A. “Mukhang napakabigat ng dinaramdam ninyo. Andito po ako at puwede tayong mag-usap.” B. "Huwag po ninyong isipin sakit ninyo. Bale wala yon. Andito naman ako para makausap ninyo." C. “Lakasan ang loob ninyo. Lahat naman po tayo ay doon ang patutunguhan." D. "Gagaling din po kayo. Huwag po kayong mag-alala." CORRECT ANSWER: A – encouraging expression of feelings False reassurance letter D, C Restricting expression of feelings letter B Reproduction is strictly prohibited… RN International Review Center 8

43. Camilia verbalizes. “Pinag-uusapan nila ako. Ayaw nila ako." A therapeutic response is:
A. "Nalulungkot ba ang pakiramdam mo?” B. “Hayaan mo sila. Arng mahalaga ay ang palagay mo sa sarili mo." C. “Sino ang “nila’' ang tinutukoy mo?” D. “Huwag mong isipan yan. Hindi tama yan” CORRECT ANSWER: C RATIONALE: Seeking Consensual Validation – process of verifying accuracy of messages sent and validation of the patients verbalization 44. During socialization, Nicanor was provoked, became furious and started shouting "Walang hiya kayo! Ako ang bida dito" The nurse's action is: A. take him away from the group until he manages to have control of himself B. Immediately restrain him and put him on isolation to protect other patients C. prevent him from becoming more furious by giving an extra PRN dose of sedative D. Respond with, "Nicanor, paro-pareho lang kayo ng mga ibang pasyente dito." CORRECT ANSWER: A RATIONALE: Patient showing signs of violence should be remove from any other patients to avoid and prevent injury

45. “Nicanor becomes verbally assaultive to the nurse. He says, "Ikaw, nurse, wala kang alam! Marunong pa ako sa
iyo e. Ano ba ang pinagmamalaki mo? The nurse responds therapeutically by: A. Admonishing him with, "Ako ang nurse dito. Dapat sumunod ka sa akin." B. Acknowledging his behavior, however, put him in his right senses; respond with, "Oo nga, galit ka sa nurse pero hindi tama na naninigaw ka." C. Acknowledging his behavior and respond. "Nagagalit ka sa nurse at nawawala ka ng kontrol sa sarili mo.” D. ignoring the behavior of the patient CORRECT ANSWER: B RATIONALE: Acknowledge client behavior, but set limits to inappropriate behavior but without rejecting the individual Situation 10 - Nicanor was discharged from the hospital and recovered from a manic episode of Bipolar Disorder. Nicanor was readmitted with an entirely different behavior. He was very depressed: 46. The defense mechanism utilized by manic patients to cover up depression is: A. reaction formation B. compensation C. displacement D. denial CORRECT ANSWER: A RATIONALE: showing the oppsite of what the patient feel. Manic  depression. 47. The psychodymics of depression is: A. lax super-ego B. weak super-ego C. internalized hostility feelings D. narcissistic personality CORRECT ANSWER: C RATIONALE: Depression according to Freud is anger directed towards the self. 48. Which of these drugs is likely to be indicated for Nicanor? A. Serenace (Haloperidol) B. Valium (Diazepam) C. Tofranil (Imipramine HCl) D. Trilafon (Perphenazine) CORRECT ANSWER: C A – anti-psychotic B – anti- anxiety D – anti-psychotic 49. Therapeutic use of self is essential in relating with psychiatric patients. This is BEST demonstrated in: A. sympathizing with the miserable feelings of Nicanor B. engaging Nicanor in productive activity Reproduction is strictly prohibited… RN International Review Center 9

C. engaging Nicanor in introspective thinking D. suppressing her own feelings toward Nicanor CORRECT ANSWER: B RATIONALE: 50. After three days of antidepressant medication, Nicanor still manifests depression. The nurse evaluates this as: A. unusual because action of antidepressant drug is immediate B. expected because it takes about two weeks for the medication to be effective C. unexpected because it takes within one week for the medication to be effective D. ineffective because perhaps the drug's dosage is inadequate CORRECT ANSWER: B Anti depressants take effect: TCA – 7 to 14 days ( 1-2 weeks), MAOI 2-3 weeks, SSRI 3-4weeks Situation 11 - Ninety year old Purita is confined at the medical unit for respiratory ailment for which a breathing apparatus is prescribed for her to use while she sleeps. She refuses to wear it continuously though she fully understands the medical indication for it. 51. Which of these, ethical principles can guide the nurse in her action? A. Beneficence B. Fidelity C. Autonomy D. Nonmaleficence CORRECT ANSWER: C RATIONALE: page 98 prof nursing in the phils by venzon A - beneficence – helping to better the condition of other beings B – fidelity – telling the truth, keeping actual implicit promises C – autonomy – involves self-determination and freedom to choose and implement one’s decision, free from deceit, duress, constraint or coercion D – non-maleficence – avoiding or preventing injury to others 52. Purita has six children who are already adults. They differ in their opinion. Whether or not to allow their mother to decide for herself. The nurse would encourage family conference for: A. the eldest child's opinion to be given priority B. majority of the children to decide C. allowing the medical staff to decide in their behalf D. consensus building CORRECT ANSWER: D RATIONALE: all children are adults thus consensus of all children are necessary 53. Breathing treatments are to be given to Purita. In anticipation that Purita might refuse, Dinio, one of the children requests that he be the one to sign consent in behalf of their mother. The nurse explains that Purita is rational in her thinking and which of these clients right must be regarded? A. Right to refuse treatment B. Right to privacy C. Right to Informed consent D. Right of habeas consent CORRECT ANSWER: A RATIONALE: Patient has the right to refuse treatment.Prof Ad by Venzon pp. 359 54. Which of these would be the nurse's priority following the treatment principle of least restrictive alternative? A. One to one staffing B. Use of on site guard/watcher C. Physical restraint D. Seclusion CORRECT ANSWER: B RATIONALE: Having a family member or significant others beside the patient during hospitalization provides the patients adequate support in regards to safety/falls 55. Purita talks about her joy in having responsible and accomplished children and recalls challenging career as a lawyer. She is demonstrating a sense of: A. ego integrity B. industry C. generativity Reproduction is strictly prohibited… RN International Review Center 10

D. autonomy CORRECT ANSWER: A RATIONALE: late adulthood – ego integrity vs. despair OPTION B – schoolager OPTION C – middle adulthood OPTION D – toddler Situation 12 – Marina, 26 years old is aloof in relating with other patients and members of the staff. She claims that the medications being given her are meant to poison her. She is also suspicious about the food being served to her. 56. Basically, Marina is suspicious because of her inability to develop a sense of: A. Intimacy B. Generativity C. Trust D. Initiative CORRECT ANSWER: C RATIONALE: Common problem in unhealthy mother and child relationship during infancy sage is trust vs mistrust. 57. Marina utilizes projection by being suspicious. This means that she: A. unconsciously refuses to accept a feeling, thought or impulse and attributes it to someone else B. justifies behavior, attitudes and feelings with excuses C. involuntarily refuses to acknowledge reality D. involuntarily excludes wishes, impulses, memories and feelings from awareness CORRECT ANSWER: A RATIONALE: Projection- the process in which an individual attributes his or her own feelings to others “blaming others” 58. Which of these nursing approaches is MOST appropriate for the nurse to begin with? A. Engage Marina for at least one hour in a one-to-one interaction dairy B. Invite her to socialize with other patients C. Make self available while maintaining distance until patient shows readiness to interact D. Refer her for activity therapy CORRECT ANSWER: C RATIONALE: Establish trust and rapport first with the patient, as part of the orientation/introductory phase of the nurse-patient interaction 59. When she resists to take her medication, it is best to: A. let her read the drug literature to convince her that it is therapeutic B. force her to take the drug to maintain therapeutic effectiveness of the drug C. have the same nurse, who she interacts with regularly, administer the drug D. request the doctor to give her medication CORRECT ANSWER: A RATIONALE: Paranoid personality disorder is characterized by a distrust of others and a constant suspicion that people around you have sinister motives. People with this disorder tend to have excessive trust in their own knowledge and abilities and usually avoid close relationships with others. They search for hidden meanings in everything and read hostile intentions into the actions of others. They are quick to challenge the loyalties of friends and loved ones and often appear cold and distant to others. They usually shift blame to others and tend to carry long grudges. 60. Another reason why she refuses to take Thorazine is because she complains of robot like movement and slurred speech. The nurse's action is: A. decrease the dosage of thorazine B. explain the extrapyramidal side effects and administer Benadryl C. avoid giving foods that are rich in tyramine D. withhold medication until referral is made to the doctor CORRECT ANSWER: B RATIONALE: robot like movement or parkinsonism is a side effect of antipsychotic, EPS which shows usually 1 to 4 weeks after administration of the drug. And the antidote fro this side effect is CABAK ( Cogentin, Artane, Benadrly, Akeniton, Kemadrin) Situation 13 - The supervising nurse received report that a staff nurse is displaying frequent irritation, anger, and even indifference toward clients and co-workers. 61. The initial action of the supervisor would be to: Reproduction is strictly prohibited… RN International Review Center 11

A. B. C. D.

post guidelines on proper decorum of nurses in the bulletin board write a memo of warning to the nurse request anecdotal report from nurse's co-workers call the nurse for a one on one conference

CORRECT ANSWER: D RATIONALE: page 104 nursing ethics by Thompson : most code of conducts ( or ethics) require nurses to be accountable for their behavior not only when at work, but also in their personal lives. The regulatory bodies rationale for this usually enhancement or at least maintenance, of the reputation of nursing as a profession. Nurses are therefore expected by their regulatory bodies to be accountable for behaviors that may not impact directly on their performance during their paid employment. 62. The nurse expressed increasing feelings of dissatisfaction. The supervising nurse intervenes therapeutically by taking on the role of: A. administrator by relieving her of responsibilities B. therapist by delving into the nurse's internal conflicts C. counselor by actively listening D. educator by reorienting her of her role as a nurse CORRECT ANSWER: C RATIONALE: same as above, active listening to encourage verbalization first, further assessment 63. Coupled with poor work performance, mental and physical fatigue and actual withdrawal from client contact and nursing duties, the nurse can be said to be suffering from: A. psychotic anxiety B. staff burnout C. personality maladjustment D. neurotic depression CORRECT ANSWER: B RATIONALE: A - Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes B - Burnout syndrome was identified first in high-stress occupations in the service sector in the 1970s, most conspicuously among health care professionals in all specialties. Prevalent among both physicians and nurses, the syndrome has been defined as the “inability to cope with emotional stress at work” and as “excessive use of energy and resources leading to feelings of failure and exhaustion.” In addition to diminished well-being, burnout syndrome is associated with symptoms of depression, although symptoms tend to be confined more to the workplace. C - "Intense psychoneurotic processes are especially characteristic of accelerated development in its course towards the formation of personality. According to our theory accelerated psychic development is actually impossible without transition through processes of nervousness and psychoneuroses, without external and internal conflicts, without maladjustment to actual conditions in order to achieve adjustment to a higher level of values (to what 'ought to be'), and without conflicts with lower level realities as a result of spontaneous or deliberate choice to strengthen the bond with reality of higher level" (Dabrowski, 1972, p. 220). D - A psychiatric disorder characterized by an inability to concentrate, insomnia, loss of appetite, anhedonia, feelings of extreme sadness, guilt, helplessness and hopelessness, and thoughts of death 64. A priority in the nurse's personal development program would be to: A. address her physical well being B. boost her self-confidence C. provide social support D. help her find value and meaning in her work CORRECT ANSWER: D RATIONALE: same as above : Total time in the job, weekly working hours, shift-working and the unit where employed influenced burnout scores Not being happy with relations with superiors, not finding the job suitable, feeling anxious about the future, perceived poor health, problems with personal life and financial difficulties were also factors influencing burnout 65. The most relevant professional program for her would be: A. assertiveness training B. stress management C. group dynamics and team building D. behavior modification CORRECT ANSWER: B RATIONALE: same as number 63

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Situation 14 - The purpose of the nursing care plan is to identify the care for an individual patient based on his problems. The nurse writes a nursing care plan for a patient based on nursing care standards. 66. Given this example of a problem; "Anxiety due to a job interview". The "due to" or the reason for the problem should be included if it is known. The initial step in identifying problems is: A. gather the data about the patient B. determine if the problems are usual or unusual C. analyze the data D. analyze the problems as concisely as possible CORRECT ANSWER: A RATIONALE: page 66 saunders: nursing care plan is a written guideline and communication tool that identifies the client’s pertinent assessment data, problems and nursing diagnosis, goals, interventions and expected outcomes 67. Given this example of an expected outcome: "Openly verbalize anxiety about job interview. Identify how he can prepare for the job interview." Which of these is not a criterion of expected outcomes? A. An expected outcome is stated in terms of what the patient will do B. An expected outcome is stated in terms of what the nurse will do C. Every outcome must be measurable D. Every outcome answers the question, “How will you know when the problem is resolved?” CORRECT ANSWER: B RATIONALE: page 322 funda kozier outcome evaluation focuses on demonstrable changes in the client’s health status as a result of nursing care. Outcome criteria are written in terms of client responses or health status just as they are for evaluation within the nursing process. 68. The following are reasons for setting deadlines within which to achieve outcomes of care EXCEPT: A. Indicate specific times to review progress or lack of progress B. Does not allow plans to be changed C. Allow plans the need to be changed D. Set the time by which the expected outcome should be reached CORRECT ANSWER: B RATIONALE: page 321 funda kozier in addition to evaluating goal achievement for individual clients, nurses are also involved in evaluating and modifying the overall quality of care given to groups of clients. This is an essential part of professional accountability 69. Which of these is not a relevant nursing order? A. Ask patient any untoward side effects of medications he is taking B. Have patient role play interview situation C. Discuss with a patient with specific means he might prepare for the job interview D. Ask the patient what he is feeling about the job interview CORRECT ANSWER: C RATIONALE: As a nurse guiding patients in any untoward problems, should try encourage expression of feelings but not asking specific actions 70. Which of these practices on evaluation support nursing care? Review of care plan is: A. a nursing team responsibility B. the sole responsibility of the primary nurse C. the responsibility of peers D. the sole responsibility of the supervisor CORRECT ANSWER: A RATIONALE: page 321 funda kozier in addition to evaluating goal achievement for individual clients, nurses are also involved in evaluating and modifying the overall quality of care given to groups of clients. This is an essential part of professional accountability Situation 15 - A nurse assigned in the neurologic unit is taking care of clients with varying degrees of degenerative disorders. 71. Mr. A with myasthenia gravis is having difficulty speaking. What communication strategies should the nurse avoid when interacting with Mr. A? A. Repeating what the client says for better understanding B. Using paper and pencil in communicating with the client C. Encouraging the client to speak slowly D. Encouraging the client to speak quickly CORRECT ANSWER: D Reproduction is strictly prohibited… RN International Review Center 13

RATIONALE: page 2182-2183 med surg black: an autoimmune disease that presents as muscular weakness and fatigue that worsens with exercise and improves with rest. Weakness of the facial and levator palpebrae muscles produces an expressionless face, with droopy eyelids, smoothed features and a tendency for the mouth to hang open. An attempt to smile often turns into a snarl because of the weakness. In the morning the patients strength his muscle group but towards the afternoon it decreases. 72. When planning for nursing care for Mr. B, who has Parkinson's disease, which of the following goals would be MOST appropriate? A. To improve muscle tone B. To start rehabilitation as much as possible C. To treat the disease D. To maintain optimal body function CORRECT ANSWER: D RATIONALE: page 2174 med-surg black : to avoid rigidity and the development of contractures, exercise and stretch regularly, exercise in the morning when energy levels are highest. 73. For the past 10 years. Alma, 42 years old, has had multiple sclerosis. Clients with multiple sclerosis experience many different symptoms. As part of the rehabilitation planned for Alma, the nurse suggested therapy and hobbies to help her: A. strengthen muscle coordination B. establish routine C. develop perseverance and motivation D. establish good health habits CORRECT ANSWER: A RATIONALE: page 2180 med-surg black : Advice that strengthening for muscle weakness (paresis) must be done with caution because they can exacerbate paresis by causing muscle fatigue; however, selective strengthening of unaffective or less affected muscles can enhance physical function and well-being. Range of motion exercises should be performed to passive movements 74. On his second day of hospitalization. Mr. Santos was unable to stand and is having difficulty swallowing and talking. Which of the following is the priority of the nurse in assisting Mr. Santos? A. To prevent bladder distention B. To prevent decubitus ulcer C. To prevent contracture D. To prevent aspiration pneumonia CORRECT ANSWER: D RATIONALE: A patient having difficulty swallowing and talking are signs of respiratory problems. 75. The wife of a seventy two (72) year old male with a diagnosis of Alzheimer's disease begins to cry and tells the nurse, "I could not understand my husband anymore. He has changed drastically." Which of the following responses of the nurse is MOST appropriate? A. “The physician and the staff will make sure that your husband will be comfortable and safe here." B. “This has been a difficult time for you. Let us walk and find a quiet place where we can talk." C. "He will soon recover in his condition.” D. "You need not worry, we are doing the best we could". CORRECT ANSWER: B RATIONALE: nurse acknowledges the feelings of the patient and is encouraging verbalization. Choices A, C and D are false reassurance Situation 16 - Annie has a morbid fear of heights. She asks the nurse what desensitization therapy is: 76. The accurate information of the nurse of the goal of desensitization is: A. to help the clients relax and progressively work up a list of anxiety provoking situations through imagery B. to provide corrective emotional experiences through a one-to-one intensive relationship C. to help clients in a group therapy setting to take on specific roles and reenact in front of an audience, situations in which interpersonal conflict is involved D. to help clients cope with their problems by learning behaviors that are more functional and be better equipped to face reality and make decisions CORRECT ANSWER: A RATIONALE: Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders.. To begin the process of systematic desensitization, one must first be taught relaxation skills in order to control fear and anxiety responses to specific phobias. Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome Reproduction is strictly prohibited… RN International Review Center 14

the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy. Systematic desensitization is sometimes called graduated exposure therapy. 77. It is essential in desensitization for the patient to: A. have rapport with the therapist B. use deep breathing or another relaxation technique C. assess one's self for the need of an anxiolytic drug D. work through unresolved unconscious conflicts CORRECT ANSWER: B RATIONALE: same as above 78. In this level of anxiety, cognitive capacity diminishes. Focus becomes limited and client experiences tunnel vision. Physical signs of anxiety become more pronounced. A. Severe anxiety B. Panic C. Mild anxiety D. Moderate anxiety CORRECT ANSWER: A RATIONALE: 4 Levels of Anxiety Mild - Senses are alert, increased attention, increased motivation for learning, growth, and creativity Moderate - narrowed perception selective inattention Severe - greatly decreased perception field focus is on specific detail, all behavior is armed at getting relief. Panic - personality disorganization, loss of control & helplessness perceptual filed is completely disrupted 79. Anti-anxiety medications should be used with extreme caution because long term use can lead to: A. Parkinsonian like syndrome B. hypertensive crisis C. hepatic failure D. risk of addiction CORRECT ANSWER: D RATIONALE: Not used w/ daily minor stresses because it can lead to addiction 80. The nursing management of anxiety related with post traumatic stress disorder includes all of the following EXCEPT: A. encourage participation in recreation or sports activities B. reassure client's safety while touching client C. speak in a calm soothing voice D. remain with the client while fear level is high CORRECT ANSWER: B RATIONALE: use touch cautiously to patients with PTSD/ASD ( acute stress disorder) as they have experiences of being suspicious of others Situation 17 – A nurse is taking care of a patient diagnosed with schizophrenia. Dealing with this patients entails therapeutic communication 81. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate? A. Approach the client and touch him to get his attention. B. Encourage the client to go to his room where he'll experience fewer distractions. C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices. D. Ask the client to describe what the voices are saying CORRECT ANSWER: C RATIONALE: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination. 82. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? A. Restlessness, difficulty sitting still, and pacing B. Involuntary rolling of the eyes Reproduction is strictly prohibited… RN International Review Center 15

C. Tremors, shuffling gait, and mask like face D. Extremity and neck spasms, facial grimacing, and jerky movements CORRECT ANSWER: C RATIONALE: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and "pill rolling." Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing. 83. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take? A. Give the next dose of fluphenazine, call the physician, and monitor vital signs. B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. C. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation. D. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake. CORRECT ANSWER: B RATIONALE: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher. 84. A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect? A. Tardive dyskinesia B. Dystonia C. Neuroleptic malignant syndrome D. Akathisia CORRECT ANSWER: A RATIONALE: Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness. 85. What medication would probably be ordered for the acutely aggressive schizophrenic client? A. chlorpromazine (Thorazine) B. haloperidol (Haldol) C. lithium carbonate (Lithonate) D. amitriptyline (Elavil) CORRECT ANSWER: B RATIONALE: Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression. Situation 18 - A Vehicle hit some pedestrians while waiting for a bus ride. Some of the victims suffered Injuries in the different parts of their bodies. The victims were brought to the nearby hospital. One of the victims, Josephine was confirmed to have a fractured left arm. While waiting for the plaster cast to be applied, Josephine appears to be anxious. 86. To reduce the anxiety, the nurse teaches the procedure to the client. Which of the following topics should NOT be included in the teaching plan? A. Leave cast uncovered to promote drying B. Bear weight on the plaster cast for one hour. A stockinet will be placed over the left arm to be placed in cast C. Handle hardening cast with palms of hands D. Trim and reshape finish cast with knife or cutter CORRECT ANSWER: B RATIONALE: page 1004 saunders: cast care: keep the cast and extremity elevated, allow a wet cast 24 to 48H to dry, handle the cast with the palms of the hands, examine the skin and cast for pressure areas, notify physician immediately if circulation is compromised, petal the cast, maintain smooth edges around the cast to prevent crumbling of the cast material

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87. Cast was applied on Josephine's left arm. In assessing the neurovascular status of the client. Which of the following assessment findings should be reported to the physician? A. Pain on the left arm B. Swelling of the fingers C. Skin abrasions on the edges of the plaster cast. D. Nail bed capillary refill time of 10 seconds CORRECT ANSWER: D RATIONALE: Capillary refill is the rate at which blood refills empty capillaries. It can be measured by pressing a fingernail until it turns white, and taking note of the time needed for color to return once the nail is released. Normal refill time is less than 2 seconds. The capillary refill time (CRT) is a common measure of peripheral perfusion. 88. One of the victims, a sixty year old woman sustained hip fracture. Prior to surgery a Buck's extension traction is to be applied. The rationale for the application of traction is primarily based on the understanding that Buck's extension traction: A. reduces muscle spasms and helps to immobilize the fracture B. allows reduction of the fracture site for bone healing C. secures the fracture site to prevent damage to the muscle tissues D. secures the fracture she for rigid immobilization CORRECT ANSWER: A RATIONALE: page 1002 saunders: buck’s traction is used to alleviate muscle spasms and immobilizes a lower limb by maintaining a straight pull on the limb with the use of weights

89. Philip was placed in skeletal leg traction with an overhead frame. He is not allowed to move from side to side.
Which of the following nursing interventions is useful in maintaining effective traction? A. Assist the client by holding the trapeze and raising the hips off the bed B. Check the apparatus, that weights hang free and knots in the rope are tied securely C. Suspend a trapeze within easy reach of the client D. Support the affected extremity while the weights are removed CORRECT ANSWER: A RATIONALE: Skeletal traction requires the placement of tongs, pins, or screws into the bone so that the weight is applied directly to the bone. This is an invasive procedure that is done in an operating room under general, regional, or local anesthesia. Patients are also encouraged to do range-of-motion exercises with the unaffected parts of the body. The patient is taught how to use a trapeze (an overhead support bar) to shift on and off a bedpan, since it is not possible to get up to use the toilet. In serious injuries, traction may be continued for several months until healing is complete. 90. To prevent complications when a child is in Buck's traction, the nurse should: A. clean the extremity and keep the skin dry B. assess any skin and circulatory disturbances C. clean the pin sites as necessary D. provide high fiber small meals CORRECT ANSWER: B RATIONALE: Weights are attached either through adhesive or nonadhesive tape, or with straps, boots, or cuffs. Care must be taken to keep the straps or tape loose enough to prevent swelling and allow good circulation to the part of the limb beyond the spot where the traction is applied. The amount of weight that can be applied through skin traction is limited because excessive weight will irritate the skin and cause it to slough off. Situation 19 - It is the nurse's primary responsibility to ensure a safe environment for the patients at the Psychiatry ward: 91. All of the following concepts are true EXCEPT: A. Hostility is destructive B. Frustration develops in response to unmet needs, wants and desire C. Anger is incompatible with love D. Aggression can be expressed in a constructive as well as a destructive manner CORRECT ANSWER: D RATIONALE: aggression refers to behavior that is intended to cause harm or pain. Aggression can be physical, mental, or verbal. Behavior that accidentally causes harm or pain is not aggression. Property damage and other destructive behavior may also fall under the definition of aggression. Aggression is always destructive. 92. Carlo is acting out hostile and aggressive feeling by kicking the chairs in the room. The MOST effective way to deal with Carlo's behavior is initially to: A. set limits on the behavior by verbal command B. administer prn tranquilizer C. remove the chairs from the room Reproduction is strictly prohibited… RN International Review Center 17

D. restrain the patient and place him in the "Isolation Room" CORRECT ANSWER: A RATIONALE: OPTION C – feelings of aggressiveness and hostility can be a problem that leads to violence. Thus removing the patient from the room can minimize harm to others. Safety is always the priority. But in option C, chairs are to be removed not the patient. :D A – cannot set limits if the patient is already aggressive B and D – last resort to be done 93. Mrs. Dizon was visiting her son at the Psychiatry Ward. Which of the following items will the nurse not allow to be brought inside the ward? A. String rosary bracelet B. Box of cake C. Bottle of coke D. Rubber shoes CORRECT ANSWER: C RATIONALE: a bottle of coke is breakable more prone to injury. Safety problem 94. 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 reprimand C. Give client support and positive feedback for controlling use of obscene language D. Provide a punching bag as an alternative to express upset emotions CORRECT ANSWER: A RATIONALE: Behavior Modification-a process used to change ineffective behavior patterns that focuses on consequences for actions rather than peer pressure. 95. Which of the following must be considered while planning activities for the depressed patient? A. Activities which require exertion of energy B. Challenging activities to get him out of his depression C. Reading materials to divert his thoughts D. Variety of unstructured activities CORRECT ANSWER: D RATIONALE: page 1114 saunders: provide activities for easy mastery to increase self esteem and assist to alleviate guilt feelings. Activities that do not require great deal of concentration ( simple card games, drawing) Engage in gross motor activities (walking) Situation 20 - Jim, age 25, recalled that his problem began around age 15 or 16. He would count pencils in a mug over and over with the thought that stopping could result in something bad happening. 96. There are many things Jim seems he has to do to keep himself from feeling: A. confused B. suspicious C. excited D. anxious CORRECT ANSWER: D RATIONALE: Obsession- recurrent & intrusive thought, feeling, idea or sensation Compulsion- conscious standardized, recurrent thought or behavior such as counting, checking or avoiding. 97. 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 reference B. denial and projection C. obsession and compulsion D. rationalization and over reaction CORRECT ANSWER: C RATIONALE: very common in OCD cases wherein patients tend to do constant repetition in actions 98. The objective of nursing care for Jim is to develop or increase feelings of: A. self-mastery B. self worth C. self-actualization D. self-determination Reproduction is strictly prohibited… RN International Review Center 18

CORRECT ANSWER: B RATIONALE: patients with OCD has a low self-steem 99. All of these are therapeutic interventions EXCEPT: A. impose limits every time the behavior becomes repetitive B. establish a routine for him C. assign task that can be done repetitively D. facilitate sett-expression CORRECT ANSWER: A RATIONALE: Never impose sitting limits to the clients repetitive behavior as this will make the client more anxious 100. Jim is aware of his behavior, yet realizes that it is very disturbing to him. This is a pattern A. personality disorder B. psychosis C. neurosis D. habitual disorder CORRECT ANSWER: A RATIONALE: When a person’s personality traits become inflexible and maladaptive and significantly interfere with how the person functions in society or cause the person emotional distress. Long term bec they continue to behave in the same familiar ways, even these behaviors cause them difficulties or distress

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