NURSING PRACTICE V- Care of Clients with physiologic and Psychosocial Alterations (Part C).

Situation 1 – Jimmy developed this goal for hospitalization. “To get a handle on my nervousness.” The nurse is going to collaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned to asphyxiate himself with exhaust from his car but frightened instead. He realized he needed help. 1. The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is: A. help the client find meaning in his experience B. help the client to plan alternatives C. help the client cope with the present problem D. help the client to communicate 2. The nurse is guided that Jimmy is aware of his concerns of the “here and now” when he crossed out which item from this “list of what to know”. A. anxiety laden unconscious conflicts B. subjective idea of the range of mild to severe anxiety C. early signs of anxiety D. physiologic indices of anxiety 3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that complete disruption of the ability to perceive occurs in: A. panic state of anxiety B. severe anxiety C. moderate anxiety D. mild anxiety 4. Jimmy initiates independence and takes an active part in his self care with the following EXCEPT: A. agreeing to contact the staff when he is anxious B. becoming aware of the conscious feeling C. assessing need for medication and medicating himself D. writing out a list of behaviors that he identified as anxious 5. The nurse notes effectiveness of interventions in using subjective and objective data in the: A. initial plans or orders B. database C. problem list D. progress notes Situation 2 – A research study was undertaken in order to identify and analyze a disabled boy’s coping reaction pattern during stress. 6. This study which is an in depth study of one boy is a: A. case study B. longitudinal study C. cross-sectional study D. evaluative study 7. The process recording was the principal tool for data collection. Which of the following is NOT a part of a process recording? A. Non verbal narrative account B. Analysis and interpretation C. Audio-visual recording D. Verbal narrative account 8. Which of these does NOT happen in a descriptive study? A. Exploration of relationship between two or more phenomena. B. Explanation of relationship between two or more phenomena. C. Investigation of a phenomenon in real life context. D. Manipulation of variable 9. The investigator also provided the nursing care of the subject. The investigator is referred to as a/an: A. Participant-observer B. Observer researcher C. Caregiver D. Advocate 10. To ensure reliability of the study, the investigator’s analysis and interpretations were: A. subjected to statistical treatment B. correlated with a list of coping behaviors C. subjected to an inter-observer agreement D. scored and compared standard criteria Situation 3 – During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 35 years old, was given Flurazepam (Dalmane) 15mg at 10:00pm because she had trouble going to sleep. Before approaching Regina,

the nurse read the observation of the night nurse. 11. Which of the following approaches of the nurse validates the data gathered? A. “I learned that you were up till ten last night, tell me what happened before you were finally able to sleep and how was your sleep?” B. “Hmm.. You look like you had a very sound sleep. That pill you were given last night is effective isn’t it?” C. “Regina, did you sleep well?” D. “Regina, how are you?” 12. Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needs for information about her medicine? A. Guided by a medication teaching plan, go over with her the purpose, indications and special instructions, about the medication and provide her a checklist B. Provide a drug literature. C. Have an informal conversation about the medication and its effects D. Ask her what time she would like to watch the informative video about the medication. 13. The nurse engages Regina in the process of mutual inquiry to provide an opportunity for Regina to: A. face emerging problems realistically B. conceptualize her problem C. cope with her present problem D. perceive her participation in an experience !4. Which of these responses indicate that Regina needs further discussion regarding special instructions? A. “I have to take this medicine judiciously” B. “I know I will stop taking the medicine when there is advice from the doctor for me to discontinue.” C. “I will inform you and the doctor any untoward reactions I have.” D. “I like taking this sleeping pill. It solves my problem of insomnia. I wish I can take it for life.” 15. Regina commits to herself that she understood and will observe all the medicine precautions by: A. affixing her signature to the teaching plan that she has understood the nurse B. committing what she learned to her memory C. verbally agreeing with the nurse D. relying on her husband to remember the precautions Situation 4 – The nurse-patient relationship is a modality through which the nurse meets the client’s needs. 16. The nurse’s most unique tool in working with the emotionally ill client is his/her A. theoretical knowledge B. personality make up C. emotional reactions D. communication skills 17. The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states: A. All behavior is meaningful, communicating a message or a need. B. Human beings are systems of interdependent and interrelated parts. C. Each individual has the potential for growth and change in the direction of positive mental health. D. There is a basic similarity among all human beings. 18. One way to increase objectivity in dealing with one’s fears and anxieties is through the process of: A. observation B. intervention C. validation D. collaboration 19. All of the following responses are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior? A. Responding in a punitive manner to the client. B. Rejecting the client as a unique human being C. Tolerating all behavior in the client. D. Communicating ambivalent messages to the client. 20. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as: A. counselor B. mother surrogate C. therapist D. socializing agent Situation 5 – The nurse engages the client in a nurse-patient interaction.

21. The best time to inform the client about terminating the nurse-patient relationship is: A. when the client asks how long the relationship would be B. during the working phase C. towards the end of the relationship D. at the start of the relationship 22. The client says, “I want to tell you something but can you promise that you will keep this a secret?” A therapeutic response of the nurse is: A. “Yes, our interaction is confidential provided the information you tell me is not detrimental to your safety.” B. “Of course yes, this is just between you and me. Promise!” C. “Yes, it is my principle to uphold my client’s rights.” D. “Yes, you have the right to invoke confidentiality of our interaction.” 23. When the nurse respects the client’s self-disclosure, this is a gauge for the nurse’s: A. trustworthiness B. loyalty C. integrity D. professionalism 24. Rapport has been established in the nurse-client relationship. The client asks to visit the nurse after his discharge. The appropriate response of the nurse would be: A. “The best time to talk is during the nurse-client interaction time. I am committed to have this time available for us while you are at the hospital and ends after your discharge.” B. “Yes, If you keep it confidential, this is part of privileged communication.” C. “I am committed for your care.” D. “I am sorry, though I would want to, it is against hospital policy.” 25. The client has not been visited by relatives for months. He gives a telephone number and requests the nurse to call. An appropriate action of the nurse would be: A. Inform the attending physician about the request of the client. B. Assist the client to bring his concern to the attention of the social worker. C. “Here (gives her mobile phone). You may call this number now”. D. Ask the client what is the purpose of contacting his relatives. Situation 6 – Camila, 25 years old, was reported to be gradually withdrawing and isolating herself from friends and family members. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently. She was diagnosed as schizophrenia disorder. 26. The past history of Camila would most probably reveal that her premorbid personality is: A. schizoid B. extrovert C. ambivert D. cycloid 27. Camila refuses to relate with to others because she: A. is irritable B. feels superior of others C. anticipates rejection D. is depressed 28. Which of the following disturbances in interpersonal relationships MOST often predispose to the development of schizophrenia? A. Lack of participation in peer groups B. Faulty family atmosphere and interaction C. Extreme rebellion towards authority figures D. Solo parenting 29. Camila’s indifference toward the environment is a compensatory behavior to overcome: A. Guilt feelings B. Ambivalence C. Narcissistic behavior D. Insecurity feelings 30. Schizophrenia is a/an: A. anxiety disorder B. neurosis C. psychosis D. personality disorder Situation 7 – Salome, 80 year old widow, has been observed to be irritable, demanding and speaking louder than usual. She would prefer to be alone and take her meals by herself, minimize receiving visitors at home and no longer bothers to answer telephone calls because of deterioration of hearing. She was brought by her daughter to the Geriatric clinic for assessment and treatment.

31. The nurse counsels Salome’s daughter that Salome’s becoming very loud and tendency to become aggressive is a/an: A. beginning indifference to the world around her B. attempt to maintain authoritative role C. overcompensation for hearing loss D. behavior indicative of unresolved repressed conflict of the past 32. A nursing diagnosis for Salome is: A. sensory deprivation B. social isolation C. cognitive impairment D. ego despair 33. The nurse will assist Salome and her daughter to plan a goal which is for Salome to: A. adjust to the loss of sensory and perceptual function B. participate in conversation and other social situations C. accept the steady loss of hearing that occurs with aging D. increase her self-esteem to maintain her authoritative role 34. The daughter understood, the following ways to assist Salome meet her needs and avoiding which of the following: A. Using short simple sentences B. Speaking distinctly and slowly C. Speaking at eye level and having the client’s attention D. Allowing her to take her meals alone 35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she says that the battery should be functional, the device is turned on and adjusted to a: A. therapeutic level B. comfortable level C. prescribed level D. audible level Situation 8 – For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her. 36. Cecilia is demonstrating: A. acrophobia B. claustrophobia C. agoraphobia D. xenophobia 37. Cecilia’s problem is that she always sees and thinks negative things hence she is always fearful. Phobia is a symptom described as: A. organic B. psychosomatic C. psychotic D. neurotic 38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her: A. communication B. cognition C. observation D. perception 39. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement? A. assist her in recognizing irrational beliefs and thoughts B. help find meaning in her behavior C. provide positive reinforcement for acceptable behavior D. Administer anxiolytic drug 40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia? A. She reads a book in the public library B. She drives alone along the long expressway. C. She watches television with the family in the recreation room D. She joins an art therapy group Situation 9 – It is the first day of clinical experience of nursing students at the Psychiatry Ward. During the orientation, the nurse emphasizes that the team members including nursing students are legally responsible to safeguard patient’s records from loss or destruction or from people not authorized to read it.

41. It is unethical to tell one’s friends and family members data about patients because doing so is a violation of patients’ rights to: A. Informed consent B. Confidentiality C. Least restrictive environment D. Civil liberty 42. The nurse must see to it that the written consent of mentally ill patients must be taken from: A. Doctor B. Social worker C. Parents or legal guardian D. Law enforcement authorities 43. In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within: A. 24 hours B. 36 hours C. 48 hours D. 12 hours 44. The following are SOAP (Subjective – Objective – Analysis – Plan) statements on a problem: Anxiety about diagnosis. What is the objective data? A. Relate patient’s feelings to physician; initiate and encourage her to verbalize her fears; give emotional support by spending more time with patient; continue to make necessary explanations regarding diagnostic tests. B. Has periods of crying; frequently verbalizes fear of what diagnostic tests will reveal C. Anxiety due to unknown D. “I’m so worried about what else they’ll find wrong with me.” 45. Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the: A. Summary of chronological notations made by individual health team members B. Identification of patient’s responses to medical diagnoses and treatment C. Patient’s responses to health and illness as a total person in interaction with the environment D. Step by step procedures for the management of common problems Situation 10 – Marie is 5½ years old and described by the mother as bedwetting at night. 46. Which of the following is the MOST common physiological cause of night bed wetting? A. deep sleep factors B. abnormal bladder development C. infections D. familial and genetic factors 47. All of the following, EXCEPT one compromise the concepts of behavior therapy program. A. reward and punishment B. extinction C. learning D. placebo as a form of treatment 48. To help Marie who bed wets at night practice acceptable and appropriate behavior, it is important for the parents to be consistent with the following approaches EXCEPT: A. discipline with a kind attitude B. matter of fact in handling the behavior C. sympathize for the child D. be loving yet firm 49. A therapeutic verbal approach that communicates strong disapproval is: A. “You are supposed to get up and go in the toilet when you feel you have to go and did not. The next time you bed wet, I’ll tell your friends and hang your sheets out the window for them to see.” B. “You are supposed to get up and go in the toilet when you feel you have to go and did not. I expect you to from now on without fail.” C. “If you bed wet, you will change your bed linen and wash the sheets.” D. “If you don’t make an effort to control your bedwetting, I’d be upset and disappointed.” 50. During your conference, the parent inquires how to motivate Marie to be dry in the morning. Your response which is an immediate intervention would be: A. Give a star each time she wakes up dry and every set of five stars, give a prize. B. Tokens make her materialistic at an early age. Give praise and hugs occasionally. C. What does your child want that you can give every time he/she wakes up dry in the morning? D. Promise him/her a long awaited vacation after school is over.

ANSWER KEY NURSING PRACTICE V- Care of Clients with physiologic and Psychosocial Alterations (Part C). Situation 1 – Jimmy developed this goal for hospitalization. “To get a handle on my nervousness.” The nurse is going to collaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned to asphyxiate himself with exhaust from his car but frightened instead. He realized he needed help. 1. The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is: help the client to plan alternatives 2. The nurse is guided that Jimmy is aware of his concerns of the “here and now” when he crossed out which item from this “list of what to know”. subjective idea of the range of mild to severe anxiety 3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that complete disruption of the ability to perceive occurs in: panic state of anxiety 4. Jimmy initiates independence and takes an active part in his self care with the following EXCEPT: agreeing to contact the staff when he is anxious 5. The nurse notes effectiveness of interventions in using subjective and objective data in the: progress notes Situation 2 – A research study was undertaken in order to identify and analyze a disabled boy’s coping reaction pattern during stress. 6. This study which is an in depth study of one boy is a: case study 7. The process recording was the principal tool for data collection. Which of the following is NOT a part of a process recording? Audio-visual recording 8. Which of these does NOT happen in a descriptive study? Manipulation of variable 9. The investigator also provided the nursing care of the subject. The investigator is referred to as a/an: Observer researcher 10. To ensure reliability of the study, the investigator’s analysis and interpretations were: subjected to an inter-observer agreement Situation 3 – During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 35 years old, was given Flurazepam (Dalmane) 15mg at 10:00pm because she had trouble going to sleep. Before approaching Regina, the nurse read the observation of the night nurse. 11. Which of the following approaches of the nurse validates the data gathered? “I learned that you were up till ten last night, tell me what happened before you were finally able to sleep and how was your sleep?” 12. Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needs for information about her medicine? Provide a drug literature. 13. The nurse engages Regina in the process of mutual inquiry to provide an opportunity for Regina to: perceive her participation in an experience !4. Which of these responses indicate that Regina needs further discussion regarding special instructions? “I like taking this sleeping pill. It solves my problem of insomnia. I wish I can take it for life.” 15. Regina commits to herself that she understood and will observe all the medicine precautions by: committing what she learned to her memory Situation 4 – The nurse-patient relationship is a modality through which the nurse meets the client’s needs. 16. The nurse’s most unique tool in working with the emotionally ill client is his/her communication skills 17. The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states: All behavior is meaningful, communicating a message or a need.

18. One way to increase objectivity in dealing with one’s fears and anxieties is through the process of: validation 19. All of the following responses are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior? Communicating ambivalent messages to the client. 20. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as: mother surrogate Situation 5 – The nurse engages the client in a nurse-patient interaction. 21. The best time to inform the client about terminating the nurse-patient relationship is: at the start of the relationship 22. The client says, “I want to tell you something but can you promise that you will keep this a secret?” A therapeutic response of the nurse is: “Yes, our interaction is confidential provided the information you tell me is not detrimental to your safety.” 23. When the nurse respects the client’s self-disclosure, this is a gauge for the nurse’s: trustworthiness 24. Rapport has been established in the nurse-client relationship. The client asks to visit the nurse after his discharge. The appropriate response of the nurse would be: “The best time to talk is during the nurse-client interaction time. I am committed to have this time available for us while you are at the hospital and ends after your discharge.” 25. The client has not been visited by relatives for months. He gives a telephone number and requests the nurse to call. An appropriate action of the nurse would be: Ask the client what is the purpose of contacting his relatives. Situation 6 – Camila, 25 years old, was reported to be gradually withdrawing and isolating herself from friends and family members. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently. She was diagnosed as schizophrenia disorder. 26. The past history of Camila would most probably reveal that her premorbid personality is: schizoid 27. Camila refuses to relate with to others because she: anticipates rejection 28. Which of the following disturbances in interpersonal relationships MOST often predispose to the development of schizophrenia? Faulty family atmosphere and interaction 29. Camila’s indifference toward the environment is a compensatory behavior to overcome: Insecurity feelings 30. Schizophrenia is a/an: psychosis Situation 7 – Salome, 80 year old widow, has been observed to be irritable, demanding and speaking louder than usual. She would prefer to be alone and take her meals by herself, minimize receiving visitors at home and no longer bothers to answer telephone calls because of deterioration of hearing. She was brought by her daughter to the Geriatric clinic for assessment and treatment. 31. The nurse counsels Salome’s daughter that Salome’s becoming very loud and tendency to become aggressive is a/an: overcompensation for hearing loss 32. A nursing diagnosis for Salome is: social isolation 33. The nurse will assist Salome and her daughter to plan a goal which is for Salome to: adjust to the loss of sensory and perceptual function 34. The daughter understood, the following ways to assist Salome meet her needs and avoiding which of the following: Allowing her to take her meals alone 35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she says that the battery should be functional, the device is turned on and adjusted to a: prescribed level Situation 8 – For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her.

36. Cecilia is demonstrating: agoraphobia 37. Cecilia’s problem is that she always sees and thinks negative things hence she is always fearful. Phobia is a symptom described as: neurotic 38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her: cognition 39. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement? provide positive reinforcement for acceptable behavior 40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia? She drives alone along the long expressway. Situation 9 – It is the first day of clinical experience of nursing students at the Psychiatry Ward. During the orientation, the nurse emphasizes that the team members including nursing students are legally responsible to safeguard patient’s records from loss or destruction or from people not authorized to read it. 41. It is unethical to tell one’s friends and family members data about patients because doing so is a violation of patients’ rights to: Confidentiality 42. The nurse must see to it that the written consent of mentally ill patients must be taken from: Parents or legal guardian 43. In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within: 24 hours 44. The following are SOAP (Subjective – Objective – Analysis – Plan) statements on a problem: Anxiety about diagnosis. What is the objective data? Has periods of crying; frequently verbalizes fear of what diagnostic tests will reveal 45. Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the: Identification of patient’s responses to medical diagnoses and treatment Situation 10 – Marie is 5½ years old and described by the mother as bedwetting at night. 46. Which of the following is the MOST common physiological cause of night bed wetting? familial and genetic factors 47. All of the following, EXCEPT one compromise the concepts of behavior therapy program. placebo as a form of treatment 48. To help Marie who bed wets at night practice acceptable and appropriate behavior, it is important for the parents to be consistent with the following approaches EXCEPT: 49. A therapeutic verbal approach that communicates strong disapproval is: “If you don’t make an effort to control your bedwetting, I’d be upset and disappointed.” 50. During your conference, the parent inquires how to motivate Marie to be dry in the morning. Your response which is an immediate intervention would be: What does your child want that you can give every time he/she wakes up dry in the morning?

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