CAT Copy GENERAL NURSING COUNCIL OF ZAMBIA (The Nurses and Midwives Act., 1997) ZAMBIA REGISTERED NURSE QUALIFYING EXAMINATION PRE-SERVICE PAPER V CANDIDATE’S No. ... WRITE No, OF QUESTIONS ‘ANSWERED / ATTEMPTED No. No. No. No. No, No,GENERAL NURSING COUNCIL OF ZAMBIA (The Nurses and Midwives Act No. 31 of 1997) JALIFYT NATION EGISTERED Nt 2y HA LTH DATE: 17™ NOVEMBER, 2017 ‘TIME: 09.00 — 12.00 HOURS RNP V QUALIFYING ERANNATION \OVEMBER/DECEMBER 2017 Page 1INSTRU a3: aa: BamNosaae eet (ONS TO CANDIDATES Answer all questions in SECTION A, B and C in the examination booklet as instructed. (Each question carries one (1) mark). SECTION D ~ Answer two (2) questions only from this part. Each question is 100 marks). Essay question number one (1) is COMPULSORY. Ensure that all page numbers inside the booklet are correct. Write your examination number on the top right hand corner of each page and on the front cover of the booklet, Begin a new essay on a new sheet of paper and write on both sides of the Paper DO NOT write beyond the margins Name of the school and candidate MUST NOT appear in the answer booklet. On the front cover of the answer booklet, indicate the number of the essay questions attempted in the space provided, Do not use pencil EXCEPT for diagrams NO form of identity or mark (other than the examination number) should appear in the answer booklet. DO NOT detach the examination booklet DO NOT attach any paper to the examination booklet MOBILE PHONES or ANY ELECTRONIC DEVICES are NOT allowed in the examination room Involvement in ANY form of examination malpractice will warrant disqualification from the examination RN PV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017 Page 2Exam No ‘SECTION A ~ MULTIPLE CHOICE QUESTIONS IN EACH OF THE FOLLOWING QUESTIONS ENCIRCLE THE LETTER ‘CORRESPONDING WITH THE MOST APPROPRIATE ANSWER. ‘ONE (1) MARK EACH 1. According to traditional definitions of mental health, which of the following would the nurse be most likely to describe as mentally healthy? a) Jerry Banda, a war veteran with no family ties, who has been unemployed for 10 years b) Tom Sakulanda, a CEO, who spends 14 hours at work each day and is too tired to do anything with his family on weekends ) George Mbewe, a shoe salesman who delights in playing affectionately with his children but has been unable to hold a steady job since they were born d) Sam Malwa, a restaurateur who loves his work, but sets limits on the hours he spends there in order to enjoy his family and friends N .. In helping a client change, the nurse should: a) Encourage the client to move rapidly to avoid delay b) Realize that the problems the client is facing will make him or her eager to change ©) Encourage feelings of hope d) Understand that change is a natural process that never involves anxiety and fear tr PV QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017 Page 3Exam No~ 3. John Chama is a 36-year-old male recently admitted to a psychiatric unit. The nurse taking his history observes that his speech is slurred, and he states that he cannot remember where he has been for the past 12 hours, but the police who brought him in stated that he was arrested driving the wrong way on a one-way street. Which of the following items on the mental status examination would the nurse NOT mark “impaired”? a) Behavior b) Judgment ©) Memory d) Affect 4, Which of the following would be the best example of an open-ended question? a) How did you come to be in the hospital? b) Did your husband bring you over to the hospital? ©) Who brought you to the hospital? d) When did you come into the hospital? 5, The purpose of a theory is to: a) Describe, explain, predict or control a phenomenon b) Encourage the development of more research ©) Prove that there can be one way to describe a phenomenon d) Prove that a phenomenon exists 6. Dorothea Orem's theory of nursing is also called the theory of: a) Behavioral Systems b) Self-care c) The environment d) Adaptation | PV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017Exam No. 7, When assessing whether or not a patient has a problem with alcohol or drugs, which criterion is the best indicator: a) How much a person uses b) How often a person uses ©) Interference with life 4) Positive laboratory findings 8. Which of the following is NOT a sign of delirium tremens? ) Confusion b) Tactile hallucinations ©) Seizures d) Stroke 9. Mr. Kakanda is a patient diagnosed with schizophrenia who is hospitalized on a Psychiatric unit. You notice him standing motionless on one leg in the day area. This would most likely be an example of: a) Attention-seeking behavior b) Catatonic posturing ©) Aside effect of neuroleptic medication ) Catatonic stupor 10. During the initial assessment, the nurse inquires of Mr. Jones, "What brought you to the hospital?” Mr, Jones replies, “An ambulance.” This is an example of: a) Deductive reasoning b) Abstract thinking ©) Concrete thinking ) Poverty of content of speech ‘11. The patient remarks repeatedly that he believes he is Jesus Christ and has come to save the world. This can best be described as: a) Defense of identification b) A delusion of grandeur ©) Anillusion ) An idea of reference QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017Exam No- 2. Possible complications from neuroleptic malignant syndrome include the following: a) Muscle rigidity, hyperthermia, autonomic instability b) Liver failure, jaundice tinnitus ) Increased intracranial pressure, headache, blurred vision d) Agranulocytosis , bleeding, anaemia 3. Nursing care for the patient with neuroleptic malignant syndrome will include: a) The discontinuation of the neuroleptic, maintenance of skin integrity and hydration, and administration of bromocriptine b) The gradual tapering of the neuroleptic, the administration of cogentin, and Maintenance of skin integrity and hydration ©) The gradual tapering of the neuroleptic, administration of bromocriptine, and maintenance of skin integrity and hydration d) The discontinuation of the neuroleptic, maintenance of skin integrity and hydration, and the administration of Cogentin 4. Which of the following statements about tardive dyskinesia is most accurate? a) Symptoms are generally reversible, particularly in younger patient population. 'b) Symptoms may appear 1-10 days following administration of neuroleptic medication. ©) Occurs most often in dehydrated patients. d) All patients on long-term neuroleptic therapy are at risk 5. According to genetic studies of schizophrenia: @) Genetic factors are not important to one’s risk of developing schizophrenia. b) A twin of a monozygotic (identical) twin with schizophrenia has a greater chance of having schizophrenia than the general population. ¢) A twin of a monozygotic (identical) twin with schizophrenia has a lesser chance of having schizophrenia than the general population. d) Genetic inheritance is most likely the only cause of schizophrenia since family interactional patterns cannot be empirically studied FYING EXAMINATION ~ NOVEMBER/DECEMBER 2017Exam No. ‘6. After a short period on a typical antipsychotic, a client complains that she can’t sit still and taps her foot continuously. The nurse should; a) Administer a PRN dose of medication because she is still agitated b) Understand that these symptoms are akathisia, and consider use of diphenhydramine and/or reduce the dosage of medication ©) Help client relax in bed and obtain an order for an antianxiety medication d) Provide for vigorous activities until she settles down 7.Which of the following symptoms is considered a “negative symptom” of schizophrenia? a) Auditory hallucinations b) Delusions ©) Flat affect d) None of the above 8,The physician plans to order lithium carbonate for a manic patient. Before beginning the lithium treatment regimen, the nurse performs a physical ‘assessment. She is aware that lithium is contraindicated when a patient exhibits dysfunction of the: a) Renal system b) Reproductive system ©) Endocrine system d) Respiratory system J.Which of the following characteristics is most typical of bulimia? a) Unsuccessful efforts to control weight normally ‘b) Persistent over-concern with body shape and weight combined with periods of strict dieting ©) Self-induced vomiting alternating with periods of normal eating d) Episodes of binge eating and self-induced vomiting or other severe weight control methods AFYING EXAMINATIOI \OVEMBER/DECEMBER 2017 Page 7Exam No— 20.Which of the following is true about a person with Paraphilia? a) Paraphilia is a sexual dysfunction, b) Persons with Paraphilia do not have normal sexual habits. ©) Erotic pleasure is received from the activity. d) The Paraphilia tends to be obsessional in nature. 21.The impulse control disorder that is characterized as the inability to resist the impulse to steal objects is which one of the following a) Pyromania b) Kleptomania ©) Trichotillomania d) Intermittent explosive disorder 22. Which of the following is the hallmark indication of delirium? a) Fluctuation of sensorium and limited attention span b) Global cognitive impairment ©) Severe agitation d) Dysphona 23. What level of consciousness is the patient likely to exhibit during delirium? a) Alert and oriented b) Hypervigilant ©) Fluctuating d) Comatose 24.Which of the following is NOT a cognitive mental disorder? a) Affective disorders b) Dementia of the Alzheimer’s Type c) Vascular Dementia d) Delirium ‘QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 20173.Ms. T who is 85, is unable to perform several of her Activities of Dally Living due to her inability to conceptualize and complete tasks. Her level of dementia is: a) Mild b) Moderate ©) Severe d) Fluctuating 3.Ms. T, notes that the patient has short-term memory loss. An example would be: @) Inability to remember what happened yesterday 'b) Inability to remember current president €) Inability to remember an anniversary d) Inability to remember three objects after five minutes ’,Which of the following is classified as a selective serotonin reuptake inhibitor (SSR)? a) Trazodone b) Desipramine ©) Fluoxetine 4) Lithium 3. Alzheimer’s disease is considered to result from a) Aluminum intoxication b) Alcohol abuse ) Tumors d) Causes 1.Vascular Dementia is characterized by which of the following: a) Stepwise and patchy deterioration in intellectual functioning b) Global cognitive impairments ©) Retrograde amnesia d) Headaches and fainting spells ee *V QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017, Page 9Exam No 30. A newly admitted client is diagnosed with posttraumatic stress disorder, Which behavioral symptom would the nurse expect to assess? a) Recurrent, distressing flashbacks. b) Intense fear, helplessness, and horror. ©) Diminished participation in significant activities 4) Detachment or estrangement from others. 31. In which situation would the nurse suspect a medical diagnosis of social phobia? a) Aclient abuses marijuana daily and avoids social situations because of fear of humiliation. b) An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school. © Adient diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. d) A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others. 32. A client experiencing a panic attack would display which physical symptom? a) Fear of dying. b) Sweating and palpitations. ©) Depersonalization. d) Restlessness and pacing. 33.A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive-compulsive disorder. Which behavioral symptom would the nurse expect to assess as a way of coping? a) The client uses excessive hand washing to relieve anxiety. b) The client rates anxiety at 8/10. ©) The client uses breathing techniques to decrease anxiety. ) The client exhibits diaphoresis and tachycardia. PV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017Exam No 34.Anxiety is a symptom that can result from which of the following physiological conditions?. a) Chronic obstructive pulmonary disease. b) Hyperthyroidism. ©) Hypertension. d) Diverticulosis. 35.Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? a) Excessive worry about items difficult to control. b) Muscle tension, ¢) Hypersomnia. d) Excessive amounts of energy. 36.A nurse is Providing care to a client with phobia who is being treated. The client is introduced to short periods of exposure to the phobia object while in relaxed state, The nurse understands that this form of behaviour modification can be best described as: a) Aversion therapy b) Self-control therapy ©) Systematic desensitization d) Operant conditioning 37.A client with major depression is considering cognitive therapy. The client say to the nurse, “how does this treatment work?" The nurse responds by telling the client that: a) “This type of treatment helps you examine how your thoughts and feelings contribute to your difficulties” b) “This type of treatment helps you examine how your past life has contributed to your problems,” ©) “This type of treatment helps you confront your fears by exposing you to the feared objects abruptly.” ) “This type of treatment will help you relax and develop new coping skills.” ly PV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017 Page 11eee Exam No— 38, The most advantageous therapy for a preschool age child with a history of physical and sexual abuse would be: a) Play b) Psychoanalysis ©) Group d) Family 39.An 18 year old client is admitted with the diagnosis of anorexia nervosa. A cognitive behavioural approach is used as part of her treatment plan. The nurse understands that the purpose of this approach is to; a) Help the client identifies and examines dysfunctional thoughts and beliefs. b) Emphasize social interaction with clients who withdraw ©) Provide a supportive environment and a therapeutic community d) Examine intrapsychic conflicts and past events in life 40. The nurse knows that in group therapy, the maximum number of members to include is: a4 b) 8 ©) 10 d) 16 41.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 ©) Being politically active in relation to mental health issues 4) Providing mental health education to members of the community PV QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017Exam No— 42.Rose seeks psychiatric consultation because of intense fear of flying in an airplane which has greatly affected her chances of success in her job. The most common defense mechanism used by phobic client is: a) Suppression b) Rationalization ©) Denial d) Displacement 43. The goal of the therapy in phobia is: a) Change her lifestyle b) Ignore reaction producing situation ©) Change her reaction towards anxiety d) Eliminate fear producing situation 44.The fear and anxiety related to phobia is said to be abruptly decreased when the patient exposed to what is feared through: a) Guided imagery b) Systematic desensitization ©) Flooding d) Hypnotherapy 45,Manase Daka, 39 year old farmer, unmarried, had been confined in Chainama hospital for three years with a diagnosis of schizophrenia. When Manase Daka saysto you: “The voices are telling me bad things again!” The best confrontational response is: a) "Whose voices are those?” b) “I doubt what the voices are telling you.” ©) “Ido not hear the voice you say you hear.” d) “Are you sure you hear these voices?” "RNP V QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017 Page 13Exam No— 46.A relevant nursing diagnosis for clients with auditory hallucination is: a) Sensory perceptual alteration b) Altered thought process ©) Impaired social interaction d) Impaired verbal communications 47. Obsessive compulsive disorder is BEST described by @) Uncontrollable impulse to perform an act or ritual repeatedly: b) Persistent thoughts © Recurring unwanted and disturbing thoughts alternating with behaviour. d) Pathological persistence of unwilled thought, feeling or impulse 48.To be more effective, the nurse who cares for persons with obsessive compulsive disorder must possess one of the following qualities: a) Compassion b) Consistency ©) Patience d) Friendliness 49. The preparation of a patient for Electro Convulsive Therapy ideally is MOST similar to preparation for a patient for: a) electroencephalogram b) X-ray ©) General anesthesia d) Electrocardiogram 50. Informed consent is necessary for the treatment for involuntary clients, When this cannot be obtained, permission may be taken from the: a) Social worker b) Doctor ©) Nursing Officer d) Next of kin or guardian inp V QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017 Page 14fam No— MATCHING ITEMS Match the following psychiatric nursing skills in Column I with their corresponding characteristics in Column II. Responses in Column II should be used once only. Column I Column 11 51.—-—Communication _A. Teach patient step by step ways of changing maladaptive lifestyle 52,-—-Self-awareness 8, Train patients to freely express themselves in an appropriate and acceptable way 53.——-Assertive skills training C. The reciprocal exchange of information, ideas and feelings 54,—-—-Counselling skills D. Inspect oneself inwardly and understand oneself objectively Behaviour modification E. Techniques used by the nurse to help the client find own solutions while being supported and guided F. One way communication to educate patients on various health issues G. Actions Nurses take to help treat or deliver nursing care to clients so that they may recover or get well 5S. PV QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017__ RN PV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017 : Bram No~———— SECTION B - MATCHING ITEMS Match the terminologies used in mental health and psychiatric nursing in Column I with their characteristics in Column IL. Responses in Column II should be used once only. Column I 56. -—--Forensic psychiatry 57. --~--Mental health 58. 59. ~-Geriatric psychiatry -Community psychiatry 60. --—-Psychiatric rehabilitation Column II A. Admission of psychiatric patients in hospitals within the community B. Shift in focus from psychiatric institutional are to home environment C. Prevention of long term disability D. A state of being happy, efficient and ability to adjust to demands of life E. A specialized or branch of psychiatry that deals with legal related matters F. A specialized or branch of psychiatry that deals with substance use disorder G. A specialized branch of psychiatry that deals with ederly Match the Items in Column I with their corresponding meaning in Column II. Responses in Column II should be used once only. Column I ‘Circumstantial thinking ~-Fragmented thinking -—--Delusion of persecution Obsession Disorientation Column II A. False, firm belief that one is being spied upon, about to be poised or hurt B. Repeating what the interviewer says C. Pre occupation or ideas coming into one’s mind frequently D. A false, fixed belief that one is very rich or has great powers E. Beating about the bush F. Inability to recognize place, time, date, year and person G. Disjointed ideas Page 16Match the types of personality disorders in Column I with their corresponding meaning in Column II, Responses in Column II should be used once only. Column 1 ~Paranoid personality disorder 67. Schizoid personality disorder 68.-——--Antisocial personality disorder 69. ~-Borderline personality disorder Narcissistic personality disorder Column IT A, Disregard for violation of the rights of others, lack of empathy and always in conflict with the law B, Pervasive pattern of instability in relationships, self-image, identity, behavior and affects often leading to self-harm and impulsivity C. Characterised by a pattern of irrational suspicion D. Detached from social relatioships, restricted affect, involved with things more than people E. Pervasive psychological need to be cared for by other people F. Pervasive feeling of worthleness and ‘overdependence on others G. Characterised by a tendency to isolate oneself, experience of bizzare ideas and rarely perpetual disturbances we V QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017 Page 17Exam No~ SECTION C - COMPLETION COMPLETE THE FOLLOWING STATEMENTS WITH ONE (1), TWO (2) OR THREE (3) WORDS ONLY. 71.Interaction between people and their environment based on stimuli and responses is known as--- 72.Northern Rhodesia had no psychiatric hospital and most of the patients where looked after in the general hospitals known as-——~ 73. The member of parliament who suggested that psychiatric patients can best be nursed at home, here in Zambia than at Ingutsheni_in Southern Rhodesia in 1957 was-—~ 74.An ability to do an activity or job well, especially because you have practiced it is called 75.The acronym that best demonstrates and summarizes behaviors during counseling/ therapeutic relationship with a client is called--——---—- 76. Looking inward to understand oneself and objectively without bias, examine one's beliefs, values, attitudes, motivations, strengths and limitations is called 77. The skill a nurse uses to examine thoughts and observable behaviour of a client during counseling that is self-defeating and change such thoughts and behaviour for the better is known as— 78. The knowledge and skills people need to have to live in the community is called 79. The term used to describe an individual's reaction to any change that requires an adjustment or response is 80. The use of coping strategies, ways or methods that protect the individual from harm in response to stressful situations or stressors is called-- 81. Adding a rewarding stimulus as a consequence of a behaviour, thus increasing the probability that it will occur again is referred to as~ ee ___RNPV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017 Page 18. -which input from both parties contributes to a climate of healing, growth promotion, and illness prevention is known as~ '83.An examination that is conducted the first time a psychiatric patient comes to the health facility with a complaint is referred to as- a 84. The type of admission where a patient is willing to be admitted and knows that he/she has a problem and the medical officer in charge of the mental hospital sees that the patient really needs it is called: _85.The type of admission where the patient is not willing to be admitted and does Rot accept treatment, or is unable to give consent for treatment, but he or she has a problem, illness or he is a potential abscondee is-—- 86.The type of admission where the employers writes a letter to the hospital requesting the medical officers who in turn consult the psychiatrist where applicable, to examine the patient thoroughly and come up with a report to say whether that person can continue working or be retired on medical grounds is called admission under-— -87.The transition (passing from mental hospital to the community) in which the "patient is discharged and given a review date for continuity of care is known as ary team holds a meeting with the client and relatives on admission in which they together begin to plan for the patient’s eventual discharge upon recovery is- '89.After the patient has stabilized the nurse meets with relatives and the rest of the mult disciplinary team to review / evaluate patient’s progress, ascertain his/her suitability for discharge, and to further prepare patient for discharge is called-91. The type of depression also known as exogenous depression where the cause is considered to be coming from outside is called-—~ 92.An affective disorder which present with elation of mood and increased psychomotor activities is referred to as - 93.A psychiatric syndrome in which specific psychological symptoms lead, in most cases, to disintegration of personality is known as ~ 94.The term that describes symptoms of a large group of illnesses that cause a Progressive decline in a person’s functioning such as loss of memory, intellect, rationality and social skills is called— 95. The type of personality disorder which is characterized by a pattern of irrational Suspicion, mistrust of others, Interprets innocent actions to be negative and defensive is~ 96. The term used for two conflicting ideas at the same time is called —~ 97. The type of personality disorder which is characterized by a pervasive pattern of grandiosity, attention seekers and always asks for favours is called: 98.The disorder in which a person's overall intellectual functioning is well below average, with an intelligence quotient (1Q) around 70 or less is~ 99.An abnormal, sudden excessive, uncontrolled electrical discharge of neurons within the brain that may result in alteration in consciousness, motor, or sensory ability and or behaviour is referred to as~ 100. The phase before the actual fit (epileptic) which is characterized by a change in the patient's mood and may last for hours to days is PV QUALIFYING EXAMINATION - NOVEMBER/DECEMBER 2017Exam No—— SECTION D: ESSAY QUESTIONS ANSWER TWO QUESTIONS ONLY. EACH QUESTION CARRIES 100 MARKS. QUESTION ONE IS COMPULSORY. 1, Diana a young female adolescent is brought to the psychiatric hospital amidst talking and shouting on top of her voice non-stop. The father had accompanied her saying this was of sudden onset, The daughter cannot sleep claims she is the Newly crowned queen of England, and feels she has some special powers to save the world. The staffs on the ward decide to manage this client accordingly. a) i, Define Mania 5% ji, Qutline five (5) predisposing factors to Mania 20% b) State five (5) clinical manifestation of mania 15% ©) Mention three (3) drugs that may be given to Diana stating the dose, frequency and two(2) side effects of each drug 15% d) Discuss the Nursing Management you would give Diana 45% N Mr. Moses Nkamba is a 80 year old man. During the past four years, Mr. Nkamba has demonstrated gradual, progressing memory impairment. The family * members found themselves close to physical exhaustion. He is brought to the hospital with history of increased incontinence when he cannot find the toilet and wonders away from home constantly. a) Outline five (5) causes of Dementia 15% b) Outline five (5) symptoms of Dementia other than the ones mentioned above. 15% ©) Explain four (4) points in the nursing assessment that will be Vital in planning the nursing care of Mr. Nkamba 20% 4) Describe the nursing care interventions that would be appropriate in meeting Mr. Nkamba needs 50% NPV QUALIFYING EXAMINATION ~ NOVEMBER/DECEMBER 2017 Page 21eee Exam No~ 3. Chembe is an epileptic patient; married with 2 children has been brought to the ward following a grandmal seizure two days ago. The patient had generalized movement of the body and confusion ensued thereafter, Since then the patient just stares blankly in the environment, withdrawn and has hallucinations and illusion. Patient is also neglecting himself and not eating. a) (i) Define epilepsy 5% (ii) Explain the psychiatric aspects of epilepsy 10% 'b) Outline five (5) types of epileptic seizure 20% ©) Describe the management of Chembe 50% d) Explain five (5) points you would include in your information, education and communication (IEC) to the community on epilepsy 15%