Professional Documents
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NURSING PRACTICE 3C:
NURSING CARE OF CLIENT WITH PHYSIOLOGICAL
AND PSYCHOSOCIAL ALTERATIONS
DIRECTION: Choose the letter of the BEST answer by shading the corresponding letter of your choice on the answer
sheet provided. STRICTLY NO ERASURE!
Situation 1: The nurse is envisioning a career path in mental health psychiatric nursing. As a beginning professional
nurse, she is guided with basic beliefs about the practice.
1. Which of the following statement reflects the scope of mental health psychiatric nursing?
A. it includes nursing actions aimed at returning the patient to his highest potential of productivity.
B. it is an integral aspect of all nursing and a specialty service to all people affected by mental
illness.
C. it includes nursing actions to reduce the rate of new cases of mental disorder in population
D. it consist of early recognition and treatment of mental disorders to reduce severity and duration of mental
illness
2. The beginning professional nurse can do mental health counseling with the following clients, EXCEPT:
A. actively psychotic patients C. parents with child rearing concerns
B. out of school adolescents D. school children with behavioral problem
3. A professional responsibility of the mental health psychiatric nurse is to provide a safe and therapeutic environment.
This is BEST reflected in:
A. restraining patients who violates policies and do not follow schedule of activities.
B. maintaining a closed door policy to prevent patients from absconding.
C. keeping a restrictive environment to prevent patients from becoming assaultive and hostile
D. ensuring physical safety and maintaining therapeutic attitude towards the patients
4. The foundation of the therapeutic process is the therapeutic relationship. What is the essential component that the
nurse must bring to the relationship?
A. humor C. reframing
B. empathy D. confrontation
5. Which of these people, the highest in population groups that would need priority mental health therapy?
A. adults going through active skills C. young professionals entering the workplace
B. single elderly with no social support D. women preparing for overseas employment
Situation 2: Some activity therapies are organized and conducted in groups where nurses may participate in.
6. A mental health nurse may not be a member of this self help group because help given to members comes from
members themselves:
A. Remotivation Group C. Activity Therapy Group
B. Alcoholics Anonymous D. Art Therapy Group
10. Community meetings are held as a part of milieu therapy on an in-patient psychiatric unit. The purpose of these
meetings would be:
A. to focus on issue arising from group living
B. to encourage expression on topics of interest
C. to provide direction from the treatment plan
D. to encourage expression of intrapsychic conflicts
11. Studies on biological depression support electroconvulsive therapy as a mode of treatment. The rationale is:
A. ECT produces massive brain damage which destroys the specific area containing memories related to
the events surrounding the development of psychotic condition
B. The treatment serves as a symbolic punishment for the client who feels guilty and worthless
C. ECT relieves depression psychologically by increasing the norepinephrine level
D. ECT is seen as a life-threatening experience and depressed patients mobilize all their bodily defenses
to deal with this attack.
12. The preparation of a patient for ECT ideally is MOST similar to preparation for a patient for:
A. electroencephalogram C. general anesthesia
B. X-ray D. electrocardiogram
13. Which of the following is a possible side effect which you will discuss with the patient?
A. hemorrhage within the brain C. encephalitis
B. robot-like body stiffness D. confusion, disorientation and short term
memory loss
14. Informed consent is necessary for the treatment for involuntary clients. When this cannot be obtained, permission
may be taken from the:
A. social worker C. next of kin or guardian
B. doctor D. chief nurse
15. After ECT, the nurse should do this action before giving the client fluids, food or medication:
A. assess the gag reflex C. next of kin or guardian
B. assess the sensorium D. check O2 Sat with a pulse oximeter
Situation 4: The community health nurse encounters special children in the community.
16. An individual with antisocial personality disorder lacks remorse, shame and guilt in going against the norms of society.
Psychodynamically, this defect in the personality reflects a disturbance of the:
A. ego C. ego ideal
B. super ego D. id
17. The nurse teaches parents about children’s beginning concepts of right and wrong by emphasizing child rearing
attitude and practices during the:
A. school age C. infancy period
B. toddler age D. latency period
18. It is BEST for parents to teach healthy interpersonal relationships to their children by:
A. modeling to their children
B. encouraging their children to attend secondary school
C. encouraging their children at home to behave properly
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D. teaching their children good manners and right conduct
19. An important principle for the nurse to follow in interacting with retarded children is:
A. seen that if the child appears contented, his needs are being met
B. provide an environment appropriate to their development task as scheduled
C. treat the child according to his chronological age
D. treat the child according to his developmental level
Situation 5: The nurse recognizes the need to learn to cope with stress and change. She becomes interested to practice
natural ways to enhance well being.
22. All of these are the behavior intervention to stress management. EXCEPT:
A. guided imagery C. meditation
B. pharmacotherapy D. progressive muscle relaxation
24. Dietary practices are very important to the health of the Filipino family. The nurse needs to assess this
lifestyle because:
A. the nurse wants to change the eating patterns of the Filipino family
B. the nurse knows that being overweight is a major health hazard
C. the nurse wants to stop all the mainstream weight-loss diets
D. the nurse has to find out what people are eating
25. A young overweight adult smokes 5-10 sticks of cigarettes/day, ambitious, looks at life as challenging and perfect and
never considers change in his lifestyle, initially needs:
A. commitment C. skills to attempt change
B. information D. motivation
Situation 6: Bernie and John in their late 40’s have been married for 20 years and at the peak of their careers.
Suddenly, Bernie discovered that her husband was falling in love with another woman. Shaken by this situation, she
started to have problems sleeping and could not function well at work and at the risk of losing her job. John asked
forgiveness and regret very much the hurt his wife was going through and suffered guilt feelings:
29. Assessment data of the nurse include all the following EXCEPT:
A. coping mechanisms C. perception of the event
B. situational support D. repressed problems
30. The duration of crisis usually lasts several days and usually:
A. 2 – 4 weeks C. 1 – 2 months
B. 1 – 2 weeks D. 4 – 6 weeks
Situation 7: Felisa has a ritualistic pattern of constantly washing her hands with soap and water followed by rubbing
alcohol.
33. The anxiety of Felisa is disabling and interferes with her job performance, interpersonal relationships and other
activities of daily living. To minimize such problems, she is likely to be given:
A. diazepam ( Valium ) C. imipramine Hcl ( Tofranil )
B. haloperidol ( Haldol ) D. chlorpromazine ( Thorazine )
Situation 8:As a professional, it is imperative that the nurse is accountable to oneself hence the importance of personal
and professional development.
37. The nurse has achieved self-awareness in which of the following verbalizations?
A. every time people around me yell, I feel upset and withdrawn
B. when the patient yelled at me I became speechless
C. with the patients tone of voice and stare, I got reminded of how my father would be so angry and
this made me anxious
D. I thought it was rude for the patient to yell hence I kept quiet
39. Self-awareness, knowledge and understanding of human behavior and communication skills define what is essential in
caring for every nurse to be able to demonstrate:
A. positive self-projection C. therapeutic use of self
B. assertiveness D. self-mastery
40. Considering that man is by nature social, it is BEST for the nurse to gain self-awareness by:
A. participating in intensive group experiences
B. individual psychotherapy
C. hypnotherapy
D. writing an autobiography for self introspection
41. To facilitate identification of persons and relationships, the family nurse utilizes this diagrammatic representation of
members of a family and their relationships:
A. flowchart C. algorithm
B. genogram D. kardex
42. A problem oriented recording system that utilizes the problem solving process as the basis of patient care
management:
A. NANDA Diagnosis C. Gordon’s Functional Health Patterns
B. Nursing Care Plan D. Problem Oriented Medical Recording
43. This is a SOAP recording of the patient’s problem of “Nervousness”. Which is the subjective data?
A. Mr. Z was nervous during the interview, he moved frequently in the bed and his palms were sweaty.
B. Mr. Z does not seem to tolerate stress too well which will aggravate his cardiac condition. He understands
Little about his health which may be increasing his state of anxiety.
C. “I am nervous at times”. Exerts himself physically and is hesitant to discuss problems.
D. Mr. Z should:
1. demonstrate an ability to cope with nervousness
2. demonstrate an understanding of the relationship between his nervousness and cardiac condition
44. The nurse researcher mutually agreed with the research subjects that all personal data of the subjects shall be kept
confidential. To safeguard anonymity of data after the report is written, the nurse researcher should:
A. throw the papers in a wastebasket
B. keep the papers for 5 years and dispose of these after
C. burnt or shred the papers
D. have the papers recycle but not as writing scratch paper
Situation 10:The nurse works with Mina to help her work through termination of the nurse-patient relationship.
46. Preparation for termination of the nurse-patient relationship begins during the:
A. termination phase C. pre-orientation phase
B. working phase D. orientation phase
47. Mina’s past reactions to ending relationships is withdrawal. The nurse assists her to practice better ways of coping
termination by providing opportunities to:
A. test new patterns of behavior C. conceptualize her problem
B. plan for alternatives D. value and find meaning in experience
48. During the early part of the interaction, the nurse asked after a period of silence. “Perhaps we would talk about my
leaving”. The nurse utilized which communication technique:
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A. encouraging C. focusing on client
B. suggesting D. understanding
49. Mina: (angrily) “ I am angry, I should never have gotten involved with you” (silence)
Nurse: “You have reason to be disappointed and to feel angry. Just when we were getting somewhere.
I leave you.”
A. reflecting words C. orienting
B. understanding D. reflecting feelings
50. The objection of the nurse-patient relationship is to provide an opportunity of the patient to:
A. clarify problems C. have a corrective emotional experience
B. develop insights D. develop interpersonal relationship
Situation 11: As a program manager, the mental health psychiatric nurse is tasked to provide general patient
management.
51. The nurse is aware that identifying the aspects of general patient management and identifying interventions for
meeting these basic needs are distinctions of:
A. psychotherapy C. pharmacotherapy
B. therapeutic milieu D. behavior therapy
52. In order to get active participation of the clients to carry out the objective of the program, it is BEST for the nurse to
conduct a/an:
A. community meeting C. observation
B. survey D. selective interview of patients
53. Through the nurse’s role modeling of effective communication, the clients learned new ways of dealing with authority
figures. This gives the clients a venue to:
A. communicate C. identify their problems
B. socialize D. test new patterns of behavior
Situation 12: Loretta is a 28 years old, unemployed patient, admitted to the psychiatric unit with a diagnosis of chronic
undifferentiated schizophrenia. She described herself as the “Virgin Mary” and her mission is to propagate peace. She was
observed laughing and talking to herself. Her thought processes were profoundly disorganized. She was also fearful and
suspicious of others.
58. Which of this intervention would NOT be therapeutic in decreasing Loretta’s anxiety?
A. joke about her thought to help her feel at ease
B. listen to her thoughts and feelings
C. simply accept
D. do not convince her that her perception is unreal
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59. The nurse evaluates that Loretta’s ready for a rehabilitation program when she:
A. approaches the nurse at frequent intervals C. goes to the coffee shop alone more often
B. ceases to talk about “Virgin Mary” D. carries a book “The Purpose Driven Life”
60. The nurse is leading a group meeting of patients to prepare them to be discharged. An appropriate goal for the group
members is to develop:
A. attitudes of society towards the mentally ill
B. skills for maintaining daily living
C. awareness of interpersonal patterns of interactions
D. insight into personal problems
Situation 13: A group of adult chronic schizophrenic patients were recommended to undergo social skills training.
61. The following are the objectives of a social skills training program EXCEPT:
A. explore deep seated intrapsychic conflicts C. help build self esteem and self confidence
B. practice skills in relating with people D. develop and practice general coping skills
62. Social skills training is NOT primarily indicated for psychiatric patients who are:
A. in acute stage of illness
B. having difficulties starting and maintaining interpersonal relationships
C. having chronic episodes of stress and anxiety while interacting with others
D. experiencing recurrence of symptoms in front of particular people or among people in general
63. The focus of the group interaction is “here and now”. An appropriate topic would be:
A. ways to celebrate Valentine’s Day in February
B. how to spend the summer vacation
C. an unforgettable experience as a child
D. how to tell a joke
64. An appropriate technique for the participants to practice how to communicate effectively is through/a:
A. lecture C. role play
B. seminar D. psychodrama
Situation 14: Community health nurses integrate their knowledge of mental health with their clients in their practice
when they do mental health counseling.
66. Who among these clients need immediate referral for psychotherapy?
A. those who are plotting to commit suicide
B. those who are not responding to usual motivators
C. those who are not solving their problems which they have the resources to solve
D. those who are engaging in self-defeating behaviors
68. This quality of the nurse allows “connecting with others feelings”:
A. warmth C. sensitivity
B. courage D. prudence
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69. “ To refuse gossip” is a reflection of the mental health nurses quality of:
A. firmness C. judgment
B. coolness D. trustworthiness
70. Which of the following concepts BEST describe the nurse’s interaction when she/he can recognize and identify
feelings and emotions of another person without even having personally experienced those feelings and emotions?
A. over involvement C. transference
B. sympathy D. empathy
Situation 15: Communicating effectively with dementia patients is a challenge to psychiatric nurses.
71. Therapeutic ways to engage the elderly to be stimulated include all of the following EXCEPT:
A. singing to or with the patients C. providing a picture album
B. listening to old familiar music D. playing complex computer games
72. The LEAST area of satisfying communication with the elderly is on:
A. recall of their courtship and love life C. fashion shown in personal pictures
B. psychological trauma D. memories of their teenage parties
73. To maximize communication with the elderly, which of the following ways of verbal communication should the nurse
use minimally?
A. asking simple questions C. restating
B. guiding the patient one step at a time D. asking for an open ended response
74. Unconditional positive regard for the elderly is BEST achieved when the nurse-patient relationship is based upon:
A. vocational choices C. addressing economic problems
B. keeping D. providing warmth and caring
75. An optimal supportive environment for a person with dementia includes all, EXCEPT:
A. engaging the elderly in logical and abstract thinking
B. developing a realistic uniformed and consistent daily schedule
C. handling memory loss by distracting or diverting patient’s attention to something more positive
D. simple nurse care for the patient day after day
Situation 16: Harry, age 36 is admitted to the psychiatry unit in an acute manic episode of bipolar disorder.
77. In the ward, Harry manifests excess energy and is difficult for him to sit still. The MOST useful activity for him would
be:
A. delivering supply of linen to other rooms C. conducting a drama workshop
B. engaging in activity therapy and group exercises D. painting a mural with other patients
78. Harry’s disruptive behavior on the unit has been increasingly annoying other clients. Which of the following would the
nurse do?
A. set limits on his behavior and be consistent in approach
B. make a rigid structured plan that he will have to follow
C. ignore his behavior
D. tell him that he is annoying other clients and isolate him in his room
79. Harry approaches you and says “I have awarded Top Salesman of the Year. My boss will come and celebarate with
me”. You know for a fact that this is NOT true. Harry is demonstrating a delusion of:
A. achievement C. influence
B. reference D. grandeur
80. The defense mechanism utilized by manic patients to cover up depression is:
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A. displacement C. compensation
B. denial D. reaction formation
Situation 17: The nurse observed that Marie, age 28 years old had not been participating in activity therapies.
81. Which of the following remarks from the nursing attendants indicates a need for further teaching and observation?
A. Marie made no response to an invitation to play
B. Marie preferred to sit at the bench and watch the ballgame
C. Marie is aloof and indifferent to co-patients
D. Marie read a book while other patients played a ballgame
82. Marie said “I don’t like to be a part of it. Look, they are being laughed at because they are singing and acting like
children”. The nurse notes that in order for the activity therapy to be therapeutic:
A. the staff should decide solely what activities to be done and what rules apply
B. patients should be allowed solely to decide what they want to do on their own
C. ballgames should be limited to male patients only
D. age and needs of patient should be considered in the choice of games
83. To encourage active participation among patients, it is BEST to plan activities they can engage in through a:
A. one to one interaction C. checklist
B. community meeting D. feedback evaluation forum
Situation 18: A research was conducted on. “ The effects of the nurse expressive role in the reduction of anxiety in
patients who will undergo nasogastric tube insertion”.
89. This study was done to check the procedures of the research:
A. protest study C. pilot study
B. proposal D. test-retest
Situation 19: The client is walking to and fro along the hospital corridor and swinging her hands. She thinks she is going
crazy. She is having palpitations, rapid pulse and hyperventilation.
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91. Your nursing intervention should be to:
A. encourage her to participate in an ongoing activity in the ward
B. stay with her in a calm environment
C. tell her to stop thinking that she is going crazy
D. isolate the client in a quiet room
94. There is increased tension and reduced ability to perceive and communicate, hence “selective attention” in this level
of anxiety:
A. moderate C. panic
B. severe D. mild
Situation 20: Andy, 30 years old, was admitted to the Psychiatric Ward because of religious preoccupation, deterioration
in self-care and disturbed thoughts. He believes that he has committed a lot of sins. He is threatened by people reaching
out to him. His fasting for several days was not sufficient for him to feel forgiven.
99. As Andy talks about his sins that he believes make people look down upon him. It is BEST to:
A. agree with him and sympathize how sinful he has really been
B. explore the nature of his sins
C. explain that he is depreciating himself too much
D. acknowledge how he feels and focus on reality oriented topics
100. The psychosocial task that Andy needs to work on is a sense of:
A. identity C. autonomy
B. trust D. intimacy
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