NURSING PRACTICE 5 Situation 1 - Jimmy developed his 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 present problem d. help the client to communicate CORRECT ANSWER: C RATIONALE: Crisis Intervention is an active but temporary entry into the life situation of an individual, a family or a group during a period of stress. It includes assessment, planning of therapeutic intervention, implementation of therapeutic intervention and evaluation. Since the client has already conceptualized his own problem, there is no need for assessment anymore. Helping him cope with present problem is already planning of therapeutic intervention. OPTION A- There is no need helping the client find meaning in his experience because as stated, he is already aware of his own problem Option B- Planning of alternatives is wrong because the client hasn’t cope with his problem yet. He hasn’t developed any coping strategies yet. Option D- There is no need to let the client verbalize and/or communicate because he has already verbalized that he needs to handle his nervousness. SOURCE: Shives, Psychiatric-Mental health Nursing, 5th ed, pp166-168 2. The nurse is guided that Jimmy is aware of his concerns of the "here and now" when he crossed out which item from his "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. physiological indices of anxiety CORRECT ANSWER: C RATIONALE: Crisis Intervention deals with the “here and now”, Gestalt therapy. It emphasizes identifying the person’s feelings and thoughts in the here and now. Therapist’s often use gestalt therapy to increase client’s self-awareness, focusing on the present. Early signs of anxiety don’t deal with the here and now because the client is already manifesting signs of anxiety. An early sign of anxiety is a part of assessment process. SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, p 59 3. he a. b. c. d. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, recognized that complete disruption of the ability to perceive occurs in: panic state of anxiety severe anxiety moderate anxiety mild anxiety

CORRECT ANSWER: B RATIONALE: A severely anxious person has trouble thinking and reasoning. They can’t complete a task. The range of perception is reduced, anxiety interferes with effective functioning.

OPTION A- In panic the ability to concentrate is disrupted, the individual may experience terror or confusion or unable to speak or move. They can’t communicate verbally and may be suicidal. OPTION C-In Moderate Anxiety, the perception becomes narrower; concentration is increased and able to ignore distractions in dealing with problems. Moderately anxious person has difficulty concentrating independently. OPTION D- In Mild anxiety, the client is more alert, more aware of environment. It helps the person focus attention to learn, solve problems, think, act, feel and protect himself. SOURCE: Videbeck, Psychiatric Mental health Nursing, 3rd ed, 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 identifies as anxious CORRECT ANSWER: A RATIONALE: Contacting the staff every time he feels anxious is still being dependent to the staff nurses of his self-care OPTION B, C, and D—implies independence 5. The nurse notes effectiveness of Interventions in using subjective and objective data in the: a. initial plans or order b. database c. problem list d. progress notes CORRECT ANSWER: D RATIONALE: A progress note is a chart entry made by all health professionals involved in a client’s care. It is in the progress notes that the nurse notes the effectiveness of interventions. OPTION AOPTION B- includes the nursing assessment, the physician’s history, social and family data and the results of the physical examination and baseline diagnostic tests. OPTION C- derived from database. It is usually kept at the front of the chart and serves as an index to the numbered entries in the progress notes. SOURCE: Kozier, Fundamentals of Nursing, 7th ed, pp 331-332 Situation 2 - A research study was undertaken in order to identify and analyze a disabled boy's coping reaction pattern during stress. 6. a. b. c. d. This study which is a depth study of one boy is a: case study longitudinal study cross-sectional study evaluative study

CORRECT ANSWER: A RATIONALE: Case study involves an in-depth, longitudinal examination of a single instance or event: a case, rather than using large samples and following a rigid protocol to examine a limited number of variables. OPTION B- Longitudinal study is a correlational research that involves repeated studies observations of the same items over a long period of time. It studies developmental ternds over a long period of time. OPTION C-Cross-sectional study is

a study design in which data are collected at one point in time; sometimes used to infer change over time when data are collected from different age or developmental groups OPTION D- Evaluative study is a research that investigates how well a program, practice or policy is working SOURCE: Polit and Beck, Nursing Research, 7th ed, pp 712, 715 717, 723 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. Audio and interpretation c. Audio-visual recording d. Verbal narrative account CORRECT ANSWER: C RATIONALE: Process recordings are written records of segment from the nurse-client session that reflects closely as possible the verbal and non-verbal behaviors of both client and nurse. It is usually best of the student can write notes verbatim in a private area immediately after the interaction has taken place. Nurses record their words and client’s words, identify whether the responses are therapeutic, and recall their emotions at that time. OPTIONS A, B & D- all are part of process recording SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 245 8. a. b. c. d. Which of these does NOT happen in a descriptive study? Describing relationship among variables Exploration of relationships between two or more phenomena Manipulation of phenomenon in real life context Manipulation of a variable

CORRECT ANSWER: D RATIONALE: Descriptive research is a nonexperimental study. The purpose of it is to observe, describe, and document aspects of a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis generation or theory development. The aim of this study is to describe relationship among variables. Neither of the variables could be experimentally manipulated. OPTIONS A, B, C- all happens in a descriptive study SOURCE: Polit and Beck, Nursing Research, 7th ed, pp 192, 195 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 CORRECT ANSWER: C RATIONALE: The primary role of caregiver is the primary role of the nurse. The provision of care to patients that combines both the art and the science of nursing in meeting all the aspect of well being. OPTION A- the researcher participates as a member of the group and observes the group at the same time in data collection OPTION B-the researcher observes a particular group and records behaviors or activities OPTION D- in advocate role, the nurse informs the client and then supports him or her in whatever decision he or she makes. Advocacy is the process of acting in the client’s behalf when he or she cannot do so.

SOURCE: Polit et al, Nursing Research, 7th ed, pp 726, 727 and Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p 104 10. To ensure reliability of the study, the investigator analysis and interpretations were: a. subjected to statistical treatment b. correlated with a list coping behaviors c. subjected to an inter-observe agreement d. scored and compared standard criteria CORRECT ANSWER: A RATIONALE: Statistical treatment is a process of using statistical tools such as mode of central tendency, mean, median to test the reliability of the study. You need to quantify first the data obtained before you can say that the study is reliable. Situation 3 - During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 5 years old, was given Flurazepam (Dalmane) 15 mg 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?" CORRECT ANSWER: A RATIONALE: Asking open-ended questions, leads or invite the client to explore (elaborate, clarify, describe, compare or illustrate) thoughts or feelings. It enables the nurse to examine important ideas, experiences and encourages communication OPTIONS B & C-it is a closed ended question. It closes an interview rapidly. SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p 116,118 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 provides her a checklist b. Provide a drug literature and explain its contents 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 CORRECT ANSWER: D RATIONALE: The main purpose is to provide health teaching to the client. Communicating helpful information to the client about the drug she is taking. Asking her what time she would like to watch the informative video least communicate attention to her needs about her medicine because you are giving the client the option to say no to the activity. Although it is an informative video, yet as a nurse, health teaching is our primary responsibility. We must be responsible for the learning of our clients. OPTIONS A,B, C—Communicates attention and care for her needs about her medicine.

It is part of health teaching. 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 CORRECT ANSWER: D RATIONALE: In mutual inquiry, the nurse involves the patient in determining the facts of his/her situation wherein the patient will be able to understand her involvement in a certain experience. Often just helping the client explore his/her perceptions of a problem stimulates potential solutions in the client’s mind. Client’s participation is effective in finding meaningful solutions to problems. OPTIONS A, B, C- pertains to goals of crisis intervention SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, p 122 14. 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 an advice form 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." CORRECT ANSWER: D RATIONALE: Sleeping pills are hypnotics. Hypnotics are effective in treating transient insomnia, but when used over the long-term, patients run the risk of developing dependence on the drug itself. Hypnotics can worsen existing sleep disturbances when they induce dug dependency insomnia, for once the drug is discontinued, the individual then have rebound insomnia and nightmares. OPTION A- taking the medicine with caution is a must OPTION B and C- shows understanding of the special instructions given to her SOURCE: Varcaloris, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 892 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 CORRECT ANSWER: A RATIONALE: The nurse should make an agreement or contract with the client. Teaching plans are signed by the patient if she/he is able to understand fully the health teaching given to her. Any documents can also serve legal purposes. OPTION B- She may not able to recall everything OPTION C- Written agreement is more formal compared to verbal agreement OPTION D- The husband has nothing to do with the medications. The patient itself must understand the precautions of her medications 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 CORRECT ANSWER: D RATIONALE: Therapist’s ability to convey an essential interest in the client has been found to be more important than position, appearance, reputation, clinical experience, training and theoretical knowledge. Skilled use of communication techniques helps the nurse understand and empathize with the client’s experience. It helps in facilitating the client’s expression of emotions. SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p112 17. The premise that an individual’s behavior and affect are largely determined by the attitudes and assumptions one has developed about the world underlies: a. modeling b. milieu therapy c. cognitive therapy d. psychoanalytic psychotherapy CORRECT ANSWER: C RATIONALE: Cognitive theory uses cognitive therapy that is an active, directive, time-limited, structured approach used to treat a variety of psychiatric disorders. Cognitive theory believes that individual’s affect and behavior are largely determined by the way in which they are structure the world. OPTION A- In modeling the therapist provides a role model for specific identified behaviors, and the client learns through imitation. OPTION B- Describe the use of the total environment to treat disturbed children. A comfortable, secure environment is created in which psychotic children were helped to form a new world. OPTION D- Uses many of the tools of psychoanalysis, such as free association, dream analysis, transference and counter transference, but the therapist is much more involved and interacts with the client more freely. SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, pp 38, 39, 42, 43 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 CORRECT ANSWER: B RATIONALE: Intervention is any act performed to prevent harming of a patient or to improve the mental, emotional or physical function of a person OPTION A- act of watching carefully and attentively OPTION C- an agreement of the listener with certain elements of the patient’s communication OPTION D- a structured, recursive process where two or more people work together toward a common goal—typically an intellectual endeavor SOURCE: Mosby, Mosby’s Pocket Dictionary, 4th ed, pp 671, 880, 1328 19. All of the following response 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 CORRECT ANSWER: D RATIONALE: Congruence signifies genuineness, or self-awareness of one’s feelings as they arise within the relationship, and the ability to communicate them when appropriate. It is conveyed by actions such as not hiding behind the role of nurse, listening to and communicating with others without distorting their message and being clear and concrete in communications with clients. Congruence connotes the ability to use therapeutic communication tools in an appropriately spontaneous manner, rather than rigidly or in a parrot-like fashion. OPTION A- although it is also communicating with client’s, it is not the most direct violation of the concept of using therapeutic communication in an appropriately spontaneous manner OPTION B- not directly connected with communicating with the client OPTION C- tolerating behavior is more on behavioral approach rather than communication SOURCE: Varcaloris, Foundations of Psychiatric Mental Health Nursing, 4th ed, p 223 20. The mentally ill person demonstrating a child-like behavior responds positively to the nurse who is warm and caring. This demonstration of the nurse's role as: a. counselor b. parent surrogate c. therapist d. socializing agent CORRECT ANSWER: B RATIONALE: When a client exhibits child-like behavior or when a nurse is required to provide personal care, the nurse may be tempted to assume the parental role. OPTION A- deals with human development concerns through support, consultation, evaluation, research OPTION C- person with special skills. More on a professional level of a relationship between client and nurse OPTION D- people and groups that influence our self-concept, emotions, attitudes, and behavior SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, p 100 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 one relationship would be b. during the working phase c. towards the end of the relationship d. at the start of the relationship CORRECT ANSWER: D RATIONALE: Termination begins in the orientation phase or at the start of the relationship. The date of the termination phase should be clear from beginning to keep the client aware, less dependent on the nurse and avoid developing a relationship more than that of a professional relationship. Also, to prevent separation anxiety. OPTION A- you should not wait for the client to ask you how long your relationship would be. It is your obligation as a nurse to inform him. OPTION B- in the working phase, the nurse and client together identify and explore

area’s in the client’s life that are causing problems OPTION C- Feelings are aroused in both the client and the nurse with regard to the experience they have had. If you will tell the client that you will terminate your nurse-patient relationship towards the end of the relationship, it would be difficult for the client to accept it and you might awaken the unresolved feelings of abandonment or loneliness, or feelings of being rejected by others. SOURCE: Varcaloris, Foundations of Psychiatric Mental Health Nursing, 4th ed, pp 232-235 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." CORRECT ANSWER: A RATIONALE: You are making your patient build a trusting relationship with you. Confidentiality means allowing only those involved in the patient’s care to have access to any information that the patient divulges. The nurse must define the boundaries of confidentiality to the patient. The nurse is clear that only members of the health care team will have access to patient data. The team must have the data to care for the patient in the best manner possible. OPTIONS B, C, D- it is non therapeutic to agree with the client. When the nurse agrees with the client, there is no opportunity for the client to change his/her mind without being wrong SOURCE: Videbeck, Psychiatric Mental Health Nursing 2nd ed, p 99 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 CORRECT ANSWER: A RATIONALE: Nurse-client relationship requires trust. Trust builds when the client is confident in the nurse and the nurse’s presence conveys integrity and reliability. Trust develops when the client believes that the nurse will be consistent in his/her words and actions and respects the client’s self-disclosure, providing confidentiality. OPTION B- it is a feeling of devotion, duty or attachment to somebody or something OPTION C- the quality of possessing and steadfastly adhering to high moral principles or professional standards OPTION D- character expected of a member of a highly trained profession SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, p 91 24. Building trust is important in: a. orientation phase of the relationship b. the problem identification subphase of the relationship c. all phases of the relationship d. the exploitation phase CORRECT ANSWER: A RATIONALE: It is during the orientation phase that the nurse begins to build trust with the client. It is the nurse’s responsibility to establish a therapeutic environment that fosters trust and understanding. The nurse should share

appropriate information about himself/herself OPTION B- part of the working phase, wherein client identifies the issues or concerns causing the problem OPTION D- during this phase the nurse guides the client to examine feelings and responses and develop better coping skills and a more positive selfimage; part of the working phase SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, pp 93, 97 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 psychiatric 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 CORRECT ANSWER: A RATIONALE: Confidentiality is important during nurse-client interaction. No information will be discussed outside the health care team. Only if information may be harmful for the client or others, information may be related to the other nurses and the attending physician and only information that will be helpful in assisting the client toward recovery will be provided to others. The attending psychiatrist or doctor will be informed regarding every concern of the patient, for he will be the one who will decide about certain things pertaining to the concern of the client. OPTION B- Social workers are secondary workers after the doctors. OPTION C- Nurses must know that every decision is made by the attending physician. Before doing anything about the concern of the patient, consult first. OPTION D- Asking the client what is the purpose is not necessary because you already have the information that he has not been visited by relatives for almost a month. SOURCE: Shives, Basic concepts of Psychiatric Mental Health Nursing, 5th ed, p 133 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 26. The past history of Camila would most probably reveal that her premorbid personality is: a. schizoid b. extrovert c. ambivert d. cycloid CORRECT ANSWER: A RATIONALE: A schizoid personality is characterized by a persistent pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. They are aloof and indifferent, appearing emotionally cold, uncaring or unfeeling (Videbeck, 352). OPTION B- An extrovert is a person who is energized by being around other people. Extroverts tend to "fade" when alone and can easily become bored without other people around. When given the chance, an extrovert will talk with someone else rather than sit alone and think (about.com). OPTION C- Ambiverts are the ones who fall between the two extremes of introversion and extroversion, possessing some tendencies of each. They have a well-balanced personality (yahoo.com). OPTION D- A cycloid personality is a person who tends to have periods of marked

swings of mood, but within normal limits. 27. Which of the following are considered the negative sign of schizophrenia? a. Anhedonia, Restricted range of feelings, Catatonia b. Delusions, hallucinations, disordered thinking c. Ambivalence, Associative looseness, hallucinations d. Alogia, Echopraxia, Ideas of reference CORRECT ANSWER: A RATIONALE: Schizophrenia has positive and negative symptoms. Positive or hard symptoms include ambivalence, associative looseness, delusions, echopraxia, flight of ideas, hallucinations, ideas of reference and preservation. Negative symptoms are alogia, anhedonia, apathy, blunted affect, catatonia, flat affect, lack of volition OPTION B- positive symptoms OPTION C- positive symptoms OPTION D- alogia is a negative symptom, while the other two are positive symptoms SOURCE: Videbeck, Psychiatric Mental Health Nursing, 3rd ed, p 276 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 CORRECT ANSWER: B RATIONALE: Interpersonal theorists suggested that schizophrenia resulted from dysfunctional relationships in early life and adolescence. Therapists also believed that schizophrenia results from dysfunctional parenting or family dynamics. OPTION C- anti social personality disorder SOURCE: Videbeck, Psychiatric Mental Health Nursing 3rd ed p 278 a. b. c. d. 29. Schizophrenia is best described as a disorder characterized by: Disturbed relationship related to an inability to communicate and think clearly Severe mood swings and periods of low to high activity Multiple personalities, one of which is more destructive than the others Auditory and visual hallucinations

CORRECT ANSWER: A RATIONALE: Schizophrenia can best be described as one of a group of psychotic reactions characterized by disturbances in an individual’s relationship with people and an inability to communicate and think clearly OPTION B- Severe mood swings and periods of low to high activity are typical of bipolar disorder OPTION C- Multiple personality, which is sometimes confused with schizophrenia, is a dissociative disorder, not a psychotic illness OPTION D- Many schizophrenic patients have auditory, not visual hallucinations. Visual hallucinations are more common in organic or toxic disorder 30. Schizophrenia is a/an: a. anxiety disorder b. neurosis c. psychosis d. personality disorder

CORRECT ANSWER: C RATIONALE: Psychosis is a mental disorder of organic and emotional origin, and schizophrenia is an organic disease with underlying physical brain pathology. Biologic theories of schizophrenia focus on genetic factors, neuroanatomic and neurochemical factors OPTION A- disorder in which anxiety is the most prominent feature OPTION B- mental disorder in which the symptoms are distressing to the person, reality testing is intact OPTION D- diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress SOURCE: Videbeck, Psychiatric Mental Health Nursing, 2nd ed, pp 299, 375 and Mosby, Mosby’s Pocket , 4th ed, pp 93, 856 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, minimized receiving visitors at home and no longer bothers to answer telephone calls because of deterioration of her 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 part CORRECT ANSWER: C RATIONALE: It is not easy for older clients to experience a slowing of their mental and physical reactions and be unable to do anything about it or to look on younger people perform their job and assume their role. Various emotional and behavioral reactions occur as people undergo physiologic changes of the aging process. These reactions include anxiety, frustration, fear depression, intolerance, loneliness, decreased independence, decreased productivity and low self-esteem. OPTION A- experienced by ages 60-65 during retirement stage OPTION B- a defense mechanism used by elder people in trying to establish a comfortable routine after retirement SOURCE: Shives, Psychiatric-Mental Health Nursing, 5th ed, pp 593-594 32. A nursing diagnosis for Salome is: a. sensory deprivation b. social isolation c. cognitive impairment d. ego despair CORRECT ANSWER: A RATIONALE: Salome is observed to be demanding and speaking louder than usual due to deterioration of her hearing. 33. The nurse will assist Salome and her daughter to plan a goal which is: 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

CORRECT ANSWER: A RATIONALE: aging necessitates adjustment to different roles, relationships, responsibilities, changes in self-image, independence and changes in physical, emotional, mental and spiritual aspects of life. OPTION B- let her adjust to the situation first before you make her participate in conversation and other social situations OPTION C- just a matter of acceptance, no action involved SOURCE: Videbeck, Psychiatric Nursing Care Plans, 7th ed, p 18 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 CORRECT ANSWER: D RATIONALE: Allowing her to take her meals alone is like depriving her of care and treatment she deserves. It will make her feel more sad and alone OPTIONS A, B, C- Communicating with the hearing impaired includes: a.) when speaking, always face the person directly as possible b.) make sure your face is as clear as possible. Locate yourself so that your face is well lighted c.) speak slowly and distinctly and use short and simple sentences SOURCE: Smeltzer, S.C. Medical-Surgical Nursing, 9th ed, p 1588 35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she ways 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 CORRECT ANSWER: D RATIONALE: Hearing aid programming software and real ear measurement equipment allow the hearing aids to be individually customized to optimize the hearing aid fitting for the child and to assure the speech signal is delivered at the most appropriate listening levels. The goal of digital hearing aids is to deliver soft sounds at an audible level. Hearing aids should be turned on to a minimal level to avoid feedback. 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 CORRECT ANSWER: C RATIONALE: Agoraphobia involves intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing, or in which help might not be available if a panic attack occurred. OPTION A- Acrophobia is the fear of high places. OPTION B- Claustrophobia is the fear of closed places.

OPTION D- Xenophobia is the fear of foreign places or strangers. SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, pp 311& 313 37. Cecilia's problem is that she always sees and thinks negative hence she is always fearful. Phobia is a symptom described as: a. organic b. psychosomatic c. psychotic d. neurotic CORRECT ANSWER: D RATIONALE: pertaining to neurosis, a category of mental disorder in which the symptoms are distressing to the person, reality testing is intact, behavior does not violate gross social norms and there is no apparent organic cause. The person who is neurotic is said to be emotionally unstable OPTION A- organic disease or condition is any disease associated with detectable or observable changes in one or more body organs OPTION B- expression of an emotional conflict through physical symptoms OPTION C- not in contact with reality SOURCE: Mosby, Mosby’s Pocket Dictionary,4th ed, pp 856, 900, 1049, 1050 38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her: a. communication b. cognition c. observation d. perception CORRECT ANSWER: B RATIONALE: Irrational thoughts refer to the impaired cognition of the person. It is the inability to think properly and reasonably. Cognition is the mental process characterized by knowing, thinking, learning, understanding and judging. Cognitive Therapy is a treatment of mental and emotional disorders that help a person change attitudes, perceptions and patterns of thinking OPTION A- has nothing to do with irrational thoughts OPTION C- observation is an act of watching carefully and attentively, and it’s not related with treatments for irrational thoughts OPTION D- perception is the conscious recognition and interpretation of sensory stimuli that serve as a basis for understanding, learning and knowing SOURCE: Mosby, Mosby’s Pocket Dictionary, 4th ed, pp 258, 880, 959 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 CORRECT ANSWER: A RATIONALE: Cognitive Behavior Therapy (CBT) helps improve a person’s moods and behavior by examining confused or distorted patterns of thinking. During CBT the person learns that thoughts cause feelings and moods which can influence behavior. 40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia? a. she read 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 goes out with a friend CORRECT ANSWER: A RATIONALE: Reading a book in the public library indicates that the client has overcome her fear of being in an open or public place, knowing that agoraphobics avoids being alone outside OPTION B- driving alone doesn’t involve too much people OPTION C- family is the comfort zone of the client 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 member's data bout patients because doing so is violation of patients' rights to: a. Informed consent b. Confidentiality c. Least restrictive environment d. Civil liberty CORRECT ANSWER: B RATIONALE: Confidentiality means respecting the client’s right to keep private information about his or her mental and physical health and related care OPTION A- obtained when a client is subjected to surgery, electroconvulsive treatment or the use of experimental drugs or procedures Option C- means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary Option D- curtails the client’s right to freedom-the ability to leave the hospital when he or she wishes. SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, p170 and Videbeck, Psychiatric Mental health Nursing, 3rd ed, p 169, 170 & 171 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 CORRECT ANSWER: C RATIONALE: A mentally incompetent person cannot legally consent to medical or surgical treatment. The consent must be taken from the parents or legal guardian. SOURCE: Venzon, Professional Nursing in the Philippines, 10th ed. p175 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 CORRECT ANSWER: A RATIONALE: Once the order is transcribed on the physician’s order sheet, the order

must be countersigned by the physician within a time period described by agency policy, but many acute care hospitals require that this be done within 24 hours. SOURCE: Kozier, Fundamentals of Nursing, 7th ed, p 346 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 test. b. Has periods of crying, frequently verbalizes fear of what diagnostic tests will reveal c. Anxiety due to the unknown d. "I'm so worried about what else they'll find wrong with me" CORRECT ANSWER: B RATIONALE: Objective Data consist of information that is measured or observed by use of the senses OPTION A- it is more of planning the care for the client OPTION C- it is assessment or analysis drawn about the subjective and objective data OPTION D- subjective data—information obtained from what the client says SOURCE: Kozier, Fundamentals of Nursing, 7th ed, p 332 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’s health team members b. Identification of patient's responses to medical diagnosis and treatment c. Patient's responses to health and illness as a total person in interaction with the environment d. Step procedures for the management of common problems CORRECT ANSWER: C RATIONALE: Nursing Care Plan is a plan based on a nursing assessment and a nursing diagnosis carried out by a nurse. It has four essential components: a.) identification of the nursing care problems b.) statement of the expected benefit to the patient c.) statement of the specific actions by the nurse that reflect the nursing approach and achieve the goals specified d.) evaluation of the patient’s response to nursing care and readjustment of that care as required OPTION A- source-oriented record—each person or department makes notations in a separate section or section’s in he client’s chart OPTION B- progress notes—provides information about the progress a client is making toward achieving the desired outcomes OPTION D- nursing intervention—part of the nursing care plan SOURCE: Kozier, Fundamentals of Nursing, 7th ed, 330, 339 and Mosby’s Pocket Dictionary, 4th ed, p 874 Situation 10 - Marie is 5 years old and described by the mother as bedwetting at night. 46. Which of the following is NOT a common cause of night bedwetting? a. deep sleep factors b. abnormal bladder development or structure problems c. infections familial and genetic factors d. drinking plenty of water before sleep CORRECT ANSWER: D RATIONALE: Bedwetting or enuresis is the involuntary urination during the day or

at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally (Videbeck, 465). Bed-wetting isn't caused by drinking too much before bedtime. Causes of bedwetting are, genetic factors (it tends to run in families), difficulties waking up from sleep, slower than normal development of the central nervous system--this reduces the child's ability to stop the bladder from emptying at night, hormonal factors (not enough antidiuretic hormone--this hormone reduces the amount of urine made by the kidneys), urinary tract infections and inability to hold urine for a long time because of small bladder (familydoctor.org). 47. All of the following, EXCEPT one comprise the concepts of behavior therapy program: a. reward and punishment b. extinction c. learning d. placebo as a form treatment CORRECT ANSWER: D RATIONALE: Behavior therapy is based on learning theory. It focuses on modifying observable and, at least in principle, quantifiable behavior by means of systematic manipulation of the environment and variables thought to be functionally related to behavior. Behaviorists believed that problem behaviors are learned, and therefore can be eliminated or replaced by desirable behaviors through new learning experiences. Behavior therapy techniques include behavior modification and systematic desensitization, aversion therapy, modeling, operant conditioning. SOURCE: Shives, Psychiatric-Mental health Nursing, 5th ed, p 153 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 king attitude b. matter of fact in handling the behavior c. sympathize for the child d. be lowing yet firm CORRECT ANSWER: A RATIONALE: Bed wetting is modified and/or eliminated through behavior modification. Reinforcing positive behaviors. Rewarding the desired behavior and withholding rewards for undesirable behaviors. Disciplining the child in a king attitude will intimidate the child and make her feel that everything is her fault. The child might develop a low self-esteem. Situation must be handled in a matter of fact attitude, sympathizing the child, be lowing yet firm and not being too strict and demanding. SOURCE: Shives, Basic concepts of Psychiatric-Mental Health Nursing, 5th ed, p153 49. Which of the following is used to treat enuresis? a. Imipramine (Tofranil) b. Methylphenidate (Ritalin) c. Olanzapine (Zyprexa) d. Resperidone (Risperdal) CORRECT ANSWER: A RATIONALE: Enuresis can be treated effectively with Imipramine (Tofranil), an antidepressant with a side effect of urinary retention. OPTION B- CNS stimulant use to treat patient’s with ADHD OPTION C- Antipsychotic use to treat Schizophrenia OPTION D- Antipsychotic, short-term treatment of schizophrenia

SOURCE: Lippincott Williams & Wilkins, Nursing Drug Handbook, 26th ed, pp 454, 495, 490, 509 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. CORRECT ANSWER: B RATIONALE: Behavior modification is based on the principle that behavior that rewarded is more likely to be repeated. Developmentally appropriate behaviors normally rewarded with validation by a significant adult in the child’s life, modifying behavior in this manner is a standard parenting technique. SOURCE: Varcarolis, Foundations of Psychiatric Mental Health Nursing, 4th ed, 875-876 is are so pp

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