SET A Seat No.____
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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
7. Which of the following determines the success of client government groups?
A. willingness of psychiatric professionals to be open and receptive to client’s ideas and suggestions
B. a way of permitting clients provide themselves with a more creative and wholesome life
C. means to acquire a variety of social skills
D. opportunity to learn democratic living
8. Which of this client situation appropriately illustrate horticulture therapy?
A. the therapist brings bongos, tambourine, and bells and encourages client participation
B. Tommy, Karen, Jon and Pia play scrabble every night after supper
C. every afternoon, Vic goes in the garden where he work with plants, seedlings, tree planting
And watering them
D. Paul finds sketching relaxing and rewarding
9. Eva is a member of a group who controls endless talking. Her role is that of a/an:
A. blocker C. recognition seeker
B. self-confessor D. monopolizer
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
Situation 3: The patient who is depressed will undergo electroconvulsive therapy.
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
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
20. Mental retardation is:
A. a delay in normal growth and development caused by an inadequate environment
B. a lack of development of sensory abilities
C. a condition of subaverage intellectual functioning that originates during the developmental
period and is associated with impairment in adaptive behavior
D. a severe lag in neuromuscular development and motor abilities
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.
21. Lifestyle modification begins with:
A. minimizing eating in fast food restaurants
B. having an exercise regimen to follow regularly
C. recognizing the impact of unhealthy habits
D. avoiding pollutants in the environment
22. All of these are the behavior intervention to stress management. EXCEPT:
A. guided imagery C. meditation
B. pharmacotherapy D. progressive muscle relaxation
23. Basic to progressive muscle relaxation is:
A. focusing on an image to relax C. use of industrial equipment
B. relaxing muscles from tension D. stopping disturbing thoughts
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:
26. Bernie and John are going through a:
A. situational crisis C. anticipated crisis
B. developmental crisis D. both developmental and situational crisis
27. All of these are characteristics of crisis EXCEPT:
A. a hazardous or threatening event occurs
B. it has a growth promoting potential
C. usual problem solving methods and coping mechanisms produce a solution
D. anxiety or depression continue to increase
28. The nurse employs this approach in crisis intervention:
A. problem-solving C. role-playing
B. behavior modification D. nurse-patient relationship
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.
31. This behavior is categorized as:
A. delusional C. neurotic
B. normal D. psychotic
32. A therapeutic intervention in this situation is:
A. avoid limits on her behavior to release her anxiety
B. call attention to her ritualistic pattern
C. provide alternative behaviors to deal with increased anxiety
D. ignore her behavior totally
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 )
34. Felisa understands the effects of her medicine when expresses:
A. “I should watch out for signs of sore lips or sore throat”
B. “I might have constipation”
C. “I might feel changes in my body temperature”
D. “ I should not drive or operate machines”
35. The level of anxiety that Felisa is experiencing is:
A. Panic C. Mild
B. Severe D. Moderate
Situation 8:As a professional, it is imperative that the nurse is accountable to oneself hence the importance of personal and professional development.
36. Nurse: “ I feel personally involved with my client’s problems” demonstrates:
A. counter transference C. transference
B. empathy D. sympathy
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
38. An accepting attitude requires being:
A. aware of ones biases C. non judgmental
B. tolerant of the faults of others D. in control of tendency to blame
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
Situation 9: Recording and the nurse.
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
45. A step by step procedure for the management of common problems is a :
A. Gavin chart C. decision tree protocol
B. pedigree chart D. problem listing
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:
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
54. This element of communication facilitates evaluation of the program:
A. receiver C. sender
B. message D. feedback
55. The nurse’s style of leadership in milieu therapy is:
A. autocratic C. democratic
B. laissez-faire D. benevolent
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.
56. Loretta’s claim of being the “Virgin Mary” is a/an:
A. imagination C. hallucination
B. delusion D. obsession
57. Her mission to propagate peace is:
A. a serious call for a need of transformation C. realistic and laudable
B. an attempt to overcome low self-esteem D. an advocacy that she can participate in
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
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
65. Considering that it is BEST to learn by example, it is MOST practical to:
A. model good social skills throughout the session
B. relate successful past experiences
C. invite a resource person
D. watch a movie
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
67. All of these describe what counseling, EXCEPT:
A. helping people manage their own problems
B. assisting people to use their own resources
C. a set of technique, skills and attitudes
D. giving advices
68. This quality of the nurse allows “connecting with others feelings”:
A. warmth C. sensitivity
B. courage D. prudence
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.
76. Harry’s condition is a disturbance of:
A. sensorium C. the CNS
B. cognition D. affect
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:
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
84. In planning activities for the patients, it is essential to consider FOREMOST:
A. safety and security C. novelty and creativity
B. variety and fun D. excitement and challenge
85. Adults, “ singing and acting like children” is a form of:
A. displacement C. sublimation
B. regression D. compensation
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”.
86. The research is experimental which means that utilized:
A. an interview scheduled C. a questionnaire
B. a survey D. control and experimental groups
87. The independent variable is:
A. patients C. reduction of anxiety
B. expressive role D. nasogastric insertion
88. The dependent variable is:
A. nasogastric ingestion C. expressive role
B. patients D. reduction of anxiety
89. This study was done to check the procedures of the research:
A. protest study C. pilot study
B. proposal D. test-retest
90. Which of the following is NOT a characteristic of experimental research?
A. value plays a significant part in research
B. research ideas are capable of being tested
C. results of tests made on the groups are compared
D. research subjects are randomly selected and placed into groups for the purpose of manipulation
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.
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
92. Which of the following is a behavioral manifestation of anxiety?
A. hyperventilation C. panic
B. tachycardia D. rapid pulse
93. Which of the following statements about anxiety is NOT true?
A. anxiety is contagious
B. repressed unresolved conflicts create anxiety
C. anxiety at any level is destructive, hence a threat to a persons well being
D. reactions to a perceived threat maybe real or imaginary
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
95. This medication is indicated for anxious patients:
A. Tofranil (Imipramine HCL) C. Valium (Diazepam)
B. Haldol (Haloperidol) D. Thorazine (Chlorpromazine)
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.
96. Andy is demonstrating:
A. religious delusion C. somatic delusion
B. delusion of grandeur D. delusion of being controlled
97. A delusion is:
A. psychomotor disturbance C. disturbance of thought
B. mood disturbance D. disturbance of perception
98. The nursing goal for Andy is to:
A. have him see a priest for confession
B. encourage him to pray to atone for his sins
C. help him develop a positive self image
D. socialize him with a group to keep him in touch with reality
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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