Comprehensive Assessment Test

Situation 1- The nurse assigned in the neurology unit is taking care of a patient with medical diagnosis of increased intracranial pressure.

1. An intracranial pressure monitor is in place and the patient is becoming lethargic. The nurse notes the intracranial pressure is high. Which of the following should be the immediate action of the nurse? A. Turn the patient to his left side with the back supported with pillows B. Elevate the legs at 15 degrees with a pillow under the head C. Elevate the head of the bed to 30 degrees D. Raise the head of the bed to 90 degrees and the head supported with pillows

ANSWER: C INTRACRANIAL PRESSURE. An increase in intracranial bulk due to blood, CSF, or brain tissue leading to an increase in pressure. can be cause by trauma, hemorrhage, tumors, abscess, hydrocephalus, edema, or inflammation. FElevate head of bed ± 30 or 40 degrees as ordered. ± This allows gravity to drain cerebral veins. (Sandra Smith ± P177)

2. The nurse is monitoring intracranial pressure of the patient. Which of the following nursing assessment would identify the earliest indication of increasing intracranial pressure? A. Widening pulse pressure B. Change in level of consciousness C. Cyanosis and hypotension D. Increased body temperature

ANSWER: B FLevel of consciousness (most sensitive indication increasing ICP) ± changes from restlessness to confusion to declining level of consciousness and coma. ( Sandra Smith ± P176 )

FAltered LOC, which is the most sensitive and earliest indication of increasing ICP. ( Saunders ± P1028)

3. The nurse completed a nursing assessment. Which of the following data concludes that the patient is showing signs of increased intracranial pressure? A. Decrease in pulse pressure, increased heart rate and irregular breathing pattern B. Dilatation of the pupil, decreased blood pressure and increase in level of consciousness C. Increase in heart rate and respiratory rate and decreased level of consciousness D. Slowing of the heart rate, increase in pulse pressure and irregular breathing pattern

ANSWER: D FRise in BP, widening pulse pressure, slowing of pulse. ( Sandra Smith ± P177 )

4. In preparing the plan of care, the nurse should prioritize which of the following nursing and medical measures? A. high backrest to prevent Valsalva¶s maneuver and promote venous drainage B. Turning every 2 hours with logrolling movement to maintain proper position C. Elevating the head of the bed and keeping the head in proper alignment D. Proper positioning and frequent change in position

ANSWER: C FElevate head of bed ± 30 to 40 degrees as prescribed. (Saunders ± P1029) 5. The nurse plan of care includes preventing environmental stimuli that may stimulate an increase in intracranial pressure. Which of the following measures should the nurse include in the nursing care plan?

1. Keeping lights on low setting 2. Keeping noise at a minimum 3. Providing a calm and restful environment 4. Having a cooling blanket available

A. 1, 2, 3 and 4 D. 2, 3 and 4

B. 1 and 2

C. 1, 2, and 3

ANSWER: C FDecrease environmental stimuli ± dim lights, speak softly, limits visitors, avoid routine procedures if client is resting. ( Sandra Smith ± P177 )

Situation 2- Mrs. Borja, 65 years old, had an acute attack of pain, soreness and swelling on both knees. She is diagnosed with rheumatoid arthritis.

6. Nurse Karen is assessing the client. Which of the following is MOST likely to be assessed? A. Early morning stiffness B. Nodules along the knees C. Joint for deformities D. Limited motions of joints

ANSWER: A ± (Black 7th e ± P2335)

FRHEUMATOID ARTHRITIS. A Chronic, systemic autoimmune disorder whose major distinctive feature is chronic, symmetrical and erosive inflammation of the synovial tissue of the joints.

FJoint pain and swelling associated with morning stiffness.

7. The client is in the acute phase of rheumatoid arthritis. In addition to the prescribed medication, the physician orders application of heat and cold to manage arthritis pain. Which of the following statements indicate that the client lacks understanding in the application of heat and cold? A. ³Cold application is applied for 20 minutes, then 20 minutes off´ B. ³Hot water bag should be covered with flannel to prevent burns.´ C. ³Heat and cold can be applied as needed.´ D. ³Heat producing liniments can be used while applying heat and cold.´

ANSWER: A ± (Lipp ± P944) FApply cold or hot to affected joints 15 ± 20 minutes, 3 ± 4x a day.

8. Nurse Karen is helping the client, who is immobilized by pain, towards self-reliance and independence. The nurse should approach the problem with which of the following: A. Set a specific goal B. Set a positive attitude toward an eventful outcome C. Need for a member of the family during the pain episode D. Recognize that little can be accomplished

ANSWER: A (Kozier 7th e. p301)

PURPOSE OF GOAL. Provide direction for planning nursing interventions, ideas for intervention come more easily. If the desired outcomes state clearly & specifically what the nurse hopes to achieve

9. The nurse should know that a client with rheumatoid arthritis will most often have pain and limited movements of the joints: A. Resulting from non-adherence to prescribed diet B. After excessive exercises C. Because of inactivity upon awakening in the morning D. During cold weather

ANSWER: C ± (Black. P2335) Restriction of movement causes the muscles to shrink from lack of use. Joint pain and swelling are associated with morning stiffness that can last several hours.

10. To prevent deformities of Mrs. Borja, the nurse includes in the nursing care plan: A. Massaging the joint with oil liniment B. Implementation of strictly prescribed diet C. Performing isometric exercises twice a day D. Alternate rest periods with active exercises

ANSWER: D ± (Black. p2344) Table 79 ± 4

FPrinciples of joint protection and associated work simplification strategies. FBalance work and rest. Rest 5 to 10 minutes periodically when doing task that takes more time. Get sufficient sleep. Take 30 minutes rest during the afternoon. FEncourage exercise consistent with degree of disease activity. Schedule adequate rest period. (Lipp±P944)

Situation 3- A team of researchers is conducting a study on the effect of high dose corticosteroids in improving the motor and sensory outcomes of patients with spinal cord injuries within 6 weeks if administered within 8 hours after injury. The study covers a three month period.

11. On the basis of the nature of the investigation, which one of the designs listed below would allow the researchers to have the most confidence that the corticosteroids is effective in improving the motor and sensory outcomes of patients with spinal cord injury: A. Quasi or semi-experimental design B. Non-experimental design study design C. Experimental design D. Retrospective-prospective

ANSWER: D - (Nsg Rea Polit 6th e. ± 179) FRETROSPECTIVE. Study begins with dependent variable and looks backward for cause of influence. PROSPECTIVE. Study begins with independent variable and looks forward for the effect.

QUASI OR SEMI-EXPERIMENTAL. Manipulation of independent variable; no randomization and/or no comparison group; but efforts to compensate for this lack. NON-EXPERIMENTAL. Non manipulation of independent variable. EXPERIMENTAL. Manipulation of independent variable; control group; randomization.

12. Which of the following is present in conducting the above study? A. Experimental group Control group B. Subjects C. Variables D.

ANSWER: A (Nsg Rea Polit. 8th e± P753) F EXPERIMENTAL GROUP. The subjects who receive the experimental treatment or intervention.

SUBJECTS. The people who provide information to the researchers (investigators) in a study (Rea Polit 8th e.± P77) VARIABLE. Is a characteristic or quality that takes on different values. (Nsg Rea Polit 8th e. ± P77) CONTROL GROUP. Refers to a group of subjects whose performance on a dependent variable is used to evaluate the performance of the treatment group of the same dependent variables. (Nsr Rea ± Polit 8th e . P252)

13. The target participants of the intended study are homogenous in the variables being measured. In determining the sample size, the researchers should include how many participants in this study? A. 500 D. 100 B. 10 C. 30

ANSWER: C (Nsg Rea ± Polit 8th e. P350)

14. In the above study, the researchers manipulate the variable under study. Which of the following variables is sufficient for the effect to occur? A. Clients with spinal cord injury B. Injection of corticosteroids within 8 hours after injury

C. Research methodology D. motor and sensory outcomes patients with spinal cord injuries

ANSWER: D METHODOLOGIC RESEARCH. Studies are investigations of the ways of obtaining and organizing data and conducting rigorous research. Methodologic studies address the development, validation, and evaluation of research tools or methods. (Nsg Rea Polit. 8th e± P328)

15. The manipulated variable to the experimental group is the: A. Improved recovery and lessen hospitalization period B. Questionnaire in gathering pertinent data C. Improved motor and sensory outcomes D. Injection of corticosteroids within 8 hours post spinal cord injury

ANSWER: D

Situation 4 ± To produce a beneficial effect on eye medications, the nurse should make sure that the amount of medication reaches the ocular site of action in sufficient concentration.

16. The nurse in the EENT unit is preparing the 8:00 AM medication. She is fully aware that topical administration of ocular medication results in how many percent rate of absorption? A. 21% to 25% 1% to 7% B. 10% to 16% C. 16% to 20% D.

ANSWER: D (Brunner 11th e. p2084)

FTopical administration of ocular medications results in only a 1% to 7% absorption rate by the ocular tissues. Ocular absorption involves the entry of a medication into the aqueous humor.

17. The nurse is preparing ocular medications for topical route of administration. The most common ocular medications is administered through instilled eye drops and applied ointments. What is the advantage of ointment application from instillation of eye drops? 1. 2. 3. 4. Self administration, ease of absorption and decreased risk of contamination B. Extended retention time and provides a higher concentration Easy to administer with reduced adverse reaction Promotes efficiency, safety and distribution of solution evenly

ANSWER: B ± (Brunner 11th e. p2085) FOphthalmic ointments have extended retention time in the conjunctival sac and provide a higher concentration that eye drops. FThe major disadvantage of ointments is the blurred vision that results after application.

18. The nurse is to administer eye ointment to the patient. Which of the following guides the nurse in the administration of the ointment? 1. 2. 3. 4. Administer during nap time or bedtime. Inform the relative of the action of the drug. C. Explain the procedure to the patient. Check medical conditions that would contraindicate the use of the drug.

ANSWER: C ± ( Lipp ± p511) FInform the patient the need of the need and reason for instilling drops or ointment.

19. Common ocular medication include topical anesthetic. In the application of topical anesthetics, the nurse MUST instruct the patient which of the following measures? 1. Place the fingers on the sides of the nose to prevent medication from draining 2. Place the patient in supine position with the head slightly hyperextended

3. Close both eyes and gently move eyes 4. D. Refrain from rubbing the eyes to prevent corneal damage

ANSWER: D (Brunner 11th e. p2085) FThe nurse must instruct the patient not to rub his or her eyes while anesthetized because this may result in corneal damage.

20. The nurse is assessing a patient receiving mydriatic eye drop. The patient is sweating, complains of blurred vision and drowsiness. These manifestations are indicative of: A. Fear and anxiety B. Overdose of the medications effect C. Allergic reactions D. Systemic anticholinergic

ANSWER: C ± Saunders. P1010

Situation 5± Consumers of health care require improvement in health care. Nurses must deliver activities and behaviors and do the right things well and continue to strive to do better to meet and satisfy the diverse needs of clients.

21. Nurse Cora observes the client with glaucoma while he instills his eye drops. The client looks up the ceiling and instills the correct number of drops at the middle of the eyeball. The technique used by the client in the installation of the medication is: 1. Correct as this spreads the medication over the eyeball 2. Aimed to protect the eyeball from injury C. Allowed so that the client is less likely to blink D. Incorrect because it may damage the cornea

ANSWER: D ± FThe sclera is fibrous & tough, but the cornea is easily injured by trauma. For this reason, application to the eye seldom is placed directly onto the eyeball. ( Funda. Taylor - P803) FInstill the drops onto the outer third of the lower conjunctival sac. (Kozier. P1347)

22. The client had cataract surgery. Shortly after, he complains of nausea. Which of the following course of action should be given priority by the nurse? A. Administer the prescribed anti-emetic B. Give ice chips to relieve nausea C. Assure the client that this is expected following surgery D. Report the complaint to the attending physician

ANSWER: B ± (Black. P1951) Ffirst priority. To give independent nursing measures to relieve nausea. Fsecond priority. Nausea & vomiting are no longer expected outcomes of the surgical procedure but, if present, should be reported immediately. Prolonged vomiting may result in increased IOP and wound dehiscence.

23. The members of the nursing team were discussing about the activity of the client treated with detached retina during the nursing rounds. Which of the following statements serves as guide for the client during the rehabilitation phase? 1. 2. 3. 4. The client may resume his activity with moderation the day after the treatment The client may indulge in normal activities after the treatment The client must be restricted in bed for one week D. The client may resume gradually her usual activities within 5 to 6 weeks.

ANSWER: D (Lipp. P529) Within 3 weeks ± light activities may be pursued

Within 6 weeks ± heavier activity and athletes are possible

24. During the nursing conference, nurse Jesette shares with the team the concerns of the wife of a client with Meniere¶s disease. She is concerned about the change in the husband¶s social activities. To assist the wife in adjusting to the present situation, the team should: 1. 2. 3. 4. Plan the course of action with the husband Create an atmosphere of sense of belonging for the couple Assist the wife to accept the condition of the husband D. Explain to the wife that her husband is experiencing social isolation related to attacks of vertigo

ANSWER: D ± (Black. p1972) FVERTIGO. Feeling that the surroundings or one¶s own body is revolving FSOCIAL ISOLATION. A state or process in which persons, groups, or cultures lose as do not have communication or cooperation with one another, often resulting in open conflict.

25. The staff nurse performs ear irrigation on a client for removal of cerumen. What relevant information should the staff nurse share with the client at the start of the procedure? 1. A. Experience a feeling of fullness, warmth and occasional discomfort when the fluid comes in contact with the tympanic membrane 2. Any medication needs to be withheld after the procedure and the physician must be notified 3. Ear irrigation requires cooperation from the client to facilitate the introduction of the solution 4. Assume lying position on the unaffected side after the procedure to facilitate drainage.

ANSWER: A ± (Kozier. p891) Situation 6 ± Following are situations that are a concern for records management of nurses.

26. A delusional patient said, ³I have no head, no stomach.´ The nurse would record this in which part of the mental status?

1. Content of thought orientation

B. Emotional State

C. Characteristics of talk D. Sensorium or

ANSWER: A ± (Shives. P109) (Keltner. p110) FCONTENT OF THOUGHT. What the client actually says, nurse determines whether verbalization makes sense.

EMOTIONAL STATE/ AFFECT. Individual¶s present emotional responsiveness. It is observable manifestation of one¶s emotions or feelings inferred from facial expressions. eg. Anger, sadness, or happiness. (Shives. P109) SENSORIUM OR ORIENTATION. Recognition of place, person & time. (Keltner. p110)

27. For proper documentation and accountability of all entries to the client¶s chart, it is important for the nurse to inspect that: 1. 2. 3. 4. A. All notes must have signature and title of person making entry The staff must not abbreviate SOAP The nurse implements the use of problem-oriented progress notes Client¶s problems in the medical record must bear the date of entry and numbers of client¶s problem.

ANSWER: A (Shives. P120)

28. Which of the following statements about Processing Recording is NOT true? 1. It provides data from which nurses can assess their own behavior in interactions with clients. 2. It is a tool for assessing nurse-client interactions 3. C. It is an important means of communication between nurses or nursing students and their clinical supervisors/instructors about their peer relationships. 4. It acquaints the student/nurse with rudimentary applied research skills.

ASNWER: C - (Shives. P147) FPROCESS RECORDING. Is a tool used in various formats to analyze nurse-client communication. Which focuses on verbal and nonverbal communication, is used to teach communication skills to student nurses in the clinical setting. Student-client role play situations are one method used to familiarized students with the process recording.

29. Data: Client is pacing, crying, waving his hands, yelling at nursing staff and other patients. In the problem-oriented progress notes this data would be noted under: 1. Assessment B. Objective C. Subjective D. Plan

ANSWER: B ± (Shives. 106) FOBJECTIVES. Are tangible and measurable data collected during a physical examination by inspection, palpation, percussion and auscultation. Also include observable client behavior such as crying or taking out loud when no one else is in the room. ( shives. P106) FConsist of information that is measured or observed by use of the senses (e.g. vital signs, laboratory & x-ray results.)kozier 7th e. p332

ASSESSMENT. Assessment phase of the nursing process includes the collection of data about a person, family or group by the method of observing, examining and interviewing. SUBJECTIVE. Obtained as the client, family members or significant others provide information spontaneously during direct questioning or during health history. PLAN. A plan of care or nursing care plan, is individualized and identifies priorities of care and proposed effective intervention. ( shives. P129)

30. In order for the process recording to be an effective learning tool for nurses, data should be: 1. Unedited and comprehensive essentials 2. Salient points that are summarized C. Brief and simple but focused on D. Edited and comprehensive

ANSWER: A

Situation 7 ± Nurses encounter situations in which they must make decision based on the determination of what is right and wrong. Professional nursing actions are both ethical and moral.

31. Mrs. Belmonte, a middle-aged, obese woman seeks medical help often for the recurring lower back pain. She does not lose weight in spite of medical advice. Which of the following questions should the nurse ask the client? 1. 2. 3. 4. A. B. C. D. ³What do you think will happen to you when you don¶t follow medical advice?´ ³Aren¶t you bothered about your condition?´ ³Are you considering other course of action?´ ³Is it difficult to follow the medical advice?´

ANSWER: A ± (Psyche. Shives. p141) F A therapeutic communication. Asking direct questions is to determine if the patient is complying to the medical advice.

32. A 75 year old frail woman had a cervical disk disorder. Conservative management did not work and the client requires surgery. The client insisted that she does not want surgery, but the family and the surgeon insisted. The staff nurse assigned to her decided not to help in the preparation of surgery. Using caring based reasoning which of the following justify the refusal of the nurse in the preparation of surgery? 1. ³I empathize with the client because of her age and her fear of not surviving surgery.´ 2. ³I strongly feel that surgery will cause her more suffering and probably will not survive and the family may even feel guilty later.´ 3. C. ³I feel that my responsibility with the client is protecting her rights and meeting her needs.´

4. ³I support the client since she has the right to decide on her medical treatment and management.´

ANSWER: C ± Client advocate

33. A community health nurse in her home visits encountered a 58 year old woman who was depressed and tearful. She was hospitalized before with glaucoma. She knows that she could be of help to the client by staying and talking to her longer for another hour. However, she has still two clients to visit; one of them is Joey who is in plaster cast of the leg and needs a great deal of teaching and the other a 60 year old female, hemiplegic needing assistance in performing activities of daily living. Which of the following is the appropriate action of the nurse? 1. 2. 3. 4. Weigh the facts carefully in order to divide her time justly among her clients Tell the client she will come back after attending to the other clients Ask one of the family members to attend to the client D. Stay with the client to prevent further depression

ANSWER: D ± for patient¶s safety

34. Mrs. Gonzales, a 40 year old professional was confined after suffering mild stroke. She has been critical of the care she received which she regarded as not of high quality. The following actions of the nurse are appropriate in addressing the complaints EXCEPT: 1. 2. 3. 4. Provide client with knowledge of what constitutes good care B. Provide client with the list of her rights Ask the client what her expectations are Give a list of evaluation criteria and ask the client to respond

ANSWER: B ± not related

35. The nurse demonstrates ethics of care when she plays the role of a: 1. Teacher Client¶s Advocate B. Care Provider C. Guidance Counselor D.

ANSWER: B ± (Funda. Taylor. p14) FCARE PROVIDER. The Provision of care to patients that combines both the art and the science of nursing in meeting physical, emotional, intellectual, socio-cultural, and spiritual needs.

TEACHER/EDUCATOR. The use of communication skills to asses, implement and evaluate individualized teaching plans to meet learning needs of patients and their families. COUNCILOR. Use of therapeutic interpersonal communication skills to provide information, make appropriate referrals and facilitate the patient¶s problem-solving and decision making skills. ADVOCATE. The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives.

Situation 8 ± The nurse considers factors related to safety effectiveness in the planning and delivery of nursing services.

36. The nurse notices that the comatose client starts to lighten. She is aware that without protection, the client could fall or be injured. Which of the following is the LEAST intervention? 1. 2. 3. 4. Restrain the client to prevent from falling Give adequate support when turning or moving Keep the side rails up on the bed D. Protect client¶s head

ANSWER: D

37. Following hip replacement after 24 hours the client asks for assistance onto the bedpan. She is placed in an orthopedic bed and to facilitate the use of the bedpan, how should the nurse assist the client? 1. Pull on the trapeze to lift the pelvis extending both legs

2. Lifting the pelvis off the bed and turn gently toward the operative side 3. Assist the client in lifting the pelvis 4. D. Elevate the pelvis using the trapeze involving the unaffected upper extremity and unoperated leg

ANSWER: D ± (Funda. Craven. 784) FTRAPEZE. Helps clients raise trunk from bed and allow client position hangs.

38. Andoy, an elderly client, is to be discharged after sustaining a sprain from fall while negotiating the last step of the stairs. The daughter asks the nurse how to promote safety in the stairways and hallways in the home. The nurse recommends extra lighting at the stairways and suggests repainting the hallways with: 1. Red and yellow and white B. Black and white C. Blue and green D. Cream

ANSWER: A

39. Cecille, 32 years old has problem with the olfactory nerve. They live in a thickly populated area and is concerned for the safety of her 3 young children. What measure should the nurse recommend for home safety? A. Install additional lighting for visibility prevention training B. Mild water heater temperature device C. Participate in fire

D. Install a smoke detector

ANSWER: D

40. Lola Carmona, 76 years old is living alone. Her married daughter visits her from time to time. She can do activities of daily living with limited assistance and seems to be independent

physically. Which of the following measure should be recommended to reduce sensory deprivation? 1. 2. 3. 4. A. Encourage acquaintances to come to the house for a chat Redecorate the house and provide a separate room Provide pictures of family members Invite friends often to share meals at home

ANSWER: A ± (Funda. Kozier. p1284) FEncourage social interaction. SENSORY DEPRIVATION. Reduction or prevention of culturally normal interaction between an individual and the rest of society.. Situation 9 ± In today¶s health care environment, nurses are increasingly accepted as essential members of the interdisciplinary health care team.

41. The nurse is working in a tertiary hospital for almost a year. In order to effectively participate and lead a health care team, she must have which of the following traits? 1. 2. 3. 4. Courteous and respectful to the health team and members. B. Committed in the exercise of duties and responsibilities to clients and co-workers Knowledge of the most effective and reliable, evidence-based approach to care Good interpersonal relationship with clients and families and the health team

ANSWER: A ± (Funda. Taylor. p160)

42. A staff nurse consulted a more experienced nurse and other health care providers whether aggressive ambulation expedites the patient¶s recovery or it requires too much energy. While this approach is extremely common, she is likely to obtain clinical answers that are: 1. Scientific B. Evidence based C. Tradition based D. Routine

ANSWER: A ± (research. Polit. P15) FSCIENTIFIC. Is a general set of orderly, disciplined procedures used to acquire information.

43. An experienced nurse is new in the work setting. Given this situation, what should the nurse do to conform to the institution¶s expectations? 1. 2. 3. 4. Pursue post graduate course to enhance skills and competence. B. Participate in the in-service education program offered by the institution. Attend seminars, conference and national convention related to the nursing profession. Learn new values, skills, attitude, and social rules.

ANSWER: B 44. Image makers provide the greatest number of visual images of nurses at work such as angel of mercy, love interest particularly to the physician, naughty nurse, handmaiden to the physician, etc. Changing nursing¶s image in the public eye will not be easy. Which of the following strategy/strategies is/are needed to change nursing image in the mind of image makers? 1. 2. 3. 4. Restriction of the term nurse to mean licensed RN. Involvement in the political processes that shape their profession. Increased effort to publicly praise and value nursing. Emphasize the contribution of nursing to patients, particularly on their desired health outcomes.

A. 1, 3 and 4 D. 2 only

B. 3 only

C. 1, 2, 3 and 4

ANSWER: C

45. Nurses naturally work to effect policy in the work place. Which of the following action(s) can nurses take to increase their influence in policy setting? 1. Be a member of a nursing organization

2. Write lobbying letters 3. Participate in coalitions of organizations 4. Get to know their elected officials

1. 1, 2, 3 and 4 D. 1 only

B. 3 only

C. 1, 3 and 4

ANSWER: A

Situation 10- The following questions refer to nurses¶ efforts to integrate in mental health community work.

46. The most important role of the nurse as a member of the team is to: A. Keeps a 24 hours watch for the patient B. Meet the needs for the physical well being of patients C. Carry out medical orders D. Coordinate the psychosocial care and management of clients

ANSWER: D ± From the issue itself which is member of the team it follows that there should be coordination.

47. Activity therapy is a treatment that utilizes which of the following? A. Psychotherapy Milieu therapy B. Behavioral therapy C. Somatic therapy D.

ANSWER: D ± Milleu therapy involves clients¶ interactions with one another; i.e. practicing interpersonal relationship skills, giving one another feedback about behavior, and working

cooperatively as a group to solve day to day problems same thing with the Activity therapist focuses on remotivation of clients by directing attention outside themselves to relieve preoccupation with personal thoughts, feelings and attitudes thus clients learn to cope with stress to through activity. Option B ± Behavioral therapy is a mode of treatment that 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 the behavior (Shahrokh & Hales, 20003). Option A - Psychotherapy it is the therapeutic interaction between a qualified provider and client or group designed to benefit persons experiencing emotional distress, impairment, or illness; therapist¶s approach is based on a theory or combination of theories. Option C ± Somatic therapy is the biologic treatment for mental disorders such as ECT, physiotherapy etc. (Videbeck) 48. Which of these nursing actions belong to the secondary level of preventive intervention? A. Providing mental health education to members of the community B. Providing mental health consultation to health care providers C. Providing emergency psychiatric services D. Being politically active in relation to mental health issues

ANSWER: C - Secondary level of prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions; Options A,B,D are primary level of prevention which is directed towards promoting health and preventing the development of disease process. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration. (Potter & Perry)

49. When the nurse identifies a client who has attempted to commit suicide the nurse should: A. Refer the matter to the police B. Refer the client to the psychiatrist C. Call a priest D. Counsel the client

ANSWER: D ± Asking clients directly about thoughts of suicide is important. It is also standard practice to inquire about suicide or self-harm thoughts in any setting where people seek treatment for emotional problems. (Videbeck p.328)

50. The community health nurse was invited by the principal of an elementary school and was asked to give a talk to parents. An appropriate topic would be: A. The legal aspects of drug abuse B. Discipline of children at home and school school youth C. Marital crises D. The problems of out of

ASNWER: B ± it is the appropriate topic because since the audience is on elementary level. Options A, and D are for highschool students. Options C is for college students.

Situation 11- Nurse Grazilda engaged clients in a group experience for medication education. Students are paired with clients to play a game and exchange knowledge about medications and disorders. Participants play with a game board and color-coded game cards which bear questions on five categories of psychotropic medications. Game questions include the five categories namely: Antipsychotic medications, Anti-depressants, Mood stabilizers, Anti-anxiety medications and Medications for drugs of abuse.

51. An opening comment about the purpose of the group encouraged clients to gather around the table and select small toy cars to move playfully around the racetrack game board. The aim of this affective learning approach is for the clients to: A. Meet diverse learning needs about medications B. Satisfy client¶s level of functioning of compliance C. Share common feelings

D. Maximize the likelihood

ANSWER: C ± this option is an example of an affective learning approach.

52. One objective of this group experience is for the clients to describe the impact of these medications on their symptoms and day to day activities. Immediate discussion and interaction about daily life situations utilizes the principle of:

A. Reinforcement D. Flexibility

B. Appropriateness

C. Efficiency

ANSWER: A ± Reinforcement is a stimulus that strengthens or weakens the behavior that produced it; Appropriateness is to take one¶s self in exclusion of other¶s; Efficiency is the quality of being efficient or producing an effect or effects; Flexibility is the quality of being adaptable or variable. (Webster Dictionary)

53. Which of the following client behaviors demonstrate that interpersonal learning occurred? A. One client advised another client that he should get a ³pill box´ so he would remember to take medications B. Clients shared a sense of ³we-ness´ C. Clients said they were ³all in the same boat.´ D. One client said, ³I feel that way.´

ANSWER: B ± Interpersonal learning includes the gaining of insight ,the development of an understanding of a transference relationship, the experience of correcting emotional thoughts and behaviors, and the importance of learning about oneself in relation to others. Option A is an example of Imparting of information. Option C is an example of Universality. Option D is an example of Catharsis. (Shives p.208)

54. One client shared her very infrequent experiences with alcohol, which she knew were contraindicated with her medications and the quietly stated, ³I don¶t want anyone to repeat this.´ This experience included which of these therapeutic factors? A. Altruism D. Group cohesiveness B. Universality C. Imparting information

ANSWER: A - Altruism in therapy groups benefit members through the act of giving to others. Clients have the experience of learning to help others and in the process they begin to feel better about themselves. Both the group therapist and the members can offer invaluable support, insight and reassurance while allowing themselves to gain self-knowledge and growth; Universality can be defined as the sense of realizing that one is not completely alone in any situation; Imparting of information includes didactic instruction and direct advice and refers to the imparting of specific

educational information plus the sharing of advice and guidance among members. Group cohesiveness is the development of a strong sense of group membership and alliance. (Shives p.208)

55. Which of the following LEAST contribute to creating a therapeutic learning environment? A. Heterogenous composition of participants B. Use of alternative teaching strategies that fit the needs of the group C. Development of pre-determined, absolute group goals D. Flexibility in accommodating the number of players

ANSWER: A ± Because being in a heterogenous group will have a hard time in controlling and manipulating the participants that will hinder in creating a therapeutic environment; Options B,C,D will help in creating a therapeutic learning environment.

Situation 12 ± Lily, the mother of two children was cooking dinner and wondering why her husband was so late. Then she received a telephone call from the police notifying her that her husband had just been pulled from the river. Witnesses say her husband jumped from a bridge in the locality.

56. Lily, together with her children walked a 10 block way to the funeral home to meet the medical examiner to identify the body of her husband. Without a tear, she became focused on attending to her children and simply signed the necessary paperwork. She is in a state of: A. Integration D. Reality B. Shock C. Recovery

ANSWER: B ± Engels Stages of Grieving first stage is shock and disbelief; second stage is Developing awareness; third stage is Restitution which is participation in rituals assoc. with death, help to accept reality of loss; fourth stage is Resolution of loss; fifth stage is Recovery. Integration is re-organizing and reintegrating the sense of self to pull life back together; Shock is the initial reaction to a loss stunned numb feeling; Recovery is the preoccupation & obsession ends and individual go on with life. (Videbeck 5th edition p.207)

57. In the following weeks after the death of her husband, Lily struggled not only with finances but with confusion and rage in response to her husband¶s actions and abandonment. The nursing diagnosis is: A. Spiritual distress Social isolation B. Disturbed self-esteem C. Powerlessness D.

ANSWER: C ± Powerlessness is the state in which an individual or group perceives a lack of personal control over a certain events or situations which affects outlook, goals and lifestyle; Spiritual distress is the state in which an individual or group experiences or is at risk of experiencing a disturbance in the belief or values system that provides strength, hope and meaning to life; Disturbed self-esteem is a state in which a person is experiences or is at risk of negative evaluation about self and capabilities; Social isolation is a state or process in which persons, groups or cultures lose or do not have communication or cooperation with one another, often resulting in an open conflict. (Videbeck)

58. Unable to handle her emotions, Lily hurls angry and explosive outbursts toward those who are helpful to her. This behavior is an example of: A. Sublimation Introjections B. Reaction formation C. Displacement D.

ANSWER: C ± Displacement is the ventilation of intense feelings toward persons less threatening than the one who aroused those feelings; Sublimation is the substituting a socially acceptable activity for an impulse that is unacceptable; Reaction formation is acting the opposite of what one thinks or feels; Introjection is accepting another person¶s attitudes, beliefs and values as one¶s own. (Videbeck) ` 59. Hostility is distinct from anger in that the former is: A. Compatible with love Ego syntonic B. Growth-promoting C. Destructive D.

ANSWER: C ± Hostile behavior is intended to intimidate or cause emotional harm to another and it can lead to physical aggression while Anger is a normal human emotion, is a strong,

uncomfortable, emotional response to a real or perceived provocation. (Videbeck) Options A and B is inappropriate. 60. During nurse-patient interactions with Lily, when she actively works out her rage which of the following is NOT therapeutic? 1. 2. 3. 4. Ask Lily to describe what is the ³hardest part´ of the death for the family Assure that death of husband is not her fault An encouragement toward normalcy must be communicated The nurse should be non-reactive

ANSWER: B ± Option B is an example of false reassurance; Option A allows exploration through verbalization; Option C is an example of reflecting; Option D is an example of active listening.

Situation 13- The nurse works in an institution that shelters street children. She encounters varied family histories and presenting behavior patterns of these clients.

61. At night when the children are being prepared to go to sleep, the nurse hears from a frightened child ³Ayaw ko matulog mag-isa. May multo.´ (³I don¶t want to sleep alone. There¶s a ghost!´). The nurse conveys acceptance with which of these responses? A. ³Gusto mong i-kwento kung ano pa ang naiisip at nararamdaman mo?´ (³Would you like to tell me more about your thoughts and feelings?´) B. ³Talaga? Anong itsura ng multo?´ (Really? How does the ghost look like?´) C. ³Nakakatakot nga ang pakiramdam na ganyan.´ (³That must really be scary.´) D. ³Huwag kang matakot, babantayan kita.´ (³Don¶t be afraid. I¶ll keep watch over you.´)

ANSWER: A ± Allows verbalization about his concerns. Option B and C is an example of Agreeing; Option D is Reassuring. (Videbeck)

62. Most street children come from broken families. The nurse is MOST therapeutic in meeting their needs by being a: A. Activity therapist D. Teacher B. Mother surrogate C. Child therapist

ANSWER: B ± Mother surrogate is the nurturing needs of clients who are unable to carry out simple tasks; Activity therapist focuses on remotivation of clients by directing their attention outside themselves to relieve preoccupation with personal thoughts, feelings and attitude; Nurseteacher educates clients about specific illnesses and medication prescribed to promote stabilization of their condition.(Shives p.145 & 156)

63. With adequate rest, food, cleanliness, shelter, warmth and safety, the child: A. Develops a sense of competence B. Acquires a sense of personal power others C. Develops a separate identity D. Learns to trust in self and in

ANSWER: D ± it is task that should be developed, by providing a rest, food, cleanliness, shelter, warmth and safety will develop the trust in oneself, other people, the environment and meaningfulness of existence. Option A is on school age; Option B is for toddler; Option C is for early adolescence.

64. Preventive interventions for children at risk are BEST achieved through: A. Family therapy for the dysfunctional families B. Non-government organizations and other workers paying attention to victims in conflict ridden communities C. Support and caring to children during family crisis situations D. Play and activity therapies for children

ANSWER: C ± in order to divert attention of the child from crisis. Option D is done after crisis.

65. Cindy was a frequent witness to domestic violence. Her father would always come home drunk and beat up Cindy¶s mother. As an effect of this experience she had nightmares, speechless for weeks, inability to sleep, tension and palpitations lasting for more than a month. Cindy is experiencing anxiety due to: A. Adjustment in growing up stress B. Fear of phobic proportion love D. Imagined loss of parental C. An identifiable traumatic

ANSWER: C ± this is an example of post traumatic stress disorder. Option A and D is inappropriate while Option B is for phobia.

Situation 14 ± Increasing problems of substance abuse continue to challenge the competencies of professional nurses.

66. The Comprehensive Dangerous Drugs Act (R.A. No.9165) challenges the nurse in his/her role as a/an: A. Advocate D. Health educator B. Therapist C. Counselor

ANSWER: D ± it is also known as Nurse-teacher educates clients about specific illnesses and medication prescribed to promote stabilization of their condition; Options B and c are the same, they uses therapeutic skills to help clients identify and deal with stressors or problems that have resulted in dysfunctional coping. In the advocate role, the nurse informs the clients and supports him or her in whatever decision he or she makes. (Videbeck p.96 and Shives p.145).

67. The nurse is conducting Parent Education Classes. Aware of the scope of nursing practice he/she recognizes the necessity to network with other agencies to discuss this area: A. Communication skills appropriate for different ages B. Constructive discipline C. Normal and deviant child and adolescent behavior and development D. Legal implications of illegal drug use

ANSWER: D ± There is needed information that should come from other agencies. Option A,B and C can be discussed thoroughly by a nurse.

68. Which of these characteristics has the LEAST potential success of treatment of drug dependency? A. An addict who has reached bottom pit level of self-disgust and who wants help B. An individual who became dependent on a drug before or during the teen years C. Individuals who have access to support from intact family groups D. A person who began taking the drug of choice for recreational or experimental reasons

ANSWER: B ± since the individual has been using drugs since his/her teenage years. Options A,C and D are all manifesting positive behavior in dealing with drug abuse.

69. The BEST model of drug abuse prevention supports: A. Programs focusing on means of dealing with problems and frustration of adolescents B. Mandatory basic education transformation of society C. An integrated program requiring development of both intellectual and affective health

D. The medical treatment of drug abuse utilizing less addictive drugs

ANSWER: A ± because it focuses on the concerns of the adolescents.

70. Clients says ³I am not a substance user. I take drugs only when I am under stress.´ What defense mechanism is this client employing? A. Repression Denial B. Substitution C. Compensation D.

ANSWER: D ± Denial is the failure to acknowledge an unbearable condition ; failure to admit the reality of the situation or how one enables the problem to continue ; Represssion is excluding emotionally painful or anxiety provoking thoughts and feelings from conscious awareness ; Substitution is the replacing of the desired gratification with one that is more readily available ; Compensation is the overachievement in one area to offset real or perceived deficiencies in another area. (Videbeck p.47)

Situation 15- Eric, a 19 year old, second year college student is seeking assistance in coping with school related stressors and sleep disturbances. During the initial evaluation of the psychiatric nurse, he reports he is ashamed and embarrassed by a mistake he made in his class oral report and feels like his classmates are going to look down on him. He reports that he failed a practical exam a year ago. Although he has made up for this, he cannot get this out of his mind.

71. When the nurse asks Eric to describe his physical experience, which of these assessment data are appropriate? A. ³I do not know what to do´ depressed´ B. ³I am tense, nervous and exhausted all the time´ lot´ C. ³I feel helpless and

D. ³I am worried and thinking a

ANSWER: B ± being tense, nervous and exhausted all the time is an example of physical experience.

72. Eric admits that he has ³always been wound up´ just like his father and that he has negative thoughts of himself. He is having a problem of: A. Inferiority D. Role confusion B. Mistrust C. Stagnation

ANSWER: D ± Eric is an adolescent which is the task is formulating a sense of self and belonging. Option A is for school age; Option B is for infancy; Option C is for middle age.

73. The nurse teaches non-pharmacologic ways to induce sleep. Which of these would she caution Eric to avoid? A. Warm milk A warm bath B. Classical music C. Coffee after dinner D.

ANSWER: C ± Coffee has caffeine which is an example of a stimulant. Other options will promote relaxation and sleep.

74. Which of these describe the characteristic of free floating anxiety? A. It is not conditioned by a specific trigger B. It creates panic C. There is an easily recognizable stressor that provokes anxiety D. It results in selective attention/inattention

ANSWER: A ± Similar to all anxiety disorders, a phobia is a response to experienced anxiety and is characterized by a persistent fear of specific places or things, as opposed to GAD, in

which the anxiety is free-floating; thus, anxiety is displaced or externalized to a source outside the body. Option D is on the Moderate level of anxiety; Option B is on the Panic level of anxiety. (Videbeck)

75. A generalized anxiety disorder is distinguished by; A. Experience of anxiety after exposure to a life threatening event B. Presence of excessive anxiety for a period of 6 months or more C. Irrational thoughts and actions D. Fear of losing control thus avoids going out or avoids crowds

ANSWER: B ± Generalized anxiety disorder is characterized by at least 6 months of persistent and excessive worry and anxiety. Option A is PTSD; Options C and D are Phobia. (Videbeck p.275)

Situation 16- Many clients in a psychiatric unit receive antipsychotic medications, also referred to as Neuroleptics.

76. Clients may be shifted from typical to atypical antipsychotic medications because of its minimal extrapyramidal side effects. A common extrapyramidal symptom that is very unpleasant and intolerable to clients is called akathisia. This is: A. Upward rolling of the eyes the hands B. Inability to sit or stand still neck D. Stiffening of the client¶s C. Pill rolling movement of

ANSWER: B ± This feeling of internal restlessness and the inability to sit still or rest often leads clients to discontinue their antipsychotic medication. Other options are also signs of EPS. (Videbeck p.28)

77. Health instructions about Haldol (haloperidol) has been given to Anthony while in the hospital and before his discharge. The client correctly understood the health techniques of the nurse when he says: A. ³I will immediately report any episode of diarrhea or vomiting to my doctor.´ B. ³I will drink about 2 liters of fluids daily and expect to urinate frequently.´ C. ³I will wear long sleeve clothing and sun block when I go out.´ D. ³I will avoid pizza, any food with cheese and processed meat.´

ANSWER: C ± Antipsychotic medications requires the use of sunscreen because photosensitivity can cause the client to sunburn easily. Option A is for SSRI¶s; Option B is inappropriate because the increase fluid intake is to solve constipation but not to urinate frequently. Option D is for MAOI¶s.(Videbeck p29-30)

78. While giving Chlorpromazine (Thorazine) to client Michelle, the nurse remembers that she should stop giving the medication when she observes this side effect: A. Shuffling gait sclerae B. Fine tremors D. Facial grimacing C. Yellow

ANSWER: C ± Is an adverse effect and is a sign of hepatotoxic which is jaundice. Options A,B and D are expected side effect and this are called EPS. (Brunner p.2313)

79. Another client in the ward, Carl, is given Thorazine (Chlorpromazine). This medication has several side effects. Which side effect should cause the nurse to be MOST concerned? A. Uncomfortable sun burns B. Sore throat, fever, decreased white blood cell count C. Tremors, inability to stand still D. Low blood pressure upon getting up from bed

ANSWER: B ± it has the potentially fatal side effect because Agranulocytosis develops suddenly and is characterized by fever, malaise, ulcerative sore throat and leukopenia. The drug must be discontinued immediately. (Videbeck p.275)

80. Clients on antipsychotic medications usually receive anti-parkinson drugs to reduce Parkinson like side effects. What medication would the nurse expect the client to receive? A. Congentin (Benztropine) C. Fluphenazine (Prolixin)

B. Nardil (Phenelzine)

D. Fluoxetine (Prozac)

ANSWER: A ± it is an example of anti-parkinsonian drug; Option B is MAOI¶s; Option C is Anti-psychotic; Option D is SSRI¶s. (Videbeck p. 29-31)

Situation 17 ± Peter, a 35 year old employee was admitted to the hospital because of behavioral problems at the office. He started to be bossy, claiming that he is the manager on the unit. On admission he was diagnosed to be having Bipolar disorder, manic phase.

81. Peter¶s condition is primarily a problem of: A. Affect D. Conscience B. Perception C. Thought

ANSWER: C ± During manic phases, clients are euphoric, grandiose, energetic and sleepless. They have poor judgment and rapid thoughts, actions and speech. (Videbeck p.317)

82. A therapeutic environment for Peter is: 1. Minimal environmental stimuli 2. Strict isolation and withholding privileges C. No limitation on his activities D. Well lit and basically colored room

ANSWER: A ± A primary nursing responsibility is to provide a safe environment for clients and for others. Option C it should be simple activities such as card games or a short walk and it is necessary to set limits when they cannot set limits on themselves. Option B and D is not appropriate. (Videbeckp.324)

83. During socialization Peter was provoked, became furious, started shouting and making personal demands. A therapeutic intervention of the nurse is: 1. 2. 3. 4. Take him away from the group until he manages to have control of himself. Restrain him and put him on isolation to protect other patients. Prevent him from becoming more furious by giving an extra PRN dose of sedative. Respond with, ³Peter, we don¶t favor anyone. Everybody in the ward is in equal footing.´

ANSWER: A ± the client must establish external control. Restraining would be the last intervention. Option D is correct since its matter of fact but the issue presents that the patient becomes FURIOUS which would further escalate due to the rsponse. (Videbeck p.304)

84. Therapeutic use of self is essential in relating with psychiatric patients. This is BEST demonstrated by the nurse in. 1. 2. 3. 4. Sympathizing with the miserable feelings of Peter Suppressing her own feelings towards Peter Engaging Peter in productive activity Engaging Peter in introspective thinking

ANSWER: B ± Therapeutic use of self: nurses uses themselves as a therapeutic tool to establish the therapeutic relationship with clients and to help clients grow, change and heal. Nurses must not allow their own issues & biases to color interactions. Option A, you don¶t sympathize but you empathize. Options C and D are concerns of the patient. (Videbeck) 85. The nurse may recommend discharge when Peter: 1. 2. 3. 4. Easily finishes projects given to him during occupational therapy Takes his medications without reminding him Demonstrates skills in activities of daily living Complies with hospital rules and regulations

ANSWER: B ± Adherence to treatment regimen of medication and psychotherapy. (Videbeck p.328)

Situation 18- The stress of hospitalization can lead to difficulties between nurses and patients. Following are situations that nurses presented during a monthly nursing circle.

86. Jurry asked the nurse to have an ³out on pass´ privilege for the weekend but his request was not granted by the nurse. He remarked, ³I thought you really liked me.´ A therapeutic response of the nurse would be: A. Say, ³I understand, you feel bad but of course, I like you.´ B. Say as a matter of fact, ³Your behavior did not meet criteria for out on pass privilege.´ C. Ignore Jurry¶s remark D. Be transparent and express disapproval openly. ³You upset me with your remark.´

ANSWER: B ± it is an example of verbalizing the implied; Option A is an example of giving approval; Option C, you don¶t ignore the client; Option D is an example of disapproving. (Videbeck p.110)

87. The dynamics of behavior underlying manipulative behavior explain that it is a behavior of: A. A sense of security and control B. Exhibiting uncooperative and hostile behavior C. Reducing patient¶s anxiety D. Sensing fear of other people

ANSWER: B ± due to lack of insight they often act-out their feelings in aggressive and hostile behavior.

88. Lolita, an elderly client idealizes some nurses as ³terrific´, ³the best´, or ³so understanding´, but refers to others as ³mean´, or ³indifferent´. This behavior can be understood by the staff as: A. Avoiding taking responsibility for her own behavior and underlying feelings B. An understandable behavior for an elderly that must not be taken seriously C. An invitation to have a social and intimate relationship with her nurse D. Immature and childish behavior

ANSWER: B ± this is a normal and an understandable behavior of an elderly.

89. A patient with delirium touches the nurse inappropriately. The therapeutic response of the nurse would be to: A. Ask for the patient¶s name and if whether he is aware where he is. B. Remove the patient¶s hand while saying calmly, ³I¶m the nurse and this is a hospital.´ C. Say nothing and just go on with the usual nursing interventions D. Say her name, ³I¶m Cathy, I¶m your nurse.´

ANSWER: D ± Delirium is confusion accompanied by altered or fluctuating consciousness. Disturbance in emotion, thought and perception is moderate to severe. The nurse provides orienting cues when talking with clients, such as calling them by name and referring to the time of day or expected activity. Often, the use of touch reassures clients and provides contact with reality. (Videbeck p.469)

90. The staff nurses have differing emotional reactions to the use of limit setting. Some staff views it as unprofessionally punitive and uncaring. The MOST appropriate approach to address the nursing concern is through: A. Counseling with the nursing supervisor B. Nursing Conference C. Seminar-workshop D. Brainstorming session

ANSWER: B ± Since it is a nursing concern, nursing conference is more appropriate.

Situation 19 ± Robert is a survivor of a tragic accident wherein his wife and child drowned when their boat sank due to stormy weather. Within the next 6 months from the accident he was observed to be detaching himself from others, unable to sleep` and concentrate and frequently would just be quiet and stare.

91. He tells you, ³It is my fault. What kind of husband and father am I?´ He is expressing; 1. Depersonalization 2. Guilt C. Inappropriate affect D. Cognitive disturbance

ANSWER: B ± Guilt is the feelings of culpability especially for imagined offenses or from a sense of inadequacy; Inappropriate affect is displaying a facial expression that is incongruent with mood or situation; Depersonalization is the feelings of being disconnected from himself or herself; Cognitive disturbance occurs when there is clinically significant deficit in cognition from a previous level of functioning. (Shives p.491) 92. The nurse can BEST intervene by mobilizing the client¶s relatives, friends and people to provide. A. Spiritual support B. Material support D. Medical support C. Social support

ANSWER: A ± religious activities such as church attendance and praying associated social support have been shown to be very important for many people and are linked with better health and a sense of well-being; Social support is emotional sustenance that comes from friends,

family members, and even health care providers who help a person when a problem arises. (Videbeck)

93. A therapeutic attitude the nurse can convey to the client while he talks about his loss is: A. Sympathy D. Optimism B. Acceptance C. Passivity

ANSWER: Acceptance is the avoiding judgments of the person, no matter what his behavior; Optimism is an inclination to put the most favorable construction upon actions and events or to anticipate the best possible outcome; Passivity is a mental state of being submissive, dependent or inactive, as a form of maladaptation; Sympathy is an expressed interest or concern regarding the problems, emotions or states of mind of another. (Mosby Dictionary)

94. The nurse encourages the client to communicate and socialize because internalized hostility can lead to: A. Depression B. Verbal assaultiveness C. Physical assaultiveness D. Amok

ANSWER: A ± Hostility turns towards self is considered depression.

95. The patient is having a: A. Post traumatic stress disorder B. Psychotic breakdown C. Developmental crisis D. Personality dysfunction

ANSWER: A ± Post traumatic stress disorder is a disturbing pattern of behavior demonstrated by someone who has experience a traumatic event such as natural disaster, combat or an assault. Option B, C and D is inappropriate. (Videbeck p.202).

Situation 20- Mrs. Cortez is an 85 year old woman who has been hospitalized due to a urinary tract infection and dehydration. She has Alzheimer¶s disease, osteoporosis, and a tendency to wander. She has an IV in her left forearm, which was difficult to establish. Concerned that Mrs. Cortez might pull out her IV and wander off the floor, the staff is considering the possibility of using restraint on her.

96. The staff is considering the possibility of using restraint on Mrs. Cortez, however, she repeatedly declares that she does not want to be restrained. The staff is faced with an ethical dilemma of autonomy versus: A. Beneficence D. Justice B. Veracity C. Fairness

ANSWER: A ± Beneficence promotes doing acts of kindness and mercy that directly benefit the patient; Veracity is truth-telling; Option C and D is the same, refers to the right to demand to be treated justly, fairly and equally. (Venzon 10th edition p. 102) 97. With a history of osteoporosis and a tendency to wander, which of the following should be a priority? A. Request for a sitter B. Wheelchair privilege commode C. Prevention of fall D. Provision of a bedside

ANSWER: C ± Safety is the priority concern.

98. Which of the following would be LEAST likely appreciated by Mrs. Cortez? A. Playing a table board game picture album B. Singing to or with her music C. Going through family

D. Listening to old familiar

ANSWER: A ± Clients lose intellectual function, which eventually involves the complete loss of their abilities and option A requires concentration and focus.

99. The nurse aims at highest level of self care. Which of the following will the nurse minimize? A. Providing mouth swabs with buttons and zippers B. Hand and body lotion C. Using clothing

D. Labeling clothing items

ANSWER: C ± Since there is a progressive cognitive impairment, the client may have difficulty recalling the use of buttons and zipper.

100. Mrs. Cortez has a dietary privilege of food preferences. Which question is MOST effective to communicate with her? A. Which way would you want your egg done? Scrambled? Sunny side up? With vegetable mix? Or boiled? B. Do you want fried egg or boiled egg? C. How would you want to have your egg done? D. What is your favorite egg recipe?

ANSWER: C ±This may asses the memory of the patient. SITUATIONAL

Situation 1- The nurse assigned in the neurology unit is taking care of a patient with medical diagnosis of increased intracranial pressure.

1. An intracranial pressure monitor is in place and the patient is becoming lethargic. The nurse notes the intracranial pressure is high. Which of the following should be the immediate action of the nurse? A. Turn the patient to his left side with the back supported with pillows B. Elevate the legs at 15 degrees with a pillow under the head C. Elevate the head of the bed to 30 degrees D. Raise the head of the bed to 90 degrees and the head supported with pillows

ANSWER: C INTRACRANIAL PRESSURE. An increase in intracranial bulk due to blood, CSF, or brain tissue leading to an increase in pressure. can be cause by trauma, hemorrhage, tumors, abscess, hydrocephalus, edema, or inflammation. FElevate head of bed ± 30 or 40 degrees as ordered. ± This allows gravity to drain cerebral veins. (Sandra Smith ± P177)

2. The nurse is monitoring intracranial pressure of the patient. Which of the following nursing assessment would identify the earliest indication of increasing intracranial pressure? A. Widening pulse pressure B. Change in level of consciousness C. Cyanosis and hypotension D. Increased body temperature

ANSWER: B FLevel of consciousness (most sensitive indication increasing ICP) ± changes from restlessness to confusion to declining level of consciousness and coma. ( Sandra Smith ± P176 ) FAltered LOC, which is the most sensitive and earliest indication of increasing ICP. ( Saunders ± P1028)

3. The nurse completed a nursing assessment. Which of the following data concludes that the patient is showing signs of increased intracranial pressure? A. Decrease in pulse pressure, increased heart rate and irregular breathing pattern B. Dilatation of the pupil, decreased blood pressure and increase in level of consciousness C. Increase in heart rate and respiratory rate and decreased level of consciousness D. Slowing of the heart rate, increase in pulse pressure and irregular breathing pattern

ANSWER: D FRise in BP, widening pulse pressure, slowing of pulse. ( Sandra Smith ± P177 )

4. In preparing the plan of care, the nurse should prioritize which of the following nursing and medical measures? A. high backrest to prevent Valsalva¶s maneuver and promote venous drainage B. Turning every 2 hours with logrolling movement to maintain proper position C. Elevating the head of the bed and keeping the head in proper alignment D. Proper positioning and frequent change in position

ANSWER: C FElevate head of bed ± 30 to 40 degrees as prescribed. (Saunders ± P1029) 5. The nurse plan of care includes preventing environmental stimuli that may stimulate an increase in intracranial pressure. Which of the following measures should the nurse include in the nursing care plan? 1. Keeping lights on low setting 2. Keeping noise at a minimum 3. Providing a calm and restful environment

4. Having a cooling blanket available

A. 1, 2, 3 and 4 D. 2, 3 and 4

B. 1 and 2

C. 1, 2, and 3

ANSWER: C FDecrease environmental stimuli ± dim lights, speak softly, limits visitors, avoid routine procedures if client is resting. ( Sandra Smith ± P177 )

Situation 2- Mrs. Borja, 65 years old, had an acute attack of pain, soreness and swelling on both knees. She is diagnosed with rheumatoid arthritis.

6. Nurse Karen is assessing the client. Which of the following is MOST likely to be assessed? A. Early morning stiffness B. Nodules along the knees C. Joint for deformities D. Limited motions of joints

ANSWER: A ± (Black 7th e ± P2335)

FRHEUMATOID ARTHRITIS. A Chronic, systemic autoimmune disorder whose major distinctive feature is chronic, symmetrical and erosive inflammation of the synovial tissue of the joints. FJoint pain and swelling associated with morning stiffness.

7. The client is in the acute phase of rheumatoid arthritis. In addition to the prescribed medication, the physician orders application of heat and cold to manage arthritis pain. Which of the following statements indicate that the client lacks understanding in the application of heat and cold? A. ³Cold application is applied for 20 minutes, then 20 minutes off´ B. ³Hot water bag should be covered with flannel to prevent burns.´ C. ³Heat and cold can be applied as needed.´ D. ³Heat producing liniments can be used while applying heat and cold.´

ANSWER: A ± (Lipp ± P944) FApply cold or hot to affected joints 15 ± 20 minutes, 3 ± 4x a day.

8. Nurse Karen is helping the client, who is immobilized by pain, towards self-reliance and independence. The nurse should approach the problem with which of the following: A. Set a specific goal B. Set a positive attitude toward an eventful outcome C. Need for a member of the family during the pain episode D. Recognize that little can be accomplished

ANSWER: A (Kozier 7th e. p301) PURPOSE OF GOAL. Provide direction for planning nursing interventions, ideas for intervention come more easily. If the desired outcomes state clearly & specifically what the nurse hopes to achieve

9. The nurse should know that a client with rheumatoid arthritis will most often have pain and limited movements of the joints:

A. Resulting from non-adherence to prescribed diet B. After excessive exercises C. Because of inactivity upon awakening in the morning D. During cold weather

ANSWER: C ± (Black. P2335) Restriction of movement causes the muscles to shrink from lack of use. Joint pain and swelling are associated with morning stiffness that can last several hours.

10. To prevent deformities of Mrs. Borja, the nurse includes in the nursing care plan: A. Massaging the joint with oil liniment B. Implementation of strictly prescribed diet C. Performing isometric exercises twice a day D. Alternate rest periods with active exercises

ANSWER: D ± (Black. p2344) Table 79 ± 4 FPrinciples of joint protection and associated work simplification strategies. FBalance work and rest. Rest 5 to 10 minutes periodically when doing task that takes more time. Get sufficient sleep. Take 30 minutes rest during the afternoon. FEncourage exercise consistent with degree of disease activity. Schedule adequate rest period. (Lipp±P944)

Situation 3- A team of researchers is conducting a study on the effect of high dose corticosteroids in improving the motor and sensory outcomes of patients with spinal cord injuries within 6 weeks if administered within 8 hours after injury. The study covers a three month period.

11. On the basis of the nature of the investigation, which one of the designs listed below would allow the researchers to have the most confidence that the corticosteroids is effective in improving the motor and sensory outcomes of patients with spinal cord injury: A. Quasi or semi-experimental design B. Non-experimental design study design C. Experimental design D. Retrospective-prospective

ANSWER: D - (Nsg Rea Polit 6th e. ± 179) FRETROSPECTIVE. Study begins with dependent variable and looks backward for cause of influence. PROSPECTIVE. Study begins with independent variable and looks forward for the effect.

QUASI OR SEMI-EXPERIMENTAL. Manipulation of independent variable; no randomization and/or no comparison group; but efforts to compensate for this lack. NON-EXPERIMENTAL. Non manipulation of independent variable. EXPERIMENTAL. Manipulation of independent variable; control group; randomization.

12. Which of the following is present in conducting the above study? A. Experimental group Control group B. Subjects C. Variables D.

ANSWER: A (Nsg Rea Polit. 8th e± P753)

F EXPERIMENTAL GROUP. The subjects who receive the experimental treatment or intervention.

SUBJECTS. The people who provide information to the researchers (investigators) in a study (Rea Polit 8th e.± P77) VARIABLE. Is a characteristic or quality that takes on different values. (Nsg Rea Polit 8th e. ± P77) CONTROL GROUP. Refers to a group of subjects whose performance on a dependent variable is used to evaluate the performance of the treatment group of the same dependent variables. (Nsr Rea ± Polit 8th e . P252)

13. The target participants of the intended study are homogenous in the variables being measured. In determining the sample size, the researchers should include how many participants in this study? A. 500 D. 100 B. 10 C. 30

ANSWER: C (Nsg Rea ± Polit 8th e. P350)

14. In the above study, the researchers manipulate the variable under study. Which of the following variables is sufficient for the effect to occur? A. Clients with spinal cord injury B. Injection of corticosteroids within 8 hours after injury C. Research methodology D. motor and sensory outcomes patients with spinal cord injuries

ANSWER: D

METHODOLOGIC RESEARCH. Studies are investigations of the ways of obtaining and organizing data and conducting rigorous research. Methodologic studies address the development, validation, and evaluation of research tools or methods. (Nsg Rea Polit. 8th e± P328)

15. The manipulated variable to the experimental group is the: A. Improved recovery and lessen hospitalization period B. Questionnaire in gathering pertinent data C. Improved motor and sensory outcomes D. Injection of corticosteroids within 8 hours post spinal cord injury

ANSWER: D

Situation 4 ± To produce a beneficial effect on eye medications, the nurse should make sure that the amount of medication reaches the ocular site of action in sufficient concentration.

16. The nurse in the EENT unit is preparing the 8:00 AM medication. She is fully aware that topical administration of ocular medication results in how many percent rate of absorption? A. 21% to 25% 1% to 7% B. 10% to 16% C. 16% to 20% D.

ANSWER: D (Brunner 11th e. p2084) FTopical administration of ocular medications results in only a 1% to 7% absorption rate by the ocular tissues. Ocular absorption involves the entry of a medication into the aqueous humor.

17. The nurse is preparing ocular medications for topical route of administration. The most common ocular medications is administered through instilled eye drops and applied ointments. What is the advantage of ointment application from instillation of eye drops?

A. B. C. D.

Self administration, ease of absorption and decreased risk of contamination Extended retention time and provides a higher concentration Easy to administer with reduced adverse reaction Promotes efficiency, safety and distribution of solution evenly

ANSWER: B ± (Brunner 11th e. p2085) FOphthalmic ointments have extended retention time in the conjunctival sac and provide a higher concentration that eye drops. FThe major disadvantage of ointments is the blurred vision that results after application.

18. The nurse is to administer eye ointment to the patient. Which of the following guides the nurse in the administration of the ointment? A. B. C. D. Administer during nap time or bedtime. Inform the relative of the action of the drug. Explain the procedure to the patient. Check medical conditions that would contraindicate the use of the drug.

ANSWER: C ± ( Lipp ± p511) FInform the patient the need of the need and reason for instilling drops or ointment.

19. Common ocular medication include topical anesthetic. In the application of topical anesthetics, the nurse MUST instruct the patient which of the following measures? A. B. C. Place the fingers on the sides of the nose to prevent medication from draining Place the patient in supine position with the head slightly hyperextended Close both eyes and gently move eyes

D.

Refrain from rubbing the eyes to prevent corneal damage

ANSWER: D (Brunner 11th e. p2085) FThe nurse must instruct the patient not to rub his or her eyes while anesthetized because this may result in corneal damage.

20. The nurse is assessing a patient receiving mydriatic eye drop. The patient is sweating, complains of blurred vision and drowsiness. These manifestations are indicative of: A. Fear and anxiety B. Overdose of the medications effect C. Allergic reactions D. Systemic anticholinergic

ANSWER: C ± Saunders. P1010

Situation 5± Consumers of health care require improvement in health care. Nurses must deliver activities and behaviors and do the right things well and continue to strive to do better to meet and satisfy the diverse needs of clients.

21. Nurse Cora observes the client with glaucoma while he instills his eye drops. The client looks up the ceiling and instills the correct number of drops at the middle of the eyeball. The technique used by the client in the installation of the medication is: A. Correct as this spreads the medication over the eyeball B. Aimed to protect the eyeball from injury C. Allowed so that the client is less likely to blink D. Incorrect because it may damage the cornea

ANSWER: D ± FThe sclera is fibrous & tough, but the cornea is easily injured by trauma. For this reason, application to the eye seldom is placed directly onto the eyeball. ( Funda. Taylor - P803) FInstill the drops onto the outer third of the lower conjunctival sac. (Kozier. P1347)

22. The client had cataract surgery. Shortly after, he complains of nausea. Which of the following course of action should be given priority by the nurse? A. Administer the prescribed anti-emetic B. Give ice chips to relieve nausea C. Assure the client that this is expected following surgery D. Report the complaint to the attending physician

ANSWER: B ± (Black. P1951) Ffirst priority. To give independent nursing measures to relieve nausea. Fsecond priority. Nausea & vomiting are no longer expected outcomes of the surgical procedure but, if present, should be reported immediately. Prolonged vomiting may result in increased IOP and wound dehiscence.

23. The members of the nursing team were discussing about the activity of the client treated with detached retina during the nursing rounds. Which of the following statements serves as guide for the client during the rehabilitation phase? A. B. C. D. The client may resume his activity with moderation the day after the treatment The client may indulge in normal activities after the treatment The client must be restricted in bed for one week The client may resume gradually her usual activities within 5 to 6 weeks.

ANSWER: D (Lipp. P529) Within 3 weeks ± light activities may be pursued Within 6 weeks ± heavier activity and athletes are possible

24. During the nursing conference, nurse Jesette shares with the team the concerns of the wife of a client with Meniere¶s disease. She is concerned about the change in the husband¶s social activities. To assist the wife in adjusting to the present situation, the team should: A. B. C. Plan the course of action with the husband Create an atmosphere of sense of belonging for the couple Assist the wife to accept the condition of the husband

D. Explain to the wife that her husband is experiencing social isolation related to attacks of vertigo

ANSWER: D ± (Black. p1972) FVERTIGO. Feeling that the surroundings or one¶s own body is revolving FSOCIAL ISOLATION. A state or process in which persons, groups, or cultures lose as do not have communication or cooperation with one another, often resulting in open conflict.

25. The staff nurse performs ear irrigation on a client for removal of cerumen. What relevant information should the staff nurse share with the client at the start of the procedure? A. Experience a feeling of fullness, warmth and occasional discomfort when the fluid comes in contact with the tympanic membrane B. Any medication needs to be withheld after the procedure and the physician must be notified C. Ear irrigation requires cooperation from the client to facilitate the introduction of the solution D. Assume lying position on the unaffected side after the procedure to facilitate drainage.

ANSWER: A ± (Kozier. p891) Situation 6 ± Following are situations that are a concern for records management of nurses.

26. A delusional patient said, ³I have no head, no stomach.´ The nurse would record this in which part of the mental status? A. Content of thought orientation B. Emotional State C. Characteristics of talk D. Sensorium or

ANSWER: A ± (Shives. P109) (Keltner. p110) FCONTENT OF THOUGHT. What the client actually says, nurse determines whether verbalization makes sense.

EMOTIONAL STATE/ AFFECT. Individual¶s present emotional responsiveness. It is observable manifestation of one¶s emotions or feelings inferred from facial expressions. eg. Anger, sadness, or happiness. (Shives. P109) SENSORIUM OR ORIENTATION. Recognition of place, person & time. (Keltner. p110)

27. For proper documentation and accountability of all entries to the client¶s chart, it is important for the nurse to inspect that: A. B. C. All notes must have signature and title of person making entry The staff must not abbreviate SOAP The nurse implements the use of problem-oriented progress notes

D. Client¶s problems in the medical record must bear the date of entry and numbers of client¶s problem.

ANSWER: A (Shives. P120)

28. Which of the following statements about Processing Recording is NOT true? A. It provides data from which nurses can assess their own behavior in interactions with clients. B. It is a tool for assessing nurse-client interactions

C. It is an important means of communication between nurses or nursing students and their clinical supervisors/instructors about their peer relationships. D. It acquaints the student/nurse with rudimentary applied research skills.

ASNWER: C - (Shives. P147) FPROCESS RECORDING. Is a tool used in various formats to analyze nurse-client communication. Which focuses on verbal and nonverbal communication, is used to teach communication skills to student nurses in the clinical setting. Student-client role play situations are one method used to familiarized students with the process recording.

29. Data: Client is pacing, crying, waving his hands, yelling at nursing staff and other patients. In the problem-oriented progress notes this data would be noted under: A. Assessment B. Objective C. Subjective D. Plan

ANSWER: B ± (Shives. 106) FOBJECTIVES. Are tangible and measurable data collected during a physical examination by inspection, palpation, percussion and auscultation. Also include observable client behavior such as crying or taking out loud when no one else is in the room. ( shives. P106) FConsist of information that is measured or observed by use of the senses (e.g. vital signs, laboratory & x-ray results.)kozier 7th e. p332

ASSESSMENT. Assessment phase of the nursing process includes the collection of data about a person, family or group by the method of observing, examining and interviewing. SUBJECTIVE. Obtained as the client, family members or significant others provide information spontaneously during direct questioning or during health history. PLAN. A plan of care or nursing care plan, is individualized and identifies priorities of care and proposed effective intervention. ( shives. P129)

30. In order for the process recording to be an effective learning tool for nurses, data should be: A. Unedited and comprehensive essentials B. Salient points that are summarized C. Brief and simple but focused on

D. Edited and comprehensive

ANSWER: A

Situation 7 ± Nurses encounter situations in which they must make decision based on the determination of what is right and wrong. Professional nursing actions are both ethical and moral.

31. Mrs. Belmonte, a middle-aged, obese woman seeks medical help often for the recurring lower back pain. She does not lose weight in spite of medical advice. Which of the following questions should the nurse ask the client? A. B. C. D. ³What do you think will happen to you when you don¶t follow medical advice?´ ³Aren¶t you bothered about your condition?´ ³Are you considering other course of action?´ ³Is it difficult to follow the medical advice?´

ANSWER: A ± (Psyche. Shives. p141) F A therapeutic communication. Asking direct questions is to determine if the patient is complying to the medical advice.

32. A 75 year old frail woman had a cervical disk disorder. Conservative management did not work and the client requires surgery. The client insisted that she does not want surgery, but the family and the surgeon insisted. The staff nurse assigned to her decided not to help in the preparation of surgery. Using caring based reasoning which of the following justify the refusal of the nurse in the preparation of surgery? A. ³I empathize with the client because of her age and her fear of not surviving surgery.´

B. ³I strongly feel that surgery will cause her more suffering and probably will not survive and the family may even feel guilty later.´ C. ³I feel that my responsibility with the client is protecting her rights and meeting her needs.´ D. ³I support the client since she has the right to decide on her medical treatment and management.´

ANSWER: C ± Client advocate

33. A community health nurse in her home visits encountered a 58 year old woman who was depressed and tearful. She was hospitalized before with glaucoma. She knows that she could be of help to the client by staying and talking to her longer for another hour. However, she has still two clients to visit; one of them is Joey who is in plaster cast of the leg and needs a great deal of teaching and the other a 60 year old female, hemiplegic needing assistance in performing activities of daily living. Which of the following is the appropriate action of the nurse? A. B. C. D. Weigh the facts carefully in order to divide her time justly among her clients Tell the client she will come back after attending to the other clients Ask one of the family members to attend to the client Stay with the client to prevent further depression

ANSWER: D ± for patient¶s safety

34. Mrs. Gonzales, a 40 year old professional was confined after suffering mild stroke. She has been critical of the care she received which she regarded as not of high quality. The following actions of the nurse are appropriate in addressing the complaints EXCEPT: A. B. C. D. Provide client with knowledge of what constitutes good care Provide client with the list of her rights Ask the client what her expectations are Give a list of evaluation criteria and ask the client to respond

ANSWER: B ± not related

35. The nurse demonstrates ethics of care when she plays the role of a: A. Teacher Client¶s Advocate B. Care Provider C. Guidance Counselor D.

ANSWER: B ± (Funda. Taylor. p14) FCARE PROVIDER. The Provision of care to patients that combines both the art and the science of nursing in meeting physical, emotional, intellectual, socio-cultural, and spiritual needs.

TEACHER/EDUCATOR. The use of communication skills to asses, implement and evaluate individualized teaching plans to meet learning needs of patients and their families. COUNCILOR. Use of therapeutic interpersonal communication skills to provide information, make appropriate referrals and facilitate the patient¶s problem-solving and decision making skills.

ADVOCATE. The protection of human or legal rights and the securing of care for all patients based on the belief that patients have the right to make informed decisions about their own health and lives.

Situation 8 ± The nurse considers factors related to safety effectiveness in the planning and delivery of nursing services.

36. The nurse notices that the comatose client starts to lighten. She is aware that without protection, the client could fall or be injured. Which of the following is the LEAST intervention? A. B. C. D. Restrain the client to prevent from falling Give adequate support when turning or moving Keep the side rails up on the bed Protect client¶s head

ANSWER: D

37. Following hip replacement after 24 hours the client asks for assistance onto the bedpan. She is placed in an orthopedic bed and to facilitate the use of the bedpan, how should the nurse assist the client? A. B. C. Pull on the trapeze to lift the pelvis extending both legs Lifting the pelvis off the bed and turn gently toward the operative side Assist the client in lifting the pelvis

D. Elevate the pelvis using the trapeze involving the unaffected upper extremity and unoperated leg

ANSWER: D ± (Funda. Craven. 784) FTRAPEZE. Helps clients raise trunk from bed and allow client position hangs.

38. Andoy, an elderly client, is to be discharged after sustaining a sprain from fall while negotiating the last step of the stairs. The daughter asks the nurse how to promote safety in the stairways and hallways in the home. The nurse recommends extra lighting at the stairways and suggests repainting the hallways with: A. Red and yellow and white B. Black and white C. Blue and green D. Cream

ANSWER: A

39. Cecille, 32 years old has problem with the olfactory nerve. They live in a thickly populated area and is concerned for the safety of her 3 young children. What measure should the nurse recommend for home safety? A. Install additional lighting for visibility prevention training B. Mild water heater temperature device C. Participate in fire

D. Install a smoke detector

ANSWER: D

40. Lola Carmona, 76 years old is living alone. Her married daughter visits her from time to time. She can do activities of daily living with limited assistance and seems to be independent physically. Which of the following measure should be recommended to reduce sensory deprivation? A. B. C. D. Encourage acquaintances to come to the house for a chat Redecorate the house and provide a separate room Provide pictures of family members Invite friends often to share meals at home

ANSWER: A ± (Funda. Kozier. p1284) FEncourage social interaction. SENSORY DEPRIVATION. Reduction or prevention of culturally normal interaction between an individual and the rest of society.. Situation 9 ± In today¶s health care environment, nurses are increasingly accepted as essential members of the interdisciplinary health care team.

41. The nurse is working in a tertiary hospital for almost a year. In order to effectively participate and lead a health care team, she must have which of the following traits? A. B. C. D. Courteous and respectful to the health team and members. Committed in the exercise of duties and responsibilities to clients and co-workers Knowledge of the most effective and reliable, evidence-based approach to care Good interpersonal relationship with clients and families and the health team

ANSWER: A ± (Funda. Taylor. p160)

42. A staff nurse consulted a more experienced nurse and other health care providers whether aggressive ambulation expedites the patient¶s recovery or it requires too much energy. While this approach is extremely common, she is likely to obtain clinical answers that are: A. Scientific B. Evidence based C. Tradition based D. Routine

ANSWER: A ± (research. Polit. P15) FSCIENTIFIC. Is a general set of orderly, disciplined procedures used to acquire information.

43. An experienced nurse is new in the work setting. Given this situation, what should the nurse do to conform to the institution¶s expectations? A. B. C. D. Pursue post graduate course to enhance skills and competence. Participate in the in-service education program offered by the institution. Attend seminars, conference and national convention related to the nursing profession. Learn new values, skills, attitude, and social rules.

ANSWER: B 44. Image makers provide the greatest number of visual images of nurses at work such as angel of mercy, love interest particularly to the physician, naughty nurse, handmaiden to the physician, etc. Changing nursing¶s image in the public eye will not be easy. Which of the following strategy/strategies is/are needed to change nursing image in the mind of image makers? 1. 2. 3. Restriction of the term nurse to mean licensed RN. Involvement in the political processes that shape their profession. Increased effort to publicly praise and value nursing.

4. Emphasize the contribution of nursing to patients, particularly on their desired health outcomes.

A. 1, 3 and 4 D. 2 only

B. 3 only

C. 1, 2, 3 and 4

ANSWER: C

45. Nurses naturally work to effect policy in the work place. Which of the following action(s) can nurses take to increase their influence in policy setting? 1. 2. Be a member of a nursing organization Write lobbying letters

3. 4.

Participate in coalitions of organizations Get to know their elected officials

A. 1, 2, 3 and 4 D. 1 only

B. 3 only

C. 1, 3 and 4

ANSWER: A

Situation 10- The following questions refer to nurses¶ efforts to integrate in mental health community work.

46. The most important role of the nurse as a member of the team is to: A. Keeps a 24 hours watch for the patient B. Meet the needs for the physical well being of patients C. Carry out medical orders D. Coordinate the psychosocial care and management of clients

ANSWER: D ± From the issue itself which is member of the team it follows that there should be coordination.

47. Activity therapy is a treatment that utilizes which of the following? A. Psychotherapy Milieu therapy B. Behavioral therapy C. Somatic therapy D.

ANSWER: D ± Milleu therapy involves clients¶ interactions with one another; i.e. practicing interpersonal relationship skills, giving one another feedback about behavior, and working

cooperatively as a group to solve day to day problems same thing with the Activity therapist focuses on remotivation of clients by directing attention outside themselves to relieve preoccupation with personal thoughts, feelings and attitudes thus clients learn to cope with stress to through activity. Option B ± Behavioral therapy is a mode of treatment that 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 the behavior (Shahrokh & Hales, 20003). Option A - Psychotherapy it is the therapeutic interaction between a qualified provider and client or group designed to benefit persons experiencing emotional distress, impairment, or illness; therapist¶s approach is based on a theory or combination of theories. Option C ± Somatic therapy is the biologic treatment for mental disorders such as ECT, physiotherapy etc. (Videbeck) 48. Which of these nursing actions belong to the secondary level of preventive intervention? A. Providing mental health education to members of the community B. Providing mental health consultation to health care providers C. Providing emergency psychiatric services D. Being politically active in relation to mental health issues

ANSWER: C - Secondary level of prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions; Options A,B,D are primary level of prevention which is directed towards promoting health and preventing the development of disease process. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration. (Potter & Perry)

49. When the nurse identifies a client who has attempted to commit suicide the nurse should: A. Refer the matter to the police B. Refer the client to the psychiatrist C. Call a priest D. Counsel the client

ANSWER: D ± Asking clients directly about thoughts of suicide is important. It is also standard practice to inquire about suicide or self-harm thoughts in any setting where people seek treatment for emotional problems. (Videbeck p.328)

50. The community health nurse was invited by the principal of an elementary school and was asked to give a talk to parents. An appropriate topic would be: A. The legal aspects of drug abuse B. Discipline of children at home and school school youth C. Marital crises D. The problems of out of

ASNWER: B ± it is the appropriate topic because since the audience is on elementary level. Options A, and D are for highschool students. Options C is for college students.

Situation 11- Nurse Grazilda engaged clients in a group experience for medication education. Students are paired with clients to play a game and exchange knowledge about medications and disorders. Participants play with a game board and color-coded game cards which bear questions on five categories of psychotropic medications. Game questions include the five categories namely: Antipsychotic medications, Anti-depressants, Mood stabilizers, Anti-anxiety medications and Medications for drugs of abuse.

51. An opening comment about the purpose of the group encouraged clients to gather around the table and select small toy cars to move playfully around the racetrack game board. The aim of this affective learning approach is for the clients to: A. Meet diverse learning needs about medications B. Satisfy client¶s level of functioning of compliance C. Share common feelings

D. Maximize the likelihood

ANSWER: C ± this option is an example of an affective learning approach.

52. One objective of this group experience is for the clients to describe the impact of these medications on their symptoms and day to day activities. Immediate discussion and interaction about daily life situations utilizes the principle of:

A. Reinforcement D. Flexibility

B. Appropriateness

C. Efficiency

ANSWER: A ± Reinforcement is a stimulus that strengthens or weakens the behavior that produced it; Appropriateness is to take one¶s self in exclusion of other¶s; Efficiency is the quality of being efficient or producing an effect or effects; Flexibility is the quality of being adaptable or variable. (Webster Dictionary)

53. Which of the following client behaviors demonstrate that interpersonal learning occurred? A. One client advised another client that he should get a ³pill box´ so he would remember to take medications B. Clients shared a sense of ³we-ness´ C. Clients said they were ³all in the same boat.´ D. One client said, ³I feel that way.´

ANSWER: B ± Interpersonal learning includes the gaining of insight ,the development of an understanding of a transference relationship, the experience of correcting emotional thoughts and behaviors, and the importance of learning about oneself in relation to others. Option A is an example of Imparting of information. Option C is an example of Universality. Option D is an example of Catharsis. (Shives p.208)

54. One client shared her very infrequent experiences with alcohol, which she knew were contraindicated with her medications and the quietly stated, ³I don¶t want anyone to repeat this.´ This experience included which of these therapeutic factors? A. Altruism D. Group cohesiveness B. Universality C. Imparting information

ANSWER: A - Altruism in therapy groups benefit members through the act of giving to others. Clients have the experience of learning to help others and in the process they begin to feel better about themselves. Both the group therapist and the members can offer invaluable support, insight and reassurance while allowing themselves to gain self-knowledge and growth; Universality can be defined as the sense of realizing that one is not completely alone in any situation; Imparting of information includes didactic instruction and direct advice and refers to the imparting of specific

educational information plus the sharing of advice and guidance among members. Group cohesiveness is the development of a strong sense of group membership and alliance. (Shives p.208)

55. Which of the following LEAST contribute to creating a therapeutic learning environment? A. Heterogenous composition of participants B. Use of alternative teaching strategies that fit the needs of the group C. Development of pre-determined, absolute group goals D. Flexibility in accommodating the number of players

ANSWER: A ± Because being in a heterogenous group will have a hard time in controlling and manipulating the participants that will hinder in creating a therapeutic environment; Options B,C,D will help in creating a therapeutic learning environment.

Situation 12 ± Lily, the mother of two children was cooking dinner and wondering why her husband was so late. Then she received a telephone call from the police notifying her that her husband had just been pulled from the river. Witnesses say her husband jumped from a bridge in the locality.

56. Lily, together with her children walked a 10 block way to the funeral home to meet the medical examiner to identify the body of her husband. Without a tear, she became focused on attending to her children and simply signed the necessary paperwork. She is in a state of: A. Integration D. Reality B. Shock C. Recovery

ANSWER: B ± Engels Stages of Grieving first stage is shock and disbelief; second stage is Developing awareness; third stage is Restitution which is participation in rituals assoc. with death, help to accept reality of loss; fourth stage is Resolution of loss; fifth stage is Recovery. Integration is re-organizing and reintegrating the sense of self to pull life back together; Shock is the initial reaction to a loss stunned numb feeling; Recovery is the preoccupation & obsession ends and individual go on with life. (Videbeck 5th edition p.207)

57. In the following weeks after the death of her husband, Lily struggled not only with finances but with confusion and rage in response to her husband¶s actions and abandonment. The nursing diagnosis is: A. Spiritual distress Social isolation B. Disturbed self-esteem C. Powerlessness D.

ANSWER: C ± Powerlessness is the state in which an individual or group perceives a lack of personal control over a certain events or situations which affects outlook, goals and lifestyle; Spiritual distress is the state in which an individual or group experiences or is at risk of experiencing a disturbance in the belief or values system that provides strength, hope and meaning to life; Disturbed self-esteem is a state in which a person is experiences or is at risk of negative evaluation about self and capabilities; Social isolation is a state or process in which persons, groups or cultures lose or do not have communication or cooperation with one another, often resulting in an open conflict. (Videbeck)

58. Unable to handle her emotions, Lily hurls angry and explosive outbursts toward those who are helpful to her. This behavior is an example of: A. Sublimation Introjections B. Reaction formation C. Displacement D.

ANSWER: C ± Displacement is the ventilation of intense feelings toward persons less threatening than the one who aroused those feelings; Sublimation is the substituting a socially acceptable activity for an impulse that is unacceptable; Reaction formation is acting the opposite of what one thinks or feels; Introjection is accepting another person¶s attitudes, beliefs and values as one¶s own. (Videbeck) ` 59. Hostility is distinct from anger in that the former is: A. Compatible with love Ego syntonic B. Growth-promoting C. Destructive D.

ANSWER: C ± Hostile behavior is intended to intimidate or cause emotional harm to another and it can lead to physical aggression while Anger is a normal human emotion, is a strong,

uncomfortable, emotional response to a real or perceived provocation. (Videbeck) Options A and B is inappropriate. 60. During nurse-patient interactions with Lily, when she actively works out her rage which of the following is NOT therapeutic? A. B. C. D. Ask Lily to describe what is the ³hardest part´ of the death for the family Assure that death of husband is not her fault An encouragement toward normalcy must be communicated The nurse should be non-reactive

ANSWER: B ± Option B is an example of false reassurance; Option A allows exploration through verbalization; Option C is an example of reflecting; Option D is an example of active listening.

Situation 13- The nurse works in an institution that shelters street children. She encounters varied family histories and presenting behavior patterns of these clients.

61. At night when the children are being prepared to go to sleep, the nurse hears from a frightened child ³Ayaw ko matulog mag-isa. May multo.´ (³I don¶t want to sleep alone. There¶s a ghost!´). The nurse conveys acceptance with which of these responses? A. ³Gusto mong i-kwento kung ano pa ang naiisip at nararamdaman mo?´ (³Would you like to tell me more about your thoughts and feelings?´) B. ³Talaga? Anong itsura ng multo?´ (Really? How does the ghost look like?´) C. ³Nakakatakot nga ang pakiramdam na ganyan.´ (³That must really be scary.´) D. ³Huwag kang matakot, babantayan kita.´ (³Don¶t be afraid. I¶ll keep watch over you.´)

ANSWER: A ± Allows verbalization about his concerns. Option B and C is an example of Agreeing; Option D is Reassuring. (Videbeck)

62. Most street children come from broken families. The nurse is MOST therapeutic in meeting their needs by being a: A. Activity therapist D. Teacher B. Mother surrogate C. Child therapist

ANSWER: B ± Mother surrogate is the nurturing needs of clients who are unable to carry out simple tasks; Activity therapist focuses on remotivation of clients by directing their attention outside themselves to relieve preoccupation with personal thoughts, feelings and attitude; Nurseteacher educates clients about specific illnesses and medication prescribed to promote stabilization of their condition.(Shives p.145 & 156)

63. With adequate rest, food, cleanliness, shelter, warmth and safety, the child: A. Develops a sense of competence B. Acquires a sense of personal power others C. Develops a separate identity D. Learns to trust in self and in

ANSWER: D ± it is task that should be developed, by providing a rest, food, cleanliness, shelter, warmth and safety will develop the trust in oneself, other people, the environment and meaningfulness of existence. Option A is on school age; Option B is for toddler; Option C is for early adolescence.

64. Preventive interventions for children at risk are BEST achieved through: A. Family therapy for the dysfunctional families B. Non-government organizations and other workers paying attention to victims in conflict ridden communities C. Support and caring to children during family crisis situations D. Play and activity therapies for children

ANSWER: C ± in order to divert attention of the child from crisis. Option D is done after crisis.

65. Cindy was a frequent witness to domestic violence. Her father would always come home drunk and beat up Cindy¶s mother. As an effect of this experience she had nightmares, speechless for weeks, inability to sleep, tension and palpitations lasting for more than a month. Cindy is experiencing anxiety due to: A. Adjustment in growing up stress B. Fear of phobic proportion love D. Imagined loss of parental C. An identifiable traumatic

ANSWER: C ± this is an example of post traumatic stress disorder. Option A and D is inappropriate while Option B is for phobia.

Situation 14 ± Increasing problems of substance abuse continue to challenge the competencies of professional nurses.

66. The Comprehensive Dangerous Drugs Act (R.A. No.9165) challenges the nurse in his/her role as a/an: A. Advocate D. Health educator B. Therapist C. Counselor

ANSWER: D ± it is also known as Nurse-teacher educates clients about specific illnesses and medication prescribed to promote stabilization of their condition; Options B and c are the same, they uses therapeutic skills to help clients identify and deal with stressors or problems that have resulted in dysfunctional coping. In the advocate role, the nurse informs the clients and supports him or her in whatever decision he or she makes. (Videbeck p.96 and Shives p.145).

67. The nurse is conducting Parent Education Classes. Aware of the scope of nursing practice he/she recognizes the necessity to network with other agencies to discuss this area: A. Communication skills appropriate for different ages B. Constructive discipline C. Normal and deviant child and adolescent behavior and development D. Legal implications of illegal drug use

ANSWER: D ± There is needed information that should come from other agencies. Option A,B and C can be discussed thoroughly by a nurse.

68. Which of these characteristics has the LEAST potential success of treatment of drug dependency? A. An addict who has reached bottom pit level of self-disgust and who wants help B. An individual who became dependent on a drug before or during the teen years C. Individuals who have access to support from intact family groups D. A person who began taking the drug of choice for recreational or experimental reasons

ANSWER: B ± since the individual has been using drugs since his/her teenage years. Options A,C and D are all manifesting positive behavior in dealing with drug abuse.

69. The BEST model of drug abuse prevention supports: A. Programs focusing on means of dealing with problems and frustration of adolescents B. Mandatory basic education transformation of society

C. An integrated program requiring development of both intellectual and affective health D. The medical treatment of drug abuse utilizing less addictive drugs

ANSWER: A ± because it focuses on the concerns of the adolescents.

70. Clients says ³I am not a substance user. I take drugs only when I am under stress.´ What defense mechanism is this client employing? A. Repression Denial B. Substitution C. Compensation D.

ANSWER: D ± Denial is the failure to acknowledge an unbearable condition ; failure to admit the reality of the situation or how one enables the problem to continue ; Represssion is excluding emotionally painful or anxiety provoking thoughts and feelings from conscious awareness ; Substitution is the replacing of the desired gratification with one that is more readily available ; Compensation is the overachievement in one area to offset real or perceived deficiencies in another area. (Videbeck p.47)

Situation 15- Eric, a 19 year old, second year college student is seeking assistance in coping with school related stressors and sleep disturbances. During the initial evaluation of the psychiatric nurse, he reports he is ashamed and embarrassed by a mistake he made in his class oral report and feels like his classmates are going to look down on him. He reports that he failed a practical exam a year ago. Although he has made up for this, he cannot get this out of his mind.

71. When the nurse asks Eric to describe his physical experience, which of these assessment data are appropriate? A. ³I do not know what to do´ depressed´ B. ³I am tense, nervous and exhausted all the time´ lot´ C. ³I feel helpless and

D. ³I am worried and thinking a

ANSWER: B ± being tense, nervous and exhausted all the time is an example of physical experience.

72. Eric admits that he has ³always been wound up´ just like his father and that he has negative thoughts of himself. He is having a problem of: A. Inferiority D. Role confusion B. Mistrust C. Stagnation

ANSWER: D ± Eric is an adolescent which is the task is formulating a sense of self and belonging. Option A is for school age; Option B is for infancy; Option C is for middle age.

73. The nurse teaches non-pharmacologic ways to induce sleep. Which of these would she caution Eric to avoid? A. Warm milk A warm bath B. Classical music C. Coffee after dinner D.

ANSWER: C ± Coffee has caffeine which is an example of a stimulant. Other options will promote relaxation and sleep.

74. Which of these describe the characteristic of free floating anxiety? A. It is not conditioned by a specific trigger B. It creates panic C. There is an easily recognizable stressor that provokes anxiety D. It results in selective attention/inattention

ANSWER: A ± Similar to all anxiety disorders, a phobia is a response to experienced anxiety and is characterized by a persistent fear of specific places or things, as opposed to GAD, in which the anxiety is free-floating; thus, anxiety is displaced or externalized to a source outside the body. Option D is on the Moderate level of anxiety; Option B is on the Panic level of anxiety. (Videbeck)

75. A generalized anxiety disorder is distinguished by; A. Experience of anxiety after exposure to a life threatening event B. Presence of excessive anxiety for a period of 6 months or more C. Irrational thoughts and actions D. Fear of losing control thus avoids going out or avoids crowds

ANSWER: B ± Generalized anxiety disorder is characterized by at least 6 months of persistent and excessive worry and anxiety. Option A is PTSD; Options C and D are Phobia. (Videbeck p.275)

Situation 16- Many clients in a psychiatric unit receive antipsychotic medications, also referred to as Neuroleptics.

76. Clients may be shifted from typical to atypical antipsychotic medications because of its minimal extrapyramidal side effects. A common extrapyramidal symptom that is very unpleasant and intolerable to clients is called akathisia. This is: A. Upward rolling of the eyes the hands B. Inability to sit or stand still neck D. Stiffening of the client¶s C. Pill rolling movement of

ANSWER: B ± This feeling of internal restlessness and the inability to sit still or rest often leads clients to discontinue their antipsychotic medication. Other options are also signs of EPS. (Videbeck p.28)

77. Health instructions about Haldol (haloperidol) has been given to Anthony while in the hospital and before his discharge. The client correctly understood the health techniques of the nurse when he says: A. ³I will immediately report any episode of diarrhea or vomiting to my doctor.´ B. ³I will drink about 2 liters of fluids daily and expect to urinate frequently.´ C. ³I will wear long sleeve clothing and sun block when I go out.´ D. ³I will avoid pizza, any food with cheese and processed meat.´

ANSWER: C ± Antipsychotic medications requires the use of sunscreen because photosensitivity can cause the client to sunburn easily. Option A is for SSRI¶s; Option B is inappropriate because the increase fluid intake is to solve constipation but not to urinate frequently. Option D is for MAOI¶s.(Videbeck p29-30)

78. While giving Chlorpromazine (Thorazine) to client Michelle, the nurse remembers that she should stop giving the medication when she observes this side effect: A. Shuffling gait sclerae B. Fine tremors D. Facial grimacing C. Yellow

ANSWER: C ± Is an adverse effect and is a sign of hepatotoxic which is jaundice. Options A,B and D are expected side effect and this are called EPS. (Brunner p.2313)

79. Another client in the ward, Carl, is given Thorazine (Chlorpromazine). This medication has several side effects. Which side effect should cause the nurse to be MOST concerned? A. Uncomfortable sun burns B. Sore throat, fever, decreased white blood cell count C. Tremors, inability to stand still

D. Low blood pressure upon getting up from bed

ANSWER: B ± it has the potentially fatal side effect because Agranulocytosis develops suddenly and is characterized by fever, malaise, ulcerative sore throat and leukopenia. The drug must be discontinued immediately. (Videbeck p.275)

80. Clients on antipsychotic medications usually receive anti-parkinson drugs to reduce Parkinson like side effects. What medication would the nurse expect the client to receive? A. Congentin (Benztropine) C. Fluphenazine (Prolixin)

B. Nardil (Phenelzine)

D. Fluoxetine (Prozac)

ANSWER: A ± it is an example of anti-parkinsonian drug; Option B is MAOI¶s; Option C is Anti-psychotic; Option D is SSRI¶s. (Videbeck p. 29-31)

Situation 17 ± Peter, a 35 year old employee was admitted to the hospital because of behavioral problems at the office. He started to be bossy, claiming that he is the manager on the unit. On admission he was diagnosed to be having Bipolar disorder, manic phase.

81. Peter¶s condition is primarily a problem of: A. Affect D. Conscience B. Perception C. Thought

ANSWER: C ± During manic phases, clients are euphoric, grandiose, energetic and sleepless. They have poor judgment and rapid thoughts, actions and speech. (Videbeck p.317)

82. A therapeutic environment for Peter is: A. Minimal environmental stimuli C. No limitation on his activities

B.

Strict isolation and withholding privileges

D. Well lit and basically colored room

ANSWER: A ± A primary nursing responsibility is to provide a safe environment for clients and for others. Option C it should be simple activities such as card games or a short walk and it is necessary to set limits when they cannot set limits on themselves. Option B and D is not appropriate. (Videbeckp.324)

83. During socialization Peter was provoked, became furious, started shouting and making personal demands. A therapeutic intervention of the nurse is: A. B. C. D. Take him away from the group until he manages to have control of himself. Restrain him and put him on isolation to protect other patients. Prevent him from becoming more furious by giving an extra PRN dose of sedative. Respond with, ³Peter, we don¶t favor anyone. Everybody in the ward is in equal footing.´

ANSWER: A ± the client must establish external control. Restraining would be the last intervention. Option D is correct since its matter of fact but the issue presents that the patient becomes FURIOUS which would further escalate due to the rsponse. (Videbeck p.304)

84. Therapeutic use of self is essential in relating with psychiatric patients. This is BEST demonstrated by the nurse in. A. B. C. D. Sympathizing with the miserable feelings of Peter Suppressing her own feelings towards Peter Engaging Peter in productive activity Engaging Peter in introspective thinking

ANSWER: B ± Therapeutic use of self: nurses uses themselves as a therapeutic tool to establish the therapeutic relationship with clients and to help clients grow, change and heal. Nurses must

not allow their own issues & biases to color interactions. Option A, you don¶t sympathize but you empathize. Options C and D are concerns of the patient. (Videbeck) 85. The nurse may recommend discharge when Peter: A. B. C. D. Easily finishes projects given to him during occupational therapy Takes his medications without reminding him Demonstrates skills in activities of daily living Complies with hospital rules and regulations

ANSWER: B ± Adherence to treatment regimen of medication and psychotherapy. (Videbeck p.328)

Situation 18- The stress of hospitalization can lead to difficulties between nurses and patients. Following are situations that nurses presented during a monthly nursing circle.

86. Jurry asked the nurse to have an ³out on pass´ privilege for the weekend but his request was not granted by the nurse. He remarked, ³I thought you really liked me.´ A therapeutic response of the nurse would be: A. Say, ³I understand, you feel bad but of course, I like you.´ B. Say as a matter of fact, ³Your behavior did not meet criteria for out on pass privilege.´ C. Ignore Jurry¶s remark D. Be transparent and express disapproval openly. ³You upset me with your remark.´

ANSWER: B ± it is an example of verbalizing the implied; Option A is an example of giving approval; Option C, you don¶t ignore the client; Option D is an example of disapproving. (Videbeck p.110)

87. The dynamics of behavior underlying manipulative behavior explain that it is a behavior of: A. A sense of security and control B. Exhibiting uncooperative and hostile behavior C. Reducing patient¶s anxiety D. Sensing fear of other people

ANSWER: B ± due to lack of insight they often act-out their feelings in aggressive and hostile behavior.

88. Lolita, an elderly client idealizes some nurses as ³terrific´, ³the best´, or ³so understanding´, but refers to others as ³mean´, or ³indifferent´. This behavior can be understood by the staff as: A. Avoiding taking responsibility for her own behavior and underlying feelings B. An understandable behavior for an elderly that must not be taken seriously C. An invitation to have a social and intimate relationship with her nurse D. Immature and childish behavior

ANSWER: B ± this is a normal and an understandable behavior of an elderly.

89. A patient with delirium touches the nurse inappropriately. The therapeutic response of the nurse would be to: A. Ask for the patient¶s name and if whether he is aware where he is. B. Remove the patient¶s hand while saying calmly, ³I¶m the nurse and this is a hospital.´ C. Say nothing and just go on with the usual nursing interventions D. Say her name, ³I¶m Cathy, I¶m your nurse.´

ANSWER: D ± Delirium is confusion accompanied by altered or fluctuating consciousness. Disturbance in emotion, thought and perception is moderate to severe. The nurse provides orienting cues when talking with clients, such as calling them by name and referring to the time of day or expected activity. Often, the use of touch reassures clients and provides contact with reality. (Videbeck p.469)

90. The staff nurses have differing emotional reactions to the use of limit setting. Some staff views it as unprofessionally punitive and uncaring. The MOST appropriate approach to address the nursing concern is through: A. Counseling with the nursing supervisor B. Nursing Conference C. Seminar-workshop D. Brainstorming session

ANSWER: B ± Since it is a nursing concern, nursing conference is more appropriate.

Situation 19 ± Robert is a survivor of a tragic accident wherein his wife and child drowned when their boat sank due to stormy weather. Within the next 6 months from the accident he was observed to be detaching himself from others, unable to sleep` and concentrate and frequently would just be quiet and stare.

91. He tells you, ³It is my fault. What kind of husband and father am I?´ He is expressing; A. B. Depersonalization Guilt C. Inappropriate affect D. Cognitive disturbance

ANSWER: B ± Guilt is the feelings of culpability especially for imagined offenses or from a sense of inadequacy; Inappropriate affect is displaying a facial expression that is incongruent with mood or situation; Depersonalization is the feelings of being disconnected from himself or herself; Cognitive disturbance occurs when there is clinically significant deficit in cognition from a previous level of functioning. (Shives p.491)

92. The nurse can BEST intervene by mobilizing the client¶s relatives, friends and people to provide. A. Spiritual support B. Material support D. Medical support C. Social support

ANSWER: A ± religious activities such as church attendance and praying associated social support have been shown to be very important for many people and are linked with better health and a sense of well-being; Social support is emotional sustenance that comes from friends, family members, and even health care providers who help a person when a problem arises. (Videbeck)

93. A therapeutic attitude the nurse can convey to the client while he talks about his loss is: A. Sympathy D. Optimism B. Acceptance C. Passivity

ANSWER: Acceptance is the avoiding judgments of the person, no matter what his behavior; Optimism is an inclination to put the most favorable construction upon actions and events or to anticipate the best possible outcome; Passivity is a mental state of being submissive, dependent or inactive, as a form of maladaptation; Sympathy is an expressed interest or concern regarding the problems, emotions or states of mind of another. (Mosby Dictionary)

94. The nurse encourages the client to communicate and socialize because internalized hostility can lead to: A. Depression B. Verbal assaultiveness C. Physical assaultiveness D. Amok

ANSWER: A ± Hostility turns towards self is considered depression.

95. The patient is having a:

A. Post traumatic stress disorder B. Psychotic breakdown

C. Developmental crisis D. Personality dysfunction

ANSWER: A ± Post traumatic stress disorder is a disturbing pattern of behavior demonstrated by someone who has experience a traumatic event such as natural disaster, combat or an assault. Option B, C and D is inappropriate. (Videbeck p.202).

Situation 20- Mrs. Cortez is an 85 year old woman who has been hospitalized due to a urinary tract infection and dehydration. She has Alzheimer¶s disease, osteoporosis, and a tendency to wander. She has an IV in her left forearm, which was difficult to establish. Concerned that Mrs. Cortez might pull out her IV and wander off the floor, the staff is considering the possibility of using restraint on her.

96. The staff is considering the possibility of using restraint on Mrs. Cortez, however, she repeatedly declares that she does not want to be restrained. The staff is faced with an ethical dilemma of autonomy versus: A. Beneficence D. Justice B. Veracity C. Fairness

ANSWER: A ± Beneficence promotes doing acts of kindness and mercy that directly benefit the patient; Veracity is truth-telling; Option C and D is the same, refers to the right to demand to be treated justly, fairly and equally. (Venzon 10th edition p. 102) 97. With a history of osteoporosis and a tendency to wander, which of the following should be a priority? A. Request for a sitter B. Wheelchair privilege commode C. Prevention of fall D. Provision of a bedside

ANSWER: C ± Safety is the priority concern.

98. Which of the following would be LEAST likely appreciated by Mrs. Cortez? A. Playing a table board game picture album B. Singing to or with her music C. Going through family

D. Listening to old familiar

ANSWER: A ± Clients lose intellectual function, which eventually involves the complete loss of their abilities and option A requires concentration and focus.

99. The nurse aims at highest level of self care. Which of the following will the nurse minimize? A. Providing mouth swabs with buttons and zippers B. Hand and body lotion C. Using clothing

D. Labeling clothing items

ANSWER: C ± Since there is a progressive cognitive impairment, the client may have difficulty recalling the use of buttons and zipper.

100. Mrs. Cortez has a dietary privilege of food preferences. Which question is MOST effective to communicate with her? A. Which way would you want your egg done? Scrambled? Sunny side up? With vegetable mix? Or boiled? B. Do you want fried egg or boiled egg? C. How would you want to have your egg done? D. What is your favorite egg recipe?

ANSWER: C ±This may asses the memory of the patient.

Situation 1- The nurse assigned in the neurology unit is taking care of a patient with medical diagnosis of increased intracranial pressure.

1. An intracranial pressure monitor is in place and the patient is becoming lethargic. The nurse notes the intracranial pressure is high. Which of the following should be the immediate action of the nurse? A. Turn the patient to his left side with the back supported with pillows B. Elevate the legs at 15 degrees with a pillow under the head C. Elevate the head of the bed to 30 degrees D. Raise the head of the bed to 90 degrees and the head supported with pillows

2. The nurse is monitoring intracranial pressure of the patient. Which of the following nursing assessment would identify the earliest indication of increasing intracranial pressure? A. Widening pulse pressure B. Change in level of consciousness C. Cyanosis and hypotension D. Increased body temperature

3. The nurse completed a nursing assessment. Which of the following data concludes that the patient is showing signs of increased intracranial pressure? A. Decrease in pulse pressure, increased heart rate and irregular breathing pattern B. Dilatation of the pupil, decreased blood pressure and increase in level of consciousness C. Increase in heart rate and respiratory rate and decreased level of consciousness D. Slowing of the heart rate, increase in pulse pressure and irregular breathing pattern

4. In preparing the plan of care, the nurse should prioritize which of the following nursing and medical measures? A. high backrest to prevent Valsalva¶s maneuver and promote venous drainage

B. Turning every 2 hours with logrolling movement to maintain proper position C. Elevating the head of the bed and keeping the head in proper alignment D. Proper positioning and frequent change in position

5. The nurse plan of care includes preventing environmental stimuli that may stimulate an increase in intracranial pressure. Which of the following measures should the nurse include in the nursing care plan? 1. Keeping lights on low setting 2. Keeping noise at a minimum 3. Providing a calm and restful environment 4. Having a cooling blanket available

A. 1, 2, 3 and 4 D. 2, 3 and 4

B. 1 and 2

C. 1, 2, and 3

6. Nurse Karen is assessing the client. Which of the following is MOST likely to be assessed? A. Early morning stiffness B. Nodules along the knees C. Joint for deformities D. Limited motions of joints

7. The client is in the acute phase of rheumatoid arthritis. In addition to the prescribed medication, the physician orders application of heat and cold to manage arthritis pain. Which of the following statements indicate that the client lacks understanding in the application of heat and cold? A. ³Cold application is applied for 20 minutes, then 20 minutes off´ B. ³Hot water bag should be covered with flannel to prevent burns.´

C. ³Heat and cold can be applied as needed.´ D. ³Heat producing liniments can be used while applying heat and cold.´

8. Nurse Karen is helping the client, who is immobilized by pain, towards self-reliance and independence. The nurse should approach the problem with which of the following: A. Set a specific goal B. Set a positive attitude toward an eventful outcome C. Need for a member of the family during the pain episode D. Recognize that little can be accomplished

9. The nurse should know that a client with rheumatoid arthritis will most often have pain and limited movements of the joints: A. Resulting from non-adherence to prescribed diet B. After excessive exercises C. Because of inactivity upon awakening in the morning D. During cold weather

10. To prevent deformities of Mrs. Borja, the nurse includes in the nursing care plan: A. Massaging the joint with oil liniment B. Implementation of strictly prescribed diet C. Performing isometric exercises twice a day D. Alternate rest periods with active exercises

Situation 3- A team of researchers is conducting a study on the effect of high dose corticosteroids in improving the motor and sensory outcomes of patients with spinal cord injuries within 6 weeks if administered within 8 hours after injury. The study covers a three month period.

11. On the basis of the nature of the investigation, which one of the designs listed below would allow the researchers to have the most confidence that the corticosteroids is effective in improving the motor and sensory outcomes of patients with spinal cord injury: A. Quasi or semi-experimental design B. Non-experimental design study design C. Experimental design D. Retrospective-prospective

12. Which of the following is present in conducting the above study? A. Experimental group D. Control group B. Subjects C. Variables

13. The target participants of the intended study are homogenous in the variables being measured. In determining the sample size, the researchers should include how many participants in this study? A. 500 D. 100 B. 10 C. 30

14. In the above study, the researchers manipulate the variable under study. Which of the following variables is sufficient for the effect to occur? A. Clients with spinal cord injury B. Injection of corticosteroids within 8 hours after injury C. Research methodology D. motor and sensory outcomes patients with spinal cord injuries

15. The manipulated variable to the experimental group is the: A. Improved recovery and lessen hospitalization period B. Questionnaire in gathering pertinent data C. Improved motor and sensory outcomes D. Injection of corticosteroids within 8 hours post spinal cord injury

Situation 4 ± To produce a beneficial effect on eye medications, the nurse should make sure that the amount of medication reaches the ocular site of action in sufficient concentration.

16. The nurse in the EENT unit is preparing the 8:00 AM medication. She is fully aware that topical administration of ocular medication results in how many percent rate of absorption? A. 21% to 25% 1% to 7% B. 10% to 16% C. 16% to 20% D.

17. The nurse is preparing ocular medications for topical route of administration. The most common ocular medications is administered through instilled eye drops and applied ointments. What is the advantage of ointment application from instillation of eye drops? A. B. C. D. Self administration, ease of absorption and decreased risk of contamination Extended retention time and provides a higher concentration Easy to administer with reduced adverse reaction Promotes efficiency, safety and distribution of solution evenly

18. The nurse is to administer eye ointment to the patient. Which of the following guides the nurse in the administration of the ointment? A. Administer during nap time or bedtime.

B. C. D.

Inform the relative of the action of the drug. Explain the procedure to the patient. Check medical conditions that would contraindicate the use of the drug.

19. Common ocular medication include topical anesthetic. In the application of topical anesthetics, the nurse MUST instruct the patient which of the following measures? A. B. C. D. Place the fingers on the sides of the nose to prevent medication from draining Place the patient in supine position with the head slightly hyperextended Close both eyes and gently move eyes Refrain from rubbing the eyes to prevent corneal damage

20. The nurse is assessing a patient receiving mydriatic eye drop. The patient is sweating, complains of blurred vision and drowsiness. These manifestations are indicative of: A. Fear and anxiety B. Overdose of the medications effect C. Allergic reactions D. Systemic anticholinergic

Situation 5± Consumers of health care require improvement in health care. Nurses must deliver activities and behaviors and do the right things well and continue to strive to do better to meet and satisfy the diverse needs of clients.

21. Nurse Cora observes the client with glaucoma while he instills his eye drops. The client looks up the ceiling and instills the correct number of drops at the middle of the eyeball. The technique used by the client in the installation of the medication is: A. Correct as this spreads the medication over the eyeball B. Aimed to protect the eyeball from injury

C. Allowed so that the client is less likely to blink D. Incorrect because it may damage the cornea

22. The client had cataract surgery. Shortly after, he complains of nausea. Which of the following course of action should be given priority by the nurse? A. Administer the prescribed anti-emetic B. Give ice chips to relieve nausea C. Assure the client that this is expected following surgery D. Report the complaint to the attending physician

23. The members of the nursing team were discussing about the activity of the client treated with detached retina during the nursing rounds. Which of the following statements serves as guide for the client during the rehabilitation phase? A. B. C. D. The client may resume his activity with moderation the day after the treatment The client may indulge in normal activities after the treatment The client must be restricted in bed for one week The client may resume gradually her usual activities within 5 to 6 weeks.

24. During the nursing conference, nurse Jesette shares with the team the concerns of the wife of a client with Meniere¶s disease. She is concerned about the change in the husband¶s social activities. To assist the wife in adjusting to the present situation, the team should: A. B. C. Plan the course of action with the husband Create an atmosphere of sense of belonging for the couple Assist the wife to accept the condition of the husband

D. Explain to the wife that her husband is experiencing social isolation related to attacks of vertigo

25. The staff nurse performs ear irrigation on a client for removal of cerumen. What relevant information should the staff nurse share with the client at the start of the procedure? A. Experience a feeling of fullness, warmth and occasional discomfort when the fluid comes in contact with the tympanic membrane B. Any medication needs to be withheld after the procedure and the physician must be notified C. Ear irrigation requires cooperation from the client to facilitate the introduction of the solution D. Assume lying position on the unaffected side after the procedure to facilitate drainage.

Situation 6 ± Following are situations that are a concern for records management of nurses.

26. A delusional patient said, ³I have no head, no stomach.´ The nurse would record this in which part of the mental status? A. Content of thought orientation B. Emotional State C. Characteristics of talk D. Sensorium or

27. For proper documentation and accountability of all entries to the client¶s chart, it is important for the nurse to inspect that: A. B. C. All notes must have signature and title of person making entry The staff must not abbreviate SOAP The nurse implements the use of problem-oriented progress notes

D. Client¶s problems in the medical record must bear the date of entry and numbers of client¶s problem.

28. Which of the following statements about Processing Recording is NOT true? A. It provides data from which nurses can assess their own behavior in interactions with clients. B. It is a tool for assessing nurse-client interactions

C. It is an important means of communication between nurses or nursing students and their clinical supervisors/instructors about their peer relationships. D. It acquaints the student/nurse with rudimentary applied research skills.

29. Data: Client is pacing, crying, waving his hands, yelling at nursing staff and other patients. In the problem-oriented progress notes this data would be noted under: A. Assessment B. Objective C. Subjective D. Plan

30. In order for the process recording to be an effective learning tool for nurses, data should be: A. B. Unedited and comprehensive Salient points that are summarized C. Brief and simple but focused on essentials D. Edited and comprehensive

Situation 7 ± Nurses encounter situations in which they must make decision based on the determination of what is right and wrong. Professional nursing actions are both ethical and moral.

31. Mrs. Belmonte, a middle-aged, obese woman seeks medical help often for the recurring lower back pain. She does not lose weight in spite of medical advice. Which of the following questions should the nurse ask the client?

A. B. C. D.

³What do you think will happen to you when you don¶t follow medical advice?´ ³Aren¶t you bothered about your condition?´ ³Are you considering other course of action?´ ³Is it difficult to follow the medical advice?´

32. A 75 year old frail woman had a cervical disk disorder. Conservative management did not work and the client requires surgery. The client insisted that she does not want surgery, but the family and the surgeon insisted. The staff nurse assigned to her decided not to help in the preparation of surgery. Using caring based reasoning which of the following justify the refusal of the nurse in the preparation of surgery? A. ³I empathize with the client because of her age and her fear of not surviving surgery.´

B. ³I strongly feel that surgery will cause her more suffering and probably will not survive and the family may even feel guilty later.´ C. ³I feel that my responsibility with the client is protecting her rights and meeting her needs.´ D. ³I support the client since she has the right to decide on her medical treatment and management.´

33. A community health nurse in her home visits encountered a 58 year old woman who was depressed and tearful. She was hospitalized before with glaucoma. She knows that she could be of help to the client by staying and talking to her longer for another hour. However, she has still two clients to visit; one of them is Joey who is in plaster cast of the leg and needs a great deal of teaching and the other a 60 year old female, hemiplegic needing assistance in performing activities of daily living. Which of the following is the appropriate action of the nurse? A. B. C. D. Weigh the facts carefully in order to divide her time justly among her clients Tell the client she will come back after attending to the other clients Ask one of the family members to attend to the client Stay with the client to prevent further depression

34. Mrs. Gonzales, a 40 year old professional was confined after suffering mild stroke. She has been critical of the care she received which she regarded as not of high quality. The following actions of the nurse are appropriate in addressing the complaints EXCEPT: A. B. C. D. Provide client with knowledge of what constitutes good care Provide client with the list of her rights Ask the client what her expectations are Give a list of evaluation criteria and ask the client to respond

35. The nurse demonstrates ethics of care when she plays the role of a: A. Teacher Advocate B. Care Provider C. Guidance Counselor D. Client¶s

Situation 8 ± The nurse considers factors related to safety effectiveness in the planning and delivery of nursing services.

36. The nurse notices that the comatose client starts to lighten. She is aware that without protection, the client could fall or be injured. Which of the following is the LEAST intervention? A. B. C. D. Restrain the client to prevent from falling Give adequate support when turning or moving Keep the side rails up on the bed Protect client¶s head

37. Following hip replacement after 24 hours the client asks for assistance onto the bedpan. She is placed in an orthopedic bed and to facilitate the use of the bedpan, how should the nurse assist the client? A. B. C. Pull on the trapeze to lift the pelvis extending both legs Lifting the pelvis off the bed and turn gently toward the operative side Assist the client in lifting the pelvis

D. Elevate the pelvis using the trapeze involving the unaffected upper extremity and unoperated leg

38. Andoy, an elderly client, is to be discharged after sustaining a sprain from fall while negotiating the last step of the stairs. The daughter asks the nurse how to promote safety in the stairways and hallways in the home. The nurse recommends extra lighting at the stairways and suggests repainting the hallways with: A. Red and yellow and white B. Black and white C. Blue and green D. Cream

39. Cecille, 32 years old has problem with the olfactory nerve. They live in a thickly populated area and is concerned for the safety of her 3 young children. What measure should the nurse recommend for home safety? A. Install additional lighting for visibility prevention training B. Mild water heater temperature device C. Participate in fire

D. Install a smoke detector

40. Lola Carmona, 76 years old is living alone. Her married daughter visits her from time to time. She can do activities of daily living with limited assistance and seems to be independent physically. Which of the following measure should be recommended to reduce sensory deprivation?

A. B. C. D.

Encourage acquaintances to come to the house for a chat Redecorate the house and provide a separate room Provide pictures of family members Invite friends often to share meals at home

Situation 9 ± In today¶s health care environment, nurses are increasingly accepted as essential members of the interdisciplinary health care team.

41. The nurse is working in a tertiary hospital for almost a year. In order to effectively participate and lead a health care team, she must have which of the following traits? A. B. C. D. Courteous and respectful to the health team and members. Committed in the exercise of duties and responsibilities to clients and co-workers Knowledge of the most effective and reliable, evidence-based approach to care Good interpersonal relationship with clients and families and the health team

42. A staff nurse consulted a more experienced nurse and other health care providers whether aggressive ambulation expedites the patient¶s recovery or it requires too much energy. While this approach is extremely common, she is likely to obtain clinical answers that are: A. Scientific B. Evidence based C. Tradition based D. Routine

43. An experienced nurse is new in the work setting. Given this situation, what should the nurse do to conform to the institution¶s expectations? A. Pursue post graduate course to enhance skills and competence.

B. C. D.

Participate in the in-service education program offered by the institution. Attend seminars, conference and national convention related to the nursing profession. Learn new values, skills, attitude, and social rules.

44. Image makers provide the greatest number of visual images of nurses at work such as angel of mercy, love interest particularly to the physician, naughty nurse, handmaiden to the physician, etc. Changing nursing¶s image in the public eye will not be easy. Which of the following strategy/strategies is/are needed to change nursing image in the mind of image makers? 1. 2. 3. Restriction of the term nurse to mean licensed RN. Involvement in the political processes that shape their profession. Increased effort to publicly praise and value nursing.

4. Emphasize the contribution of nursing to patients, particularly on their desired health outcomes.

A. 1, 3 and 4 D. 2 only

B. 3 only

C. 1, 2, 3 and 4

45. Nurses naturally work to effect policy in the work place. Which of the following action(s) can nurses take to increase their influence in policy setting? 2. 3. 4. 5. Be a member of a nursing organization Write lobbying letters Participate in coalitions of organizations Get to know their elected officials

A. 1, 2, 3 and 4 D. 1 only

B. 3 only

C. 1, 3 and 4

Situation 10- The following questions refer to nurses¶ efforts to integrate in mental health community work.

46. The most important role of the nurse as a member of the team is to: A. Keeps a 24 hours watch for the patient B. Meet the needs for the physical well being of patients C. Carry out medical orders D. Coordinate the psychosocial care and management of clients

47. Activity therapy is a treatment that utilizes which of the following? A. Psychotherapy Milieu therapy B. Behavioral therapy C. Somatic therapy D.

48. Which of these nursing actions belong to the secondary level of preventive intervention? A. Providing mental health education to members of the community B. Providing mental health consultation to health care providers C. Providing emergency psychiatric services D. Being politically active in relation to mental health issues

49. When the nurse identifies a client who has attempted to commit suicide the nurse should: A. Refer the matter to the police B. Refer the client to the psychiatrist C. Call a priest D. Counsel the client

50. The community health nurse was invited by the principal of an elementary school and was asked to give a talk to parents. An appropriate topic would be: A. The legal aspects of drug abuse B. Discipline of children at home and school school youth C. Marital crises D. The problems of out of

Situation 11- Nurse Grazilda engaged clients in a group experience for medication education. Students are paired with clients to play a game and exchange knowledge about medications and disorders. Participants play with a game board and color-coded game cards which bear questions on five categories of psychotropic medications. Game questions include the five categories namely: Antipsychotic medications, Anti-depressants, Mood stabilizers, Anti-anxiety medications and Medications for drugs of abuse.

51. An opening comment about the purpose of the group encouraged clients to gather around the table and select small toy cars to move playfully around the racetrack game board. The aim of this affective learning approach is for the clients to: A. Meet diverse learning needs about medications B. Satisfy client¶s level of functioning of compliance C. Share common feelings

D. Maximize the likelihood

52. One objective of this group experience is for the clients to describe the impact of these medications on their symptoms and day to day activities. Immediate discussion and interaction about daily life situations utilizes the principle of: A. Reinforcement D. Flexibility B. Appropriateness C. Efficiency

53. Which of the following client behaviors demonstrate that interpersonal learning occurred? A. One client advised another client that he should get a ³pill box´ so he would remember to take medications B. Clients shared a sense of ³we-ness´ C. Clients said they were ³all in the same boat.´ D. One client said, ³I feel that way.´

54. One client shared her very infrequent experiences with alcohol, which she knew were contraindicated with her medications and the quietly stated, ³I don¶t want anyone to repeat this.´ This experience included which of these therapeutic factors? A. Altruism D. Group cohesiveness B. Universality C. Imparting information

55. Which of the following LEAST contribute to creating a therapeutic learning environment? A. Heterogenous composition of participants B. Use of alternative teaching strategies that fit the needs of the group C. Development of pre-determined, absolute group goals D. Flexibility in accommodating the number of players

Situation 12 ± Lily, the mother of two children was cooking dinner and wondering why her husband was so late. Then she received a telephone call from the police notifying her that her husband had just been pulled from the river. Witnesses say her husband jumped from a bridge in the locality.

56. Lily, together with her children walked a 10 block way to the funeral home to meet the medical examiner to identify the body of her husband. Without a tear, she became focused on attending to her children and simply signed the necessary paperwork. She is in a state of:

A. Integration D. Reality

B. Shock

C. Recovery

57. In the following weeks after the death of her husband, Lily struggled not only with finances but with confusion and rage in response to her husband¶s actions and abandonment. The nursing diagnosis is: A. Spiritual distress Social isolation B. Disturbed self-esteem C. Powerlessness D.

58. Unable to handle her emotions, Lily hurls angry and explosive outbursts toward those who are helpful to her. This behavior is an example of: A. Sublimation Introjections B. Reaction formation C. Displacement D.

59. Hostility is distinct from anger in that the former is: A. Compatible with love Ego syntonic B. Growth-promoting C. Destructive D.

60. During nurse-patient interactions with Lily, when she actively works out her rage which of the following is NOT therapeutic? A. B. C. D. Ask Lily to describe what is the ³hardest part´ of the death for the family Assure that death of husband is not her fault An encouragement toward normalcy must be communicated The nurse should be non-reactive

Situation 13- The nurse works in an institution that shelters street children. She encounters varied family histories and presenting behavior patterns of these clients.

61. At night when the children are being prepared to go to sleep, the nurse hears from a frightened child ³Ayaw ko matulog mag-isa. May multo.´ (³I don¶t want to sleep alone. There¶s a ghost!´). The nurse conveys acceptance with which of these responses? A. ³Gusto mong i-kwento kung ano pa ang naiisip at nararamdaman mo?´ (³Would you like to tell me more about your thoughts and feelings?´) B. ³Talaga? Anong itsura ng multo?´ (Really? How does the ghost look like?´) C. ³Nakakatakot nga ang pakiramdam na ganyan.´ (³That must really be scary.´) D. ³Huwag kang matakot, babantayan kita.´ (³Don¶t be afraid. I¶ll keep watch over you.´)

62. Most street children come from broken families. The nurse is MOST therapeutic in meeting their needs by being a: A. Activity therapist D. Teacher B. Mother surrogate C. Child therapist

63. With adequate rest, food, cleanliness, shelter, warmth and safety, the child: A. Develops a sense of competence B. Acquires a sense of personal power others 64. Preventive interventions for children at risk are BEST achieved through: A. Family therapy for the dysfunctional families B. Non-government organizations and other workers paying attention to victims in conflict ridden communities C. Support and caring to children during family crisis situations D. Play and activity therapies for children C. Develops a separate identity D. Learns to trust in self and in

65. Cindy was a frequent witness to domestic violence. Her father would always come home drunk and beat up Cindy¶s mother. As an effect of this experience she had nightmares, speechless for weeks, inability to sleep, tension and palpitations lasting for more than a month. Cindy is experiencing anxiety due to: A. Adjustment in growing up stress B. Fear of phobic proportion love D. Imagined loss of parental C. An identifiable traumatic

Situation 14 ± Increasing problems of substance abuse continue to challenge the competencies of professional nurses.

66. The Comprehensive Dangerous Drugs Act (R.A. No.9165) challenges the nurse in his/her role as a/an: A. Advocate D. Health educator B. Therapist C. Counselor

67. The nurse is conducting Parent Education Classes. Aware of the scope of nursing practice he/she recognizes the necessity to network with other agencies to discuss this area: A. Communication skills appropriate for different ages B. Constructive discipline C. Normal and deviant child and adolescent behavior and development D. Legal implications of illegal drug use

68. Which of these characteristics has the LEAST potential success of treatment of drug dependency? A. An addict who has reached bottom pit level of self-disgust and who wants help B. An individual who became dependent on a drug before or during the teen years C. Individuals who have access to support from intact family groups D. A person who began taking the drug of choice for recreational or experimental reasons

69. The BEST model of drug abuse prevention supports: A. Programs focusing on means of dealing with problems and frustration of adolescents B. Mandatory basic education transformation of society C. An integrated program requiring development of both intellectual and affective health D. The medical treatment of drug abuse utilizing less addictive drugs

70. Clients says ³I am not a substance user. I take drugs only when I am under stress.´ What defense mechanism is this client employing? A. Repression Denial B. Substitution C. Compensation D.

Situation 15- Eric, a 19 year old, second year college student is seeking assistance in coping with school related stressors and sleep disturbances. During the initial evaluation of the psychiatric nurse, he reports he is ashamed and embarrassed by a mistake he made in his class oral report and feels like his classmates are going to look down on him. He reports that he failed a practical exam a year ago. Although he has made up for this, he cannot get this out of his mind.

71. When the nurse asks Eric to describe his physical experience, which of these assessment data are appropriate?

A. ³I do not know what to do´ depressed´ B. ³I am tense, nervous and exhausted all the time´ lot´

C. ³I feel helpless and

D. ³I am worried and thinking a

72. Eric admits that he has ³always been wound up´ just like his father and that he has negative thoughts of himself. He is having a problem of: A. Inferiority D. Role confusion B. Mistrust C. Stagnation

73. The nurse teaches non-pharmacologic ways to induce sleep. Which of these would she caution Eric to avoid? A. Warm milk A warm bath B. Classical music C. Coffee after dinner D.

74. Which of these describe the characteristic of free floating anxiety? A. It is not conditioned by a specific trigger B. It creates panic C. There is an easily recognizable stressor that provokes anxiety D. It results in selective attention/inattention

75. A generalized anxiety disorder is distinguished by;

A. Experience of anxiety after exposure to a life threatening event B. Presence of excessive anxiety for a period of 6 months or more C. Irrational thoughts and actions D. Fear of losing control thus avoids going out or avoids crowds

Situation 16- Many clients in a psychiatric unit receive antipsychotic medications, also referred to as Neuroleptics.

76. Clients may be shifted from typical to atypical antipsychotic medications because of its minimal extrapyramidal side effects. A common extrapyramidal symptom that is very unpleasant and intolerable to clients is called akathisia. This is: A. Upward rolling of the eyes the hands B. Inability to sit or stand still neck D. Stiffening of the client¶s C. Pill rolling movement of

77. Health instructions about Haldol (haloperidol) has been given to Anthony while in the hospital and before his discharge. The client correctly understood the health techniques of the nurse when he says: A. ³I will immediately report any episode of diarrhea or vomiting to my doctor.´ B. ³I will drink about 2 liters of fluids daily and expect to urinate frequently.´ C. ³I will wear long sleeve clothing and sun block when I go out.´ D. ³I will avoid pizza, any food with cheese and processed meat.´

78. While giving Chlorpromazine (Thorazine) to client Michelle, the nurse remembers that she should stop giving the medication when she observes this side effect: A. Shuffling gait sclerae B. Fine tremors D. Facial grimacing C. Yellow

79. Another client in the ward, Carl, is given Thorazine (Chlorpromazine). This medication has several side effects. Which side effect should cause the nurse to be MOST concerned? A. Uncomfortable sun burns B. Sore throat, fever, decreased white blood cell count C. Tremors, inability to stand still D. Low blood pressure upon getting up from bed

80. Clients on antipsychotic medications usually receive anti-parkinson drugs to reduce Parkinson like side effects. What medication would the nurse expect the client to receive? A. Congentin (Benztropine) C. Fluphenazine (Prolixin)

B. Nardil (Phenelzine)

D. Fluoxetine (Prozac)

Situation 17 ± Peter, a 35 year old employee was admitted to the hospital because of behavioral problems at the office. He started to be bossy, claiming that he is the manager on the unit. On admission he was diagnosed to be having Bipolar disorder, manic phase.

81. Peter¶s condition is primarily a problem of: A. Affect D. Conscience B. Perception C. Thought

82. A therapeutic environment for Peter is: A. Minimal environmental stimuli C. No limitation on his activities

B.

Strict isolation and withholding privileges

D. Well lit and basically colored room

83. During socialization Peter was provoked, became furious, started shouting and making personal demands. A therapeutic intervention of the nurse is: A. B. C. D. Take him away from the group until he manages to have control of himself. Restrain him and put him on isolation to protect other patients. Prevent him from becoming more furious by giving an extra PRN dose of sedative. Respond with, ³Peter, we don¶t favor anyone. Everybody in the ward is in equal footing.´

84. Therapeutic use of self is essential in relating with psychiatric patients. This is BEST demonstrated by the nurse in. A. B. C. D. Sympathizing with the miserable feelings of Peter Suppressing her own feelings towards Peter Engaging Peter in productive activity Engaging Peter in introspective thinking

85. The nurse may recommend discharge when Peter: A. B. C. D. Easily finishes projects given to him during occupational therapy Takes his medications without reminding him Demonstrates skills in activities of daily living Complies with hospital rules and regulations

Situation 18- The stress of hospitalization can lead to difficulties between nurses and patients. Following are situations that nurses presented during a monthly nursing circle.

86. Jurry asked the nurse to have an ³out on pass´ privilege for the weekend but his request was not granted by the nurse. He remarked, ³I thought you really liked me.´ A therapeutic response of the nurse would be: A. Say, ³I understand, you feel bad but of course, I like you.´ B. Say as a matter of fact, ³Your behavior did not meet criteria for out on pass privilege.´ C. Ignore Jurry¶s remark D. Be transparent and express disapproval openly. ³You upset me with your remark.´

87. The dynamics of behavior underlying manipulative behavior explain that it is a behavior of: A. A sense of security and control B. Exhibiting uncooperative and hostile behavior C. Reducing patient¶s anxiety D. Sensing fear of other people

88. Lolita, an elderly client idealizes some nurses as ³terrific´, ³the best´, or ³so understanding´, but refers to others as ³mean´, or ³indifferent´. This behavior can be understood by the staff as: A. Avoiding taking responsibility for her own behavior and underlying feelings B. An understandable behavior for an elderly that must not be taken seriously C. An invitation to have a social and intimate relationship with her nurse D. Immature and childish behavior

89. A patient with delirium touches the nurse inappropriately. The therapeutic response of the nurse would be to: A. Ask for the patient¶s name and if whether he is aware where he is. B. Remove the patient¶s hand while saying calmly, ³I¶m the nurse and this is a hospital.´ C. Say nothing and just go on with the usual nursing interventions D. Say her name, ³I¶m Cathy, I¶m your nurse.´

90. The staff nurses have differing emotional reactions to the use of limit setting. Some staff views it as unprofessionally punitive and uncaring. The MOST appropriate approach to address the nursing concern is through: A. Counseling with the nursing supervisor B. Nursing Conference C. Seminar-workshop D. Brainstorming session

Situation 19 ± Robert is a survivor of a tragic accident wherein his wife and child drowned when their boat sank due to stormy weather. Within the next 6 months from the accident he was observed to be detaching himself from others, unable to sleep` and concentrate and frequently would just be quiet and stare.

91. He tells you, ³It is my fault. What kind of husband and father am I?´ He is expressing; A. B. Depersonalization Guilt C. Inappropriate affect D. Cognitive disturbance

92. The nurse can BEST intervene by mobilizing the client¶s relatives, friends and people to provide. A. Spiritual support B. Material support D. Medical support C. Social support

93. A therapeutic attitude the nurse can convey to the client while he talks about his loss is: A. Sympathy D. Optimism B. Acceptance C. Passivity

94. The nurse encourages the client to communicate and socialize because internalized hostility can lead to: A. Depression B. Verbal assaultiveness C. Physical assaultiveness D. Amok

95. The patient is having a: A. Post traumatic stress disorder B. Psychotic breakdown C. Developmental crisis D. Personality dysfunction

Situation 20- Mrs. Cortez is an 85 year old woman who has been hospitalized due to a urinary tract infection and dehydration. She has Alzheimer¶s disease, osteoporosis, and a tendency to wander. She has an IV in her left forearm, which was difficult to establish. Concerned that Mrs. Cortez might pull out her IV and wander off the floor, the staff is considering the possibility of using restraint on her.

96. The staff is considering the possibility of using restraint on Mrs. Cortez, however, she repeatedly declares that she does not want to be restrained. The staff is faced with an ethical dilemma of autonomy versus: A. Beneficence D. Justice B. Veracity C. Fairness

97. With a history of osteoporosis and a tendency to wander, which of the following should be a priority? A. Request for a sitter B. Wheelchair privilege commode C. Prevention of fall D. Provision of a bedside

98. Which of the following would be LEAST likely appreciated by Mrs. Cortez? A. Playing a table board game picture album B. Singing to or with her music C. Going through family

D. Listening to old familiar

99. The nurse aims at highest level of self care. Which of the following will the nurse minimize? A. Providing mouth swabs with buttons and zippers B. Hand and body lotion C. Using clothing

D. Labeling clothing items

100. Mrs. Cortez has a dietary privilege of food preferences. Which question is MOST effective to communicate with her? A. Which way would you want your egg done? Scrambled? Sunny side up? With vegetable mix? Or boiled? B. Do you want fried egg or boiled egg? C. How would you want to have your egg done? D. What is your favorite egg recipe?

SITUATION 1: Technique of therapeutic communication should be utilized and incorporated into nursing practice. 1. When a nurse establishes a therapeutic relationship with a client, which of the following is the primary focus of the client s care? a. The medical diagnosis c. The nursing diagnosis b. The client s needs and problems d. The client s social interaction Answer: B- The nurse establishes the therapeutic relationship, which is a helping relationship, to assist the client in working in his needs and problems. Both medical and nursing diagnosis would be important in understanding the client. However, the nurse provides care for person, not the diagnosis. Improving social interaction, but it is not the purpose of the relationship 2. Which of the following is the overall purpose of therapeutic communication? a. To analyze client s problems b. To elicit cooperation c. To facilitate a helping relationship d. To provide emotional support Answer: C- The purpose of the therapeutic communication is to foster a helping relationship, so that the client can more effectively cope with problems. The other tasks described are part of the helping relationship but are not the over-all purpose 3. In which of the following situations would communications be LEAST likely hindered? a. Mrs.L, 30 years old is admitted to the hospital for the first time for acute appendicitis b. Mrs. R, 50 years old, diabetic, is admitted to the hospital after a stroke. She has right hemiplegia c. Mrs. D, 45 years old, is admitted to the hospital for cervical cancer d. Mr. T, 70 years old, is admitted for fractured tibia. He speaks Spanish only Answer: C. the rest can hinder communication except C... unless if the patient with cervical cancer is in severe pain (but not present in situation) 4. Which of the following communication technique is MOST effective in dealing with covert communication? a. Listening c. Clarification b. Evaluation d. Validation Answer: A- Clarification and validation is just the result of listening. Evaluation doesn t have to do with covert communication 5. Which of the following is MOST important in fostering a positive relationship? a. The nurse recognizes that some patient regress when confronted with illness b. The nurse functions as a positive role model to encourage health oriented patient behavior c. Needs to understand that patients may test her before he can accept and trust her

d. The nurse must fully share the patient s feelings before she can develop her goal for her nursing care Answer: D- The nurse should accept the role of the patient SITUATION 2: Stress can bring about various human reactions that may result to illness or enhance one s coping mechanism. Stress also triggers local and general adaptation syndrome. 6. Which of the following BEST describes the general adaptation syndrome. It is a: a. Psychological response to stress c. Behavioral response to stress b. Physiologic response to stress d. Sociocultural response to stress Answer: B- General adaptation syndrome refers to the physiologic response to stress 7. Which of the following levels of anxiety is BEST for client s learning? a. Moderate c. Severe b. Mild d. No anxiety Answer: B- In mild level of anxiety, it produces a slight arousal state that enhances perception, learning and productive abilities. Moderate anxiety increases client s arousal state to a point where the person expresses feelings of tension, nervousness and concerns but perceptual ability is narrowed. Sever anxiety consumes most of person s energies and requires intervention, perception is further decreased 8. Which of the following defense mechanism is consciously used in coping mechanism with stress? a. Regression c. Repression b. Suppression d. Projection Answer: B- Suppression refers to consciously forgetting of painful events while repression refers to unconsciously forgetting of painful events 9. Which of the following models identifies ability to cope with stress, practice and norms of the peer group, effect of social environment and the resources used to deal with stress as determinants to stress and stress reactions? a. Stimulus based model c. Response based model b. Adaptation based model d. Transaction based model Answer: D- Transaction based model was created by Lazarus which is a Stimulus Theory and Response theory in which do not consider individual differences 10. The purpose of the first stage of the General Adaptation Syndrome is which of the following? a. Determine the causes of the danger b. Present the individual from having an unpleasant experience c. Mobilize energy needed for adaptation d. Alert the individual to danger Answer: C- this is the purpose of the first stage of GAS in order to prevent crisis SITUATION 3: Paul, 16 year old was committed to a mental health facility with diagnosis of personality disorder. He has a history of promiscuity and running away. He tells the staff I can t stand this place, I

want to go away. 11. How would the nurse deal effectively with Paul s threat to run away? a. Tell him to stay in her room b. Lock him in her room c. Tell him firmly that if he does not control herself, the staff will help him control herself d. Ignore the threat Answer: C. global 12. The early experiences of Paul may indicate a history of: a. Severe parental rejection c. Severe temper tantrums b. Failure in interpersonal relationship d. Failure to identify positively with father Answer: A 13. How would you describe parental rejection? a. Failure to identify positively with father c. Lack of recognition as a person b. Lack of parental love and discipline d. Lack of the capacity to trust others Answer: B- Clients with antisocial disorder lacks trust for others 14. What should the nurse do to prevent Paul from manipulating and dominating others? a. Ignore him demands c. Observe him closely b. Isolate Paul d. Protect others from being manipulated Answer: D- Safety precautions must be posed to protect others, provide endorsement to other nurses 15. In dealing with manipulative behavior, the nurse should convey an attitude of: a. Active friendliness c. Love and understanding b. Permissiveness d. Consistency Answer: D- Firmness, matter of fact and consistency is used to approach clients with antisocial personality SITUATION 4: Mark was brought to the National Center for Mental Health for substance abuse. 16. Which of the following behaviors would indicate stimulant intoxication? a. Slurred speech, unsteady gait, impaired concentration b. Hyperactivity, talkativeness, euphoria c. Relaxed inhibitions, increased appetite, distorted perceptions d. Depersonalization, dilated pupils, visual hallucinations Answer: B- Choice a are manifestations of depressants, choice b and c are manifestations of hallucinogen while hyperactivity, talkativeness, euphoria are signs of stimulant intoxication 17. Which of the following statements would indicate the teaching about Naltrexone (Revia) had been effective? a. I ll get sick if I use heroine on this medication.

b. This medication will block the effects of any opioid substance I take. c. If I use opioid while taking naltrexone, I ll become extremely ill. d. Using naltrexone may make me dizzy. Answer: B- Naltrexone (Revia) is a narcotic antagonist 18. Clonidine (Catapres) is prescribed for symptoms of opioid withdrawal. Which of the following nursing assessments is essential before giving a dose of this medication? a. Assessing the client s blood pressure b. Determining when the client last use an opiate c. Monitoring the client for tremors d. Completing a thorough physical assessment Answer: A- Clonidine (Catapres) is an antihypertensive which is given to patients with opioid withdrawal because these patients are hyperactive which results to increase in their vital signs. 19. The nurse has provided an in-service program on impaired professionals. She knows that teaching has been effective when staff identify the following as the greatest risk for substance abuse among professionals: a. Most nurses are codependent in their personal and professional relationships b. Most nurses come from dysfunctional families and are risk for developing addiction c. Most nurses are exposed to various substances and believe they are not risk to develop the disease d. Most nurses have preconceived ideas about what kind of people become addicted Answer: C- It is due to availability of drugs 20. The client tells the nurse that she takes a drink every morning to calm her nerves and stops her tremors. The nurse realizes the client is at risk for: a. An anxiety disorder c. Physical dependence b. A neurological disorder d. Psychological addiction Answer: C- Physical dependence is a physical effect of drug SITUATION 5: A nurse must be aware of the latest issues on Child Abuse and Family Violence. 21. Marinel, a 16 years old young lady was left with her stepfather and with a mother who is working in the office the whole day. As a nurse, what would be your advice? a. Tell the mother to keep watching her daughter b. Tell the child get to her regular activities c. Ask the child to get away from her stepfather d. Let the child stay with the relatives Answer: D- Other than her stepfather let the child stay with the relatives 22. Marinel s high school friend made a visit and talked to her father. Marinel feels fidgety and continuously smoked while her friend is talking to her mother. Beth is experiencing: a. Worries

b. Anger c. Nervousness d. Stress Answer: C- Nervousness is a physiological symptom to relieve anxiety 23. The best way a nurse can advise an abused child is to call the: a. Police station b. School c. Parish d. Bantay Bata 163 Answer: D- Bantay Bata 163 is a non-government organization 24. When planning the care for a client who is abused, which of the following measures would be most important to include? a. Being compassionate and empathetic b. Teaching the client about abuse and the cycle of violence c. Explaining to the client his or her personal and legal rights d. Helping the client develop a safety plan Answer: D- So that the client can escape the abuse for safety reason 25. During the session with the nurse, a client who is being abused states, I don t know what to do anymore. He doesn t want me to go anywhere while he s at work, not even to visit my friends. Which of the following nursing diagnoses would the nurse formulate in respect to this information? a. Risk for violence related to abusive husband, as evidenced by victim s statement of being battered b. Low Self-Esteem related to victimization, as evidenced by not being able to leave the house c. Powerlessness related to abusive husband, as evidenced by inability to make decisions d. Ineffective Coping related to victimization, as evidenced by crying Answer: C- Powerlessness related to abusive husband, as evidenced by inability to make decisions refers to marital status SITUATION 6: The following questions pertains to Musculoskeletal System of aging persons 26. Which of the following behaviors contribute to osteoporosis: a. Smoking, and lack of exercise c. Drinking tea, deep breathing, and losing weight b. Physical activity, dancing, and swimming d. Knee bends, shopping, and weight lifting Answer: A 27. As people gets older, they lose height (become shorter). This is due to: a. The fact that they don t stand up straight c. Loss of bone mass in the vertebral discs b. The rest of the population has grown taller d. Inaccurate measurement Answer: C

28. As one ages, muscle mass (that is muscle size): a. Decreases c. Stays about the same b. Increases d. Can go either way Answer: A 29. As a result of changes in long bones and the spinal column, the gait of older people: a. Becomes like a dancer c. Is more steady b. Is less stable and balanced when walking d. Hardly changes at all Answer: B 30. Changes in the bone of older people make which of the following a major danger? a. Infection c. Allergy b. Contagion d. Fractures Answer: D SITUATION 7: Sensory deprivation is experienced by most people in any setting whether they are patients confined in hospitals, workers assigned in mining industries or a family member assigned in far places. 31. Which of the following will LEAST likely result to sensory deprivation? a. Increased sensory input brought about by unlimited visitors from families and friends b. Restriction of the environment in patients who are on absolute bed rest c. Reduced sensory input in the case of patients who have just been operated on glaucoma d. Elimination of order or meaning from input in the case of ICU patients or was in reverse isolation Ans.A.. the rest can lead to sensory deprivation.. A is the least 32. Which of the following are observed in sensorially deprived adult and elderly people because of deafness? a. They prefer interaction with hearing adults b. They show greater interdependence than hearing adult c. They become more flexible in daily routine d. They show poor social judgment Ans.A.. they show poor social judgment becoz of the deprived hearing loss 33. Which nursing intervention would be appropriate for client with hyperthesia? a. Firm pressure when touching body parts c. Minimal use of direct touch b. Vigorous hair brushing d. Frequent back rubs Ans. C.. becoz the rest can aggravate sensitivity to stimuli of any senses

34. A post-operative blind patient needs to be assisted for ambulation. Which of the following should the nurse do in ambulating a client with visual impairment? a. Stand on the client s nondominant side, approximately one step behind the client, grasping the client s arm b. Stand on the client s dominant side and grasp the client s arm c. Stand on the client s dominant aside slightly in front of the client, allowing the client to grasp the nurse s arm d. Stand slightly in front of the client s nondominant side allowing the client to grasp the nurse s arm Ans. D.. The nurse should stand slightly infront so you can better guide the patient with visual impairment 35. Which of the following is an appropriate communication method for client s with hearing impairment? a. Talk side by side with the client b. Use visual aide and gestures to enhance the spoken word c. Restrict use of the client s hands d. Speak loud enough or shout if you may so that client will be able to hear you Ans. B. Gesture and visual aids can enhance better understanding for people with hearing impairment SITUATION 8: Sexuality is one problem area that is often neglected by nurses in the care of elderly clients. The nurse however must be able to identify and address the sexual changes to provide nursing care. 36. Menopause is considered complete when: a. Hot flashes cease c. A woman has been without periods for a year b. Emotional stability ends d. Irritability goes away Answer: C 37. Hormonal decline in women causes: a. Increased risk for atherosclerotic plaques c. No changes in risk for atherosclerotic plaques b. Decreased risk for atherosclerotic plaques d. None of the above Answer: A 38. Benefits of hormone replacement therapy (HRT) include: a. Protection against constipation b. Protection against osteoporosis and elimination of the unpleasant symptoms of menopause c. Protection against the flu d. Protection against fever

Answer: B 39. Which of the following is NOT a known risk of hormone replacement therapy: a. Formation of blood clots and hypertension b. Development of noncancerous fibroid tumors in the uterus c. Breast and endometrial cancers d. Lung cancer Answer: D SITUATION 9: The nurse is caring for an adult admitted with a diagnosis of brain tumor. He was scheduled for craniotomy. 40. A client has a supratentorial craniotomy for a tumor in the right frontal lobe of the cerebral cortex. Post operatively, the position that would be most appropriate for this client would be: a. High fowler s with knee gatch raised b. Flat with small pillow under the nape of the neck c. Head of the bed elevated 20 degrees with the head turned to the operative side d. Head of the bed elevated 45 degrees with a large pillow under the head and shoulders Answer: D- This lessens the possibility of hemorrhage, provides for better circulation of CSF, and promotes venous return 41. A client is regaining consciousness after a craniotomy becomes restless and attempts to pull out her intravenous line. Which nursing intervention protects the client without increasing her ICP? a. Place her in a jacket restraint b. Wrap her hands in soft mitten restraints c. Tuck her arms and hands under the draw sheet d. Apply a wrist restraint to each arm Answer: B- It is best for the client to wear mitts, because restraining her movements will cause agitation and lead to an increase of the ICP 42. Following 3 months of rehabilitation after craniotomy, a female client is still having some motor speech difficulty. To promote the client s use of speech the nurse should: a. Correct her mistakes immediately b. Respond to her crude efforts of speaking c. Re-explain why she is having difficulty of speaking d. Speak to her in simple words and short sentences Answer: B- Recognition of effort is motivating 43. A client undergoes a craniotomy for removal of her brain tumor. The nurse notes that her dressing is saturated with blood. Which of the following interventions is most appropriate? a. Replacing the dressing b. Marking the area of drainage on the dressing

c. Reinforcing the dressing and notifying the doctor immediately d. Doing nothing because this is normal occurrence Answer: C- If the dressing becomes saturated with blood, it should be reinforced and the doctor notified immediately. The patient may need to return to the operating room to stop the bleeding. The dressing shouldn t be removed because removing it might disturb clot formation. When there is a small amount of drainage on the dressing, the drainage area can be marked to easily identify an increase in drainage 44. After craniotomy, what is your primary goal? a. Prevent increased ICP b. Prevent infection c. Prevent secondary surgery d. Prevent hemorrhage SITUATION 10: Dementing illness and changes in the brain 45. As one gets older, there is a loss of brain cells. The significance of this is: a. A cell transplant is indicated b. The lost cells will regenerate on their own c. The remaining cells are more than enough for learning and remembering d. The significance is not known Answer: C 46. ACUTE dementia is due to causes which can be reversed. A frequent cause of this type of dementia is: a. Cerebrovascular accident b. Alzheimer s disease c. Multiple Infarcts d. Electrolyte imbalance, especially hyponatremia (loss of sodium) Answer: D 47. When assessing a client with dementia, which of the following behaviors would the nurse interpret as a manifestation of disinhibition? a. Wandering and getting lost b. Auditory and/or visual hallucinations c. Decreased interest in bathing and hygiene d. Inappropriate language and sexual behaviors Answer: D- Loss of judgment decreases the ability to control impulses and behaviors in social situations. Therefore, the client typically exhibits inappropriate language and sexual behaviors. Wandering and getting lost involve cognitive changes, not disinhibition 48. The brains of persons with Alzheimer s disease are characterized by the presence of: a. Fatty deposits c. Calcium deposits

b. Senile plaques and neurofibrillary tangles d. Lack of gray matter Answer: B SITUATION 11: A 23 year-old man was voluntarily admitted to the inpatient unit with a diagnosis of paranoid schizophrenia. 49. As the nurse approaches the client, he says, If you come any closer, I ll die. This is an example of: a. Hallucination b. Delusion c. Illusion d. Idea of reference Answer: B- A delusion is a fixed false belief 50. Delusion is: a. Psychomotor disturbance b. Mood disturbance c. Disturbance of thought d. Disturbance of perception 51. When communicating with a paranoid client, the main principle is to: a. Use logic and be persistent b. Provide an anxiety-free environment c. Express doubt and do not argue d. Encourage ventilation of anger Answer: C- Paranoid clients develop a delusional system to defend against anxiety. Arguing with the client would increase his anxiety 52. The client tells his primary nurse that he s scheduled to meet the President of the Philippines a special time, making it impossible for the client to leave his room for dinner. Which of the following responses by the nurse is most appropriate? a. It s meal time. Let s go so you can eat. b. The President of the Philippines told me to take you to dinner. c. Your physician expects you to follow the unit s schedule. d. People who don t eat on this unit aren t being cooperative. Answer: A- A delusional client is wrapped up in his false beliefs that he tends to disregard activities of daily living, such as nutrition and hydration. He needs clear, concise, firm directions from a caring nurse to meet his needs. The second option belittles and tricks the client, possibly evoking mistrust on the part of the client. The third option evades the issue of meeting his basic needs. The last option is demeaning and doesn t address the delusion 53. A schizophrenic patient who began taking haloperidol (Haloperidol) 1 week ago now exhibits jerking movements of the neck and mouth. These are signs of:

a. Dystonia b. Psychosis c. Akathisia d. Parkinsonism Answer: A- Haloperidol and other high-potency conventional antipsychotics cause a high incidence of dystonia and other extrapyramidal adverse effects. Dystonia is marked by prolonged, repetitive muscle contractions that cause twisting or jerking movements especially of the neck, mouth, and tongue SITUATION 12: Nico, 27 yrs. old, is admitted for treatment of a major depression. 54. He is withdrawn, appears disheveled, and states, No one could ever love me. The nurse can expect the client to be placed on a. Antiparkinsonism medication b. Suicide precautions c. A low-salt diet d. Phototherapy Answer: B- Maintaining safety for the client is a priority because she may have suicidal ideation and/or plan 55. Which of the following behaviors indicates to the nurse that a client s major depression is improving? The client: a. Displays a blunted effect b. Has lost an additional 2 pounds c. States one good thing about himself d. Sleeps about 16 hours per day Answer: C- This behavior may indicate an increase in self-esteem that accompanies an improvement in depression. A depressed person often cannot problem solve or acknowledge any positive aspects of their lives 56. Nico is scheduled for electroconvulsive therapy (ECT) tomorrow. The nurse would plan for which of the following activities? a. Force fluids 6 to 8 hours before treatment b. Administer succinylcholine (Inestine, Anectine) during pretreatment care c. Encourage the client s spouse to accompany him d. Reorient the client frequently during posttreatment care Answer: D- Common side effects of bilateral treatment include confusion, disorientation, and short-term memory loss. The nurse should provide frequent orientation statements that are brief, distinct, and simple 57. Nico is recovering from a severe depression. Which of the following behaviors alerts the nurse to a risk for suicide? a. The client sleeps most of the day

b. The client has a plan to kill himself c. The client loses 5 pounds d. The client does not attend unit activities Answer: B- Having a suicide plan is a risk factor. The lethality needs to be assessed. When a depression is lifting, the client may have the energy and resources to carry out a plan. Behavioral, somatic, and emotional cues may be overt or covert 58. Nico has been depressed severely depressed for 2 weeks. He had mentioned ending it all prior to admission. Which of the following questions should the nurse ask during the prescreen assessment? a. How long have you thought about harming yourself? b. What is it that makes you think about harming yourself? c. How has your concentration been? d. What specifically have you thought about doing to harm yourself? Answer: D- This question assists in determining suicidal intent and lethality SITUATION 13: A client is admitted with a diagnosis of Alzheimer s Disease. 59. When developing the plan of care for a client with Alzheimer s disease who is experiencing moderate impairment, which of the following types of care would the nurse expect to include? a. Considerable assistance with activities of daily living b. Managing complex medication schedule c. Constant supervision and total care d. Supervision of risky activities, such as shaving Answer: D- Considerable assistance is associated with moderate impairment when the client is unable to make decisions but can follow directions. Supervision of shaving is appropriate with mild impairment that is, when the client still has motor function but lacks judgment about safety issues. Managing medications is needed even in mild impairment. Constant care is unable to follow directions 60. Which of the following would be priority to include in the plan of care for a client with Alzheimer s disease who is experiencing difficulty processing and completing complex tasks? a. Repeating the directions until the client follows them b. Asking the client to do one step of the task at a time c. Demonstrating for the client how to do the task d. Maintaining routine and structure for the client Answer: B- Because the client is experiencing difficulty processing and completing complex tasks, the priority is to provide the client with only one step at a time, thereby breaking the task up into simple step, ones that the client is able to process. Repeating the directions until the client follows them or demonstrating how to do the task is still too overwhelming to the client because of the multiple steps involved. However, demonstrating one step would be helpful. Although maintaining structure and routine is important, it is unrelated to task completion 61. Clients with Alzheimer s disease may have delusions about being harmed by staff and others. When

the client expresses fear of being killed by staff, which of the following responses would be most appropriate? a. What makes you think we want to kill you? b. We like you too much to want to kill you. c. You are in the hospital. We are nurses trying to help you. d. Oh, don t be so silly. No one wants to kill you here. Answer: C- The nurse needs to present reality without arguing with the delusions. Therefore, stating that the client is in the hospital and the nurses are trying to help is most appropriate. The client doesn t recognize the delusion or why it exists. Telling the client that the staff likes him too much to want to kill him is inappropriate because the client believes the delusions and doesn t know that they are false beliefs. It also restates the word, kill, which may reinforce the client s delusions. Telling the client not to be silly is condescending and disparaging and therefore inappropriate 62. When helping the families of clients with Alzheimer s disease to cope with vulgar or sexual behaviors, which of the following suggestions would be most helpful? a. Ignore the behaviors, but try to identify the purposes b. Give feedback on the inappropriateness of the behaviors c. Employ anger management strategies d. Administer the prescribed risperidone (Risperdal) Answer: A- The vulgar or sexual behaviors are often expressions of anger or more sensual needs that can be addressed directly. Therefore, the families should be encouraged to ignore the behaviors but attempt to identify their purpose. Then the purpose can be addressed, possibly leading to decrease in the behaviors. Because of impaired cognitive function, the client is not likely to be able to process the inappropriateness of the behaviors if given feedback. Likewise, anger management strategies would be ineffective because the client would probably be unable to process the inappropriateness of the behaviors. Risperidone (Risperdal) may decrease agitation, but it does not improve social behaviors 63. The nurse determines that the son of the client with Alzheimer s disease needs further education about the disease when he makes which of the following statements? a. I didn t realize the deterioration would be so incapacitating. b. The Alzheimer s support group has so much good information. c. I get tired of the same old stories, but I know it s important for Dad. d. I woke up this morning hoping that my old Dad would be back. Answer: D- The statement about hoping that the Dad would be back conveys a lack of acceptance of the irreversible nature of the disease. The statement about not realizing that the deterioration would be so incapacitating is based in reality. The statement about Alzheimer s group is based in reality and demonstrates the son s involvement with managing the disease. Stating that reminiscing is important reflects a realistic interpretation on the son s part SITUATION 14: A 34-year old is hospitalized with bipolar disorder. 64. The nurse knows that the major factor that distinguishes a bipolar from a unipolar disorder is the

a. Higher incidence in women b. Severity of the depression c. Genetic etiology d. Presence of mania Answer: D- Both unipolar and bipolar disorders include episodes of depression. The diagnosis of bipolar disorder is given to persons who also experience manic episodes 65. At 2 a.m. the nurse the nurse finds him phoning friends all across the country to discuss his new plan for eradicating world hunger. His excited explanations are keeping the entire unit awake, but he won t quiet down. The nurse caring for him knows the drug most likely to be prescribed for this client is: a. A tricyclic depressant b. An MAOI-inhibitor antidepressant c. Lithium carbonate (Eskalith) d. An antianxiety drug Answer: C- A drug frequently used to treat manic clients is lithium carbonate (Eskalith) 66. Supportive therapy for a client who is exhibiting manic behavior may include all of the following EXCEPT: a. Psychoanalysis b. Cognitive therapy c. Interpersonal therapy d. Problem-solving therapy Answer: A- Psychoanalysis is an in-depth, insight-oriented psychotherapy, not appropriate in treatment of bipolar disorders 67. The client is creating considerable chaos in a day treatment program with dominating and manipulative behavior. Which of the following nursing intervention is most appropriate? a. Allow the peer group to intervene b. Describe acceptable behavior and set realistic limits with the client c. Recommend the client to be hospitalized for treatment d. Tell client that his behavior is not appropriate Answer: B- The nurse s response is an alternative behavior for unacceptable ones in order to assist the client in self-control. It is not the responsibility of the peer group to monitor the client s behavior. The client s behavior does not warrant hospitalization. The intervention in answer choice (D) is inappropriate because the client is told only what is unacceptable and is not given any alternatives 68. The client is skipping up and down the hallway practically running into other clients. Which of the following activities would the nurse expect to include in the client s plan of care? a. Leading a group activity b. Watching television c. Reading the newspaper d. Cleaning the dayroom tables

Answer: D- The client with mania is very active and needs to have this energy channeled in a constructive task such as cleaning or tidying the dayroom. Because the client is distracted easily and can concentrate only for short periods, the successful completion of a helpful task would give the nurse the opportunity to thank the client for the help, thereby enhancing the client s self-esteem. Leading a group activity is too stimulating for the client. Participating in this type of activity also would be probably causes the client to be disruptive. Watching television or reading the newspaper would be inappropriate for the client who is unable to sit for a period of time. SITUATION 15: A client is admitted to outpatient surgery for cataract extraction on the right eye. 69. The client asks, What does the lens of my eye do? The nurse should explain that the lens of the eye: a. Produces aqueous humor b. Holds the rods and cones c. Focuses light rays onto the retina d. Regulates the amount of light entering the eye Answer: C- The lens of the eye is suspended on the suspensory ligaments. The ligaments influence the tension on the lens and thereby focus light rays onto the retina. Accommodation is the ability of the lens to adjust to near and far objects. The ciliary bodies secrete aqueous humor. The retina contains the rods and cones. The iris regulates the amount of light entering the eye 70. The client would most likely to complain of which symptoms? a. Halos and rainbows around lights b. Eye pain and irritation that worsens at night c. Blurred and hazy vision d. Eye strain and headache when doing close work Answer: C- A client with a cataract usually complains of dimness, blurring, and/or hazy vision. Typically, light scattering occurs and is related to the degree of opacity of the lens. Opacity of the lens blocks light rays from reaching the retina. Eye pain and irritation are not associated with glaucoma. Eye strain and headache when doing close work is associated with refractive errors 71. The nurse is to instill drops of phenylephrine hydrochloride (Neo-Synephrine) into a client s right eye before cataract removal surgery. This preparation acts in the eye produce a. Dilatation of the pupil and blood vessels b. Dilatation of the pupil and constriction of blood vessels c. Constriction of the pupil and constriction of blood vessels d. Constriction of the pupil and dilatation of blood Answer: B- Instilled in the eye, phenylephrine hydrochloride asks as a mydriatic, causing the pupil to dilate. It also constricts small blood vessels in the eye 72. A short time after cataract surgery, the client complains of nausea. Which of the following represents the nurse s best course of action?

a. Instruct the client to take a few deep breaths until the nausea subsides b. Explain that this is a common feeling that will pass quickly c. Tell the client to call the nurse promptly if vomiting occurs d. Medicate the client with an antiemetic, as ordered Answer: D- A prescribed antiemetic should be administered as soon as the client who has undergone cataract extraction complains of nausea. Vomiting can increase intraocular pressure, which should be avoided after eye surgery because it can cause complications. Deep breathing is unlikely to relieve nausea. Postoperative nausea may be common; however, it doesn t necessarily pass quickly and can lead to vomiting. Telling the client to call only if vomiting occurs ignores the client s need for comfort and intervention to prevent complications 73. Discharge planning would include: a. Wearing eye patches for the first 72 hours b. Lifting light objects is acceptable c. Bending with the knees and keep the head straight d. Bending with the waist is acceptable if slowly done SITUATION 16: A client is admitted with a diagnosis of Parkinson s disease. 74. Which of the following is an initial sign of Parkinson s disease? a. Rigidity b. Tremor c. Bradykinesia d. Akinesia Answer: B- The first sign of Parkinson s disease is usually tremors. The client often is the first to notice this sign, because the tremors may be minimal at first. Rigidity is the second sign, and bradykinesia is the third sign. Akinesia is a later stage of bradykinesia 75. The nurse develops a teaching plan for a client newly diagnosed with Parkinson s disease. Which of the following topics that the nurse plans to discuss is the most important? a. Maintaining a balanced nutritional diet b. Enhancing the immune system c. Maintaining a safe environment d. Engaging in diversional activity Answer: C- The primary focus is on maintaining a safe environment, because the client with Parkinson s disease often has a propulsive gait, characterized by a tendency to take increasingly quicker steps while walking. This type of gait often causes the client to fall or to have trouble stopping 76. When does the nurse encourage a client with Parkinson s disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? a. Early in the morning, when the client s energy level is high b. To coincide with the peak action of drug therapy

c. Immediately after a rest period d. When family members will be available Answer: B- Demanding physical activity should be performed during the peak action of drug therapy. Clients should be encouraged to maintain independence in self-care activities to the greatest extent possible 77. Which goal is the most realistic and appropriate for a client diagnosed with Parkinson s disease? a. To cure the disease b. To stop the progression of the disease c. To begin preparations for terminal care d. To maintain optimal body function Answer: D- The most appropriate and realistic goal is to help the client function at his best. There is no known cure for Parkinson s disease. Parkinson s disease progresses in severity, and there is no known way to stop its progression. Many clients live for years with the disease, however, and it would not be appropriate to start planning terminal care at this time 78. The client needs a long time to complete her morning hygiene, but she becomes annoyed when the nurse offers assistance and refuses all help. Which statement is the nurse s best initial response in this situation? a. Tell the client firmly that she needs assistance and help her with her care b. Praise the client for her desire to be independent and give her extra time and encouragement c. Tell the client that she is being unrealistic about her abilities and accept that she needs help d. Suggest to the client that if she insists on self care, she should at least modify her routine Answer: B- Ongoing self-care is a major goal for clients with Parkinson s disease. The client should be given additional time as needed and praised for her efforts to remain independent. Firmly telling the client that she needs assistance will undermine her self-esteem and defeat her efforts to be independent. Telling the client that her perception is unrealistic does not foster hope in her ability to care for herself. Suggesting that the client modify her routine seems to put the hospital or the nurse s time schedule before the patient s needs. This will only decrease the client s self-esteem and her desire to try to continue self-care, which is obviously important to her SITUATION 17: A client is admitted to the hospital with Bell s Palsy. 79. A client with Bell s Palsy asks the nurse why artificial tears were ordered by the physician. Select the best reply by the nurse. a. When your affected eye fails to make tears, the eye can become irritated and ulcerated. b. Because your eye remains closed, foreign matter can be trapped beneath the lid. c. Artificial tears will remove the purulent drainage from your eye, which speeds healing. d. Because you cannot blink the affected eye, it can become dry and irritated. Answer: D- Bell s palsy may cause paralysis of the eyelid and loss of the blink reflex on the affected side. The eye may not close completely. These problems render the eye susceptible to drying and irritation from dust or other debris

80. Which nursing diagnosis takes priority for the patient with Bell s palsy? a. Risk for dysfunctional grieving b. Risk for injury related to corneal laceration c. Risk for chronic low self-esteem d. Risk for impaired physical mobility Answer: B- The patient with Bell s palsy will be unable to close his eyelid on the affected side; therefore, he ll be at risk for injury to the cornea 81. The nurse observes that the client s right eye does not close completely. Based on this, which of the following nursing interventions would be most appropriate? a. Making sure the client wears her eyeglasses at all times b. Placing an eye patch over her eye c. Instilling artificial tears once every shift d. Cleansing the eye with a clean washcloth every shift Answer: B- When the blink reflex is absent or the eyes do not close completely, the cornea may be dry and irritated. Placing a patch over the eye is the most appropriate intervention to prevent eye injury. Making sure the client wears her eyeglasses at all times will not help protect the eye from injury. A once-per-shift intervention will not adequately relieve the potential for injury from a dry and irritating ocular environment. A normal saline solution should be used to moisten the eye, not tap water 82. The client has a feeling of stiffness and a drawing sensation of the face. What would be an important teaching to the patient? a. Eye is susceptible to injury when eyelid does not close b. Drooling from an increased saliva on the affected area may occur c. Cleaning the eye will prevent ulceration d. All of the above SITUATION 18: A 46-year old is admitted to the hospital because her family is unable to manage her constant hand washing rituals. 83. Her family reports she washes her hands at least 30 times each day. The nurse noticed the client s hands are reddened, scaly, and cracked. The main nursing goal is to: a. Remind the client several times of her appointment b. Limit the number of hand washings c. Tell her it is her responsibility to be there on time d. Provide ample time for her to complete her rituals Answer: B- Obsessive-compulsive behavior represents displacement of anxiety. A concrete measurable goal is to decrease the number of hand washings 84. Which of the following is an appropriate treatment for this client? a. An unstructured schedule of activities

b. A structured schedule of activities c. Intense counseling d. Negative reinforcement every time she performs her rituals Answer: B- Planning a structured schedule of activities provides the client with ways other than hand washing to reduce anxiety 85. The most effective way for the nurse to intervene with her hand and face washing is to: a. Allow her a certain amount of time each shift to engage in this behavior b. Interrupt the activity briefly and frequently c. Lock the door to her room and restrict access to the bathroom d. Tell her to stop each time she is observed doing it Answer: A- Allowing the client a certain amount of time to engage in the activity alleviates some of the client s anxiety 86. The client is also constipated and dehydrated. Which nursing intervention would the client be most likely to comply with? a. Drinking Ensure between meals b. Drinking extra fluids with meals c. Drinking 8 oz water every hour between meals d. Drinking adequate amounts of fluid during the day Answer: C- Building the intake of a specified amount of liquid into a daily schedule of activities is very consistent with the obsessive-compulsive client s need to control as many aspects of her life as possible 87. Upon admission she was also dehydrated and underweight. The nurse and the client will know That discharge planning is appropriate when the client: a. Regains her normal body weight b. Expresses a desire to leave the hospital c. Is able to start talking about her guilt and anxiety d. Limits her hand and face washing to a few times a day Answer: D- The major issue is control of behavior and thoughts. When the client is able to control her compulsive behavior, ie., limit her hand and face washing to a few times a day, she will then be able to resume normal activities of daily living SITUATION 19: The nurse is caring for a client who is experiencing panic attack. 88. Which intervention would be most appropriate? a. Tell the client he s all right, and there is no need to panic b. Speak to the client in short, simple sentences c. Explain to the client that there s no need to worry because he s safe d. Give the client a detailed explanation of his panic reaction Answer: B- The client experiencing a panic attack is unable to focus and his ability to relate to others is diminished; therefore, short, simple sentences are the most effective means of communication. Options

A, B and C minimize the patient s anxiety 89. The client reports that she often feels a choking sensation in her throat, a racing heart, dizziness and fearfulness. All of these symptoms have occurred almost daily for the past 3 months. Suspecting a psychological component to these symptoms, what would the nurse anticipate administering? a. Benzodiazepines b. Proton pump inhibitors c. Nitropusside d. Lithium carbonate Answer: A- Pharmacologic management would consist of either tricyclic antidepressants or benzodiazepines. Proton pump inhibitors are used for GI disorders. Nitroprusside is a potent vasodilator, used for hypertensive emergencies. Lithium carbonate is an antimanic agent 90. The client has a generalized anxiety disorder. Which statement is true about this client? a. The client has regular obsessions b. Relaxation techniques and psychotherapy are necessary for care c. Nightmares and flashbacks are common in individuals who suffer from generalized anxiety disorder d. Generalized anxiety disorder is characterized by anxiety that lasts longer than 6 months Answer: D- Constant patterns of anxiety that affect the client for more than 6 months and interfere with normal activities are characteristic of generalized anxiety disorder. Frequently, pharmaceutical therapy with benzodiazepines can help. Clients having regular obsessions are probably suffering from obsessivecompulsive disorder. Nightmares and flashbacks are typical symptoms of posttraumatic stress disorder 91. The client is pacing and complains of racing thoughts. The nurse asks the client if something upsetting happens, and the client response is vague and not focused on nurse s question. The nurse assesses the client s level of anxiety as: a. Mild b. Moderate c. Severe d. Panic Answer: C- When the client has difficulty focusing and exhibits excessive motor activity, the level of anxiety is severe. Mild anxiety is characterized by increased alertness and problem-solving ability; the client described is unable to do this. Moderate anxiety is characterized by the ability to focus on central concerns, but the inability to solve problem without assistance; the client described is unable to do this. Panic level of anxiety is characterized by complete inability to focus and reduced perceptions; the client described is not at this point 92. Which of the following is a behavior manifestation of anxiety, except: a. Panic b. Tachycardia c. Hyperventilation d. Tachypnea

SITUATION 20: Defense Mechanisms 93. Sam is diagnosed with cancer does not talk about or acknowledge the diagnosis. Which of the following defense mechanism is Sam using? a. Denial b. Identification c. Projection d. Rationalization Answer: A- The failure to acknowledge the reality of the diagnosis is an example of defense mechanism of denial. The other choices do not apply to this situation 94. Nathaniel, released from prison for selling narcotics has been rehabilitated and now works for a youth drug prevention agency. Darwin is reflecting which of the following defense mechanism? a. Denial b. Displacement c. Identification d. Sublimation Answer: D- Sublimation is the defense mechanism whereby an individual substitutes constructive, socially acceptable behavior for strong impulses that are unacceptable. The other answer choice options are not applicable to this situation 95. Nina is admitted to the ICU with chest pain, an abnormal ECG, and elevated enzymes. When the significance of this is explained to her, she says, I can t be having a heart attack. No way. You must be mistaken. The nurse suspects the client is using which defense mechanism? a. Sublimation b. Regression c. Dissociation d. Denial Answer: D- Denial helps the person escape unpleasant or intolerable reality by refusing to perceive the facts. It can serve as a normal protection in the early stages of crisis, but if the denial persists it will prevent the client from coping 96. In patients with dissociative disorders, the defense mechanism most often used to block traumatic experiences is: a. Passive-aggression b. Reaction formation c. Denial d. Repression Answer: D- Repression is the defense mechanism used most often to block traumatic experiences. Neither reaction formation nor denial is relevant in these disorders

97. The defense mechanism utilized by manic patients to cover up depression is: a. Displacement b. Denial c. Compensation d. Reaction formation SITUATION 21: Psychosomatic disorders 98. A man s family brought him onto the hospital because of his many somatic complaints. He has been seen by many medical specialists in the past without discovery of organic pathology. The nurse assesses that the client is probably experiencing which of the following problems? a. Conversion disorder b. Body dysmorphic disorder c. Malingering d. Hypochondriasis Answer: D- Hypochondriasis is excessive preoccupation with one s physical health, without organic pathology 99. Amie is hospitalized for treatment of conversion disorder. She complained of paralysis of her right side after her husband threatened to leave her and their children. She seems unconcerned about her paralysis. An appropriate long term goal for the nurse to formulate is that client will: a. Cope effectively with stress without using conversion b. Identify stressors c. Express feelings about conflict d. Develop an increased sense of relatedness to others Answer: A- This is an appropriate long term goal related to the client s ineffective coping (use of conversion symptom, paralysis) related to unresolved conflicts and anxiety 100. A patient who reports paralysis with no specific cause but has a history of a recent stressful event has a probable diagnosis of: a. Hypochondriasis b. Somatic illness c. Conversion disorder d. Pain disorder Answer: C- In conversion disorder, symptoms suggest a physical disorder, but physical examination and diagnostic tests find no physiological cause PART II CARE FOR CLIENTS WITH PHYSIOLOGICAL AND PSYCHOSOCIAL ALTERATIONS SITUATION 1: Technique of therapeutic communication should be utilized and incorporated into nursing practice.

1. When a nurse establishes a therapeutic relationship with a client, which of the following is the primary focus of the client s care? a. The medical diagnosis c. The nursing diagnosis b. The client s needs and problems d. The client s social interaction

2. Which of the following is the overall purpose of therapeutic communication? a. To analyze client s problems b. To elicit cooperation c. To facilitate a helping relationship d. To provide emotional support

3. In which of the following situations would communications be LEAST likely hindered? a. Mrs.L, 30 years old is admitted to the hospital for the first time for acute appendicitis b. Mrs. R, 50 years old, diabetic, is admitted to the hospital after a stroke. She has right hemiplegia c. Mrs. D, 45 years old, is admitted to the hospital for cervical cancer d. Mr. T, 70 years old, is admitted for fractured tibia. He speaks Spanish only

4. Which of the following communication technique is MOST effective in dealing with covert communication? a. Listening c. Clarification b. Evaluation d. Validation

5. Which of the following is MOST important in fostering a positive relationship? a. The nurse recognizes that some patient regress when confronted with illness b. The nurse functions as a positive role model to encourage health oriented patient behavior c. Needs to understand that patients may test her before he can accept and trust her d. The nurse must fully share the patient s feelings before she can develop her goal for her nursing care

SITUATION 2: Stress can bring about various human reactions that may result to illness or enhance one s coping mechanism. Stress also triggers local and general adaptation syndrome.

6. Which of the following BEST describes the general adaptation syndrome. It is a: a. Psychological response to stress c. Behavioral response to stress b. Physiologic response to stress d. Sociocultural response to stress

7. Which of the following levels of anxiety is BEST for client s learning? a. Moderate c. Severe b. Mild d. No anxiety

8. Which of the following defense mechanism is consciously used in coping mechanism with stress? a. Regression c. Repression b. Suppression d. Projection

9. Which of the following models identifies ability to cope with stress, practice and norms of the peer group, effect of social environment and the resources used to deal with stress as determinants to stress and stress reactions? a. Stimulus based model c. Response based model b. Adaptation based model d. Transaction based model

10. The purpose of the first stage of the General Adaptation Syndrome is which of the following? a. Determine the causes of the danger b. Present the individual from having an unpleasant experience c. Mobilize energy needed for adaptation d. Alert the individual to danger

SITUATION 3: Paul, 16 year old was committed to a mental health facility with diagnosis of personality disorder. He has a history of promiscuity and running away. He tells the staff I can t stand this place, I want to go away. 11. How would the nurse deal effectively with Paul s threat to run away? a. Tell him to stay in her room b. Lock him in her room c. Tell him firmly that if he does not control herself, the staff will help him control herself d. Ignore the threat

12. The early experiences of Paul may indicate a history of: a. Severe parental rejection c. Severe temper tantrums b. Failure in interpersonal relationship d. Failure to identify positively with father

13. How would you describe parental rejection?

a. Failure to identify positively with father c. Lack of recognition as a person b. Lack of parental love and discipline d. Lack of the capacity to trust others

14. What should the nurse do to prevent Paul from manipulating and dominating others? a. Ignore him demands c. Observe him closely b. Isolate Paul d. Protect others from being manipulated Answer: D- Safety precautions must be posed to protect others, provide endorsement to other nurses 15. In dealing with manipulative behavior, the nurse should convey an attitude of: a. Active friendliness c. Love and understanding b. Permissiveness d. Consistency Answer: D- Firmness, matter of fact and consistency is used to approach clients with antisocial personality SITUATION 4: Mark was brought to the National Center for Mental Health for substance abuse. 16. Which of the following behaviors would indicate stimulant intoxication? a. Slurred speech, unsteady gait, impaired concentration b. Hyperactivity, talkativeness, euphoria c. Relaxed inhibitions, increased appetite, distorted perceptions d. Depersonalization, dilated pupils, visual hallucinations 17. Which of the following statements would indicate the teaching about Naltrexone (Revia) had been effective? a. I ll get sick if I use heroine on this medication. b. This medication will block the effects of any opioid substance I take. c. If I use opioid while taking naltrexone, I ll become extremely ill. d. Using naltrexone may make me dizzy.

18. Clonidine (Catapres) is prescribed for symptoms of opioid withdrawal. Which of the following nursing assessments is essential before giving a dose of this medication? a. Assessing the client s blood pressure b. Determining when the client last use an opiate c. Monitoring the client for tremors d. Completing a thorough physical assessment

19. The nurse has provided an in-service program on impaired professionals. She knows that teaching has been effective when staff identify the following as the greatest risk for substance abuse among professionals:

a. Most nurses are codependent in their personal and professional relationships b. Most nurses come from dysfunctional families and are risk for developing addiction c. Most nurses are exposed to various substances and believe they are not risk to develop the disease d. Most nurses have preconceived ideas about what kind of people become addicted

20. The client tells the nurse that she takes a drink every morning to calm her nerves and stops her tremors. The nurse realizes the client is at risk for: a. An anxiety disorder c. Physical dependence b. A neurological disorder d. Psychological addiction

SITUATION 5: A nurse must be aware of the latest issues on Child Abuse and Family Violence. 21. Marinel, a 16 years old young lady was left with her stepfather and with a mother who is working in the office the whole day. As a nurse, what would be your advice? a. Tell the mother to keep watching her daughter b. Tell the child get to her regular activities c. Ask the child to get away from her stepfather d. Let the child stay with the relatives

22. Marinel s high school friend made a visit and talked to her father. Marinel feels fidgety and continuously smoked while her friend is talking to her mother. Beth is experiencing: a. Worries b. Anger c. Nervousness d. Stress

23. The best way a nurse can advise an abused child is to call the: a. Police station b. School c. Parish d. Bantay Bata 163

24. When planning the care for a client who is abused, which of the following measures would be most important to include? a. Being compassionate and empathetic b. Teaching the client about abuse and the cycle of violence c. Explaining to the client his or her personal and legal rights

d. Helping the client develop a safety plan

25. During the session with the nurse, a client who is being abused states, I don t know what to do anymore. He doesn t want me to go anywhere while he s at work, not even to visit my friends. Which of the following nursing diagnoses would the nurse formulate in respect to this information? a. Risk for violence related to abusive husband, as evidenced by victim s statement of being battered b. Low Self-Esteem related to victimization, as evidenced by not being able to leave the house c. Powerlessness related to abusive husband, as evidenced by inability to make decisions d. Ineffective Coping related to victimization, as evidenced by crying SITUATION 6: The following questions pertains to Musculoskeletal System of aging persons 26. Which of the following behaviors contribute to osteoporosis: a. Smoking, and lack of exercise c. Drinking tea, deep breathing, and losing weight b. Physical activity, dancing, and swimming d. Knee bends, shopping, and weight lifting

27. As people gets older, they lose height (become shorter). This is due to: a. The fact that they don t stand up straight c. Loss of bone mass in the vertebral discs b. The rest of the population has grown taller d. Inaccurate measurement

28. As one ages, muscle mass (that is muscle size): a. Decreases c. Stays about the same b. Increases d. Can go either way

29. As a result of changes in long bones and the spinal column, the gait of older people: a. Becomes like a dancer c. Is more steady b. Is less stable and balanced when walking d. Hardly changes at all

30. Changes in the bone of older people make which of the following a major danger? a. Infection c. Allergy b. Contagion d. Fractures

SITUATION 7: Sensory deprivation is experienced by most people in any setting whether they are patients confined in hospitals, workers assigned in mining industries or a family member assigned in far places.

31. Which of the following will LEAST likely result to sensory deprivation? a. Increased sensory input brought about by unlimited visitors from families and friends b. Restriction of the environment in patients who are on absolute bed rest c. Reduced sensory input in the case of patients who have just been operated on glaucoma d. Elimination of order or meaning from input in the case of ICU patients or was in reverse isolation

32. Which of the following are observed in sensorially deprived adult and elderly people because of deafness? a. They prefer interaction with hearing adults b. They show greater interdependence than hearing adult c. They become more flexible in daily routine d. They show poor social judgment

33. Which nursing intervention would be appropriate for client with hyperthesia? a. Firm pressure when touching body parts c. Minimal use of direct touch b. Vigorous hair brushing d. Frequent back rubs

34. A post-operative blind patient needs to be assisted for ambulation. Which of the following should the nurse do in ambulating a client with visual impairment? a. Stand on the client s nondominant side, approximately one step behind the client, grasping the client s arm b. Stand on the client s dominant side and grasp the client s arm c. Stand on the client s dominant aside slightly in front of the client, allowing the client to grasp the nurse s arm d. Stand slightly in front of the client s nondominant side allowing the client to grasp the nurse s arm

35. Which of the following is an appropriate communication method for client s with hearing impairment? a. Talk side by side with the client b. Use visual aide and gestures to enhance the spoken word c. Restrict use of the client s hands d. Speak loud enough or shout if you may so that client will be able to hear you

SITUATION 8: Sexuality is one problem area that is often neglected by nurses in the care of elderly clients. The nurse however must be able to identify and address the sexual changes to provide nursing

care. 36. Menopause is considered complete when: a. Hot flashes cease c. A woman has been without periods for a year b. Emotional stability ends d. Irritability goes away

37. Hormonal decline in women causes: a. Increased risk for atherosclerotic plaques c. No changes in risk for atherosclerotic plaques b. Decreased risk for atherosclerotic plaques d. None of the above

38. Benefits of hormone replacement therapy (HRT) include: a. Protection against constipation b. Protection against osteoporosis and elimination of the unpleasant symptoms of menopause c. Protection against the flu d. Protection against fever

39. Which of the following is NOT a known risk of hormone replacement therapy: a. Formation of blood clots and hypertension b. Development of noncancerous fibroid tumors in the uterus c. Breast and endometrial cancers d. Lung cancer

SITUATION 9: The nurse is caring for an adult admitted with a diagnosis of brain tumor. He was scheduled for craniotomy. 40. A client has a supratentorial craniotomy for a tumor in the right frontal lobe of the cerebral cortex. Post operatively, the position that would be most appropriate for this client would be: a. High fowler s with knee gatch raised b. Flat with small pillow under the nape of the neck c. Head of the bed elevated 20 degrees with the head turned to the operative side d. Head of the bed elevated 45 degrees with a large pillow under the head and shoulders

41. A client is regaining consciousness after a craniotomy becomes restless and attempts to pull out her intravenous line. Which nursing intervention protects the client without increasing her ICP? a. Place her in a jacket restraint b. Wrap her hands in soft mitten restraints

c. Tuck her arms and hands under the draw sheet d. Apply a wrist restraint to each arm

42. Following 3 months of rehabilitation after craniotomy, a female client is still having some motor speech difficulty. To promote the client s use of speech the nurse should: a. Correct her mistakes immediately b. Respond to her crude efforts of speaking c. Re-explain why she is having difficulty of speaking d. Speak to her in simple words and short sentences 43. A client undergoes a craniotomy for removal of her brain tumor. The nurse notes that her dressing is saturated with blood. Which of the following interventions is most appropriate? a. Replacing the dressing b. Marking the area of drainage on the dressing c. Reinforcing the dressing and notifying the doctor immediately d. Doing nothing because this is normal occurrence

44. After craniotomy, what is your primary goal? a. Prevent increased ICP b. Prevent infection c. Prevent secondary surgery d. Prevent hemorrhage

SITUATION 10: Dementing illness and changes in the brain 45. As one gets older, there is a loss of brain cells. The significance of this is: a. A cell transplant is indicated b. The lost cells will regenerate on their own c. The remaining cells are more than enough for learning and remembering d. The significance is not known

46. ACUTE dementia is due to causes which can be reversed. A frequent cause of this type of dementia is: a. Cerebrovascular accident b. Alzheimer s disease c. Multiple Infarcts d. Electrolyte imbalance, especially hyponatremia (loss of sodium)

47. When assessing a client with dementia, which of the following behaviors would the nurse interpret as a manifestation of disinhibition? a. Wandering and getting lost b. Auditory and/or visual hallucinations c. Decreased interest in bathing and hygiene d. Inappropriate language and sexual behaviors

48. The brains of persons with Alzheimer s disease are characterized by the presence of: a. Fatty deposits c. Calcium deposits b. Senile plaques and neurofibrillary tangles d. Lack of gray matter

SITUATION 11: A 23 year-old man was voluntarily admitted to the inpatient unit with a diagnosis of paranoid schizophrenia. 49. As the nurse approaches the client, he says, If you come any closer, I ll die. This is an example of: a. Hallucination b. Delusion c. Illusion d. Idea of reference

50. Delusion is: a. Psychomotor disturbance b. Mood disturbance c. Disturbance of thought d. Disturbance of perception

51. When communicating with a paranoid client, the main principle is to: a. Use logic and be persistent b. Provide an anxiety-free environment c. Express doubt and do not argue d. Encourage ventilation of anger

52. The client tells his primary nurse that he s scheduled to meet the President of the Philippines a special time, making it impossible for the client to leave his room for dinner. Which of the following responses by the nurse is most appropriate? a. It s meal time. Let s go so you can eat.

b. The President of the Philippines told me to take you to dinner. c. Your physician expects you to follow the unit s schedule. d. People who don t eat on this unit aren t being cooperative.

53. A schizophrenic patient who began taking haloperidol (Haloperidol) 1 week ago now exhibits jerking movements of the neck and mouth. These are signs of: a. Dystonia b. Psychosis c. Akathisia d. Parkinsonism

SITUATION 12: Nico, 27 yrs. old, is admitted for treatment of a major depression. 54. He is withdrawn, appears disheveled, and states, No one could ever love me. The nurse can expect the client to be placed on a. Antiparkinsonism medication b. Suicide precautions c. A low-salt diet d. Phototherapy

55. Which of the following behaviors indicates to the nurse that a client s major depression is improving? The client: a. Displays a blunted effect b. Has lost an additional 2 pounds c. States one good thing about himself d. Sleeps about 16 hours per day

56. Nico is scheduled for electroconvulsive therapy (ECT) tomorrow. The nurse would plan for which of the following activities? a. Force fluids 6 to 8 hours before treatment b. Administer succinylcholine (Inestine, Anectine) during pretreatment care c. Encourage the client s spouse to accompany him d. Reorient the client frequently during posttreatment care

57. Nico is recovering from a severe depression. Which of the following behaviors alerts the nurse to a risk for suicide? a. The client sleeps most of the day

b. The client has a plan to kill himself c. The client loses 5 pounds d. The client does not attend unit activities

58. Nico has been depressed severely depressed for 2 weeks. He had mentioned ending it all prior to admission. Which of the following questions should the nurse ask during the prescreen assessment? a. How long have you thought about harming yourself? b. What is it that makes you think about harming yourself? c. How has your concentration been? d. What specifically have you thought about doing to harm yourself?

SITUATION 13: A client is admitted with a diagnosis of Alzheimer s Disease. 59. When developing the plan of care for a client with Alzheimer s disease who is experiencing moderate impairment, which of the following types of care would the nurse expect to include? a. Considerable assistance with activities of daily living b. Managing complex medication schedule c. Constant supervision and total care d. Supervision of risky activities, such as shaving

60. Which of the following would be priority to include in the plan of care for a client with Alzheimer s disease who is experiencing difficulty processing and completing complex tasks? a. Repeating the directions until the client follows them b. Asking the client to do one step of the task at a time c. Demonstrating for the client how to do the task d. Maintaining routine and structure for the client

61. Clients with Alzheimer s disease may have delusions about being harmed by staff and others. When the client expresses fear of being killed by staff, which of the following responses would be most appropriate? a. What makes you think we want to kill you? b. We like you too much to want to kill you. c. You are in the hospital. We are nurses trying to help you. d. Oh, don t be so silly. No one wants to kill you here.

62. When helping the families of clients with Alzheimer s disease to cope with vulgar or sexual behaviors, which of the following suggestions would be most helpful?

a. Ignore the behaviors, but try to identify the purposes b. Give feedback on the inappropriateness of the behaviors c. Employ anger management strategies d. Administer the prescribed risperidone (Risperdal)

63. The nurse determines that the son of the client with Alzheimer s disease needs further education about the disease when he makes which of the following statements? a. I didn t realize the deterioration would be so incapacitating. b. The Alzheimer s support group has so much good information. c. I get tired of the same old stories, but I know it s important for Dad. d. I woke up this morning hoping that my old Dad would be back.

SITUATION 14: A 34-year old is hospitalized with bipolar disorder.

64. The nurse knows that the major factor that distinguishes a bipolar from a unipolar disorder is the a. Higher incidence in women b. Severity of the depression c. Genetic etiology d. Presence of mania

65. At 2 a.m. the nurse the nurse finds him phoning friends all across the country to discuss his new plan for eradicating world hunger. His excited explanations are keeping the entire unit awake, but he won t quiet down. The nurse caring for him knows the drug most likely to be prescribed for this client is: a. A tricyclic depressant b. An MAOI-inhibitor antidepressant c. Lithium carbonate (Eskalith) d. An antianxiety drug

66. Supportive therapy for a client who is exhibiting manic behavior may include all of the following EXCEPT: a. Psychoanalysis b. Cognitive therapy c. Interpersonal therapy d. Problem-solving therapy

67. The client is creating considerable chaos in a day treatment program with dominating and

manipulative behavior. Which of the following nursing intervention is most appropriate? a. Allow the peer group to intervene b. Describe acceptable behavior and set realistic limits with the client c. Recommend the client to be hospitalized for treatment d. Tell client that his behavior is not appropriate

68. The client is skipping up and down the hallway practically running into other clients. Which of the following activities would the nurse expect to include in the client s plan of care? a. Leading a group activity b. Watching television c. Reading the newspaper d. Cleaning the dayroom tables

SITUATION 15: A client is admitted to outpatient surgery for cataract extraction on the right eye. 69. The client asks, What does the lens of my eye do? The nurse should explain that the lens of the eye: a. Produces aqueous humor b. Holds the rods and cones c. Focuses light rays onto the retina d. Regulates the amount of light entering the eye

70. The client would most likely to complain of which symptoms? a. Halos and rainbows around lights b. Eye pain and irritation that worsens at night c. Blurred and hazy vision d. Eye strain and headache when doing close work

71. The nurse is to instill drops of phenylephrine hydrochloride (Neo-Synephrine) into a client s right eye before cataract removal surgery. This preparation acts in the eye produce a. Dilatation of the pupil and blood vessels b. Dilatation of the pupil and constriction of blood vessels c. Constriction of the pupil and constriction of blood vessels d. Constriction of the pupil and dilatation of blood

72. A short time after cataract surgery, the client complains of nausea. Which of the following represents the nurse s best course of action?

a. Instruct the client to take a few deep breaths until the nausea subsides b. Explain that this is a common feeling that will pass quickly c. Tell the client to call the nurse promptly if vomiting occurs d. Medicate the client with an antiemetic, as ordered 73. Discharge planning would include: a. Wearing eye patches for the first 72 hours b. Lifting light objects is acceptable c. Bending with the knees and keep the head straight d. Bending with the waist is acceptable if slowly done SITUATION 16: A client is admitted with a diagnosis of Parkinson s disease. 74. Which of the following is an initial sign of Parkinson s disease? a. Rigidity b. Tremor c. Bradykinesia d. Akinesia

75. The nurse develops a teaching plan for a client newly diagnosed with Parkinson s disease. Which of the following topics that the nurse plans to discuss is the most important? a. Maintaining a balanced nutritional diet b. Enhancing the immune system c. Maintaining a safe environment d. Engaging in diversional activity

76. When does the nurse encourage a client with Parkinson s disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? a. Early in the morning, when the client s energy level is high b. To coincide with the peak action of drug therapy c. Immediately after a rest period d. When family members will be available

77. Which goal is the most realistic and appropriate for a client diagnosed with Parkinson s disease? a. To cure the disease b. To stop the progression of the disease c. To begin preparations for terminal care d. To maintain optimal body function

78. The client needs a long time to complete her morning hygiene, but she becomes annoyed when the nurse offers assistance and refuses all help. Which statement is the nurse s best initial response in this situation? a. Tell the client firmly that she needs assistance and help her with her care b. Praise the client for her desire to be independent and give her extra time and encouragement c. Tell the client that she is being unrealistic about her abilities and accept that she needs help d. Suggest to the client that if she insists on self care, she should at least modify her routine

SITUATION 17: A client is admitted to the hospital with Bell s Palsy. 79. A client with Bell s Palsy asks the nurse why artificial tears were ordered by the physician. Select the best reply by the nurse. a. When your affected eye fails to make tears, the eye can become irritated and ulcerated. b. Because your eye remains closed, foreign matter can be trapped beneath the lid. c. Artificial tears will remove the purulent drainage from your eye, which speeds healing. d. Because you cannot blink the affected eye, it can become dry and irritated.

80. Which nursing diagnosis takes priority for the patient with Bell s palsy? a. Risk for dysfunctional grieving b. Risk for injury related to corneal laceration c. Risk for chronic low self-esteem d. Risk for impaired physical mobility

81. The nurse observes that the client s right eye does not close completely. Based on this, which of the following nursing interventions would be most appropriate? a. Making sure the client wears her eyeglasses at all times b. Placing an eye patch over her eye c. Instilling artificial tears once every shift d. Cleansing the eye with a clean washcloth every shift

82. The client has a feeling of stiffness and a drawing sensation of the face. What would be an important teaching to the patient? a. Eye is susceptible to injury when eyelid does not close b. Drooling from an increased saliva on the affected area may occur c. Cleaning the eye will prevent ulceration d. All of the above

SITUATION 18: A 46-year old is admitted to the hospital because her family is unable to manage her constant hand washing rituals.

83. Her family reports she washes her hands at least 30 times each day. The nurse noticed the client s hands are reddened, scaly, and cracked. The main nursing goal is to: a. Remind the client several times of her appointment b. Limit the number of hand washings c. Tell her it is her responsibility to be there on time d. Provide ample time for her to complete her rituals

84. Which of the following is an appropriate treatment for this client? a. An unstructured schedule of activities b. A structured schedule of activities c. Intense counseling d. Negative reinforcement every time she performs her rituals

85. The most effective way for the nurse to intervene with her hand and face washing is to: a. Allow her a certain amount of time each shift to engage in this behavior b. Interrupt the activity briefly and frequently c. Lock the door to her room and restrict access to the bathroom d. Tell her to stop each time she is observed doing it

86. The client is also constipated and dehydrated. Which nursing intervention would the client be most likely to comply with? a. Drinking Ensure between meals b. Drinking extra fluids with meals c. Drinking 8 oz water every hour between meals d. Drinking adequate amounts of fluid during the day

87. Upon admission she was also dehydrated and underweight. The nurse and the client will know That discharge planning is appropriate when the client: a. Regains her normal body weight b. Expresses a desire to leave the hospital c. Is able to start talking about her guilt and anxiety d. Limits her hand and face washing to a few times a day

SITUATION 19: The nurse is caring for a client who is experiencing panic attack. 88. Which intervention would be most appropriate? a. Tell the client he s all right, and there is no need to panic b. Speak to the client in short, simple sentences c. Explain to the client that there s no need to worry because he s safe d. Give the client a detailed explanation of his panic reaction

89. The client reports that she often feels a choking sensation in her throat, a racing heart, dizziness and fearfulness. All of these symptoms have occurred almost daily for the past 3 months. Suspecting a psychological component to these symptoms, what would the nurse anticipate administering? a. Benzodiazepines b. Proton pump inhibitors c. Nitropusside d. Lithium carbonate

90. The client has a generalized anxiety disorder. Which statement is true about this client? a. The client has regular obsessions b. Relaxation techniques and psychotherapy are necessary for care c. Nightmares and flashbacks are common in individuals who suffer from generalized anxiety disorder d. Generalized anxiety disorder is characterized by anxiety that lasts longer than 6 months

91. The client is pacing and complains of racing thoughts. The nurse asks the client if something upsetting happens, and the client response is vague and not focused on nurse s question. The nurse assesses the client s level of anxiety as: a. Mild b. Moderate c. Severe d. Panic

92. Which of the following is a behavior manifestation of anxiety, except: a. Panic b. Tachycardia c. Hyperventilation d. Tachypnea SITUATION 20: Defense Mechanisms

93. Sam is diagnosed with cancer does not talk about or acknowledge the diagnosis. Which of the following defense mechanism is Sam using? a. Denial b. Identification c. Projection d. Rationalization

94. Nathaniel, released from prison for selling narcotics has been rehabilitated and now works for a youth drug prevention agency. Darwin is reflecting which of the following defense mechanism? a. Denial b. Displacement c. Identification d. Sublimation

95. Nina is admitted to the ICU with chest pain, an abnormal ECG, and elevated enzymes. When the significance of this is explained to her, she says, I can t be having a heart attack. No way. You must be mistaken. The nurse suspects the client is using which defense mechanism? a. Sublimation b. Regression c. Dissociation d. Denial 96. In patients with dissociative disorders, the defense mechanism most often used to block traumatic experiences is: a. Passive-aggression b. Reaction formation c. Denial d. Repression

97. The defense mechanism utilized by manic patients to cover up depression is: a. Displacement b. Denial c. Compensation d. Reaction formation SITUATION 21: Psychosomatic disorders 98. A man s family brought him onto the hospital because of his many somatic complaints. He has been seen by many medical specialists in the past without discovery of organic pathology. The nurse assesses that the client is probably experiencing which of the following problems?

a. Conversion disorder b. Body dysmorphic disorder c. Malingering d. Hypochondriasis

99. Amie is hospitalized for treatment of conversion disorder. She complained of paralysis of her right side after her husband threatened to leave her and their children. She seems unconcerned about her paralysis. An appropriate long term goal for the nurse to formulate is that client will: a. Cope effectively with stress without using conversion b. Identify stressors c. Express feelings about conflict d. Develop an increased sense of relatedness to others

100. A patient who reports paralysis with no specific cause but has a history of a recent stressful event has a probable diagnosis of: a. Hypochondriasis b. Somatic illness c. Conversion disorder d. Pain disorder The JAY BALICHA Predictor test 1. First board exam a. 1920 b. 1915 c. 1953 d. 1944 (Answer) A. RA 2493 was passed during this year. Also the year where first board exam in the Philippines was given by the board of examiners for nurses (d) April of 1944, graduate nurses took the first board examination at the Iloilo Mission Hospital. (Venzon p140) 2. First True Philippine Nursing Law a. RA 2808 b. RA 877 c. RA 887 d. RA 2880 (Answer) A. In 1919 RA 2808 was passed. Also known as the first true nursing law. It created the first board of examiners for nurses. (B) Philippine Nursing law enacted on June 19, 1953 which pertains to the need for registration as nurse before anyone may practice nursing in the Philippines. (venzon p140) 3. You will soon be a registered nurse. Which of the following best describe contemporary nursing practice? Humanistic caring b. People-oriented c. Knowledge-based d. Technically focused

(Answer) C. In the advent of nursing research. Contemporary nursing has become an evidence-based practice. Therefore knowledge is the foundation. As a science and a helping profession, nursing is a welldefined body of knowledge and expertise. A number of conceptual frameworks contribute to the knowledge base of nursing and give direction to nursing practice, education, and ongoing research. (Kozier p7)

4. A nursing change of shift report has indicated that a client s pulse volume is described as 1 (one). The nurse s first action after report is to do which of the following? a. Notify the physician c. Document that the pulse volume is normal b. Assess the client right away d. Change the clients position (Answer) B. The nurse should recognize that a pulse volume of 1 indicates the client s pulse is difficult to feel, thready, and the client s circulatory status is altered. The first action is to check the client s condition and circulatory status. If the nurse notified the physician first, the nurse will be reporting another nurse s assessment, which is not an appropriate nursing practice. The other options are not applicable to the situation. (book #18) Pulse volume is the pulse strength or amplitude, refers to the force of blood with each beat. Usually the pulse volume is the same with beat. It can range from bounding to absent. (Kozier p146) 0 Absent pulse: no pulsation is felt despite extreme pressure 1 Thready pulse. It can easily be obliterated. 2 Weak pulse. Stronger than a thready pulse, light pressure causes it to disappear 3 a normal pulse. Which can be felt with moderate pressure 4 full or bounding. It can be obliterated only with great pressure (Taylor p413)

5. A client who is unconscious needs frequent mouth care. While performing mouth care, in what position should the client be placed? a. Fowler s position b. Side-lying position c. Supine position d. Trendelenburg position (Answer) B. In this position, the saliva and other liquid automatically runs out of the mouth by gravity or pool in the side of the mouth where it could be suctioned rather than being aspirated into the lungs (kozier p730) 6. Which of the following is not a physical hazard? a. Unstable and slippery stairway c. Inadequate lighting on inside and outside home b. Large windows for good ventilation d. Unfixed electrical circuits

(Answer) B. In home care assessment, physical hazards includes uneven and highly polished or slippery floors and any unanchored rugs or mats. Adequacy of lighting, in particular the availability of night-light and availability of light switches. Unanchored of frayed electrical cords and outlets those are overloaded or near water. Last would be hazardous placement of furniture with sharp corners. (kozier p144-145)

7. Jordan Luis appears quite thin and dehydrated. What data would you initially need to determine his level of nutrition: a. Nutrition noted by dietitian c. Foods he ate yesterday b. A sample of his daily diet d. His height and weight (Answer)D . Nutrition can be initially assessed by measuring the height and the weight and if it is proportional to each other and the age and built of the client. It s anthropometric measurements

8. When dressing contaminated wounds, you must keep in mind the following, except a. Apply cold around wound area after dressing c. Use a non-irritating disinfectant solution b. Disinfect all instruments d. Isolate patient from those with clean wounds (Answer) D. Isolation is not necessary in this case

9. Dan Paolo, a student nurse believes that all patients should be treated as individuals. The ethical principle that this reflect: a. Beneficence b. Nonmaleficence c. Respect for others d. Autonomy (Answer) C. Beneficence The principle that imposes on the practitioner a duty to seek the good for the patient under all circumstances. (Edge p44) Nonmalecicence The principle that imposes the duty to avoid or refrain from harming the patient (edge p46) Respect for others having empathy for others and not using people as a means to an end Autonomy Independent, self-governing, self-determination (kozier p 73)

10. Doing a nursing procedure without the patient s informed consent may bring nurse Andrei to the court of law for this violation:

a. Negligence b. Assault c. Battery d. Tort (Answer) D. tort is a legal wrong doing, committed against a person or property independent of a contract which renders the person who has been liable for damages in a civil action. Battery is an example of tort. It is an intentional, unconsented touching of another person. Assult is the imminent treat of harmful or offensive bodily contact Negligence refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would or would not do. (Answer) (book 54 mosby s dictionary) 11. What leadership style works well with professional groups but does not in health care settings? a. Laissez faire b. Situational c. Autocratic d. Democratic (Answer) A. Laissez faire also known as nondirective leadership. The leader participates minimally and often only on request of the members. Also known as permissive or ultraliberalism. Situational manage as the need arises Autocratic under one command Democratic rule of the majority 12. Nurse Reggie assigns the new nurse to be charge nurse for the evening shift because the regular nurse has called in sick. This would be an example of which of the following? a. Over delegation c. Reverse delegation b. Substitution delegation d. Expert power A. overdelegation occurs when too much authority or accountability is transferred to the delegate. Substitution delegation is not a recognized term. Reverse delegation occurs when authority is transferred to an individual of higher rank. Expert power is power vested in the skills and talents on the individuals. 13. Which type of research inquiring and investigating the issues of human complexities (e.g. understanding human expertise) a. Logical position b. Natural inquiry c. Quantitative research d. Positivism (Answer) B. Positivism a direct relationship between two variables; as one increases, the other can be expected to increase. Logical positioning deals with the rules and test of sound thinking and proof of reasoning Natural inquiry study of the phenomenon as it unravels or qualitative research (book 169) Quantitative research - use of statistical methods to analyze data (mosbys dicationary) 14. What is the research design used? a. Experimental b. Quasi-experimental c. Descriptive d. Exploratory (Answer) A. Experimental an inquiry on cause and effect relationships. The researcher consciously manipulates and control situations related to the study. It has four elements: Randomization, control, validity and

manipulation Quasi-experimental an experiment that lacks one or more of the elements of the true experiment. It is based on human judgment. Descriptive an applied research that described the nature of the phenomenon under investigation of after a survey of current trends, practices, and conditions that relate to that phenomenon. (Answer) Exploratory also known as investigative research 15. Bert can be advised that his brother can be treated involuntarily if: a. Nobody can take care of him at home c. He is dangerous to others b. He has suicidal tendencies d. all of these (Answer) D. involuntary means an individual who has the legal capacity to consent to mental treatment refuses to do so. Persons considered dangerous to self and others because of mental disorder can be involuntarily treated. The third condition is being gravely disabled. (keltner p48) 16. Using IMCI model, the pink row needs: a. No specific treatment such as antibiotics b. Specific antibiotics c. No urgent measures d. Urgent referral

The pink row is classified as severe dehydration. Urgent referral to a hospital is necessary, with the mother giving the child frequent sips of ORS on the way to prevent further dehydration. 17. What is the recommended treatment for patients classified under the yellow row having blood in the stool? a. Urgent referral b. Advise the mother on feeding a child who has PERSISTENT DIARRHEA c. Oral antibiotics for 5 days d. Give fluid and food to treat diarrhea at home Ans. C If the patient has diarrhea and blood has been seen in the stool, the patient can be classified under dysentery. With this classification you should treat the child with an oral antibiotic specific for shigella for 5 days. Urgent referral is the priority in patients classified under the pink row. Persistent diarrhea is considered when the patient has diarrhea for 14 days and more. Giving fluid and food to treat diarrhea at home is a plan A treatment for patients classified under the green row or No Dehydration .

18. During the patient s clinic visit, it is the PHN s duty to carry out one of the following, EXCEPT: a. Carry out physician s order as giving medication or injection

b. Explain and reinforce physician s orders and advises c. Seek information regarding health status of other family members d. Instruct midwife to give the medication to the client ans. d As a PHN it s a part of the duty to carry out physician s orders such as giving medication or injection. Another is explanation and reinforcement of the physician s orders and advises; and assessing health status of the whole family. However, giving medications to the client is an order of the physician which is the nurses responsibility to carry out and cannot be delegated to midwives. If this task will be delegated to the midwives the PHN will be over delegating. 19. Which of the following specific preventive method is the role of the nurse to the family? a. Advise the family to consult the physician as soon as symptoms occur b. Explain the mechanism of actions of the drugs c. Interpret nature of disease and discuss proper preventive practices d. Encourage the patient to increase fluid intake Ans: C 20. Margot visits her gynecologist to confirm a suspected pregnancy. During the nursing history, she states that her last menstrual period began on April 11. Cathy states that some spotting occurred in May 8. The nurse calculates that her due date is: a. January 10 c. February 12 b. January 18 d. February 15

Ans. B 21. During labor, station +1 indicates that the presenting part is: a. On the perineum C. Slightly below the ischial spines b. High in the false pelvis D. Slightly above the ischial spine Ans. C 22. Four hours after a vaginal delivery Mrs. Reyes still has not voided. The nurse s initial action should be to: a. Palpate her suprapubic area for distention b. Encourage voiding by placing her on a bedpan frequently c. Place her hands in warm water to encourage micturation d. Inform the physician of her inability to void and await orders Ans. A 23. The community health survey aims to analyze:

a. the status of health education b. health education program c. date of introducing charges d. the population and environment that influence the health of community Ans. D

SITUATION 4 A child is admitted to the pediatric unit with a diagnosis of acute glomerulonephritis. 24. The action that has priority is: a. Assessing for dysuria c. Monitoring blood pressure Observing for Jaundice d. Testing vomits for occult blood 25. A mother whose child has glomerulonephritis is fearful that her other child may get the disease. To allay the fears of the mother, the nurse should tell her that: a. The cause of acute glomerulonephritis is unknown, so it is difficult to know how to prevent b. Acute glomerulonephritis is inherited by an autosomal recessive trait but usually occurs only in males c. Acute glomerulonephritis is caused by clot formation in the small renal tubules secondary to systemic function d. Acute glomerulonephritis is caused by an antigen-antibody response secondary to group A betahemolytic streptococcus ANSWER: ( D ) The beta-hemolytic streptococcal immune complex becomes trapped in the glomerular capillary loop, causing glomerulonephritis. SITUATION 5 A young man is admitted in chronic renal failure and scheduled for kidney transplant. 26. Which of the following pre-operative assessment is important for a client who will undergo kidney transplant: a. Urine output b. Signs of graft rejection c. Signs and symptoms of infection Client s support system and understanding of life style changes 27. Which of the following symptoms indicate acute rejection of a transplanted kidney? a. Fever and weight gain c. Oliguria b. Hematuria and seizure d. Muscle atrophy ANSWER: ( A ) Signs of rejection increase WBC and fever because the body is recognizing the graft as foreign and attempting to fight. 28. The client is at the physician s office for a follow-up visit. The client tells the office nurse. I am not

worried about rejection. I am not going to be here weekly. The nurse interprets his reaction to constant follow-up care as an example of: a. Projection c. Denial b. Intellectualization d. Regression ANSWER: ( C ) Denial disowning intolerable thoughts. Client denying feelings of anxiety and seriousness of potential rejection of the organ. 29. The client with renal transplant has started cyclosporine therapy to prevent graft rejection. Which of the following conditions is a major complications of this drug therapy: a. Depression c. Infection b. Hemorrhage d. Peptic ulcer disease ANSWER: ( C ) Infection major complications because its an immuno suppressive drug. Depression may occur post transplantation but not because of drug. Hemorrhage is complication related with anticoagulant therapy. Peptic ulcer is a complication of steroid therapy.

SITUATION 6 Jane Santos has an acute episode of right-sided heart failure and is receiving furosemide (Lasix). 30. When taking Mrs. Santos admission history, the nurse would expect her to complain of: a. Dyspnea, edema, fatigue c. Weakness, palpitations, nausea b. Fatigue, vertigo, headache d. A feeling of distress when breathing ANSWER ( A ) Congestive Heart Failure is the failure of the heart to pump adequately to meet the needs of the body, resulting in a backward build up of pressure in the venous system. Adaptations by the body include edema, ascites, hepatomegaly, tachycardia, dyspnea, and fatigue. 31. The nurse can best assess the degree of edema in an extremity by: a. Checking for pitting c. Measuring the affected area b. Weighing Mrs. Santos d. Observing intake and output ANSWER ( C ) Measuring an area is an objective assessment and is not subject to individual interpretations. 32. Mrs. Santos has edematous ankles. To limit edema of the feet the nurse should prepare to: a. Restrict fluids c. Apply elastic bandages Elevate the legs d. Do range-of-motion exercises ANSWER ( B ) Elevation of an extremity promotes venous and lymphatic drainage by gravity.

33. The nurse is having difficulty assessing peripheral pulses. The most appropriate action for the nurse to take is to: a. Ask him to lie on his stomach c. Asks him to flex and extend his foot b. Have him do 20 jumping jacks d. Ask him to elevate his leg ANSWER: ( A ) Asking to lie in prone position will provide greater exposure to the popliteal space and thereby make assessment easier. Flexing and extending the foot may obliterate the pulse. 34. An adult female experiences painful arterial spasm in her hands due to Raynaud s phenomenon. Which of the following should the nurse include in the teaching plan for her? a. Drink a hot beverage such as tea or coffee to relieve spasms b. Reduce intake of high fat or high cholesterol foods c. Raise the hands above the head to relieve spasms d. Wear gloves when handling refrigerated foods ANSWER: ( D ) Cold induces arterial spasm. When hands will be exposed to cold, warm gloves or mittens should be worn. 35. What is the most common symptoms in a client with abdominal aortic aneurysm? a. Abdominal pain c. Headache Diaphoresis d. Upper back pain

ANSWER: ( A ) Abdominal pain results from the disruption of normal circulation in abdominal region. Lower back pain not upper signifying expansion and impending rupture of aneurysm. Headache and diaphoreses not associated.

SITUATION 8 Mr. Simon is admitted with cirrhosis of the liver, malnutrition, ascites, and elevated BP. 36. The nurse recognizes that the main role of the liver in relation to fat metabolism is: a. Producing phospholipids b. Storing fat for energy reserves c. Oxidizing fatty acids to produce energy d. Converting fat to lipoproteins for rapid transport out into the body ANSWER ( D ) In the liver a simple protein combines with a lipid to form a lipoprotein. Lipoproteins circulates freely in the blood and can be utilized easily and quickly in various metabolic processes. 37. The most therapeutic diet for Mr. Simon would be: a. High protein, low carbohydrate, low fat b. Low protein, low carbohydrate, high fat, soft c. High carbohydrate, low saturated fat, 1200 calories

d. Low sodium, protein to tolerance, moderate fat, high calorie, high vitamin, soft ANSWER ( D ) Low sodium controls fluid retention, blood pressure, and consequently edema; low protein controls ammonia formation in proportion to the liver s ability to detoxify ammonia in forming urea; moderate fat and high calories and vitamins help repair a long-standing nutritional deficit. 38. Mr. Simon s emergency medical treatment for bleeding esophageal varices that is unrelated to the control of hemorrhage is: a. Gastric lavage c. Balloon tamponade b. Gastric suctioning d. Aminocaproic acid (Amicar)

ANSWER ( D ) Low sodium controls fluid retention, blood pressure, and consequently edema; low protein controls ammonia formation in proportion to the liver s ability to detoxify ammonia in forming urea; moderate fat and high calories and vitamins help repair a long-standing nutritional deficit. 39. When admitting a 4-year-old child with nephrotic syndrome to the hospital, the nurse should assess for: a. Severe lethargy c. Dark, frothy urine output b. Chronic hypertension d. Flushed, ruddy complexion ANSWER ( C ) This is a characteristic of a child in nephrotic syndrome, large amounts of protein in the urine cause it to have a dark, frothy appearance. 40. During the first 24 hours the colostomy does not drain. The nurse should realize this is a result of: a. Intestinal edema c. The absence of gastrointestinal motility a. A presurgical decrease in fluid intake d. Proper functioning of nasogastric suctions SITUATION 11 A client was admitted to the hospital diagnosed with myocardial infarction. 41. Which laboratory result should the nurse report to the physician? a. Blood urea nitrogen of 15 mg/ dl c. Blood glucose level of 40 mg b. Serum albumin level of 3. 5 g d. Serum creatinine level of 0.6 mg

ANSWER ( C ) This is caused by the trauma of intestinal manipulation and the depressive effects of anesthetics and analgesics.

ANSWER: ( C ) Glucose level 60 120 mg. 40 mg hypoglycemia impair brain and neurological system s ability to function. BUN ( N ) 10 - 20 mg increase kidney disease. Crea ( N ) .4 1.5 mg 42. Eight weeks after MI, the client tells the nurse My wife wants to make love; but I don t think I can, I m worried that it might kill me. Which of the following responses from the nurse would be appropriate?

a. Tell me about your feelings b. Let s increase your rehabilitation schedule c. Let me call the doctor for you d. Tell your wife when you re able to make love ANSWER: ( A ) Nurse must address patient s concern. Ask to verbalize permit to gain insight into problem. 43. She appears withdrawn after a mastectomy although her recovery is uneventful the nurse can be helpful during this period by: a. Allowing the patient time alone so that she can reflect on her surgery b. Encouraging the patient to talk to her family c. Offering the patient the name of a support group d. Encouraging the patient to become involve in her exercises ANSWER ( C ) Mastectomy support groups provide an opportunity for patient to talk with other women who have had similar surgery. 44. The nurse recognizing the need to decrease the size and vascularity of the thyroid gland prior to thyroidectomy, would expect the physician to order? a. Propythiuracil c. Potassium permanganate b. Lugol s iodine solution d. Liothyronine sodium (Cytomel) ANSWER: (B) Adds iodine to body fluids, exerting negative feedback on thyroid tissue and decrease its metabolism and vascularity. A & D anti thyroid. 45. A client has chest tubes attached to a chest tube drainage system. When caring for this client, the nurse should: a. Clamp the chest tubes when suctioning b. Palpate the surrounding area for crepitus c. Change the dressing daily using aseptic technique d. Empty the drainage chambers at the end of the shift ANSWER: ( B ) Leakage of air into subcutaneous tissue is evidenced by a crackling sound when the area is gently palpated. This is referred as crepitus, although hemostat should be available. SITUATION 18 Sheila is a 3 year old who has asthma. 46. Sheila s initial treatment is to be aminophylline IV, for 20 minutes every 8 hours. Which of the following actions should the nurse implement with administration of the drug? a. Assess Sheila s vital signs c. Check Sheila s temperature b. Place Sheila in a croup tent d. Administer oxygen to Sheila ANSWER: ( A ) Xanthenes can cause either hypotension or tachycardia. It would be essential for the nurse to monitor her cardiovascular response to the drug. This is best done by assessing her baseline

vital signs prior to and with administration. 47. Which of the following nursing interventions is appropriate to correct dehydration for a 2 year old client with asthma? a. Give warm liquids c. Provide three meals and three snacks b. Give cold juice or ice pops d. Give IV fluids boluses ANSWER: ( A ) Liquids are best tolerated if they re warm. Cold liquids may cause bronchospasm and should be avoided. Dehydration should be corrected slowly overhydration may increase interstitial pulmonary fluid and exacerbate small airway obstruction. Small frequent meals should be provided to avoid abdominal distension that may interfere with diaphragm excursion. 48. The client was taking regular and NPH insulin. She asks the nurse why she must mix the 2 insulin. The nurse explains that regular and NPH are mixed to ensure: a. Immediate onset of the regular insulin b. Onset of the regular insulin within 2 hours c. A peak action of the NPH insulin at 2 hours d. A total duration of action of 24 hours ANSWER: ( D ) NPH is an intermediate acting insulin, Regular is rapid acting insulin, Mixing the 2 gives insulin over a 24 hours period requiring fewer injections for the client. 49. When the nurse enters the room to administer the morning dose of regular and NPH insulin, the client complains of dizziness, diaphoresis and nausea. The nurse does a blood glucose which is 30. What is the next nursing action? a. Give the usual dose of regular insulin and get the client s breakfast tray b. Hold the NPH insulin but give the regular insulin c. Hold the regular and NPH insulin and call the physician d. Give the client a glass of orange juice, hold all insulin and call the doctor ANSWER: ( D ) Symptom indicate hypoglycemia, 10 grams of rapidly absorbed CHO in prescribed. Repeated in 5 minutes, if client does not feel better. Hold insulin but should administer concentrated CHO. 50. Which of the following chronic complications is associated with diabetes mellitus? a. Dizziness, dyspnea on exertion and angina b. Retinopathy, neuropathy and coronary artery disease c. Leg ulcers, cerebral ischemia events, and pulmonary infarcts d. Fatigue, nausea, vomiting, muscle weakness and cardiac arrhythmias ANSWER: ( B ) All chronic complications A- symptoms of aortic valve stenosis. D symptoms of hyper parathyroidism. C complication of sickle cell anemia

CARE FOR CLIENTS WITH PHYSIOLOGICAL AND PSYCHOSOCIAL ALTERATIONS SITUATION 1: Technique of therapeutic communication should be utilized and incorporated into nursing

practice. 1. When a nurse establishes a therapeutic relationship with a client, which of the following is the primary focus of the client s care? a. The medical diagnosis c. The nursing diagnosis b. The client s needs and problems d. The client s social interaction

2. Which of the following is the overall purpose of therapeutic communication? a. To analyze client s problems b. To elicit cooperation c. To facilitate a helping relationship d. To provide emotional support

3. In which of the following situations would communications be LEAST likely hindered? a. Mrs.L, 30 years old is admitted to the hospital for the first time for acute appendicitis b. Mrs. R, 50 years old, diabetic, is admitted to the hospital after a stroke. She has right hemiplegia c. Mrs. D, 45 years old, is admitted to the hospital for cervical cancer d. Mr. T, 70 years old, is admitted for fractured tibia. He speaks Spanish only

4. Which of the following communication technique is MOST effective in dealing with covert communication? a. Listening c. Clarification b. Evaluation d. Validation

5. Which of the following is MOST important in fostering a positive relationship? a. The nurse recognizes that some patient regress when confronted with illness b. The nurse functions as a positive role model to encourage health oriented patient behavior c. Needs to understand that patients may test her before he can accept and trust her d. The nurse must fully share the patient s feelings before she can develop her goal for her nursing care

SITUATION 2: Stress can bring about various human reactions that may result to illness or enhance one s coping mechanism. Stress also triggers local and general adaptation syndrome.

6. Which of the following BEST describes the general adaptation syndrome. It is a: a. Psychological response to stress c. Behavioral response to stress b. Physiologic response to stress d. Sociocultural response to stress

7. Which of the following levels of anxiety is BEST for client s learning? a. Moderate c. Severe b. Mild d. No anxiety

8. Which of the following defense mechanism is consciously used in coping mechanism with stress? a. Regression c. Repression b. Suppression d. Projection

9. Which of the following models identifies ability to cope with stress, practice and norms of the peer group, effect of social environment and the resources used to deal with stress as determinants to stress and stress reactions? a. Stimulus based model c. Response based model b. Adaptation based model d. Transaction based model

10. The purpose of the first stage of the General Adaptation Syndrome is which of the following? a. Determine the causes of the danger b. Present the individual from having an unpleasant experience c. Mobilize energy needed for adaptation d. Alert the individual to danger

SITUATION 3: Paul, 16 year old was committed to a mental health facility with diagnosis of personality disorder. He has a history of promiscuity and running away. He tells the staff I can t stand this place, I want to go away. 11. How would the nurse deal effectively with Paul s threat to run away? a. Tell him to stay in her room b. Lock him in her room c. Tell him firmly that if he does not control herself, the staff will help him control herself d. Ignore the threat

12. The early experiences of Paul may indicate a history of: a. Severe parental rejection c. Severe temper tantrums b. Failure in interpersonal relationship d. Failure to identify positively with father

13. How would you describe parental rejection? a. Failure to identify positively with father c. Lack of recognition as a person b. Lack of parental love and discipline d. Lack of the capacity to trust others

14. What should the nurse do to prevent Paul from manipulating and dominating others? a. Ignore him demands c. Observe him closely b. Isolate Paul d. Protect others from being manipulated Answer: D- Safety precautions must be posed to protect others, provide endorsement to other nurses 15. In dealing with manipulative behavior, the nurse should convey an attitude of: a. Active friendliness c. Love and understanding b. Permissiveness d. Consistency Answer: D- Firmness, matter of fact and consistency is used to approach clients with antisocial personality SITUATION 4: Mark was brought to the National Center for Mental Health for substance abuse. 16. Which of the following behaviors would indicate stimulant intoxication? a. Slurred speech, unsteady gait, impaired concentration b. Hyperactivity, talkativeness, euphoria c. Relaxed inhibitions, increased appetite, distorted perceptions d. Depersonalization, dilated pupils, visual hallucinations 17. Which of the following statements would indicate the teaching about Naltrexone (Revia) had been effective? a. I ll get sick if I use heroine on this medication. b. This medication will block the effects of any opioid substance I take. c. If I use opioid while taking naltrexone, I ll become extremely ill. d. Using naltrexone may make me dizzy.

18. Clonidine (Catapres) is prescribed for symptoms of opioid withdrawal. Which of the following nursing assessments is essential before giving a dose of this medication? a. Assessing the client s blood pressure b. Determining when the client last use an opiate c. Monitoring the client for tremors d. Completing a thorough physical assessment

19. The nurse has provided an in-service program on impaired professionals. She knows that teaching has been effective when staff identify the following as the greatest risk for substance abuse among

professionals: a. Most nurses are codependent in their personal and professional relationships b. Most nurses come from dysfunctional families and are risk for developing addiction c. Most nurses are exposed to various substances and believe they are not risk to develop the disease d. Most nurses have preconceived ideas about what kind of people become addicted

20. The client tells the nurse that she takes a drink every morning to calm her nerves and stops her tremors. The nurse realizes the client is at risk for: a. An anxiety disorder c. Physical dependence b. A neurological disorder d. Psychological addiction

SITUATION 5: A nurse must be aware of the latest issues on Child Abuse and Family Violence. 21. Marinel, a 16 years old young lady was left with her stepfather and with a mother who is working in the office the whole day. As a nurse, what would be your advice? a. Tell the mother to keep watching her daughter b. Tell the child get to her regular activities c. Ask the child to get away from her stepfather d. Let the child stay with the relatives

22. Marinel s high school friend made a visit and talked to her father. Marinel feels fidgety and continuously smoked while her friend is talking to her mother. Beth is experiencing: a. Worries b. Anger c. Nervousness d. Stress

23. The best way a nurse can advise an abused child is to call the: a. Police station b. School c. Parish d. Bantay Bata 163

24. When planning the care for a client who is abused, which of the following measures would be most important to include? a. Being compassionate and empathetic b. Teaching the client about abuse and the cycle of violence

c. Explaining to the client his or her personal and legal rights d. Helping the client develop a safety plan

25. During the session with the nurse, a client who is being abused states, I don t know what to do anymore. He doesn t want me to go anywhere while he s at work, not even to visit my friends. Which of the following nursing diagnoses would the nurse formulate in respect to this information? a. Risk for violence related to abusive husband, as evidenced by victim s statement of being battered b. Low Self-Esteem related to victimization, as evidenced by not being able to leave the house c. Powerlessness related to abusive husband, as evidenced by inability to make decisions d. Ineffective Coping related to victimization, as evidenced by crying SITUATION 6: The following questions pertains to Musculoskeletal System of aging persons 26. Which of the following behaviors contribute to osteoporosis: a. Smoking, and lack of exercise c. Drinking tea, deep breathing, and losing weight b. Physical activity, dancing, and swimming d. Knee bends, shopping, and weight lifting

27. As people gets older, they lose height (become shorter). This is due to: a. The fact that they don t stand up straight c. Loss of bone mass in the vertebral discs b. The rest of the population has grown taller d. Inaccurate measurement

28. As one ages, muscle mass (that is muscle size): a. Decreases c. Stays about the same b. Increases d. Can go either way

29. As a result of changes in long bones and the spinal column, the gait of older people: a. Becomes like a dancer c. Is more steady b. Is less stable and balanced when walking d. Hardly changes at all

30. Changes in the bone of older people make which of the following a major danger? a. Infection c. Allergy b. Contagion d. Fractures

SITUATION 7: Sensory deprivation is experienced by most people in any setting whether they are patients confined in hospitals, workers assigned in mining industries or a family member assigned in far places.

31. Which of the following will LEAST likely result to sensory deprivation? a. Increased sensory input brought about by unlimited visitors from families and friends b. Restriction of the environment in patients who are on absolute bed rest c. Reduced sensory input in the case of patients who have just been operated on glaucoma d. Elimination of order or meaning from input in the case of ICU patients or was in reverse isolation

32. Which of the following are observed in sensorially deprived adult and elderly people because of deafness? a. They prefer interaction with hearing adults b. They show greater interdependence than hearing adult c. They become more flexible in daily routine d. They show poor social judgment

33. Which nursing intervention would be appropriate for client with hyperthesia? a. Firm pressure when touching body parts c. Minimal use of direct touch b. Vigorous hair brushing d. Frequent back rubs

34. A post-operative blind patient needs to be assisted for ambulation. Which of the following should the nurse do in ambulating a client with visual impairment? a. Stand on the client s nondominant side, approximately one step behind the client, grasping the client s arm b. Stand on the client s dominant side and grasp the client s arm c. Stand on the client s dominant aside slightly in front of the client, allowing the client to grasp the nurse s arm d. Stand slightly in front of the client s nondominant side allowing the client to grasp the nurse s arm

35. Which of the following is an appropriate communication method for client s with hearing impairment? a. Talk side by side with the client b. Use visual aide and gestures to enhance the spoken word c. Restrict use of the client s hands d. Speak loud enough or shout if you may so that client will be able to hear you

SITUATION 8: Sexuality is one problem area that is often neglected by nurses in the care of elderly

clients. The nurse however must be able to identify and address the sexual changes to provide nursing care. 36. Menopause is considered complete when: a. Hot flashes cease c. A woman has been without periods for a year b. Emotional stability ends d. Irritability goes away

37. Hormonal decline in women causes: a. Increased risk for atherosclerotic plaques c. No changes in risk for atherosclerotic plaques b. Decreased risk for atherosclerotic plaques d. None of the above

38. Benefits of hormone replacement therapy (HRT) include: a. Protection against constipation b. Protection against osteoporosis and elimination of the unpleasant symptoms of menopause c. Protection against the flu d. Protection against fever

39. Which of the following is NOT a known risk of hormone replacement therapy: a. Formation of blood clots and hypertension b. Development of noncancerous fibroid tumors in the uterus c. Breast and endometrial cancers d. Lung cancer

SITUATION 9: The nurse is caring for an adult admitted with a diagnosis of brain tumor. He was scheduled for craniotomy. 40. A client has a supratentorial craniotomy for a tumor in the right frontal lobe of the cerebral cortex. Post operatively, the position that would be most appropriate for this client would be: a. High fowler s with knee gatch raised b. Flat with small pillow under the nape of the neck c. Head of the bed elevated 20 degrees with the head turned to the operative side d. Head of the bed elevated 45 degrees with a large pillow under the head and shoulders

41. A client is regaining consciousness after a craniotomy becomes restless and attempts to pull out her intravenous line. Which nursing intervention protects the client without increasing her ICP? a. Place her in a jacket restraint

b. Wrap her hands in soft mitten restraints c. Tuck her arms and hands under the draw sheet d. Apply a wrist restraint to each arm

42. Following 3 months of rehabilitation after craniotomy, a female client is still having some motor speech difficulty. To promote the client s use of speech the nurse should: a. Correct her mistakes immediately b. Respond to her crude efforts of speaking c. Re-explain why she is having difficulty of speaking d. Speak to her in simple words and short sentences 43. A client undergoes a craniotomy for removal of her brain tumor. The nurse notes that her dressing is saturated with blood. Which of the following interventions is most appropriate? a. Replacing the dressing b. Marking the area of drainage on the dressing c. Reinforcing the dressing and notifying the doctor immediately d. Doing nothing because this is normal occurrence

44. After craniotomy, what is your primary goal? a. Prevent increased ICP b. Prevent infection c. Prevent secondary surgery d. Prevent hemorrhage

SITUATION 10: Dementing illness and changes in the brain 45. As one gets older, there is a loss of brain cells. The significance of this is: a. A cell transplant is indicated b. The lost cells will regenerate on their own c. The remaining cells are more than enough for learning and remembering d. The significance is not known

46. ACUTE dementia is due to causes which can be reversed. A frequent cause of this type of dementia is: a. Cerebrovascular accident b. Alzheimer s disease c. Multiple Infarcts d. Electrolyte imbalance, especially hyponatremia (loss of sodium)

47. When assessing a client with dementia, which of the following behaviors would the nurse interpret as a manifestation of disinhibition? a. Wandering and getting lost b. Auditory and/or visual hallucinations c. Decreased interest in bathing and hygiene d. Inappropriate language and sexual behaviors

48. The brains of persons with Alzheimer s disease are characterized by the presence of: a. Fatty deposits c. Calcium deposits b. Senile plaques and neurofibrillary tangles d. Lack of gray matter

SITUATION 11: A 23 year-old man was voluntarily admitted to the inpatient unit with a diagnosis of paranoid schizophrenia. 49. As the nurse approaches the client, he says, If you come any closer, I ll die. This is an example of: a. Hallucination b. Delusion c. Illusion d. Idea of reference

50. Delusion is: a. Psychomotor disturbance b. Mood disturbance c. Disturbance of thought d. Disturbance of perception

51. When communicating with a paranoid client, the main principle is to: a. Use logic and be persistent b. Provide an anxiety-free environment c. Express doubt and do not argue d. Encourage ventilation of anger

52. The client tells his primary nurse that he s scheduled to meet the President of the Philippines a special time, making it impossible for the client to leave his room for dinner. Which of the following responses by the nurse is most appropriate?

a. b. c. d.

It s meal time. Let s go so you can eat. The President of the Philippines told me to take you to dinner. Your physician expects you to follow the unit s schedule. People who don t eat on this unit aren t being cooperative.

53. A schizophrenic patient who began taking haloperidol (Haloperidol) 1 week ago now exhibits jerking movements of the neck and mouth. These are signs of: a. Dystonia b. Psychosis c. Akathisia d. Parkinsonism

SITUATION 12: Nico, 27 yrs. old, is admitted for treatment of a major depression. 54. He is withdrawn, appears disheveled, and states, No one could ever love me. The nurse can expect the client to be placed on a. Antiparkinsonism medication b. Suicide precautions c. A low-salt diet d. Phototherapy

55. Which of the following behaviors indicates to the nurse that a client s major depression is improving? The client: a. Displays a blunted effect b. Has lost an additional 2 pounds c. States one good thing about himself d. Sleeps about 16 hours per day

56. Nico is scheduled for electroconvulsive therapy (ECT) tomorrow. The nurse would plan for which of the following activities? a. Force fluids 6 to 8 hours before treatment b. Administer succinylcholine (Inestine, Anectine) during pretreatment care c. Encourage the client s spouse to accompany him d. Reorient the client frequently during posttreatment care

57. Nico is recovering from a severe depression. Which of the following behaviors alerts the nurse to a risk for suicide?

a. The client sleeps most of the day b. The client has a plan to kill himself c. The client loses 5 pounds d. The client does not attend unit activities

58. Nico has been depressed severely depressed for 2 weeks. He had mentioned ending it all prior to admission. Which of the following questions should the nurse ask during the prescreen assessment? a. How long have you thought about harming yourself? b. What is it that makes you think about harming yourself? c. How has your concentration been? d. What specifically have you thought about doing to harm yourself?

SITUATION 13: A client is admitted with a diagnosis of Alzheimer s Disease. 59. When developing the plan of care for a client with Alzheimer s disease who is experiencing moderate impairment, which of the following types of care would the nurse expect to include? a. Considerable assistance with activities of daily living b. Managing complex medication schedule c. Constant supervision and total care d. Supervision of risky activities, such as shaving

60. Which of the following would be priority to include in the plan of care for a client with Alzheimer s disease who is experiencing difficulty processing and completing complex tasks? a. Repeating the directions until the client follows them b. Asking the client to do one step of the task at a time c. Demonstrating for the client how to do the task d. Maintaining routine and structure for the client

61. Clients with Alzheimer s disease may have delusions about being harmed by staff and others. When the client expresses fear of being killed by staff, which of the following responses would be most appropriate? a. What makes you think we want to kill you? b. We like you too much to want to kill you. c. You are in the hospital. We are nurses trying to help you. d. Oh, don t be so silly. No one wants to kill you here.

62. When helping the families of clients with Alzheimer s disease to cope with vulgar or sexual

behaviors, which of the following suggestions would be most helpful? a. Ignore the behaviors, but try to identify the purposes b. Give feedback on the inappropriateness of the behaviors c. Employ anger management strategies d. Administer the prescribed risperidone (Risperdal)

63. The nurse determines that the son of the client with Alzheimer s disease needs further education about the disease when he makes which of the following statements? a. I didn t realize the deterioration would be so incapacitating. b. The Alzheimer s support group has so much good information. c. I get tired of the same old stories, but I know it s important for Dad. d. I woke up this morning hoping that my old Dad would be back.

SITUATION 14: A 34-year old is hospitalized with bipolar disorder.

64. The nurse knows that the major factor that distinguishes a bipolar from a unipolar disorder is the a. Higher incidence in women b. Severity of the depression c. Genetic etiology d. Presence of mania

65. At 2 a.m. the nurse the nurse finds him phoning friends all across the country to discuss his new plan for eradicating world hunger. His excited explanations are keeping the entire unit awake, but he won t quiet down. The nurse caring for him knows the drug most likely to be prescribed for this client is: a. A tricyclic depressant b. An MAOI-inhibitor antidepressant c. Lithium carbonate (Eskalith) d. An antianxiety drug

66. Supportive therapy for a client who is exhibiting manic behavior may include all of the following EXCEPT: a. Psychoanalysis b. Cognitive therapy c. Interpersonal therapy d. Problem-solving therapy

67. The client is creating considerable chaos in a day treatment program with dominating and manipulative behavior. Which of the following nursing intervention is most appropriate? a. Allow the peer group to intervene b. Describe acceptable behavior and set realistic limits with the client c. Recommend the client to be hospitalized for treatment d. Tell client that his behavior is not appropriate

68. The client is skipping up and down the hallway practically running into other clients. Which of the following activities would the nurse expect to include in the client s plan of care? a. Leading a group activity b. Watching television c. Reading the newspaper d. Cleaning the dayroom tables

SITUATION 15: A client is admitted to outpatient surgery for cataract extraction on the right eye. 69. The client asks, What does the lens of my eye do? The nurse should explain that the lens of the eye: a. Produces aqueous humor b. Holds the rods and cones c. Focuses light rays onto the retina d. Regulates the amount of light entering the eye

70. The client would most likely to complain of which symptoms? a. Halos and rainbows around lights b. Eye pain and irritation that worsens at night c. Blurred and hazy vision d. Eye strain and headache when doing close work

71. The nurse is to instill drops of phenylephrine hydrochloride (Neo-Synephrine) into a client s right eye before cataract removal surgery. This preparation acts in the eye produce a. Dilatation of the pupil and blood vessels b. Dilatation of the pupil and constriction of blood vessels c. Constriction of the pupil and constriction of blood vessels d. Constriction of the pupil and dilatation of blood

72. A short time after cataract surgery, the client complains of nausea. Which of the following

represents the nurse s best course of action? a. Instruct the client to take a few deep breaths until the nausea subsides b. Explain that this is a common feeling that will pass quickly c. Tell the client to call the nurse promptly if vomiting occurs d. Medicate the client with an antiemetic, as ordered 73. Discharge planning would include: a. Wearing eye patches for the first 72 hours b. Lifting light objects is acceptable c. Bending with the knees and keep the head straight d. Bending with the waist is acceptable if slowly done SITUATION 16: A client is admitted with a diagnosis of Parkinson s disease. 74. Which of the following is an initial sign of Parkinson s disease? a. Rigidity b. Tremor c. Bradykinesia d. Akinesia

75. The nurse develops a teaching plan for a client newly diagnosed with Parkinson s disease. Which of the following topics that the nurse plans to discuss is the most important? a. Maintaining a balanced nutritional diet b. Enhancing the immune system c. Maintaining a safe environment d. Engaging in diversional activity

76. When does the nurse encourage a client with Parkinson s disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? a. Early in the morning, when the client s energy level is high b. To coincide with the peak action of drug therapy c. Immediately after a rest period d. When family members will be available

77. Which goal is the most realistic and appropriate for a client diagnosed with Parkinson s disease? a. To cure the disease b. To stop the progression of the disease c. To begin preparations for terminal care d. To maintain optimal body function

78. The client needs a long time to complete her morning hygiene, but she becomes annoyed when the nurse offers assistance and refuses all help. Which statement is the nurse s best initial response in this situation? a. Tell the client firmly that she needs assistance and help her with her care b. Praise the client for her desire to be independent and give her extra time and encouragement c. Tell the client that she is being unrealistic about her abilities and accept that she needs help d. Suggest to the client that if she insists on self care, she should at least modify her routine

SITUATION 17: A client is admitted to the hospital with Bell s Palsy. 79. A client with Bell s Palsy asks the nurse why artificial tears were ordered by the physician. Select the best reply by the nurse. a. When your affected eye fails to make tears, the eye can become irritated and ulcerated. b. Because your eye remains closed, foreign matter can be trapped beneath the lid. c. Artificial tears will remove the purulent drainage from your eye, which speeds healing. d. Because you cannot blink the affected eye, it can become dry and irritated.

80. Which nursing diagnosis takes priority for the patient with Bell s palsy? a. Risk for dysfunctional grieving b. Risk for injury related to corneal laceration c. Risk for chronic low self-esteem d. Risk for impaired physical mobility

81. The nurse observes that the client s right eye does not close completely. Based on this, which of the following nursing interventions would be most appropriate? a. Making sure the client wears her eyeglasses at all times b. Placing an eye patch over her eye c. Instilling artificial tears once every shift d. Cleansing the eye with a clean washcloth every shift

82. The client has a feeling of stiffness and a drawing sensation of the face. What would be an important teaching to the patient? a. Eye is susceptible to injury when eyelid does not close b. Drooling from an increased saliva on the affected area may occur c. Cleaning the eye will prevent ulceration d. All of the above

SITUATION 18: A 46-year old is admitted to the hospital because her family is unable to manage her constant hand washing rituals.

83. Her family reports she washes her hands at least 30 times each day. The nurse noticed the client s hands are reddened, scaly, and cracked. The main nursing goal is to: a. Remind the client several times of her appointment b. Limit the number of hand washings c. Tell her it is her responsibility to be there on time d. Provide ample time for her to complete her rituals

84. Which of the following is an appropriate treatment for this client? a. An unstructured schedule of activities b. A structured schedule of activities c. Intense counseling d. Negative reinforcement every time she performs her rituals

85. The most effective way for the nurse to intervene with her hand and face washing is to: a. Allow her a certain amount of time each shift to engage in this behavior b. Interrupt the activity briefly and frequently c. Lock the door to her room and restrict access to the bathroom d. Tell her to stop each time she is observed doing it

86. The client is also constipated and dehydrated. Which nursing intervention would the client be most likely to comply with? a. Drinking Ensure between meals b. Drinking extra fluids with meals c. Drinking 8 oz water every hour between meals d. Drinking adequate amounts of fluid during the day

87. Upon admission she was also dehydrated and underweight. The nurse and the client will know That discharge planning is appropriate when the client: a. Regains her normal body weight b. Expresses a desire to leave the hospital c. Is able to start talking about her guilt and anxiety d. Limits her hand and face washing to a few times a day

SITUATION 19: The nurse is caring for a client who is experiencing panic attack. 88. Which intervention would be most appropriate? a. Tell the client he s all right, and there is no need to panic b. Speak to the client in short, simple sentences c. Explain to the client that there s no need to worry because he s safe d. Give the client a detailed explanation of his panic reaction

89. The client reports that she often feels a choking sensation in her throat, a racing heart, dizziness and fearfulness. All of these symptoms have occurred almost daily for the past 3 months. Suspecting a psychological component to these symptoms, what would the nurse anticipate administering? a. Benzodiazepines b. Proton pump inhibitors c. Nitropusside d. Lithium carbonate

90. The client has a generalized anxiety disorder. Which statement is true about this client? a. The client has regular obsessions b. Relaxation techniques and psychotherapy are necessary for care c. Nightmares and flashbacks are common in individuals who suffer from generalized anxiety disorder d. Generalized anxiety disorder is characterized by anxiety that lasts longer than 6 months

91. The client is pacing and complains of racing thoughts. The nurse asks the client if something upsetting happens, and the client response is vague and not focused on nurse s question. The nurse assesses the client s level of anxiety as: a. Mild b. Moderate c. Severe d. Panic

92. Which of the following is a behavior manifestation of anxiety, except: a. Panic b. Tachycardia c. Hyperventilation d. Tachypnea SITUATION 20: Defense Mechanisms

93. Sam is diagnosed with cancer does not talk about or acknowledge the diagnosis. Which of the following defense mechanism is Sam using? a. Denial b. Identification c. Projection d. Rationalization

94. Nathaniel, released from prison for selling narcotics has been rehabilitated and now works for a youth drug prevention agency. Darwin is reflecting which of the following defense mechanism? a. Denial b. Displacement c. Identification d. Sublimation

95. Nina is admitted to the ICU with chest pain, an abnormal ECG, and elevated enzymes. When the significance of this is explained to her, she says, I can t be having a heart attack. No way. You must be mistaken. The nurse suspects the client is using which defense mechanism? a. Sublimation b. Regression c. Dissociation d. Denial 96. In patients with dissociative disorders, the defense mechanism most often used to block traumatic experiences is: a. Passive-aggression b. Reaction formation c. Denial d. Repression

97. The defense mechanism utilized by manic patients to cover up depression is: a. Displacement b. Denial c. Compensation d. Reaction formation SITUATION 21: Psychosomatic disorders 98. A man s family brought him onto the hospital because of his many somatic complaints. He has been seen by many medical specialists in the past without discovery of organic pathology. The nurse assesses

that the client is probably experiencing which of the following problems? a. Conversion disorder b. Body dysmorphic disorder c. Malingering d. Hypochondriasis

99. Amie is hospitalized for treatment of conversion disorder. She complained of paralysis of her right side after her husband threatened to leave her and their children. She seems unconcerned about her paralysis. An appropriate long term goal for the nurse to formulate is that client will: a. Cope effectively with stress without using conversion b. Identify stressors c. Express feelings about conflict d. Develop an increased sense of relatedness to others

100. A patient who reports paralysis with no specific cause but has a history of a recent stressful event has a probable diagnosis of: a. Hypochondriasis b. Somatic illness c. Conversion disorder d. Pain disorder