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COLEGIO DE DAGUPANCOLLEGE OF NURSING

NCM 101 PSYCHIATRIC NURSINGFINAL EXAMINATION

OCTOBER 16, 2010

1. Nurse Tony should first discuss terminating the nurse-client relationship with aclient during the:

a. Termination phase when discharge plans are being made.b. Working phase when the client shows some progress.c. Orientation phase when a contract is established.d. Working phase when the client brings it up.

2. To establish open and trusting relationship with a female client who has beenhospitalized with severe anxiety, the nurse in charge should?

a. Encourage the staff to have frequent interaction with the clientb. Share an activity with the clientc. Give client feedback about behavior d. Respect clients need for personal space

3. When teaching Mario with a typical depression about foods to avoid while takingphenelzine(Nardil), which of the following would the nurse in charge include?

a. Roasted chickenb. Fresh fishc. Salamid. Hamburger

4. When assessing a female client who is receiving tricyclic antidepressant therapy,which of the following would alert the nurse to the possibility that the client isexperiencing anticholinergic effects?

a. Urine retention and blurred visionb. Respiratory depression and convulsionc. Delirium and Sedationd. Tremors and cardiac arrhythmias

5. Danny who is diagnosed with bipolar disorder and acute mania, states the nurse,Where is my daughter? I love Louis. Rain, rain go away. Dogs eat dirt. Thenurse interprets these statements as indicating which of the following?

a. Echolaliab. Neologismc. Clang associationsd. Flight of ideas

6. Nurse Hazel is caring for a male client who experience false sensory perceptionswith no basis in reality. This perception is known as:

a. Hallucinationsb. Delusionsc. Loose associationsd. Neologisms

7. A female client is admitted with a diagnosis of delusions of GRANDEUR. Thisdiagnosis reflects a belief that one is:

a. Being Killedb. Highly famous and importantc. Responsible for evil world

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d. Connected to client unrelated to oneself

8. A 20 year old client was diagnosed with dependent personality disorder. Whichbehavior is not most likely to be evidence of ineffective individual coping?

a. Recurrent self-destructive behavior

b. Avoiding relationshipc. Showing interest in solitary activitiesd. Inability to make choices and decision without advise

9. A male client is diagnosed with schizotypal personality disorder. Which signswould this client exhibit during social situation?

a. Paranoid thoughtsb. Emotional affectc. Independence needd. Aggressive behavior

10. A 39 year old mother with obsessive-compulsive disorder has becomeimmobilized by her elaborate hand washing and walking rituals. Nurse Trishrecognizes that the basis of O.C. disorder is often:

a. Problems with being too conscientiousb. Problems with anger and remorsec. Feelings of guilt and inadequacyd. Feeling of unworthiness and hopelessness

11. Conney with borderline personality disorder who is to be discharge soonthreatens to do something to herself if discharged. Which of the followingactions by the nurse would be most important?

a. Ask a family member to stay with the client at home temporarilyb. Discuss the meaning of the clients statement with her c. Request an immediate extension for the clientd. Ignore the clients statement because its a sign of manipulation

12. Which of the following approaches would be most appropriate to use with a clientsuffering from narcissistic personality disorder when discrepancies exist betweenwhat the client states and what actually exist?

a. Rationalizationb. Supportive confrontationc. Limit settingd. Consistency

13. Joey a client with antisocial personality disorder belches loudly. A staff member asks Joey, Do you know why people find you repulsive? this statement mostlikely would elicit which of the following client reaction?

a. Defensivenessb. Embarrassmentc. Shamed. Remorsefulness

14. Nurse Tony was caring for a 41 year old female client. Which behavior by theclient indicates adult cognitive development?

a. Generates new levels of awarenessb. Assumes responsibility for her actionsc. Has maximum ability to solve problems and learn new skillsd. Her perception are based on reality

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15. When developing the plan of care for a client receiving haloperidol, which of thefollowing medications would nurse Monet anticipate administering if the clientdeveloped extra pyramidal side effects?

a. Olanzapine (Zyprexa)b. Paroxetine (Paxil)

c. Benztropinemesylate (Cogentin)d. Lorazepam (Ativan)

16. Jon a suspicious client states that I know you nurses are spraying my food withpoison as you take it out of the cart. Which of the following would be the bestresponse of the nurse?

a. Giving the client canned supplements until the delusion subsidesb. Asking what kind of poison the client suspects is being usedc. Serving foods that come in sealed packagesd. Allowing the client to be the first to open the cart and get a tray

17. A client is suffering from catatonic behaviors. Which of the following would thenurse use to determine that the medication administered PRN have been mosteffective?

a. The client responds to verbal directions to eatb. The client initiates simple activities without directionc. The client walks with the nurse to her roomd. The client is able to move all extremities occasionally

18. When planning care for Dory with schizotypal personality disorder, which of thefollowing would help the client become involved with others?

a. Attending an activity with the nurseb. Leading a sing a long in the afternoonc. Participating solely in group activitiesd. Being involved with primarily one to one activities

19. Which statement about an individual with a personality disorder is true?a. Psychotic behavior is common during acute episodesb. Prognosis for recovery is good with therapeutic interventionc. The individual typically remains in the mainstream of society,

although he has problems in social and occupational rolesd. The individual usually seeks treatment willingly for symptoms that are

personally distressful.

20. Nurse John is talking with a client who has been diagnosed with antisocialpersonality about how to socialize during activities without being seductive.Nurse John would focus the discussion on which of the following areas?

a. Discussing his relationship with his mother b. Asking him to explain reasons for his seductive behavior c. Suggesting to apologize to others for his behavior d. Explaining the negative reactions of others toward his behavior

21. Tina with a histrionic personality disorder is melodramatic and responds to othersand situations in an exaggerated manner. Nurse Trish would recommend whichof the following activities for Tina?

a. Baking classb. Role playingc. Scrap book makingd. Music group

22. Joey who has a chronic user of cocaine reports that he feels like he hascockroaches crawling under his skin. His arms are red because of scratching.

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The nurse in charge interprets these findings as possibly indicating which of thefollowing?

a. Delusionb. Formicationc. Flash back

d. Confusion23. When asking the parents about the onset of problems in young client with the

diagnosis of schizophrenia, Nurse Linda would expect that they would relate theclients difficulties began in:

a. Early childhoodb. Late childhoodc. Adolescenced. Puberty

24. Jose who has been hospitalized with schizophrenia tells Nurse Ron, My heart

has stopped and my veins have turned to glass! Nurse Ron is aware that this isan example of:a. Somatic delusionsb. Depersonalizationc. Hypochondriasisd. Echolalia

25. In recognizing common behaviors exhibited by male client who has a diagnosisof schizophrenia, nurse Josie can anticipate:

a. Slumped posture, pessimistic out look and flight of ideasb. Grandiosity, arrogance and distractibilityc. Withdrawal, regressed behavior and lack of social skillsd. Disorientation, forgetfulness and anxiety

26. One morning, nurse Diane finds a disturbed client curled up in the fetal positionin the corner of the dayroom. The most accurate initial evaluation of the behavior would be that the client is:

a. Physically ill and experiencing abdominal discomfortb. Tired and probably did not sleep well last nightc. Attempting to hide from the nursed. Feeling more anxious today

27. Nurse Bea notices a female client sitting alone in the corner smiling and talking toherself. Realizing that the client is hallucinating. Nurse Bea should:

a. Invite the client to help decorate the dayroomb. Leave the client alone until he stops talkingc. Ask the client why he is smiling and talkingd. Tell the client it is not good for him to talk to himself

28. When being admitted to a mental health facility, a young female adult tells NurseMylene that the voices she hears frighten her. Nurse Mylene understands thatthe client tends to hallucinate more vividly:

a. While watching TVb. During meal timec. During group activitiesd. After going to bed

29. Nurse John recognizes that paranoid delusions usually are related to the defensemechanism of:

a. Projectionb. Identification

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c. Repressiond. Regression

30. When planning care for a male client using paranoid ideation, nurse Jasminshould realize the importance of:

a. Giving the client difficult tasks to provide stimulationb. Providing the client with activities in which success can be achievedc. Removing stress so that the client can relaxd. Not placing any demands on the client

31. Nurse Gerry is aware that the defense mechanism commonly used by clientswho are alcoholics is:

a. Displacementb. Denialc. Projectiond. Compensation

32. Which nursing intervention is best for facilitating communication with apsychiatric client who speaks a foreign language?

a. Rely on nonverbal communication.b. Select symbolic pictures as aids.c. Speak in universal phrases.d. Use the services of an interpreter.

33. The nurse explains to a mental health care technician that a clients obsessive-compulsive personality are related to unconscious conflict between id impulsesand the superego (or conscience). On which of the following theories does thenurse base this statement?

a. Behavioral theoryb. Cognitive theoryc. Interpersonal theoryd. Psychoanalytic theory

34. The nurse observes a client pacing in the hall. Which statement by the nursemay help the client recognize his anxiety?

a. I guess youre worried about something, arent you?b. Can I get you some medication to help calm you?c. Have you been pacing for a long time?d. I notice that youre pacing. How are you feeling?

35. A client tells a nurse. Everyone would be better off if I wasnt alive. Whichnursing diagnosis would be made based on this statement?

a. Disturbed thought processesb. Ineffective copingc. Risk for self-directed violenced. Impaired social interaction

36. Which information is most essential in the initial teaching session for the family of a young adult recently diagnosed with schizophrenia?

a. Symptoms of this disease imbalance in the brain.b. Genetic history is an important factor related to the development of

schizophrenia.c. Schizophrenia is a serious disease affecting every aspect of a persons

functioning.d. The distressing symptoms of this disorder can respond to treatment

with medications.

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37. A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the clients delusional perceptions would thenurse establish?

a. The client will demonstrate realistic interpretation of daily events inthe unit.

b. The client will perform daily hygiene and grooming without assistance.c. The client will take prescribed medications without difficulty.d. The client will participate in unit activities.

38. A client who abuses alcohol and cocaine tells a nurse that he only usessubstances because of his stressful marriage and difficult job. Which defensemechanisms is this client using?

a. Displacementb. Projectionc. Rationalizationd. Sublimation

39. Two nurses are co-leading group therapy for seven clients in the psychiatric unit.The leaders observe that the group members are anxious and look to the leadersfor answers. Which phase of development is this group in?

a. Conflict resolution phaseb. Initiation phasec. Working phased. Termination phase

40. Group members have worked very hard, and the nurse reminds them thattermination is approaching. Termination is considered successful if groupmembers:

a. Decide to continue.b. Elevate group progressc. Focus on positive experienced. Stop attending prior to termination.

41. A client taking the monoamine oxidase inhibitor (MAOI) antidepressantisocarboxazid (Marplan) is instructed by the nurse to avoid which foods andbeverages?

a. Aged cheese and red wineb. Milk and green, leaf vegetablesc. Carbonated beverages and tomato productsd. Lean red meats and fruit juices

42. Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurseshould:

a. Assess skin color and sclerab. Assess the radial pulsec. Take the clients blood pressured. Ask the client to void

43. The nurse understands that electroconvulsive therapy is primary used inpsychiatric care for the treatment of:

a. Anxiety disorders.b. Depression.c. Mania.d. Schizophrenia.

44. A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takesall of the medications listed below. Which medication would cause the nurse toexpress concern and therefore initiate further teaching?

a. Acetaminophen (Tylenol)

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b. Diphenhydramine (Benadryl)c. Furosemide (Lasix)d. Isosorbidedinitrate (Isordil)

45. The nurse is administering a psychotropic drug to an elderly client who has

history of benign prostatic hypertrophy. It is most important for the nurse to teachthis client to:a. Add fiber to his diet.b. Exercise on a regular basis.c. Report incomplete bladder emptyingd. Take the prescribed dose at bedtime.

46. The nurse correctly teaches a client taking the benzodiazepine oxazepam(Serax) to avoid excessive intake of:

a. Cheeseb. Coffee

c. Sugar d. Shellfish

47. The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client.The medication is labeled haloperidol 10 mg/2 ml. The nurse prepares thecorrect dose by drawing up how many milliliters in the syringe?

a. 0.3b. 0.4c. 0.5d. 0.6

48. The nurse enters the room of a client with a cognitive impairment disorder andasks what day of the week it is: what the date, month, and year are; and wherethe client is. The nurse is attempting to assess:

a. Confabulationb. Deliriumc. Orientationd. Perseveration

49. Which of the following will the nurse use when communicating with a client whohas a cognitive impairment?

a. Complete explanations with multiple detailsb. Picture or gestures instead of wordsc. Stimulating words and phrases to capture the clients attentiond. Short words and simple sentences

50. The parents of a young man with schizophrenia express feelings of responsibilityand guilt for their sons problems. How can the nurse best educate the family?

a. Acknowledge the parents responsibility.b. Explain the biological nature of schizophrenia.c. Refer the family to a support groupd. Teach the parents various ways they must change.

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