Affect The outward manifestation of a persons feelings, tone or mood.

Affect and emotions are commonly used

interchangeable.
Agitation Excessive motor activity, usually purposeless and associated with internal tension. Examples: inability to sit still, pacing,
wringing of hands, or pulling of clothing.
Akathisia Motor restlessness ranging from a feeling of inner disquiet, often localized in the muscles, to inability to sit still or lie
quietly, a side effect of some antipsychotic drugs.
Akinesia A side effect of the antipsychotic drugs characterized by a general lack of motor movement in the patient, as well as a
slowing down of speech and responsiveness.
Ambivalence The coexistence of contradictory emotions, attitudes, ideas, or desires with respect to a particular person, object, or
situation. Suggests psychopathology only when present in an extreme form.
Anhedonia Loss of interest and/or pleasure in usual activities associated with depression.
Anxiety Apprehension, tension or uneasiness that stems from the anticipation of a danger, whose source is largely unknown.
Primarily of intrapsychic origin. (top)
Catatonia Immobility with muscular rigidity or inflexibility and at times excitability most often seen in schizophrenia.
Circumstantiality In conversation, the use of excessive and irrelevant detail in describing simple events, the speaker eventually reaching
his goal only after many digressions.
Clang Association In thinking, the association of words by sound rather than meaning, after resulting in nonsensical rhymes and puns.
Cognitive Refers to the mental process of comprehension, judgement, memory, and reasoning, as contrasted with emotional and
volitional processes.
compulsion An insistent, repetitive, intrusive and unwanted urge to perform an act that is contrary to one’s ordinary wishes and
standard.
Confabulation Fabrication of facts or events in response to questions about events that are not recalled because of memory
impairment.
Confict A mental struggle that arises from the simultaneous operation of opposing impulses, drives external or internal
demands (intra psychic when the conflict is between internal forces – extra psychic when the conflict is between self
and the environment.
confusion Disturbed orientation in respect to time, place or person.
Counter transference The therapist’s partly unconscious or conscious emotional reactions to the patient. (top)
Defense Mechanisms Patterns of feelings, thoughts, or behaviors that arc relatively involuntary and arise in response to perceptions of
psychic danger to alleviate the conflicts or stressors that give rise to anxiety. May be either maladaptive or adaptive,
depending on their severity, their inflexibility, arid the context in which they occur. Some common defense
mechanisms arc compensation, conversion, denial, displacement, dissociation, intellectualization, repression,
projection, somatization, suppression, undoing, splitting, idealization, reaction formation.
Delirium A clouding of consciousness, marked by reduced ability to focus on and sustain attention to environmental stimuli.
Usually of abrupt onset, the syndrome develops over a short period of time with symptoms fluctuating in severity over
the course of a day. Perceptual disturbance, incoherent speech, sleep-wake disturbance, emotional liability,
disorientation and memory impairment may be present. Condition is reversible except when followed by dementia or
death.
Delirium tremors An acute and sometimes fatal brain disorder caused by total or partial withdrawal from excessive alcohol intake.
Usually develops in 24 to 96 hours after cessation of drinking. Symptoms include fever, tremors, ataxia, and
sometimes convulsions, frightening illusions, delusions, and hallucinations.
Delusion A firm, fixed idea not amenable to rational explanation and maintained despite objective evidence to the contrary.
Some types of common delusions are delusions of being controlled, delusions of grandeur, delusions or persecution
and somatic delusions.
Dementia A deterioration of intellectual abilities of sufficient severity to interfere with social or occupational functioning.
Dementia may follow a progressive, static, or remitting course depending on the underlying etiology. Memory
disturbance is the most prominent symptom. In addition there is impairment of abstract thinking, judgement, impulse
control, and/or personality change.
Depersonalization An alteration in the perception or experience of the self so that the feelings of one’s own reality is temporarily lost; a
sense of unreality.
Dystonia Acute tonic muscular spasms, often of the tongue, jaw, eyes and neck but sometimes of the whole body.
Reactions may come on quickly and dramatically, A treatable side effect of antipsychotic drugs.
Echolalia Repetition (echoing) of words or phrases of others.
Echopraxia The pathological repetition by imitation of the movements of another person.
Flight of Ideas A nearly continuous flow or accelerated speech with abrupt changes from topic to topic, usually based on
understandable associations, distracting stimuli, or plays on words.
Grandiosity An inflated appraisal of one’s worth, power knowledge, importance, or identity.
Hallucinations A sensory impression in the absence of any external stimuli; can arise in respect to any sensory modality – visual,
auditory, olfactory, tactile or gustatory.
Hypomania Abnormality of mood but even normal euphoria and mania. Characterized by optimism, pressure of speech and
activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment
and irritability.
Ideas of influence The conviction that one’s behavior, including one’s thoughts is being influenced in some way by an external agency,
when in fact it is not.
Ideas of reference The interpretation of external events, especially the actions and statements of other people, as having reference to one’s
self when in fact they do not.
Loose Associations Thinking that is overgeneralized, diffuse, and vague with only a tenuous connection between one thought and the next.
Mania A mood disorder characterized by excessive elation, hyperactivity, agitation,- and accelerated thinking and speaking –
sometimes manifested as flight of ideas. Mania is seen in major affective disorders and in some organic mental
disorders.
Mood A pervasive and sustained emotion that in the extreme markedly colors one’s perception of the world. ‘ Examples of
mood include depression, elation, and anger.
Obsession A persistent, unwanted idea or impulse that can not be eliminated by logic or reasoning. (top)
Panic Attacks Sudden onset of intense apprehension, fearfulness, or terror – is accompanied by physiological changes.
Paranoid Ideation Suspiciousness or nondelusional belief that one is being harassed, persecuted, or unfairly treated.
Parkinson’s : A treatable syndrome of side effects from antipsychotic medication which appear after one or two weeks and that is
characterized by resting tremor, muscle rigidity, including a mask-like face; slow motor movement, and a stooped,
shuffling gait.
Preservation The emission of the same verbal or motor response again and again to varied stimuli, despite the parson’s effort to
move on.
Phobia An obsessive, persistent, unrealistic intense fear of an object or situation.
Posturing Maintaining an unusual or awkward posture for a considerable amount of time.
Poverty of Thought Few verbal communications or ones that convey little information because of vagueness, empty repetitions, or
stereotyped or obscure phrases.
Pseudodementia Clinical features resembling a dementia that are not due to organic brain dysfunction or disease.
Psychomotor Excessive motor activity associated with a feeling of inner tension, the activity is usually non productive and
repetitious.
Retardation
Psychomotor Visible generalized slowing down of physical reactions, movements, and speech.
Agitation
Psychosis A major mental disorder of organic or emotional origin in which a person’s ability to think, respond emotionally,
remember, communicate, interpret reality, and behave appropriately is sufficiently impaired so as to interfere grossly
with the capacity to meet the ordinary demands of life. Often characterized by regressive behavior, inappropriate
mood, diminished impulse control, and such abnormal mental content as delusions and hallucinations.
Psychosomatic The constant and inseparable interaction of the psyche (mind) and the soma (body). Commonly used to refer to
illnesses in which the manifestations are primarily physical with at least a partial emotional etiology. (top)
Tangential In conversation, digressions that divert the speaker from his goal, which he never reaches; to be distinguished from
circumstantial in which the goal is eventually reached.
Tardive Dyskinesia Literally ‘late appearing abnormal movements;’ a variable complex of choreiform or athetoid movements developing
in patients exposed to antipsychotic drugs. Typical movements include tongue-writhing or protrusion, chewing, lip-
puckcring, choreiform finger movements, toe and ankle movements, leg-jiggling, or movements of neck, trunk, and
pelvis.
Thought Blocking A sudden obstruction or interruption in the train of thought or speech, which the person is unable to complete.
Thought A symptom of psychosis in which the patient believes that thoughts are broadcast outside the head so that other
persons can actually hear them.
Broadcasting
Thought insertion The patient’s belief that thoughts that are not the patient’s own Can be inserted into his mind.
Thought Withdrawal An interruption in the train of thought perceived by tile person as someone removing or taking away his thoughts.

1. Mental health is defined as:

A. The ability to distinguish what is
real from what is not.
B. A state of well-being where a
person can realize his own abilities can
cope with normal stresses of life and
work productively.
C. Is the promotion of mental health,
prevention of mental disorders, nursing
care of patients during illness and
rehabilitation
D. Absence of mental illness
Answer: (B) A state of well-being
where a person can realize his own
abilities can cope with normal stresses
of life and work productively.
Mental health is a state of emotional
and psychosocial well being. A
mentally healthy individual is self
aware and self directive, has the ability
to solve problems, can cope with crisis
without assistance beyond the support
of family and friends fulfill the
capacity to love and work and sets
goals and realistic limits. A. This
describes the ego function reality
testing. C. This is the definition of
Mental Health and Psychiatric
Nursing. D. Mental health is not just
the absence of mental illness.
2. Which of the following describes
the role of a technician?
A. Administers medications to a
schizophrenic patient.
B. The nurse feeds and bathes a
catatonic client
C. Coordinates diverse aspects of care
rendered to the patient
D. Disseminates information about
alcohol and its effects.
Answer: (A) Administers medications
to a schizophrenic patient.
Administration of medications and
treatments, assessment, documentation
are the activities of the nurse as a
technician. B. Activities as a parent
surrogate. C. Refers to the ward
manager role. D. Role as a teacher.
3. Liza says, “Give me 10 minutes to
recall the name of our college
professor who failed many students in
our anatomy class.” She is operating
on her:
A. Subconscious
B. Conscious
C. Unconscious
D. Ego
Answer: (A) Subconscious
Subconscious refers to the materials
that are partly remembered partly
forgotten but these can be recalled
spontaneously and voluntarily. B. This
functions when one is awake. One is
aware of his thoughts, feelings actions
and what is going on in the
environment. C. The largest potion of
the mind that contains the memories of
one’s past particularly the unpleasant.
It is difficult to recall the unconscious
content. D. The conscious self that
deals and tests reality.
4. The superego is that part of the
psyche that:
A. Uses defensive function for
protection. (ego)
B. Is impulsive and without morals. (id)
C. Determines the circumstances
before making decisions. (ego)
D. The censoring portion of the mind.
Answer: (D) The censoring portion of
the mind.
The critical censoring portion of one’s
personality; the conscience. A. This
refers to the ego function that protects
itself from anything that threatens it..
B. The Id is composed of the untamed,
primitive drives and impulses. C. This
refers to the ego that acts as the
moderator of the struggle between the
id and the superego.
5. Primary level of prevention is
exemplified by:
A. Helping the client resume self care.
B. Ensuring the safety of a suicidal
client in the institution.
C. Teaching the client stress
management techniques
D. Case finding and surveillance in the
community
Answer: (C) Teaching the client stress
management techniques
Primary level of prevention refers to
the promotion of mental health and
prevention of mental illness. This can
be achieved by rendering health
teachings such as modifying ones
responses to stress. A. This is tertiary
level of prevention that deals with
rehabilitation. B and D. Secondary
level of prevention which involves
reduction of actual illness through
early detection and treatment of
illness.
6. Situation: In a home visit done by
the nurse, she suspects that the wife
and her child are victims of abuse.
Which of the following is the most
appropriate for the nurse to ask?
A. “Are you being threatened or hurt
by your partner?
B. “Are you frightened of you partner”
C. “Is something bothering you?”
D. “What happens when you and your
partner argue?”
Answer: (A) “Are you being
threatened or hurt by your partner?
The nurse validates her observation by
asking simple, direct question. This
also shows empathy. B, C, and D are
indirect questions which may not lead
to the discussion of abuse.
7. The wife admits that she is a victim
of abuse and opens up about her
persistent distaste for sex. This sexual
disorder is:
A. Sexual desire disorder
B. Sexual arousal Disorder
C. Orgasm Disorder
D. Sexual Pain Disorder
Answer: (A) Sexual desire disorder
Has little or no sexual desire or has
distaste for sex. B. Failure to maintain
the physiologic requirements for
sexual intercourse. C. Persistent and
recurrent inability to achieve an
orgasm. D. Also called dyspareunia.
Individuals with this disorder suffer
genital pain before, during and after
sexual intercourse.
8. What would be the best approach
for a wife who is still living with her
abusive husband?
A. “Here’s the number of a crisis
center that you can call for help .”
B. “Its best to leave your husband.”
C. “Did you discuss this with your
family?”
D. “ Why do you allow yourself to be
treated this way”
Answer: (A) “Here’s the number of a
crisis center that you can call for help
.”
Protection is a priority concern in
abuse. Help the victim to develop a
plan to ensure safety. B. Do not give
advice to leave the abuser. Making
decisions for the victim further erodes
her esteem. However discuss options
available. C. The victim tends to
isolate from friends and family. D.
This is judgmental. Avoid in anyway
implying that she is at fault.
9. Which comment about a 3 year old
child if made by the parent may
indicate child abuse?
A. “Once my child is toilet trained, I
can still expect her to have some”
B. “When I tell my child to do
something once, I don’t expect to have
to tell”
C. “My child is expected to try to do
things such as, dress and feed.”
D. “My 3 year old loves to say NO.”
Answer: (B) “When I tell my child to
do something once, I don’t expect to
have to tell”
Abusive parents tend to have
unrealistic expectations on the child.
A,B and C are realistic expectations on
a 3 year old.
10. The primary nursing intervention
for a victim of child abuse is:
A. Assess the scope of the problem
B. Analyze the family dynamics
C. Ensure the safety of the victim
D. Teach the victim coping skills
Answer: (C) Ensure the safety of the
victim
The priority consideration is the safety
of the victim. Attend to
the physical injuries to ensure the
physiologic safety and integrity of the
child. Reporting suspected case of
abuse may deter recurrence of abuse.
A,B and D may be addressed later.
11. Situation: A 30 year old male
employee frequently complains of low
back pain that leads to frequent
absences from work. Consultation and
tests reveal negative results.
The client has which somatoform
disorder?
A. Somatization Disorder
B. Hypochondriaisis
C. Conversion Disorder
D. Somatoform Pain Disorder
Answer: (D) Somatoform Pain
Disorder
This is characterized by severe and
prolonged pain that causes significant
distress. A. This is a chronic syndrome
of somatic symptoms that cannot be
explained medically and is associated
with psychosocial distress. B. This is
an unrealistic preoccupation with a
fear of having a serious illness. C.
Characterized by alteration or loss in
sensory or motor function resulting
from a psychological conflict.
12. Freud explains anxiety as:
A. Strives to gratify the needs for
satisfaction and security
B. Conflict between id and superego
C. A hypothalamic-pituitary-adrenal
reaction to stress
D. A conditioned response to stressors
Answer: (B) Conflict between id and
superego
Freud explains anxiety as due to
opposing action drives between the id
and the superego. A. Sullivan
identified 2 types of needs, satisfaction
and security. Failure to gratify these
needs may result in anxiety. C.
Biomedical perspective of anxiety. D.
Explanation of anxiety using the
behavioral model.
13. The following are appropriate
nursing diagnosis for the client
EXCEPT:
A. Ineffective individual coping
B. Alteration in comfort, pain
C. Altered role performance
D. Impaired social interaction
Answer: (D) Impaired social
interaction
The client may not have difficulty in
social exchange. The cues do not
support this diagnosis. A. The client
maladaptively uses body symptoms to
manage anxiety. B. The client will
have discomfort due to pain. C. The
client may fail to meet environmental
expectations due to pain.
14. The following statements describe
somatoform disorders:
A. Physical symptoms are explained
by organic causes
B. It is a voluntary expression of
psychological conflicts
C. Expression of conflicts through
bodily symptoms
D. Management entails a specific
medical treatment
Answer: (C) Expression of conflicts
through bodily symptoms
Bodily symptoms are used to handle
conflicts. A. Manifestations do not
have an organic basis. B. This occurs
unconsciously. D. Medical treatment is
not used because the disorder does not
have a structural or organic basis.
15. What would be the best response to
the client’s repeated complaints of
pain:
A. “I know the feeling is real tests
revealed negative results.”
B. . “I think you’re exaggerating things
a little bit.”
C. “Try to forget this feeling and have
activities to take it off your mind”
D. “So tell me more about the pain”
Answer: (A) “I know the feeling is real
tests revealed negative results.”
Shows empathy and offers
information. B. This is a demeaning
statement. C. This belittles the client’s
feelings. D. Giving undue attention to
the physical symptom reinforces the
complaint.
16. Situation: A nurse may encounter
children with mental disorders. Her
knowledge of these various disorders
is vital.
When planning school interventions
for a child with a diagnosis of attention
deficit hyperactivity disorder, a guide
to remember is to:
A. provide as much structure as
possible for the child
B. ignore the child’s overactivity.
C. encourage the child to engage in
any play activity to dissipate energy
D. remove the child from the
classroom when disruptive behavior
occurs
Answer: (A) provide as much structure
as possible for the child
Decrease stimuli for behavior control
thru an environment that is free of
distractions, a calm non –
confrontational approach and setting
limit to time allotted for activities. B.
The child will not benefit from a
lenient approach. C. Dissipate energy
through safe activities. D. This
indicates that the classroom
environment lacks structure.
17. The child with conduct disorder
will likely demonstrate:
A. Easy distractibility to external
stimuli.
B. Ritualistic behaviors
C. Preference for inanimate objects.
D. Serious violations of age related
norms.
Answer: (D) Serious violations of age
related norms.
This is a disruptive disorder among
children characterized by more serious
violations of social standards such as
aggression, vandalism, stealing, lying
and truancy. A. This is characteristic
of attention deficit disorder. B and C.
These are noted among children with
autistic disorder.
18. Ritalin is the drug of choice for
chidren with ADHD. The side effects
of the following may be noted:
A. increased attention span and
concentration
B. increase in appetite
C. sleepiness and lethargy
D. bradycardia and diarrhea
Answer: (A) increased attention span
and concentration
The medication has a paradoxic effect
that decrease hyperactivity and
impulsivity among children with
ADHD. B, C, D. Side effects of Ritalin
include anorexia, insomnia, diarrhea
and irritability.
19. School phobia is usually treated
by:
A. Returning the child to the school
immediately with family support.
B. Calmly explaining why attendance
in school is necessary
C. Allowing the child to enter the
school before the other children
D. Allowing the parent to accompany
the child in the classroom
Answer: (A) Returning the child to the
school immediately with family
support.
Exposure to the feared situation can
help in overcoming anxiety. A. This
will not help in relieving the anxiety
due separation from a significant other.
C. and C. Anxiety in school phobia is
not due to being in school but due to
separation from parents/caregivers so
these interventions are not applicable.
D. This will not help the child
overcome the fear
20. A 10 year old child has very
limited vocabulary and interaction
skills. She has an I.Q. of 45. She is
diagnosed to have Mental retardation
of this classification:
A. Profound
B. Mild
C. Moderate
D. Severe
Answer: (C) Moderate
The child with moderate mental
retardation has an I.Q. of 35-50
Profound Mental retardation has an
I.Q. of below 20; Mild mental
retardation 50-70 and Severe mental
retardation has an I.Q. of 20-35.
21. The nurse teaches the parents of a
mentally retarded child regarding her
care. The following guidelines may be
taught except:
A. overprotection of the child
B. patience, routine and repetition
C. assisting the parents set realistic
goals
D. giving reasonable compliments
Answer: (A) overprotection of the
child
The child with mental retardation
should not be overprotected but need
protection from injury and the teasing
of other children. B,C, and D Children
with mental retardation have learning
difficulty. They should be taught with
patience and repetition, start from
simple to complex, use visuals and
compliment them for motivation.
Realistic expectations should be set
and optimize their capability.
22. The parents express apprehensions
on their ability to care for their
maladaptive child. The nurse identifies
what nursing diagnosis:
A. hopelessness
B. altered parenting role
C. altered family process
D. ineffective coping
Answer: (B) altered parenting role
Altered parenting role refers to the
inability to create an environment that
promotes optimum growth and
development of the child. This is
reflected in the parent’s inability to
care for the child. A. This refers to
lack of choices or inability to mobilize
one’s resources. C. Refers to change in
family relationship and function. D.
Ineffective coping is the inability to
form valid appraisal of the stressor or
inability to use available resources
23. A 5 year old boy is diagnosed to
have autistic disorder.
Which of the following manifestations
may be noted in a client with autistic
disorder?
A. argumentativeness, disobedience,
angry outburst
B. intolerance to change, disturbed
relatedness, stereotypes
C. distractibility, impulsiveness and
overactivity
D. aggression, truancy, stealing, lying
Answer: (B) intolerance to change,
disturbed relatedness, stereotypes
These are manifestations of autistic
disorder. A. These manifestations are
noted in Oppositional Defiant
Disorder, a disruptive disorder among
children. C. These are manifestations
of Attention Deficit Disorder D. These
are the manifestations of Conduct
Disorder
24. The therapeutic approach in the
care of an autistic child include the
following EXCEPT:
A. Engage in diversionary activities
when acting -out
B. Provide an atmosphere of
acceptance
C. Provide safety measures
D. Rearrange the environment to
activate the child
Answer: (D) Rearrange the
environment to activate the child
The child with autistic disorder does
not want change. Maintaining a
consistent environment is therapeutic.
A. Angry outburst can be rechannelled
through safe activities. B. Acceptance
enhances a trusting relationship. C.
Ensure safety from self-destructive
behaviors like head banging and hair
pulling.
25. According to Piaget a 5 year old is
in what stage of development:
A. Sensory motor stage
B. Concrete operations
C. Pre-operational
D. Formal operation
Answer: (C) Pre-operational
Pre-operational stage (2-7 years) is the
stage when the use of language, the
use of symbols and the concept of time
occur. A. Sensory-motor stage (0-2
years) is the stage when the child uses
the senses in learning about the self
and the environment through
exploration. B. Concrete operations (7-
12 years) when inductive reasoning
develops. D. Formal operations (2 till
adulthood) is when abstract thinking
and deductive reasoning develop.
26. Situation : The nurse assigned in
the detoxification unit attends to
various patients with substance-related
disorders.
A 45 years old male revealed that he
experienced a marked increase in his
intake of alcohol to achieve the desired
effect This indicates:
A. withdrawal
B. tolerance
C. intoxication
D. psychological dependence
Answer: (B) tolerance
tolerance refers to the increase in the
amount of the substance to achieve the
same effects. A. Withdrawal refers to
the physical signs and symptoms that
occur when the addictive substance is
reduced or withheld. B. Intoxication
refers to the behavioral changes that
occur upon recent ingestion of a
substance. D. Psychological
dependence refers to the intake of the
substance to prevent the onset of
withdrawal symptoms.
27. The client admitted for alcohol
detoxification develops increased
tremors, irritability, hypertension and
fever. The nurse should be alert for
impending:
A. delirium tremens
B. Korsakoff’s syndrome
C. esophageal varices
D. Wernicke’s syndrome
Answer: (A) delirium tremens
Delirium Tremens is the most extreme
central nervous system irritability due
to withdrawal from alcohol B. This
refers to an amnestic syndrome
associated with chronic alcoholism due
to a deficiency in Vit. B C. This is a
complication of liver cirrhosis which
may be secondary to alcoholism . D.
This is a complication of alcoholism
characterized by irregularities of eye
movements and lack of coordination.
28. The care for the client places
priority to which of the following:
A. Monitoring his vital signs every
hour
B. Providing a quiet, dim room
C. Encouraging adequate fluids and
nutritious foods
D. Administering Librium as ordered
Answer: (A) Monitoring his vital signs
every hour
Pulse and blood pressure are usually
elevated during withdrawal, Elevation
may indicate impending delirium
tremens B. Client needs quiet, well
lighted, consistent and secure
environment. Excessive stimulation
can aggravate anxiety and cause
illusions and hallucinations. C.
Adequate nutrition with sulpplement
of Vit. B should be ensured. D.
Sedatives are used to relieve anxiety.
29. Another client is brought to the
emergency room by friends who state
that he took something an hour ago.
He is actively hallucinating, agitated,
with irritated nasal septum.
A. Heroin
B. cocaine
C. LSD
D. marijuana
Answer: (B) cocaine
The manifestations indicate
intoxication with cocaine, a CNS
stimulant. A. Intoxication with heroine
is manifested by euphoria then
impairment in judgment, attention and
the presence of papillary constriction.
C. Intoxication with hallucinogen like
LSD is manifested by grandiosity,
hallucinations, synesthesia and
increase in vital signs D. Intoxication
with Marijuana, a cannabinoid is
manifested by sensation of slowed
time, conjunctival redness, social
withdrawal, impaired judgment and
hallucinations.
30. A client is admitted with needle
tracts on his arm, stuporous and with
pin point pupil will likely be managed
with:
A. Naltrexone (Revia)
B. Narcan (Naloxone)
C. Disulfiram (Antabuse)
D. Methadone (Dolophine)
Answer: (B) Narcan (Naloxone)
Narcan is a narcotic antagonist used to
manage the CNS depression due to
overdose with heroin. A. This is an
opiate receptor blocker used to relieve
the craving for heroine C. Disulfiram
is used as a deterrent in the use of
alcohol. D. Methadone is used as a
substitute in the withdrawal from
heroine
31. Situation: An old woman was
brought for evaluation due to the
hospital for evaluation due to
increasing forgetfulness and
limitations in daily function.
The daughter revealed that the client
used her toothbrush to comb her hair.
She is manifesting:
A. apraxia
B. aphasia
C. agnosia
D. amnesia
Answer: (C) agnosia
This is the inability to recognize
objects. A. Apraxia is the inability to
execute motor activities despite intact
comprehension. B. Aphasia is the loss
of ability to use or understand words.
D. Amnesia is loss of memory.
32. She tearfully tells the nurse “I can’t
take it when she accuses me of stealing
her things.” Which response by the
nurse will be most therapeutic?
A. ”Don’t take it personally. Your
mother does not mean it.”
B. “Have you tried discussing this with
your mother?”
C. “This must be difficult for you and
your mother.”
D. “Next time ask your mother where
her things were last seen.”
Answer: (C) “This must be difficult for
you and your mother.”
This reflecting the feeling of the
daughter that shows empathy. A and
D. Giving advise does not encourage
verbalization. B. This response does
not encourage verbalization of
feelings.
33. The primary nursing intervention
in working with a client with moderate
stage dementia is ensuring that the
client:
A. receives adequate nutrition and
hydration
B. will reminisce to decrease isolation
C. remains in a safe and secure
environment
D. independently performs self care
Answer: (C) remains in a safe and
secure environment
Safety is a priority consideration as the
client’s cognitive ability deteriorates..
A is appropriate interventions because
the client’s cognitive impairment can
affect the client’s ability to attend to
his nutritional needs, but it is not the
priority B. Patient is allowed to
reminisce but it is not the priority. D.
The client in the moderate stage of
Alzheimer’s disease will have
difficulty in performing activities
independently
34. She says to the nurse who offers
her breakfast, “Oh no, I will wait for
my husband. We will eat together” The
therapeutic response by the nurse is:
A. “Your husband is dead. Let me
serve you your breakfast.”
B. “I’ve told you several times that he
is dead. It’s time to eat.”
C. “You’re going to have to wait a
long time.”
D. “What made you say that your
husband is alive?
Answer: (A) “Your husband is dead.
Let me serve you your breakfast.”
The client should be reoriented to
reality and be focused on the here and
now.. B. This is not a helpful approach
because of the short term memory of
the client. C. This indicates a pompous
response. D. The cognitive limitation
of the client makes the client incapable
of giving explanation.
35. Dementia unlike delirium is
characterized by:
A. slurred speech
B. insidious onset
C. clouding of consciousness
D. sensory perceptual change
Answer: (B) insidious onset
Dementia has a gradual onset and
progressive deterioration. It causes
pronounced memory and cognitive
disturbances. A,C and D are all
characteristics of delirium.
36. Situation: A 17 year old gymnast is
admitted to the hospital due to weight
loss and dehydration secondary to
starvation.
Which of the following nursing
diagnoses will be given priority for the
client?
A. altered self-image
B. fluid volume deficit
C. altered nutrition less than body
requirements
D. altered family process
Answer: (B) fluid volume deficit
Fluid volume deficit is the priority
over altered nutrition (A) since the
situation indicates that the client is
dehydrated. A and D are psychosocial
needs of a client with anorexia nervosa
but they are not the priority.
37. What is the best intervention to
teach the client when she feels the
need to starve?
A. Allow her to starve to relieve her
anxiety
B. Do a short term exercise until the
urge passes
C. Approach the nurse and talk out her
feelings
D. Call her mother on the phone and
tell her how she feels
Answer: (C) Approach the nurse and
talk out her feelings
The client with anorexia nervosa uses
starvation as a way of managing
anxiety. Talking out feelings with the
nurse is an adaptive coping. A.
Starvation should not be encouraged.
Physical safety is a priority. Without
adequate nutrition, a life threatening
situation exists. B. The client with
anorexia nervosa is preoccupied with
losing weight due to disturbed body
image. Limits should be set on
attempts to lose more weight. D. The
client may have a domineering mother
which causes the client to feel
ambivalent. The client will not discuss
her feelings with her mother.
38. The client with anorexia nervosa is
improving if:
A. She eats meals in the dining room.
B. Weight gain
C. She attends ward activities.
D. She has a more realistic self
concept.
Answer: (B) Weight gain
Weight gain is the best indication of
the client’s improvement. The goal is
for the client to gain 1-2 pounds per
week. (A)The client may purge after
eating. (C) Attending an activity does
not indicate improvement in nutritional
state. (D) Body image is a factor in
anorexia nervosa but it is not an
indicator for improvement.
39. The characteristic manifestation
that will differentiate bulimia nervosa
from anorexia nervosa is that bulimic
individuals
A. have episodic binge eating and
purging
B. have repeated attempts to stabilize
their weight
C. have peculiar food handling
patterns
D. have threatened self-esteem
Answer: (A) have episodic binge
eating and purging
Bulimia is characterized by binge
eating which is characterized by taking
in a large amount of food over a short
period of time. B and C are
characteristics of a client with anorexia
nervosa D. Low esteem is noted in
both eating disorders
40. A nursing diagnosis for bulimia
nervosa is powerlessness related to
feeling not in control of eating habits.
The goal for this problem is:
A. Patient will learn problem solving
skills
B. Patient will have decreased
symptoms of anxiety.
C. Patient will perform self care
activities daily.
D. Patient will verbalize how to set
limits on others.
Answer: (A) Patient will learn problem
solving skills
if the client learns problem solving
skills she will gain a sense of control
over her life. (B) Anxiety is caused by
powerlessness. (C) Performing self
care activities will not decrease ones
powerlessness (D) Setting limits to
control imposed by others is a
necessary skill but problem solving
skill is the priority.
41. In the management of bulimic
patients, the following nursing
interventions will promote a
therapeutic relationship EXCEPT:
A. Establish an atmosphere of trust
B. Discuss their eating behavior.
C. Help patients identify feelings
associated with binge-purge behavior
D. Teach patient about bulimia
nervosa
Answer: (B) Discuss their eating
behavior.
The client is often ashamed of her
eating behavior. Discussion should
focus on feelings. A,C and D promote
a therapeutic relationship
42. Situation: A 35 year old male has
intense fear of riding an elevator. He
claims “ As if I will die inside.” This
has affected his studies
The client is suffering from:
A. agoraphobia
B. social phobia
C. Claustrophobia
D. xenophobia
Answer: (C) Claustrophobia
Claustrophobia is fear of closed space.
A. Agoraphobia is fear of open space
or being a situation where escape is
difficult. B. Social phobia is fear of
performing in the presence of others in
a way that will be humiliating or
embarrassing. D. Xenophobia is fear of
strangers.
43. Initial intervention for the client
should be to:
A. Encourage to verbalize his fears as
much as he wants.
B. Assist him to find meaning to his
feelings in relation to his past.
C. Establish trust through a consistent
approach.
D. Accept her fears without criticizing.
Answer: (D) Accept her fears without
criticizing.
The client cannot control her fears
although the client knows its silly and
can joke about it. A. Allow expression
of the client’s fears but he should focus
on other productive activities as well.
B and C. These are not the initial
interventions.
44. The nurse develops a
countertransference reaction. This is
evidenced by:
A. Revealing personal information to
the client
B. Focusing on the feelings of the
client.
C. Confronting the client about
discrepancies in verbal or non-verbal
behavior
D. The client feels angry towards the
nurse who resembles his mother.
Answer: (A) Revealing personal
information to the client
A. Countertransference is an emotional
reaction of the nurse on the client
based on her unconscious needs and
conflicts. B and C. These are
therapeutic approaches. D. This is
transference reaction where a client
has an emotional reaction towards the
nurse based on her past.
45. Which is the desired outcome in
conducting desensitization:
A. The client verbalize his fears about
the situation
B. The client will voluntarily attend
group therapy in the social hall.
C. The client will socialize with others
willingly
D. The client will be able to overcome
his disabling fear.
Answer: (D) The client will be able to
overcome his disabling fear.
The client will overcome his disabling
fear by gradual exposure to the feared
object. A,B and C are not the desired
outcome of desensitization.
46. Which of the following should be
included in the health teachings among
clients receiving Valium:
A. Avoid taking CNS depressant like
alcohol.
B. There are no restrictions in
activities.
C. Limit fluid intake.
D. Any beverage like coffee may be
taken
Answer: (A) Avoid taking CNS
depressant like alcohol.
Valium is a CNS depressant. Taking it
with other CNS depressants like
alcohol; potentiates its effect. B. The
client should be taught to avoid
activities that require alertness. C.
Valium causes dry mouth so the client
must increase her fluid intake. D.
Stimulants must not be taken by the
client because it can decrease the
effect of Valium.
47. Situation: A 20 year old college
student is admitted to the medical ward
because of sudden onset of paralysis of
both legs. Extensive examination
revealed no physical basis for the
complaint.
The nurse plans intervention based on
which correct statement about
conversion disorder?
A. The symptoms are conscious effort
to control anxiety
B. The client will experience high
level of anxiety in response to the
paralysis.
C. The conversion symptom has
symbolic meaning to the client
D. A confrontational approach will be
beneficial for the client.
Answer: (C) The conversion symptom
has symbolic meaning to the client
the client uses body symptoms to
relieve anxiety. A. The condition
occurs unconsciously. B. The client is
not distressed by the lost or altered
body function. D. The client should
not be confronted by the underlying
cause of his condition because this can
aggravate the client’s anxiety.
48. Nina reveals that the boyfriend has
been pressuring her to engage in
premarital sex. The most therapeutic
response by the nurse is:
A. “I can refer you to a spiritual
counselor if you like.”
B. “You shouldn’t allow anyone to
pressure you into sex.”
C. “It sounds like this problem is
related to your paralysis.”
D. “How do you feel about being
pressured into sex by your boyfriend?”
Answer: (D) “How do you feel about
being pressured into sex by your
boyfriend?”
Focusing on expression of feelings is
therapeutic. The central force of the
client’s condition is anxiety. A. This is
not therapeutic because the nurse
passes the responsibility to the
counselor. B. Giving advice is not
therapeutic. C. This is not therapeutic
because it confronts the underlying
cause.
49. Malingering is different from
somatoform disorder because the
former:
A. Has evidence of an organic basis.
B. It is a deliberate effort to handle
upsetting events
C. Gratification from the environment
are obtained.
D. Stress is expressed through physical
symptoms.
Answer: (B) It is a deliberate effort to
handle upsetting events
Malingering is a conscious simulation
of an illness while somatoform
disorder occurs unconscious. A. Both
disorders do not have an organic or
structural basis. C. Both have primary
gains. D. This is a characteristic of
somatoform disorder.
50. Unlike psychophysiologic disorder
Linda may be best managed with:
A. medical regimen
B. milieu therapy
C. stress management techniques
D. psychotherapy
Answer: (C) stress management
techniques
Stree management techniques is the
best management of somatoform
disorder because the disorder is related
to stress and it does not have a medical
basis. A. This disorder is not supported
by organic pathology so no medical
regimen is required. B and D. Milieu
therapy and psychotherapy may be
used a therapeutic modalities but these
are not the best.
51. Which is the best indicator of
success in the long term management
of the client?
A. His symptoms are replaced by
indifference to his feelings
B. He participates in diversionary
activities.
C. He learns to verbalize his feelings
and concerns
D. He states that his behavior is
irrational.
Answer: (C) He learns to verbalize his
feelings and concerns
C. The client is encouraged to talk
about his feelings and concerns instead
of using body symptoms to manage his
stressors. A. The client is encouraged
to acknowledge feelings rather than
being indifferent to her feelings. B.
Participation in activities diverts the
client’s attention away from his bodily
concerns but this is not the best
indicator of success. D. Help the client
recognize that his physical symptoms
occur because of or are exacerbated by
specific stressor, not as irrational.
52. Situation: A young woman is
brought to the emergency room
appearing depressed. The nurse
learned that her child died a year ago
due to an accident.
The initial nursing diagnosis is
dysfunctional grieving. The statement
of the woman that supports this
diagnosis is:
A. “I feel envious of mothers who
have toddlers”
B. “I haven’t been able to open the
door and go into my baby’s room “
C. “I watch other toddlers and think
about their play activities and I cry.”
D. “I often find myself thinking of
how I could have prevented the death.
Answer: (B) “I haven’t been able to
open the door and go into my baby’s
room “
This indicates denial. This defense is
adaptive as an initial reaction to loss
but an extended, unsuccessful use of
denial is dysfunctional. A. This
indicates acknowledgement of the loss.
Expressing feelings openly is
acceptable. C. This indicates the stage
of depression in the grieving process.
D. Remembering both positive and
negative aspects of the deceased love
one signals successful mourning.
53. The client said “I can’t even take
care of my baby. I’m good for
nothing.” Which is the appropriate
nursing diagnosis?
A. Ineffective individual coping
related to loss.
B. Impaired verbal communication
related to inadequate social skills.
C. Low esteem related to failure in role
performance
D. Impaired social interaction related
to repressed anger.
Answer: (C) Low esteem related to
failure in role performance
This indicates the client’s negative self
evaluation. A sense of worthlessness
may accompany depression. A,B and
D are not relevant. The cues do not
indicate inability to use coping
resources, decreased ability to
transmit/process symbols, nor
insufficient quality of social exchange
54. The following medications will
likely be prescribed for the client
EXCEPT:
A. Prozac
B. Tofranil
C. Parnate
D. Zyprexa
Answer: (D) Zyprexa
This is an antipsychotic. A. This is a
SSRI antidepressant. B. This
antidepressant belongs to the Tricyclic
group. C. This is a MAOI
antidepressant.
55. Which is the highest priority in the
post ECT care?
A. Observe for confusion
B. Monitor respiratory status
C. Reorient to time, place and person
D. Document the client’s response to
the treatment
Answer: (B) Monitor respiratory status
A side effect of ECT which is life
threatening is respiratory arrest. A and
C. Confusion and disorientation are
side effects of ECT but these are not
the highest priority.
56. Situation: A 27 year old writer is
admitted for the second time
accompanied by his wife. He is
demanding, arrogant talked fast and
hyperactive.
Initially the nurse should plan this for a
manic client:
A. set realistic limits to the client’s
behavior
B. repeat verbal instructions as often as
needed
C. allow the client to get out feelings
to relieve tension
D. assign a staff to be with the client at
all times to help maintain control
Answer: (A) set realistic limits to the
client’s behavior
The manic client is hyperactive and
may engage in injurious activities. A
quiet environment and consistent and
firm limits should be set to ensure
safety. B. Clear, concise directions are
given because of the distractibility of
the client but this is not the priority. C.
The manic client tend to externalize
hostile feelings, however only non-
destructive methods of expression
should be allowed D. Nurses set limit
as needed. Assigning a staff to be with
the client at all times is not realistic.
57. An activity appropriate for the
client is:
A. table tennis
B. painting
C. chess
D. cleaning
Answer: (D) cleaning
The client’s excess energy can be
rechanelled through physical activities
that are not competitive like cleaning.
This is also a way to dissipate tension.
A. Tennis is a competitive activity
which can stimulate the client.
58. The client is arrogant and
manipulative. In ensuring a therapeutic
milieu, the nurse does one of the
following:
A. Agree on a consistent approach
among the staff assigned to the client.
B. Suggest that the client take a
leading role in the social activities
C. Provide the client with extra time
for one on one sessions
D. Allow the client to negotiate the
plan of care
Answer: (A) Agree on a consistent
approach among the staff assigned to
the client.
A consistent firm approach is
appropriate. This is a therapeutic way
of to handle attempts of exploiting the
weakness in others or create conflicts
among the staff. Bargaining should not
be allowed. B. This is not therapeutic
because the client tends to control and
dominate others. C. Limits are set for
interaction time. D. Allowing the client
to negotiate may reinforce
manipulative behavior.
59. The nurse exemplifies awareness
of the rights of a client whose anger is
escalating by:
A. Taking a directive role in
verbalizing feelings
B. Using an authoritarian,
confrontational approach
C. Putting the client in a seclusion
room
D. Applying mechanical restraints
Answer: (A) Taking a directive role in
verbalizing feelings
The client has the right to be free from
unnecessary restraints. Verbalization
of feelings or “talking down” in a non-
threatening environment is helpful to
relieve the client’s anger. B. This is a
threatening approach. C and D.
Seclusion and application restraints are
done only when less restrictive
measures have failed to contain the
client’s anger.
60. A client on Lithium has diarrhea
and vomiting. What should the nurse
do first:
A. Recognize this as a drug interaction
B. Give the client Cogentin
C. Reassure the client that these are
common side effects of lithium therapy
D. Hold the next dose and obtain an
order for a stat serum lithium level
Answer: (D) Hold the next dose and
obtain an order for a stat serum lithium
level
Diarrhea and vomiting are
manifestations of Lithium toxicity. The
next dose of lithium should be
withheld and test is done to validate
the observation. A. The manifestations
are not due to drug interaction. B.
Cogentin is used to manage the extra
pyramidal symptom side effects of
antipsychotics. C. The common side
effects of Lithium are fine hand
tremors, nausea, polyuria and
polydipsia.
61. Situation: A widow age 28, whose
husband died one year ago due to
AIDS, has just been told that she has
AIDS.
Pamela says to the nurse, “Why me?
How could God do this to me?” This
reaction is one of:
A. Depression
B. Denial
C. anger
D. bargaining
Answer: (C) anger
Anger is experienced as reality sets in.
This may either be directed to God, the
deceased or displaced on others. A.
Depression is a painful stage where the
individual mourns for what was lost.
B. Denial is the first stage of the
grieving process evidenced by the
statement “No, it can’t be true.” The
individual does not acknowledge that
the loss has occurred to protect self
from the psychological pain of the
loss. D. In bargaining the individual
holds out hope for additional
alternatives to forestall the loss,
evidenced by the statement “If only…”
62. The nurse’s therapeutic response
is:
A. “I will refer you to a clergy who
can help you understand what is
happening to you.”
B. “ It isn’t fair that an innocent like
you will suffer from AIDS.”
C. “That is a negative attitude.”
D. ”It must really be frustrating for
you. How can I best help you?”
Answer: (D) ”It must really be
frustrating for you. How can I best
help you?”
This response reflects the pain due to
loss. A helping relationship can be
forged by showing empathy and
concern. A. This is not therapeutic
since it passes the buck or
responsibility to the clergy. B. This
response is not therapeutic because it
gives the client the impression that she
is right which prevents the client from
reconsidering her thoughts. C. This
statement passes judgment on the
client.
63. One morning the nurse sees the
client in a depressed mood. The nurse
asks her “What are you thinking
about?” This communication technique
is:
A. focusing
B. validating
C. reflecting
D. giving broad opening
Answer: (D) giving broad opening
Broad opening technique allows the
client to take the initiative in
introducing the topic. A,B and C are
all therapeutic techniques but these are
not exemplified by the nurse’s
statement.
64. The client says to the nurse ” Pray
for me” and entrusts her wedding ring
to the nurse. The nurse knows that this
may signal which of the following:
A. anxiety
B. suicidal ideation
C. Major depression
D. Hopelessness
Answer: (B) suicidal ideation
The client’s statement is a verbal cue
of suicidal ideation not anxiety. While
suicide is common among clients with
major depression, this occurs when
their depression starts to lift.
Hopelessness indicates no alternatives
available and may lead to suicide, the
statement and non verbal cue of the
client indicate suicide.
65. Which of the following
interventions should be prioritized in
the care of the suicidal client?
A. Remove all potentially harmful
items from the client’s room.
B. Allow the client to express feelings
of hopelessness.
C. Note the client’s capabilities to
increase self esteem.
D. Set a “no suicide” contract with the
client.
Answer: (A) Remove all potentially
harmful items from the client’s room.
Accessibility of the means of suicide
increases the lethality. Allowing
patient to express feelings and setting a
no suicide contract are interventions
for suicidal client but blocking the
means of suicide is priority. Increasing
self esteem is an intervention for
depressed clients bur not specifically
for suicide.
66. Situation: A 14 year old male was
admitted to a medical ward due to
bronchial asthma after learning that his
mother was leaving soon for U.K. to
work as nurse.
The client has which of the following
developmental focus:
A. Establishing relationship with the
opposite sex and career planning.
B. Parental and societal
responsibilities.
C. Establishing ones sense of
competence in school.
D. Developing initial commitments
and collaboration in work
Answer: (A) Establishing relationship
with the opposite sex and career
planning.
The client belongs to the adolescent
stage. The adolescent establishes his
sense of identity by making decisions
regarding familial, occupational and
social roles. The adolescent
emancipates himself from the family
and decides what career to pursue,
what set of friends to have and what
value system to uphold. B. This refers
to the middle adulthood stage
concerned with transmitting his values
to the next generation to ensure his
immortality through the perpetuation
of his culture. C. This reflects school
age which is concerned with the
pursuit of knowledge and skills to deal
with the environment both in the
present and in the future. D. The stage
of young adulthood is concerned with
development of intimate relationship
with the opposite sex, establishment of
a safe and congenial family
environment and building of one’s
lifework.
67. The personality type of Ryan is:
A. conforming
B. dependent
C. perfectionist
D. masochistic
Answer: (B) dependent
A client with dependent personality is
predisposed to develop asthma. A. The
conforming non-assertive client is
predisposed to develop hypertension
because of the tendency to repress
rage. C. The perfectionist and
compulsive tend to develop migraine.
D. The masochistic, self sacrificing
type are prone to develop rheumatoid
arthritis.
68. The nurse ensures a therapeutic
environment for the client. Which of
the following best describes a
therapeutic milieu?
A. A therapy that rewards adaptive
behavior
B. A cognitive approach to change
behavior
C. A living, learning or working
environment.
D. A permissive and congenial
environment
Answer: (C) A living, learning or
working environment.
A therapeutic milieu refers to a broad
conceptual approach in which all
aspects of the environment are
channeled to provide a therapeutic
environment for the client. The six
environmental elements include
structure, safety, norms, limit setting,
balance and unit modification. A.
Behavioral approach in psychiatric
care is based on the premise that
behavior can be learned or unlearned
through the use of reward and
punishment. B. Cognitive approach to
change behavior is done by correcting
distorted perceptions and irrational
beliefs to correct maladaptive
behaviors. D. This is not congruent
with therapeutic milieu.
69. Included as priority of care for the
client will be:
A. Encourage verbalization of
concerns instead of demonstrating
them through the body
B. Divert attention to ward activities
C. Place in semi-fowlers position and
render O2 inhalation as ordered
D. Help her recognize that her physical
condition has an emotional component
Answer: (C) Place in semi-fowlers
position and render O2 inhalation as
ordered
Since psychopysiologic disorder has
organic basis, priority intervention is
directed towards disease-specific
management. Failure to address the
medical condition of the client may be
a life threat. A and B. The client has
physical symptom that is adversely
affected by psychological factors.
Verbalization of feelings in a non
threatening environment and
involvement in relaxing activities are
adaptive way of dealing with stressors.
However, these are not the priority. D.
Helping the client connect the physical
symptoms with the emotional
problems can be done when the client
is ready.
70. The client is concerned about his
coming discharge, manifested by being
unusually sad. Which is the most
therapeutic approach by the nurse?
A. “You are much better than when
you were admitted so there’s no reason
to worry.”
B. “What would you like to do now
that you’re about to go home?”
C. “You seem to have concerns about
going home.”
D. “Aren’t you glad that you’re going
home soon?”
Answer: (C) “You seem to have
concerns about going home.”
. This statement reflects how the client
feels. Showing empathy can encourage
the client to talk which is important as
an alternative more adaptive way of
coping with stressors.. A. Giving false
reassurance is not therapeutic. B.
While this technique explores plans
after discharge, it does not focus on
expression of feelings. D. This close
ended question does not encourage
verbalization of feelings.
71. Situation: The nurse may
encounter clients with concerns on
sexuality.
The most basic factor in the
intervention with clients in the area of
sexuality is:
A. Knowledge about sexuality.
B. Experience in dealing with clients
with sexual problems
C. Comfort with one’s sexuality
D. Ability to communicate effectively
Answer: (C) Comfort with one’s
sexuality
The nurse must be accepting,
empathetic and non-judgmental to
patients who disclose concerns
regarding sexuality. This can happen
only when the nurse has reconciled
and accepted her feelings and beliefs
related to sexuality. A,B and D are
important considerations but these are
not the priority.
72. Which of the following statements
is true for gender identity disorder?
A. It is the sexual pleasure derived
from inanimate objects.
B. It is the pleasure derived from being
humiliated and made to suffer
C. It is the pleasure of shocking the
victim with exposure of the genitalia
D. It is the desire to live or involve in
reactions of the opposite sex
Answer: (D) It is the desire to live or
involve in reactions of the opposite sex
Gender identity disorder is a strong
and persistent desire to be the other
sex. A. This is fetishism. B. This refers
to masochism. C. This describes
exhibitionism.
73. The sexual response cycle in which
the sexual interest continues to build:
A. Sexual Desire
B. Sexual arousal
C. Orgasm
D. Resolution
Answer: (B) Sexual arousal
Sexual arousal or excitement refers to
attaining and maintaining the
physiologic requirements for sexual
intercourse. A. Sexual Desire refers to
the ability, interest or willingness for
sexual stimulation. C. Orgasm refers to
the peak of the sexual response where
the female has vaginal contractions for
the female and ejaculatory contractions
for the male. D. Resolution is the final
phase of the sexual response in which
the organs and the body systems
gradually return to the unaroused state.
74. The inability to maintain the
physiologic requirements in sexual
intercourse is:
A. Sexual Desire Disorder
B. Sexual Arousal Disorder
C. Orgasm Disorder
D. Sexual Pain disorder
Answer: (B) Sexual Arousal Disorder
This describes sexual arousal disorder.
A. Sexual Desire Disorder refers to the
persistent and recurrent lack of desire
or willingness for sexual intercourse.
C. Orgasm Disorder is the inability to
complete the sexual response cycle
because of the inability to achieve an
orgasm. D. Sexual Pain Disorder is
characterized by genital pain before,
during or after sexual intercourse.
75. The nurse asks a client to roll up
his sleeves so she can take his blood
pressure. The client replies “If you
want I can go naked for you.” The
most therapeutic response by the nurse
is:
A. “You’re attractive but I’m not
interested.”
B. “You wouldn’t be the first that I
will see naked.”
C. “I will report you to the guard if
you don’t control yourself.”
D. “I only need access to your arm.
Putting up your sleeve is fine.”
Answer: (D) “I only need access to
your arm. Putting up your sleeve is
fine.”
The nurse needs to deal with the client
with sexually connotative behavior in a
casual, matter of fact way. A and B.
These responses are not therapeutic
because they are challenging and
rejecting. C. Threatening the client is
not therapeutic.
76. Situation: Knowledge and skills in
the care of violent clients is vital in the
psychiatric unit. A nurse observes that
a client with a potential for violence is
agitated, pacing up and down the
hallway and making aggressive
remarks.
Which of the following statements is
most appropriate to make to this
patient?
A. What is causing you to become
agitated?
B. You need to stop that behavior now.
C. You will need to be restrained if
you do not change your behavior.
D. You will need to be placed in
seclusion.
Answer: (A) What is causing you to
become agitated?
In a non-violent aggressive behavior,
help the client identify the stressor or
the true object of hostility. This helps
reveal unresolved issues so that they
may be confronted. B. Pacing is a
tension relieving measure for an
agitated client. C. This is a threatening
statement that can heighten the client’s
tension. D. Seclusion is used when less
restrictive measures have failed.
77. The nurse closely observes the
client who has been displaying
aggressive behavior. The nurse
observes that the client’s anger is
escalating. Which approach is least
helpful for the client at this time?
A. Acknowledge the client’s behavior
B. Maintain a safe distance from the
client
C. Assist the client to an area that is
quiet
D. Initiate confinement measures
Answer: (D) Initiate confinement
measures
The proper procedure for dealing with
harmful behavior is to first try to calm
patient verbally. . When verbal and
psychopharmacologic interventions are
not adequate to handle the
aggressiveness, seclusion or restraints
may be applicable. A, B and C are
appropriate approaches during the
escalation phase of aggression.
78. The charge nurse of a psychiatric
unit is planning the client assignment
for the day. The most appropriate staff
to be assigned to a client with a
potential for violence is which of the
following:
A. A timid nurse
B. A mature experienced nurse
C. an inexperienced nurse
D. a soft spoken nurse
Answer: (B) A mature experienced
nurse
The unstable, aggressive client should
be assigned to the most experienced
nurse. A, C and D. A shy,
inexperienced, soft spoken nurse may
feel intimidated by the angry patient.
79. The nurse exemplifies awareness
of the rights of a client whose anger is
escalating by:
A. Taking a directive role in
verbalizing feelings
B. Using an authoritarian,
confrontational approach
C. Putting the client in a seclusion
room
D. Applying mechanical restraints
Answer: (A) Taking a directive role in
verbalizing feelings
Taking a directive role in the client’s
verbalization of feelings can deescalate
the client’s anger. B. A confrontational
approach can be threatening and adds
to the client’s tension. C and D. Use of
restraints and isolation may be
required if less restrictive interventions
are unsuccessful.
80. The client jumps up and throws a
chair out of the window. He was
restrained after his behavior can no
longer be controlled by the staff.
Which of these documentations
indicates the safeguarding of the
patient’s rights?
A. There was a doctor’s order for
restraints/seclusion
B. The patient’s rights were explained
to him.
C. The staff observed confidentiality
D. The staff carried out less restrictive
measures but were unsuccessful.
Answer: (D) The staff carried out less
restrictive measures but were
unsuccessful.
This documentation indicates that the
client has been placed on restraints
after the least restrictive measures
failed in containing the client’s violent
behavior.
81. Situation: Clients with personality
disorders have difficulties in their
social and occupational functions.
Clients with personality disorder will
most likely:
A. recover with therapeutic
intervention
B. respond to antianxiety medication
C. manifest enduring patterns of
inflexible behaviors
D. Seek treatment willingly from some
personally distressing symptoms
Answer: (C) manifest enduring
patterns of inflexible behaviors
Personality disorders are characterized
by inflexible traits and characteristics
that are lifelong. A and D. This
disorder is manifested by life-long
patterns of behavior. The client with
this disorder will not likely present
himself for treatment unless something
has gone wrong in his life so he may
not recover from therapeutic
intervention. B. Medications are
generally not recommended for
personality disorders.
82. A client tends to be insensitive to
others, engages in abusive behaviors
and does not have a sense of remorse.
Which personality disorder is he likely
to have?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Antisocial
Answer: (D) Antisocial
These are the characteristics of an
individual with antisocial personality.
A. Narcissistic personality disorder is
characterized by grandiosity and a
need for constant admiration from
others. B. Individuals with paranoid
personality demonstrate a pattern of
distrust and suspiciousness and
interprets others motives as
threatening. C. Individuals with
histrionic have excessive emotionality,
and attention-seeking behaviors.
83. The client joins a support group
and frequently preaches against abuse,
is demonstrating the use of:
A. denial
B. reaction formation
C. rationalization
D. projection
Answer: (B) reaction formation
Reaction formation is the adoption of
behavior or feelings that are exactly
opposite of one’s true emotions. A.
Denial is refusal to accept a painful
reality. C. Rationalization is
attempting to justify one’s behavior by
presenting reasons that sounds logical.
D. Projection is attributing of one’s
behaviors and feelings to another
person.
84. A teenage girl is diagnosed to have
borderline personality disorder. Which
manifestations support the diagnosis?
A. Lack of self esteem, strong
dependency needs and impulsive
behavior
B. social withdrawal, inadequacy,
sensitivity to rejection and criticism
C. Suspicious, hypervigilance and
coldness
D. Preoccupation with perfectionism,
orderliness and need for control
Answer: (A) Lack of self esteem,
strong dependency needs and
impulsive behavior
These are the characteristics of client
with borderline personality. B. This
describes the avoidant personality. C.
These are the characteristics of a client
with paranoid personality D. This
describes the obsessive compulsive
personality
85. The plan of care for clients with
borderline personality should include:
A. Limit setting and flexibility in
schedule
B. Giving medications to prevent
acting out
C. Restricting her from other clients
D. Ensuring she adheres to certain
restrictions
Answer: (D) Ensuring she adheres to
certain restrictions
The client is manipulative. The client
must be informed about the policies,
expectations, rules and regulation upon
admission. A. Limits should be firmly
and consistently implemented.
Flexibility and bargaining are not
therapeutic in dealing with a
manipulative client. B. There is no
specific medication prescribed for this
condition. C. This is not part of the
care plan. Interaction with other clients
are allowed but the client should be
observed and given limits in her
attempt to manipulate and dominate
others.
86. Situation: A 42 year old male
client, is admitted in the ward because
of bizarre behaviors. He is given a
diagnosis of schizophrenia paranoid
type.
The client should have achieved the
developmental task of:
A. Trust vs. mistrust
B. Industry vs. inferiority
C. Generativity vs. stagnation
D. Ego integrity vs. despair
Answer: (D) Ego integrity vs. despair
The client belongs to the middle
adulthood stage (30 to 65 yrs.) The
developmental task generativity is
characterized by concern and care for
others. It is a productive and creative
stage. (A) Infancy stage (0 – 18 mos.)
is concerned with gratification of oral
needs (B) School Age child (6 – 12
yrs.) is characterized by acquisition of
school competencies and social skills
(C) Late adulthood ( 60 and above)
Concerned with reflection on the past
and his contributions to others and face
the future.
87. Clients who are suspicious
primarily use projection for which
purpose:
A. deny reality
B. to deal with feelings and thoughts
that are not acceptable
C. to show resentment towards others
D. manipulate others
Answer: (B) to deal with feelings and
thoughts that are not acceptable
Projection is a defense mechanism
where one attributes ones feelings and
inadequacies to others to reduce
anxiety. A. This is not true in all
instances of projection C and D. This
focuses on the self rather than others
88. The client says “ the NBI is out to
get me.” The nurse’s best response is:
A. “The NBI is not out to catch you.”
B. “I don’t believe that.”
C. “I don’t know anything about that.
You are afraid of being harmed.”
D. “ What made you think of that.”
Answer: (C) “I don’t know anything
about that. You are afraid of being
harmed.”
This presents reality and acknowledges
the clients feeling A and B. are not
therapeutic responses because these
disagree with the client’s false belief
and makes the client feel challenged D.
unnecessary exploration of the false
89. The client on Haldol has pill
rolling tremors and muscle rigidity. He
is likely manifesting:
A. tardive dyskinesia
B. Pseudoparkinsonism
C. akinesia
D. dystonia
Answer: (B) Pseudoparkinsonism
Pseudoparkinsonism is a side effect of
antipsychotic drugs characterized by
mask-like facies, pill rolling tremors,
muscle rigidity A. Tardive dyskinesia
is manifested by lip smacking,
wormlike movement of the tongue C.
Akinesia is characterized by feeling of
weakness and muscle fatigue D.
Dystonia is manifested by torticollis
and rolling back of the eyes
90. The client is very hostile toward
one of the staff for no apparent reason.
The client is manifesting:
A. Splitting
B. Transference
C. Countertransference
D. Resistance
Answer: (B) Transference
Transference is a positive or negative
feeling associated with a significant
person in the client’s past that are
unconsciously assigned to another A.
Splitting is a defense mechanism
commonly seen in a client with
personality disorder in which the world
is perceived as all good or all bad C.
Counterttransference is a phenomenon
where the nurse shifts feelings
assigned to someone in her past to the
patient D. Resistance is the client’s
refusal to submit himself to the care of
the nurse
91. Situation: An 18 year old female
was sexually attacked while on her
way home from work. She is brought
to the hospital by her mother.
Rape is an example of which type of
crisis:
A. Situational
B. Adventitious
C. Developmental
D. Internal
Answer: (B) Adventitious
Adventitious crisis is a crisis involving
a traumatic event. It is not part of
everyday life. A. Situational crisis is
from an external source that upset ones
psychological equilibrium C and D.
Are the same. They are transitional or
developmental periods in life
92. During the initial care of rape
victims the following are to be
considered EXCEPT:
A. Assure privacy.
B. Touch the client to show acceptance
and empathy
C. Accompany the client in the
examination room.
D. Maintain a non-judgmental
approach.
Answer: (B) Touch the client to show
acceptance and empathy
The client finds touch intrusive and
therefore should be avoided. A.
Privacy is one of the rights of a victim
of rape. C.The client is anxious.
Accompanying the client in a quiet
room ensures safety and offers
emotional support. D. Guilt feeling is
common among rape victims. They
should not be blamed.
93. The nurse acts as a patient
advocate when she does one of the
following:
A. She encourages the client to express
her feeling regarding her experience.
B. She assesses the client for injuries.
C. She postpones the physical
assessment until the client is calm
D. Explains to the client that her
reactions are normal
Answer: (C) She postpones the
physical assessment until the client is
calm
The nurse acts as a patient advocate as
she protects the client from
psychological harm A. The nurse acts
a a counselor B. The nurse acts as a
technician D. This exemplifies the role
of a teacher
94. Crisis intervention carried out to
the client has this primary goal:
A. Assist the client to express her
feelings
B. Help her identify her resources
C. Support her adaptive coping skills
D. Help her return to her pre-rape level
of function
Answer: (D) Help her return to her
pre-rape level of function
The goal of crisis intervention to help
the client return to her level of function
prior to the crisis. A,B and C are
interventions or strategies to attain the
goal
95. Five months after the incident the
client complains of difficulty to
concentrate, poor appetite, inability to
sleep and guilt. She is likely suffering
from:
A. Adjustment disorder
B. Somatoform Disorder
C. Generalized Anxiety Disorder
D. Post traumatic disorder
Answer: (D) Post traumatic disorder
Post traumatic stress disorder is
characterized by flashback, irritability,
difficulty falling asleep and
concentrating following an extremely
traumatic event. This lasts for more
that one month A. Adjustment disorder
is the maladaptive reaction to stressful
events characterized by anxiety,
depression and work or social
impairments. This occurs within 3
months after the event B. Somatoform
disorders are anxiety related disorders
characterized by presence of physical
symptoms without demonstrable
organic basis C. Generalized anxiety
disorder is characterized by chronic,
excessive anxiety for at least 6 months
96. Situation: A 29 year old client
newly diagnosed with breast cancer is
pacing, with rapid speech headache
and inability to focus with what the
doctor was saying.
The nurse assesses the level of anxiety
as:
A. Mild
B. Moderate
C. Severe
D. Panic
Answer: (C) Severe
The client’s manifestations indicate
severe anxiety. A Mild anxiety is
manifested by slight muscle tension,
slight fidgeting, alertness, ability to
concentrate and capable of problem
solving. B. Moderate muscle tension,
increased vital signs, periodic slow
pacing, increased rate of speech and
difficulty in concentrating are noted in
moderate anxiety. D. Panic level of
anxiety is characterized
immobilization, incoherence, feeling
of being overwhelmed and
disorganization
97. Anxiety is caused by:
A. an objective threat
B. a subjectively perceived threat
C. hostility turned to the self
D. masked depression
Answer: (B) a subjectively perceived
threat
Anxiety is caused by a subjectively
perceived threat A. Fear is caused by
an objective threat C. A depressed
client internalizes hostility D. Mania is
due to masked depression
98. It would be most helpful for the
nurse to deal with a client with severe
anxiety by:
A. Give specific instructions using
speak in concise statements.
B. Ask the client to identify the cause
of her anxiety.
C. Explain in detail the plan of care
developed
D. Urge the client to focus on what the
nurse is saying
Answer: (A) Give specific instructions
using speak in concise statements.
The client has narrowed perceptual
field. Lengthy explanations cannot be
followed by the client. B. The client
will not be able to identify the cause of
anxiety C and D. The client has
difficulty concentrating and will not be
able to focus.
99. Which of the following
medications will likely be ordered for
the client?”
A. Prozac
B. Valium
C. Risperdal
D. Lithium
Answer: (B) Valium
Antianxiety A. Antidepressant C.
Antipsychotic D. Antimanic
100. Which of the following is
included in the health teachings among
clients receiving Valium?:
A. Avoid foods rich in tyramine.
B. Take the medication after meals.
C. It is safe to stop it anytime after
long term use.
D. Double up the dose if the client
forgets her medication.
Answer: (B) Take the medication after
meals.
Antianxiety medications cause G.I.
upset so it should be taken after meals.
A. This is specific for antidepressant
MAOI. Taking tyramine rich food can
cause hypertensive crisis. C. Valium
causes dependency. In which case, the
medication should be gradually
withdrawn to prevent the occurrence of
convulsion. D The dose of Valium
should not be doubled if the previous
dose was not taken. It can intensify the
CNS depressant effects.