1. Mental Health Is Defined As :

1. Mental health is defined as :

A. A disturbance in the person's thoughts, feelings and behavior.

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. Absence of mental illness

D. Absolute state of mental wellness CORRECT 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. RATIONALE: Mental health is a positive state where an individual has self awareness and self acceptance, the ability to cope with life stresses, can set realistic goals, has interdependence without losing one's independence, is satisfied with interpersonal relationship and fulfills

2. The following are characteristics of a mentally health person except:

A. Has the ability to accept himself and others

B. Makes decisions according to realistic perceptions.

C. Always feels relaxed despite stressors.

D. Faces stressors with serenity and problem solving ability. CORRECT ANSWER: C. Always feels relaxed despite stressors. RATIONALE: A mentally healthy person does not always feel relaxed though he can tolerate life stresses, appropriately handle anxiety and experience failure without devastation.

3. Mental health and psychiatric nursing is the:

A. Assessment of behavior and care of individuals with mental disorder.

B. Use of interactions between the nurse and the individual to address problems

C. Dependent, interdependent and independent functions of the nurse to regain mental health

D. Promotion of optimal mental health, and early diagnosis, treatment and rehabilitation of the mentally ill. CORRECT ANSWER: D. Promotion of optimal mental health, and early diagnosis, treatment and rehabilitation of the mentally ill. RATIONALE: Mental Health and Psychiatric Nursing is an interpersonal process that includes the promotive, preventive, curative and rehabilitative aspects of care of the individual, family or community.

4. The mind structure that focuses on reality principle by distinguishing fantasy from what exist in the environment is:

A. Id

B. ego

C. Superego

D. Unconcious CORRECT ANSWER: B. ego RATIONALE: The ego operates on the reality principle and meets and interacts with the outside world. The Id is the unconscious reservoir of primitive drives and is dominated by the pleasure principle. The superego acts as a censoring force and is composed of morals and values.

5. The ability to recall the name of one's classmate in high school who went out with you most of the time is a manifestation of the:

A. Subconscious

B. Conscious

C. Unconscious

D. Both conscious and subconscious CORRECT ANSWER: A. Subconscious RATIONALE: Subconscious are memories that can be recalled to consciousness with some effort. Consciousness is a state of awareness. Unconsciousness consist of memories and conflicts that cannot be recalled at will and are said to be repressed.

6. According to Freud a child who idolizes and imitates her mother is noted in which stage of development?

A. Oral

B. Anal

C. Phallic

D. Latency CORRECT ANSWER: C. Phallic RATIONALE: The resolution of the Electra complex occurs in the phallic stage and this entails incestuous feelings towards the father and identification of the girl with the same sex parent.

7. Protective processes to prevent mental illness include the following except:

A. enhance self esteem

B. supportive relationship

C. taking new opportunities for growth

D. maintenance of usual life patterns during stress

CORRECT ANSWER: D. maintenance of usual life patterns during stress RATIONALE: Maintenance of the usual life patterns during stress indicates difficulty in adjusting to changes in life that disturb one's equilibrium. The other choices indicate characteristics of a mentally healthy individual who achieves self actualization.

8. A model that emphasizes the importance of interpersonal relationship and communication on behavior was proposed by:

A. Piaget

B. Sullivan

C. Glasser

D. Selye CORRECT ANSWER: B. Sullivan RATIONALE: The interpersonal theory by Sullivan is based on the assumption that interpersonal relationships facilitate development of the self system. Faulty patterns of relating interfere with maturity and security. Piaget views intellectual development as a result of a constant interaction between environmental influences and genetically determined attributes. Glasser who proposed the reality therapy model cited that psychological needs must be met responsibly and within the context of reality. Selye's stress model assumes that inadequate handling of stress can lead to physical and mental illness

9. A 5 year old division chief teaches his assistant techniques in the company's business dealings. Which of the following statements best describes the chief's behavior?

A. his behavior is expected in his developmental stage

B. he feels threatened of his advancing age

C. he wants to control other people

D. he is making up for the past mistakes

CORRECT ANSWER: A. his behavior is expected in his developmental stage RATIONALE: The chief is in the middle adult stage where an individual's task is generativity. Adult behavior that reflects mastery of this stage is passing on one's good traits to the next generation and other societal responsibilities.

10. Which of the following behaviors exemplifies the use of rationalization?

A. An unattractive girl who wears stylish clothes and make up to draw attention.

B. A young man who is angry engages in a tennis match.

C. A student who fails a quiz claims that the lectures were not sufficient.

D. A secretary has kind words for her boss who reprimanded her for her incompetence. CORRECT ANSWER: C. A student who fails a quiz claims that the lectures were not sufficient. RATIONALE: In rationalization one attempts to justify one's behavior. Choice A is an example of compensation where one overemphasizes a desirable trait to cover up a weakness. Choice B is channeling one's instinctual drives into acceptable activities known as sublimation. Choice D is reaction formation where one shows an exact opposite of what one feels.

11. Situation: One of the basic tools that the nurse uses in dealing with her client is the therapeutic use of the self. The therapeutic use of self is best described as:

A. The ability to effect a change in the patient by imposing spiritual values.

B. Being accurate in analyzing the patient's behavior.

C. The ability to establish relatedness and structure nursing interventions.

D. Being skillful and artistic in rendering care

CORRECT ANSWER: C. The ability to establish relatedness and structure nursing interventions. RATIONALE: The nurse uses aspects of the self to help clients grow, change and heal. The nurse's personal strengths, understanding of human behavior, and the nurse's clinical skills are essential in meeting the client's needs.

12. A client tells the nurse "I'm going to kill myself tonight but don't tell the others about it." When the nurse responds "I can't keep the promise not to tell as this involves your safety" reflects an essential characteristic of the nurse that must be established early in the therapeutic relationship as:

A. Acceptance

B. Genuine Interest

C. Trustworthiness

D. Concreteness CORRECT ANSWER: C. Trustworthiness RATIONALE: Trustworthiness is when the nurse is consistent in her words and actions and can be relied on what she says. Acceptance is avoiding judgment of the client no matter what the behavior is. Genuineness is when the nurse is authentic when interacting with the patient. Concreteness is being specific and realistic, not theoretical in her response to the client

13. The general feelings or emotional reference the nurse uses in organizing her knowledge about the world are referred to as:

A. Attitudes

B. Values

C. Beliefs

D. Culture CORRECT ANSWER: A. Attitudes

RATIONALE: Attitudes refer to how one views people and the world which may affect how the nurse will express her feelings and how she will behave towards others. Values are abstract standards that give the person a notion of right and wrong. Beliefs are ideas that one holds to be true. Culture consists of socially learned behaviors, values and beliefs transmitted from one generation to another.

14. Which behavior by the nurse would be least effective in helping the client to achieve growth:

A. Completing a task for the client instead of repeatedly prompting him to finish it.

B. Taking time to adjust to the slower pace of the client.

C. Making self available to the client who refuses to interact.

D. Using listening and observation skills.

it.

CORRECT ANSWER: A. Completing a task for the client instead of repeatedly prompting him to finish

RATIONALE: . Completing task for the client is ineffective and may interfere in the client’s ability to achieve goals. Adjusting to the client’s pace avoids frustration. Making self available to the client, listening and skillfully observing the client makes him feel important and gives him encouragement to complete a task or achieve goals.

15. The psychiatric nurse's role in tertiary prevention is:

A. Prevent the chronicity of disease.

B. Promote mental health through anticipatory guidance.

C. Case finding for early diagnosis of the disease.

D. Rehabilitation programs to prevent the crippling effects of illness CORRECT ANSWER: D. Rehabilitation programs to prevent the crippling effects of illness RATIONALE: Rehabilitation is aimed at optimizing the function of the patient and preventing the disability caused by the illness. A and C belong to the secondary level of prevention while B is primary level of prevention.

16. Situation: The nurse engages the client in a corrective interpersonal experience. During the assessment process the nurse:

A. Establishes a therapeutic contract

B. Participates in nursing conferences

C. Collaborates with other nurses

D. Uses a system of data collection CORRECT ANSWER: D. Uses a system of data collection RATIONALE: A system of data collection that includes mental status examination, history taking through interview and observation leads to a more precise documentation. This serves as a well founded basis in planning the care of the client.

17. In dealing with the client's problems, the nurse prioritizes the nursing diagnosis according to:

A. The established goals of care

B. The ward's priority list

C. life threatening potential

D. Focus on resolution of patient's problems CORRECT ANSWER: C. life threatening potential RATIONALE: Nursing diagnosis is the identification of the patient's problem based on the conclusion of the client's behaviors and verbalizations. The safety of the client is a prime consideration in emergency situations like suicide, aggression, and other destructive behaviors. These serve as a basis for planning interventions to protect the client and in negotiating a no harm contract with the client.

18. The nurse ensures an accepting atmosphere in the unit where the client can relax and secure in

sharing thoughts and feelings is assuming the role of a:

A. socializing agent

B. milieu therapist

C. patient advocate

D. technician CORRECT ANSWER: B. milieu therapist RATIONALE: As a creator of a therapeutic milieu the nurse creates an environment where a client feels secure and a client that encourages improvement and positive change in behavior. As a socializing agent the nurse helps the client improve their social skills and participate in group activities. The nurse informs the client about his rights and upholds these rights in her role as a patient advocate. The nurse as a technician does the activities of assessment, documentation, administration of medications and carrying out treatments.

19. An appropriate topic to be discussed in the working phase of the nurse-client relationship is:

A. A summary of the relationship and the client's growth.

B. The client's problems and coping are explored.

C. The client's perception of her illness.

D. Setting the boundaries of the relationship CORRECT ANSWER: B. The client's problems and coping are explored. RATIONALE: Problem solving occurs in the working phase of the nurse-client relationship. The client who has learned to trust the nurse may be encouraged to share her problems and concerns and alternative behaviors and techniques are explored. A summary of the relationship and the client's growth are done in the termination phase. The client's perception of her illness is part of the initial assessment done in the orientation phase. Setting the time, place and duration of each meeting are part of the contract set at the start of the relationship.

20. A newly admitted client shouts at the staff she has just met for no apparent reason. The client is likely manifesting:

A. Transference

B. Countertransference

C. Resistance

D. Splitting CORRECT ANSWER: A. Transference RATIONALE: Transference is one of the impasses in the nurse client relationship where positive and negative feelings associated with a significant other in the client's past is unconsciously assigned to another person like the nurse.

21. Situation: Various treatment modalities and interventions may be utilized for clients with psychosocial concerns. A client approaches the nurse and complains of being bored and requests some activity be conducted. Which response by the nurse is in context with a therapeutic community:

A. "Ok, let's play cards."

B. "Let's discuss this with the head nurse."

C. "You can ask other patients to play with you."

D. "We can discuss this together with the staff and other patients." CORRECT ANSWER: D. "We can discuss this together with the staff and other patients." RATIONALE: Therapeutic community calls for a group effort. A joint planning and decision making among the patients and staff is done. The other choices do not indicate group effort and open communication in the community.

22. The nurse gives an extra privilege to a client who regularly participates in ward activities is an

example of:

A. Role modeling

B. Aversion therapy

C. Behavior modification

D. Logotherapy

CORRECT ANSWER:

B. Aversion therapy

RATIONALE: Behavior modification is a treatment modality that consists of rewarding good behavior with physical reinforcers while withholding these reinforcers if a maladaptive behavior occurs. Role modeling is where a nurse performs certain behaviors that the client can emulate. Aversion therapy is the use of unpleasant or noxious stimuli to change inappropriate behavior. Logotherapy focuses on searching for meaning in the client's life.

23. Which of the following best describes the patient's benefit from group therapy?

A. It offers a venue where the client can openly talk about feelings.

B. Patient gets support from the leader

C. It reinforces the client's strength

D. The patient can learn how their behavior affect others CORRECT ANSWER: D. The patient can learn how their behavior affect others RATIONALE: Group therapy offers a venue for interpersonal learning or learning about oneself in relation to others. Choices A and D are benefits that may be attained on an individual as well as group setting. Effective group leaders focus on group process and encourage participation of group members and do not focus on only one member. 24. A member of group therapy who actively seeks control thru incessant talking is a :

A. monopolizer

B. complainer

C. moralist

D. seducer CORRECT ANSWER: A. monopolizer RATIONALE: A monopolizer takes control by dominating the discussion. A complainer discourages positive work and vents anger. A moralist serves as the judge of the right and the wrong. A seducer attempts to gain personal attention.

25. In counseling the nurse does one of the following:

A. Rewards a client with anorexia nervosa whenever she attains the desired weight.

B. Helps the parents of a client with attention deficit hyperactivity to establish communication.

C. Helps clients enhance coping by discussing their concerns.

D. Refers the depressed client to a post discharge support group CORRECT ANSWER: C. Helps clients enhance coping by discussing their concerns. RATIONALE: Counseling is a form of supportive psychotherapy in which the nurse offers guidance or assistance to the client in viewing options to problems that are discussed by the client in the context of the nurse-client relationship geared at health promotion. Rewarding the client for adaptive behavior is achieved in behavior therapy. Educating parents on how to handle a hyperactive client is done though educational group therapy. Referral is not a form of therapy.

26. Situation: The management of clients with various psychosocial concerns may be facilitated by the nurse's communication skills. When attempting to engage the client in conversation which technique is most effective?

A. Silence

B. Exploring

C. Broad opening

D. Focusing CORRECT ANSWER: C. Broad opening RATIONALE: Broad opening technique indicates that the client takes the lead in the interaction. In a client who is hesitant in interacting this technique may stimulate him to take the initiative.

27. During a one on one interaction with the nurse the client states, "I'm worried about going home." The nurse responds, "I'd rather you wouldn't worry." This response by the nurse is:

A. Therapeutic because this helps the client become aware of what the nurse thinks.

B. Therapeutic, because the nurse is being direct without feeling blunt.

C. Non-therapeutic because the nurse is passing judgment on the client.

D. Non-therapeutic because it indicates that only the nurse knows what is best. CORRECT ANSWER: C. Non-therapeutic because the nurse is passing judgment on the client. RATIONALE: The nurse is not therapeutic because she is disapproving the client. The nurse should not pass judgment on the client

28. A withdrawn client asks the nurse, "Do you think they'll ever let me out of here?" The nurse's best reply would be:

A. "Why don't you ask your doctor?"

B. "Everyone says you're doing just fine."

C. "Why don't you think you're ready to leave?"

D. "You have the feeling that you might not leave?" CORRECT ANSWER: D. "You have the feeling that you might not leave?" RATIONALE: Directing back to the client her feelings is reflecting technique. This makes the client aware of what she feels that may pave the way to verbalization. Choice A gives advice which implies that only the nurse knows what is best for the client. Choice D is a false reassurance which attempts to dispel the client's anxiety disregards the client's feeling. Choice C demands the client to explain and may intimidate the client.

29. The nurse initiates conversation with the client by saying "Is there something you would like to talk about?" but the nurse has her arms crossed and is looking at another client. Which of the following describes the nurse's approach?

A. There is incongruence between her verbal and non-verbal communication.

B. The nurse is attempting to make the client less tense by looking away.

C. The nurse is trying to maintain appropriate boundaries.

D. The nurse is being judgmental. CORRECT ANSWER: A. There is incongruence between her verbal and non-verbal communication. RATIONALE: The nurse is using the verbal communication technique of broad opening that invites the client to take the initiative but her crossed arms and lack of eye contact is incongruent with the verbal message. The nurse is non-verbally distancing herself from the client.

30. Which of the following behaviors of the nurse reflect empathy?

A. Gestures and laughs a lot

B. Shares about the self when it is appropriate

C. Listens to what is said and understands how the client feels

D. Assist the client to be specific rather that speak in generalities CORRECT ANSWER: C. Listens to what is said and understands how the client feels RATIONALE: Empathy is the ability of the nurse to perceive the meanings and the feelings of the client and to communicate that understanding to the client.

31. Situation: A female client age 40, was admitted because of bouts of sweating, nervousness and selective inattention. This has progressed for the past 3 months. What is the initial responsibility of the nurse?

A. Encourage a relative to stay with her

B. Encourage her to talk about her feelings

C. Administer medication to allay her apprehension

D. Assess her level of anxiety CORRECT ANSWER: D. Assess her level of anxiety RATIONALE: The initial responsibility of the nurse is to begin an assessment of the patient's needs. The patient's physiologic responses, recurring thoughts, feelings and behaviors are cues to the client's problem areas that will lead to planning appropriate interventions.

32. The client is likely manifesting what level of anxiety?

A. mild

B. moderate

C. severe

D. panic CORRECT ANSWER: B. moderate RATIONALE: The client has moderate anxiety. Other physiologic manifestations of moderate anxiety include muscle tension, pounding pulse dry mouth, high pitch voice and faster rate of speech. Psychological responses of moderate anxiety are increased irritability, narrowing of perceptual field, and easy distractibility but the individual can focus with assistance.

33. The nurse does the SOAP recording. The following are objective manifestations of anxiety except:

A. The client said "I can't sleep well."

B. The client's blood pressure is 130/90.

C. The client had sweaty palms.

D. The client was noted to be pacing and can't sit still. CORRECT ANSWER: A. The client said "I can't sleep well." RATIONALE: The inability to sleep as claimed by the client's is a subjective manifestation of anxiety.

34. Stress management techniques include the following except:

A. problem solving

B. imagery

C. progressive muscle relaxation

D. meditation

CORRECT ANSWER: A. problem solving RATIONALE: Problem solving is a technique where a nurse helps the client explore possibilities and find solutions to his problem. The rest of the choices are techniques to reduce anxiety. Imagery is the use of fantasy to relieve anxiety. Progressive muscle relaxation uses a process of tensing and releasing groups of muscles starting from the facial muscles and moving down to the body to the muscles in the feet. Meditation involves focusing attention and self-regulation

35. The nurse engages the client in problem solving. The client says, “I know that my work and family concerns upset me.” The next statement the nurse makes in guiding the client do problem solving is:

A. "What have you tried to solve it?"

B. "Perhaps we can discuss other things you can do to ease your work."

C. "Engage other family members in household chores."

D. "That is something you can discuss with your boss." CORRECT ANSWER: A. "What have you tried to solve it?" RATIONALE: This attempts to assess the problem solving techniques previously tried that may help the nurse in guiding the client identify alternative solutions to the problem. Choice B helps the client identify new coping strategies after assessment is done. Choice C and D give advice and do not allow the client to have a role in the problem solving process that makes the client feel helpless and not in control.

36. Situation: A 35 year old homemaker goes to the clinic and talks about having lost everything after the husband, 42 years old, leaves her for a much younger woman. The husband's behavior may reflect a developmental concern of:

A. role identity vs. role confusion

B. intimacy vs. isolation

C. generativity vs. stagnation

D. ego integrity vs. despair

CORRECT ANSWER: C. generativity vs. stagnation RATIONALE: This stage refers to middle adulthood stage where one confronts mortality for the first time that leads to reevaluation of life's goals and purposes in life. In generativity this individual attempts to ensure his immortality by transmitting his values to the next generation. Persons who had previously unexamined lives often find themselves in a state of crisis as in the case of this husband.

37. When the woman was asked to talk about her husband she remarked, "Let's talk about it later" is utilizing what defense mechanism?

A. isolation

B. denial

C. repression

D. suppression CORRECT ANSWER: D. suppression RATIONALE: Suppression is a conscious attempt to exclude from conscious awareness unacceptable thoughts and feelings.

38. Which of the following is true of crisis?

A. Ones usual coping helps in resolving the problem.

B. A crisis for one may not be a crisis for another.

C. One experiences a crisis alone.

D. A crisis state indicates mental illness. CORRECT ANSWER: B. A crisis for one may not be a crisis for another. RATIONALE: Crisis is highly individualized. People vary in their appraisal of events, their ability to cope, coping resources and support system so that what maybe a crisis for one may not be a crisis for

another. Crisis is a state of disequilibrium where the usual coping patterns fail in dealing with the present problem. A crisis state affecting an individual usually also affects the significant others who constitute his support system. A crisis is not seen as an illness but an upset in the steady state of the system in which there is massive amount of anxiety.

39. The following questions may be included when assessing a client in crisis: 1. "What are your feelings about the situation?" 2. "Have you experienced any similar situation in the past?" 3. "Who can be helpful to you?" 4. "What were your childhood conflicts?"

A. 1 and 2

B. 3 and 4

C. 1,2,and 3

D. 1,2,3 and 4 CORRECT ANSWER: C. 1,2,and 3 RATIONALE: Nursing assessment of a client in crisis includes the precipitating event and circumstance, the client's perception of the event, past experience of similar event and coping measures in the past, the client's strength and support system. Crisis intervention does not focus on any unresolved conflicts that occurred in the past but rather on the present problem.

40. During the course of therapy, the woman agrees to join a support group. After listening to someone who talked about her marital problem during the group session she remarks "I didn't think anyone else had a problem like mine", reflects a curative factor of group therapy:

A. Altruism

B. Existential factors

C. Catharsis

D. Universality

CORRECT ANSWER: D. Universality RATIONALE: Universality assists participants in recognizing common experiences. Altruism is finding meaning through helping others. Existential factors refer to having control over the quality of one's life. Catharsis is expressing openly one's suppressed feelings.

41. Situation : Ann, 23 years old is very talkative, moves about a lot and is irritable. Impression : Bipolar Mood Disorder, manic phase. The elevated, expansive emotional response in a manic client is a disturbance in:

A. Mood

B. Impulse control

C. Affect

D. Both A and C CORRECT ANSWER: A. Mood RATIONALE: Mood disorder is a disturbance in the prevailing emotional state of a client. Bipolar disorder involves extreme mood swings from episodes of mania to episodes of depression. Mood refers to the client's pervasive, enduring emotional state while affect is an outward expression of an emotional state and is temporary. Affect does not prevail and therefore it is an inappropriate term to refer to the pervasive emotional state that occurs in mania.

42. The best primary prevention for mood disorders is :

A. expression of feelings

B. suppressing ones problems

C. avoiding stressors

D. Taking mood stabilizers CORRECT ANSWER: A. expression of feelings

RATIONALE: Depression occurs when hostility is turned inwards. On the other hand mania is a defense against an underlying depression. A manic client externalizes his hostility to the environment. The best primary prevention of mood disorder is verbalization of feelings.

43. During assessment the client frequently switches topics but the nurse can still follow the client's thought pattern is manifesting:

A. word salad

B. Circumstantiality

C. looseness of association

D. flight of ideas CORRECT ANSWER: D. flight of ideas RATIONALE: Flight of ideas is characterized from jumping from one topic to another but the client can still be followed. Word salad is a jumble of words put together. Circumstantiality is talking around the topic with inclusion of unnecessary details that delays the meeting of a goal. Looseness of association is fragmented thought without logical sequence resulting to incoherent speech.

44. When planning a therapeutic milieu for a hyperactive client the nurse considers which of the following activities?

A. making her bed

B. Initiate social activities in the patient group

C. competitive sports

D. bingo CORRECT ANSWER: A. making her bed RATIONALE: Making her bed is a safe activity to dissipate the excessive energy of a manic patient. It

is not therapeutic to engage the client in competitive activities nor initiate group activities because these are stimulating activities. Bingo requires concentration which the client does not have the capability to sustain.

45. The following medications maybe given to the client except:

A. Lithium Carbonate

B. Epival

C. Tegretol

D. Tofranil CORRECT ANSWER: D. Tofranil RATIONALE: Tofranil is an antidepressant. Lithium Carbonate is an antimanic drug. Epival and Tegretol are anticonvulsants but may also be used to manage mania.

46. Situation: A 30 year old woman, single is admitted to the psychiatric unit after being increasingly withdrawn and eating and sleeping poorly after she has become burdened of her family problems and demotion in her work. Relatives claimed that she attempted suicide by cutting her wrist. Which of the following has the highest priority in the nursing care of the client?

A. Assess the client's support system. Cccchanannaggeeeee????

B. Monitor the client's whereabouts.

C. Reassure him of worthiness and acceptance

D. The client expresses her hostile feelings. CORRECT ANSWER: B. Monitor the client's whereabouts. RATIONALE: The highest priority is given to keeping the client safe from self harm.Monitoring the client will ensure safety as this will prevent the possibility of overlooking attempts for self harm. This communicates a message of concern. The other interventions are also appropriate for a depressed

suicidal client but are not priority. 47. Indecision, inability to concentrate, loss of interest pessimism and self depreciation noted in a depressed client are alterations in:

A. affect

B. perception

C. cognition

D. activity CORRECT ANSWER: C. cognition RATIONALE: The indecision, inability to concentrate, loss of interest, pessimism and self depreciation are cognitive manifestations of depression. Alterations in activity among the depressed may either be psychomotor retardation or agitation. Alterations in perception include delusions and hallucinations which are congruent with the depressed mood of the client. Alteration in affect include sadness, apathy, despondency, anger, guilt, helplessness and hopelessness.

48. The nurse's initial approach in caring for a patient with major depression would be to:

A. Encourage to select her own meals

B. Actively listen to the client

C. Involve the patient in group therapy

D. Provide cheerful activities CORRECT ANSWER: B. Actively listen to the client RATIONALE: A depressed client needs to express her angry feelings within appropriate limits. This helps resolve anger that is turned to the self engaged in by the depressed and suicidal client. Placing demands on a depressed client who has psychomotor retardation as in making decisions and group activities and cheerful activities are not therapeutic.

49. In planning care for a client with endogenous depression, the nurse considers engaging the client

in activities:

A. At anytime during the day

B. In the morning

C. Towards the afternoon

D. At night CORRECT ANSWER: C. Towards the afternoon RATIONALE: Endogenous depression is associated with alterations in the neurochemicals nor epinephrine and serotonin. Its diurnal variation indicates that clients are more depressed in the early part of the day and are more accessible for activities towards the afternoon. These clients respond well to antidepressants.

50. The client says “I'm not good in anything. I’ve always been a failure." Which of the following responses is best for the client’s statement ?

A. " You’re not suppose to say that. You can function."

B. " What's making you good for nothing".

C. "Let’s work on your strengths."

D. "Can we talk about this tomorrow?" CORRECT ANSWER: C. "Let’s work on your strengths." RATIONALE: The client’s statement indicates low esteem. Focusing on the client’s strength enhances self worth. Choice A is not therapeutic because it disapproving and gives false reassurance. Choice B explores the client’s negative view of himself. Choice D disregards the client’s concern.

51. The client is withdrawn and spends most of the time on bed. The client refuses to join activities that require social exchange. The appropriate nursing diagnosis for this client behavior is:

A. Ineffective individual coping

B. Self esteem disturbance

C. Impaired social interaction

D. Powerlessness CORRECT ANSWER: C. Impaired social interaction RATIONALE: A depressed client has difficulty in relationship and tend to be solitary. While this poor social skill is directly linked to the client's feeling of worthlessness the clues indicate impaired social interaction.

52. Which nurse's action would be therapeutic:

A. Engage her in dance therapy.

B. Stay at the bedside at short but frequent intervals.

C. Tell her that her behavior is self defeating.

D. Inform her that from time to time the nurse will check on her. CORRECT ANSWER: B. Stay at the bedside at short but frequent intervals. RATIONALE: Offering to stay with the client at short but frequent interval communicates that the patient is important. This makes the nurse available during a time when the patient feels comfortable with initiating a dialogue.

53. Which behavior would the nurse expect to see in a patient following ECT?

A. Loss of short term memory

B. Hyperalertness

C. Hyperkinesis

D. Relief of delusions CORRECT ANSWER: A. Loss of short term memory RATIONALE: An expected outcome post ECT is short term memory impairment. The client may also be mildly confused and briefly disoriented. 54. The client asks the nurse about the purpose of ECT. The nurse responds that ECT will:

A. Relieve the symptoms of severe depression

B. Helps the client focus on a positive outlook

C. Give the patient insight into his conflict

D. Potentiate the therapeutic effect of psychotropic drugs CORRECT ANSWER: A. Relieve the symptoms of severe depression RATIONALE: ECT relieves symptoms of depression by causing changes in the monoamine neurotransmitter system similar to the changes caused by antidepressant drugs. It does not potentiate the therapeutic effects of psychotropic drugs.

55. The client who is on Tofranil (Imipramine), comments "I've been taking it for a week but I still feels sad and hopeless." Which statement by the nurse is correct about the medication?

A. It takes 2 to 3 weeks before the medication has its effect.

B. That's not usual. The medicine has an immediate effect.

C. People respond differently to medications.

D. Just be patient. It will take effect in due time. CORRECT ANSWER: A. It takes 2 to 3 weeks before the medication has its effect. RATIONALE: The therapeutic effect of Tofranil, a tricyclic antidepressant, takes 3 to 4 weeks.

56. Situation: Ann, 18 years old, is admitted to the psychiatric unit because of behavioral changes. The verbalization if made by a client indicates psychosis?

A. ' I just heard the voices telling me to scratch my face.'

B. I can't get myself to stop hand washing.

C. I feel hopeless about anything changing in my life.

D. I have trouble with the police because of my friends. CORRECT ANSWER: A. ' I just heard the voices telling me to scratch my face.' RATIONALE: Psychosis is the inability to distinguish what is real from what is not. The client's manifestation is hallucination, a false sensory perception. Choice B describes compulsion noted in Obsessive Compulsive disorder, a neurosis or abnormal anxiety. Choice C indicates hopelessness that may be noted among depressed clients. Choice D may indicate antisocial personality disorder.

57. Ann is noted to assume a far away look and mumbles to self. The nurse is likely experiencing:

A. illusion

B. delusion

C. hallucination

D. depersonalization CORRECT ANSWER: C. hallucination

RATIONALE: Talking to self behavior may indicate auditory hallucination. Illusion is a misinterpretation of an external stimuli. Delusion is a false fixed belief. Depersonalization is the feeling of unreality of the self.

58. Ann says "You'll kill me. Go away" Which is a therapeutic response

A. How can I hurt you?

B. Ann I'm your nurse

C. Tell me about your fear of being killed.

D. I won' come close to you. CORRECT ANSWER: B. Ann I'm your nurse RATIONALE: Presenting reality to a delusional client is the therapeutic response. Choice A is challenging. Choice C is not therapeutic because it explores the false content. Choice D reinforces the false.

59. Ann has progressively withdrawn from relationships. This reaction may be a result of the following except:

A. self punishment

B. inadequate confidence

C. fear of rejection

D. unclear self concept CORRECT ANSWER: A. self punishment RATIONALE: The client with schizophrenia has difficulty in social relationship may be due to positive signs like delusions and hallucinations, loss of ego boundaries, low esteem and lack of confidence.

60. The nurse conducts remotivation therapy for the purpose of:

A. assisting a regressed client to socialize

B. helps the client learn to compete and compromise

C. providing work opportunities for clients who are emotionally disturbed.

D. using reading materials to help develop emotional maturity. CORRECT ANSWER: A. assisting a regressed client to socialize RATIONALE: Remotivation also called conversation therapy is a form of socializing activity through group interaction about a topic associated with the real world. Choice B is the goal of recreational therapy. Choice C refer to vocational therapy. Choice C refers to bibliotherapy

61. Situation: Jose, 57 y/o, is admitted to the psychiatric ward due to aggressive behavior. The nurse was doing an assessment when the client became agitated. Which is an appropriate documentation made by the nurse regarding the patient's behavior?

A. The client became tense.

B. When asked to talk about his family the client became agitated.

C. When asked to talk about his family the client was noted to pace and with a clenched fist remarked “I’ll get back at them.”

D. When asked to talk the client became tense. CORRECT ANSWER: C. When asked to talk about his family the client was noted to pace and with a clenched fist remarked “I’ll get back at them.” RATIONALE: Recording of the client's behavior must be accurate, objective and describe the behavior. It should include potential triggers of aggression to alert the staff.

62. When responding to a verbally abusive client it is important for the nurse to:

A. Limit the client's verbal expressions

B. Point out the inappropriateness of the behavior

C. Remind the client that he will be restrained if he does not stop.

D. Remain calm and firm CORRECT ANSWER: D. Remain calm and firm RATIONALE: Remaining calm and firm when the client is verbally abusive provides a low level of stimuli to the client that provides a feeling of safety and security.

63. In encouraging verbal expression of the feelings the nurse therapeutically says:

A. What has caused you to feel angry?

B. Don't shout. Others will be disturbed.

C. Why are you angry?

D. Stop that or you'll be placed on restraints CORRECT ANSWER: A. What has caused you to feel angry? RATIONALE: This helps the client identify the true object of his hostility. Helping the client identify this in a non threatening manner may help reveal unresolved issues so they may be confronted.

64. When he was asked to be seated for his vital signs to be checked, he threw a chair across the room. Four staff members were needed to control and restrain him. The nurse identifies which appropriate nursing diagnosis:

A. Self directed Violence due to aggression. changeeeeeeeeeeeeeeeeeee

B. Potential for injury related to aggression

C. Potential for violence directed to others related to poor impulse control.

D. Ineffective individual coping related to poor defensive function CORRECT ANSWER: D. Ineffective individual coping related to poor defensive function RATIONALE: The client's behavior indicates that he can be physically harmful to others.

65. Which goal is most appropriate for this nursing diagnosis?

A. The patient will strike out at the staff but not to patients.

B. The patient will verbalize anger rather than act out.

C. The patient will be placed in restraints whenever he threatens anyone.

D. The patient will not talk about anger or strike out at anyone. CORRECT ANSWER: B. The patient will verbalize anger rather than act out. RATIONALE: The goal in dealing with a potentially violent client is to be able to express his anger/feelings in way that will not be harmful to self and others.

66. The nurse's initial action when dealing with an assaultive client is to:

A. Keep the patient away from others and under one-to-one supervision.

B. Restore the patient's self control and prevent further loss of control.

C. Allow the patient to act-out his frustrations, then establish a line of communication.

D. Use of seclusion and restraints to prevent harm to patients or others CORRECT ANSWER: B. Restore the patient's self control and prevent further loss of control. RATIONALE: Restoring the client's self control may be done initially by talking down the client. When this approach fails medications may be used. When these fail, seclusion or mechanical restraints may be necessary.

67. Situation: Carlo is diagnosed to have schizoid personality. Which of the following behaviors may be noted in the patient:

A. seductive, dramatic, center of attention

B. seclusive, doubts others, fears confiding in others

C. cold, introvert, lacks desire for close relationship

D. fantasies about success, power and intelligence CORRECT ANSWER: C. cold, introvert, lacks desire for close relationship RATIONALE: Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range emotional expression in interpersonal settings. Choice A describes histrionic personality disorder. Choice B is paranoid personality disorder while Choice D describes narcissistic personality disorder.

68. Known etiology of personality disorders include:

A. genetic influence

B. social learning

C. behavioral factors

D. all of them

CORRECT ANSWER: D. all of them RATIONALE: The development of personality disorders is a combination of biological, psychological, behavioral and socio-cultural factors.

69. Identification is one of the defense mechanisms used among clients with personality disorders. This mechanism:

A. Integrates some ways of a significant other.

B. Channels unacceptable drives into socially approved behavior

C. Return to earlier less mature stage of development.

D. Act in reverse something that is already done. CORRECT ANSWER: A. Integrates some ways of a significant other. RATIONALE: Persons with personality disorder may model their actions after those around them, particularly their parents. Choice B describes sublimation. Choice C is regression. Choice D is undoing.

70. The nursing diagnosis that may be identified in a client with schizoid personality disorders may include the following except:

A. impaired social interaction

B. ineffective individual coping

C. altered role performance

D. Perceptual alteration CORRECT ANSWER: D. Perceptual alteration RATIONALE: Perceptual alteration is not noted in a client with personality disorder. Personality disorders are characterized by inflexible and dysfunctional traits that impair their social and occupational function. Clients with schizoid personality use intellectualization when these patients describe emotional

and interpersonal experiences in an impersonal way.

71. Carlo withdraws from everyone. A therapeutic approach for Carlo is:

A. Escort Carlo to the activity and leave him there.

B. Tell Carlo to rest in his room until he is more comfortable of joining activities.

C. Include Carlo when the nurse initiates conversation with the patient’s

D. Suggest to the patient that he discuss this difficulty to his doctor. CORRECT ANSWER: C. Include Carlo when the nurse initiates conversation with the patient’s RATIONALE: The client has a pervasive lack of desire for involvement with others. The nurse should promote socialization initially by building trust then slowly involving the patient in milieu and group activities.

72. Situation 7 - Vina, a 28 year old movie starlet who was caught by the narcotics command during a shabu session. She voluntarily submitted herself for rehabilitation The best level of prevention in dealing with problems on drug abuse is:

A. Primary

B. Secondary

C. Tertiary

D. A and C CORRECT ANSWER: A. Primary RATIONALE: Primary level of prevention includes education and information dissemination regarding the effects of dangerous drugs. This involves altering the causative factors before they have the opportunity to cause drug abuse problems.