1. The student nurse is studying the different models affecting the ego defense mechanisms used by some patients. Which of the following is relating to the interpersonal model?

a. Based on inadequate resolution of developmental conflicts, thus ego defenses are unable to control anxiety
b. Anxiety arises and is experienced in between persons. A basic fear is the fear of rejection. A person needs security and satisfaction from others
c. Social and environmental factors create stress, which causes anxiety and symptoms. Unacceptable behaviors is socially defined
d. Problems are a result of biopsychosocial factors with emphasis on current maladaptive coping mechanisms

2. Shortly after his voluntary admission to a psychiatric inpatient unit, a client tells the nurse “I don’t know if I should be here. What will my family think?” Using reflection, which response by the nurse is most appropriate?

a. “Your family can visit you here and they will see that this is a helpful place.”
b. “You think your family will be upset because you have a psychiatric problem?”
c. “There is still a stigma associated with mental illness. Hopefully your family won’t feel this way.
d. “You are wondering if you made the vest decision and you are concerned about your family’s reaction.”

3. The nurse is aware that to establish a therapeutic proxemics between her and the patient, she should apply the personal space, which is:

a. 18 inches to 4 feet
b. 12 feet and more
c. 4 feet to 12 feet
d. 1 inch to 18 inches

4. In the phases of the nurse-patient relationship, which one of the following nursing actions falls under the identification stage?

a. Gathering data about the patient if information is available, including the significant other if present
b. Diagnosing the patient using the DSM-IV-TR axis and prioritizing patient care based on the presenting signs and symptoms
c. Collaborates with the patient using a problem-solving approach to resolve her problems
d. Observes the patient for regressive behaviors and encourage the identification of new coping mechanisms involved

5. In establishing therapeutic relationship, the nurse should implement certain boundaries. Which of the following statements describe this principle?

a. “I am here to listen to your problems, I am your nurse.”
b. “I am nurse and you are my patient.”
c. “This is where we are going to meet every other day, from 4:00 to 6:00 pm.”
d. “This is between you and me only.”

6. The NPR has already evolved into a nurse-patient partnership. The psychiatric nurse is aware that all of the following elements constitute this evolution except.

a. elements of clinical competence
b. intradisciplinary collaboration
c. patient-family advocacy
d. fiscal responsibility

7. Which of the following is the overall purpose of therapeutic communication?

a. To analyze the client’s problems
b. To elicit client’s cooperation
c. To facilitate a helping relationship
d. To provide emotional support

8. According to the protocols of Philippine laws and policies, what is the first nursing intervention in dealing with an abused victim?

a. Provide first aid or medical treatment as needed
b. Separate the victim from the perpetrator if the violence or abuse is imminent
c. Ensure sensitive, compassionate care of the victim
d. Provide reports to support the need for protective services for the child and elderly

9. The nurse accounted for the reasons why battered women often choose to remain in an abusive relationship. Which is considered to be the most important factor?

a. Fear of physical reprisal if they leave
b. Feelings of self-blame, guilt and depression, which can immobilize the victim
c. Emotional dependence and low self-esteem and the belief that they do not deserve better treatment
d. Feelings that they have no choice and no control over the situation

10. In the principle of intrafamily violence, the violence does not occur randomly but constitute a predictable three-phase cycle. Which one is not a part of the cycle?

a. tension building
b. remorseful and undoing
c. serious abusive incident
d. honeymoon phase

11. In applying the different verbal communication techniques, which one is false?

a. Reflecting directs feeling and questions back to the client to encourage elaboration
b. Validating information assures the client that he was heard ad understood
c. Summarizing key points of the discussion helps ensure accurate communication
d. Asking positive questions encourages the client to express concerns

 12. Which of the following statements is an example of seeking clarification?

a. “Do you mean that you become more anxious each time you leave your house?”
b. “Tell me more about that.”
c. “You’re feeling really sad since you’ve been unable to go back to work.”
d. “Did I understand you correctly when you said you were afraid of black people?”

13. In the nursing assessment of the psychiatric patient, which of the following data collection is best representing the area of the past psychiatric history?

a. Names and ages of family member or significant others, characteristics of relationships, and cultural or spiritual factors
b. First occurrences, hospitalizations, treatments and community follow-up care
c. Allergies, vital signs, weight, nutritional and dietary history, sexual orientation, reproductive history
d. General appearance, behavior, attention and orientation, use of language and speech patterns

14. The therapeutic nurse should possess an attribute about empathy. Which is the best example of this behavior?

a. “I know what you are going through right now.”
b. “Tell me more about your problem.”
c. “I understand that you are in a position that you can’t make up your mind.”
d. “I’m here to listen to you, just talk to me whenever you are ready.”

15. The nurse is trying to study some barriers to successful communication. Which one of the following is considered to be the most common?

a. Changing the subject is conversation
b. Stating one’s personal opinions and ideas about the client and his/her situation
c. Giving false or inappropriate reassurance
d. Making improper use of medical or nursing knowledge

16. In the use of confidentiality, which of the following nursing action best depicts this principle?

a. The nurse shares client information with professional staff only on a need-to-know basis
b. The nurse shares client information with the other staff for further investigation
c. The nurse must obtain the patient’s consent before giving out personal information
d. The nurse denies the information of her patient in relation to the drug regimen

17. In establishing trust, the prudent nurse should be equipped with the principles of active listening. What does “F” stands for in FERMS for active listening?

a. focus on the patient
b. feedback as appropriate
c. face the patient
d. follow on the topics presented by the patient

18. The nurse understands that which one of the following risk factors for the development of mental retardation is considered to be the highest?

a. early embryonic development
b. unknown etiology
c. environmental or other mental disorders
d. hereditary

19. The boy is diagnosed with autism at age 3. The mother asked the nurse what foods are contraindicated for her child. The nurse is correct when she answered

a. Avoid tyramine-rich foods and offer small frequent feedings
b. Allow the child to participate in meal planning and meal preparation
c. Avoid high caffeine diet and provide ample time in feeding the child
d. Give the child the opportunity to verbalize the foods that he wants to eat and the foods that he doesn’t want to eat

20. The nurse observed the mother who is taking care of her child with moderate mental retardation. Which one of the following parental actions needs further assistance?

a. The mother was teaching the child only one thing at a time
b. The mother was teaching the child small social graces and manners which are a tremendous factor in helping to be accepted by others
c. Selecting attractive, well-fitted clothing, hair style and good hygiene practices
d. Prolonging teaching sessions since retarded individuals easily become fatigue

21.The nurse understands that in studying autistic disorder, all of the following are related for the development of this disease except

a. Occurs more on males that in females
b. Fastest-growing serious developmental disability all over the world
c. Special education is necessary
d. The IQ levels falls below normal

22. All of the following are nursing responsibilities for mental retardation except

a. Promote optimal functioning in ADL and feelings of accomplishment and self-worth
b. Provide opportunities for client or family to communicate thoughts and feelings
c. Provide positive reinforcement for every success
d. Protect the client from self-injury

23. Which of the following characteristics is more inclined to an autistic person?

a. High risk for developing seizure disorder
b. High risk for developing high activity and achievement in academics
c. High risk for body mutilation: directed towards others
d. High risk for poisoning

24. The nurse is teaching a group of pregnant mothers on the proper procedures and prevention of mental retardation. Which of the following is considered to be of the highest importance?

a. Early detection of the various disorders present to early childhood
b. Immunizations against communicable diseases and completing by age 1
c. Improved nutrition through a dietary requirement instruction and proper meal planning
d. Genetic counseling and adequate medical care during the prenatal period and after birth

25. The mother came in to the clinic with her child diagnosed to have a mild level of mental retardation. Upon assessment of the child, all of the following can be expected except

a. able to become self-supporting
b. can be educated up to grade 6
c. able to perform skills with mild supervision
d. can perform deductive reasoning

26. The nurse understands that which of the following vaccines has the highest incidence of autism-pervasive disorders?

a. thimerosal vaccine
b. pneumococcal conjugate vaccine
c. live attenuated virus vaccines
d. acellular pertussis vaccine

27. The student nurse is doing a clinical study on the different clinical types of mental retardation. Which of the following attributes to a person with Wilson’s disease?

a. Usually mouth-breathers and prone to respiratory infections; tongue is flabby with deep grooves and fissures
b. Dwarfed bodies, large heads and dry, wrinkled skin with the development of the thickened lips, nostrils, hands, feet and back of the neck
c. Always fair-haired, light skin, have blue eyes and widely-spaced incisors; may void more frequently and in larger amounts
d. Rare hereditary disease characterized by normal deposits of copper in body organs and tissues which develops involuntary movements with progressive deterioration in articulation and swallowing

28. The nurse is aware that the priority of the child with profound level of mental retardation are all of the following except

a. nutrition
b. safety and comfort
c. self-esteem
d. communication

29. The nurse is taking care of a child diagnosed to have mild mental retardation. The principles of the nurse to be followed are all of the following except

a. repetition of daily tasks and activities of daily living
b. reinforcement on the importance of self-worth and suicidal precautions
c. role modeling to patients in accordance to the level of cognitive and personality development
d. restructuring the physical environment based on safety and security of the patient

30. This is the repetition of sounds, words of frequent hesitations in speaking

a. echolalia
b. verbigeration
c. stuttering
d. preservation

31. The 25 year old boy came in with a personality development age presenting like a school-age. The nurse understands that the boy is suffering from what level of mental retardation?

a. mild MR
b. severe MR
c. moderate MR
d. profound MR

32. Which of the following herbal medicines is believed to increase the metal capacity of a person?

a. echinea
b. kava-kava
c. St. John’s wort
d. ginko biloba

33. By research, what is the least common type of mental retardation in the Philippines?

a. mild mental retardation
b. moderate mental retardation
c. severe mental retardation
d. profound mental retardation

34. The girl came in with a mild mental retardation. The mother asked the nurse about the issues affecting object permanence? The nurse is correct when she relates the issue to what level of Jean Piaget’s theory?

a. sensorimotor
b. pre operational
c. concrete
d. formal

35. The nurse knows that of all the antipsychotic drugs developed, there are three which can be given in depot injection. All of the following are these drugs except

a. Fluphenazine (Prolixin)
b. Risperidone (Risperdal)
c. Haloperidol (Haldol)
d. Trifluperazine (Stelazine)

36. The patient who is taking Biperiden (Akineton) to combat EPS is now complaining of dry mouth. Knowing the principle of the anti-cholinergic side effects, which would the nurse do to alleviate the complaint?

a. offer a high-calorie juice drink every 2 hours
b. offer a sugar-free hard candy for the patient to suck on
c. apply Vaseline jelly on the patient’s lips
d. wet the mouth with water every 2 hours

37. The student nurse is doing a drug study on the mechanism of actions of certain neuroleptic drugs for his patient in the psychiatric ward. Which of the following statement of the student needs further education?

a. Clozapine (Clozaril) is relatively weak blockers of dopamine-2 thus decreasing the incidence of EPS
b. Ziprasidone (Geodon) inhibit the reuptake of serotonin thus increasing the effectiveness in treating the depressive aspects of schizophrenia
c. Paliperidone (Invega) is the newest atypical antipsychotic which has an extended release preparation
d. Aripiprazole (Abilify) is classified as dopamine system antagonist thus stabilizing the dopamine out of the body

41. The patient has an order of Clozapine (Clozaril) 300 mg PO OD. Knowing that the drug has greater affinity to develop fatal side effects, which of the following is the best nursing management?

a. The patient should have a weekly WBC monitoring with ANC monitoring after 2 weeks
b. The patient should be isolated from other patients for some time until resistance is developed
c. The patient should have cardiac enzymes checked every month and monitor for altered heart rhythms
d. The patient should be discontinued from taking Clozaril and be shifted to other drug regimen

42. Which of the following neurotransmitter is located primarily in the brain stem which has been found to be involved in the control of complex movements, motivation, cognition and regulation of emotional response?

a. serotonin
b. dopamine
c. acetylcholine
d. gama-aminobutyric acid

43. After research, which of the atypical antipsychotic drug is proven to be highly effective and rarely causes EPS to patients?

a. Clozapine (Clozaril)
b. Ziprasidone (Geodon)
c. Olanzapine (Zyprexa)
d. Risperidone (Risperdal)

44. Which of the following extrapyramidal symptoms would most likely to occur in the first week of taking high-dose Haloperidol (Haldol)?

a. Acute muscular rigidity and cramping, a stiff or thick tongue with difficulty of swallowing
b. Stiff, stooped posture, mask-like faces, decreased arm swing and shuffling, festinating gait
c. Restlessness, anxiety attack, agitation and lack of spontaneous gestures
d. Tongue twisting, lip-smacking, ear moving and fine finger tremors

45. When the nurse reviewed the medication history of a schizophrenic patient, she found out that most of the drugs were “low-potency drugs”. Knowing the principle of safety, the nurse correctly interprets this as

a. The amount of the drug needed to achieve that maximum effect
b. These drugs require higher dosages to achieve efficacy
c. This is the time it takes for half of the drug to be removed from the blood-stream
d. Refers to the maximum therapeutic effect that a drug needed to achieve that maximum effect

46. The mother of a schizophrenic child asked the nurse what is the meaning and relevance of “depot injection”? The nurse’s best response is

a. The medication is absorbed slowly over time, thus less frequent administration is needed to maintain the desired therapeutic effects
b. The medication is shifted to intramuscular injection for a lesser gastric irritation and more absorption of the drug is achieved
c. The medication is coated with sunflower oil for the drug to be released over a period of time
d. The medication is shifted to intramuscular to prevent hoarding of the drugs and for better compliance of the patient

47. Neuroleptics are generally used to treat symptoms of psychosis but can also be used as an “off-label drug” for all of the following conditions except

a. treatment of anxiety and insomnia
b. hallucinations, delusions and episodes of illusions
c. aggressive behaviors and other disruptive behaviors
d. major depression which do not respond to ECT              

48. Knowing that the patient already had a history of neuroleptic malignant syndrome, which of the following will the nurse’s top priority?

a. nutrition monitoring
b. hydration monitoring
c. safety monitoring
d. cardiac enzymes monitoring

49. An elderly patient came was admitted at the psychiatric facility with a diagnosis of dementia-related psychosis. Reviewing the principle of safe drug regimen, which of the following anti-psychotic order should the nurse question?

a. Chlorpromazine (Thorazine) 250 mg BID PO
b. Thioridazine (Mellaril) 200 mg QID PO
c. Olanzapine (Zyprexa) 15 mg TID PO
d. Haloperidol (Haldol) 10 mg BID PO

50. The psychiatrist left an order for the nurse to monitor the patient for potential development of neuroleptic malignant syndrome. Which of the following signs would indicate to report immediately?

a. The patient’s feeling of internal restlessness and intense tremors
b. The patient’s permanent involuntary movements which alters the daily activities of daily living
c. The patient’s sudden high fever, unstable blood pressure and elevated CPK levels
d. The patient’s confusion and agitation with intense need to move about

51. The mother of a paranoid patient asked the nurse why her son is still needing to take the certain medications where she knew it will “not cure” his condition. The response of the nurse should be guided on which principle in pharmacologic treatment?

a. The medication prescribed is based on its effect on the patient’s target symptoms and is largely evaluated by its ability to diminish or eliminate the target symptoms
b. Many psychotropic drugs must be given in adequate dosages for some time before their full effect is realized
c. Compliance with the medication regimen often is enhanced when the family is in accordance with the prescription
d. Follow-up care is essential to ensure compliance with the medication regimen to make needed adjustments in dosage and to manage side effects

52. Of all the EPS, this is considered to be the irreversible

a. acute dystonia
b. tardive dyskinesia
c. akathisia
d. pseudoparkinsonism

53. Which of the following anti EPS is classified also as a dopaminergic agonist drug thus reducing the incidence of pseudoparkinsonism?

a. Benztropine (Cogentin)
b. Biperiden (Akineton)
c. Amantadine (Symmetrel)
d. Trihexyphenidyl (Artane)

54. A patient is undergoing treatment for alcoholism and is monitored for alcohol withdrawal as well as to relieve anxiety. The nurse knows that all of the following drugs can be given except

a. Diazepam (Valium)
b. Diazepoxide (Librium)
c. Clonazepam (Klonopin)
d. Flurazepam (Dalmane)

55. When screening the client with undetected alcohol problems, the nurse must use an established questionnaire, such as CAGE. Which of the following is not a part of this questionnaire>

a. “Have you ever felt like you ought to cut down on your drinking?”
b. “Have people annoyed you by criticizing your drinking?”
c. “Have you ever had a drink at lunch to study your nerves or get rid of hangover?”
d. “Have you felt bad or guilty about your drinking?”

56. A new nurse observed that her patient was an alcoholic for more than 20 years. The psychiatrist initiated an alcohol-induced seizure precaution for the patient. The nurse understands that the patient is suffering from delirium tremens if

a. The patient suddenly loses consciousness, rolls eyeballs and started to have agitation
b. The patient has increased pulse rate, increased blood pressure, severe agitation and delusions with hallucinations
c. The patient has manifested a grand mal seizure with periods of petit mal seizure in between
d. The patient hyperactivity level is uncontrollable then produced severe agitation

57. The prudent nurse knows that anti-psychotic drugs may produce postural hypotension effects. Knowing this principle, all of the following are the nurse’s responsibility except

a. Withhold drug if systolic pressure drops more than 20-30 mmHg from previous reading
b. Elevate client’s legs while seated
c. Teach client the importance of lying down prone for 1 hour following injection
d. Obtain baseline blood pressure and monitor on lying and standing position

58. The patient, who is taking Disulfiram (Antabuse) for 2 weeks went into remission and took red wine as part of the dinner regime. The nurse understands that which of the following reactions is expected from the patient?

a. hypotension, confusion and vomiting
b. tachycardia, palpitations, vomiting and dyspnea
c. agitation, hallucination and vomiting
d. vomiting and loss of consciousness

59. The psych nurse is aware that which of the following reactions is considered to be seen first on a patient to have an antabuse-alcohol episode?

a. extreme thirst
b. extreme palpitations
c. extreme diaphoresis
d. extreme vomiting

60.    The prudent nurse notes that alcoholic person for 10 years has stopped and discontinued consuming alcohol for about 3-5 days. The nurse will expect the alcoholic to present which of the following manifestations?

a. increased blood pressure, diaphoresis, and nervousness
b. gross tremors, profound confusion, insomnia and disorientation
c. severe hallucinations and grand mal seizures
d. delirium tremens, confusion, agitations, severe psychomotor activity

61. An alcoholic patient was diagnosed to have moderate Korsakoff syndrome. The patient asked the nurse what it was. The nurse is correct when she answered

a. It is an acute confusional state characterized by ataxia, delirium and peripheral neuropathy
b. This can be reversed by increasing the dose of thiamine in the diet
c. This is a chronic cognitive impairment characterized by cerebral atrophy and memory loss
d. this includes black outs or anterograde amnesia and some may develop into seizure

62. A nurse is about to administer Clozapine (Clozaril) 500 mg PO to a psychotic patient diagnosed with undifferentiated schizophrenia. Which of the following would alert the nurse for the possible and significant side effects of the drug?

a. sedation, weight gain and increase blood glucose, lipid and prolactin levels
b. sedation and extrapyramidal effects, orthostatic hypotension
c. sedation, weight gain and agranulocytosis
d. sedation, decreased prolactin levels and increased EPS at higher levels

63. Which of the following characteristics is correct about alcohol use and its effects to a person?

a. Only approximately about 2% of alcohol abusers are the “skid row” type
b. Alcohol generally is classified as a central nervous system depressant in acute stage and a central nervous system stimulant in chronic stage
c. Alcohol is considered a medical disease and legal case than can be arrested but cannot be cured
d. Chronic alcoholics tend to use only 3 defense mechanisms: introjection, denial and rationalization

64. Ritualistic and repetitive behavior is common in children with autism. Knowing this condition, the nurse will plan to

a. Provide a safe environment and protect the child from self-injury
b. Avoid scolding the child and letting him finish his rituals
c. Take precautionary measures in maintaining a low caffeine meal
d. Encourage the child to develop a relationship with another person

65. The nurse is giving health teachings to a parent of an alcoholic teenager who is taking Disulfiram. The parent questioned the nurse about certain cough medicines to be avoided. The nurse is correct when she said it is best to avoid which cough medication?

a. Dextrometorphan
b. Guaiafenesin
c. Carbocisteine
d. Epinephrine

66. The patient who is in Disulfiram (Antabuse) treatment should be given health teachings on the proper care and prevention of potential side effects. All of the following responses of the nurse is correct except

a. Teach the patient to read product labels carefully and select items that are alcohol-free
b. Teach the patient to report signs of facial and body flushing, throbbing, headache, sweating and dizziness
c. Teach the mother of a patient never to give Antabuse if the patient is in a state of alcohol intoxication
d. Teach the patient to substitute perfume with colognes for a fewer side effects

67. Which of the following is considered a legal blood alcohol level?

a. 0.01-0.10
b. 0.10-0.90
c. 0.50-1.50
d. 0.60-1.20

68. After the assessment of the patient and taking the initial history, the doctor prescribed Carbamazepine (Tegretol) to her. The prudent nurse understands that before starting therapy, the nurse should prepare the patient for what laboratory procedure?

a. serum SGPT and serum SGOT
b. CBC
c. serum creatinine and serum BUN
d. cardiac enzyme test

69. When the nurse reviewed the laboratory data of the patient, she found out that the lithium level was 3.5 mEq/L. Knowing the therapeutic range of the drug, the nurse will expect

a. The patient be discontinued from the therapy and be given diuretics in bolus
b. The patient be monitored under ECG for certain arrhythmias might arise
c. The patient will undergo dialysis treatment
d. The drug will be substituted with an anticonvulsant immediately

70. The patient had a history of committing suicide because of failure of the board exams. After initiating suicidal precautions to the patient, the nurse would prepare what antidepressant drug appropriate for this patient?

a. cyclic compounds
b. other compounds
c. selective serotonin reuptake inhibitors
d. MAOI

71. The manic patient was started with Eskalith 900 mg daily for the control of extreme physical behavior and agitation. Knowing the principles of lithium management, which of the following should be included in the plan of care?

a. Instruct patient to return to clinic after 2-3 days for blood extraction
b. Teach the patient on the foods rich in tyramine to be avoided
c. Encourage taking lithium on an empty stomach
d. Teach the patient to increase fiber in the diet to prevent constipation

72. The nurse reviewed the chart and noticed that her patient had a history of Buspirone (Buspar) toxicity. Knowing the principles of this drug, the nurse should

a. Prepare and activated charcoal to minimize systematic absorption of Buspar
b. Administer Flumazenil (Romazicon) immediately to reverse the effects of the ingested drug
c. Since there is no direct antidote to Buspar, respiratory support is provided until the drug is removed from the system
d. Give the patient Naloxone (Narcan) to prevent respiratory depression

73. A new nurse was assigned in a ward with known substance abuse. The psychiatrist told the nurse that one patient is having a dual diagnosis on cannabis. The nurse understands this as

a. The person uses two or more than one abusive substance
b. It refers to the assignment of another psychiatric diagnosis for an individual with a substance-specific disorder
c. This is the development of a reversible substance-specific syndrome induced by ingestion or exposure to a substance that produces physiologic effects on the CNS
d. It is a cluster of cognitive, behavioral and physiologic symptoms indicating continued use of a substance despite significant life problems related to its use

74. Certain anticonvulsant drugs may cause rashes and rarely, life threatening toxic epidermal necrolysis. This term is described as

a. anaphylactive shock syndrome
b. acute hemolysis syndrome
c. Steven-Johnson syndrome
d. Goodpasteur syndrome

75. The prudent nurse is administering lithium to a patient diagnose with bipolar disorder. The mother of the patient asked the nurse what is the action of lithium in mania. The nurse’s best response is

a. Lithium increases the reuptake of serotonin, acetylcholine, norepinephrine and dopamine thus decreasing incidence of manic episodes
b. Lithium reduces the release of norepinephrine through competition with calcium
c. Lithium relaxes smooth muscle thereby reducing the muscle contraction and increasing the total body relaxation
d. Lithium enhances the absorption of the excitatory neurotransmitters thus decreasing the agitation and tremor-like symptoms

76. One of the major advent of new anti-anxiety is the development of non-benzodiazepine Buspirone (Buspar). The nurse knows that Buspar has the same effect of Valium except

a. Buspirone does not cause physical dependence especially on long term use
b. Buspirone produces sedation and drowsiness is common
c. Client taking high dose of Buspirone may experience “next-day sedation”
d. Common side effects of Buspirone include dizziness, nausea and headache

77. The patient complained that there was a bitter taste of lithium, like metal. After assessing, which is best nursing response?

a. This is considered an expected side effect of lithium therapy
b. Take a blood level extraction to determine the lithium level for it might a sign of toxicity
c. Take lithium with fruit juice to decrease the unpleasant taste
d. Notify the physician to change the dosage of lithium of the patient

78. The nurse is monitoring a patient on anti-depressant therapy for potential serotonin syndrome effects. Which of the following signs will the nurse look out for?

a. agitation, sweating, tachycardia, hypotension, hyperreflexia
b. bradycardia, bradypnea, hypotension
c. diaphoresis, tremors, seizures, palpitations
d. fever, night sweats, insomnia, weight gain, sedation

79. A patient who is an Phenelzine (Nardil) is asking the nurse on what types of cheese can be ingested to prevent potential hypertensive crisis. All of the following cheeses can be given except

a. cream cheese
b. ricotta cheese
c. cottage cheese
d. cheddar cheese

80. Which of the following is the only antidepressant drug that can be given on a weekly basis after the patient has been stabilized?

a. Fluoxetine (Prozac)
b. Imipramine (Tofranil)
c. Isocarboxacid (Marplan)
d. Clomipramine (Anafranil)

81. The mother of the patient reported to the nurse that her son missed the required dose of a drug about 2 hours ago. Knowing the principles of safety precaution, the nurse should

a. Give the required dose to the patient immediately and check the vital signs
b. Omit the forgotten dose and check the patient for agitation
c. Report to the psychiatrist for a change of drug product
d. Omit the forgotten dose and document in the nurse’s notes

82. The nurse understands that all of the following are considered to be characteristics of a typical abuser except

a. social isolation and poor coping skills
b. poor impulse control and has low self-esteem
c. narcissistic personality
d. flexible but obsessive views about control issues

83. The nurse is aware that a person who is a chronic user of any substance abuse has the greatest concern on which nursing diagnosis?

a. chronic low self-esteem
b. altered nutrition: less than body requirements
c. altered defensive coping
d. impaired social interaction

84. The patient asked the nurse why volume replacement is needed for those known to have morphine toxicity. The nurse’s best response is

a. It lessens the effects of morphine and helps in eliminating the drug through urine
b. It helps dilute the drug by increasing the plasma of the blood thereby increasing cell permeability
c. It helps in preventing or treating hypotension which may lead to shock
d. It increases the peristalsis of the person thereby increasing the release of the drug through defecation

85. Recognizing that relapse is always possible and considered a threat to the patient. Which of the following is considered the best nursing intervention to prevent such incidence?

a. Nurses should refer patient to self-help groups
b. Nurses should set up contracts with patients
c. Nurses should educate and present videotapes and talks by previous patients
d. Nurses should explain the effects of the substance of the body

86. The nurse is preparing her chart for a patient who is positive for perforated nasal septum, lung damage and euphoria. Sometimes the patient manifest grandiosity, combativeness, tachycardia, hypertension, nausea and vomiting. Knowing all these signs, the nurse would prepare what antidote?

a. Disulfiram (Antabuse)
b. Naloxone (Narcan)
c. Nortriptyline (Pamelor)
d. Bupropion (Wellbutrin)

87. The student nurse was initiating a study on the possible causes of persons going to substance abuse. One theory was about psychobiologic theory which states that

a. The individual has ego impairment and a disturbance in sense of self
b. Addictive substances activate neurotransmitters in the mesolimbic dopaminergic reward pathways  in the brain
c. Suggests that substance abuse is resorted to in an attempt to relieve the feeling of hopelessness experienced with poverty and chronic unemployment
d. Suggests that substance abuse is a learned response to stressful stimuli and increases a feeling of well-being

88. Upon interview, the nurse observes that the girl complained of rape and acts of lasciviousness. Knowing this principle, the nurse is guided that the key factor for considering an act as a rape is the

a. any forced sexual contact
b. lack of adult consent
c. tearing of the vaginal and/or rectal wall
d. date-rape cycle

89. Battered women with presenting signs should be encouraged to assert their rights and welfare. In relation to this, what is the best role of the nurse?

a. nurse advocate
b. nurse counselor
c. legal nurse
d. nurse educator

90. An addict patient was admitted to the unit positive for abuse of Methyloxyedenydextromethamphetamine HCl. Which of the following doctor’s order would the nurse question?

a. Gradually increase the level of physical activity to combat depression
b. Gradually increase fluid intake to prevent severe dehydration
c. Gradually expose patient to direct sunlight
d. Gradually increase the diet from soft diet to full diet as tolerated with emphasis more on proteins

91. Which of the following characteristics is considered to be categorized as psychological abuse?

a. Stealing of the victim’s money or assets
b. Denying the victim access to personal finances
c. Inconsistent communication patterns
d. Beating, hitting and raping the victim

92. Knowing the recommended daily allowance of coffee for Filipinos, how many cups would greatly cause anxiety, insomnia and depression, tachycardia and arrhythmias?

a. around 3-4 cups per day
b. around 4-5 cups per day
c. around 5-6 cups per day
d. around 6-7 cups per day

93. The nurse is aware that which of the following is considered as a herald sign of behavioral and psychological signs of abuse in elderly persons?

a. Seeks attention from others
b. Unusual interest in, or avoidance of, all things of a sexual nature
c. Rationalizes abuse
d. Feelings of hopelessness

94. The patient was a known Ganjha user for around 10 years. The prudent nurse knows that the patient will manifest which of the following?

a. altered sensory perceptions, euphoria, social withdrawal, conjunctival irritation and increased appetite
b. muscle cramping, lacrimation, rhinorrhea, piloerection, sweating, fever and insomnia
c. euphoria, hyperactivity, anxiety, impaired judgment, tachycardia, myocardial infarction, hypotension and may go to seizure
d. depression, insomnia, irritability, anxiety, bradycardia and seizure

95. A patient came in and complained to the nurse of a sadistic rape brought about by her alleged boyfriend. The nurse interprets this as

a. Aims merely to inflict physical violence and cruelty to the victim
b. The intention of the rapist is not to injure the victim but to command and master another person sexually
c. This is motivated by the pleasure derived from being brutal while doing a sexual act
d. The rapist just use force and viciousness to debase the victim

96. The nurse is planning to use a direct confrontational strategy on a patient diagnosed with chronic crack user. Which of the following statement best illustrate this principle?

a. “You have slurred speech.”
b. “Either you get help now or you will have to leave your job.”
c. “You have alcohol on your breath.”
d. “Tell me more about your concerns.”

97. The nurse is studying on the following factors which led to under reporting of crimes committed in rape cases. Which of the following is not considered a factor?

a. Rape victims return home, shower and bathe before notifying the police or going to the hospital
b. A majority appear to be in good control of their feelings and behavior which denotes numbness, disbelief and emotional shock
c. They do not report the crime committed to them because of guilt or embarrassment about their experience
d. The family experiences different thoughts and feelings as the victim

1. A 21 year old male was for the treatment of a severe sexual disorder. The patient asked the nurse as to why he is to receive anti-androgen drugs. The nurse is correct when she states that:

a.     This will help curb the deviant sexual behaviors of sex offenders, thus reducing the person’s sex drive
b.     By reducing the androgens, you will be more capable of having self-sexual gratification
c.     By decreasing the testosterone levels in your body, you will be more like a female – fragile and non-sexually active
d.     This will give you a negative effect after having certain ejaculations thus controlling your sexual appetite

2. Hospitalization is required to a patient if at risk and a danger to other. One of the treatment modality for sexual disorders is orgasmic reconditioning. The nurse understands this as:

a.     By pairing a patient’s harmful sexual variation with an unpleasant stimulus, this technique helps deter the person from repeating the same abnormal sexual act
b.     The patient is initially asked to masturbate to his or her typical, then the patient is told to concentrate on a more acceptable fantasy just before orgasm
c.     This involves causing the person to feel shame in order to discourage him from engaging in the deviant behavior again
d.     This technique entails showing video tapes of deviant behaviors and their consequences such as victims describing desired revenge

3. When the nurse was reviewing a chart of a certain patient, she found out that the doctor diagnosed him as autogynephilia. The nurse is aware that this is

a.     A sexual activity wherein a man’s propensity to be sexually aroused by thoughts or images of himself as a woman
b.     The man uses a hypoxia to achieve sexual excitement, this can be complicated by autoerotic asphyxiation
c.     Is a new subcategory of pedophilia in the victims who are younger than 5 years old
d.     Derives sexual gratification from videos, usually of women doing natural acts or women involved in sexual activity

4. Scatologia is a form of paraphilia which is not otherwise categorized. The nurse is aware that scatologia means:

a.     Sexual interest exclusively focused on a particular body part
b.     Sexual act which involves making obscene phone calls
c.     Sexual activity involving giving enemas while having sex
d.     Is a sexual gratification

5. According to research, all of the following are the mose common paraphilias worldwide except:

a.     Pedophilia
b.     Voyeurism
c.     Exhibitionism
d.     Masochism

6. What is the term used to describe when the person is aroused and having sexual preoccupation with objects or things of another person?

a.     Exhibitionism
b.     Fetishism
c.     Transvestism
d.     Frotteurism

7. Taking care of a patient with dependent personality disorder is a great challenge for the nurse. To foster development of autonomy to the patient, the nurse should

a.     Help the client explore strength and assets
b.     Teach client problem solving skills
c.     Assist client to improve daily functioning
d.     All of the above

8. What is considered to be the gold standard of therapy for narcissistic personality disorder?

a.     Group Therapy
b.     Gestalt Therapy
c.     Cognitive-Behavioral Therapy
d.     Electroconvulsive Therapy

9. What is considered to be the best intervention for manipulative behavior?

a.     Set clear and realistic limits with appropriate consequences
b.     Confront client about the manipulative behavior
c.     Reinforce adaptive behavior through positive feedback and realistic praise
d.     Clearly and consistently communicate care plans and client’s behavior to other staff

10. Lamotrigine (Lamictal) was ordered for the patient with bipolar. What is the indication of this drug?

a.     Effective treatment of the depressed-phase in bipolar
b.     Effective treatment of the manic-phase in bipolar
c.     Effective anti-anxiety treatment
d.     Effective control for hallucination, delusion and illusion

11. The patient is taking Carbamazepine (Tegretol) for some time already. The prudent nurse understands that the patient should be closely monitored for what type of anemia?

a.     Hemolytic anemia
b.     Aplastic anemia
c.     Pernicious anemia
d.     Sickle cell anemia

12. The patient is taking lithium carbonate to control his bipolar. Knowing the principles of safety, the nurse should question what order?

a.     Give patient small frequent feeding
b.     Alternate ECT on days when mania is expected
c.     Increase the oral fluid intake to 1 gallon per day
d.     Limit exercise and sun exposure to prevent excessive sweating

13. What is the recommended dietary change if a patient is diagnoses with a bipolar disorder?

a.     Provide a high-calorie and high-protein diet
b.     Provide a well-balanced diet
c.     Small amounts of caffeine can be given
d.     Provide energy drink to replace energy lost during elation

14. All of the following should be implemented when a person is on a manic episode, except:

a.     Move client to a safe and less stimulating area
b.     Reduce external stimuli, people, noise and motion
c.     Do not interrupt when dancing, singing or making a speech
d.     Do not allow client to express hostility and ambivalence

15. The only difference with bipolar disorder from other major depressive disorders is that

a.     Exact cause is related to biochemical or genetic factors
b.     Presence of suicidal in bipolar
c.     Presence of manic or hypomanic episodes
d.     Generally occurs in middle adulthood

16. This is a chronic mood disorder characterized by alternating levels of short periods of mild to moderate depression and hypomania or mild elation

a.     Cyclothymia
b.     Dysthymia
c.     Seasonal-affective disorder
d.     Melancholia

17. What is the drug usually given to a male with moderate to severe paraphilia?

a.     Medroxyprogesterone acetate
b.     Long acting gonadotropin-releasing hormone
c.     Misoprostol
d.     Estrogen pills

18. Which of the following typical beliefs of a person is directly related to borderline personality disorder?

a.     “People will hurt me, attack me, and take advantage of me. I must protect them from me.”
b.      “I must control my emotions or something terrible will happen to you.”
c.      “No one is ever there to meet your needs, so you need me, please let me take care of you.”
d.     “I must subjugate my wants to the desires of my subconscious mind or they’ll abandon me or attack me.”

19. when a client believes that he can cause harm or something bad will happen to other people by thinking angry thoughts about them is an example of

a.     Paranoid delusion
b.     Magical thinking
c.     Ideas of reference
d.     Suspiciousness

20. All of the following are characteristics of schizoid people except

a.     Forms attachment to animals than to people
b.     Preferred habit, restricted routines and a lifestyle that is rigid and predictable causing them to be labelled as “robots”
c.     Restricted expression of emotions
d.     Prefers parallel, mechanical or abstract activities that solitary

21. Although schizoid personality disorder shares many similarities with schizophrenia, what distinguishing feature differentiates schizoid from schizophrenia?

a.     Schizoid personality disorder does not have the perceptual distortion seen in schizophrenia
b.     Schizoid people tend to be more “sociable” than schizphrenics do
c.     Schizoid people are self-obsessed which is not true for schizophrenia
d.     Schizoid people uses the same defense mechanisms with schizophrenia

22. To gain trust and rapport with a patient diagnosed with paranoid personality disorder, the nurse should implement all of the following nursing interventions, except

a.     Talk with the patient in a formal, honest and direct manner
b.     Clarify everything that was discussed during interactions and do not leave any query of the patient unanswered
c.     Inquire deeply into the client’s life or history, exploring more possible causes and effects
d.     Avoid making indirect statements to the patients

23. This personality disorder is characterized by excessive need to be the center of attention, excessive emotionally and superficial relationships as a result of poor self-image.

a.     Histrionic
b.     Narcissistic
c.     Schizoid
d.     Borderline

24. To be diagnosed with a personality disorder, what following criterion should be met?

a.     The symptoms have caused the person continuous and significant progress in different aspects of his life
b.     The enduring pattern of maladaptive behavior is pervasive, inflexible and is due to alcohol, drugs or other mental conditions
c.     The enduring pattern of maladaptive behavior has been present for an extended period of time and has roots in adolescence or early adulthood
d.     The pattern of maladaptive behavior conforms with the norms of the person’s culture and environment

25. EDMR may be used to help heal and resolve the psychological trauma from past experiences like sexual abuse and parental neglect that is often found in the history of patients with personality disorders. The prudent nurse understands that EDMR stands for

a.     Eye Movement Desensitization and Reprocessing
b.     Energy Detachment with Mechanical Reprocessing
c.     Effective Dissociation and Mental Recovery
d.     Electricity-Derived Mental Restructuring

26. To be able to help individuals with personality disorders, it is important to understand the defenses that these patients use. All of the following are defense mechanisms used by borderline people except

a.     Splitting behavior
b.     Hypochondriasis behavior
c.     Acting out behavior
d.     Fantasy behavior

27. One of the nursing responsibilities in taking care of a patient with anorexia nervosa is to supervise meals to ensure adequate food intake and weight gain is achieved. This can be done through

a.     Provide a high carbohydrate, low protein and small frequent feeding meal
b.     Do not accept excuses to leave eating area and set time limits allotted for eating
c.     Restrict use of bathroom for 30 minutes to 1 hour after eating
d.     Serve foods the client prefer but stick to the diet calculated by the nutritionist

28. All of the following are characteristics of a person with bulimia nervosa except

a.     Bulimics often engage in binging when they can no longer tolerate feelings of unworthiness, inadequacy and emotional pain
b.     The person is aware that the behavior is abnormal but it is unable to stop because she is immobilized by her fear that she cannot stop her behavior voluntarily until she becomes exhausted in eating
c.     Sufferers are often extrovert, perfectionist, and achievers scholastically and professionally and highly dependent on the approval of others to maintain self-esteem
d.     They show their disorder because of fear of rejection. These persons report self-loathing, low self-esteem, fear of losing control, have symptoms of depression with self-destructive tendencies such as suicide

 29. A student nurse asked her clinical instructor about the prominent signs of bulimia nervosa. She cascaded the question about the Russel’s sign. The CI is correct when she states that

a.     Hypokalemia due to diarrhea and vomiting resulting to muscle weakness, cardiac arrhythmias and hypotension
b.     Cuts and abrasions over the knuckles because of putting the fingers down into the throat to induce vomiting
c.     Elevated BUN from fluid restriction and refuced GFR resulting to kidney failure
d.     Delayed or lack of peristalsis due to excessive use of laxatives resulting to urge to binge so that feeling and alternative ways of coping can’t be explored

30. In dealing with a patient diagnosed with bulimia nervosa, the associated with or that triggers binge eating, which includes all of the following except

a.     Assist to explore alternatives and positive ways of coping
b.     Encourage to make a journal of incident and feelings before, during and after a binge episode
c.     Make a contract with the client to approach the nurse when she feel the urge to binge so that feelings and alternative ways of coping can’t be explored
d.     Encourage the client to adhere to meal and snack schedule based on the preference of the client

 31. This disorder is sometimes called bigorexia and is considered to be the opposite of anorexia nervosa. People with this disorder worry excessively that they are too small, undeveloped and frail even if they have good muscle mass.

a.     Orthorexia nervosa
b.     Muscle dysmorphia
c.     Gourmand syndrome
d.     Pica syndrome

32. This cluster includes personalities that are commonly characterized by affective dysregulation, detachment and cognitive disorganization. Because of similarities with schizophrenia, this cluster also referred to as “Schizophrenic Spectrum Cluster”.

a.     Cluster A
b.     Cluster B
c.     Cluster C
d.     Undifferentiated

33. This is the only personality disorder that cannot be treated with any drugs available in the market today.

a.     Borderline Personality
b.     Dependent Personality
c.     Anti-Social Personality
d.     Schizoid Personality

34. One of the major nursing interventions in dealing with delusions is to avoid situations that increase patient’s suspiciousness. This can be done by all of the following except

a.     Avoid whispering in patient’s presence or talking to another person when the client can see the nurse but cannot hear
b.     Provide a daily structure of activities and avoid changing schedules without informing first the patient
c.     Provide more intimate space and avoid physical contact with the patient
d.     Do not confirm and negate delusions. Avoid arguing with the patient

35. To determine the content of the delusional perception of the patient, the nurse should

a.     Ask the patient to describe the delusions
b.     Dispute the delusions as unreal and distract the patient
c.     Use empathy in accepting and understanding the delusional conflicts of the patient
d.     Let the patient write down or draw the delusional processes experienced

36. The nurse is about to take care of a patient known to be catatonic (excitement type). Knowing the principles of this disorder the nurse should initiate what parameter?

a.     Observe and protect from victimization by other patients (both physical and verbal)
b.     Meet the basic food needs and hygiene of the patient
c.     Encourage participating in activities that do not require concentration and fine motor skills
d.     Provide a sage environment where patient can pace and release energy like a small, isolated room

37. In building a trusting relationship to a patient, all of the following should be included in the care plan, except

a.     Be consistent in keeping appointments
b.     Avoid making demands, do not force to participate in activities or to respond verbally during interactions with client
c.     Stay even if client does not arrive or does not respond
d.     Initiate interaction and always address client by his preferred name

 38. In meeting the basic needs of a patient with schizophrenia, all of the following will be instituted by the nurse except

a.     Accept and respect client as a human being with worth and dignity
b.     Speak with client in simple and concrete terms
c.     Modify the environment: calm, less stimulating and safe
d.     Provide safe and complex activities to distract from altered though processes

39. What is the best nursing diagnosis that can be applied to a patient suffering from hallucination?

a.     Altered thought process related to presence of persecutory delusions
b.     Anxiety related to failure to develop meaningful relationships
c.     Disturbed sensory perceptions related to presence of visual hallucinations
d.     Acute confusion related to disturbance in attention, cognition and memory

40. This is a type of delusion wherein the person has a false belief that one has lost all his possessions, status, organs and strength as well as entire being.

a.     Capgras syndrome
b.     Cotard sundrome
c.     Fregoli sundrome
d.     Mixed syndrome

41. Upon reviewing the chart of a patient, the nurse noted that the diagnosis of her patient was Folie a Deux. The prudent nurse interprets this as

a.     A psychotic disorder that develops in a person as a result of a close relationship with another person who has established delusions
b.     A short term and time limited disorder that has a rapid onset, usually after a stressful event in a person’s life and characterized by psychotic symptoms that last at least one day but not more than one month
c.     Is a form of psychiatric disorder that has the prominent features of both thought and moods disorders within the same period of illness
d.     Is a short-term type of schizophrenia having symptoms that are identical to those of schizophrenia but lasts only from 1-6 months

42. Which of the following nursing interventions is geared towards weight improvement in the patient with anorexia nervosa?

a.     Weight gain of 1-3 lbs per week
b.     Monitor weight of the patient 3-5 times per week
c.     Weigh in the patient’s outfit but remove heavy metals in the body
d.     Ensure adequate hydration by offering large amount of fluids 3-4 liters per day.

43. What would the nurse suspect from a female patient diagnosed with anorexia nervosa in her dermatologic system?

a.     Loss of scalp hair, brittle nails and dry skin
b.     Hypothermia from loss of subcutaneous fat, dehydration and elevated growth hormone levels
c.     Teeth calcification and caries are common findings
d.     Osteoporosis may result from decreased calcium and phosphorus

44. One of the main causes of eating disorders has been linked to psychodynamic theories. All but one belongs to this category.

a.     Starvation is an attempt of female that fears adult femininity to prevent growing up and be like her mother, with whom the anorexic has negative feelings.
b.     Starvation is a form of self-punishment and an attempt to please an internalized harsh and rigid parent
c.     People with eating disorders tend to be perfectionists. They have unrealistic expectations of themselves and others
d.     Binging and overeating is believed to be a response to stress. Comfort foods have been seen to provide calm during episodes of stress

45. Anorexia nervosa is mainly characterized by:

a.     Refusal to maintain at or above normal body weight or failure to gain weight during period of growth
b.     Accompanied by feelings of powerlessness to stop eating followed by compensatory use of laxatives or fasting
c.     Repeated regurgitation and rechewing of food and is present for at least one month
d.     Eating more rapidly than normal and eating until uncomfortably full

46. This is a type of language and communication disturbance manifested by patients wherein there is a sudden cessation of thought in the middle of the sentence, unable to continue the train of thought. This could be due to interruption by anxiety, delusions and hallucinations.

a.     Mutism
b.     Blocking
c.     Poverty of speech
d.     Stilted language

47. Assaultive behavior is any attempt of the client to inflict physical harm on others. Nursing interventions for this behavior include all of the following except

a.     Make a contract with client to inform the nurse when anxiety in becoming so high and loss of control is impossible
b.     Inform the client what the staff will do to the client if he becomes violent and follow through once violence occurs
c.     Talk client down and five a therapeutic touch to calm client’s agitation
d.     Leave temporarily if the client is agitated and is asking to be left alone

48. In dealing with perceptual distortions like hallucinations, illusions and delusions, the prudent nurse initially should

a.     Assess the content of the delusions and hallucinations to find out if the client is at risk for violence directed to self or others
b.     Establish trust, ensure safety and provide sense of security to patient
c.     Avoid reinforcing the hallucinations by not going along or react on the hallucinations as if they are real
d.     Focus on reality and accept the hallucinations as part of illness and a sign of anxiety but present reality and encourage consensual validation

49. This is a subtype of schizophrenia wherein it is considered to be the most severe form, with a very poor prognosis. The patient manifests withdrawal, and flattening of affect or inappropriate emotions from disintegration of personality.

a.     Paranoid schizophrenia
b.     Disorganized schizophrenia
c.     Catatonic schizophrenia
d.     Undifferentiated schizophrenia

50. In the four A’s of schizophrenia, which of the following describes the domain of associative looseness?

a.     The person suffers a severe reduction in emotional expressiveness, they may speak in monotonous voice and have diminished facial expressions.
b.     The person is unable to make decisions or initiate activities. The client may engage in compulsive rituals or repetitive activity as an attempt to deal with conflicting feelings
c.     The person’s thoughts are excessively involved with self and focused inward. As a result, the person loose contact with the outside world, becoming unresponsive to what is actually going on around 
d.     The person cannot sort out what is relevant and what is not to a situation or to the subject of their conversation and thus unable to connect thoughts into logical sequences

 

51. He was considered to be the first psychiatrist to describe the psychiatric symptoms of schizophrenia. He also named the disorder dementia praecox which means early dementia.

a.     Morel
b.     Kahlbum
c.     Hecker
d.     Bleuler

52. The student asked the nurse about the prevalence of schizophrenia among teenagers, specifically Diathesis Stress Theory. Knowing this principle, the nurse cascaded the information that this theory

a.     Affects the double bind communication – two messages that contradict each other is sent causing the person to be confused on what action to engage
b.     Some element of one’s physiology makes one particularly prone to develop and illness if exposed in the right conditions
c.     A “schizophrenegenic” mother who is distant, cold and unfeeling and who provided inadequate care, cause the symptoms of schizophrenia
d.     Schizophrenia has a greater affinity to left-handed people and to single parents with low socioeconomic status

53. Decrease in dopamine activity in the mesocortical system causes what symptoms to a patient with schizophrenia?

a.     Hallucination, delusion and illusion
b.     Agitation, ideas of reference, insomnia and bizarre behavior
c.     Pressured speech, tangentiality and circumstantiality
d.     Anhedonia, avolition and affective flattening

 

54. According to a research entitled “Understanding Mental Health”, all of the following represents a person with schizophrenia who has a good prognosis except

a.     The patient has good social and professional adjustment prior to the onset of the symptoms
b.     There is absence of symptoms between psychotic episodes
c.     The onset of symptoms occur at later years of life
d.     If the disease comes in a slow and patterned manner

55. In studying the sex-based difference of schizophrenia, which parameter is correct?

a.     Earlier onset of the disease occurs more in women
b.     Women have more positive mood symptoms and fewer negative symptoms than men
c.     Men respond better to low dose conventional antipsychotic drugs
d.     Tends to be less severe in men and thus they have better chance at sustaining recovery from symptoms

56. This is the time when the person begins to experience a change in personality and a decline in academic functioning, avoids social interactions and isolates himself. Often it occurs during mid-to-late adolescence and could last for many years.

a.     Schizoid personality
b.     Prodromal phase
c.     Psychotic break
d.     Residual impairment

57. The wife of a schizophrenic husband asked the nurse the probability of their child to acquire disease, since schizophrenia has a genetic factor. The nurse is correct when she responds that

a.     Only 10-15% risk if only one parent
b.     About 30% risk if both parents are affected
c.     20% in first degree relatives
d.     25% risk in monozygotic twins

 

58. “Mapping” the personality system and understanding the psychological dynamics and relationships between personalities is one major task of the psychiatric nurse. How is this achieved?

a.     Identify the personalities and make contact and form effective relationship with as many personalities as possible
b.     Explore ways to identify, control and manage anxiety of the “host” personality
c.     Encourage to participate in group therapy to earn social skills, art therapy and alternative methods to decrease anxiety
d.     A planned abreaction sessions are conducted in which the patient relives the traumatic experiences in the past, process these painful episodes, mourn losses and other negative effects of the trauma

59. The goal of treatment for a patient with DID is to connect or integrate the different personalities into one functioning individual. Which of the following would the nurse be non-therapeutic?

a.     Provide structure in the nurse-client relationship with emphasis on consistency and predictability
b.     Play favorites among the alternate personalities and urge the patient to ignore or get rid of alternate personalities
c.     Make the whole person be responsible, all alter-identities should be held responsible for the behavior of each of the other alter identities. 
d.     Provide clearly defined limits and consequences for inappropriate behavior. Encourage patient to talk about or write his feelings and not to act them out

60. The nurse is studying dissociative disorders. She found out that another important feature of depersonalization disorder is derealization. This term signifies

a.     A state of consciousness in which the person experiences a detachment from all environments, as if a plate of glass is in between the mind and the physical world
b.     The feeling that one’s body or self is disconnected or unreal, which describes an alteration in the sense of self, a frightening experience of “not being within one’s own body”
c.     An emotional detachment that is associated with lower level nerve cell responses in regions of the brain that are responsible for emotional feeling
d.     A major defense mechanism used by people who suffer from depersonalization disorder

61 .Researchers have identified four psychological concepts that appear to underlie somatization disorder. Which of the following is not a part of it?

a.     Amplification of body sensations in which the patient gives excessive attention on common variations in body sensation to the point that they believe such sensation is abnormal
b.     When a family is in conflict, one way by which the family can cope with it is to focus attention to one member and make that member the bearer of the conflict, that member assumes the weak and defective role
c.     An effort relives oneself of obligations and to gain attention
d.     It may have begun in childhood when the child experienced personal gains during childhood illness

62. The patient came in to the clinic and is complaining and frequently comparing the flaw in appearance with that of others. She has preoccupation with the size and shape of body parts such as her hips, abdomen and hands. After the assessment, the prudent nurse understands that the patient is suffering from what disorder?

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

63. Persons with PTSD usually suffer from sleep problems. The nurse is aware all of the following can manage sleeping problems associated with PTSD except

a.     Use of bed only for sleeping and at a regular time, the person uses the couch or sofa when napping during the day
b.     Physical exercise during the day, but not right before sleeping
c.     Prayer or meditation with a relaxing music or a relaxation tape at bedtime
d.     Drinking warm chocolate milk drink 30 minutes before bedtime to help induce sleep

64. One of the major management for OCD is with the use of Yoga meditation. For what reason is yoga in relation to OCD?

a.     Helps the patient gain insight of their irrational thoughts or faulty belief systems
b.     It induces a person into a meditative state thus decreasing the emotional stress, anxiety and mental tension
c.     It provides support and decreases social isolation. Appropriate social skills can be learned and coping mechanisms can be explored
d.     It helps patients to learn techniques to decrease and then stop the rituals that plague their lives

65. OCD and OCPD are two disorders which are often misused or even misdiagnosed as each other. In order for the nurse to understand the main difference of OCD and OCPD is that in the later

a.     The person knows that the symptoms are unacceptable but is necessary to alleviate anxiety
b.     It involves depression, eating disorders and alcohol abuse
c.     Personifies an ambitious, impatient, perfectionist and inflexible
d.     Has a genetic trait and might run in the family genes

66. The patient known to have agoraphobia was prescribed with treatment of flooding. The patient asked the nurse what is flooding. The nurse is correct when she answers that

a.     It is a type of rapid desensitization in which the patient is exposed to the feared object or situation
b.     It uses relaxation techniques and carefully planned exposure to the feared object or situation gradually to help individual overcome her fears
c.     It uses direct confrontation technique on the feared object by reversing psychology
d.     It is a type of group therapy in which the patient shares same concerns to other people with the same needs and problems and gets positive inputs from it

67. This is a rare and usually temporary disorder characterized by sudden, unexplainable and unexpected travel to a faraway place accompanied by identity confusion and an inability of the person to recall some of his entire past

a.     Depersonalization disorder
b.     Dissociative fugue
c.     Dissociative amnesia
d.     Dissociative identity disorder

68. The parent of a rape victim asked the nurse about the impending amnesia that her daughter has after the incident. The mother asked the nurse on the difference between dissociative amnesia and other amnesia like that of Alzheimer’s. The nurse is correct if she replies that

a.     Both dissociative and Alzheimer’s type of amnesia occurs from organic origin
b.     Dissociative amnesia is more permanent than that of Alzheimer’s amnesia
c.     In dissociative amnesia, the memories are lost suddenly and the person is aware of the memory loss
d.     In Alzheimer’s amnesia, the individual cannot recall her name, where she came from or any family members

69. A patient who came in and was assessed for certain history of events. The survivor of a kidnapping case could not remember how he got out of the building to escape his captors until 2 days later. The patient is categorized to be having what type of amnesia?

a.     Selective amnesia
b.     Generalized amnesia
c.     Localized amnesia
d.     Continuous amnesia

70. The prudent nurse understands that the most prominent sign or criterion of hypochondriasis according to the DM-IV-TR is

a.     Preoccupation with the notion or hear of having or that one has a serious disease based on misinterpretation of physical symptom
b.     Preoccupation that is not as intense or distorted as delusional disorder or as restricted as body dysmorphic disorder
c.     Preoccupation that causes significant distress and impaired social and occupational functioning
d.     The symptoms should not be caused by anxiety somatoform, and major depressive disorders

71. Which of the following statements is false in relation to patients with conversion disorders?

a.     The condition is reversible and treatment is available
b.     Explaining that the nurse knows that patient is not faking the symptoms conveys empathy
c.     Focus on anxiety reduction because symptoms will be relieved when anxiety is relieved
d.     Matter of fact attitude: discourage verbalization of physical symptoms by responding with negative reinforcement

72. One of the main foals in managing somatoforms is to avoid focusing and reinforcing symptoms. All of the following can help the nurse and the patient in dealing with this dilemma except

a.     The clinic visits of the patient should be scheduled regularly and consistently
b.     Discourage emergency visits to the hospitals and doctors
c.     Direct topic on interaction towards daily life, activities and relationships
d.     Frequent phone calls help patient on their own rather than frequent visits

73. Somatization disorder is often lifelong and difficult to treat because of the patient’s strong denial that their symptoms are psychologic in nature. Knowing this concept, how can the nurse address the problem?

a.     Inform the patients  in a matter of fact manner about the diagnosis but acknowledge the symptoms as real and distressing to the patient
b.     Protect the patient from unnecessary diagnostic and therapeutic procedures
c.     Accept with empathy and help the patient identify situations in which the symptoms arise
d.     Set limits and provide structure. Avoid and discourage emergency therapist and hospital visits

74. A community psychiatric nurse visits a client’s home after a referral from a case manager who is concerned about the client’s increased delusions. A spiritual healer from the family’s cultural group is present in the home and indicates the desire to work with the client and family. Which action of the nurse would be most appropriate?

a.     Explain the healer’s efforts would be incompatible with psychiatric care
b.     Proceed with data collection only after requesting a private interview with the client
c.     Plan to collaborate with the healer to provide care to the client and family
d.     Refuse to continue with the client and family and contact the case manager immediately.

75. When the nurse interacts with a client from a different cultural background, which technique would provide sensitive care?

a.     Confronting issues of noncompliance
b.     Use of therapeutic silence
c.     Use of therapeutic touch
d.     Validation of communication

76. Which legal-ethical principle would the nurse use when interacting with a psychotic client who refuses psychotropic medications?

a.     Autonomy
b.     Nonmaleficence
c.     Confidentiality
d.     Beneficence

77. While a new nurse was reading the guidelines and policies of the institution, which of the following principle should be questioned?

a.     All clients have the right to refuse treatment
b.     Only the court can determine the client’s competence
c.     The client may involuntarily be confined or secluded in a room or area to prevent him from physically leaving

78. The nurse of a schizophrenic patient asked the head nurse about the issues of involuntary inpatient commitment. The head nurse is correct when she related that this principle is applicable to all situations except

a.     Applied when the client is institutionalized against his will
b.     Can be applied to those who pose a threat to self or to others
c.     Those who lack the capacity to decide on his own
d.     Those who are seriously mentally ill but fail to seek medical psychiatric treatment

79. Following the safe principles of voluntary admissions of a patient, which of the following should the nurse question?

a.     The client willingly enters and consents to treatment
b.     The client retains all their rights and may discontinue treatment whenever they choose
c.     If the staff disagrees with client’s decision to discontinue treatment, the client should sign a form acknowledging that he has been discharged against medical advice
d.     If the staff may seek voluntarily commitment of the client if there is resistance in the treatment regimen

 

80. The nurse is conducting a class on the effects of drugs for the treatment of ADHD. One of the audience asked what is a “drug holiday”, the nurse’s best response is

a.     This is a time on weekends and on summer where the child will not take the drug to restore normal eating and growth patterns
b.     This is the time where the drug should be tapered down to prevent withdrawal symptoms
c.     This is a term to describe the biologic half-life of the drug and should be monitored carefully to prevent toxicity
d.     This is the term used to denote the window period of the drug, wherein the child is expected to be at his peak agitation

81. The patient verbalized that she has an intense fear of small insects like bugs and flying bees. The nurse understood that the correct diagnosis for this patient is

a.     Astrophobia
b.     Entomophobia
c.     Iatrophobia
d.     Insectophobia

82. During a panic attack, one of the major goals of the nurse is to make the patient feel safe during the entire course. Which of the following does not address the issue?

a.     Stay close to the patient to reduce feelings of alienation and terror
b.     Provide privacy
c.     Move the patient to a smaller room with less stimulation
d.     Administer prescribed anti-anxiety drugs

83. The nurse is conducting a seminar on the different types of anxiety disorders. One of the participants asked the nurse what is GAD. The nurse is correct when she relates it to

a.     GAD is an overwhelming fear that occurs out of the clue without warning and for no reason at all
b.     GAD is an excessive anxiety which makes the person worry often excessively about his/her health, money, family or work for 6 months or more
c.     GAD is a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
d.     GAD is an anxiety which makes the patient try to ignore or suppress symptomatic thought and behaviors and may not seek treatment for a long time until it has greatly impaired his/her life

84. The nurse is taking care of a patient having an anxiety attack categorized to be on the panic level. Which of the following nursing interventions is appropriate for this patient?

a.     Talk calmly and clearly in short and simple sentences. Guide patient step by step to action
b.     Encourage the patient to move from affective (feeling) to cognitive (thinking) mode like asking what he is thinking at that moment
c.     Provide an anti-anxiety oral medications and monitor for its side effects
d.     Modify the environment which includes seclusion, limit interaction with others, reduce environment stimuli to calm the patient, smaller and quiet room

85. The nurse assessing a patient coming from a post-trauma situation of a recent fire in the village. What assessment findings will the nurse alert for if the patient is already at the free-floating level of anxiety?

a.     Tunnel-vision, muscle tension, perspiration, tremors and constantly pacing
b.     Enhance visual and auditory perception, alertness and increase motivation and capacity for learning, growth and creativity
c.     Dilated pupils, fixed vision, marked reduction on perceptual field, fight and flight response and needs direction to focus
d.     Hallucination, increased motor activity, unable to concentrate, uses dysfunctional coping mechanisms and feelings of dread and horror

86. What level of anxiety represents a feeling that something bad is about to happen or a feeling of an impending doom?

a.     Mild anxiety
b.     Severe anxiety
c.     Moderate anxiety
d.     Panic anxiety

87. A nurse is assigned to a client who has a domineering and a demanding attitude similar to the nurse’s mother. The nurse seeks out a colleague to share feelings about this situation. The nurse’s action indicates

a.     Appropriate self-awareness
b.     An inability to cope effectively
c.     Lack of knowledge about the client’s problems
d.     A need to change client assignment

88. The psychiatrist ordered for the nurse to use a supportive therapy to psychotic patient. The prudent nurse knows that in this model, she will demonstrate

a.     Diagnosing illness and prescribes therapeutic approach
b.     A warm, empathetic and allied with the patient approach
c.     Exploration of the patient’s social system and resources available
d.     Uses empathy to perceive patient’s feelings and uses relationship[ as a corrective interpersonal experience

89. The mother of a seven year old boy diagnose with ADHD on Ritalin treatment asked the nurse in the dietary restrictions for his boy. All of the following responses of the nurse is correct except

a.     Avoid giving the child high-calorie beverages and chocolates
b.     Increase the fiver in the diet since the drug may produce constipation
c.     Divide the meal times into small frequent feeding and offer finger foods
d.     Monitor the weight of the boy since weight loss is common

90. Which of the following nursing interventions does not address the situation on limiting the distraction of the child?

a.     Avoid loud music and computer games
b.     Use checklist and charts to help track progress on chores
c.     Allow only one or two playmates at a time
d.     Organize the house like placing things that the child frequently needs in logical places

91. Which of the following models interprets that life is meaningful when the person can fully experience and accept the self. The self can be experienced through authentic relationships with other people.

a.     Interpersonal model
b.     Social model
c.     Existentialism model
d.     Eclecticism therapy model

91. An alcoholic is one of the psychiatric patients which use multiple defense mechanisms. Which of the following relates to the use of projection?

a.     Attributing intolerable wishes, emotional feelings and motivations to other persons
b.     Attitudes, motives and needs that are directly opposite of those consciously acknowledged
c.     An unconscious, symbolic attempt to eliminate the existence of a previous dreadful or painful experience
d.     Pent-up feelings from one person, idea or object are discharged to another

92. In relation to the above question, which illustrates the vest example of projection?

a.     A student is poor in academics but is talented in artistry
b.     A reviewee blames the review center for his failure in the board exams
c.     A student whose cellphone was snatched does not remember the details of the incident
d.     A rape victim says she is not ready to talk about the experience

93. As part of the parent skills training to help parents understand the condition of a child with ADHD, the nurse must provide a structured environment and routine to help child complete tasks such as

a.     Limit choices of the child to 2 or 3 options at a time to help the child make better decisions
b.     Seat the child near the teacher and in an area with few distractions
c.     Review instructions or write assignments in the board
d.     Give the child extra time on test

94. Which of the following examples best illustrates the defese mechanism restitution?

a.     A teenager “happily” relates his motorcycle accident to all his friends
b.     A woman rushes into marriage following a breakup with her boyfriend
c.     A mother spanked her child and afterwards treat her to Jollibee
d.     A man washes his hands after committing a crime

95. The nursing graduate is about to take the board exam in 2 days. Suddenly, she develops uncontrollable diarrhea and extreme nervousness. The student is manifesting what defense mechanism?

a.     Denial

b.     Conversion

c.     Reaction formation

d.     Displacement

96. Which of the following treatment regimen is classified as the first non-stimulant medication specifically designed and tested for ADHD?

a.     Pemoline (Cylert)

b.     Atomoxetine (Strattera)

c.     Dextroamphetamine (Dexedrine)

d.     Amphetamine (Adderall)

97. One of the following diagnostic criterion for ADHD is the inattention of the child in any given setting. The prudent nurse knows that this criterion is best exemplified by:

 

a.     The child is forgetful in daily activities

b.     The child had difficulty in playing or engaging in leisure activities quietly

c.     The child shows difficulty in waiting in lines or awaiting turn in games or group situations

98. The mother asked the nurse about the meaning of dissociation. The nurse is correct when she states that

a.      it is an attempt to make to make unacceptable feelings and behavior consciously tolerable and acceptable
b.     It is a diversion of consciously unacceptable instinctual drives into personally and socially accepted areas
c.     This is a temporary alteration of consciousness or identity of a person
d.     This is a conscious creation or distortion of unacceptable fears, wishes and behaviors

99. Upon studying the mechanisms of action of certain drugs for ADHD, which of the following is correct?

a.     Stimulants like Ritalin and Cylert produce the reverse effects of most stimulants – a calming or slowing of activity in the brain
b.     Stimulants like Ritalin and Adderall enhances the effects of the inhibitory centers of the brain, helping the child to filter out distractions
c.     Stimulants like Dexedrine help in managing behavior of children by blocking the release of norepinephrine, epinephrine and glutamate
d.     Stimulants like Strattera enhances the calming effect of smooth muscles thereby reducing agitation and extreme behavior

100. The student nurse is studying the different methods affecting the ego defense mechanisms used by some patients. Which of the following is relating to the interpersonal model?

a.     Based on inadequate resolution of developmental conflicts, this ego defenses are unable to control anxiety
b.     Anxiety arises and is experienced in between persons. A basic fear is the fear of rejection. A person needs security and satisfaction from others
c.     Social and environmental factors create stress, which causes anxiety and symptoms. Unacceptable behaviors is socially defined
d.     Problems are a result of biophysical factors with emphasis on current maladaptive coping mechanisms