Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION

Manila

BOARD OF NURSING

Philippine Nurse Licensure Examination

NURSING PRACTICE V – Care of Clients with Physiologic & Psychosocial
Alterations C

INSTRUCTION: Select the correct answer for each of the following

questions. Mark only one answer for each item by shading the box
corresponding to the letter of your choice on the answer sheet provided.
STRICTLY NO ERASURES ALLOWED.

✓ NO OPEN OF NOTES
✓ EVALUATE YOUR RETENTION
✓ EVALUATE YOUR UNDERSTANDING/COMPREHENSION
✓ EVALUATE YOUR CRITICAL THINKING SKILLS & APPLICATION

TAKE THE EXAM AS SIMULATED BOARD EXAM!!!

Situation 1: The onset of neurologic disorders may be sudden or

insidious. These disorders can be frightening, even devastating to the
clients and their significant others especially if the process is
reversible. The following questions pertain to Care of Clients with
Alteration in Neurologic Functioning.

1. A client has signs of increased intracranial pressure (ICP). Which of

the following is an early indication of deterioration in the client’s
condition?
A. Widening pulse pressure C. Dilated, fixed pupil
B. Decrease in pulse rate D. Decreased LOC

2. The client has a sustained ICP of 20mmHg. The nurse should position
the client:
A. With the head of bed elevated 30 to 45 degrees
B. In Trendelenburg’s position
C. In Sim’s position
D. With the head elevated on two pillows

3. Which of the following is most effective in assessing the client with a

head injury for the development of Diabetes Insipidus?
A. Checking the blood glucose level in the blood
B. Assessing arterial blood gas values every other day
C. Measuring urine output hourly
D. Taking vital signs every 2 hours

4. A client with a subdural hematoma was given Mannitol to decrease

intracranial pressure (ICP). Which of the following best shows that
Mannitol was effective?
A. Urine output increases
B. Pupils are 8mm and non reactive
C. Systolic BP remains at 150mmHg
D. BUN and creatinine levels return to normal

5. What is the priority intervention when suctioning an unconscious client

to maintain cerebral perfusion?
A. Hyperoxygenate before and after suctioning
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 B. Administer analgesics
C. Provide oral hygiene
D. Administer diuretic

Situation 2: Carlo, RN is newly assigned to the EENT department of the

hospital. He reviewed important nursing concepts and skills in the
management of clients with alteration in sensory functions.

6. Carlo was assigned to a client who had undergone cataract extraction.

He was asked by the SO why the client had iridectomy. He is correct if
he answered that iridectomy is done in order:
A. To prevent secondary glaucoma
B. To prevent color blindness
C. To prevent retinal detachment
D. To prevent color blindness

7. Which of the following instructions given to a client after cataract

surgery is inappropriate?
A. “Avoid bending and straining”
B. “Avoid high-sodium foods to reduce intraocular pressure”
C. “Don’t drive or sleep on the affected side”
D. “Don’t use makeup on the affected eye”

8. The client is experiencing vertigo due to Meniere’s disease. Which of

the following is the priority nursing diagnosis?
A. Altered nutrition related to nausea and vomiting
B. Altered body image disturbance related to hearing loss
C. Alteration in comfort related to tinnitus
D. High risk for injury related to vertigo

9. The nurse is to administer ear irrigation as prescribed by the

physician. Which of the following is appropriate nursing action?
A. Direct the flow of solution to the ear drum
B. Use cold water
C. Warm solution at 98OF
D. Position the client with the ear to be irrigated facing upward

10. The most common complaint of a client with ear disorder is?
A. Earache C. Hearing loss
B. Discharge from ear D. Tinnitus

Situation 3: The ability to move, and maintain a desirable position is a

basic human need. The bony skeleton provides support and the movable
parts. The musculature facilitates movement.

11. On a visit to the clinic, a client reports the onset of early symptom
of Rheumatoid Arthritis. Which of the following would the nurse most
likely assess?
A. Limited motion of joint
B. Deformed form of the hands
C. Early morning stiffness
D. Rheumatoid arthritis

12. The nurse is planning care for the client with femoral fracture who is
in balanced suspension traction. Which of the following would the
nurse least likely to include in the plan of care?
A. Use the fracture bedpan
B. Check for redness over ischial tuberosity
C. Elevation of the head no more than 25 degrees

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 D. Personal hygiene with a complete bed bath.

13. A client who had a right total elbow joint replacement yesterday is
complaining of numbness on the lateral surface of the right leg and the
dorsal surface of the right foot. After assessing the neurovascular
status of both upper and lower extremities, the nurse finds no other
discrepancy except the numbness. The nurse should:
A. Administer the ordered pain medication
B. Reposition the leg to a neutral position and notify the physician
C. Inform client that this finding is not uncommon after surgery
D. Reassure the client and share this data at the change-of-shift
report

14. Allopurinol is used to treat gout. Objective of therapy is to:

A. Increase joint mobility
B. Decrease synovial swelling
C. Decrease uric acid production
D. Prevent crystallization of uric acid

15. Nursing care of a client with a fractured hip should include the
assessment of pedal pulses. The important characteristics of pedal
pulses are:
A. Contractility and rate
B. Color of skin and rhythm
C. Amplitude and symmetry
D. Local temperature and visible pulsations

Situation 4: The body’s most organized and complex system, the nervous
system, profoundly affects both psychological and physiological functions.
Even more fascinating is the knowledge of man’s ability to comprehend,
learn, act and, feel as an individual organism.

16. Which of the following is an initial sign of Parkinson’s disease?

A. Rigidity C. Bradykinesia
B. Tremors D. Akinesia

17. The nurse determines that Baclofen (Lioresal) is accomplishing its

intended purpose for a client with Multiple Sclerosis when it achieves
which of the following?
A. Sleep is induced
B. The client’s appetite is stimulated
C. Muscular spasticity is relieved
D. The urine bacterial count is reduced

18. A client is being switched from Levodopa to Carbidopa-Levodopa

(Sinemet). The nurse should monitor for which of the following
possible complications that can occur during the period of medication
change and dosage adjustment?
A. Euphoria C. Vital signs fluctuation
B. Jaundice D. Symptoms of diabetes

19. Which clinical manifestation in a client does the nurse assess as a

typical reaction to long-term Phenytoin (Dilantin) therapy?
A. Weight gain C. Excessive growth of gum tissue
B. Insomnia D. Deteriorating eyesight

20. Which goal is the most realistic and appropriate for a client diagnosed
with Parkinson’s disease?
A. To cure the disease

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 B. To stop progression of disease
C. To begin preparation for terminal care
D. To maintain optimal body function

Situation 5: Fred, 80-year old retiree, was institutionalized in a

nursing home 5 years ago. His family barely visits him there and he has
been longing for them. He is now being well taken-cared of by the newly
hired nurses in the nursing home. The following are questions related to
the care of Fred as an elderly client.

21. You have reviewed and reread the physiologic changes that elderly
clients undergo. You consider that it is most difficult for Fred to
distinguish colors especially the color:
A. Purple C. Yellow
B. Red D. Green

22. You are aware that elderly clients are prone to pressure sores because
of inactive lifestyle and immobility. The following nursing
interventions are appropriate in the prevention of pressure sores among
bed ridden elderly clients EXCEPT:
A. Massage bony prominences
B. Apply alcohol on the skin
C. Keep the skin clean and dry
D. Turn the client every 1 to 2 hours

23. The following are appropriate nursing actions to prevent postural

hypotension in an elderly client EXCEPT:
A. Advise to get out of bed gradually
B. Instruct to have a daily fluid intake of 3 glasses a day
C. Advise to avoid straining at stool
D. Advise to avoid bending down and suddenly standing up again

24. Which of the following nursing interventions is inappropriate when

caring for an elderly experiencing dementia?
A. Have clocks or calendar in the environment
B. Provide consistent routine of activities
C. Spend time with the patient
D. Address the patient by calling him “papa”

25. The developmental task of Fred according to Erikson is:

A. Identify vs. Role confusion
B. Intimacy vs. isolation
C. Generatively vs. stagnation
D. Ego integrity vs. despair

26. A client approaches a nurse and tells her that he hears a voice telling
that he’s evil and deserves to die. Which of the following terms
describes the client’s perception?
A. Delusion C. Hallucination
B. Disorganized speech D. Idea of reference

27. Which of the following symptoms is usually responsive to traditional

antipsychotic drugs?
A. Apathy C. Social withdrawal
B. Delusions D. Attention impairment

28. A client was hospitalized after his son filed a petition for
involuntary hospitalization for safe reasons. The son seeks out the
nurse because his father is angry and refuses to talk with him. He is

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 frustrated and a feeling very guilty about his decision. Which of the
following responses to this client is the most empathetic?
A. “Your father is here because he needs help”
B. “He’ll feel differently about you as he gets better”
C. “It sounds like you’re feeling guilty about leaving your father
here”
D. “This is a stressful time for you, but you’ll feel better as he
gets well”

29. A client asks a nurse if she hears the voice of the non-existent man
speaking to him. Which of the following response is best?
A. “No one is in your room except you”
B. “Yes, I hear him, but I won’t listen to him”
C. “What has he told you? Is it helpful advice?”
D. “No I don’t hear him, but I know you do what is he saying?”

30. Which of the following actions by the nurse is an appropriate

therapeutic intervention for a client experiencing hallucinations?
A. Confine him in his room until he feels better
B. Provide a competing stimulus that distracts from the hallucinations
C. Discourage attempts to understand what precipitates his
hallucinations
D. Support perceptual distortions until he gives them up of his own
accord

Situation 6: The psychiatric nurse should suspect suicidal ideation in

most depressed patients because suicide is a prudent theme among this
population. The following questions refer to care for clients with mood
disorders.

31. A client is admitted to the mental health unit because of a

progressively increasing depression over the past month. During the
initial assessment, the nurse would expect the client to display:
A. Elated affect related to reaction formation
B. Loose associations related to thought disorder
C. Physical exhaustion resulting from decreased physical activity
D. Paucity of verbal expression related to slowed thought processes

32. When developing a plan of care for a depressed client, the approach
that would be most therapeutic would be:
A. Allowing time for the client’s slowness when planning activities
B. Helping the client focus on family strength and support systems
C. Encouraging the client to perform menial tasks to meet the need for
punishment
D. Repeating again and again that the staff views the client as
worthwhile and important

33. An activity that would be most appropriate for a depressed client

during the early part of hospitalization would be a:
A. Game of trivial pursuit
B. Project involving drawing
C. Small dance therapy group
D. Card game with three other clients

34. After admission, the nurse needs to evaluate a depressed client’s

potential for suicide. The approach that would best in this
information would be to ask:
A. The client about plans for the future
B. The client whether suicide is now being considered

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 C. Family members whether the client has ever attempted suicide
D. Other clients about suicide while the client is in the group

35. Which side effect of Tricyclic antidepressants is the most potentially

dangerous?
A. Mydriasis C. Constipation
B. Dry mouth D. Urinary retention

Situation 7: For nurses in any setting, including non psychiatric ones,

understanding the nature of Anxiety, its causes, the reasons that make it
difficult to manage and the way in which individuals normally cope with
it, is crucial.

36. When caring for a client with a generalizing anxiety disorder, the
nurse should be aware that one of the best indicators of the client’s
present condition is the client’s:
A. Memory C. Judgment
B. Behavior D. Responsiveness

37. The nurse recognizes that it would be unusual for an individual with
anxiety disorders to handle the anxiety by:
A. Acting it out with antisocial behavior
B. Converting it into a physical symptoms
C. Regressing to earlier levels of adjustment
D. Displacing it on to less threatening objects

38. Physiologically, the nurse would expect a client’s anxiety to be

manifested by:
A. Constricted pupils, dilated bronchioles, increased pulse rate,
hypoglycemic and peripheral vasodilation
B. Dilated pupils, dilated bronchioles, increased pulse rate,
hyperglycemic and peripheral vasoconstriction
C. Dilated pupils, constricted bronchioles, increased pulse rate,
hypoglycemic and peripheral vasoconstriction
D. Dilated pupils, constricted bronchioles, decreased pulse rate,
hypoglycemic and peripheral vasoconstriction

39. Compulsive symptoms, such as using paper towels to open doors develop
because the clients are:
A. Consciously using this method to punish themselves
B. Listening to voices that tell them the door knobs are unclean
C. Unconsciously controlling unacceptable impulses or feelings
D. Fulfilling a need to punish others by carrying out an annoying
procedure

40. The nurse could most appropriately begin to help an extremely anxious
client with a sleep problem who has been assigned to a four bed room
since admission by saying:
A. “You seem unable to sleep at night”
B. “I’m going to move you to a private room”
C. “Don’t worry; you’ll sleep when you’re tired”
D. “I’ll get you the sedative your doctor ordered”

Situation 8: Tina was always a chubby child. When she was 23 year old,
she lost considerable weight by dieting. Shortly thereafter, she began
seriously dating and was married. Tina was thrilled with her new look and
worked hard to maintain her weight loss, consistently keeping her weight
slightly under the ideal for her height. After 2 years of marriage, Tina
became pregnant. The thought of gaining weight during her pregnancy upset

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Tina greatly, and she vowed to herself never to let herself became chubby
again. Before long, Tina’s doctor noticed that she was not gaining weight
at her monthly prenatal check-ups and asked what she was eating. When she
did a food log for the office nurse, her anorexic behavior was revealed.

41. Which of the following communication strategies is best to use with

Tina who is having problems with peer relationships?
A. Use concrete language and maintain a focus on reality
B. Direct the client to talk about what is causing the anxiety
C. Teach the client to communicate feelings and express self
appropriately
D. Comfort the client about being depressed and self-absorbed

42. Tina started to tell the nurse that she has developed hair in most of
her body. Which of the following conditions may be associated with
this?
A. Anemia C. Dehydration
B. Osteoporosis D. Electrolyte imbalance

43. Tina tells the nurse, “I feel so awful and inadequate.” Which of the
following responses is best?
A. “You’re being too hard on yourself”
B. “Somebody you’ll feel better about things”
C. “Tell me something you like about yourself”
D. “Maybe relaxing by yourself will help you feel better

44. An appropriate behavior modification goal for a client with anorexia

nervosa would be, the client will:
A. Eat every meal for a week
B. Gain a pound of weight a week
C. Attend group therapy every day
D. Talk about food for 1 hour a day

45. During a prenatal interview, the nurse becomes aware that Tina has a
history of PICA. The most appropriate nursing action would be to:
A. Seek a psychologic referral for the client
B. Make sure the client’s diet is nutritionally adequate
C. Inform the client of the danger this poses to her baby
D. Obtain an order for multivitamin supplement for the client

Situation 9: Substance related disorders refer to the use and abuse of

alcohol, illicit drugs, or substances such as over-the-counter (OTC) or
prescription drugs. When substance use creates difficulties for the user
or ceases to be entirely volitional, it becomes the concern of all the
helping professionals, including nursing.

46. A nurse assesses a client for signs of alcohol withdrawal. During the
period of early withdrawal, which of the following findings are
expected?
A. Depression C. Insomnia
B. Hyperactivity D. Nausea

47. Which of the following behaviors in a client who abuses alcohol

indicates a knowledge deficit in nutrition?
A. Avoiding foods high in fat
B. Eating one adequate meal each day
C. Taking vitamin and mineral supplement
D. Eating large portions of foods containing fiber

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48. A client says, “I didn’t mean to keep taking the drug. I just had a
lot of difficulty sleeping.” Which of the following drug
classification is the client most at risk for abusing?
A. Barbiturates C. Cannabis
B. Amphetamines D. Opioids

49. The nurse evaluates that a male client has accepted his drinking as a
problem when he:
A. Attends scheduled in-patient group meetings
B. Takes his anti-abuse each morning as ordered
C. Attends alcoholics anonymous meetings daily
D. Volunteers to be a sponsor for another alcoholic

50. Drug abuse is best defined as a(an):

A. Physiologic need for a drug
B. Psychologic dependence on a drug
C. Compulsion to take a drug on either a continuous or periodic basis
D. Excessive drug use inconsistent with acceptable medical practice

Situation 10: Communication is the process of conveying information

verbally through the use of words and nonverbally, through gestures or
behaviors that accompany words. Nonverbal communication also can occur in
the absence of spoken words.

51. If a psychiatric nurse were to use the family system theory in

practice, the statement that would be expected when the nurse interacts
with a client would be:
A. “Describe for me in your own words what cause this situation”
B. “You need to abide by the unit rules and attend the community
meetings”
C. “Whenever someone permanently leaves the home, the boundaries are
upset”
D. “You’re doing better, let’s talk to the doctor about lowering your
medication dosage”

52. A client approaches the nurse and points to the sky, showing her where
the men would be coming from to get him. Which is the most therapeutic
response?
A. “Why do you think the men are coming here?”
B. “You’re safe here, we won’t let them harm you”
C. “It seems like the world is pretty slow for you, but you‘re safe
here”
D. “There are no bad men in the sky because no one lives that close to
earth”

53. An older adult client has not been eating well since admission. The
client repeatedly states, “No one cares.” The most appropriate
response by the nurse would be:
A. “We all care about you; now please eat.”
B. “You know you have to eat to stay alive”
C. “I care about you. What foods do you especially like?”
D. “I care about you. Please eat some of this food for me”

54. During a one-to-one interaction with a nurse, the client states, “I’m
worried about going home.” The nurse responds, “Tell me more about
this.” This response is an example of:
A. Clarifying C. Refocusing
B. Reflecting D. Acknowledging

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55. Which of these techniques was developed to eliminate intrusive,
unwanted thoughts?
A. Reflecting C. Clouding/fogging
B. Thoughts stopping D. Verbalizing the implied

Situation 11: Billy is a homeless man with a long history of mental

illness. He has not seen his family in many years. Although his family
was supportive at one time, they simply grew tired of trying to cope with
Billy. At this point, even modest improvements in his mental health are
compromised by his lack of social support.

56. Billy was diagnosed with Schizophrenia and is experiencing delusions of

persecution and auditory hallucinations. Later, the nurse on the unit
greets him by saying “Good evening. How are you?” Billy, who has been
referring to himself as “man” answers, “The man is bad.” This is an
example of:
A. Dissociation C. Displacement
B. Transference D. Reaction formation

57. Billy started to be delusional and refuses to eat because of a belief

that the food is poisoned. One of the most appropriate ways for the
nurse to initially intervene is to:
A. Taste the food in the client’s presence
B. Simply state that the food is not poisoned
C. Suggest that food be brought in from home
D. Tell the client that tube feedings will be started it eating does
not begin.

58. When a client starts to openly masturbate, the nurse’s most appropriate
action would be to:
A. Not react to the behavior
B. Put the client in seclusion
C. Restrain the client’s hands
D. State that such behavior is unacceptable

59. Billy yelled at the nurse and said, “You think you’re so damned perfect
and good. I think you stink!!! The best response of the nurse would
be:
A. “You seem angry with me”
B. “Stink? Now look who’s talking”
C. “Boy, you’re in a bad mood”
D. “I can’t be all that bad, can I?”

60. An extrapyramidal symptom that is a potentially irreversible side

effect of antipsychotic drugs is:
A. Torticollis C. Tardive Dyskinesia
B. Oculogyric crisis D. Pseudoparkinsonism

Situation 12: One of the most important aspects of the treatment

environment is the relationship among and between staff members and
patients.

61. The nurse is aware that the approach to be used during crisis
intervention should be:
A. Passive and reflective C. Future – oriented and passive
B. Active and goal-directed D. Interpretative and analytic

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62. A client is encouraged to join a self-help group when discharged from a
mental health facility. The purpose of having people work in a group
is to provide:
A. Support C. Confrontation
B. Therapy D. Self-awareness

63. A psychiatric unit uses a behavioral approach to determine clients’

level of privileges. Which factor would have the most influence in
determining an increase in privileges?
A. A lifting of depression
B. An improved short-term memory
C. Performing grooming and hygiene independently
D. Verbalizing a desire to change the response to stress

64. The most advantageous therapy for a preschool age child with a history
of physical and sexual abuse would be:
A. Play C. Family
B. Group D. Psychodrama

65. Drug therapies are dependent interventions of nurses. A client is

prescribed with MAOIs. The client should be cautioned against:
A. Prolonged exposure to the sun
B. Ingesting wines and aged cheese
C. Engaging in active physical exercise
D. The use of medication with an elixir base

Situation 13: A failure to meet the standard of care that results in an

injury to a client or consumer makes the nurse liable for negligence or
malpractice.

66. When caring for psychiatric-mental health clients whose ability to give
informed consent depends on their degree of psychiatric impairment, the
nurse’s priority obligation is to:
A. Assess the client’s legal capacity when that client is asked to
give consent
B. Prevent the client form revoking consent
C. Obtain informed consent when the primary provider cannot be present
D. Persuade the client to consent

67. A client with a history of depression is committed voluntarily to the

psychiatric hospital, having been transferred from a medical center
where he was treated for a self-inflicted gunshot wound to the chest.
After few days of treatment, the client decided he would like to leave
the hospital. The treatment team believing he is still a danger to
himself, discusses initiating legal proceedings to have the client’s
admission status changed to involuntary. Which ethical concepts are in
conflict? Select all that apply:
1. Beneficence 4. Autonomy
2. Fidelity 5. Fidelity
3. Paternalism

A. 3 and 2 C. 4 and 1
B. 3 and 4 D. 4 and 2

68. A client has developed a therapeutic relationship with the nurse. Upon
discharge, she asks for the nurse’s home phone number so she can “keep
in touch.” The nurse likes the client very much but tells her that a
friendship would violate the boundaries of the therapeutic

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 relationship. The nurse’s response best reflects which ethical
concepts are in conflict?
A. Veracity C. Autonomy
B. Beneficence D. Fidelity

69. A 35-year old man was hospitalized 2 weeks ago for Acute Anemia. Upon
admission, he made many lewd and offensive comments to the nurse. The
nurse finds it hard to have a conversation with the client now, even
though his offensive remarks have ceased. The nurse’s ethical dilemma
involves which principle?
A. Justice C. Beneficence
B. Veracity D. Paternalism

70. After discussing “everyday ethics” with a group of nursing students,

which description would lead the nursing instructor to determine that
the students have understood the concept?
A. The focus is interpersonal relationships, respect, caring with
unconditional positive regard, and fostering of human dignity
B. The primary focus of everyday ethics is promoting and maintaining
the client’s autonomy
C. It reflects the practice of the principles of beneficence and
paternalism in all nurse-client interactions
D. The ultimate outcome is the assurance that health-care is provided
justly

Situation 14: Evidence-based care involves the conscientious, explicit

and judicious use of current best evidence in making decisions about the
care of individual clients. It is about integrating the best available
evidence from research with clinical expertise to enhance decision making.

71. When explaining evidence-based care to a group of nursing students,

which of the following concepts would the instructor address?
A. Increase emphasis on intuition
B. Integration of research findings with clinical expertise
C. Use of pseudo scientific practices and therapies
D. Increased reliance on assumptions

72. When conducting an experimental research study investigating the

effects of a medication, one group receives the medication, a second
group receives no medication, and third group receives a capsule
containing a sugar solution. The nurse identifies the sugar solution
capsule as:
A. Stain treatment C. Empirics
B. Placebo D. Junk Science

73. The hallmark of scientific research is the:

A. Experiment C. Evaluation
B. Survey D. Literature Review

74. Persons selected for comparison and experimental research groups are
known as the:
A. Subjects C. Researchers
B. Control group D. Experimental group

75. Qualitative nursing research is the investigation of phenomena that

are:
A. Not easily quantified
B. Easily categorized
C. Obtained in a numerical form

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 D. Developed through deductive reasoning

Situation 15: Personal disorder can be considered a lifelong pattern of

behavior that affects many areas of the person’s life, causes problems,
and is not provided by another disorder or illness. It is also considered
serious psychiatric conditions because of their associated symptoms.

76. A client tells the nurse that her coworkers are sabotaging the
computer. When the nurse asks questions, the client becomes
argumentative. This behavior shows personality traits associated with
which of the following personality disorders?
A. Antisocial C. Paranoid
B. Histrionic D. Schizotypal

77. Which of the following findings is expected when taking a health

history from a client with borderline personality disorder?
A. A negative sense of self
B. A tendency to be compulsive
C. A problem with communication
D. An inclination to be philosophical

78. Which of the following defense mechanisms is most likely to be seen in

a client with borderline personality disorder?
A. Compensation C. Identification
B. Displacement D. Projection

79. A client with dependent personality disorder is taking Fluoxetine

(Prozac) for depression. Which of the following instructions is
included in client teaching?
A. Drink only wine and beer when taking this drug
B. Add as needed doses if depression becomes worse
C. Expect 3 to 4 weeks to go by before effects are seen
D. Be aware that alterations is usual sleep

80. A client with schizotypal personality disorder is sitting in puddle of

urine. She’s playing in it, and softly singing a child’s song. Which
action would be best?
A. Admonish the client for not using the bathroom
B. Firmly tell the client that her behavior is unacceptable
C. Ask the client whether she’s ready to get cleaned up now
D. Help the client to the shower, and change the bedclothes

Situation 16: Childhood mental illness has staggering effects. Untreated

mental illness in childhood results in long term mental illness in adults.

81. When using behavior modification to foster toilet training efforts in a

cognitively impaired child, the nurse should reinforce appropriate use
of the toilet by giving the child a:
A. Piece of fruit C. Hug and praise
B. Piece of candy D. Choice of rewards

82. The most common characteristic of autistic children is that they:

A. Respond to any stimulus
B. Respond to little external stimulus
C. Seem unresponsive to the environment
D. Are totally involved with the environment

83. A 6-year old girl with autism is nonverbal and has limited eye contact.
To promote social interaction, the nurse initially should:

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 A. Engage in parallel play while sitting next to the child
B. Encourage the child to vocalize through sound games and songs
C. Provide play opportunities for the child to play with other
children
D. Use therapeutic holding when the child does not respond to verbal
interactions

84. One of the major behavioral characteristics of children with attention

deficit disorders is their:
A. Overreaction to stimuli
B. Continued use of rituals
C. Delayed speech development
D. Inability to use abstract thought

85. Attention deficit hyperactivity disorders (ADHD) in children is treated

with:
A. Lorazepam (Ativan)
B. Haloperidol (Haldol)
C. Methocarbamol (Robaxin)
D. Methylphenidate Hydrochloride (Ritalin)

Situation 17: Philip Wilson has a long history of mental problems. Mr.
Wilson is a patient in the state hospital system. Mr. Wilson is diagnosed
with Schizophrenia.

86. Mr. Wilson repeats the nurse’s phrases and shows motor immobility with
prominent grimacing. Which type of schizophrenia is Mr. Wilson having?
A. Catatonic C. Residual
B. Disorganized D. Undifferentiated

87. While talking to Mr. Wilson, the nurse notes that Mr. Wilson frequently
uses unrecognizable words with no common meaning. The nurse knows that
this is termed as:
A. Echolalia C. Neologism
B. Clang association D. Word Salad

88. The nurse is talking with Mr. Wilson’s family. The Significant Other
(SO) asks, “What causes this disorder?” Which of the following
explanations is most widely accepted?
A. Prenatal or post partum central nervous system damage
B. Bacterial infections in the mother during pregnancy or delivery
C. A biological predisposition exacerbated by environmental stressors
D. Lack of bonding and attachment during infancy, which teals to
depression in later life

89. A nurse observes the client in the corner of the room moving his lips
as if he were talking to himself. Which of the following actions is
the most appropriate?
A. Ask him why he’s talking to himself
B. Leave him alone until he stops talking
C. Tell him it isn’t good for him to talk to himself
D. Invite him to join in a card game with the nurse

90. A client is taking Chlorpromazine (Thorazine) for the treatment of his

Schizophrenia. This drug blocks the transmission of which of the
following substances?
A. Dopamine C. Norepinephrine
B. Epinephrine D. Thyroxine

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Situation 18: Major depression is a disorder of severity and is
treatable, with 80% of individuals able to resume normal activities within
a few weeks.

91. A 50-year old client is scheduled for electroconvulsive therapy (ECT).

The nurse knows that ECT is most commonly prescribed for which of the
following conditions?
A. Antisocial personality disorder
B. Major depression
C. Chronic schizophrenia
D. Somatoform disorder

92. A client recently lost a spouse. Which behavior indicates that the
client is going through a normal stage of grieving?
A. The client starts using chemicals
B. The client becomes an over achiever
C. The client shows signs of hyperactivity
D. The client shows loss of warmth when interacting with others

93. Which of the following therapies has been most strongly advocated for
the treatment of Post Trauma Stress Disorder (PTSD)?
A. ECT C. Group therapy
B. Hypnotherapy D. Individual therapy

94. A side effect of ECT that a client may experience is:

A. Loss of appetite
B. Postural hypotension
C. Complete loss of memory for a time
D. Confusion immediately after the treatment

95. A long-term therapy goal for a female client hospitalized for a major
depressive episode should be that the client will be:
A. Able to talk about her depressed feelings
B. Able to develop new defense mechanisms
C. More realistic in accepting herself and others
D. Aware of the unconscious source of her anger

Situation 19: Certain situations in psychiatric nursing pose particular

challenges and call for variations in communication techniques.

96. A client tells the nurse, “I want to tell you something but you must
promise to keep it a secret.” Which response would impair the
therapeutic relationship? “I would like to hear what you have to say:
A. “Ana as a client advocate, I will respect your right to
confidentiality”
B. “But I am part of a team that shares important information about
clients”
C. “But I cannot promise to keep what you say confidential from the
rest of the staff”
D. “Ana I hope that you will trust me to do what is in your best
interests with the information”
97. In psychiatric nursing, the most important tool the nurse brings to a
helping relationship is:
A. Oneself and desire to keep
B. Advanced communication skills
C. Knowledge of psychopathology
D. Years of experience in milieu therapy

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98. A client states, “I get down on myself when I make a mistake, “Using
the cognitive therapy approach, the nurse should:
A. Teach the client relaxation exercises to diminish stress
B. Provide the client with mastery experiences to boost self-esteem
C. Explore with the client past experiences that caused the client’s
distress
D. Help the client modify the belief that anything less than
perfection is horrible

99. A nurse has been assigned to work with a depressed client on a one-to-
one basis. The next morning the client refuses to get out of bed
saying, “I’m too sick to be helped and I don’t want to be bothered.”
The nurse’s best response would be:
A. “You will not feel better unless you make the effort to get up and
get dressed”
B. “I know you will feel better again if only you make the attempt to
help yourself”
C. “Everyone feels this way in the beginning as they confront
repressed feelings. I’ll sit down with you”
D. “I know you don’t feel like getting up, but you probably will feel
better if you do. Let me help you get started.”

100. A nurse asks the supervisor, “What coping strategy could I develop to
prevent over responding to stress in the future? The supervisor could
best respond:
A. “Have your problem-solving skills”
B. “Ignore situations that you can change”
C. “Improve your time management skills”
D. “Develop a wide variety of coping strategies”

***** END OF EXAMINATION *****

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