CHIPATA SCHOOL OF NURSING

End of Year Examinations

July 2011 (RNs)

FIRST THEORY BLOCK TEST

SUBJECT: Mental Health and Psychiatry

DURATION: 3 HOURS

DATE:

START TIME:

FINISH TIME:

INSTRUCTIONS TO CANDIDATE

1. READ THE INSTRUCTIONS CAREFULLY

2. WRITE NEATLY AND LEGIBLY

3. WRITE YOUR NAME ON EACH PAGE

4. NUMBER EACH PAGE AND EACH QUESTION

5. CANDIDATES MAY NOT BRING BOOKS, NOTEBOOKS OR MOBILE PHONES INTO THE

EXAM ROOM

6. CANDIDATES MAY NOT LEAVE THE EXAM ROOM DURING THE FIRST 30 MINUTES

AND THE LAST 30 MINUTES OF THE EXAM

YOU MUST ANSWER ALL OF THE QUESTIONS

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Section A: Multiple Choice Questions 20 marks

Please answer all questions, and circle the correct answer

1. Which one of the following is not commonly associated with a psychotic disturbance
a. anxiety
b. agitation
c. personality changes
d. insight is present

2. Which of the following symptoms are characteristic of schizophrenia

a. delusions, hallucinations, disorders of volition, disorders of behaviour
b. depression, anxiety, suicidal intent, insomnia,
c. mania, disinhibition, nakedness, amnesia
d. insanity, disorientation, loss of muscle tone, mutism

3. The worst outcome to the person if his/her endogenous depression is left untreated will be
a. suicide and death
b. permanent hospitalisation
c. resolution and discharge
d. loss of libido

4. Which of the following factors is least contribute to the development of schizophrenia

a. inheritance
b. over controlling parenting
c. hi gh expressed emotion
d. hospitalisation in a psychiatric ward

5. A 50-year-old man comes to the doctor because he had been feeling depressed after the
death of his wife two months ago. He says he's had a hard time sleeping and even has
imagined that she is still in the home with him. He's not below to return to work yet and has
had difficulty motivating himself to resume his normal activities. What additional symptom
would cause a position to diagnose a patient with abnormal grieving
a. delusions that his wife is controlling his thoughts
b. depressive symptoms
c. experience the anniversary reaction in which symptoms of grief re-occur in anniversaries or
holidays
d. guilt that causes him to blame himself for his wife's death

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6. A 28-year-old woman presents to her primary care provider complaining of difficulty
sleeping. Although the patient group reports trouble falling asleep and waking up before the
sun every morning, her major complaint is awakening groups sleep many times during the
night. She also complains of decreased energy and motivation to complete assets at work.
Which of the following interventions would be most appropriate for this patient?
a. Avoidance of caffeine
b. continuous positive airway pressure
c. fluoxetine
d. reading the novel when awake

7. A patient is in OPD has being evaluated. She has persistent sore throat and fevers. It is found
that her history is extremely difficult to follow because she's continuously shifting
conversation topics, talking about being from Mars and claiming that she is the Pres of
Zambia. The patient speech is flat. The patient asked the Dr to prescribe new medication to
help her mind. Which of the following medications is most likely contributing to the
patient's sore throat and fevers?
a. Diazepam
b. Clozapine
c. Haloperidol
d. Lithium

8. A seven-year-old boys broughtp in to see a aediatrician by his mother after a troubling

parent teacher conference. The teacher reports childish disruptive in class and generally
does not finish their homework assignments. The mother reports that the child's room is
always messy and that he has difficulty completing chores in a timely fashion. In the office
the child is restless and interrupt his mother often which of the following is the most likely
diagnosis
a. antisocial personality disorder
b. attention deficit/hyperactivity disorder
c. childhood bipolar disorder
d. conduct disorder

9. A psychologist whose first child is 4 years old is applying the principles of behaviour
modification to child-rearing. Ffor instance if the child throws temper tantrums store
because she will not buy himsweets, she just picks him up and leaves store; however it child
behaves in the store she takes into the zoo. This is an example of which of the following kind
of behaviour modification
a. aversive conditioning
b. classical conditioning

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c. learned helplessness
d. operant conditioning

10. A 26-year-old African woman sees the doctor at the clinic. She is complaining of fatigue and
insomnia the past eight months. She also complained of difficulty concentrating and is
irritable as well as feeling continually anxious. She states that nothing seems to make her
feel better or worse; she is still able to perform all of her work duties. She denies
palpitations and any physical change in the time period and a past medical history is clear.
Vital signs within the normal range, and physical examination shows no focal findings, but
the woman appears markedly agitated. Which of the following is this patient is the most
likely diagnosis
a. adjustment disorder
b. attention deficit/overactive disorder
c. generalised anxiety disorder
d. hypothyroidism

11. A 35-year-old woman who was hospitalised for a manic episode two weeks ago show
substantial improvement. Her mania has resolved; she's sleeping through the night. She no
longer has delusions of grandeur; her speech is not pressured and she does not show any
flight of ideas. She's ready for discharge. Which of the following drugs could be described as
maintaining therapy for this patient
a. haloperidol
b. lithium
c. fluoxetine
d. diazepam

12. A 40-year-old woman presents to a psychiatrist after referral from your own doctor due to
the fact that she is feeling anxious all of the time. She's been diagnosed with the general
anxiety disorder and prescribed diazepam, but she's not feeling any better. She works as a
computer programmer and spends most of her day in a private cubicle. She has no close
friends and lives by herself. She says that occasionally people work in writer out at night, but
she never goes (even though she would like to) she's not dating currently and is worried that
people will like her. Which of the following personality disorders best describes this patient
a. avoidant
b. dependent
c. histrionic
d. narcissistic

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13. A 44-year-old schizophrenic patient on a mental health unit is interviewed daily as part of
her treatment. She has been persistently reporting that she is married to the ex-president of
Zambia. This psychotic symptom is a disorder of which of the following
a. affect
b. cognition
c. perception
d. thought content

14. which of the following is not an affective disorder

a. mania
b. depression
c. hysteria
d. unipolar disorder

15. The incidence of schizophrenia within the general population is:

a. 25%
b. 5%
c. 0.4%
d. 1%

16. Which of the following best describes generalised anxiety disorder

a. a feeling of dread
b. a feeling of being anxious for all of most of the time
c. a fear of being attacked
d. a feeling of being disconnected with the world

17. The aim of caring for a person with generalised anxiety disorder (GAD) is to
a. eradicate anxiety by daily medication
b. solve the underlying problem causing the anxiety
c. to teach the person to live with high levels of anxiety
d. to help the person to reduce anxiety and comfort in the persons living

18. gradual and staged desensitisation can be used in the treatment of

a. generalised anxiety disorder
b. bipolar disorder
c. phobic disorder
d. depression

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19. Electrical therapy (ECT) is most often used to treat which one of the following conditions?
a. Personality disorders
b. Mania
c. Hysteria
d. Substance misuse

20. Precious is an 18-year-old girl who is not getting on well with her mother she is annoyed and
confides in you saying “she still think she can bus me about and forgets that I am an 18-year-
old now and I am quite capable of running my own life”. Which of the following is the best
empathic response?
a. You should respect your mother
b. I think you should leave home
c. it sounds like you feel quite angry with your mom and perhaps feel she is treating you like
child
d. I know how you feel. I have similar problems

Section 2: completion statements 20 marks

Please Complete the Missing Word or Phrase in the Following Questions

1. Psychiatry is the diagnosis and treatment of mental illness..........................................

2. The main defining characteristic of a neurotic illness is the presence
of...ANXIETY..................................
3. Psychosis is characterised by the loss of...INSIGHT.............................. which presents itself as
the patient denying that he has any problems.
4. Anxiety is a response to..STRESS...........................
5. The symptoms of anxiety are controlled by the autonomic nervous system which, at times
of perceived threat triggers a series of reactions.
6. The reactions brought about by anxiety prepare the individual for... Fight or flight from
7. A delusion is an example of a thought disorder. which is characteristic of the group of
disorders called psychoses.
8. The mood state in mania is often described as being in a state of..elation ( euphoria)
9. In a phobic disorder the level of anxiety rises in relation to the...perception of the threat.
10. .Implosion. may be used to assist the phobic patient to cope with the object of the fear
placing the person in close contact with that object or situation
11. When we say that depression is a endogenous we're mean that it is created from..within.
Depression that is reactive is created from outside (external) factors
12. Chlorpromazine is otherwise known as Largactil and is a member of the.Phenothiazines
(major tranquilisers) family of drugs.
13. Chlorpromazine may cause side effects which, when recognised can be treated by using the
drug called Benxhexol (Artane).
14. Impulse control disorders may be presented as an obsession. or as a compulsion

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 15. When a person repeatedly tries to kill themselves without success we call this type of
behaviour.Parasuicide
16. Two examples of stressors that may cause ill-health are . Ill health, divirce, losing job,
death of family member etc
17. Anxiety can be presented at various levels. The most extreme level is Panic.
18. A person who repeatedly presents with physical symptoms in reaction to stressful events in
his or her life can be described as a hypochondriac.
19. Giving information is the process of telling someone facts so that they are in a position to
make an informed decision about what action to take.
20. Giving advice is the process of telling someone what course of action they should take and
how you think they should take it. If the if

Section 3 (Part A): Cross Matching 10 marks

Please answer all five questions by matching the words in column 1 with the statements in column
2 (place the number from your choice in column 1 into the space provided in column 2)

Column 1 Column 2
1
Operant A sensation of taste in the absence of any external
conditioning stimulus is called…………6…………………………………….

2 Ideas of reference ………………………………3……………………Include ataxia,

agitation and tremor and are associated with
treatment of schizophrenia by major tranquilisers

3 Extrapyramidal A ……………………5………………………Is recognised by

side-effects thoughts related to death or dying.

4 Counseling
…………………10………………………..encourages a person
with a mental illness to be amenable to treatment
by medical interventions

5 Nihilistic Delusion
……………4………. relates to the process of dialogue
and mutual interaction

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 6 Gustatory ……………………1…………………..means promotion of
Hallucination learning through the association of stimulus and
response

7 Mental health A……………………………8………………….should be

managed by reassurance, calmness and assistance
in the control of respirations.
8 Panic attack A person who believes that people, television,
newspapers, or the media are talking about him is
expressing……………………2…………………………………….
9 Catatonic The disorder characterised by stiffness and
schizophreni postural rigidity, often in uncomfortable and
a energy taxing stances is called…………………
9…………………………………
10 Therapeutic nurse- ……………………7……………………is the absence of
patient relationship mental disorder

Section 3 (Part B): True or False statements 10 Marks

Please answer all questions by circling clearly which of the following statements are true or
false.

1. In schizophrenia the main presenting challenge is aggression

FALSE

2. The main risk in leaving depression untreated is that the person, because of
inactivity will become obese

FALSE

3. Hypnotherapy can be used successfully to treat bipolar disorders

FALSE

4. Dementia is a treatable and reversible condition of old age

FALSE

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 5. Mental retardation can be defined as an intelligence quotient of 100 Percentile or
less

FALSE

6. Electroconvulsive therapy produces a state of calmness by the injection of relaxing

drugs

FALSE

7. Mirroring within counseling is the process by which the counselor avoids sitting in
the same posture and using the same gestures as the client

FALSE

8. Stress is the physiological (of body) and psychological (of the mind) reactions
people exhibit in response to environmental events called stressors.

TRUE

9. An obsession takes the form of repetitive behaviours such as handwashing in order

to reduce anxiety

FALSE

10. a compulsion can be treated by psychotherapy

TRUE

Section D: answer one of the following essay questions

20 marks per question

1. Andrew is a happily married man with two young children; recently he has been
experiencing panic attacks at work after being promoted to office manager. He has
been offered counselling.

a. Define counseling 3%
Relates to the process of dialogue and mutual interaction for the purpose of developing insight,
problem solving, encouraging catharsis

b. Discuss the possible benefits of counseling for Andrew 7%

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 In providing a confidential setting to provide him with opportunities to discuss his
thoughts, feelings, fears., counselling will help Andrew to discover reasons for his anxiety;
identify factors that have lead to his panic attacks; discuss other’s responses to his
behaviour, perhaps looking at the dynamics of his interactions with those staff that he
now manages and to identify any possible conflict. Promote the identification of coping
strategies through problem solving; validate his concerns; offer reassurance; provide
positive and non judgemental acceptance of Andrew as a person and provide him with
assurances that he is not going mad.

c. describe (not list) five skills that are needed in counseling and why they are important
10%

Ability to attend and to listen actively to include prompting, paraphrasing, reflecting,

mirroring (SOLER responses)

Non judgemental attitude evident in choosing language and non verbal communication

Genuine

Empathetic

Ability to create a setting that is conducive to the interaction and negotiate groundrules

2. Ignatious Phiri, aged 34, is admitted to the Ward after becoming agitated and hearing
voices that tell him to cause violence to his family. He has been diagnosed with paranoid
schizophrenia which is developed over the past six months.
a. Define psychosis 2%

Group of severe mental illnesses disorders characterised by disruption in contact with

reality, impaired inight. Common symptoms are hallucinations, thought disorder, affective
disturbances (mania/depression), drug misuse, organic deterioration (dementia)

b. Describe and explain five symptoms of schizophrenia

Hallucinations
Delusions

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Lack of volition
Personality deterioration
Flattening of affect
Behavioural disorders such as catatonia
Poor concentration 10 %

c. Explain the main treatment methods that may be used to treat paranoid 8%
schizophrenia

Students should describe nature of the nurse-patient relationship; management of

delusions and hallucinations; attending to basic needs and motivating the patient to be
self caring; ensuring rest; administration of psychotropic medication and observation
for any side effects; multi disciplinary team involvement

END OF EXAMINATION

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