S?

CPlA18lC nu8SlnC

1 MenLal healLh ls deflned as
A 1he ablllLy Lo dlsLlngulsh whaL ls real from
whaL ls noL
8 A sLaLe of wellbelng where a person can
reallze hls own ablllLles can cope wlLh normal
sLresses of llfe and work producLlvely
C ls Lhe promoLlon of menLal
healLh prevenLlon of menLal dlsorders nurslng
care of paLlenLs durlng lllness and rehablllLaLlon
u Absence of menLal lllness

Answer (8) A sLaLe of wellbelng where a
person can reallze hls own ablllLles can cope
wlLh normal sLresses of llfe and work
producLlvely
MenLal healLh ls a sLaLe of emoLlonal and
psychosoclal well belng A
menLally healLhy lndlvldual ls self aware and self
dlrecLlve has Lhe ablllLy Lo solve problems can
cope wlLh crlsls wlLhouL asslsLance beyond Lhe
supporL of famlly and frlends fulflll Lhe capaclLy
Lo love and work and seLs goals and reallsLlc
llmlLs A 1hls descrlbes Lhe ego funcLlon reallLy
LesLlng C 1hls ls Lhe deflnlLlon of MenLal
PealLh and sychlaLrlc nurslng u MenLal healLh
ls noL [usL Lhe absence of menLal lllness

2 Whlch of Lhe followlng descrlbes Lhe role of a
Lechnlclan?
A AdmlnlsLers medlcaLlons Lo a schlzophrenlc
paLlenL
8 1he nurse feeds and baLhes a caLaLonlc cllenL
C CoordlnaLes dlverse aspecLs of care rendered
Lo Lhe paLlenL
u ulssemlnaLes lnformaLlon abouL alcohol and
lLs effecLs

Answer (A) AdmlnlsLers medlcaLlons Lo a
schlzophrenlc paLlenL
AdmlnlsLraLlon of medlcaLlons and LreaLmenLs
assessmenL documenLaLlon are Lhe acLlvlLles of
Lhe nurse as a Lechnlclan 8 AcLlvlLles as a
parenL surrogaLe C 8efers Lo Lhe ward manager
role u 8ole as a Leacher

3 Llza says Clve me 10 mlnuLes Lo recall Lhe
name of our college professor who falled many
sLudenLs ln our anaLomy class" She ls operaLlng
on her
A Subconsclous
8 Consclous
C unconsclous
u Lgo

Answer (A) Subconsclous
Subconsclous refers Lo Lhe maLerlals LhaL are
parLly remembered parLly forgoLLen buL Lhese
can be recalled sponLaneously and volunLarlly
8 1hls funcLlons when one ls awake Cne ls
aware of hls LhoughLs feellngs acLlonsand whaL
ls golng on ln Lhe envlronmenL C 1he largesL
poLlon of Lhe mlnd LhaL conLalns Lhe memorles
of one's pasL parLlcularly Lhe unpleasanL lL ls
dlfflculL Lo recall Lhe unconsclous conLenL u
1he consclous self LhaL deals and LesLs reallLy

4 1he superego ls LhaL parL of Lhe psyche LhaL
A uses defenslve funcLlon for proLecLlon
8 ls lmpulslve and wlLhouL morals
C ueLermlnes Lhe clrcumsLances before maklng
declslons
u 1he censorlng porLlon of Lhe mlnd

Answer (u) 1he censorlng porLlon of Lhe mlnd
1he crlLlcal censorlng porLlon of one's
personallLy Lhe consclence A 1hls refers Lo Lhe
ego funcLlon LhaL proLecLs lLself from anyLhlng
LhaL LhreaLens lL 8 1he ld ls composed of Lhe
unLamed prlmlLlve drlves and lmpulses C 1hls
refers Lo Lhe ego LhaL acLs as Lhe moderaLor of
Lhe sLruggle beLween Lhe ld and Lhe superego
3 rlmary level of prevenLlon ls exempllfled by
A Pelplng Lhe cllenL resume self care
8 Lnsurlng Lhe safeLy of a sulcldal cllenL ln Lhe
lnsLlLuLlon
C 1eachlng Lhe cllenL sLress managemenL
Lechnlques
u Case flndlng and survelllance ln Lhe
communlLy

Answer (C) 1eachlng Lhe cllenL sLress
managemenL Lechnlques
rlmary level of prevenLlon refers Lo Lhe
promoLlon of menLal healLh andprevenLlon of
menLal lllness 1hls can be achleved by
renderlng healLh Leachlngs such as modlfylng
ones responses Lo sLress A 1hls ls LerLlary level
of prevenLlon LhaL deals wlLh rehablllLaLlon 8
and u Secondary level of prevenLlon whlch
lnvolves reducLlon of acLual lllness Lhrough early
deLecLlon and LreaLmenL of lllness
6 SlLuaLlon ln a home vlslL done by Lhe nurse
she suspecLs LhaL Lhe wlfe and her chlld are
vlcLlms of abuse

Whlch of Lhe followlng ls Lhe mosL approprlaLe
for Lhe nurse Lo ask?
A Are you belng LhreaLened or hurL by your
parLner?
8 Are you frlghLened of you parLner"
C ls someLhlng boLherlng you?"
u WhaL happens when you and your parLner
argue?"

Answer (A) Are you belng LhreaLened or hurL
by your parLner?
1he nurse valldaLes her observaLlon by asklng
slmple dlrecL quesLlon 1hls also shows
empaLhy 8 C and u are lndlrecL quesLlons
whlch may noL lead Lo Lhe dlscusslon of abuse
7 1he wlfe admlLs LhaL she ls a vlcLlm of abuse
and opens up abouL her perslsLenL dlsLasLe for
sex 1hls sexual dlsorder ls
A Sexual deslre dlsorder
8 Sexual arousal ulsorder
C Crgasm ulsorder
u Sexual aln ulsorder

Answer (A) Sexual deslre dlsorder
Pas llLLle or no sexual deslre or has dlsLasLe for
sex 8 lallure Lo malnLaln Lhe physlologlc
requlremenLs for sexual lnLercourse C
erslsLenL and recurrenL lnablllLy Lo achleve an
orgasm u Also called dyspareunla lndlvlduals
wlLh Lhls dlsorder suffer genlLal paln before
durlng and afLer sexual lnLercourse
8 WhaL would be Lhe besL approach for a wlfe
who ls sLlll llvlng wlLh her abuslve husband?
A Pere's Lhe number of a crlsls cenLer LhaL you
can call for help "
8 lLs besL Lo leave your husband"
C uld you dlscuss Lhls wlLh your famlly?"
u Why do you allow yourself Lo be LreaLed
Lhls way"

Answer (A) Pere's Lhe number of a crlsls
cenLer LhaL you can call for help "
roLecLlon ls a prlorlLy concern ln abuse Pelp
Lhe vlcLlm Lo develop a plan Lo ensure safeLy 8
uo noL glve advlce Lo leave Lhe abuser Maklng
declslons for Lhe vlcLlm furLher erodes her
esLeem Powever dlscuss opLlons avallable C
1he vlcLlm Lends Lo lsolaLe from frlends and
famlly u 1hls ls [udgmenLal Avold ln anyway
lmplylng LhaL she ls aL faulL
9 Whlch commenL abouL a 3 year old chlld lf
made by Lhe parenL may lndlcaLe chlld abuse?
A Cnce my chlld ls LolleL Lralned l can sLlll
expecL her Lo have some
8 When l Lell my chlld Lo do someLhlng once l
don'L expecL Lo have Lo Lell
C My chlld ls expecLed Lo Lry Lo do Lhlngs such
as dress and feed"
u My 3 year old loves Lo say nC"

Answer (8) When l Lell my chlld Lo do
someLhlng once l don'L expecL Lo have Lo Lell
Abuslve parenLs Lend Lo have unreallsLlc
expecLaLlons on Lhe chlld A8 and C are reallsLlc
expecLaLlons on a 3 year old
10 1he prlmary nurslng lnLervenLlon for a vlcLlm
of chlld abuse ls
A Assess Lhe scope of Lhe problem
8 Analyze Lhe famlly dynamlcs
C Lnsure Lhe safeLy of Lhe vlcLlm
u 1each Lhe vlcLlm coplng skllls

Answer (C) Lnsure Lhe safeLy of Lhe vlcLlm
1he prlorlLy conslderaLlon ls Lhe safeLy of Lhe
vlcLlm ALLend Lo Lhe physlcal ln[urles Lo ensure
Lhe physlologlc safeLy and lnLegrlLy of Lhe chlld
8eporLlng suspecLed case of abuse may deLer
recurrence of abuse A8 and u may be
addressed laLer
11 SlLuaLlon A 30 year old male employee
frequenLly complalns of low back paln LhaL leads
Lo frequenL absences from work ConsulLaLlon
and LesLs reveal negaLlve resulLs

1he cllenL has whlch somaLoform dlsorder?
A SomaLlzaLlon ulsorder
8 Pypochondrlalsls
C Converslon ulsorder
u SomaLoform aln ulsorder

Answer (u) SomaLoform aln ulsorder
1hls ls characLerlzed by severe and prolonged
paln LhaL causes slgnlflcanL dlsLress A 1hls ls a
chronlc syndrome of somaLlc sympLoms LhaL
cannoL be explalned medlcally and ls assoclaLed
wlLh psychosoclal dlsLress 8 1hls ls an
unreallsLlc preoccupaLlon wlLh a fear of havlng a
serlous lllness C CharacLerlzed by alLeraLlon or
loss ln sensory or moLor funcLlon resulLlng from
a psychologlcal confllcL
12 lreud explalns anxleLy as
A SLrlves Lo graLlfy Lhe needs for saLlsfacLlon
and securlLy
8 ConfllcL beLween ld and superego
C A hypoLhalamlcplLulLaryadrenal reacLlon Lo
sLress
u A condlLloned response Lo sLressors

Answer (8) ConfllcL beLween ld and superego
lreud explalns anxleLy as due Lo opposlng acLlon
drlves beLween Lhe ld and Lhe superego A
Sulllvan ldenLlfled 2 Lypes of needs saLlsfacLlon
and securlLy lallure Lo graLlfy Lhese needs may
resulL ln anxleLy C 8lomedlcal perspecLlve of
anxleLy u LxplanaLlon of anxleLy uslng Lhe
behavloral model
13 1he followlng are approprlaLe nurslng
dlagnosls for Lhe cllenL LxCL1
A lneffecLlve lndlvldual coplng
8 AlLeraLlon ln comforL paln
C AlLered role performance
u lmpalred soclal lnLeracLlon

Answer (u) lmpalred soclal lnLeracLlon
1he cllenL may noL have dlfflculLy ln soclal
exchange 1he cues do noL supporL Lhls
dlagnosls A 1he cllenL maladapLlvely uses body
sympLoms Lo manage anxleLy 8 1he cllenL wlll
have dlscomforL due Lo paln C 1he cllenL may
fall Lo meeL envlronmenLal expecLaLlons due Lo
paln
14 1he followlng sLaLemenLs descrlbe
somaLoform dlsorders
A hyslcal sympLoms are explalned by organlc
causes
8 lL ls a volunLary expresslon of psychologlcal
confllcLs
C Lxpresslon of confllcLs Lhrough bodlly
sympLoms
u ManagemenL enLalls a speclflc medlcal
LreaLmenL

Answer (C) Lxpresslon of confllcLs Lhrough
bodlly sympLoms
8odlly sympLoms are used Lo handle confllcLs A
ManlfesLaLlons do noL have an organlc basls 8
1hls occurs unconsclously u Medlcal LreaLmenL
ls noL used because Lhe dlsorder does noL have
a sLrucLural or organlc basls
13 WhaL would be Lhe besL response Lo Lhe
cllenL's repeaLed complalnLs of paln
A l know Lhe feellng ls real LesLs revealed
negaLlve resulLs"
8 l Lhlnk you're exaggeraLlng Lhlngs a llLLle
blL"
C 1ry Lo forgeL Lhls feellng and have acLlvlLles
Lo Lake lL off your mlnd"
u So Lell me more abouL Lhe paln"

Answer (A) l know Lhe feellng ls real LesLs
revealed negaLlve resulLs"
Shows empaLhy and offers lnformaLlon 8 1hls
ls a demeanlng sLaLemenL C 1hls bellLLles Lhe
cllenL's feellngs u Clvlng undue aLLenLlon Lo
Lhe physlcal sympLom relnforces Lhe complalnL
16 SlLuaLlon A nurse may encounLer chlldren
wlLh menLal dlsorders Per knowledge of Lhese
varlous dlsorders ls vlLal

When plannlng school lnLervenLlons for a chlld
wlLh a dlagnosls of aLLenLlon deflclL
hyperacLlvlLy dlsorder a gulde Lo remember ls
Lo
A provlde as much sLrucLure as posslble for Lhe
chlld
8 lgnore Lhe chlld's overacLlvlLy
C encourage Lhe chlld Lo engage ln any play
acLlvlLy Lo dlsslpaLe energy
u remove Lhe chlld from Lhe classroom when
dlsrupLlve behavlor occurs

Answer (A) provlde as much sLrucLure as
posslble for Lhe chlld
uecrease sLlmull for behavlor conLrol Lhru an
envlronmenL LhaL ls free of dlsLracLlons a calm
non confronLaLlonal approach and seLLlng llmlL
Lo Llme alloLLed for acLlvlLles 8 1he chlld wlll
noL beneflL from a lenlenL approach C ulsslpaLe
energy Lhrough safe acLlvlLles u 1hls lndlcaLes
LhaL Lhe classroom envlronmenL lacks sLrucLure
17 1he chlld wlLh conducL dlsorder wlll llkely
demonsLraLe
A Lasy dlsLracLlblllLy Lo exLernal sLlmull
8 8lLuallsLlc behavlors
C reference for lnanlmaLe ob[ecLs
u Serlous vlolaLlons of age relaLed norms

Answer (u) Serlous vlolaLlons of age relaLed
norms
1hls ls a dlsrupLlve dlsorder among chlldren
characLerlzed by more serlous vlolaLlons of
soclal sLandards such as aggresslon vandallsm
sLeallng lylng and Lruancy A 1hls ls
characLerlsLlc of aLLenLlon deflclL dlsorder 8 and
C 1hese are noLed among chlldren wlLh auLlsLlc
dlsorder
18 8lLalln ls Lhe drug of cholce for chldren wlLh
AuPu 1he slde effecLs of Lhe followlng may be
noLed
A lncreased aLLenLlon span and concenLraLlon
8 lncrease ln appeLlLe
C sleeplness and leLhargy
u bradycardla and dlarrhea

Answer (A) lncreased aLLenLlon span and
concenLraLlon
1he medlcaLlon has a paradoxlc effecL LhaL
decrease hyperacLlvlLy and lmpulslvlLy among
chlldren wlLh AuPu 8 C u Slde effecLs of
8lLalln lnclude anorexla lnsomnla dlarrhea and
lrrlLablllLy
19 School phobla ls usually LreaLed by
A 8eLurnlng Lhe chlld Lo Lhe school lmmedlaLely
wlLh famlly supporL
8 Calmly explalnlng why aLLendance ln school ls
necessary
C Allowlng Lhe chlld Lo enLer Lhe school before
Lhe oLher chlldren
u Allowlng Lhe parenL Lo accompany Lhe chlld ln
Lhe classroom

Answer (A) 8eLurnlng Lhe chlld Lo Lhe school
lmmedlaLely wlLh famlly supporL
Lxposure Lo Lhe feared slLuaLlon can help ln
overcomlng anxleLy A 1hls wlll noL help ln
rellevlng Lhe anxleLy due separaLlon from a
slgnlflcanL oLher C and C AnxleLy ln school
phobla ls noL due Lo belng ln school buL due Lo
separaLlon from parenLs/careglvers so Lhese
lnLervenLlons are noL appllcable u 1hls wlll noL
help Lhe chlld overcome Lhe fear
20 A 10 year old chlld has very llmlLed
vocabulary and lnLeracLlon skllls She has an lC
of 43 She ls dlagnosed Lo have MenLal
reLardaLlon of Lhls classlflcaLlon
A rofound
8 Mlld
C ModeraLe
u Severe

Answer (C) ModeraLe
1he chlld wlLh moderaLe menLal reLardaLlon has
an lC of 3330 rofound MenLal reLardaLlon
has an lC of below 20 Mlld menLal reLardaLlon
3070 and Severe menLal reLardaLlon has an lC
of 2033
21 1he nurse Leaches Lhe parenLs of a menLally
reLarded chlld regardlng her care 1he followlng
guldellnes may be LaughL excepL
A overproLecLlon of Lhe chlld
8 paLlence rouLlne and repeLlLlon
C asslsLlng Lhe parenLs seL reallsLlc goals
u glvlng reasonable compllmenLs

Answer (A) overproLecLlon of Lhe chlld
1he chlld wlLh menLal reLardaLlon should noL be
overproLecLed buL need proLecLlon from ln[ury
and Lhe Leaslng of oLher chlldren 8C and u
Chlldren wlLh menLal reLardaLlon have learnlng
dlfflculLy 1hey should be LaughL wlLh paLlence
and repeLlLlon sLarL from slmple Lo complex
use vlsuals and compllmenL Lhem for
moLlvaLlon 8eallsLlc expecLaLlons should be seL
and opLlmlze Lhelr capablllLy
22 1he parenLs express apprehenslons on Lhelr
ablllLy Lo care for Lhelr maladapLlve chlld 1he
nurse ldenLlfles whaL nurslng dlagnosls
A hopelessness
8 alLered parenLlng role
C alLered famlly process
u lneffecLlve coplng

Answer (8) alLered parenLlng role
AlLered parenLlng role refers Lo Lhe lnablllLy Lo
creaLe an envlronmenL LhaL promoLes opLlmum
growLh and developmenL of Lhe chlld 1hls ls
reflecLed ln Lhe parenL's lnablllLy Lo care for Lhe
chlld A 1hls refers Lo lack of cholces or lnablllLy
Lo moblllze one's resources C 8efers Lo change
ln famlly relaLlonshlp and funcLlon u
lneffecLlve coplng ls Lhe lnablllLy Lo form valld
appralsal of Lhe sLressor or lnablllLy Lo use
avallable resources
23 A 3 year old boy ls dlagnosed Lo have auLlsLlc
dlsorder
Whlch of Lhe followlng manlfesLaLlons may be
noLed ln a cllenL wlLh auLlsLlc dlsorder?

A argumenLaLlveness dlsobedlence angry
ouLbursL
8 lnLolerance Lo change dlsLurbed relaLedness
sLereoLypes
C dlsLracLlblllLy lmpulslveness and overacLlvlLy
u aggresslon Lruancy sLeallng lylng

Answer (8) lnLolerance Lo change dlsLurbed
relaLedness sLereoLypes
1hese are manlfesLaLlons of auLlsLlc dlsorder A
1hese manlfesLaLlons are noLed ln CpposlLlonal
ueflanL ulsorder a dlsrupLlve dlsorder among
chlldren C 1hese are manlfesLaLlons of
ALLenLlon ueflclL ulsorder u 1hese are Lhe
manlfesLaLlons of ConducL ulsorder
24 1he LherapeuLlc approach ln Lhe care of an
auLlsLlc chlld lnclude Lhe followlng LxCL1
A Lngage ln dlverslonary acLlvlLles when acLlng
ouL
8 rovlde an aLmosphere of accepLance
C rovlde safeLy measures
u 8earrange Lhe envlronmenL Lo acLlvaLe Lhe
chlld

Answer (u) 8earrange Lhe envlronmenL Lo
acLlvaLe Lhe chlld
1he chlld wlLh auLlsLlc dlsorder does noL wanL
change MalnLalnlng a conslsLenL envlronmenL ls
LherapeuLlc A Angry ouLbursL can be
rechannelled Lhrough safe acLlvlLles 8
AccepLance enhances a LrusLlng relaLlonshlp C
Lnsure safeLy from selfdesLrucLlve behavlors
llke head banglng and halr pulllng
23 Accordlng Lo lageL a 3 year old ls ln whaL
sLage of developmenL
A Sensory moLor sLage
8 ConcreLe operaLlons
C reoperaLlonal
u lormal operaLlon

Answer (C) reoperaLlonal
reoperaLlonal sLage (27 years) ls Lhe sLage
when Lhe use of language Lhe use of symbols
and Lhe concepL of Llme occur A SensorymoLor
sLage (02 years) ls Lhe sLage when Lhe chlld
uses Lhe senses ln learnlng abouL Lhe self and
Lhe envlronmenL Lhrough exploraLlon 8
ConcreLe operaLlons (712 years) when
lnducLlve reasonlng develops u lormal
operaLlons (2 Llll adulLhood) ls when absLracL
Lhlnklng and deducLlve reasonlng develop
26 SlLuaLlon 1he nurse asslgned ln Lhe
deLoxlflcaLlon unlL aLLends Lo varlous paLlenLs
wlLh subsLancerelaLed dlsorders

A 43 years old male revealed LhaL he
experlenced a marked lncrease ln hls lnLake of
alcohol Lo achleve Lhe deslred effecL 1hls
lndlcaLes
A wlLhdrawal
8 Lolerance
C lnLoxlcaLlon
u psychologlcal dependence

Answer (8) Lolerance
Lolerance refers Lo Lhe lncrease ln Lhe amounL
of Lhe subsLance Lo achleve Lhe same effecLs A
WlLhdrawal refers Lo Lhe physlcal slgns and
sympLoms LhaL occur when Lhe addlcLlve
subsLance ls reduced or wlLhheld 8 lnLoxlcaLlon
refers Lo Lhe behavloral changes LhaL occur
upon recenL lngesLlon of a subsLance u
sychologlcal dependence refers Lo Lhe lnLake of
Lhe subsLance Lo prevenL Lhe onseL of
wlLhdrawal sympLoms
27 1he cllenL admlLLed for alcohol
deLoxlflcaLlon develops lncreased Lremors
lrrlLablllLy hyperLenslon and fever 1he nurse
should be alerL for lmpendlng
A dellrlum Lremens
8 korsakoff's syndrome
C esophageal varlces
u Wernlcke's syndrome

Answer (A) dellrlum Lremens
uellrlum 1remens ls Lhe mosL exLreme cenLral
nervous sysLem lrrlLablllLy due Lo wlLhdrawal
from alcohol 8 1hls refers Lo an amnesLlc
syndrome assoclaLed wlLh chronlc alcohollsm
due Lo a deflclency ln vlL 8 C 1hls ls a
compllcaLlon of llver clrrhosls whlch may be
secondary Lo alcohollsm u 1hls ls a
compllcaLlon of alcohollsm characLerlzed by
lrregularlLles of eye movemenLs and lack of
coordlnaLlon
28 1he care for Lhe cllenL places prlorlLy Lo
whlch of Lhe followlng
A MonlLorlng hls vlLal slgns every hour
8 rovldlng a quleL dlm room
C Lncouraglng adequaLe flulds and nuLrlLlous
foods
u AdmlnlsLerlng Llbrlum as ordered

Answer (A) MonlLorlng hls vlLal slgns every hour
ulse and blood pressure are usually elevaLed
durlng wlLhdrawal LlevaLlon may lndlcaLe
lmpendlng dellrlum Lremens 8 CllenL needs
quleL well llghLed conslsLenL and secure
envlronmenL Lxcesslve sLlmulaLlon can
aggravaLe anxleLy and cause llluslons and
halluclnaLlons C AdequaLe nuLrlLlon wlLh
sulpplemenL of vlL 8 should be ensured u
SedaLlves are used Lo relleve anxleLy
29 AnoLher cllenL ls broughL Lo Lhe emergency
room by frlends who sLaLe LhaL he Look
someLhlng an hour ago Pe ls acLlvely
halluclnaLlng aglLaLed wlLh lrrlLaLed nasal
sepLum
A Peroln
8 cocalne
C LSu
u marl[uana

Answer (8) cocalne
1he manlfesLaLlons lndlcaLe lnLoxlcaLlon wlLh
cocalne a CnS sLlmulanL A lnLoxlcaLlon wlLh
herolne ls manlfesLed by euphorla Lhen
lmpalrmenL ln [udgmenL aLLenLlon and Lhe
presence of paplllary consLrlcLlon C
lnLoxlcaLlon wlLh halluclnogen llke LSu ls
manlfesLed by grandloslLy halluclnaLlons
synesLhesla and lncrease ln vlLal slgns u
lnLoxlcaLlon wlLh Marl[uana a cannablnold ls
manlfesLed by sensaLlon of slowed Llme
con[uncLlval redness soclal wlLhdrawal
lmpalred [udgmenL and halluclnaLlons
30 A cllenL ls admlLLed wlLh needle LracLs on hls
arm sLuporous and wlLh pln polnL pupll wlll
llkely be managed wlLh
A nalLrexone (8evla)
8 narcan (naloxone)
C ulsulflram (AnLabuse)
u MeLhadone (uolophlne)

Answer (8) narcan (naloxone)
narcan ls a narcoLlc anLagonlsL used Lo manage
Lhe CnS depresslon due Lo overdose wlLh
heroln A 1hls ls an oplaLe recepLor blocker
used Lo relleve Lhe cravlng for herolne C
ulsulflram ls used as a deLerrenL ln Lhe use of
alcohol u MeLhadone ls used as a subsLlLuLe ln
Lhe wlLhdrawal from herolne
31 SlLuaLlon An old woman was broughL for
evaluaLlon due Lo Lhe hosplLal for evaluaLlon
due Lo lncreaslng forgeLfulness and llmlLaLlons
ln dally funcLlon

1he daughLer revealed LhaL Lhe cllenL used her
LooLhbrush Lo comb her halr She ls manlfesLlng
A apraxla
8 aphasla
C agnosla
u amnesla

Answer (C) agnosla
1hls ls Lhe lnablllLy Lo recognlze ob[ecLs A
Apraxla ls Lhe lnablllLy Lo execuLe moLor
acLlvlLles desplLe lnLacL comprehenslon 8
Aphasla ls Lhe loss of ablllLy Lo use or
undersLand words u Amnesla ls loss of
memory
32 She Learfully Lells Lhe nurse l can'L Lake lL
when she accuses me of sLeallng her Lhlngs"
Whlch response by Lhe nurse wlll be mosL
LherapeuLlc?
A "uon'L Lake lL personally ?our moLher does
noL mean lL"
8 Pave you Lrled dlscusslng Lhls wlLh your
moLher?"
C 1hls musL be dlfflculL for you and your
moLher"
u nexL Llme ask your moLher where her Lhlngs
were lasL seen"

Answer (C) 1hls musL be dlfflculL for you and
your moLher"
1hls reflecLlng Lhe feellng of Lhe daughLer LhaL
shows empaLhy A and u Clvlng advlse does noL
encourage verballzaLlon 8 1hls response does
noL encourage verballzaLlon of feellngs
33 1he prlmary nurslng lnLervenLlon ln worklng
wlLh a cllenL wlLh moderaLe sLage demenLla ls
ensurlng LhaL Lhe cllenL
A recelves adequaLe nuLrlLlon and hydraLlon
8 wlll remlnlsce Lo decrease lsolaLlon
C remalns ln a safe and secure envlronmenL
u lndependenLly performs self care

Answer (C) remalns ln a safe and secure
envlronmenL
SafeLy ls a prlorlLy conslderaLlon as Lhe cllenL's
cognlLlve ablllLy deLerloraLes A ls approprlaLe
lnLervenLlons because Lhe cllenL's cognlLlve
lmpalrmenL can affecL Lhe cllenL's ablllLy Lo
aLLend Lo hls nuLrlLlonal needs buL lL ls noL Lhe
prlorlLy 8 aLlenL ls allowed Lo remlnlsce buL lL
ls noL Lhe prlorlLy u 1he cllenL ln Lhe moderaLe
sLage of Alzhelmer's dlsease wlll have dlfflculLy
ln performlng acLlvlLles lndependenLly
34 She says Lo Lhe nurse who offers her
breakfasL Ch no l wlll walL for my husband
We wlll eaL LogeLher" 1he LherapeuLlc response
by Lhe nurse ls
A ?our husband ls dead LeL me serve you your
breakfasL"
8 l've Lold you several Llmes LhaL he ls dead
lL's Llme Lo eaL"
C ?ou're golng Lo have Lo walL a long Llme"
u WhaL made you say LhaL your husband ls
allve?

Answer (A) ?our husband ls dead LeL me serve
you your breakfasL"
1he cllenL should be reorlenLed Lo reallLy and be
focused on Lhe here and now 8 1hls ls noL a
helpful approach because of Lhe shorL Lerm
memory of Lhe cllenL C 1hls lndlcaLes a
pompous response u 1he cognlLlve llmlLaLlon
of Lhe cllenL makes Lhe cllenL lncapable of glvlng
explanaLlon
33 uemenLla unllke dellrlum ls characLerlzed
by
A slurred speech
8 lnsldlous onseL
C cloudlng of consclousness
u sensory percepLual change

Answer (8) lnsldlous onseL
uemenLla has a gradual onseL and progresslve
deLerloraLlon lL causes pronounced memory
and cognlLlve dlsLurbances AC and u are all
characLerlsLlcs of dellrlum
36 SlLuaLlon A 17 year old gymnasL ls admlLLed
Lo Lhe hosplLal due Lo welghL loss and
dehydraLlon secondary Lo sLarvaLlon

Whlch of Lhe followlng nurslng dlagnoses wlll be
glven prlorlLy for Lhe cllenL?
A alLered selflmage
8 fluld volume deflclL
C alLered nuLrlLlon less Lhan body requlremenLs
u alLered famlly process

Answer (8) fluld volume deflclL
lluld volume deflclL ls Lhe prlorlLy over alLered
nuLrlLlon (A) slnce Lhe slLuaLlon lndlcaLes LhaL
Lhe cllenL ls dehydraLed A and u are
psychosoclal needs of a cllenL wlLh anorexla
nervosa buL Lhey are noL Lhe prlorlLy
37 WhaL ls Lhe besL lnLervenLlon Lo Leach Lhe
cllenL when she feels Lhe need Lo sLarve?
A Allow her Lo sLarve Lo relleve her anxleLy
8 uo a shorL Lerm exerclse unLll Lhe urge passes
C Approach Lhe nurse and Lalk ouL her feellngs
u Call her moLher on Lhe phone and Lell her
how she feels

Answer (C) Approach Lhe nurse and Lalk ouL her
feellngs
1he cllenL wlLh anorexla nervosa uses sLarvaLlon
as a way of managlng anxleLy 1alklng ouL
feellngs wlLh Lhe nurse ls an adapLlve coplng A
SLarvaLlon should noL be encouraged hyslcal
safeLy ls a prlorlLy WlLhouL adequaLe nuLrlLlon
a llfe LhreaLenlng slLuaLlon exlsLs 8 1he cllenL
wlLh anorexla nervosa ls preoccupled wlLh loslng
welghL due Lo dlsLurbed body lmage LlmlLs
should be seL on aLLempLs Lo lose more welghL
u 1he cllenL may have a domlneerlng moLher
whlch causes Lhe cllenL Lo feel amblvalenL 1he
cllenL wlll noL dlscuss her feellngs wlLh her
moLher
38 1he cllenL wlLh anorexla nervosa ls
lmprovlng lf
A She eaLs meals ln Lhe dlnlng room
8 WelghL galn
C She aLLends ward acLlvlLles
u She has a more reallsLlc self concepL

Answer (8) WelghL galn
WelghL galn ls Lhe besL lndlcaLlon of Lhe cllenL's
lmprovemenL 1he goal ls for Lhe cllenL Lo galn
12 pounds per week (A)1he cllenL may purge
afLer eaLlng (C) ALLendlng an acLlvlLy does noL
lndlcaLe lmprovemenL ln nuLrlLlonal sLaLe (u)
8ody lmage ls a facLor ln anorexla nervosa buL lL
ls noL an lndlcaLor for lmprovemenL
39 1he characLerlsLlc manlfesLaLlon LhaL wlll
dlfferenLlaLe bullmla nervosa from anorexla
nervosa ls LhaL bullmlc lndlvlduals
A have eplsodlc blnge eaLlng and purglng
8 have repeaLed aLLempLs Lo sLablllze Lhelr
welghL
C have pecullar food handllng paLLerns
u have LhreaLened selfesLeem

Answer (A) have eplsodlc blnge eaLlng and
purglng
8ullmla ls characLerlzed by blnge eaLlng whlch ls
characLerlzed by Laklng ln a large amounL of
food over a shorL perlod of Llme 8 and C are
characLerlsLlcs of a cllenL wlLh anorexla nervosa
u Low esLeem ls noLed ln boLh eaLlng dlsorders
40 A nurslng dlagnosls for bullmla nervosa ls
powerlessness relaLed Lo feellng noL ln conLrol
of eaLlng hablLs 1he goal for Lhls problem ls
A aLlenL wlll learn problem solvlng skllls
8 aLlenL wlll have decreased sympLoms of
anxleLy
C aLlenL wlll perform self care acLlvlLles dally
u aLlenL wlll verballze how Lo seL llmlLs on
oLhers

Answer (A) aLlenL wlll learn problem solvlng
skllls
lf Lhe cllenL learns problem solvlng skllls she wlll
galn a sense of conLrol over her llfe (8) AnxleLy
ls caused by powerlessness (C) erformlng self
care acLlvlLles wlll noL decrease ones
powerlessness (u) SeLLlng llmlLs Lo conLrol
lmposed by oLhers ls a necessary sklll buL
problem solvlng sklll ls Lhe prlorlLy
41 ln Lhe managemenL of bullmlc paLlenLs Lhe
followlng nurslng lnLervenLlons wlll promoLe a
LherapeuLlc relaLlonshlp LxCL1
A LsLabllsh an aLmosphere of LrusL
8 ulscuss Lhelr eaLlng behavlor
C Pelp paLlenLs ldenLlfy feellngs assoclaLed wlLh
blngepurge behavlor
u 1each paLlenL abouL bullmla nervosa

Answer (8) ulscuss Lhelr eaLlng behavlor
1he cllenL ls ofLen ashamed of her eaLlng
behavlor ulscusslon should focus on feellngs
AC and u promoLe a LherapeuLlc relaLlonshlp
42 SlLuaLlon A 33 year old male has lnLense
fear of rldlng an elevaLor Pe clalms As lf l wlll
dle lnslde" 1hls has affecLed hls sLudles

1he cllenL ls sufferlng from


A agoraphobla
8 soclal phobla
C ClausLrophobla
u xenophobla

Answer (C) ClausLrophobla
ClausLrophobla ls fear of closed space A
Agoraphobla ls fear of open space or belng a
slLuaLlon where escape ls dlfflculL 8 Soclal
phobla ls fear of performlng ln Lhe presence of
oLhers ln a way LhaL wlll be humlllaLlng or
embarrasslng u xenophobla ls fear of
sLrangers
43 lnlLlal lnLervenLlon for Lhe cllenL should be
Lo
A Lncourage Lo verballze hls fears as much as
he wanLs
8 AsslsL hlm Lo flnd meanlng Lo hls feellngs ln
relaLlon Lo hls pasL
C LsLabllsh LrusL Lhrough a conslsLenL approach
u AccepL her fears wlLhouL crlLlclzlng

Answer (u) AccepL her fears wlLhouL crlLlclzlng
1he cllenL cannoL conLrol her fears alLhough Lhe
cllenL knows lLs sllly and can [oke abouL lL A
Allow expresslon of Lhe cllenL's fears buL he
should focus on oLher producLlve acLlvlLles as
well 8 and C 1hese are noL Lhe lnlLlal
lnLervenLlons
44 1he nurse develops a counLerLransference
reacLlon 1hls ls evldenced by
A 8eveallng personal lnformaLlon Lo Lhe cllenL
8 locuslng on Lhe feellngs of Lhe cllenL
C ConfronLlng Lhe cllenL abouL dlscrepancles ln
verbal or nonverbal behavlor
u 1he cllenL feels angry Lowards Lhe nurse who
resembles hls moLher

Answer (A) 8eveallng personal lnformaLlon Lo
Lhe cllenL
A CounLerLransference ls an emoLlonal reacLlon
of Lhe nurse on Lhe cllenL based on her
unconsclous needs and confllcLs 8 and C 1hese
are LherapeuLlc approaches u 1hls ls
Lransference reacLlon where a cllenL has an
emoLlonal reacLlon Lowards Lhe nurse based on
her pasL
43 Whlch ls Lhe deslred ouLcome ln conducLlng
desenslLlzaLlon
A 1he cllenL verballze hls fears abouL Lhe
slLuaLlon
8 1he cllenL wlll volunLarlly aLLend group
Lherapy ln Lhe soclal hall
C 1he cllenL wlll soclallze wlLh oLhers wllllngly
u 1he cllenL wlll be able Lo overcome hls
dlsabllng fear

Answer (u) 1he cllenL wlll be able Lo overcome
hls dlsabllng fear
1he cllenL wlll overcome hls dlsabllng fear by
gradual exposure Lo Lhe feared ob[ecL A8 and C
are noL Lhe deslred ouLcome of desenslLlzaLlon
46 Whlch of Lhe followlng should be lncluded ln
Lhe healLh Leachlngs among cllenLs recelvlng
vallum
A Avold Laklng CnS depressanL llke alcohol
8 1here are no resLrlcLlons ln acLlvlLles
C LlmlL fluld lnLake
u Any beverage llke coffee may be Laken

Answer (A) Avold Laklng CnS depressanL llke
alcohol
vallum ls a CnS depressanL 1aklng lL wlLh oLher
CnS depressanLs llke alcohol poLenLlaLes lLs
effecL 8 1he cllenL should be LaughL Lo avold
acLlvlLles LhaL requlre alerLness C vallum
causes dry mouLh so Lhe cllenL musL lncrease
her fluld lnLake u SLlmulanLs musL noL be Laken
by Lhe cllenL because lL can decrease Lhe effecL
of vallum
47 SlLuaLlon A 20 year old college sLudenL ls
admlLLed Lo Lhe medlcal ward because of
sudden onseL of paralysls of boLh legs LxLenslve
examlnaLlon revealed no physlcal basls for Lhe
complalnL

1he nurse plans lnLervenLlon based on whlch
correcL sLaLemenL abouL converslon dlsorder?
A 1he sympLoms are consclous efforL Lo conLrol
anxleLy
8 1he cllenL wlll experlence hlgh level of anxleLy
ln response Lo Lhe paralysls
C 1he converslon sympLom has symbollc
meanlng Lo Lhe cllenL
u A confronLaLlonal approach wlll be beneflclal
for Lhe cllenL

Answer (C) 1he converslon sympLom has
symbollc meanlng Lo Lhe cllenL
Lhe cllenL uses body sympLoms Lo relleve
anxleLy A 1he condlLlon occurs unconsclously
8 1he cllenL ls noL dlsLressed by Lhe losL or
alLered body funcLlon u 1he cllenL should noL
be confronLed by Lhe underlylng cause of hls
condlLlon because Lhls can aggravaLe Lhe cllenL's
anxleLy
48 nlna reveals LhaL Lhe boyfrlend has been
pressurlng her Lo engage ln premarlLal sex 1he
mosL LherapeuLlc response by Lhe nurse ls
A l can refer you Lo a splrlLual counselor lf you
llke"
8 ?ou shouldn'L allow anyone Lo pressure you
lnLo sex"
C lL sounds llke Lhls problem ls relaLed Lo your
paralysls"
u Pow do you feel abouL belng pressured lnLo
sex by your boyfrlend?"

Answer (u) Pow do you feel abouL belng
pressured lnLo sex by your boyfrlend?"
locuslng on expresslon of feellngs ls
LherapeuLlc 1he cenLral force of Lhe cllenL's
condlLlon ls anxleLy A 1hls ls noL LherapeuLlc
because Lhe nurse passes Lhe responslblllLy Lo
Lhe counselor 8 Clvlng advlce ls noL
LherapeuLlc C 1hls ls noL LherapeuLlc because lL
confronLs Lhe underlylng cause
49 Mallngerlng ls dlfferenL from somaLoform
dlsorder because Lhe former
A Pas evldence of an organlc basls
8 lL ls a dellberaLe efforL Lo handle upseLLlng
evenLs
C CraLlflcaLlon from Lhe envlronmenL are
obLalned
u SLress ls expressed Lhrough physlcal
sympLoms

Answer (8) lL ls a dellberaLe efforL Lo handle
upseLLlng evenLs
Mallngerlng ls a consclous slmulaLlon of an
lllness whlle somaLoform dlsorder occurs
unconsclous A 8oLh dlsorders do noL have an
organlc or sLrucLural basls C 8oLh have prlmary
galns u 1hls ls a characLerlsLlc of somaLoform
dlsorder
30 unllke psychophyslologlc dlsorder Llnda may
be besL managed wlLh
A medlcal reglmen
8 mllleu Lherapy
C sLress managemenL Lechnlques
u psychoLherapy

Answer (C) sLress managemenL Lechnlques
SLree managemenL Lechnlques ls Lhe besL
managemenL of somaLoform dlsorder because
Lhe dlsorder ls relaLed Lo sLress and lL does noL
have a medlcal basls A 1hls dlsorder ls noL
supporLed by organlc paLhology so no medlcal
reglmen ls requlred 8 and u Mllleu Lherapy and
psychoLherapy may be used a LherapeuLlc
modallLles buL Lhese are noL Lhe besL
31 Whlch ls Lhe besL lndlcaLor of success ln Lhe
long Lerm managemenL of Lhe cllenL?
A Pls sympLoms are replaced by lndlfference Lo
hls feellngs
8 Pe parLlclpaLes ln dlverslonary acLlvlLles
C Pe learns Lo verballze hls feellngs and
concerns
u Pe sLaLes LhaL hls behavlor ls lrraLlonal

Answer (C) Pe learns Lo verballze hls feellngs
and concerns
C 1he cllenL ls encouraged Lo Lalk abouL hls
feellngs and concerns lnsLead of uslng body
sympLoms Lo manage hls sLressors A 1he cllenL
ls encouraged Lo acknowledge feellngs raLher
Lhan belng lndlfferenL Lo her feellngs 8
arLlclpaLlon ln acLlvlLles dlverLs Lhe cllenL's
aLLenLlon away from hls bodlly concerns buL Lhls
ls noL Lhe besL lndlcaLor of success u Pelp Lhe
cllenL recognlze LhaL hls physlcal sympLoms
occur because of or are exacerbaLed by speclflc
sLressor noL as lrraLlonal
32 SlLuaLlon A young woman ls broughL Lo Lhe
emergency room appearlng depressed 1he
nurse learned LhaL her chlld dled a year ago due
Lo an accldenL

1he lnlLlal nurslng dlagnosls ls dysfuncLlonal
grlevlng 1he sLaLemenL of Lhe woman LhaL
supporLs Lhls dlagnosls ls


A l feel envlous of moLhers who have Loddlers"
8 l haven'L been able Lo open Lhe door and go
lnLo my baby's room
C l waLch oLher Loddlers and Lhlnk abouL Lhelr
play acLlvlLles and l cry"
u l ofLen flnd myself Lhlnklng of how l could
have prevenLed Lhe deaLh

Answer (8) l haven'L been able Lo open Lhe
door and go lnLo my baby's room
1hls lndlcaLes denlal 1hls defense ls adapLlve as
an lnlLlal reacLlon Lo loss buL an exLended
unsuccessful use of denlal ls dysfuncLlonal A
1hls lndlcaLes acknowledgemenL of Lhe loss
Lxpresslng feellngs openly ls accepLable C 1hls
lndlcaLes Lhe sLage of depresslon ln Lhe grlevlng
process u 8ememberlng boLh poslLlve and
negaLlve aspecLs of Lhe deceased love one
slgnals successful mournlng
33 1he cllenL sald l can'L even Lake care of my
baby l'm good for noLhlng" Whlch ls Lhe
approprlaLe nurslng dlagnosls?
A lneffecLlve lndlvldual coplng relaLed Lo loss
8 lmpalred verbal communlcaLlon relaLed Lo
lnadequaLe soclal skllls
C Low esLeem relaLed Lo fallure ln role
performance
u lmpalred soclal lnLeracLlon relaLed Lo
repressed anger

Answer (C) Low esLeem relaLed Lo fallure ln role
performance
1hls lndlcaLes Lhe cllenL's negaLlve self
evaluaLlon A sense of worLhlessness may
accompany depresslon A8 and u are noL
relevanL 1he cues do noL lndlcaLe lnablllLy Lo
use coplng resources decreased ablllLy Lo
LransmlL/process symbols nor lnsufflclenL
quallLy of soclal exchange
34 1he followlng medlcaLlons wlll llkely be
prescrlbed for Lhe cllenL LxCL1
A rozac
8 1ofranll
C arnaLe
u Zyprexa

Answer (u) Zyprexa
1hls ls an anLlpsychoLlc A 1hls ls a SS8l
anLldepressanL 8 1hls anLldepressanL belongs
Lo Lhe 1rlcycllc group C 1hls ls a MACl
anLldepressanL
33 Whlch ls Lhe hlghesL prlorlLy ln Lhe posL LC1
care?
A Cbserve for confuslon
8 MonlLor resplraLory sLaLus
C 8eorlenL Lo Llme place and person
u uocumenL Lhe cllenL's response Lo Lhe
LreaLmenL

Answer (8) MonlLor resplraLory sLaLus
A slde effecL of LC1 whlch ls llfe LhreaLenlng ls
resplraLory arresL A and C Confuslon and
dlsorlenLaLlon are slde effecLs of LC1 buL Lhese
are noL Lhe hlghesL prlorlLy
36 SlLuaLlon A 27 year old wrlLer ls admlLLed
for Lhe second Llme accompanled by hls wlfe Pe
ls demandlng arroganL Lalked fasL and
hyperacLlve

lnlLlally Lhe nurse should plan Lhls for a manlc
cllenL

A seL reallsLlc llmlLs Lo Lhe cllenL's behavlor
8 repeaL verbal lnsLrucLlons as ofLen as needed
C allow Lhe cllenL Lo geL ouL feellngs Lo relleve
Lenslon
u asslgn a sLaff Lo be wlLh Lhe cllenL aL all Llmes
Lo help malnLaln conLrol

Answer (A) seL reallsLlc llmlLs Lo Lhe cllenL's
behavlor
1he manlc cllenL ls hyperacLlve and may engage
ln ln[urlous acLlvlLles A quleL envlronmenL and
conslsLenL and flrm llmlLs should be seL Lo
ensure safeLy 8 Clear conclse dlrecLlons are
glven because of Lhe dlsLracLlblllLy of Lhe cllenL
buL Lhls ls noL Lhe prlorlLy C 1he manlc cllenL
Lend Lo exLernallze hosLlle feellngs however
only nondesLrucLlve meLhods of expresslon
should be allowed u nurses seL llmlL as needed
Asslgnlng a sLaff Lo be wlLh Lhe cllenL aL all Llmes
ls noL reallsLlc
37 An acLlvlLy approprlaLe for Lhe cllenL ls
A Lable Lennls
8 palnLlng
C chess
u cleanlng

Answer (u) cleanlng
1he cllenL's excess energy can be rechanelled
Lhrough physlcal acLlvlLles LhaL are noL
compeLlLlve llke cleanlng 1hls ls also a way Lo
dlsslpaLe Lenslon A 1ennls ls a compeLlLlve
acLlvlLy whlch can sLlmulaLe Lhe cllenL
38 1he cllenL ls arroganL and manlpulaLlve ln
ensurlng a LherapeuLlc mllleu Lhe nurse does
one of Lhe followlng
A Agree on a conslsLenL approach among Lhe
sLaff asslgned Lo Lhe cllenL
8 SuggesL LhaL Lhe cllenL Lake a leadlng role ln
Lhe soclal acLlvlLles
C rovlde Lhe cllenL wlLh exLra Llme for one on
one sesslons
u Allow Lhe cllenL Lo negoLlaLe Lhe plan of care

Answer (A) Agree on a conslsLenL approach
among Lhe sLaff asslgned Lo Lhe cllenL
A conslsLenL flrm approach ls approprlaLe 1hls
ls a LherapeuLlc way of Lo handle aLLempLs of
explolLlng Lhe weakness ln oLhers or creaLe
confllcLs among Lhe sLaff 8argalnlng should noL
be allowed 8 1hls ls noL LherapeuLlc because
Lhe cllenL Lends Lo conLrol and domlnaLe oLhers
C LlmlLs are seL for lnLeracLlon Llme u Allowlng
Lhe cllenL Lo negoLlaLe may relnforce
manlpulaLlve behavlor
39 1he nurse exempllfles awareness of Lhe
rlghLs of a cllenL whose anger ls escalaLlng by
A 1aklng a dlrecLlve role ln verballzlng feellngs
8 uslng an auLhorlLarlan confronLaLlonal
approach
C uLLlng Lhe cllenL ln a secluslon room
u Applylng mechanlcal resLralnLs

Answer (A) 1aklng a dlrecLlve role ln verballzlng
feellngs
1he cllenL has Lhe rlghL Lo be free from
unnecessary resLralnLs verballzaLlon of feellngs
or Lalklng down" ln a nonLhreaLenlng
envlronmenL ls helpful Lo relleve Lhe cllenL's
anger 8 1hls ls a LhreaLenlng approach C and
u Secluslon and appllcaLlon resLralnLs are done
only when less resLrlcLlve measures have falled
Lo conLaln Lhe cllenL's anger
60 A cllenL on LlLhlum has dlarrhea and
vomlLlng WhaL should Lhe nurse do flrsL
A 8ecognlze Lhls as a drug lnLeracLlon
8 Clve Lhe cllenL CogenLln
C 8eassure Lhe cllenL LhaL Lhese are common
slde effecLs of llLhlum Lherapy
u Pold Lhe nexL dose and obLaln an order for a
sLaL serum llLhlum level

Answer (u) Pold Lhe nexL dose and obLaln an
order for a sLaL serum llLhlum level
ularrhea and vomlLlng are manlfesLaLlons of
LlLhlum LoxlclLy 1he nexL dose of llLhlum should
be wlLhheld and LesL ls done Lo valldaLe Lhe
observaLlon A 1he manlfesLaLlons are noL due
Lo drug lnLeracLlon 8 CogenLln ls used Lo
manage Lhe exLra pyramldal sympLom slde
effecLs of anLlpsychoLlcs C 1he common slde
effecLs of LlLhlum are flne hand Lremors
nausea polyurla and polydlpsla
61 SlLuaLlon A wldow age 28 whose husband
dled one year ago due Lo AluS has [usL been
Lold LhaL she has AluS

amela says Lo Lhe nurse Why me? Pow could
Cod do Lhls Lo me?" 1hls reacLlon ls one of
A uepresslon
8 uenlal
C anger
u bargalnlng

Answer (C) anger
Anger ls experlenced as reallLy seLs ln 1hls may
elLher be dlrecLed Lo Cod Lhe deceased or
dlsplaced on oLhers A uepresslon ls a palnful
sLage where Lhe lndlvldual mourns for whaL was
losL 8 uenlal ls Lhe flrsL sLage of Lhe grlevlng
process evldenced by Lhe sLaLemenL no lL
can'L be Lrue" 1he lndlvldual does noL
acknowledge LhaL Lhe loss has occurred Lo
proLecL self from Lhe psychologlcal paln of Lhe
loss u ln bargalnlng Lhe lndlvldual holds ouL
hope for addlLlonal alLernaLlves Lo foresLall Lhe
loss evldenced by Lhe sLaLemenL lf only"
62 1he nurse's LherapeuLlc response ls
A l wlll refer you Lo a clergy who can help you
undersLand whaL ls happenlng Lo you"
8 lL lsn'L falr LhaL an lnnocenL llke you wlll
suffer from AluS"
C 1haL ls a negaLlve aLLlLude"
u "lL musL really be frusLraLlng for you Pow can
l besL help you?"

Answer (u) "lL musL really be frusLraLlng for
you Pow can l besL help you?"
1hls response reflecLs Lhe paln due Lo loss A
helplng relaLlonshlp can be forged by showlng
empaLhy and concern A 1hls ls noL LherapeuLlc
slnce lL passes Lhe buck or responslblllLy Lo Lhe
clergy 8 1hls response ls noL LherapeuLlc
because lL glves Lhe cllenL Lhe lmpresslon LhaL
she ls rlghL whlch prevenLs Lhe cllenL from
reconslderlng her LhoughLs C 1hls sLaLemenL
passes [udgmenL on Lhe cllenL

63 Cne mornlng Lhe nurse sees Lhe cllenL ln a
depressed mood 1he nurse asks her WhaL are
you Lhlnklng abouL?" 1hls communlcaLlon
Lechnlque ls
A focuslng
8 valldaLlng
C reflecLlng
u glvlng broad openlng

Answer (u) glvlng broad openlng
8road openlng Lechnlque allows Lhe cllenL Lo
Lake Lhe lnlLlaLlve ln lnLroduclng Lhe Loplc A8
and C are all LherapeuLlc Lechnlques buL Lhese
are noL exempllfled by Lhe nurse's sLaLemenL
64 1he cllenL says Lo Lhe nurse " ray for me"
and enLrusLs her weddlng rlng Lo Lhe nurse 1he
nurse knows LhaL Lhls may slgnal whlch of Lhe
followlng
A anxleLy
8 sulcldal ldeaLlon
C Ma[or depresslon
u Popelessness

Answer (8) sulcldal ldeaLlon
1he cllenL's sLaLemenL ls a verbal cue of sulcldal
ldeaLlon noL anxleLy Whlle sulclde ls common
among cllenLs wlLh ma[or depresslon Lhls
occurs when Lhelr depresslon sLarLs Lo llfL
Popelessness lndlcaLes no alLernaLlves avallable
and may lead Lo sulclde Lhe sLaLemenL and non
verbal cue of Lhe cllenL lndlcaLe sulclde
63 Whlch of Lhe followlng lnLervenLlons should
be prlorlLlzed ln Lhe care of Lhe sulcldal cllenL?
A 8emove all poLenLlally harmful lLems from
Lhe cllenL's room
8 Allow Lhe cllenL Lo express feellngs of
hopelessness
C noLe Lhe cllenL's capablllLles Lo lncrease self
esLeem
u SeL a no sulclde" conLracL wlLh Lhe cllenL

Answer (A) 8emove all poLenLlally harmful
lLems from Lhe cllenL's room
AccesslblllLy of Lhe means of sulclde lncreases
Lhe leLhallLy Allowlng paLlenL Lo express
feellngs and seLLlng a no sulclde conLracL are
lnLervenLlons for sulcldal cllenL buL blocklng Lhe
means of sulclde ls prlorlLy lncreaslng self
esLeem ls an lnLervenLlon for depressed cllenLs
bur noL speclflcally for sulclde
66 SlLuaLlon A 14 year old male was admlLLed
Lo a medlcal ward due Lo bronchlal asLhma afLer
learnlng LhaL hls moLher was leavlng soon for
uk Lo work as nurse

1he cllenL has whlch of Lhe followlng
developmenLal focus
A LsLabllshlng relaLlonshlp wlLh Lhe opposlLe
sex and career plannlng
8 arenLal and socleLal responslblllLles
C LsLabllshlng ones sense of compeLence ln
school
u ueveloplng lnlLlal commlLmenLs and
collaboraLlon ln work

Answer (A) LsLabllshlng relaLlonshlp wlLh Lhe
opposlLe sex and career plannlng
1he cllenL belongs Lo Lhe adolescenL sLage 1he
adolescenL esLabllshes hls sense of ldenLlLy by
maklng declslons regardlng famlllal
occupaLlonal and soclal roles 1he adolescenL
emanclpaLes hlmself from Lhe famlly and
decldes whaL career Lo pursue whaL seL of
frlends Lo have and whaL value sysLem Lo
uphold 8 1hls refers Lo Lhe mlddle adulLhood
sLage concerned wlLh LransmlLLlng hls values Lo
Lhe nexL generaLlon Lo ensure hls lmmorLallLy
Lhrough Lhe perpeLuaLlon of hls culLure C 1hls
reflecLs school age whlch ls concerned wlLh Lhe
pursulL of knowledge and skllls Lo deal wlLh Lhe
envlronmenL boLh ln Lhe presenL and ln Lhe
fuLure u 1he sLage of young adulLhood ls
concerned wlLh developmenL of lnLlmaLe
relaLlonshlp wlLh Lhe opposlLe sex
esLabllshmenL of a safe and congenlal famlly
envlronmenL and bulldlng of one's llfework
67 1he personallLy Lype of 8yan ls
A conformlng
8 dependenL
C perfecLlonlsL
u masochlsLlc

Answer (8) dependenL
A cllenL wlLh dependenL personallLy ls
predlsposed Lo develop asLhma A 1he
conformlng nonasserLlve cllenL ls predlsposed
Lo develop hyperLenslon because of Lhe
Lendency Lo repress rage C 1he perfecLlonlsL
and compulslve Lend Lo develop mlgralne u
1he masochlsLlc self sacrlflclng Lype are prone
Lo develop rheumaLold arLhrlLls
68 1he nurse ensures a LherapeuLlc
envlronmenL for Lhe cllenL Whlch of Lhe
followlng besL descrlbes a LherapeuLlc mllleu?
A A Lherapy LhaL rewards adapLlve behavlor
8 A cognlLlve approach Lo change behavlor
C A llvlng learnlng or worklng envlronmenL
u A permlsslve and congenlal envlronmenL

Answer (C) A llvlng learnlng or worklng
envlronmenL
A LherapeuLlc mllleu refers Lo a broad
concepLual approach ln whlch all aspecLs of Lhe
envlronmenL are channeled Lo provlde a
LherapeuLlc envlronmenL for Lhe cllenL 1he slx
envlronmenLal elemenLs lnclude sLrucLure
safeLy norms llmlL seLLlng balance and unlL
modlflcaLlon A 8ehavloral approach ln
psychlaLrlc care ls based on Lhe premlse LhaL
behavlor can be learned or unlearned Lhrough
Lhe use of reward and punlshmenL 8 CognlLlve
approach Lo change behavlor ls done by
correcLlng dlsLorLed percepLlons and lrraLlonal
bellefs Lo correcL maladapLlve behavlors u 1hls
ls noL congruenL wlLh LherapeuLlc mllleu
69 lncluded as prlorlLy of care for Lhe cllenL wlll
be
A Lncourage verballzaLlon of concerns lnsLead
of demonsLraLlng Lhem Lhrough Lhe body
8 ulverL aLLenLlon Lo ward acLlvlLles
C lace ln semlfowlers poslLlon and render C2
lnhalaLlon as ordered
u Pelp her recognlze LhaL her physlcal condlLlon
has an emoLlonal componenL

Answer (C) lace ln semlfowlers poslLlon and
render C2 lnhalaLlon as ordered
Slnce psychopyslologlc dlsorder has organlc
basls prlorlLy lnLervenLlon ls dlrecLed Lowards
dlseasespeclflc managemenL lallure Lo address
Lhe medlcal condlLlon of Lhe cllenL may be a llfe
LhreaL A and 8 1he cllenL has physlcal sympLom
LhaL ls adversely affecLed by psychologlcal
facLors verballzaLlon of feellngs ln a non
LhreaLenlng envlronmenL and lnvolvemenL ln
relaxlng acLlvlLles are adapLlve way of deallng
wlLh sLressors Powever Lhese are noL Lhe
prlorlLy u Pelplng Lhe cllenL connecL Lhe
physlcal sympLoms wlLh Lhe emoLlonal problems
can be done when Lhe cllenL ls ready
70 1he cllenL ls concerned abouL hls comlng
dlscharge manlfesLed by belng unusually sad
Whlch ls Lhe mosL LherapeuLlc approach by Lhe
nurse?
A ?ou are much beLLer Lhan when you were
admlLLed so Lhere's no reason Lo worry"
8 WhaL would you llke Lo do now LhaL you're
abouL Lo go home?"
C ?ou seem Lo have concerns abouL golng
home"
u Aren'L you glad LhaL you're golng home
soon?"

Answer (C) ?ou seem Lo have concerns abouL
golng home"
1hls sLaLemenL reflecLs how Lhe cllenL feels
Showlng empaLhy can encourage Lhe cllenL Lo
Lalk whlch ls lmporLanL as an alLernaLlve more
adapLlve way of coplng wlLh sLressors A Clvlng
false reassurance ls noL LherapeuLlc 8 Whlle
Lhls Lechnlque explores plans afLer dlscharge lL
does noL focus on expresslon of feellngs u 1hls
close ended quesLlon does noL encourage
verballzaLlon of feellngs
71 SlLuaLlon 1he nurse may encounLer cllenLs
wlLh concerns on sexuallLy

1he mosL baslc facLor ln Lhe lnLervenLlon wlLh
cllenLs ln Lhe area of sexuallLy ls
A knowledge abouL sexuallLy
8 Lxperlence ln deallng wlLh cllenLs wlLh sexual
problems
C ComforL wlLh one's sexuallLy
u AblllLy Lo communlcaLe effecLlvely

Answer (C) ComforL wlLh one's sexuallLy
1he nurse musL be accepLlng empaLheLlc and
non[udgmenLal Lo paLlenLs who dlsclose
concerns regardlng sexuallLy 1hls can happen
only when Lhe nurse has reconclled and
accepLed her feellngs and bellefs relaLed Lo
sexuallLy A8 and u are lmporLanL
conslderaLlons buL Lhese are noL Lhe prlorlLy
72 Whlch of Lhe followlng sLaLemenLs ls Lrue for
gender ldenLlLy dlsorder?
A lL ls Lhe sexual pleasure derlved from
lnanlmaLe ob[ecLs
8 lL ls Lhe pleasure derlved from belng
humlllaLed and made Lo suffer
C lL ls Lhe pleasure of shocklng Lhe vlcLlm wlLh
exposure of Lhe genlLalla
u lL ls Lhe deslre Lo llve or lnvolve ln reacLlons
of Lhe opposlLe sex

Answer (u) lL ls Lhe deslre Lo llve or lnvolve ln
reacLlons of Lhe opposlLe sex
Cender ldenLlLy dlsorder ls a sLrong and
perslsLenL deslre Lo be Lhe oLher sex A 1hls ls
feLlshlsm 8 1hls refers Lo masochlsm C 1hls
descrlbes exhlblLlonlsm
73 1he sexual response cycle ln whlch Lhe
sexual lnLeresL conLlnues Lo bulld
A Sexual ueslre
8 Sexual arousal
C Crgasm
u 8esoluLlon

Answer (8) Sexual arousal
Sexual arousal or exclLemenL refers Lo aLLalnlng
and malnLalnlng Lhe physlologlc requlremenLs
for sexual lnLercourse A Sexual ueslre refers Lo
Lhe ablllLy lnLeresL or wllllngness for sexual
sLlmulaLlon C Crgasm refers Lo Lhe peak of Lhe
sexual response where Lhe female has vaglnal
conLracLlons for Lhe female and e[aculaLory
conLracLlons for Lhe male u 8esoluLlon ls Lhe
flnal phase of Lhe sexual response ln whlch Lhe
organs and Lhe body sysLems gradually reLurn Lo
Lhe unaroused sLaLe
74 1he lnablllLy Lo malnLaln Lhe physlologlc
requlremenLs ln sexual lnLercourse ls
A Sexual ueslre ulsorder
8 Sexual Arousal ulsorder
C Crgasm ulsorder
u Sexual aln dlsorder

Answer (8) Sexual Arousal ulsorder
1hls descrlbes sexual arousal dlsorder A Sexual
ueslre ulsorder refers Lo Lhe perslsLenL and
recurrenL lack of deslre or wllllngness for sexual
lnLercourse C Crgasm ulsorder ls Lhe lnablllLy
Lo compleLe Lhe sexual response cycle because
of Lhe lnablllLy Lo achleve an orgasm u Sexual
aln ulsorder ls characLerlzed by genlLal paln
before durlng or afLer sexual lnLercourse
73 1he nurse asks a cllenL Lo roll up hls sleeves
so she can Lake hls blood pressure 1he cllenL
replles lf you wanL l can go naked for you" 1he
mosL LherapeuLlc response by Lhe nurse ls
A ?ou're aLLracLlve buL l'm noL lnLeresLed"
8 ?ou wouldn'L be Lhe flrsL LhaL l wlll see
naked"
C l wlll reporL you Lo Lhe guard lf you don'L
conLrol yourself"
u l only need access Lo your arm uLLlng up
your sleeve ls flne"

Answer (u) l only need access Lo your arm
uLLlng up your sleeve ls flne"
1he nurse needs Lo deal wlLh Lhe cllenL wlLh
sexually connoLaLlve behavlor ln a casual
maLLer of facL way A and 8 1hese responses
are noL LherapeuLlc because Lhey are
challenglng and re[ecLlng C 1hreaLenlng Lhe
cllenL ls noL LherapeuLlc
76 SlLuaLlon knowledge and skllls ln Lhe care of
vlolenL cllenLs ls vlLal ln Lhe psychlaLrlc unlL A
nurse observes LhaL a cllenL wlLh a poLenLlal for
vlolence ls aglLaLed paclng up and down Lhe
hallway and maklng aggresslve remarks

Whlch of Lhe followlng sLaLemenLs ls mosL
approprlaLe Lo make Lo Lhls paLlenL?
A WhaL ls causlng you Lo become aglLaLed?
8 ?ou need Lo sLop LhaL behavlor now
C ?ou wlll need Lo be resLralned lf you do noL
change your behavlor
u ?ou wlll need Lo be placed ln secluslon

Answer (A) WhaL ls causlng you Lo become
aglLaLed?
ln a nonvlolenL aggresslve behavlor help Lhe
cllenL ldenLlfy Lhe sLressor or Lhe Lrue ob[ecL of
hosLlllLy 1hls helps reveal unresolved lssues so
LhaL Lhey may be confronLed 8 aclng ls a
Lenslon rellevlng measure for an aglLaLed cllenL
C 1hls ls a LhreaLenlng sLaLemenL LhaL can
helghLen Lhe cllenL's Lenslon u Secluslon ls
used when less resLrlcLlve measures have falled
77 1he nurse closely observes Lhe cllenL who
has been dlsplaylng aggresslve behavlor 1he
nurse observes LhaL Lhe cllenL's anger ls
escalaLlng Whlch approach ls leasL helpful for
Lhe cllenL aL Lhls Llme?
A Acknowledge Lhe cllenL's behavlor
8 MalnLaln a safe dlsLance from Lhe cllenL
C AsslsL Lhe cllenL Lo an area LhaL ls quleL
u lnlLlaLe conflnemenL measures

Answer (u) lnlLlaLe conflnemenL measures
1he proper procedure for deallng wlLh harmful
behavlor ls Lo flrsL Lry Lo calm paLlenL verbally
When verbal and psychopharmacologlc
lnLervenLlons are noL adequaLe Lo handle Lhe
aggresslveness secluslon or resLralnLs may be
appllcable A 8 and C are approprlaLe
approaches durlng Lhe escalaLlon phase of
aggresslon
78 1he charge nurse of a psychlaLrlc unlL ls
plannlng Lhe cllenL asslgnmenL for Lhe day 1he
mosL approprlaLe sLaff Lo be asslgned Lo a cllenL
wlLh a poLenLlal for vlolence ls whlch of Lhe
followlng
A A Llmld nurse
8 A maLure experlenced nurse
C an lnexperlenced nurse
u a sofL spoken nurse

Answer (8) A maLure experlenced nurse
1he unsLable aggresslve cllenL should be
asslgned Lo Lhe mosL experlenced nurse A C
and u A shy lnexperlenced sofL spoken nurse
may feel lnLlmldaLed by Lhe angry paLlenL
79 1he nurse exempllfles awareness of Lhe
rlghLs of a cllenL whose anger ls escalaLlng by
A 1aklng a dlrecLlve role ln verballzlng feellngs
8 uslng an auLhorlLarlan confronLaLlonal
approach
C uLLlng Lhe cllenL ln a secluslon room
u Applylng mechanlcal resLralnLs

Answer (A) 1aklng a dlrecLlve role ln verballzlng
feellngs
1aklng a dlrecLlve role ln Lhe cllenL's
verballzaLlon of feellngs can deescalaLe Lhe
cllenL's anger 8 A confronLaLlonal approach can
be LhreaLenlng and adds Lo Lhe cllenL's Lenslon
C and u use of resLralnLs and lsolaLlon may be
requlred lf less resLrlcLlve lnLervenLlons are
unsuccessful
80 1he cllenL [umps up and Lhrows a chalr ouL
of Lhe wlndow Pe was resLralned afLer hls
behavlor can no longer be conLrolled by Lhe
sLaff Whlch of Lhese documenLaLlons lndlcaLes
Lhe safeguardlng of Lhe paLlenL's rlghLs?
A 1here was a docLor's order for
resLralnLs/secluslon
8 1he paLlenL's rlghLs were explalned Lo hlm
C 1he sLaff observed confldenLlallLy
u 1he sLaff carrled ouL less resLrlcLlve measures
buL were unsuccessful

Answer (u) 1he sLaff carrled ouL less resLrlcLlve
measures buL were unsuccessful
1hls documenLaLlon lndlcaLes LhaL Lhe cllenL has
been placed on resLralnLs afLer Lhe leasL
resLrlcLlve measures falled ln conLalnlng Lhe
cllenL's vlolenL behavlor
81 SlLuaLlon CllenLs wlLh personallLy dlsorders
have dlfflculLles ln Lhelr soclal and occupaLlonal
funcLlons

CllenLs wlLh personallLy dlsorder wlll mosL llkely
A recover wlLh LherapeuLlc lnLervenLlon
8 respond Lo anLlanxleLy medlcaLlon
C manlfesL endurlng paLLerns of lnflexlble
behavlors
u Seek LreaLmenL wllllngly from some
personally dlsLresslng sympLoms

Answer (C) manlfesL endurlng paLLerns of
lnflexlble behavlors
ersonallLy dlsorders are characLerlzed by
lnflexlble LralLs and characLerlsLlcs LhaL are
llfelong A and u 1hls dlsorder ls manlfesLed by
llfelong paLLerns of behavlor 1he cllenL wlLh
Lhls dlsorder wlll noL llkely presenL hlmself for
LreaLmenL unless someLhlng has gone wrong ln
hls llfe so he may noL recover from LherapeuLlc
lnLervenLlon 8 MedlcaLlons are generally noL
recommended for personallLy dlsorders
82 A cllenL Lends Lo be lnsenslLlve Lo oLhers
engages ln abuslve behavlors and does noL have
a sense of remorse Whlch personallLy dlsorder
ls he llkely Lo have?
A narclsslsLlc
8 aranold
C PlsLrlonlc
u AnLlsoclal

Answer (u) AnLlsoclal
1hese are Lhe characLerlsLlcs of an lndlvldual
wlLh anLlsoclal personallLy A narclsslsLlc
personallLy dlsorder ls characLerlzed by
grandloslLy and a need for consLanL admlraLlon
from oLhers 8 lndlvlduals wlLh paranold
personallLy demonsLraLe a paLLern of dlsLrusL
and susplclousness and lnLerpreLs oLhers
moLlves as LhreaLenlng C lndlvlduals wlLh
hlsLrlonlc have excesslve emoLlonallLy and
aLLenLlonseeklng behavlors
83 1he cllenL [olns a supporL group and
frequenLly preaches agalnsL abuse ls
demonsLraLlng Lhe use of
A denlal
8 reacLlon formaLlon
C raLlonallzaLlon
u pro[ecLlon

Answer (8) reacLlon formaLlon
8eacLlon formaLlon ls Lhe adopLlon of behavlor
or feellngs LhaL are exacLly opposlLe of one's
Lrue emoLlons A uenlal ls refusal Lo accepL a
palnful reallLy C 8aLlonallzaLlon ls aLLempLlng
Lo [usLlfy one's behavlor by presenLlng reasons
LhaL sounds loglcal u ro[ecLlon ls aLLrlbuLlng
of one's behavlors and feellngs Lo anoLher
person
84 A Leenage glrl ls dlagnosed Lo have
borderllne personallLy dlsorder Whlch
manlfesLaLlons supporL Lhe dlagnosls?
A Lack of self esLeem sLrong dependency needs
and lmpulslve behavlor
8 soclal wlLhdrawal lnadequacy senslLlvlLy Lo
re[ecLlon and crlLlclsm
C Susplclous hypervlgllance and coldness
u reoccupaLlon wlLh perfecLlonlsm
orderllness and need for conLrol

Answer (A) Lack of self esLeem sLrong
dependency needs and lmpulslve behavlor
1hese are Lhe characLerlsLlcs of cllenL wlLh
borderllne personallLy 8 1hls descrlbes Lhe
avoldanL personallLy C 1hese are Lhe
characLerlsLlcs of a cllenL wlLh paranold
personallLy u 1hls descrlbes Lhe obsesslve
compulslve personallLy
83 1he plan of care for cllenLs wlLh borderllne
personallLy should lnclude
A LlmlL seLLlng and flexlblllLy ln schedule
8 Clvlng medlcaLlons Lo prevenL acLlng ouL
C 8esLrlcLlng her from oLher cllenLs
u Lnsurlng she adheres Lo cerLaln resLrlcLlons

Answer (u) Lnsurlng she adheres Lo cerLaln
resLrlcLlons
1he cllenL ls manlpulaLlve 1he cllenL musL be
lnformed abouL Lhe pollcles expecLaLlons rules
and regulaLlon upon admlsslon A LlmlLs should
be flrmly and conslsLenLly lmplemenLed
llexlblllLy and bargalnlng are noL LherapeuLlc ln
deallng wlLh a manlpulaLlve cllenL 8 1here ls no
speclflc medlcaLlon prescrlbed for Lhls condlLlon
C 1hls ls noL parL of Lhe care plan lnLeracLlon
wlLh oLher cllenLs are allowed buL Lhe cllenL
should be observed and glven llmlLs ln her
aLLempL Lo manlpulaLe and domlnaLe oLhers
86 SlLuaLlon A 42 year old male cllenL ls
admlLLed ln Lhe ward because of blzarre
behavlors Pe ls glven a dlagnosls of
schlzophrenla paranold Lype

1he cllenL should have achleved Lhe
developmenLal Lask of
A 1rusL vs mlsLrusL
8 lndusLry vs lnferlorlLy
C CeneraLlvlLy vs sLagnaLlon
u Lgo lnLegrlLy vs despalr

Answer (u) Lgo lnLegrlLy vs despalr
1he cllenL belongs Lo Lhe mlddle adulLhood
sLage (30 Lo 63 yrs) 1he developmenLal Lask
generaLlvlLy ls characLerlzed by concern and
care for oLhers lL ls a producLlve and creaLlve
sLage (A) lnfancy sLage (0 18 mos) ls
concerned wlLh graLlflcaLlon of oral needs (8)
School Age chlld (6 12 yrs) ls characLerlzed by
acqulslLlon of school compeLencles and soclal
skllls (C) LaLe adulLhood ( 60 and above)
Concerned wlLh reflecLlon on Lhe pasL and hls
conLrlbuLlons Lo oLhers and face Lhe fuLure
87 CllenLs who are susplclous prlmarlly use
pro[ecLlon for whlch purpose

A deny reallLy
8 Lo deal wlLh feellngs and LhoughLs LhaL are
noL accepLable
C Lo show resenLmenL Lowards oLhers
u manlpulaLe oLhers

Answer (8) Lo deal wlLh feellngs and LhoughLs
LhaL are noL accepLable
ro[ecLlon ls a defense mechanlsm where one
aLLrlbuLes ones feellngs and lnadequacles Lo
oLhers Lo reduce anxleLy A 1hls ls noL Lrue ln all
lnsLances of pro[ecLlon C and u 1hls focuses on
Lhe self raLher Lhan oLhers
88 1he cllenL says Lhe n8l ls ouL Lo geL me"
1he nurse's besL response ls
A 1he n8l ls noL ouL Lo caLch you"
8 l don'L belleve LhaL"
C l don'L know anyLhlng abouL LhaL ?ou are
afrald of belng harmed"
u WhaL made you Lhlnk of LhaL"

Answer (C) l don'L know anyLhlng abouL LhaL
?ou are afrald of belng harmed"
1hls presenLs reallLy and acknowledges Lhe
cllenLs feellng A and 8 are noL LherapeuLlc
responses because Lhese dlsagree wlLh Lhe
cllenL's false bellef and makes Lhe cllenL feel
challenged u unnecessary exploraLlon of Lhe
false
89 1he cllenL on Paldol has plll rolllng Lremors
and muscle rlgldlLy Pe ls llkely manlfesLlng
A Lardlve dysklnesla
8 seudoparklnsonlsm
C aklnesla
u dysLonla

Answer (8) seudoparklnsonlsm
seudoparklnsonlsm ls a slde effecL of
anLlpsychoLlc drugs characLerlzed by maskllke
facles plll rolllng Lremors muscle rlgldlLy A
1ardlve dysklnesla ls manlfesLed by llp smacklng
wormllke movemenL of Lhe Longue C Aklnesla ls
characLerlzed by feellng of weakness and muscle
faLlgue u uysLonla ls manlfesLed by LorLlcollls
and rolllng back of Lhe eyes
90 1he cllenL ls very hosLlle Loward one of Lhe
sLaff for no apparenL reason 1he cllenL ls
manlfesLlng
A SpllLLlng
8 1ransference
C CounLerLransference
u 8eslsLance

Answer (8) 1ransference
1ransference ls a poslLlve or negaLlve feellng
assoclaLed wlLh a slgnlflcanL person ln Lhe
cllenL's pasL LhaL are unconsclously asslgned Lo
anoLher A SpllLLlng ls a defense mechanlsm
commonly seen ln a cllenL wlLh personallLy
dlsorder ln whlch Lhe world ls percelved as all
good or all bad C CounLerLLransference ls a
phenomenon where Lhe nurse shlfLs feellngs
asslgned Lo someone ln her pasL Lo Lhe paLlenL
u 8eslsLance ls Lhe cllenL's refusal Lo submlL
hlmself Lo Lhe care of Lhe nurse
91 SlLuaLlon An 18 year old female was sexually
aLLacked whlle on her way home from work She
ls broughL Lo Lhe hosplLal by her moLher

8ape ls an example of whlch Lype of crlsls
A SlLuaLlonal
8 AdvenLlLlous
C uevelopmenLal
u lnLernal

Answer (8) AdvenLlLlous
AdvenLlLlous crlsls ls a crlsls lnvolvlng a
LraumaLlc evenL lL ls noL parL of everyday llfe A
SlLuaLlonal crlsls ls from an exLernal source LhaL
upseL ones psychologlcal equlllbrlum C and u
Are Lhe same 1hey are LranslLlonal or
developmenLal perlods ln llfe
92 uurlng Lhe lnlLlal care of rape vlcLlms Lhe
followlng are Lo be consldered LxCL1
A Assure prlvacy
8 1ouch Lhe cllenL Lo show accepLance and
empaLhy
C Accompany Lhe cllenL ln Lhe examlnaLlon
room
u MalnLaln a non[udgmenLal approach

Answer (8) 1ouch Lhe cllenL Lo show accepLance
and empaLhy
1he cllenL flnds Louch lnLruslve and Lherefore
should be avolded A rlvacy ls one of Lhe rlghLs
of a vlcLlm of rape C1he cllenL ls anxlous
Accompanylng Lhe cllenL ln a quleL room
ensures safeLy and offers emoLlonal supporL u
CullL feellng ls common among rape vlcLlms
1hey should noL be blamed
93 1he nurse acLs as a paLlenL advocaLe when
she does one of Lhe followlng
A She encourages Lhe cllenL Lo express her
feellng regardlng her experlence
8 She assesses Lhe cllenL for ln[urles
C She posLpones Lhe physlcal assessmenL unLll
Lhe cllenL ls calm
u Lxplalns Lo Lhe cllenL LhaL her reacLlons are
normal

Answer (C) She posLpones Lhe physlcal
assessmenL unLll Lhe cllenL ls calm
1he nurse acLs as a paLlenL advocaLe as she
proLecLs Lhe cllenL from psychologlcal harm A
1he nurse acLs a a counselor 8 1he nurse acLs as
a Lechnlclan u 1hls exempllfles Lhe role of a
Leacher
94 Crlsls lnLervenLlon carrled ouL Lo Lhe cllenL
has Lhls prlmary goal
A AsslsL Lhe cllenL Lo express her feellngs
8 Pelp her ldenLlfy her resources
C SupporL her adapLlve coplng skllls
u Pelp her reLurn Lo her prerape level of
funcLlon

Answer (u) Pelp her reLurn Lo her prerape
level of funcLlon
1he goal of crlsls lnLervenLlon Lo help Lhe cllenL
reLurn Lo her level of funcLlon prlor Lo Lhe crlsls
A8 and C are lnLervenLlons or sLraLegles Lo
aLLaln Lhe goal
93 llve monLhs afLer Lhe lncldenL Lhe cllenL
complalns of dlfflculLy Lo concenLraLe poor
appeLlLe lnablllLy Lo sleep and gullL She ls llkely
sufferlng from
A Ad[usLmenL dlsorder
8 SomaLoform ulsorder
C Cenerallzed AnxleLy ulsorder
u osL LraumaLlc dlsorder

Answer (u) osL LraumaLlc dlsorder
osL LraumaLlc sLress dlsorder ls characLerlzed
by flashback lrrlLablllLy dlfflculLy falllng asleep
and concenLraLlng followlng an exLremely
LraumaLlc evenL 1hls lasLs for more LhaL one
monLh A Ad[usLmenL dlsorder ls Lhe
maladapLlve reacLlon Lo sLressful evenLs
characLerlzed by anxleLy depresslon and work
or soclal lmpalrmenLs 1hls occurs wlLhln 3
monLhs afLer Lhe evenL 8 SomaLoform dlsorders
are anxleLy relaLed dlsorders characLerlzed by
presence of physlcal sympLoms wlLhouL
demonsLrable organlc basls C Cenerallzed
anxleLy dlsorder ls characLerlzed by chronlc
excesslve anxleLy for aL leasL 6 monLhs
96 SlLuaLlon A 29 year old cllenL newly
dlagnosed wlLh breasL cancer ls paclng wlLh
rapld speech headache and lnablllLy Lo focus
wlLh whaL Lhe docLor was saylng

1he nurse assesses Lhe level of anxleLy as
A Mlld
8 ModeraLe
C Severe
u anlc

Answer (C) Severe
1he cllenL's manlfesLaLlons lndlcaLe severe
anxleLy A Mlld anxleLy ls manlfesLed by sllghL
muscle Lenslon sllghL fldgeLlng alerLness ablllLy
Lo concenLraLe and capable of problem solvlng
8 ModeraLe muscle Lenslon lncreased vlLal
slgns perlodlc slow paclng lncreased raLe of
speech and dlfflculLy ln concenLraLlng are noLed
ln moderaLe anxleLy u anlc level of anxleLy ls
characLerlzed lmmoblllzaLlon lncoherence
feellng of belng overwhelmed and
dlsorganlzaLlon

97 AnxleLy ls caused by
A an ob[ecLlve LhreaL
8 a sub[ecLlvely percelved LhreaL
C hosLlllLy Lurned Lo Lhe self
u masked depresslon

Answer (8) a sub[ecLlvely percelved LhreaL
AnxleLy ls caused by a sub[ecLlvely percelved
LhreaL A lear ls caused by an ob[ecLlve LhreaL C
A depressed cllenL lnLernallzes hosLlllLy u Manla
ls due Lo masked depresslon

98 lL would be mosL helpful for Lhe nurse Lo
deal wlLh a cllenL wlLh severe anxleLy by
A Clve speclflc lnsLrucLlons uslng speak ln
conclse sLaLemenLs
8 Ask Lhe cllenL Lo ldenLlfy Lhe cause of her
anxleLy
C Lxplaln ln deLall Lhe plan of care developed
u urge Lhe cllenL Lo focus on whaL Lhe nurse ls
saylng

Answer (A) Clve speclflc lnsLrucLlons uslng
speak ln conclse sLaLemenLs
1he cllenL has narrowed percepLual fleld
LengLhy explanaLlons cannoL be followed by Lhe
cllenL 8 1he cllenL wlll noL be able Lo ldenLlfy
Lhe cause of anxleLy C and u 1he cllenL has
dlfflculLy concenLraLlng and wlll noL be able Lo
focus

99 Whlch of Lhe followlng medlcaLlons wlll
llkely be ordered for Lhe cllenL?"
A rozac
8 vallum
C 8lsperdal
u LlLhlum

Answer (8) vallum
AnLlanxleLy A AnLldepressanL C AnLlpsychoLlc
u AnLlmanlc

100 Whlch of Lhe followlng ls lncluded ln Lhe
healLh Leachlngs among cllenLs recelvlng
vallum?
A Avold foods rlch ln Lyramlne
8 1ake Lhe medlcaLlon afLer meals
C lL ls safe Lo sLop lL anyLlme afLer long Lerm
use
u uouble up Lhe dose lf Lhe cllenL forgeLs her
medlcaLlon

Answer (8) 1ake Lhe medlcaLlon afLer meals
AnLlanxleLy medlcaLlons cause Cl upseL so lL
should be Laken afLer meals A 1hls ls speclflc
for anLldepressanL MACl 1aklng Lyramlne rlch
food can cause hyperLenslve crlsls C vallum
causes dependency ln whlch case Lhe
medlcaLlon should be gradually wlLhdrawn Lo
prevenL Lhe occurrence of convulslon u 1he
dose of vallum should noL be doubled lf Lhe
prevlous dose was noL Laken lL can lnLenslfy Lhe
CnS depressanL effecLs