PSYCHIATRIC NURSING

1. Mental health is defined as:

A. The ability to distinguish what is real from what is not.
B. A state of well-being where a person can realize his own abilities can cope with
normal stresses of life and work productively.
C. s the promotion of mental health, prevention of mental disorders, nursing care of
patients during illness and rehabilitation
D. Absence of mental illness

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 acLlons and 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 and prevenLlon 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 subsLance
relaLed 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 dlsease
speclflc 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