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Psychiatric Nursing III level

Comprehensive Examination

Lea Gordon 26 yrs . old woman was raped on her way home from work
one evening. The raped accured in the parking lot where she was
1. Which of the ff. actions is the most important for the ER nurse to take? C.
Provide emotional support
2. The nurse in the ER can provide best emotional support to Miss Gordon by: C.
Telling her at some she may feel angry afraid and sad feelings are
3. A co-worker tells the nurse “Miss Gordon is calm and wasn’t even raped” the
sourse of co-worker response is probably reflected in w/c of the ff. C. The
client rape reminds her that she is also vulnerable to rape.
4. After the physical exam is finished Miss Gordon quietly and calmly ask the
nurse if she can see the psychiatric clinical specialist. C. it provides the
long term therapy needed for an event this serious.
5. D. An awareness of how she might prevent rape in the future.
6. A. she is angry at her rapist for what he did to her.
7. B. you sound angry.
8. According in the community mental health model Miss Gordon rape would be
considered? D. the stress generated was much greater than the
support system could handle.
9. Crisis-intervention therapy is considered to be? A. secondary prevention.
10. Primary prevention for the community problem of rape? B. A class by
policewomen on how to avoid rape
11. Need for better law enforcement and rape prevention program? D. Isolation
12. History of sexual abuse was admitted to the psychiatric unit experiencing
Ernesto Pulido has become increasingly depressed and is brought to the
ER after slashing his wrist with a razor blade. He is conscious and crying
13. Which of the ff. actions by the ER nurse should have been the highest priority?
A. Examine the extent of the wound.
14. I don’t know why they saved me. As soon as I can. I will try again. Nothing in
my life is ever going better. Best response? B. Youre feeling things are
pretty hopeless right now.
15. In Assessing suicide potential as reflected in Mr. Pulido’s statement, what other
information would be most useful for the nurse to have? A. Does he have a
workable plan.
16. What would be the best place for the client at this time? D. Any room where
he can be closely observed.
17. Mr. Pulido has been taking amitripyline (ELAVIL) for 7 days. He continues to
appear depressed and express a desire to commit suicide. What is the most
likely explanation for this? D. Amitriphyrine may take 4 weeks to take
Nora Montano 47 years old was admitted to the psychiatric unit.
Accompanied by her daughter. He admission diagnosis is a major
depressive episodes. She is delusional and has vegetative signs of
18. Often times depression is accompanied by guilt. The multidisciplinary mental
health’s learn develops a care plan that includes” assist client to express guilty
feelings.” The primary nurse realized that some clients are not aware of the
guilt feelings. To implement this goal. It will be best for the nurse to have Mrs.
Montano: B. Explore feeling of resentment and anger.
19. In which type of depression would delusions be may be likely to occur? C.
20. Which of the ff. are specific indicators of depression? D. negative view of
the self and future.
21. Which of the ff. statements indicates most clearly that the client is suffering
from depression. A. I don’t feel that I have any chance of good
relationship with a man.
22. Which of the ff. is not considered as a sign of depression? D. Ataxia
23. Which of the ff. are considered vegetative signs of depression? C. Hagard
appearance (slowness, uncooperativeness, indeciveness) hesitant
24. The largest number of psychiatric hospitalization are accounted for by. A.
25. Mrs. Montano frequently seek out the nurse whom she resembles in weight and
appearance. In this nurse’s presence Mrs. Montano irritates her mannerisms
and supportive ways, this defense mechanism is: C. Identification
26. During the course of her treatment Mrs. Montano’s psychiatric drug is
Amitriptyline (HCL) Elavil 20 mg. tid po. Which of ff. side effect is not expected
to occur? C. Hypertension
27. The psychiatrist also order isocaboxaxid (Marplan) 30 mg po daily. When
recording these medication orders the nurse should do which of the ff? D. Call
the psychiatrist and question the administration of these medication
28. Anti-depressant may cause a number of side effects. Which of the ff
antidepressant may lead to hypertensive crisis and possibly a CVA if taken with
natural foods such as aged or alcoholic beverages. Such as beer and wine? D.
Isocarboxacid (Marplan)
29. All of the ff assessment would be included for Mrs. Montano which one would
be carried our first? B. Possibility of self harm
30. Which of the ff. suicide methods has a lower rate of lethality than the others.?
B. Setting herself on fire.
31. Which of the ff. group has the lowest suicide risk ? D. Marrid Man
Irene Gubat is a 44 years old woman who has separated from her
husband and 2 months ago. She is having trouble taking care of her
32. The symptoms that Mrs. Gubat describes are most likely to manifestation of.
A. Depression
33. Which o f ff. is most appropriate goal for Mrs. Gubat? B. the client will
resume ADL after 1 month
34. Which of the ff best explains the symptoms of Mrs. Gubat? D. she loss her
husband and is taking out the anger on herself
35. During an interview with the nurse Mrs. Gubat begins to cry. The appropriate
nursing response is: C. this is really a difficult time for you. Isn’t it mrs.
36. Mrs. Gubat appears to be feeling much better the next day, when the nurse
talks with her Mrs. Gubat asks to be discharged stating “I can handle it on my
own” you’ve helped me so much”. The nurse knows the appropriate response
to such request is to: A. deny the discharge suspecting that she may
have made the decision to attempt suicide.
37. The next week Mrs. Gubat is irritable. She is criticizing the staff and their
treatment of her. The nurse is most likely to evaluate this behavior as: C.
38. Which of the ff would the nurse consider when evaluating Mrs. Gubat’s
progress? D. ability to do ADL
Andrea is admitted due to reactive depression she is 26 years old. She
was severly injured in a car accident 2 months ago. Her husband and
3 years old daughter were killed in the same accident. Because of her
injuries. She was unable to attend and there funeral she has full leg
cast is thin and apathetic.
39. Which of the ff. is the best explanation for the behavior of the client? B. the
inability to attend the funeral has probably affected the process of
40. Andrea had a 10 lb weight loss since the accident. Which would be most helpful
for her? C. allow her to eat in the cafeteria, so she can select food
that appeals to her.
41. The patient difficulty falling asleep. It is most appropriate to: D. provide a
warm sponge bath and warm glass of milk at bedtime.
42. Since there are variations in energy level in depressed client at what time of
the day would it be best to schedule activities. A. Moring.
43. Which of the ff. behavior would demonstrate to the nurse that andrea is
progressive in the resolution of her grief? B. she begin to talk about the
positive and negative aspect of her relationship with the deceased.
44. Mr. Honday is withdrawn and non-communicative to encourage him to talk, the
best plan for nursing intervention would be to: B. focus on the non-
threatening subjects.
45. When caring for client exhibiting withdrawn patterns of behavior, an important
aspect of nursing care is to. C. help keep the client oriented to reality.
46. Observation is an important aspect of nursing care. It is provide an
environment in the care of the withdrawn client because? A. helps in
understanding the client feeling
47. The best approach in helping a very withdrawn client is to provide an
environment with. C. trusting relationship
48. The most accurate definition of depression as used in psychiatry is: A.
disturbance in mood as reaction to the loss of loved object.
49. He is brought to the hospital after taking an overdose of Phenobarbital after a
lavage. The patients states, “let me die I’m no good”.Nurse response? B. you
must have been upset to try to take ur life.
50. Mr. Geres has been placed on suicide precautions. A therapeutic community
would provide these precautions by. D. assigning staff member to be
with him at all times.
51. Mr. Geres is received (ECT) the nurse explains this procedure should
emphasize that: C. Someone will be with him all the times.
52. One of the side effects of ECT that Mr. Geres may experience is. C. Confusion
for a time after treatment
53. The patient is given a muscle relaxant just before ECT. The major disadvantage
of this drug is it inhibits. A. intercostals and diaphragmatic muscles
54. The aspect of ECT that can result in the most serious complication is the use
of? B. Succinylchloride chloride to relax muscle.
55. The staff set specific goals directed at helping the client. B. express the
hostile feeling
56. The least helpful activity for a severely depressed client such as Mr. Geres
would be: A. allowing the client to plan his own projects.
57. Ms Jose Age 35 is admitted for treatment of depression with of these
symptoms would be the nurse least likely find in the initial assessment of Ms.
Jose? D. increase interest in sex
58. The nurse is evaluating a client who has been treated for major depression for
2 weeks. Which best indication client is improving? B. The patient says “I
think I can set more realistic goals”
59. The nurse enters the room of a depressed client to find out the client who is
poorly responsive and found an empty bottle and water pitcher. What is the
best initial action by the nurse. B. checks the client level of
consciousness and vital signs.
60. Nursing intervention prior to ECT should include? A. providing an
opportunity for the client to ask questions and express concern about
61. The client ask the nurse how long will be before she feels better. The nurse
that the beneficial effect of ECT usually occur within. A. 1 week
62. Nursing assess before ECT therapy is aimed at establishing parameters that
reflects the client mental and physical status. Which is not a part assess
before ECT therapy. A. activity level
63. The side effects of ECT would include: C. slowing of electrical impulses in
the brain causes temporary amnesia and confusion
64. The nurse and the severely depressed client mutually plan a short term goal
regarding self esteem needs. Which ff would appropriate to meet in one week?
A. the client will be able to describe one positive attribute about
Mrs. Paredes 52 yrs old is brought to the psychiatric word by his
husband Mr. Paredes reports that his wife has not been sleeping well
has not been eating and has been extremely anxious for the last
month. He often finds her pacing the floor and crying.
65. Which of these approaches would be best when orienting Mrs. Paredes in the
unit? A. introduces Mrs. Paredes to her roommate
66. At meal time Mrs. Paredes sits pushing the food around her plate w/o eating
anything. To improve her food intake, which plans should tried first? A. stay
with her during meals.
67. Whenever Mrs. Paredes is asked to participate in activities she say’s “I cant
please, don’t make me” which of these would most effective for dealing with
this behavior? C. contact with Mrs. Paredes to follow a written
schedules of daily activities.
68. To promote Mrs. Paredes ability to sleep which of the measures would probably
be most effective? C. increasing her activities during the day.
Mr. Ledesma is a 60 years old successful businessman. He refused to
attend to his business because he is to sad and has sat quietly in a
chair mumbling to himself. He is diagnosed as having major
depression with physchiatric features.
69. Mr. Ledesma say’s “I don’t cry because my wife can’t bear it. The nurse needs
to be aware that this is an example of: D. Rationalization
70. What feeling tone would the nurse must likely to see the client demonstrate
during the major depression with psychiatric features? D. worthlessness
71. After Mr. Ledesma makes a home visit his wife reports that it was a stressful
time. In an interview Mr. ledesma say’s “we had a marvelous visit. Nurse
aware that this is an example of: B. denial
72. It would be important for the nurse to implement definite suicide precautions
for Mr. Ledesma if his mood suddenly to one of. A. cheerfulness
73. Chronic alcohol clients with Wernicke’s encephalopathy associated with
Korsakoff’s syndrome are treated initially by: D. intramuscular injection of
74. Is thinking about alcohol and drug abuse the nurse should be aware that. A.
most polydrug abusers also abuse alcohol.
Aling Berta 46 yrs old had a history of alcohol abuse. She is admitted
to an alcohol rehabilitation center where she is being detoxified.
75. A nursing assessment of aling berta would probably reveal A. nausea,
hypertension and loss of appetite.
76. In the initial interview with aling berta the nurse should plan to include. B. an
77. Aling berta should be assigned to a A. room that is well lit
78. The plan that would best gain Aling Berta’s involved in her own hygienic care
would include: D. any work family
79. An Adult male who appears like 40 yrs old is admitted to the psychiatric unit for
alcohol detoxification. He is tremulous and irritable and complaints of
nervousness and nausea. Which information is most important for the
admitting nurse to obtain? A.
80. The nurse is assessing a client who has been admitted for treatment of
alcoholism. Which question by the nurse is least appropriate?
a. “How much do you think” c.”How is your general health”
b. “What other drugs do you use” d.”Why do you drink so much”
81.An adult male is admitted for alcohol withdrawal. The nurse plans his care to
include all of the ff. which appropriate approach first? B. client may remain
free from injury.
Mr. Piolo 27 years old and a known narcotic user, is brought to ER in an
unconscious state.
82.Naloxene Hydrochloride (Narcan) is administered IV to Mr. Piolo. If the
medication has the desired effects which of these changes in his conditions will
occur? C. he will wake up
83. Mr. Piolo is being assessed for early signs of Narcotic withdrawal which include
a. Yawning and perspiring c.drowsiness and fruity odor of
b. syncope and pulse deficit d. bradycardia and headache
Mr. Piolo has been injecting Narcotics several times a day. Methadone
Hydrochloride is prescribed for his and is to be gradually withdrawn.
84. To determine is the Methadone does is sufficient Mr. Piolo should observe for?
a. Anxiety c. Hallucinations
b. Hypertensive crisis d. Syncope
85. Mr. Piolo express concern that he has AIDS. The diagnosis of AIDS is
confirmed. He becomes depress and is being observe for suicidal tendencies.
Which behavior is greater danger?
a. He reveals that his sister committed suicide.
b. He has a plan for committing suicide
c. He express suicidal thoughts
d. He made a previous suicide attempts.
David 16 yrs old is a substance abuse. He appeared to be hallucinating
and is admitted.
86. After a few days the nurse finds marijuana under his pillows. After confronting
David he promise not to smoke marijuana again. The nurse fears that he is
manipulating her. The most therapeutic intervention when working with a
manipulative clients is to:
a. Make decision for them c.Set rigid limits
b.Reinforce use of alternative dependence d.Confident them in
front others.
87.David asks the nurse whether Marijuana is addictive. The most appropriate
response would be:
a. it is addictive c .it is not addictive
b. it cause a psychological dependence d. confront them in
front of others.
88.which recreational activity would be most appropriate for the nurse to support?
a. a television to watch in his room
b. school work that can be thought to the hospital
c. a board game such as checkers and backgammons
d. various novels david says he wants to read.
A mother who is extremely upset is engaged in alcoholism. She
consumes 22 oz to 80 proof drinks per day. She gets angry with her
children very quickly, cries spontaneously several times a day and
complains of headache constantly.
89. In the planning care for this client, what would be considered the least
appropriate. D. isolating her from stimuli.
90. The most important nursing intervention in planning care for this client would
include: B. identify how she has coped w/ anxiety in the past.
The patient overdosed herself with sleeping pills and alcohol. She is
brought to the ER unconscious. Vital signs is BP 90/50; TPR 98-60-10 her
reflexes are dull.
91. The initial response of the nurse should include which of the ff. C.
maintaining a patent airway.
92. in the planning care for suicidal patient, which of the ff. is the least
appropriate nursing action? C. placing the client in small groups for
93. Since the patient has history of alcohol abuse the nurse should be aware that
she is most likely to exhibit which ff. in first 72 hours ff. admission to the hospital.
A. withdrawal delirium
94. the least appropriate nursing intervention for a client experiencing withdrawal
delirium would be. D. applying and maintaining physical restraints.
Jason Lee 23 yrs old has just been admitted to the unit with behavior of
withdrawal, flat affect disregard of hygiene and growing and associate
lousiness. His diagnosis is paranoid schizophrenia.
95. Which of the ff. is not char of client with schizophrenia
a. Delusions c. Decreased sensitivity
b. Hallucinations d. Ideas of reference.
96. Which of the ff. would not be an appropriate goal when working with a client
with paranoid hallucinations? B. projection
97.Which of the ff. would not be an appropriate goal when working with a client
with paranoid hallucinations? D. the client will act out his fantacies in group
98.which of the ff. is not be appropriate if the goals was, “Client will developed a
relationship with a staff member? D. if their client widraws from social
interaction all the client to be alone.
99. Which of ff. action would not be helpful when dealing with paranoid
hallucination? D. listen carefully to the content of hallucination and
delusion and encourages the client to describe them
100. Which of the ff. would be most helpful to meet the goal. Client will
demonstrate improve hygiene and grooming. A. identify the specific clients
needs for assistance.