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HS/APR 2009/NRS423

UNIVERSITI TEKNOLOGI MARA FINAL EXAMINATION

COURSE COURSE CODE EXAMINATION TIME .

MENTAL HEALTH CARE NRS423 APRIL 2009 2 HOURS

INSTRUCTIONS TO CANDIDATES 1. This question paper consists of two (2) parts : PART A (50 Questions) PART B (2 Questions) 2. Answer ALL questions from all two (2) parts : i) Answer PART A in the OMR Multiple Choice Answer Sheet. ii) Answer PART B in the Answer Booklet. Start each answer on a new page. Do not bring any material into the examination room unless permission is given by the invigilator. Please check to make sure that this examination pack consists of: i) ii) iii) the Question Paper an Answer Booklet - provided by the Faculty an OMR Multiple Choice Answer Sheet - provided by the Faculty

3. 4.

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO


This examination paper consists of 13 printed pages
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PART A

(50 marks)

Answer ALL questions. Choose the MOST appropriate answer for each question. 1. One of the steps taken in primary prevention of mental illness is A. B. C. D. giving genetic counseling. giving psychotherapy. ensuring that there are facilities for treating mental illness. ensuring that there are facilities for providing follow-up care.

2.

Which of the following response is an example of a non-therapeutic communication? A. B. C. D. "You say everything is ok?" "I'm not sure I understand..." "Your husband is angry because you accuse him of having an affair?" "Why are you behaving like this?"

3.

Which of the following describes the correct stages of nurse-client relationship? A. B. C. D. Assessment, planning and evaluation phase. Identification, formulation and intervention phase. Orientation, working and termination phase. Admission, intervention and discharge phase.

4.

Factors that hinder the establishment of therapeutic relationship include A. B. C. D. interest, genuineness and level of education of the client. inconsistency, negative attitude and unavailability of the nurse. environment, attitude and client's mental state. nurse's state of mind, level of task and client's negative attitude.

5.

A misinterpretation of real external stimuli is known as A. B. C. D. hallucination. illusions. delusion. obsess.

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6. "He took a long time to get to the point but he got there" is a description of A. B. C. D. perseverance. flight of ideas. looseness of association. circumstantiality.

7.

A client reports that her neighbours are poisoning her food. The sign manifested by her is known as A. B. C. D. hallucination. illusion. delusion. flight of ideas.

8.

Which of the following type of hallucinations is MOST commonly manifested in clients with mental illness? A. B. C. D. Visual Olfactory Tactile Auditory

9.

An exaggerated, inappropriate feeling of pleasure is known as A. B. C. D. euphoria. anhedonia. perseveration. dysphoria.

10. Mental Disorder Ordinance (MDO) is an act of law that A. B. C. D. enables the authorities to confine in hospitals anyone with emotional problems. ensures all those with schizophrenia are admitted to psychiatric institutions. ensures all those who commit crimes are punished by law. ensures all those with mental illness are protected against exploitation.

11. Committing a mentally disturbed person to a psychiatric institution A. B. C. D. is for an indefinite time. needs the police involvement. is only recommended for voluntary clients. is recommended if a client is considered a danger to self or others.
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12. The MOST important and commonly used tool in assessing a client's condition is A. B. C. D. interview. observation. participation. seclusion.

13. What should the doctor do to a client who had attempted suicide and refuses admission to a psychiatric ward? A. B. C. D. Admit him to a gazetted psychiatric ward/hospital using Form A. Allow him to go home after he has promised not to attempt suicide again. Allow him to go home if his relatives promise to be responsible for his safety. Admit him to a medical ward till he agrees to be transferred to a psychiatric ward.

14. An increased level of dopamine is said to be one of causes of A. B. C. D. mania. depression. schizophrenia. obsessive compulsive neurosis.

15. An individual who is having psychotic symptoms will NOT be diagnosed as having schizophrenia if A. B. C. D. his/her he/she he/she his/her age is thirty five. has a history of alcoholism. has delusions of paranoia. has been present for more than six months.

16. What is the MOST priority nursing diagnosis for a client who is neglecting himself, aggressive, paranoid towards one of the inmates and is frequently argumentative? A. B. C. D. Self care deficit related to disease process. Food refusal related to hallucination and delusion. Alteration of thought related to symptoms of illness. Potential for aggressive behavior related to paranoid delusion.

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17. The following intervention needs to be taken when nursing a potentially violent client. A. B. C. D. Ensure that he is isolated from other clients. Monitor his behavior and mood changes. Encourage him to play scrabble or chess to calm him down. Restrain him until he promises to behave himself.

18. A client who is in a state of confusion should be A. B. C. D. nursed in a quiet, dimly lit cubicle/room. restrained till he is not restless anymore. monitored to detect deterioration of his medical status. sedated with tranquilizers to reduce his confusion.

19. The attention that a client gives to auditory hallucinations can be reduced by A. B. C. D. giving the client amitriptyline. encouraging the client to read. talking to the client. advising the client not to pay attention to the voices.

20. These symptoms may be present in a client during the initial phase of schizophrenia. A. B. C. D. Heightened work performance. Increased social interaction. Increased energy and motivation. Impaired role functioning and neglect of personal hygiene.

21. The presence of the following cluster of symptoms would indicate that a client has schizophrenia. A. B. C. D. Unstable mood and delusions of grandeur. Obsessive thoughts and ritualistic behavior. Feelings of hopelessness and helplessness. Hallucinations and delusions and decreased ability to function in society.

22. A schizophrenic client A. B. C. D. can become aggressive due to grandiose delusions. needs to be assisted in all his activities of daily living (ADL). will relapse if he is not given electro-convulsive therapy (ECT). may be given haloperidol to reduce his psychosis.

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23. The presence of the following symptom increases the risk of violence. A. B. C. D. Delusions of grandious. Psychomotor retardation. Anhedonia. Auditory hallucinations.

24. The presence of the following signs and symptoms could indicate an impending aggressive outburst EXCEPT A. B. C. D. restlessness. argumentativeness. increasing anxiety. social withdrawal.

25. The purpose of doing regular monitoring of a client who have been restrained is to A. B. C. D. to assess the client mental status. find out when the client is ready to be released. check if the client is ready to talk about his behavior. identify the client's is ready to apologize to the staff he assaulted.

26. Depressed clients are prone to physiological disorders such as constipation primarily because of their A. B. C. D. delusional beliefs. inactivity and lack of physical exercise. preoccupation with their bodily functions. failure to seek prompt medical help for health problems.

27. Which of the following nursing approaches would be MOST helpful to use for a depressed client? A. B. C. D. Presenting a cheerful, energetic manner to client. Expecting the client to take an initiative in self-care. Providing the client with opportunities for decision making. Establishing a simple daily schedule of activities for the client.

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28. A client diagnosed with manic disorder needs a period of hospitalization because A. B. C. D. he/she may attempt suicide. he/she may be suffering from severe insomnia. of his/her inability to take care of his/her personal hygiene. of his/her reckless behaviour that may endanger the client or others.

29. Which one of the following intervention is applicable to all acutely ill, elated and hyperactive clients? A. B. C. D. Control their use of loud and vulgar language. Maintain their contact with the members of their family. Protect them from their unconscious suicidal impulses. Protect them and others from their impulsive behavior

30. Which of the following measures should be included when teaching a client strategy to help to sleep? A. B. C. D. Keep the room warm. Eat a heavy meal before bedtime. Schedule bed-time when you feel tired. Avoid caffeine and excessive fluid intake.

31. Which of the following characteristics BEST describes dementia? A. B. C. D. Personal neglect in self-care. Poor judgment, especially in social situations. Memory loss occurring as a natural consequence of aging. Loss of intellectual abilities sufficient to impair the ability to perform basic care

32. Clients with cognitive impairment disorder need reality orientation so that A. B. C. D. the risk of relapse is reduced. he/she does not become aggressive. he/she is not disturbed by other clients. the personality deterioration is slowed down.

33. A client who is in a state of confusion should be A. B. C. D. restrained till he/she is not restless anymore. started on habit training to reduce his/her confusion. closely monitored to detect deterioration in his/her medical status. sedated with high doses of anti-psychotics to reduce his/her confusion. CONFIDENTIAL

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34. Which of the following disorder can result in dementia? A. B. C. D. Alzheimer's disease. Alcohol withdrawal. Obsessive disorder. Major depression.

35. Which of the following nursing intervention receives the HIGHEST priority for a client who attempted suicide? A. B. C. D. Constant suicide watch. Introduction and familiarization with the other clients. Orientation to the unit to promote a feeling of well-being. Administration and maintenance of prescribed antidepressants.

36. The treatment of choice for an actively suicidal client is A. B. C. D. tricyciclic anti-depressants. electro-convulsive therapy. atypical antipsychotics. benzodiazepines.

37. A high-risk suicidal client is one who A. B. C. D. has visual hallucinations has no psychotic symptoms. has had no previous history suicidal attempts. expresses clear intent with a lethal plan.

38. The MOST common side effect experienced by the client after ECT is A. B. C. D. depression. loss of appetite. transient amnesia. recurrence of hallucinations.

39. Which of the statements about ECT is CORRECT? A. B. C. D. Hypertension is a contraindication. The client frequently loses weight during the treatment. Amenorrhea for two or three months may commonly result. It is necessary to produce an obvious muscular convulsion.

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40. The role of a nurse in the preparation of the client for ECT includes all of the following EXCEPT A. B. C. D. taking the consent for the procedure. ensure that the client is kept fasting for the procedure. document the medications given or withheld on the day of ECT. reinforcement of explanation about the procedure to the client and the family.

41. A client who just had ECT asks for a drink. The following assessment is a PRIORITY when meeting the client's request. A. B. C. D. Taking the client's blood pressure. Monitoring the gag's reflex. Taking the body temperature. Determining the level of consciousness.

42. Akathisia is A. B. C. D. jaundice caused by individual sensitivity to phenothiazines. a fatal condition that occurs in clients with prolonged use of phenothiazines. an extrapyramidal symptom most commonly associated with antipsychotics. a type of bluish-gray skin coloration occurring with prolonged use of chlorpromazine.

43. A client who was just started on haloperidol complains of not feeling well. Her temperature is 38C. The client also complains that her face and leg muscles feel stiff. You should be concerned that she may be developing A. B. C. D. acute dystonic reaction. tardive dyskinesia. drug-induced catatonia. neuroleptic malignant syndrome.

44. What information would you give to the client (and his family) who is receiving tricyclic antidepressants. A. B. C. D. A manic episode might be induced. Should stop taking the medication if he experiences anti-cholinergic effects. Mood improvement take place in about 2 - 3 weeks after treatment is started. Dry mouth, constipation, and urinary problems may develop in the first week of treatment.

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45. Nursing diagnoses applicable to the clients taking anti-psychotic drugs include the following EXCEPT A. B. C. D. risk for injury. risk for activity intolerance. non-compliance with medication. risk of suicide.

46. The MAIN purpose of prescribing benzhexol in combination with anti-psychotic drugs to clients is to A. B. C. D. enhance the effects of the drug. reduce the excretion rate of the drug. increase the absorption rate of the drug. minimize the side effects of the drug.

47. A client who has been started on antipsychotic drugs for the first time needs close monitoring because he/she can experience A. B. C. D. nausea and vomiting. acute dystonic reaction. tardive dyskinesia. polyuria.

48. Encik Raju's family reports that he is not compliant with haloperidol. To reduce the risk of relapse he would be A. B. C. D. given antidepressants. informed that he will be given injections daily as a substitute. persuaded until he takes his medication. given intramuscular fluphenazine.

49. A client taking lithium should report the following adverse reactions. A. B. C. D. Double vision. Increase lacrimation. Periods of confusion. Persistent gastro-intestinal disturbances.

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50. Which discharge instruction is MOST important for a client taking lithium? A. B. C. D. Maintain a high fluid intake. Limit fluid to 1,500 ml per day. Take the lithium before meal time. Stop taking the medication if he experiences constipation.

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PART B

(50 marks)

Answer ALL questions. QUESTION 1 a) Psychiatric disorders usually have multi-factorial etiology. Explain THREE of these causative factors. (6 marks)

b) Anti-psychotic drugs help to reduce psychotic symptoms. i) Name FOUR common side effects of anti-psychotic drugs. (2 marks) ii) Explain how you would advice the patient to overcome or reduce these side-effects. (6 marks) c) Explain briefly Peplau's THREE phases in a nurse-patient relationship. (6 marks) d) What is delusion? Give two examples of delusions. (5 marks)

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QUESTION 2 Mr. Samuel, a 25-year-old, was admitted to the psychiatric ward with a diagnosis of Bipolar Affective Disorder - Manic phase. His father had complained to the admitting doctor that Mr. Samuel had been aggressive at home and is very irritable. a) Explain the mental assessment you would do for Mr. Samuel. (8 marks)

In the ward, Mr. Samuel was noted to be very irritable and his mood was labile. b) State the possible reasons why Mr. Samuel can become aggressive in the ward. (4 marks) c) Explain your nursing interventions to reduce the risk of the patient becoming aggressive in the ward. (7 marks)

Mr. Samuel has been sleeping only two to three hours since admission. d) Explain the nursing interventions you would take to help the patient sleep. (6 marks)

END OF QUESTION PAPER

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