Situation 13. Emotional problems related to physical health and childbearing
61. The nurse should plan to explain to the adult daughters of a dying client, whose mood changes and apparent anger at them is causing them concern, that their mother is:
a. Frightened by her impending death
b. Working through acceptance of her situation
c. Attempting to reduce her family's dependence on her
d. Hurt that the family will not take her home to die in her own bed
62. When a continent, bedridden client with a chronic illness expresses anger through urinary incontinence, the nurse should:
a. Limit the client's fluid intake in the evening
b. Provide television or radio for the client when alone
c. Frequently ask if the client need the bedpan to void
d. Create an environment that prevents sensory monotony
63. A client with a chronic illness who had been incontinent of urine at home has not been incontinent since being hospitalized. When discussing past and present elimination patterns, the client also tells the nurse about being angry at being bedridden and unable to go anywhere or see anyone. The nurse deduces that the client's incontinence at home may have been related to:
a. A way of maintaining control
b. An unconscious expression of hostility
c. A method to determine the family's love
d. A physiologic response expected with the elderly.
64. A female client who has had multiple hospital admissions for recurring congestive heart failure is returned to the hospital by her daughter. The client is admitted to the coronary care unit for observation. She states, “I know I'm sick, but I could really take care of myself at home.” the nurse recognizes that the client is attempting to:
a. Deny her illness
b. Suppress her fears
c. Reassure her daughter
d. Maintain her independence
65. Clients on dialysis frequently experience the psychological problem of:
a. Reactive depression
b. Postpump psychosis
c. Depersonalization disorder
d. Dialysis disequilibrium
Situation 14. Joey, a 50 year old male client, was admitted to a psychiatric nursing unit. He exhibits negative symptoms (flat affect, isolation, poverty of speech and lack of motivation) of Schizophrenia.
66. A psychiatrist is making morning rounds and after examining Joey who continues to exhibit negative symptoms of Schizophrenia, the doctor writes an order to change from haloperidol (Haldol) to resperidone (Risperdal). The dosage ordered is 1 mg BID for 3 days. It is most important that the nurse:
a. Monitor the client for mood changes and suicidal tendencies especially during early therapy
b. Assess for the side effects of sedation, restlessness, and muscle spasm once the drug has been administered
c. Determine if the morning dosage of Haldol had been given and then start the initial dose of Risperdal at bedtime
d. Review the medication sheet to determine the time of the last dose of Haldol before administering the correct dosage of Risperdal at 2 PM
67. Joey is about to be discharged to a halfway house. This is his fifth admission in less than 1 year. He improves while in the unit, but after discharge he forgets to take his medication, is unable to function, and must be returned to the unit again. A medication that could be given IM to this client on an outpatient basis every 2 to 3 weeks would be:
a. Haldol c. Lithium carbonate
b. Valium d. Prolixin decanoate
68. Joey is to be discharged with orders for haloperidol (Haldol) therapy. When developing a teaching plan for discharge, the nurse should include cautioning the client against:
a. Driving at night
b. Staying in the sun
c. Ingesting wines and cheeses
d. Taking medications containing aspirin
69. Drugs such as trihexyphenidyl (Artane), biperiden (Akineton), or benztropine (Cogentin) is often prescribed in conjunction with:
a. Barbiturates
b. Antidepressants
c. Antianxiety agents/anxiolytics
d. Antipsychotic agents/neuroleptics
70. An extrapyramidal symptom that is potentially irreversible side effect of antipsychotic drugs is:
a. Torticollis
b. Oculogyric crisis
c. Tardive dyskinesia
d. Pseudoparkinsonism
Situation 15. Personality development is the sum of all traits that differentiate one individual from another.
71. A generally accepted concept of personality development is:
a. By 2 years of age the basic personality is rather firmly set
b. The personality is capable of change and modification throughout life
c. The capacity for personality change decreases rapidly after adolescence
d. By the end of the first 6 years, the personality has reached its adult parameters
72. According to psychosexual theory, the primary emergence of the personality is demonstrated around the age of:
a. 6 months c. 24 months
b. 9 months d. 48 months
73. Personality is unique for every individual because it is the result of the person's:
a. Intellectual capacity, race and socioeconomic status
b. Genetic background, placement in family and autoimmunity
c. Biologic constitution, psychologic development and cultural setting
d. Childhood experiences, intellectual capacity and socioeconomic status
74. The relationship that is of extreme importance in the formation of the personality is the:
a. Peer c. Parent-child
b. Sibling d. Heterosexual
75. The nurse is aware that Freud's phallic stage of psychosexual development, which compares with Erikson's psychosocial phase of initiative vs guilt, is best seen at:
a. Adolescence c. Birth to 1 year
b. 6 to 12 years d. 3 to 5 ½ years
Situation 16. In understanding Psychiatric/Mental Health Nursing, nurses should know the factors involved in personality development
76. Evidence of the existence of the unconscious is best demonstrated by:
a. The ease of recall c. Déja vu experiences
b. Slips of the tongue d. Free-floating anxiety
77. The ability to tolerate frustration is an example of one of the functions of the:
a. Id c. Superego
b. Ego d. Unconscious
78. The superego is the part of the psyche that:
a. Contains the instinctual drives
b. Is the source of creative energy
c. Operates on the pleasure principle and demands immediate gratification
d. Develops from internalizing the concepts of parents and significant others
79. The ego is that part of the self that says:
a. I like what I want
b. I want what I want
c. I should not want that
d. I can wait for what I want
80. A person has a mature personality if the:
a. Ego responds to the demands of the superego
b. Society sets demands to which the ego responds
c. Superego has replaced and increased all the controls of the parents
d. Ego acts as a balance between the pressures of the id and the superego
Situation 17. The personality of an individual develops in overlapping stages that shades and merge together. It is further supported by different theories.
81. During the oedipal stage of growth and development, the child:
a. Love and hates (ambivalence) both parents
b. Loves the parent of the same sex and the parent of the opposite sex
c. Loves the parent of the opposite sex and hates the parent of the same sex
d. Loves the parent of the same sex and hates the parent of the opposite sex
82. Play for the preschool-age child is necessary for the emotional development of:
a. Projection c. Competition
b. Introjection d. Independence
83. The stage of growth and development basically concerned with role identification is the:
a. Oral stage c. Oedipal stage
b. Genital stage d. Latency stage
84. Surgery can be very traumatic event for a child. The nurse when performing preoperative preparation knows that according to Piaget's stages of cognitive development children will experience the greatest fear during the:
a. Sensorimotor stage
b. Preoperational stage
c. Concrete operational stage
d. Formal operational stage
85. An elderly client with a diagnosis of early dementia of the Alzheimer's type tells the nurse, “I am useless to everyone, even myself.” the nurse recognizes that the client has probably failed to accomplish Erikson's developmental task of:
a. Ego integrity versus Despair
b. Identity versus Role Confusion
c. Generativity versus Stagnation
d. Autonomy versus Shame/Doub
Situation 18. There are disorders first evident before adulthood. Nurses should be aware of this.
86. About a month after their toddler is diagnosed as moderately retarded, the parents' discussion of the toddler's future reflects plans for their child's normal independent functioning. The nurse recognizes that the parents:
a. Are using denial
b. Accept the diagnosis
c. Are using intellectualization
d. Understand their child's limitations
87. When using behavior modification to foster toilet training efforts in a cognitively impaired child, the nurse should reinforce appropriate use of the toilet by giving the child a:
a. Piece of fruit c. Hug and praise
b. Piece of candy d. Choice of rewards
88. A 7 year old male has recently been diagnosed with an attention-deficit disorder with hyperactivity. Cylert 37.5 mg/day has been prescribed. In discussing their child's treatment with the parents, the nurse emphasizes the fact that it would be important for them to:
a. Tutor their son in the subjects that are troublesome
b. Monitor the effect of the medication on their son's behavior
c. Point out to their son that he can control his behavior if he desires
d. Avoid imposing too many rules because they would frustrate their son
89. A child scores between 55 and 68 on a standardized intelligent quotient (IQ) assessment test. The nurse is aware that this degree of intellectual impairment would be considered:
a. Mild c. Profound
b. Severe d. Moderate
90. The prognosis for a normal productive life for a child diagnosed with an autistic disorder is:
a. Dependent upon an early diagnosis
b. Often related to the child's overall temperament
c. Emphasized with the parents regardless of the child's level of functioning
d. Looked upon with caution because of interference with so many parameters of functioning
Situation 19. Autism and ADHD (Attention-deficit Hyperactive disorder) are two of the most common mental disorders among children. Nurses should be knowledgeable on this.
91. Autism can usually be diagnosed when the child is about:
a. 2 years of age c. 6 months of age
b. 6 years of age d. 1 to 3 months of age
92. The 6 years old child who has been diagnosed as autistic is admitted for sever dehydration. The child demonstrates frequent spinning and hand-flapping activities. Nursing intervention to limit these activities should focus on:
a. Physically holding the child
b. Redirecting the child's behavior
c. Asking the child why the spinning and hand-flapping is done
d. Moving furniture to minimize the space available for these activities
93. When planning activities for a child with autism, the nurse must remember that autistic children respond best to:
a. Large group activity
b. Loud, cheerful music
c. Individuals in small group
d. Their own self-stimulating acts
94. Attention-deficit hyperactivity disorder in children is usually treated with:
a. Lorazepam (Ativan)
b. Haloperidol (Haldol)
c. Methocarbamol (Robaxin)
d. Methylphenidate hydrochloride (Ritalin)
95. The nursing assessment of a hyperactive 9 year old with a history of an attention-deficit disorder, admitted for observation following a motor vehicle accident, reveals a knowledge deficit regarding personal safety. Nursing actions to meet the goal of personal safety should focus on:
a. Requesting the child write at least 3 safety rules
b. Asking the child to verbalize as many safety rules as possible
c. Talking with the child about the importance of using a seat belt
d. Encouraging the child to talk with other children about their opinions of safety rules
Situation 20. Delirium, dementia and other cognitive disorders
96. The approach that would be most helpful in meeting the needs of an elderly client hospitalized with the diagnosis of dementia of the Alzheimer's type is:
a. Providing a nutritious diet high in carbohydrates and proteins
b. Simplifying the environment as much as possible while eliminating need for choices
c. Providing an opportunity for many alternative choices in the daily schedule to stimulate interest
d. Developing a consistent nursing pan with fixed schedules to provide for physical and emotional needs
97. When attempting to understand the behavior of an elderly client diagnosed with vascular dementia, the nurse recognizes that the client is probably:
a. Not capable of using any defense mechanisms
b. Using one method of defense for every situation
c. Making exaggerated use of old, familiar mechanisms
d. Attempting to develop new defense mechanisms to meet the current situation
98. When planning care for a client with delirium, dementia or other cognitive disorders, the nurse should appropriately:
a. Teach the client new social skills to encourage participation
b. Encourage the client to talk of the past and early experiences
c. Discuss current events to keep the client in contact with reality
d. Maintain the daily routine of living with which the client is familiar
99. The nurse is assessing a client with dementia. To effectively elicit information about the client's ability to provide self-care, the nurse should:
a. State, “I notice that your shoes do not match your dress.”
b. State, “Continue to knit and I shall observe you for a while.”
c. Ask, “Can you find your way from the bed to the bathroom?”
d. Ask, “Can you show me how you would open the door if you had a key?”
100. The current trend in the treatment of the older adult with delirium, dementia or other cognitive disorder is to:
a. Provide occupational therapy
b. Maintain them in the community
c. Medicate during stressful periods
d. Encourage the assumption of responsibility
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