NURSING PRACTICE V- Care of Clients with physiologic and Psychosocial Alterations (Part C).

Situation 1 – Jimmy developed this goal for hospitalization. “To get a handle on my nervousness.” The nurse is going to collaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned to asphyxiate himself with exhaust from his car but frightened instead. He realized he needed help.1. The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is:A. help the client find meaning in his experienceB. help the client to plan alternativesC. help the client cope with the present problemD. help the client to communicate

2. The nurse is guided that Jimmy is aware of his concerns of the “here and now” when he crossed out which item from this “list of what to know”.A. anxiety laden unconscious conflictsB. subjective idea of the range of mild to severe anxietyC. early signs of anxietyD. physiologic indices of anxiety

3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that complete disruption of the ability to perceive occurs in:A. panic state of anxietyB. severe anxietyC. moderate anxietyD. mild anxiety

4. Jimmy initiates independence and takes an active part in his self care with the following EXCEPT:A. agreeing to contact the staff when he is anxiousB. becoming aware of the conscious feelingC. assessing need for medication and medicating himselfD. writing out a list of behaviors that he identified as anxious

5. The nurse notes effectiveness of interventions in using subjective and objective data in the:A. initial plans or ordersB. databaseC. problem listD. progress notes

Situation 2 – A research study was undertaken in order to identify and analyze a disabled boy’s coping reaction pattern during stress.6. This study which is an in depth study of one boy is a:A. case studyB. longitudinal studyC. cross-sectional studyD. evaluative study

7. The process recording was the principal tool for data collection. Which of the following is NOT a part of a process recording?A. Non verbal narrative accountB. Analysis and interpretationC. Audio-visual recordingD. Verbal narrative account

8. Which of these does NOT happen in a descriptive study?A. Exploration of relationship between two or more phenomena.B. Explanation of relationship between two or more phenomena.C. Investigation of a phenomenon in real life context.D. Manipulation of variable

9. The investigator also provided the nursing care of the subject. The investigator is referred to as a/an:A. Participant-observerB. Observer researcherC. CaregiverD. Advocate

10. To ensure reliability of the study, the investigator’s analysis and interpretations were:A. subjected to statistical treatmentB. correlated with a list of coping behaviorsC. subjected to an inter-observer agreementD. scored and compared standard criteria

Situation 3 – During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 35 years old, was given Flurazepam (Dalmane) 15mg at 10:00pm because she had trouble going to sleep. Before approaching Regina,

the nurse read the observation of the night nurse.

11. Which of the following approaches of the nurse validates the data gathered?A. “I learned that you were up till ten last night, tell me what happenedbefore you were finally able to sleep and how was your sleep?”B. “Hmm.. You look like you had a very sound sleep. That pill you weregiven last night is effective isn’t it?”C. “Regina, did you sleep well?”D. “Regina, how are you?”

12. Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needs for information about her medicine?A. Guided by a medication teaching plan, go over with her the purpose, indications and special instructions, about the medication and provide her a checklistB. Provide a drug literature.C. Have an informal conversation about the medication and its effectsD. Ask her what time she would like to watch the informative video about the medication.

13. The nurse engages Regina in the process of mutual inquiry to provide an opportunity for Regina to:A. face emerging problems realisticallyB. conceptualize her problemC. cope with her present problemD. perceive her participation in an experience

!4. Which of these responses indicate that Regina needs further discussion regarding special instructions?A. “I have to take this medicine judiciously”B. “I know I will stop taking the medicine when there is advice from the doctor for me to discontinue.”C. “I will inform you and the doctor any untoward reactions I have.”D. “I like taking this sleeping pill. It solves my problem of insomnia. I wish I can take it for life.”

15. Regina commits to herself that she understood and will observe all the medicine precautions by:A. affixing her signature to the teaching plan that she has understood the nurseB. committing what she learned to her memoryC. verbally agreeing with the nurseD. relying on her husband to remember the precautions

Situation 4 – The nurse-patient relationship is a modality through which the nurse meets the client’s needs.

16. The nurse’s most unique tool in working with the emotionally ill client is his/herA. theoretical knowledgeB. personality make upC. emotional reactionsD. communication skills

17. The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states:A. All behavior is meaningful, communicating a message or a need.B. Human beings are systems of interdependent and interrelated parts.C. Each individual has the potential for growth and change in the direction of positive mental health.D. There is a basic similarity among all human beings.

18. One way to increase objectivity in dealing with one’s fears and anxieties is through the process of:A. observationB. interventionC. validationD. collaboration

19. All of the following responses are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior?A. Responding in a punitive manner to the client.B. Rejecting the client as a unique human beingC. Tolerating all behavior in the client.D. Communicating ambivalent messages to the client.

20. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as:A. counselorB. mother surrogateC. therapistD. socializing agent

Situation 5 – The nurse engages the client in a nurse-patient interaction.

21. The best time to inform the client about terminating the nurse-patient relationship is:A. when the client asks how long the relationship would beB. during the working phaseC. towards the end of the relationshipD. at the start of the relationship

22. The client says, “I want to tell you something but can you promise that you will keep this a secret?” A therapeutic response of the nurse is:A. “Yes, our interaction is confidential provided the information you tell me is not detrimental to your safety.”B. “Of course yes, this is just between you and me. Promise!”C. “Yes, it is my principle to uphold my client’s rights.”D. “Yes, you have the right to invoke confidentiality of our interaction.”

23. When the nurse respects the client’s self-disclosure, this is a gauge for the nurse’s:A. trustworthinessB. loyaltyC. integrityD. professionalism

24. Rapport has been established in the nurse-client relationship. The client asks to visit the nurse after his discharge. The appropriate response of the nurse would be:A. “The best time to talk is during the nurse-client interaction time. I am committed to have this time available for us while you are at the hospital and ends after your discharge.”B. “Yes, If you keep it confidential, this is part of privileged communication.”C. “I am committed for your care.”D. “I am sorry, though I would want to, it is against hospital policy.”

25. The client has not been visited by relatives for months. He gives a telephone number and requests the nurse to call. An appropriate action of the nurse would be:A. Inform the attending physician about the request of the client.B. Assist the client to bring his concern to the attention of the social worker.C. “Here (gives her mobile phone). You may call this number now”.D. Ask the client what is the purpose of contacting his relatives.

Situation 6 – Camila, 25 years old, was reported to be gradually withdrawing and isolating herself from friends and family members. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently. She was diagnosed as schizophrenia disorder.26. The past history of Camila would most probably reveal that her premorbid personality is:A. schizoidB. extrovertC. ambivertD. cycloid

27. Camila refuses to relate with to others because she:A. is irritableB. feels superior of othersC. anticipates rejectionD. is depressed

28. Which of the following disturbances in interpersonal relationships MOST often predispose to the development of schizophrenia?A. Lack of participation in peer groupsB. Faulty family atmosphere and interactionC. Extreme rebellion towards authority figuresD. Solo parenting

29. Camila’s indifference toward the environment is a compensatory behavior to overcome:A. Guilt feelingsB. AmbivalenceC. Narcissistic behaviorD. Insecurity feelings

30. Schizophrenia is a/an:A. anxiety disorderB. neurosisC. psychosisD. personality disorder

Situation 7 – Salome, 80 year old widow, has been observed to be irritable, demanding and speaking louder than usual. She would prefer to be alone and take her meals by herself, minimize receiving visitors at home and no longer bothers to answer telephone calls because of deterioration of hearing. She was brought by her daughter to the Geriatric clinic for assessment and treatment.

31. The nurse counsels Salome’s daughter that Salome’s becoming very loud and tendency to become aggressive is a/an:A. beginning indifference to the world around herB. attempt to maintain authoritative roleC. overcompensation for hearing lossD. behavior indicative of unresolved repressed conflict of the past

32. A nursing diagnosis for Salome is:A. sensory deprivationB. social isolationC. cognitive impairmentD. ego despair

33. The nurse will assist Salome and her daughter to plan a goal which is for Salome to:A. adjust to the loss of sensory and perceptual functionB. participate in conversation and other social situationsC. accept the steady loss of hearing that occurs with agingD. increase her self-esteem to maintain her authoritative role

34. The daughter understood, the following ways to assist Salome meet her needs and avoiding which of the following:A. Using short simple sentencesB. Speaking distinctly and slowlyC. Speaking at eye level and having the client’s attentionD. Allowing her to take her meals alone

35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she says that the battery should be functional, the device is turned on and adjusted to a:A. therapeutic levelB. comfortable levelC. prescribed levelD. audible level

Situation 8 – For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her.36. Cecilia is demonstrating:A. acrophobiaB. claustrophobiaC. agoraphobiaD. xenophobia

37. Cecilia’s problem is that she always sees and thinks negative things hence she is always fearful. Phobia is a symptom described as:A. organicB. psychosomaticC. psychoticD. neurotic

38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her:A. communicationB. cognitionC. observationD. perception

39. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement?A. assist her in recognizing irrational beliefs and thoughtsB. help find meaning in her behaviorC. provide positive reinforcement for acceptable behaviorD. Administer anxiolytic drug

40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia?A. She reads a book in the public libraryB. She drives alone along the long expressway.C. She watches television with the family in the recreation roomD. She joins an art therapy group

Situation 9 – It is the first day of clinical experience of nursing students at the Psychiatry Ward. During the orientation, the nurse emphasizes that the team members including nursing students are legally responsible to safeguard patient’s records from loss or destruction or from people not authorized to read it.

41. It is unethical to tell one’s friends and family members data about patients because doing so is a violation of patients’ rights to:A. Informed consentB. ConfidentialityC. Least restrictive environmentD. Civil liberty

42. The nurse must see to it that the written consent of mentally ill patients must be taken from:A. DoctorB. Social workerC. Parents or legal guardianD. Law enforcement authorities

43. In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within:A. 24 hoursB. 36 hoursC. 48 hoursD. 12 hours

44. The following are SOAP (Subjective – Objective – Analysis – Plan) statements on a problem: Anxiety about diagnosis. What is the objective data?A. Relate patient’s feelings to physician; initiate and encourage her to verbalize her fears; give emotional support by spending more time with patient; continue to make necessary explanations regarding diagnostic tests.B. Has periods of crying; frequently verbalizes fear of what diagnostic tests will revealC. Anxiety due to unknownD. “I’m so worried about what else they’ll find wrong with me.”

45. Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the:A. Summary of chronological notations made by individual health team membersB. Identification of patient’s responses to medical diagnoses and treatmentC. Patient’s responses to health and illness as a total person in interaction with the environmentD. Step by step procedures for the management of common problems

Situation 10 – Marie is 5½ years old and described by the mother as bedwetting at night.

46. Which of the following is the MOST common physiological cause of night bed wetting?A. deep sleep factorsB. abnormal bladder developmentC. infectionsD. familial and genetic factors

47. All of the following, EXCEPT one compromise the concepts of behavior therapy program.A. reward and punishmentB. extinctionC. learningD. placebo as a form of treatment

48. To help Marie who bed wets at night practice acceptable and appropriate behavior, it is important for the parents to be consistent with the following approaches EXCEPT:A. discipline with a kind attitudeB. matter of fact in handling the behaviorC. sympathize for the childD. be loving yet firm

49. A therapeutic verbal approach that communicates strong disapproval is:A. “You are supposed to get up and go in the toilet when you feel you have to go and did not. The next time you bed wet, I’ll tell your friends and hang your sheets out the window for them to see.”B. “You are supposed to get up and go in the toilet when you feel you have to go and did not. I expect you to from now on without fail.”C. “If you bed wet, you will change your bed linen and wash the sheets.”D. “If you don’t make an effort to control your bedwetting, I’d be upset and disappointed.”

50. During your conference, the parent inquires how to motivate Marie to be dry in the morning. Your response which is an immediate intervention would be:A. Give a star each time she wakes up dry and every set of five stars, give a prize.B. Tokens make her materialistic at an early age. Give praise and hugs occasionally.C. What does your child want that you can give every time he/she wakes up dry in the morning?D. Promise him/her a long awaited vacation after school is over.

ANSWER KEY

NURSING PRACTICE V- Care of Clients with physiologic and Psychosocial Alterations (Part C).

Situation 1 – Jimmy developed this goal for hospitalization. “To get a handle on my nervousness.” The nurse is going to collaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned to asphyxiate himself with exhaust from his car but frightened instead. He realized he needed help.1. The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is:help the client to plan alternatives

2. The nurse is guided that Jimmy is aware of his concerns of the “here and now” when he crossed out which item from this “list of what to know”.subjective idea of the range of mild to severe anxiety

3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that complete disruption of the ability to perceive occurs in:panic state of anxiety

4. Jimmy initiates independence and takes an active part in his self care with the following EXCEPT:agreeing to contact the staff when he is anxious

5. The nurse notes effectiveness of interventions in using subjective and objective data in the:progress notes

Situation 2 – A research study was undertaken in order to identify and analyze a disabled boy’s coping reaction pattern during stress.6. This study which is an in depth study of one boy is a:case study

7. The process recording was the principal tool for data collection. Which of the following is NOT a part of a process recording?Audio-visual recording

8. Which of these does NOT happen in a descriptive study?Manipulation of variable

9. The investigator also provided the nursing care of the subject. The investigator is referred to as a/an:Observer researcher

10. To ensure reliability of the study, the investigator’s analysis and interpretations were:subjected to an inter-observer agreement

Situation 3 – During the morning endorsement, the outgoing nurse informed the nursing staff that Regina, 35 years old, was given Flurazepam (Dalmane) 15mg at 10:00pm because she had trouble going to sleep. Before approaching Regina, the nurse read the observation of the night nurse.11. Which of the following approaches of the nurse validates the data gathered?“I learned that you were up till ten last night, tell me what happenedbefore you were finally able to sleep and how was your sleep?”

12. Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needs for information about her medicine?Provide a drug literature.

13. The nurse engages Regina in the process of mutual inquiry to provide an opportunity for Regina to:perceive her participation in an experience

!4. Which of these responses indicate that Regina needs further discussion regarding special instructions?“I like taking this sleeping pill. It solves my problem of insomnia. I wish I can take it for life.”

15. Regina commits to herself that she understood and will observe all the medicine precautions by: committing what she learned to her memory

Situation 4 – The nurse-patient relationship is a modality through which the nurse meets the client’s needs.16. The nurse’s most unique tool in working with the emotionally ill client is his/hercommunication skills

17. The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states:All behavior is meaningful, communicating a message or a need.

18. One way to increase objectivity in dealing with one’s fears and anxieties is through the process of:validation

19. All of the following responses are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior?Communicating ambivalent messages to the client.

20. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as:mother surrogateSituation 5 – The nurse engages the client in a nurse-patient interaction.21. The best time to inform the client about terminating the nurse-patient relationship is:at the start of the relationship

22. The client says, “I want to tell you something but can you promise that you will keep this a secret?” A therapeutic response of the nurse is:“Yes, our interaction is confidential provided the information you tell me is not detrimental to your safety.”

23. When the nurse respects the client’s self-disclosure, this is a gauge for the nurse’s:trustworthiness

24. Rapport has been established in the nurse-client relationship. The client asks to visit the nurse after his discharge. The appropriate response of the nurse would be:“The best time to talk is during the nurse-client interaction time. I am committed to have this time available for us while you are at the hospital and ends after your discharge.”

25. The client has not been visited by relatives for months. He gives a telephone number and requests the nurse to call. An appropriate action of the nurse would be:Ask the client what is the purpose of contacting his relatives.

Situation 6 – Camila, 25 years old, was reported to be gradually withdrawing and isolating herself from friends and family members. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently. She was diagnosed as schizophrenia disorder.26. The past history of Camila would most probably reveal that her premorbid personality is:schizoid

27. Camila refuses to relate with to others because she:anticipates rejection

28. Which of the following disturbances in interpersonal relationships MOST often predispose to the development of schizophrenia?Faulty family atmosphere and interaction

29. Camila’s indifference toward the environment is a compensatory behavior to overcome:Insecurity feelings

30. Schizophrenia is a/an:psychosis

Situation 7 – Salome, 80 year old widow, has been observed to be irritable, demanding and speaking louder than usual. She would prefer to be alone and take her meals by herself, minimize receiving visitors at home and no longer bothers to answer telephone calls because of deterioration of hearing. She was brought by her daughter to the Geriatric clinic for assessment and treatment.31. The nurse counsels Salome’s daughter that Salome’s becoming very loud and tendency to become aggressive is a/an:overcompensation for hearing loss

32. A nursing diagnosis for Salome is:social isolation

33. The nurse will assist Salome and her daughter to plan a goal which is for Salome to:adjust to the loss of sensory and perceptual function

34. The daughter understood, the following ways to assist Salome meet her needs and avoiding which of the following:Allowing her to take her meals alone35. Salome was fitted a hearing aid. She understood the proper use and wear of this device when she says that the battery should be functional, the device is turned on and adjusted to a:prescribed level

Situation 8 – For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her.

36. Cecilia is demonstrating:agoraphobia

37. Cecilia’s problem is that she always sees and thinks negative things hence she is always fearful. Phobia is a symptom described as:neurotic

38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her:cognition

39. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement?provide positive reinforcement for acceptable behavior

40. After discharge, which of these behaviors indicate a positive result of being able to overcome her phobia?She drives alone along the long expressway.

Situation 9 – It is the first day of clinical experience of nursing students at the Psychiatry Ward. During the orientation, the nurse emphasizes that the team members including nursing students are legally responsible to safeguard patient’s records from loss or destruction or from people not authorized to read it.41. It is unethical to tell one’s friends and family members data about patients because doing so is a violation of patients’ rights to:Confidentiality

42. The nurse must see to it that the written consent of mentally ill patients must be taken from:Parents or legal guardian

43. In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within:24 hours

44. The following are SOAP (Subjective – Objective – Analysis – Plan) statements on a problem: Anxiety about diagnosis. What is the objective data?Has periods of crying; frequently verbalizes fear of what diagnostic tests will reveal

45. Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the:Identification of patient’s responses to medical diagnoses and treatment

Situation 10 – Marie is 5½ years old and described by the mother as bedwetting at night.46. Which of the following is the MOST common physiological cause of night bed wetting?familial and genetic factors

47. All of the following, EXCEPT one compromise the concepts of behavior therapy program.placebo as a form of treatment

48. To help Marie who bed wets at night practice acceptable and appropriate behavior, it is important for the parents to be consistent with the following approaches EXCEPT:

49. A therapeutic verbal approach that communicates strong disapproval is:“If you don’t make an effort to control your bedwetting, I’d be upset and disappointed.”

50. During your conference, the parent inquires how to motivate Marie to be dry in the morning. Your response which is an immediate intervention would be:What does your child want that you can give every time he/she wakes up dry in the morning?