FINAL CDC - NP V

CDC – Psychiatric Nursing ANXIETY DISORDERS Situation: 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. 

The nurse recognized that Jimmy had conceptualized his problem and the next priority goal in the care plan is:  C. help the client cope with the present problem

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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”.  C. early signs of anxiety

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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:  B. severe anxiety

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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 anxious

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

Situation: 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. 

Cecilia is demonstrating:  C. agoraphobia

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

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

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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 thoughts

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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 library

NURSING RESEARCH Situation 2 – A research study was undertaken in order to identify and analyze a disabled boy’s coping reaction pattern during stress. 

This study which is an in depth study of one boy is a:  D. evaluative study

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The process recording was the principal tool for data collection. Which of the following is NOT a part of a process recording?  B. Analysis and interpretation

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

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The investigator also provided the nursing care of the subject. The investigator is referred to as a/an:  A. Participant-observer

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To ensure reliability of the study, the investigator’s analysis and interpretations were:  A. subjected to statistical treatment

THERAPEUTIC TECHNIQUES OF COMMUNICATION Situation: 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. 

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 happened before you were finally able to sleep and how was your sleep?”

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Regina is a high school teacher. Which of these information LEAST communicate attention and care for her needs for information about her medicine?  D. Ask her what time she would like to watch the informative video about the medication.

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

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

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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 nurse

NURSE – PATIENT INTERACTION Situation: The nurse-patient relationship is a modality through which the nurse meets the client’s needs. 

The nurse’s most unique tool in working with the emotionally ill client is his/her  D. communication skills

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The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states:  C. Each individual has the potential for growth and change in the direction of positive mental health.

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

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All of the following responses are non therapeutic. Which is the MOST direct violation of the concept, congruence of behavior?  C. Tolerating all behavior in the client. A. Responding in a punitive manner to the client.

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The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse’s role as:  B. mother surrogate C. therapist

Situation: The nurse engages the client in a nurse-patient interaction. 

The best time to inform the client about terminating the nurse-patient relationship is:  D. at the start of the relationship

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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.”

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

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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.”

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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.

Situation: It is common that clients ask the nurse personal questions. 

Anticipation of personal questions is given adequate attention during which phase of the nurse patient relationship?  B. Working phase

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If the client asks for the nurse’s telephone number, which of these responses is NOT appropriate?  A.“It is confidential I just don’t give it to anyone.”

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When the client asks about the family of the nurse, the MOST appropriate response is:  B. Give a brief and simple response and focus on the client.

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When the nurse is asked a personal question, which of these reactions indicates a need for her to introspect?  D. Some patients are like children in seeking recognition from the nurse.

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It is 10 o’clock on your watch. The client asks, “What time is it?” The nurse’s appropriate is:  B. “It is 10 o’clock.”

SCHIZOPHRENIA Situation: 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. 

The past history of Camila would most probably reveal that her premorbid personality is:  A. schizoid

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

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

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Camila’s indifference toward the environment is a compensatory behavior to overcome:  C. Narcissistic behavior

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Schizophrenia is a:  C. psychosis

CARE OF THE ELDERLY Situation: 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. 

The nurse counsels Salome’s daughter that Salome’s becoming very loud and tendency to become aggressive is a/an:  C. overcompensation for hearing

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A nursing diagnosis for Salome is:  A. sensory deprivation

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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 function

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The daughter understood, the following ways to assist Salome meet her needs and avoiding which of the following:  D. Allowing her to take her meals alone

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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:  D. audible level

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In planning care for a patient with Parkinson’s disease, which of these nursing diagnoses should have priority?  A. potential for injury

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A healthy adaptation to aging is primarily related to an individual’s…  C. Physical health throughout life

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The frequent use of the older client’s name by the nurse is MOST effective in alleviating which of the following responses to old age?  D. Confusion

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An elderly confused client gets out of bed at night to go to the bathroom and tries to go to another bed when she returns. The MOST appropriate action the nurse would take is to:  A. Assign client to a single room

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An elderly who has lots of regrets, unhappy and miserable is experiencing:  B. Despair

LEGAL ISSUES Situation: 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. 

It is unethical to tell one’s friends and family members data about patients because doing so is a violation of patients’ rights to:  B. Confidentiality

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

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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 hours

NURSING CARE PLAN 

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

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Nursing care plans provide very meaningful data for the patient profile and initial plan because the focus is on the:  D. Step by step procedures for the management of common problems

ENURESIS Situation: Marie is 5½ years old and described by the mother as bedwetting at night.  Which of the following is the MOST common physiological cause of night bed wetting?  A. deep sleep factors  All of the following, EXCEPT one compromise the concepts of behavior therapy program.  B. extinction  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:  C. sympathize for the child  A therapeutic verbal approach that communicates strong disapproval is:  C. “If you bed wet, you will change your bed linen and wash the sheets.”

 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. AGGRESSION Situation: The nurse is often met with the following situations when clients become angry and hostile. 

To maintain a therapeutic eye contact and body posture while interacting with angry and aggressive individual, the nurse should:  D. keep an “open” posture, e.g. Hands by sides but palms turned outwards

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During the pre-interaction phase of the N-P relationship, the nurse recognizes this normal INITIAL reaction to an assaultive or potentially assaultive person.  B. Display empathy towards the patient

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Which of the following is an accurate way of reporting and recording an incident?  B. “When asked about his relationship with his father, client clenched his jaw/teeth, made a fist and turned away from the nurse.”

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To encourage thought, which of the following approaches is NOT therapeutic?  A. “Why do you feel angry?”

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A patient grabs and about to throw it. The nurse best responds saying.  A. “Stop! Put that chair down.”

ORTHOPEDIC NURSING Situation: Graciela 1½ year old is admitted to the hospital from the emergency room with a fracture of the left femur due to a fall down a flight of stairs. Graciela is placed on Bryant’s traction. 

While on Bryant’s traction, which of these observations of Graciela and her traction apparatus would indicate a decrease in the effectiveness of her traction?  A. Graciela’s buttocks are resting on the bed.

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The nurse notes that the fall might also cause a possible head injury. She will be observed for signs of increased intracranial pressure which include:  B. Vomiting

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Graciela is assessed to have no head injury. The Bryant’s traction is removed. A plaster of Paris hip spica is applied. Which of these finding is a concern of immediate attention that must be reported to the physician immediately?  D. The nurse is unable to insert a finger under the edge of Graciela’s cast on her left foot.

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Part of discharge plan is for the nurse to give instructions about the care of Graciela’s cast to the mother. Which of these statements indicate that the mother understood an important aspect of cast care?  D. I will reinforce cracked areas on the cast with adhesive tape.

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The nurse counsels Graciela’s mother ways to safeguard safety while providing opportunities for Graciela to develop a sense of:  D. Autonomy

DEPRESSION Situation: Jolina is an 18 year old beginning college student. Her mother observed that she is having problems relating with her friends. She is undecided about her future. She has lost insight, lost interest in anything and complained of constant tiredness. 

Jolina is put on antidepressant drugs. These drugs act on the brain chemistry, therefore they would be useful in which type of depression?  B. neurotic depression

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This is a tricyclic antidepressant drug:  D. Imipramine (Tofranil)

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After one week of antidepressant medication, Jolina still manifests depression. The nurse evaluates this as:  C. Expected because therapeutic effectiveness takes 2-4 weeks.

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Jolina continues to verbalize feeling sad and hopeless. She is not mixing well with other clients. One of the nurse’s important considerations for Jolina INITIALLY is:  C. Encourage her to join socialization hour so she will start to relate with others.

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During the predischarge conference, the nurse suggests vocational guidance because it should help Jolina to:  C. Realistically assess her assets and limitations

GROUP APPROACH IN NURING 

Membership dropout generally occurs in group therapy after a member:  C. Experiences feelings of frustration in the group

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Which of the following questions illustrates the group role of encourager?  B. Who wants to respond next?

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The goal of remotivation therapy is to facilitate:  B. Productivity

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The treatment of the family as a unit is based on the belief that the family:  A. is a social system and all the members are interrelated components of that system

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The working phase in a therapy group is usually characterized by which of the following?  B. Cohesiveness

FUNCTIONS OF A PSYCHIATRIC NURSE Situation: The mental health – psychiatric nurse functions in a variety of setting with different types of clients. 

Poverty as reflected in prevalence of communicable diseases, malnutrition and social ills such as street children, homeless and prostitution is a predisposing factor to mental illness. A community approach to cope with this problem is for the nurse to support:  B. provision of social welfare benefits for the poor

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The MOST cost effective way to meet the mental health needs of the public is through programs with a priority goal of:  B. prevention

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Lorelie upon discharge was referred to a volunteer group where she has learned to read patterns, cut out fabric and use a sewing machine to make simple outfits that will help her earn in the future. What type of therapy is this?  C. Vocational therapy

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In a residential treatment home for adolescent girls, the clients were becoming increasingly tense and upset because of shortening of their recreation time. To de-escalate possible anger and aggression among the clients it is BEST to play:  B. relaxation music C. dance music

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The parents of special children who are behaviorally disturbed need mental health education. Which of these topics would the school nurse consider as priority for their parent’s class?  C. Effective parenting B. Child abuse

DRUG DEPENDENCE Situation: Nurses in all practice areas are likely to come in contact with clients suffering from acute or chronic drug abuse. 

The psychodynamic therapy of substance abuse is based upon the premise that drug abuse is:  B. caused by multiplicity of factors

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Being in contact with reality and the environment is a function of the:  B. ego

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Substance abuse is different from substance dependence in that, substance dependence:  D. includes characteristics of tolerance and withdrawal

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During the detoxification stage, it is a priority for the nurse to:  D. promote homeostasis and minimize the client’s withdrawal symptoms

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Commonly known as “shabu” is:  D. Methamphetamine hydrochloride

Situation: The abuse of dangerous drugs is a serious public health concern that nurses need to address. 

The nurse should recognize that the unit primarily responsible for education and awareness of the members of the family on the ill effects of dangerous drugs is the:  D. family 

A drug dependent utilizes this defense mechanism and enables him to forget shame and pain.  A.repression

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This drug produces mirthfulness, fantasies, flight of ideas, loss of train of thought, distortion of size, distance and time, and “bloodshot eyes” due to dilated pupils.  B. LSD

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The nurse evaluates that her health teaching to a group of high school boys is effective if these students recognize which of the following dangers of inhalant abuse.  A.Sudden death from cardiac or respiratory depression

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The mother of a drug dependent would never consider referring her son to a drug rehabilitation agency because she fears her son might just become worse while relating with other drug users. The mother’s behavior can be described as:  A. Unhelpful

MENTAL RETARDATION Situation: Ricky is a 12 year old boy with Down’s syndrome. He stands 5’ ½” and weighs 100 lbs. he is slim and walks sluggishly with a limp. He wears a neck brace as a support for his neck. X-ray of cervical spine showed “subluxation of C1 in relation to C2 with cord compression”. He attends a school for a special education. 

The classroom teacher consults the school nurse for guidance on how to take care of Ricky while inside of the classroom. The nurse considers as priority, Ricky’s:  C. Needs for safety and security

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Ricky’s mother visited the school nurse. She asked, “What should I do when Ricky fondles his genitalia?” An appropriate response of the nurse is for the mother to:  A. Divert Ricky’s attention and engage him in satisfying activities  The nurse had one on one health education sessions with Ricky’s mother. The mother understood that for her son to learn to cope and be independent, she should constantly provide activities for Ricky to be able to:  D. do activities of daily living All of the following activities are appropriate for Ricky EXCEPT:  B. Competitive sport Ricky’s IQ falls within the range of 50-55. he can be expected to:  C. Perform simple tasks in closely supervised settings