Jun 27, 2010

NP5 Nursing Board Exam June 2008 Answer Key 'Nursing Care of Client with Physiological and Psychosocial Alteration'

100 Nursing Board Exam test questions of June 2008 Nurse Licensure Examination (NLE)
Nursing Practice V – Nursing Care of Client with Physiological and Psychosocial Alteration
Medical and Surgical Nursing / Psychology

PART 2 Board Exam test questions 1 - 50

June 2008

Situation – A vehicle hit some pedestrian while waiting for a bus ride. Some of the victims suffered injuries in different part of the body. The victims were brought to the nearby hospital. One of the victims, Josephine was confirmed to have a fractured left arm. While waiting for plaster cast to be applied, Josephine appears to be anxious.

51. To reduce anxiety, the nurse teaches the procedure to the client, which of the following topics should NOT be included in the teaching plan?
     A. Leave the cast uncovered to promote drying
     B. Bear weight on the plaster for one hour. A stockinet will be placed  
     over the left arm to be placed in the cast.
     C. Handle hardening cast with palm of hands.
     D. Trim and reshape finish cast with knife or cutter.

52. Cast was applied on Josephine’s left arm. In assessing the neurovascular status of the client, which of the following assessment findings should be reported to the physician?
     A. Pain on the left arm
     B. Swelling of the fingers
     C. Skin abrasion on the edges of the plaster cast
     D. Nail bed capillary refill time of 10 seconds

53. One of the victims a sixty year old woman sustained hip fracture. Prior to surgery, a Buck’s extension traction is to be applied. The rationale of traction is primarily based the understanding that Buck’s extension traction:
     A. Reduces muscle spasms and helps to immobilize the fracture
     B. Allows reduction of the fracture site for bone healing.
     C. Secures the fracture site to prevent damage to the muscle tissues
     D. Secures the fracture site for rigid immobilization

54. Philip was placed in skeletal leg traction with an overbed frame. He is not allowed to move from side to side. Which of the following nursing interventions is useful in maintaining.
     A. Assist the client by holding the trapeze and raising hips of the bed.
     B. Check the apparatus that weights hang free and knots in the rope
     are   tied securely.
     C. Suspend a trapeze within easy reach of the client
     D. Support the affected extremity while the weights are removed.

55. To prevent complication when a child is in Buck’s traction, the nurse should:
     A. Clean the extremity and keep the skin dry
     B. Assess any skin and circulatory disturbances
     C. Clean the pin sites as necessary
     D. Provide high fiber small meals.


56. The following concept are true EXCEPT:
     A. Hostility is destructive
     B. Frustration develops in response to unmet needs, wants and desire
     C. Anger is incompatible with love
     D. Aggression can be expressed in a constructive as well as a destructive
     Manner

57. Carlo is acting out hostile and aggressive feeling by kicking the chairs in the room, the MOST effective way to deal with Carlo’s behavior is initially to:
     A. Set limits on the behavior by verbal command
     B. Administer PRN tranquilizer
     C. Remove the chairs from the room
     D. Restrain the patient and place him in the “Isolation Room”

58. Mrs. Dizon was visiting her son at the Psychiatry Ward. Which of the following items will the nurse NOT allow to brought inside the ward?
     A. String rosary bracelet
     B. Box of cake
     C. Bottle of coke
     D. Rubber shoes

59. Which of the following will probably be most therapeutic for a patient on a behavioral modification ward?
     A. If the client is agitated, discuss the feelings especially anger
     B. Insist to stop obscene language by verbal reprimand
     C. Give client support and positive feedback for controlling use of  
     obscene language.
     D. Provide a punching bag as an alternative to express upset emotions.

60. Which of the following must be considered while planning activities for the depressed client?
     A. Activities which require exertion of energy
     B. Challenging activities to get him out of his depression
     C. Structured activities that the client can participate
     D. Variety of unstructured activities

Situation - The nurse works with Mina to help her work through termination of the nurse-patient relationship.

61. Preparation for termination of the nurse-patient relationship begins during the:
     A. termination phase                                    
     B. working phase
     C. pre-orientation phase                                           
     D. orientation phase

62. Mina’s past reactions to ending relationships is withdrawal. The nurse assists her to practice better ways of coping termination by providing opportunities to:
      A. test new patterns of behavior                               
      B. plan for alternatives                    
      C. conceptualize her problem                       
      D. value and find meaning in experience

63. During the early part of the interaction, the nurse asked after a period of silence. “Perhaps we would talk about my leaving”. The nurse utilized which communication technique:
      A. encouraging                                                        
      B. suggesting
      C. focusing on client                                                
      D. understanding

64. The longest and the most productive phase of the NPR is:
     A. Termination phase
     B. Working phase
     C. Pre-orientation phase
     D. Orientation phase                                     

65. The objection of the nurse-patient relationship is to provide an opportunity of the patient to:
      A. clarify problems                                                         
      B. develop insights                                                  
      C. have a corrective emotional experience
      D. develop interpersonal relationship

Situation - As a program manager, the mental health psychiatric nurse is tasked to provide general patient management.

66. The nurse is aware that identifying the aspects of general patient management and identifying interventions for meeting these basic needs are distinctions of:
     A. psychotherapy                                                     
     B. therapeutic milieu                                 
     C. pharmacotherapy             
     D. behavior therapy

67. In order to get active participation of the clients to carry out the objective of the program, it is BEST for the nurse to conduct a/an:
     A. community meeting                                          
     B. survey                                                    
     C. observation         
     D. selective interview of patients

68. Through the nurse’s role modeling of effective communication, the clients learned new ways of dealing with authority figures. This gives the clients a venue to:
     A. communicate                                                       
     B. socialize                                      
     C. identify their problems                  
     D. test new patterns of behavior

69. This element of communication facilitates evaluation of the program:
     A. receiver                                                              
     B. message                                                             
     C. sender
     D. feedback
              
70. The nurse’s style of leadership in milieu therapy is:
     A. autocratic                                                            
     B. laissez-faire                                                         
     C. democratic
    D. benevolent

Situation - Loretta is a 28 years old, unemployed patient, admitted to the psychiatric unit with a diagnosis of chronic undifferentiated schizophrenia. She described herself as the “Virgin Mary” and her mission is to propagate peace. She was observed laughing and talking to herself. Her thought processes were profoundly disorganized. She was also fearful and suspicious of others.

71. Loretta’s claim of being the “Virgin Mary” is a/an:
     A. imagination                                                          
     B. delusion                                                             
    C. hallucination
     D. obsession

72. Her mission to propagate peace is:
     A. a serious call for a need of transformation              
     B. an attempt to overcome low self-esteem          
     C. realistic and laudable
     D. an advocacy that she can participate in

73. Which of this intervention would NOT be therapeutic in decreasing Loretta’s anxiety?
     A. joke about her thought to help her feel at ease
     B. listen to her thoughts and feelings
     C. simply accept
     D. do not convince her that her perception is unreal

74. The nurse evaluates that Loretta’s ready for a rehabilitation program when she:
     A. approaches the nurse at frequent intervals      
     B. ceases to talk about “Virgin Mary”        
     C. goes to the coffee shop alone more often
     D. carries a book “The Purpose Driven Life”

75. The nurse is leading a group meeting of patients to prepare them to be discharged. An appropriate goal for the group members is to develop:
     A. attitudes of society towards the mentally ill
     B. skills for maintaining daily living
     C. awareness of interpersonal patterns of interactions
     D. insight into personal problems

Situation - A group of adult chronic schizophrenic patients were recommended to undergo social skills training.

76. The following are the objectives of a social skills training program EXCEPT:
     A. explore deep seated intrapsychic conflicts             
     B. practice skills in relating with people                          
     C. help build self esteem and self confidence
      D. develop and practice general coping skills

77. Social skills training is NOT primarily indicated for psychiatric patients who are:
     A. in acute stage of illness
     B. having difficulties starting and maintaining interpersonal relationships
     C. having chronic episodes of stress and anxiety while interacting with others
     D. experiencing recurrence of symptoms in front of particular people or among
     people in general

78. The focus of the group interaction is “here and now”. An appropriate topic would be:
     A. ways to celebrate Valentine’s Day in February
     B. how to spend the summer vacation
     C. an unforgettable experience as a child
     D. how to tell a joke

79. An appropriate technique for the participants to practice how to communicate effectively is through/a:
     A. lecture                                                                
     B. seminar                                                               
     C. role play
     D. psychodrama

80. Considering that it is BEST to learn by example, it is MOST practical to:
     A. model good social skills throughout the session
     B. relate successful past experiences
     C. invite a resource person
     D. watch a movie

Situation - Andy, 30 years old, was admitted to the Psychiatric Ward because of religious preoccupation, deterioration in self-care and disturbed thoughts. He believes that he has committed a lot of sins. He is threatened by people reaching out to him. His fasting for several days was not sufficient for him to feel forgiven.

81. Andy is demonstrating:
     A. religious delusion                                             
     B. delusion of grandeur                     
     C. somatic delusion  
     D. delusion of being controlled

82. A delusion is:
     A. psychomotor disturbance                                 
     B. mood disturbance 
     C. disturbance of thought
     D. disturbance of perception

83. The nursing goal for Andy is to:
       A. have him see a priest for confession
       B. encourage him to pray to atone for his sins
       C. help him develop a positive self image
       D. socialize him with a group to keep him in touch with reality

84. As Andy talks about his sins that he believes make people look down upon him. It is BEST to:
       A. agree with him and sympathize how sinful he has really been
       B. explore the nature of his sins
       C. explain that he is depreciating himself too much
       D. acknowledge how he feels and focus on reality oriented topics

85. Which of the following drugs will most likely to decrease Andy’s hallucination?
     A. Chlorpromazine (Thorazine)
     B. Chlomipramine (Anafranil)
     C.  Fluoxetine (Prozac)
     D. Carbamazepine (Tegretol)

86. Which of this client situation appropriately illustrate horticulture therapy?
     A. the therapist brings bongos, tambourine, and bells and encourages client
     participation
     B. Tommy, Karen, Jon and Pia play scrabble every night after supper
     C. every afternoon, Vic goes in the garden where he work with plants,
     seedlings, tree planting and watering them
     D. Paul finds sketching relaxing and rewarding

87. The beginning professional nurse can do mental health counseling with the following clients EXCEPT:
     A. Actively psychotic patients
     B. Out of school adolescents
     C. Parents with child rearing concerns
     D. School children with behavioral problem

88. A professional responsibility of the mental health psychiatric nurse is to provide a safe and therapeutic environment. This is BEST reflected in:
     A. restraining patients who violates policies and do not follow schedule of
     activities.
     B. maintaining a closed door policy to prevent patients from absconding.
     C. keeping a restrictive environment to prevent patients from becoming
     assaultive and hostile
     D. ensuring physical safety and maintaining therapeutic attitude
     towards the patients

89. The foundation of the therapeutic process is the therapeutic relationship. What is the essential component that the nurse must bring to the relationship?
     A. humor                                                     
     B. empathy                                                                   
     C.  reframing 
     D. confrontation
    
90. Which of these people, the highest in population groups that would need priority mental health therapy?
     A. adults going through active skills                               
     B. single elderly with no social support          
     C. young professionals entering the workplace
     D. women preparing for overseas employment

Situation - The nurse observed that Marie, age 28 years old had not been participating in activity therapies.

91. Which of the following remarks from the nursing attendants indicates a need for further teaching and observation?
      A. Marie made no response to an invitation to play
      B. Marie preferred to sit at the bench and watch the ballgame
      C. Marie is aloof and indifferent to co-patients
      D. Marie read a book while other patients played a ballgame

92. Marie said “I don’t like to be a part of it. Look, they are being laughed at because they are singing and acting like children”. The nurse notes that in order for the activity therapy to be therapeutic:
      A. the staff should decide solely what activities to be done and what rules
      apply
      B. patients should be allowed solely to decide what they want to do on their
      own
      C. ballgames should be limited to male patients only
      D. age and needs of patient should be considered in the choice of
      games

93. To encourage active participation among patients, it is BEST to plan activities they can engage in through a:
      A. one to one interaction                                           
      B. community meeting                                             
      C. checklist
      D. feedback evaluation forum

94. In planning activities for the patients, it is essential to consider FOREMOST:
      A. safety and security                                           
      B. variety and fun                                       
     C. novelty and creativity       
     D. excitement and challenge

95. Adults, “ singing and acting like children” is a form of:
      A. displacement                                                      
      B. regression                                            
     C. sublimation          
     D. compensation

Situation – Nursing care for the elderly

96. In planning care for a patient with Parkinson’s disease, which of these nursing diagnoses should have priority?
A. potential for injury
B. altered nutritional state
C. ineffective coping
D. altered mood state

97. 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?
A. Loneliness
B. Suspicion
C. Grief
D. Confusion

98. An elderly who has lots of regrets, unhappy and miserable is experiencing:
A. Crisis
B. Despair              
C. Loss
D. Ambivalence

99. The pre-morbid personality of a schizophrenic elderly client is:
A. Schizoid
B. Extrovert
C. Ambivert
D. Cycloid

100. Schizophrenia is a/an:
A. Anxiety disorder
B. Neurosis
C. Psychosis
D. Personality disoder

CLICK HERE PART 1 (1 - 50) 'NP5 Nursing Care of Client with Physiological and Psychosocial AlterationMedical and Surgical Nursing / Psychology'

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