Jun 27, 2010

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

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

PART 1 Board Exam test questions 1 - 50

Nov. ’08 NP 5

Situation 1: Understanding different models of care is a necessary part of the nurse patient relationship.

1. The focus of this therapy is to have a positive environmental manipulation, physical and social to effect a positive change.
A. Milieu
B. Psychotherapy
C. Behaviour
D. Group

2. The client asks the nurse about the Milieu therapy. The nurse responds knowing that the primary focus of milieu therapy can be best described by which of the following?
A. A form of behaviour modification therapy
B. A cognitive approach of changing the behaviour
C. A living learning or working environment
D. A behavioural approach to changing behaviour

3. A nurse is caring to client with phobia who is being treated for the condition. The client is introduced to short periods of exposure to the phobia object while in relaxed state. The nurse understands that this form of behaviour modification can be best described as:
A. Systematic desensitization
B. Aversion therapy
C. Self-control therapy
D. Operant conditioning

4. A client with major depression is considering cognitive therapy. The client say to the nurse, “how does this treatment works?” The nurse responds by telling the client that:
A. “This type of treatment helps you examine how your thoughts and feelings contribute to your difficulties”
B. “This type of treatment helps you examine how your past life has contributed to your problems.”
C. “This type of treatment helps you confront your fears by exposing you to the feared objects abruptly.”
D. “This type of treatment will help you relax and develop new coping skills.”

5. A client state, “I get down on myself when I make mistake.” Using Cognitive therapy approach, the nurse should:
A. Teach the client relaxation exercise to diminish stress
B. Provide the client with Mastery experience to boost self esteem
C. Explore the client’s past experiences that causes the illness
D. Help client modify the belief that anything less than perfect is horrible.

6. The most advantageous therapy for a preschool age child with a history of physical and sexual abuse would be:
A. Play
B. Psychoanalysis
C. Group
D. Family

7. An 18 year old client is admitted with the diagnosis of anorexia nervosa. A cognitive behavioural approach is used as part of her treatment plan. The nurse understands that the purpose of this approach is to:
A. Help the client identify and examine dysfunctional thoughts and beliefs.
B. Emphasize social interaction with clients who withdraw
C. Provide a supportive environment and a therapeutic community
D. Examine intrapsychic conflicts and past events in life

8. The nurse is preparing to provide reminiscence activity for a group of clients. Which of the following clients will the nurse select for this group?
A. A client who experiences profound depression with moderate cognitive impairment
B. A catatonic, immobile with moderate cognitive impairment
C. An undifferentiated schizophrenic client with moderate cognitive impairment
D. A client with mild depression who exhibits who demonstrates normal cognition

9. Which intervention would be typical of a nurse using cognitive-behavioral approach to a client experiencing stress disorders?
A. Use of unconditional positive regard
B. Classical conditioning
C. Analysis of free association
D. Examination of negative thought patterns

10. Which of the following therapies has been strongly advocated for the treatment of post traumatic stress disorders?
B. Group Therapy
C. Hypnotherapy
D. Psychoanalysis

11. The nurse knows that in group therapy, the maximum number of members to include is:
A. 4
B. 8
C. 10
D. 16

12. The nurse is providing information to a client with the use of disulfiram (antabuse) for the treatment of alcohol abuse. The nurse understands that this form of therapy works on what principle?
A. Negative Reinforcement
B. Aversion Therapy
C. Operant Conditioning
D. Gestalt therapy

13. A biological or medical approach in treating psychiatric patient is:
A. Million therapy
B. Somatic therapy
C. Behavioral therapy
D. Psychotherapy

14. Which of these nursing actions belong to the secondary level of preventive intervention?
A. Providing mental health consultation to health care providers
B. Providing emergency psychiatric services
C. Being politically active in relation to mental health issues
D. Providing mental health education to members of the community

15. When the nurse identifies a client who has attempted to commit suicide the nurse should:
A. call a priest
B. Counsel the client
C. refer the client to psychiatrist
D. refer the matter to the police

Situation 2: Rose seeks psychiatric consultation because of intense fear of flying in an airplane which has greatly affected her chances of success in her job.

16. The most common defense mechanism used by phobic client is:
A. Supression
B. Rationalization
C. Denial
D. Displacement

17. The goal of the therapy in phobia is:
A. Change her lifestyle
B. Ignore reaction producing situation
C. Change her reaction towards anxiety
D. Eliminate fear producing situation

18. The therapy most effective for clients with phobia is:
A. Hypnotherapy
B. Group therapy
C. Cognitive therapy
D. Behavior therapy

19. The fear and anxiety related to phobia is said to be abruptly decreased when the patient exposed to what is feared through:
A. Guided imagery
B. Systematic desensitization
C. Flooding
D. Hypotherapy

20. Based on the presence of symptom. The appropriate nursing diagnosis is:
A. Self esteem disturbance
B. Activity intolerance
C. Impaired adjustment
D. Ineffective individual coping                                                                                        

Situation 3: Mang Jose, 39 year old farmer, unmarried, had been confined in the National center for mental health for three years with a diagnosis of schizophrenia.

21. The most common defense mechanism used by a paranoid client is:
A. Displacement
B. Suppression
C. Rationalization
D. Projection

22. When Mang Jose says to you: “The voices are telling me bad things again!” The best response is:
A. “Whose voices are those?”
B. “I doubt what the voices are telling you.”
C. “I do not hear the voice you say you hear.”
D. “Are you sure you hear these voices?”

23. A relevant nursing diagnosis for clients with auditory hallucination is:
A. Sensory perceptual alteration
B. Altered thought process
C. Impaired social interaction
D. Impaired verbal communications

24. During mealtime, Jose refused to eat telling that the food was poisoned. The nurse considers the following except:
A. Ignore his remark
B. Offer him food in his own container
C. Show him how irrational his thinking is
D. Respect his refusal to eat.

25. When communicating with Jose. The nurse considers the following except:
A. Be Warm and enthusiastic
B. Refrain from touching Jose
C. Do not argue regarding his hallucination and delusion
D. Use simple, clear language

Situation 4: Gringo seeks psychiatric counselling for his ritualistic bahavior of counting his money as many as 10 times before leaving home.

26. An initial appropriate nursing diagnosis is:
A. Impaired social interaction
B. Ineffective individual coping
C. Impaired Adjustment
D. Anxiety Moderate

27. Obsessive compulsive disorder is BEST described by:
A. Uncontrollable impulse to perform an act or ritual repeatedly:
B. Persistent thoughts
C. Recurring unwanted and disturbing thoughts alternating with a behaviour.
D. Pathological persistence of unwilled thought, feeling or impulse

28. The defense mechanism used by persons with obsessive compulsive disorder is undoing and it is best described in one of the following statements:
A. Unacceptable feeling or behaviour are kept out of awareness by developing the opposite behaviour or emotion.
B. Consciously unacceptable instinctual drives are diverted into personally and socially acceptable channels
C. Something unacceptable already done is symbolically acted in reverse.
D. Transfer of emotions associated with a particular person, object or situation to another less threatening person, object or situation.

29. TO be more effective, the nurse who cares for persons with obsessive compulsive disorder must possess one of the following qualities:
A. Compassion
B. Consistency
C. Patience
D. Friendliness
30. Person with OCD usually manifest:
A. Fear
B. Apathy
C. Suspiciousness
D. Anxiety

Situation 3:  The patient who is depressed will undergo electroconvulsive therapy.

31.  Studies on biological depression support electroconvulsive therapy as a mode of treatment.  The rationale is:
 A.  ECT produces massive brain damage which destroys the specific area containing memories related to   the events surrounding the development of psychotic condition
B.  The treatment serves as a symbolic punishment for the client who feels guilty and worthless
C.  ECT relieves depression psychologically by increasing the norepinephrine level
D.  ECT is seen as a life-threatening experience and depressed patients mobilize all their bodily defenses
to deal with this attack.
32.  The preparation of a patient for ECT ideally is MOST similar to preparation for a patient for:
 A.  electroencephalogram                                                                          
 B.  X-ray                                                                                                                               
C. general anesthesia
D. electrocardiogram

33. Which of the following is a possible side effect which you will discuss with the patient?
A. hemorrhage within the brain                                                                                          
B. robot-like body stiffness                                                 
C. encephalitis
D. confusion, disorientation and short term memory loss

34. Informed consent is necessary for the treatment for involuntary clients. When this cannot be obtained, permission may be taken from the:
 A. social worker                                                                                                                  
 B. doctor                                                                                                                              
C. next of kin or guardian
D. chief nurse

35. After ECT, the nurse should do this action before giving the client fluids, food or medication:
A. assess the gag reflex                                                                              
B. assess the sensorium                                                                             
C. next of kin or guardian
D. check O2 Sat with a pulse oximeter

Situation 6: Mrs. Ethel Agustin 50 y/o, teacher is affected with myasthenia gravis

36. Looking at Mrs. Agustin, your assessment would include the ff except:
A. Nystagmus
B. Difficulty of hearing
C. Weakness of the levator palpebrae
D. Weakness of the ocular muscle

37. In an effort to combat complications which might occur relatives should be taught:
A. Checking cardiac rate
B. Taking blood pressure reading
C. Techniques of oxygen inhalation
D. Administration of oxygen inhalation

38. The drug of choice for her condition is:
A. Prostigmine
B. Morphine
C. Codeine
D. Prednisone

39. As her nurse, you have be cautious about administration of medication, if she is undermedicated this can cause:
A. Emotional crisis
B. Cholinergic crisis
C. Menopausal crisis
D. Myasthenia crisis

40. If you are extra careful and by chance you give over medication, this would lead to:
A. Cholinergic crisis
B. Menopausal crisis
C. Emotional crisis
D. Myasthenia crisis

Situation 7: Rosanna 20 y/0 unmarried patient believes that the toilet for the female patient in contaminated with AIDS virus and refuses to use it unless she flushes it three times and wipes the seat same number of times with antiseptic solution.

41. The fear of using “contaminated” toilet seat can be attributed to Rosanna’s inability to:
A. Adjust to a strange environment
B. Express her anxiety
C. Develop the sense of trust in other person
D. Control unacceptable impulses or feelings

42. Assessment data upon admission help the nurse to identify this appropriate nursing diagnosis
A. Ineffective denial
B. Impaired adjustment
C. Ineffective individual coping
D. Impaired social interaction

43. An effective nursing intervention to help Rosana is:
A. Convincing her to use the toilet after the nurse has used it first.
B. Explaining to her that AIDS cannot be transmitted by using the toilet
C. Allowing her to flush and clear the toilet seat until she can manage her anxiety
D. Explaining to her how AIDS is transmitted.

44. The goal for treatment for Rosana must be directed toward helping her to:
A. Walk freely about her past experience
B. Develop trusting relationship with other
C. Gain insight that her behaviour is due to feeling of anxiety
D. Accept the environment unconditionally

45. Psychotherapy which is prescribed for Rosana is described as:
A. Establishing an environment adapted to an individual patient needs
B. Sustained interaction between the therapist and client to help her develop more functional behaviour
C. Using dramatic techniques to portray interpersonal conflicts
D. Biologic treatment for mental disorder

Situation 8: Dennis 40 y/o married man, an electrical engineer was admitted with the diagnosis of paranoid disorders. He has became suspicious and distrustful 2 months before admission. Upon admission, he kept on saying, “my wife has been planning to kill me.”

46. A paranoid individual who ca not accept the guilt demonstrate one of the following defense mechanism:
A. Denial
B. Projection
C. Rationalization
D. Displacement

47. One morning, Dennis was seen tilting his head as if he was listening to someone. An appropriate nursing intervention would be:
A. Tell him to socialize with other patient to diverts his attention
B. Involve him in group activities
C. Address him by name to ask if he is hearing voices again
D. Request for an order of antipsychotic medicine

48. When he says, “these voices are telling me my wife is going to kill me.” A therapeutic communication of the nurse is which one of the following:
A. “I do not hear the voices you say you hear.”
B. “Are you really sure you heard those voices?”
C. “I do not think you heard those voices?”
D. “Whose voices are those?”

49. The nurse confirms that Dennis is manifesting auditory hallucination. The appropriate nursing diagnosis she identifies is:
A. Sensory perceptual alteration
B. Self esteem disturbance
C. Ineffective individual coping
D. Defensive coping

50. Most appropriate nursing intervention for a client with suspicious behaviour is one of the following:
A. Talk to the client constantly to reinforce reality
B. Involve him in competitive activities
C. Use of Non Judgemental and Consistent approach
D. Project cheerfulness in interacting with the patient

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