PNLE V Nursing Practice

The scope of this Nursing Test V is parallel to the NP5 NLE Coverage:

• Psychiatric Nursing

1. A 17-year-old client has a record of being absent in the class without permission, and “borrowing” other people’s things without asking permission. The client denies stealing; rationalizing instead that as long as no one was using the items, there is no problem to use it by other people. It is important for the nurse to understand that psychodynamically, the behavior of the client may be largely attributed to a development defect related to the:

1. Oedipal complex
2. Superego
3. Id
4. Ego

2. A client tells the nurse, “Yesterday, I was planning to kill myself.” What is the best nursing response to this cient?

1. “What are you going to do this time?”
2. Say nothing. Wait for the client’s next comment
3. “You seem upset. I am going to be here with you; perhaps you will want to talk about it”
4. “Have you felt this way before?”

3. In crisis intervention therapy, which of the following principle that the nurse will use to plan her/his goals?

1. Crises are related to deep, underlying problems
2. Crises seldom occur in normal people’s lives
3. Crises may go on indefinitely.
4. Crises usually resolved in 4-6 weeks.

4. The nurse enters the room of the male client and found out that the client urinates on the floor. The client hides when the nurse is about to talk to him. Which of the following is the best nursing intervention?

1. Place restriction on the client’s activities when his behavior occurs.
2. Ask the client to clean the soiled floor.
3. Take the client to the bathroom at regular intervals.
4. Limit fluid intake.

5. A young lady with a diagnosis of schizophrenic reaction is admitted to the psychiatric unit. In the past two months, the client has poor appetite, experienced difficulty in sleeping, was mute for long periods of time, just stayed in her room, grinning and pointing at things. What would be the initial nursing action on admitting the client to the unit?

1. Assure the client that “ You will be well cared for.”
2. Introduce the client to some of the other clients.
3. Ask “Do you know where you are?”
4. Take the client to the assigned room.

6. A 16-year-old girl was diagnosed with anorexia. What would be the first assessment of the nurse?

1. What food she likes.
2. Her desired weight.
3. Her body image.
4. What causes her behavior.

7. On an adolescent unit, a nurse caring to a client was informed that her client’s closest roommate dies at night. What would be the most appropriate nursing action?

1. Do not bring it up unless the client asks.
2. Tell the client that her roommate went home.
3. Tell the client, if asked, “You should ask the doctor.”
4. Tell the client that her closest roommate died.

8. A woman gave birth to an unhealthy infant, and with some body defects. The nurse should expect the woman’s initial reactions to include:

1. Depression
2. Withdrawal
3. Apathy
4. Anger

9. A client in the psychiatric unit is shouting out loud and tells the nurse, “Please, help me. They are coming to get me.” What would be the appropriate nursing response?

1. “ I won’t let anyone get you.”
2. “Who are they?”
3. “I don’t see anyone coming.”
4. “You look frightened.”

10. A client who is severely obese tells the nurse, “My therapist told me that I eat a lot because I didn’t get any attention and love from my mother. What does the therapist mean?” What is the best nursing response?

1. “What do you think is the connection between your not getting enough love and overeating?”
2. “Tell me what you think the therapist means.”
3. “You need to ask your therapist.”
4. “ We are here to deal with your diet, not with your psychological problems.”

11. After the discussion about the procedure the physician scheduled the client for mastectomy. The client tells the nurse, “If my breasts will be removed, I’m afraid my husband will not love me anymore and maybe he will never touch me.” What should the nurse’s response?

1. “I doubt that he feels that way.”
2. “What makes you feel that way?”
3. “Have you discussed your feelings with your husband?”
4. Ask the husband, in front of the wife, how he feels about this.

12. The child is brought to the hospital by the parents. During assessment of the nurse, what parental behavior toward a child should alert the nurse to suspect child abuse?

1. Ignoring the child.
2. Flat affect.
3. Expressions of guilt.
4. Acting overly solicitous toward the child

13. A nurse is caring to a client with manic disorder in the psychiatric ward. On the morning shift, the nurse is talking with the client who is now exhibiting a manic episode with flight of ideas. The nurse primarily needs to:

1. Focus on the feelings conveyed rather than the thoughts expressed.
2. Speak loudly and rapidly to keep the client’s attention, because the client is easily distracted.
3. Allow the client to talk freely.
4. Encourage the client to complete one thought at a time.

14. The nurse is caring to an autistic child. Which of the following play behavior would the nurse expect to see in a child?

1. competitive play
2. nonverbal play
3. cooperative play
4. solitary play

15. The client is telling the nurse in the psychiatric ward, “I hate them.” Which of the following is the most appropriate nursing response to the client?

1. “Tell me about your hate.”
2. “I will stay with you as long as you feel this way.”
3. “For whom do you have these feelings?”
4. “I understand how you can feel this way.”

16. The mother visits her son with major depression in the psychiatric unit. After the conversation of the client and the mother, the nurse asks the mother how it is talking to her son. The mother tells the nurse that it was a stressful time. During an interview with the client, the client says, “we had a marvelous visit.” Which of the following coping mechanism can be described to thestatement of the client?

1. Identification.
2. Rationalization.
3. Denial.
4. Compensation.

17. A male client is quiet when the physician told him that he has stage IV cancer and has 4 months to live. The nurse determines that this reaction may be an example of:

1. Indifference
2. Denial
3. Resignation
4. Anger

18. A nurse is caring to a female client with five young children. The family member told the client that her ex-husband has died 2 days ago. The reaction of the client is stunned silence, followed by anger that the ex-husband left no insurance money for their young children. The nurse should understand that:

1. The children and the injustice done to them by their father’s death are the woman’s main concern.
2. To explain the woman’s reaction, the nurse needs more information about the relationship and breakup.
3. The woman is not reacting normally to the news.
4. The woman is experiencing a normal bereavement reaction.

19. A client who is manic comes to the outpatient department. The nurse is assigning an activity for the client. What activity is best for the nurse to encourage for a client in a manic phase?

1. Solitary activity, such as walking with the nurse, to decrease stimulation.
2. Competitive activity, such as bingo, to increase the client’s self-esteem.
3. Group activity, such as basketball, to decrease isolation.
4. Intellectual activity, such as scrabble, to increase concentration.

20. The nurse is about to administer Imipramine HCI (Tofranil) to the client, the client says, “Why should I take this?” The doctor started me on this 10days ago; it didn’t help me at all.” Which of the following is the best nursing response:

1. “What were you expecting to happen?”
2. “It usually takes 2-3 weeks to be effective.”
3. “Do you want to refuse this medication? You have the right.”
4. “That’s a long time wait when you feel so depressed.”

21. Which of the following drugs the nurse should choose to administer to a client to prevent pseudoparkinsonism?

1. Isocarboxazid (Marplan)
2. Chlorpromazine HCI (Thorazine)
3. Trihexyphenidyl HCI (Artane)
4. Trifluoperazine HCI (Stelazine)

22. The nurse is caring to an 80-year-old client with dementia? What is the most important psychosocial need for this client?

1. Focus on the there-and-then rather the here-and-now.
2. Limit in the number of visitors, to minimize confusion.
3. Variety in their daily life, to decrease depression.
4. A structured environment, to minimize regressive behaviors.

23. A client tells the nurse, “I don’t want to eat any meals offered in this hospital because the food is poisoned.” The nurse is aware that the client is expressing an example of:

1. Delusion.
2. Hallucination.
3. Negativism.
4. Illusion.

24. A client is admitted in the hospital. On assessment, the nurse found out that the client had several suicidal attempts. Which of the following is the most important nursing action?

1. Ignore the client as long as he or she is talking about suicide, because suicide attempt is unlikely.
2. Administer medication.
3. Relax vigilance when the client seems to be recovering from depression.
4. Maintain constant awareness of the client’s whereabouts.

25. The nurse suspects that the client is suffering from depression. During assessment, what are the most characteristic signs and symptoms of depression the nurse would note?

1. Constipation, increased appetite.
2. Anorexia, insomnia.
3. Diarrhea, anger.
4. Verbosity, increased social interaction.

26. The client in the psychiatric unit states that, “The goodas are coming! I must be ready.” In response to this neologism, the nurse’s initial response is to:

1. Acknowledge that the word has some special meaning for the client.
2. Try to interpret what the client means.
3. Divert the client’s attention to an aspect of reality.
4. State that what the client is saying has not been understood and then divert attention to something that is really bound.

27. A male client diagnosed with depression tells the nurse, “I don’t want to look weak and I don’t even cry because my wife and my kids can’t bear it.” The nurse understands that this is an example of:

1. Repression.
2. Suppression.
3. Undoing.
4. Rationalization.

28. A female client tells the nurse that she is afraid to go out from her room because she thinks that the other client might kill her. The nurse is aware that this behavior is related to:

1. Hallucination.
2. Ideas of reference.
3. Delusion of persecution.
4. Illusion.

29. A female client is taking Imipramine HCI (Tofranil) for almost 1 week and shows less awareness of the physical body. What problem would the nurse be most concerned?

1. Nausea.
2. Gait disturbances.
3. Bowel movements.
4. Voiding.

30. A 6-year-old client dies in the nursing unit. The parents want to see the child. What is the most appropriate nursing action?

1. Give the parents time alone with the body.
2. Ask the physician for permission.
3. Complete the postmortem care and quietly accompany the family to the child’s room.
4. Suggest the parents to wait until the funeral service to say “good-bye.”

31. A 20-year-old female client is diagnosed with anxiety disorder. The physician prescribed Flouxetine (Prozac). What is the most important side effects should a nurse be concerned?

1. Tremor, drowsiness.
2. Seizures, suicidal tendencies.
3. Visual disturbance, headache.
4. Excessive diaphoresis, diarrhea.

32. A nurse is assigned to activate a client who is withdrawn, hears voices and negativistic. What would be the best nursing approach?

1. Mention that the “voices” would want the client to participate.
2. Demand that the client must join a group activity.
3. Give the client a long explanation of the benefits of activity.
4. Tell the client that the nurse needs a partner for an activity.

33. A nurse is going to give a rectal suppository as a preoperative medication to a 4-year-old boy. The boy is very anxious and frightened. Which of the following statement by the nurse would be most appropriate to gain the child’s cooperation?

1. “Be a big kid! Everyone’s waiting for you.”
2. “Lie still now and I’ll let you have one of your presents before you even have your operation.”
3. “Take a nice, big, deep breath and then let me hear you count to five.”
4. “You look so scared. Want to know a secret? This won’t hurt a bit!”

34. A depressed client is on an MAO inhibitor? What should the nurse watch out for?

1. Hypertensive crisis.
2. Diet restrictions.
3. Taking medication with meals.
4. Exposure to sunlight.

35. A 16-year-old girl is admitted for treatment of a fracture. The client shares to the nurse caring to her that her step-father has made sexual advances to her. She got the chance to tell it to her mother but refuses to believe. What is the most therapeutic action of the nurse would be:

1. Tell the client to work it out with her father.
2. Tell the client to discuss it with her mother.
3. Ask the father about it.
4. Ask the mother what she thinks.

36. A client with a diagnosis of paranoid disorder is admitted in the psychiatric hospital. The client tells the nurse, “the FBI is following me. These people are plotting against me.” With this statement the nurse will need to:

1. Acknowledge that this is the client’s belief but not the nurse’s belief.
2. Ask how that makes the client feel.
3. Show the client that no one is behind.
4. Use logic to help the client doubt this belief.

37. A nurse is completing the routine physical examination to a healthy 16-year-old male client. The client shares to the nurse that he feels like killing his girlfriend because he found out that her girlfriend had another boyfriend. He then laughs, and asks the nurse to keep this a secret just between the two of them. The nurse reviews his chart and notes that there is no previously history of violence or psychiatric illness. Which of the following would be the best action of the nurse to take at this time?

1. Suggest the teen meet with a counselor to discuss his feelings about his girlfriend.
2. Tell the teen that his feelings are normal, and recommend that he find another girlfriend to take his mind off the problem.
3. Recall the teenage boys often say things they really do not mean and ignore the comment.
4. Regard the comment seriously and notify the teen’s primary health care provider and parents

38. Which of the following person will be at highest risk for suicide?

1. A student at exam time
2. A married woman, age 40, with 6 children.
3. A person who is an alcoholic.
4. A person who made a previous suicide attempt.

39. A male client is repetitively doing the handwashing every time he touches things. It is important for a nurse to understand that the client’s behavior is probably an attempt to:

1. Seek attention from the staff.
2. Control unacceptable impulses or feelings.
3. Do what the voices the patient hears tell him or her to do.
4. Punish himself or herself for guilt feeling.

40. In a mental health settings, the basic goal of nursing is to:

1. Advance the science of psychiatry by initiating research and gathering data for current statistics on emotional illness.
2. Plan activity programs for clients.
3. Understand various types of family therapy and psychological tests and how to interpret them.
4. Maintain a therapeutic environment.

41. A 3-year-old boy is brought to the emergency department. After an hour, the boy dies of respiratory failure. The mother of the boy becomes upset, shouting and abusive, saying to the nurse, “If it had been your son, they would have done more to save it. “What should the nurse say or do?

1. Touch her and tell her exactly what was done for her baby.
2. Allow the mother to continue her present behavior while sitting quietly with her.
3. “No, all clients are given the same good care.”
4. “Yes, you’re probably right. Your son did not get better care.”

42. The nurse is interacting to a client with an antisocial personality disorder. What would be the most therapeutic approach of the nurse to an antisocial behavior?

1. Gratify the client’s inner needs.
2. Give the client opportunities to test reality.
3. Provide external controls.
4. Reinforce the client’s self-concept.

43. A 55-year-old male client tells the nurse that he needs his glasses and hearing aid with him in the recovery room after the surgery, or he will be upset for not granting his request. What is the appropriate nursing response?

1. “Do you get upset and confused often?”
2. “You won’t need your glasses or hearing aid. The nurses will take care of you.”
3. “I understand. You will be able to cooperate best if you know what is going on, so I will find out how I can arrange to have your glasses and hearing aid available to you in the recovery room.”
4. I understand you might be more cooperative if you have your aid and glasses, but that is just not possible. Rules, you know.”

44. The male client had fight with his roommates in the psychiatric unit. The client agitated client is placed in isolation for seclusion. The nurse knows it is essential that:

1. A staff member has frequent contacts with the client.
2. Restraints are applied.
3. The client is allowed to come out after 4 hours.
4. All the furniture is removed form the isolation room.

45. A medical representative comes to the hospital unit for the promotion of a new product. A female client, admitted for hysterical behavior, is found embracing him. What should the nurse say?

1. “Have you considered birth control?”
2. “This isn’t the purpose of either of you being here.”
3. “I see you’ve made a new friend.”
4. “Think about what you are doing.”

46. A client with dementia is for discharge. The nurse is providing a discharge instruction to the family member regarding safety measures at home. What suggestion can the nurse make to the family members?

1. Avoid stairs without banisters.
2. Use restraints while the client is in bed to keep him or her from wandering off during the night.
3. Use restraints while the client is sitting in a chair to keep him or her from wandering off during the day.
4. Provide a night-light and a big clock.

47. A 30-year-old married woman comes to the hospital for treatment of fractures. The woman tells the nurse that she was physically abused by her husband. The woman receives a call from her husband telling her to get home and things will be different. He felt sorry of what he did. What can the nurse advise her?

1. “Do you think so?”
2. “It’s not likely.”
3. “What will be different?”
4. “I hope so, for your sake.”

48. A female client was diagnosed with breast cancer. It is found to be stage IV, and a modified mastectomy is performed. After the procedure, what behaviors could the nurse expects the client to display?

1. Denial of the possibility of carcinoma.
2. Signs of grief reaction.
3. Relief that the operation is over.
4. Signs of deep depression.

49. A client is withdrawn and does not want to interact to anybody even to the nurse. What is the best initial nursing approach to encourage communication with this client?

1. Use simple questions that call for a response.
2. Encourage discussion of feelings.
3. Look through a photo album together.
4. Bring up neutral topics.

50. Which of the following nursing approach is most important in a client with depression?

1. Deemphasizing preoccupation with elimination, nourishment, and sleep.
2. Protecting against harm to others.
3. Providing motor outlets for aggressive, hostile feelings.
4. Reducing interpersonal contacts.

Answers and Rationales

1. B. This shows a weak sense of moral consciousness. According to Freudian theory, personality disorders stem from a weak superego.
2. C. The client needs to have his or her feelings acknowledged, with encouragement to discuss feelings, and be reassured about the nurse’s presence.
3. D. Part of the definition of a crisis is a time span of 4-6 weeks.
4. C. The client is most likely confused, rather than exhibiting acting-out, hostile behavior. Frequent toileting will allow urination in an appropriate place.
5. D. The client needs basic, simple orientation that directly relates to the here-and-now, and does not require verbal interaction.
6. A. Although all options may appear correct. A is the best because it focuses on a range of possible positive reinforcers, a basis for an effective behavior modification program. It can lead to concrete, specific nursing interventions right away and provides a therapeutic use of “control” for the 16-year-old.
7. A. The nurse needs to wait and see: do not “jump the gun”; do not assume that the client wants to know now.
8. D. The woman is experiencing an actual loss and will probably exhibit many of the same symptoms as a person who has lost someone to death.
9. C. This option is an example of pointing out reality- the nurse’s perception.
10. B. This response asks information that the nurse can use. If the client understands the statement, the nurse can support the therapist when focusing on connection between food, love, and mother. If the client does not understand thestatement, the nurse can help get clarification from the therapist.
11. C. This option redirects the client to talk to her husband.
12. D. This is an example of reaction formation, a coping mechanism.
13. A. Often the verbalized ideas are jumbled, but the underlying feelings are discernible and must be acknowledged.
14. D. Autistic children do best with solitary play because they typically do not interact with others in a socially comprehensible and acceptable way.
15. A. The nurse is asking the client to clarify and further discuss feelings.
16. C. Denial is the act of avoiding disagreeable realities by ignoring them.
17. B. Reactions when told of a life-threatening illness stem from Kübler-Ross’ ideas on death and dying. Denial is a typical grief response, and usually is a first reaction.
18. D. Shock and anger are commonly the primary initial reactions.
19. A. This option avoids external stimuli, yet channels the excess motor activity that is often part of the manic phase.
20. B. The patient needs a brief, factual answer.
21. C. Trihexyphenidyl HCI (Artane) is often used to counteract side effect of pseudoparkinsonism, which often accompanies the use of phenothiazine, such as chlorpromazine HCI (Thorazine or Trifluoperazine HCI (Stelazine).
22. D. Persons with dementia needs sameness, consistency, structure, routine, and predictability.
23. A. This is a false belief developed in response to an emotional need.
24. D. The client must be constantly observed.
25. B. The appetite is diminished and sleeping is affected to a client with depression.
26. A. It is important to acknowledge a statement, even if it is not understood.
27. D. Rationalization is the process of constructing plausible reasons for one’s responses.
28. C. The client has ideas that someone is out to kill her.
29. D. A serious side effect of Imipramine HCI (Tofranil) is urinary retention (voiding problems)
30. A. This allows the parents/family to grieve over the loss of the child, by going through the steps of leave taking.
31. B. Assess for suicidal tendencies, especially during early therapy. There is an increased risk of seizures in debilitated client and those with a history of seizures.
32. D. The nurse helps to activate by doing something with the client.
33. C. Preschool children commonly experience fears and fantasies regarding invasive procedures. The nurse should attempts to momentarily distract the child with a simple task that can be easily accomplished while the child remains in the side-lying position. The suppository can be slipped into place while the child is counting, and then the nurse can praise the child for cooperating, while holding the buttocks together to prevent expulsion of the suppository.
34. A. This is the more inclusive answer, although diet restrictions (answer1) are important, their purpose is to prevent hypertensive crisis (answer 2).
35. D. This comes closest to beginning to focus on family-centered approach to intervene in the “conspiracy of silence”. This is therefore the best among the options.
36. A. The nurse should neither challenge nor use logic to dispel an irrational belief.
37. D. Any threat to the safety of oneself or other should always be taken seriously and never disregarded by the nurse.
38. C. The likelihood of multiple contributing factors may make this person at higher risk for suicide. Some factors that may exist are physical illness related to alcoholism, emotional factors ( anxiety, guilt, remorse), social isolation due to impaired relationships and economic problems related to employment.
39. B. A ritual, such as compulsive handwashing, is an attempt to allay anxiety caused by unconscious impulses that are frightening.
40. D. This is the most neutral answer by process of elimination.
41. B. This option allows a normal grief response (anger).
42. C. Personality disorders stem from a weak superego, implying a lack of adequate controls.
43. C. The client will be easier to care for if he has his hearing aid and glasses.
44. A. Frequent contacts at times of stress are important, especially when a client is isolated.
45. B. This response is aimed at redirecting the inappropriate behavior.
46. D. This option is best to decrease confusion and disorientation to place and time.
47. C. This option helps the woman to think through and elaborate on her own thoughts and prognosis.
48. B. It is mostly likely that grief would be expressed because of object loss.
49. D. Neutral, nonthreatening topics are best in attempting to encourage a response.
50. C. It is important to externalize the anger away from self.