COMPREHENSIVE EXAMINATION

NURSE LICENSURE NOV. 2008 NURSING PRACTICE V SET A

NURSING PRACTICE V: CARE OF CLIENT WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATION C GENERAL INSTRUCTIONS: 1. This test booklet contains 100 test questions. 2. Read INSTRUCTIONS TO EXAMINEES printed on your answer sheet. 3. Shade only one (1) box for each question on your answer sheets. Two or more boxes shaded will invalidate your answer. 4. AVOID ERASURES. 5. This is PRC property. Unauthorized possession, reproduction, and/or sale of this test is punishable by law. Per RA 8981.

INSTRUCTIONS: 1. 2. 3. Detach one (1) answer sheet from the bottom of your Examinee ID/Answer Sheet Set. Write the subject title Nursing Practice V on the box provided. Shade Set Box A on your answer sheet if your test booklet is Set A; Set Box B if your test booklet is Set B.

SITUATION: Mastery of Psychotropic medications is necessary for the therapeutic improvement in the health of the psychiatric clients. 1. Lithium is only given: A. P.O 2. B. IM C. IV D. SQ

The nurse should expect that a client who cheeks the medication is a non-complaint patient. Knowing the non compliance is the single most important factor for exacerbation and rehospitalisation, the doctor ordered Prolixin [Fluphenazine Decanoate]. The nurse knows that is it given: A. Orally B. Sublingually C. IV D. IM

3.

Which of the following is an antidepressant? A. Serenace (Haloperidol) B. Valium (Diazepam) C. Tofranil (Imipramine HCl) D. Trilaton (Pherpenazine)

4.

The nurse knows that the relationship between sodium and lithium is that: A. When lithium increases, sodium also increases B. When sodium increases, lithium also increases C. They are inversely proportional D. They are directly proportional

5.

Which of the following class of antidepressant is the least sedating? A. SSRI B. MAOI C. TCA D. Neuroleptics

SITUATION: A nurse is working with an aggressive client in the psychiatric unit.

6.

All of the following concepts are true EXCEPT:

A. Hostility is destructive B. Frustration develops in response to unmet needs, wants and desire C. Anger is always incompatible with love D. Aggression can be expressed in a constructive as well as a destructive manner. 7. Carlo is acting out hostile and aggressive feeling by kicking the chairs in the room. the MOST effective way to deal with Carlos 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 8. Mrs. Dizon was visiting her son at the Psychiatry Ward. Which of the following items will the nurse not allow to be brought inside the ward? A. String rosary bracelet B. Box of cake 9. C. Bottle of coke D.Rubber shoes

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

10. Which of the following must be considered while planning activities for the depressed patient? 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 11. To maintain a therapeutic eye contact and body posture while interacting with angry and aggressive individual, the nurse should: A. B. C. D. Keep an eye contact while staring at the client Keep his/her hands behind his/her back or in ones pockets Fold his/her arms across his/her chest Keep an open posture, e.g. Hands by sides but palms turned outwards

12. A patient in the ward suddenly slapped you in the face and spitted on your face and is obviously agitated and violent. Which of the following is the best nursing action? A. Tell the client: Because of that, you are not going to eat your lunch, dinner and breakfast anymore. B. Slap the client back and say I am your nurse, you are a patient and you have no right to hurt me. C. Prepare a 5 member team to restraint the client D. Respond by saying You are losing control of yourself, you slapped me and you spitted on me and you are way out of control 13. Which of the following is an accurate way of reporting and recording an incident? A. When asked about his relationship with his father, client became anxious. B. When asked about his relationship with his father, client clenched his jaw/teeth, made a fist and turned away from the nurse. C. When asked about his relationship with his father, client was resistant to respond D. When asked about his relationship with his father, his anger was suppressed

14. To encourage thought, which of the following approaches is NOT therapeutic? A. Why do you feel angry? B. When do you usually feel angry? C. How do you usually express anger? D. What situations provoke you to be angry?

15. A patient grabs and about to throw it. The nurse best responds saying. A. B. C. D. Stop! Put that chair down. Dont be silly. Stop! The security will be here in a minute. Calm down.

SITUATION: Client government is essential and building the foundation of improving the patients adaptation to different environmental settings. 16. In psychiatric hospital setting, a community means: A. Group of families living together in a common environment B. People sharing same beliefs, attitude and values C. The whole hospital, its staff, nurses, patients, students, workers, employees, guards and everyone that makes the hospital a safe and living environment D. It consists of staff, patients or student nurses on duty in the treatment setting 17. Which of the following accurately describes the client government? A. These are communities led by group of patients as officers B. This is a form of the manipulation of the physical environmental setting C. These are communities led by staff nurses and physicians as officers D. Government officials from the baranggay or municipality lead patients in the therapeutic milieu 18. Which of the following determines the success of client government groups? A. Willingness of psychiatric professionals to be open and receptive to clients ideas and suggestions B. A way of permitting clients provide themselves with a more creative and wholesome life C. Means to acquire a variety of social skills D. Opportunity to learn democratic living 19. The heart of the client government as well as the therapeutic milieu is: A. Community meeting B. Survey C. Observation D. Selective interview of patients

20. 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 Bhavior therapy

21. 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

22. Through the nurses 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

23. Which of the following is basic and the most important quality that a therapeutic milieu should possess as in client government? A. Contract, rules and regulation B. Consistency, trust and efficacy 24. The nurses style of leadership in milieu therapy is: A. Autocratic B. Laissez-faire C. Democratic D. Benevolent C. Communication and Good relationships D. Safety

25. In a client government therapy, which of the following best describes remotivation therapy? A. Helping the client achieve sense of accomplishment by making handicrafts like wallet or bags or performing activities such as art and music to distract themselves from self defeating thinking. B. It is focused on teaching acceptable social behaviours such as dressing, table manners, conversation initiations, paying bills and other activities of social living. C. It is a reward and punishment therapy. The patient is rewarded or given a token whenever a positive attitude has been performed. D. This therapy focuses on enhancing the patients social skills such as communication skills, humour and jokes, developing non verbal social skills and developing listening skills. SITUATION: A group of adult chronic schizophrenic patients were recommended to undergo social skills training. 26. The following are the objectives of a social skills training program EXCEPT: A. Explore deep seated intrapsychic conflicts B. Help build self esteem and self confidence C. Practice skills in relating with people D. Develop and practice general coping skills 27. 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 28. The focus of the group interaction is here and now. An appropriate topic would be: A. ways to celebrate Valentines Day in February B. how to spend the summer vacation C. an unforgettable experience as a child D. how to tell a joke 29. An appropriate technique for the participants to practice how to communicate effectively is through/a: A. Lecture C. Role play B. Seminar D. Psychodrama 30. 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: The nurse works with Mina to help her work through termination of the nurse-patient relationship. 31. Preparation for termination of the nurse-patient relationship begins during the: A. Termination phase B. Working phase C. Pre-orientation phase D. Orientation phase

32. Minas 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

33. 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

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

35. 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: Mr. David is brought to the hospital due to pain radiating to the hip and leg. He is diagnosed with a herniated lumbar disk. He is scheduled for myelogram. 36. After the procedure, the nurse must include which of the following nursing action in his care? A. Assess for movement and sensation of the lower extremity B. Place the client in most comfortable position C. Lying supine with heels flexed D. Bed rest with bed elevated at 45 degrees 37. Mr. David is scheduled for lumbar laminectomy. Post operatively the nurse should: A. Logroll the client with the help of another nurse B. Inform the client that he should be in supine position C. Assess the sensory loss in his legs D. Instruct the patient to move from side to side 38. Trimethobenzamine Hydrochloride (Tigan) was administered postoperatively. The action of this drug is effective when it: A. Controls nausea B. Controls pain C. Controls muscle spasm D. Controls edema

39. Mr. David is to ambulate for the first time following surgery. What nursing action should be BEST when the client begins to faint?

A. Get another nurse for help B. Maneuver the client to a sitting position C. Get back to his bed and place in side lying position D. Assist the client to form a wide base of support and lean against the nurse 40. Mr. David has to wear back brace. Which position is recommended when the brace is applied? A. Sitting position B. Standing position SITUATION: Nursing care for the elderly 41. In planning care for a patient with Parkinsons disease, which of these nursing diagnoses should have priority? A. Potential for injury B. Altered nutritional state C. Ineffective coping D. Altered mood state C. Lying on his side in bed D. Supine position in bed

42. The frequent use of the older clients 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

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

44. The premorbid personality of an schizophrenic elderly client is: A. Schizoid B. Extrovert 45. Schizophrenia is a/an: A. Anxiety disorder B. Neurosis C. Psychosis D. Personality disorder C. Ambivert D. Cycloid

SITUATION: Margie has been diagnosed with Bipolar I disorder. The client demonstrates extreme psychomotor agitation, flight of ideas, loud talking and elated mood. 46. The doctor ordered lithium. You know that this is indicated in patients with: A. Depression B. Mania 47. Lithium has a narrow therapeutic range of: A. 0.1 to 1.0 mEq/L B. 0.6 to 1.2 mEq/L C. 10 to 50 mEq/L D. 50 to 100 mEq/L C. Schizophrenia D. Anxiety disorders

48. Which of the following is a side effect of lithium toxicity? A. Anuria B. Oliguria C. Sudden burst of muscle strength D. Polyuria

49. What specimen is taken from a client when checking the lithium level of the body? A. Blood B. Stool C. Urine 50. Which of the following is NOT a drug use to augment lithium toxicity? A. Urea B. Mannitol C. Aminophylline D. Sweat D. Acetylcysteine

SITUAION: The therapeutic communication is one of the most essential skill a nurse should use in ANY health care settings. Best responses are always dependent on the clients message. 51. Jacob, is a client with hypochondriasis verbalized Ang sakit sakit! Nakakaramdam ako ng sakit! The nurses best response is: A. Nasaan ang masakit sayo? B. Pwede mo ba saking inguso kung ano ang sumasakit? C. Huwag mo masyadong isipin yang sakit mo, Guni guni mo lamang yan D. Sabihin mo sakin, ano ang nararamdaman mo at paki turo gamit ang isang daliri kung saan mo ito nararamdaman. 52. One morning, Jacob stated Halimaw! Halimaw! Halimaw ka nurse! this is a sign of: A. Neurosis B. Psychoses C. Joke D. Hallucination

53. The nurses best response when Jacob shouts Halimaw ka nurse! is: A. Maari mo ba saking sabihin paano akong naging halimaw? B. Nawawalan ka na ng kontrol sa sarili mo Jakob C. Hindi ka nanaman siguro nabigyan ng nurse ng pang pa kalma mo D. Hindi ako halimaw Jakob, ako ay ang iyong nurse. 54. When the nurse entered another clients room, Rodrigo, he said leave me alone and stop bothering me and I dont want your pity. The following response by the nurse would be MOST appropriate? A. You seem upset this morning and remains with the client B. You are probably upset because you dont feel well C. Why you angry with me? What did I do anything to upset you? D. I understand and will leave you for a while 55. The nurse understands that the use of self awareness is a therapeutic alliance because: A. The nurse is a role model for a client B. This is an essential part of the nursing process C. The nurse has to be therapeutic at all times D. How the nurse thinks and feels affects her actions and behavior towards her client and her work SITUATION: Bernie and John in their late 40s have been married for 20 years and at the peak of their careers. Suddenly, Bernie discovered that her husband was falling in love with another woman. Shaken by this situation, she started to have problems sleeping and could not function well at work and at the risk of losing her job. John asked forgiveness and regret very much the hurt his wife was going through and suffered guilt feelings: 56. Bernie and John are going through a: A. situational crisis B. developmental crisis 57. All of these are characteristics of crisis EXCEPT: A. a hazardous or threatening event occurs B. it has a growth promoting potential C. usual problem solving methods and coping mechanisms produce a solution D. anxiety or depression continue to increase C. anticipated crisis D. both developmental and situational crisis

58. The nurse employs this approach in crisis intervention: A. problem-solving B. behavior modification C. role-playing D. nurse-patient relationship

59. Assessment data of the nurse include all the following EXCEPT: A. coping mechanisms B. situational support C. perception of the event D. repressed problems

60. The duration of crisis usually lasts several days and usually: A. 2 4 weeks B. 1 2 weeks C. 1 2 months D. 4 6 weeks

SITUATION: Felisa has a ritualistic pattern of constantly washing her hands with soap and water followed by rubbing alcohol. 61. This behavior is categorized as: A. Delusional B. Normal 62. A therapeutic intervention in this situation is: A. Avoid limits on her behavior to release her anxiety B. Call attention to her ritualistic pattern C. Provide alternative behaviors to deal with increased anxiety D. Ignore her behavior totally 63. The anxiety of Felisa is disabling and interferes with her job performance, interpersonal relationships and other activities of daily living. To minimize such problems, she is likely to be given: A. Diazepam ( Valium ) B. Haloperidol ( Haldol ) C. Imipramine Hcl ( Tofranil ) D. Chlorpromazine ( Thorazine ) C. Neurotic D. Psychotic

64. Felisa understands the effects of her medicine when expresses: A. I should watch out for signs of sore lips or sore throat B. I might have constipation C. I might feel changes in my body temperature D. I should not drive or operate machines 65. The level of anxiety that Felisa is experiencing is: A. Panic B. Severe C. Mild D. Moderate

66. Which of the following is the difference between obsession and compulsion? A. Obsession are recurrent, persistent, intrusive and unwanted thoughts images or impulses while compulsions are ritualistic and repetitive behaviours or actions. B. Obsession is not repetitive while compulsion is repetitive. C. Compulsions are recurrent, persistent, intrusive and unwanted thoughts images or impulses while Obsessions are ritualistic and repetitive behaviours or actions. D. The patient can control obsessions but cannot control the compulsions. 67. Which psychomodality is recommended for clients with OCD?

A. Behavior therapy B. Systematic desensitization

C. Cognitive therapy D. Aversion therapy

68. Which of the following is the drug of choice for people suffering from OCD? A. Clomipramine ( Anafranil ) B. Diazepam ( Valium ) C. Chlordiazepoxide ( Librium ) D. Oxazepam ( Serax )

69. The performance of rituals is a mechanism that a person with OCD uses in order to protect him from feelings of: A. Inadequacy B. Loneliness C. Anxiety D. Stress

70. All of these are therapeutic interventions EXCEPT: A. Impose limits every time the behavior becomes repetitive B. Establish a routine for him C. Assign task that can be done repetitively D. Facilitate self-expression SITUATION: Mr. Sison has been diagnosed as having early chronic glaucoma. He has been admitted to the hospital for treatment. 71. The nurse identified a nursing problem of disturbed sensory perception: visual impairment characterized by: A. Sudden loss of eyesight B. Loss of night vision C. Loss of peripheral vision D. Loss of central vision

72. In order to understand the rationale for drug therapy, it is important for the nurse to know that glaucoma is usually caused by: A. Opacity in the lens B. Gradual diminution of the retina C. Damage to the proteins in the lens D. Increase production of aqueous fluid

73. Diamox is a drug used in the treatment of glaucoma. Which of these is the effect of this drug? A. Constricts the pupil B. Acts as osmotic diuretic C. Reduces the production of aqueous humoR D. Facilitates outflow of aqueous humor

74. Public health nurses should identify which of these patients as a risk group for development of glaucoma, hence the need for annual eye examinations: A. Patient with Parkinsons disease B. Cancer patients C. Diabetic and hypertensive patients D. Patient with COPD

75. The appropriate method of instilling eye drops is: Instilling into an opened eye, with the head held back and with the eye looking: A. Upward B. Downward C. Aggressiveness D. Suspiciousness

SITUATION: A nurse was interested to study the research question: What are thedifferences and similarities between aggressive and non-aggressive cognitively impaired, elderly, institutionalized people? 76. Investigation of cognitively impaired individual presented some ethical dilemmas. Which of the following protocol would be considered unethical? A. Recording interaction with the elderly with their permission B. Verbal permission from the subject is unnecessary C. Data coded and recorded solely by the investigation D. A written consent from the institution and a significant other

77. Semi-structured interview was conducted. This means that: A. Interview is conducted precisely in the same manner B. Interviewer is not held to any specific question C. Subject is allowed to express without any suggestion from interviewer D. Interviewer is free to probe beyond a number of specific major questions 78. The type of study conducted is: A. Descriptive B. Quasi-experimental C. experimental D. case study

79. The review of literature included reference to retrospective studies. Such studies have the advantages EXCEPT: A. B. C. D. Data are inexpensive to obtain Possibility of memory bias and distortion of fact There is much material available It is easy to get data

80. The average age of the respondents was 86. this represents: A. The sum ages divided by total number of participants B. The youngest participant is 86 years old C. The oldest participant is 86 years old D. Most of the number participant is 86 years old SITUATION: The surgical setting is created in order to provide a safe and therapeutic environment in patient undergoing surgical intervention. 81. The surgical suite is created in such way that it divides the suite into 3 main areas namely, the restricted, semi restricted and the unrestricted areas and this is for one ultimate goal, and that is: A. The prevention of cross contamination from one area to another B. To optimize the environment for patients recovery C. To delineate the areas for maximum efficiency D. To improve procedure techniques and enhance accuracy and speed of operations 82. Microorganism grows the fastest in a temperature of 37 degree Celsius. The nurse knows that the temperature in the procedure room should be maintained within the range of: A. 26 to 28 Degrees Celsius B. 20 to 24 Degrees Celsius C. 30 to 34 Degrees Celsius D. 0 to 8 Degrees Celsius

83. Which of the following gear is expected that the nurse should wear in the semi-restricted area? A. Scrub suit, OR shoes, head cap B. Head cap, scrub suit, mask, OR shoes 84. What OR attires are worn in the restricted area? A. Scrub suit, OR shoes, head cap B. Head cap, scrub suit, mask, OR shoes 85. Which of the following is NOT an OR Attire? A. Scrub Suit B. Surgical Mask C. Shoe covers D. Gloves C. Mask, OR shoes, scrub suit D. Cap, mask, gloves, shoes C. Mask, OR shoes, scrub suit D. Cap, mask, gloves, shoes

86. According to the three concept zone of the surgical suite design, the dressing rooms are located in the: A. Restricted area C. Semirestricted area B. Clean area D. Nonrestricted area 87. The following techniques illustrates the concept confine and contain EXCEPT:

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A. Contaminated items like sponges are handled using Gloves B. All blood tissue, and body fluid specimens should be placed in leak-proof containers C. Surgeons conduct their patients rounds in scrub suit D. Prompt cleanup of accidental spills of contaminated debris e.g. blood, body fluids 88. The OR is a restricted area where OR attire is worn. Temperature and humidity are set for patient and personnel safety and reduce bacterial contamination. During the surgery, movement of personnel including the circulating nurse is: A. Kept to minimum B. Eliminated when possible C. Restricted D. Monitored

89. The humidity in the operating room is set in the recommended level to reduce contamination. The range of humidity is always set at: A. 90-100% B. 2-10% C. 50-55% D. 20-25%

90. Which of the following is not a PPE? A. Cover gown B. Eyewear C. Gloves D. Face Shields

SITUATION: Knowledge of anaesthetics is required in providing safe and efficient operative care. 91. Where will the spinal anaesthesia be injected? A. It is injected directly on the spinal cord to provide immediate effect B. It is injected directly into the CSF within subarachnoid space C. It is injected into the epidural space D. It is directly injected between the dura and the pia matter 92. The nurse knows that in both spinal and epidural anaesthesia, the patient is placed in what position? A. Knee-chest or lateral decubitus B. Sims position C. Prone position D. Trendelenburg position

93. The most common side effect of both the epidural and spinal anaesthesia is: A. Total spinal anaesthesia B. Postspinal headache C. Nausea and vomiting D. Hypotension

94. A regional anesthesia technique especially useful in labor and delivery is: A. Epidural B. Spinal C. Nerve block D. Intravenous block

95. Epinephrine is used in adjunct with different local anaesthetics. Why is this so? A. To prevent shock from bradycardia B. To prevent the respiratory depression caused by anesthesia C. It produces vasoconstricting effects, leading to control in bleeding D. To increase the clients blood pressure thereby preventing hypotension SITUATION: Knowledge of sutures and needles used in the operating room is essentially needed in providing safe and efficient operating room care. 96. Sizes of sutures denotes the diameter. The physician will perform a corneal transplant and will suture the eye. The nurse will prepare which of the following suture size? A. 7 B. 5 C. 3 D. 9-0

97. Who holds the packet flaps of sutures to open it and place it in the sterile table for use? A. Scrub nurse B. Circulating nurse C. Assistant surgeon D. Surgeon

98. Non absorbable suture material such as cotton, nylon and silk are best used in suturing which of

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the following abdominal layer? A. Skin B. Peritoneum C. Fascia D. Muscle

99. When least amount of trauma is desired, or when the client is prone to keloid formation, the nurse should prepare which type of the needle? A. Swaged B. Round C. Blunt D. Taper

100. Another alternative suture for skin closure is the use of ____________ A. B. C. D. Staple Therapeutic glue Absorbent dressing Invisible suture

Study. Study in earnest. If you are to be salt and light, you need knowledge. Or do you imagine that an idle and lazy life will entitle you to receive infused knowledge?

END OF EXAM AIM HIGH NURSES!!! GOD BLESS

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