CONFIDENTIAL HS/APR 2010/NRS476

UNIVERSITI TEKNOLOGI MARA

FINAL EXAMINATION

COURSE MENTAL HEALTH AND GERONTOLOGY NURSING

COURSE CODE NRS476
EXAMINATION APRIL 2010
TIME 3 HOURS

INSTRUCTIONS TO CANDIDATES

1. This question paper consists of two (2) parts : PART A (50 Questions)

PART B (2 Questions)

2. Answer ALL questions from all two (2) parts :

i) Answer PART A in the Objective Answer Sheet.

ii) Answer PART B in the Answer Booklet. Start each answer on a new page.
3. Do not bring any material into the examination room unless permission is given by the
invigilator.

4. Please check to make sure that this examination pack consists of:

i) the Question Paper

ii) an Answer Booklet - provided by the Faculty
Hi) an Objective Answer Sheet - provided by the Faculty

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

This examination paper consists of 11 printed pages
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PART A (50 marks)

Answer ALL questions.

Choose the MOST appropriate answer for each question.

1. A client reports that her neighbours are poisoning her food. The sign manifested by her
is known as

A. illusion.
B. delusion.
C. hallucination.
D. flight of ideas.

2. Mental Disorder Ordinance is an act of law that

A. ensures all those with mental illness are protected.

B. ensures all those who commit crimes are punished by the law.
C. ensures all those with schizophrenia be admitted to a psychiatric hospital.
D. enables the authorities to confine in hospital everyone with emotional problems.

3. Form is signed by the doctor if he wants to admit a psychiatric client for

observation.

A. A
B. B
C. C
D. G

4. A schizophrenic client may refuse to eat because he/she has this delusion.

A. Paranoid.
B. Reference.
C. Withdrawal.
D. Broadcasting.

5. Psychotherapy is the treatment of choice for clients with

A. anxiety neurosis.
B. Alzeimer's disease.
C. organic brain psychosis.
D. major depression with suicidal ideations.

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6. The presence of delusions in a psychiatric client can be reduced when

A. the client is given antipsychotic.

B. the client participates in group therapy.
C. clear explanations are given to the client why delusions occur.
D. the nurse does not encourage the client to discuss his delusions.

7. A manic client can become aggressive because of this symptom.

A. Illusion.
B. Irritability.
C. Disorientation.
D. Tactile hallucination.

8. Research has proven that one of the causes of this psychiatric illness is the presence of
increased dopamine in the central nervous system.

A. Mania
B. Depression
C. Schizophrenia
D. Organic psychosis

9. This nursing action can help an insomnic client sleep.

A. Give the client anxiolitics.

B. Encourage visitors to keep the client company.
C. Ensure that the environment is psychotherapeutic.
D. Allow the client to walk about the ward till he / she is tired.

10. Electrocardiogram must be done for a client before commencing him / her on

A. prosac.
B. haloperidol.
C. amitriptyline.
D. chlorpromazine.

11. Lithium carbonate is given to a client with

A. mania.
B. phobia.
C. schizophrenia.
D. organic psychosis.

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12. Electro convulsive therapy can cause confusion to a client with this diagnosis.

A. Mania
B. Depression
C. Schizophrenia
D. Organic psychosis

13. Intensive occupational therapy can be started for a client when he / she

A. has insomnia.
B. is ready for discharge.
C. has symptoms of ambivalence.
D. does not have symptoms of psychosis.

14. A client's attention to hallucinations can be reduced with this nursing action.

A. Talk to the client.

B. Give the client amitriptyline.
C. Encourage the client to read.
D. Advice the client not to pay attention to the hallucination.

15. The FALSE statement about hallucinations.

A. It involves the senses.

B. It can occur without any stimulus.
C. It is a form of thought disturbance.
D. The client cannot control its existence.

16. This nursing action can help in the socialization of a withdrawn client.

A. Have frequent conversations with him / her.

B. Encourage client to talk to other friendly clients.
C. Leave the client alone till he / she is ready to socialize.
D. Give the client anti-psychotics to reduce his psychosis.

17. Electro-convulsive therapy is contraindicated for clients with this condition.

A. Mania
B. Organic psychosis
C. Catatonic schizophrenia
D. Depression with suicidal ideation

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18. A client who has been started on antipsychotics needs close observation because he /
she can experience

A. poliuria.
B. tardive dyskinesia.
C. nausea and vomiting.
D. acute dystonic reaction.

19. A client with dementia needs reality orientation

A. to enable him to read and write.

B. so that he does not become aggressive.
C. to prevent other clients from disturbing him / her.
D. to slow down the detonation of his / her personality.

20. A client who complains that the television is broadcasting his story is suffering from

A. delusion of nihilism.
B. delusion of paranoia.
C. auditory hallucination.
D. delusion of broadcasting.

21. Acute dystonic reactions can be treated with

A. benzhexol.
B. ophenadrine.
C. fluphenazine.
D. chlorpromazine.

22. Phenothiazines can cause irreversible side effects known as

A. akathesia.
B. delirium tremens.
C. tardive dyskinesia.
D. neuroleptic malignant syndrome.

23. Waxy flexibility is a symptom seen in a client with

A. hebephrenia.
B. simple schizophrenia.
C. residual schizophrenia.
D. catatonic schizophrenia.

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24. Which of the following is an example of disturbance of perception?

A. Hallucination.
B. Flight of ideas.
C. Ideas of reference.
D. Thought withdrawal.

25. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a
belief that one is

A. being persecuted.
B. highly important or famous.
C. responsible for the evil in the world.
D. connected to events unrelated to oneself.

26. Which of the following nursing action will help in maintaining safety for the elderly?

A. Encourage independence.
B. Ensure adequate hydration.
C. Provide for regular ambulation.
D. Orientation to new surroundings.

27. When administering an analgesic to an elderly client with severe arthritis, the nurse
should

A. administer analgesic at mealtime.

B. ensure that the medication is not a narcotic.
C. administer analgesic before the activity session.
D. administer analgesic when the client complaint of pain.

28. When assessing for pain in an elderly client who has dementia, the nurse should

A. expect that the client is able to localize the pain.

B. look for signs of increased agitation or restlessness.
C. know that only family members could reliably point out the pain.
D. be aware that episodes of incontinence increase in the presence of pain.

29. An accurate description of a frail older person is one who

A. experiences frequent periods of depression.

B. is independent in minimum activities of daily living.
C. has a noticeable planned weight loss of 5 kg in a year.
D. exhibits dependence in several activities of daily living.

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30. Which of these factors will create a rapid increase in the number of people over the age
of 65 in the years 2010 to 2030?

A. Medical technology has allowed people to live longer.

B. During these years the baby boomers will reach age 65.
C. People over age 65 are living an average of 25 years longer.
D. Individuals in this age category are taking better care of themselves.

31. Which theory of aging states that life satisfaction is dependent on maintaining
involvement by developing new interests, hobbies, roles, and relationships?

A. Activity theory.
B. Collagen theory.
C. Continuity theory.
D. Disengagement theory.

32. Which of these actions should a nurse take if an older adult client experiences bowel
elimination problems?

A. Help the client monitor fluid intake.

B. Encourage the client to exercise daily.
C. Include adequate protein in the client's diet.
D. Ask the client's health care provider to order a laxative.

33. Which of these dietary guidelines is most important for older adult clients?

A. Decrease intake of protein-rich fluids.

B. Increase intake of potassium-rich foods.
C. Maintain intake of carbohydrates and fat.
D. Maintain a calcium intake of 1,000 to 1,500 mg daily.

34. Which of these respiratory changes occurs as part of the normal aging process?

A. Chest pain accompanies any respiratory deficit.

B. Diseases such as tuberculosis and respiratory tract infections are expected.
C. Muscles of respiration become less flexible, increasing vital capacity of the lungs.
D. Effectiveness of the cough mechanism lessens, increasing risk of lung infection.

35. Which of these changes in the gastrointestinal system of an older adult client places the
client at risk?

A. Liver size increases.

B. Alcohol is absorbed faster.
C. Gag reflex is less effective.
D. Saliva production decreases.
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36. What is the most common disorder related to aging and the endocrine system?

A. Gallstones.
B. Incontinence.
C. Type 1 diabetes mellitus.
D. Type 2 diabetes mellitus.

37. Which of these nursing interventions would be MOST important for a client who has
Alzheimer's disease?

A. Serve favorite foods.

B. Assist with activities of daily living (ADLs).
C. Observe for improvement in mental status.
D. Arrange a therapeutic, calm, safe, consistent care environment.

38. Which of these nursing interventions would be MOST important for an older adult client
who has been diagnosed with depression?

A. Involve the client in group activities.

B. Allow the client to remain in the assigned room.
C. Give the client opportunities for making decisions.
D. Assess for verbal or nonverbal signs of suicidal thoughts.

39. The major clinical manifestation of an older adult clients with urinary tract infection is

A. incontinence.
B. nausea and vomiting.
C. fever of unknown origin.
D. signs of acute confusion.

40. The older adult client often has difficulty seeing objects that are close because the lens
of the eye becomes less pliable. Which of these terms describes this condition?

A. Myopia.
B. Glaucoma.
C. Presbyopia.
D. Macular degeneration.

41. One of the MOST important aspects of health care for the elderly is

A. maintaining family ties.

B. securing adequate income.
C. ensuring adequate housing.
D. focusing on illness and disability.

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42. The leading cause of death in the elderly is

A. cancer.
B. infectious disease.
C. cardiovascular disease.
D. complications from falls.

43. What is the priority nursing action before the initiation of the nursing process when first
meeting with an elderly client in the clinic?

A. Solicit family participation.

B. Ascertain the chief complaint.
C. Establish rapport with the client.
D. Read available medical records.

44. When an elderly male client states he has pain, the nurse recognizes that

A. pain is the most frequent reason the elderly visit a healthcare provider.
B. the client probably has significant pain, because many elderly understate and
under-report pain.
C. the loss of pain receptors that occurs with aging means that the elderly have
diminished capacity to experience pain.
D. pain probably is being exaggerated, because many lonely elderly clients use pain to
get more attention from their families.

45. One of the MOST common reasons that depression is misunderstood in the elderly is
the belief that

A. the elderly have less need for companionship as they age.

B. the elderly have come to terms with the inevitability of their death.
C. depression is to be expected as part of aging and declining health.
D. the elderly have relatively stable mental health due to their maturity.

46. The primary purpose for documenting an adverse event, such as a fall, is to

A. prevent litigation.
B. improve the quality of care.
C. record unusual occurrences.
D. identify the need for disciplinary action.

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47. When obtaining a social history from an elderly client, the nurse will ask about

A. acute and chronic medical problems.

B. living arrangements and family dynamics.
C. problems with hearing, vision, and speech.
D. problems with memory, judgment, and thought.

48. When an elderly person is hospitalized with pneumonia, what would be the best action
by the nurse to encourage eating?

A. Provide small, more frequent meals.

B. Make sure the client is adequately hydrated.
C. Provide a high-calorie snack of the client's choice.
D. Secure an order for a daily multivitamin to stimulate appetite.

49. The elderly client who wants to take a herbal supplement for arthritis symptoms should
be advised to

A. reconsider the idea, because they might have serious side effects.
B. verify their effectiveness with friends or family members who have taken them.
C. consult their healthcare provider about possible interactions with current
medications.
D. read labels very carefully prior to making a selection, because they are usually quite
expensive.

50. is the greatest threat to the mental well-being of the elderly.

A. Pain
B. Anxiety
C. Depression
D. Alcoholism

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PART B (70 marks)

Answer ALL questions.

QUESTION 1

a) Psychiatric disorders usually have multi-factorial etiology. Explain THREE of these

causative factors.

(6 marks)

b) Anti-psychotic drugs help to reduce psychotic symptoms.

i) List FOUR common side effects of anti-psychotic drugs.

(4 marks)
ii) Explain how you would advice the client to overcome or reduce these side-effects.
(6 marks)

c) Explain briefly Peplau's three phases in a nurse-client relationship.

(6 marks)

d) Define delusion and list THREE examples of delusions.

(5 marks)

e) Explain the nursing intervention to reduce the risk of the client with schizophrenia being
aggressive in the ward.
(8 marks)

QUESTION 2

a) Describe effective communication techniques appropriate for use with the older adult.
(10 marks)

b) Describe the assessment of older persons who are using medications.

(10 marks)

c) Discuss FIVE health care needs of the elderly.

(15 marks)

END OF QUESTION PAPER

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