BicolNurses.Org Awaits November 2009 Nursing Board Exam Results

Nursing Diagnoses / Diagnosis

2009-09-25T07:42:00.000-07:00

A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual and/or potential health problems or life processes. A medical diagnosis, on the other hand, is the identification of a disease based on its signs and symptoms.

The professional practice of nursing is the diagnosing and treatment of these basic human responses. Nurses need a common language to describe the human responses of individuals, families, and communities to health threats. NANDA strives to classify in a scientific manner these basic human responses.

Nursing diagnoses are classified under the concepts of ingestion, digestion, absorption, metabolism, urinary/gastrointestinal elimination, sleep/rest, activity/exercises, energy balance, sexuality, post trauma responses, comfort, and growth and development.

dentification of human responses to health problems and life processes is the basis for the nurses' decisions on how to best intervene to help people heal or improve their quality of life. With nursing diagnoses, emphasis is placed upon achievement of the client's maximum health potential. The nurse gathers the assessment data and from this data, identifies high-priority nursing diagnoses. The nursing diagnoses then provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.

The PATIENT (not the nurse) is central to the nursing process. The nursing process involves looking at the whole patient at all times. It personalizes the patient. Nursing care needs to be directed at all times for improving outcomes for the PATIENT.

In order to tailor the nursing process to the patient, you need to identify the patient's problems related to the objective and subjective assessment data. Then you need to formulate a nursing diagnosis for each of these problems. You will also prioritize the problems in formulating your plan and goals (according to the ABC's and Maslow's Hierarchy of Needs).

Nursing diagnoses are written in "PES" format:

* "P" stands for PROBLEM
* "E "stands for ETIOLOGY or cause of problem
* "S "stands SIGNS and SYMPTOMS of problem

However, if you identify a high-priority "RISK FOR" nursing diagnosis, then you do not put the signs and symptoms (in other words, no "AEB"). How can you have evidence (signs and symptoms) for something that is only a risk?

Nursing goals are simply the antithesis of the nursing diagnostic statement with a reasonable time frame. In other words, diagnostic statements are "problems" (negative). Goals are "positive" (turn the nursing diagnostic statement around). If the nursing diagnosis is "Risk for Infection r/t..." for instance, then the goal statement might be "Client will not experience infection throughout hospital stay AEB clear lung sounds, afebrile, WBC count between 5,000 and 11,000, wound site well approximated with no purulent drainage." Goal statements always begin with "The patient/ client will..." and have a specified time element.

Nursing interventions are the "meat and gravy" of the nursing process and flow from the "etiology" part of the nursing diagnostic statement. Nursing interventions are either independent (such as teaching/learning or safety) or collaborative/ dependent (require a physician's order, such as administration of medications). The nurse must use his or her critical thinking skills to plan, coordinate, and implement nursing interventions, and then EVALUATE the effect of these interventions in achieving the desired patient goal. Nursing interventions always begin with "Student nurse will..." or "Nurse will..." and are very specific, as well as being realistic to the client situation (not just "cookie-cutter" interventions copied from a nursing careplan book).

Helpful examples of nursing interventions (in this case, related to visual disturbances) may be found at this website:

http://www1.us.elsevierhealth.com/ME...ex.cfm?plan=46

Nursing interventions must be backed up with a scientific rationale - Otherwise, this action is just your opinion and has no merit. Remember, everything in nursing must be EVIDENCED-BASED. Provide a citation for your scientific rationale, in APA format, from a peer-reviewed source: professional journal, textbook, lecture.

When evaluating your goals, need to state specifically: GOAL MET, GOAL NOT MET, GOAL PARTIALLY MET, or UNABLE TO EVALUATE GOAL due to time constraints. If the latter is the case (Unable to evaluate goal due to time constraints), then you need to state what outcome criteria would be needed in order to state GOAL MET. In other words, if I were present (at specified time element), I would look for the following outcome criteria in order to state, "GOAL MET." Then you list the desired outcome criteria. Remember, you are evaluating the goals, not the interventions.

So you see, it is an orderly, evidenced-based process and not that difficult with practice. Nurses cannot know what interventions to select or which outcomes to project unless they have accurate representations of what patients are experiencing (using a common reference language, NANDA).

References

Care Plan Constructor

2009-2011 Nursing Diagnoses with Functional Domains (starting on p.2)

Manual of Nursing Diagnosis

Handbook of Nursing Diagnosis

Nursing Diagnosis Reference Manual

NANDA Nursing Diagnosis Home Page

Original Post from VickyRN of allnurses.com:
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2009-09-23T10:47:00.000-07:00

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2009-09-23T10:32:00.000-07:00

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Pneumothorax

2009-09-22T07:48:00.000-07:00

Definition
■ Disruption of lining of lung (visceral pleura) or lining of thoracic cavity
(parietal pleura) permitting air (pneumothorax) and/or blood (hemothorax)
into pleural space → lung collapse
■ 2° rib fx, stab or gunshot wound, thoracentesis, emphysema

Signs and Symptoms
■ Sudden unilateral chest pain
■ ↑P, ↑R, Signs and Symptoms
■ Sudden unilateral chest pain
■ ↑P, ↑R, dyspnea, ↓breath sounds on affected side, ↓PaO2
■ Air/blood in pleural space on x-ray
Treatment
■ O2, assist with insertion of chest tube/water seal drainage to reestablish
negative pressure (pneumothorax—2nd anterior intercostal space,
hemothorax—lower and more posterior space)
Nursing
■ Monitor S&S; relieve pain
■ Assess water seal chamber fluid level (↑ on inspiration and ↓ with
exhalation) and for bubbling in water seal chamber (continuous bubbling
suggests air leak and absence suggests full lung expansion or blocked
tube)
■ Instruct patient to exhale and bear down when removing chest tube, then
apply occlusive dressing
■ Subcutaneous emphysema: Palpate around insertion site for crackles,
which indicates air in subcutaneous tissue (crepitus)
■ Air/blood in pleural space on x-ray

Treatment
■ O2, assist with insertion of chest tube/water seal drainage to reestablish
negative pressure (pneumothorax—2nd anterior intercostal space,
hemothorax—lower and more posterior space)

Nursing Management
■ Monitor S&S; relieve pain
■ Assess water seal chamber fluid level (↑ on inspiration and ↓ with
exhalation) and for bubbling in water seal chamber (continuous bubbling
suggests air leak and absence suggests full lung expansion or blocked
tube),
■ Instruct patient to exhale and bear down when removing chest tube, then
apply occlusive dressing
■ Subcutaneous emphysema: Palpate around insertion site for crackles,
which indicates air in subcutaneous tissue (crepitus)

Saunders NCLEX-RN Review 4th Edition

2009-09-18T09:55:00.000-07:00

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Regional Oathtaking Ceremony Schedule

2009-08-01T10:12:00.000-07:00

TO ALL OUR REGIONAL PARTNERS
UNDERTAKING OATHTAKING CEREMONIES
In Accordance with the Provisions of Law Warm greetings from the Board of Nursing.

Last June 6 and 7, 2009 the Board of Nursing again was able to successfully satisfy another NLE event in the National Capital Region ang in various other parts of the country with the administrative supervision of the Professional Regulation Commission.

We are writing to formally inform all our regional partners that -
(1)The Oathtaking schedules are being worked out for implementation:
August 18 and 19, SMX Convention Center will be the Oathtaking Ceremonies in Manila. And the following assignments have so far been made:

Areas Identified/ BoN Assigned/ Date Specified/Requested
1. Bacolod - Hon. Betty F. Merritt - August 24
2. Baguio - Hon. Betty F. Merritt -August 21
3. Bohol - Hon. Yolanda C. Arugay
4. CARAGA - Hon. Leonila A. Faire -August 22
5. CDO -Hon. Amelia B. Rosales -September 7
6. CEBU -Hon. Betty F. Merritt -August 25
7. DAVAO -Hon. Leonila A. Faire -August 29
8. GEN. SANTOS -Hon. Marco Sto Tomas
9. ILOILO -Hon. Yolanda C. Arugay
10. ILOCOS -Hon. Perla G. Po -August 22
11. LEGASPI -Hon. Carmencita M. Abaquin -August 21
12. LUCENA -Hon. Perla G. Po
13. PAGADIAN -Hon. Carmencita M. Abaquin
14. PANGASINAN -Hon. Carmencita M. Abaquin -August 28
15. ROXAS -Hon. Leonila A. Faire -August 26
16. TACLOBAN -Hon. Yolanda C. Arugay
17. TUGUEGARAO -Hon. Marco Sto Tomas -August 31
18. ZAMBOANGA/Sulu -Hon. Amelia B. Rosales -August 27

Additional areas may be adopted by the BoN upon request depending on the capability of the combined forces of PNA and ADPCN to organize and lead the Oathtaking Ceremony in the said area. The BoN on deck for such requests are: Hon. Leonila A. Faire, Hon. Amelia B. Rosales, and Hon. Marco Sto Tomas. The Board of Nursing believes this activity brings government particularly PRC and the Board of Nursing closer to our public/constituents.

(2)The BoN strongly recommends that all Regional Oathtaking Ceremonies apply/follow the “Prototype” Oathtaking Program as used in the National Capital Region (NCR) (with minor modifications as applied in the Regions) as provided for in our Oathtaking Souvenir Program.

(3)The names of all successful examinees released in newspapers of national circulation and printed by the Board of Nursing in the National Oathtaking Souvenir Program and together with other relevant and timely issuances/articles these are considered “historic documents”. It is therefore strongly recommended that regional oathtaking partners include in their budget the cost of this souvenir program so that every successful examinee/new nurse may avail of the same,

In view hereof, all regional organizing partners are hereby advised to place your orders directly at least 2-3 weeks prior to scheduled Regional/Satellite Oathtaking Ceremonies for timely delivery through the EDUCATIONAL PUBLISHING HOUSE or JADE BOOKSTORE, Manila at Tele-Fax Numbers (02) 288-7278 or (02) 525-0468. The souvenir program cost shall be Php 150.00 each and freight cost shall be borne by the oathtaking host organizer.

(4)For purposes of better synchronicity and organization we advise all our oathtaking partners to keep communications open through:

Ms. Edna Luna, BoN Secretary, PRC Central Office at P. Paredes St., Sampaloc, Manila at Telephone Nos. (02) 735 1534 / 735 4476 / 736 3619 / 736 2250; or The BoN website & BoN e mail access address: www.bonphilippines.org or philnursing7@bonphilippines.orgThis e-mail address is being protected from spam bots, you need JavaScript enabled to view it

NOTE: The NCR Oathtaking Ceremonies for New Nurses can be viewed nationwide/worldwide/mobile phone by live streaming through our BoN Website.

Thank you so much and let us do this as ONE BODY!

Very truly yours,

HON. AMELIA B. ROSALES, RN, Ph.D.
Member, Board of Nursing
Chair, Oathtaking for the June 6-7 NLE New Nurses

Noted:

HON. CARMENCITA M.ABAQUIN, RN, PhD
Chairman, Board of Nursing

Source: http://bonphilippines.org/index.php?option=com_content&task=view&id=250&Itemid=1

June 2009 NLE Passers Oathtaking Ceremony Advisory

2009-08-01T09:33:00.000-07:00

ADVISORY TO ALL JUNE 2009 NURSE LICENSURE EXAMINATION PASSERS AFTER THE RELEASE OF RESULTS OF THE JUNE 2009 NLE

1. The MANILA oathtaking ceremony for the successful examinees in the JUNE 2009 Nurse Licensure Examination as well as the previous ones who have not taken their Oaths of Professional, in accordance with Republic Act 9891 and Republic Act 9173 will be held before the Board of Nursing on Tuesday and Wednesday, August 18 and 19, 2009 respectively with morning (8:00 AM) and afternoon (1:00 PM) sessions at the SMX Convention Center, SM Mall of Asia, Pasay City.

2. Oathtaking tickets are available at the Philippine Nurses’ Association (PNA) at 1663 F.T. Benitez Street, Malate, Manila starting July 29, 2009 - Wednesday.

3. All oathtaking candidates must come in their white gala uniform, nurse’s cap, white duty shoes, without earrings, hair not touching the collar and without corsage.

4. The Board of Nursing (BON) wishes to reiterate that the assignment for oathtaking will be according to pre-determined “schedule of school assignments” which will serve as basis for the schedule of tickets to be issued only by the Philippine Nurses Association (PNA) ON WEEKDAYS!

5. For schools without schedule, inductees may buy tickets on a first come first serve basis.

6. Here are the deadlines for buying tickets:

Last day /time for PNA to be selling tickets

Aug 18
AM August 17 5 pm
PM August 18 12 noon

Aug 19
AM August 18 5 pm
PM August 19 12 noon

6.1 ONLY VALID TICKETS SHALL BE ALLOWED ENTRY TO SMX (RECEIPTS WILL NOT BE ENTERTAINED)

7. For orderly conduct THERE SHALL ABSOLUTELY BE NO SELLING OF TICKETS WITHIN THE SMX COMPOUND. Admission tickets are only available at PNA on set schedules.

8. On the day of the oathtaking:
 SMX OPENING TIME shall be at 6:30A.M. FOR the MORNING SESSION
12:30P.M. FOR AFTERNOON SESSION
 SMX ENTRANCE - there shall be 7 ENTRANCES to SMX -
>TOPNOTCHERS AND THEIR PARENTS - USE FRONT/MAIN ENTRANCES
>CHILDREN BELOW 7 YEARS are NOT ALLOWED
>GUESTS ARE ADVISED TO TAKE THE BASEMENT PARKING ENTRANCE

Adequate parking is available right in front of SMX
No reserved seats. First come First serve basis.
Food stalls available at the lobby. Eating not allowed inside the convention hall.

June 2009 Nursing Board Exam Result

2009-07-25T07:38:00.001-07:00

http://newsinfo.inquirer.net/examresults/NURSE/20090725/

Smoking More Than Five Cigarettes A Day Provokes Migraine Attacks

2009-06-27T02:56:00.000-07:00

obacco acts as a precipitating factor for headaches, specifically migraines. This is indicated in a study which shows that smokers have more migraine attacks and that smoking more than five cigarettes a day triggers this headache. The work has appeared in The Journal of Headache and Pain.

The influence of tobacco as a precipitating, non-causal factor of migraine attacks has produced contradictory data in scientific literature. The limited research prior to the work published in The Journal of Headache and Pain indicated that smoking could improve migraines by reducing anxiety, one of the factors that triggers an attack.

"This study is groundbreaking in Spain as there are few studies on this topic, and all are very biased. This is due to the complexity and need for prior training of the participants", Julio Pascual, one of the authors of this research and doctor at the Neurology Unit of Marqués de Valdecilla, University Hospital (Santander), explains to SINC.

One advantage of this study is that the sample used, 361 medicine students from the University of Salamanca, were fully aware what a migraine was. The experts, who enquired about the presence or absence of migraine (and its characteristics) and whether or not they smoked, guaranteed the reliability of the results obtained, as most surveys for this type of study are done over the phone, randomly and in people without knowledge of the illness.

The results show that 16% of students fulfilled migraine criteria, while 20% smoked. The percentage of smokers was higher (29%) in those who were also migraine sufferers and migraine frequency in those students who were migraine sufferers and smokers was clearly higher than in those who were non-smokers and migraine sufferers.

According to Pascual, "smoking is a precipitating factor of this type of headache, as the prevalence of active smokers is one third higher in migraine sufferers and there is a direct relationship between the number of cigarettes consumed and the frequency of migraine attacks".

The researchers stressed the importance of the dosage. The results of the interviews reveal that the migraine sets in after five daily cigarettes. Furthermore, although the percentage of those who smoked was higher in people with migraines, they smoked less than those who did not suffer migraines.

"This is because they themselves knew that if they exceeded five cigarettes a day, they were more likely to have a migraine attack. The pain itself acts as a limiting factor", explains the neurologist, who maintains that "in no case should a migraine sufferer be advised to smoke thinking that it is going to improve their migraines. What's more, if you smoke a lot you should reduce the dose drastically".

90% of affected people self-medicate

"The supposed migraine cure ends up becoming its cause because of self-medication". Feliu Titus, an honorary member of the Spanish Neurological Society, explained last May in the paper Migraine treatment. The role of non-pharmacological methods, in Barcelona.

In Spain, this illness affects five million people and 2% of the population suffers attacks for more than 15 days a month. According to Titus, "more than 20% have never consulted a specialist". 90% of migraine sufferers self-medicate, without being aware of the risk that this entails. Anyone who suffers from migraines and abuses drugs ends up suffering adverse effects and a worsening of the illness due to a "rebound effect", according to specialists.

Chronic headaches are a separate illness and one of the most frequent chronic diseases. Although the causes are still not clear, in some migraine cases it is already demonstrated that there is a genetic basis. In fact, most patients with migraines have a history of it in their family.

"Nowadays it is believed that migraines are a state of hyperexcitability of the neurons that control headaches. Migraine sufferers are born with ion channels in the membrane of the neurons which are much more permeable and excitable. The brain of migraine sufferers is therefore able to link an attack with precipitating stimuli such as tobacco", Julio Pascual concludes.

To a large extent, the cause of this hyperexcitability has a genetic basis. In fact, some specific mutations are already known to be responsible for the hyperexcitabilty of these membrane ion channels.

Link Source: http://www.medicalnewstoday.com/articles/155596.php

June 2009 Nursing Board Exam Hot Topic : Tracheostomy Care

2009-05-30T09:58:00.000-07:00

Tracheostomy Care Guidelines - Upload a Document to Scribd

June 2009 Nursing Board Exam Hot topics

2009-05-30T08:38:00.000-07:00

IMCI Notes

Handouts IMCI - Upload a Document to Scribd

Announcement

2009-04-25T10:03:00.001-07:00

I have been missing for almost a month now since my pc turned down. I was'nt able to post nor give any nursing updates, but i promise that i will do so as soon as i have my pc working again

For site comments and suggestions you can drop me some words on my email add listed below:

nurseuragon08@gmail.com

You can also add our friendster group, just click the logo @ the left side.

Thankz and God Bless!

misses everyone..

Crackles

2009-03-23T00:16:00.000-07:00

Crackles are discontinuous, brief sounds heard more commonly on inspiration.

They can be classified as

* fine (high pitched, very brief) or
* coarse (low pitched, less brief).

Crackles can be produced by two common mechanisms.

* When previously closed small airways suddenly open. To see how this can happen, gently close your wet lips and open them suddenly. You will hear a 'plop'. When this happens in the terminal bronchioles, fine crackels are produced.
* Another explanation is that air bubbles through secretions as in pulmonary edema and resolving pneumonia.

Causes:

1. bronchiectasis
2. pulmonary edema
3. ARDS
4. consolidation
5. fibrosis
6. asthma
7. chronic bronchitis
8. interstitial lung disease

Nurse Assigned in Rural Areas (NARS)

2009-03-11T10:58:00.001-07:00

Appply Now:APPLY NOW

The NARS Program, a Training cum Employment Program, aims to address the (1) glut in inexperienced nurses and the proliferation of "volunteer nurses" working in hospitals without being paid, but instead, they themselves pay the hospitals to obtain Certificate of work experience; and (2) to promote health of the people and bring the government closer to them.

Unemployed nurses will be mobilized in their hometowns as warriors for wellness to do the three I's:

* Initiate primary health, school nutrition, maternal health programs, first line diagnosis
* Inform about community water sanitation practices and also do health surveillance
* Immunize children and mothers.

They shall likewise serve as roving nurses for rural schools.

Nurses will be deployed at an average of 5 per town in the 1,000 poorest municipalities, for a six-months tour of duty. Another batch will be deployed for the second half of the year. These nurses will undergo training and development for competency enhancement in accordance with the training program designed by the DOH in collaboration with the PRC-BON. The training program will cover both the clinical and public health functions.

Completion of the training program under NARS program shall be considered as a substitute for the work experience requirement of hospitals and other health facilities, both local and overseas. The Certificate of Completion shall be issued jointly by the DOLE, DOH and PRC.

While on training, nurses will be given a stipend/allowance of P8,000.00 per month. This translates to about P366.00 per day for a forty (40) hours training/workweek. As these nurses are already in their hometowns, transportation expenses will no longer be a problem.

The stipend of P8,000 may be increased if the host LGUs will offer a counterpart of say P2,000. Corporations may chip in by providing shirts, insurance, vitamins, etc., making the program a national enterprise with private equity.

Program Coverage

Unemployed registered nurses who are physically and mentally fit and willing to serve in their hometowns and who meet the following requirements may qualify for the training cum employment under NARS:

* With valid nurse license issued by the PRC
* Not over 35 years old
* Resident of the identified municipalities
* No nursing-related practice for the past 3 years

Nurse applicants who are dependents of workers affected by the Global Crisis based on the list provided by the DOLE Regional office shall be given priority in the selection.
Online Application

Application may be filed from 20 February 2009 to 22 March 2009. List of successful applicants with area of assignment shall be posted on 26-31 March 2009.

Covered Municipalities

The selection of the 1,000 poorest municipalities shall be based on the City and Municipal Poverty Incidence based on Small Area Poverty Estimates (SAE) of the National Statistics and Coordination Board/World Bank Intercensal Updating of Small Area Poverty Estimates. This same SAE is being used by the DSWD in their Pantawid Pamilyang Pilipino Program and also for prioritizing target households for their National Household Targeting System for Poverty Reduction. Covered under the NARS Project shall be those cities and municipalities with poverty rank 1 (poorest) to rank 1,000.

Timetable of Activities

First Batch (5,000 nurse-trainees)

1. Recruitment and selection February 20 - March 22
2. Posting of successful applicants with area of assignment March 26-31
3. Orientation of nurse-trainees, Deployment to area of assignments April 1-2

For more details: http://www.nars.dole.gov.ph

Philippine Nursing Board Exam (NLE) Questions - Psychiatric Nursing

2009-02-26T03:16:00.000-08:00

PSYCHIATRIC NURSING

1. Mental health is defined as:
A. The ability to distinguish what is real from what is not.
B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively.
C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and rehabilitation
D. Absence of mental illness

Answer: (B) A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively.
Mental health is a state of emotional and psychosocial well being. A mentally healthy individual is self aware and self directive, has the ability to solve problems, can cope with crisis without assistance beyond the support of family and friends fulfill the capacity to love and work and sets goals and realistic limits. A. This describes the ego function reality testing. C. This is the definition of Mental Health and Psychiatric Nursing. D. Mental health is not just the absence of mental illness.

2. Which of the following describes the role of a technician?
A. Administers medications to a schizophrenic patient.
B. The nurse feeds and bathes a catatonic client
C. Coordinates diverse aspects of care rendered to the patient
D. Disseminates information about alcohol and its effects.

Answer: (A) Administers medications to a schizophrenic patient.
Administration of medications and treatments, assessment, documentation are the activities of the nurse as a technician. B. Activities as a parent surrogate. C. Refers to the ward manager role. D. Role as a teacher.

3. Liza says, “Give me 10 minutes to recall the name of our college professor who failed many students in our anatomy class.” She is operating on her:
A. Subconscious
B. Conscious
C. Unconscious
D. Ego

Answer: (A) Subconscious
Subconscious refers to the materials that are partly remembered partly forgotten but these can be recalled spontaneously and voluntarily. B. This functions when one is awake. One is aware of his thoughts, feelings actions and what is going on in the environment. C. The largest potion of the mind that contains the memories of one’s past particularly the unpleasant. It is difficult to recall the unconscious content. D. The conscious self that deals and tests reality.

4. The superego is that part of the psyche that:
A. Uses defensive function for protection.
B. Is impulsive and without morals.
C. Determines the circumstances before making decisions.
D. The censoring portion of the mind.

Answer: (D) The censoring portion of the mind.
The critical censoring portion of one’s personality; the conscience. A. This refers to the ego function that protects itself from anything that threatens it.. B. The Id is composed of the untamed, primitive drives and impulses. C. This refers to the ego that acts as the moderator of the struggle between the id and the superego.
5. Primary level of prevention is exemplified by:
A. Helping the client resume self care.
B. Ensuring the safety of a suicidal client in the institution.
C. Teaching the client stress management techniques
D. Case finding and surveillance in the community

Answer: (C) Teaching the client stress management techniques
Primary level of prevention refers to the promotion of mental health and prevention of mental illness. This can be achieved by rendering health teachings such as modifying ones responses to stress. A. This is tertiary level of prevention that deals with rehabilitation. B and D. Secondary level of prevention which involves reduction of actual illness through early detection and treatment of illness.
6. Situation: In a home visit done by the nurse, she suspects that the wife and her child are victims of abuse.

Which of the following is the most appropriate for the nurse to ask?
A. “Are you being threatened or hurt by your partner?
B. “Are you frightened of you partner”
C. “Is something bothering you?”
D. “What happens when you and your partner argue?”

Answer: (A) “Are you being threatened or hurt by your partner?
The nurse validates her observation by asking simple, direct question. This also shows empathy. B, C, and D are indirect questions which may not lead to the discussion of abuse.
7. The wife admits that she is a victim of abuse and opens up about her persistent distaste for sex. This sexual disorder is:
A. Sexual desire disorder
B. Sexual arousal Disorder
C. Orgasm Disorder
D. Sexual Pain Disorder

Answer: (A) Sexual desire disorder
Has little or no sexual desire or has distaste for sex. B. Failure to maintain the physiologic requirements for sexual intercourse. C. Persistent and recurrent inability to achieve an orgasm. D. Also called dyspareunia. Individuals with this disorder suffer genital pain before, during and after sexual intercourse.
8. What would be the best approach for a wife who is still living with her abusive husband?
A. “Here’s the number of a crisis center that you can call for help .”
B. “Its best to leave your husband.”
C. “Did you discuss this with your family?”
D. “ Why do you allow yourself to be treated this way”

Answer: (A) “Here’s the number of a crisis center that you can call for help .”
Protection is a priority concern in abuse. Help the victim to develop a plan to ensure safety. B. Do not give advice to leave the abuser. Making decisions for the victim further erodes her esteem. However discuss options available. C. The victim tends to isolate from friends and family. D. This is judgmental. Avoid in anyway implying that she is at fault.
9. Which comment about a 3 year old child if made by the parent may indicate child abuse?
A. “Once my child is toilet trained, I can still expect her to have some"
B. “When I tell my child to do something once, I don’t expect to have to tell"
C. “My child is expected to try to do things such as, dress and feed.”
D. “My 3 year old loves to say NO.”

Answer: (B) “When I tell my child to do something once, I don’t expect to have to tell"
Abusive parents tend to have unrealistic expectations on the child. A,B and C are realistic expectations on a 3 year old.
10. The primary nursing intervention for a victim of child abuse is:
A. Assess the scope of the problem
B. Analyze the family dynamics
C. Ensure the safety of the victim
D. Teach the victim coping skills

Answer: (C) Ensure the safety of the victim
The priority consideration is the safety of the victim. Attend to the physical injuries to ensure the physiologic safety and integrity of the child. Reporting suspected case of abuse may deter recurrence of abuse. A,B and D may be addressed later.
11. Situation: A 30 year old male employee frequently complains of low back pain that leads to frequent absences from work. Consultation and tests reveal negative results.

The client has which somatoform disorder?
A. Somatization Disorder
B. Hypochondriaisis
C. Conversion Disorder
D. Somatoform Pain Disorder

Answer: (D) Somatoform Pain Disorder
This is characterized by severe and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of having a serious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict.
12. Freud explains anxiety as:
A. Strives to gratify the needs for satisfaction and security
B. Conflict between id and superego
C. A hypothalamic-pituitary-adrenal reaction to stress
D. A conditioned response to stressors

Answer: (B) Conflict between id and superego
Freud explains anxiety as due to opposing action drives between the id and the superego. A. Sullivan identified 2 types of needs, satisfaction and security. Failure to gratify these needs may result in anxiety. C. Biomedical perspective of anxiety. D. Explanation of anxiety using the behavioral model.
13. The following are appropriate nursing diagnosis for the client EXCEPT:
A. Ineffective individual coping
B. Alteration in comfort, pain
C. Altered role performance
D. Impaired social interaction

Answer: (D) Impaired social interaction
The client may not have difficulty in social exchange. The cues do not support this diagnosis. A. The client maladaptively uses body symptoms to manage anxiety. B. The client will have discomfort due to pain. C. The client may fail to meet environmental expectations due to pain.
14. The following statements describe somatoform disorders:
A. Physical symptoms are explained by organic causes
B. It is a voluntary expression of psychological conflicts
C. Expression of conflicts through bodily symptoms
D. Management entails a specific medical treatment

Answer: (C) Expression of conflicts through bodily symptoms
Bodily symptoms are used to handle conflicts. A. Manifestations do not have an organic basis. B. This occurs unconsciously. D. Medical treatment is not used because the disorder does not have a structural or organic basis.
15. What would be the best response to the client’s repeated complaints of pain:
A. “I know the feeling is real tests revealed negative results.”
B. . “I think you’re exaggerating things a little bit.”
C. “Try to forget this feeling and have activities to take it off your mind”
D. “So tell me more about the pain”

Answer: (A) “I know the feeling is real tests revealed negative results.”
Shows empathy and offers information. B. This is a demeaning statement. C. This belittles the client’s feelings. D. Giving undue attention to the physical symptom reinforces the complaint.
16. Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital.

When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to:
A. provide as much structure as possible for the child
B. ignore the child’s overactivity.
C. encourage the child to engage in any play activity to dissipate energy
D. remove the child from the classroom when disruptive behavior occurs

Answer: (A) provide as much structure as possible for the child
Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non –confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure.
17. The child with conduct disorder will likely demonstrate:
A. Easy distractibility to external stimuli.
B. Ritualistic behaviors
C. Preference for inanimate objects.
D. Serious violations of age related norms.

Answer: (D) Serious violations of age related norms.
This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder.
18. Ritalin is the drug of choice for chidren with ADHD. The side effects of the following may be noted:
A. increased attention span and concentration
B. increase in appetite
C. sleepiness and lethargy
D. bradycardia and diarrhea

Answer: (A) increased attention span and concentration
The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability.
19. School phobia is usually treated by:
A. Returning the child to the school immediately with family support.
B. Calmly explaining why attendance in school is necessary
C. Allowing the child to enter the school before the other children
D. Allowing the parent to accompany the child in the classroom

Answer: (A) Returning the child to the school immediately with family support.
Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. This will not help the child overcome the fear
20. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification:
A. Profound
B. Mild
C. Moderate
D. Severe

Answer: (C) Moderate
The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.
21. The nurse teaches the parents of a mentally retarded child regarding her care. The following guidelines may be taught except:
A. overprotection of the child
B. patience, routine and repetition
C. assisting the parents set realistic goals
D. giving reasonable compliments

Answer: (A) overprotection of the child
The child with mental retardation should not be overprotected but need protection from injury and the teasing of other children. B,C, and D Children with mental retardation have learning difficulty. They should be taught with patience and repetition, start from simple to complex, use visuals and compliment them for motivation. Realistic expectations should be set and optimize their capability.
22. The parents express apprehensions on their ability to care for their maladaptive child. The nurse identifies what nursing diagnosis:
A. hopelessness
B. altered parenting role
C. altered family process
D. ineffective coping

Answer: (B) altered parenting role
Altered parenting role refers to the inability to create an environment that promotes optimum growth and development of the child. This is reflected in the parent’s inability to care for the child. A. This refers to lack of choices or inability to mobilize one’s resources. C. Refers to change in family relationship and function. D. Ineffective coping is the inability to form valid appraisal of the stressor or inability to use available resources
23. A 5 year old boy is diagnosed to have autistic disorder.
Which of the following manifestations may be noted in a client with autistic disorder?

A. argumentativeness, disobedience, angry outburst
B. intolerance to change, disturbed relatedness, stereotypes
C. distractibility, impulsiveness and overactivity
D. aggression, truancy, stealing, lying

Answer: (B) intolerance to change, disturbed relatedness, stereotypes
These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder
24. The therapeutic approach in the care of an autistic child include the following EXCEPT:
A. Engage in diversionary activities when acting -out
B. Provide an atmosphere of acceptance
C. Provide safety measures
D. Rearrange the environment to activate the child

Answer: (D) Rearrange the environment to activate the child
The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling.
25. According to Piaget a 5 year old is in what stage of development:
A. Sensory motor stage
B. Concrete operations
C. Pre-operational
D. Formal operation

Answer: (C) Pre-operational
Pre-operational stage (2-7 years) is the stage when the use of language, the use of symbols and the concept of time occur. A. Sensory-motor stage (0-2 years) is the stage when the child uses the senses in learning about the self and the environment through exploration. B. Concrete operations (7-12 years) when inductive reasoning develops. D. Formal operations (2 till adulthood) is when abstract thinking and deductive reasoning develop.
26. Situation : The nurse assigned in the detoxification unit attends to various patients with substance-related disorders.

A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates:
A. withdrawal
B. tolerance
C. intoxication
D. psychological dependence

Answer: (B) tolerance
tolerance refers to the increase in the amount of the substance to achieve the same effects. A. Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependence refers to the intake of the substance to prevent the onset of withdrawal symptoms.
27. The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension and fever. The nurse should be alert for impending:
A. delirium tremens
B. Korsakoff’s syndrome
C. esophageal varices
D. Wernicke’s syndrome

Answer: (A) delirium tremens
Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B C. This is a complication of liver cirrhosis which may be secondary to alcoholism . D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination.
28. The care for the client places priority to which of the following:
A. Monitoring his vital signs every hour
B. Providing a quiet, dim room
C. Encouraging adequate fluids and nutritious foods
D. Administering Librium as ordered

Answer: (A) Monitoring his vital signs every hour
Pulse and blood pressure are usually elevated during withdrawal, Elevation may indicate impending delirium tremens B. Client needs quiet, well lighted, consistent and secure environment. Excessive stimulation can aggravate anxiety and cause illusions and hallucinations. C. Adequate nutrition with sulpplement of Vit. B should be ensured. D. Sedatives are used to relieve anxiety.
29. Another client is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum.
A. Heroin
B. cocaine
C. LSD
D. marijuana

Answer: (B) cocaine
The manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. C. Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia and increase in vital signs D. Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment and hallucinations.
30. A client is admitted with needle tracts on his arm, stuporous and with pin point pupil will likely be managed with:
A. Naltrexone (Revia)
B. Narcan (Naloxone)
C. Disulfiram (Antabuse)
D. Methadone (Dolophine)

Answer: (B) Narcan (Naloxone)
Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. A. This is an opiate receptor blocker used to relieve the craving for heroine C. Disulfiram is used as a deterrent in the use of alcohol. D. Methadone is used as a substitute in the withdrawal from heroine
31. Situation: An old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function.

The daughter revealed that the client used her toothbrush to comb her hair. She is manifesting:
A. apraxia
B. aphasia
C. agnosia
D. amnesia

Answer: (C) agnosia
This is the inability to recognize objects. A. Apraxia is the inability to execute motor activities despite intact comprehension. B. Aphasia is the loss of ability to use or understand words. D. Amnesia is loss of memory.
32. She tearfully tells the nurse “I can’t take it when she accuses me of stealing her things.” Which response by the nurse will be most therapeutic?
A. ”Don’t take it personally. Your mother does not mean it.”
B. “Have you tried discussing this with your mother?”
C. “This must be difficult for you and your mother.”
D. “Next time ask your mother where her things were last seen.”

Answer: (C) “This must be difficult for you and your mother.”
This reflecting the feeling of the daughter that shows empathy. A and D. Giving advise does not encourage verbalization. B. This response does not encourage verbalization of feelings.
33. The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
A. receives adequate nutrition and hydration
B. will reminisce to decrease isolation
C. remains in a safe and secure environment
D. independently performs self care

Answer: (C) remains in a safe and secure environment
Safety is a priority consideration as the client’s cognitive ability deteriorates.. A is appropriate interventions because the client’s cognitive impairment can affect the client’s ability to attend to his nutritional needs, but it is not the priority B. Patient is allowed to reminisce but it is not the priority. D. The client in the moderate stage of Alzheimer’s disease will have difficulty in performing activities independently
34. She says to the nurse who offers her breakfast, “Oh no, I will wait for my husband. We will eat together” The therapeutic response by the nurse is:
A. “Your husband is dead. Let me serve you your breakfast.”
B. “I’ve told you several times that he is dead. It’s time to eat.”
C. “You’re going to have to wait a long time.”
D. “What made you say that your husband is alive?

Answer: (A) “Your husband is dead. Let me serve you your breakfast.”
The client should be reoriented to reality and be focused on the here and now.. B. This is not a helpful approach because of the short term memory of the client. C. This indicates a pompous response. D. The cognitive limitation of the client makes the client incapable of giving explanation.
35. Dementia unlike delirium is characterized by:
A. slurred speech
B. insidious onset
C. clouding of consciousness
D. sensory perceptual change

Answer: (B) insidious onset
Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances. A,C and D are all characteristics of delirium.
36. Situation: A 17 year old gymnast is admitted to the hospital due to weight loss and dehydration secondary to starvation.

Which of the following nursing diagnoses will be given priority for the client?
A. altered self-image
B. fluid volume deficit
C. altered nutrition less than body requirements
D. altered family process

Answer: (B) fluid volume deficit
Fluid volume deficit is the priority over altered nutrition (A) since the situation indicates that the client is dehydrated. A and D are psychosocial needs of a client with anorexia nervosa but they are not the priority.
37. What is the best intervention to teach the client when she feels the need to starve?
A. Allow her to starve to relieve her anxiety
B. Do a short term exercise until the urge passes
C. Approach the nurse and talk out her feelings
D. Call her mother on the phone and tell her how she feels

Answer: (C) Approach the nurse and talk out her feelings
The client with anorexia nervosa uses starvation as a way of managing anxiety. Talking out feelings with the nurse is an adaptive coping. A. Starvation should not be encouraged. Physical safety is a priority. Without adequate nutrition, a life threatening situation exists. B. The client with anorexia nervosa is preoccupied with losing weight due to disturbed body image. Limits should be set on attempts to lose more weight. D. The client may have a domineering mother which causes the client to feel ambivalent. The client will not discuss her feelings with her mother.
38. The client with anorexia nervosa is improving if:
A. She eats meals in the dining room.
B. Weight gain
C. She attends ward activities.
D. She has a more realistic self concept.

Answer: (B) Weight gain
Weight gain is the best indication of the client’s improvement. The goal is for the client to gain 1-2 pounds per week. (A)The client may purge after eating. (C) Attending an activity does not indicate improvement in nutritional state. (D) Body image is a factor in anorexia nervosa but it is not an indicator for improvement.
39. The characteristic manifestation that will differentiate bulimia nervosa from anorexia nervosa is that bulimic individuals
A. have episodic binge eating and purging
B. have repeated attempts to stabilize their weight
C. have peculiar food handling patterns
D. have threatened self-esteem

Answer: (A) have episodic binge eating and purging
Bulimia is characterized by binge eating which is characterized by taking in a large amount of food over a short period of time. B and C are characteristics of a client with anorexia nervosa D. Low esteem is noted in both eating disorders
40. A nursing diagnosis for bulimia nervosa is powerlessness related to feeling not in control of eating habits. The goal for this problem is:
A. Patient will learn problem solving skills
B. Patient will have decreased symptoms of anxiety.
C. Patient will perform self care activities daily.
D. Patient will verbalize how to set limits on others.

Answer: (A) Patient will learn problem solving skills
if the client learns problem solving skills she will gain a sense of control over her life. (B) Anxiety is caused by powerlessness. (C) Performing self care activities will not decrease ones powerlessness (D) Setting limits to control imposed by others is a necessary skill but problem solving skill is the priority.
41. In the management of bulimic patients, the following nursing interventions will promote a therapeutic relationship EXCEPT:
A. Establish an atmosphere of trust
B. Discuss their eating behavior.
C. Help patients identify feelings associated with binge-purge behavior
D. Teach patient about bulimia nervosa

Answer: (B) Discuss their eating behavior.
The client is often ashamed of her eating behavior. Discussion should focus on feelings. A,C and D promote a therapeutic relationship
42. Situation: A 35 year old male has intense fear of riding an elevator. He claims “ As if I will die inside.” This has affected his studies

The client is suffering from:

A. agoraphobia
B. social phobia
C. Claustrophobia
D. xenophobia

Answer: (C) Claustrophobia
Claustrophobia is fear of closed space. A. Agoraphobia is fear of open space or being a situation where escape is difficult. B. Social phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing. D. Xenophobia is fear of strangers.
43. Initial intervention for the client should be to:
A. Encourage to verbalize his fears as much as he wants.
B. Assist him to find meaning to his feelings in relation to his past.
C. Establish trust through a consistent approach.
D. Accept her fears without criticizing.

Answer: (D) Accept her fears without criticizing.
The client cannot control her fears although the client knows its silly and can joke about it. A. Allow expression of the client’s fears but he should focus on other productive activities as well. B and C. These are not the initial interventions.
44. The nurse develops a countertransference reaction. This is evidenced by:
A. Revealing personal information to the client
B. Focusing on the feelings of the client.
C. Confronting the client about discrepancies in verbal or non-verbal behavior
D. The client feels angry towards the nurse who resembles his mother.

Answer: (A) Revealing personal information to the client
A. Countertransference is an emotional reaction of the nurse on the client based on her unconscious needs and conflicts. B and C. These are therapeutic approaches. D. This is transference reaction where a client has an emotional reaction towards the nurse based on her past.
45. Which is the desired outcome in conducting desensitization:
A. The client verbalize his fears about the situation
B. The client will voluntarily attend group therapy in the social hall.
C. The client will socialize with others willingly
D. The client will be able to overcome his disabling fear.

Answer: (D) The client will be able to overcome his disabling fear.
The client will overcome his disabling fear by gradual exposure to the feared object. A,B and C are not the desired outcome of desensitization.
46. Which of the following should be included in the health teachings among clients receiving Valium:
A. Avoid taking CNS depressant like alcohol.
B. There are no restrictions in activities.
C. Limit fluid intake.
D. Any beverage like coffee may be taken

Answer: (A) Avoid taking CNS depressant like alcohol.
Valium is a CNS depressant. Taking it with other CNS depressants like alcohol; potentiates its effect. B. The client should be taught to avoid activities that require alertness. C. Valium causes dry mouth so the client must increase her fluid intake. D. Stimulants must not be taken by the client because it can decrease the effect of Valium.
47. Situation: A 20 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Extensive examination revealed no physical basis for the complaint.

The nurse plans intervention based on which correct statement about conversion disorder?
A. The symptoms are conscious effort to control anxiety
B. The client will experience high level of anxiety in response to the paralysis.
C. The conversion symptom has symbolic meaning to the client
D. A confrontational approach will be beneficial for the client.

Answer: (C) The conversion symptom has symbolic meaning to the client
the client uses body symptoms to relieve anxiety. A. The condition occurs unconsciously. B. The client is not distressed by the lost or altered body function. D. The client should not be confronted by the underlying cause of his condition because this can aggravate the client’s anxiety.
48. Nina reveals that the boyfriend has been pressuring her to engage in premarital sex. The most therapeutic response by the nurse is:
A. “I can refer you to a spiritual counselor if you like.”
B. “You shouldn’t allow anyone to pressure you into sex.”
C. “It sounds like this problem is related to your paralysis.”
D. “How do you feel about being pressured into sex by your boyfriend?”

Answer: (D) “How do you feel about being pressured into sex by your boyfriend?”
Focusing on expression of feelings is therapeutic. The central force of the client’s condition is anxiety. A. This is not therapeutic because the nurse passes the responsibility to the counselor. B. Giving advice is not therapeutic. C. This is not therapeutic because it confronts the underlying cause.
49. Malingering is different from somatoform disorder because the former:
A. Has evidence of an organic basis.
B. It is a deliberate effort to handle upsetting events
C. Gratification from the environment are obtained.
D. Stress is expressed through physical symptoms.

Answer: (B) It is a deliberate effort to handle upsetting events
Malingering is a conscious simulation of an illness while somatoform disorder occurs unconscious. A. Both disorders do not have an organic or structural basis. C. Both have primary gains. D. This is a characteristic of somatoform disorder.
50. Unlike psychophysiologic disorder Linda may be best managed with:
A. medical regimen
B. milieu therapy
C. stress management techniques
D. psychotherapy

Answer: (C) stress management techniques
Stree management techniques is the best management of somatoform disorder because the disorder is related to stress and it does not have a medical basis. A. This disorder is not supported by organic pathology so no medical regimen is required. B and D. Milieu therapy and psychotherapy may be used a therapeutic modalities but these are not the best.
51. Which is the best indicator of success in the long term management of the client?
A. His symptoms are replaced by indifference to his feelings
B. He participates in diversionary activities.
C. He learns to verbalize his feelings and concerns
D. He states that his behavior is irrational.

Answer: (C) He learns to verbalize his feelings and concerns
C. The client is encouraged to talk about his feelings and concerns instead of using body symptoms to manage his stressors. A. The client is encouraged to acknowledge feelings rather than being indifferent to her feelings. B. Participation in activities diverts the client’s attention away from his bodily concerns but this is not the best indicator of success. D. Help the client recognize that his physical symptoms occur because of or are exacerbated by specific stressor, not as irrational.
52. Situation: A young woman is brought to the emergency room appearing depressed. The nurse learned that her child died a year ago due to an accident.

The initial nursing diagnosis is dysfunctional grieving. The statement of the woman that supports this diagnosis is:

A. “I feel envious of mothers who have toddlers”
B. “I haven’t been able to open the door and go into my baby’s room “
C. “I watch other toddlers and think about their play activities and I cry.”
D. “I often find myself thinking of how I could have prevented the death.

Answer: (B) “I haven’t been able to open the door and go into my baby’s room “
This indicates denial. This defense is adaptive as an initial reaction to loss but an extended, unsuccessful use of denial is dysfunctional. A. This indicates acknowledgement of the loss. Expressing feelings openly is acceptable. C. This indicates the stage of depression in the grieving process. D. Remembering both positive and negative aspects of the deceased love one signals successful mourning.
53. The client said “I can’t even take care of my baby. I’m good for nothing.” Which is the appropriate nursing diagnosis?
A. Ineffective individual coping related to loss.
B. Impaired verbal communication related to inadequate social skills.
C. Low esteem related to failure in role performance
D. Impaired social interaction related to repressed anger.

Answer: (C) Low esteem related to failure in role performance
This indicates the client’s negative self evaluation. A sense of worthlessness may accompany depression. A,B and D are not relevant. The cues do not indicate inability to use coping resources, decreased ability to transmit/process symbols, nor insufficient quality of social exchange
54. The following medications will likely be prescribed for the client EXCEPT:
A. Prozac
B. Tofranil
C. Parnate
D. Zyprexa

Answer: (D) Zyprexa
This is an antipsychotic. A. This is a SSRI antidepressant. B. This antidepressant belongs to the Tricyclic group. C. This is a MAOI antidepressant.
55. Which is the highest priority in the post ECT care?
A. Observe for confusion
B. Monitor respiratory status
C. Reorient to time, place and person
D. Document the client’s response to the treatment

Answer: (B) Monitor respiratory status
A side effect of ECT which is life threatening is respiratory arrest. A and C. Confusion and disorientation are side effects of ECT but these are not the highest priority.
56. Situation: A 27 year old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant talked fast and hyperactive.

Initially the nurse should plan this for a manic client:

A. set realistic limits to the client’s behavior
B. repeat verbal instructions as often as needed
C. allow the client to get out feelings to relieve tension
D. assign a staff to be with the client at all times to help maintain control

Answer: (A) set realistic limits to the client’s behavior
The manic client is hyperactive and may engage in injurious activities. A quiet environment and consistent and firm limits should be set to ensure safety. B. Clear, concise directions are given because of the distractibility of the client but this is not the priority. C. The manic client tend to externalize hostile feelings, however only non-destructive methods of expression should be allowed D. Nurses set limit as needed. Assigning a staff to be with the client at all times is not realistic.
57. An activity appropriate for the client is:
A. table tennis
B. painting
C. chess
D. cleaning

Answer: (D) cleaning
The client’s excess energy can be rechanelled through physical activities that are not competitive like cleaning. This is also a way to dissipate tension. A. Tennis is a competitive activity which can stimulate the client.
58. The client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse does one of the following:
A. Agree on a consistent approach among the staff assigned to the client.
B. Suggest that the client take a leading role in the social activities
C. Provide the client with extra time for one on one sessions
D. Allow the client to negotiate the plan of care

Answer: (A) Agree on a consistent approach among the staff assigned to the client.
A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of exploiting the weakness in others or create conflicts among the staff. Bargaining should not be allowed. B. This is not therapeutic because the client tends to control and dominate others. C. Limits are set for interaction time. D. Allowing the client to negotiate may reinforce manipulative behavior.
59. The nurse exemplifies awareness of the rights of a client whose anger is escalating by:
A. Taking a directive role in verbalizing feelings
B. Using an authoritarian, confrontational approach
C. Putting the client in a seclusion room
D. Applying mechanical restraints

Answer: (A) Taking a directive role in verbalizing feelings
The client has the right to be free from unnecessary restraints. Verbalization of feelings or “talking down” in a non-threatening environment is helpful to relieve the client’s anger. B. This is a threatening approach. C and D. Seclusion and application restraints are done only when less restrictive measures have failed to contain the client’s anger.
60. A client on Lithium has diarrhea and vomiting. What should the nurse do first:
A. Recognize this as a drug interaction
B. Give the client Cogentin
C. Reassure the client that these are common side effects of lithium therapy
D. Hold the next dose and obtain an order for a stat serum lithium level

Answer: (D) Hold the next dose and obtain an order for a stat serum lithium level
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extra pyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.
61. Situation: A widow age 28, whose husband died one year ago due to AIDS, has just been told that she has AIDS.

Pamela says to the nurse, “Why me? How could God do this to me?” This reaction is one of:
A. Depression
B. Denial
C. anger
D. bargaining

Answer: (C) anger
Anger is experienced as reality sets in. This may either be directed to God, the deceased or displaced on others. A. Depression is a painful stage where the individual mourns for what was lost. B. Denial is the first stage of the grieving process evidenced by the statement “No, it can’t be true.” The individual does not acknowledge that the loss has occurred to protect self from the psychological pain of the loss. D. In bargaining the individual holds out hope for additional alternatives to forestall the loss, evidenced by the statement “If only…”
62. The nurse’s therapeutic response is:
A. “I will refer you to a clergy who can help you understand what is happening to you.”
B. “ It isn’t fair that an innocent like you will suffer from AIDS.”
C. “That is a negative attitude.”
D. ”It must really be frustrating for you. How can I best help you?”

Answer: (D) ”It must really be frustrating for you. How can I best help you?”
This response reflects the pain due to loss. A helping relationship can be forged by showing empathy and concern. A. This is not therapeutic since it passes the buck or responsibility to the clergy. B. This response is not therapeutic because it gives the client the impression that she is right which prevents the client from reconsidering her thoughts. C. This statement passes judgment on the client.

63. One morning the nurse sees the client in a depressed mood. The nurse asks her “What are you thinking about?” This communication technique is:
A. focusing
B. validating
C. reflecting
D. giving broad opening

Answer: (D) giving broad opening
Broad opening technique allows the client to take the initiative in introducing the topic. A,B and C are all therapeutic techniques but these are not exemplified by the nurse’s statement.
64. The client says to the nurse ” Pray for me” and entrusts her wedding ring to the nurse. The nurse knows that this may signal which of the following:
A. anxiety
B. suicidal ideation
C. Major depression
D. Hopelessness

Answer: (B) suicidal ideation
The client’s statement is a verbal cue of suicidal ideation not anxiety. While suicide is common among clients with major depression, this occurs when their depression starts to lift. Hopelessness indicates no alternatives available and may lead to suicide, the statement and non verbal cue of the client indicate suicide.
65. Which of the following interventions should be prioritized in the care of the suicidal client?
A. Remove all potentially harmful items from the client’s room.
B. Allow the client to express feelings of hopelessness.
C. Note the client’s capabilities to increase self esteem.
D. Set a “no suicide” contract with the client.

Answer: (A) Remove all potentially harmful items from the client’s room.
Accessibility of the means of suicide increases the lethality. Allowing patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients bur not specifically for suicide.
66. Situation: A 14 year old male was admitted to a medical ward due to bronchial asthma after learning that his mother was leaving soon for U.K. to work as nurse.

The client has which of the following developmental focus:
A. Establishing relationship with the opposite sex and career planning.
B. Parental and societal responsibilities.
C. Establishing ones sense of competence in school.
D. Developing initial commitments and collaboration in work

Answer: (A) Establishing relationship with the opposite sex and career planning.
The client belongs to the adolescent stage. The adolescent establishes his sense of identity by making decisions regarding familial, occupational and social roles. The adolescent emancipates himself from the family and decides what career to pursue, what set of friends to have and what value system to uphold. B. This refers to the middle adulthood stage concerned with transmitting his values to the next generation to ensure his immortality through the perpetuation of his culture. C. This reflects school age which is concerned with the pursuit of knowledge and skills to deal with the environment both in the present and in the future. D. The stage of young adulthood is concerned with development of intimate relationship with the opposite sex, establishment of a safe and congenial family environment and building of one’s lifework.
67. The personality type of Ryan is:
A. conforming
B. dependent
C. perfectionist
D. masochistic

Answer: (B) dependent
A client with dependent personality is predisposed to develop asthma. A. The conforming non-assertive client is predisposed to develop hypertension because of the tendency to repress rage. C. The perfectionist and compulsive tend to develop migraine. D. The masochistic, self sacrificing type are prone to develop rheumatoid arthritis.
68. The nurse ensures a therapeutic environment for the client. Which of the following best describes a therapeutic milieu?
A. A therapy that rewards adaptive behavior
B. A cognitive approach to change behavior
C. A living, learning or working environment.
D. A permissive and congenial environment

Answer: (C) A living, learning or working environment.
A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms, limit setting, balance and unit modification. A. Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment. B. Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic milieu.
69. Included as priority of care for the client will be:
A. Encourage verbalization of concerns instead of demonstrating them through the body
B. Divert attention to ward activities
C. Place in semi-fowlers position and render O2 inhalation as ordered
D. Help her recognize that her physical condition has an emotional component

Answer: (C) Place in semi-fowlers position and render O2 inhalation as ordered
Since psychopysiologic disorder has organic basis, priority intervention is directed towards disease-specific management. Failure to address the medical condition of the client may be a life threat. A and B. The client has physical symptom that is adversely affected by psychological factors. Verbalization of feelings in a non threatening environment and involvement in relaxing activities are adaptive way of dealing with stressors. However, these are not the priority. D. Helping the client connect the physical symptoms with the emotional problems can be done when the client is ready.
70. The client is concerned about his coming discharge, manifested by being unusually sad. Which is the most therapeutic approach by the nurse?
A. “You are much better than when you were admitted so there’s no reason to worry.”
B. “What would you like to do now that you’re about to go home?”
C. “You seem to have concerns about going home.”
D. “Aren’t you glad that you’re going home soon?”

Answer: (C) “You seem to have concerns about going home.”
. This statement reflects how the client feels. Showing empathy can encourage the client to talk which is important as an alternative more adaptive way of coping with stressors.. A. Giving false reassurance is not therapeutic. B. While this technique explores plans after discharge, it does not focus on expression of feelings. D. This close ended question does not encourage verbalization of feelings.
71. Situation: The nurse may encounter clients with concerns on sexuality.

The most basic factor in the intervention with clients in the area of sexuality is:
A. Knowledge about sexuality.
B. Experience in dealing with clients with sexual problems
C. Comfort with one’s sexuality
D. Ability to communicate effectively

Answer: (C) Comfort with one’s sexuality
The nurse must be accepting, empathetic and non-judgmental to patients who disclose concerns regarding sexuality. This can happen only when the nurse has reconciled and accepted her feelings and beliefs related to sexuality. A,B and D are important considerations but these are not the priority.
72. Which of the following statements is true for gender identity disorder?
A. It is the sexual pleasure derived from inanimate objects.
B. It is the pleasure derived from being humiliated and made to suffer
C. It is the pleasure of shocking the victim with exposure of the genitalia
D. It is the desire to live or involve in reactions of the opposite sex

Answer: (D) It is the desire to live or involve in reactions of the opposite sex
Gender identity disorder is a strong and persistent desire to be the other sex. A. This is fetishism. B. This refers to masochism. C. This describes exhibitionism.
73. The sexual response cycle in which the sexual interest continues to build:
A. Sexual Desire
B. Sexual arousal
C. Orgasm
D. Resolution

Answer: (B) Sexual arousal
Sexual arousal or excitement refers to attaining and maintaining the physiologic requirements for sexual intercourse. A. Sexual Desire refers to the ability, interest or willingness for sexual stimulation. C. Orgasm refers to the peak of the sexual response where the female has vaginal contractions for the female and ejaculatory contractions for the male. D. Resolution is the final phase of the sexual response in which the organs and the body systems gradually return to the unaroused state.
74. The inability to maintain the physiologic requirements in sexual intercourse is:
A. Sexual Desire Disorder
B. Sexual Arousal Disorder
C. Orgasm Disorder
D. Sexual Pain disorder

Answer: (B) Sexual Arousal Disorder
This describes sexual arousal disorder. A. Sexual Desire Disorder refers to the persistent and recurrent lack of desire or willingness for sexual intercourse. C. Orgasm Disorder is the inability to complete the sexual response cycle because of the inability to achieve an orgasm. D. Sexual Pain Disorder is characterized by genital pain before, during or after sexual intercourse.
75. The nurse asks a client to roll up his sleeves so she can take his blood pressure. The client replies “If you want I can go naked for you.” The most therapeutic response by the nurse is:
A. “You’re attractive but I’m not interested.”
B. “You wouldn’t be the first that I will see naked.”
C. “I will report you to the guard if you don’t control yourself.”
D. “I only need access to your arm. Putting up your sleeve is fine.”

Answer: (D) “I only need access to your arm. Putting up your sleeve is fine.”
The nurse needs to deal with the client with sexually connotative behavior in a casual, matter of fact way. A and B. These responses are not therapeutic because they are challenging and rejecting. C. Threatening the client is not therapeutic.
76. Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway and making aggressive remarks.

Which of the following statements is most appropriate to make to this patient?
A. What is causing you to become agitated?
B. You need to stop that behavior now.
C. You will need to be restrained if you do not change your behavior.
D. You will need to be placed in seclusion.

Answer: (A) What is causing you to become agitated?
In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted. B. Pacing is a tension relieving measure for an agitated client. C. This is a threatening statement that can heighten the client’s tension. D. Seclusion is used when less restrictive measures have failed.
77. The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time?
A. Acknowledge the client’s behavior
B. Maintain a safe distance from the client
C. Assist the client to an area that is quiet
D. Initiate confinement measures

Answer: (D) Initiate confinement measures
The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. . When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness, seclusion or restraints may be applicable. A, B and C are appropriate approaches during the escalation phase of aggression.
78. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for violence is which of the following:
A. A timid nurse
B. A mature experienced nurse
C. an inexperienced nurse
D. a soft spoken nurse

Answer: (B) A mature experienced nurse
The unstable, aggressive client should be assigned to the most experienced nurse. A, C and D. A shy, inexperienced, soft spoken nurse may feel intimidated by the angry patient.
79. The nurse exemplifies awareness of the rights of a client whose anger is escalating by:
A. Taking a directive role in verbalizing feelings
B. Using an authoritarian, confrontational approach
C. Putting the client in a seclusion room
D. Applying mechanical restraints

Answer: (A) Taking a directive role in verbalizing feelings
Taking a directive role in the client’s verbalization of feelings can deescalate the client’s anger. B. A confrontational approach can be threatening and adds to the client’s tension. C and D. Use of restraints and isolation may be required if less restrictive interventions are unsuccessful.
80. The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights?
A. There was a doctor’s order for restraints/seclusion
B. The patient’s rights were explained to him.
C. The staff observed confidentiality
D. The staff carried out less restrictive measures but were unsuccessful.

Answer: (D) The staff carried out less restrictive measures but were unsuccessful.
This documentation indicates that the client has been placed on restraints after the least restrictive measures failed in containing the client’s violent behavior.
81. Situation: Clients with personality disorders have difficulties in their social and occupational functions.

Clients with personality disorder will most likely:
A. recover with therapeutic intervention
B. respond to antianxiety medication
C. manifest enduring patterns of inflexible behaviors
D. Seek treatment willingly from some personally distressing symptoms

Answer: (C) manifest enduring patterns of inflexible behaviors
Personality disorders are characterized by inflexible traits and characteristics that are lifelong. A and D. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention. B. Medications are generally not recommended for personality disorders.
82. A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Antisocial

Answer: (D) Antisocial
These are the characteristics of an individual with antisocial personality. A. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. B. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. C. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors.
83. The client joins a support group and frequently preaches against abuse, is demonstrating the use of:
A. denial
B. reaction formation
C. rationalization
D. projection

Answer: (B) reaction formation
Reaction formation is the adoption of behavior or feelings that are exactly opposite of one’s true emotions. A. Denial is refusal to accept a painful reality. C. Rationalization is attempting to justify one’s behavior by presenting reasons that sounds logical. D. Projection is attributing of one’s behaviors and feelings to another person.
84. A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?
A. Lack of self esteem, strong dependency needs and impulsive behavior
B. social withdrawal, inadequacy, sensitivity to rejection and criticism
C. Suspicious, hypervigilance and coldness
D. Preoccupation with perfectionism, orderliness and need for control

Answer: (A) Lack of self esteem, strong dependency needs and impulsive behavior
These are the characteristics of client with borderline personality. B. This describes the avoidant personality. C. These are the characteristics of a client with paranoid personality D. This describes the obsessive compulsive personality
85. The plan of care for clients with borderline personality should include:
A. Limit setting and flexibility in schedule
B. Giving medications to prevent acting out
C. Restricting her from other clients
D. Ensuring she adheres to certain restrictions

Answer: (D) Ensuring she adheres to certain restrictions
The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission. A. Limits should be firmly and consistently implemented. Flexibility and bargaining are not therapeutic in dealing with a manipulative client. B. There is no specific medication prescribed for this condition. C. This is not part of the care plan. Interaction with other clients are allowed but the client should be observed and given limits in her attempt to manipulate and dominate others.
86. Situation: A 42 year old male client, is admitted in the ward because of bizarre behaviors. He is given a diagnosis of schizophrenia paranoid type.

The client should have achieved the developmental task of:
A. Trust vs. mistrust
B. Industry vs. inferiority
C. Generativity vs. stagnation
D. Ego integrity vs. despair

Answer: (D) Ego integrity vs. despair
The client belongs to the middle adulthood stage (30 to 65 yrs.) The developmental task generativity is characterized by concern and care for others. It is a productive and creative stage. (A) Infancy stage (0 – 18 mos.) is concerned with gratification of oral needs (B) School Age child (6 – 12 yrs.) is characterized by acquisition of school competencies and social skills (C) Late adulthood ( 60 and above) Concerned with reflection on the past and his contributions to others and face the future.
87. Clients who are suspicious primarily use projection for which purpose:

A. deny reality
B. to deal with feelings and thoughts that are not acceptable
C. to show resentment towards others
D. manipulate others

Answer: (B) to deal with feelings and thoughts that are not acceptable
Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety. A. This is not true in all instances of projection C and D. This focuses on the self rather than others
88. The client says “ the NBI is out to get me.” The nurse’s best response is:
A. “The NBI is not out to catch you.”
B. “I don’t believe that.”
C. “I don’t know anything about that. You are afraid of being harmed.”
D. “ What made you think of that.”

Answer: (C) “I don’t know anything about that. You are afraid of being harmed.”
This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses because these disagree with the client’s false belief and makes the client feel challenged D. unnecessary exploration of the false
89. The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:
A. tardive dyskinesia
B. Pseudoparkinsonism
C. akinesia
D. dystonia

Answer: (B) Pseudoparkinsonism
Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity A. Tardive dyskinesia is manifested by lip smacking, wormlike movement of the tongue C. Akinesia is characterized by feeling of weakness and muscle fatigue D. Dystonia is manifested by torticollis and rolling back of the eyes
90. The client is very hostile toward one of the staff for no apparent reason. The client is manifesting:
A. Splitting
B. Transference
C. Countertransference
D. Resistance

Answer: (B) Transference
Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another A. Splitting is a defense mechanism commonly seen in a client with personality disorder in which the world is perceived as all good or all bad C. Counterttransference is a phenomenon where the nurse shifts feelings assigned to someone in her past to the patient D. Resistance is the client’s refusal to submit himself to the care of the nurse
91. Situation: An 18 year old female was sexually attacked while on her way home from work. She is brought to the hospital by her mother.

Rape is an example of which type of crisis:
A. Situational
B. Adventitious
C. Developmental
D. Internal

Answer: (B) Adventitious
Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life. A. Situational crisis is from an external source that upset ones psychological equilibrium C and D. Are the same. They are transitional or developmental periods in life
92. During the initial care of rape victims the following are to be considered EXCEPT:
A. Assure privacy.
B. Touch the client to show acceptance and empathy
C. Accompany the client in the examination room.
D. Maintain a non-judgmental approach.

Answer: (B) Touch the client to show acceptance and empathy
The client finds touch intrusive and therefore should be avoided. A. Privacy is one of the rights of a victim of rape. C.The client is anxious. Accompanying the client in a quiet room ensures safety and offers emotional support. D. Guilt feeling is common among rape victims. They should not be blamed.
93. The nurse acts as a patient advocate when she does one of the following:
A. She encourages the client to express her feeling regarding her experience.
B. She assesses the client for injuries.
C. She postpones the physical assessment until the client is calm
D. Explains to the client that her reactions are normal

Answer: (C) She postpones the physical assessment until the client is calm
The nurse acts as a patient advocate as she protects the client from psychological harm A. The nurse acts a a counselor B. The nurse acts as a technician D. This exemplifies the role of a teacher
94. Crisis intervention carried out to the client has this primary goal:
A. Assist the client to express her feelings
B. Help her identify her resources
C. Support her adaptive coping skills
D. Help her return to her pre-rape level of function

Answer: (D) Help her return to her pre-rape level of function
The goal of crisis intervention to help the client return to her level of function prior to the crisis. A,B and C are interventions or strategies to attain the goal
95. Five months after the incident the client complains of difficulty to concentrate, poor appetite, inability to sleep and guilt. She is likely suffering from:
A. Adjustment disorder
B. Somatoform Disorder
C. Generalized Anxiety Disorder
D. Post traumatic disorder

Answer: (D) Post traumatic disorder
Post traumatic stress disorder is characterized by flashback, irritability, difficulty falling asleep and concentrating following an extremely traumatic event. This lasts for more that one month A. Adjustment disorder is the maladaptive reaction to stressful events characterized by anxiety, depression and work or social impairments. This occurs within 3 months after the event B. Somatoform disorders are anxiety related disorders characterized by presence of physical symptoms without demonstrable organic basis C. Generalized anxiety disorder is characterized by chronic, excessive anxiety for at least 6 months
96. Situation: A 29 year old client newly diagnosed with breast cancer is pacing, with rapid speech headache and inability to focus with what the doctor was saying.

The nurse assesses the level of anxiety as:
A. Mild
B. Moderate
C. Severe
D. Panic

Answer: (C) Severe
The client’s manifestations indicate severe anxiety. A Mild anxiety is manifested by slight muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem solving. B. Moderate muscle tension, increased vital signs, periodic slow pacing, increased rate of speech and difficulty in concentrating are noted in moderate anxiety. D. Panic level of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and disorganization

97. Anxiety is caused by:
A. an objective threat
B. a subjectively perceived threat
C. hostility turned to the self
D. masked depression

Answer: (B) a subjectively perceived threat
Anxiety is caused by a subjectively perceived threat A. Fear is caused by an objective threat C. A depressed client internalizes hostility D. Mania is due to masked depression

98. It would be most helpful for the nurse to deal with a client with severe anxiety by:
A. Give specific instructions using speak in concise statements.
B. Ask the client to identify the cause of her anxiety.
C. Explain in detail the plan of care developed
D. Urge the client to focus on what the nurse is saying

Answer: (A) Give specific instructions using speak in concise statements.
The client has narrowed perceptual field. Lengthy explanations cannot be followed by the client. B. The client will not be able to identify the cause of anxiety C and D. The client has difficulty concentrating and will not be able to focus.

99. Which of the following medications will likely be ordered for the client?”
A. Prozac
B. Valium
C. Risperdal
D. Lithium

Answer: (B) Valium
Antianxiety A. Antidepressant C. Antipsychotic D. Antimanic

100. Which of the following is included in the health teachings among clients receiving Valium?:
A. Avoid foods rich in tyramine.
B. Take the medication after meals.
C. It is safe to stop it anytime after long term use.
D. Double up the dose if the client forgets her medication.

Answer: (B) Take the medication after meals.
Antianxiety medications cause G.I. upset so it should be taken after meals. A. This is specific for antidepressant MAOI. Taking tyramine rich food can cause hypertensive crisis. C. Valium causes dependency. In which case, the medication should be gradually withdrawn to prevent the occurrence of convulsion. D The dose of Valium should not be doubled if the previous dose was not taken. It can intensify the CNS depressant effects.

Nursing Board Exam Result - November 2008

2009-02-19T20:44:00.000-08:00

Nursing board exam result november 2008

Publish at Scribd or explore others:

BON Nursing Advisory (DR, OR & Cord Care Cases)

2009-01-30T00:19:00.000-08:00

TO: DEANS OF COLLEGES OF NURSING
SUBJECT: INTRA-PARTAL , INTRA-OPERATIVE, AND IMMEDIATE CARE OF THE NEWBON REQUIREMENTS IN THE FILING OF APPLICATION FOR THE NURSE LICENSURE EXAMINATION
DATE: JANUARY 30, 2008

It has come to the attention of the PRC Board of Nursing that some Nursing Colleges have reduced the required number of “intra-partal, intra-operative, and immediate care of the newborn” (D.R. / O.R. / Cord Care) from five (5) to three(3) cases causing confusion especially among nursing students.

The BOARD wishes to reiterate to all concerned that in accordance with its quasi-legislative function (Article III, Section 9 (c), (d) and (h), it is still in the process of HEARING the outputs from the Association of Deans of Philippine Colleges of Nursing (ADPCN) based on commitments duly made during the last ADPCN Convention of October 2008 and therefore has not announced any changes in the prevailing requirement of cases for the intra-partal, intraoperative and immediate care of the newborn.

This BOARD wishes to FURTHER EMPHASIZE, that it adheres to a NO RETROACTIVE APPLICATION OF ANY NEW POLICY, therefore if and when new promulgations are finally issued this will never be applied to “graduating students”.

And that FINALLY, this BOARD envisions that all related policy-changes that will be announced shall be in effect for those who will enrol for their intra-partal, intra-operative, and immediate care of the newborn clinical experiences in June of 2009.

In view hereof, all Deans and faculty-members of Colleges of Nursing, and all concerned professional nurses ARE HEREBY DIRECTED to follow the PREVAILING PRESCRIPTIONS of five cases each with regards to O.R., D.R., and Cord Care requirements for the filing of applications to the 2009-2010 Nurse Licensure Examinations (NLE). Nursing graduates of 2011 and 2012, meaning those enrolling in their 2nd and 3rd Academic Year shall be those who shall be affected by the new policy promulgations.

PLEASE BE GUIDED ACCORDINGLY.

Download the file here BON Cases Advisory

Originally posted by: BON Philippines

Tips for taking NCLEX

2009-01-28T08:35:00.000-08:00

Take Care of Yourself

· Get a good night's sleep.

· Eat a nutritious breakfast.

· Do not cram the night before the exam; cramming increases stress.

· Dress comfortably for the exam.

· Avoid taking sleeping pills or drinking alcohol the night before the exam.

Plan Ahead

· Schedule the exam at a location close to home to reduce the stress of traveling. Scout out parking options and the location of the exam in relationship to your hotel prior to your test date.

· Plan carefully. Be sure you have your identification and your exam admission ticket with you.

Study Tips

· Develop a study schedule months in advance of the exam and stick to it.

· If a study group helps you, organize one. Be careful that the group does not drag you down or waste your time.

· If you sign up for a NCLEX® Examination review course, check out its pass rate first.

· Practice often - become familiar with the multiple choice format used on the NCLEX® Examination.

· Take advantage of the CD's available with practice books to take the computerized test.

· Avoid distractions.

· Time yourself and try to get the time you need for each question down to a minimum.

· Reward yourself (with something healthy) for making progress on your study schedule.

· Develop or use mnemonic devices to help you remember details. "ABC," or Airway-Breathing-Circulation, is a good example.

· Develop flashcards and take them with you for a quick study wherever you are.

· If you run into difficult content, seek help from an instructor who knows the topic well for assistance understanding it; as you study, ask yourself questions that apply the knowledge.

NCLEX Questions Tips

· The NCLEX® Examination-RN is a "computer adaptive test." In other words, after you answer a question correctly, the computer will ask a harder question next. If you answer a question incorrectly, the computer will ask an easier question next. Scoring varies; an exam could have from 75 to 265 questions. The goal of the exam is to find out your competence level in the different areas the exam covers.

· Fifteen of the questions on the exam are experimental. They will neither help you nor hurt you. You will not know which questions are experimental.

· You will be given five hours to complete the exam, which includes the tutorial at the beginning, a mandatory break, and an optional break.

· The test is user friendly. You will receive instructions on how to use the computer and an opportunity to practice before the timing begins. You will use a minimum number of keys (space bar and enter key). You will give your answer then be asked to hit the enter key to confirm that this is the answer you want.

· You will proceed through the questions and will not be allowed to go back to revise your answers. You can not skip a question.

· Read each question carefully. Quickly try to answer the question before reading the responses. If your answer is in one of the responses, you are more likely to answer the question correctly.

· NCLEX® Examination questions basically ask "What should you do in this situation?" When studying, always think in terms of how you should handle a nursing problem.

· If you are having trouble remembering material, try to remember people you've cared for with similar problems.

· Think conceptually rather than specifically. For example, understand how classes of drugs work and how side effects are related to actions. In this way, you will not need to memorize all the details about each drug.

· Remember to think about what the priority would be in each situation. For example, in an emergency always think of the ABC's first--Airway, breathing, and circulation

· Chose nursing actions before medical actions. For example, you would try repositioning before giving medications.

· Think about the nursing process when answering questions. I.e., you would assess a situation before doing an intervention.

· Do not select uncompromising answers such as "never" or "all."

· Remember that the person is your client, not the person's machine.

· Remember that your correct response will be what you, as a nurse, should do, not who you should call for orders.

· Be alert when answering questions related to children. Their responses to medical conditions often vary from the adult response.

· Be sure you identify the client, the problem, and the part of the nursing process the question addresses. For example, if the question is about assessment, a response about intervention would be incorrect.

· The RN NCLEX® Examination covers "Meeting Patient Needs." The four areas of patient need it addresses are

o Safe and effective care environment

o Health promotion and maintenance

o Psychosocial integrity

o Physiological integrity

· When a question concerns delegation

o Remember that assessment, nursing diagnosis, and evaluation of care are activities done by a professional nurse; these should not be delegated.

o You would not delegate the care of an unstable client or complicated interventions to nonprofessionals.

· As of April, 2003, "Innovative questions" will be added to the NCLEX® Examination.

o These could include fill-in-the blanks questions, questions with more than one possible correct answer, or questions that ask the candidate to respond to a diagram.

o The advantage of these questions is that they allow candidates to demonstrate their knowledge in multiple ways.

o The questions are developed and tested by expert nurses and statisticians. They will be tested before used, just like the multiple choice questions. Therefore, they will not be scored until after the April, 2003 exam.

o Item difficulty will be taken into account, just as with the present multiple choice exam.

o Items will be scored as "right" or "wrong."

Test Taking Tips

· You will not be allowed to take anything into the exam center with you.

· Remember that your first choice for an answer is likely to be your best guess. Changing answers typically does not work.

· Don't worry about how much time the other test-takers are taking for the exam.

· Avoid panic; taking some deep breathes if you are feeling stressed during the exam. Purposefully relax your face, neck, shoulders, arms, legs, and feet in succession before going on.

· Remember that italicized words, such as not or first give you clues as to which answer is correct. Read those question stems carefully.

· Use the paper and pencil provided for you during the exam to make outlines or diagrams or otherwise help you remember.

· Take full advantage of breaks during the exam. Bring something healthy to eat.

· Schedule your exam at the time of day most productive for you.

Passing/Failing the NCLEX® Examination

· The NCLEX® Examination is a pass/fail exam. Your state board of nursing will notify you whether you passed or failed two to four weeks after your exam.

· If you do not pass, you can retake the exam in three months.

· If you do not pass, you will receive a printout showing your weak areas when you receive your exam. Use this information when you study for the next time you take the exam.

· If you want to get a diagnosis of your strong and weak areas before the exam, try this book from Kaplan: NCLEX® Examination Computer Diagnostic

Fractures

2009-01-23T23:52:00.000-08:00

Break in bone continuity from excessive force. Traumatizes muscles, blood
vessels, and nerves leading to inflammation and possible hemorrhage

Types of Fractures

Simple (closed): Skin remains intact
Compound (open): Fragments penetrate skin
Transverse: Straight across
Oblique: Angled across
Spiral: Twists around shaft
Comminuted: Multiple fragments
Compression: Compressed bone mass
Depressed: Fragments forced inward
Green stick: Break partially extends across and then along length; more
common in children
Pathological: Force than normal needed to break bone due to ↑age, porous,
brittle bones (osteoporosis), metastatic or primary tumors, Paget’s disease

Signs and Symptoms
■ Pain, spasms, shortening of extremity, ecchymosis
■ Grating sound when moved (crepitus)
■ ↓Mobility, deformity, paresthesia 2° nerve damage
■ Shock 2° hemorrhage
■ Fat emboli: Dyspnea; ↑R; ↑P; ↑T; copious white sputum; crackles;
↑mentation; buccal, conjunctival and chest petechiae
■ Compartment syndrome: ↑Muscle compartment pressure 2°
edema/bleeding → ↓circulation → tissue hypoxia → ↑pain and damage

Treatment
■ Closed reduction: Fragments aligned and stabilized with cast, splint, or
traction
■ Open reduction and internal fixation (ORIF) with wires, pins, nails, rods, or
plates
■ Hemiarthroplasty (surgery for femur head prosthesis)

Nursing Management
■ Immobilize (↓trauma and pain); pain management
■ Peripheral neurovascular assessment: Peripheral pulses, color, T, capillary
refill, motor/sensory function
■ Monitor for compartment syndrome (elevate limb and notify MD)
■ Patient with a cast: ↑On pillow, uncover to ↑drying, handle with palms
not fingertips until dry, isometric exercise to ↓atrophy; odor may indicate
infection
■ Patient with traction: Hang weights freely, functional alignment, pin care
as ordered for skeletal traction
■ Postoperative care for patient with hemiarthroplasty:
■ ↓Pain (patient controlled analgesia)
■ ↓Displacement of prosthesis (abduction pillow, avoid internal rotation
or flexing >90 degrees, ↑toilet seat/chair)
■ Prevent DVT (anticoagulants and compression devices as ordered,
dorsiflexion, avoid popliteal pressure)
■ ↓Atelectasis/pneumonia (incentive spirometry, coughing, deep
breathing)

Pneumothorax

2009-01-23T23:39:00.000-08:00

Acute Respiratory Distress Syndrome (ARDS)

2009-01-23T23:15:00.000-08:00

Etiology and Pathophysiology
■ Direct or indirect lung trauma → inflammation → fluid movement into
alveolar spaces and ↓surfactant → atelectasis → hypoxia and ↑dead space
■ Secondary to trauma, aspiration, shock, infection

Signs and Symptoms
■ Early: Dyspnea, anxiety, ↓O2 sat, ↓PaO2
■ Late: ↑CO2, cyanosis, lung infiltrate on x-ray

Treatment
■ Treat cause; mechanical ventilation and positive end expiratory pressure
(PEEP—keeps alveoli open)
■ Steroids, interleukin-1 receptor antagonists, surfactant therapy
■ Sedatives or neuromuscular

Nursing Management
■ Monitor S&S; suction airway
■ Mechanical ventilator care:
■ Assess breath sounds for equality (PEEP → ↑risk of pneumothorax,
ET tube may be in right bronchi)
■ Maintain trach or endotracheal tube cuff pressure seal to ensure full
volume delivery
■ Check ventilator settings and alarms (↑pressure secondary to mucus or
tubing kinks and ↓pressure secondary to ↓cuff pressure or separation
of tubing)
■ Provide alternate mode of communication

Pneumonia

2009-01-12T08:18:00.000-08:00

Etiology and Pathophysiology

■ Microorganisms from upper airway/blood, aspiration of
food/gastric contents → inflammation
(exudate and WBCs into alveoli) →
consolidation,↓ventilation, and ↓diffusion
■ Aerosolized or droplet transmission

Risk Factors
■ ↑ ↓Age, smoking, immunosuppression
■ Winter (Streptococcal pneumonia), summer and fall (Legionella)

Signs and Symptoms
■ ↑ T and WBC, adventitious breath sounds, cough, sputum (character
depends on organism)
■ Chest x-ray indicates patchy or lobe consolidation or infiltrates

Treatment
■ Antibiotic regime based on organism
■ Replace fluid losses secondary to ↑T and ↑R

Nursing Management
■ Chest PT, if ordered; ↑fluids
■ Teach ↓transmission (hand washing, tissue disposal)
■ Teach need to finish med regime to ↓recurrence or resistance

Lung Cancer

2009-01-08T09:27:00.000-08:00

Etiology and Pathophysiology
■ Altered DNA → alters cellular replication; may be primary or metastatic;
often metastasizes to lymph nodes, bone, brain before diagnosis
■ Types: Adenocarcinoma, small cell (oat cell), large cell (undifferentiated),
and squamous cell carcinoma

Risk Factors
■ Smoking, heredity, ↓intake of fruits and vegetables
■ Exposure to asbestos or radon

Signs and Symptoms
■ Dry, chronic cough; hoarseness
■ ↓Weight, lymphadenopathy
■ Sputum positive for cytology
■ Chest x-ray indicates lesion and possible effusion
■ Biopsy indicates source (primary or secondary)

Treatment
■ Lobectomy, pneumonectomy
■ Chemotherapy, radiation, palliative care (↓pain)

Nursing Management
■ Lobectomy: Manage chest tubes
■ Pneumonectomy: Place on operative side
■ Chemotherapy: Manage side effects; hospice prn

Emphysema

2009-01-08T09:24:00.000-08:00

Etiology and Pathophysiology
■ Alveolar wall distention → ↑surface area for gas exchange, air trapping,
and ↑residual volume → ↑work to exhale, barrel chest, chronic
hypercapnia; may → right-sided heart failure (cor pulmonale)

Risk Factors
■ ↑Age, smoking, secondhand smoke, inhaled pollutants
■ Alpha antitrypsin deficiency

Signs and Symptoms
■ Barrel chest, clubbing of fingers
■ Pursed-lip breathing, ↓forced expiratory volume
■ Bronchodilators ineffective (unlike asthma)

Treatment
■ Smoking cessation
■ O2; meds: steroids and bronchodilators
■ Lung transplant

Nursing Management
■ Give O2 at ≤2L because with emphysema excessive exogenous O2
diminishes the respiratory drive and results in ↓breathing and ↑CO2
retention (CO2 narcosis). Normally ↑CO2 stimulates breathing. With
emphysema there is chronic ↑CO2 and as a result low O2 stimulates
breathing
■ Teach diaphragmatic and pursed-lip breathing to extend exhalation and
keep alveoli open

Tuberculosis (TB)

2009-01-03T08:44:00.000-08:00

Etiology and Pathophysiology
■ Mycobacterium tuberculosis → granulomas of bacilli that become fibrous
tissue mass (Ghon tubercle) that can calcify or ulcerate and free bacilli
■ Miliary TB: Bacilli may travel to bone, kidneys, or brain

Risk Factors
■ ↓Immune response (HIV, steroids), crowded living conditions
■ Alcoholism, malnutrition

Signs and Symptoms
■ Night sweats, ↓weight, cough, hemoptysis
■ +PPD/Mantoux of 10mm induration indicates immune response
■ +Chest x-ray, acid fast bacteria in sputum

Treatment
■ Combination of antituberculars for 6-12mo
■ Prophylactic INH for exposure

Nursing Management
■ Use airborne precautions during active disease
■ Teach need for long-term compliance with meds