Practice questions

Question 1

Mary is admitted to an inpatient ward with a diagnosis of bipolar disorder. The family reports that over the last two months Mary has been very busy, sleeping only 3-4 hours a night and has been spending lots of money. During the initial interview what type of response should the nurse expect from Mary?

A: Short, polite responses to questions.
B: Exaggerated self-importance.
C: Feelings of hopelessness and helplessness.
D: Introspection related to her current situation.

Answer 1

B Exaggerated self-importance.

Question 2

The priority nursing diagnosis for Mary would be

A: risk for injury.
B: chronic low self-esteem.
C: noncompliance with medication.
D: insomnia.

Answer 2

A risk for injury.

Question 3

Which of the principles should the nurse apply when planning care?

A: Manic clients respond well to peer pressure.
B: Decreasing stimulation tends to diminish symptoms.
C: Increasing stimulation tends to focus the client.
D: Detailed activities will help the client control behaviour.

Answer 3

B Decreasing stimulation tends to diminish symptoms.

Question 4

One of the nursing interventions most suitable for her is

A: give firm simple, clear directions and comments.
B: tell Mary everything she needs to know immediately so that she feels safe.
C: ensure that the family know everything that is going on for consistency.
D: provide a teaching session on sleep hygiene

Answer 4

A give firm simple, clear directions and comments.

Question 5

Robert is uncomfortable in social situations due to fear and anxiety. One of the nursing interventions most appropriate for him is

A: encourage participation in group activities to help him take his mind off things.
B: encourage participation with the therapy sessions being run this week to help him find himself.
C: assess the level of discomfort and fear in social situations.
D: encourage him to stay in his room and rest.

Answer 5

C assess the level of discomfort and fear in social situations.

Question 6

The most common coexisting psychiatric disorder for someone with a substance use disorder is

A: depression.
B: anxiety.
C: schizophrenia.
D: borderline personality disorder.

Answer 6

B anxiety.

Question 7

A nursing diagnosis that should be considered for an individual who had inconsistent, unpredictable, and discontinuous care as an infant would be

A: anxiety.
B: ineffective coping.
C: hopelessness.
D: role confusion.

Answer 7

B ineffective coping.

Question 8

Which of the following symptoms is indicative of a manic episode

A: Inflated sense of self-esteem
B: decreased need for sleep
C: increased energy and rapid speech
D: All of the above

Answer 8

D All of the above

Question 9

A useful definition for anxiety could be considered as,

A: that it is a normal response that the body uses to respond to alarm to triggers
B: Emotional distress that is constant, surging or unpredictable
C: Comes in waves of nausea, hot flushes and intrusive irrational thoughts
D: Results in avoidance of exposure to triggers that induce heightened fear or arousal

Answer 9

A - that it is a normal response that the body uses to respond to alarm to triggers
(all the others are related to anxiety disorder)

Question 10

A useful definition of recovery could include.

A: Living well in the absence or presence of illness
B: Being able to work again
C: Having full remission of symptoms
D: Being able to talk freely about mental illness

Answer 10

A Living well in the absence or presence of illness

Question 11

Principles of recovery-orientated mental health practice can be defined as,

A: Attitudes and rights
B: Partnership and communication
C: Uniqueness of the individual
D: All of the above

Answer 11

D All of the above

Question 12

Mrs Smith is a 27 year old single mother with an 8 year old daughter, Mrs smith has lived with anxiety for a number of years and often has panic attacks when she leaves the house. Mrs Smith is trying to be a ‘normal’ mother and walks her daughter to school each day and gets involved in classroom activities. This is causing her to become increasingly stressed and she is now worried she will avoid going out in public.

Q1 Why do you think Mrs Smith is anxious about leaving her home?

Q 2 What types of nursing interventions can you consider to assist Mrs Smith (at least 2)

Answer 12

Q1 Answer She appears to have an anxiety disorder and is fearful about leaving the house due to past panic attacks so now she actively avoids the risk of having another panic attack

Q2 Answers 10 commandments, CBT techniques, relaxation therapy, gradual exposure

Question 13

Mr Smith has been diagnosed with depression. Name 4 symptoms that Mr Smith may be experiencing that support a diagnosis of depression.

Answer 13

1___sleep disturbance 2recurrent thoughts of death or dying 3__ anhedonia (loss of interest in normally pleasurable activities) 4_pervasive and persistent low mood ALSO low self-esteem, weight changes, fatigue or loss of energy, feelings of worthlessness, diminished ability to think

Question 14

Recovery from borderline personality disorder may be harder than living with the illness itself. Discuss why you think this may be the case?

Answer 14

Actually being able to cope appropriately with distress and emotional turmoil is very challenging and for many people it is easier to act out, blame someone else, deny there is a problem or seek physical relief through self-harm. Recovery means taking responsibility, changing thoughts, behaviours and beliefs and fighting the urge to resist old and comforting behaviours. (Or something along those lines)

Question 15

Discuss why discrimination and stigmatisation may be more prevalent towards people who engage in self-harm than any other major mental disorder.

Answer 15

Self harming behaviour is emotionally challenging not only for clients but for those nursing and a sense of rejection and failure can result in those nurses who eel let down when a plan is broken. This can result in negative reactions and active fear and avoidance by the nurse which can result in discrimination and stigmatisation, i.e. attention seeking, not worthy if they can’t help themselves. Also nurses can fear retribution or blame for not stopping the self-harm.

Question 16

Identify and discuss potential barriers for recovery with people in the forensic mental health system.

Answer 16

Lost opportunity and a sense of worthlessness often associated with offending behaviour rather than mental illness. A reluctance to try new things for fear of failure, rejection from employers, communities and fear of being judged and labelled. On top of this a loss of autonomy related to incarceration and limited movement.

Question 17

Identify 4 skills associated with developing a positive therapeutic relationship.

Answer 17

Communication skills, (listening, body language, cultural respect) positive regard, trust, honesty, non-judgemental approach, identifying strength, not weakness, collaboration, partnership

Question 18

A client has been labelled by staff as ‘difficult’. A nurse could anticipate that this client would demonstrate

A: denial of illness.
B: withdrawn, isolated behaviour.
C: inability to test reality accurately.
D: excessively demanding behaviours.

Answer 18

D excessively demanding behaviours.

Question 19

A 30 year old male client has been admitted to the ward. The nurse receives a call from a person who says he is the client’s friend and is inquiring about the client’s condition. The nurse’s response should

A: not acknowledge that the client has been admitted to the unit.
B: invite the caller to contact the client’s physician for information.
C: give only the information that the client’s condition is stable.
D: suggest that the co-worker call the client directly on the client’s phone.

Answer 19

A not acknowledge that the client has been admitted to the unit.

Question 20

Sally has a mood disorder; Sally’s husband asks the nurse, “Is this cycling of moods from depressed to manic going to continue the rest of her life”. What information should serve as the basis for the nurse’s reply?

A: Clinical observation tells us that mood disorders tend to remit and recur.
B: I suggest you discuss this with her Doctor at the next family meeting.
C: Most mood disorders are cured within five years of onset.
D: Persons from higher socioeconomic groups have fewer relapses.

Answer 20

A Clinical observation tells us that mood disorders tend to remit and recur.

Question 21

A patient is admitted in a state of crisis and is at risk of committing suicide. The most immediate goal for this patient is which of the following?

A: Helping him find a better support system.
B: Teaching him new coping skills.
C: Insuring his safety and security.
D: Discussing his short and long term goals.

Answer 21

C Insuring his safety and security.

Question 22

Which of the following client outcomes would be appropriate to determine early favourable response to antidepressant medication? The client will

A: describe signs and symptoms of major depression.
B: make plans to attend one community social activity a week.
C: demonstrate assertive communication skills.
D: state he feels fine and expect to go home.

Answer 22

B make plans to attend one community social activity a week.

Question 23

When a patient with anorexia nervosa is admitted for treatment, the nurse’s priority interventions will be directed towards

A: teaching assertiveness.
B: sharing information on self-help groups.
C: supervision of patient activities.
D: developing a friendship with the patient.

Answer 23

C supervision of patient activities.

Question 24

For care-planning purposes, the nurse must consider that a client who has abused alcohol and other illicit substance throughout her pregnancy is at high risk for

A: a difficult labour and delivery.
B: having a normal but underweight baby.
C: delivering a baby with facial abnormalities and mental retardation.
D: having a child who will have hyperbilirubinaemia and brain damage.

Answer 24

C delivering a baby with facial abnormalities and mental retardation.

Question 25

Identify four (4) common symptoms of alcohol withdrawal.

Answer 25

Initial symptoms may include headache, tremor, sweating, agitation, anxiety and irritability, nausea and vomiting, heightened sensitivity to light and sound, disorientation, difficulty concentrating, disturbed sleep

Question 26

A 47 year old man, John, is seen during a psychiatric admission assessment and is noted to have blood glucose of 15.4 mmol/L on routine testing. He is 174cm tall and weighs 121kg.

a)State three (3) risk factors for Type 2 diabetes.

b)State three (3) symptoms of hyperglycaemia.

Answer 26

a) Obesity
* Aging
* Genetic make up
* In NZ Maori, Pacific peoples, & Asians have an increased risk

b) Excessive thirst (Polydipsia)
* Excessive urination (Polyuria)
* Excessive hunger (Polyphagia)
* Dry mouth
* Blurry vision
* Fatigue or drowsiness
* Weight loss

Question 27

Mr Smith has been admitted to the unit expressing thoughts of wanting to go to sleep and not wake up again. Her family report that she has been isolating herself at home, is very thin and has stopped going to her bowls club.

a)State two (2) key issues for Mrs Smith.

b)State two (2)nursing interventions and two (2) rationales to address each key issue.

Answer 27

a) Risk of suicide/self-harm related to thoughts of not wanting to wake up
Risk of malnutrition related to weight loss
Risk of increased lowering in mood and self-neglect related to isolation
Lack of engagement in usual activities (anhedonia) related to not going to her bowls club

b) Risk management- assess risk of harm to self and suicide
Establishing the therapeutic relationship – develop trust and open communication
Physical health needs – adequate food/fluids/ADLs
Structuring the day- increase engagement in activity, motivation, develop hope
Education – symptom management and medication
Education and support of family members- reduce loneliness, improve engagement and accurate support levels

Question 28

A 38 year old married mother of two was admitted to the psychiatric unit. Recently she has spent $10,000 on new furniture, made excessive long-distance phone calls, and has not slept for three days. She is presently dressed in a green bathing suit and singing loudly in the examining room. The nurse would initially plan to focus on

A. assessing needs for food, liquids, and rest.
B. setting strict limits on dress and behavior.
C. obtaining a complete psychosocial assessment.
D. conducting an in-depth suicide assessment.

Answer 28

A. assessing needs for food, liquids, and rest.

Question 29

2. A client has been placed on antidepressant medication. What information about the expected outcome of this medication therapy would the nurse give the client? “This medication is expected to

A.cure your depression.”
B.improve brain chemical imbalance.”
C.help you understand your distorted thinking.”
D. give you the opportunity to unlearn your helplessness.”

Answer 29

B. improve brain chemical imbalance.”

Question 30

3. A loud, hyper verbal, hyperactive client admitted with bipolar disorder, manic phase, has been on the unit for two days. The other clients are planning their weekend activity when this client interrupts and insists that they change their plans to a disco party. The client curses and becomes louder when the disco idea is rebuffed. The preferable nursing intervention would be to

A. ask the group to reconsider the suggestion.
B. tell the client to quiet down or leave the room.
C.accompany the client to a quieter place.
D. ignore the outburst because it is related to mania.

Answer 30

C. accompany the client to a quieter place.

Question 31

4. The most effective nursing approach to deal with denial in a client who abuses substances is

A. discussing the addictive personality.
B.confronting the client regarding his or her hopeless life situation.
C.having the client identify the effects of substance abuse on his or her life.
D. describing the physiologic effects of substance abuse.

Answer 31

C. having the client identify the effects of substance abuse on his or her life.

Question 32

5. Which of the following should the nurse incorporate into the care plan of a client demonstrating symptoms of withdrawal delirium?

A. Encourage group participation.
B. Confront denial of substance abuse.
C.Use restraints on all extremities.
D.Create quiet, non stimulating environment.

Answer 32

D. Create quiet, non stimulating environment.

Question 33

6. A client with paranoid schizophrenia has said she feels like throwing a chair. The nurse in the lounge hears this and wishes to encourage verbalisation as a de-escalation technique. Which response by the nurse would fulfill this plan?

A.”Tell me what’s going on.”
B.”If you throw something, you will be restrained.”
C.”Why are you so upset?”
D.”It’s time for group therapy. You can talk there.”

Answer 33

A. “Tell me what’s going on.”

Question 34

7. An elderly client was well until 12 hours ago, when she reported to her family that during the evening she saw strange faces peering in her windows and in the middle of the night awakened to see a man standing at the foot of her bed. The client’s family reports that the client has recently been to the doctor who made some medication changes, although they are unsure of what the changes were. The nurse hearing this history will identify the history and symptoms as pointing to

A.delirium related to drug toxicity.
B.Pick’s disease.
C.Parkinson’s dementia.
D.amnestic disorder.

Answer 34

A. delirium related to drug toxicity.

Question 35

8. A client experiencing psychosis tells the nurse she cannot participate in group therapy because her head is empty. Which of the following responses should the nurse plan to use with this client?

A.”If your head is empty, how can you walk and talk?”
B.”Don’t talk nonsense. No one has an empty head.”
C.”You’re feeling as though you are not able to think?”
D.”Let’s not focus on that right now.”

Answer 35

C. “You’re feeling as though you are not able to think?”

Question 36

9. The nurse mentions, “I like to use open-ended questions and statements because they result in fuller, more revealing responses by the client, and they stimulate discussion.” Based on this, which of the following is the nurse likely to ask or say during client assessment?

A.”Where is your family?”
B.”Tell me about your family.”
C.”Do you have a family?”
D.”Would you like to talk about your family?”

Answer 36

B. “Tell me about your family.”

Question 37

10. Which of the following questions would the nurse use to assess a client’s judgment?

A.”Why did you run away?”
B.”When did you first start hearing voices?”
C.”What would you do if you smelled smoke in your home?”
D.”Do you believe you hear voices, or do you think it is in your mind?”

Answer 37

C. “What would you do if you smelled smoke in your home?”

Question 38

State THREE (3) common side-effects and THREE (3) related nursing interventions for mood stabilising medication.

Answer 38

gastric irritation/nausea (Sodium Valporate)

tremor, stomach upset, polyuria, polydipsia. (Lithium Carbonate)

diplopia, dizziness, drowsiness (Carbamazapine)

Take with food, education around medication use, side effects and toxicity, operating machinery, interactions with other medications, avoid alcohol, monitor hepatic and renal function.

Question 39

1. Name the SIX (6) classic symptoms of the groups of disorders known as schizophrenia.

Answer 39

POSITIVE SYMPTOMS
Delusions
Hallucinations
Thought Disorder
NEGATIVE SYMPTOMS
Anhedonia
Avolition
Affective flattening

Question 40

3. Rex, a 66 year old retired man, was having trouble doing up the waistband of his old trousers. He realised that he had put on a lot of weight since he last wore them. He had an appointment to tell his family doctor he had some patchy loss of vision. The doctor asked Rex to return the next morning to have a glucose tolerance test.
   Why did Dr Collins suggest a glucose tolerance test should be done on a man who had a problem with loss of vision?

Answer 40

Rex’s age (over 45), weight gain and possible inactivity since retirement indicates he is in the high risk category for developing type II diabetes.

Question 41

4. An elderly gentleman is admitted with suicidal ideation. He has recently lost his spouse of 43 years. Although he owns his home, there is little money to pay repairs and utilities. His adult children live hundreds of kilometres away and rarely visit. In his younger years he hunted pigs and deer. He still has guns in his home. Last month the doctor diagnosed cataracts, and he has difficulty reading.
   a.What assessments must be undertaken?
   b.What risk factors for suicide are present?
   c.What is your priority nursing diagnosis?
   d.What nursing interventions should be implemented?

Answer 41

a. What assessments must be undertaken?
Risk of suicide
Levels of support
ADL’s and nutrition

b. What risk factors for suicide are present?
Voicing suicidal ideation
Loss of spouse
Access to weapons
Loneliness and remoteness (from family)
Financial stress

c. What is your priority nursing diagnosis?
Risk of suicide related to his voicing suicidal ideation and loss.

d. What nursing interventions should be implemented?
Assessment for suicide
Removal of guns
Contact with family
Support with ADL’s finances