REVIEW CENTER FOR ALLIED PROFESSIONS

(RCAP)
PRE-BOARD EXAMINATION

NURSING PRACTICE V CARE OF CLIENTS WITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS (PART C)
GENERAL INSTRUCTIONS:
1. This test questionnaires contains 100 test items
2. Shade only one (1) box for each questions on your answer sheets. Two or more boxes shaded will validate your answer.
3. AVOID ERASURES.
4. Write the subject title NURSING PRACTICE on the box provided
SITUATIONAL

Situation 1 Carmen, a 61 year-old supervising clerk in a university was referred to the Psychiatric Unit by the school
physician with the chief complaints of lack of appetite resulting to weight loss; lack of interest in her work and carrying for no
reason at all. Carmen verbalized that she wished she was dead so all her sufferings will end.
1. Which of the following outcomes is the most appropriate for Carmen with nursing diagnosis of suicide?
A. Carmen will resume her usual activities in the office
C. Carmen will achieve adequate nutritional status
B. Carmen will not harm herself
D. Carmens sleeping pattern will return to normal
2. Carmen tells her daughter, Why will I go with you? I do not enjoy watching movies like you wanted to. This is
manifestation of:
A. Hopelessness
B. Tiredness
C. Worthlessness
D. Anhedonism
3. Carmen is due to be discharged. She is taking tricyclic antidepressant. Which of the following will be of most concern to
you as her nurse?
A. You need to include in your teaching the signs of Neuroleptic Malignant Syndrome (NMS)
B. Carmen may need a prescription of Benadryl to be used for side effect
C. Evaluate the risk for suicide by overdose of the drug
D. Carmen will need laboratory work to monitor therapeutic
4. Which of the following are the side effects of Prozec?
A. Headache, weight gain, diarrhea
B. Headache, anorexia, weight loss

C. Headache, nausea, constipation

D. Anorexia, dizziness, sweating

5. Which of the following precautionary measures will follow to prevent the side effect of Prozac?
A. Check orthostatic pressure
C. Monitor for hypernatremia
B. Encourage use of sugar-free beverage
D. Administer the drug with food
Situation 2 You are a staff nurse in a Psychiatric Unit
6. A patient needs an MRI. Which of the following will you consider as a violation of patients right?
A. The HMO refused to pay for the MRI as there is no need for it
B. The physician determines the treatment of the client
C. Confidentiality is maintained by the nurse
D. Client was informed of the treatment options for his conditions
7. Patient was involuntarily committed to an in-patient Psychiatric Unit. Which of the following rights does the patient lose?
A. The HMO refused to pay for the MRI as there is no need for it
B. The physician determines the treatment
C. Right to sign legal document
D. The client loses no right
8. Autonomy refers to the patients right to self-determination and independence. The following aspects the patients
autonomy in the following situations, EXCEPT:
A. Being truthful and honest
B. Trough respecting the clients right
C. Through discussing the informed consent with the client
D. Encouraging the client to make a choice on his health care

9. In implementing the informed consent, which is NOT a nursing action?

A. Assessing the clients understanding and competence in giving the consent
B. Act as a client advocate in witnessing the informed consent
C. Answer and clarify clients question
D. Contact the attending physician if a client has major questions or misunderstanding about treatment or procedure
10. A-5 year old client confined in you that she is being sexually abused by her uncle. What is the MOST APPROPRIATE
response to her request that everything she discussed with her will remain confidential?
A. Look at her directly in the eyes and tell her sincerely that everything she says will not be divulged to anybody
B. You tell her, Im sorry but you are a minor. Your parents should know about this.
C. You tell her, Lets report this matter to the police.
D. You ask her, Would you like me to talk to your uncle?
Situation 3 Ethical principles serve as guide to nurses in their decision-making when faced with ethical dilemma.
11. Ethics refers to the standards for professional behavior. It is related to:
A. Moral standards of the society
C. Right and Wrong professional conduct
B. Professional views and belief
D. Personal views and belief
12. A family of patient who has been declared brain dead is considered organ donation. Which of the following nursing
actions is the MOST APPROPRIATE in this situation?
A. Continuously support the client by providing complete psychological care until a final decision is made
B. Support both the client and family until a final decision is made
C. Show support to the family members by just being there
D. Question the family members if providing patient with expensive measures is justified
13. Which of the following would determine the nursing professions standards of conduct.
A. The Philippine Nursing Law
C. The Nightingales Pledge
B. Nurses code of Ethics
D. The PNAs mission and vision
14. You are staff nurse in the Orthopedic Ward. You have two patients, one of them is complaining of severe pain in his
operative site on the knee, and the other one is given a shampoo and a bed bath. You attended to the latter patient
first. Which of the following ethical principles did you violate?
A. Veracity
B. Justice
C. Respect for person
D. Autonomy
15. Which of the following situations the respect for autonomy does not apply?
A. When the clients is willing to participate in his care
C. when the client agrees with the recommendations
B. When the client disagree with the health care team.

D. When the client is unconscious

Situation 4 Corazon, a 76 year old female, was seen wandering around the neighborhood early in the morning. At about
noontime, she was found unconscious along the sidewalks and was brought to the Emergency Room of the nearest
hospital. When she regained consciousness she was confused and cannot give any information about herself. She was
diagnosed with delirium.
16. Upon admission, Corazon was perspiring profusely with a temperature of 103.2 degrees Fahrenheit are showing signs
of severe dehydration. She was placed on IV Therapy. In her case, which of the following in the cause of her Delirium?
A. Vit. C deficiency
B. Hypoglycemia
C. Severe dehydration
D. Intoxication
17. Which of the following is the primary and often an initial sign of delirium?
A. Altered Psychomotor Function
C. Sleep disturbances
B. Aphasia
D. Altered level of consciousness
18. In managing clients with Delirium, it is important to give realistic reassurance. Which of the following statements is the
MOST APPROPRIATE for this nursing action?
A. Stop crying Corazon. It will not make you any better.
B. Do not worry. Your confusion is normal at your age.
C. I know things are upsetting and confusing right now. You confusion should clear if you get better.
D. I know you are confused right now. Just wait for your medications to take effect.
19. Corazon attempted to remove the I.V. tubing from her arm saying to you, Get off this snakes from me. Corazon is
experiencing which of the following?

A. Disorientation

B. Auditory Hallucination

C. visual hallucination

D. Delusion

20. Corazon gets agitated saying, There is a snake! There is a snake! pointing to the connecting cord of the electric fan.
Your appropriate response would be?
A. Corazon, where is it? I dont see any.
B. Corazon, you may hold it. You see, it is just a connecting cord.
C. Corazon, this is just a connecting cord of the electric fan.
D. Corazon, gunigunimolangyan.
Situation 5 Mr. M, a 45 year old male, was brought to the OPD. The wife reported that 3 days prior to consultation, Mr. M.
was restless, threatens to harm her and the people around him with slight provocation.
21. Which of the following increases the risk for violence?
A. Increasing anxiety
B. Auditory hallucinations
C. Anhedonia
D. Delusion of grandeur
22. Which of the following is NOT an indicator of impending violence?
A. Increasing anxiety
B. Argumentativeness
C. Restlessness

D. Social Withdrawal

23. Potential aggressive patients should:

A. Be isolated until he promises not to be aggressive
B. Be restrained until he has no more psychotic symptoms
C. Be nursed in a psychotherapeutic environment
D. Attend group therapy
24. Nurse observes the client muttering to himself and pounding his fist in his head while pacing the hallway. Which of the
following principles should guide the nurse in her next action?
A. Talking to the client is not helpful because the client has no ability to comprehend
B. Verbally aggressive clients often calm down on their own if left alone
C. Clients who can verbalize angry feelings are less likely to become harmful
D. Only one nurse should approach the client to avoid threatening the patient
25. In the assaultive stage of violence, medications are usually avoided if the patient.
A. Is am elderly
B. Is believed to be under the influence of an unknown drug
C. Promises to attend counseling sessions
D. Refuses the medications
Situation 6 Norma, a 38 year old elementary school teacher, consulted in an ENT clinic due to complaint of severe pain of
the right ear, fever and difficulty of hearing. Her husband is a knownchain-smoker. An otoscopic examination was ordered
for Norma. The diagnosis is Acute Otitis Media (AOM).
26. In otoscopic examination you would expect the following results:
A. Erythematous external auditory canal; normal tympanic membrane
B. Presence of impact cerumen in the middle ear
C. Normal appearing external auditory canal, erythematous and bulging tympanic membrane
D. Normal appearingtympanic membrane
27. Which of the following is the predisposing factor of Otitis Media in the case of Norma?
A. Downs syndrome
C. Cystic fibrosis
B. Chronic exposure to second hand cigarette smoke
D. chronic respiratory infections
28. In AOM, purulent exudate is usually present. This will result to:
A. Difficulty of hearing
C. Difficulty of speaking
B. Conductive hearing loss
D. Sensory-neural hearing loss
29. Technically, which of the following is a predisposing factor for AOM?
A. Flexible Eustachian tube
C. Eustachian tube lies laterally
B. Short, wide straight Eustachian tube
D. Wide and flexible Esutachian tube
30. In AOM with effusion you would expect the result of audiometry to be:
A. Moderate compliance of the tympanic membrane
C. reduced compliance of the tympanic membrane
B. Increased compliance of the tympanic membrane
D. Normal compliance of the tympanic membrane

Situation 7 To keep yourself updated with the advanced technology, you availed of a free training on computerized
documentation offered by the hospital.
31. A specialty in which nurses are considered expert in the health care information technology?
A. Computer system expert
C. information specialist
B. Advance practice nursing
D. Nursing informatics
32. Which of the following is not considered technologically sophisticated equipment?
A. Blood gas analyzer
C. patientcontrolledenalgesia
B. Chest X-ray machine
D. Computerized infusion pumps
33. Which of the following is a language system that includes common nursing terms for unity of vocabularies?
A. NANDA
C. United Nursing Language System
B. NIC
D. Cochrane Collaboration System
34. The following trend in patient care is the virtual office visit. Which of the following is an example of this type of visit?
A. The patient and the nurse are able to exchange information
B. The patient and the nurse are able to view and speak to one another
C. It uses e-mail
D. The nurse communicates with the client via audio-monitors
35. Which of the following chronic disease conditions is NOT considered in tele-monitor devices?
A. Congestive heart failure
C. Multiple sclerosis
B. Chronic renal failure
D. COPD
Situation 8 You are the staff nurse in the Medical Unit. You have a stroke patient with tracheostomy.
36. In providing tracheotomy care which of the following is the nurse priority action?
A. Uses clean technique
C. Cuts the dressings using sterile scissors
B. Secures clean ties before removing soiled ones
D. clears the incision with iodine-based antiseptic
37. Which of the following nursing action should the nurse teach the patient about tracheostomy care?
A. Leave the tracheostomy ties in place until the physician changes them
B. Remove the tracheostomy tube if obstruction occurs
C. Never put a covering over the trachesotomy stoma
D. Remove and clean the inner cannula daily
38. In tracheostomy procedure the nurse documents important observations made during the procdure such as:
A. Behavior of the patient during the procedure
B. Vital signs of the patient during the procedure
C. Amount, color and consistency of sputum and appearance of the incision
D. Response of the patient after the procedure
39. Which of the following is the purpose of tracheostomy?
A. To establish a pathway for nutrition
B. To monitor respiratory functions

C. To establish an airway
D. to maintain the patency of the airway

40. Which of the following can be a major problem for client with tracheostomy?
A. Ingesting
B. breathing
C. Swallowing

D. Singing

Situation 9 You are a member of the research Committee of the Nursing Department. The committee decided to explore
the meaning of physical restraints to the patients. What factors influence their decision to use physical restraints on hospital
on their geriatric patients.
41. Descriptive-exploratory study was carried out to identify the values and factors that influence the decision-making of
psychiatric nurses in applying restraints to their old patients. Open-ended questions were formulated. An appropriate
data collection purpose is:
A. Rating scale
C. Checklist
B. Survey
D. Semi-structured interview

42. In the two-hour interview in the patient ward, you carried out a partial participation of the ward activities. This enabled
you to:
A. Do some bedside nursing care for the restrained patient
B. Solely observe specific restraints processes and status of each patient being restrained
C. Record field notes
D. Examine the general situation of the ward
43. When humans are used as study participants, acre must be exercised in ensuring that the rights of those humans are
protected. The ethical principles for protecting study participants include the following EXCEPT:
A. Establish of contract
C. Informed consent
B. Provision of confidentiality
D. statement of disclosure
44. You assessed the cognitive status of restrained patients. Inter-rater reliability in cognitive status was made. This is used
to assess the:
A. Consistency of results across items within a test
B. Consistency of measure from one time to another
C. Degree to which different rater/observers give consistent estimate of the same phenomenon
D. Consistency of the results of two tests conducted in the same way as the content domain
45. Results of the research indicated that more than half of the nurses interview is not having ethical dilemma when using
restraints on their patients. It was revealed that nurses were not generally aware of the adverse consequences of
restraints of patients especially the psycho=social effects. This indicates an urgent need for:
A. Continuing education on the use of restraints and its implications
B. Formulation of hospital policies and regulations
C. Implementation and monitoring of nursing care standards
D. Development of appropriate guidelines and protocols on the use of restraints
Situation 10 Alona has been employed at a mental hospital for the past 10 years. She is the Quality Assurance Officers
giving a lecture to newly hired nurses.
46. Alona begins by giving the meaning of quality in nursing practice which is _________.
A. Providing affordable care
C. Meeting patients needs
B. Providing accessible nursing care
D. providing safe nursing care
47. Keeping clients safe all the time is one of the objectives of QA. One BEST illustration of this in the Mental Health Unit
according to Alona is:
A. Keeping the areas clean and dry
B. To see to it that there are no sharp objects inside the ward
C. Creating harmonious relationship among clients
D. Not allowing cigarettes smoking in the ward
48. Alona made a hypothetical scenario. If one day you find a patient who is agitated threatening to hurt another patient,
what should be your MOST APPROPRIATE intervention?
A. Give him some medications as ordered by the physician
B. Leave him alone
C. Calm him down by using friendly, persuasion techniques
D. Isolate him from the other clients.
49. Alona asked for suggestions on how to improve nurse client relationship. The best suggestion agreed upon with Alona
was _________.
A. Meeting patients needs
C. Including the family members in patient care
B. Providing patient-centered care
D. Maintaining respect for the patient as a person
50. Alona asked what would be the appropriate behavior of a professional nurse towards suicidal client. her expected
answer is that the nurse must be:
A. Sympathetic
B. compassionate
C. Tacitum
D. Firm
Situation 11 Cristina, a 24-year old staff nurse in a government hospital in for sick leave from conjunctivitis.
51. Which among these causative organisms for viral conjunctivitis is highly contagious?
A. Herpes simplex virus B. Adenovirus
C. Staphyloccocus aureus

D. H. influenza

52. Which of the following causes the photophobia in conjunctivitis?

A. Presence of lymphadermonopathy
C. Corneal involvement
B. Formation of the true membrane
C. formation of pseudo membrane
53. Which of the following types of conjunctivitis is a medical emergency?
A. Pink eye
C. Gonococcal conjunctivitis
B. Viral conjunctivitis
D. bacterial conjunctivitis
54. The type of conjunctivitis considered as medical emergency can lead to:
A. Retinal detachment
B. Cataract
C. Glaucoma

D. Corneal perforation

55. You were the nurse caring for Cristina what would be your priority Nursing Diagnosis?
A. Risk for altered nutrition
C. risk for altered motor function
B. Risk for infection
D. risk for scarring
Situation 12 Mrs. Rosa Santos, a 78-year old widow, was admitted to your ward with fractured hip. She was found on the
floor by her care-giver.
56. Which of the following Best described the appearance of the leg of the fractured hip?
A. Shortened, abducted, and internally rotated
C. Shortened, adducted, and internally rotated
B. Shortened, abducted, and externally rotated
D. Shortened adducted and externally rotated
57. Prior to surgery Mrs. Santos will be maintained in Bucks traction. The main purpose of Bucks traction is to:
A. Set the fracture
C. maintain complete bed rest
B. Decrease muscle pain
D. Reduce the fracture
58. Nursing care for Mrs. Santos while she is in traction should include which of the following?
A. Keeping
B. Applying a footboard to prevent foot drops
D. Allowing her to sit in a chair at the bedside
59. Which of the following is the MOST important assessment for the nurse to observe while caring for a client in Bucks
traction?
A. Verify that weight of at least 25 lbs. are freely hanging
B. Check the area around the hip where the traction is applied on
C. Check the pin sites at least daily
D. Assess the skin under the fraction boot every eight hours
60. Counter-traction is applied to Bucks traction by:
A. Applying the knee gatch and elevating the head of the bed at 30 o angle
B. Applying a ten-pound counter weight at the knee
C. Putting shock blocks under the head of the bed
D. Placing the bed in Trendenburg position
Situation 13 As a professional nurse, documentation and reporting of nursing activities and responses are important.
61. Standards regulating ones access to medical records are controlled by the:
A. Department of Health
B. Department of Justice
C. Laws of the land and its implementing rules and regulations
D. Civil Service Commission
62. While reviewing a client record, you come upon a document that includes information and clients wishes in relation to
life-sustaining measures if the client loses his capacity to decide. This documents is a/an:
A. Durable power of attorney
C. Advance directive
B. Informed consent
D. Last will and testament
63. In charting, you being each entry with time and end it with your signature and title. This is to:
1. Ensure recording of the correct sequence of events
2. Ensure accurate and reliable charting
3. Document who is accountable for the care provided
4. Be used as evidence for poor quality of care

A. 1, 2 and 4

B. 2, 3, and 4

C. 1 & 2

D. 1 and 4

64. Which of the following methods of documentation uses flow sheets extensively and documents deviation from preestablished norms?
A. Focus charting
C. Problem-Oriented Medical Record
B. Point-of-cane-charting
D. Charting by exception
65. To demonstrate the quality, effectiveness, and value of nursing service in computerized documentation, this is
necessary:
A. A standardized nursing terminology
C. nurses with expertise in nursing informatics
B. A final version of the nursing diagnosis
D. A standardized database
Situation 14 Mrs. D.C., a 38-year old female elementary school teacher in a public school has been promoted to the
position of Master teacher 1, three months ago. On consultation, Mrs. D.C. feels weakness especially in her lower
extremities; gets in and feels confused at times.
66. Mrs. D.C. is suffering from Multiple Sclerosis (MS). Which of the following is NOT considered a sign/symptom of this
disease?
A. Scanning speech
B. Non-international tremors
C. Nystagmus
D. Diplopia
67. Which of the following may be a precipitating factor for Mrs. D.C.s clinical manifestation?
A. Infection
B. Pregnancy
C. Trauma

D. Stress

68. A CSF examination was ordered for Mrs. D.C. Which of the following results from this examination?
A. Increase chloride
C. Increased gamma globin
B. Increased White Blood Cells
D. Increased glucose
69. Which of the following drugs is used for decreasing relapses of MS?
A. Cyclosporine
B. Methylprednisone
C. Cyclosphamide

D. Azathioprine

70. Patient education for clients with MS is focused on building the general resistant including nutrition and well-balanced
meal. Diet for MS patient is:
A. High carbohydrates and raw vegetables
C. low-fat and gluten-free foods
B. High-protein and low vegetables
D. Low carbohydrates and low fat
Situation 15 A comprehensive approach to the treatment of a child with separation anxiety involves the parents, the child,
and the school.
71. Which of the following is the role of the school in the collaborative care of separation anxiety?
A. Ensuring the childs nutritional requirements through the school.
B. Helping the child maintain a regular school attendance
C. Setting limits to the childs absence
D. Administration of anti-anxiety medication by the school nurse
72. You are the school school nurse in a private school. Minerva a 7-year old grade one pupil, who is under your care for
separation anxiety is sick and has been absent for several days. Which of the following interventions would help
Minerva at this time?
A. Call up Minervas parents and offer help
B. Encourage Minervas friends to call her up and visit her
C. Offer reasurance for Minerva
D. Plan play activities for Minerva
73. In planning collaborative care for Minerva, which of the following is the priority nursing action?
A. Evaluating Minervas mental status
C. Identify Minervas coping skills
B. Identifying the coping skills of Minervas parents
D. establishing rapport with Minerva and her family
74. Which of the following approaches is basic to community-and-home-based mental care?
A. Family-centered approach
C. Holistic Approach
B. Cultural Approach
D. Age-specific Approach
75. Which of the following is your objective for the nursing intervention to a client with anxiety disorder?
A. To strengthen the clients coping skills

B. To prevent complications of anti-represent drugs

C. To reduce the manifestations of the symptoms of anxiety
D. To restore the client to a previous or higher level functioning
Situation 16 You are a nurse in the Adolescent clinic of the Department of Pediatric, Sharon, a 16-year old third year high
school student, is being treated for her Bulimia.
76. Which of the following best defined what bulimia is? It is a/an:
A. Disorder of unknown cause associated with starving oneself
B. Eating disorder associated with vomiting
C. Phobic disorder of fear of obesity
D. Pathological disorder of bingeing and vomiting
77. Which of the following conditions is NOT likely to develop in a bulimic client?
A. Rectal bleeding
B. Hyperkalemia
C. gastric ulcers

D. dental erosion

78. Which of the following conditions may lead to death in a bulimic client?
A. Hypermatremia and congestive heart failure
C. Hyponatremia and circulatory collapse
B. Metabolic acidosis and renal failure
D. Hypokalemia and cardiac arrhythmias and arrest
79. Bulimia often results to endocrine changes. Which of the following would be change in a bulimic client?
A. Increase FSH
C. Decreased ACTH in response to cortisone
B. Delayed TSH response to HRT
D. Hypopituitarism
80. Anti-depressants are often given in the treatment of Bulimia. Which of the following is common side effect of
amitriptyline (Elavil)?
A. Cholinergic effects
B. urinary frequency
C. Anticholinergic effectsd. Diarrhea
Situation 17 Rona, a17-year old college student, came in the Adolescent Clinic, complaints of easy fatigability and
irritability. You have noticed the dark circles.
81. Rona claims she has difficulty staying awake especially in the classroom. Which of the following is the most appropriate
nursing diagnostic for Rona?
A. Situational self-esteem
C. Disturbed sleep pattern
B. Anxiety
D. ineffective coping
82. Which of the following would be your priority nursing action for Rona?
A. Identify Ronas coping skills
C. Convey acceptance and empathy
B. Provide health education on sleep hygiene
D. Assess Ronas normal sleeping patterns
83. Rona was diagnosed to be suffering from short-term insomnia, which is a sign of sleeplessness:
A. Slow eye movement
C. Lasting one to four weeks
B. Lasting for more than a month
D. Lasting one to four days
84. Nursing interventions used for clients with sleep disorder is structuring the clients environment. Which of the following
would you advise Rona to do?
A. Have a back rub before bedtime
B. Drink a warm glass of milk before bedtime
C. Reduce noise or light her room
D. take one those over-the-counter medications for insomnia
85. Nembutal 30 mg.b.i.d. for one week was ordered for Rona, which she continued taking for three days. Which of the
following phenomena may likely occur?
A. Drowsiness
B. Coma
C.Rebound insomnia
D. Dependance
Situation 18 you are staff nurse in the Stroke Unit of the Neurology Department. One of your responsibilities is to give
health teachings to stroke clients and the other members of the family.
86. You are teaching a client about taking prophylactic warfarin sodium (Coumadin). Which requirements indicate that the
client understands how to take the drug? (Select all that apply)
1. The drugs action peaks in 2 hours.
2. Maximum dosage is not achieved until 3 to 4 days after starting the medication.
3. Effects of the drug continue for 4 to 5 days after continuing the medications.

4. Protamine sulfate is the antidote for warfarin.

5. I should have my blood levels tested periodically.
A. 2, 4 & 5

B. 2, 3, & 5

C. 1, 4 & 5

D. 1, 3 & 4

87. You are teaching a family member how to give oral hygiene to a stroke client. Which of the following nursing measures
is NOT APPROPRIATE when giving oral hygiene to the client?
A. Keeping portable suctioning equipment at the bedside
B. Cleaning the clients mouth and teeth with a toothbrush
C. Opening the clients mouth with a padded tongue blade
D. Placing the client on the back with a small pillow under the head
88. The client has hemiparalysis. In giving instruction to the etcher when changing the clients position in bed, which of the
following is not appropriate?
A. Rolling the client unto the side
C. Having the client help lift off the bed using a trapeze
B. Sliding the client to move up in bed
D. Lifting the client when moving the client up in bed
89. Client is experiencing moods swings after a stroke and often has episode of tearful eye distressing to the family. Which
is the best technique that you will instruct to the family members to use when the client experiences a crying episode?
A. Tell the client that this behavior is unacceptable
C. Sit quietly with the client until the episode is over
B. Attempt to divert the clients attention
D. Ignore behavior
90. You are teaching the family members positions prevent joint deformities of the arms of a hemiplegic client. Which of the
following positions are appropriate? (Select all that apply)
1. Placing a pillow in the axilla so the arm is away from the body
2. Inserting a pillow under the slightly flexed arm so the hand is higher than the elbow
3. Immobilizing the extremity in a sling
4. Positioning a hand core in the hand so the fingers are barely flexed
5. Keeping the arm at the side using a pillow
A. 2, 3, 4

B. 1, 2, 4

C. 1, 3, 5

D. 2, 4, 5

Situation 19 Jericho, a 36- year old script writer of a leading movie company, came with complaints of anxiety,
restlessness and loss of appetite. He admitted he is a user of amphetamine.
91. Jericho claimed somebody came during the night and tried to harm him. This is a manifestation of:
A. Denial
B. Hallucination
C. Reaction formation
D. Paranoia
92. Another occasion Jericho told you I often hear my mother calling me to buy food. It is a manifestation of:
A. Paranoia
B. Auditory hallucination C. Visual hallucination
D. Projection
93. Considering Jerichos occupation which of the following may have been problem prior to his condition?
A. He wants to lose weight
C. He wants to write good script
B. He always wants to stay awake to meet his deadlines
D. he wants to belong
94. Which of the following is the cause of symptoms associated with amphetamine withdrawal?
A. Increased norepinephrine in the neuron
C. Depletion of norepinephrine in the neurons
B. Depletion of dopamine and serotonin in the neurons
D. Increased dopamine and serotonin in the neurons
95. Which of the following is not a symptom of amphetamine withdrawal?
A. Talkative
B. Hallucinations
C. crashing symptoms

D. Hyperactivity

Situation 20 You are staff nurse in the Psychiatric Unit of the hospital. As such in different therapeutic communication
techniques as you provide nursing care to client with psychiatric disorder.
96. The client with acute mania was admitted voluntarily to the in-patient unit. You approach the client with medication to
be taken orally as prescribed by the attending physician and client told you I dont need that stuff, which of the
following would be your BEST response?
A. If you dont take it orally, Ill give you an injection.
B. Ill get you same written information about the medications.
C. You cant refuse to take this medication.
D. The medication will help you feel calmer.

97. You observed a male client, who is hyperactive and intrusive, sitting closely with the client with his arm around her
shoulders. You heard him telling sexually explicit, jokes and asked him to walk down the hallway with you. Which of
your statements should be directed to client?
A. She will not want to be around you with you talking that way.
B. You need to be careful about what you say to other people.
C. Telling sexual jokes and touching others is not permitted here.
D. I think it is time now to return to your room.
98. The husband of a client who is experiencing mania and swearing using profane languages apologizes to you for her
wifes behavior. Which of your replies would be the MOST therapeutic?
A. Its okay. We have heard worse.
C. This must be difficult for you
B. How long has she been like this?
D. She needs come medication.
99. When client tells you I am the prince of peace and can save the world. They will come and know it. The client is
beginning to look around the room and starts, repeat his delusion. Which of your responses is the MOST therapeutic?
A. You are not the prince of peace. Your name is Juan.
C. Described to me the people who will come.
B. The staff and I will protect you from these people.
D. Let walk around the unit for a while.
100. The client with bipolar disorder tells you youre looking good. Im taking you out to dinner. Which of the following
responses is the MOST therapeutic?
A. I cant go out to dinner with you.
C. It does not matter how I look, the answer is no
B. I dont want to go out to dinner.
D. Im Vilma Aunor, the staff nurse in this unit

GOOD BLESS