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Benha University

Faculty of Nursing

Fourth year final exam

Course title: Psychiatric and Mental Health Nursing 2nd

semester

Date: 27 / 5 / 2012

Time allowed: 3 hours

Parts Questions Marks

Parts( 1) Multiple-choice questions 20

Parts(2) True and false 15

Parts(3) Matching 10

Parts(4) Definitions 5

Parts(5) Fill in the blanks 30

total 80

د مواهب محمود ذكى

د/رحاب السيد محمد احمد

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Please answer all of the following questions:-

Part (1): Multiple Choice Questions (M C Q)

For each of the following (M C Q), select the one most appropriate answer,

there is only one best answer.

1- The nurse interprets a patient's fear of being in situations or places

that may be difficult or embarrassing to leave as evidence of:

a) Social phobia

b) Panic disorder

c) Agoraphobia

d) Generalized anxiety disorder.

2- The diagnosis of cyclothymic disorder requires which one of the

following criteria?

a) Repeated episodes of hypomania and mild depression

b) A minimum duration of 6 months

c) At least one prior manic episode

d) At least one prior major depressive episode

3- The nurse has just assessed a patient with anorexia in the outpatient

clinic, which finding would prompt the nurse to anticipate the need for

hospitalization for this patient?

a) Persistent tachycardia

b) Hyperthermia

c) Blood pressure of 85/50 mmHg

d) Amenorrhea

4- The nurse observes a patient washing his hands every 5 minutes

throughout the course of an interview, identifying this behavior as a

characteristic of someone with:

a) Compulsions

b) Obsessions

c) Ideas of reference

d) Delusions

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5- Which intervention would the nurse include with developing a care

plan for a patient with Alzheimer's disease or vascular dementia?

a) Speak to the patient in a loud voice

b) Keep the television on throughout the day's activities

c) Frequently tell the patient what's going to happen

d) Place the patient in a group activity room with about 10 people

6- A patient with schizophrenia says, "We can, pan, scan, ran, plan."

The nurse identifies this as which speech abnormality?

a) Clang association

b) Echolalia

c) Word salad

d) Neologism

7- A patient is to receive conventional antipsychotic drug therapy

which drug would the nurse except to administer?

a) Prolixin

b) Olanzapine

c) Seroquel

d) Risperidone

8- A schizophrenic patient who began taking Haldol 1 week ago is

exhibiting jerking movements of the neck and mouth. The nurse

interprets theses findings as suggesting:

a) Dystonia

b) Tradive dyskinesia

c) Akathisia

d) Parkinsonism

9- When caring for a patient with schizophrenia, which nursing

intervention would be least effective?

a) Exploring the content of his hallucinations

b) Asking the patient to clarify his neologisms

c) Rewarding the patient for positive behavior

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d) Performing all activities for the client so his needs are met

10- During his assessment interview, a schizophrenic patient tells the

nurse, people are reading my mind. They are out to get me. The nurse

documents that the patient is experiencing:

a) Delusions

b) Hallucinations

c) Illusions

d) Magical thinking

11- Which of the following conditions is known to have the best

response to ECT?

a) Depression with suicidal tendancy

b) Simple schizophrenia

c) Paranoid schizophrenia

d) Obsessive compulsive disorder

12- Which of the following condition is associated with long-term use of

lithium in mood disorders?

a. Hypothyroidism

b. Hyperprolactinemia

c. Hypoglycemia

d. Hypertension

13- Combining MAOIs with SSRIs may cause

a) Serotonin Syndrome

b) Extrapyramidal Symptoms (EPS)

c) Neroleptic Malignant Syndrome (NMS)

d) Agranulocytosis

14- Depression is characterized by all, Except:

a) Psychomotor retardation

b) Loosening of association

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c) Retardation of thinking process

d) Pervasive mood of sadness

15- Which of the following disturbances is the basic defect in mania?

a) Ideas of reference

b) coining of new words

c) Delusion of grandiosity

d) Elation

16- Older adults have reached Erikson's developmental stage of ego

integrity when they:

a) Acknowledge that one cannot get everything one wants in life.

b) Assess their lives and identify actions that had value and purpose.

c) Express a wish that life could be relieved differently.

d) Feel that they are being punished for things they did not do.

17- A Psychiatric and mental health nurse manager of a milieu

treatment team receives a report that a nurse was threatened and

frightened by a patient. No assault occurred; another staff member

intervened to calm the patient. The threatened nurse is visibly shaken.

After ensuring the safety of the milieu, the nurse manager

a) has the threatened nurse attend Managing Assault Behavior classes

b) Identifies ways that the threatened nurse could have prevented the

confrontation.

c) Spends time with the threatened nurse and the team to process

attitudes and feelings.

d) tells the threatened nurse that this situation is a normal risk of

psychiatric and mental health nursing

18- The most important assessment data for the nurse to gather from

the client in crisis would be:

a. The client's work habits

b. Any significant physical health data

c. A past history of any emotional problems in the family

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d. The specific circumstances surrounding the perceived crisis situation

19- A female client is admitted for surgery. Although not physically

distressed, the client appears apprehensive and alienated. A nursing

action that may help the client to feel more at ease includes:

a. Telling her that everything is all right

b. Giving her a copy of hospital regulations

c. Orienting her to the environment and unit personnel

d. Reassuring her that staff will be available if she becomes upset

20- Parents are at the clinic with a child diagnosed with attention

deficit hyperactivity disorder. Which group characteristics would the

nurse most likely observe in the waiting room of the clinic? The child

a. plays with 2 children in the waiting room

b. runs over and turns on the video player without listening to parent's

directions

c. constantly wiggles( يتذبذذ) a leg when waiting to take a turn at the

board game

d. Puts the toy truck back into the playbox only after visiting with three

other children and their parents

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Part (2)

II -Read each statement carefully and circle (T) if the statement is true

and (F) if statement false

No T F statement

1 T F When the nurse talks with the delirious patient, she must avoid face-

to-face contact to increase the patient orientation with persons.

2 T F You can say to psychotic patient, you will get well

3 T F Child develops psychologically and grows normally by passing

through more positive experiences than negative ones.

4 T F Mental health is defined as the ability to distinguish what is real

from what is not

5 T F Depersonalization is the false perception by a person that the

environment has changed.

6 T F One of the main nursing roles regarding chronically schizophrenic

client is to assist him to enjoy dependence on staff

7 T F In caring for a patient receiving antidepressant drugs the nurse

should be alert for sudden cheerfulness of the patient

8 T F Crisis intervention emphasizes the healthy aspect of the personality

9 T F In a therapeutic relationship the nurse must argue with the patient

about his delusion

10 T F Patient can take mono-amino-oxidase inhibitors and eating milk

product

11 T F Anxiety has been defined as diffuse apprehension that is vague in

nature and is associated with feeling of uncertainty

12 T F Suppression is the refusal to acknowledge the existence of a real

situation or the feeling of association

13 T F Sitting silently with depressed patient saying nothing conveys

acceptance to him

14 T F Coexistence of tow opposing impulses toward the same thing in the

same person at the same time is called ambivalence.

15 T F The principles of acceptance shouldn't be applied with all patient's

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Part (3) Matching

In the space provided in front of each statement in column (A)place the

corresponding number from column (B)

No Column (A) Column (B)

D 1- Disorientation A. Retreating to level of behavior that reduces

anxiety, allows one to feel more comfortable

and permits dependency.

C 2- Delusion of

influence

B. The continuous repetition of the same word or

theme in response to different questions.

F 3- Phobia C. False belief that one is being controlled by other

or agencies.

E 4- Insight D. Inability to locate oneself in relation to time or

persons.

B 5- Echolalia E. Patient' awareness of his condition and the need

of treatment.

A 6- Regression F. Abnormal symbolic fear

G 7- situational

crisis

G. Dysthymic disorder

J 8- Distractability H. Feeling that one's environment is strange, unreal

or unfamiliar

I 9- Chronically

depressed mood

I. Occurs in response to a sudden unexpected

event in a person's life from an external source.

H 10-Derealization J. Disorder in attention

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Part (4)

Define the following

(1) Distractibility

Is the disorder of attention in which the patient gives attention to every passing stimulus (e.g. someone coughing, a door opened or a bird flying) it is prominent in manic states.

(2) Mental health - mental illness continuum

Experts agree that mental health and mental illness are not polar opposites.

This approach is useful in communicating that neither state exists in isolation from the other.

Mental health Mental illnes (3) Denial

Failure to acknowledge an intolerable thought, feeling, experience or reality

E.g. A middle-aged man after being admitted to the CCU because of an AMI insists that he is in the Hospital for just a diagnostic work-up.

(4) Derealization

The false perception by a person that his or her environment has changed

For example: - everything seems bigger or smaller or familiar objects have become stranger and unfamiliar.

N.B depersonalization and derealisation are usually not delusional and the patient recognizes their abnormality and complains of the distress which they cause.

(5) Crisis

It is biopsychosocial response to conditions of stress and change that overwhelm the individual, families and communities that are involved or as a threat to homeostasis.

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Part V: - Fill in the blanks

1- When working with a patient with paranoid schizophrenia the nurse

can assess the following systems

Persistent delusions/persecutory nature.

Frequent Auditory hallucinations.

Guarded المعادى, suspicious, hostile, angry, possibly violent.

Pervasive anxietyقلق شديد.

Intensive, reserved, controlled social interactions

Onset- later in life.

Independent living/occupational functioning.

Body remains in affixed position" wax-like state.

2- Symptoms associated with panic attack include:

This disorder is characterized by recurrent panic attacks, the onset of

which is unpredictable, and manifested by intense apprehension, fear

of terror often associated with feeling of impending doom and

accompanied by intense physical discomfort.

At least four of following symptoms must be present to identify the

presence of a panic attack. When fewer than four symptoms are

present, the individual is diagnosed as having limited-symptoms

attack:-

Palpitations/pounding heart/or accelerated heart rate.

Sweating/trembling or shaking

Sensation of shortness of breath or smothering

Intense apprehension

Feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

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Feeling dizzy, unsteady, lightheaded, or faint

Derealization or depersonalization

Fear of losing control or going crazy

Fear of dying

Paresthesias (numbness or tingling sections)

Chills or hot flashes

3- Nursing care of client with hallucination includes:

Be aware of all surrounding stimuli, including sounds from other

rooms (such as television or stereo in adjacent areas).

Try to decrease stimuli or move the client to another area

Avoid conveying to the client the belief that hallucinations are real.

Do not converse with the “voices” or otherwise reinforce the client’s

belief in the hallucinations as reality.

Explore the content of the client’s hallucinations during the initial

assessment to determine what kind of stimuli the client is receiving,

but do not reinforce the hallucinations as real. You might say, "I don’t

hear any voices-what are you hearing?"

Use concrete, specific verbal communication with the client. Avoid

gestures, abstract ideas

Avoid asking the client to make choices. Don’t ask “Would you like to

talk or be alone?” Rather, suggest that the client talk with you.

Respond verbally and reinforce the client’s conversation when he or

she refers to reality.

Encourage the client to tell staff members about hallucinations.

If the client appears to be hallucinating, attempt to engage the

client’s in conversation or a concrete activity.

Maintain simple topics of conversation to provide a base in reality.

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Provide simple activities that the client can realistically accomplish

(such as uncomplicated craft projects).

Encourage the client to express any feelings of remorse or

embarrassment once he or she is aware of psychotic behavior; be

supportive.

Show acceptance of the client’s behavior and of the client as a

person; do not joke about or judge the client’s behavior.

4-Phallic stage of psychosexual theory is characterized by:

It begins from (3-6 years)

The child experiences both pleasurable and conflicting feelings

associated with genital organs.

At this time. Children devote much energy to examining their

genitalia, masturbating, and expressing interest in sexual maters.

Children are curious about every thing, including anatomical

differences between the sexes and the origin of babies. They create

unconscious fantasies about the sexual act itself and about the birth

process.

5-Signs of lithium toxicity

Early sign of toxicity:-

Nausea, vomiting, diarrhea, thrust , polyuria

Slurred speech, muscle weakness, hand tremor.

Advanced toxicity:-

Ataxia, seizure, stupor,

Decreased BP, EEG change

Confusion and cardiac arrethmia, coma ,fatalities

6- Goals of recreational and occupational therapy

It is powerful tool to venting aggression

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To increase enjoyment of life ,simulate activity and self expression

Assist the patient in developing leisure skills

Augment verbal psychotherapy

Assist Patient in bridging the gab between the hospital and

community

7- Nursing care after ECT includes

Monitored closely patient for any signs of respiratory distress

Once the Remain patient in a recovery room

Patient able to awake talk to him and check vital signs

When the patient confused give frequent orientation and

reassurance

Return patient to the unit and still beside him

8- Nursing approach for prevention of suicide:

Implement suicide precautions, such as explain to client that I am

concerned for client safety and that I will be helping client to stay

free.

Provide close observations place in room close to nurse's station, do

not assign to signal room. Accompany to out ward activities if

attendance is indiosted.

Be alert to use of hazardous equipment, remove hazardous personal

item (e.g. scarven, belts, rarer blades, scissors).

Check all items brought in to or by, the client as indicated ask family,

visitors to avoid bringing hazardous items.

Maintain special care in administration of medications.

Be alert when client is using bathroom.

Making rounds at frequent, irregular intervals especially at night,

toward early morning at change of shift or other predictably busy

tries for staff.

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Routinely check environment for has words. Provides for

environmental safety e.g. relating to construction areas, lock doors,

windows when not supervised, block access to stair ways, roof,

monitor cleaning chemical, repair supplies.

Allowing client and family to ask questions and express feelings freely

9-Indications of antianxiety drugs include

In the treatment of anxiety disorders

Anxiety symptoms - Acute alcohol withdrawal

Skeletal muscle spasm - Convulsion disorders

Preoperative sedation

10- The initiating phase of the nurse-patient relationship is

characterized by:

1- Initiating or orientation phase: Beings when the nurse and client meet, ends when the client begins

to identify problem to examine.

Characteristics of the phase:

1. Lack of knowledge

2. Lack of trust

3. High level of anxiety

4. High level of dependency

Lack of knowledge, lack of trust and high level of anxiety are present

on both sides, this leads to some of the most common behaviors that

characterize this phase:

Discuss role of the nurse in community mental health:

**Role of the nurse in community mental health:

There are a variety of positions and roles for the nurse who is interested

in community mental health

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For example:-

The In-patient Services:

The nurse will utilize a therapeutic milieu and focus on early

discharge for her patients.

Take an active part in the daily living of her patients in the clinical

area.

She will be expected to speak spontaneously in the ward meetings.

To interact therapeutically with patients.

To plan and carry through on measures developed by the treatment

team for individual patients and groups.

She must develop an understanding of the culture of the people she

serves.

The Day and Night Services:

The function of the nurse will be as her function in the in-patient

services, with the difference, that there is a mobile population who

come and go according to their own individual needs i.e. the activities

she engages in with patients who were hospitalized over a 24 hours

period must won be compressed into a shorter time interval.

The nurse needs much flexibility, so that she can pace herself

according to the every changing situation confronting her patients.

Out-Patients Clinic:-

The nurse always visiting patients homes, evaluating situations and

helping to situate patients in new settings, (referral)

The nurse might work with family and neighborhood for better

housing condition for the patients.

Consultations and education services must be made available to

community agencies and professional personnel. The psychiatric

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nurse who undertakes these functions must be a competent

practitioner. She must acquire knowledge of wide range of issues-

social, economic, political and administrative; these will enable her to

plan and to implement programs that focus not only on individual

patients but on the community of which they are a part.