Faculty of Nursing

Psychiatric mental Health Nursing

Fourth year Final Exam
Second semester
2015- 2016
Course Title: Psychiatric Mental Health Nursing
Date: 4/6/2016
Time allowed: 3 hours
Number of exam paper:
(Including cover sheet)
Parts Questions Marks Student's
marks
Part 1 Multiple choice questions 30

Part II True & false 10

Part III Matching 10

Part IV List questions 25

Part V situation 25

Total 100

Signatures:
1-
2

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Part I:- Multiple choice questions: ( 30Marks
Read the following statements and encircle the correct answer. There is only
one best answer:
1. You would expect a client with a diagnosis of bipolar disorder to be
treated with:
a- librium c- lithium
b- lioresal d- lindane

2. The nurse is preparing a patient for the termination phase of the nurse-
patient relationship. Which nursing task that is most appropriate for this
phase
a- Planning short-term goals
b- Decrease her visited to patient
c- Developing realistic solution.
d- Tries to keep patient dependent on her

3. A client is diagnosed with obsessive compulsive disorder. Which

behavioral symptoms would the nurse expect to assess?
a- Restlessness and pacing
b- Exhibit diaphoresis and tachycardia
c- Use breathing techniques to decrease anxiety
d- Use excessive and ritualistic behaviors to relieve anxiety.

4. The nurse caring for an individual with schizoid personality disorder

would expect to assess:
a- Impulsive, restless, aggressive behavior.
b- Magical thinking and suspicious, odd behavior.
c- Distrustful, cold, often angry behaviors.
d- Few interactions wish other and little verbalization

5. An angry man channels his hostilities into competitive sports in which

there are many opportunities for combat. This is an example of.
a- Sublimation
b- Rationalization
c- Repression
d- Reaction formation

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6. Which of the following statements indicates that the speaker is missing
an important aspect of a mentally health life?
a- “I am responsible for my reactions to situation; others have no
control over my emotion.”
b- “My goal in life is to always treat other people as I want to be
treated.”
c- “I am self-sufficient; I do not need personal relationships with other
people.”
d- “I see each problem as a challenges and a source of creative
growth.”

7. A client with delusion of persecution believes the hospital food is being

poisoned by the staff. The nurse knows the best appropriate method to
encourage client to eat is:
a- Put the client’s favorite foods in an attractive arrangement
b- Present only the warm foods that arrive from the kitchen.
c- The client prepared the food by himself and packaged in his items.
d- food items that are the same as what other clients in the dining
room are eating

8. Odd, eccentric, cold, withdrawn, and irrational describe the symptoms

associated with which cluster of personality disorder?
a- Cluster A
b- Cluster B
c- Cluster C
d- Cluster D

9. 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

10.What would the nurse most expect to observe in a client with impulsive
behavior?
a- ability to delay gratification
b- low tolerance for frustration
c- good problem solving skills
d- commitment to long term goal

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11.A client who is taking chlorpromazine hydrochloride (Thorazine) is
experiencing extrapyramidal side effects (EPS). The nurse understands
that EPS is:
a- Dysfunction of the cardiovascular system
b- Involuntary muscle movements
c- Similar to a seizure disorder
d- toxic reaction of the liver

12.The nurse knows the most common side effect of benzodiazepine

antianxiety medications is:
a- Confusion
b- Headache
c- Sedation
d- Flatulence
13.The nurse is interviewing an elderly client who may have been abused by
the neighbor. The nurse during interview should:
a- be confrontational
b- Blame patient about this abuse.
c- be nonthreatening and nonjudgmental
d- Avoid asking the client about the potential abuse in the future.

14. A client is admitted through the emergency department with a diagnosis

of depression. During the initial phase of the relationship with this client,
the nurse would expect which reaction to interpersonal communication?
a- insight b- Silence
c- Anger d- elation

15.Which of the following are considered the positive signs of

schizophrenia?
a- Delusions ,anhedonia, ambivalence
b- Hallucinations, illusions, ambivalence.
c- Delusions, hallucinations , disorganized thought
d- Disordered thinking, anhedonia, illusions.

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16.Which principle of the psychoanalytic model is particularly useful to
psychiatric nurses?
a- Behavior has meaning.
b- Behavior that is reinforced will be perpetuated.
c- The first 7 years of a person's life determine personality.
d- Behavioral deviations result from an incongruence between verbal
and nonverbal communication.

17.A nurse working with a client with agoraphobia recognizes that the most
effective technique for treatment of agoraphobia is:
a- Gradual desensitization by controlled exposure to the situation the
client fears
b- Teaching relaxation techniques
c- Repeated exposure to the situations the client fears
d- Distraction each time the client brings up the problem

18.If the client was experiencing negative symptoms of schizophrenia, the

nurse would expect to see :
a- Flat affect and little speech
b- Rigid posture
c- Excessive purposeless movement
d- Inappropriate laughter

19.The secondary gain for patient with somatoform disorders are :-

a- Getting out usual responsibilities.
b- Getting extra attention.
c- Manipulating others in the environment.
d- Fulfillment of dependency needs.
e- Financial gain from insurance, worker's compensation, or sick
benefits.

20.The client's family asks the nurse " what is hypchondriasis ? . The best
response by the nurse, hypochondriasis is …..
a- A persistent preoccupation with getting a serious disease without
support by medical investigation
b- An illness fully explained by a diagnosed medical condition
c- Characterized by a variety of symptoms over a number of years.
d- The eventual result of excessive worry about disease.

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21.An employee uses the defense mechanism of displacement when the boss
openly disagrees with suggestions. What behavior would be expected
from this employee?
a. The employee assertively confronts the boss.
b. The employee leaves the staff meeting to work out in the gym.
c. The employee criticizes a coworker.
d. The employee takes the boss out to lunch.
22. Which neurotransmitter has been implicated in the development of
Alzheimer’s disease?
a- Acetylcholine
b- Dopamine
c- Epinephrine
d- Serotonin

23.Which of the following will the nurse use when communicating with a
client who has a cognitive impairment?
a- Complete explanations with multiple details
b- Picture or gestures instead of words
c- Stimulating words and phrases to capture the client’s attention
d- Short words and simple sentences

24.What question would help the nurse determine the meaning of substance
use to the individual client
a- “Why are you an alcoholic?”
b- “How often do you use drugs and alcohol?”
c- “What symptoms do you have when you use drugs?”
d- “What circumstances lead you to use drugs?”

25.A client asks the nurse, "Do you think I should leave my husband?" The
nurse responds, "You aren't sure if you should leave your husband?" The
nurse is using which therapeutic technique?
a- Restating
b- Reframing
c- Reflecting
d- Offering a general lead

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26.Silence in therapeutic communication is:
a- Not therapeutic.
b- A means of disapproval
c- It indicates intolerance and anger.
d- It allowing the client space in which to respond

27.The main focus of milieu therapy is on

a- Daily living skill and Increase patient's self-esteem.
b- Crisis intervention and control deviant behavior
c- Decrease patient anxiety and psychotic symptoms
d- Provide safe structured environment and sense of communication

28.According to Maslow’s hierarchy of needs, which situation on an in-

patient psychiatric unit would require priority intervention?
a- A client is disturbed that family can be seen only during visiting
hours
b- A client exhibits hostile and angry behaviors toward another client.
c- A client states, “I have no one who cares about me.”
d- A client states, “I have never met my career goals.

29.A patient with bipolar disorder is pacing constantly today, while other
clients are having a birthday party. There is music, noise, food. The
patient walks over to the table and takes handfuls of cake to eat as he
paces up and down the hall, the nurse best response to patient’s behavior
would be to:
a- Lit him continue to pace and eat.
b- Medicate him with a p.r.n anti-anxiety drugs
c- Restrain him in his room.
d- Ask patient to go outside and take a walk with you.

30.Giving broad opening is technique of communication that

a- encourage the client to talk
b- Giving meaning to what the patient is saying.
c- Facing the client with his behavior.
d- observe client’s nonverbal communication

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Part II; True and False questions; (10 mark)
Read each statement carefully and encircle "T" if the statement is true,
encircle "F" if the statement is false.
Statements True False
1. All people not necessary need a balance between energy and T
anxiety to preserve themselves, fulfill their beings and affirm
their existence.
2. Experiences provoking anxiety begins in infancy and continue T
throughout life
3. An important distinction between anxiety and fear is that T
anxiety attacks at deeper level than fear
4. Rationalization is seeing in others the same traits in which one F
feels inadequate.
5. Client with bulimia nervosa are in no serious medical danger as F
long as their weight remain near normal
6. The main differences between major depression and dysthymia T
are in the duration and severity of the symptoms
7. Objectivity is an ability to evaluate exactly the patient's F
behavior, with mixing one's own feelings, opinion or judgment

8. The nurse should promoting dependence for schizophrenic F

patient
9. A professional relationship focuses upon the personal and T
emotional needs of the patient
10.Torticollis means stiffness of the neck T

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 Part III : Match the term in column A with the correct definition in
column B (10 marks)

Answer A B

10 a- projection 1- Retreating to level of behavior that reduce anxiety, allow

me to feel more comfortable.
5 b- fear 2-This is voluntary conscious forcing of unpleasant anxiety
producing experiences into the preconscious mind.
9 c- phobia 3- .Refers to illogica1 and haphazard between ideas
connections
4 d- Tangentiality 4. The patient never gets from desired point to desired goal.
So, he goes off the core of the topic
2 e- repression 5- is reaction to specific danger " event, situation , object "

3 f- Looseness of 6- An unpleasant, unacceptable ideas, or impulses are

association involuntary stored in the unconscious mind.
6 g- Regression 7- Holding two opposing emotions, attitudes, wishes, or
impulses toward the same person, at the same time
--------- h- Echolalia 8- A monotonous repetition of certain movement or speech
without purpose
8 i- Stereotypy 9- irrational and persistent fear from " event, situation ,
object "
7 j- Ambivalence 10- The person rejects unwanted characteristics of self and
assigns them to others.
2 k- Suppression:-

-------- l- Denial

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IV - List the followings ;( 25 marks ):
1- Contraindications of ECT: (2marks )
a. -------------------------------------------------------------------------------------------------

b. -------------------------------------------------------------------------------------------------

c. -------------------------------------------------------------------------------------------------

d. --------------------------------------------------------------------------------------------------

2- The main principle in creating a therapeutic nurse patient relationship:

(2marks)
a. -------------------------------------------------------------------------------------------------

b. -------------------------------------------------------------------------------------------------

c. -------------------------------------------------------------------------------------------------

d. --------------------------------------------------------------------------------------------------

3- Type of dissociative amnesia: ( 2 marks)

a. -------------------------------------------------------------------------------------------------

b. -------------------------------------------------------------------------------------------------

c. -------------------------------------------------------------------------------------------------

d. -------------------------------------------------------------------------------------------------

4- Type of abusive behaviors: (2marks )

a. -------------------------------------------------------------------------------------------------

b. -------------------------------------------------------------------------------------------------

c. -------------------------------------------------------------------------------------------------

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5- Problems in Milieu Therapy ( 2marks)
a. -------------------------------------------------------------------------------------------------

b. -------------------------------------------------------------------------------------------------

c. -------------------------------------------------------------------------------------------------

d. ------------------------------------------------------------------------------------------------

1. Confidentiality. 2. Decision making 3.Limit setting.

4. Parallel process: staff behavior often mirrors patient's behaviors and vices
versa.
6- Kind of patient discharge from the hospital (1.5 marks)
a. -------------------------------------------------------------------------------------------------

b. -------------------------------------------------------------------------------------------------

c. -------------------------------------------------------------------------------------------------

Conditional discharge Absolute discharge: Judicial discha

7- Situations in which the staff must be consistent. (1.5 marks)
a. ---------------------------------------------------------------------------------------
b. ---------------------------------------------------------------------------------------
c. ---------------------------------------------------------------------------------------
8-Discuss four concepts of positive mental health (2 marks)

a. -----------------------------------------------------------------------------------
b. -----------------------------------------------------------------------------------
c. -------------------------------------------------------------------------------------
d. -------------------------------------------------------------------------------------

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9- Principles of therapeutic communication ( 2marks )
a. -----------------------------------------------------------------------------------
b. -----------------------------------------------------------------------------------
c. -------------------------------------------------------------------------------------
d. -------------------------------------------------------------------------------------

10- Functions of Ego are: (2 marks)

a. -----------------------------------------------------------------------------------
b. -----------------------------------------------------------------------------------
c. -------------------------------------------------------------------------------------
d. ------------------------------------------------------------------------------------
l. Control of impulses &master of body. 2. Directs motor activities. .
3. Maintains sense of reality through perception, memory, reason and
insight. 4. preserves us from danger; help survival.
5. Deals effectively and balances between the forces of ld& Superego.

11- Assessment of generalized anxiety disorder ( 2marks )

a. -----------------------------------------------------------------------------------
b. -----------------------------------------------------------------------------------
c. -------------------------------------------------------------------------------------
d. ------------------------------------------------------------------------------------
 People with (GAD) are chronic worriers. Decision making is Difficult because of poor
concentration and the fear of making a mistake.
 Restlessness, inability to relax, and fatigue.
 Autonomic hyperactivity e.g. Sweating, palpitations, cold clammy hands, urinary
frequency, pallor or flushing, increased pulse and rapid respiration.
 Apprehensiveness.
 Insomnia: initiating sleep is difficult because the individual worries about the day's events
and real or imagined mistakes. Nightmares often occur.
 Distractibility

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12- Negative symptoms of schizophrenia (2 marks)
a. -----------------------------------------------------------------------------------
b. -----------------------------------------------------------------------------------
c. ------------------------------------------------------------------------------------
d. -------------------------------------------------------------------------------------

13- Assessment of thought process of bipolar patient (2 marks)

a. -----------------------------------------------------------------------------------
b. -----------------------------------------------------------------------------------
c. ------------------------------------------------------------------------------------
d. -------------------------------------------------------------------------------------

Part V. Case study (Essay):

(25 marks)
A 35-years old patient, is admitted to a psychiatric unit .It is the third
admission for him .He speaks negatively about himself and states that he
would be better if dead. He is complains of insomnia. Although he has been
suicidal during past hospitalization, he now denies suicidal ideas and is not
put on suicide alert status. He is quiet and withdrawn, and responds slowly
to all stimuli.

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Questions
1-What assessment data does the nurse need to plan this patient? (5 marks)

2-Write two nursing diagnosis and expected outcome? (10 marks)

3-Write two nursing intervention? (10 marks)

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