NP5: COMMON FINAL EXAMINATION

• Set A (1–25): EENT (Special Senses)

• Set B (26–100): Psychiatric & Mental Health Nursing

1. A 9-year-old swimmer returns to the clinic for recurring ear discomfort after pool
activities. The nurse diagnoses otitis externa. During discharge, the nurse teaches the
mother preventive care. Which instruction best prevents recurrence while protecting the
external ear canal integrity?
A. Dry the ears after swimming using a hair dryer on the lowest heat setting, keeping it
several inches away.
B. Instill oil drops after every swim session.
C. Use cotton swabs to absorb remaining water.
D. Avoid cleaning the ears altogether.

2. A 3-year-old child is brought to the pediatric clinic with complaints of ear pain and
irritability. The nurse prepares for otoscopic examination. Which action by the nurse
demonstrates correct assessment technique for a child of this age?
A. Pull the auricle upward and outward to visualize the tympanic membrane.
B. Gently pull the auricle downward and backward to straighten the canal.
C. Ask the child to tilt the head downward while inserting the otoscope.
D. Insert the otoscope deeply to visualize the middle ear.

3. A 65-year-old client complains that speech sounds seem muffled, especially high-
pitched voices. The nurse suspects presbycusis. Which patient statement indicates
understanding of strategies to enhance communication?
A. “I’ll ask people to face me when speaking so I can read their lips.”
B. “I should talk louder so others will speak louder back.”
C. “I’ll clean my ears daily using cotton-tipped swabs.”
D. “I’ll turn the TV to the maximum volume for clarity.”
4. A 27-year-old machine operator reports ringing in his ears after long exposure to loud
grinding equipment. The nurse recognizes this as occupational tinnitus. Which preventive
measure should be emphasized?
A. Schedule regular ear irrigation to prevent wax buildup.
B. Avoid wearing any headgear that covers the ears.
C. Use properly fitted noise-canceling or protective ear devices at work.
D. Drink more water during breaks to reduce inner ear pressure.

5. A 40-year-old woman complains of dizziness, hearing loss, and a sensation of ear

fullness that worsens with caffeine intake. The physician confirms Meniere’s disease.
Which dietary modification should the nurse reinforce?
A. Increase sodium intake to balance inner ear pressure.
B. Restrict salt, caffeine, and alcohol to reduce fluid accumulation.
C. Add more potassium-rich fruits for vestibular balance.
D. Take multivitamins to stabilize nerve transmission.

6. A client using timolol eye drops for glaucoma calls the nurse reporting mild dizziness
and bradycardia. The nurse recognizes possible systemic absorption. Which instruction
should be reinforced to prevent this effect?
A. Blink rapidly after instillation to promote absorption.
B. Wipe off excess medication from the eyelids.
C. Instill multiple drops to ensure coverage.
D. Press on the inner canthus after instilling the drops for 1–2 minutes.

7. A 30-year-old welder presents with sudden eye pain after a small metal fragment hit his
cornea. He reports photophobia and tearing. What should the nurse do while waiting for
ophthalmology consult?
A. Cover both eyes with sterile dressings to minimize movement.
B. Flush the affected eye continuously with sterile saline.
C. Administer anesthetic drops for pain relief.
D. Attempt to remove the visible foreign body using sterile forceps.
8. A 72-year-old woman describes seeing flashes of light followed by a dark curtain over
part of her vision. The nurse suspects retinal detachment. What initial action supports
retinal preservation?
A. Place the client in a semi-Fowler’s position.
B. Patch both eyes to restrict movement.
C. Instruct the client to remain on bed rest with the affected eye positioned upward.
D. Encourage active range of motion to maintain circulation.

9. A mother of a 3-year-old child asks how to perform ear irrigation safely at home. Which
teaching statement shows correct understanding?
A. “I’ll use warm water and gently pull his ear down and back during irrigation.”
B. “I’ll flush using cold water to avoid dizziness.”
C. “I’ll insert the syringe deep into the canal for better cleaning.”
D. “I’ll use cotton buds daily to remove earwax.”

10. A 58-year-old diabetic client complains of blurry vision. Retinal exam shows
microaneurysms and hemorrhages. Which nursing diagnosis is most appropriate for this
client?
A. Disturbed sensory perception (visual) related to retinal ischemia.
B. Risk for infection related to decreased immunity.
C. Self-care deficit related to visual limitation.
D. Knowledge deficit regarding medication regimen.

11. A 46-year-old male complains of severe eye pain, halos around lights, and nausea.
Assessment reveals a fixed, mid-dilated pupil and elevated intraocular pressure. The nurse
suspects:
A. Acute angle-closure glaucoma.
B. Macular degeneration.
C. Retinal detachment.
D. Optic neuritis.
12. A 70-year-old client reports difficulty reading fine print but denies peripheral vision
loss. The nurse recognizes this as:
A. Cataract formation.
B. Retinal detachment.
C. Macular degeneration.
D. Glaucoma.

13. A 15-year-old swimmer has recurrent ear pain and drainage. The nurse teaches
preventive measures for otitis externa. Which statement shows correct understanding?
A. “I’ll dry my ears completely and avoid inserting anything into them.”
B. “I’ll place cotton balls soaked in oil before swimming.”
C. “I’ll clean with hydrogen peroxide every night.”
D. “I’ll use earplugs when sleeping.”

14. A 60-year-old woman complains of cloudy, blurred vision and glare sensitivity while
driving at night. The nurse expects findings consistent with:
A. Glaucoma.
B. Retinal detachment.
C. Cataract formation.
D. Presbyopia.

15. A chemical spill splashes into a worker’s right eye. The nurse on duty immediately
performs emergency care. What is the first nursing action?
A. Irrigate the affected eye continuously with sterile normal saline.
B. Apply a sterile patch to protect the cornea.
C. Instill antibiotic drops immediately.
D. Notify the ophthalmologist before intervening.

16. A patient who underwent myringotomy for chronic otitis media is preparing for
discharge. Which instruction should the nurse emphasize?
A. “Avoid getting water in your ear until cleared by your provider.”
B. “You can swim again once the drainage stops.”
C. “Insert cotton swabs to clean the incision daily.”
D. “Report mild serous drainage as normal healing.”

17. A 68-year-old client asks the nurse what causes cataracts. Which explanation is
correct?
A. “They form when lens proteins clump together due to aging or sun exposure.”
B. “They occur because of increased intraocular pressure.”
C. “They result from repeated infections.”
D. “They happen after inflammation of the retina.”

18. A patient using timolol for glaucoma reports difficulty breathing. The nurse recognizes
this as a serious effect of systemic beta-blockade. Which action is appropriate?
A. Advise the client to skip the next dose.
B. Encourage more fluids to dilute the drug.
C. Continue the medication until symptoms resolve.
D. Instruct the client to contact the physician immediately.

19. A 5-year-old child frequently develops otitis media. The nurse explains that this is
common in children because:
A. Their Eustachian tubes are shorter and more horizontal than in adults.
B. They often place foreign objects into the ears.
C. Their immune systems are immature.
D. Their tympanic membranes are thinner.

20. On the second day after cataract extraction, a patient reports sudden sharp pain and
blurred vision. What should the nurse do first?
A. Notify the surgeon immediately about these symptoms.
B. Administer the prescribed analgesic for pain.
C. Encourage bed rest to promote healing.
D. Document the findings as expected postoperative discomfort.
21. A child recovering from tympanic membrane perforation is being discharged. Which
instruction by the nurse is appropriate?
A. “Keep water out of the ear during bathing until healed.”
B. “Allow the child to blow the nose forcefully.”
C. “Insert ear drops until drainage stops.”
D. “Apply warm compresses directly into the canal.”

22. A 68-year-old client reports seeing distorted and wavy lines when reading. The nurse
recognizes this symptom as:
A. Macular degeneration.
B. Retinal vein occlusion.
C. Glaucoma.
D. Presbyopia.

23. A 55-year-old factory worker says that conversations sound muffled and that he often
misses words. Audiometry confirms sensorineural hearing loss. The nurse explains this is
most likely due to:
A. Prolonged exposure to loud occupational noise.
B. Cerumen impaction obstructing the canal.
C. Recurrent otitis media.
D. Fluid accumulation behind the eardrum.

24. A client recovering from corneal transplant asks which signs should prompt a call to
the surgeon. The nurse should emphasize:
A. Report any eye redness, pain, or light sensitivity immediately.
B. Resume all normal activities after 48 hours.
C. Sleep on the operated side to prevent swelling.
D. Avoid sunglasses outdoors to allow natural light exposure.

25. A 12-year-old is brought to the clinic for hearing difficulty. The nurse observes air-fluid
levels behind the tympanic membrane. Which condition does the nurse suspect?
A. Otitis media with effusion.
B. Otitis externa.
C. Acute otitis media.
D. Tympanic membrane rupture.

Psychiatric & Mental Health Nursing 26-100

26. A 34-year-old woman with obsessive-compulsive disorder insists on checking the

stove for hours before bed. When redirected, she becomes anxious and tearful. The nurse
wants to reduce ritual time without heightening anxiety. Which approach best maintains
therapeutic structure?
A. Allow brief ritual time, then gently redirect to another activity once anxiety subsides.
B. Stop the ritual immediately to extinguish the behavior.
C. Distract her with unrelated conversation.
D. Restrict her access to the kitchen altogether.

27. A 21-year-old student washes her hands repeatedly until her skin cracks. She says, “If I
don’t, my parents will die.” The nurse interprets this behavior as a compulsion serving to —
A. Punish herself for obsessive thoughts.
B. Reduce anxiety produced by obsessional fear.
C. Gain reassurance from others.
D. Seek attention for stress relief.

28. A 28-year-old client with major depression states, “Everyone would be better off if I
were dead.” What should the nurse do first?
A. Assess suicidal intent and institute safety precautions.
B. Ask about childhood losses.
C. Encourage journaling of thoughts.
D. Offer medication for sleep.

29. A 44-year-old veteran with PTSD refuses to discuss trauma and avoids crowds. Before
therapy begins, the nurse prioritizes which step?
A. Exploring traumatic memories in detail.
B. Establishing trust and ensuring safety in the environment.
C. Teaching systematic desensitization immediately.
D. Assigning group therapy on day 1.

30. A client with schizophrenia answers every unrelated question by repeating, “Good
day.” The nurse documents this speech pattern as —
A. Echolalia.
B. Neologism.
C. Perseveration.
D. Word salad.

31. A paranoid client refuses meals, claiming the staff poisoned the food. Which
intervention best encourages intake?
A. Persuade the client that food is safe.
B. Offer sealed or pre-packaged foods the client can open.
C. Have a peer taste the meal first.
D. Skip the meal until trust develops.

32. A 33-year-old alternates between two distinct personalities—one childlike, one

aggressive. The nurse recognizes this as —
A. Dissociative Identity Disorder.
B. Depersonalization Disorder.
C. Conversion Disorder.
D. Schizotypal Personality Disorder.

33. A man claims, “The government controls my thoughts through satellite beams.” This
belief exemplifies a —
A. Grandiose delusion.
B. Delusion of control.
C. Somatic delusion.
D. Idea of reference.
34. A client with schizophrenia repeatedly stops taking medication, saying, “I’m fine now.”
Which plan best promotes adherence?
A. Increase education sessions only.
B. Enlist family reminders for dosing.
C. Schedule long-acting depot antipsychotic injections with follow-up.
D. Confront the client’s denial directly.

35. A nurse notes a client pacing, clenching fists, and glaring at staff. What is the best
initial action?
A. Confront the behavior directly.
B. Approach calmly, maintaining safe distance and non-threatening posture.
C. Ask another client to assist.
D. Touch the client’s arm reassuringly.

36. A patient on clozapine reports sore throat and fever. Which nursing response has
highest priority?
A. Check white-cell count and notify provider immediately.
B. Give acetaminophen and fluids.
C. Encourage mouth gargles.
D. Continue drug until results return.

37. A client on haloperidol suddenly develops fever, rigidity, and fluctuating blood
pressure. The nurse suspects neuroleptic malignant syndrome. The first action is —
A. Assess airway patency.
B. Apply cooling blankets only.
C. Hold the antipsychotic and inform the physician.
D. Give anticholinergic medication.

38. The nurse explains to a new schizophrenia patient that haloperidol is prescribed to
target which symptoms?
A. Negative symptoms like apathy.
B. Positive symptoms such as hallucinations and delusions.
C. Cognitive disorganization only.
D. Depressive features.

39. A client starting risperidone asks how it differs from older agents. The nurse responds:
A. “It acts on both dopamine and serotonin to manage positive and negative symptoms.”
B. “It causes more tremors than haloperidol.”
C. “It only treats paranoia.”
D. “It’s used only for depression.”

40. A client receiving aripiprazole wants to know how the drug works. The nurse states:
A. “It blocks all dopamine activity.”
B. “It increases serotonin production.”
C. “It stabilizes dopamine—acting partly as agonist and antagonist.”
D. “It suppresses neurotransmitters completely.”

41. A 46-year-old with fatigue, loss of pleasure, and guilt for two weeks meets diagnostic
criteria for —
A. Cyclothymic disorder.
B. Major depressive episode.
C. Adjustment disorder.
D. Persistent depressive disorder.

42. During teaching, a bipolar client on lithium says, “I take ibuprofen for headaches.”
Which nursing response is appropriate?
A. “That’s safe if taken with meals.”
B. “Increase your lithium dose when taking it.”
C. “Avoid NSAIDs; they can raise lithium levels dangerously.”
D. “Take both together to enhance effect.”
43. A client alternates between praising and demeaning staff members in short intervals.
The nurse identifies this defense mechanism as —
A. Projection.
B. Splitting.
C. Rationalization.
D. Compensation.

44. An inmate with antisocial personality disorder manipulates peers for cigarettes and
refuses rules. The most effective intervention is —
A. Assign the most lenient nurse to reduce conflict.
B. Encourage insight through open discussion.
C. Ignore minor rule violations.
D. Set firm limits and communicate consistent consequences.

45. A patient experiencing restlessness and muscle tension says, “I can’t stop worrying.”
The nurse’s best initial action is —
A. Challenge the client’s irrational beliefs.
B. Teach grounding and deep-breathing exercises to lower anxiety.
C. Offer sedative medication immediately.
D. Explore early life stressors first.

46. A client reports chronic sadness for more than two years without suicidal thoughts. The
nurse suspects —
A. Bipolar II Disorder.
B. Major Depressive Episode.
C. Dysthymic (Persistent Depressive) Disorder.
D. Cyclothymic Disorder.

47. An 8-year-old boy flaps his hands repeatedly and avoids eye contact. The nurse
recognizes this as —
A. ADHD.
B. Autism Spectrum Disorder.
C. Oppositional Defiant Disorder.
D. Conduct Disorder.

48. A 12-year-old resumes thumb-sucking during hospitalization. The nurse interprets this
as —
A. Displacement.
B. Sublimation.
C. Projection.
D. Regression to an earlier stage.

49. A depressed client says, “Everything bad that happens is my fault.” The nurse identifies
this as —
A. Rationalization.
B. Personalization
C. Projection.
D. Denial.

50. In group therapy, a patient accuses another of jealousy, though the accuser later
admits similar feelings. The nurse recognizes this defense mechanism as —
A. Reaction formation.
B. Identification.
C. Projection of one’s own feelings onto others.
D. Sublimation.

51. A 40-year-old woman with generalized anxiety disorder reports that her heart races
whenever she feels overwhelmed. The nurse teaches her relaxation breathing and
grounding techniques. At the next visit, the client says, “When I feel anxious, I take slow
breaths and I calm down again.” The nurse recognizes this statement as a sign of:
A. Effective use of adaptive coping through relaxation and self-control.
B. Continued dependency on nursing intervention.
C. Suppression of emotional expression.
D. Denial of anxiety symptoms.

52. A patient admitted for acute mania is restless, hyperverbal, and distractible, trying to
hug and touch staff frequently. The nurse develops an environmental plan to manage the
behavior. Which intervention is most appropriate for this client’s condition?
A. Encourage free movement to release excess energy.
B. Provide a low-stimulation, structured environment with clear limits.
C. Involve the client in stimulating group activities.
D. Allow unrestricted access to peers to promote socialization.

53. A 35-year-old client taking lithium carbonate for bipolar disorder reports nausea,
tremors, and unsteady gait. Laboratory findings show a lithium level of 2.0 mEq/L. The
nurse interprets these findings as:
A. Expected therapeutic response.
B. Evidence of noncompliance.
C. Toxicity requiring the dose to be held and the provider notified.
D. Mild side effects to be managed with hydration.

54. A patient with a history of alcohol use disorder is admitted eight hours after last drink,
presenting with tremors, diaphoresis, and auditory hallucinations. Which medication
should the nurse expect to administer to manage withdrawal symptoms?
A. Haloperidol to control hallucinations.
B. Lorazepam to decrease CNS hyperactivity.
C. Disulfiram to maintain abstinence.
D. Methadone to reduce cravings.

55. During discharge teaching, a client prescribed disulfiram asks, “What happens if I drink
while taking this?” The nurse’s best response is:
A. “You’ll just feel nauseous for a few minutes.”
B. “It will make alcohol taste unpleasant, that’s all.”
C. “Combining alcohol and this drug can cause severe hypotension, nausea, and
vomiting.”
D. “It will only reduce your craving for alcohol.”

56. A client with antisocial personality disorder manipulates peers to give him cigarettes
despite ward rules. The nurse intervenes to prevent further boundary violations. What is
the best therapeutic approach?
A. Allow flexibility in rules to avoid conflict.
B. Set consistent, firm limits and enforce consequences.
C. Redirect attention to unrelated activities.
D. Ignore minor manipulative behaviors.

57. During an acute panic attack, a client suddenly clutches her chest and cries, “I can’t
breathe, I’m dying!” The nurse’s best immediate action is to:
A. Analyze the underlying cause of her anxiety.
B. Stay with her, remain calm, and speak reassuringly until symptoms subside.
C. Ask her to recall when the symptoms began.
D. Offer a benzodiazepine right away.

58. After three weeks of antidepressant therapy, a client who was previously withdrawn
becomes cheerful and begins giving away personal belongings. Which is the nurse’s
priority action?
A. Praise the improvement in mood as progress.
B. Encourage participation in activities.
C. Assess for suicidal ideation and ensure safety measures.
D. Document the change and notify the physician later.

59. The nurse is preparing a client for electroconvulsive therapy (ECT). Which pre-
procedure nursing action holds the highest priority?
A. Shave and prepare electrode sites.
B. Verify that the informed consent form has been signed and witnessed.
C. Insert an IV line for medication administration.
D. Obtain vital signs and weight baseline.
60. A client with multiple vague complaints—headache, stomach pain, and fatigue—
insists on repeated diagnostic tests despite normal results. The nurse’s best therapeutic
response is:
A. “You’re exaggerating; nothing is physically wrong.”
B. “Let’s discuss what you feel when these symptoms occur.”
C. “Your symptoms are psychological, not physical.”
D. “You must learn to ignore these feelings.”

61. A man with schizoaffective disorder refuses medication, saying, “The pills make me
feel like a zombie.” The nurse using motivational interviewing responds:
A. “You have to take your medicine if you want to get better.”
B. “It sounds like being alert and clear-headed is important to you. Tell me more.”
C. “Your refusal could cause another relapse.”
D. “I’ll tell your doctor you’re being uncooperative.”

62. A woman with obsessive-compulsive disorder washes her hands until the skin bleeds.
Which nursing plan promotes gradual behavioral improvement?
A. Limit ritual time gradually and introduce alternative coping techniques.
B. Stop the ritual immediately to eliminate the behavior.
C. Encourage family to prevent her from washing.
D. Substitute the ritual with another repetitive task.

63. A client insists, “Cameras are watching me from the ceiling.” The nurse’s most
therapeutic response is:
A. “That’s impossible; there are no cameras here.”
B. “It must feel frightening to believe you’re being watched.”
C. “Tell me more about the people controlling you.”
D. “Ignore those thoughts—they’re not real.”
64. A patient taking haloperidol develops tremors, stiffness, and mask-like facial
expression. The nurse identifies these findings as:
A. Akathisia.
B. Tardive dyskinesia.
C. Extrapyramidal symptoms related to dopamine blockade.
D. Neuroleptic malignant syndrome.

65. The nurse facilitates a group therapy session for clients with depression. Which goal
best represents the therapeutic purpose of group work?
A. To eliminate sadness through confrontation.
B. To promote mutual understanding and shared insight among peers.
C. To replace pharmacologic therapy entirely.
D. To enforce behavioral compliance with staff expectations.

66. A client diagnosed with panic disorder asks, “Why do my attacks happen even when
I’m calm?” The nurse explains that panic attacks occur because:
A. The brain has too much serotonin.
B. Stress hormones stop functioning.
C. The heart overreacts to anxiety.
D. The sympathetic nervous system suddenly overactivates, triggering physical
symptoms.

67. A patient taking fluoxetine with an herbal supplement presents with agitation, fever,
and muscle rigidity. The nurse suspects serotonin syndrome. Which assessment finding
supports this?
A. Slow reflexes and bradycardia.
B. Hyperreflexia, hyperthermia, and muscle rigidity.
C. Cold, clammy skin and hypotension.
D. Fatigue and decreased coordination.

68. The nurse educates a client newly prescribed an SSRI for obsessive-compulsive
disorder. Which statement indicates correct understanding?
A. “I’ll stop the medicine when I feel calmer.”
B. “It should start working in a few hours.”
C. “It may take 2 to 4 weeks before I notice improvement.”
D. “I can take it only during stressful times.”

69. The nurse observes that a client with schizophrenia shows flat affect, social
withdrawal, and lack of motivation. The nurse correctly identifies these behaviors as:
A. Positive symptoms of psychosis.
B. Negative symptoms representing loss of normal function.
C. Cognitive symptoms involving attention deficits.
D. Affective symptoms caused by depression.

70. After a nurse makes a medication error, she says, “I’m terrible at my job; I should quit.”
The charge nurse replies, “Everyone makes mistakes—let’s focus on what you learned
from this.” This demonstrates:
A. Minimization.
B. Rationalization.
C. Deflection.
D. Empathy with cognitive reframing to promote adaptive coping.

71. A client with dependent personality disorder frequently asks, “Can you decide for me?”
The nurse encourages autonomy by:
A. Providing specific decisions for the client to follow.
B. Assisting the client to make simple independent choices.
C. Ignoring the dependency behavior.
D. Offering reassurance that dependence is acceptable.

72. A client states, “I feel like I’m outside my body, watching myself move.” The nurse
recognizes this experience as:
A. Derealization.
B. Dissociative amnesia.
C. Conversion disorder.
D. Depersonalization, a form of dissociation from self.

73. The nurse plans discharge goals for a client recovering from depression. Which goal
reflects progress toward recovery?
A. The client will avoid all stressful events.
B. The client will remain medication-free after discharge.
C. The client will identify and demonstrate two adaptive coping skills.
D. The client will avoid emotional expression to prevent relapse.

74. A client with PTSD becomes anxious when hearing sudden noises. Which nursing
intervention best demonstrates trauma-informed care?
A. Encourage detailed recounting of the trauma.
B. Avoid discussing triggers to prevent anxiety.
C. Offer desensitization therapy during hospitalization.
D. Maintain predictable routines and emphasize current safety.

75. During family teaching, the sister of a client with schizophrenia says, “He’s just lazy,
not sick.” The nurse’s best response is:
A. “You just need to encourage him more.”
B. “Schizophrenia is a stress reaction, not an illness.”
C. “Schizophrenia is a biologically based brain disorder that affects motivation and
behavior.”
D. “Ignore his behavior so he’ll learn responsibility.”

76. A community nurse conducts mental-health education in a rural barangay to dispel

myths that “mental illness means insanity.” Families begin asking how to seek help. Which
principle of the Philippine Mental Health Act (RA 11036) does this initiative best represent?
A. Promotion of mental-health awareness and community participation.
B. Institutional confinement for those with mental disorders.
C. Centralization of care in psychiatric hospitals.
D. Limitation of public exposure to mental-health topics.

77. A homeless man with chronic depression says, “People avoid me because I’m poor.”
The nurse recognizes this as social suffering, which refers to—
A. Pain purely from biologic disease.
B. Psychological distress rooted in social inequality and marginalization.
C. Temporary sadness due to isolation.
D. Emotional fatigue from unemployment alone.

78. A municipal health officer integrates mental-health screening into barangay clinics so
patients need not travel to tertiary hospitals. This demonstrates which RA 11036 strategy?
A. Restricting services to psychiatric specialists.
B. Mandatory hospital admission for all clients.
C. Integration of mental-health promotion into primary care.
D. Community exclusion of high-risk clients.

79. A psychiatric nurse develops a high-school suicide-prevention program emphasizing

empathy, stress-management, and peer-support groups. This initiative fulfills which
mandate under RA 11036?
A. Institutional care of minors with depression.
B. Criminalization of self-harm.
C. Promotion of youth mental-health programs as preventive care.
D. Hospital-based early intervention.

80. A client with schizophrenia says, “I hear God telling me to destroy evil.” The nurse
maintains calm presence and therapeutic communication. Which response is most
appropriate?
A. “Ignore those voices; they aren’t real.”
B. “You shouldn’t think about that.”
C. “Tell me what the voices say and how they make you feel.”
D. “You’ll be restrained if you act on that.”
81. A barangay health nurse collaborates with teachers and pastors to identify individuals
showing suicidal tendencies. This action aligns with which provision of RA 11036?
A. Mandating confinement for suicidal persons.
B. Building community gatekeeper networks for suicide prevention.
C. Limiting referrals to psychiatrists only.
D. Requiring law enforcement surveillance of at-risk individuals.

82. A psychiatric nurse conducts follow-up home visits after discharge of clients with
psychosis, collaborating with local health workers for continuity of care. This represents—
A. Institutional psychiatric care.
B. Private practice coordination.
C. Community-based mental-health service integration.
D. Crisis intervention unit referral.

83. During rounds, a patient remains motionless for hours, resists repositioning, and
maintains fixed postures when moved. The nurse documents these findings as features
of—
A. Paranoid schizophrenia.
B. Disorganized schizophrenia.
C. Catatonic schizophrenia characterized by waxy flexibility.
D. Residual schizophrenia.

84. Two months after childbirth, a mother reports constant sadness, guilt, and lack of
bonding with her infant. Which condition should the nurse suspect?
A. Postpartum blues.
B. Adjustment disorder.
C. Postpartum depression requiring evaluation.
D. Psychotic depression.
85. A manic client spends excessively, attempts to leave the unit, and argues when
redirected. The nurse sets clear limits on spending and movement primarily to—
A. Promote insight through confrontation.
B. Reinforce dependency on staff.
C. Maintain safety and prevent impulsive harm.
D. Discourage expression of feelings.

86. A veteran with PTSD blames himself for the death of a comrade and experiences
flashbacks triggered by loud noises. Cognitive-behavioral therapy (CBT) is implemented
to—
A. Explore unconscious guilt.
B. Focus only on desensitization.
C. Modify distorted thoughts sustaining anxiety.
D. Repress trauma memories completely.

87. A client with borderline personality disorder cuts her wrist after an argument. The nurse
approaches calmly, provides wound care, and encourages verbalization of emotion. This
response exemplifies—
A. Authoritarian limit-setting.
B. Punitive behavior control.
C. Therapeutic empathy that promotes emotional regulation.
D. Avoidance to discourage attention-seeking.

88. The nurse educates the family of a client with schizophrenia about early relapse
warning signs and the importance of medication adherence. This teaching focuses on—
A. Behavior modification through punishment.
B. Minimizing patient independence.
C. Empowering families in relapse-prevention management.
D. Reducing medication to prevent side effects.

89. During documentation review, a nurse learns that a client was physically restrained
without consent or justification. According to RA 11036, this violates which specific patient
right?
A. Confidentiality of records.
B. Equal employment opportunity.
C. Freedom from stigma.
D. Right to humane treatment and informed consent.

90. A patient with anxiety disorder repeatedly visits the ER complaining of chest pain
despite normal tests. The nurse explains that this occurs because—
A. Anxiety only affects emotional state.
B. The symptoms are fabricated to gain attention.
C. Psychological stress can manifest as real physical symptoms via mind–body
connection.
D. Anxiety directly causes cardiac disease.

91. A client suddenly turns away, whispering to unseen persons, then becomes frightened.
What should the nurse do first?
A. Reassure the client that voices are not real.
B. Leave the client alone to reduce stimulation.
C. Assess the hallucination content and potential for harm.
D. Distract the client with group activity.

92. In a community psychiatric rehabilitation center, nurses guide clients to learn job
skills, budgeting, and social interaction. This exemplifies—
A. Psychoanalytic therapy.
B. Authoritarian supervision.
C. Long-term institutionalization.
D. Recovery-oriented practice promoting autonomy and reintegration.

93. A prisoner expresses no remorse after committing violent acts and disregards others’
rights. The nurse identifies behavior consistent with—
A. Paranoid personality disorder.
B. Schizoid personality disorder.
C. Antisocial personality disorder.
D. Narcissistic personality disorder.

94. A woman arrives in the ER after witnessing a fatal accident, crying uncontrollably and
hyperventilating. In crisis intervention, the nurse’s immediate focus is to—
A. Explore long-standing conflicts.
B. Encourage free recall of the trauma.
C. Ensure immediate safety and short-term stabilization.
D. Postpone support until calm.

95. A client stabilized from acute psychosis attends therapy and requires social skills
training. The nurse recommends referral to—
A. Emergency psychiatric unit.
B. Acute in-patient ward.
C. Long-term custodial home.
D. Day-treatment rehabilitation program.

96. The nurse observes a patient who moves slowly, avoids eye contact, and says,
“Nothing makes me happy anymore.” These manifestations most likely indicate—
A. Dysthymic disorder.
B. Cyclothymia.
C. Schizoaffective disorder.
D. Major depressive disorder with psychomotor retardation.

97. To strengthen continuity of mental-health care, a community nurse establishes a

referral network linking hospitals, clinics, and social agencies. Which component ensures
the system’s effectiveness?
A. Physician-exclusive leadership.
B. Centralized decision-making.
C. Interdisciplinary coordination across sectors.
D. Reduction of community involvement.
98. Three months after her husband’s death, a widow reports occasionally hearing his
voice but continues normal activities. The nurse interprets this as—
A. Complicated grief reaction.
B. Major depressive disorder.
C. Normal grief process with transient sensory experience.
D. Pathologic hallucination requiring antipsychotics.

99. A psychiatric nurse leads a university campaign promoting mental-health rights,

equality, and anti-stigma awareness. This activity reflects which nursing role under RA
11036?
A. Clinician.
B. Educator.
C. Advocate for psychosocial and legal rights.
D. Researcher.

100. During supervision, a psychiatric nurse states, “I use my awareness of self and
emotions to build healing relationships.” This statement describes
A. Boundary crossing.
B. Personal disclosure for bonding.
C. Objective detachment.
D. Therapeutic use of self
 TO TOP THE BOARD EXAM!

ANSWER KEY AND RATIONALE

SET A — EENT (1–25)

No. Ans Rationale

1 A Using a low-heat hair dryer dries the ear canal and prevents moisture
accumulation—key in preventing otitis externa (Udan).
2 B For children under 3–4 years, pull the auricle down and back to straighten
the ear canal.
3 A Lip-reading compensates for sensorineural loss in presbycusis; auditory
discrimination remains difficult.
4 C Noise-canceling or protective devices prevent cochlear damage from
chronic loud noise exposure.
5 B Meniere’s disease management includes sodium restriction and avoidance
of caffeine/alcohol to reduce endolymphatic pressure.
6 D Pressing on the inner canthus prevents systemic absorption of beta-blocker
drops like timolol.
7 A Both eyes are covered to minimize ocular movement and prevent further
injury in penetrating trauma.
8 C Positioning the affected eye upward prevents retinal detachment extension
before surgery.
9 B Ear irrigation for children uses warm water and pulling the pinna down and
back.
10 D Findings show diabetic retinopathy causing visual sensory disturbance.
11 A Acute angle-closure glaucoma presents with ocular pain, fixed pupil, and
elevated IOP.
12 C Macular degeneration causes loss of central vision, preserved periphery.
13 B Keeping ears dry and avoiding foreign objects prevents otitis externa
recurrence.
14 D Cataract causes lens opacity and glare sensitivity.
15 A Immediate eye irrigation removes chemical contaminants; delay leads to
corneal necrosis.
16 C After myringotomy, keep the ear dry; water entry risks infection.
17 B Cataract results from lens protein denaturation due to age or UV exposure.
18 D Difficulty breathing indicates systemic beta-blocker absorption—priority to
report.
19 A Children’s Eustachian tubes are short/horizontal, promoting pathogen
entry.
20 C Severe pain post-op cataract may indicate increased intraocular pressure
or hemorrhage—urgent report.
21 B Water entry increases risk for reinfection and delayed healing of perforation.
22 A Distorted central vision = macular degeneration hallmark.
23 A Prolonged loud noise causes irreversible sensorineural loss.
24 A Early graft rejection shows pain/redness—urgent reporting required.
25 A Air bubbles behind the tympanic membrane indicate middle ear effusion.

SET B — Psychiatric I (26–50)

No Ans Rationale
.
26 A Allowing brief ritual time then redirecting reduces anxiety while
maintaining structure.
27 B Compulsions temporarily reduce anxiety caused by obsessions.
28 A Assess suicide risk first—client verbalizes worthlessness (Udan: safety
priority).
29 B Trust and safety precede trauma exploration in PTSD management.
30 C Perseveration = repetition of same response to different questions.
31 B Sealed foods enhance client’s perception of safety and autonomy.
32 A Two alternating identities = Dissociative Identity Disorder (DSM-5).
33 B Belief in external control of mind = delusion of control.
34 C Long-acting depot antipsychotics promote adherence in poor insight
cases.
35 B Stay calm, maintain distance; ensures safety during agitation.
36 A Agranulocytosis is a life-threatening clozapine effect; check ANC.
37 C Hold medication; NMS is a medical emergency.
38 B 1st-gen antipsychotics target positive symptoms (hallucinations,
delusions).
39 A Atypical antipsychotics act on dopamine and serotonin for both symptom
types.
40 C Aripiprazole stabilizes dopamine as partial agonist-antagonist.
41 B DSM-5 defines MDD as ≥2 weeks with anhedonia, guilt, and
worthlessness.
42 C NSAIDs increase lithium toxicity—contraindicated.
43 B Splitting = alternating extremes of idealization/devaluation.
44 D Firm, consistent limits reduce manipulation in antisocial disorder.
45 B Grounding and breathing lower physiologic anxiety before analysis.
46 C Chronic low mood ≥2 years = Dysthymic disorder.
47 B Autism: repetitive behavior, poor social reciprocity, early onset.
48 D Regression = returning to earlier developmental behaviors.
49 B Personalization = self-blame for external events.
50 C Projection = attributing one’s own emotions to others.

SET C — Psychiatric II (51–75)

No. Ans Rationale

51 A Client demonstrates self-control using relaxation—adaptive coping.
52 B Low-stimulation, structured setting decreases manic hyperactivity.
53 C GI distress + ataxia = lithium toxicity; hold dose, notify provider.
54 B Benzodiazepines (lorazepam) manage alcohol withdrawal
symptoms.
55 C Alcohol + disulfiram causes disulfiram reaction—potentially fatal.
56 B Consistent rules prevent manipulation; therapeutic limit-setting.
57 B Stay with the client—presence lowers panic intensity.
58 C Sudden improvement + giving belongings = suicide risk—safety first.
59 B Informed consent precedes ECT; ethical and legal priority.
60 C Focus on feelings, not physical symptoms, for therapeutic
redirection.
61 B Reflective, nonjudgmental dialogue supports motivational
interviewing.
62 A Gradually reduce ritual time and introduce alternative coping.
63 B Acknowledge emotion without validating delusion.
64 C Extrapyramidal symptoms = tremors, rigidity, facial stiffness.
65 B Group therapy promotes shared insight and adaptive functioning.
66 D Panic attacks stem from sympathetic overactivity (adrenal
response).
67 B Serotonin syndrome: rigidity, fever, hyperreflexia—life-threatening.
68 C SSRIs require 2–4 weeks for effect; educate on delayed onset.
69 B Negative symptoms include flat affect, anhedonia, avolition.
70 D Reframing + empathy encourages adaptive coping.
71 B Encouraging independent decisions fosters autonomy.
72 D Depersonalization = feeling detached from one’s body/self.
73 C Goal-setting and coping skill demonstration indicate recovery
progress.
74 D Predictability and safety are central to trauma-informed care.
75 C Schizophrenia is a neurobiological disorder—educate family
accurately.
SET D — Psychiatric III (76–100)

No. Ans Rationale

76 A RA 11036 promotes community awareness and mental health advocacy.
77 B Social suffering links psychosocial distress to structural inequality.
78 C Integrating mental health into primary care decentralizes access.
79 C Promoting youth mental health fulfills RA 11036’s preventive mandate.
80 C Explore content safely—therapeutic communication, not confrontation.
81 B Community gatekeeper engagement supports suicide prevention network.
82 C Community-based care ensures continuity and reintegration.
83 C Catatonic schizophrenia = rigidity, mutism, waxy flexibility.
84 C Persistent sadness post-birth = postpartum depression.
85 C Limits protect safety during mania; prevent risky impulsive acts.
86 C CBT modifies cognitive distortions that perpetuate PTSD anxiety.
87 C Calm empathy defuses crisis; supports emotional regulation.
88 C Relapse prevention education empowers family monitoring.
89 D Forced restraint without consent violates humane treatment rights.
90 C Psych stress manifests physical symptoms—psychoneuroimmunologic link.
91 C Assess hallucination content for safety—priority step.
92 D Recovery-oriented care promotes autonomy, function, reintegration.
93 C Antisocial traits: lack of remorse, disregard for rights.
94 C Crisis care prioritizes immediate safety and short-term stability.
95 D Day treatment suits stable clients needing structured rehab.
96 D Psychomotor retardation, anhedonia define major depression.
97 C Interdisciplinary linkage ensures effective mental health referral systems.
98 C Transient auditory hallucination post-loss = normal grief.
99 C Advocacy role combats stigma and promotes legal mental health rights.
100 D Therapeutic use of self = conscious application of one’s personality to promote
healing (Udan core).