Practice Test 1
A nurse is caring for a 34-year-old male patient with violent features. He was admitted involuntarily in hospital. Now, the patient asks for discharge. The nurse should understand that keeping the patient in hospital, after his demand for discharge would lead to:
- Charges of penalty
- Charges of insult
- Charges of slander
- Charges of assault
- No charge as the nursing action is correct
Correct Answer: E. No charge as the nursing action is correct
No charges will be given for the nurse as the nursing action is correct. This is not false imprisonment, as the patient is not admitted voluntarily. The patient is not confined to a specific area with intent by the nurse. He is admitted involuntarily, with the help of relatives or friends. All other above mentioned charges will not be taken against the nurse, in case of an involuntary admission.
A 35-year-old male patient is diagnosed with bipolar affective disorder currently mania. Which of the following symptoms would necessitate an immediate nursing intervention?
- Inappropriate dress
- Outlandish behavior
- Non-stop physical activity with less nutritional intake
- Grandiose delusions
- Teasing the nursing staff
Correct Answer: C. Non-stop physical activity with less nutritional intake
The nurse has to immediately intervene, in case of non-stop physical activity with less nutritional intake. The patient can become dehydrated if not intervened. Calories easily get burnt as the patient is on the go. The nurse has to provide with high-calorie finger food for the patient. All other above mentioned symptoms are common in case of mania, which would improve with medications.
A patient is diagnosed with dementia. Which of the following symptoms would indicate to the nurse the presence of dementia?
- Presence of hygiene
- Improvement in sleep
- Improvement in immediate memory
- Absence of sun-downing syndrome
Correct Answer: B. Confabulation
Confabulation is present in dementia. It means that the patient fabricates events. There will be absence of personal hygiene in patients with dementia. There will be lack of proper sleep in dementia. Immediate memory will be impaired in dementia. There will be a presence of sun-downing syndrome in patients with dementia.
Which of the following symptoms would occur if a patient takes excess amount of the drug bupropion?
- Absence of dizziness
- Loss of weight
- Seizure activity
Correct Answer: E. Seizure activity
A drug dosage of more than 450mg per day would cause an adverse effect of seizures. Constipation and increase in weight occurs as an adverse effect of the drug. Confabulation is not present as an adverse effect of the drug. Dizziness is a common side-effect of this drug.
A 45 year old female patient is diagnosed with paranoid schizophrenia in an acute psychiatric ward. The patient must be in the developmental task of:
- Industry vs. inferiority
- Generativity vs. stagnation
- Trust vs. mistrust
- Identity vs. role confusion
- Ego integrity vs. despair
Correct Answer: E. Ego integrity vs. despair
The patient is in her middle adulthood. The developmental task generativity vs. stagnation is characterized by concern and care for others. Generativity is a productive and creative stage. If failed with task of generativity, stagnation develops. In infancy stage, there is trust vs. mistrust. The infant needs gratification of oral needs. In schoolchildren, there is industry vs. inferiority; the child tries to learn school competencies and social skills. In late adulthood, there is ego integrity vs. despair; they are concerned with reflection of their past and they contribute to others and face the future.
Which of the following statements must be included while providing health education for a patient taking the drug valium?
- Triple up the dose if the patient forgets the medication.
- Take the medication after meals.
- Double up the dose if the patient forgets the medication.
- It is safe to stop it anytime after long term use.
- Avoid foods rich in tyramine.
Correct Answer: B. Take the medication after meals.
Anti-anxiety drugs like valium cause G.I. problems, if not taken with food. The patient must be encouraged to take the drug after meals. The dose of valium should not be doubled or tripled if the dose was missed. As the drug valium causes dependency, it is best that the medication is gradually withdrawn and not during any time, so that convulsion is avoided. Taking tyramine rich food can cause hypertensive crisis, only if the patient is on MAOI anti-depressants.
A nurse is caring for an aggressive patient. The nurse observes that the patient’s anger is becoming more on conversation. Which nursing intervention is least helpful for the patient at this time?
- Acknowledging the behavior
- Keeping distance from the client
- Moving the patient to a quiet area
- Initiating confinement measures
- Pouring water in the patient’s face
Correct Answer: D. initiating confinement measures
Confinement does not help the patient during this stage. The proper method for dealing with an aggressive patient is trying to calm the patient verbally. When verbal assurance and medications are not adequate to handle the aggressiveness, seclusion and restraints are used. All the other above-mentioned procedures are useful to escalate the aggression.
Which of the following must be included in the plan of care for patients with borderline personality?
- Flexibilities in limits
- Administering medications to avoid acting out
- Restricting the patient from other patients
- Ensuring the patient to adhere to certain restrictions
- Providing health education
Correct Answer: D. Ensuring the patient to adhere to certain restrictions
Borderline personalities are manipulative. The patient must be informed about the policies of the hospital and rules followed in a ward on admission. Limits should be firm. Flexibility is not considered therapeutic in dealing with a manipulative client. There is no need for medications as this would not be a part of the care plan. Interaction with other patients is encouraged but the patient should be prevented from dominating other patients.
A patient is non-responsive to others’ feelings and uses abusive language. Which personality disorder is the patient likely to have?
Correct Answer: A. Anti-social
The features depicted in the patient are typically seen in anti-social personality. Patients with histrionic personality will have excessive emotions, with attention-seeking behavior. Patients with paranoid personality have features of distrust and suspicion. Patients with narcissistic personality disorder have grandiosity and they require constant admiration from others.
A 40 year old female patient is newly diagnosed with cervical cancer. After hearing the diagnosis, the patient starts speaking rapidly. She says that she has got severe headache. She is unable to focus on the conversation with the doctor. The nurse notes the level of anxiety in the patient as:
Correct Answer: D. Severe
The patient’s features typically come under severe anxiety. Average anxiety is not seen in anxiety categorization. Mild anxiety is featured with minimal muscle tension, less fidgeting. The patient will have attention and also the ability to concentrate. The patient can use problem solving techniques. Moderate anxiety is featured with moderate muscle tension, higher than normal vital signs. Patient has periodic slow pacing with difficulty in concentration, in case of moderate anxiety. Panic anxiety is characterized by immobilization and incoherence of speech.
A head nurse of a psychiatric unit prepares for a patient assignment plan. Who is considered as the most appropriate nurse to be assigned to a patient with aggression and violence?
- A nervous and timid nurse
- An in-experienced RN
- A matured and experienced RN
- A soft spoken RN
- A fast spoken RN
Correct Answer: C. A matured and experienced RN
An aggressive patient who is unstable must be assigned to the most experienced nurse. A nervous and timid nurse or an inexperienced nurse cannot manage aggressive patients. A soft-spoken nurse cannot manage an angry patient. The patient must be given instructions slowly and clearly. A fast spoken nurse cannot manage an aggressive patient.
Four months after an aeroplane crash, a 24-year-old female patient recollects the incident and complains of difficulty in concentrating on her work. She has anorexia and insomnia. Which of the following could the patient be suffering from?
- Adjustment disorder
- Post traumatic stress disorder
- Generalized Anxiety Disorder
- Somatoform Disorder
Correct Answer: C. Post traumatic stress disorder
Post traumatic stress disorder is featured with recollection of the episode, irritability, insomnia and lack of concentration in the daily work. These features could be present in the patient for more than one month. In adjustment disorder, there is a maladaptive behavior to stressful life events. GAD is characterized by excessive anxiety. Somatoform disorders are caused by anxiety, with the presence of physical symptoms.
A 44-year-old male patient jumps and throws his things out of the room. The nurse uses restraints for this patient after this incident. Which of these nursing documented statements suggests of safeguarding the patient’s rights?
- The nurse carried out less restrictive measures which were unsuccessful
- The doctor ordered for restraints
- All the rights of the patient were explained to the patient and his family members
- The nurse observed confidentiality
- The staff carried out more restrictive measures but were unsuccessful
Correct Answer: A. The nurse carried out less restrictive measures which were unsuccessful
The nurse’s documentation suggests that the patient is put on restraints after the least restrictive measures like verbal request failed in preventing the patients’ violent behavior. All other above- mentioned statements do not point out the nurse’s best effort in caring for the violent patient, so these statements cannot be used for safe-guarding the patient’s rights.
A 46-year-old male patient joins an anti-alcohol support group and he is an active participant against alcohol abuse. Which of the following defense mechanisms is the patient using?
- Reaction formation
Correct Answer: E. Reaction formation
In reaction formation, the person adopts the feelings which are exactly the opposite of one’s true emotions. In projection, the person attributes one’s own feelings to another person. In denial, the person refuses to accept the painful reality. In displacement, one’s anger is displaced on a less threatening person or an object. In rationalization, the person tries to justify his behavior with reasons, which sounds logical.
A nurse is newly posted in an acute neurotic ward. The nurse must know that anxiety in a patient in neurotic ward is caused by which one of the following?
- Hostility turned to the self
- An objective threat
- Masked depression
- A subjectively perceived threat
Correct Answer: E. A subjectively perceived threat
The nurse must understand that the anxiety occurs due to a subjectively perceived threat. In a depressed patient, the nurse can identify that the patient usually internalizes hostility. Fear occurs due to an objective threat. Mania occurs due to masked depression.