NURSING PRACTICE V- Care of Clients with physiologic and Psychosocial

Alterations (Part C).

SITUATIONAL

Situation 1 – Jimmy developed this goal for hospitalization. “To get a handle on my
nervousness.” The nurse is going to collaborate with him to reach his
goal. Jimmy was admitted to the hospital because he called his therapist
that he planned to asphyxiate himself with exhaust from his car but
frightened instead. He realized he needed help.

1. The nurse recognized that Jimmy had conceptualized his problem and the next
priority goal in the care plan is:

A.help the client find meaning in his experience

B.help the client to plan alternatives
C.help the client cope with the present problem
D.help the client to communicate

2. The nurse is guided that Jimmy is aware of his concerns of the “here and now”
when he crossed out which item from this “list of what to know”.

A.anxiety laden unconscious conflicts

B.subjective idea of the range of mild to severe anxiety
C.early signs of anxiety
D.physiologic indices of anxiety

3. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he
recognized that complete disruption of the ability to perceive occurs in:

A.panic state of anxiety

B.severe anxiety
C.moderate anxiety
D.mild anxiety

4. Jimmy initiates independence and takes an active part in his self care with the
following EXCEPT:

A.agreeing to contact the staff when he is anxious

B.becoming aware of the conscious feeling
C.assessing need for medication and medicating himself
D.writing out a list of behaviors that he identified as anxious

5. The nurse notes effectiveness of interventions in using subjective and objective

data in the:

A.initial plans or orders

B.database
C.problem list
D.progress notes

Situation 2 – A research study was undertaken in order to identify and analyze a

disabled boy’s coping reaction pattern during stress.
6. This study which is an in depth study of one boy is a:

A.case study
B.longitudinal study
C.cross-sectional study
D.evaluative study

7. The process recording was the principal tool for data collection. Which of the
following is NOT a part of a process recording?

A.Non verbal narrative account

B.Analysis and interpretation
C.Audio-visual recording
D.Verbal narrative account

8. Which of these does NOT happen in a descriptive study?

A.Exploration of relationship between two or more phenomena.

B.Explanation of relationship between two or more phenomena.
C.Investigation of a phenomenon in real life context.
D.Manipulation of variable

9. The investigator also provided the nursing care of the subject. The investigator is
referred to as a/an:

A.Participant-observer
B.Observer researcher
C.Caregiver
D.Advocate

10. To ensure reliability of the study, the investigator’s analysis and interpretations
were:

A.subjected to statistical treatment

B.correlated with a list of coping behaviors
C.subjected to an inter-observer agreement
D.scored and compared standard criteria

Situation 3 – During the morning endorsement, the outgoing nurse informed the
nursing staff that Regina, 35 years old, was given Flurazepam
(Dalmane) 15mg at 10:00pm because she had trouble going to sleep.
Before approaching Regina, the nurse read the observation of the night
nurse.

11. Which of the following approaches of the nurse validates the data gathered?

A.“I learned that you were up till ten last night, tell me what happened
before you were finally able to sleep and how was your sleep?”
B. “Hmm.. You look like you had a very sound sleep. That pill you were
given last night is effective isn’t it?”
C. “Regina, did you sleep well?”
D. “Regina, how are you?”
12. Regina is a high school teacher. Which of these information LEAST communicate
attention and care for her needs for information about her medicine?

A.Guided by a medication teaching plan, go over with her the purpose,

indications and special instructions, about the medication and provide her a
checklist
B.Provide a drug literature.
C.Have an informal conversation about the medication and its effects
D.Ask her what time she would like to watch the informative video about the
medication.

13. The nurse engages Regina in the process of mutual inquiry to provide an
opportunity for Regina to:

A.face emerging problems realistically

B.conceptualize her problem
C.cope with her present problem
D.perceive her participation in an experience

!4. Which of these responses indicate that Regina needs further discussion regarding
special instructions?

A.“I have to take this medicine judiciously”

B.“I know I will stop taking the medicine when there is advice from the doctor
for me to discontinue.”
C.“I will inform you and the doctor any untoward reactions I have.”
D.“I like taking this sleeping pill. It solves my problem of insomnia. I wish I can
take it for life.”

15. Regina commits to herself that she understood and will observe all the medicine
precautions by:

A.affixing her signature to the teaching plan that she has understood the
nurse
B.committing what she learned to her memory
C.verbally agreeing with the nurse
D.relying on her husband to remember the precautions

Situation 4 – The nurse-patient relationship is a modality through which the nurse

meets the client’s needs.

16. The nurse’s most unique tool in working with the emotionally ill client is his/her

A.theoretical knowledge
B.personality make up
C.emotional reactions
D.communication skills

17. The psychiatric nurse who is alert to both the physical and emotional needs of
clients is working from the philosophical framework that states:

A.All behavior is meaningful, communicating a message or a need.

B.Human beings are systems of interdependent and interrelated parts.
C.Each individual has the potential for growth and change in the direction of
positive mental health.
 D.There is a basic similarity among all human beings.

18. One way to increase objectivity in dealing with one’s fears and anxieties is
through the process of:

A.observation
B.intervention
C.validation
D.collaboration

19. All of the following responses are non therapeutic. Which is the MOST direct
violation of the concept, congruence of behavior?

A.Responding in a punitive manner to the client.

B.Rejecting the client as a unique human being
C.Tolerating all behavior in the client.
D.Communicating ambivalent messages to the client.

20. The mentally ill person responds positively to the nurse who is warm and caring.
This is a demonstration of the nurse’s role as:

A.counselor
B.mother surrogate
C.therapist
D.socializing agent

Situation 5 – The nurse engages the client in a nurse-patient interaction.

21. The best time to inform the client about terminating the nurse-patient
relationship is:

A.when the client asks how long the relationship would be

B.during the working phase
C.towards the end of the relationship
D.at the start of the relationship

22. The client says, “I want to tell you something but can you promise that you will
keep this a secret?” A therapeutic response of the nurse is:

A.“Yes, our interaction is confidential provided the information you tell me is

not detrimental to your safety.”
B.“Of course yes, this is just between you and me. Promise!”
C.“Yes, it is my principle to uphold my client’s rights.”
D.“Yes, you have the right to invoke confidentiality of our interaction.”

23. When the nurse respects the client’s self-disclosure, this is a gauge for the
nurse’s:

A.trustworthiness
B.loyalty
C.integrity
D.professionalism

24. Rapport has been established in the nurse-client relationship. The client asks to
visit the nurse after his discharge. The appropriate response of the nurse would
 be:

A.“The best time to talk is during the nurse-client interaction time. I am

committed to have this time available for us while you are at the hospital and
ends after your discharge.”
B.“Yes, If you keep it confidential, this is part of privileged communication.”
C.“I am committed for your care.”
D.“I am sorry, though I would want to, it is against hospital policy.”

25. The client has not been visited by relatives for months. He gives a telephone
number and requests the nurse to call. An appropriate action of the nurse would
be:

A.Inform the attending physician about the request of the client.

B.Assist the client to bring his concern to the attention of the social worker.
C.“Here (gives her mobile phone). You may call this number now”.
D.Ask the client what is the purpose of contacting his relatives.

Situation 6 – Camila, 25 years old, was reported to be gradually withdrawing and

isolating herself from friends and family members. She became
neglectful of her personal hygiene. She was observed to be talking
irrelevantly and incoherently. She was diagnosed as schizophrenia
disorder.

26. The past history of Camila would most probably reveal that her premorbid
personality is:

A.schizoid
B.extrovert
C.ambivert
D.cycloid

27. Camila refuses to relate with to others because she:

A.is irritable
B.feels superior of others
C.anticipates rejection
D.is depressed

28. Which of the following disturbances in interpersonal relationships MOST often

predispose to the development of schizophrenia?

A.Lack of participation in peer groups

B.Faulty family atmosphere and interaction
C.Extreme rebellion towards authority figures
D.Solo parenting

29. Camila’s indifference toward the environment is a compensatory behavior to

overcome:

A.Guilt feelings
B.Ambivalence
C.Narcissistic behavior
D.Insecurity feelings
30. Schizophrenia is a/an:

A.anxiety disorder
B.neurosis
C.psychosis
D.personality disorder

Situation 7 – Salome, 80 year old widow, has been observed to be irritable,

demanding and speaking louder than usual. She would prefer to be
alone and take her meals by herself, minimize receiving visitors at
home and no longer bothers to answer telephone calls because of
deterioration of hearing. She was brought by her daughter to the
Geriatric clinic for assessment and treatment.

31. The nurse counsels Salome’s daughter that Salome’s becoming very loud and
tendency to become aggressive is a/an:

A.beginning indifference to the world around her

B.attempt to maintain authoritative role
C.overcompensation for hearing loss
D.behavior indicative of unresolved repressed conflict of the past

32. A nursing diagnosis for Salome is:

A.sensory deprivation
B.social isolation
C.cognitive impairment
D.ego despair

33. The nurse will assist Salome and her daughter to plan a goal which is for Salome
to:

A.adjust to the loss of sensory and perceptual function

B.participate in conversation and other social situations
C.accept the steady loss of hearing that occurs with aging
D.increase her self-esteem to maintain her authoritative role

34. The daughter understood, the following ways to assist Salome meet her needs
and avoiding which of the following:

A.Using short simple sentences

B.Speaking distinctly and slowly
C.Speaking at eye level and having the client’s attention
D.Allowing her to take her meals alone

35. Salome was fitted a hearing aid. She understood the proper use and wear of this
device when she says that the battery should be functional, the device is turned
on and adjusted to a:

A.therapeutic level
B.comfortable level
C.prescribed level
D.audible level

Situation 8 – For more than a month now, Cecilia is persistently feeling restless,
 worried and feeling as if something dreadful is going to happen. She
fears being alone in places and situations where she thinks that no
one might come to rescue her just in case something happens to her.

36. Cecilia is demonstrating:

A.acrophobia
B.claustrophobia
C.agoraphobia
D.xenophobia

37. Cecilia’s problem is that she always sees and thinks negative things hence she is
always fearful. Phobia is a symptom described as:

A.organic
B.psychosomatic
C.psychotic
D.neurotic

38. Cecilia has a lot of irrational thoughts: The goal of therapy is to modify her:

A.communication
B.cognition
C.observation
D.perception

39. Cognitive therapy is indicated for Cecilia when she is already able to handle
anxiety reactions. Which of the following should the nurse implement?

A.assist her in recognizing irrational beliefs and thoughts

B.help find meaning in her behavior
C.provide positive reinforcement for acceptable behavior
D.Administer anxiolytic drug

40. After discharge, which of these behaviors indicate a positive result of being able
to overcome her phobia?

A.She reads a book in the public library

B.She drives alone along the long expressway.
C.She watches television with the family in the recreation room
D.She joins an art therapy group

Situation 9 – It is the first day of clinical experience of nursing students at the

Psychiatry Ward. During the orientation, the nurse emphasizes that
the team members including nursing students are legally responsible
to safeguard patient’s records from loss or destruction or from people
not authorized to read it.

41. It is unethical to tell one’s friends and family members data about patients
because doing so is a violation of patients’ rights to:

A.Informed consent
B.Confidentiality
C.Least restrictive environment
D.Civil liberty
42. The nurse must see to it that the written consent of mentally ill patients must be
taken from:

A.Doctor
B.Social worker
C.Parents or legal guardian
D.Law enforcement authorities

43. In an extreme situation and when no other resident or intern is available, should a
nurse receive telephone orders, the order has to be correctly written and signed
by the physician within:

A.24 hours
B.36 hours
C.48 hours
D.12 hours

44. The following are SOAP (Subjective – Objective – Analysis – Plan) statements on a
problem: Anxiety about diagnosis. What is the objective data?

A.Relate patient’s feelings to physician; initiate and encourage her to verbalize

her fears; give emotional support by spending more time with patient;
continue to make necessary explanations regarding diagnostic tests.
B.Has periods of crying; frequently verbalizes fear of what diagnostic tests will
reveal
C.Anxiety due to unknown
D.“I’m so worried about what else they’ll find wrong with me.”

45. Nursing care plans provide very meaningful data for the patient profile and initial
plan because the focus is on the:

A.Summary of chronological notations made by individual health team

members
B.Identification of patient’s responses to medical diagnoses and treatment
C.Patient’s responses to health and illness as a total person in interaction with
the environment
D.Step by step procedures for the management of common problems

Situation 10 – Marie is 5½ years old and described by the mother as bedwetting at

night.

46. Which of the following is the MOST common physiological cause of night bed
wetting?

A.deep sleep factors

B.abnormal bladder development
C.infections
D.familial and genetic factors

47. All of the following, EXCEPT one compromise the concepts of behavior therapy
program.

A.reward and punishment

B.extinction
 C.learning
D.placebo as a form of treatment

48. To help Marie who bed wets at night practice acceptable and appropriate
behavior, it is important for the parents to be consistent with the following
approaches EXCEPT:

A.discipline with a kind attitude

B.matter of fact in handling the behavior
C.sympathize for the child
D.be loving yet firm

49. A therapeutic verbal approach that communicates strong disapproval is:

A.“You are supposed to get up and go in the toilet when you feel you have to
go and did not. The next time you bed wet, I’ll tell your friends and hang your
sheets out the window for them to see.”
B.“You are supposed to get up and go in the toilet when you feel you have to
go and did not. I expect you to from now on without fail.”
C.“If you bed wet, you will change your bed linen and wash the sheets.”
D.“If you don’t make an effort to control your bedwetting, I’d be upset and
disappointed.”

50. During your conference, the parent inquires how to motivate Marie to be dry in
the morning. Your response which is an immediate intervention would be:

A.Give a star each time she wakes up dry and every set of five stars, give a
prize.
B.Tokens make her materialistic at an early age. Give praise and hugs
occasionally.
C.What does your child want that you can give every time he/she wakes up
dry in the morning?
D.Promise him/her a long awaited vacation after school is over.

Situation 11 – The nurse is often met with the following situations when clients
become angry and hostile.

51. To maintain a therapeutic eye contact and body posture while interacting with
angry and aggressive individual, the nurse should:

A.keep an eye contact while staring at the client

B.keep his/her hands behind his/her back or in one’s pockets
C.fold his/her arms across his/her chest
D.keep an “open” posture, e.g. Hands by sides but palms turned outwards

52. During the pre-interaction phase of the N-P relationship, the nurse recognizes this
normal INITIAL reaction to an assaultive or potentially assaultive person.

A.To remain and cope with the incident

B.Display empathy towards the patient
C.To call for help from other members of the team
D.To stay and fight or run away

53. Which of the following is an accurate way of reporting and recording an incident?
 A.“When asked about his relationship with his father, client became anxious.”
B.“When asked about his relationship with his father, client clenched his
jaw/teeth, made a fist and turned away from the nurse.”
C.“When asked about his relationship with his father, client was resistant to
respond”
D.“When asked about his relationship with his father, his anger was
suppressed”

54. To encourage thought, which of the following approaches is NOT therapeutic?

A.“Why do you feel angry?”

B.“When do you usually feel angry?”
C.“How do you usually express anger?”
D.What situations provoke you to be angry?”

55. A patient grabs and about to throw it. The nurse best responds saying.

A.“Stop! Put that chair down.”

B.“Don’t be silly.”
C.“Stop! The security will be here in a minute.”
D.“Calm down.”

Situation 12 – Nursing care for the elderly

56. In planning care for a patient with Parkinson’s disease, which of these nursing
diagnoses should have priority?

A.potential for injury

B.altered nutritional state
C.ineffective coping
D.altered mood state

57. A healthy adaptation to aging is primarily related to an individual’s…

A.Number of accomplishments
B.Ability to avoid interpersonal conflict
C.Physical health throughout life
D.Personality development in his life span

58. The frequent use of the older client’s name by the nurse is MOST effective in
alleviating which of the following responses to old age?

A.Loneliness
B.Suspicion
C.Grief
D.Confusion

59. An elderly confused client gets out of bed at night to go to the bathroom and tries
to go to another bed when she returns. The MOST appropriate action the nurse
would take is to:

A.Assign client to a single room

B.Leave a light on all night
C.Remind client to call the nurse when she wants to get up
D.Put side rails on the bed
60. An elderly who has lots of regrets, unhappy and miserable is experiencing:

A.Crisis
B.Despair
C.Loss
D.Ambivalence

Situation 13 – Graciela 1½ year old is admitted to the hospital from the emergency
room with a fracture of the left femur due to a fall down a flight of
stairs. Graciela is placed on Bryant’s traction.

61. While on Bryant’s traction, which of these observations of Graciela and her
traction apparatus would indicate a decrease in the effectiveness of her
traction?

A.Graciela’s buttocks are resting on the bed.

B. The traction weights are hanging 10 inches above the floor.
C.Graciela’s legs are suspended at a 90 degree angle to her trunk.
D.The traction ropes move freely through the pulley.

62. The nurse notes that the fall might also cause a possible head injury. She will be
observed for signs of increased intracranial pressure which include:

A.Narrowing of the pulse pressure

B.Vomiting
C.Periorbital edema
D.A positive Kernig’s sign

63. Graciela is assessed to have no head injury. The Bryant’s traction is removed. A
plaster of Paris hip spica is applied. Which of these finding is a concern of
immediate attention that must be reported to the physician immediately?

A.Graciela is scratching the cast over her abdomen.

B.The toes of Graciela’s left foot blanch when the nurse applies pressure on
them.
C.Graciela’s cast is still damp.
D.The nurse is unable to insert a finger under the edge of Graciela’s cast on
her left foot.

64. Part of discharge plan is for the nurse to give instructions about the care of
Graciela’s cast to the mother. Which of these statements indicate that the
mother understood an important aspect of cast care?

A.I will use white shoe polish to keep the cast neat.
B.I will place plastic sheeting around the perineal area of the cast.
C.I will use cool water to wash the cast.
D.I will reinforce cracked areas on the cast with adhesive tape.

65. The nurse counsels Graciela’s mother ways to safeguard safety while providing
opportunities for Graciela to develop a sense of:

A.Trust
B.Initiative
C.Industry
 D.Autonomy

Situation 14 – Jolina is an 18 year old beginning college student. Her mother

observed that she is having problems relating with her friends. She is
undecided about her future. She has lost insight, lost interest in
anything and complained of constant tiredness.

66. Jolina is put on antidepressant drugs. These drugs act on the brain chemistry,
therefore they would be useful in which type of depression?

A.exogenous depression
B.neurotic depression
C.endogenous depression
D.psychotic depression

67. This is a tricyclic antidepressant drug:

A.Venlafaxine (Effexor)
B.Flouxetine (Prozac)
C.Sertraline (Zoloft)
D.Imipramine (Tofranil)

68. After one week of antidepressant medication, Jolina still manifests depression.
The nurse evaluates this as:

A.Unusual because action of antidepressant drug is immediate.

B.Unexpected because therapeutic effectiveness takes within a few days.
C.Expected because therapeutic effectiveness takes 2-4 weeks.
D.Ineffective result because perhaps the drug’s dosage is inadequate.

69. Jolina continues to verbalize feeling sad and hopeless. She is not mixing well with
other clients. One of the nurse’s important considerations for Jolina INITIALLY is:

A.Formulate a structured schedule so she is able to channel her energies

externally
B.Let her alone until she feels like mingling with others.
C.Encourage her to join socialization hour so she will start to relate with
others.
D.Encourage her to join group therapy with other patients.

70. During the predischarge conference, the nurse suggests vocational guidance
because it should help Jolina to:

A.Find a good job.

B.Make some decisions about her future
C.Realistically assess her assets and limitations
D.Solve her own problems

Situation 15 – Group Approach in Nursing

71. Membership dropout generally occurs in group therapy after a member:

A.Accomplishes his goal in joining the group

B.Discovers that his feelings are shared by the group members
C.Experiences feelings of frustration in the group
 D.Discusses personal concerns with group members

72. Which of the following questions illustrates the group role of encourager?

A.What were you saying?

B.Who wants to respond next?
C.Where do you go from here?
D.Why haven’t we heard from you?

73. The goal of remotivation therapy is to facilitate:

A.Insight
B.Productivity
C.Socialization
D.Intimacy

74. The treatment of the family as a unit is based on the belief that the family:

A.is a social system and all the members are interrelated components of that
system
B.as a unit of society needs the opportunity to change its own destiny
C.who has therapy together will tend to remain together
D.is “contaminated” by the presence of deviant member and all members
need treatment.

75. The working phase in a therapy group is usually characterized by which of the
following?

A.Caution
B.Cohesiveness
C.Confusion
D.Competition

Situation 16 – The mental health – psychiatric nurse functions in a variety of setting

with different types of clients.

76. Poverty as reflected in prevalence of communicable diseases, malnutrition and

social ills such as street children, homeless and prostitution is a predisposing
factor to mental illness. A community approach to cope with this problem is for
the nurse to support:

A.aggressive family planning methods

B.provision of social welfare benefits for the poor
C.social action
D.free clinics and more hospitals

77. The MOST cost effective way to meet the mental health needs of the public is
through programs with a priority goal of:

A.treatment
B.prevention
C.rehabilitation
D.research

78. Lorelie upon discharge was referred to a volunteer group where she has learned
 to read patterns, cut out fabric and use a sewing machine to make simple
outfits that will help her earn in the future. What type of therapy is this?

A.Recreational therapy
B.Art therapy
C.Vocational therapy
D.Educational therapy

79. In a residential treatment home for adolescent girls, the clients were becoming
increasingly tense and upset because of shortening of their recreation time. To
de-escalate possible anger and aggression among the clients it is BEST to play:

A.religious music
B.relaxation music
C.dance music
D.rock music

80. The parents of special children who are behaviorally disturbed need mental
health education. Which of these topics would the school nurse consider as
priority for their parent’s class?

A.Drug education
B.Child abuse
C.Effective parenting
D.Sex education

Situation 17 – Nurses in all practice areas are likely to come in contact with clients
suffering from acute or chronic drug abuse.

81. The psychodynamic therapy of substance abuse is based upon the premise that
drug abuse is:

A.a common problem brought about by socioeconomic deprivation

B.caused by multiplicity of factors
C.predisposed by an inability to develop appropriate psychological resources
to manage developmental stresses
D.due to biochemical factors

82. Being in contact with reality and the environment is a function of the:

A.conscience
B.ego
C.id
D.super ego

83. Substance abuse is different from substance dependence in that, substance

dependence:

A.includes characteristics of adverse consequences and repeated use

B.requires long term treatment in a hospital based program
C.produces less severe symptoms than that of abuse
D.includes characteristics of tolerance and withdrawal

84. During the detoxification stage, it is a priority for the nurse to:
 A.teach skills to recognize and respond to health threatening situations
B.increase the client’s awareness of unsatisfactory protective behaviors
C.implement behavior modification
D.promote homeostasis and minimize the client’s withdrawal symptoms

85. Commonly known as “shabu” is:

A.Cannabis Sativa
B.Lysergic acid diethylamide
C.Methylenedioxy methamphetamine
D.Methamphetamine hydrochloride

Situation 18 – It is common that clients ask the nurse personal questions.

86. Anticipation of personal questions is given adequate attention during which

phase of the nurse patient relationship?

A.Orientation phase
B.Working phase
C.Pre-interaction phase
D.Termination phase

87. If the client asks for the nurse’s telephone number, which of these responses is
NOT appropriate?

A. “It is confidential I just don’t give it to anyone.”

B. “What would you do with my number if I give it to you?”
C. “If I say No to your request, what are your thoughts about it?”
D. “Are you asking for an official number of the hospital/clinic for your
reference?”

88. When the client asks about the family of the nurse, the MOST appropriate
response is:

A.Avoid the situation and redirect the client’s attention

B.Give a brief and simple response and focus on the client.
C.“Why don’t we talk about your family instead?”
D.Introduce another topic like the client’s interests

89. When the nurse is asked a personal question, which of these reactions indicates a
need for her to introspect?

A.The client is simply curious.

B.His/Her right to privacy is being intruded.
C.The client knows no other way to begin a conversation.
D.Some patients are like children in seeking recognition from the nurse.

90. It is 10 o’clock on your watch. The client asks, “What time is it?” The nurse’s
appropriate is:

A.“Are you getting bored?”

B.“It is 10 o’clock.”
C.“Why do you ask?”
D.“Guess, what time is it?”
Situation 19 – Ricky is a 12 year old boy with Down’s syndrome. He stands 5’ ½”
and weighs 100 lbs. he is slim and walks sluggishly with a limp. He
wears a neck brace as a support for his neck. X-ray of cervical spine
showed “subluxation of C1 in relation to C2 with cord compression”.
He attends a school for a special education.

91. The classroom teacher consults the school nurse for guidance on how to take
care of Ricky while inside of the classroom. The nurse considers as priority,
Ricky’s:

A.Physiological needs
B.Need for self esteem
C.Needs for safety and security
D.Needs for belonging

92. Ricky’s mother visited the school nurse. She asked, “What should I do when Ricky
fondles his genitalia?” An appropriate response of the nurse is for the mother to:

A.Divert Ricky’s attention and engage him in satisfying activities

B.Tell Ricky that it is wrong to keep fondling his genitalia
C.Ignore Ricky’s behavior because he will outgrow it later
D.Engage him in computer TV games that engage his hands

93. The nurse had one on one health education sessions with Ricky’s mother. The
mother understood that for her son to learn to cope and be independent, she
should constantly provide activities for Ricky to be able to:

A.socialize with people

B.eventually go to school alone
C.select and prepare his own food
D.do activities of daily living

94. All of the following activities are appropriate for Ricky EXCEPT:

A.Working with clay

B.Competitive sport
C.Preparing and cooking simple menu
D.Card and table games

95. Ricky’s IQ falls within the range of 50-55. he can be expected to:

A.Profit from vocational training with moderate supervision

B.Live successfully in the community
C.Perform simple tasks in closely supervised settings
D.Acquire academic skills of 6th grade level
Situation 20 – The abuse of dangerous drugs is a serious public health concern that
nurses need to address.

96. The nurse should recognize that the unit primarily responsible for education and
awareness of the members of the family on the ill effects of dangerous drugs is
the:

A.law enforcement agencies

B.school
 C.church
D.family

97. A drug dependent utilizes this defense mechanism and enables him to forget
shame and pain.

A.repression
B.rationalization
C.projection
D.sublimation

98. This drug produces mirthfulness, fantasies, flight of ideas, loss of train of thought,
distortion of size, distance and time, and “bloodshot eyes” due to dilated pupils.

A.Opiates
B.LSD
C.Marijuana
D.Heroin

99. The nurse evaluates that her health teaching to a group of high school boys is
effective if these students recognize which of the following dangers of inhalant
abuse.

A.Sudden death from cardiac or respiratory depression

B.Danger of acquiring hepatitis or AIDS
C.Experience of “blackout”
D.Psychological dependence after prolonged use

100. The mother of a drug dependent would never consider referring her son to a
drug rehabilitation agency because she fears her son might just become worse
while relating with other drug users. The mother’s behavior can be described
as:

A.Unhelpful
B.Codependent
C.Caretaking
D.Supportive