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‫ ترم ثاني‬2011/2010 ‫نموذج إجابة امتحان التمريض النفسي دور مايو‬
Benha University
Faculty of Nursing
Fourth Year Final Exam
Course Title: Psychiatric and Mental Health Nursing
Date: 18/6/2011
Time allowed: 3 hours
Parts
Questions
Marks
Parts( 1)
Multiple-choice questions
25
Parts(2)
True and false
25
Parts(3)
Matching
10
Parts(4)
Definitions
5
Parts(5)
Fill in the blanks
15
Total
‫مدرس تمريض الصحة النفسية والعقلية‬
80
‫ دكتورة مواهب محمود ذك‬/‫مسئول المادة‬
‫مدرس تمريض الصحة النفسية والعقلية‬
‫دكتورة حنان ناصف ذكي ناص‬
1
Please answer all of the following questions:Part (1)
1-Multiple Choice Questions (M C Q)
For each of the following (M C Q), select the one most appropriate answer,
there is only one best answer.
1- The developmental theories of Freud are associated with….
a) Genetic field theory
b) Psychosexual maturation
c) Cognitive development
d) Ethologic development
2- Extreme mood swings ranging from deep depression to elation
and high activity level is most often seen in?
a. Paranoid disorders
b. Bipolar disorders
c. Schizophrenia
d. Eating disorders
3- Genetic factors are considered to be of major significance in the
etiology of all the following disorders……..Except
a) post traumatic stress disorder
b) bipolar disorder
c) schizophrenia
d) Alzheimer's disease
4- The unconscious exclusion of an idea or feeling from conscious
awareness (select one mechanism)
a) Acting out
b) Sublimation
c) Repression
2
d) Rationalization
5- Identity diffusion, as described by Erickson. Occurs primarily
during
a) Infancy
b) Childhood
c) Adolescence
d) Old age
6- The syndrome of delirium is characterized by all of the
following ……except
a) Depressed affect
b) Disorientation and confusion
c) Global cognitive change
d) Perceptual disturbance
7- Which of the following statements regarding delusion is true.
a) Delusions are almost exclusively found in schizophrenia
b) Delusions involve a disturbance of cognition
c) Delusions involve a disturbance of perception
d) Delusions are a type of hallucination
8- The statements about Risperdal include all the following…..Except
a) It is used in the treatment of schizophrenia
b) It is a D2 antagonist
c) It is usually prescribed in dosages of about 6mg\day
d) It is associated with a high incidence of tardive dyskinesia
9- In the catatonic form of schizophrenia, the clinical picture is
dominated by at least two of the following features……Except
a) Waxy flexibility or stupor
b) Marked paranoid delusion
c) Excessive motor activity
d) Extreme negativism
3
10- Mental health is defined as
a) The ability to distinguish what is real from what is not.
b) A state of well-being where a person can realize his own abilities
can cope with normal stresses of life and work productively.
c) Is the promotion of mental health, prevention of mental disorders,
nursing care of patients during illness and rehabilitation
d) Absence of mental illness
11- Positive schizophrenic symptoms include all the
following ……Except
a. Hallucinations
b. Flatting of affect
c. Marked incoherence
d. Delusions
12The
mental
following……Except
status
examination
includes
all
the
a. Thought process
b. Mood and affect
c. State of consciousness
d. Family history
13- A 35- year old woman has a diagnosis of chronic schizophrenia. All
the following drugs would commonly be considered as possible
medications to control her psychotic symptoms …….except
a. Haldol
b. Thorazine
c. Risperdal
d. Lithium
14- In the treatment of depression, which of the following drugs is least
likely to lower the seizure threshold?
a. Xanax
b. Ludiomil
4
c. Anafranil
d. Asendin
15- All the following statements about (ECT) are true ……Except
a. The principal indication is for the treatment of severe depression
b. It may be of benefit in the treatment of manic excitement
c. It may be associated with impairment of memory
d. It is a procedure with a relatively high mortality
16- For long –term control therapeutic lithium levels are
a. 0.4 to 0.8 mg%
b. 0.8 to 1.8 mg%
c. 0.2 to 0.4 meg/L
d. 0.6 to 1.2 meg/L
17- The nurse's discharge plans for client diagnosed with major
depression should include
a. Discussion of outpatient treatment
b. Discussion of inpatient treatment
c. Discussion of work setting
d. None of above
18- Crisis intervention carried out to the client has this primary goal
a) Assist the client to express her feelings
b) Support her adaptive coping skills
c) Help her return to her pre-rape level of function
d) Help her identify her resources
19- Clozaril is one of the newer drugs used to treat chronic and
refractory
a. Obsessive compulsive disorder
b. Schizophrenia
c. Alzheimer's disease
d. panic disorder
20- Side effects commonly associated with tricyclic antidepressants
include all the following …..Except
a. Blurred vision
b. Diarrhea
5
c. Dry mouth
d. Urinary retention
21-It would be most helpful for the nurse to deal with a client with
severe anxiety by:
a. Explain in detail the plan of care developed
b. Ask the client to identify the cause of her anxiety
c. Give specific instructions using speak in concise statements.
d. Urge the client to focus on what the nurse is saying
22- Preparing the client for the termination phase begins:
a. Pre orientation
b. Orientation
c. Working
d. Termination
23-Which client is at highest risk for suicide?
A. One who appears depressed, frequently thinks of dying, and gives away
all personal possessions
B. One who plans a violent death and has the means readily available
C. One who tells others that he or she might do something if life doesn't get
better soon?
D. One who talks about wanting to die?
24- For a client with anorexia nervosa, which goal takes the highest
priority?
A. The client will establish adequate daily nutritional intake.
B. The client will make a contract with the nurse that sets a target weight.
C. The client will identify self-perceptions about body size as unrealistic.
D. The client will verbalize the possible physiological consequences of
self-starvation
25- A 5 year old boy is diagnosed to have autistic disorder.
Which of the following manifestations may be noted in a client with
autistic disorder?
A. argumentativeness, disobedience, angry outburst
B Likes things to stay the same, stereotypes
C. distractibility, impulsiveness and overactivity
6
D. aggression, truancy, stealing, lying
Part (2)
II -Read each statement carefully and circle (T) if the statement is true,
and encircle (F) if the statement is false
No T F
statement
1
T F Lack of agreement and consistency between the staff gives rise to
more aggressive behavior between the patients.
2
T F Termination of relationship may create feelings of rejection,
depression, anxiety.
3
T F Delusions of grandiosity mean an exaggerated belief in one's
importance.
4
T F Severe hyperactivity can cause exhaustion.
5
T F Echolalia means repetition of action seen.
6
T F Mental health is the absence of mental illness.
7
T F Patient should be punished for her undesired behavior.
8
T F Hallucination means false perception with external stimuli .
9
T F A patient with obsessional disorder is not a ware about her
thought.
10
T F The working phase of the nurse patient relationship is
characterized by a highs level of anxiety
11
T F Electro- convulsive therapy is most commonly prescribed for
obsessive- compulsive disorder
12
T F Initial symptoms of lithium toxicity include ataxia, tinnitus,
blurred vision and diarrhea.
13
T F Buspirone is considered antipsychotic agent.
14
T F Sublimation is the defense by which the stress appears in more
acceptable manner.
15
T F To help a patient with delusions' the nurse shouldn't argue with
him to decrease his anxiety.
7
No T F
statement
16
T F The most important side effect of valium is physical and
psychological dependence.
17
T F One of the main nursing roles regarding chronically.
schizophrenic client is to assist him to enjoy dependence on staff.
18
T F Defense mechanisms indicate pathological behavior patterns.
19
T F Obsessional thoughts are psychotic symptoms used as defenses
against underling anxiety.
20
T F The patient receiving major tranquilizers and exposure to
excessive sunlight.
21 T F Show interest in the patient as a person by listening to the patient
and recognize his feeling.
22 T F Panic defined as anxiety accompanied by severe definite
restlessness.
23 T F Freud who discover the unconscious mental process.
24 T F The purpose of therapeutic communication is increase coping
abilities and developing ego strengths
25 T F Denial is a mechanism by which the ego refuses to perceive or
face emotional conflict.
8
Part (3) Matching
In the space provided in front of each statement in column (A) place
the corresponding number from column (B)
No
Column (A)
Column (B)
D
1-Primary
prevention
(A)- Sudden cessation of thinking in the middle of a
discussion or sentence.
C
2-Obsessivecompulsive
disorder
(B)- Bizarre delusions.
F
3-Dementia
(C)- Perfectionism.
B
4- Schizophrenia
(D)- Attempting to discover and eliminate the causes of
mental illness.
E
5- Looseness of
associations
(E)- Discontinuous and illogical stream of thought.
G
6-Depersonalization
(F)- Memory impairment.
A
7-Blocking
(G) -The feeling that one is standing apart from one self
and observing one's own actions.
I
8- Identification
(H)-Characterized by persistent, irrational fear of
humiliation or embarrassment.
H
9-Social phobia
( I )- The unconscious process by which persons pattern
themselves after others.
j
10-Sigmud Freud
( J)-Signal anxiety as a result of conflict between the id,
ego, and superego.
9
Part (4)
Define the following
(1) Flight of ideas
continuous verbalization or play in words produce constant shifting from
one idea to another, idea tend to e connected
(2)Mental health
means the successful performance of mental function, resulting in
productive activities, fulfilling relationships, and the ability to adapt to
change and cope with adversity. Mental health provides the capacity for
rational thinking, communication, learning, emotional growth, resilience,
and self- esteem.
(3)Schizophrenia
Schizophrenia is a psychotic disorder (or a group of disorders) marked by
severely impaired thinking, emotions, and behaviors. Schizophrenic
patients are typically unable to filter sensory stimuli and may have
enhanced perceptions of sounds, colors, and other features of their
environment. Most schizophrenics, if untreated, gradually withdraw from
interactions with other people, and lose their ability to take care of personal
needs and grooming.
4) Derealisation
The false perception by a person that his or her environment has changed.
For example:- everything seems bigger or smaller or familiar objects have
become stranger and unfamiliar.
(5)Communication
Is a continuous circular process by which information, such as ideas and
feelings is transmitted between people and their environment, it involves
symbols such as written words and spoken language, Communication is an
10
essential tool of psychiatric nursing, the ultimate goal of communication is
to understand and be understood
Part V :- Fill in the blanks
1-Negative symptoms of schizophrenia are




Decreased activity level
Limited speech
A logia(poverty of speech/slowed )
Minimal self care






Inappropriate affect
Over reactive affect
Blunted affect
Flat affect
Anhedonia
Hostility
 Social withdrawal/isolation
 Poor rapport ‫ الوئام‬with others
 Inadequate social and occupational skills
2-Phases of aggression
a- Triggering
b- Escalation
c- Crisis
d- Recovery
e- Post Crisis
- Signs of lithium toxicity
- Nausea, vomiting, diarrhea, thrust, polyuria
- Slurred speech, muscle weakness, hand tremor.
- Advanced toxicity:- Ataxia, seizure, stupor,
- Decreased BP, EEG change
- Confusion and cardiac arrethmia, coma, fatalities
11
4- Assessment of behavior of manic patient includes
Increased talkativeness - Impulsivity
- Increased goal directed behavior
- Excessive involvement in activities
- Impulsive marriage and divorce
- Decreased need for sleep
- Bizarre dressing - excessive makeup
- Weight loss (no time to eat)
 State one nursing diagnosis for generalized anxiety disorder
and respond to the following
Assessment phase:
1- People with(GAD) are chronic worries. Decision-making is difficult
because poor concentration and the fear making mistakes
2- Restlessness, inability to relax and fatigue
3- Autonomic hyperactivity e.g. palpitations, cold clammy hands,
urinary frequency, pallor, pulse rate and rapid respiration.
4- Apprehensiveness
5- Sleep disturbance, muscle tension
6- The symptoms have, existed 6 months or longer. With no history of
medical causes or substance abuse.
Nursing diagnosis, goals, and interventions:
1- Ineffective individual coping related to anxiety- it is
evidenced by increased muscle tension and restlessness,
apprehensive, sweating, frequent urination, pulse,
elevated, skin pale.
Goals: The patient will recognize his own anxiety and cope effectively
with associated with anxiety.
Interventions:
12
1- Stay with patient and listen to him
2- Acknowledge patient's anxiety
3- Speak slowly and calmly, use short simple words
4- Assure patient that you are available and can assists him or her
5- Give brief directions
6- Decrease excessive stimuli and approved quiet environment.
7- Walk with pacing patient to give him support
8- Increase level of supervision for acutely patient to minimize selfinjury or loss control
9- Allow patient to use defenses as long as physical well-being is not at
danger
10-Teach the sign and symptoms of anxiety
11-Give positive reinforcement for use of health behavior
12-Help the patient to know the life situation that can control or not help
to identify his or her in ability.
OR
2- Sleep pattern disturbance related to physiologic
disturbances caused by anxiety. it is evidenced by
difficulty getting in sleep.
Goals: The patient will achieve adequate sleep
Interventions:
1-Encourage verbalization of problems associated with anxiety
2-Provide measures appropriate reduce insomnia:3-Quite, secure environment
4-Relaxation techniques
5- Night light decrease
13
6-Number of distraction e.g. taking temperature during night
7-Structured bedtime routine for the patient e.g. bath, reading, warm milk,
music
8-Consistent structured day time activities include physical exercise as
tolerated
9-Discourages napping
14