Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
First Semester 2013/2014
Day: Monday
Time Allowed: 3 Hours
Fourth Year
Date: 6/1/2014
Total Grades: 80
Final Written Psychiatric Nursing and Mental Health Exam
General Instructions
1. Read and understand carefully before answering.
2. Answer all questions in the answer space provided.
3. Answer in completes sentences and write carefully.
Parts
Allotted Score
I
15
II
35
III
15
IV
5
V
5
VI
5
Grand Total
80
Student Score
Page 1 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
Part I: Situation (15marks)
A psychiatric nurse is called to see a 64- years old man after he began screaming that
there were strange men in his hospital room. The patient had undergone a coronary
artery bypass graft 3 days previously and had appeared to be recovering without
complications. He claims that the previous night he had seen several men standing in
his room by the window. The patient states that they did not say anything to him but
that he was “sure that they were going to hurt him”. He had never seen anything
unusual before. The nurses’ notes from the late shift indicate that the patient had
become agitated, restless, and remove the I.V line strongly, although at times during
the evening he was also noted to be disoriented and stuporous. He had not been
observed in this condition on previous evenings. On a mental status examination, the
patient was alert and oriented to person but not oriented to time and place.
a. What is the most diagnosis of this patient?
b. Assess this patient.
c. Mention the most nursing diagnoses with this patient, and discuss one of them
"according to priority".
a. Medical diagnosis: delirium
b. Assessment:
1- Patient is elderly 65 years
2- Physical: coronary artery bypass
3- Thought: disorientation to time and place Stupor
4- Perception: visual hallucination
5- Behavior: -agitation
-Restlessness
-Possible to harm self (remove I.V line strongly)
6- Affect: fear of harm (fear of men he saw)
c. Nursing diagnoses:
1-high risk for injury
Page 2 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
2- Perceptual alteration
3-Altered thought process
4- Hyperactivity
5- Fear
Nursing diagnosis according to priority:
Risk for injury related to hallucination as evidenced by removing IV tubes
Goal: The client will remain safe and free from injury.
Intervention
1. Provide one to one observation
2. Decease stimulus in the environment (low light, low noise)
3- Keep any dangerous equipment away from the client.
4. Bed side rails may be used to prevent falling.
5. Bed should be away from windows and doors.
6. Reassure the client that the environment is safe or provide safety measures as
simple room, simple furniture.
7. Restraint if it's necessary.
Part II: Fill in the blanks (35 marks)
1. Nursing intervention for a patient who suffers from "orthostatic hypotension as a
side effect from medication" includes:
a.
b.
c.
1.
2.
3.
…………………………………………………………………………………...........................................
…………………………………………………………………………………………………………………………
…………………….………………………………………………….……………………………………………….
Instruct the client to rise slowly from a lying or sitting position
Monitor blood pressure (lying and standing) each shift
Document and report significant changes.
Page 3 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
2. Nursing interventions for a depressed client who has "high risk for violence
directed toward him" may include:
a.
b.
c.
d.
e.
1.
…………………………………………………………………………………....................………………….…
.…………………….……………………………..……………..………………………………………………….…
……………………………………………………………………………………………………………………….…
…………………………………………………………………………………………………………………….……
…………………………………………………………………………………………………………………….……
Provide close observation
2. Monitor the environment for potential harmful items as sharp objects
3. Observe for behaviors and statements as statement of hopelessness ,
4. Contract with patient to tell someone if her suicidal thinking increase
5. Encourage patient to express her feelings
6. Encourage patient to focus on people and things are important to him
7. Encourage patient to problem solve
8. Provide patient with information about community resources
9. Patient round at infrequent intervals
10.Assess suicidal thinking includes frequency, plan, opportunity and past attempts
3. Differentiate between mania and hypomania.
Mania
Hypomania
Mania
Hypomania
Symptoms sever
Impairment in occupational and social
activities or relationships
Delusions (grandiose- paranoid or both)
Need to hospitalization
to Protect client and others from
irresponsible or aggressive behavior
Symptoms less severe than in mania
Absence of impairment in social
and occupational functioning
Delusions (never present)
Hospitalization is not indicated
Page 4 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
4. Key symptoms of depression are
a.
b.
c.
d.
…………………………………………………………………………………....................………………….…
.…………………….……………………………..……………..………………………………………………….…
……………………………………………………………………………………………………………………….…
…………………………………………………………………………………………………………………….……
1.
2.
3.
4.
A depressed mood
Anxiety
Anergia
Anhedonia
5. Concepts of mental health include:
a.
b.
c.
d.
e.
f.
1.
2.
3.
4.
5.
6.
…………………………………………………………………………………....................………………….…
.…………………….……………………………..……………..………………………………………………….…
……………………………………………………………………………………………………………………….…
…………………………………………………………………………………………………………………….……
……………………………………………………………………………………………………………………….…
…………………………………………………………………………………………………………………….……
Positive attitude toward the individual self
Growth development and self actualization
Integrative capacity
Autonomous behavior
Reality perception
Environmental mastery
6. Forms of non verbal communication are:a.
b.
c.
d.
e.
…………………………………………………………………………………....................………………….…
.…………………….……………………………..……………..………………………………………………….…
……………………………………………………………………………………………………………………….…
…………………………………………………………………………………………………………………….……
……………………………………………………………………………………………………………………….…
1.
2.
3.
4.
5.
6.
Appearance
Eye contact
Posture and gait
Facial expression
Paralanguage
Touch
Page 5 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
7. Personal space
8. Gesture
7. Beck triad theory include the following
a.
b.
c.
1.
2.
3.
…………………………………………………………………………………....................………………….…
.…………………….……………………………..……………..………………………………………………….…
……………………………………………………………………………………………………………………….…
Negative view of self
Negative view to the world
Negative view to the future
8. Blurer 4 A's including:
a. …………………………………………………………………………………....................………………….…
b. .…………………….……………………………..……………..………………………………………………….…
c. ……………………………………………………………………………………………………………………….…
d. …………………………………………………………………………………………………………………….……
1. Affect
2. Associative looseness
3. Autism
4. Ambivalence
Part III: Multiple-choice question (15 marks)
For each of the following multiple-choice question select the One most appropriate
answer:
1. The following are abnormalities of thought
a. "Delusion, echolalia, echoprexia and circumstantialities".
b. "Delusion, hallucinations, echolalia, and mannerism".
c. "Delusion, echolalia, circumstantialities and flight of idea".
d. "Delusion, echolalia, echoprexia and hypochondriasis".
2. When patient given personal possessions to others. This person is suffering from
a. Mania.
b. Incoherent speech.
c. Suicide.
d. Labile mood.
Page 6 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
3. Nursing considerations given to the patients complain from drying of mouth as a
side effect of medication.
a. Encourage fluids and frequent voiding and monitor voiding patterns.
b. Increase fluids, dietary fiber and roughage in diet.
c. Encourage oral hygiene, frequent sips of water, frequent rinses, sugar-free hard
candy and gums.
d. Use lubricant and instruct the client to rise slowly from a lying or sitting position.
4. Clang association means
a. Thought and speech associated with unnecessary details.
b. Meaningless rhyming of words.
c. Various disturbances of associations that render speech and thought.
d. Knowledge of objective reality of a situation; person is aware of a mental
problem.
5. Which part of the personality represents values, ideals, and moral standards of
society?
a. Id.
b. Ego
c. Superego.
d. Conscious.
6. Miss Fatama mentions "the food on my plate is poisoned, take it away
immediately". This is example for
a.
b.
c.
d.
Visual hallucination.
Persecutory delusions.
Reference delusions.
Auditory hallucination.
7. The most important nursing diagnosis in patients who has mania is
a.
b.
c.
d.
High risk of violence.
Sensory perceptual alteration.
Sleep pattern disturbances.
Defensive coping.
Page 7 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
8. A client tells the nurse that his body is made of wood and is quite heavy –The
client is experiencing which of the following symptoms of a mental disorder
a.
b.
c.
d.
Compulsion.
Autism
Depersonalization
Obsession
9. On caring of delusional patient the nurse should
a.
b.
c.
d.
Tell him to stop it.
Put him in quite room.
Use voicing doubt technique.
Avoid interrupting his delusion.
10. Patient reported to receive letters from her beloved Tamer Hosney, is an
example of
a.
b.
c.
d.
Erotic Delusion.
Litigious Delusion.
Infidelity Delusion.
Grandeur Delusion.
11. The anal stage is characterized by
a. Penis envy
b. Super ego development
c. Complete development
d. Ego development
12. In caring for auditory hallucinating patient the nurse should:
a.
b.
c.
d.
Tell him to stop it.
Keep him in a simulating area.
Put him in a quiet room.
Avoid interrupting his hallucination.
Page 8 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
13. Accepting patient exactly as he is mean
a. Realistic patient nurse relationship to meet all patient needs.
b. Respecting his humanity, dignity and worth.
c. Avoid increase patient anxiety.
d. Sharing patient in group activity.
14. Which one of the following indicates abnormality of perception?
a. Apathy.
b. Illusion.
c. Associative looseness.
d. Delusion.
15. The client complains of anhedonia, reduction of energy and anxiety. This is the
key symptoms of:
a. Depression.
b. Mania.
c. Schizophrenia.
d. Substance abuse.
16. Anus is the erogenous zone of
a. Puppetry and adolescence stage.
b. Latency stage.
c. Later child hood stage.
d. Early child hood stage.
17. One of the characteristics of a successful communication is:a. Listening.
b. Talking.
c. Silence.
d. Feedback.
18. The nurse is discussing the orientation phase. The student nurse asks what the
primary goal between the nurse and the client is during this phase. The nurse
should respond that the primary goal is to:
Page 9 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
a. Explain unit rules.
b. Solve client problems.
c. Establish trust and support.
d. Formulate a mutual plan of action.
19. When assessing secondary gains that obtain through somatoform disorders
include all the following except:
a. Getting out usual responsibilities.
b. Getting extra attention.
c. Reduce Anxiety with physical symptoms.
d. Fulfillment of dependency needs.
20. The characteristic task of puberty and adolescents according to Erickson's stage
is
a. Identity versus role confusion
b. Ego integrity versus despair
c. Initiative versus guilt
d. Intimacy versus isolation
21. A manic patient could be helped to eat during periods of over activity by
a. Ordering him to eat
b. Serving food which can be carried in his hand
c. Stop meals until she quiets down
d. Spoon feed him
22. To calm down a manic patient, it is helpful to
a.
b.
c.
d.
Restrain the patient
Share him in activities until he is exhausted
Reduce external stimuli to a minimum
Provide for a stimulating environment
23. When questions, ideas and feelings are directed back to the client which type of
therapeutic technique is being used?
Page 10 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
a.
b.
c.
d.
General leads
Making observation
Giving recognition
Reflecting
24. Which of the following statements is a part of definition of obsession?
a.
b.
c.
d.
Actions that help eliminate the discomfort associated with thoughts.
Easy to ignore.
Thoughts that interfere with functioning.
Worries about real life problems.
25. The nurse is working with a client with a somatoform disorder. Which client
outcome goal would the nurse most likely establish with this client?
a.
b.
c.
d.
The client will recognize signs and symptoms of physical illness.
The client will cope with physical illness.
The client will take prescribed medications.
The client will express anxiety verbally rather than through physical symptoms.
26. A patient perceives that his face is distorted and his hands are becoming long.
The term used to explain this condition is:
a. Dejavu.
b. Derealization.
c. Depersonalization.
d. Jamaia vu.
27. The followings are positive symptoms of schizophrenia except:
a. Delusions.
b. Hallucination.
c. Inappropriate affect.
d. Ideas of reference.
Page 11 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
28. Which of the following is a person with social phobia likely to experience?
a.
b.
c.
d.
Fear of speaking in public
Fear of heights
Fear of going to school
Fear of leaving the house
29. Which of the following features most distinguishes delirium from dementia?
a.
b.
c.
d.
Behavioral disturbances.
Altered level of consciousness.
Cognitive deficit.
Disorientation.
30. Which of the following conditions is most commonly associated with post
traumatic stress disorder?
a.
b.
c.
d.
Depression
Dementia
Schizophrenia
Narcissistic personality disorder
Part IV: True or False (5 marks)
Read the following statements carefully .If it is true circle (T)and if is False circle (F)
on the line
Page 12 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
1
2
3
T. F
T. F
T. F
4
T. F
5
T. F
6
T. F
7
8
T. F
T. F
9
T. F
10 T. F
Selecting topics of interest to the patient may block communication.
Decreased level of acetylcholine leads to depression.
To stimulate communication ask questions which may be answered
with one word.
The unconscious includes all experiences that are within a person’s
awareness at any given time.
Delusions are commonly present in psychotic depression and never
present in neurotic depression.
In communicating with depressed client, try to cheer up the person
with a song or joke.
Avoid highly competitive activities with manic patient
Social relationships require the persons with scientific knowledge, and
special skills.
Client with somatoform disorders able to control symptoms
voluntarily.
Visual hallucination is the most common type reported by patients
with schizophrenia.
Part V: Matching (5 marks)
Match each term in the column "A" with the correct definition in column "B".
Part VI: Define the following (5 marks)
Page 13 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
Column A"
Attention
Perception
Catalepsy
Cognition
Pressure of speech
Hallucination
Labile mood
Delusions
Derealization and
depersonalization
Answer
Column "B"
4
1-The act or process of knowing
3
2-The retention and storage of knowledge learned
9
3-Identification and initial interpretation of a stimulus
based on information from senses
1
4-The ability to focus
7
5- False perception without external stimuli
5
6- False fixed beliefs that are not consistent with one's
culture and education
8
7-Forceful rapid speech that is increased in amount
and difficult to interrupt
6
8- Rapidly shifting emotions, unrelated to external
stimuli
10
9- Voluntary assumption of an inappropriate or bizarre
posture, maintained for long periods of time, in which
the patient chooses this posture.
2
10- Disorders of ego boundaries " unreality states"
Memory
Neologism
………………………………………………………………………………….....................................................
……………………………………………………………………………………………………………………………………
New word created by patient, and only understand by patient's, often by combining
syllables of other words.
Confabulation
………………………………………………………………………………….....................................................
……………………………………………………………………………………………………………………………………
Unconscious filling of gaps in memory by imagined or untrue experience
Mood
………………………………………………………………………………….....................................................
……………………………………………………………………………………………………………………………………
Felling state reported by the patient or subjective internal felling that report by the
patient
Page 14 of 15
Port-Said University
Faculty of Nursing
Psychiatric Nursing Department
Apraxia
………………………………………………………………………………….....................................................
……………………………………………………………………………………………………………………………………
The loss of purposeful movement without loss muscle power or coordination
Schizophrenia
………………………………………………………………………………….....................................................
……………………………………………………………………………………………………………………………………
1. Schizophrenia is a major psychotic disorder characterized by: Profound
withdrawal from interpersonal relationship.-Cognitive & perceptual disturbances.Make dealing with reality difficult.
2. Is a disintegrative psychosis Characterized by Splitting of normal links between
Perception, mood, thinking, behavior and contact with reality.
Page 15 of 15