PSYCHIATRIC NURSING

TYPICAL SIGNS AND SYMPTOMS OF PSYCHIATRIC ILLNESS DEFINED

I. CONSCIOUSNESS: State of awareness

o Apperception: Perception modified by one’s own emotions & thoughts
A. DISTURBANCES OF
CONSCIOUSNESS o Sensorium: State of cognitive functioning of the special senses

1. Disorientation Disturbance of orientation in time, place, or person.

2. Clouding of consciousness Incomplete clearmindedness w/ disturbances in perception & attitudes

3. Stupor Lack of reaction to & unawareness of surroundings.

4. Delirium Bewildered, restless, confused, disoriented reaction associated with fear & hallucinations.

5. Coma Profound degree of unconsciousness.

6. Coma Vigil Coma in w/c a px appears to be asleep but ready to be aroused (akinetic mutism)

7. Twilight state Disturbed consciousness w/ hallucinations

8. Dreamlike state Often used as a synonym for complex partial seizure or psychomotor epilepsy

9. Somnolence Abnormal drowsiness

10. Confusion Disturbance of consciousness in w/c reactions to environmental stimuli are inappropriate:
manifested by a disordered orientation in relation to TPP

11. Drowsiness A state of impaired awareness associated with a desire or inclination to sleep

12. Sundowning Syndrome in older people that usually occurs at night & is characterized by drowsiness,
confusion, ataxia & falling as the result of being overly sedated w/ medications (Sundowner’s
Syndrome)
Is the amount of effort exerted in focusing on certain portions of an experience;
B. Disturbances of Attention
Ability to sustain a focus on one activity ; Ability to concentrate

1. Distractibility Inability to concentrate attention; state in w/c attention is drawn to unimportant or irrelevant
external stimuli

2. Selective inattention Blocking out only those things that generate anxiety

3. Hypervigilance Excessive attention & focus on all internal & external stimuli, usually 2ndary to delusional or
paranoid states

4. Trance Focused attention & altered consciousness, usually seen in hypnosis, dissociative d/o’s, &
ecstatic religious experiences

C. Disturbances in suggestibility Compliant & uncritical response to an idea or influence

1. Folie a deux ( folie a trois) Communicated emotional illness bet 2 (3) persons

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2. Hypnosis Artificially induced modification of consciousness characterized by a heightened suggestibility
Complex feeling state w/ psychic, somatic, & behavioral components that is r/t affect & mood
II. Emotion:

A. Affect Observed expression of emotion

1. Appropriate affect Condition in w/c the emotional tone is in harmony w/ the accompanying idea, thought, or
speech

2. Inappropriate affect Disharmony bet the emotional feeling tone & the idea, thought, or speech accompanying it

3. Blunted affect Disturbance in affect manifested by a severe reduction in the intensity of externalized feeling
tone

4. Restricted or Constricted Reduction in intensity of feeling tone les severe than blunted affect but clearly reduced

5. Flat affect Absence or near absence of any signs of affective expression; voice monotonous, face
immobile

6. Labile affect Rapid & abrupt changes in emotional feeling tone, unrelated to external stimuli

B. MOOD A pervasive & sustained emotion, subjectively experienced & reported by a px & observed by
others

1. Dysphoric mood an unpleasant mood

2. Euthymic mood normal range of mood, implying absence of depressed or elevated mood
a person's expression of feelings without restraint, frequently with an overestimation of their
3. Expansive mood significance or importance.
oscillations between euphoria & depression or anxiety
4. Mood swings (labile mood)

5. Elevated mood Air of confidence & enjoyment; a mood more cheerful than usual

6. Euphoria intense elation with feelings of grandeur

7. Ecstasy Feeling of intense rapture

psychopathological feeling of sadness
8. Depression

9. Irritable A state in w/c a person is easily annoyed & provoked to anger

10. Anhedonia loss of interest in and withdrawal from all regular and pleasurable activities, often associated with
depression
sadness appropriate to a real loss
11. Grief or mourning

12. Alexithymia a person's inability to or difficulty in describing being aware of emotions or mood.

13. Suicidal ideation thoughts or act of taking one's own life.

14. Elation Feelings of joy, .euphoria, triumph, intense self-satisfaction, or optimism.

C. OTHER EMOTIONS
Feeling of apprehension caused by anticipation of danger, which may be internal or external.
1. Anxiety

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2. Free-floating anxiety Pervasive, unfocused fear not att ached lo any idea.
Anxiety caused by consciously recognized and realisti c danger.
3. Fear

4. Agitati on severe anxiety associated with motor restlessness.

increased and unpleasant motor and psychological activity.
5. Tension

6. Panic acute, episodic, intense att ack of anxiety associated with overwhelming feelings of dread and
autonomic discharge.

7. Apathy dulled emotional tone associated with detachment or indifference

8. Ambivalence coexistence of two opposing impulses toward the same thing in the same thing in the same person at
the same time.
emotional release or discharge after recalling a painful experience.
9. Abreaction

10. Shame failure to live up to self-expectations.

11. Guilt emotion secondary to doing what is perceived as wrong.

12. Impulse control ability to resist an impulse, drive, or temptation to perform an action.

13. Melancholia severe depressive state; used in the term involutional melancholia both descriptively and also in
reference to a disti nct diagnostic entity
signs of somatic (usually autonomic) dysfunction, most often associated with depression(Also
D. PHYSIOLOGICAL DISTURBANCES called vegetative signs).
ASSOCIATED WITH MOOD:
loss of or decrease in appetite.
1. Anorexia
increase in appetite and intake of food.
2. Hypcrphagia

3. Insomnia lack of or diminished ability to sleep.

a. Initial difficulty in falling asleep

b. Middle difficulty in sleeping through the night without waking up and diffi culty in going back to sleep.

c. Terminal early morning awakening

4. Hypersomnia excessive sleeping

mood is regularly worst in the morning, immediately after awakening, and improves as the day
5. Diurnal variation progresses.
decreased sexual interest, drive, and performance (increased libido is of ten associated with manic
6. Diminished libido states).
inability to defecate or diffi culty in defecating.
7. Constipation
a feeling of weariness, sleepiness, or irritability following a period of mental or bodily activity.
8. Fatigue

9. Pica craving and eating of nonfood substances, such as paint and clay (usually girls)
rare condition in which a patient has the signs and symptoms of pregnancy, such as abdominal
10. Pseudocyesis distention, breast enlargement, pigmentation, cessation of menses, and morning sickness.

11. Bulimia insatiable hunger and voracious eating; seen in bulimia nervosa and a typical depression

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12. Adynamia
III. MOTOR BEHAVIOR BEHAVIOR aspect of the psyche that includes impulses, motivations, wishes, drives, instincts, and cravings, as-
(CONATION): expressed by a person's behavior or motor activity.

1. Echopraxia pathological imitation of movements of one person by another.

2. Catatonia and postural abnormalities seen in catatonic schizophrenia and some cases of brain diseases, such as encephalitis.
general term for an immobile position that is constantly maintained
a. Catalepsy

b. Catatonic excitement agitated, purposeless motor activity uninfluenced by external sti muli

c. Catatonic stupor markedly slowed motor activity, often ID a point of immobility and seeming unawareness of
surroundings

d. Catatonic rigidity Voluntary assumption of a rigid posture,-held against all efforts to be moved.

e. Catatonic posturing voluntary assumption of an inappropriate or bizarre posture, generally maintained for long periods

f. Cerea flexibilitas (waxy condition of a person who can be molded into a position that is then maintained; when an examiner
flexibility) moves the person's limb, the limb feels as if it were made of wax.

g. Akinesia lack of physical movement, as in the extreme immobility of catatonic schizophrenia; may also occur
as an extrapyramidal side effect of antipsychotic medication.

3. Negativism motiveless resistance to all attempts to be moved or to all instructions

temporary loss of muscle tone and weakness precipitated by a variety of emotional states.
4. Cataplexy

5. Stereotypy repetitive fixed pattern of physical action or speech.

ingrained, habitual involuntary movement.
6. Mannerism

7. Automatism automatic performance of an act or acts generally representative of unconscious symbolic activity.
automatic following of suggestions (also automatic obedience).
8. Command automatism

9. Mutism voicelessness without structural abnormalities.

10. Overactivity

a. Psychomotor agitation Excessive & motor & cognitive overactivity, usually nonproductive & in response to inner
tension.

b. Hyperactive (hyperkinesis) Restless, aggressive, destructive activity, often associated with some underlying brain
pathology

c. Tic Involuntary, spasmodic motor movement

d. Sleepwalking (somnambulism) motor activity during sleep.

e. Akathisia subjective feeling of muscular tension secondary to antipsychotic or other medication, which can
cause restlessness, pacing, repeated sitti ng and standing; can be mistaken for psychotic agitation

f. Compulsion uncontrollable impulse to perform an act repetitively

compulsion to drink alcohol
i. Dipsomania

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 ii. Kleptomania compulsion to steal

iii. Nymphomania excessive and compulsive need for coitus in a woman

iv. Satyriasis excessive and compulsive need for coitus in a man

compulsion to pull out hair
v. Trichotillomania
automatic activity, compulsive in nature, anxiety reducing in origin
vi. Ritual

g. Ataxia failure of muscle coordination; irregularity of muscle action

H. Polyphagia pathological overeating

i. Tremor rhythmical alteration in movement, which is visually faster than one beat a second; typically,
tremors decrease during periods of relaxation and sleep and increase during periods of anger and
increased tension. |
decreased motor and cognitive activity, as in psychomotor retardation; visible slowing of thought,
1 1 . Hypoactivity (Hypokinesis) speech, and movements.
simple, imitative motor activity of childhood.
12. Mimicry

13. Aggression forceful, goal-directed action that may be verbal or physical; the motor counterpart of the affect
of rage, anger, or hostility
direct expression of an unconscious wish or impulse in action; living out unconscious fantasy
14. Acting Out impulsively in behavior

15. Abulia reduced impulse to act and think, associated with indifference about consequences of action; a
result of neurological deficit

16. Anergia lack of energy (anergy)

17. Astasia abasia the inability to stand or walk in a normal manner, even though normal leg movements can be
performed in a sitti ng or lying down position. The gait is bizarre and is not suggestive of a
specific organic lesion; seen in conversion disorder.

18. Coprophagia eating of filth or feces

19. Dyskinesia difficulty in performing voluntary movements, as in extrapyramidal disorders.

state in which the muscles remain immovable; seen in schizophrenia.
20. Muscle rigidity

21. Twirling a sign present in autistic children who continually rotate in the direction in which their head is
turned.
slowness of motor activity with n decrease in normal spontaneous movement.
22. Bradykinesia
random and involuntary quick, jerky, purposeless movements.
23. Chorea

24. Convulsion An involuntary, violent muscular contraction or spasm

convulsion in which the muscles alternately contract and relax
a. Clonic convulsion
convulsion in which the muscle contraction is sustained
b. Tonic convulsion

25. Seizure an attack or sudden onset of certain symptoms, such as convulsions, loss of consciousness, and
psychic or sensory disturbances; seen in epilepsy and can be substance-induced

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 a. Generalized tonic-clonic seizure generalized onset of tonic-clonic movements of the limbs, tongue biting, and incontinence followed
by slow, gradual recovery of consciousness and cognition; also called grandmal seizure and
psychomotor seizure

b. Simple partial seizure localized ictal onset of seizure without alteration:; in consciousness.
Localized ictal onset of seizure with alterations in consciousness
c. Complex partial seizure
slow, sustained contractions of the trunk or limbs; seen in medication-induced dystonia
26. Dystonia

Goal-directed flow of ideas, symbols, and associations initiated by a problem or task and leading
IV. THINKING toward a reality-oriented conclusion; when a logical sequence occurs, thinking is normal; parapraxis
(unconsciously motivated lapse from logic is also called a freudian slip) considered part of normal
thinking.

A. GENERAL DISTURBANCES IN FORM OR PROCESS OF THINKING

Clinically significant behavior or psychological syndrome associated with distress or disability, not just
1. Mental disorder an expected response to a particular event or limited to relations between a person and society.

2. Psychosis inability to distinguish reality from fantasy; impaired reality testing, with the creation of a new reality (as
opposed to neurosis: mental disorder in which reality testing is intact; behavior may not violate gross
social norms, but is relatively enduring or recurrent without treatment)

3. Reality testing Objective evaluation and judgment of the world outside the self.

4. Formal thought disorder disturbance in the form of thought rather than the content of thought; thinking characterized by loosened
associations, neologisms, and illogical constructs; thought process is disordered and the person is defined
as psychotic

5. Illogical thinking Thinking containing erroneous conclusions or intern al contradictions; psychopathological only when it
is marked & when not caused by cultural values or intellectual deficit.

6. Dereism mental activity not concordant with logic or experience

Preoccupation with inner, private world; term used somewhat synonymously with dereism.
7. Autistic thinking

8. Magical thinking A form of dereistic thought; thinking similar to that of the preoperational phase in children(jean
piaget), in which thoughts, words, or actions assume power (e.g. to cause or prevent events)

9. Primary process thinking

General term for thinking that is dereistic, illogical;-magical; normally found in dreams, abnormally in psy-
chosis.

10. Emotional insight Deep level of understanding or awareness that is likely to lead to positive changes in personality and
behavior.

B. SPECIFIC DISTURBANCES IN FORM OF THOUGHT

1. Neologism New word created by a patient, often by combining syllables of other words, for idiosyncratic psychological
reasons.
incoherent mixture of words and phrases.
2. Word salad
3. Circumstantiality indirect speech that is delayed in reaching the point but eventually gets from original point to desired
goal; characterized by an over inclusion of details and parenthetical remarks.

4. Tangetiality Inability to have goal-directed associations of thought; speaker never gets from desired point to desired

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 goal.
Thought that generally is not understandable; running together of thoughts or words; with no logical or
5. Incoherence grammatical connection, resulting in disorganization.

6. Perseveration Persisting response to a previous sti mulus after a new sti mulus has been presented; often associated with
cogniti ve disorders.
meaningless repetition of specific words or phrases
7. Verbigeration
psychopathological repeating of words or phrases of one person by another; tends to be repetitive and
8. Echolalia persistent; may be spoken with mocking or staccato intonation

9. condensation Fusion of various concepts into one

10. irrelevant answer Answer that is not in harmony with question asked (person appears to ignore or not attend to
question).

11. Loosening of association Flow of thought in which ideas shift from one subject to another in a completely unrelated way: when
sever speech may be incoherent.

12. derailment

13. flight of ideas Rapid, continuous verbalizations or plays on words produce constant shifting from one idea to another;
ideas tend to be connected, & in the less severe from a listener may be able to follow them.

14. Clang association Association of words similar in sound but not in meaning; words have no logical connection; nay include
rhyming and punning.

15. Blocking Abruption eruption in train of thinking before a though or idea is finished; after a brief pause, person
indicates no recall of what was being said or was going to be said (also known as thought deprivation).

16. Glossolalia expression of a revelatory message through unintelligible words (also known as speaking in tongues); not
considered a disturbance in thought if associated with practices of specific Pentecostal religions

C. SPECIFIC DISTURBANCES IN CONTENT OF THOUGHT

1. Poverty of content Thought that gives little information because of vagueness, empty repetitions, or obscure
phrases.

2. Overvalued idea Unreasonable, sustained false belief maintained less firmly than a delusion
false belief, based on incorrect inference about external reality, not consistent with patient's
3. Delusion intelligence, and cultural background; cannot be corrected by reasoning
an absurd, totally implausible, strange false belief (for example, invaders from space have
a. Bizarre delusion implanted electrodes in a person's brain).

b. Systematized delusion False belief of beliefs united by a single event or theme (for example, a person is being
persecuted by the CIA, the FBI, or the Mafia).
Delusion with mood-appropriate content (for example, a depressed patient believes that he or
c. Mood-congruent delusion she is responsible for the destruction of the world).
Delusion with content that has no association to mood or is mood neutral (for example, a
d. Mood-incongruent delusion depressed patient has delusions of thought control or thought broadcasting).

e. Nihilistic delusion False feeling that self, others, or the world is nonexistent or, coming to an end.

f. delusion of poverty A person’s false belief that he or she is bereft or will be deprived of all material possessions.

g. somatic delusion False belief involving functioning of the body

h. paranoid delusion

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 i. delusion of persecution

ii. delusion of grandeur

iii. delusion of reference A person’s false belief that the behavior of others refers to himself or herself; that events,
objects, or other people have a particular & unusual significance, usually of a negative
nature; derived from idea of reference, in which a person falsely feels that others are talking
about him or her ( for example, belief that people on TV or radio are talking to or about the
person)

i. Delusion of self accusation False feeling of remorse or guilt

j. delusion of control False feeling that a person’s will, thoughts, or feelings are being controlled by external
forces.

i. thought withdrawal Delusion that thoughts are being removed from a person’s mind by other people or forces

ii. thought insertion Delusion that thoughts are being implanted in a person’s mind by other people or forces

iii. thought broadcasting Delusion that a person’s thoughts can be heard by others, as though they were being
broadcast over the air.

iv. thought control Delusion that a person’s thoughts are being controlled by other people or forces.

K . delusion of infidelity (delusional False belief derived from pathological jealousy about a person’s lover being unfaithful.
jealousy)

l. erotomania Delusional belief, more common in women than in men, that someone is deeply in love
with them (also known as Clerambault-Kandinsky complex)

m. pseudologia phantastica A type of lying in which a person appears to believe in the reality of his or her fantasies and
acts on them, associated with Munchausen’s syndrome, repeated feigning of illness.

4. Trend or preoccupation of thought Centering of thought content on a particular idea, associated with a strong affective tone,
such as a paranoid trend or a suicidal or homicidal preoccupation

5. Egomania Pathological self-preoccupation

6. monomania Preoccupation with a single object

7. hypochondria Exaggerated concern about health that is based not on real organic pathology but, rather,
on unrealistic interpretations of physical signs or sensations as abnormal.

8. obsession Pathological persistence of an irresistible thought or feeling that cannot be eliminated from
consciousness by logical effort; associated with anxiety

9. compulsion Pathological need to act on an impulse that, if rested, produces anxiety; repetitive behavior
in response to an obsession or performed according to certain rules, with no true end in
itself other than to prevent something from occurring in the future

10. coprolalia Compulsive utterance of obscene words

11. phobia Persistent, irrational, exaggerated, & invariably pathological dread of a specific stimulus or
situation; results in a compelling desire to avoid the feared stimulus.

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 a. specific phobia Circumscribed dread of a discrete object or situation ( dread of spiders or snakes)

b. social phobia Dread of public humiliation, as in fear of public speaking, performing, or eating in public.

c. acrophobia

d. agoraphobia Dread in open places

e. algophobia Dread of pain

f. ailurophobia Dread of cats

g. erythrophobia Dread of red (refers to a fear of blushing)

h. panphobia Dread of Everything

i. claustrophobia Dread of closed places

j. xenophobia Dread of strangers

k. zoophobia Dread of animals

l. needle phobia The persistent, intense, pathological fear of receiving an injection.

12. Noesis A revelation in which immense illumination occurs in association with a sense that a person
has been chosen to lead & command

13. Unio Mystica An oceanic feeling of mystic with an infinite power; not considered a disturbance in thought
content if congruent with person’s religious or cultural milieu.

V. Speech

A. DISTURBANCES IN SPEECH

1. Pressure of speech Rapid speech that is increased in amount & difficult to interrupt

2. Volubility(logorrhea) Copious, coherent, logical speech

3. poverty of speech Restriction in the amount of speech used; replies may be monosyllabic

4. nonspontaneous speech Verbal responses given only when asked or spoken to directly; no self-initiation of speech

5. Poverty of content of speech speech that is adequate in amount that conveys litt le information because of
vagueness, emptiness, or stereotyped phrases.
loss of normal speech melody (called prosody).
6. Dysprosody

7. dysarthria Difficulty in articulation, not in word finding or in grammar

loss of modulation of normal speech volume; may reflect a variety of pathological
8. excessive loud or soft speech conditi ons ranging from psychosis to depression to deafness.

9. Stuttering frequent repetition or prolongati on of a sound or syllable, leading to markedly

impaired speech fluency

10. cluttering Erratic & dysrhytmic speech, consisting of rapid & jerky spurts

B. APHASIC DISTURBANCES: DISTURBANCES IN LANGUAGE OUTPUT

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 Disturbance of speech caused by a cognitive disorder in which understanding
1. Motor aphasia remains but ability to speak is grossly impaired; halting, laborious, and inaccurate
speech (also known as Broca's, nonfluent, and expressive aphasia).
Organic loss of ability to comprehend the meaning of words; fluid and
2. Sensory aphasia spontaneous but incoherent and nonsensical speech (also known as Wernicke's,
fluent, and recepti ve aphasia).
Difficulty in finding correct name for an object (also termed anomia and amnestic
3. Nominal aphasia aphasia).
Inability to arrange words in proper sequence.
4. Syntactical aphasia
Words produced are totally neologisti c; nonsense words repeated with various
5. Jargon aphasia intonati ons and infl ecti ons.

6. Global aphasia Combination of a grossly non-fl uent aphasia and a severe fluent aphasia.

7. Alogia Inability to speak because of a mental deficiency or an episode of dementia

8. copropregia Involuntary use of vulgar or obscene language; seen in Tourette’s disorder and some cases
schizophrenia

VI. Perception:
A. DISTURBANCES OF
PERCEPTION process of transferring physical stimulation into psychological information; mental process
by w/c sensory stimuli are brought to awareness.

1. Hallucination False sensory perception not associated with real external stimuli; there may or may
no! be a delusional-interpretati on of the hallucinatory experience

a. Hypnagogic hallucination False sensory perception not associated with real external stimuli; there may or may not be
delusional interpretation of the hallucinatory experience.

b. Hypnopompic hallucination False perception occurring while awakening from sleep

c. Auditory hallucination False perception of sound, usually voices but also other noises, such as music; most
common hallucination in psychiatric disorders.

d. Visual hallucination False perception involving sight consisting of both formed images (for example,
people) and unformed images (for example, flashes of Light); most common in
medically determined disorders.

e. Olfactory hallucination False perception of smell; most common in medical disorders.

f. Gustatory hallucination False perception of taste, such as unpleasant taste, caused by an uncinate seizure; most
common in medical disorders.

g. Tactile (haptic) hallucination False perception of touch or surface sensation, as from an amputated limb (phantom limb);
crawling sensation on or under the skin (formication)

h. Somatic hallucination False sensation of things occurring in or to the body, most often visceral in origin (also
known as cenesthesic hallucination)

i. Lilliputian hallucination False perception in which objects are seen as reduced in size (also termed micropsia)
Hallucination in which the content is consistent with either a depressed or a manic
j. Mood-congruent hallucination mood (for example, a depressed patient hears voices saying that the patient is a bad
person; a manic patient hears voices saying that the pati ent is of inflated worth, power,
and knowledge).

k. Mood-incongruent hallucination Hallucination in which the content is not consistent with either depressed or manic mood

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 (in depression, hallucinations not involving such themes as guilt, deserved punishment or
inadequacy; in mania, hallucinations not involving such themes as inflated worth or power.

l. Hallucinosis Hallucinations, most often auditory, that are associated with chronic alcohol abuse and that
occur within a clear sensorium, as opposed to delirium tremens, hallucinations that occur in
the text of a clouded sensorium.

m. Trailing phenomenon Perceptual abnormality associated with hallucinogenic drugs in which moving objects are
seen as series of discrete and discontinuous images.

n. command hallucination

2. Illusion Misperception or misinterpretation of real external sensory stimuli

B. DISTURBANCES ASSOCIATED WITH : agnosia – an inability to recognize & interpret the significance of sensory impressions.
COGNITIVE DISORDER & MEDICAL
CONDITIONS

1. Anosognosia (ignorance of illness) A person's inability to recognize a neurological deficit as occurring to himself or
herself.

2. Somatognosia (ignorance of the body) A person’s inability to recognize a body part as his or her own (autotopagnosia)
Inability to recognize objects or persons.
3. Visual agnosia

4. Astereognosis inability to recognize objects by touch.

5. Prosopagnosia inability to recognize faces

6. apraxia Inability to carry out specific tasks

7. Simultagnosia inability to comprehend more than one element of a visual scene at a time or to
integrate the parts into a whole

8. Adiadochokinesia inability to perform rapid alternating movements.

warning sensations such as automatisms, fullness in the stomach, blushing, and
9. Aura changes in respiration; cognitive sensations, and affective states usually experienced
before a seizure; a sensory prodrome that precedes a classic migraine headache.
C. DISTURBANCES ASSOCIATED WITH somatization of repressed material or the development of physical symptoms and
CONVERSION AND DISSOCIATIVE distortions involving the voluntary muscles or special sense organs; not under
PHENOMENA: voluntary control an{! not explained by any physical disorder.
loss of sensory modalities resulting from emotional conflicts
1'. Hysterical anesthesia
state in which objects seem larger than they are
2. Macropsia
State in which objects seem smaller than they are (both macropsia and micropsia can
3. Micropsia also be associated with clear organic conditions, such as complex partial seizures).
A person's subjective sense of being unreal, strange, or unfamiliar.
4. Depersonalization
A subjective sense that the environment is strange or unreal; a feeling of changed
5. Derealization reality.

6. Fugue Taking on a new identity with amnesia for the old identity; often involves travel or
wandering to new environments.

7. Multiple personality One person who appears at different times to be tow or more entirely different

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 personalities and characters(called DID in the 4th edition DSM-IV)

8. Dissociation Unconscious defense mechanism involving the segregation of any group of mental or
behavioral processes from the rest of the person’s psychic activity; may entail the
separation of an idea from its accompanying emotional tone, as seen in dissociative &
conversion disorders.

VII. Memory: function by which information stored in the brain is later recalled to consciousness

A. DISTURBANCES OF MEMORY

1. Amnesia Partial or total inability to recall past experiences; may be organic or emotional in
origin.

a. Anterograde Amnesia for events occurring after a point in time

b. Retrograde Amnesia for -vents occurring before a point in time.

Falsification of memory by distortion of recall.
2. Paramnesia

a. Fausse reconnaissance false recognition

b. Retrospective falsification Memory becomes unintentionally (unconsciously) distorted by being filtered

through a person's present emotional, cognitive, and experiential state.

c. Confabulation Unconscious filling of gaps in memory by imagined (r untrue experiences that a person
believes but that have no basis in fact; most often associated with | organic pathology.
d. Déjà vu
Illusion of visual recognition in which a new situation is incorrectly regarded as a
repetition of a previous memory.

e. Déjà entendu Illusion of auditory recognition.

Illusion that a new thought is recognized as a thought previously fell or expressed.
f. Déjà pense
g. Jamais vu
false feeling of unfamiliarity with a real situation that a person has experienced

A person's recollection and belief by the pati ent of an event that did not actually occur.
h. False memory

3. Hypermnesia Exaggerated degree of retention and recall.

4. Eidetic image Visual memory of almost hallucinatory vividness

5. Screen memory a consciously tolerable memory covering for a painful memory

A defense mechanism characterized by unconscious forgetti ng of unacceptable ideas or
6. Repression impulses.

7. Lethologica Temporary inability to remember a name or a proper noun.

8. Blackout Amnesia experienced by alcoholics about behavior during drinking bouts; usually
indicates that reversible brain damage has occurred.

B. LEVELS OF MEMORY

1. Immediate Reproduction or recall of perceived material within seconds to minutes

2. Recent Recall of events over past few days

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3. Recent past Recall of events over past few months

4. Remote Recall of events in distant past

VIII. INTELLIGENCE:
ability to understand, recall, mobilize, and constructively integrate previous
learning in meeting new situations.
lack of intelligence to a degree in which there is interference with social and
a. Mental retardation vocational performance: mild (IQ of 50 or 55 to approximately 70), moderate (IQ of
35 or 40 to 5O or 55), severe (IQ of 20 or 25 to 35 or 40), or pro-found (IQ below 20
or 25); obsolete terms are idiot (mental age less than 3 years), imbecile (mental age of
3 to 7 years), and moron (mental age of about 8).
Organic and global deterioration of intellectual functioning without clouding of
b. Dementia consciousness.
Loss of ability to do calculations; not caused by anxiety or impairment in
I. Dyscalculia (acalculia) concentration.

2. Dysgraphia (agraphia) Loss of ability to write in cursive style; loss of word structure.
Loss of a previously possessed reading facility; not explained by defective visual
3. Alexia activity.
Clinical features resembling a dementia not caused by an organic condition; most
c. Pseudodementia often caused by depression (dementia syndrome of depression).
literal thinking; limited use of metaphor without understanding of nuances of
d. Concrete thinking meaning; one-dimensional thought.

e. Abstract thinking Ability to appreciate nuances of meaning; multidimensional thinking with ability to use
metaphors and hypotheses appropriately.

IX. INSIGHT A person's ability to understand the true cause and meaning of a situation (such as a set of
symptoms).

a. Intellectual insight Understanding of the objective reality of a set of circumstances without the ability to
apply the understanding in any useful way to master the situation

B. True insight
understanding of the objective reality of a situation, coupled with the motivation and the
emotional impetus to master the situation.

C. Impaired insight diminished ability to understand the objective reality of a situation

X. JUDGMENT Ability to assess a situation correctly and to act appropriately in the situation.
Ability to assess, discern, and choose among various options in a situation
A. Critical judgment
Reflex performance of an action.
b. Automatic judgment

c. Impaired judgment Diminished ability to Understand a situation correctly and to act appropriately.

DEFENSE Means and ways of avoiding emotional stress, destructive impulses, or threat to self-esteem
MECHANISMS
NARCISSISTIC DEFENSES
Denial Avoidance of the awareness of some painful aspects of reality by negating the sensory data
Distortion External reality is grossly reshaped to suit inner needs including the unrealistic beliefs, hallucinations, wishful thinking,
delusions
Splitting External objects are divided into extreme category to the other
"all good" and "all bad" accompanied by abrupt shifting of an object from one
Projection Unconscious blaming of unacceptable inclinations or thoughts on an external object
IMMATURE DEFENSES

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Acting Out The person expresses an unconscious wish or impulse through action to avoid being conscious of an accompanying effect.
Blocking A temporary or transient inhibition of thinking which resembles repression but differs in that tension arises when the
impulse, affect or thoughts are inhibited
Hypochondriasis Reproach arising from bereavement, loneliness, or unacceptable aggressive impulses toward others is transformed into
self-reproach and complaints of pain, somatic illness, and neurasthenia.
Introjection Accepting another person's attitudes, beliefs, and values as one's own
Passive-Aggressive Aggression towards others is expressed indirectly through passivity, masochism, and turning against the self.
Behavior
Regression Person moves back to the previous developmental stage in order to feel safe or have needs met.
Fixation The immobilization of a portion of a personality resulting from unsuccessful completion of tasks in a development stage.
Somatization Converting psychic derivatives into bodily symptoms & tending to react with somatic manifestations, rather than psychic
manifestations
Schizoid Fantasy Through fantasy, the person indulges autistic retreat to resolve conflicts and obtain gratification.
NEUROTIC DEFENSES
Controlling An excessive attempt to manage or regulate events or objects in the environment to minimize anxiety and to resolve inner
conflicts
Displacement Involves the ventilation of intense feelings towards persons less threatening than the one whom aroused those feelings
Dissociation A temporary but drastic modification of a person's character or of one's sense of personal identity takes place to avoid
emotional distress
Compensation Presence of overachievement in
one area to offset real or perceived deficiencies in another area
Externalization The tendency to perceive elements of one's own personality, including instinctual impulses, conflicts, moods, attitudes
and styles of thinking in the external environment
Identification Modeling actions and opinions of influential others, while searching for identity, or aspiring to reach a personal, social, or
occupational goal
Inhibition Limitation or renunciation of ego functions that occur consciously
Intellectualization Excessive use of intellectual processes to avoid affective expressions or experiences by paying attention to the external
reality
Isolation Separation of the idea from the repressed affect that accompanies it
Rationalization Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
Reaction Formation Acting the opposite of what one feels
Repression Excluding emotionally painful or anxiety provoking thoughts and feelings from conscious awareness
Substitution Replacing the desired gratification with one that is more readily available
Sexualization An object or function is endowed with sexual significance that did not previously have or that it possessed to a similar
degree in order to ward off anxieties associated with prohibited impulses or their derivatives.
MATURE DEFENSES
Anticipation Planning for future inner discomfort that is goal-directed and implies careful planning or worrying and premature but
realistic affective expectation of dire and potentially dreadful outcomes
Humor Permits the overt expression of unpleasant effect on others;
Asceticism Eliminating the pleasurable effects of experiences. There is moral element in assigning values to specific pleasures.
Sublimation Substituting a socially acceptable activity for an impulse that is unacceptable
Suppression A conscious or semiconscious decision to postpone attention to a conscious impulse or conflict

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 REVIEW QUESTIONS
1. A client who is depressed states, “I’m an awful person. Everything about me is bad. I can’t do anything right.” Which of the
following responses by the nurse would be most therapeutic?
a. “Everybody around here likes you.”
b. “I can see many good qualities in you.”
c. “Let’s discuss what you’ve done correctly.”
d. “You were able to bathe today.”

2. When teaching a client with atypical depression about foods to avoid while taking phenelzine (Nardil), which of the following
would the nurse include?
a. Roasted chicken
b. Salami
c. Fresh fish
d. Hamburger

3. When preparing a teaching plan for a client about imipramine (Tofranil), which of the following substances will the nurse tell the
client to avoid while taking the medication?
a. Caffeinated coffee
b. Sunscreen
c. Alcohol
d. Artificial tears

4. The client with bipolar disorder manic phase appears at the nurse’s station wearing a transparent shirt, miniskirt, high heels, 10
bracelets, and 8 necklaces. Her makeup is overdone and she is not wearing underwear. A pair of inverted underpants is plopped
on her head. Which of the following would be the nurse’s best response?
a. Tell the client to dress appropriately while out of her room.
b. Ask the client to put on hospital pajamas until she can dress appropriately.
c. Instruct the client to go to her room and change clothes.
d. Escort the client to her room and assist with choosing the appropriate attire.

5. A client who is diagnosed with bipolar disorder, acute mania, states to the nurse, “where is my son? I love Lucy. Rain, rain goes
away. Dogs eat dirt.” The nurse interprets these statements as indicating which of the following?
a. Echolalia
b. Flight of ideas
c. Neologism
d. Clang associations

6. A client is complaining about blurred vision after 4 days of taking haloperidol (Haldol), benztropine (Cogentin), quetiapine
(Seroquel), and buspirone (Buspar). Which of the following medications would the nurse suspect as the most likely cause of this
side effect?
a. Buspirone (Buspar)
b. Quetiapine (Seroquel)
c. Haloperidol (Haldol)
d. Benztropine (Cogentin)

7. When describing AD to a group of nursing students, which of the following would the nurse identify as the characteristic found in
AD that distinguishes it from other dementia?
a. Hypoxic destruction of brain cells
b. Hyperkinesis causing choreiform movements
c. Neurofibrillary tangles and plaques
d. An infectious particle called a portion

8. The client with a histrionic disorder is melodramatic and responds to others and situation in an exaggerated manner. The nurse
would recommend which of the following activities for this client?
a. Party planning
b. Music group
c. Cooking class
d. Role-playing

9. A client is entering the chemical dependency unit for treatment of alcohol dependency. Which of the client’s possessions will the
nurse most likely placed in a lock area?

______________________________________________________________
 a. Toothpaste
b. Dental floss
c. Shaving cream
d. Antiseptic mouthwash

10. While meeting with the nurse, a client’s wife states, “ I don’t know what else to do make him stop drinking.” The nurse would
anticipate initiating a referral for the wife to which of the following organizations?
a. Alateen
b. Al-anon
c. Employee assistance program
d. Alcoholics anonymous

11. Which of the following client statements would indicate to the nurse that the client needs further teaching about disulfiram
(Antabuse)?
a. “I can drink one or two beers and not get sick while on Antabuse.”
b. “ I can take Antabuse at bedtime if it makes me sleepy.”
c. “ A metallic or garlic taste in my mouth is normal when star on Antabuse.”
d. “I’ll read the labels on cough syrup and mouthwash for possible alcohol content.”

12. Which of the following foods would the nurse eliminate from the diet of a client in alcohol withdrawal?
a. Milk
b. Regular coffee
c. Orange juice
d. Eggs

13. Which of the following would the nurse expect to assess for a client who is exhibiting late signs of heroin withdrawal?
a. Vomiting and diarrhea
b. Yawning and diaphoresis
c. Lacrimation and rhinorrhea
d. Restlessness irritability

14. A client brought by ambulance to the hospital emergency room taking an overdose of barbiturates is comatose. The nurse would
be especially alert for which of the following?
a. Kidney failure
b. Cerebral vascular accident
c. Status epilepticus
d. Respiratory failure

15. A client who is a chronic user of cocaine reports that he feels like he has bugs crawling under his skin. His arms are red from
scratching. The nurse interprets these findings as possibly indicating which of the following?
a. Illusion
b. Fornication
c. Confusion
d. Flashback

16. When caring for a client who has overdosed on phenycyclidine (PCP), the nurse would be especially cautious about which of the
following client behaviors?
a. Visual hallucinations
b. Violent behavior
c. Bizarre behavior
d. Loud screaming

17. Which of the following liquids would the nurse administer to a client who is intoxicated on PCP to hasten excretion of the
chemical?
a. Water
b. Milk
c. Cranberry juice
d. Grape juice

18. When assessing a client with possible poisoning, the nurse would investigate the client’s use of which of the following
substances while drinking alcohol?
a. Marijuana
b. LSD

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 c. Peyote
d. Psilocybin

19. The nurse would teach a client with an anxiety disorder who is taking a benzodiazepine about using which of the following in
combination with this medication?
a. Antacids
b. Acetaminophen (Tylenol)
c. Vitamins
d. Aspirin

20. At 10 AM a client with an axis I diagnosis of pain disorder demands that the nurse call the physician for more pain medication
because she’s still in pain after the 9 AM analgesic. Which of the following would the nurse do next?
a. Call the physician as the client requests
b. Suggest the client to lie down because she has to wait for the next dosage
c. Tell the client that the physician will be in later to talk to her about it
d. Inform the client that the nurse cannot give her additional medication at this time

21. A true crisis state, involving a period of severe disorganization, is difficult to endure emotionally and physically. The nurse
recognizes that a client will only be able to tolerate being in crisis for which of the following lengths of time?
a. 1 to 2 weeks
b. 4 to 6 weeks
c. 12 to 14 weeks
d. 24 to 26 weeks

22. Which of the following physiologic responses would the nurse expect as unlikely to occur when a client is angry?
a. Increased respiratory rate
b. Decreased blood pressure
c. Increased muscle tension
d. Decrease peristalsis

23. A client who is agitated but not currently psychomotor is willing to take a medication ordered PRN. If all the following
medications were ordered for the client, which would the nurse expect to administer?
a. Oral lorazepam (Ativan)
b. Oral quetiapine (Seroquel)
c. Intramuscular (IM) haloperidol (Haldol)
d. IM Fluphenazine (prolixin)

24. One of the myths about sexual abuse of young children is that it usually involves physically violent acts. Which of the behaviors is
most likely to be used by the abusers?
a. Tying the child down
b. Bribery with money
c. Coercion as a result of the trusting relationship
d. Asking for the child’s consent for sex

25. A young child is suspected of being sexually abused because he demonstrates the self destructive behavior of head banging and
self mutilation. Which of the following behaviors would the nurse also commonly expect to assess?
a. Inability to play
b. Truancy and running away
c. Substance abuse
d. Over control of anger

26. When teaching a group adolescent about anorexia nervosa, the nurse would describe this disorder as being characterized by
which of the following?
a. Excessive fear of becoming obese, near normal weight and a self-critical body image
b. Obsession with the weight of others, chronic dieting and an altered body image
c. Extreme concern about dieting, calorie counting and an unrealistic body image
d. Intense fear of becoming obese, emaciation, and a disturbed body image

27. When assessing the client with anorexia nervosa, the nurse would expect to find which of the following?
a. Hyperthermia, oliguria, and bradycardia
b. Lanugo, hypothermia, and hypotension
c. Constipation, Dysmenorrhea, and hypertension
d. Diarrhea, dry skin and menorrhagia

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28. When developing appropriate short-term goals with clients who are inpatients. Which of the following would be the most
realistic?
a. The client will demonstrate a positive self image
b. The client will describe plans for how to get back into school
c. The client will write a list of strengths and abilities
d. The client will practice assertive skills in a dating situation

29. One day, a client receiving dialysis directs a stream of profanities at the nurse, then abruptly hangs his head and pleads, “Please
forgive me. Something just came over me. Why do I say those things?” the nurse interprets this as which of the following?
a. Punning
b. Confabulation
c. Flight of ideas
d. Emotional Lability

30. A client is admitted to the hospital in the manic phase of bipolar. When placing a diet order for the client which foods would be
most appropriate?
a. A bowl of soup, crackers, and a dish of peaches
b. Cheese sandwich, carrot sticks, fresh grapes and cookies
c. Roast chicken, mashed potatoes, and peas
d. A tuna sandwich, an apple, and a dish of ice cream

31. Obsessive-Compulsive behavior disorder is characterized by which of the following?

a. Recurring unwanted thoughts alternating with uncontrolled behavior
b. Pathological persistence of unwilled thoughts, feelings or impulses
c. Persistent thoughts and behavior
d. Uncontrolled impulses to perform an act or ritual repeatedly

32. Which of the following date suggests Retrograde Amnesia in a patient who has received ECT (Electro-Convulsive Therapy)?
a. Difficulty in recalling information learned prior to ECT for 2 days
b. Memory loss for 2 days after the procedure
c. Difficulty remembering information learned prior to ECT for over 4 months
d. Difficulty recalling newly learned information for 2 weeks following the procedure

33. The neurotransmitter affected in a patient with schizophrenia:

a. Serotonin
b. Dopamine
c. Acetylcholine
d. GABA

34. The neurotransmitter affected in a patient with PTSD (post-traumatic stress disorder)
a. Serotonin
b. Norepinephrine
c. Acetylcholine
d. GABA

35. An IQ of below 20 is classified as what type of mental retardation?

a. Mild
b. Moderate
c. Severe
d. Profound

36. A person diagnosed with Moderate Mental Retardation has an IQ of:

a. 50-70
b. 35-49
c. 20-34
d. 20 and below

37. Which of the following assessment date is suggestive of moderate mental retardation?
a. The child can develop social and communication skills with minimal retardation in sensorimotor area
b. The child can be managed with moderate supervision
c. The child manifests poor motor development
d. The child manifests gross motor retardation and needs nursing care

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38. Repeated eating of non-nutritive substances such as dirt, clay, plaster and paper for at least two months is known as:
a. Pica
b. Anorexia Nervosa
c. Bulimia Nervosa
d. Autism

39. Sexual gratification that involves receiving pain:

a. Masochism
b. Pedophilia
c. Voyeurism
d. Sadism

40. Obsession with wearing clothing of the opposite sex is:

a. Heterosexuality
b. Homosexuality
c. Bisexuality
d. Transvestism

41. Using non-living objects foe sexual gratification is:

a. Fetishism
b. Transexualism
c. Voyeurism
d. Frotteurism

42. Which of the following activities is the most appropriate for a patient with Bipolar Disorder with aggressive social behavior?
a. Badminton
b. Chess
c. Baseball
d. Writing

43. The best activity that the manic patient can participate in is:
a. Badminton
b. Deep breathing exercises
c. Painting
d. Walking

44. A client receiving anti-psychotic medications manifests pill-rolling, tremors and rigidity. The nurse is correct in interpreting these
symptoms as:
a. Pseudo-parkinsonism
b. Akathisia
c. Tardive Dyskinesia
d. Akinesia

45. The bizarre, involuntary facial grimace, excessive blinking and lip smacking in a client taking an anti-psychotic drug is a sign of:
a. Pseudo-parkinsonism
b. Akathisia
c. Tardive Dyskinesia
d. Akinesia

46. The nurse is planning care for a suicidal patient. The nurse will prepare additional precautions at which of the following times?
a. Day shift
b. Weekdays
c. 7:00 am to 10:00 am
d. Weekends

47. The most common hallucination of an alcoholic patient is:

a. Auditory
b. Visual
c. Tactile
d. Olfactory

48. The earliest sign of heroin withdrawal is:

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 a. Yawning
b. Nausea
c. Vomiting
d. Malaise

49. Neuroleptics are also known as:

a. Anti-anxiety drugs
b. Anti-depressant drugs
c. Anti-psychotic drugs
d. Anti-manic drugs

50. The drug of choice for Schizophrenic patients is:

a. Benzodiazepines
b. Mono-Amine Oxidase Inhibitors (MAOI)
c. Haloperidol
d. Benadryl

51. An adverse effect of anti-psychotics manifested by pacing, fidgeting and “ants in my pants” sensation is termed:
a. Akinesia
b. Akathisia
c. Tardive Dyskinesia
d. Pseudo-Parkinsonism

52. Cocaine is classified as a:

a. Psychostimulant
b. Narcotic
c. Anxiolytic
d. Hallucinogen

53. The drug of choice for a manic patient is:

a. Haloperidol
b. Valium
c. Lithium Carbonate (Eskalith)
d. Thorazine

54. The normal therapeutic serum level for Lithium is:

a. 1.0 – 2.0 mEq/L
b. 0.5 – 1.5 mEq/L
c. 1.0 – 2.5 mEq/L
d. 1.0 – 1.8 mEq/L

55. Alcohol is classified as:

a. CNS stimulant
b. CNS depressant
c. Narcotic
d. LSD

56. Crisis is a self-limiting situation, which means that it is transitory. It is commonly resolved within a period of:
a. 2-4 weeks
b. 4-6 weeks
c. 6-8 weeks
d. 8-10 weeks

57. An adverse effect of non-phenothiazine neuroleptics characterized by tachycardia, fever, diaphoresis and come.
a. Tardive Dyskinesia
b. EPS
c. Neuroleptic Malignant Syndrome (NMS)
d. Akathisia

58. Which of the following is correct regarding NMS?

a. It is characterized by high fever

______________________________________________________________
 b. The drug of choice to reverse it is Dantrolene (Dantrium)
c. It is usually associated with Haloperidol administration
d. All of the above

59. A therapeutic impasse characterized by the patient who is always late, breaks appointments, becomes forgetful, silent or sleepy
during the session:
a. Resistance
b. Transference
c. Counter-transference
d. Boundary violation

60. Stelazine, Prolixin, Clozaril, and Tehretol are examples of:

a. Anti-manic drugs
b. Anti-anxiety drugs
c. Anti-psychotics
d. Anti-depressants
61. Elavil and tofranil are classified under which group of anti-depressants?
a. Tri-Cyclic antidepressants
b. Non-Tricyclic antidepressants
c. Mono-Amine Oxidase Inhibitors
d. Benzodiazepines

62. Lorazepam (Ativan), Diazepam (Valium), Alprazolam (Xanax), Flurazepam (Dalmane), Chlordiazepoxide (Librium), Vistaril, Equanil,
Atarax and Serax are all examples of:
a. TCA
b. Non-TCA
c. Minor Tranquilizers
d. Anti-psychotics

63. An unconscious response in which the patient experiences feelings and attitudes towards the nurse is called:
a. Transference
b. Counter-transference
c. Boundary violation
d. None of the above

64. A specific emotional response of a nurse to a patient characterized by either an intense caring or love or intense feeling of
hatred, anxiety or hostility in response to the resistance of the patient.
a. Transference
b. Counter-transference
c. Boundary violation
d. Resistance

65. A therapeutic impasse characterized by a professional relationship turning into a social relationship between the nurse and the
patient.
a. Transference
b. Counter-transference
c. Boundary violation
d. Resistance

66. When excessive thoughts and speeches are associated with excessive and unnecessary details that is usually irrelevant to the
question and the answer is untimely given, this is termed:
a. Circumstantiality
b. Loose association
c. Tangentiality
d. Waxy Flexibility

67. An excessive thought and speech associated with excessive and unnecessary details which are irrelevant to the question, and the
patient never returns to the central point and never answers the original question, the patient is described as having:
a. Circumstantiality

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 b. Loose association
c. Tangentiality
d. Waxy flexibility

68. The injection of a clever or humorous word in order to convey a different meaning:
a. Echolalia
b. Echopraxia
c. Punning
d. Clang association

69. Coining new words with symbolic meanings is termed as:

a. Punning
b. Clang association
c. Neologism
d. Word salad

70. When the patient says, “ olang, bang, rang, lang, sang,” in order to compensate for communication deficits, the patient is doing:
a. Echolalia
b. Echpraxia
c. Punning
d. Clang association

71. A co-existence of 2 existing opposing factors

a. Labile affect
b. Blunt affect
c. Ambivalence
d. Anhedonia

72. Known as ataractic, neuroleptic, psychic energizer or major tranquilizer

a. Anti-psychotic
b. Anti-anxiety
c. Anti-depressant
d. Anti-manic

73. Known as minor tranquilizer or anxiolytics:

a. Anti-psychotics
b. Anti-anxiety
c. Anti-depressant
d. Anti-manic

74. A symptom of mental illness characterized by airing to the public and the outside world what the person id thinking:
a. Thought broadcasting
b. Thought insertion
c. Nihilistic ideas
d. Ideas of reference

75. Which of the following indicates level of personality?

a. Id, ego, and superego
b. Conscious, sub-conscious, and unconscious
c. Endomorph, mesomorph, ectomorph
d. Mild, moderate, severe, panic

76. The level of consciousness that exerts a greatest influence in one’s personality because it serves as a storehouse for all
memories, feelings and responses is:
a. Conscious
b. Subconscious
c. Unconscious
d. None of the above

77. The level of consciousness where memories cannot be recalled at will and can be expressed by dreams, slip of the tongue,
memory lapses and jokes:
a. Conscious
b. Subconscious

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 c. Unconscious
d. None of the above

78. According to Freud, which part of the mind functions when the person is awake, can recall past experiences without exerting
effort?
a. Conscious
b. Subconscious
c. Unconscious
d. None of the above

79. The level of consciousness which sets as the watchman because it prevents certain unacceptable disturbing unconscious
memories from reaching the conscious mind:
a. Conscious
b. Subconscious
c. Unconscious
d. None of the above

80. Mrs. R was given Lithium Carbonate. Which nursing teaching is most appropriate?
a. regular sleeping pattern
b. avoid tyramine rich foods
c. monitoring for hypertension
d. increase sodium in the diet

81. Which of the following foods would the nurse expects to include in Mrs. R’s plan of care?
a. Bacon, lettuce, and tomato sandwich
b. Cheeseburger
c. Strawberry sundae
d. Beef stew

Situation: Roy, 25 years old, was brought up to the emergency room extremely restless, disorganized, and chaotic. His wife claims
that he has not slept for two days. Diagnosis: Bipolar, Manic disorder.

82. During initial assessment, the nurse states this nursing diagnosis:
a. Altered nutrition
b. Ineffective individual coping
c. Self-esteem disturbance
d. Altered thought process

83. To provide for the basic needs of Roy, the nurse assumes mother surrogate role which is exemplified by:
a. administering medication as ordered
b. bathing, dressing, feeding Roy
c. taking vital signs, as TPR and RP
d. supervising ward games and activities

84. In planning activities and recreation for Roy, what should be avoided?
a. solitary activities such as writing and painting
b. walks with the staff
c. games of competition such as volleyball and basketball
d. listening to soft music

85. One week after admission, Roy was given Lithium Carbonate. The nurse should consider these precautions:
1. should not be given on an empty stomach
2. can be given on empty stomach
3. should not be given with diuretics
4. can be given with diuretic
a. 1 and 4 c. 2 and 3
b. 1 and 3 d. 1 and 2

86. As an adult to the anti-manic drug, group therapy is mainly utilized to help Roy:
a. reintegrating himself socially
b. decreasing undesirable behavior
c. increase compliance to therapy

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 d. setting limits to his inappropriate behavior

87. Alcoholics commonly use a defense mechanism known as:

a. denial
b. regression
c. displacement
d. sublimation

88. In planning nursing care for Mario, priority is focused on:

a. preparing Mario for immediate physical and social rehabilitation
b. helping Mario acknowledge that he has alcohol problems
c. informing Mario of the possible development of medical problem resulting from alcoholism
d. offering desirable alternatives to alcohol problem

89. The chief characteristic of Korsakoffs syndrome is:

a. illusion
b. confabulation
c. delusion
d. hallucination

90. Chronic heavy drinking can result to serious nutritional deficiency because:
a. digestion and absorption of food are impaired by excessive drinking
b. liver function is affected by heavy drinking
c. alcoholics usually forget to eat regular meals
d. alcohol reduces the drinker’s appetite for food

91. Detoxification using Disulfiram is ordered for Mario. Disulfiram’s action is:
a. replaces the relaxing effect of alcohol
b. causes the alcoholic to relax
c. produces an extremely unpleasant physical reaction when alcohol is ingested
d. increases Mario’s tolerance for alcohol withdrawal

Situation: Mang Berto, 66 years old, is brought to the hospital for progressive memory impairment, often disoriented and confused,
easily irritated.

92. The basic principle underlying all care for cognitively impaired is to:
a. encourage familiar and simple group activities
b. facilitate the highest level of functioning a person is capable of in all areas
c. reorient the client on time, place and persons
d. minimize client’s confusion

93. An appropriate nursing intervention is to assign the same nurse to care for Mang Berto. The rationale for this is:
a. provide comfort and support
b. give special care and attention
c. lower anxiety and increase orientation
d. minimize client’s confusion

94. Mang Berto makes up stories in response to questions about situations for events that he cannot recall. This manifestation is:
a. confabulation
b. neologism
c. perseveration
d. illusion

95. Mang Berto makes up stories or answers questions about situations for events that he cannot recall in order to:
a. compensate for his inability to recall
b. avoid reality
c. maintain self-esteem
d. conceal his inability to recall

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96. One morning during medication time, Mang Berto was found walking aimlessly in front of the hospital. When asked, he says “My
son is coming to bring me home.” An appropriate nursing intervention would be:
a. reorient him into reality and assess the reasons for his behavior
b. remind him the importance of taking the medication on time
c. explain to him the danger of going out of the hospital premises
d. encourage him to interact with other patients

Situation: Rita, a 45 year old executive secretary was admitted to the psychiatric unit following suicide attempt
97. In admission room, she was heard saying. “No one could ever love me. I am not good enough.” The most appropriate nursing
diagnosis based on this statement is:
a. hopelessness
b. ineffective individual coping
c. personal identity disturbance
d. disturbance in self-concept: low self-esteem

98. A nursing intervention most appropriate for Rita would be:

a. avoid discussion on the topic of suicide
b. encourage her to express her feelings and pain
c. provide the client with alternative behavior
d. give her time to reflect on her suicide attempt

99. This drug will most probably be ordered for Rita:

a. Thiotexene (Navane)
b. Imipramine HCI (Tofranil)
c. Dipireden (Akineton)
d. Trihexyphinidyl (Artane)

100. Separation anxiety is usually first experienced during which stage of psychosexual development:
a. Phallic
b. Oral
c. Anal
d. Genital

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