Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION

Manila

BOARD OF NURSING

Philippine Nurse Licensure Examination

NURSING PRACTICE V – Care of Clients with Physiologic/Psychosocial
Alterations

INSTRUCTION: Select the correct answer for each of the following

questions. Mark only one answer for each item by shading the box
corresponding to the letter of your choice on the answer sheet provided.
STRICTLY NO ERASURES ALLOWED.

Situation: Alterations in structure and/or function of the nervous system

have the potential to affect a wide variety of human functions, including
activity and exercise, comfort, cardiovascular and respiratory function,
elimination, and sexuality.

1. The nurse assesses a client who has trauma to the cerebrum. Which
clinical manifestation does the nurse expect to observe?
a. Poor coordination
b. Memory loss
c. Hyperthermia
d. Slurred speech

2. The nurse is assessing a client with a frontal lobe brain injury. Which
clinical manifestation does the nurse expect to see?
a. Inability to interpret taste sensations
b. Inability to interpret sound
c. Impaired judgment
d. Impaired learning

3. The nurse is planning to provide discharge teaching related to cardiac

medications to a client who has experienced damage to the left temporal
lobe of the brain. What does the nurse do to assist the client to
understand the content of the instruction?
a. Use a larger print size for written materials.
b. Ensure that the client is wearing glasses.
c. Point out the color of the medication.
d. Sit on the client’s right side.

4. The nurse is discharging an 80-year-old client with diminished touch

sensation. Which instruction does the nurse provide to promote client
safety?
a. Walk barefoot only in your home.
b. Bathe in warm water to increase your circulation.
c. Look at the placement of your feet when walking.

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 d. Put throw rugs at the foot of your bed for cushioning.

5. A client admitted the previous day for a suspected neurologic disorder

becomes increasingly lethargic. Which is the best nursing action?
a. Promote a quiet atmosphere for sleep and rest to treat the client’s
sleep deprivation.
b. Explain to the family that this is a normal age-related decline in
mental processing.
c. Consult a psychiatrist to treat the client’s hospital-acquired
depression.
d. Complete a full neurologic assessment and notify the neurologist.

Situation: The results of diagnostic tests of neurologic structure and

function are used to support the diagnosis of a specific injury or
disease, to provide information to identify or modify the appropriate
medications or therapy used to treat the disease, and to help nurse’s
monitor the patient’s responses to treatment and nursing care
interventions.

6. Before electroencephalography, a client asks, “Why will I be asked to

take deep breaths during the procedure? How does the nurse respond?
a. Hyperventilation causes cerebral vasodilatation and increases the
likelihood of seizure activity.
b. Hyperventilation causes cerebral vasoconstriction and increases the
likelihood of seizure activity.
c. Deep breathing will keep you relaxed and will lower the seizure
threshold.
d. Deep breathing will make you hypoxemic, which lowers the seizure
threshold.

7. The nurse is caring for a client post-cerebral angiography via the

client’s right femoral artery. Which intervention does the nurse
Implement?
a. Check the right lower extremity pulses.
b. Measure orthostatic blood pressure.
c. Perform a funduscopic examination.
d. Assess the client’s gag reflex.

8. The nurse is preparing a client for magnetic resonance angiography.

Which question is a priority at this time?
a. Have you had a recent blood transfusion?
b. Do you have allergies to iodine or shellfish?
c. Do you have a history of urinary tract infections?
d. Do you currently use oral contraceptives?

9. The nurse is caring for a client who had a computed tomography (CT)
scan of the head with contrast medium. Which priority intervention does
the nurse Implement?

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 a. Maintain bedrest with the head of the bed elevated less than 30
degrees.
b. Apply a pressure dressing to the site of injection.
c. Increase fluid intake after the procedure.
d. Maintain sedation for 8 hours postprocedure.

10. The nurse is obtaining the health history of a client scheduled for
magnetic resonance Imaging (MRI). Which condition requires the nurse to
cancel the MRI?
a. Amputated leg
b. Internal insulin pump
c. Intrauterine device
d. Atrioventricular (AV) graft

Situation: Nurse Vangie is assigned in the neurologic ward of Vanguardia’s

Medical Center.

11. A client with epilepsy develops stiffening of the muscles of the arms
and legs, followed by an Immediate loss of consciousness and jerking of
all extremities. How does the nurse document this seizure activity?
a. Atonic seizure
b. Absence seizure
c. Myoclonic seizure
d. Tonic-clonic seizure

12. The nurse is assessing a client with a history of absence seizures.

Which clinical manifestation does the nurse assess for?
a. Automatisms
b. Intermittent rigidity
c. Sudden loss of muscle tone
d. Brief jerking of the extremities

13. The nurse is caring for a client with a history of epilepsy who
suddenly begins to experience a tonic-clonic seizure and loses
consciousness. What is the nurse’s priority action?
a. Restrain the client’s extremities.
b. Turn the client’s head to the side.
c. Take the client’s blood pressure.
d. Place an airway into the client’s mouth.

14. A client is actively experiencing status epilepticus. Which prescribed

medication does the nurse prepare to administer?
a. Atropine
b. Lorazepam (Ativan)
c. Phenytoin (Dilantin)
d. Morphine sulfate

15. A client with new-onset status epilepticus is prescribed phenytoin

(Dilantin). After teaching the client about this treatment regimen, the

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nurse assesses the client’s understanding. Which statement indicates that
the client understands the teaching?
a. I must drink at least 2 liters of water daily.
b. This will stop me from getting an aura before a seizure.
c. I will not be able to be employed while taking this medication.
d. Even when my seizures stop, I will take this drug.

Situation: Ongoing medical research into degenerative neurologic disorders

such as Alzheimer’s Disease, offers an increasing measure of hope to
patients and their families

16. A client with Alzheimer’s disease is admitted to the hospital. Which

psychosocial assessment is most Important for the nurse to complete?
a. Ability to recall past events
b. Ability to perform self-care
c. Reaction to a change of environment
d. Relationship with close family members

17. The nurse is caring for a hospitalized client with Alzheimer’s disease
who has a history of agitation. Which intervention does the nurse
Implement to help prevent agitation and aggressive behavior in this
client?
a. Provide undisturbed sleep.
b. Orient the client to reality.
c. Leave the television turned on.
d. Administer hypnotic drugs as needed.

18. A hospitalized client with late-stage Alzheimer’s disease says that

breakfast has not been served. The nurse witnessed the client eating
breakfast earlier. Which statement made to this client is an example of
validation therapy?
a. I see you are still hungry. I will get you some toast.
b. You are confused about mealtimes this morning.
c. You ate your breakfast 30 minutes ago.
d. You look tired. Maybe a nap will help.

19. The caregiver of a client with advanced Alzheimer’s disease states,

She is always wandering off. What can I do to manage this restless
behavior? How does the nurse respond?
a. Allow for a 45-minute daytime nap.
b. Take the client for frequent walks throughout the day.
c. Using a Geri-chair may decrease agitation.
d. Give a mild sedative during periods of restlessness.

20. A client who has Alzheimer’s disease is being discharged home. What
safety instructions does the nurse include in the teaching plan for the
client’s caregiver?
a. Keep exercise to a minimum.
b. Place a padded throw rug at the bedside.

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 c. Install deadbolt locks on all outside doors.
d. Keep the lights off in the bedroom at night.

Situation: Care of the patient with MG focuses on providing appropriate

treatment, preventing complications, and supporting the patient and family
in meeting physical and psychosocial needs, especially as the disease
progresses.

21. The nurse assesses a client who has myasthenia gravis. Which clinical
manifestation does the nurse expect to observe in this client?
a. Inability to perform the six cardinal positions of gaze
b. Lateralization to the affected side during the Weber test
c. Absent deep tendon reflexes
d. Impaired stereognosis

22. The nurse is assessing laboratory results for a client with myasthenia
gravis (MG). Which results does the nurse correlate with this disease
process?
a. Elevated serum calcium level
b. Decreased thyroid hormone level
c. Decreased complete blood count
d. Elevated acetylcholine receptor antibody levels

23. A client suspected to have myasthenia gravis is scheduled for the

Tensilon (edrophonium chloride) test. Which prescribed medication does the
nurse prepare to administer if complications of this test occur?
a. Epinephrine
b. Atropine sulfate
c. Diphenhydramine
d. Neostigmine bromide

24. The nurse is caring for a client who has myasthenia gravis. Which
nursing intervention does the nurse Implement to reduce muscle weakness in
this client?
a. Administer a therapeutic massage.
b. Collaborate with the physical therapist.
c. Perform passive range-of-motion exercises.
d. Reposition the client every 2 hours.

25. The nurse is assessing a client who is experiencing a myasthenia

crisis. Which diagnostic test does the nurse anticipate being ordered?
a. Babinski reflex test
b. Tensilon test
c. Cholinesterase challenge test
d. Caloric reflex test

Situation: The focus in the acute care phase is on diagnosing the type and
cause of the brain attack, supporting cerebral circulation, and
controlling or preventing further deficit

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26. The nurse is obtaining a health history for a client admitted to the
hospital after experiencing a brain attack. Which disorder does the nurse
identify as a predisposing factor for an embolic stroke?
a. Seizures
b. Psychotropic drug use
c. Atrial fibrillation
d. Cerebral aneurysm

27. A client with aphasia presents to the emergency department with a

suspected brain attack. Which clinical manifestation leads the nurse to
suspect that this client has had a thrombotic stroke?
a. Two episodes of speech difficulties in the last month
b. Sudden loss of motor coordination
c. A grand mal seizure 2 months ago
d. Chest pain and nuchal rigidity

28. The nurse is caring for an 80-year-old client who presented to the
emergency department in a coma. Which question does the nurse ask the
client’s family to help determine whether the coma is related to a brain
attack?
a. How many hours does your mother usually sleep at night?
b. Did your mother complain recently of weakness in her lower
extremities?
c. Is any history of seizures known among your mother’s immediate
family?
d. Does your mother drink any alcohol or take any medications?

29. The nurse notes that the left arm of a client who has experienced a
brain attack is in a contracted, fixed position. Which complication of
this position does the nurse monitor for in this client?
a. Shoulder subluxation
b. Flaccid hemiparesis
c. Pathologic fracture
d. Neglect syndrome

30. A client who had a brain attack was admitted to the intensive care
unit yesterday. The nurse observes that the client is becoming lethargic
and is unable to articulate words when speaking. What does the nurse do
next?
a. Check the client’s blood pressure and apical heart rate.
b. Elevate the back rest to 30 degrees and notify the health care
provider.
c. Place the client in a supine position with a flat back rest, and
observe.
d. Assess the client’s white blood cell count and differential.

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Situation: Structures and functions of the eyes are assessed by findings
from diagnostic tests, a health assessment interview to collect subjective
data, and a physical assessment to collect objective data.

31. During assessment of an older adult, which finding does the nurse
Immediately report to the health care provider?
a. Yellowing or bluing of the sclera
b. Lack of discrimination between green and violet
c. An opaque, bluish-white ring within the outer edge of the cornea
d. Pupil constriction in response to light occurring in 2 seconds

32. Which teaching is essential for a client who is going to have

intraocular pressure measurement with a slit lamp?
a. The test causes temporary blindness.
b. The test is quick and a local anesthetic is used.
c. The test does cause a little pain, but it is over quickly.
d. The test causes some tearing, but no pain.

33. The nurse performs an assessment of a client’s extraocular movement

and notes no difficulty. Which additional assessment data assist in
confirming this finding?
a. No episodes of double vision
b. Synchronized blinking movements
c. No reports of headaches and dizziness
d. Both pupils constricting equally in response to light

34. The nurse is performing vision screenings. Which client is at greatest

risk for developing vision problems?
a. Postpartum woman with no complications
b. Young client who has diabetes mellitus
c. Middle-aged adult who takes aspirin daily
d. Older client with chronic dry eye syndrome

35. The nurse is assessing extraocular eye movements (EOMs) in an older

adult client and finds that the client is unable to sustain an upward gaze
for longer than 2 seconds. What does the nurse do next?
a. Repeat the test while holding the client’s head in a fixed position.
b. Perform a cover-uncover eye test.
c. Document the finding and continue assessing.
d. Assess for additional signs of Impending brain attack.

Situation: Cataracts are a common and significant cause of visual

deficits. The following questions are related to care of clients with
cataract/cataract surgery.

36. An older adult client who has a mature cataract in the right eye
states, Now I have lost the sight in my right eye because I waited too
long for treatment. How does the nurse best respond to the client?

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 a. Yes, this type of blindness could have been prevented by earlier
treatment.
b. It is fortunate you came for treatment in time to save the sight of
your other eye.
c. Nothing you could have done would have made any difference.
d. Surgery can still save the sight in your eye with removal of the
cataract.

37. Which statement indicates that the client understands teaching about
the use of aspirin postcataract surgery?
a. It may increase intraocular pressure after cataract surgery.
b. It changes the ability of the blood to clot and increases the risk of
bleeding.
c. It reduces inflammation and might mask any symptoms of infection.
d. It can cause nausea and vomiting and may increase intraocular
pressure.

38. Which assessment alerts the nurse to the possible presence of a

cataract in a client?
a. Loss of central vision
b. Loss of peripheral vision
c. Dull aching in the eye and brow areas
d. Blurred vision and reduced color perception

39. A client is recovering from cataract surgery and needs medication to

prevent a potential eye infection. Which drug does the nurse question
administering to the client?
a. Tobramycin (Tobrex)
b. Apraclonidine (Iopidine)
c. Gentamicin (Genoptic)
d. Ciprofloxacin (Ciloxan)

40. Which statement indicates that a client understands why his cataract
surgery is being done first on the eye with the poorest vision?
a. Insurance reimbursement dictates the timing of surgeries.
b. The eye with poorer vision is at greater risk for permanent damage.
c. The pressure in the poorer eye could increase, causing permanent
damage.
d. If a complication arises in that eye, I will still have some vision
in the better eye.

Situation: The development of a therapeutic relationship enables

the nurse to join in a partnership with the client to set goals for
solving problems.

40. What is the most essential task for a nurse to accomplish prior to
forming a therapeutic relationship with a client?
a. Clarify personal attitudes, values, and beliefs.
b. Obtain thorough assessment data.

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 c. Determine the client’s length of stay.
d. Establish personal goals for the interaction.

42. If a client demonstrates transference toward a nurse, how should the

nurse respond?
a. Promote safety and Immediately terminate the relationship with the
client.
b. Encourage the client to ignore these thoughts and feelings.
c. Immediately reassign the client to another staff member.
d. Help the client to clarify the meaning of the relationship, based on
the present situation.

43. What should be the priority nursing action during the orientation
(introductory) phase of the nurse-client relationship?
a. Acknowledge the client’s actions and generate alternative behaviors.
b. Establish rapport and develop treatment goals.
c. Attempt to find alternative placement.
d. Explore how thoughts and feelings about this client may adversely
Impact nursing care.

44. Which client action should a nurse expect during the working phase of
the nurse-client relationship?
a. The client gains insight and incorporates alternative behaviors.
b. The client establishes rapport with the nurse and mutually develops
treatment goals.
c. The client explores feelings related to reentering the community.
d. The client explores personal strengths and weaknesses that Impact
behavioral choices.

45. Which client statement should a nurse identify as a typical response

to stress most often experienced in the working phase of the nurse-client
relationship?
a. I can’t bear the thought of leaving here and failing.
b. I might have a hard time working with you, because you remind me of
my mother.
c. I really don’t want to talk any more about my childhood abuse.
d. I’m not sure that I can count on you to protect my confidentiality.

Situation: Milieu therapy is a form of psychotherapy that involves the use

of therapeutic communities. During their stay, patients are encouraged to
take responsibility for themselves and the others within the unit, based
upon a hierarchy of collective consequences.

46. An angry client on an inpatient unit approaches a nurse stating,

“Someone took my lunch! People need to respect others, and you need to do
something about this now!” The nurse’s response should be guided by which
basic assumption of milieu therapy?
a. Conflict should be avoided at all costs on inpatient psychiatric
units.

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 b. Conflict should be resolved by the nursing staff.
c. On inpatient units, every interaction is an opportunity for
therapeutic intervention.
d. Conflict resolution should only be addressed during group therapy.

47. A client on an inpatient unit angrily says to a nurse, Peter is not

cleaning up after himself in the community bathroom. You need to address
this problem. Which is the appropriate nursing response?
a. I’ll talk to Peter and present your concerns.
b. Why are you overreacting to this issue?
c. You should bring this to the attention of your treatment team.
d. I can see that you are angry. Let’s discuss ways to approach Peter
with your concerns.

48. A newly admitted client asks, “Why do we need a unit schedule? I’m not
going to these groups. I’m here to get some rest.” Which is the most
appropriate nursing response?
a. The purpose of group therapy is to learn and practice new coping
skills.
b. Group therapy is mandatory. All clients must attend.
c. Group therapy is optional. You can go if you find the topic helpful
and interesting.
d. Group therapy is an economical way of providing therapy to many
client’s concurrently.

49. A client diagnosed with schizophrenia functions well and is bright,

spontaneous, and interactive during hospitalization but then decompensates
after discharge. What does the milieu provide that may be missing in the
home environment?
a. Peer pressure
b. Structured programming
c. Visitor restrictions
d. Mandated activities

50. To promote self-reliance, how should a psychiatric nurse best conduct

medication administration?
a. Encourage clients to request their medications at the appropriate
times.
b. Refuse to administer medications unless client’s request them at the
appropriate times.
c. Allow the clients to determine appropriate medication times.
d. Take medications to the client’s bedside at the appropriate times.

Situation: Schizophrenia requires lifelong treatment, even when symptoms

have subsided. Treatment with medications and psychosocial therapy can
help manage the condition. In some cases, hospitalization may be needed.

51. A 16-year-old client diagnosed with schizophrenia spectrum disorder

experiences command hallucinations to harm others. The client’s parents

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ask a nurse, “Where do the voices come from? Which is the appropriate
nursing response?
a. Your child has a chemical Imbalance of the brain, which leads to
altered perceptions
b. Your child’s hallucinations are caused by medication interactions.
c. Your child has too little serotonin in the brain, causing delusions
and hallucinations.
d. Your child’s abnormal hormonal changes have precipitated auditory
hallucinations.

52. Parents ask a nurse how they should reply when their child, diagnosed
with schizophrenia spectrum disorder, tells them that voices command him
to harm others. Which is the appropriate nursing response?
a. Tell him to stop discussing the voices.
b. Ignore what he is saying, while attempting to discover the underlying
cause.
c. Focus on the feelings generated by the hallucinations and present
reality.
d. Present objective evidence that the voices are not real.

53. A nurse is assessing a client diagnosed with schizophrenia spectrum

disorder. The nurse asks the client, “Do you receive special messages from
certain sources, such as the television or radio? The nurse is assessing
which potential symptom of this disorder?
a. Thought insertion
b. Paranoid delusions
c. Magical thinking
d. Delusions of reference

54. A client diagnosed with schizophrenia spectrum disorder states, “Can’t

you hear him? It’s the devil. He’s telling me I’m going to hell. Which is
the most appropriate nursing response?
a. Did you take your medicine this morning?
b. You are not going to hell. You are a good person.
c. The voices must sound scary, but the devil is not talking to you.
This is part of your illness.
d. The devil only talks to people who are receptive to his influence.

55. A client diagnosed with schizophrenia spectrum disorder tells a nurse

about voices commanding him to kill the president. Which is the priority
nursing diagnosis for this client?
a. Disturbed sensory perception
b. Altered thought processes
c. Risk for violence: directed toward others
d. Risk for injury

Situation: Depression is a mood disorder that causes a persistent feeling

of sadness and loss of interest and can interfere with your daily
functioning.

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56. A client is diagnosed with major depressive episode. Which nursing
diagnosis should a nurse assign to this client, to address a behavioral
symptom of this disorder?
a. Altered communication R/T feelings of worthlessness AEB anhedonia
b. Social isolation R/T poor self-esteem AEB secluding self in room
c. Altered thought processes R/T hopelessness AEB persecutory delusions
d. Altered nutrition: less than body requirements R/T high anxiety AEB
anorexia

57. A client diagnosed with major depressive episode hears voices

commanding self-harm. Which should be the nurse’s priority intervention at
this time?
a. Obtaining an order for locked seclusion until client is no longer
suicidal.
b. Conducting 15-minute checks to ensure safety.
c. Placing the client on one-to-one observation while continuing to
monitor suicidal ideations.
d. Encouraging client to express feelings related to suicide.

58. A nurse assesses a client suspected of having the diagnosis of major

depressive episode. Which client symptom would rule out this diagnosis?
a. The client is disheveled and malodorous.
b. The client refuses to interact with others and isolates self in room.
c. The client is unable to feel any pleasure.
d. The client has maxed-out charge cards and exhibits promiscuous
behaviors.

59. A nurse reviews the laboratory data of a client suspected of having

the diagnosis of major depressive episode. Which lab value would
potentially rule out this diagnosis?
a. Thyroid-stimulating hormone (TSH) level of 25 U/mL
b. Potassium (K+) level of 4.2 mEq/L
c. Sodium (Na+) level of 140 mEq/L
d. Calcium (Ca2+) level of 9.5 mg/dL

60. What is the rationale for a nurse to perform a full physical health
assessment on a client admitted with a diagnosis of major depressive
episode?
a. The attention during the assessment is beneficial in decreasing
social isolation.
b. Depression can generate somatic symptoms that can mask actual
physical disorders.
c. Physical health complications are likely to arise from antidepressant
therapy.
d. Depressed client’s avoid addressing physical health and ignore
medical problems.

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Situation: Anxiety disorders should be treated with psychological therapy,
pharmacotherapy, or a combination of both.

61. What symptoms should a nurse recognize that differentiate a client

diagnosed with panic disorder from a client diagnosed with generalized
anxiety disorder (GAD)?
a. GAD is acute in nature, and panic disorder is chronic.
b. Chest pain is a common GAD symptom, whereas this symptom is absent in
panic disorders.
c. Hyperventilation is a common symptom in GAD and rare in panic
disorder.
d. Depersonalization is commonly seen in panic disorder and absent in
GAD.

62. Which treatment should a nurse identify as most appropriate for

client’s diagnosed with generalized anxiety disorder (GAD)?
a. Long-term treatment with diazepam (Valium)
b. Acute symptom control with citalopram (Celexa)
c. Long-term treatment with buspirone (BuSpar)
d. Acute symptom control with ziprasidone (Geodon)

63. Which symptoms should a nurse recognize that differentiate a client

diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed
with obsessive-compulsive personality disorder?
a. Client’s diagnosed with OCD experience both obsessions and
compulsions, and client’s diagnosed with obsessive-compulsive
personality disorder do not.
b. Client’s diagnosed with obsessive-compulsive personality disorder
experience both obsessions and compulsions, and client’s diagnosed
with OCD do not.
c. Client’s diagnosed with obsessive-compulsive personality disorder
experience only obsessions, and client’s diagnosed with OCD
experience only compulsions.
d. Client’s diagnosed with OCD experience only obsessions, and client’s
diagnosed with obsessive-compulsive personality disorder experience
only compulsions.

64. A cab driver, stuck in traffic, becomes lightheaded, tremulous,

diaphoretic, tachycardic and dyspneic. A workup in an emergency department
reveals no pathology. Which medical diagnosis should a nurse suspect, and
what nursing diagnosis should be the nurse’s first priority?
a. Generalized anxiety disorder and a nursing diagnosis of fear
b. Altered sensory perception and a nursing diagnosis of panic disorder
c. Pain disorder and a nursing diagnosis of altered role performance
d. Panic disorder and a nursing diagnosis of anxiety

65. A client diagnosed with panic disorder states, “When an attack

happens, I feel like I am going to die. Which is the most appropriate
nursing response?

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 a. I know it’s frightening, but try to remind yourself that this will
only last a short time.
b. Death from a panic attack happens so infrequently that there is no
need to worry.
c. Most people who experience panic attacks have feelings of Impending
doom.
d. Tell me why you think you are going to die every time you have a
panic attack.

Situation: Trauma and stressor-related disorders are a group of emotional

and behavioral problems that may result from childhood traumatic and
stressful experiences. These traumatic and stressful experiences can
include exposure to physical or emotional violence or pain, including
abuse, neglect or family conflict.

66. A nursing instructor is teaching about trauma and stressor-related

disorders. Which student statement indicates that further instruction is
needed?
a. The trauma that women experience is more likely to be sexual assault
and child sexual abuse.
b. The trauma that men experience is more likely to be accidents,
physical assaults, combat, or viewing death or injury.
c. After exposure to a traumatic event, only 10 percent of victims
develop post-traumatic stress disorder (PTSD).
d. Research shows that PTSD is more common in men than in women.

67. Which factors differentiate the diagnosis of PTSD from the diagnosis
of adjustment disorder (AD)?
a. PTSD results from exposure to an extreme traumatic event, whereas AD
results from exposure to normal daily events.
b. AD results from exposure to an extreme traumatic event, whereas PTSD
results from exposure to normal daily events.
c. Depressive symptoms occur in PTSD and not in AD.
d. Depressive symptoms occur in AD and not in PTSD.

68. Which client would a nurse recognize as being at highest risk for the
development of an AD?
a. A young married woman
b. An elderly unmarried man
c. A young unmarried woman
d. A young unmarried man

69. A nursing instructor is explaining the etiology of trauma-related

disorders from a learning theory perspective. Which student statement
indicates that learning has occurred?
a. How client’s perceive events and view the world affect their response
to trauma.
b. The psychic numbing in PTSD is a result of negative reinforcement.

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 c. The individual becomes addicted to the trauma owing to an endogenous
opioid response.
d. Believing that the world is meaningful and controllable can protect
an individual from PTSD.

70. As the sole survivor of a roadside bombing, a veteran is experiencing

extreme guilt. Which nursing diagnosis would address this client’s
symptom?
a. Anxiety
b. Altered thought processes
c. Complicated grieving
d. Altered sensory perception

Situation: Somatic symptom disorder involves a person having a significant

focus on physical symptoms, such as pain, weakness or shortness of breath,
that results in major distress and/or problems functioning.

71. A client diagnosed with somatic symptom disorder (SSD) is most likely
to exhibit which personality disorder characteristics?
a. Experiences intense and chaotic relationships with fluctuating
attitudes toward others.
b. Socially irresponsible, exploitative, guiltless, and disregards
rights of others.
c. Self-dramatizing, attention seeking, overly gregarious, and
seductive.
d. Uncomfortable in social situations, perceived as timid, withdrawn,
cold, and strange.

72. A nurse is working with a client diagnosed with SSD. What criteria
would differentiate this diagnosis from illness anxiety disorder (IAD)?
a. The client diagnosed with SSD experiences physical symptoms in
various body systems, and the client diagnosed with IAD does not.
b. The client diagnosed with SSD experiences a change in the quality of
self-awareness, and the client diagnosed with IAD does not.
c. The client diagnosed with SSD disorder has a perceived disturbance in
body Image or appearance, and the client diagnosed with IAD does not.
d. The client diagnosed with SSD only experiences anxiety about the
possibility of illness, and the client diagnosed with IAD does not.

73. Which would be considered an appropriate outcome when planning care

for an inpatient client diagnosed with SSD?
a. The client will admit to fabricating physical symptoms to gain
benefits by day three.
b. The client will list three potential adaptive coping strategies to
deal with stress by day two.
c. The client will comply with medical treatments for physical symptoms
by day three.
d. The client will openly discuss physical symptoms with staff by day
four.

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74. Which are examples of primary and secondary gains that client’s
diagnosed with SSD: predominately pain, may experience?
a. Primary: chooses to seek a new doctor; Secondary: euphoric feeling
from new medications
b. Primary: euphoric feeling from new medications; Secondary: chooses to
seek a new doctor
c. Primary: receives get-well cards; Secondary: pain prevents attending
stressful family reunion
d. Primary: pain prevents attending stressful family reunion; Secondary:
receives get-well cards

75. An inpatient client is newly diagnosed with dissociative identity

disorder (DID) stemming from severe childhood sexual abuse. Which nursing
intervention takes priority?
a. Encourage exploration of sexual abuse.
b. Encourage guided Imagery.
c. Establish trust and rapport.
d. Administer antianxiety medications.

Situation: An eating disorder is a mental disorder defined by abnormal

eating habits that negatively affect a person's physical and/or mental
health

76. A nurse is attempting to differentiate between the symptoms of

anorexia nervosa and the symptoms of bulimia. Which statement delineates
the difference between these two disorders?
a. Client’s diagnosed with anorexia nervosa experience extreme
nutritional deficits, whereas client’s diagnosed with bulimia nervosa
do not.
b. Client’s diagnosed with bulimia nervosa experience amenorrhea,
whereas client’s diagnosed with anorexia nervosa do not.
c. Client’s diagnosed with bulimia nervosa experience hypotension,
edema, and lanugo, whereas client’s diagnosed with anorexia nervosa
do not.
d. Client’s diagnosed with anorexia nervosa have eroded tooth enamel,
whereas client’s diagnosed with bulimia nervosa do not.

77. A client diagnosed with a history of anorexia nervosa comes to an

outpatient clinic after being medically cleared. The client states, My
parents watch me like a hawk and never let me out of their sight. Which
nursing diagnosis would take priority at this time?
a. Altered nutrition less than body requirements
b. Altered social interaction
c. Impaired verbal communication
d. Altered family processes

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78. Family dynamics are thought to be a major influence in the development
of anorexia nervosa. Which statement regarding a client’s home environment
should a nurse associate with the development of anorexia nervosa?
a. The home environment maintains loose personal boundaries.
b. The home environment places an overemphasis on food.
c. The home environment is overprotective and demands perfection.
d. The home environment condones corporal punishment.

79. A client’s altered body Image is evidenced by claims of feeling fat,

even though the client is emaciated. Which is the appropriate outcome
criterion for this client’s problem?
a. The client will consume adequate calories to sustain normal weight.
b. The client will cease strenuous exercise programs.
c. The client will perceive personal ideal body weight and shape as
normal.
d. The client will not express a preoccupation with food.

80. A nurse is counseling a client diagnosed with bulimia nervosa about

the symptom of tooth enamel deterioration. Which explanation for this
complication of bulimia nervosa, should the nurse provide?
a. The emesis produced during purging is acidic and corrodes the tooth
enamel.
b. Purging causes the depletion of dietary calcium.
c. Food is rapidly ingested without proper mastication.
d. Poor dental and oral hygiene leads to dental caries.

Situation: Strong nursing leadership helps encourage other nurses to

function as team units. Nurses -- leaders or otherwise -- must have strong
interpersonal skills to be successful.

81. A patient complains to you that she has no idea who her nurse is on
any given day. I ask one nurse for my pills and she says, Thats not my
job. I ask the pill nurse about my lab tests and she says that I should
ask another nurse. This nursing care delivery model employed in this
situation might be particularly effective in:
a. Promoting communication among diverse team members.
b. Facilitating multiple perspectives on the total care of a patient.
c. Avoiding patient-provider conflict.
d. Developing competence and confidence in unskilled workers.

82. For a nurse manager in the functional nursing model, an approach that
will assist in maintaining staff satisfaction in this specific model is:
a. Rotation of task assignments.
b. Frequent opportunities for in-service education.
c. Orientation to job responsibilities and performance expectations.
d. Team social events in off hours.

83. In comparing team and functional models of care, a nurse manager

favors the team model. In particular, she finds that the team model:

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a. Can be effective in recognizing individual strengths and backgrounds of
staff.
b. Promotes autonomy and independence for the RN.
c. Avoids conflict because of role clarity.
d. Is efficient in delivering care to a large group of patients, utilizing
a staffing mix.

84. To effectively delegate in a team nursing environment, the RN team

leader must be familiar with the legal and organizational roles of each
group of personnel and must:
a. Be able to effectively communicate with patients.
b. Build relationships with physicians.
c. Be able to adapt to daily changes in staffing.
d. Adapt in communicating information to her supervisor.

85. A nurse manager questions the true difference between primary nursing
and total patient care. After careful consideration of both models, the
nurse manager concludes that primary nursing differs significantly from
total patient care in:
a. Breadth of nursing knowledge and expertise required.
b. Intention to provide holistic nursing.
c. Degree of task orientation.
d. Levels and types of assessment.

86. A conflict develops between an associate nurse and a primary nurse

over the assessment of a patient with pulmonary edema. Based on her
assessment of the patient, the associate nurse insists that it is her role
to change the care plan because she is the one who has made the
assessment. As the nurse manager, you clarify that:
a. It is the role of the primary nurse to make alterations based on
assessment data and input.
b. The associate nurse is accountable and responsible while the primary
nurse is off duty and therefore is able to alter the care plan.
c. Neither the primary nor the associate should make changes without first
consulting you as the manager.
d. It really does not matter who alters the nursing care plan as it
depends on situation and time to do so.

87. When comparing functional nursing and primary nursing, a nurse

manager, after evaluating particular models of nursing care for potential
adoption, determines that patient and nurse satisfaction in primary
nursing are:
a. Similar to those in functional nursing.
b. Not of significance in either model.
c. Low by comparison with functional nursing.
d. High when compared with functional nursing.

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88. In transitioning to a primary nursing model, it is Important for a
nurse manager who enjoys a high level of control over patient care to
understand that his or her decision making at the patient care level:
a. Is increased.
b. Is decreased.
c. Is relinquished.
d. Remains the same.

89. You are considering putting forward a proposal to move the model of
care from team nursing to a primary nursing hybrid: patient-focused care
model. In considering this proposal, you recognize that significant costs
specific to operationalizing this model are related to:
a. Implementation of an all-RN staff complement.
b. Significant changes in the physical structure of units.
c. Orientation of staff to new roles and responsibilities.
d. Testing and piloting technology at the bedside.

90. When hiring a case manager for a rehabilitation setting, you would
most likely consider a:
a. Registered nurse with a masters degree.
b. Physiotherapist with a background in stroke rehabilitation.
c. Social worker with a background in counseling.
d. Health professional with advanced background who is client and outcome
focused.

Situation: Nurses need research because it helps them advance their field,
stay updated and offer better patient care.

91. Research subjects in a study of body Image after mastectomy will

complete a questionnaire about body Image after surgery. Which assumption
would the researcher likely make when conducting this study?
a. All mastectomy patients are likely to be negatively affected by the
surgery.
b. Body Image and appearance are Important to survivors of breast
cancer.
c. Subjects will be able to describe a personal awareness of body Image.
d. Subjects will complete every item on the questionnaire.

92. Statements that will be scientifically tested as part of a research

study are called:
a. assumptions.
b. hypotheses.
c. limitations.
d. variables.

93. A study that analyzes the effect of exercise on diabetes control among
Native-American children with type II diabetes would most credibly be
generalizable to which population?
a. African-Americans with type II diabetes

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 b. Native-American children with type I diabetes
c. Children with type II diabetes
d. All people with type II diabetes

94. To evaluate data collection methodology prior to conducting a large-

scale study, a researcher might carry out a smaller-scale study. This
smaller-scale study is known as a/an:
a. abstract.
b. exploratory design.
c. pilot study.
d. proposal.

95. The nurse researcher is developing a study to examine the effects of

asthma education on missed school days among grade school children. When
defining the research problem in the research proposal, the nurse will
discuss:
a. the proposed methodologies for data collection.
b. statistics about the number of school days missed by children with
asthma.
c. the costs and types of various medications to treat asthma symptoms.
d. the need for future studies to examine asthma care for this
population.

96. Which portion of a research report would the nurse initially read to
get an overview of the study?
a. Abstract
b. Conclusion
c. Framework
d. Methodology

97. The section of a research report that describes the purpose of a

research study will include:
a. what relationships among key variables will be examined.
b. which various theories provide context for the research problem.
c. what is currently understood about the research problem.
d. why the research is necessary to help close a gap in knowledge.

98. A researcher conducts a review of relevant literature prior to

developing a research study in order to:
a. avoid duplication of research ideas.
b. determine which theoretical framework is best adapted to the research
problem.
c. determine which type of study would be most cost-effective.
d. identify what is known and unknown about a particular problem.

99. In a qualitative study to describe stages of grief, the researcher

asks parents who have lost a child to cancer to describe their experiences
with grief at specific time intervals after their childrens deaths. Which
assumption will the researcher make?

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 a. Study subjects have knowledge about theoretical concepts about grief.
b. Study subjects understand the concept of grief.
c. Subjects will be able to articulate their feelings coherently.
d. Subjects will be available for data collection at specific time
intervals.

100. How is theory tested in quantitative research?

a. Assumptions about the theoretical framework are evaluated.
b. Concepts become more clearly defined as they are tested.
c. Relationships among concepts are tested.
d. The entire theory is proven or disproven.

***** END OF EXAMINATION *****

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