CONFIDENTIAL HS/APR 2009/NRS476

UNIVERSITI TEKNOLOGI MARA

FINAL EXAMINATION

COURSE MENTAL HEALTH AND GERONTOLOGICAL

NURSING
COURSE CODE NRS476
EXAMINATION APRIL 2009
TIME 3 HOURS

INSTRUCTIONS TO CANDIDATES

1. This question paper consists of two (2) parts : PART A (50 Questions)
PART B (3 Questions)

2. Answer ALL questions from all two (2) parts :

i) Answer PART A in the OMR Multiple Choice Answer Sheet.

ii) Answer PART B in the Answer Booklet. Start each answer on a new page.
3. Do not bring any material into the examination room unless permission is given by the
invigilator.

4. Please check to make sure that this examination pack consists of:

i) the Question Paper

ii) an Answer Booklet - provided by the Faculty
iii) an OMR Multiple Choice Answer Sheet - provided by the Faculty

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

This examination paper consists of 13 printed pages
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PART A (50 marks)

Answer ALL questions.

Choose the MOST appropriate answer for each question.

1. One of the MOST important aspect of health care for the elderly is .

A. securing adequate income

B. maintaining family ties
C. ensuring adequate housing
D. focusing on chronic illness and disability

2. The cohort that is expected to be the largest consumers of healthcare in the next
three decades is known as the .

A. war generation
B. baby boomers
C. sandwich generation
D. generation X

3. Which theory of aging would be used for a person who says "the body just falls apart
when it gets old"?

A. Continuity.
B. Biologic.
C. Developmental.
D. Disengagement.

4. Which of the following represents an appropriate generalization about the elderly?

A. Intellectual decline begins at age 70.

B. The aging experience is unique to the individual.
C. Employee provident fund (EPF) proves an adequate level of income for most
elderly.
D. Psychological changes are unavoidable.

5. Which of the following nursing actions will help in maintaining safety for the elderly?

A. Encourage independence.
B. Orientation to new surrounding.
C. Ensure adequate hydration.
D. Provide for regular ambulation.

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6. Which of the following advice is MOST appropriate to be given to the spouse of an

client with Alzheimer's disease who frequently gets up during the night and wanders
around the house?

A. Increase daily activity by going for frequent short walks.

B. Try using a soft restraint jacket at night.
C. Contact the physician to obtain an order for a mild hypnotic or sedative.
D. Make sure the client takes a brief nap during the afternoon.

7. Potential complication of sleep deprivation in the elderly is .

A. unremitting fatigue
B. disorientation
C. sleepwalking
D. cardiac arrhythmias

8. Sleep disturbance in an elderly client who has been prescribed with diuretic might
cause .

A. nocturia
B. sleepwalking
C. nightmares
D. decreased of rapid eye movement (REM) sleep

9. When administering an analgesic to severe arthritis elderly client, the nurse should

A. administer analgesic before the activity session.

B. administer analgesic when the client complaints of pain.
C. administer analgesic at mealtime.
D. ensure that the medication is not a narcotic.

10. When assessing for pain in an elderly client with dementia, the nurse should

A. expect that the client is able to localize the pain.

B. look for signs of increased agitation or restlessness.
C. know that only family members could reliably point out the pain.
D. be aware that episodes of incontinence increase in the presence of pain.

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11. Which of the following observations is indicate of physical abuse in an elderly client?

A. Agitation.
B. Downcast eyes.
C. Dislocated shoulder.
D. Withdrawing from soft touch.

12. Impaired near vision, especially in clients over 45-years-old, often indicates

A. strabismus.
B. nystagmus.
C. myopia.
D. presbyopia.

13. The goal of nursing interventions for a bereaved elderly person is to

A. encourage verbalization about the loved one.

B. teach about the grieving process and offer support.
C. assist the bereaved individual to achieve a healthy adjustment to the loss.
D. guide the bereaved individual through the stages of grief in the usual order.

14. Palliative care for the elderly client with end-stage renal disease would be

A. pain relief.
B. ambulation as desired.
C. assessment for urinary output.
D. cardiopulmonary resuscitation (CPR) if needed.

15. During the aging process, the hair looks gray or white and begins to feel thin and fine.
This is due to decreased number of functioning

A. phagocytes.
B. melanocytes.
C. lymphocytes.
D. eosinophils.

16. A client with glaucoma has medication prescribed to decrease intraocular pressure.
Which of the following medication should be omitted?

A. Timolol maleate (Timoptic).

B. Levobunolol (Betagan).
C. Pilocarpine HCI (Isopto).
D. Artificial tears.

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17. An older client is receiving postural drainage treatments but is unable to expel the
secretions. The client is confused and having difficulty following instructions. The best
response by the nurse would be to

A. suck out the secretions.

B. administer humidified oxygen.
C. encourage the client to drink water.
D. change the client's position frequently.

18. Which of the following muscle exercises is frequently taught by nurses when caring
for clients with urge or stress urinary incontinence?

A. Kegel exercise.
B. Aerobic exercise.
C. Abdominal exercise.
D. Buerger Allen's exercise.

19. Osteoporosis is

A. loss of bone matrix.

B. loss of bone density.
C. a growth of weaker bone.
D. an increase in phagocytic activity.

20. The principal goals of therapy for older clients who have poor glycemic control is

A. enhancing the quality of life

B. improving self-care through education
C. decreasing the chance of complications
D. all of the above

21. The MOST important responsibility of the nurse when an elderly client has a seizure
is to .

A. prevent status epilepticus

B. provide oxygen immediately
C. prevent injury to the client
D. maintain the head-tilt chin-lift method

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22. An accurate description of a frail older person is one who

A. experiences frequent periods of depression.

B. is independent in performing of minimum activities of daily living.
C. exhibits dependence in several activities of daily living.
D. has a noticeable planned weight loss of 10 pounds in a year.

23. Alzheimer's disease (AD) is a

A. result of complex interactions between genetic and environmental factors.

B. form of dementia, with reversible manifestations of memory loss and altered
cognition.
C. form of dementia that begins with memory loss, which is immediately noticeable.
D. rapid, progressive, degenerative neurologic disease, which causes brain
degeneration without inflammation.

24. Gerontology nurses have the challenge to educate the older population and their
families that a healthy old age can be achieved by

A. reducing their chances of disability with vigorous exercises and balanced diet.
B. becoming aware that cultural motivation is the key to achieving a healthy old age.
C. taking advantage of recommended preventive health services and lifestyle
changes.
D. a shift in paradigm as it relates to dietary intake, rest, and yearly medical
interventions.

25. Which of the following statements BEST describe the treatment of pain at the end of
life?

A. As a client nears death, no pain is perceived and no medications are necessary.

B. It is important to withhold pain medications if the client has respiratory changes.
C. There is no maximum allowable dose for opioids during end-of-life care.
D. Nurses should not administer opioids to the dying client.

26. Which of the following is an example of disturbance of perception?

A. Flight of ideas.
B. Hallucination.
C. Thought withdrawal.
D. Ideas of reference.

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27. In assessing a client's suicide potential, which of the following statements by the
client would give the nurse the HIGHEST cause for concern?

A. "My thoughts of hurting myself are scary to me."

B. "I'd like to go to sleep and not wake up."
C. "I'd like to be free from all these worries."
D. "I've thought about taking pills and alcohol till I pass out."

28. Which of the following would indicate the required effect of intramuscular (IM)
chlorpromazine in paranoid schizophrenia client?

A. Complains of dry mouth.

B. States he feels restless in his body.
C. Stops pacing and sits with the nurse.
D. Exhibits increase activity and speech.

29. A client receiving haloperidol complains of stiff jaw and difficulty in swallowing. The
nurse's FIRST action is to.

A. administer oral orphenadrine as ordered.

B. reassure the client and tell him to rest in bed.
C. administer a prescribed dose of IM haloperidol.
D. administer IM ophenadrine as ordered.

30. A client with catatonic schizophrenia is mute, unable to perform activities of daily
living and stares out the window for hours. What is the nurse's FIRST action?

A. Assist the client with feeding.

B. Assist the client with showering.
C. Reassure the client about safety.
D. Encourage socialization with peers.

31. A client tells the nurse that the television newscaster is sending a secret message to
her. The nurse suspects that the client is experiencing following symptom?

A. delusion.
B. flight of ideas.
C. hallucination.
D. ideas of reference.

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32. Which nursing diagnosis should receive the HIGHEST priority for a client who
admitted with paranoid schizophrenia?

A. Ineffective family coping.

B. Impaired verbal communication.
C. Risk for violence toward self or others.
D. Imbalanced nutrition: Less than body requirements.

33. The side effect of prolonged use of antipsychotics drug are unusual movements of
the tongue, neck and arms. This condition is called .

A. dystonia
B. akathisia
C. tardive dyskinesia
D. neuroleptic malignant syndrome

34. The etiology of schizophrenia is BEST described by .

A. structural and neurobiological factors

B. environmental factors and poor parenting
C. genetics factor due to a faulty dopamine receptor
D. a combination of biological, psychological, and environmental factors.

35. Important teaching for clients receiving antipsychotic drugs, such as haloperidol,
includes which of the following instruction?

A. Abstain from eating aged cheese.

B. Take the antipsychotic drugs one hour before food.
C. Use sunscreen to reduce experiencing photosensitivity.
D. Have routine blood tests to determine levels of the drugs.

36. Which of the following are positive symptoms of schizophrenia?

A. Waxy flexibility, alogia, and apathy.

B. Flat affect, avolition, and anhedonia.
C. Hallucinations, delusions, and disorganized thinking.
D. Somatic delusions, echolalia, and a flat affect.

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37. Which of the following is NOT a desirable outcome when caring for a client with
schizophrenia?

A. The client spends more time by himself.

B. The client does not harm himself or others.
C. The client does not engage in delusional thinking.
D. The client demonstrates the ability to meet his own self-care needs.

38. A client with schizophrenia tells the nurse he hears the voices of his dead parents. To
help the client ignore the voices, the nurse should recommend that he should

A. engage in strenuous exercise

B. use a walkman and sing along with the music
C. sit in a quiet, dark room and concentrate on the voices
D. call a friend and discuss the voices and his feelings about them

39. Orphenadrine/benztropine administered with chlorpromazine is to

A. relieve anxiety
B. control nausea and vomiting
C. reduce psychotic symptoms
D. reduce extrapyramidal symptoms

40. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects
a belief that one is .

A. being persecuted
B. highly important or famous
C. responsible for the evil in the world
D. connected to events unrelated to oneself

41. An individual can usually reduce his/her anxiety caused by failures and frustration in
life with the use of .

A. alcohol
B. smoking
C. psychotropic drugs
D. defense mechanism

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42. Mental Disorder Ordinance (MDO) is an act of law that

A. enables the authorities to confine in hospitals anyone with emotional problems.

B. ensures all those with schizophrenia are admitted to psychiatric institutions.
C. ensures all those who commit crimes are punished by law.
D. ensures all those with mental illness are protected.

43. Which of the following forms will be signed by the doctor if he wants to admit a
person with emotional problems for observation?

A. A
B. B
C. C
D. G

44. Psychotherapy is the treatment of choice for clients with

A. anxiety neurosis.
B. major depression.
C. Alzheimer's disease.
D. cognitive impairment syndrome.

45. Delusions in a psychiatric client can be reduced when

A. the client is given antipsychotic drugs.

B. the client participates in group therapy.
C. clear explanations are given to the client about the delusions.
D. the nurse does not encourage the client to discuss his delusions.

46. An increased level of dopamine is said to be one of the causes for

A. mania
B. depression
C. schizophrenia
D. obsessive compulsive neurosis

47. Habit training should commence for a client with hebephrenia so that

A. he/she will be compliant with medication

B. his/her psychotic symptoms will disappear
C. he/she will be able to attend group therapy
D. his/her personality deterioration is slowed down

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48. Psychiatric clients can be non-compliant to medication because of the following

reasons EXCEPT

A. medication is expensive.
B. medication is not effective.
C. medication has many side effects.
D. client may feel that he/she has recovered.

49. A client with dementia needs reality orientation

A. to enable him/her to read and write

B. so that he/she does not become aggressive
C. to slow down his/her personality deterioration
D. to prevent other clients from disturbing him/her

50. The family of dementia client should be .

A. encouraged to look for a private nurse to take care of the client once thie client is
discharged
B. advised to register the client with the welfare department so that they can receive
assistance
C. informed that the client will not return to his/her former state of mental health
D. advised to place the client in a nursing home

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PART B (70 marks)

Answer ALL questions.

QUESTION 1

Madam Soh, an 80-year-old, is admitted with mild confusion. She is a resident of an old-
folk's home and no one is accompanied her on admission. The nursing home reported
that before this illness she was moderately independent, alert and oriented.

a) i) State TWO most important nursing diagnoses for Madam Soh.

(2 marks)
ii) Describe nursing interventions for the above nursing diagnoses.
(10 marks)
iii) Explain specific nursing interventions to assist communication with this client.
(5 marks)

b) A sleep pattern disturbance is a common problem in the elderly population. Discuss

nonpharmacologic measures that can be incorporated into an older adult's lifestyle to
facilitate sleep.
(8 marks)

QUESTION 2

a) Psychiatric disorders usually have multi-factorial etiology. Explain THREE of these

causative factors.
(6 marks)

b) Anti-psychotic drugs help to reduce psychotic symptoms.

i) Name FOUR common side effects of anti-psychotic drugs.

(2 marks)

ii) Explain how you would advice the client to overcome or reduce the above side-
effects.
(8 marks)

c) Explain briefly Peplau's THREE phases in a nurse-client relationship.

(9 marks)

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QUESTION 3

Mr. Joseph, a 25-year-old, was admitted to the psychiatric ward with a diagnosis of
bipolar affective disorder - manic phase. His father had complained to the admitting
doctor that Mr. Joseph had been aggressive at home and is very irritable.

a) Explain the mental assessment you would do for Mr. Joseph.

(8 marks)

In the ward, the client was noted to be over-friendly and elated.

b) Explain the appropriate nursing intervention that you would take to ensure that he is
not exploited.
(6 marks)

Mr. Samuel has slept only two to three hours since admission.

c) Explain the nursing interventions you would take to help the patient sleep.
(6 marks)

d) What is a delusion? Give TWO examples of delusions.

(5 marks)

END OF QUESTION PAPER

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