Jenny is discharged.

The next week she telephones and asks if she should have her usual
dose of insulin as she has influenza and no appetite. What is the most appropriate advice
Jenny should be given?
A) Omit her injection for that day.
B) Tell her to telephone her doctor.
C) Inject herself and take extra sugar drinks.
D) Tell her to give herself an injection later on.

Mrs Stone, aged 38, is admitted to hospital after a motor vehicle accident. Mrs Stone has
one litre of fluid running intravenously every 12 hours. The drop factor of the metriset is 60
drops per minute. How many drops per minute should be given?
A) 68 drops per minute.
B) 83 drops per minute.
C) 96 drops per minute.
D) 120 drops per minute.

Mrs Stone has severe bruising. Her condition begins to deteriorate and she complains of
abdominal pain and swelling. After assessing her vital signs what is the appropriate further
assessment to make before contacting the doctor?
A) Assess her urine output.
B) Assess the intravenous flow rate.
C) Measure her abdominal girth.
D) Check if her bowels have moved.

Pethidine 75 mg is prescribed. The ampoule available contains 100 mg in 2 ml. How much
should be given?
A) 0.75 ml. B) 1.25 ml. C) 1.425 ml. D) 1.5 ml.

The intravenous infusion prescription is changed to be completed in 4 hours' time and has
600ml left in the bottle. The drop factor is 15 drops per ml. How many drops per minute will
ensure the infusion finishes at the correct time?
A) 24. B) 27. C) 34. D) 37.

Mrs Stone's condition stabilises. The intravenous infusion is removed. Three days later her
temperature is again 39 °C. Which of the following actions should you take immediately?
A) Administer panadol.
B) Check her urine and sputum.
C) Check her wound and drain sites.
D) Give her a tepid sponge.

Why does the nurse check the gastric contents of a naso-gastric tube with litmus paper
before feeding?
A) To find out if the stomach contents are acid.
B) To ensure the stomach contents are alkaline.
C) To find out if the naso-gastric tube is in the stomach.
D) To ensure the food has been thoroughly digested
Mrs Stone is to have a unit of blood. Why is it very important to administer blood at the
correct rate?
A) To prevent anaphylaxis. B) To prevent fluid overload. C) To prevent hypertension. D) To
prevent palpitations.

Half an hour after the unit of blood is commenced, Mrs Stone has a raised temperature of
39 °C. She is shaking and complains of feeling cold. What is the immediate action to take in
this situation?
A) Stop the blood.
B) Ring the doctor.
C) Reassure Mrs Stone.
D) Give her a tepid sponge.

After seven days Mrs Stone is ready for discharge. What advice should she receive regarding
her wound care?
A) Cover it with a dry dressing until sutures are removed in 10 days.
B) Check her wound daily for signs of inflammation or oozing.
C) Explain that the district nurses will call daily to check her wound.
D) There is no further need to worry as wounds heal within seven days.

Mr H, aged 35, is admitted informally to the acute psychiatric unit diagnosed as bipolar
disorder, manic phase. Mr H is placed in the acute wing with eight other patients.
This phase of Mr H's illness is typically characterised by
A) distractibility, suspiciousness and psychomotor acceleration.
B) overactivity, insomnia and increased libido.
C) pressure of speech, inhibition and destructiveness.
D) acute onset, confabulation and extravagance.

The IMMEDIATE nursing measure for Mr H will be to

A) restrict the stimulation in his environment.
B) provide for his personal security.
C) provide for his psychological safety.
D) restore his physical health status.

Mr H leaves his room and races along the corridor singing, speaking in rhymes and laughing
loudly. The MOST effective nursing measure for Mr H will be to
A) replace him in his room and lock the door.
B) write a contract for Mr H to stay in his room.
C) provide activities in his room to occupy his time.
D) escort Mr H to his room immediately.

During the afternoon you find Mr H sitting on his bed, crying. The MOST therapeutic
approach to him would be to
A) state that this is a manifestation of guilt.
B) withhold further doses of his prescribed medication.
C) confront Mr H with his annoying behaviour.
D) sit with Mr H until this phase passes.
Mr H's speech includes sentences such as, "In the stir, sir, I'll purr with fur, like fir in a
forest." This is an example of
A) Neologisms
B) Verbigeration
C) Clang Associations
D) Confabulation

Your assessment of Mr H indicates he is constipated. This is MOST likely due to

A) inability to recognise his elimination needs. B) the cholinergic effect of medication.
C) reduced peristalsis of the bowel.
D) his physical inactivity.

Mr H is charted lithium carbonate (Camcolit) 500 mg nocte. Common initial side effects
would include
A) dry mouth, rashes and tremor of the hands. B) akathisia, constipation and marked thirst.
C) fine tremor, nausea and polydipsia.
D) photosensitivity, pallor and dizziness.

Mr H refuses his lithium carbonate medication, stating "I don't need that stuff. I'm not sick."
The BEST response to Mr H would be
A) "You are sick and need this medication."
B) "You must take your medication."
C) 'Why don't you want to take your medication?" D) "These tablets will help stabilise your
moods."

Mr H states, "I can leave anytime I want. Why am I still here?" The MOST therapeutic
response would be
A) "You sound frustrated and want to go home."
B) "You must stay here until you are more settled."
C) "I am sure your family would not want you home like this."
D) ''We would prefer that you were more settled before you leave."

Mr H becomes irritable at being in hospital. It is decided to give him a short task to do.
Which of the following would be MOST appropriate?
A) Assembling a simple model.
B) Sweeping a small courtyard.
C) Cleaning out kitchen cupboards.
D) Making something in wood.

Mr J was first admitted to a psychiatric hospital 10 years ago at the age of 19, with an acute
schizophrenic illness. He has had a series of admissions since that time and his diagnosis has
been reviewed and is now residual schizophrenia.
Residual schizophrenia is characterised by
A) paranoid delusions and hallucinations.
B) independent coping with the symptoms.
C) affective ability and inability to socialise.
D) withdrawal, impoverished ideation and inability to socialise.

Mr J does not like going outside the hospital. This reluctance to leave the hospital is MOST
likely due to his
A) many friends in hospital.
B) non-compliance with medication.
C) institutional neurosis.
D) belief that he is not ill.

Mr J states, "You people are forcing me to leave hospital." Your best reply is
A) ''Why do you think this Mr J?"
B) "No Mr J, that is not true."
C) "No, we are preparing you to live in the community."
D) "You would never leave hospital if we didn't.

Mr J is prescribed chlorpromazine (Largactil) 100 mg B.D. The MOST common side effects of
chlorpromazine are
A) drowsiness, hypotension, restlessness and tremor.
B) agranulocytosis, proliferative effects and jaundice.
C) photosensitivity, hypertension and tardive dyskinesia.
D) urinary retention, constipation and agranulocytosis.

Mr J complains of a sore throat. As the staff nurse you should

A) supply him with throat lozenges.
B) give him copious fluids.
C) continue with his medication regime.
D) notify the medical officer.

Following investigation, it is decided Mr J is suffering from agranulocytosis. This is a

condition in which there is a/an
A) increased number of white blood cells. B) decreased number of white blood cells. C)
increased number of red blood cells. D) decreased number of red blood cells.

Mr J develops drug induced Parkinsonism. The drug he is most likely to have prescribed to
lessen this side effect is
A) Levodopa (L-dopa).
B) Perphenazine (Trilafon).
C) Trifluoperazine (Stelazine).
D) Benztropine (Cogentin).

The most appropriate way to help Mr J socialise is to

A) participate in a quiet game with him.
B) place him in the centre of an activity and encourage him to participate. C) encourage him
to play table tennis.
D) encourage him to join in a group sing-song.
The emotional state most characteristic of persons with residual schizophrenia like Mr J is
one of
A) happiness and elation. B) apathy and flatness.
C) sadness and depression. D) anger and hostility.

The ward team are planning the long term placement for Mr J. This will MOST probably be
in
A) a long term ward for the rest of his life.2 B) the psychogeriatric ward.
C) A hospital house
D) a flat by himself.

Mrs W, who is 48 years old, was brought into hospital by her husband. She had sandals on
and dirty, swollen feet, and wore a stained, crumpled dress. She moved slowly and looked
confused. Her provisional diagnosis is Paranoid Schizophrenia. You are her primary nurse.
Your PRIORITY action during Mrs W's admission should be to
A) ensure Mrs W complies with treatment.
B) help her get acquainted with others.
C) form a therapeutic relationship with her. D) provide her with a bath and clean clothes.

It is Mrs W's first admission to hospital. A favourable prognosis would be associated with
which of the following?
A) Emotional flattening.
B) Gradual onset of illness.
C) Lengthy illness prior to hospitalisation.
D) Good social adjustment prior to present illness.

When spoken to Mrs W stares blankly and mutters unintelligibly to herself. This is BEST
recorded as
A) "uncooperative during admission procedure."
B) "not able to answer questions at this time."
C) "responded to questions with a blank look and incomprehensible mumble." D) "stared at
nurse when questioned, was disorientated and incoherent."

At times Mrs W displays an air of arrogance and superiority, concealing feelings of inferiority
and inadequacy. Which of the following is she using to protect her self- esteem?
A) Rationalisation and symbolism. B) Reaction formation.
C) lntrojection and denial.
D) Repression and undoing.

Mrs W is having difficulty expressing herself verbally. Which of the following is MOST LIKELY
to help Mrs W?
A) Asking questions to draw her out.
B) Saying what you think she is experiencing.
C) Making frequent remarks about her condition.
D) Sitting with your hand on top of hers
Like many sufferers of schizophrenia, Mrs W experiences ambivalence. This is best
described as
A) contradictory feelings, ideas and wishes. B) inability to experience pleasure.
C) feeling unrelated to the environment.
D) emotional detachment from others.

Mrs W often does the opposite to what is requested of her.

Which action will MOST LIKELY get her to the dining room for meals?
A) Ask her to eat in her room alone.
B) Wait for her to get hungry enough to come alone.
C) Say it is lunch time and show her to the dining room. D) Get other staff to help you get
her to the dining-room.

When upset Mrs W curls up on the bed with her knees under her chin. Which defence
mechanism is she using?
A) Regression. B) Substitution. C) Symbolism. D) Repression

Mrs W refers to nurses as "hems", her husband as "hoomaloony" and a cigarette as a "flim-
flam-jam". This is an example of
A) impoverished thinking. B) illusions.
C) neologisms.
D) loosening of association.

Mrs W has two children being cared for by a friend. After visiting, Mrs W tells the nurse that
the friend has turned her children against her. Which of the following interventions would
be MOST THERAPEUTIC?
A) Tell Mrs W that the friend cannot bring the children in to visit. B) Ignore this remark and
focus Mrs Won her physical needs.
C) Suggest Mrs W arrange for someone else to look after them. D) Ask Mrs W to explain why
she believes this.

Dan, a 19-year-old unemployed labourer, has a history of violent behaviour with outbursts
of verbal and physical aggression. His attack on a factory foreman led to Dan's admission to
hospital with a psychiatric diagnosis of personality disorder.
Dan's personality disorder is of which type?
A) Paranoid. B) Antisocial. C) Histrionic. D) Schizoid

Dan's childhood experiences probably included attitudes of significant others that were
A) cold and rejecting.
B) overprotective and submissive. C) caring but demanding.
D) trusting and inconsistent.

In social relationships Dan's behaviour will probably indicate

A) shyness.
B) self-centeredness. C) grandiosity.
D) anxiety.
Dan's main problem is likely to be
A) a low tolerance of frustration and stress.
B) a distorted perception of the actions of others.
C) his uncertainty and apprehension.
D) his dependence on other people.

The MAIN therapeutic intervention is to assist Dan to

A) improve his social relationship skills. B) develop insight into his behaviour. C) develop
controls on his behaviour. D) set realistic goals for himself

Dan's INITIAL behaviour is compliant. This is MOST probably due to his

A) knowing his limitations.
B) wanting to assess his surroundings.
C) not wanting any medication.
D) overwhelming anxiety.

The therapy of choice for Dan would be

A) psychotherapeutic drugs. B) behaviour therapy.
C) insight psychotherapy.
D) supportive group therapy.

Early in Dan's relationship with staff he will be helped to

A) become responsible for his behaviour. B) decrease his apprehension.
C) develop long term goals.
D) develop insight into his illness.

Dan provokes a fight with another client. It is MOST therapeutic for Dan to have to
A) apologise to all the other clients.
B) undergo appropriate punishment.
C) lose all his previously earned privileges.
D) forego earning other privileges for one month.

When preparing Dan for discharge, the MAJOR consideration should be his
A) previous pattern of functioning.
B) level of self-esteem.
C) maintenance of control of his behaviour.
D) formation of effective social relationships.

Mrs B is a 50-year-old married woman admitted for the third time. She has no children but
her husband has always been very supportive. Her diagnosis is Bipolar disorder, circular type
but currently depressed.
At meal times Mrs B refuses to eat, stating "my bowels have rotted away, it is no good me
eating anything." This is an example of
A) a nihilistic delusion.
B) a tactile delusion.
C) a persecutory delusion. D) derealisation.
The MOST effective approach in dealing with Mrs B's statement is to
A) try to change her belief by reasoning with her. B) agree with what she says.
C) divert the conversation to another topic.
D) find out why she believes this.

On the second day of her stay you find her crying on her bed. She states that she will never
get better. The MOST therapeutic response would be
A) "You're just having a bad patch, come and watch the cricket." B) "You will get worse
before you get better."
C) "Did your husband's visit upset you?"
D) "I know you can't believe it, but you will feel better eventually."

Nursing intervention includes making frequent contact with Mrs B. The MOST IMPORTANT
reason for doing so is to
A) protect her from suicide.
B) provide contact with reality.
C) reduce her anxiety level.
D) show that the staff are concerned

You are taking the activity - to make a collage of "My Life". Mrs B has only two small pictures
on her sheet of paper at the end of the group. You should
A) ask her if she's finished.
B) ask her to explain her collage. C) tell her it is lovely.
D) thank her for her contribution.

Mrs B is prescribed a short course of electroconvulsive therapy. Mrs B states that she is
dreading electroconvulsive therapy and is scared. The BEST helpful response you can make
is
A) "I know it is unpleasant. Try not to be afraid. It will help you." B) "You seem very anxious.
I will stay with you during treatment." C) "Most people are afraid. That's all right."
D) "Cheer up; there is nothing to worry about."

Routine nursing care of Mrs B post electroconvulsive therapy involves all of the following
EXCEPT
A) returning the patient's property promptly.
B) assisting the patient to gain insight into her behaviour.
C) preparing a light meal and hot drink for the patient.
D) watching for signs and symptoms such as nausea, vomiting or headache.

Electroconvulsive therapy is MOST frequently prescribed for clients with symptoms of

A) paranoid ideation.
B) mild depression.
C) hebephrenic schizophrenia. D) severe depression.

Mrs B is right-handed. Electroconvulsive therapy would MOST likely be given by placing

A) one electrode on the right side of her skull. B) one electrode on the left side of her skull.
C) both electrodes on the right side of her skull. D) both electrodes on the left side of her
skull.

Unilateral electroconvulsive therapy (ECT) is used in preference to bilateral because it

A) is more effective.
B) has less severe side effects.
C) does not induce the same degree of convulsion.
D) is effective in disorders which do not respond to bilateral ECT.

Mr D, a 47-year-old market gardener, is admitted to a neurological unit for assessment after

his wife took him to their family doctor. He is confused and disorientated and a provisional
diagnosis of delirium is made. You are his primary nurse and are admitting him.
Mrs D states, "I knew something was wrong yesterday." Which of the following signs would
Mrs D have noticed FIRST?
A) Disorientation. B) Confusion.
C) Drowsiness. D) Hallucination.

Mr D presents with clouding of consciousness. This is best described as

A) confusing the source of any stimuli. B) inability to see clearly.
C) a reduced level of alertness.
D) loss of response to any stimuli.

You notice Mr D is wearing an expensive gold watch. You should

A) check that Mr D knows he is wearing it. B) mark it on his property sheet.
C) give it to his wife to take home.
D) put it in his locker drawer.

Mrs D has brought her husband's favourite dressing gown. You should
A) put it in the ward storeroom. B) use a hospital gown.
C) hang it up in his room.
D) say it won't be needed.

Mr D would be placed in which of the following?

A single room.
B) quiet dormitory. C) four bed unit. D) seclusion room.

It has been noticed Mr D becomes more agitated whenever his family visits him. It would be
MOST therapeutic to
A) ask all visitors to leave.
B) stay with Mr D during visiting. C) limit his visitors to one.
D) record this in his notes.

Mr D's condition continues to deteriorate and his wife becomes visibly upset on her next
visit. You should
A) suggest she not visit for several days.
B) allow Mrs D to discuss her fears with you.
C) tell her that her husband will make a full recovery. D) make an appointment for her to see
the doctor.

Other ward staff are called away to an emergency in the next unit. You should
A) stay with Mr D.
B) attend the emergency.
C) leave only if Mr D appears settled.
D) go but check Mr D every ten minutes.

Mr D makes crude and suggestive remarks to another client's visitor. You should
A) tell him that those comments are not acceptable. B) ask him to apologise to her on her
next visit.
C) ask the doctor to medicate Mr D.
D) apologise to the visitor on Mr D's behalf.

Mr D mumbles incoherently to himself. This MOST PROBABLY indicates

A) disorganised thinking. B) perseveration.
C) a perceptual disorder. D) he is hallucinating.

Following a television programme on "Mental Health", a young mothers' group asks you to
speak to them about mental health. Indicate the MOST appropriate response to the
following questions asked after your presentation.
Statistically, what is the percentage of a population that is likely to have some form of
mental illness during their lifetime?
A) "Between 2 and 3%." B) "Approximately 5%." C) "Between 7 and 8%." D) "Above
10%."
Can mental illnesses be cured?
A) "As yet there is no one cure for mental illness."
symptoms of most mental illnesses."
B) "Almost all persons can be returned to the community free of symptoms."
C"There are treatments that can control the symptoms of most mental illnesses."
D) "Because of the variety of illnesses there is no answer."

Can stress alone cause mental illness?

A) "Only if a person is subject to an abnormal amount of stress."
B) "Stress plays a small part in the development of mental illnesses." C) "It is not the most
important factor in any illness."
D) "It is how people react to stress that is important."

What are some examples of the cause of stress? "Stressors may be

A) having a child."
B) moving to own home." C) job promotion."
D) all of the above.

What is the best way to deal with negative feelings?

A) "Channel these into work related tasks."
B) "Share these feelings with people you are close to."
C) "Accept your feelings as part of your make up."
D) "Freely admit your feelings whenever you are aware of them.

What helps to promote a person's mental health?

A) "Learning many psychological defences." B) "Patterning one's behaviour."
C) "Wanting to improve oneself."
D) "Controlling one's environment."

How do close friends help in maintaining one's mental health? "By

A) allowing the venting/sharing of feelings." B) giving continuous reinforcement."
C) providing solutions to problems."
D) minimising any criticisms."

Primary prevention of mental illness refers to

A) identifying the causes of mental illness and removing these.
B) providing safety and security for all of the population.
C) establishing valid assessment tools for all groups.
D) assessing and treating stress-related illnesses.

Secondary prevention of affective disorders includes

A) providing the client's relations with effective coping skills
B) implementing effective treatments following early diagnosis.
C) treating the whole family rather than the individual.
D) using community resources to prevent hospitalisation.

Tertiary prevention of schizophrenic illnesses includes

A) providing effective rehabilitation and early return to the community
B) hospitalising clients to ensure they receive consistent treatments.
C) use of adequate assessment and diagnostic techniques. D) providing a full range of
services to hospitalised clients.

Mrs S, a widow, aged 78, has become increasingly forgetful and unable to care for herself.
She wanders away from home frequently and argues constantly. A diagnosis of Alzheimer's
disease is made and the family arrange to place Mrs S in a Geriatric Assessment Unit.
Nursing assessment of Mrs S would MOST PROBABLY reveal which of the following cognitive
changes?
A) Decreased use of words. B) Disorientation in person. C) Tangential thinking.
D) Impaired memory.

Mrs S becomes more confused after her admission. Which of the following nursing actions
would be MOST helpful to decrease her confusion?
A) Assist her with everything she does.
B) Follow her usual daily routine closely.
C) Explain everything in detail.
D) Restrict visitors during the first two weeks.
Mrs S's confusion is probably caused by
A) anger towards her daughter. B) unfamiliar surroundings.
C) increased brain deterioration. D) decreased self-awareness.

Mrs S frequently wanders out to the street.

he MOST EFFECTIVE nursing intervention would be to A) guide Mrs S back to the lounge.
B) confine Mrs S to her room.
C) direct her to return to her room.
D) give her a map of the unit.

Mrs S repeatedly attempts to leave the Unit, stating "My husband is waiting for me. I have
to go home now." The MOST therapeutic response is
A) "He knows you are here. Come back in now."
B) "Come and see what the others are doing."
C) "You can't leave. You have to stay here now."
D) "Your husband died five years ago and you are in hospital now."

Parents have sought the advice of the Plunket nurse concerning their pre-school child
touching his genitals. The nurse should acknowledge their concern and suggest that the
parents
A) make an appointment with the child health clinic.
B) keep the child in constant view until the phase passes.
C) deal with the matter casually.
D) discuss the harm of masturbation openly and frankly with the child.

When interviewing a parent of three pre-school children at the Plunket Clinic, the nurse
should focus on
A) only the newborn infant. B) all children in the family. C) the entire family.
D) how the mother is coping.

One of the basic assumptions about community health nursing practice is that the family
A) will accept the nurse's intervention.
B) has the responsibility and right to make its own decisions.
C) will contact only those agencies to which they are referred.
D) will be guided by the nurse's definition of their health problems.

The health supervision of school-age children is the MAJOR responsibility of the

A) District nurse.
B) Practice nurse.
C) Plunket nurse.
D) Public Health nurse.

Community health programmes place emphasis on

A) changing social and environmental conditions. B) curative treatment of disease.
C) early diagnosis and treatment of disease.
D) identifying major causes of illness.