NFDN 2007

MIDTERM REVIEW
2019
Which of the following would the nurse see as
signs of alcohol withdrawal?
a. coma, disorientation, and hyper vigilance
b. tremulousness, sweating, and elevated B/P
c. increased temperature, lethargy and hypothermia
d. talkativeness, hyperactivity and blackouts
How long does it take for light therapy to
decrease SAD symptoms?
a. 2-4 days
b. 1-4 days
c. 1-5 days
d. 2-5 days
What would we do with a pt. in a manic state
who is screaming and yelling at other pts?

a. Yell back at them and return them to their room

b. Call their family
c. Just let them scream and yell
d. Quietly remove them and return them to their room.
Stop and Consider
 An alcohol dependent client is brought to the ER severely intoxicated.
 They are slurring their words, shouting and having visual
hallucinations --- cockroaches climbing up the walls.

 What is the priority nursing diagnosis?

 SAFETY IS #1 Priority
Which type of speech pattern is being used?

1. It’s time to eat, to eat, to eat

2. Tick-tock said the clock in the sock
3. Do you have any theplz? I like theplz.
4. Jump, corn, summer, rivers
True or False?
• Many psychiatric medications are anticholinergic.
The effects of anticholinergic include:
a. dry mouth
b. constipation
c. urinary retention
d. confusion with elderly patients
e. all the above
Dopamine is:
a. an inhibitory transmitter
b. an excitatory transmitter
c. does both
d. does neither
 Nurse taking care of a client in alcohol withdrawal would
need to administer diazepam (Valium) for what symptom?

a. BP 168/105
b. Pulse 84
c. Resp 20
d. temp 38.4
What is the difference between Schizophrenia
and Schizophrenia-Affective Disorder?
a. One has a mood disorder in its diagnosis
b. Both have a mood disorder in its diagnosis
c. One has no delusions or hallucinations
d. Both have no mood disorder in its diagnosis
Dysthymic disorder is:
a. More serious then MDD
b. Milder but more chronic than MDD
c. Has manic episodes
d. Has euphoric periods
True or False?
Serotonin is:
a. increased levels associated with depression and insomnia
b. decreased levels associated with mania
Which neurotransmitter has a direct
effect on the sleep/wake cycle?

a. GABA
b. Histamine
c. Acetylcholine
d. Norepinephrine
Foundation of Biologic Basis includes:
(Select all that apply)
a. View the symptoms they are portraying
b. Increased risk if in your family
c. Environment plays a role
d. How your parents raised you
SSRI drugs are what?

a. Valium and Librium

b. Elavil and Paxil
c. Paxil and Prozac
d. Prozac and Lithium
Neurotransmitter that is implicated in Schizophrenia is?

a. Increased serotonin
b. Increased norepinephrine
c. Decreased serotonin and dopamine
d. Increased dopamine
Lithium levels are drawn due to :
a. our bodies like lithium
b. it is similar to sodium and is reabsorbed
c. acts as a CNS depressant
d. it is like potassium and affects the heart
What is a desired outcome of behavior
modification?
a. Client must practice new coping behaviours
b. Teach the reasons for changes in behaviours
c. Client will demonstrate and appropriate mood and affect
d. Healthy behaviours replace inappropriate ones
Which of the following would the nurse see as
signs of alcohol withdrawal?

• A) coma, disorientation, and hyper vigilance

• B) tremulousness, sweating, and elevated B/P
• C) increased temperature, lethargy and hypothermia
• D) talkativeness, hyperactivity and blackouts
Nurse taking care of a client in alcohol withdrawal would
need to administer diazepam (Valium) for what symptom?

• A) BP 168/105
• B) Pulse 84
• C) Resp 20
• D) temp 38.4
SSRI drugs are what?

• A) valium & Librium

• B) Elavil and Paxil
• C) Paxil & Prozac
• D) Prozac and Lithium
Mood stabilizers are usually prescribed for:
a. Bipolar II
b. Bipolar I
c. Manic disorder
d. Depressive disorder
Neurotransmitter that is implicated in Schizophrenia is?

• A) increased serotonin
• B) Increased Norepinephrine
• C) Decreased Serotonin and Dopamine
• D) increased Dopamine
What are the phases of Bipolar?
a. Acute, continuation and discontinuation
b. Acute, maintenance and discontinuation
c. Acute, continuation, maintenance and discontinuation
d. Continuation, maintenance and discontinuation
Lithium levels are drawn due to :
• A) our bodies like lithium
• B) It is similar to sodium and is reabsorbed
• C) Acts as a CNS depressant
• D) It is like potassium and affects the heart
What is a desired outcome of behavior
modification?

• A) Client must practice new coping behaviours

• B) Teach the reasons for changes in behaviours
• C) Client will demonstrate and appropriate mood and affect
• D) Healthy behaviours replace inappropriate ones
Which of the following is a cognitive
psychological intervention?

A) Validating
B) Anticipating needs
C) Rewarding positive behavior
D) Exploring beliefs
Antipsychotics work by:

• A) controlling agitation, hallucinations and thought disturbances

• B) Increase feelings of self worth
• C) Are a CNS depressant
• D) Help with insomnia and healthy behaviours
What statement best explains a bipolar disorder?

• A) two episodes of depression in a row.

• B) Delusions of grandeur with depression
• C) Mood swings with periods of normalcy
• D) insomnia or hypersomnia for more than two weeks
What are Negative symptoms of Schizophrenia?

• A) lack of motivation, hallucinations, restless

• B) emotional withdrawal, sleep disorder, lack of hygiene
• C) slow speech, blunted emotions, disordered thoughts.
• D) elevated status, delusions, hyperactive
Ken is admitted with Wernicke’s syndrome, what is the best
treatment?

• A) Vitamin K
• B) Riboflavin
• C) Vitamin D
• D) Thiamine
What does Anhedonia mean?
a. Lack of sleep
b. Feeling of euphoria
c. Unable to stop crying
d. Inability to experience any pleasant emotion
What is the purpose of the thalamus?

• A) cognitive disturbances
• B) Side effects of some medication
• C) decreased motor activity
• D) works with dopamine
Nurses need to know what common side effects
of antipsychotic medications?

• A) need to understand the action of norepinephrine

• B) How it decreases dopamine
• C) the action of acetylcholine
• D) the decrease of serotonin
What symptoms would be noted if Anti-anxiety
drugs are working?

• A) crying & sad facial expression

• B) decreased BP, HR and respirations
• C) Anger
• D) smiling & decreased HR and BP
Milieu Therapy
a. Is behavioral therapy
b. Group psychotherapy
c. Support the clients safety in a familiar environment
d. Unstructured interactions
What are Negative symptoms of Schizophrenia?
a. Lack of motivation, hallucinations, restless
b. Emotional withdrawal, sleep disorder, lack of hygiene
c. Slow speech, blunted emotions, disordered thoughts.
d. Elevated status, delusions, hyperactive
The client that displays limited range of emotions during an MSE (mental
status exam) would be described as having which of the following affects?

a. Flat
b. Labile
c. Normal
d. Blunted
What is an illusion?
a. False sensory perception no associated with real external stimulus
b. Hearing voices
c. Feeling bugs crawling on their back
d. Misperception of a real external stimulus
Rapid, continuous verbalization with frequent shifting from
one topic to another defines?
a. Flight of ideas
b. Circumstantiality
c. Loosening of associations
d. Tangentially
Using phrases with similar sounds, including rhyming with no
meaning between the words is an example of what thought
process

a. Echolalia
b. Verbigeration
c. Clang Association
d. Word Salad
Ken is admitted with Wernicke’s syndrome, what is the best
treatment?
a. Vitamin K
b. Riboflavin
c. Vitamin D
d. Thiamine
In what order is the 5 stages of change approach?
a. Preparation, action, maintenance, contemplation, precontemplation
b. Contemplation, preparation, precontemplation, action, maintenance
c. Precontemplation, preparation, action, contemplation, maintenance
d. Precontemplation, contemplation, preparation, action, maintenance
What is the purpose of the thalamus?

a. Cognitive disturbances
b. Side effects of some medication
c. Decreased motor activity
d. Works with dopamine
Nurses need to know what common side effects
of antipsychotic medications?

a. Need to understand the action of norepinephrine

b. How it decreases dopamine
c. The action of acetylcholine
d. The decrease of serotonin
What symptoms would be noted if Anti-anxiety
drugs are working?
a. Crying and sad facial expression
b. Decreased BP, HR and respirations
c. Anger
d. Smiling and decreased HR and BP
 Stop and Consider
o What behavior would you expect from a person who is
acutely psychotic??
Milieu Therapy
a. Is behavioral therapy
b. Group psychotherapy
c. Support the clients safety in a familiar environment
d. Unstructured interactions
Which of the following is an example of an open-
ended question?
a. Who is the current Prime Minister of Canada
b. What concerns you most about your health?
c. What is your address?
d. Have you lost any weight recently?
 First Episode Psychosis
A psychotic episode happens in three phases:

o What is Phase 1?
o What is Phase 2?
o What is Phase 3?
Match the following:
a. Clang Associations 1. rapid, continuous verbalization with
b. Neologisms frequent shifting from one topic to
another.
c. Flight of ideas
2. Relating ideas based on sound/rhyme
d. Echolalia
3. Imitation or repetition what someone
says
4. Invented words by the client
AA is what type of therapeutic group?
a. Structured
b. Interactive self-help
c. Milieu therapy
d. Closed group
Gerry asks you “why am I addicted to drinking?” You
know the following about the cause: (Select all that apply)

a. Gerry drinks because of the stress in his life.

b. People born with certain temperaments are more susceptible.
c. Ask him if his mother had any stress during her pregnancy with
him? Or was he away from his mother for a time period.
d. It is only caused by alterations in brain structure and functioning.
What is the difference between:
a. Substance-use
b. Substance induced
c. Substance-induced disorder of
Intoxication
d. Substance-induced disorder of
withdrawal
1. It is substance specific – alcohol, tobacco
2. Negative psychological and physical
reactions when the substance is reduced or
removed
3. Measured on a continuum from mild to
severe
4. Disorder due to withdrawal or intoxication
or other – induced mental disorders
5. Reversible behaviour changes due to the
effect of the substance on the CNS – results
in maladaptive behaviour
Alcohol withdrawal occurs: (Select all that apply)
a. Immediately within 4 hours of last drink(severe untreated)
b. 12 – 72 hours after last drink (intermediate)
c. 24 – 48 hours after last drink (intermediate)
d. 5 – 6 days after (severe untreated)
Which of the following are considered the
positive signs of schizophrenia?
 
a. Delusions, Anhedonia, ambivalence
b. Hallucinations, illusions, ambivalence
c. Delusions, hallucinations, disordered thinking
d. Disordered thinking, Anhedonia, illusions
The family of a client with schizophrenia asks the nurse about the
difference between typical and atypical antipsychotic medications. The
nurse’s answer is based on which of the following?
 
a. Atypical antipsychotics are newer medications but act in the same
ways as typical antipsychotics
b. Typical antipsychotics are dopamine antagonists; atypical
antipsychotics inhibit the reuptake of serotonin
c. Typical antipsychotics have serious side effects; the atypical
antipsychotics have virtually no side effects
d. Atypical antipsychotics are dopamine and serotonin antagonists;
typical antipsychotics are only dopamine antagonists
 
What statement best explains a bipolar disorder?

• A) two episodes of depression in a row.

• B) Delusions of grandeur with depression
• C) Mood swings with periods of normalcy
• D) insomnia or hypersomnia for more than two weeks
Which of the following statements would indicate that family teaching
about schizophrenia had been effective?

a. “if our son takes his medication properly, he won’t have another
psychotic episode”
b. “I guess we’ll have to face the fact that our daughter will eventually be
institutionalized.”
c. “As long as our son takes his medication properly, it will reduce his
chance of relapse”
d. “it is a shame our daughter will never be able to have children”
Alcohol withdrawal delirium has the following
signs: (Select all that apply)
a. Swearing
b. Shaking
c. Vomiting
d. Sweating
e. Hallucinations
f. Incontinence
g. Death
h. Increased pulse, blood pressure, and temperature
Match the Domain of Practice with the CPMHN
Standard
Standard I Manages rapidly changing situations
Standard II Performs client assessments
Standard III Active in health promotion
Standard IV Recognize the influence of culture, language,
and ethnicity of the client
Standard V Utilizes evidence based research
Standard VI Works in partnership with clients and families
Standard VII Identifies workplace attitudes & beliefs that may
affect the nurse’s ability to perform duties in a safe
manner
Review the following areas:
• Alcoholism
• Determinants of health
• Serotonin
• Schizophrenia diagnosis – DSM 5
• Frontal lobe damage – effects
• Aboriginal’s and mental health.
• What is meant by being culturally competent?
• What drug is used to treat extrapyramidal syndrome?
• What are the clinical course of Schizophrenia?
• What is meant by recovery and mental health?
• Mental Health Act? What act did it replace?
• What changes occurred following WW2?
• Stigmas
• Opening minds
• What is the social domain of PMH practice?
• What is meant by harm reduction?
• Review our Mental Health Rights
• What are the steps to involuntary admission?
• When developing a nursing care plan, what is the very first priority?
Answers Slide 1-62
•1– • 10- a 21- a 32-d
• 11- a 22- c 33-d
• 2 –b
• 12- b 23- b&c 34-a
• 3 –b • 13- f 24- d 35-c
• 4 –d • 14- d 25- c 36-b
• 5-slide • 15- a 26- b 37-c
• 6. slide • 16- c 27- d 38-b
• 17- d 28- c 39-d
• 7-True • 18- b 29- a 40-d
• 8-e • 19- d 30- c 41-a
• 9-b • 20- b 31- b 42-c
Answers continued
• 43-d • 51-slide 59- c
• 44-d • 52-slide 60-c
• 45-a • 53-b 61-slide
• 46-c • 54-slide 62-slide
• 47-b • 55-slide
• 48-Initially be out of touch • 56-b&d
• 49-c • 57-c
• 50-b • 58-d
Good Luck!