Ang Sopas at ang Ipis
Ang Sopas ni Dante Ang!!! Wooooooooot!!!!!!!!!!!!!!!!
Hahahahahaha Enjoy..........
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Saturday, August 26, 2006
ASEAN pact to benefit nurses -- TUCP
ASEAN pact to benefit nurses -- TUCP
http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17408
By Jerome Aning
Inquirer
Last updated 08:49pm (Mla time) 08/26/2006
THE Trade Union Congress of the Philippines on Friday said that Filipino nurses could look forward to greater employment opportunities abroad in the coming months with the scheduled adoption of a new agreement liberalizing the trade in professional nursing services within the Association of Southeast Asian Nations.
“Our nurses can count on easier access to the lucrative job markets of Asean members once the Mutual Recognition Agreement (MRA) on Nursing Services comes into force,” said Ernesto Herrera, TUCP secretary general.
The agreement will definitely be signed during the 12th Asean Summit in Cebu in December, according to the former senator.
“The covenant essentially means that Philippine-licensed nurses will be automatically recognized as nurse practitioners by other Asean members,” Herrera said.
Asean is composed of Brunei, Cambodia, Indonesia, Laos, Malaysia, Burma (Myanmar), the Philippines, Singapore, Thailand, and Vietnam.
Herrera said the MRA would expedite the recognition of the qualifications of Filipino nurses and, thus, facilitate their recruitment and deployment within Asean.
“This means our nurses do not have to take the national nurse licensure examinations of other Asean members to be able to practice in those countries,” he said.
He said that right now, for example, Singapore recognizes nurses from Malaysia and Brunei, but the city-state does not recognize nurses from the Philippines.
For a Filipino nurse to practice in Singapore, he or she has to pass the city-state’s nurse eligibility test.
At present, most of the 4,000 foreign nurses working in Singapore are Filipinos. They all had to pass Singapore’s nurse licensure test, Herrera said.
“The Philippines will be the MRA’s biggest beneficiary, since we are now the world’s biggest exporter of nurses,” he said, adding that since the MRA is mutual, the country would also automatically recognize nurses from other Asean members.
Herrera said the MRA is part of a free trade agreement initiative that had been in the works for years and was finalized only this month, ahead of the December summit.
FROM : http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17408
http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17408
By Jerome Aning
Inquirer
Last updated 08:49pm (Mla time) 08/26/2006
THE Trade Union Congress of the Philippines on Friday said that Filipino nurses could look forward to greater employment opportunities abroad in the coming months with the scheduled adoption of a new agreement liberalizing the trade in professional nursing services within the Association of Southeast Asian Nations.
“Our nurses can count on easier access to the lucrative job markets of Asean members once the Mutual Recognition Agreement (MRA) on Nursing Services comes into force,” said Ernesto Herrera, TUCP secretary general.
The agreement will definitely be signed during the 12th Asean Summit in Cebu in December, according to the former senator.
“The covenant essentially means that Philippine-licensed nurses will be automatically recognized as nurse practitioners by other Asean members,” Herrera said.
Asean is composed of Brunei, Cambodia, Indonesia, Laos, Malaysia, Burma (Myanmar), the Philippines, Singapore, Thailand, and Vietnam.
Herrera said the MRA would expedite the recognition of the qualifications of Filipino nurses and, thus, facilitate their recruitment and deployment within Asean.
“This means our nurses do not have to take the national nurse licensure examinations of other Asean members to be able to practice in those countries,” he said.
He said that right now, for example, Singapore recognizes nurses from Malaysia and Brunei, but the city-state does not recognize nurses from the Philippines.
For a Filipino nurse to practice in Singapore, he or she has to pass the city-state’s nurse eligibility test.
At present, most of the 4,000 foreign nurses working in Singapore are Filipinos. They all had to pass Singapore’s nurse licensure test, Herrera said.
“The Philippines will be the MRA’s biggest beneficiary, since we are now the world’s biggest exporter of nurses,” he said, adding that since the MRA is mutual, the country would also automatically recognize nurses from other Asean members.
Herrera said the MRA is part of a free trade agreement initiative that had been in the works for years and was finalized only this month, ahead of the December summit.
FROM : http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17408
Pinoy BSN Needs NEW Administrators, Contributors and Channel Operators
To facilitate the rapid growth of the student nurse community, PinoyBSN is looking for 3 more administrators, 10 contributors and 5 channel operators.
ADMINISTRATORS
Have access to everything , from templates to posting. Responsible for editing posts from any members including fellow administrators in case of corrections.
Will continuously provide helpful information for the Nursing students. Test exams, News, Opinions etc.
Frequent posting is required.
CONTRIBUTORS
Casual posters who have access to posting. Can edit his posts only.
Will provide News, Information, Exams, Test questions for the Nursing students.
Frequent posting not required.
CHANNEL OPERATORS
Have knowledge on MIRC and CHANSERV/NICKSERV Commands
Frequently online to monitor the channel, Can online for long periods of time.
Contact pinoybsn@yahoo.com
Write the positions you are applying for , details about you and things you will do to contribute to the growth of Pinoy BSN towards a non profit service for the Nursing students.
Pinoy BSN Is a NON PROFIT Blog site. We do not receive any forms of income running the site. We expect volunteers who will participate in the community together with our goal of PURE NON PROFIT SERVICE To uplift standards of Nursing education by building an ACADEMIC COMMUNITY for nursing students.
ADMINISTRATORS
Have access to everything , from templates to posting. Responsible for editing posts from any members including fellow administrators in case of corrections.
Will continuously provide helpful information for the Nursing students. Test exams, News, Opinions etc.
Frequent posting is required.
CONTRIBUTORS
Casual posters who have access to posting. Can edit his posts only.
Will provide News, Information, Exams, Test questions for the Nursing students.
Frequent posting not required.
CHANNEL OPERATORS
Have knowledge on MIRC and CHANSERV/NICKSERV Commands
Frequently online to monitor the channel, Can online for long periods of time.
Contact pinoybsn@yahoo.com
Write the positions you are applying for , details about you and things you will do to contribute to the growth of Pinoy BSN towards a non profit service for the Nursing students.
Pinoy BSN Is a NON PROFIT Blog site. We do not receive any forms of income running the site. We expect volunteers who will participate in the community together with our goal of PURE NON PROFIT SERVICE To uplift standards of Nursing education by building an ACADEMIC COMMUNITY for nursing students.
WHAT IS THE MOST PRUDENT THING TO DO IN THE NURSING SCANDAL
Subject: WHAT IS THE MOST PRUDENT THING TO DO IN THE NURSING SCANDAL—PUT A CLOSURE TO IT OR ANNOUNCE TO THE WORLD MARKETS FOR OUR NURSES THAT WE COULD NOT CONDUCT HONEST EXAMS, NOT JUST IN 2006 BUT ALSO IN PRIOR YEARS?
Perhaps, we should go international--make a clean breast of it before the world markets for our nurses. Let us blow the scandal sky-high, so it will get more attention. Let us not put a prompt closure to it, that may do us more good than harm. Let us not give the benefit of the doubt to 2006 innocent passers—that will do them justice. Let us have a retake that will prolong the case, especially if the passers—or their parents--will fight it all the way up to the Supreme Court. That way, it may even open a can of worms involving even prior years' passers. That maybe very embarrassing to the nursing profession, very difficult to handle on the part of the government, and cannot be solved without collateral damage to the entire nation—but who cares? It seems not the Task force created by the President to look into the scandal, which appears to be saying ugly things without benefit of careful study and evaluation.
A retake is an open admission to our world markets for nurses that we cannot conduct honest examinations--and that impression will apply not just to 2006 but also to prior years' exams. Anybody who says that there were no leakages in past years' exams should tell it to the marines!
If the scandal drags on, it may spill to prior years. The 2006 passers, once they know that they will be forced to retake, may dig into the past to get even with complaining deans, or implore remorseful examiners and review center officials to make a clean breast of it by confessing leakages even in prior years. If that happens, 2006 passers will definitely demand retake even of prior years' exams. How will the government handle that? How will it contravene such demand that, though impractical and disgraceful, is the logical extension of the right against discrimination enshrined in the Bill of Rights?
Indeed, a retake by 2006 passers may open a Pandora's box. So, why not let sleeping dogs lie, or leave well enough alone? Truth hurts, that is why sometimes it is best to simply keep it to ourselves. Let us not shout it before the world markets of our nurses—but we must make sure that what was wrong in the past is corrected in the future.
Mr. Dante Ang seems a disappointment. He maybe worsening the problem instead of solving it. Even before conducting an exhaustive investigation, he already announced to media (like ABS-CBN) that two out of five subjects were compromised and have to be retaken—which is factually wrong. On one subject covered by test 3, only 20 out of 100 questions were invalidated, so the remaining 80% or 80 questions definitely serve the purpose of the examination for that subject—thereby leaving only one subject in doubt, the benefit of which may be reasonably given to the passers.
A retake even of just one remaining subject erroneously assumes that 100% of the passers did not hurdle this last subject . That assumption is simply absurd, against common sense, and probability. It insults the honor graduates of the batch, together with other deserving passers. Look at all prior years' exams and the record will show that always, there were thousands of passers—almost half the annual examinees—so the reasonable and defensible assumption is that the 25,000 failing examinees did not pass it but the 17,000 successful examinees did. Implying that 100% of them did not pass and should retake the remaining subject is simply wrong and contrary to reality! When all examinees during the time of the beloved examiner Dr. Felipe Ollada failed the CPA board exam, the CPA Board of Examiners had to pass the top 100 examinees who obtained the highest failing grades-- rather than come up with a board exam with zero passer! The 100 forced passers were given a uniform grade of 75 percent, thereby making all of them topnochers!
On the erroneous premise that two subjects were compromised instead of just one, Mr. Ang prematurely declared even without careful study that the measure of competence has been lessened. Lessened, all right, but is it enough to warrant a retake? If not, it is better to keep quiet and stop downgrading the 2006 passers because that is unjustly harming them. What's more, is he a nurse who technically knows what competence is required of nurses, not in closed-book exams but in open-book actual practice? Further, did he conduct a review of prior years' exams to see if all subjects were given equal weights, to contravene the gripes of some prior years' examinees who said that too much emphasis was given on a subject that one has to have practically 100% mastery of it, not just 75%, in order to pass the whole exam? Did he take into account that even in NCLEX—apparently the most crucial test of them all--there are only 265 questions, instead of 500 as in the nursing exam, and if 60 of the first 75 questions are correctly answered, the computer automatically declares the examinee as passer and does not go to the extent of checking the answers to the rest of the 265 questions.
At any rate, the nursing scandal can be resolved with minimized harm to the nation—let the Task Force figure it out.
Incidentally, as pointed out in my earlier email on the subject Clue to Resolution of Nursing Scandal… it is better to be a 2006 PASSER who hurdled a 390-question edited exam CLEANSED of DETECTED LEAKED QUESTIONS, than ONE of PRIOR YEARS' PASSERS who hurdled a 500-question exam, all right—but INCLUSIVE of UNDETECTED LEAKAGES!
Media have crucified 2006 passers as "unclean ," and yet, under the foregoing situation, who are "dirtier"--- 2006 passers who passed leakage-cleansed exam, or prior years' passers who passed leakage-inclusive exams?
MARCELO L. TECSON
San Miguel, Bulacan
August 25, 2006
Perhaps, we should go international--make a clean breast of it before the world markets for our nurses. Let us blow the scandal sky-high, so it will get more attention. Let us not put a prompt closure to it, that may do us more good than harm. Let us not give the benefit of the doubt to 2006 innocent passers—that will do them justice. Let us have a retake that will prolong the case, especially if the passers—or their parents--will fight it all the way up to the Supreme Court. That way, it may even open a can of worms involving even prior years' passers. That maybe very embarrassing to the nursing profession, very difficult to handle on the part of the government, and cannot be solved without collateral damage to the entire nation—but who cares? It seems not the Task force created by the President to look into the scandal, which appears to be saying ugly things without benefit of careful study and evaluation.
A retake is an open admission to our world markets for nurses that we cannot conduct honest examinations--and that impression will apply not just to 2006 but also to prior years' exams. Anybody who says that there were no leakages in past years' exams should tell it to the marines!
If the scandal drags on, it may spill to prior years. The 2006 passers, once they know that they will be forced to retake, may dig into the past to get even with complaining deans, or implore remorseful examiners and review center officials to make a clean breast of it by confessing leakages even in prior years. If that happens, 2006 passers will definitely demand retake even of prior years' exams. How will the government handle that? How will it contravene such demand that, though impractical and disgraceful, is the logical extension of the right against discrimination enshrined in the Bill of Rights?
Indeed, a retake by 2006 passers may open a Pandora's box. So, why not let sleeping dogs lie, or leave well enough alone? Truth hurts, that is why sometimes it is best to simply keep it to ourselves. Let us not shout it before the world markets of our nurses—but we must make sure that what was wrong in the past is corrected in the future.
Mr. Dante Ang seems a disappointment. He maybe worsening the problem instead of solving it. Even before conducting an exhaustive investigation, he already announced to media (like ABS-CBN) that two out of five subjects were compromised and have to be retaken—which is factually wrong. On one subject covered by test 3, only 20 out of 100 questions were invalidated, so the remaining 80% or 80 questions definitely serve the purpose of the examination for that subject—thereby leaving only one subject in doubt, the benefit of which may be reasonably given to the passers.
A retake even of just one remaining subject erroneously assumes that 100% of the passers did not hurdle this last subject . That assumption is simply absurd, against common sense, and probability. It insults the honor graduates of the batch, together with other deserving passers. Look at all prior years' exams and the record will show that always, there were thousands of passers—almost half the annual examinees—so the reasonable and defensible assumption is that the 25,000 failing examinees did not pass it but the 17,000 successful examinees did. Implying that 100% of them did not pass and should retake the remaining subject is simply wrong and contrary to reality! When all examinees during the time of the beloved examiner Dr. Felipe Ollada failed the CPA board exam, the CPA Board of Examiners had to pass the top 100 examinees who obtained the highest failing grades-- rather than come up with a board exam with zero passer! The 100 forced passers were given a uniform grade of 75 percent, thereby making all of them topnochers!
On the erroneous premise that two subjects were compromised instead of just one, Mr. Ang prematurely declared even without careful study that the measure of competence has been lessened. Lessened, all right, but is it enough to warrant a retake? If not, it is better to keep quiet and stop downgrading the 2006 passers because that is unjustly harming them. What's more, is he a nurse who technically knows what competence is required of nurses, not in closed-book exams but in open-book actual practice? Further, did he conduct a review of prior years' exams to see if all subjects were given equal weights, to contravene the gripes of some prior years' examinees who said that too much emphasis was given on a subject that one has to have practically 100% mastery of it, not just 75%, in order to pass the whole exam? Did he take into account that even in NCLEX—apparently the most crucial test of them all--there are only 265 questions, instead of 500 as in the nursing exam, and if 60 of the first 75 questions are correctly answered, the computer automatically declares the examinee as passer and does not go to the extent of checking the answers to the rest of the 265 questions.
At any rate, the nursing scandal can be resolved with minimized harm to the nation—let the Task Force figure it out.
Incidentally, as pointed out in my earlier email on the subject Clue to Resolution of Nursing Scandal… it is better to be a 2006 PASSER who hurdled a 390-question edited exam CLEANSED of DETECTED LEAKED QUESTIONS, than ONE of PRIOR YEARS' PASSERS who hurdled a 500-question exam, all right—but INCLUSIVE of UNDETECTED LEAKAGES!
Media have crucified 2006 passers as "unclean ," and yet, under the foregoing situation, who are "dirtier"--- 2006 passers who passed leakage-cleansed exam, or prior years' passers who passed leakage-inclusive exams?
MARCELO L. TECSON
San Miguel, Bulacan
August 25, 2006
Inaction in case of nursing leakage
Inaction in case of nursing leakage
http://www.mb.com.ph/archive_pages.php?url=http://www.mb.com.ph/issues/2006/08/26/OPED2006082672652.html
By Willie Ng
MALACAÑANG should not take so long to accept the recommendation of Commission on Overseas Filipino Chairman Dante Ang to invalidate the recent nursing exams because of the leakage of test questions.
There is no other way. It is not only because the leakage smeared the reputation of the nursing profession, which is the most powerful reason to invalidate.
The other reason is that the culprits have long been pinpointed and many of the test takers have come forward as witnesses. There is a strong case against the main perpetrator, the owner of a review center for nursing students.
* * *
Why the foot dragging? The monstrosity of the crime, affecting all examinees, both the innocent and the guilty, demands that the authorities should charge the culprits with the crime forthwith.
Up to now, no one has been charged. It’s as if the authorities are waiting for the public indignation to subside.
Meanwhile, the guilty have all the time to suborn the witnesses. The main witness who had accused the review center owner of personally distributing the leaked questions, has retracted.
* * *
All who took the tests had their time table: They had expected to be licensed so that they would begin working, preferably abroad, in order to repay their parents’ sacrifices.
If they must retake the tests, that should be done now, not next December as is the regular schedule.
Let the Professional Regulation Commission, which bungled the thing, make up for its blunder by advancing the date of the tests and accelerating the correcting process.
Having caused them so much harm and anguish, the PRC must cut short the waste of time for the test takers.
Together with that, the PRC must see to inflicting the maximum punishment on the culprits. In other countries, they would have long been detained. Here, although identified, they remain free men.
FROM : http://www.mb.com.ph/archive_pages.php?url=http://www.mb.com.ph/issues/2006/08/26/OPED2006082672652.html
http://www.mb.com.ph/archive_pages.php?url=http://www.mb.com.ph/issues/2006/08/26/OPED2006082672652.html
By Willie Ng
MALACAÑANG should not take so long to accept the recommendation of Commission on Overseas Filipino Chairman Dante Ang to invalidate the recent nursing exams because of the leakage of test questions.
There is no other way. It is not only because the leakage smeared the reputation of the nursing profession, which is the most powerful reason to invalidate.
The other reason is that the culprits have long been pinpointed and many of the test takers have come forward as witnesses. There is a strong case against the main perpetrator, the owner of a review center for nursing students.
* * *
Why the foot dragging? The monstrosity of the crime, affecting all examinees, both the innocent and the guilty, demands that the authorities should charge the culprits with the crime forthwith.
Up to now, no one has been charged. It’s as if the authorities are waiting for the public indignation to subside.
Meanwhile, the guilty have all the time to suborn the witnesses. The main witness who had accused the review center owner of personally distributing the leaked questions, has retracted.
* * *
All who took the tests had their time table: They had expected to be licensed so that they would begin working, preferably abroad, in order to repay their parents’ sacrifices.
If they must retake the tests, that should be done now, not next December as is the regular schedule.
Let the Professional Regulation Commission, which bungled the thing, make up for its blunder by advancing the date of the tests and accelerating the correcting process.
Having caused them so much harm and anguish, the PRC must cut short the waste of time for the test takers.
Together with that, the PRC must see to inflicting the maximum punishment on the culprits. In other countries, they would have long been detained. Here, although identified, they remain free men.
FROM : http://www.mb.com.ph/archive_pages.php?url=http://www.mb.com.ph/issues/2006/08/26/OPED2006082672652.html
Cordero bumwelta sa mga kritiko
Cordero bumwelta sa mga kritiko
http://www.abs-cbnnews.com/topofthehour.aspx?StoryId=48507
Bumwelta ang nagbitiw na presidente ng Philippine Nursing Association sa mga taong nagdidiin sa kanya bilang pasimuno ng leakage sa Nursing Licensure Exam (NLE) nitong Hulyo.
"Naiinggit lang sila sa akin dahil sa aking stature. I've been PNA president for so many years," ani George Cordero.
Itinanggi ni Cordero ang alegasyon na nagbayad siya ng P7 milyon para ipapuslit ang mga tanong sa Test 3 at Test 5 ng NLE.
Unang-una, wala umano siyang pera at pangalawa ay wala siyang dahilan para gawin iyon.
"Wala akong pakinabang dito. Iilan lang ang mga naka-enroll sa school at review center ko. Baka 'yung malalaking review center, kaya nila magbayad ng P7 million," ani Cordero.
Pinabulaanan din ni Cordero na binantaan niya ang nursing graduate na si Pamela Ortega upang iatras ang testimonya laban sa kanya. Si Ortega ang isa sa mga testigo ng Philippine Regulation Commission na nagdawit kay Cordero sa leakage.
Sa ulat ng Bandila, inamin ni Ortega sa isang Board of Nursing examiner na pinatawag siya ni Cordero at pinagbantaan matapos lumabas ang report ng PRC tungkol sa leakage.
"I don't know her. I never threatened her," ani Cordero. Itinanggi rin niyang kilala niya si Dennis Bautista, ang isa pang testigo na naunang lumutang sa Bandila.
Isinumbong ng dalawa na nasaksihan nila ang "final coaching" na pinangunahan ni Cordero saSM Cinema 9 noong Hulyo.
Si Ortega ang nagsabing narinig umano niya si Cordero na nagsabing nagbayad siya ng P7 milyon para sa leakage.
Iginiit ni Cordero na hindi na dapat muling pakuhanin ng eksaminasyon ang mga nursing graduates dahil lamang sa napabalitang dayaan.
Ang dapat umanong gawin ay linisin ang sistema sa paggawa ng mga pagsusulit habang sinisikap rin niyang linisin ang kanyang reputasyon.
"I will file charges against those who are accusing me. I will consult my lawyer," aniya.
FROM : http://www.abs-cbnnews.com/topofthehour.aspx?StoryId=48507
http://www.abs-cbnnews.com/topofthehour.aspx?StoryId=48507
Bumwelta ang nagbitiw na presidente ng Philippine Nursing Association sa mga taong nagdidiin sa kanya bilang pasimuno ng leakage sa Nursing Licensure Exam (NLE) nitong Hulyo.
"Naiinggit lang sila sa akin dahil sa aking stature. I've been PNA president for so many years," ani George Cordero.
Itinanggi ni Cordero ang alegasyon na nagbayad siya ng P7 milyon para ipapuslit ang mga tanong sa Test 3 at Test 5 ng NLE.
Unang-una, wala umano siyang pera at pangalawa ay wala siyang dahilan para gawin iyon.
"Wala akong pakinabang dito. Iilan lang ang mga naka-enroll sa school at review center ko. Baka 'yung malalaking review center, kaya nila magbayad ng P7 million," ani Cordero.
Pinabulaanan din ni Cordero na binantaan niya ang nursing graduate na si Pamela Ortega upang iatras ang testimonya laban sa kanya. Si Ortega ang isa sa mga testigo ng Philippine Regulation Commission na nagdawit kay Cordero sa leakage.
Sa ulat ng Bandila, inamin ni Ortega sa isang Board of Nursing examiner na pinatawag siya ni Cordero at pinagbantaan matapos lumabas ang report ng PRC tungkol sa leakage.
"I don't know her. I never threatened her," ani Cordero. Itinanggi rin niyang kilala niya si Dennis Bautista, ang isa pang testigo na naunang lumutang sa Bandila.
Isinumbong ng dalawa na nasaksihan nila ang "final coaching" na pinangunahan ni Cordero saSM Cinema 9 noong Hulyo.
Si Ortega ang nagsabing narinig umano niya si Cordero na nagsabing nagbayad siya ng P7 milyon para sa leakage.
Iginiit ni Cordero na hindi na dapat muling pakuhanin ng eksaminasyon ang mga nursing graduates dahil lamang sa napabalitang dayaan.
Ang dapat umanong gawin ay linisin ang sistema sa paggawa ng mga pagsusulit habang sinisikap rin niyang linisin ang kanyang reputasyon.
"I will file charges against those who are accusing me. I will consult my lawyer," aniya.
FROM : http://www.abs-cbnnews.com/topofthehour.aspx?StoryId=48507
The exodus of Filipino health-care workers
The exodus of Filipino health-care workers
http://www.manilatimes.net/national/2006/aug/26/yehey/opinion/20060826opi7.html
The migration of Filipino health-care professionals for overseas work has led to the continuing decline in quality of the Philippine health-care service. Merely churning out more graduates may not be the best solution.
The Department of Health and related government agencies have tried to address this growing concern by producing an equal number of health-care professionals (for example, allowing more nursing schools to operate, incentive programs for doctors, etc.). A mere offsetting of numbers, however, does not result to in good workforce quality. Such quality can only be achieved through proper exposure and hands-on training.
The steady exodus of experienced medical professionals prompted Tthe advisory practice of accounting firm Isla Lipana & Co. PricewaterhouseCoopers (formerly Joaquin Cunanan & Co.) and medical experts Asuan, Caragay and Cruz & Associates Healthcare Systems, Inc., to study Filipino health workers’ compensation and benefits. The 2005 Philippine Health Industry Remuneration and Benefits Survey is the product of this study.
Isla Lipana & Co. says that “the survey, which covered primary, secondary and tertiary private and government hospitals inside and outside Metro Manila, aims to provide health-care providers with a comprehensive industry compensation guide in:
• Assessing alignment of actual compensation versus existing marketplace practices for a particular job function;
• Evaluating the capability to remain competitive and minimize the risk of losing skilled employees to other organizations; and
• Comparing job contents within the industry.”
Survey findings
The survey findings support the view that compensation is a key factor in the migration of health-care workers.
• Consultants, physicians and paramedics in government hospitals earn more than their counterparts in private hospitals.
• However, as opposed to previous years, the private sector now competes with the government hospitals in acquiring and keeping the best of paramedical practitioners.
• Although the number of nursing schools has increased, the problem lies in the quality of nurses. Good and experienced ones immediately seek jobs outside the country as soon as minimum basic requirements are completed.
• The Department of Health has just initiated a scholarship program for aspiring doctors due to the decreasing number of youths wanting to pursue medical practice.
Survey method
The survey involves 100 benchmark positions and full analysis of the information gathered. Compensation data include hospital classification, salary ranges (minimum and maximum), method of payment (salaried or nonsalaried), workhours (full-time or part-time), number of incumbents and average years of service are presented. Benefits tabulation includes type of benefit and coverage. The survey also touches on general human-resource practices.
FROM : http://www.manilatimes.net/national/2006/aug/26/yehey/opinion/20060826opi7.html
http://www.manilatimes.net/national/2006/aug/26/yehey/opinion/20060826opi7.html
The migration of Filipino health-care professionals for overseas work has led to the continuing decline in quality of the Philippine health-care service. Merely churning out more graduates may not be the best solution.
The Department of Health and related government agencies have tried to address this growing concern by producing an equal number of health-care professionals (for example, allowing more nursing schools to operate, incentive programs for doctors, etc.). A mere offsetting of numbers, however, does not result to in good workforce quality. Such quality can only be achieved through proper exposure and hands-on training.
The steady exodus of experienced medical professionals prompted Tthe advisory practice of accounting firm Isla Lipana & Co. PricewaterhouseCoopers (formerly Joaquin Cunanan & Co.) and medical experts Asuan, Caragay and Cruz & Associates Healthcare Systems, Inc., to study Filipino health workers’ compensation and benefits. The 2005 Philippine Health Industry Remuneration and Benefits Survey is the product of this study.
Isla Lipana & Co. says that “the survey, which covered primary, secondary and tertiary private and government hospitals inside and outside Metro Manila, aims to provide health-care providers with a comprehensive industry compensation guide in:
• Assessing alignment of actual compensation versus existing marketplace practices for a particular job function;
• Evaluating the capability to remain competitive and minimize the risk of losing skilled employees to other organizations; and
• Comparing job contents within the industry.”
Survey findings
The survey findings support the view that compensation is a key factor in the migration of health-care workers.
• Consultants, physicians and paramedics in government hospitals earn more than their counterparts in private hospitals.
• However, as opposed to previous years, the private sector now competes with the government hospitals in acquiring and keeping the best of paramedical practitioners.
• Although the number of nursing schools has increased, the problem lies in the quality of nurses. Good and experienced ones immediately seek jobs outside the country as soon as minimum basic requirements are completed.
• The Department of Health has just initiated a scholarship program for aspiring doctors due to the decreasing number of youths wanting to pursue medical practice.
Survey method
The survey involves 100 benchmark positions and full analysis of the information gathered. Compensation data include hospital classification, salary ranges (minimum and maximum), method of payment (salaried or nonsalaried), workhours (full-time or part-time), number of incumbents and average years of service are presented. Benefits tabulation includes type of benefit and coverage. The survey also touches on general human-resource practices.
FROM : http://www.manilatimes.net/national/2006/aug/26/yehey/opinion/20060826opi7.html
Friday, August 25, 2006
NURSING BOARD PASSERS LAUNCH SIGNATURE DRIVE VS CA ORDER
NURSING BOARD PASSERS LAUNCH SIGNATURE DRIVE VS CA ORDER
MANILA, AUGUST 25, 2006 (STAR) By Sheila Crisostomo - Board passers in the leakage-tainted nursing licensure exam last June have formed an alliance and launched a signature drive to demand the prosecution of the perpetrators of the irregularities without sacrificing their wishes not to take another exam.
Renato Aquino, head of the "Alliance of New Nurses," said that they have decided to join forces "so that their voices will be heard."
The group laments the fact that they are being sacrificed by some sectors that are pressing for a retake of Tests 3 and 5.
"This is an informal group but we felt we have to join forces so that our voices will be heard. We are the victims here but we are the ones being prosecuted," he told The STAR.
He said they would collect the signatures of all those who passed the board and submit this to Malacañang, the Senate, House of Representatives and other concerned bodies.
"We are trying to reach out to those in the provinces through the friends of our friends... We are definitely against the retake of exams. It is unfair for us to go through sleepless nights prior to and after the exam just to satisfy the request of a few," he noted.
Aquino said many of the nursing board passers come from provinces and they spend for their board and lodging to review in Metro Manila.
"For those of us who were working, we gave up our jobs or took months off from work without the benefit of compensation just to concentrate on the Board. We missed family gatherings, had broken relationships to get a passing mark," he said.
The Professional Regulation Commission (PRC) supports the position of the passers in not taking another nursing exam and gave assurances that the leaked questions have been excluded.
But various sectors, including the Commission on Filipinos Overseas (CFO) which has been convincing the United States to put up a National Council Licensure Examination (NCLEX) testing center in the Philippines, are in favor of a retake of Tests 3 and 5.
Aquino added those behind the leakage should be identified and prosecuted and appealed that they be spared from personal persecution.
"We already suffered persecution from media branding us as a batch of cheaters when in fact, hardly anyone bothered to seek us out to air our side. We were able to pass the board exams with our integrity intact, upholding the family names our parents and our forefathers worked so hard to keep clean," he added.
Meanwhile, the PRC reiterated yesterday that nursing board passers truly deserved the grades they earned.
In a joint statement issued by PRC Chairman Leonor Rosero, Commissioners Avelina dela Rea and Renato Valdecantos and Board of Nursing chair Dr. Eufemia Octaviano and members Drs. Remedios Hernadez, Letty Kuan and Estelita Galutira, they gave assurances that the "June 2006 passers are real passers."
"The results of the examination have been cleansed of leaked questions. The released June results are clean," they said.
The officials branded as "purely speculative" fears that NCLEX would not be put up in the Philippines because of the leakage controversy.
"The nursing leaders calling for a retake of the exams are offering a sacrifice that has not been made a condition by the NCLEX. More serious steps of cleansing the profession’s ranks may be more convincing," they added.
From:
http://www.newsflash.org/2004/02/hl/hl104544.htm
Communicable Disease Nursing Study Bullets
Communicable Disease Nursing
DRUG OF CHOICE
Tetanus: PEN G Na; DIAZEPAM (Valium)
Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant)
Rabies Vaccines: LYSSAVAC, VERORAB
Immunoglobulins: ERIG or HRIg
DIAGNOSTIC TESTS
Tetanus: WOUND CULTURE
Meningitis: LUMBAR PUNCTURE
Encephalitis: EEG
Polio: EMG; Muscle testing
Rabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody test
Dengue: TOURNIQUET test (Rumpel lead)
Malaria: Malarial smear; QBC (Quantitative Buffy Coat)
Scarlet: DICK'S TEST; SCHULTZ-CHARLTON TEST
Diphtheria: SCHICK'S TEST; Moloney's Test
Pertussis: Nasal swab; agar plate
Tuberculosis: MANTOUX test
Leprosy: SLIT SKIN SMEAR
Pinworm: SCOTCH TAPE SWAB
Typhoid: WIDAL'S test
HIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test
CAUSATIVE AGENTS
Tetanus: CLOSTRIDIUM TETANI
Meningococcemia: NEISSERIA MENINGITIDIS
Rabies: RHABDOVIRUS
Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III Leon)
Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses) (Common in the Phil.)
Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P. Ovale
Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI
Leprosy: MYCOBACTERIUM LEPRAE
Measles: PARAMYXO VIRUS
German measles: TOGA VIRUS
Chicken pox: VARICELLA ZOSTER VIRUS
Herpes zoster: HERPES ZOSTER VIRUS
Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS
Scabies: SARCOPTES SCABIEI (itch mite)
Bubonic plague: YERSINIA PESTIS
Diphtheria: KLEBS LOEFFLER
Pertussis: BORDETELLA PERTUSSIS
Tuberculosis: MYCOBACTERIUM TUBERCULOSIS
Typhoid: SALMONELLA TYPHI
Cholera: VIBRIO CHOLERA
Amoebiasis: ENTAMOEBA HYSTOLITICA
Leptospirosis: LEPTOSPIRA Spirochete
Schistosomiasis: Schistosoma japonicum
Gonorrhea: N. GONORRHEAE
Syphilis: TREPONEMA PALLIDUM
Chlamydia: C. trachomatis, T. vaginalis
Genital herpes: HERPES SIMPLEX 2
CD PHARMACOLOGY
Malaria: CHLOROQUINE
Schistosomiasis: PRAZIQUANTEL
Scabies: EURAX/ CROTAMITON
Chicken pox: ACYCLOVIR/ZOVIRAX
Tuberculosis: R.I.P.E.S.
Pneumonia: COTRIMOXAZOLE; Procaine Penicillin
Helminths: MEBENDAZOLE; PYRANTEL PAMOATE
DRUG OF CHOICE
Tetanus: PEN G Na; DIAZEPAM (Valium)
Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant)
Rabies Vaccines: LYSSAVAC, VERORAB
Immunoglobulins: ERIG or HRIg
DIAGNOSTIC TESTS
Tetanus: WOUND CULTURE
Meningitis: LUMBAR PUNCTURE
Encephalitis: EEG
Polio: EMG; Muscle testing
Rabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody test
Dengue: TOURNIQUET test (Rumpel lead)
Malaria: Malarial smear; QBC (Quantitative Buffy Coat)
Scarlet: DICK'S TEST; SCHULTZ-CHARLTON TEST
Diphtheria: SCHICK'S TEST; Moloney's Test
Pertussis: Nasal swab; agar plate
Tuberculosis: MANTOUX test
Leprosy: SLIT SKIN SMEAR
Pinworm: SCOTCH TAPE SWAB
Typhoid: WIDAL'S test
HIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test
CAUSATIVE AGENTS
Tetanus: CLOSTRIDIUM TETANI
Meningococcemia: NEISSERIA MENINGITIDIS
Rabies: RHABDOVIRUS
Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III Leon)
Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses) (Common in the Phil.)
Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P. Ovale
Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI
Leprosy: MYCOBACTERIUM LEPRAE
Measles: PARAMYXO VIRUS
German measles: TOGA VIRUS
Chicken pox: VARICELLA ZOSTER VIRUS
Herpes zoster: HERPES ZOSTER VIRUS
Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS
Scabies: SARCOPTES SCABIEI (itch mite)
Bubonic plague: YERSINIA PESTIS
Diphtheria: KLEBS LOEFFLER
Pertussis: BORDETELLA PERTUSSIS
Tuberculosis: MYCOBACTERIUM TUBERCULOSIS
Typhoid: SALMONELLA TYPHI
Cholera: VIBRIO CHOLERA
Amoebiasis: ENTAMOEBA HYSTOLITICA
Leptospirosis: LEPTOSPIRA Spirochete
Schistosomiasis: Schistosoma japonicum
Gonorrhea: N. GONORRHEAE
Syphilis: TREPONEMA PALLIDUM
Chlamydia: C. trachomatis, T. vaginalis
Genital herpes: HERPES SIMPLEX 2
CD PHARMACOLOGY
Malaria: CHLOROQUINE
Schistosomiasis: PRAZIQUANTEL
Scabies: EURAX/ CROTAMITON
Chicken pox: ACYCLOVIR/ZOVIRAX
Tuberculosis: R.I.P.E.S.
Pneumonia: COTRIMOXAZOLE; Procaine Penicillin
Helminths: MEBENDAZOLE; PYRANTEL PAMOATE
CA asked to nullify 2006 Nursing board exam
CA asked to nullify 2006 Nursing board exam
http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17245
By Tetch Torres
INQ7.net
Last updated 07:43pm (Mla time) 08/25/2006
THE PRESIDENTIAL Task Force on National Licensure Examination (NCLEX) for Nurses in the Philippines has asked the Court of Appeals to invalidate the 2006 Nursing licensure exams.
"The determination and proclamation of the passing examinees in the June 2006 nursing test be nullified for lack of basis," said Dante Ang, chairman of the Commission on Filipinos Overseas (COF), in a six-page petition for intervention.
Ang said it was important that the aspiring nurses should retake tests 3 and 5, which were the alleged sources of the leak.
The Professional Regulation Commission (PRC) has issued Resolution 31, which has implemented a new scheme for computing the scores of the examinees by using the grades from the other tests for the invalidated portions of test 3 or the medical/surgical nursing exam and test 5 or the neuro-psychiatric nursing exam.
"The June 2006 nursing examination covering test 3 and 5 [should] be declared null and void for being tainted with fraud, and a new examination be ordered for two subjects within 60 days from rendition of judgment in this case with the expense or cost thereof to be provided by the government from available funds as may be determined by the Department of Budget and Management (DBM)," Ang said.
He said the PRC and the Board of Nurses should not have issued Resolution 31 because the National Bureau of Investigation (NBI) was still investigating the matter.
"The act of the respondents was evidently intended to preempt, as it were, all other official acts and render moot whatever findings and recommendations they may come up with...Thus the proclamation and publication by the respondents [PRC, Board of Nursing] of the names of the examinees who have purportedly passed the June 2006 nursing test was without legitimate basis and therefore invalid," he said.
On August 18, the Court of Appeals restrained the PRC and the Board of Nursing from proceeding with the scheduled oath taking of 14,000 new nurses last August 22.
In a two-page resolution, the Appeals Court Special Third Division issued a 60-day temporary restraining order enjoining the PRC and Board of Nursing from allowing the nurses who passed the June 2006 board exams to take their oaths.
FROM : http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17245
http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17245
By Tetch Torres
INQ7.net
Last updated 07:43pm (Mla time) 08/25/2006
THE PRESIDENTIAL Task Force on National Licensure Examination (NCLEX) for Nurses in the Philippines has asked the Court of Appeals to invalidate the 2006 Nursing licensure exams.
"The determination and proclamation of the passing examinees in the June 2006 nursing test be nullified for lack of basis," said Dante Ang, chairman of the Commission on Filipinos Overseas (COF), in a six-page petition for intervention.
Ang said it was important that the aspiring nurses should retake tests 3 and 5, which were the alleged sources of the leak.
The Professional Regulation Commission (PRC) has issued Resolution 31, which has implemented a new scheme for computing the scores of the examinees by using the grades from the other tests for the invalidated portions of test 3 or the medical/surgical nursing exam and test 5 or the neuro-psychiatric nursing exam.
"The June 2006 nursing examination covering test 3 and 5 [should] be declared null and void for being tainted with fraud, and a new examination be ordered for two subjects within 60 days from rendition of judgment in this case with the expense or cost thereof to be provided by the government from available funds as may be determined by the Department of Budget and Management (DBM)," Ang said.
He said the PRC and the Board of Nurses should not have issued Resolution 31 because the National Bureau of Investigation (NBI) was still investigating the matter.
"The act of the respondents was evidently intended to preempt, as it were, all other official acts and render moot whatever findings and recommendations they may come up with...Thus the proclamation and publication by the respondents [PRC, Board of Nursing] of the names of the examinees who have purportedly passed the June 2006 nursing test was without legitimate basis and therefore invalid," he said.
On August 18, the Court of Appeals restrained the PRC and the Board of Nursing from proceeding with the scheduled oath taking of 14,000 new nurses last August 22.
In a two-page resolution, the Appeals Court Special Third Division issued a 60-day temporary restraining order enjoining the PRC and Board of Nursing from allowing the nurses who passed the June 2006 board exams to take their oaths.
FROM : http://newsinfo.inq7.net/breakingnews/nation/view_article.php?article_id=17245
Lawmaker changes mind, backs retake of nurses board test
Lawmaker changes mind, backs retake of nurses board test
(10:40 a.m.)
MANILA -- Senator Rodolfo Biazon now supports retaking of the nursing examination following reports that there was also a leakage on Tests I and II of the June 11 and June 12 nurses licensure examination.
"But right now, because of another report and another witness saying that it is not only Tests III and V that had been leaked but also including Tests I and II. So with this additional information I would now support a retake," he said.
Biazon said the Senate committee on civil service and government reorganization, which he chairs, will conduct another hearing on Wednesday next week to look into the alleged leakage in Tests I and II.
The investigation will also help in crafting legislation to address cheating in board exams such as
placing review centers under Commission on Higher Education (Ched).
FROM: Sunstar Network Online
http://www.sunstar.com.ph/static/net/2006/08/25/lawmaker.changes.mind.backs.retake.of.nurses.board.test.(10.40.a.m.).html
(10:40 a.m.)
MANILA -- Senator Rodolfo Biazon now supports retaking of the nursing examination following reports that there was also a leakage on Tests I and II of the June 11 and June 12 nurses licensure examination.
"But right now, because of another report and another witness saying that it is not only Tests III and V that had been leaked but also including Tests I and II. So with this additional information I would now support a retake," he said.
Biazon said the Senate committee on civil service and government reorganization, which he chairs, will conduct another hearing on Wednesday next week to look into the alleged leakage in Tests I and II.
The investigation will also help in crafting legislation to address cheating in board exams such as
placing review centers under Commission on Higher Education (Ched).
FROM: Sunstar Network Online
http://www.sunstar.com.ph/static/net/2006/08/25/lawmaker.changes.mind.backs.retake.of.nurses.board.test.(10.40.a.m.).html
Nursing schools, review centers linked to exams mess should be closed down, says solon
Nursing schools, review centers linked to exams mess should be closed down, says solon
http://www.mb.com.ph/YTCP2006082572526.html
Catanduanes Rep. Joseph Santiago has urged the Commission on Higher Education (CHED) and the local government units concerned to promptly close down schools and review centers linked to alleged irregularities in the June nursing licensure examinations.
"Nursing schools and review centers that have been directly or indirectly implicated in the alleged cheating have forfeited the privilege to continue to provide educational services. They have no right to stay in business a minute longer," Santiago said.
At least two nursing board review centers — Inress Review Center Inc. and R.A. Gapuz Review Center Inc. — have so far been implicated in the test leakage, according to the Professional Regulation Commission (PRC).
Review centers, as local business entities, are under the supervision of local governments.
The PRC also previously indicated that three individuals have so far been linked to the cheating. They are Anesia Dionisio and Virginia Madeja, both former members of the PRC’s Board of Nursing, and George Cordero, the resigned president of the Philippine Nursing Association (PNA).
Cordero also owns Inress and the Philippine College of Health Sciences (PCHS), one of the "substandard" nursing schools in the country, according to CHED.
PCHS, however, produced at least one graduate who managed to land in the top 10 passers in the controversial June licensure examinations.
During a Senate inquiry last week, a nursing graduate who took the June examinations testified that leaked test questions were shown by Cordero to a group of reviewees.
Dennis Bautista said Cordero presented the questions during the final coaching sessions for examinees on June 8 and June 9, two days before the licensure examinations. Bautista said he attended the sessions.
Another examinee, Pamela Ortega, a graduate of PCHS, said that during the June 9 coaching session, she also overhead Cordero as saying that he "did not pay P7 million for nothing."
R.A. Gapuz has denied involvement in the cheating, saying it obtained "in good faith" the leaked questions. The center said it was not aware the questions would actually come out in the examinations.
FROM : http://www.mb.com.ph/YTCP2006082572526.html
http://www.mb.com.ph/YTCP2006082572526.html
Catanduanes Rep. Joseph Santiago has urged the Commission on Higher Education (CHED) and the local government units concerned to promptly close down schools and review centers linked to alleged irregularities in the June nursing licensure examinations.
"Nursing schools and review centers that have been directly or indirectly implicated in the alleged cheating have forfeited the privilege to continue to provide educational services. They have no right to stay in business a minute longer," Santiago said.
At least two nursing board review centers — Inress Review Center Inc. and R.A. Gapuz Review Center Inc. — have so far been implicated in the test leakage, according to the Professional Regulation Commission (PRC).
Review centers, as local business entities, are under the supervision of local governments.
The PRC also previously indicated that three individuals have so far been linked to the cheating. They are Anesia Dionisio and Virginia Madeja, both former members of the PRC’s Board of Nursing, and George Cordero, the resigned president of the Philippine Nursing Association (PNA).
Cordero also owns Inress and the Philippine College of Health Sciences (PCHS), one of the "substandard" nursing schools in the country, according to CHED.
PCHS, however, produced at least one graduate who managed to land in the top 10 passers in the controversial June licensure examinations.
During a Senate inquiry last week, a nursing graduate who took the June examinations testified that leaked test questions were shown by Cordero to a group of reviewees.
Dennis Bautista said Cordero presented the questions during the final coaching sessions for examinees on June 8 and June 9, two days before the licensure examinations. Bautista said he attended the sessions.
Another examinee, Pamela Ortega, a graduate of PCHS, said that during the June 9 coaching session, she also overhead Cordero as saying that he "did not pay P7 million for nothing."
R.A. Gapuz has denied involvement in the cheating, saying it obtained "in good faith" the leaked questions. The center said it was not aware the questions would actually come out in the examinations.
FROM : http://www.mb.com.ph/YTCP2006082572526.html
Doctored exam for nurses stirs furor In Philippines, fear of tainted reputation
Doctored exam for nurses stirs furor
In Philippines, fear of tainted reputation
http://www.chicagotribune.com/news/nationworld/chi-0608210195aug21,1,7098530.story?coll=chi-newsnationworld-hed
By Carlos Conde
New York Times News Service
Published August 21, 2006
MANILA -- After disclosures that test questions for Philippine nursing board examinations in June were leaked to hundreds of applicants, officials and industry experts are warning that the country's status as one of the world's top producers of nurses could be threatened.
The country's Professional Regulation Commission has confirmed that questions in the board exams taken by more than 42,000 nursing graduates had been provided in advance to hundreds of examinees.
The initial accusations were made by students, who said that the president of the Philippine Nurses Association had provided the exams to students who took his coaching classes.
The president, George Cordero, has denied the charges, but he has resigned.
Industry groups are calling on the commission to compel the students to retake the exam to repair, according to one of the groups, the "tainted credibility of Filipino nurses here and abroad."
They have also asked the courts to stop the new nurses in Manila from taking their professional oath Tuesday, and on Friday, the court ruled in the groups' favor. Students in the provinces had already taken their oaths.
Those who passed the June exams said it would be unfair to force them to retake the test or to delay their certification.
The Philippines is the top supplier of nurses to the United States, sending several thousand a year. Earlier this year, a change in American immigration law lifted the cap on the number of foreign nurses American hospitals and clinics can hire.
The move created more opportunities for Filipino nurses, who are also in demand in Europe, Japan and other more affluent Asian countries.
The scandal, officials said, could greatly damage this status of Filipino nurses abroad. Already, Philippine officials said, American recruiters are turning away nurses who took the fraudulent board exams, while those who remain in the Philippines are having difficulty finding jobs. Questions also have been raised about the integrity of previous nursing board exams.
The Philippine Senate has started investigating the scandal. "American hospitals, Japanese hospitals, European hospitals are watching us," Sen. Richard Gordon, said during a Senate hearing last week.
Health experts at the hearing said they feared a moratorium by other countries on hiring Filipino nurses.
Although officials contend that the quality of Filipino nurses hired in other countries would not be affected in the long run because the new nurses generally must pass tests in destination countries, the credibility problem could persist.
"The credibility of the Filipino nurses has been tainted," said Rosalinda Baldoz, administrator of the Philippine Overseas Employment Administration.
The Philippine economy is heavily dependent on the remittances sent home by millions of its overseas workers.
While Filipino nurses have always enjoyed some kind of a favored status in the United States because of its past colonial affinity with the Philippines, the emergence of other countries that supply nurses, such as India, has been a concern in the Philippines of late. This scandal, officials said, will certainly add to the problem.
Cordero, who headed the nurse's association, was accused during the Senate hearing of leaking the exam in order to favor students who took reviews at a nursing review center that he owns, thus improving their chances of being recruited abroad.
He has also been accused of bribing examiners so that he could get advance copies of the test questions and of paying for a trip to Switzerland for some members of the Board of Nursing, which administers the exams.
Cordero has denied the allegations.
FROM : http://www.chicagotribune.com/news/nationworld/chi-0608210195aug21,1,7098530.story?coll=chi-newsnationworld-hed
In Philippines, fear of tainted reputation
http://www.chicagotribune.com/news/nationworld/chi-0608210195aug21,1,7098530.story?coll=chi-newsnationworld-hed
By Carlos Conde
New York Times News Service
Published August 21, 2006
MANILA -- After disclosures that test questions for Philippine nursing board examinations in June were leaked to hundreds of applicants, officials and industry experts are warning that the country's status as one of the world's top producers of nurses could be threatened.
The country's Professional Regulation Commission has confirmed that questions in the board exams taken by more than 42,000 nursing graduates had been provided in advance to hundreds of examinees.
The initial accusations were made by students, who said that the president of the Philippine Nurses Association had provided the exams to students who took his coaching classes.
The president, George Cordero, has denied the charges, but he has resigned.
Industry groups are calling on the commission to compel the students to retake the exam to repair, according to one of the groups, the "tainted credibility of Filipino nurses here and abroad."
They have also asked the courts to stop the new nurses in Manila from taking their professional oath Tuesday, and on Friday, the court ruled in the groups' favor. Students in the provinces had already taken their oaths.
Those who passed the June exams said it would be unfair to force them to retake the test or to delay their certification.
The Philippines is the top supplier of nurses to the United States, sending several thousand a year. Earlier this year, a change in American immigration law lifted the cap on the number of foreign nurses American hospitals and clinics can hire.
The move created more opportunities for Filipino nurses, who are also in demand in Europe, Japan and other more affluent Asian countries.
The scandal, officials said, could greatly damage this status of Filipino nurses abroad. Already, Philippine officials said, American recruiters are turning away nurses who took the fraudulent board exams, while those who remain in the Philippines are having difficulty finding jobs. Questions also have been raised about the integrity of previous nursing board exams.
The Philippine Senate has started investigating the scandal. "American hospitals, Japanese hospitals, European hospitals are watching us," Sen. Richard Gordon, said during a Senate hearing last week.
Health experts at the hearing said they feared a moratorium by other countries on hiring Filipino nurses.
Although officials contend that the quality of Filipino nurses hired in other countries would not be affected in the long run because the new nurses generally must pass tests in destination countries, the credibility problem could persist.
"The credibility of the Filipino nurses has been tainted," said Rosalinda Baldoz, administrator of the Philippine Overseas Employment Administration.
The Philippine economy is heavily dependent on the remittances sent home by millions of its overseas workers.
While Filipino nurses have always enjoyed some kind of a favored status in the United States because of its past colonial affinity with the Philippines, the emergence of other countries that supply nurses, such as India, has been a concern in the Philippines of late. This scandal, officials said, will certainly add to the problem.
Cordero, who headed the nurse's association, was accused during the Senate hearing of leaking the exam in order to favor students who took reviews at a nursing review center that he owns, thus improving their chances of being recruited abroad.
He has also been accused of bribing examiners so that he could get advance copies of the test questions and of paying for a trip to Switzerland for some members of the Board of Nursing, which administers the exams.
Cordero has denied the allegations.
FROM : http://www.chicagotribune.com/news/nationworld/chi-0608210195aug21,1,7098530.story?coll=chi-newsnationworld-hed
Nursing exam flunker says she, too, got test leaks
Nursing exam flunker says she, too, got test leaks
http://newsinfo.inq7.net/breakingnews/metroregions/view_article.php?article_id=17182
By Alcuin Papa
Inquirer
Last updated 10:15am (Mla time) 08/25/2006
ANOTHER nursing student has confirmed having obtained a set of the leaked test questions in the last nursing licensure examinations even as a key witness, nursing student Pamela Ortega, recanted her testimony on the leakage the other day.
In her July 28 testimony before the Board of Nursing (BON), a copy of which was furnished the Inquirer by the Professional Regulation Commission, Christie Makabenta said a friend gave her a set of review materials from the Inress Review Center, owned by former Philippine Nursing Association president George Cordero.
The review materials, Makabenta said, contained questions and answers to Test 5 (psychiatric nursing) that appeared in the last board exam.
Makabenta, an employee of the Asian Hospital’s financial counselor’s office, said she took her nursing degree from the Laguna Northwestern College in San Pedro, Laguna. She took the licensure exam on June 11 and 12 but failed.
Makabenta said she enrolled for review classes at the Pentagon Review Center. She said that on June 10, a friend who was reviewing with Inress gave her a thick folder with 500 questions for Test 5.
But she claimed to have been so overwhelmed by the volume of the materials, she decided there was no time to go over them.
After the exams, she leafed through the materials and discovered that they contained the very questions that came out in the board exams.
Makabenta, who regretted not having studied the review materials, felt better for it after the leakage scandal erupted. But she has since been bothered at being in possession of the materials and decided to turn them over to the BON.
She said she was so nervous she did not even stay long enough to sign the report of the incident which the BON submitted to the PRC.
PRC Commissioner Renato Valdecantos, who headed the PRC’s fact-finding committee on the alleged nursing
FROM : http://newsinfo.inq7.net/breakingnews/metroregions/view_article.php?article_id=17182
http://newsinfo.inq7.net/breakingnews/metroregions/view_article.php?article_id=17182
By Alcuin Papa
Inquirer
Last updated 10:15am (Mla time) 08/25/2006
ANOTHER nursing student has confirmed having obtained a set of the leaked test questions in the last nursing licensure examinations even as a key witness, nursing student Pamela Ortega, recanted her testimony on the leakage the other day.
In her July 28 testimony before the Board of Nursing (BON), a copy of which was furnished the Inquirer by the Professional Regulation Commission, Christie Makabenta said a friend gave her a set of review materials from the Inress Review Center, owned by former Philippine Nursing Association president George Cordero.
The review materials, Makabenta said, contained questions and answers to Test 5 (psychiatric nursing) that appeared in the last board exam.
Makabenta, an employee of the Asian Hospital’s financial counselor’s office, said she took her nursing degree from the Laguna Northwestern College in San Pedro, Laguna. She took the licensure exam on June 11 and 12 but failed.
Makabenta said she enrolled for review classes at the Pentagon Review Center. She said that on June 10, a friend who was reviewing with Inress gave her a thick folder with 500 questions for Test 5.
But she claimed to have been so overwhelmed by the volume of the materials, she decided there was no time to go over them.
After the exams, she leafed through the materials and discovered that they contained the very questions that came out in the board exams.
Makabenta, who regretted not having studied the review materials, felt better for it after the leakage scandal erupted. But she has since been bothered at being in possession of the materials and decided to turn them over to the BON.
She said she was so nervous she did not even stay long enough to sign the report of the incident which the BON submitted to the PRC.
PRC Commissioner Renato Valdecantos, who headed the PRC’s fact-finding committee on the alleged nursing
FROM : http://newsinfo.inq7.net/breakingnews/metroregions/view_article.php?article_id=17182
Leakage won’t harm nurses — PRC
Leakage won’t harm nurses — PRC
The Professional Regulation Commission (PRC) disputed claims yesterday that the leakage in this year’s nursing board examinations will harm the chances of passers who wish to work abroad.
Hospitals abroad, particularly those in the United States, do not hire an entire class but individuals who show through the National Council Licensure Examination (NCLEX), screening, and orientation, that they have both the skills and motivation to provide health care, PRC officials said.
"It is not the leakage but the controversy that could harm Philippine standing," they said. "In fact, a number of US recruitment and placement firms have invited 2006 June passers to apply with their agencies."
One agency described the threat that foreign employers would not hire the June 2006 passers as "ridiculous."
David Huff, head of GSN agency, explained that "hiring is much more thorough than determining if a person passed a licensure examination."
"Having high grades may get an applicant to the interview levels, but will quickly be forgotten in the required demonstration skills. There are even states, such as California, that may not even require the PRC license," Huff said.
In a press statement, the PRC also bared measures officials are taking to prevent leakage problem in the future.
These include asking Congress to enact a bill that will compel review centers to submit the names of their reviewees to the PRC to identify beneficiaries in case of leakage and make correction of scores more specific and to revise the rules in accrediting professional organizations to include criteria that owners, officials, and teachers of review centers should not be officials of the Accredited Professional Organization which nominates members of the board to remove all possible sources of conflict of interest.
The PRC also proposed to the Commission on Higher Education to incorporate a three to six-month review course in the curriculum an integrating subject at the end of the course work to provide the needed synthesis to examinees and correct the weaknesses on internal PRC system to further strengthen controls in examinations.
The commission announced that while the decision to release the examination results was for the benefit of the majority, the investigation being conducted by the National Bureau of Investigation is still going on and the publication of the results of the examinations do not mean that those involved will not be penalized.
FROM: http://www.mb.com.ph/MTNN2006082572566.html
The Professional Regulation Commission (PRC) disputed claims yesterday that the leakage in this year’s nursing board examinations will harm the chances of passers who wish to work abroad.
Hospitals abroad, particularly those in the United States, do not hire an entire class but individuals who show through the National Council Licensure Examination (NCLEX), screening, and orientation, that they have both the skills and motivation to provide health care, PRC officials said.
"It is not the leakage but the controversy that could harm Philippine standing," they said. "In fact, a number of US recruitment and placement firms have invited 2006 June passers to apply with their agencies."
One agency described the threat that foreign employers would not hire the June 2006 passers as "ridiculous."
David Huff, head of GSN agency, explained that "hiring is much more thorough than determining if a person passed a licensure examination."
"Having high grades may get an applicant to the interview levels, but will quickly be forgotten in the required demonstration skills. There are even states, such as California, that may not even require the PRC license," Huff said.
In a press statement, the PRC also bared measures officials are taking to prevent leakage problem in the future.
These include asking Congress to enact a bill that will compel review centers to submit the names of their reviewees to the PRC to identify beneficiaries in case of leakage and make correction of scores more specific and to revise the rules in accrediting professional organizations to include criteria that owners, officials, and teachers of review centers should not be officials of the Accredited Professional Organization which nominates members of the board to remove all possible sources of conflict of interest.
The PRC also proposed to the Commission on Higher Education to incorporate a three to six-month review course in the curriculum an integrating subject at the end of the course work to provide the needed synthesis to examinees and correct the weaknesses on internal PRC system to further strengthen controls in examinations.
The commission announced that while the decision to release the examination results was for the benefit of the majority, the investigation being conducted by the National Bureau of Investigation is still going on and the publication of the results of the examinations do not mean that those involved will not be penalized.
FROM: http://www.mb.com.ph/MTNN2006082572566.html
'Ex-PNA president threatened student to retract testimony'
'Ex-PNA president threatened student to retract testimony'
The Philippine Regulatory Board of Nursing on Thursday said ex-Philippine Nursing Association president George Cordero threatened a student to retract her testimony on the alleged leakage in the 2006 Nursing Licensure Exams (NLE).
Sister Letty Kuan, BON examiner, said nursing student Pamela Ortega tearfully confessed that Cordero called and threatened her after she linked Cordero to the leakage. Ortega is a nursing graduate of Philippine College of Health Sciences Inc. (PCHS), which is owned by Cordero.
"Cordero must tell the truth on what actually happened," Kuan told Bandila.
Ortega earlier told Philippine Regulation Commission investigators that Cordero gave a stapled set of papers to PCHS graduates during a review class at a Manila moviehouse on June 9. She said Cordero told the graduates that 100 questions from the set would appear in the board exams on June 11 and 12.
Ortega said Cordero told graduates that he paid P7 million for the leakage and even bought plane tickets to Switzerland for two BON members.
The leaked questions and answers were also flashed on the questions, allowing students to copy the leakage.
On Wednesday Ortega retracted her original testimony before the PRC.
BON members condemned the alleged threat against Ortega. The group also scored two BON members, Virginia Madeja at Anesia Dionisio, who were the alleged source of the leakage.
Palace leans toward retake
A consensus is forming in Malacañan that the nursing graduates who took the licensure examination in June should take the test again.
Presidential Management Staff chief Arthur Yap on Thursday informed reporters of the consensus after Dr. Dante Ang, chairman of the Commission on Overseas Filipinos who was directed by the President to look into allegations that questions in the exam had been leaked, submitted his recommendations to President Arroyo Wednesday night.
Yap said Ang proposed a retake of the exam, particularly Tests 3 and 5, to remove the stigma of the leakage.
"We are trying to win back the confidence of the world market, and so Ang proposed that the examinees should retake the entire thing," Yap said in an interview over Radio Mindanao Network.
In an interview on dzRH radio, Ang said he understood the frustration of the nursing students who passed the test but that the leakage issue must be cleared.
The BON had invalidated the tests on "clinical surgery" and "incremental health" and given the go-ahead for the oath-taking of the 17,000 who passed the board, but the Court of Appeals issued a restraining order.
Ang proposed that future nursing board exams be patterned after the National Council Licensure Examination.
Yap said the government wants to protect the integrity of the nursing profession, which has been tainted by the leakage.
He backed Ang’s recommendation, saying it would be hard to distinguish who among the examinees benefited from the leakage, and it was "not realistic" to expect the examinees who benefited from the leak to admit it.
Yap said Malacañan would still look at Ang’s recommendations.
Health Secretary Francisco Duque in a radio interview also supported Ang’s recommendation for a retake of the exam and appealed to hospital institutions to be fair to this year’s batch of nursing graduates.
Duque argued that nursing students’ rating in the licensure examination should not be the hospital management’s sole basis for hiring them. Students should also be assessed on the basis of their academic performance before they took the board exams.
Sen. Rodolfo Biazon has gone a step further and wants the entire exam invalidated.
Biazon, who had opposed a retake, now supports it after receiving reports that questions in Tests 1 and 2 were also leaked.
"But right now because of another report and another witness is saying that it is not only Tests 3 and 5 that had been leaked but also Tests 1 and 2. So with this additional information I would now support a retake," he said.
Biazon said that the Senate Committee on Civil Service and Government Reorganization he heads will conduct another hearing Wednesday next week to look into the alleged leakage in Tests 1 and 2.
The investigation will also help craft a legislation to deal with cheating in board exams such as regulating the review centers by the Commission on Higher Education, he said.
"We need laws. I am looking at the possibility of proposing a law to regulate and control review centers because the result of the hearing indicates that leakage was made through the test centers Gapuz [Review Center] and INRESS," Biazon said.
He has summoned officials of the PRC and the National Bureau of Investigation to the hearing. "Let us see if they will invoke Memorandum Circular 108."
Biazon said Memorandum Circular 108, issued by President Arroyo, was similar to Executive Order 464, which requires consent from Malacañan before any government official can attend congressional hearings.
The circular prescribes the "guidelines on appearances of departments heads and other officials of the executive department before Congress." With a report from The Manila Times
FROM: http://www.abs-cbnnews.com/storypage.aspx?StoryId=48414
The Philippine Regulatory Board of Nursing on Thursday said ex-Philippine Nursing Association president George Cordero threatened a student to retract her testimony on the alleged leakage in the 2006 Nursing Licensure Exams (NLE).
Sister Letty Kuan, BON examiner, said nursing student Pamela Ortega tearfully confessed that Cordero called and threatened her after she linked Cordero to the leakage. Ortega is a nursing graduate of Philippine College of Health Sciences Inc. (PCHS), which is owned by Cordero.
"Cordero must tell the truth on what actually happened," Kuan told Bandila.
Ortega earlier told Philippine Regulation Commission investigators that Cordero gave a stapled set of papers to PCHS graduates during a review class at a Manila moviehouse on June 9. She said Cordero told the graduates that 100 questions from the set would appear in the board exams on June 11 and 12.
Ortega said Cordero told graduates that he paid P7 million for the leakage and even bought plane tickets to Switzerland for two BON members.
The leaked questions and answers were also flashed on the questions, allowing students to copy the leakage.
On Wednesday Ortega retracted her original testimony before the PRC.
BON members condemned the alleged threat against Ortega. The group also scored two BON members, Virginia Madeja at Anesia Dionisio, who were the alleged source of the leakage.
Palace leans toward retake
A consensus is forming in Malacañan that the nursing graduates who took the licensure examination in June should take the test again.
Presidential Management Staff chief Arthur Yap on Thursday informed reporters of the consensus after Dr. Dante Ang, chairman of the Commission on Overseas Filipinos who was directed by the President to look into allegations that questions in the exam had been leaked, submitted his recommendations to President Arroyo Wednesday night.
Yap said Ang proposed a retake of the exam, particularly Tests 3 and 5, to remove the stigma of the leakage.
"We are trying to win back the confidence of the world market, and so Ang proposed that the examinees should retake the entire thing," Yap said in an interview over Radio Mindanao Network.
In an interview on dzRH radio, Ang said he understood the frustration of the nursing students who passed the test but that the leakage issue must be cleared.
The BON had invalidated the tests on "clinical surgery" and "incremental health" and given the go-ahead for the oath-taking of the 17,000 who passed the board, but the Court of Appeals issued a restraining order.
Ang proposed that future nursing board exams be patterned after the National Council Licensure Examination.
Yap said the government wants to protect the integrity of the nursing profession, which has been tainted by the leakage.
He backed Ang’s recommendation, saying it would be hard to distinguish who among the examinees benefited from the leakage, and it was "not realistic" to expect the examinees who benefited from the leak to admit it.
Yap said Malacañan would still look at Ang’s recommendations.
Health Secretary Francisco Duque in a radio interview also supported Ang’s recommendation for a retake of the exam and appealed to hospital institutions to be fair to this year’s batch of nursing graduates.
Duque argued that nursing students’ rating in the licensure examination should not be the hospital management’s sole basis for hiring them. Students should also be assessed on the basis of their academic performance before they took the board exams.
Sen. Rodolfo Biazon has gone a step further and wants the entire exam invalidated.
Biazon, who had opposed a retake, now supports it after receiving reports that questions in Tests 1 and 2 were also leaked.
"But right now because of another report and another witness is saying that it is not only Tests 3 and 5 that had been leaked but also Tests 1 and 2. So with this additional information I would now support a retake," he said.
Biazon said that the Senate Committee on Civil Service and Government Reorganization he heads will conduct another hearing Wednesday next week to look into the alleged leakage in Tests 1 and 2.
The investigation will also help craft a legislation to deal with cheating in board exams such as regulating the review centers by the Commission on Higher Education, he said.
"We need laws. I am looking at the possibility of proposing a law to regulate and control review centers because the result of the hearing indicates that leakage was made through the test centers Gapuz [Review Center] and INRESS," Biazon said.
He has summoned officials of the PRC and the National Bureau of Investigation to the hearing. "Let us see if they will invoke Memorandum Circular 108."
Biazon said Memorandum Circular 108, issued by President Arroyo, was similar to Executive Order 464, which requires consent from Malacañan before any government official can attend congressional hearings.
The circular prescribes the "guidelines on appearances of departments heads and other officials of the executive department before Congress." With a report from The Manila Times
FROM: http://www.abs-cbnnews.com/storypage.aspx?StoryId=48414
Thursday, August 24, 2006
Assembly tomorrow in front of PRC
BULLETIN : [ Requested to be posted ]
guys our permit had been granted for an assembly tom9am, infront of PRC.. wear white with black armband orribbon..please make placards or streamers for noretake.mobilize please.we have to showforce.thanks.pakipasa sa friends from other schools
-Toto Aquino
guys our permit had been granted for an assembly tom9am, infront of PRC.. wear white with black armband orribbon..please make placards or streamers for noretake.mobilize please.we have to showforce.thanks.pakipasa sa friends from other schools
-Toto Aquino
Palace leans toward a retake
Friday, August 25, 2006 |
| Palace leans toward a retake |
|
Presidential Management Staff chief Arthur Yap on Thursday informed reporters of the consensus after Dr. Dante Ang, chairman of the Commission on Overseas Filipinos who was directed by the President to look into allegations that questions in the exam had been leaked, submitted his recommendations to President Arroyo Wednesday night. Yap said Ang proposed a retake of the exam, particularly Tests 3 and 5, to remove the stigma of the leakage. “We are trying to win back the confidence of the world market, and so Ang proposed that the examinees should retake the entire thing,” Yap said in an interview over Radio Mindanao Network. In an interview on dzRH radio, Ang said he understood the frustration of the nursing students who passed the test but that the leakage issue must be cleared. The nursing board of the Professional Regulation Commission had invalidated the tests on “clinical surgery” and “incremental health” and given the go-ahead for the oath-taking of the 17,000 who passed the board, but the Court of Appeals issued a restraining order. Ang proposed that future nursing board exams be patterned after the National Council Licensure Examination. Yap said the government wants to protect the integrity of the nursing profession, which has been tainted by the leakage. He backed Ang’s recommendation, saying it would be hard to distinguish who among the examinees benefited from the leakage, and it was “not realistic” to expect the examinees who benefited from the leak to admit it. Yap said Malacañang would still look at Ang’s recommendations. Health Secretary Francisco Duque in a radio interview also supported Ang’s recommendation for a retake of the exam and appealed to hospital institutions to be fair to this year’s batch of nursing graduates. Duque argued that nursing students’ rating in the licensure examination should not be the hospital management’s sole basis for hiring them. Students should also be assessed on the basis of their academic performance before they took the board exams. Sen. Rodolfo Biazon has gone a step further and wants the entire exam invalidated. Biazon, who had opposed a retake, now supports it after receiving reports that questions in Tests 1 and 2 were also leaked. “But right now because of another report and another witness is saying that it is not only Tests 3 and 5 that had been leaked but also Tests 1 and 2. So with this additional information I would now support a retake,” he said. Biazon said that the Senate Committee on Civil Service and Government Reorganization he heads will conduct another hearing Wednesday next week to look into the alleged leakage in Tests 1 and 2. The investigation will also help craft a legislation to deal with cheating in board exams such as regulating the review centers by the Commission on Higher Education, he said. George Cordero, owner of the INRESS Review Center and the Philippine College of Health Sciences who had been implicated in the leakage, was also president of the Philippine Nurses Association, which chose members of the PRC nursing board. Cordero has resigned from the PNA. “We need laws. I am looking at the possibility of proposing a law to regulate and control review centers because the result of the hearing indicates that leakage was made through the test centers Gapuz [Review Center] and INRESS,” Biazon said. He has summoned officials of the PRC and the National Bureau of Investigation to the hearing. “Let us see if they will invoke Memorandum Circular 108.” Biazon said Memorandum Circular 108, issued by President Arroyo, was similar to Executive Order 464, which requires consent from Malacañang before any government official can attend congressional hearings. The circular prescribes the “guidelines on appearances of departments heads and other officials of the executive department before Congress.” |
http://www.manilatimes.net/national/2006/aug/25/yehey/top_stories/20060825top3.html
Commentary: On the nursing board exams scandal
Commentary: On the nursing board exams scandal
http://www.pia.gov.ph/news.asp?fi=p060824.htm&no=22
By Renee F. De Guzman
San Fernando City, La Union (24 August) -- It is sad that the 42,000 nursing graduates who took the licensure exams last June may have to retake a new examinations.
Painful as it is and unfair too to those examinees who really worked hard and honestly passed the examinations. The apparent leaked questions in the examination probably benefited only a few hundred cheaters but the cheating scandal has tainted the entire Philippine nursing corps.
We have to bite the bullet if only to redeem the integrity of the Philippine Nursing Licensure Examination and the country itself.
National interest is at stake. This scandal gives a black eye to the country’s nurses who are considered among the best in the world and the most sought after by foreign employers.
Owing to the examination scandal, there are reports that US recruiters are turning away from nurses who took the board exams in June 2006 while Philippine hospital administrators are not also eager to hire any nurses from the same batch for they might proved to be incompetent having passed the exam by cheating.
Chairman Dante Ang of the Commission on Filipino Overseas (CFO) also reported that the application of the Philippines for inclusion on the list of international testing centers of the United States National Commission on Licensure (NCLEX) has been put on hold due to the scandal leakage issue.
Unfortunately, the credibility of the professional board exams has been compromised even as Malacanang said that it is an “isolated case and should not be cause for stigma” on Filipino nurses and other professionals who are among the best in the world. That the government will charge and punish the culprits who will be found guilty.
The country is placed in a disgraceful situation as even the integrity of previous nursing board examinations is now in question. The imperative solution is a bitter pill to swallow require all examinees to take a new set of examinations.
On the part of the government, through the Commission on Higher Education, without any dent of politics and business interests a tougher regulation should also be implemented on the mushrooming nursing schools and review centers across the country by closing down poor performing schools in the nursing board examinations. This is to improve quality and promote excellence in the nursing education which has been declining as seen in high failing rate in the yearly nursing board exams. Also, there is a need to replace the members of the Professional Regulation Commission with new ones who are not owners or deans of nursing schools or review centers.
This way, we are able to restore the credibility of our professional board examinations and at the same time make our professionals competitive both locally and globally. (PIA La Union)
FROM : http://www.pia.gov.ph/news.asp?fi=p060824.htm&no=22
http://www.pia.gov.ph/news.asp?fi=p060824.htm&no=22
By Renee F. De Guzman
San Fernando City, La Union (24 August) -- It is sad that the 42,000 nursing graduates who took the licensure exams last June may have to retake a new examinations.
Painful as it is and unfair too to those examinees who really worked hard and honestly passed the examinations. The apparent leaked questions in the examination probably benefited only a few hundred cheaters but the cheating scandal has tainted the entire Philippine nursing corps.
We have to bite the bullet if only to redeem the integrity of the Philippine Nursing Licensure Examination and the country itself.
National interest is at stake. This scandal gives a black eye to the country’s nurses who are considered among the best in the world and the most sought after by foreign employers.
Owing to the examination scandal, there are reports that US recruiters are turning away from nurses who took the board exams in June 2006 while Philippine hospital administrators are not also eager to hire any nurses from the same batch for they might proved to be incompetent having passed the exam by cheating.
Chairman Dante Ang of the Commission on Filipino Overseas (CFO) also reported that the application of the Philippines for inclusion on the list of international testing centers of the United States National Commission on Licensure (NCLEX) has been put on hold due to the scandal leakage issue.
Unfortunately, the credibility of the professional board exams has been compromised even as Malacanang said that it is an “isolated case and should not be cause for stigma” on Filipino nurses and other professionals who are among the best in the world. That the government will charge and punish the culprits who will be found guilty.
The country is placed in a disgraceful situation as even the integrity of previous nursing board examinations is now in question. The imperative solution is a bitter pill to swallow require all examinees to take a new set of examinations.
On the part of the government, through the Commission on Higher Education, without any dent of politics and business interests a tougher regulation should also be implemented on the mushrooming nursing schools and review centers across the country by closing down poor performing schools in the nursing board examinations. This is to improve quality and promote excellence in the nursing education which has been declining as seen in high failing rate in the yearly nursing board exams. Also, there is a need to replace the members of the Professional Regulation Commission with new ones who are not owners or deans of nursing schools or review centers.
This way, we are able to restore the credibility of our professional board examinations and at the same time make our professionals competitive both locally and globally. (PIA La Union)
FROM : http://www.pia.gov.ph/news.asp?fi=p060824.htm&no=22
109 Questions and Rationale on Psychotic Disorders
109 Questions and Rationale on Psychotic Disorders
1. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is:
A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.
Rationale: The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn't helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn't therapeutic.
2. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?
A. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."
Rationale: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
3. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.
4. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger?
A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."
Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Option A wouldn't address the client's anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client's misconceptions. The nurse can't promise that a delay will never occur again, as in option D, because such matters are outside the nurse's control.
5. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.
6. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:
A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.
Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.
7. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.
Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.
8. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.
D. Ask the client to describe what the voices are saying.
Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination.
9. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow
Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.
10. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.
Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
11. A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?
A. Assist the client with feeding.
B. Assist the client with showering.
C. Reassure the client about safety.
D. Encourage socialization with peers.
Rationale: According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.
12. A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
Rationale: Ideas of reference refers to the mistaken belief that neutral stimuli have special meaning to the individual such as the television newscaster sending a message directly to the individual. A delusion is a false belief. Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences.
13. The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid:
A. has a more predictable onset of action.
B. produces fewer anticholinergic effects.
C. produces fewer drug interactions.
D. has a longer duration of action.
Rationale: A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.
14. A client who has been hospitalized with disorganized type schizophrenia for 8 years can't complete activities of daily living (ADLs) without staff direction and assistance. The nurse formulates a nursing diagnosis of Self-care deficient: Dressing/grooming related to inability to function without assistance. What is an appropriate goal for this client?
A. "Client will be able to complete ADLs independently within 1 month."
B. "Client will be able to complete ADLs with only verbal encouragement within 1 month."
C. "Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month."
D. "Client will be able to complete ADLs with complete assistance within 1 month."
Rationale: The client's disorganized personality and history of hospitalization have affected the ability to perform self-care activities. Interventions should be directed at helping the client complete ADLs with the assistance of staff members, who can provide needed structure by helping the client select grooming items and clothing. This goal promotes realistic independence. As the client improves and achieves the established goal, the nurse can set new goals that focus on the client completing ADLs with only verbal encouragement and, ultimately, completing them independently. The client's condition doesn't indicate a need for complete assistance, which would only foster dependence.
15. The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Which nursing diagnosis should receive the highest priority?
A. Risk for violence toward self or others
B. Imbalanced nutrition: Less than body requirements
C. Ineffective family coping
D. Impaired verbal communication
Rationale: Because of such factors as suspiciousness, anxiety, and hallucinations, the client with paranoid schizophrenia is at risk for violence toward himself or others. The other options are also appropriate nursing diagnoses but should be addressed after the safety of the client and those around him is established.
16. The nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia. The client's husband expresses concern over whether his wife will continue to take her daily prescribed medication. The nurse should inform him that:
A. his concern is valid but his wife is an adult and has the right to make her own decisions.
B. he can easily mix the medication in his wife's food if she stops taking it.
C. his wife can be given a long-acting medication that is administered every 1 to 4 weeks.
D. his wife knows she must take her medication as prescribed to avoid future hospitalizations.
Rationale: Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic. A client has the right to refuse medication, but this issue isn't the focus of discussion at this time. Medication should never be hidden in food or drink to trick the client into taking it; besides destroying the client's trust, doing so would place the client at risk for overmedication or undermedication because the amount administered is hard to determine. Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic.
17. Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by:
A. decreasing the anxiety causing muscle rigidity.
B. blocking the cholinergic activity in the central nervous system (CNS).
C. increasing the level of acetylcholine in the CNS.
D. increasing norepinephrine in the CNS.
Rationale: Option B is the action of Cogentin. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS.
18. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?
A. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."
Rationale: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
19. A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by:
A. blocking dopamine receptors in the central nervous system (CNS).
B. blocking acetylcholine in the CNS.
C. activating norepinephrine in the CNS.
D. activating dopamine receptors in the CNS.
Rationale: Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity. They don't affect norepinephrine or acetylcholine.
20. Most antipsychotic medications exert which of following effects on the central nervous system (CNS)?
A. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors.
B. Sedate the CNS by stimulating serotonin at the synaptic cleft.
C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine.
D. Depress the CNS by stimulating the release of acetylcholine.
Rationale: The exact mechanism of antipsychotic medication action is unknown, but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.
21. A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:
A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.
Rationale: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.
22. Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction?
A. prochlorperazine (Compazine)
B. diphenhydramine (Benadryl)
C. haloperidol (Haldol)
D. midazolam (Versed)
Rationale: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.
23. A schizophrenic client states, "I hear the voice of King Tut." Which response by the nurse would be most therapeutic?
A. "I don't hear the voice, but I know you hear what sounds like a voice."
B. "You shouldn't focus on that voice."
C. "Don't worry about the voice as long as it doesn't belong to anyone real."
D. "King Tut has been dead for years."
Rationale: This response states reality about the client's hallucination. The other options are judgmental, flippant, or dismissive.
24. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is:
A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.
Rationale: The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn't helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn't therapeutic.
25. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.
D. Ask the client to describe what the voices are saying
Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination.
26. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?
A. Restlessness, difficulty sitting still, and pacing
B. Involuntary rolling of the eyes
C. Tremors, shuffling gait, and masklike face
D. Extremity and neck spasms, facial grimacing, and jerky movements
Rationale: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and "pill rolling." Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.
27. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take?
A. Give the next dose of fluphenazine, call the physician, and monitor vital signs.
B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.
C. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation.
D. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake.
Rationale: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher.
28. A schizophrenic client with delusions tells the nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be the best response?
A. "This subject seems to be troubling you. Let's walk to the activity room."
B. "Describe the man who's out to get you. What does he look like?"
C. "There is no reason to be afraid of that man. This hospital is very secure."
D. "There is no need to be concerned with a man who isn't even real."
Rationale: This remark distracts the client from the delusion by engaging the client in a less threatening or more comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the false belief. The other options focus on the content of the delusion rather than the meaning, feeling, or intent that it provokes.
29. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
A. Occurrence of increased libido due to medication adverse effects
B. Increased incidence of dysmenorrhea while taking the drug
C. Continuing previous use of contraception during periods of amenorrhea
D. Instruction that amenorrhea is irreversible
Rationale: Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation; therefore, the client can still become pregnant. The client should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and libido generally decreases because of the depressant effect.
30. A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect?
A. Tardive dyskinesia
B. Dystonia
C. Neuroleptic malignant syndrome
D. Akathisia
Rationale: Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
31. What medication would probably be ordered for the acutely aggressive schizophrenic client?
A. chlorpromazine (Thorazine)
B. haloperidol (Haldol)
C. lithium carbonate (Lithonate)
D. amitriptyline (Elavil)
Rationale: Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression.
32. A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?
A. Aggressive behavior
B. Paranoid thoughts
C. Emotional affect
D. Independence needs
Rationale: Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.
33. During the initial interview, a client with schizophrenia suddenly turns to the empty chair beside him and whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What is the nurse's best initial response?
A. "When people are under stress, they may see things or hear things that others don't. Is that what just happened?"
B. "I'm having a difficult time hearing you. Please look at me when you talk."
C. "There is no one else in the room. What are you doing?"
D. "Who are you talking to? Are you hallucinating?"
Rationale: This response makes the client feel that experiencing hallucinations is acceptable and promotes an open, therapeutic relationship. Directing the client to look at the nurse wouldn't address the obvious issue of the hallucination. Confrontational approaches, such as in options C and D, are likely to elicit an uninformative or negative response.
34. The definition of nihilistic delusions is:
A. a false belief about the functioning of the body.
B. belief that the body is deformed or defective in a specific way.
C. false ideas about the self, others, or the world
D. the inability to carry out motor activities.
Rationale: Nihilistic delusions are false ideas about the self, others, or the world. Somatic delusions involve a false belief about the functioning of the body. Body dysmorphic disorder is characterized by a belief that the body is deformed or defective in a specific way. Apraxia is the inability to carry out motor activities.
35. A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy?
A. Agranulocytosis
B. Extrapyramidal effects
C. Anticholinergic effects
D. Neuroleptic malignant syndrome (NMS)
Rationale: A rare but potentially fatal condition of antipsychotic medication is called NMS. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism.
36. The nurse formulates a nursing diagnosis of Impaired social interaction related to disorganized thinking for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention takes highest priority?
A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Exploring the effects of the client's behavior on social interactions
D. Developing a schedule for the client's participation in social interactions
Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established.
37. A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
Rationale: A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.
38. A client with delusional thinking shows a lack of interest in eating at meal times. She states that she is unworthy of eating and that her children will die if she eats. Which nursing action would be most appropriate for this client?
A. Telling the client that she may become sick and die unless she eats
B. Paying special attention to the client's rituals and emotions associated with meals
C. Restricting the client's access to food except at specified meal and snack times
D. Encouraging the client to express her feelings at meal times
Rationale: Restricting access to food except at specified times prevents the client from eating when she feels anxious, guilty, or depressed; this, in turn, decreases the association between these emotions and food. Telling the client she may become sick or die may reinforce her behavior because illness or death may be her goal. Paying special attention to rituals and emotions associated with meals also would reinforce undesirable behavior. Encouraging the client to express feelings at meal times would increase the association between emotions and food; instead, the nurse should encourage her to express feelings at other times.
39. Which of the following groups of characteristics would the nurse expect to see in the client with schizophrenia?
A. Loose associations, grandiose delusions, and auditory hallucinations
B. Periods of hyperactivity and irritability alternating with depression
C. Delusions of jealousy and persecution, paranoia, and mistrust
D. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss
Rationale: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren't able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.
40. The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is:
A. Benztropine (Cogentin).
B. diphenhydramine (Benadryl).
C. propranolol (Inderal).
D. haloperidol (Haldol).
Rationale: Benztropine, trihexyphenidyl, or amantadine are prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.
41. A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation?
A. Ask the client to sit still or leave the room because he is distracting the other clients.
B. Ask the client if he is nervous or anxious about something.
C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
D. Administer an as needed dose of haloperidol to decrease agitation.
Rationale: Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can't control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn't address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn't stop them from occurring. Giving more antipsychotic medication would worsen akathisia.
42. A man is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her of trying to poison him. During the initial interview, the client's speech, only partly comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the devil. The physician diagnoses paranoid schizophrenia. Schizophrenia is best described as a disorder characterized by:
A. disturbed relationships related to an inability to communicate and think clearly.
B. severe mood swings and periods of low to high activity.
C. multiple personalities, one of which is more destructive than the others.
D. auditory and tactile hallucinations.
Rationale: Schizophrenia is best described as one of a group of psychotic reactions characterized by disturbed relationships with others and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior commonly are evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and periods of low to high activity are typical of bipolar disorder. Multiple personality, sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. Many schizophrenic clients have auditory hallucinations; tactile hallucinations are more common in organic or toxic disorders
43. A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?
A. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur
B. Sitting up for a few minutes before standing to minimize orthostatic hypotension
C. Notifying the physician if her thoughts don't normalize within 1 week
D. Expecting symptoms of tardive dyskinesia to occur and to be transient
Rationale: The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may take several weeks to appear. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately
44. A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction:
A. tardive dyskinesia.
B. dystonia.
C. neuroleptic malignant syndrome.
D. akathisia.
Rationale: The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.
45. While looking out the window, a client with schizophrenia remarks, "That school across the street has creatures in it that are waiting for me." Which of the following terms best describes what the creatures represent?
A. Anxiety attack
B. Projection
C. Hallucination
D. Delusion
Rationale: A delusion is a false belief based on a misrepresentation of a real event or experience. Although anxiety can increase delusional responses, it isn't considered the primary symptom. Projection is falsely attributing to another person one's own unacceptable feelings. Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation
46. A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a:
A. delusion of persecution.
B. delusion of grandeur.
C. somatic delusion.
D. jealous delusion.
Rationale: Somatic delusions focus on bodily functions or systems and commonly include delusions about foul odor emissions, insect infestations, internal parasites, and misshapen parts. Delusions of persecution are morbid beliefs that one is being mistreated and harassed by unidentified enemies. Delusions of grandeur are gross exaggerations of one's importance, wealth, power, or talents. Jealous delusions are delusions that one's spouse or lover is unfaithful.
47. During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:
A. somatic delusions.
B. waxy flexibility.
C. neologisms.
D. nihilistic delusions.
Rationale: The correct answer is waxy flexibility, which is defined as retaining any position that the body has been placed in. Somatic delusions involve a false belief about the functioning of the body. Neologisms are invented meaningless words. Nihilistic delusions are false ideas about self, others, or the world.
48. A client with paranoid type schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should
A. tell him that she'll leave for now but will return soon.
B. ask him if it's okay if she sits quietly with him.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything happen to him
Rationale: If the client tells the nurse to leave, the nurse should leave but let the client know that she'll return so that he doesn't feel abandoned. Not heeding the client's request can agitate him further. Also, challenging the client isn't therapeutic and may increase his anger. False reassurance isn't warranted in this situation
49. Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing theories. The nurse's interpersonal communication with the client and specific nursing interventions must be:
A. clearly identified with boundaries and specifically defined roles.
B. warm and nonthreatening.
C. centered on clearly defined limits and expression of empathy.
D. flexible enough for the nurse to adjust the plan of care as the situation warrants.
Rationale: A flexible plan of care is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and is in control of himself at various times, the nurse must be able to adjust nursing care as the situation warrants. The nurse's role should be clear; however, the boundaries or limits of this role should be flexible enough to meet client needs. Because a client with schizophrenia fears closeness and affection, a warm approach may be too threatening. Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the client's situation may change without warning.
50. When discharging a client after treatment for a dystonic reaction, the emergency department nurse must ensure that the client understands which of the following?
A. Results of treatment are rapid and dramatic but may not last.
B. Although uncomfortable, this reaction isn't serious.
C. The client shouldn't buy drugs on the street.
D. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms.
Rationale: An oral anticholinergic agent such as benztropine (Cogentin) is commonly prescribed to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn't appropriate
51. The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable?
A. The client spends more time by himself.
B. The client doesn't engage in delusional thinking.
C. The client doesn't harm himself or others.
D. The client demonstrates the ability to meet his own self-care needs.
Rationale: The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.
52. The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate?
A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Establishing alternative forms of communication
D. Allowing the client to decide when he wants to participate in verbal communication with the nurse
Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established.
53. Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?
A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client's body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath
Rationale: By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality (as in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by shaming or embarrassing the client.
54. Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction?
A. Hypertension
B. Respiratory arrest
C. Tourette syndrome
D. Retinal pigmentation
Rationale: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options don't occur as a result of exceeding this dose.
55. A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?
A. "I get upset once in a while, too."
B. "I know just how you feel. I'd feel the same way in your situation."
C. "I worry, too, when I think people are talking about me."
D. "At times, it's normal not to trust anyone."
Rationale: Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client to confide in the nurse
56. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated?
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.
57. A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?
A. Take the medication 1 hour before a meal.
B. Decrease the dosage if signs of illness decrease.
C. Apply a sunscreen before being exposed to the sun.
D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
Rationale: Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it
58. A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
A. "Your behavior won't be tolerated. Go to your room immediately."
B. "You're just doing this to get back at me for making you come to therapy."
C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D. "I'm disappointed in you. You can't control yourself even for a few minutes."
Rationale: The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended, as in option A. Option B is incorrect because it implies that the client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks, such as option D, may decrease the client's self-esteem.
59. Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)?
A. The absence of anticholinergic effects
B. A lower incidence of extrapyramidal effects
C. Photosensitivity and sedation
D. No incidence of neuroleptic malignant syndrome
Rationale: Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.
60. The etiology of schizophrenia is best described by:
A. genetics due to a faulty dopamine receptor.
B. environmental factors and poor parenting.
C. structural and neurobiological factors.
D. a combination of biological, psychological, and environmental factors.
Rationale: A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia.
61. A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)
Rationale: Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety.
62. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.
Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.
63. A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic?
A. "That must be frightening to you. Can you tell me how you feel about it?"
B. "There are no people living on Mars."
C. "What do you mean when you say they're going to invade the earth?"
D. "I know you believe the earth is going to be invaded, but I don't believe that."
Rationale: This response addresses the client's underlying fears without feeding the delusion. Refuting the client's delusion, as in option B, would increase anxiety and reinforce the delusion. Asking the client to elaborate on the delusion, as in option C, would also reinforce it. Voicing disbelief about the delusion, as in option D, wouldn't help the client deal with underlying fears
64. 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:
A. sit in a quiet, dark room and concentrate on the voices.
B. listen to a personal stereo through headphones and sing along with the music.
C. call a friend and discuss the voices and his feelings about them.
D. engage in strenuous exercise.
Rationale: Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Option A would make it harder for the client to ignore the hallucinations. Talking about the voices, as in option C, would encourage the client to focus on them. Option D is incorrect because exercise alone wouldn't provide enough auditory stimulation to drown out the voices.
65. A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?
A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of antipsychotic medication
C. Risk for injury related to a severely decreased level of consciousness
D. Risk for injury related to electrolyte disturbances
Rationale: Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Urinary frequency isn't an approved nursing diagnosis. Although antipsychotic medications may cause sedation, they don't severely decrease the level of consciousness, eliminating option C. These drugs don't cause electrolyte disturbances, eliminating option D.
66. A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?
A. Dystonia
B. Akathisia
C. Pseudoparkinsonism
D. Tardive dyskinesia
Rationale: An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Dystonia refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease.
67. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care?
A. Meeting all of the client's physical needs
B. Giving the client an opportunity to express concerns
C. Administering lithium carbonate (Lithonate) as prescribed
D. Providing a quiet environment where the client can be alone
Rationale: Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. This client is incapable of expressing concerns; however, the nurse should try to verbalize the message conveyed by the client's nonverbal behavior. Lithium is used to treat mania, not catatonic schizophrenia. Despite the client's mute, unresponsive state, the nurse should provide nonthreatening stimulation and should spend time with the client, not leave the client alone all the time. Although aware of the environment, the client doesn't interact with it actively; the nurse's support and presence can be reassuring.
68. A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?
A. chlorpromazine (Thorazine)
B. imipramine (Tofranil)
C. lithium carbonate (Lithane)
D. fluphenazine decanoate (Prolixin Decanoate)
Rationale: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.
69. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.
70. Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond?
A. "Why do you think there is a bomb in the elevator?"
B. "That is the same thing you said in yesterday's session."
C. "I know you think there are bombs in the elevator, but there aren't."
D. "If you have something to say, you must do it according to our group rules."
Rationale: Option C is the most therapeutic response because it orients the client to reality. Options A and B are condescending. Option D sounds punitive and could embarrass the client.
71. A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
C. lithium carbonate (Lithonate)
D. alcohol
Rationale: When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. The other options are incorrect
72. A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development?
A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust
Rationale: This client's paranoid ideation indicates difficulty trusting others. The stage of autonomy versus shame and doubt deals with separation, cooperation, and self-control. Generativity versus stagnation is the normal stage for this client's chronologic age. Integrity versus despair is the stage for accepting the positive and negative aspects of one's life, which would be difficult or impossible for this client.
73. During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of:
A. paranoid personality disorder.
B. avoidant personality disorder.
C. histrionic personality disorder.
D. borderline personality disorder.
Rationale: This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Typically, a client with paranoid personality disorder is suspicious, cold, hostile, and argumentative. Avoidant personality disorder is characterized by anxiety, fear, and social isolation. Borderline personality disorder is characterized by impulsive, unpredictable behavior and unstable, intense interpersonal relationships.
74. The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered?
A. To reduce psychotic symptoms
B. To reduce extrapyramidal symptoms
C. To control nausea and vomiting
D. To relieve anxiety
Rationale: Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting.
75. A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:
A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.
Rationale: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.
76. A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?
A. Schizophrenia
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)
Rationale: Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania. Schizophrenia doesn't exhibit mood swings from depression to euphoria. Paranoia is characterized by unrealistic suspiciousness and is often accompanied by grandiosity. OCD is a preoccupation with rituals and rules.
77. A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's:
A. thinking, perceiving, and decision-making skills.
B. verbal and nonverbal communication processes.
C. affect and behavior.
D. psychomotor activity.
Rationale: Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning. Although assessing communication processes, affect, behavior, and psychomotor activity would reveal important information about the client's condition, the nurse should concentrate on determining whether the client is hallucinating by assessing thought processes and decision-making ability.
78. Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?
A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician immediately.
C. Blood pressure must be monitored for hypertension.
D. Stop the medication when symptoms subside.
Rationale: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/μl, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.
79. Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions?
A. Use sunscreen because of photosensitivity.
B. Take the antipsychotic medication with food.
C. Have routine blood tests to determine levels of the medication.
D. Abstain from eating aged cheese.
* A and B are both correct in taking HALDOL.
80. Positive symptoms of schizophrenia include which of the following?
A. Hallucinations, delusions, and disorganized thinking
B. Somatic delusions, echolalia, and a flat affect
C. Waxy flexibility, alogia, and apathy
D. Flat affect, avolition, and anhedonia
Rationale: The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia. A flat affect, alogia, apathy, avolition, and anhedonia refer to the negative symptoms. Negative symptoms list the diminution or loss of normal function
81. A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction?
A. Dystonia
B. Akinesia
C. Akathisia
D. Tardive dyskinesia
Rationale: Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.
82. Hormonal effects of the antipsychotic medications include which of the following?
A. Retrograde ejaculation and gynecomastia
B. Dysmenorrhea and increased vaginal bleeding
C. Polydipsia and dysmenorrhea
D. Akinesia and dysphasia
Rationale: Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Polydipsia, akinesia, and dysphasia aren't hormonal effects.
83. A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?
A. Word salad
B. Tangential
C. Perseveration
D. Avolition
Rationale: Avolition refers to impairment in the ability to initiate goal-directed activity. Word salad is when a group of words are put together in a random fashion without logical connection. Tangential is where a person never gets to the point of the communication. Perseveration is when a person repeats the same word or idea in response to different questions.
84. An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat:
A. dyskinesia.
B. dementia.
C. psychosis.
D. tardive dyskinesia.
Rationale: By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.
85. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow.
Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.
86. A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect?
A. phenytoin (Dilantin)
B. amantadine (Symmetrel)
C. benztropine (Cogentin)
D. diphenhydramine (Benadryl)
Rationale: An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.
87. Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:
A. double the dose if missed to maintain a therapeutic level.
B. be sure to take the drug with a meal because it's very irritating to the stomach.
C. discontinue the drug if the client reports weight gain.
D. notify the physician if the client notices an increase in bruising.
Rationale: Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Don't double the dose. This drug doesn't irritate the stomach, and weight gain isn't a problem.
88. A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting:
A. suggestibility.
B. negativity.
C. waxy flexibility.
D. retardation.
Rationale: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Clients with dependency problems may demonstrate suggestibility, a response pattern in which one easily agrees to the ideas and suggestions of others rather than making independent judgments. Negativity (for example, resistance to being moved or being asked to cooperate) and retardation (slowed movement) also occur in catatonic clients.
89. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger?
A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."
Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Option A wouldn't address the client's anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client's misconceptions. The nurse can't promise that a delay will never occur again, as in option D, because such matters are outside the nurse's control.
90. A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?
A. Hepatitis
B. Infection
C. Granulocytopenia
D. Systemic dermatitis
Rationale: Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions of clozapine therapy.
91. Which nonantipsychotic medication is used to treat some clients with schizoaffective disorder?
A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)
Rationale: Lithium carbonate, an antimania drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including maniclike activity. Lithium helps control the affective component of this disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification.
92. A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?
A. Personality disorder
B. Mood disorder
C. Thought disorder
D. Amnestic disorder
Rationale: According to the DSM-IV, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it's worse than the prognosis for a mood disorder alone. Option A is incorrect because personality disorders and psychotic illness aren't listed together on the same axis. Option C is incorrect because schizophrenia is a major thought disorder and the question asks for elements of another disorder. Clients with schizoaffective disorder aren't suffering from schizophrenia and an amnestic disorder.
93. When teaching the family of a client with schizophrenia, the nurse should provide which information?
A. Relapse can be prevented if the client takes the medication.
B. Support is available to help family members meet their own needs.
C. Improvement should occur if the client has a stimulating environment.
D. Stressful family situations can precipitate a relapse in the client.
Rationale: Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems. The nurse should also teach them that medication can't prevent relapses and that environmental stimuli may precipitate symptoms. Although stress can trigger symptoms, the nurse shouldn't make the family feel responsible for relapses (as in option D).
94. A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:
A. loss of identity and self-esteem.
B. multiple personalities and decreased self-esteem.
C. disturbances in affect, perception, and thought content and form.
D. persistent memory impairment and confusion.
Rationale: The Diagnostic and Statistic Manual of Mental Disorders, 4th edition, defines schizophrenia as a disturbance in multiple psychological processes that affects thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Loss of identity sometimes occurs but is only one characteristic of the disorder. Multiple personalities typify multiple personality disorder, a dissociative personality disorder. Mood disorders are commonly accompanied by increased or decreased self-esteem. Schizophrenia doesn't cause a disturbance in sensorium, although the client may exhibit confusion, disorientation, and memory impairment during the acute phase.
95. The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should:
A. ask the client which activity he would prefer to do first.
B. negotiate a time when the client will perform activities.
C. tell the client specifically and concisely what needs to be done.
D. prepare the client ahead of time for the activity.
Rationale: The client needs to be informed of the activity and when it will be done. Giving the client choices isn't desirable because he can be manipulative or refuse to do anything. Negotiating and preparing the client ahead of time also isn't therapeutic with this type of client because he may not want to perform the activity.
96. The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:
A. delusions.
B. hallucinations.
C. loose associations.
D. neologisms.
Rationale: Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. Delusions are false beliefs, rather than perceptions, that the client accepts as real. Loose associations are rapid shifts among unrelated ideas. Neologisms are bizarre words that have meaning only to the client.
97. The nurse is aware that antipsychotic medications may cause which of the following adverse effects?
A. Increased production of insulin
B. Lower seizure threshold
C. Increased coagulation time
D. Increased risk of heart failure
Rationale: Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents
98. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is:
A. highly important or famous.
B. being persecuted.
C. connected to events unrelated to oneself.
D. responsible for the evil in the world.
Rationale: A delusion of grandeur is a false belief that one is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.
99. A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing diagnosis?
A. Anxiety
B. Impaired verbal communication
C. Disturbed thought processes
D. Self-care deficient: Dressing/grooming
Rationale: For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client's extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury. Impaired verbal communication, manifested by noncommunicativeness; Disturbed thought processes, evidenced by inability to understand the situation; and Self-care deficient: Dressing/grooming, evidenced by a disheveled appearance, are appropriate nursing diagnoses but aren't the highest priority
100. A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should:
A. administer the medication as prescribed.
B. question the physician about the order.
C. administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n.
D. administer the medication as prescribed but observe the client closely for adverse effects.
Rationale: The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately, before the client's health is jeopardized.
101. A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. The nurse expects the assessment to reveal:
A. unpredictable behavior and intense interpersonal relationships.
B. inability to function as a responsible parent.
C. somatic symptoms.
D. coldness, detachment, and lack of tender feelings.
Rationale: A client with borderline personality disorder displays a pervasive pattern of unpredictable behavior, mood, and self-image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive. Although the client's impaired ability to form relationships may affect parenting skills, inability to function as a responsible parent is more typical of antisocial personality disorder. Somatic symptoms characterize avoidant personality disorder. Coldness, detachment, and lack of tender feelings typify schizoid and schizotypal personality disorders.
102. A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a unit for chronic mentally ill clients. The client's behavior is labile and fluctuates from childishness and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all activities of daily living. Which behavior is characteristic of disorganized type schizophrenia?
A. Extreme social impairment
B. Suspicious delusions
C. Waxy flexibility
D. Elevated affect
Rationale: Disorganized type schizophrenia (formerly called hebephrenia) is characterized by extreme social impairment, marked inappropriate affect, silliness, grimacing, posturing, and fragmented delusions and hallucinations. A client with a paranoid disorder typically exhibits suspicious delusions, such as a belief that evil forces are after him. Waxy flexibility, a condition in which the client's limbs remain fixed in uncomfortable positions for long periods, characterizes catatonic schizophrenia. Elevated affect is associated with schizoaffective disorder.
103. The nurse is providing care for a female client with a history of schizophrenia who's experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse's best action?
A. Administer the haloperidol orally if the client agrees to take it.
B. Call the physician to clarify whether the haloperidol should be given orally or I.M.
C. Call the physician to clarify the order because the dosage is too high.
D. Withhold haloperidol because it may worsen hallucinations.
Rationale: The dosage is too high (normal dosage ranges from 5 to 10 mg daily). Options A and B may lead to an overdose. Option D is incorrect because haloperidol helps with symptoms of hallucinations.
104. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:
A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.
Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.
105. A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse's best response at this time would be to:
A. take the client's vital signs.
B. explore the content of the hallucinations.
C. tell him his fear is unrealistic.
D. engage the client in reality-oriented activities.
Rationale: Exploring the content of the hallucinations will help the nurse understand the client's perspective on the situation. The client shouldn't be touched, such as in taking vital signs, without telling him exactly what is going to happen. Debating with the client about his emotions isn't therapeutic. When the client is calm, engage him in reality-based activities.
106. Which medication can control the extrapyramidal effects associated with antipsychotic agents?
A. perphenazine (Trilafon)
B. doxepin (Sinequan)
C. amantadine (Symmetrel)
D. clorazepate (Tranxene)
Rationale: Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia. Other anticholinergic agents used to control extrapyramidal reactions include benztropine mesylate (Cogentin), trihexyphenidyl (Artane), biperiden (Akineton), and diphenhydramine (Benadryl). Perphenazine is an antipsychotic agent; doxepin, an antidepressant; and chlorazepate, an antianxiety agent. Because these medications have no anticholinergic or neurotransmitter effects, they don't alleviate extrapyramidal reactions.
107. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.
Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
108. A dystonic reaction can be caused by which of the following medications?
A. diazepam (Valium)
B. haloperidol (Haldol)
C. amitriptyline (Elavil)
D. clonazepam (Klonopin)
Rationale: Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Diazepam and clonazepam are benzodiazepines, and amitriptyline is a tricyclic antidepressant. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.
109. While pacing in the hall, a client with paranoid schizophrenia runs to the nurse and says, "Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!" How should the nurse respond during the early stage of the therapeutic process?
A. "I'm a nurse. I'm not poisoning you. It's against the nursing code of ethics."
B. "I'm a nurse, and you're a client in the hospital. I'm not going to harm you."
C. "I'm not poisoning you. And how could I possibly steal your soul?"
D. "I sense anger. Are you feeling angry today?"
Rationale: The nurse should directly orient a delusional client to reality, especially to place and person. Options A and C may encourage further delusions by denying poisoning and offering information related to the delusion. Validating the client's feelings, as in option D, occurs during a later stage in the therapeutic process.
1. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is:
A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.
Rationale: The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn't helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn't therapeutic.
2. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?
A. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."
Rationale: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
3. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.
4. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger?
A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."
Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Option A wouldn't address the client's anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client's misconceptions. The nurse can't promise that a delay will never occur again, as in option D, because such matters are outside the nurse's control.
5. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.
6. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:
A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.
Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.
7. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.
Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.
8. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.
D. Ask the client to describe what the voices are saying.
Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination.
9. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow
Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.
10. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.
Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
11. A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?
A. Assist the client with feeding.
B. Assist the client with showering.
C. Reassure the client about safety.
D. Encourage socialization with peers.
Rationale: According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.
12. A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
Rationale: Ideas of reference refers to the mistaken belief that neutral stimuli have special meaning to the individual such as the television newscaster sending a message directly to the individual. A delusion is a false belief. Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences.
13. The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid:
A. has a more predictable onset of action.
B. produces fewer anticholinergic effects.
C. produces fewer drug interactions.
D. has a longer duration of action.
Rationale: A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.
14. A client who has been hospitalized with disorganized type schizophrenia for 8 years can't complete activities of daily living (ADLs) without staff direction and assistance. The nurse formulates a nursing diagnosis of Self-care deficient: Dressing/grooming related to inability to function without assistance. What is an appropriate goal for this client?
A. "Client will be able to complete ADLs independently within 1 month."
B. "Client will be able to complete ADLs with only verbal encouragement within 1 month."
C. "Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month."
D. "Client will be able to complete ADLs with complete assistance within 1 month."
Rationale: The client's disorganized personality and history of hospitalization have affected the ability to perform self-care activities. Interventions should be directed at helping the client complete ADLs with the assistance of staff members, who can provide needed structure by helping the client select grooming items and clothing. This goal promotes realistic independence. As the client improves and achieves the established goal, the nurse can set new goals that focus on the client completing ADLs with only verbal encouragement and, ultimately, completing them independently. The client's condition doesn't indicate a need for complete assistance, which would only foster dependence.
15. The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Which nursing diagnosis should receive the highest priority?
A. Risk for violence toward self or others
B. Imbalanced nutrition: Less than body requirements
C. Ineffective family coping
D. Impaired verbal communication
Rationale: Because of such factors as suspiciousness, anxiety, and hallucinations, the client with paranoid schizophrenia is at risk for violence toward himself or others. The other options are also appropriate nursing diagnoses but should be addressed after the safety of the client and those around him is established.
16. The nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia. The client's husband expresses concern over whether his wife will continue to take her daily prescribed medication. The nurse should inform him that:
A. his concern is valid but his wife is an adult and has the right to make her own decisions.
B. he can easily mix the medication in his wife's food if she stops taking it.
C. his wife can be given a long-acting medication that is administered every 1 to 4 weeks.
D. his wife knows she must take her medication as prescribed to avoid future hospitalizations.
Rationale: Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic. A client has the right to refuse medication, but this issue isn't the focus of discussion at this time. Medication should never be hidden in food or drink to trick the client into taking it; besides destroying the client's trust, doing so would place the client at risk for overmedication or undermedication because the amount administered is hard to determine. Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic.
17. Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by:
A. decreasing the anxiety causing muscle rigidity.
B. blocking the cholinergic activity in the central nervous system (CNS).
C. increasing the level of acetylcholine in the CNS.
D. increasing norepinephrine in the CNS.
Rationale: Option B is the action of Cogentin. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS.
18. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?
A. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."
Rationale: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
19. A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by:
A. blocking dopamine receptors in the central nervous system (CNS).
B. blocking acetylcholine in the CNS.
C. activating norepinephrine in the CNS.
D. activating dopamine receptors in the CNS.
Rationale: Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity. They don't affect norepinephrine or acetylcholine.
20. Most antipsychotic medications exert which of following effects on the central nervous system (CNS)?
A. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors.
B. Sedate the CNS by stimulating serotonin at the synaptic cleft.
C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine.
D. Depress the CNS by stimulating the release of acetylcholine.
Rationale: The exact mechanism of antipsychotic medication action is unknown, but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.
21. A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:
A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.
Rationale: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.
22. Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction?
A. prochlorperazine (Compazine)
B. diphenhydramine (Benadryl)
C. haloperidol (Haldol)
D. midazolam (Versed)
Rationale: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.
23. A schizophrenic client states, "I hear the voice of King Tut." Which response by the nurse would be most therapeutic?
A. "I don't hear the voice, but I know you hear what sounds like a voice."
B. "You shouldn't focus on that voice."
C. "Don't worry about the voice as long as it doesn't belong to anyone real."
D. "King Tut has been dead for years."
Rationale: This response states reality about the client's hallucination. The other options are judgmental, flippant, or dismissive.
24. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is:
A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.
Rationale: The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn't helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn't therapeutic.
25. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.
D. Ask the client to describe what the voices are saying
Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination.
26. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?
A. Restlessness, difficulty sitting still, and pacing
B. Involuntary rolling of the eyes
C. Tremors, shuffling gait, and masklike face
D. Extremity and neck spasms, facial grimacing, and jerky movements
Rationale: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and "pill rolling." Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.
27. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take?
A. Give the next dose of fluphenazine, call the physician, and monitor vital signs.
B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.
C. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation.
D. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake.
Rationale: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher.
28. A schizophrenic client with delusions tells the nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be the best response?
A. "This subject seems to be troubling you. Let's walk to the activity room."
B. "Describe the man who's out to get you. What does he look like?"
C. "There is no reason to be afraid of that man. This hospital is very secure."
D. "There is no need to be concerned with a man who isn't even real."
Rationale: This remark distracts the client from the delusion by engaging the client in a less threatening or more comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the false belief. The other options focus on the content of the delusion rather than the meaning, feeling, or intent that it provokes.
29. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
A. Occurrence of increased libido due to medication adverse effects
B. Increased incidence of dysmenorrhea while taking the drug
C. Continuing previous use of contraception during periods of amenorrhea
D. Instruction that amenorrhea is irreversible
Rationale: Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation; therefore, the client can still become pregnant. The client should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and libido generally decreases because of the depressant effect.
30. A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect?
A. Tardive dyskinesia
B. Dystonia
C. Neuroleptic malignant syndrome
D. Akathisia
Rationale: Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
31. What medication would probably be ordered for the acutely aggressive schizophrenic client?
A. chlorpromazine (Thorazine)
B. haloperidol (Haldol)
C. lithium carbonate (Lithonate)
D. amitriptyline (Elavil)
Rationale: Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression.
32. A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?
A. Aggressive behavior
B. Paranoid thoughts
C. Emotional affect
D. Independence needs
Rationale: Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.
33. During the initial interview, a client with schizophrenia suddenly turns to the empty chair beside him and whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What is the nurse's best initial response?
A. "When people are under stress, they may see things or hear things that others don't. Is that what just happened?"
B. "I'm having a difficult time hearing you. Please look at me when you talk."
C. "There is no one else in the room. What are you doing?"
D. "Who are you talking to? Are you hallucinating?"
Rationale: This response makes the client feel that experiencing hallucinations is acceptable and promotes an open, therapeutic relationship. Directing the client to look at the nurse wouldn't address the obvious issue of the hallucination. Confrontational approaches, such as in options C and D, are likely to elicit an uninformative or negative response.
34. The definition of nihilistic delusions is:
A. a false belief about the functioning of the body.
B. belief that the body is deformed or defective in a specific way.
C. false ideas about the self, others, or the world
D. the inability to carry out motor activities.
Rationale: Nihilistic delusions are false ideas about the self, others, or the world. Somatic delusions involve a false belief about the functioning of the body. Body dysmorphic disorder is characterized by a belief that the body is deformed or defective in a specific way. Apraxia is the inability to carry out motor activities.
35. A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy?
A. Agranulocytosis
B. Extrapyramidal effects
C. Anticholinergic effects
D. Neuroleptic malignant syndrome (NMS)
Rationale: A rare but potentially fatal condition of antipsychotic medication is called NMS. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism.
36. The nurse formulates a nursing diagnosis of Impaired social interaction related to disorganized thinking for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention takes highest priority?
A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Exploring the effects of the client's behavior on social interactions
D. Developing a schedule for the client's participation in social interactions
Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established.
37. A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
Rationale: A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.
38. A client with delusional thinking shows a lack of interest in eating at meal times. She states that she is unworthy of eating and that her children will die if she eats. Which nursing action would be most appropriate for this client?
A. Telling the client that she may become sick and die unless she eats
B. Paying special attention to the client's rituals and emotions associated with meals
C. Restricting the client's access to food except at specified meal and snack times
D. Encouraging the client to express her feelings at meal times
Rationale: Restricting access to food except at specified times prevents the client from eating when she feels anxious, guilty, or depressed; this, in turn, decreases the association between these emotions and food. Telling the client she may become sick or die may reinforce her behavior because illness or death may be her goal. Paying special attention to rituals and emotions associated with meals also would reinforce undesirable behavior. Encouraging the client to express feelings at meal times would increase the association between emotions and food; instead, the nurse should encourage her to express feelings at other times.
39. Which of the following groups of characteristics would the nurse expect to see in the client with schizophrenia?
A. Loose associations, grandiose delusions, and auditory hallucinations
B. Periods of hyperactivity and irritability alternating with depression
C. Delusions of jealousy and persecution, paranoia, and mistrust
D. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss
Rationale: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren't able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.
40. The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is:
A. Benztropine (Cogentin).
B. diphenhydramine (Benadryl).
C. propranolol (Inderal).
D. haloperidol (Haldol).
Rationale: Benztropine, trihexyphenidyl, or amantadine are prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.
41. A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation?
A. Ask the client to sit still or leave the room because he is distracting the other clients.
B. Ask the client if he is nervous or anxious about something.
C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
D. Administer an as needed dose of haloperidol to decrease agitation.
Rationale: Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can't control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn't address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn't stop them from occurring. Giving more antipsychotic medication would worsen akathisia.
42. A man is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her of trying to poison him. During the initial interview, the client's speech, only partly comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the devil. The physician diagnoses paranoid schizophrenia. Schizophrenia is best described as a disorder characterized by:
A. disturbed relationships related to an inability to communicate and think clearly.
B. severe mood swings and periods of low to high activity.
C. multiple personalities, one of which is more destructive than the others.
D. auditory and tactile hallucinations.
Rationale: Schizophrenia is best described as one of a group of psychotic reactions characterized by disturbed relationships with others and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior commonly are evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and periods of low to high activity are typical of bipolar disorder. Multiple personality, sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. Many schizophrenic clients have auditory hallucinations; tactile hallucinations are more common in organic or toxic disorders
43. A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?
A. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur
B. Sitting up for a few minutes before standing to minimize orthostatic hypotension
C. Notifying the physician if her thoughts don't normalize within 1 week
D. Expecting symptoms of tardive dyskinesia to occur and to be transient
Rationale: The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may take several weeks to appear. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately
44. A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction:
A. tardive dyskinesia.
B. dystonia.
C. neuroleptic malignant syndrome.
D. akathisia.
Rationale: The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.
45. While looking out the window, a client with schizophrenia remarks, "That school across the street has creatures in it that are waiting for me." Which of the following terms best describes what the creatures represent?
A. Anxiety attack
B. Projection
C. Hallucination
D. Delusion
Rationale: A delusion is a false belief based on a misrepresentation of a real event or experience. Although anxiety can increase delusional responses, it isn't considered the primary symptom. Projection is falsely attributing to another person one's own unacceptable feelings. Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation
46. A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a:
A. delusion of persecution.
B. delusion of grandeur.
C. somatic delusion.
D. jealous delusion.
Rationale: Somatic delusions focus on bodily functions or systems and commonly include delusions about foul odor emissions, insect infestations, internal parasites, and misshapen parts. Delusions of persecution are morbid beliefs that one is being mistreated and harassed by unidentified enemies. Delusions of grandeur are gross exaggerations of one's importance, wealth, power, or talents. Jealous delusions are delusions that one's spouse or lover is unfaithful.
47. During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:
A. somatic delusions.
B. waxy flexibility.
C. neologisms.
D. nihilistic delusions.
Rationale: The correct answer is waxy flexibility, which is defined as retaining any position that the body has been placed in. Somatic delusions involve a false belief about the functioning of the body. Neologisms are invented meaningless words. Nihilistic delusions are false ideas about self, others, or the world.
48. A client with paranoid type schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should
A. tell him that she'll leave for now but will return soon.
B. ask him if it's okay if she sits quietly with him.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything happen to him
Rationale: If the client tells the nurse to leave, the nurse should leave but let the client know that she'll return so that he doesn't feel abandoned. Not heeding the client's request can agitate him further. Also, challenging the client isn't therapeutic and may increase his anger. False reassurance isn't warranted in this situation
49. Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing theories. The nurse's interpersonal communication with the client and specific nursing interventions must be:
A. clearly identified with boundaries and specifically defined roles.
B. warm and nonthreatening.
C. centered on clearly defined limits and expression of empathy.
D. flexible enough for the nurse to adjust the plan of care as the situation warrants.
Rationale: A flexible plan of care is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and is in control of himself at various times, the nurse must be able to adjust nursing care as the situation warrants. The nurse's role should be clear; however, the boundaries or limits of this role should be flexible enough to meet client needs. Because a client with schizophrenia fears closeness and affection, a warm approach may be too threatening. Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the client's situation may change without warning.
50. When discharging a client after treatment for a dystonic reaction, the emergency department nurse must ensure that the client understands which of the following?
A. Results of treatment are rapid and dramatic but may not last.
B. Although uncomfortable, this reaction isn't serious.
C. The client shouldn't buy drugs on the street.
D. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms.
Rationale: An oral anticholinergic agent such as benztropine (Cogentin) is commonly prescribed to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn't appropriate
51. The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable?
A. The client spends more time by himself.
B. The client doesn't engage in delusional thinking.
C. The client doesn't harm himself or others.
D. The client demonstrates the ability to meet his own self-care needs.
Rationale: The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.
52. The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate?
A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Establishing alternative forms of communication
D. Allowing the client to decide when he wants to participate in verbal communication with the nurse
Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established.
53. Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?
A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client's body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath
Rationale: By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality (as in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by shaming or embarrassing the client.
54. Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction?
A. Hypertension
B. Respiratory arrest
C. Tourette syndrome
D. Retinal pigmentation
Rationale: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options don't occur as a result of exceeding this dose.
55. A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?
A. "I get upset once in a while, too."
B. "I know just how you feel. I'd feel the same way in your situation."
C. "I worry, too, when I think people are talking about me."
D. "At times, it's normal not to trust anyone."
Rationale: Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client to confide in the nurse
56. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated?
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.
57. A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?
A. Take the medication 1 hour before a meal.
B. Decrease the dosage if signs of illness decrease.
C. Apply a sunscreen before being exposed to the sun.
D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
Rationale: Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it
58. A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
A. "Your behavior won't be tolerated. Go to your room immediately."
B. "You're just doing this to get back at me for making you come to therapy."
C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D. "I'm disappointed in you. You can't control yourself even for a few minutes."
Rationale: The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended, as in option A. Option B is incorrect because it implies that the client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks, such as option D, may decrease the client's self-esteem.
59. Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)?
A. The absence of anticholinergic effects
B. A lower incidence of extrapyramidal effects
C. Photosensitivity and sedation
D. No incidence of neuroleptic malignant syndrome
Rationale: Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.
60. The etiology of schizophrenia is best described by:
A. genetics due to a faulty dopamine receptor.
B. environmental factors and poor parenting.
C. structural and neurobiological factors.
D. a combination of biological, psychological, and environmental factors.
Rationale: A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia.
61. A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)
Rationale: Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety.
62. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.
Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.
63. A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic?
A. "That must be frightening to you. Can you tell me how you feel about it?"
B. "There are no people living on Mars."
C. "What do you mean when you say they're going to invade the earth?"
D. "I know you believe the earth is going to be invaded, but I don't believe that."
Rationale: This response addresses the client's underlying fears without feeding the delusion. Refuting the client's delusion, as in option B, would increase anxiety and reinforce the delusion. Asking the client to elaborate on the delusion, as in option C, would also reinforce it. Voicing disbelief about the delusion, as in option D, wouldn't help the client deal with underlying fears
64. 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:
A. sit in a quiet, dark room and concentrate on the voices.
B. listen to a personal stereo through headphones and sing along with the music.
C. call a friend and discuss the voices and his feelings about them.
D. engage in strenuous exercise.
Rationale: Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Option A would make it harder for the client to ignore the hallucinations. Talking about the voices, as in option C, would encourage the client to focus on them. Option D is incorrect because exercise alone wouldn't provide enough auditory stimulation to drown out the voices.
65. A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?
A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of antipsychotic medication
C. Risk for injury related to a severely decreased level of consciousness
D. Risk for injury related to electrolyte disturbances
Rationale: Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Urinary frequency isn't an approved nursing diagnosis. Although antipsychotic medications may cause sedation, they don't severely decrease the level of consciousness, eliminating option C. These drugs don't cause electrolyte disturbances, eliminating option D.
66. A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?
A. Dystonia
B. Akathisia
C. Pseudoparkinsonism
D. Tardive dyskinesia
Rationale: An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Dystonia refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease.
67. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care?
A. Meeting all of the client's physical needs
B. Giving the client an opportunity to express concerns
C. Administering lithium carbonate (Lithonate) as prescribed
D. Providing a quiet environment where the client can be alone
Rationale: Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. This client is incapable of expressing concerns; however, the nurse should try to verbalize the message conveyed by the client's nonverbal behavior. Lithium is used to treat mania, not catatonic schizophrenia. Despite the client's mute, unresponsive state, the nurse should provide nonthreatening stimulation and should spend time with the client, not leave the client alone all the time. Although aware of the environment, the client doesn't interact with it actively; the nurse's support and presence can be reassuring.
68. A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?
A. chlorpromazine (Thorazine)
B. imipramine (Tofranil)
C. lithium carbonate (Lithane)
D. fluphenazine decanoate (Prolixin Decanoate)
Rationale: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.
69. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.
70. Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond?
A. "Why do you think there is a bomb in the elevator?"
B. "That is the same thing you said in yesterday's session."
C. "I know you think there are bombs in the elevator, but there aren't."
D. "If you have something to say, you must do it according to our group rules."
Rationale: Option C is the most therapeutic response because it orients the client to reality. Options A and B are condescending. Option D sounds punitive and could embarrass the client.
71. A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
C. lithium carbonate (Lithonate)
D. alcohol
Rationale: When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. The other options are incorrect
72. A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development?
A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust
Rationale: This client's paranoid ideation indicates difficulty trusting others. The stage of autonomy versus shame and doubt deals with separation, cooperation, and self-control. Generativity versus stagnation is the normal stage for this client's chronologic age. Integrity versus despair is the stage for accepting the positive and negative aspects of one's life, which would be difficult or impossible for this client.
73. During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of:
A. paranoid personality disorder.
B. avoidant personality disorder.
C. histrionic personality disorder.
D. borderline personality disorder.
Rationale: This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Typically, a client with paranoid personality disorder is suspicious, cold, hostile, and argumentative. Avoidant personality disorder is characterized by anxiety, fear, and social isolation. Borderline personality disorder is characterized by impulsive, unpredictable behavior and unstable, intense interpersonal relationships.
74. The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered?
A. To reduce psychotic symptoms
B. To reduce extrapyramidal symptoms
C. To control nausea and vomiting
D. To relieve anxiety
Rationale: Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting.
75. A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:
A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.
Rationale: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.
76. A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?
A. Schizophrenia
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)
Rationale: Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania. Schizophrenia doesn't exhibit mood swings from depression to euphoria. Paranoia is characterized by unrealistic suspiciousness and is often accompanied by grandiosity. OCD is a preoccupation with rituals and rules.
77. A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's:
A. thinking, perceiving, and decision-making skills.
B. verbal and nonverbal communication processes.
C. affect and behavior.
D. psychomotor activity.
Rationale: Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning. Although assessing communication processes, affect, behavior, and psychomotor activity would reveal important information about the client's condition, the nurse should concentrate on determining whether the client is hallucinating by assessing thought processes and decision-making ability.
78. Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?
A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician immediately.
C. Blood pressure must be monitored for hypertension.
D. Stop the medication when symptoms subside.
Rationale: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/μl, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.
79. Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions?
A. Use sunscreen because of photosensitivity.
B. Take the antipsychotic medication with food.
C. Have routine blood tests to determine levels of the medication.
D. Abstain from eating aged cheese.
* A and B are both correct in taking HALDOL.
80. Positive symptoms of schizophrenia include which of the following?
A. Hallucinations, delusions, and disorganized thinking
B. Somatic delusions, echolalia, and a flat affect
C. Waxy flexibility, alogia, and apathy
D. Flat affect, avolition, and anhedonia
Rationale: The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia. A flat affect, alogia, apathy, avolition, and anhedonia refer to the negative symptoms. Negative symptoms list the diminution or loss of normal function
81. A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction?
A. Dystonia
B. Akinesia
C. Akathisia
D. Tardive dyskinesia
Rationale: Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.
82. Hormonal effects of the antipsychotic medications include which of the following?
A. Retrograde ejaculation and gynecomastia
B. Dysmenorrhea and increased vaginal bleeding
C. Polydipsia and dysmenorrhea
D. Akinesia and dysphasia
Rationale: Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Polydipsia, akinesia, and dysphasia aren't hormonal effects.
83. A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?
A. Word salad
B. Tangential
C. Perseveration
D. Avolition
Rationale: Avolition refers to impairment in the ability to initiate goal-directed activity. Word salad is when a group of words are put together in a random fashion without logical connection. Tangential is where a person never gets to the point of the communication. Perseveration is when a person repeats the same word or idea in response to different questions.
84. An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat:
A. dyskinesia.
B. dementia.
C. psychosis.
D. tardive dyskinesia.
Rationale: By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.
85. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow.
Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.
86. A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect?
A. phenytoin (Dilantin)
B. amantadine (Symmetrel)
C. benztropine (Cogentin)
D. diphenhydramine (Benadryl)
Rationale: An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.
87. Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:
A. double the dose if missed to maintain a therapeutic level.
B. be sure to take the drug with a meal because it's very irritating to the stomach.
C. discontinue the drug if the client reports weight gain.
D. notify the physician if the client notices an increase in bruising.
Rationale: Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Don't double the dose. This drug doesn't irritate the stomach, and weight gain isn't a problem.
88. A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting:
A. suggestibility.
B. negativity.
C. waxy flexibility.
D. retardation.
Rationale: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Clients with dependency problems may demonstrate suggestibility, a response pattern in which one easily agrees to the ideas and suggestions of others rather than making independent judgments. Negativity (for example, resistance to being moved or being asked to cooperate) and retardation (slowed movement) also occur in catatonic clients.
89. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger?
A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."
Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Option A wouldn't address the client's anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client's misconceptions. The nurse can't promise that a delay will never occur again, as in option D, because such matters are outside the nurse's control.
90. A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?
A. Hepatitis
B. Infection
C. Granulocytopenia
D. Systemic dermatitis
Rationale: Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions of clozapine therapy.
91. Which nonantipsychotic medication is used to treat some clients with schizoaffective disorder?
A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)
Rationale: Lithium carbonate, an antimania drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including maniclike activity. Lithium helps control the affective component of this disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification.
92. A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?
A. Personality disorder
B. Mood disorder
C. Thought disorder
D. Amnestic disorder
Rationale: According to the DSM-IV, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it's worse than the prognosis for a mood disorder alone. Option A is incorrect because personality disorders and psychotic illness aren't listed together on the same axis. Option C is incorrect because schizophrenia is a major thought disorder and the question asks for elements of another disorder. Clients with schizoaffective disorder aren't suffering from schizophrenia and an amnestic disorder.
93. When teaching the family of a client with schizophrenia, the nurse should provide which information?
A. Relapse can be prevented if the client takes the medication.
B. Support is available to help family members meet their own needs.
C. Improvement should occur if the client has a stimulating environment.
D. Stressful family situations can precipitate a relapse in the client.
Rationale: Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems. The nurse should also teach them that medication can't prevent relapses and that environmental stimuli may precipitate symptoms. Although stress can trigger symptoms, the nurse shouldn't make the family feel responsible for relapses (as in option D).
94. A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:
A. loss of identity and self-esteem.
B. multiple personalities and decreased self-esteem.
C. disturbances in affect, perception, and thought content and form.
D. persistent memory impairment and confusion.
Rationale: The Diagnostic and Statistic Manual of Mental Disorders, 4th edition, defines schizophrenia as a disturbance in multiple psychological processes that affects thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Loss of identity sometimes occurs but is only one characteristic of the disorder. Multiple personalities typify multiple personality disorder, a dissociative personality disorder. Mood disorders are commonly accompanied by increased or decreased self-esteem. Schizophrenia doesn't cause a disturbance in sensorium, although the client may exhibit confusion, disorientation, and memory impairment during the acute phase.
95. The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should:
A. ask the client which activity he would prefer to do first.
B. negotiate a time when the client will perform activities.
C. tell the client specifically and concisely what needs to be done.
D. prepare the client ahead of time for the activity.
Rationale: The client needs to be informed of the activity and when it will be done. Giving the client choices isn't desirable because he can be manipulative or refuse to do anything. Negotiating and preparing the client ahead of time also isn't therapeutic with this type of client because he may not want to perform the activity.
96. The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:
A. delusions.
B. hallucinations.
C. loose associations.
D. neologisms.
Rationale: Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. Delusions are false beliefs, rather than perceptions, that the client accepts as real. Loose associations are rapid shifts among unrelated ideas. Neologisms are bizarre words that have meaning only to the client.
97. The nurse is aware that antipsychotic medications may cause which of the following adverse effects?
A. Increased production of insulin
B. Lower seizure threshold
C. Increased coagulation time
D. Increased risk of heart failure
Rationale: Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents
98. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is:
A. highly important or famous.
B. being persecuted.
C. connected to events unrelated to oneself.
D. responsible for the evil in the world.
Rationale: A delusion of grandeur is a false belief that one is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.
99. A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing diagnosis?
A. Anxiety
B. Impaired verbal communication
C. Disturbed thought processes
D. Self-care deficient: Dressing/grooming
Rationale: For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client's extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury. Impaired verbal communication, manifested by noncommunicativeness; Disturbed thought processes, evidenced by inability to understand the situation; and Self-care deficient: Dressing/grooming, evidenced by a disheveled appearance, are appropriate nursing diagnoses but aren't the highest priority
100. A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should:
A. administer the medication as prescribed.
B. question the physician about the order.
C. administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n.
D. administer the medication as prescribed but observe the client closely for adverse effects.
Rationale: The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately, before the client's health is jeopardized.
101. A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. The nurse expects the assessment to reveal:
A. unpredictable behavior and intense interpersonal relationships.
B. inability to function as a responsible parent.
C. somatic symptoms.
D. coldness, detachment, and lack of tender feelings.
Rationale: A client with borderline personality disorder displays a pervasive pattern of unpredictable behavior, mood, and self-image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive. Although the client's impaired ability to form relationships may affect parenting skills, inability to function as a responsible parent is more typical of antisocial personality disorder. Somatic symptoms characterize avoidant personality disorder. Coldness, detachment, and lack of tender feelings typify schizoid and schizotypal personality disorders.
102. A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a unit for chronic mentally ill clients. The client's behavior is labile and fluctuates from childishness and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all activities of daily living. Which behavior is characteristic of disorganized type schizophrenia?
A. Extreme social impairment
B. Suspicious delusions
C. Waxy flexibility
D. Elevated affect
Rationale: Disorganized type schizophrenia (formerly called hebephrenia) is characterized by extreme social impairment, marked inappropriate affect, silliness, grimacing, posturing, and fragmented delusions and hallucinations. A client with a paranoid disorder typically exhibits suspicious delusions, such as a belief that evil forces are after him. Waxy flexibility, a condition in which the client's limbs remain fixed in uncomfortable positions for long periods, characterizes catatonic schizophrenia. Elevated affect is associated with schizoaffective disorder.
103. The nurse is providing care for a female client with a history of schizophrenia who's experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse's best action?
A. Administer the haloperidol orally if the client agrees to take it.
B. Call the physician to clarify whether the haloperidol should be given orally or I.M.
C. Call the physician to clarify the order because the dosage is too high.
D. Withhold haloperidol because it may worsen hallucinations.
Rationale: The dosage is too high (normal dosage ranges from 5 to 10 mg daily). Options A and B may lead to an overdose. Option D is incorrect because haloperidol helps with symptoms of hallucinations.
104. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:
A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.
Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.
105. A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse's best response at this time would be to:
A. take the client's vital signs.
B. explore the content of the hallucinations.
C. tell him his fear is unrealistic.
D. engage the client in reality-oriented activities.
Rationale: Exploring the content of the hallucinations will help the nurse understand the client's perspective on the situation. The client shouldn't be touched, such as in taking vital signs, without telling him exactly what is going to happen. Debating with the client about his emotions isn't therapeutic. When the client is calm, engage him in reality-based activities.
106. Which medication can control the extrapyramidal effects associated with antipsychotic agents?
A. perphenazine (Trilafon)
B. doxepin (Sinequan)
C. amantadine (Symmetrel)
D. clorazepate (Tranxene)
Rationale: Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia. Other anticholinergic agents used to control extrapyramidal reactions include benztropine mesylate (Cogentin), trihexyphenidyl (Artane), biperiden (Akineton), and diphenhydramine (Benadryl). Perphenazine is an antipsychotic agent; doxepin, an antidepressant; and chlorazepate, an antianxiety agent. Because these medications have no anticholinergic or neurotransmitter effects, they don't alleviate extrapyramidal reactions.
107. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.
Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
108. A dystonic reaction can be caused by which of the following medications?
A. diazepam (Valium)
B. haloperidol (Haldol)
C. amitriptyline (Elavil)
D. clonazepam (Klonopin)
Rationale: Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Diazepam and clonazepam are benzodiazepines, and amitriptyline is a tricyclic antidepressant. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.
109. While pacing in the hall, a client with paranoid schizophrenia runs to the nurse and says, "Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!" How should the nurse respond during the early stage of the therapeutic process?
A. "I'm a nurse. I'm not poisoning you. It's against the nursing code of ethics."
B. "I'm a nurse, and you're a client in the hospital. I'm not going to harm you."
C. "I'm not poisoning you. And how could I possibly steal your soul?"
D. "I sense anger. Are you feeling angry today?"
Rationale: The nurse should directly orient a delusional client to reality, especially to place and person. Options A and C may encourage further delusions by denying poisoning and offering information related to the delusion. Validating the client's feelings, as in option D, occurs during a later stage in the therapeutic process.
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- Identifying Skin Lesions
- Newborn Screening
- Anorexia Nervosa
- Antiemetics
- Anxiolytics/Antiparkinsons
- Abdominal Assessment
- Information Desk
- NCLEX-California FAQS
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- NCLEX RN Experience
- PRC New Reg Dates [JUN Batch]
- IELTS : Applying
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- US Boards Of Nursing Websites
- PRC-BON Course Syllabus
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- Downloads
- December 2006 NLE Results
- IMCI.doc
- June 2006 NLE Results
- Contact The Authors
- Budek:pinoybsn@yahoo.com
- Joan:joangillen@gmail.com
- Kitchie:sweetenkind@yahoo.com
- Jeddah:jedz_boi18@yahoo.com
- Marisse:mariz_gnzls@yahoo.com
- Brewed:brewed_box@yahoo.com
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- Ren:mahinhingbinata@yahoo.com
- Chum:danv3r@yahoo.com
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