Child abuse is suspected in a 3-year-old girl admitted to the hospital with many poorly explained injuries. During a conversation, the statement by the mother that would further this suspicion would be
    A．"When I get angry, I take her for a walk. "
    B．"I send her to her room alone when she misbehaves. "
    C．"I make her stand in the corner when she doesn't eat her dinner. "
    D．"The other children were no problem; this one is stubborn and whiny. \

A mother of four is remanded to the psychiatric unit by the court for observation. She was arrested and charged with abusing her 2-year-old son, who is in the pediatric intensive care unit in critical condition with a fractured skull and other injuries from a beating. When approaching the client, the nurse should expect the client to
     A．Deny beating her son
     B．Express concern for her son
     C．Ask where her three other children are
    D．Avoid talking about the situation completely

When speaking with a mother accused of child abuse, the nurse should expect her to
    A．Attempt to rationalize and explain her behavior
    B．Offer a detailed explanation of how her son was injured
    C．Reveal an overwhelming feeling that her children are worthless
    D．Ask how she may get permission to visit her son on the pediatric unit

The nurse may best assist an abusing parent to alter behavior toward an abused 2-year-old child by helping the client to
    A．Learn what behavior is appropriate for a 2-year-old child
    B．Learn appropriate ways of punishing the child's inappropriate behavior
    C．Identify the specific ways in which the child's behavior provokes frustration
    D．Ignore the child's negative, nondestructive behavior and support acceptable behavior

A young child suspected of being sexually abused says to the nurse, "Did I do something bad?" The nurse's most therapeutic reply would be
    A．"Who said you did something bad?"
    B．"What do you mean, something bad?"
    C．"Do you think that you did something bad?"
    D．"I'm not sure I would say it was something bad. \

A recently married 22-year-old is brought to the trauma center by the police. She had been robbed, beaten, raped, and sodomized. The client, although very anxious and tearful, appears in control. The physician orders diazepam(Valium) 5 mg po prn for agitation. The nurse should administer this medication when the
    A．Client requests something to calm her
    B．Client's crying and trembling seem to increase
    C．Physician is ready to do a vaginal examination abuse history
     D．Nurse determines the client's anxiety is increasing

The most important feeling for the nurse to convey to the client in order for the client with personality disorder to accept the nurse is one of
    A．Let client feel warm and being care
     B．Willingness to help
     C．Remorse for client
     D．No-nonsense demands with client

When the physician examines the genital area of a child suspected of being abused, the nurse can be most therapeutic by
     A．Explaining the procedure and remaining with the child during the examination
     B．Telling the child that the doctor wants to see if there is "anything wrong down there. "
     C．Helping the mother explain the examination and the findings in terms the child will understand
     D．Asking whether the child would prefer the nurse or the mother to be present during the examination

When a six-year-old girl who is suspected of being sex abused refuse to be examined by an emergency nurse, what's the best appropriate response by the nurse?
     A．Ask another nurse in emergency room to examine her
     B．Refer the child to a clinician expert in the examination and care of the sexually abused child or adolescent
     C．Carefully explain to the girl why she need be examined
     D．Call the local child protective service

Which one is not common factor attributing to the child abuse?
    A．Family stress factors
    B．Parent's psychological factors
    C．Social factors
    D．Children's knowledge

A woman who is firmly committed to natural childbirth and who has attended each natural childbirth class in preparation for her experience of labour and delivery undergoes a caesarean delivery when her fetus displays signs of distress. Inconsolable, she cries and calls herself a failure as a mother. Her loss may best be described as
    A．Actual               B．Perceived            C．Psychological        D．Combination of above

When you interview an 82-year-old resident in a nursing home, she tells you that she has never gotten over the death of her son who died 20 years age. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. This type of grief is best described as
    A．Abbreviated         B．Anticipatory         C．Dysfunctional        D．Inhibited

Mr. Cooney is an 85-year-old male patient in advanced stages of pneumonia with a no-code order in his chart. Which of the following nursing care actions will help establish a trusting nurse-patient relationship?
    A．The nurse should not express his own fears about death in order to better concentrate on the patient's needs
    B．The nurse should reduce verbal and nonverbal contact with the patient to avoid confusing him
    C．The Nurse should encourage family members to assist in his nursing care
    D．The nurse should arrange a visit from a spiritual advisor against the patient's wishes to provide hope in the face of death

When you next visit this dying patient with AIDS, he breaks down and cries and tells you that it is unfair that he should have to die now when he's finally made peace with his family and wants to live. You are shocked by this change in his mood. Your best reply would be
    A．"You can't be feeling this way. You have to proceed through the stages of dying in an orderly progression, and you've just moved backward. "
    B．"It does seem unfair ... tell me more about how you are feeling ... "
    C．"You'll be all right.., who knows how much time any of us has to enjoy relationships with those we love. You are lucky to have had the opportunity to make your peace. "
    D．"Tell me about your pain. Did it keep you awake last night?\

Which of the following nurse responses would be endorsed by the American Nurses Association?
     A．A nurse promises a dying patient that he will do everything possible to keep her comfortable but that he cannot administer an injection or overdose to cause her death.
     B．A nurse tells a dying patient who is on a ventilator that under no condition can he be removed from the ventilator because this is active euthanasia and it is expressly forbidden by the Code for Nurses.
     C．After exhausting every intervention in her bag of tricks to keep a dying patient comfortable the nurse says, "I think you are now at a point where I'm prepared to do what you've been asking me. Let's talk about when and how you want to die. "
     D．In response to a patient who asks for assistance in committing suicide a nurse replies, "I'm personally opposed to assisted suicide but I'll find you a colleague who can help you. \

You are caring for a comatose patient whose primary diagnosis is breast cancer but who has suffered multiple complications and who is now in the end stages of her illness. She has been in the medical intensive care unit for 3 weeks. Her husband tells you that he and his wife often talked about the end of her life and that she was very clear about not wanting aggressive treatment that would merely prolong her dying. You both agree that this seems to be all that therapy is now doing for her. Which of the following orders would you recommend the husband speak to her physician about
    A．Comfort-measures-only                        B．Do-not-hospitalize
    C．Do-not-resuscitate                            D．Slow-code-only

If you are involved in the terminal weaning of a patient, you will want to do all of the following except
    A．Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support
    B．Explain to the family what will happen at each phase of the weaning and offer support
    C．Check the orders for sedation and analgesia and make sure that the anticipated death is comfortable and dignified
    D．Tell the family that death will occur almost immediately after the patient is removed from the ventilator

Which of the nursing actions described below would you correct if you saw a nursing assistant doing this?
    A．Talking to a comatose patient
    B．Sitting on the bed of a dying patient holding her hand and crying
    C．Agreeing with the daughter of a dying resident with Alzheimer's disease that the burdens associated with artificially feeding her father may outweigh the benefits
     D．Telling a dying patient to sit back and relax and that she will wash him because it's easier that way

Which of the following nursing actions violates the standards of caring for the body after a patient has been pronounced dead?
     A．Keeping the patient in a comfortable sitting position until the family has arrived and said their goodbyes
     B．Placing identification tags on both the shroud and the ankle
    C．Removing soiled dressings and tubes
    D．Preparing to transfer the body to the morgue

The family of a patient who has just died requests to be alone with the body and asks for supplies to wash the body. You know that the mortician usually washes the body. Your best response is
     A．Inform the family that there is no need for them to wash the body since the mortician does this
     B．Explain that hospital policy forbids their being alone with the deceased patient and that hospital supplies are only to be used by hospital personnel
     C．Give the supplies but watch the family so that nothing unusual happens
     D．Provide the requested supplies and ask if this request is linked to their religious or cultural customs and if there is anything else you can do to be of assistance

A 70-year-old woman who has had a number of strokes refuses further life-sustaining interventions, including artificial nutrition and hydration. She is competent, understands the consequences of her actions, is not depressed, and persists in refusing treatment. Her doctor is adamant that she cannot be allowed to die this way and her daughter agrees. An ethics consult has been placed. Who is the appropriate decision maker?
     A．Patient              B．Daughter            C．Doctor              D．Ethics consult team

Prior to the death of her husband, Mrs. Sardi complained of frequent headaches and loss of appetite. No medical cause was found. Mrs. Sardi probably was experiencing which type of grief?
     A．Abbreviated grief                            B．Anticipatory grief
     C．Unresolved grief                             D．Inhibited grief

A mother whose daughter is killed in a school bus accident tells the nurse that her daughter was just getting over the chickenpox and did not want to go to school, but she insisted that she go. The mother cries bitterly and says her child's death is her fault. The nurse should realize that perceiving a death as preventable would most often influence the grieving process in that:
    A．The loss may be easier to understand and to accept
    B．Bereavement may be of greater intensity and duration
    C．The grieving process may progress to a psychiatric illness
    D．It causes the mourner to experience a pathologic grief reaction

The husband of a patient who has died is unable to express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. Which of the following types of grief would the husband be experiencing?
    A．Anticipatory grief    B．Inhibited grief        C．Normal grief         D．Unresolved grief

The nurse recognizes that at this time to assist a couple to deal with their feelings about the husband's terminal illness, it would be important to:
     A．Assist the couple to express their feelings about his terminal illness to each other
     B．Refer the husband to the psychotherapist for assistance in dealing with his anger about death
     C．Place the couple in a couple's therapy group that deals with the terminal illness of one partner
     D．Encourage the couple to verbalize their feelings to a therapist during their individual therapy sessions

Client: "I had an accident. "
    Nurse: "Tell me about your accident. "
    This is an example of which therapeutic communication technique?
    A．Making observations                          B．Offering self
    C．General lead                                  D．Reflection

"Earlier today you said you were concerned that your son was still upset with you. When I stopped by your room about an hour ago, you and your son seemed relaxed and smiling as you spoke to each other. How did things go between the two of you?"
    This is an example of which therapeutic communication technique?
    A．Consensual validation                         B．Encouraging comparison
    C．Accepting                                      D．General lead

"Why do you always complain about the night nurse? She is a nice woman and a fine nurse, and has five kids to support. You're wrong when you say she is noisy and uncaring. "
    This example reflects which nontherapeutic technique?
    A．Requesting an explanation                     B．Defending
    C．Disagreeing                                     D．Advising

"How does Jerry make you upset?" is a non-therapeutic communication technique because it
    A．Gives a literal response                       B．Indicates an external source of the emotion
    C．Interprets what the client is saying             D．Is just another stereotyped comment

Client: "I was so upset about my sister ignoring my pain when I broke my leg. "
    Nurse: "When are you going to your next diabetes education program?"
    This is a nontherapeutic response because the nurse has
     A．Used testing to evaluate the client's insight    B．Changed the topic
    C．Exhibited an egocentric focus                  D．Advised the client what to do

When the client says, "I met Joe at the dance last week," what is the best way for the nurse to ask the client to describe her relationship with Joe?
     A．"Joe who?"
     B．"Tell me about Joe. "
     C．"Tell me about you and Joe. "
     D．"Joe, you mean that blond guy with the dark blue eyes?\

Many popular entertainments involve us in vivid portrayals of violence and/or sexuality. Freud might argue that the success of such movies is due to the mechanism of
     A．Transference         B．Libido               C．Ego development     D．Sublimation

Projection
     A．Makes threatening material unavailable for recall
     B．Involves casting our unacceptable traits onto other people
     C．Allows us to excuse unacceptable behavior
     D．Produces behavior designed to reverse the effects of undesirable behavior

Tamara says that her sister is attracted to their new next door neighbor, yet it is typically Tamara who watches their neighbor whenever he leaves his house.  Freud would suggest that Tamara is using
     A．Projection           B．Sublimation          C．Intellectualization     D．Reaction formation

Mark is a boy who is afraid of a lot of things. One day, his mather calls the community mental health clinic and tells the nurse that Mark has suddenly become terrified of getting into the family car, refuses to do so, and is in the yard screaming uncontrollably.
    what would it be BEST for the nurse to tell Ms. Levine to do FIRST?
    A．Hold Mark snugly and talk softly to him
    B．Give Mark a warm bath and put him to bed
    C．Bring Mark to the clinic as soon as possible
    D．Remind Mark that he has never before been afraid of automobiles

The choice of play therapy for children should PROBABLY be based upon their inability to
    A．Overcome inhibitors about revealing family conflicts and behaviors
    B．Differentiate between reality and fantasy
    C．Recognize the difference between right and wrong
    D．Adequately describe feelings and experience

A patient carries on brief conversations with a nurse. During one such conversation, he seems relaxed and affable initially but soon begins to shift his position frequently, grasping the arms of his chair so tightly that his fingers blanch. The nurse remarks to him that he seems tense, to which he replies Yes.
    Which of these responses by the nurse at this time would demonstrate the BEST understanding?
    A．I'm beginning to feel tense too, Mr. Miles
    B．I wonder if I have said something wrong, Mr. Miles
    C．Do women usually make you feel nervous, Mr. Miles
    D．At what point in our talk did you begin to feel uneasy, Mr. Miles?