MENTAL HEALTH PAMPLET

NMCZ QUESTIONS
MCQ
ONE WORD
CROSS MATCH
ESSAYS

YOU CAN BE THE BEST

MENTAL HEALTH AND PSYCHIATRIC NURSING

MCQS

1. To evaluate whether patient teaching for coping skills has been effective,
the psychiatric and mental health nurse asks an adolescent patient to:
A. Consider the outcomes objectively.
B. Keep a written journal.
C. Perform a return demonstration.
D. Get measurable goals. Answer C
2. A patient who was admitted yesterday with an adjustment disorder and depressed
mood has not left his or her room. The psychiatric and mental health nurse's most
appropriate approach at meal time today is to respond:
A. ―I will bring your tray to your room, if it will make you more comfortable.‖
B. ―I will walk with you to the dining room and sit with you while you eat.‖
C. ―Where would you like to eat your meal this noon?‖
D. ―You will feel better if you go to the dining room and eat with the others.‖ Answer B
3. A 17-year-old, female patient with anorexia nervosa has just been released from
the hospital. To facilitate recovery at home, the psychiatric and mental health
nurse instructs the family to:
A. Discourage the patient from sneaking food between meals, by unobtrusively
reducing her access to the kitchen.
B. Encourage the patient's interest in menu planning, food magazines, and cooking
lessons, by leaving information and materials around the house.
C. Inform the patient that she is expected to join in routine family meals and clear
the dishes after dinner, even if she does not eat.
D. Permit the patient to eat her meals privately in her bedroom to discourage family
preoccupation with meals.
Answer C
4. A patient is admitted to the inpatient unit with a diagnosis of schizophrenia. The
patient has had episodes of school absenteeism, withdrawal from friends, and
bizarre behavior, including talking to his or her "keeper." The psychiatric and
mental health nurse's most appropriate response is to:
A. Acknowledge that the patient's perceptions seem real to him or her, and refocus
the patient's attention on a task or activity.
B. Encourage the patient to express his or her thoughts, to determine the meaning
they have for the patient.
C. Ignore the patient's bizarre behavior, because it will diminish after he or she has
been given the correct medication.
D. Inform the patient that his or her perceptions of reality have become distorted
because of the illness.
Answer A
5. Nursing staff members at a community mental health center are formulating an
outpatient treatment plan with a 30-year-old patient with schizophrenia. A major
consideration is that:
A. The patient will likely need weekly supportive treatment for life.
B. The patient will require a referral for vocational rehabilitation services.
C. The patient's contact with the center will diminish as he or she becomes
stable, but the patient will continue to need support.
D. The patient's contact with the center will gradually decrease until his or her
therapy can be terminated. Answer C
6. A supervisor observes inconsistency in the psychiatric and mental health nurse's
behavior toward a patient; the nurse is unreasonably concerned, overly kind, or
irrationally hostile. The most appropriate explanation is that the nurse is
displaying:
A. Counter transference.
B. Empathic resonance.
C. Negative transference.
D. Splitting behavior. Answer A
7. During an initial patient interview, the psychiatric and mental health nurse
begins by asking the patient to describe his or her: A. Thoughts about the
current situation.
B. Current situation.
C. Feelings about the current situation.
D. Personal history. Answer B
8. In which circumstance is a breach of patient confidentiality appropriate?
A. A supervisor inquires about the patient.
B. The family inquires about the patient without his or her knowledge.
C. The patient appears sincere in threatening to harm another person.
D. The patient has participated in illegal activity. Answer C
9. A short-term goal for a patient with Alzheimer's disease is:
A. Improved problem solving in activities of daily living.
B. Increased self-esteem and improved self-concept.
C. Regained sensory perception and cognitive function.
D. Optimum functioning in the least restrictive environment. Answer D
10. A 23-year-old patient with borderline personality disorder reports a frequent
desire to cut him- or herself and insists that only a specific psychiatric and mental
health nurse can help the patient. The nursing care plan for the patient includes: A.
Allowing the patient to choose the nurse assigned to him or her.
B. Decreasing the patient's stimuli.
C. Holding frequent, interdisciplinary staff meetings to provide consistent care.
D. Providing one-to-one suicide precautions.
Answer C
11. Older adults have reached Erikson's developmental stage of ego integrity, when
they:
A. Acknowledge that one cannot get everything one wants in life.
B. Assess their lives and identify actions that had value and purpose.
C. Express a wish that life could be relived differently.
D. Feel that they are being punished for things they did not do. Answer B
12. A patient states that unit staff members have been avoiding him or her since an
attempt to self-mutilate. The psychiatric and mental health nurse's most
appropriate response is to:
A. Apologize for the staff's behavior.
B. Explain that feelings of rejection are typical after self-mutilation.
C. Listen, redirect the patient to his or her feelings, and explore the issue with
the staff.
D. Report the matter to the nurse manager. Answer C
13. When planning inpatient psychotherapeutic activities for a patient who has
antisocial personality disorder, the psychiatric and mental health nurse: A.
Focuses on group, rather than individual, therapy.
B. Provides an organized, structured environment.
C. Provides a permissive atmosphere, so the patient feels a sense of control.
D. Recognizes that the disorder is characterized by social withdrawal. Answer B
14. According to family systems theory, removing the "identified patient" from the
environment most likely causes the:
A. Patient to decompensate, due to the loss of his or her support system.
B. Patient to significantly improve, often with minimal or no additional therapy.
C. Remaining family members to decompensate, as evidenced by new, dysfunctional behavior.
D. Remaining family members to lose motivation and withdraw from therapy.
Answer C
15. A patient who is admitted to the psychiatric unit with a diagnosis of obsessive-
compulsive disorder spends a significant amount of time during the day and night
washing his or her hands. On the third hospital day, the patient reports feeling
better and more comfortable with the staff and other patients. The psychiatric and
mental health nurse knows that the most appropriate nursing intervention is to:
A. Collaborate with the patient to reduce the amount of time he or she engages in
ritualistic behavior.
B. Acknowledge the ritualistic behavior each time and point out that it is
inappropriate.
C. Allow the patient to carry out the ritualistic behavior, since it is helping him or
her.
D. Ignore the ritualistic behaviors, and the behaviors will be eliminated due to lack
of reinforcement. Answer A
16. Which factors are associated with the development of post-traumatic stress
disorder?
A. Anxiety and low self-esteem.
B. Distorted and negative cognitive functioning.
C. Excess serotonin and norepinephrine levels.
D. Severity of the stressor and availability of support systems. Answer D
17. A selective serotonin reuptake inhibitor targets which part of the brain? A.
Basal ganglia.
B. Frontal cortex.
C. Hippocampus.
D. Putamen. Answer B

18. To obtain an accurate medication list and assess a new patient's understanding of
medications, the psychiatric and mental health nurse:
A. Asks the patient to provide medical records of the medications taken in the
past.
B. Instructs the patient to list medications and describe how the medications are
taken.
C. Relies upon the medical record, rather than asking the patient.
D. Asks about the patient's current medications, herbs, home remedies, and
overthe-counter drugs. Answer D
19. The psychiatric and mental health nurse knows that the patient's spouse clearly
understands the side effects of lithium carbonate (Eskalith), when he or she says:
A. ―I should call the doctor if my spouse shakes badly.‖
B. ―I should make sure my spouse drinks as much water as she or he can.‖
C. ―My spouse must remain on a salt-free diet.‖
D. ―When the lithium level is 1.6 mEq/L, my spouse can go back to work.‖ Answer A
20. A school-aged patient with attention-deficit hyperactivity disorder is displaying
disruptive behaviors at home. The psychiatric and mental health nurse modifies
the treatment plan for the social domain, by advising the patient's parents to:
A. Establish eye contact before giving directions.
B. Initiate a point system, to reward the patient for appropriate behavior.
C. Instruct the patient to work on one homework assignment at a time.
D. Maintain a predictable environment in the home. Answer B
21. After taking an antidepressant for about a week, a patient reports constipation
and blurred vision, with no improvement in mood. The psychiatric and mental
health nurse informs the patient:
A. ―Stop the medication immediately and contact your primary care physician.‖
B. ―You should contact your doctor.
C. The doctor may need to change your medication.‖
D. It takes approximately two to four weeks for depression to lessen, and side effects usually
diminish over time. Answer D
22. A patient is being discharged after spending six days in the hospital, due to
depression with suicidal ideation. The psychiatric and mental health nurse knows
that an important outcome has been met when the patient states:
A. ―I can't wait to get home and forget that this ever happened.‖
B. ―I feel so much better. If I continue to feel this way, I can probably stop
taking my medications soon.‖
C. ―I have a list of support groups and a crisis line that I can call, if I feel
suicidal.‖
D. ―I have to leave here soon, if I want to make it to the shelter before they run
out of beds.‖ Answer C
23. When developing a lecture series for nursing home residents, the psychiatric and
mental health nurse considers which factor to be the primary barrier to learning?
A. Decreased bodily functions.
B. Information processing impairments.
C. Lack of interest.
D. Lack of patience.
E. Question 23 Answer B
24. When screening families for post-traumatic stress disorder following a major natural
disaster, psychiatric and mental health nurses are practicing which type of disease
prevention?
A. Secondary.
B. Primary.
C.
Tertiar
y.
D. Universal. Answer
A
25. When a research study is based on a small sample size, the findings may: A.
Be statistically significant, but will not be clinically significant.
 B. Not be statistically significant, because the research design was
quasiexperimental, instead of experimental.
C. Not be statistically significant, because the research was poorly conducted.
D. Be statistically significant, but will be less generalizable than if the sample size
had been larger. Answer D

26. The nurse is caring for a client with schizophrenia. Which of the following
outcomes is the least desirable?

[Link] 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.

Answer A

27. 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

Answer B
28. Since admission 4 days ago, a client has refused to take a shower, stating, ―There
are poison crystals hidden in the shower head. 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

Ans D
29. Drug therapy with thioridazine (Mellaril) shouldn‘t exceed a daily dose of 800 mg
to prevent which adverse reaction?

A. Hypertension
[Link] Arrest
[Link] Syndrome
D. Retinal pigmentation

Ans D

30. 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.‖

Ans A

31. 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

Ans D

32. 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.

Ans C

33. 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.‖

Ans A

34. 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
Ans B

35. 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.

Ans D

36. 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)

Ans A

37. 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.

Ans B

38. 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.‖ Ans A

39. 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.

Ans B
40. 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

Ans A

41. 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

Ans D
42. 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

Ans A

43. 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)

Ans D

44. 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

Ans A

45. 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.‖

Ans C

46. 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

Ans B
47. 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

Ans D

48. 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.

Ans C

49. 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

Ans B
50. 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.

Ans C

51. 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)

Ans C

52. 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.

Ans A

53. 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.

Ans B

54. 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.

Ans A

55. 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

Ans A

56. 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

Ans A
57. 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

Ans A

58. 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

Ans D

59. 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.

Ans C

60. 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.

Ans C

61. 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)

Ans B

62. 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.

Ans D

63. 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.

Ans C
64. 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.‖

Ans C

65. 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

Ans C

66. Which non antipsychotic medication is used to treat some clients with
schizoaffective disorder?

A. Phenelzine (Nardil)
B. Chlordiazepoxide (Librium)
C. Lithium carbonate (Lithane)
D. Imipramine (Tofranil)

Ans C

67. 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

Ans B
68. 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.

Ans B

69. 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.

Ans C

70. 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.

Ans C

71. 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.

Ans B

72. 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

Ans B

73. 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.

Ans A

74. 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 deficit: Dressing/grooming
Ans A

75. 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.

Ans B

76. A person‘s tendency to become addicted to a drug depends not only on the properties of the drug
but also on the reason the person uses the drug. What does this observation suggest?

A. There is a genetic predisposition to drug addiction

B. Psychological factors influence drug addiction
C. Drug addiction depends on the biochemistry of a drug
D. None of the above Ans B

77. Which is likely true about people with somatoform disorders?

A. They intentionally produce their symptoms

B. They have symptoms that are caused by a medical condition
C. They may pay too much attention to bodily symptoms
D. They do not experience real symptoms Ans C

78. People with obsessive-compulsive disorder often do which of the following?

A. Experience anxiety-producing thoughts, impulses, or images

B. Have panic attacks
C. Have false beliefs that they hold despite contradictory evidence
D. Have sensory or perceptual experiences that occur without an external stimulus Ans A

79. Which disorder is characterized by an inability to remember a traumatic incident?

A. Post–traumatic stress disorder

 B. Conversion disorder
C. Schizophrenia
D. Dissociative amnesia Ans D

80. Which of the following might contribute to the onset of antisocial personality disorder?

A. Abnormal physiological arousal

B. An inability to control impulses
C. Brain damage
D. All of the above Ans D

81. Which subtype of schizophrenia often involves relatively normal cognitive functioning?

A. The paranoid type

B. The disorganized type
C. The catatonic type
D. The undifferentiated type Ans A

82. Which is likely true about people with anorexia nervosa?

A. They do not binge eat

B. They tend to be relatively physically healthy
C. They tend to be rigidly confident that they won‘t gain weight
D. They do not have normal body weight
Ans D

83. Which of the following is likely to be implicated in the etiology of schizophrenia?

A. A histrionic personality type

B. Learned helplessness
C. Dopamine
D. All of the above Ans C

84. What is a culture-bound disorder?

A. A disorder that is bound to occur in most cultures

 B. A disorder specific to a particular cultural context
C. A disorder not included in one of the DSM‘s diagnostic categories
D. Any disorder whose onset is highly influenced by cultural factors Ans B

85. Insanity refers to which of the following?

A. The inability to take responsibility for one‘s actions

B. The existence of a psychological disorder
C. A defense available to someone who committed a crime and who has a psychological disorder
D. A specific diagnostic category in the DSM Ans A

86. A person‘s tendency to become addicted to a drug depends not only on the properties of the drug
but also on the reason the person uses the drug. What does this observation suggest?

A. There is a genetic predisposition to drug addiction

B. Psychological factors influence drug addiction

C. Drug addiction depends on the biochemistry of a drug

D. None of the above

Ans D

87. Which is likely true about people with somatoform disorders?

A. They intentionally produce their symptoms

B. They have symptoms that are caused by a medical condition

C. They may pay too much attention to bodily symptoms

D. They do not experience real symptoms

Ans B

88. People with obsessive-compulsive disorder often do which of the following?

A. Experience anxiety-producing thoughts, impulses, or images

B. Have panic attacks

C. Have false beliefs that they hold despite contradictory evidence

D. Have sensory or perceptual experiences that occur without an external stimulus

Ans A

89. Which disorder is characterized by an inability to remember a traumatic incident?

A. Post–traumatic stress disorder

B. Conversion disorder

C. Schizophrenia

D. Dissociative amnesia

Ans A

90. Which of the following might contribute to the onset of antisocial personality
disorder?

A. Abnormal physiological arousal

B. An inability to control impulses

C. Brain damage
D. All of the above

Ans D

91. Which subtype of schizophrenia often involves relatively normal cognitive

functioning?

A. The paranoid type

B. The disorganized type

C. The catatonic type

D. The undifferentiated type

Ans B
92. Which is likely true about people with anorexia nervosa?

A. They do not binge eat

B. They tend to be relatively physically healthy

C. They tend to be rigidly confident that they won‘t gain weight

D. They do not have normal body weight

Ans C

93. Which of the following is likely to be implicated in the etiology of schizophrenia?

A. A histrionic personality type

B. Learned helplessness

C. Dopamine

D. All of the above

Ans B

94. What is a culture-bound disorder?

A. A disorder that is bound to occur in most cultures

B. A disorder specific to a particular cultural context

C. A disorder not included in one of the DSM‘s diagnostic categories

D. Any disorder whose onset is highly influenced by cultural factors

Ans B

95. Insanity refers to which of the following?

A. The inability to take responsibility for one‘s actions

B. The existence of a psychological disorder

C. A defense available to someone who committed a crime and who has a psychological disorder
D. A specific diagnostic category in the DSM

Ans A

96. Primary prevention is when:

A. Treatment is given to reduce severity of mental illness.

B. Education is given to at risk groups.
C. Measures to reduce residual effects of severe mental illness are undertaken.
D. Health and wellbeing of individuals is improved.

Ans B

97. Secondary prevention is:

A. Treatment is given to reduce severity of mental illness.

B. Education is given to at risk groups.
C. Measures to reduce residual effects of severe mental illness are undertaken.
D. Health and wellbeing of individuals is improved. Ans A

98. Tertiary prevention is:

A. Treatment is given to reduce severity of mental illness.

B. Education is given to at risk groups.
C. Measures to reduce residual effects of severe mental illness are undertaken.
D. Health and wellbeing of individuals is improved.

Ans C

99. Deinstitutionalization is:

A. Actions that foster good mental health

B. When people with mental illness are treated in the ward
C. Passive dependent behavior.
D. Transfer of patients from a hospital to the community. Ans D

100. Institutionalism is:

A. Actions that foster good mental health
B. When people with mental illness are treated in the ward
C. Passive dependent behavior.
D. Transfer of patients from a hospital to the community. Ans C

101. Mental Health Promotion is:

A. Actions that foster good mental health

B. When people with mental illness are treated in the ward
C. Passive dependent behavior.
D. Transfer of patients from a hospital to the community. Ans A
102. The following is not an example of defense mechanism:-
a) Sublimation
b) Fantasy
c) Denial
d) Repression
103. The drug of choice in management of epilepsy is?

a) Sodium valproate
b) Amitriptylline
c) Haloperidol
d) Benzhexol Hydrochloride

104. One of the following is a Definition of personality

a) Is a pattern of behavior each person evolves both consciously and
unconsciously as a means of adapting to a particular environment and
its cultural standards.

b)Is a pattern of perception each person evolves both consciously and

unconsciously as a means of adapting to a particular environment and its
cultural standards.
 c) Is a pattern of traits each person evolves both consciously and
unconsciously as a means of adapting to a particular environment and its
cultural standards.
d)Is a pattern of genetic each person evolves both consciously and
unconsciously as a means of adapting to a particular environment and its
cultural standards.
105. Reflecting skills in counseling refers to:-
a) Counselor’s ability to communicate understanding of the client’s
concerns and perspective at emotional level.
b) Coming up with right questions to elicit and capture as much
information as possible.
c) Examination of internal and external behavior that appears to be self-
defeating and harmful to others.
d) Involves listening to client, clarifying his concerns and communicating
this understanding with the client.
106. B.F Skinner has been regarded as the father of ………………………..in
psychology?
a) Operant condition
b) Observational
c) Carol Rodgers
d) Ivan Pavlov
107. In psycho sexual development according to Sigmund Freud at Anal Stage the child
derives pleasure from…
a) Playing with the anus
b) Developing sexual interest in the mother if its male
c) Watching pornographic materials
d) The mothers nipple
108. Gifted individuals have an intelligence quotient score of;
a) 100 and above
b) 100 and below
c) 140 and above
 d) 130
109. Four levels of anxiety according to progression are
a) Moderate, panic, mild, panic
b) Mild, moderate, severe, panic
c) Mild, severe, mild, panic
d) Panic, mild, moderate, severe
110. The type of delusions where the client is convinced that comments, newspaper
articles and other types of media are directed towards him/her are called
a) Grandiose
b) Referential
c) Persecutory
d) Paranoid
111. A type of schizophrenia where there is psychomotor disturbances such as stupor
negativism, rigidity and posturing is called
a) Hebephrenic
b) Catatonic
c) Paranoid
d) Disorganized
112. An irrational fear and wish to avoid specific situation, object or activity
a) Hallucination
b) Phobia
c) Illusion
d) delusion
113. A change of self-awareness where the person feels unreal and unable to feel
emotion is called
a) Dementia
b) Depersonalization
c) Agoraphobia
d) amnesia
114. The unpleasant feeling of fear and apprehension accompanied by high
physiological arousal is called
a) Depression
b) Mania
c) Anxiety
d) obsession
115. Ritualistic behaviors which are usually repetitive in nature are called?
a) Obsessions
b) Compulsions
c) Anxiety
d) Manic disorders
116. Neuroses are minor mental disorders and examples include:-
a) Illusions
b) Anxiety, hysteria and reactive depression
c) Delusions
d) Hallucinations
117. Risk factors for postpartum depression include:-
a) History of depression, low self -esteem and child care stress.
b)Attending Antenatal clinic occasionary.
c) Missing Antenatal clinic appointments.
d)Being illiterate
118. A syndrome involving the loss of contact with reality is called
a) Neurosis
b) Mental
c) Psychosis
d) Anxiety
119. Mania is the opposite of depression: in Mania the patient feels
a) Euphoric, confident, optimistic, and brimming with psychological
and physical energy.
 b)Aggressive
c) Mute
d)isolated
120. In a depressed patient, general appearance;
a) Reflects patient‘s sense of well being.
b) Reflects the patient’s lack of interest & clothing may be unkempt and personal hygiene
neglected.

c) Reflects patient‘s ideas of importance.

d) Reflects patient‘s nutritional status
121. Early insomnia is common in reactive depression in which the patient;
a) Has difficulties in going to sleep in the early part of the night.
b) Has a tendency to wake early in the morning & unable to sleep again.
c) May feel that self or environment to be strangely unreal.
d) May go to sleep early
122. The client is very hostile towards one of the staff for no apparent reasons the client
is manifesting;
a) Splitting
b) Transference
c) Counter transference
d) Resistance
123. A chronic and progressive illness with disturbance of memory, thinking orientation,
comprehension, learning and judgement is known as;
a) Dementia
b) Delirium
c) Depression
d) Mania
124. Chanda is assigned in a psychiatric ward; he notices that one of the patients would
follow every move he would make. When he moves his hand, the patient would also
move his hand. This is:
a) Waxy flexibility
 b) Echolalia
c) Perseveration
d) Echopraxia
125. Andy, a manic depressive patient is being admitted into the psychiatry ward.
What will not be allowed into the ward?
a) Rosary bracelet
b) Laced running shoes
c) Decorated cake
d) A packet of assorted biscuits
126. ―I am the heir of the Gumusu land, they only taken it away from my father.‖
claimed by a patient in a psychiatric ward, this is an example of:
a) Delusion of jealous
b) Delusion of paranoia
c) Delusion of persecution
d) Delusion of grandeur
127. ―That man wants to kill me, he keeps on stalking on me for almost three months
now‖. This is:
a) Illusion
b) Delusion
c) Hallucination
d) Idea of reference
128. During impeachment trial, a client happened to watch one of the episodes of the
senate hearing. The client shouted: ― they are asking me to tell the truth. They are
looking for me now.‖ This is an example of:
a) Illusion
b) Delusion
c) Hallucination
d) Idea of reference
129. Monde is a nurse assigned in a psychiatric ward; he takes note that the most
common type of hallucination is:
a) Visual
 b) Olfactory
c) Auditory
d) Tactile
130. The fear and anxiety related to phobia is said to be abruptly decreased when the
patient is exposed to what is feared through:
a) Guided imagery
b) Systematic desensitization
c) Flooding
d) Hypnotherapy
131. The most common defence mechanism used by a paranoid client is:
a) Displacement
b) Suppression
c) Rationalisation
d) Projection
132. A relevant nursing diagnosis for clients with auditory hallucination is:
a) Sensory perceptual alteration
b) Altered thought process
c) Impaired social interaction
d) Impaired verbal communication
133. The patient remarks repeatedly that ―I know you‖ but can not give details of were
they met. This can best be described as:
a) Defense of identification
b) Dejavu
c) An folie a deux
d) An idea of reference
134. What is the new name of mental retardation?
a) Psychosis disorder
b) Attention deficit hyperactivity
c) Intellectual disability
d) Delirium
135. A chronic and progressive illness with disturbance of memory, thinking, orientation,
comprehension, learning and judgement is called:-
a) Dementia
b) Delirium
c) Depression
d) Mania
136. Severe reduction in expression of emotions is called:-
a) Flat affect
b) Waxy flexibility
c) Flight of ideas
d) Clang association
137. ―Waaaal ! This is my work, I want to shop, apple, Masuku, ifishimu, pie.
This is an example of;
a) Neologism
b) Word salad
c) Flight of ideas
d) Clang association
138. Shadrick notices that one of the patients in the psychiatry unit keeps saying the
following words ―deep, keep, beep, deed,‖ the patient is manifesting with
a) Neologism
b) Word salad
c) Flight of ideas
d) Clang association
139. A mental disorder characterised by alternating bouts of excitement and depression
ups and downs. Is called:
a) Undifferentiated schizophrenia
b) Bipolar disorder
c) Depressive syndrome
d) Major depressive syndrome
140. While working in the psychiatry unit charity noticed one patient scratching herself
and saying ―there are countless insects crawling on my skin‖. The patient is
manifesting with:
a) Visual hallucinations
b) Gustatory hallucinations
c) Tactile hallucinations
d) Olfactory hallucinations
141. A talk that does not go directly to the topic but takes time for that individual to state
the point or simply beating about the bush is called;
a) Circumstantial thinking
b) Flight of ideas
c) Thought retardation
d) Fragmented thinking
142. A therapeutic method of relieving distress under taken by means of dialogue
between two people is…
a) Counselling
b) Assertiveness
c) Awareness
d) Discussion
143. Echopraxia is a tendency of a patient repeating the……………….made by the
interviewer.
a) Words
b) Writing
c) Speech
d) Movements
144. In mental health, abnormal sexual preference such as being sexually aroused by
objects, children or pants is referred to as…
a) Paraphilia
b) Fetishism
c) Homosexuality
d) Transvestism
145. The psychiatric nurse should reinforce……………………….. before dealing with
the concerns of a psychiatric patient.
a) Self-awareness
b) Self- assertiveness
c) Self- discipline
d) Advocacy
146. The most common post-partum psychosis is
a) Mania
b) Depression
c) Dementia
d) Schizophrenia
147. The following are psychotic disorders except
a) Schizophrenia
b) Mania
c) Psychotic depression
d) Hysteria
148. A disorder that results in involuntary, repetitive body movements which includes
grimacing, sticking out the tongue or smacking of lips is called…
a) Tardive dyskinesia
b) Akathesia
c) Dystonia
d) Echopraxia
149. The inability to feel pleasure; lack of interest or enjoyment in activities or
relationships which one previously enjoyed is called;
a) Avolition
b) Anhedonia
c) Alogia
d) A sociality
150. Mumba a male patient admitted to your psychiatric unit informs you he hears his
one‘s own thoughts spoken aloud. This is
 a) Thought echo
b) Thought insertion
c) Thought withdraw
d) Tangentiality
151. A female psychiatry patient aged 40 years complains about hearing voices talking
about her, referring to her as ‗‘she‘‘: This is characteristic of ;
a) Third-person hallucinations
b) Second person hallucinations
c) First person hallucination
d) Fourth person hallucination
152. Abulia is a disorder of volition and it refers to
a) Exaggerated ability to make decisions
b) ability to make decisions
c) Lack of speech
d) Lack of ability to make decisions
153. The following are side effects likely to be caused by Artane except a) Dry mouth
b) Urinary retention
c)blurred vision
d) Insomnia
154. Which one of these are tricyclic antidepressants? a)
Fluoxetine and Imipramine
b) Imipramine and Amitriptyline
c) Amitriptyline and Fluoxetine
d) Imipramine and diazepam
155. Moodstablizers have the ability to reduce mood swings that occur in________
a) Mania
b) Bipolar disorder
c) Seizure disorder
d) Anxiety disorder
156. Moodstablizers have the similar mechanism of action with_________ a)
Anxiolytics
b) Anticholinergic
c) Antipsychotics
d) Antidepressant
157. The following causes amnesic syndrome except? a)
Thiamine deficiency
b) Intoxication
c) Intracranial causes
d) Poor vision
158. The following are an example of Delusions except? a)
Thought insertion
b) Thought withdrawal
c) Hallucinosis
d) Thought broadcasting
159. Unpleasant mood is known as__________________________ a)
Elated mood
b)Irritable mood
c) Dysphoric mood
d) Euphoria
160. The loss of emotional tone and the ability to feel pleasure associated with the detachment
is ____________
a) Apathy
b) Anhedonia
c) Avolition
d) Flat affect
161. An elevated mood or exaggerated feeling of well-being which is pathological and
seen in manic patient
a) Elation mood
b) Irritable mood
c) Dysphoric mood
d) Euphoria
162. ___________ a persistent irrational fear of an activity, object or situation, leading
to avoidance.
a) Obsession
b) Phobia
c) Panic attacks
d) Agitation
163. The following are the examples of Affect except? a)
labile affect
b) Flat affect
c) blunted affect
d) Cheerful affect
164. The following are examples of speech disorders except? a)
Mutism
b) Pressure of speech
c) Impulsivity
d)Stammering
165. _____________ the repeated involuntary movements that appear to be goal directed
a) Mannerisms
b) Negativism
c) Echopraxia
d) Stereotypes
166. ______________ refers to a patient who is mute and immobile but who is also
fully conscious
a) Depressive retardation
b) Waxy flexibility
c) Stupor
d) Tics
167. The type of therapy where the patient is taught the skills such as cooking and how
to organize he or her life better is__________
a) Psycho education
b) Social skills training
c) Rehabilitation
d) Occupation therapy
168. The client is very hostile towards one of the staff for no apparent reason. The client
is manifesting;
a) Splitting
b) Transference
c) Countertransference
d) Resistance
169. A chronic and progressive illness with disturbance of memory, thinking, orientation,
comprehension, learning and judgement is known as:
a) Dementia
b) Delirium
c) Depression
d) Mania
170. Clients may use projection for the purpose of; a)
Denying reality
b) Manipulating others
c)Showing resentment towards others
d) To deal with feelings and thoughts that are not acceptable
171. During an interview, Mwansa notices that the client‘s response is similar to what
she says. This is:
a) Waxy flexibility
b) Echolalia
c) Perseveration
d) Echopraxia
172. Mwenda is assigned in a psychiatry ward; he notices that one of the patients would
follow every move he would make. When he moves his hand, the patient would also
move his hand. This is:
a) Waxy flexibility
b) Echolalia
c) Perseveration
d) Echopraxia
173. Severe reduction in expression of emotions is called a)
Flat affect
b) Waxy flexibility
c) Flight of ideas
d) Clang association
174. Persistent repetition of words beyond their relevance is called a)
Illusion
b) Perseveration
c) Word salad
d) Neologism
175. Britney said to her fellow patient‘ you know that cup the nurse uses to give us
medicines from contains blood of sacrificed animals, her aim is to kill all of us
one day. Britney is manifesting with:
e) Phobia
f) Delusion of reference
g) Paranoia
h) Delusion of grandeur
176. ‗‘Handy dandy, this is my work, I want to shop, Apple, pie, custard pie. This is
a) Neologism
b) Word salad
c) Flight of ideas
d) Clang association
177. Mary an unmarried female patient falsely believe that she is loved by a person of
high social status. She engages in writing letters, sending gifts, telephoning and
attempt to escape from the hospital to visit the love of her life. This is;
e) Erotomania
f) Confabulation
g) Compulsion
h) Illusion
178. ―Iam the heir of the Ayala land,‘‘ they only took it away from my father‘‘,
Claimed a patient in the psychiatry ward, this is an example of:
a) Defense of identification
b) A delusion of grandeur
c) An illusion
d) An idea of reference
179. When Mutale says to you:‘‘ The voices are telling me bad things again! ‗‘The best
response is:
a) ‗‘ Whose voices are those?‘‘
b) ‘’ I doubt what the voices are telling you‘‘
c) ‗‘I do not hear the voice you say you hear‘‘
d) ‗‘ Are you sure you hear these voices?‘‘
180. A relevant nursing diagnosis for clients with auditory hallucination is: e)
Sensory perceptual alteration
f) Altered thought process
g) Impaired thought process
h) Impaired verbal communication
181. Mwika a patient in the psychiatry unit sees a design on the floor and exclaims,‖
this is a fossil, this is an example of
a) Illusion
b) Delusion
c) Hallucinations
d) Idea of reference
182. Mono a nurse working in the psychiatry ward notices that one of the
schizophrenic clients has sudden interruption of the stream of speech before the
thought is completed and after a pause, the client cannot recall what he had meant
to say. This is an example of
a) Poverty of speech
b) Neologism
c) Perseveration
d) Thought blocking
183. Marked inability to decide for or against is called: e)
Ambivalence
f) Autism
g) Affect disturbances
h) Loosening of associations
184. Newly formed words or phrases whose derivation cannot be understood except
to the coiner, coined especially by a person affected with schizophrenia are called
a) Neologisms
b) Verbigerations
c) Ambivalences
d) Ecstasy
185. A ―mental disorder‖ with alternating bouts of excitement and depression—
―ups and downs.‖ More often referred to as ―bipolar disorder.‖ Is called:
a) Undifferentiated schizophrenia
b) Manic-depression
c) Manic- depressive syndrome
d) Neuroleptic malignant syndrome
186. A pattern of spontaneous speech in which things said in juxtaposition lack a
meaningful relationship or there is idiosyncratic shifting from one frame of
reference to another, often described as being ‗disjointed‘ speech. Is called:
a) Loosening of associations
b) Poverty of speech
c) Verbigerations
d) Poverty of ideation
187. You are working in the psychiatry unit and you notice one client scratching
herself and saying there are countless insects crawling on her skin. This is called: a)
Delusions of persecution
b) Delusions of control
c) Hypochondriacal delusions
d) Delusions of reference
188. A talk that does not go directly to the topic but takes time for that individual to
state the point or simply beating about the bush is called
a) Circumstantial thinking
b) Flight of ideas
c) Thought retardation
d) Fragmented thinking
189. _____________ is a sexual arousal involving the use of non-living objects such
as shoes or under garments
a) Voyeurism
b) Fetishism
c) Frotteurism
d) Exhibitionism
190. A therapeutic method of relieving distress undertaken by means of a dialogue between
two people is…
a) Counselling
b) Assertiveness
c) Awareness
d) Discussion
200. A Subjective feeling of motor restlessness manifested by a compelling need to
be in constant movement, common as extrapyramidal side effects of
antipsychotic medication…
e) Akinesia
f) Akathisia
g) Steriotype
h) Ataxia
201. Echopraxia is a tendency of a patient repeating the ________ made by the interviewer
a) Words
b) Writing
c) Speech
d) Movement
202. In the course of rendering care to an alcoholic client, the mental health
Nurse‘s goals would mainly be directed to the following except…
a) Withdraw
b) Retardation
c) Intoxication
d) Addiction
203. One of the following is NOT a predisposing factor to substance- related disorders.
e) Biochemical
f) Social learning
g) Age
h) Psycho-dynamic
204. The involuntary constriction of the outer one third of the vagina that prevents penile
insertion and intercourse in sexual disorder is called…
a) Sadism
b) Vaginismus
c) Dyspareunia
d) Sadism
205. In mental health, abnormal sexual Preference is referred to as… a)
Paraphilia
b) Fetishism
c) Homosexuality
d) Transvestism
206. Mr. Abdul Ali has committed suicide as a suicide bomber so as to benefit society.
This type of suicide is referred to as…
e) Egoistic suicide
f) Altruistic suicide
g) Anomic suicide
h) Fatalistic suicide
207. A 53-year-old hospitalized schizophrenic patient tells you that a newscaster
was talking about her when he said on television "A woman was found
shoplifting today". This patient's statement is an example of
a) An illusion
b) Hallucination
c) Flight of ideas
d) Idea of reference
208. Mr Chitangala, a 35-year-old male schizophrenic patient reports that he has difficulty
staying awake during the daytime and waking up in the morning. The antipsychotic
agent that this patient is most likely to be taking is
a) Haloperidol
b) Clozapine
c) Chlorpromazine
d) Trifluphenazine
 209. Following the sustained administration of typical antipsychotics, your patient has
developed abnormal involuntary movements e.g. chewing, sucking or tongue
protrusion. The best drug to give is…
a) Trifluphenazine
b) Benzhexol
c) Diazepam
d) Lithium carbonate
[Link] elements of mental state examination include:
a) Speech, mood, insight, cognitive, thought content, appearance and behavior
b) Speech, mood, anxiety, cognitive, thought content, appearance and behavior
c) Speech, complaint, insight, cognitive, thought content, appearance and behavior
d) Speech, mood, insight, cognitive, reason for referral, appearance and behavior
[Link] differentiate delirium from dementia in a 75-year-old male patient, the most
appropriate diagnostic technique is
e) Positron emission tomography (PET)
f) Computed tomography (CT)
g) Am barbital sodium [Amytal] interview
h) Electroencephalogram (EEG)
[Link] psychiatric nurse should reinforce __________________ before dealing with
the concerns of a psychiatric patient.
a) Self-awareness
b) Self- assertiveness
c) Self- discipline
d) Advocacy
[Link] best approach for the mental health nurse to take when a client thinks his food
is poisoned is to
a) Assure the client that all food served on the hospital is safe to eat.
b) Obtain an order for a tube feeding for the client.
c) Provide the client with food in unopened containers.
d) Tell the client that irrational thinking is detrimental to good health.
214. Delusions in clear consciousness are seen in
a) Dementia
b) Delirium
c) Schizophrenia
d) Neurosis
[Link] consciousness, visual hallucinations, hyperactivity and fragmentary
delusions are
e) Delirium
f) Dementia
g) Paranoid psychosis
h) Schizophrenia
[Link] is seen in all of the following EXCEPT
a) Schizophrenia
b) Head injury
c) Huntington‘s Chorea
d) Cannabis
[Link] of the following is a mature defense mechanism
a) Projection
b) Reaction formation
c) Anticipation
d) Denial
[Link] most common post-partum psychosis is
a) Mania
b) Depression
c) Dementia
d) Schizophrenia
219. An Irresistible urge to move about and increased motor activity is
a) Rabbits syndrome
b) Malignant neuroleptic syndrome
c) Akathasia
d) Tardive dyskinesia
220. The following are psychotic disorders except
a) Schizophrenia
b) Mania
c) Psychotic depression
d) Hysteria
221. When maintaining accurate records in situations of suspected abuse, the nurse should
document:
a) An interpretation of the client‘s statements regarding the abuse.
b) A body map to indicate size, color, areas and types of injuries.
 c) A description of the suspected abuser.
d) Generalized statements about the events leading up to the abuse
222. A client is experiencing anxiety attack. The most appropriate nursing intervention should
include
a) Turning on the television
b) Leaving the client alone
c) Staying with the client and speaking in short sentences
d) Ask the client to play with other clients
223. All of the following are effects of child abuse EXCEPT.
a) Mental disorders
b) Exhibitionism
c) Depression
d) Fear/phobia
224. A disorder that results in involuntary, repetitive body movements which includes
grimacing, sticking out the tongue or smacking of the lips is called
a) Tardive dyskinesia
b) Akathasia
c) Dystonia
d) Echopraxia
224. The inability to feel pleasure; lack of interest or enjoyment in activities or
relationships is called
a) Avolition
b) Anhedonia
c) Alogia
d) Asociality
226. All of the following are behavioral deficits that endure beyond an acute episode
of schizophrenia EXCEPT
191. Avolition
192. Anhedonia
193. Alogia
194. Neologisms

SECTION B- MATCHING ITEMS

( I MARK EACH)

MATCH THE FOLLOWING DISORDERS OF MEMORY IN COLUMN A WITH THEIR

MEANING IN COLUMN B

COLUMN A COLUMN B

51__G___ Déjà vu A. Loss of memory for recent events

52__D____Confabulation B. Loss of memory of events that happened after the accident or injury.

53__F____ Grandiose delusion C. Loss of memory of events that happened before the accident.

54___E__Erotomania D. Creating own ideas or feeling in blanks to cover up what you have
forgotten

55__C___Anterograde amnesia E. An individual who has a false belief that she is loved by a
person of high social status.

F. An individual believes he/she possess a recognized

talent or in sight such as that of religious leader and seek
for position of power

G. A patient seeing a strange person and believing

that he/she has seen that person before.

MATCH THE FOLLOWING VARIATIONS IN SEXUAL PREFERENCES IN COLUMN

A WITH THEIR DEFINITIONS IN COLUMN B

56_G__Necrophilia A. Sexual satisfaction achieved from inflicting pain on

another person.

57__D__Masochism B. Sexual pleasure is obtained from viewing nudes

58__A__Sadism C. Sexual arousal obtained with children under 16 years

59__B__Voyeurism D. Sexual pleasure gratification is obtained by

experiencing pain
60__F__Exibitionism E. Obtaining sexual satisfaction by having sex with

animals

F. Sexual pleasure obtained from exposing one’s genitals

to others

G. Obtaining sexual gratification by having sex with a

corpse

MATCH THE TERMS IN COLLUMN I WITH THEIR DEFINITIONS IN COLLUMN II

I II
61._D__Thought withdrawal A. No longer interested in going out with friends
62._C__Alogia B. Impairments in social relationships; few friends, poor
social skills, little interest in being with other people
63.__B_Asociality C. Lack of meaningful speech; poverty of speech
64._E__Flat affect D. Belief that one’s thoughts are being removed from
one’s mind

65._A__Avolition E. No stimulus can elicit an emotional response

F. Belief that one’s thoughts are being broadcast or transmitted
to others
G. New, seemingly meaningless words that are formed
by combining words

MATCH THE FOLLOWING PSYCHIATRIC NURSING SKILLS IN COLUMN I WITH THEIR

CORRESPONDING CHARACTERISTICS IN COLUMN II. RESPONSES IN COLUMN II
SHOULD BE USED ONCE ONLY.
Column I Column II
66_C__Communication A. Teach patient step by step ways of changing
maladaptive lifestyle

67__D__Self-awareness B. Train patients to freely express themselves in an

appropriate and acceptable way
68_B___Assertive skills training C. The reciprocal exchange of information, ideas and
feelings
69__E___Counselling skills D. Inspect oneself inwardly and understand
oneself
objectively
70___A__Behaviour modification E. Techniques used by the nurse to help the client
find own solutions while being supported and guided

F. One-way communication to educate patients on various

health issues

G. Actions Nurses take to help treat or deliver nursing

care to clients so that they may recover or get well

CROSS MATCH THE TYPE OF MENTAL DISORDER IN COLUMN I WITH THE CORRESPONDING TERM
IN COLUMN II. RESPONSES IN COLUMN II SHOULD BE USED ONCE ONLY

Column I Column II
195. ……C………….. A. Teach patient step by
Communication ways of changing
maladaptive lifestyle

196. ………D…………Self- B. Train patients to freely

Awareness express themselves in an
appropriate and
acceptable way

197. ……B……Assertive C. The reciprocal exchange

Skills Training of information, ideas
and feeling
 198. ……E………Counselli ng D. Inspect oneself inwardly
Skills and understand oneself
objectively

199. ……A………Behaviou r E. Techniques used by the

Modification nurse to help the client
find own solutions while
being supported and
guided

F. One-way
communication to
educate patients on
various health issues

G. Actions nurses take to

help treat or deliver
nursing care to clients so
that they may recover

or get well

CROSS MATCH THE TYPE OF ADMISSIONS IN COLUMN I WITH THE

CORRESPONDING TERM IN COLUMN II. RESPONSES IN COLUMN II
SHOULD BE USED ONCE ONLY

Column I Column II
200. ………D………voluntary A. Family request that
admission patient be admitted

201. ………B………emergenc y B. Community

admission request for admission
because patient is a
danger to himself and
others
 202. ……G…………involunta C. Admission to
ry admission
assess person‘s
mental state at the
time of committing a
crime

203. ……F…..admission under D. Patient request for

medical board admission and is
aware that he/she is
not well

204. ………C……admission by E. Patient is admitted

court adjudication due to a sudden
health crisis

F. Employers request
medical officers to
assess if the employee
is fit to continue work
or be retired on
medical ground

G. Patient is admitted
without his/her
consent

CROSS MATCH THE TYPES OF HALLUCINATIONS IN COLUMN I WITH

THE CORRESPONDING TERM IN COLUMN II. RESPONSES IN COLUMN
II SHOULD BE USED ONCE ONLY
COLUMN I COLUMN II
205. ………F…………Visual A. Patient
hallucinations hears voices
arguing

206. ………C…………Gustato B. Patient is

ry hallucinations mute

207. ………D……… Tactile C. Patient

hallucinations
says, ‗‘this beef
is tasty, I‘m
enjoying‘‘ when
he is not
actually eating
anything

208. ………G……… Olfactory D. Patient

hallucinations
exclaims‘ ‗‘this
small snake
keeps moving
on my arm

209. ………A………Auditory E. Patients

hallucinations maintaining the
same posture
for hours

F. Patient
complains of
seeing huge men
behind him
every day

G. Patients
 exclaims ‗‘the rotten
fish is smelling
badly here‘‘ when
actually the room is
free from any smell.

CROSS MATCH THE WORDS IN COLUMN I WITH THE

CORRESPONDING TERM IN COLUMN II. RESPONSES IN COLUMN II
SHOULD BE USED ONCE ONLY.

COLUMN I COLUMN II
66.………C……… Neologisms A. Speech includes
irrelevant details but
eventually makes a
point

67 B. Exaggerated ability to
………A………Circumstantiality make decisions

68………B……. .Hyperbulia C. Creating new words

69……E……. Flight of ideas D. Ideas are unrelated

70……D……. Loosening of E. Rapid thinking with

Associations fast changes in topics

(ideas are related)

 F. Learns how to run fast

G. Words are said in a

rhyming manner

MATCHING QUESTIONS

DO NOT USE ANY STATEMENT OR OPTION FROM COLUMN B MORE

THAN ONCE

Match the following psychiatric nursing skills in Colum A with their

corresponding definitions in Colum B

COLUMN A COLUMN B ANSWERS

1. (A).Teach patient H
Communication step by step way
of changing bad
skills
behavior and
learn good
manners.

2. Self awareness (B).To watch C

skills carefully the way
something
happens or the
way someone
does something.

3. Assertiveness (C).Inspect F
training skills oneself inwardly
4. Counseling (D)Help patients G
skills change abnormal
behaviour

5. Social training (E)Train patients A

skills to express
themselves in an
appropriate way

6. Observation (F)Train patients B

skills not to be
aggressive

7. Stress (G)Solve a E
management problem
successfully
skills
8. Behavior (H)The D
modification reciprocal
skills exchange of
information,
ideas and feelings
9. Therapeutic (I).Acting to I
intervention bring about a
skills desired treatment
outcome.

10. Physical (J)When a patient K

assessment of makes up his
psychiatric mind and leaves
patient minus psychiatric
consent.
 (K).An
examination that
is conducted the
first time a
patient comes to
the health facility
with a complaint.

It may also be
conducted upon
admission.

Match the following psychiatric nursing skills in Colum A with their

corresponding definitions in Colum B

COLUMN A COLUMN B ANSWERS

11. Admission of (A).Leaving of E
psychiatric the hospital by a
patients patient which
involves a
corresponding
discharge note

12. Discharge of (B).A review of A

psychiatric the main points
patients already discussed
in the session to
ensure continuity
in a focused
direction.
13. Summarizing (C).Copying what B
skill someone else is
doing.

14. Stereotyped (D).Advising or C

activity instructing
patients to change
bad behavior

15. Negativism (E)Actions nurses F

take to help treat
or deliver nursing
care to clients so
that they may
recover or get
well.

(F).Doing
opposite of what
you are taught.

Match the following common terminologies used in mental health and psychiatric
nursing in Colum A with their corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

16. Psychiatry (A).Misinterpretation L
of stimuli.

17. Agraphia (B).No thinking in H

place such as seen in
depression.
18. Mental health (C).Absence of I
disease or infirmity

19. Health (D).No psychiatric K

illness or symptoms

20. (E).Too much ideas G

Communication. flowing together.

21. Language (F).Presence of

perception without
stimuli.

22. Illusion (G).Interaction A

between people and
their environment
based on stimuli and
responses

23. Hallucinations (H).An inability to F

write occurring in
general dysphasia
also called apraxia.
24. Flight of ideas (I).Being happy, E
efficient, lack of
anxiety, maturity,
able to adjust,
practicing autonomy
and self-esteem is
high.

25. Retardation of (J).Method by which B

thought thoughts and
activities are made
available to
conscious awareness.

(K).A state of well

being, but not merely
the absence of
infirmity

(L).A specialized or
branch of medicine
that deal in the
diagnosis and
management of
mental disorders.
Match the following common terminologies used in mental health and psychiatric
nursing in Colum A with their corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

26. (A).False belief G
Circumstantial
thinking

27. Fragmented (B).Repeating H

thinking what the
interviewer says.

28. Delusion ©.Mixing of A

words that only
make sense to the
owner.

29. Obsession (D).When N

someone can‘t
talk, as seen in
severe
depression.

30. Disorientation (E).Ideas coming K

into your ears
frequently

31. Incoherent (F).Mouthful of I

speech speeches
32. Echolalia (G).Beating B
about the bush

33. Neologism (H).Disjointed L

ideas.

34. Word salads (I).Senseless C

speech.

35. Mutism (J).Ideas coming D

into your mind
frequently

(K).Inability to
recognize place,
time, date, year
and person

(L).Formation of
own words.

Match the following common terminologies used in mental health and psychiatric
nursing in Colum A with their corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

36. Compulsion (A).Un-aroused E
affect

37. Waxy (B).Forgetting F

flexibility things that
happened.

[Link]/elation ©.Amnesia of G
events that
happened after
the accident or
injury.

39. Depression (D).Two I

conflicting ideas
at the same time.

40. Incongruent (E).An act due to J

affects a repeated ideas
coming into your
mind.

41. Flat affect (F).Maintaining A

of awkward
posture.

42. Ambivalence (G).Excessive D

happiness
43. Amnesia (H).Amnesia of B
events that
happened before
the accident.

44. Anterograde (I)Reduced O

amnesia affects.

45. Retrograde (J).Unexpected H

amnesia behavior or affect.

(K).Excessive
Sadness

Match the following common terminologies used in mental health and psychiatric
nursing in Colum A with their corresponding meaning in Colum B
COLUMN A COLUMN B ANSWERS
46. Confabulation (A).Expected D
behavior

47. Erotomania (B).An individual C

believe he/she
possess a
recognized talent
or in sight such as

that of religious
leader and seek
for position of
power.
48. Grandiose (C).An individual B
delusion normally
unmarried woman
who believes that
she is loved by a
person of high
social status

49. Folie ᾰ duex (D).Creating own E

ideas to cover up
what you have
forgotten

50. Anhedonia (E).Shared F

paranoid disorder
which develops as
a result of close
relationship with
a person who
already
experience
persecutory
delusion.

(F) Diminished
capacity to

experience
pleasure
Match the following Qualities of a Counselor in Colum A with their
corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

51. Being (A).A counselor C
genuine understands the
client‘s feelings
and experiences
and conveys this
understanding
back to the client.

52. Being (B).A counselor D

accepting should be smiling
and good to
everybody

53. Being ©.A counselor A

empathic cares for the
client and
behaves toward
the client as they
really feel. It is
similar to
congruence.

54. (D).A counselor E

Confidentiality appreciates
clients for who
they are, despite
the things that
they may have
done.

55. Positive (E). A counselor F

regard assures the client
that ever
information
discussed will be
kept in between
the counselor and
the client

(F).Basic
acceptance and
support of a
person regardless
of what the
person says or
does

Match the following different ways of changing abnormal behavior in Colum A

with their corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

56. Positive (A).Many of our C
reinforcement feelings e.g.
violent emotions,
are probably
conditioned

responses to a
face, or voice that
we associate with
previous
childhood bad
experiences, such
as being scolded,
beaten, or
mistreatment.

57. Extinction (B).Is a strategy E

used to form new
behaviour
patterns, increase
existing skills, or
reduce avoidance
behaviour (such
as phobias and
panic attacks
(systemic
desensitisation)

[Link] (C).Adding a
conditioning rewarding
 stimulus as a A
consequence of
behaviour, thus
increasing the
probability that it
will occur again.

59. Social (D).Giving B

learning / punishment for
observation perceived bad
behavior

[Link] (E).When F
conditioning positive
reinforcement for
a particular
response
(behaviour) is
withdrawn, the
behaviour usually
stops.

(F). A response
to a stimulus
produces positive
consequences to
the individual, it
will tend to be
repeated
Match the following main clinical features of obsessive compulsive neurosis in
Colum A with their corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

61. Obsessional (A).Memory C
rituals impairment

62. Obsessional (B).Impairment in I

doubts performing
sensory
movements

[Link] ©.Communication E
rumination impairment

64. Obsessional The patient has to F

phobias do things in a
particular order,
or a certain
number of times.

65. Amnesia (D).Impairment in A

performing motor
movements
66. Aphasia (E).These are C
internal debates in
which arguments
for and against
even the simplest
everyday actions
are reviewed
endlessly.

67. Apraxia (F).In Obsessional E

phobia, the patient
usually has a fear
that she will do
something wrong

against her better

judgment.

68. Agnosia (G).Impairment in H

recognition of
what is taken in
through the senses

69. Agoraphobia (H).Memory J

improvement
70. Aphonia (I).Obsessional K
doubts make the
patient wonder if
something really
happened

(J). Fear of open

spaces

(K). Loss of the

ability to vocalise

Match the following types of personality disorders in Colum A with their

corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

71. Paranoid (A).Disregard for C
personality disorder and violation of
the rights of
others, lack of
empathy &

always in conflict
with the law
71. Schizoid (B).Pervasive J
personality disorder pattern of
instability in
relationships,
selfimage,
identity, behavior
and affects often
leading to
selfharm and
impulsivity

73. Antisocial ©.Characterized A

personality disorder by a pattern of
irrational
suspicion

74. Borderline (D).Pervasive B

personality disorder: feelings of social
inhibition and
inadequacy with
extreme
sensitivity to
negative
evaluation

75. Narcissistic (E).Pervasive I

personality disorder psychological
need to be cared
 for by other
people.

76. Avoidant (F).Rigid D

personality disorder conformity to
rule,
perfectionists

77. Dependent (G).Characterized E

personality disorder by a pattern of
rational suspicion

78. (H).Empathy & F

Obsessivecompulsive always in
personality disorder:
agreement with
the law

(I).A pervasive
pattern of
grandiosity,
attention seekers
& always asks
for favours
 (J).Lack of
interest and
avoids social
relationship &
enjoys solitary
activities

Match the following conditions in Colum A with their possible precipitating

factors for seizures (Epileptic) in Colum B

COLUMN A COLUMN B ANSWERS

79. Physical D
(A).

•Withdrawal of
alcohol or other
sedative agents

• Administration
of drugs with
proconvulsant
properties (e.g., central
nervous system
stimulants and
anticholinergics
including over the
counter
antihistamines)

• Most dopamine
blocking agents

80. (B). F
Psychosocial /
emotional Menstruation

• Ovulation

• Pregnancy Stress
81. Metabolic (C). G
and
Electrolyte • Particular odors
Imbalance
• Flashing lights

• Certain types of
music
82. Hormonal (D). B
variations
Overexertion

• Sleep
deprivation

• Alteration in
bowel elimination

• Fever

• Recent head
trauma

• Concurrent
illness/infections

• Over-hydration

• Excesses in
caffeine, sugar, and
other foods
83. C
Environmental (E).

• Newer
antipsychotics,
particularly clozapine

• Antidepressants,
especially buproprion

• Immune
suppressants such as
cyclosporine

• Antibiotics such
as quinolones or
imipenem/cilastatin

• Toxins

(F).

• Depression

• Anxiety

• Psychosis

• Anger
(G).

• Low blood
glucose

• Low sodium
 • Low calcium

• Low magnesium

• Dehydration

• Hyperventilation

Match the following types of child abuse in Colum A with their corresponding
meaning in Colum B

COLUMN A COLUMN B ANSWERS

84. Physical abuse (A).Involve F

conveying to
children that they
are worthless or
unloved,
inadequate, or
valued only
insofar as they
meet the needs of
another person.

85. Sexual abuse: (B).Abandoning D

relationships
[Link] ©.The persistent A
abuse failure to meet a
child‘s basic
physical and/or
psychological

needs, likely to
result in the
serious
impairment of the
child‘s health or
development.

87. Neglect (D).Involves C

forcing or enticing
a child or young
person to take part
in sexual
activities,
including
prostitution,
whether or not the
child is aware of
what is happening.
[Link] labor (E).child is given E
work that is
inappropriate to
age

(F)Involve hitting,
shaking, throwing,
poisoning, burning
or

scalding,
drowning,
suffocating, or
otherwise causing
physical harm to a
child.

Match the following types of sexual dysfunctions in Colum A with their

corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

89. Erectile (A).This is F
dysfunction or characterized by
the inability of
impotence
the female to
express sexual
satisfaction.
90. Premature (B).This is a H
ejaculation recurrent and
persistent pain
during coitus in
either the man or
the women.

91. Frigidity A
92. Anorgasmia (D).It refers to D
the ability of the
women to
achieve
orgasm by
masturbation or
coitus.

93. Dyspareunia (E).This is B

characterized by
the ability of the
female to express
sexual
satisfaction.
94. Vaginismus (F).This is C
characterized by
an inability to
achieve or
maintain an
erection
sufficient for
successful sexual
intercourse.

(G).It refers to
the inability of
the women to
achieve orgasm
by masturbation
or coitus.

(H).This occurs
when the man
recurrently
achieves orgasm

and ejaculation
before he wishes
to do so.

Match the following types of sexual behavior (not customarily accepted) in Colum
A with their corresponding meaning in Colum B
COLUMN A COLUMN B ANSWERS
95. (A).This involves J
Homosexuality. obtaining sexual
gratification
through contact
with animals.

96. Exhibitionism (B).).It is sexual G

gratification from
observing others
engaged in sexual
activity

97. Pedophilia (C)This involves F

the enjoyment of
pain, humiliation
and punishment
by the sexual
partner.

98. Voyeurism (D).This is B

excessive sexual
drive or desire in
females.
99. Fetishism (E).This involves K
a persistent sense
of discomfort
about one‘s
anatomic sex and
wish to live as a
member of the
opposite sex.

100. (F).This is a H
Transvestitism sexual deviation in
which there is
unusual sexual
interest directed
towards children
of either sex.

101 Sadism (G).This is sexual I

gratification by
genital exposure
in public.

102. (H).This involves F

Transsexualism sexual arousal and
satisfaction by
wearing the
 clothes
appropriate to the
opposite sex.

103. Masochism (I).This involves a C

sexual
gratification from
inflicting of pain
on one's sexual
partner.

104. Zoophilia (J).This involves A

(bestiality) the attraction for
sexual relation
with persons of
the same sex

(K).This is a male
sexual deviation in
which the deviant
is unable to love a
person sexually
because of
immature sexual
development

Match the following types of sexual behavior (not customarily accepted) in Colum
A with their corresponding meaning in Colum B
COLUMN A COLUMN B ANSWERS
[Link] (A).Excessive B
sexual drive or
desire in females.

106. Incest. (B).Violence and C

the lack of
consent by the
sexual partner

107. ©.This involves A

Nymphomania sexual union of
close relatives..

108. Satyriasis (D).Sexual G

gratification is
achieved by
telephoning
someone and
making
rude/vulgar
remarks or
remaining silent
on the line.
109. Telephone (E).Sexual D
scatology excitement is
achieved by
touching and
rubbing against a
none consenting

person and even

ejaculating on
that person or
woman.
110. Frotteurism (F).This is a E
sexual deviation
in which there is
unusual sexual
interest directed
towards children
of opposite sex.

(G)This is
excessive sexual
drive or desire in
males.

Match the following types of aggression (Moyer Classification- 1968) in Colum A

with their corresponding meaning in Colum B

COLUMN A COLUMN B ANSWERS

111. Instrumental (A).A form of F
aggression hostile
aggression that
does damage to
another's peer
relationships, as
in social
exclusion or
rumor spreading

112. Hostile (B).Competition J

aggression between males of
the same species
over access to
resources such as
females,
dominance, status

113. Relational ©.Aggression A

aggression associated with
attempts to flee
from a threat.

114. Predatory (D).Aggression G

aggression induced by
frustration and
directed against
an available
target.
115. Inter-male (E).A female's B
aggression. aggression to
protect her
offspring from a
threat. Paternal
aggression also
exists.

116. Fear- (F).Aggression C

induced aimed at
obtaining an
aggression
object, privilege

or space with no
deliberate intent
to harm another
person

117. Irritable (G).Attack on D

aggression prey by a
predator.

118. Territorial (H).A male's K

aggression. aggression to
protect his
offspring from a
threat. Paternal
aggression also
exists.
119. Maternal (I).Aggression E
aggression not intended to
harm another
person, such as
hitting, kicking,
or threatening to
beat up someone.

(J).Aggression
intended to harm
another person,
such as hitting,
kicking, or
threatening to

beat up someone.

(K).Defense of a
fixed area against
intruders,
typically conflicts

Match the following forms used in forensic psychiatry (Column 1) with the
corresponding description in (Column 2).

COLUMN 1 COLUMN 2 ANSWERS

120. (A).Ensures B
Adjudication patient is
forms admitted for 14
days
121. Control (B).The patient C
order forms has to be tried
before courts of
law.

122. Transfer ©.Courts D

order forms determine where
patient will be
detained.

123. Detention (D).Used to A

Order forms transfer patients
with mental
illness.

(E).Ensures
patients are
treated on demand
(F).Used to force
patients to eat
food

Match the following terms used in community psychiatry (Column 1) with the
corresponding description in (Column 2).

COLUMN A COLUMN B ANSWERS

124. Community (A).A means of I
Psychiatry reaching the
goal of good
mental health
through actions
that are taken
for the purpose
of fostering,
protecting and
improving
mental health.

125. Institutionalism (B).Preventing F

psychiatric
illness rather
than treating it.

[Link] ©.The range of H

social
educational,
 occupational,
behavioral and
cognitive
interventions
used to increase
the role
performance of
persons with
serious and
persistent
mental illness
and to enhance
their recovery

127. Severe mental (D).Having J

disorders sufficient
autonomy in
order to exercise
some control in
response to
adversity or
adverse events.

128: Mental health (E).Mental A

promotion Health
Prevention
129. Primary prevention (F).Is a pattern B
of passive
dependent

behavior
observed among

psychiatric
inpatients,
which is
characterized by
hospital
attachment and
resistance to
discharge.

130. Secondary (G).Resistance L

prevention
131. Tertiary prevention (H).Refers to a K
shift in the
focus of care
from long term
institutions to
the community,
accompanied by
discharging
long-term
patients, and
avoiding
unnecessary
admissions.

132. Psychiatric (I).Psychiatry C

rehabilitation focusing on

detection,
prevention and
early treatment
and
rehabilitation of
emotional and
behavioral
problems as
they occur in
the community.
133. Protective factors (J).Mental D
illnesses
characterized by
functional
disability
(inability to
function in the
following areas:
occupational,
social).

(K).The
prevention of
long term
disability from
chronic and
persistent severe
mental illness.
Such

disability
includes poor
social
integration,
aggression,
indecent
behaviors.
 (L). Reducing
the number of
existing mental
illnesses
through
screening early
diagnosis,
prompt
treatment and
education of
signs and
symptoms.

Match the types of admission used in psychiatry in (Column A) with their

meaning in (Column B).

COLUMN A COLUMN B ANSWERS

134. Voluntary (A).This is where G
Admission the patient is not
willing to be
 admitted and
does not accept
treatment, or is
unable to give
consent for
treatment, but he
or she has a
problem, illness
or he is a
potential
abscondee

135. Emergency (B).The client is E

admission admitted into a
psychiatric
forensic unit by
the court‘s
decision, whilst
his/her case is
being reviewed
by the courts of
law.

136. Involuntary ©.This is when a A

or Compulsory patient suddenly
Admission
falls ill.
137. Admission (D).When a F
under medical mentally ill
board
patient lacks
shelter and food

138. Admission (E).A person in a B

by Court community
Adjudication
begins to act in a
manner
inconsistent with
the norms of
society because
of suspected
mental illness
(F).This is when
the employers
writes a letter to
the hospital
requesting the
medical officers
who in turn
consult the
psychiatrist
where applicable,
to examine the
patient
thoroughly and
come up with a
report to say
whether that
person can
continue working
or be retired on
medical grounds.

(G).A patient is
 willing to be
admitted and
knows that he/she
has a problem,
and the medical
officer in charge
of the mental
hospital sees that
the patient really
needs admission.

Match the disorders in Column I with their characteristic signs and symptoms in
Column II

Column I Column II

139._B____Schizophrenia A. Frequent visit to the health centre even

140.___C___Mania B. Hallucination puzzled and perplexed look

141.__A___Neurosis C. Elevation of mood

142._D_____Acute Psychotic Disorder D. Poor hygiene and social withdrawal

143._F____Organic Brain Syndrome E. Guilty feeling

F. Chronic and progressive illness with disturbed

memory
ONE WORD ANSWER

It occurs within 1 to 5 days following delivery………………postpartum

blues…………

71. Hebephrenic schizophrenia is also

called…………………disorganized……….…type.
72. …Schizophrenia……….. Is a functional mental disorder characterized by
disturbances in volition, thinking, emotions and perception.
73. A skill that involves coming up with right questions so as elicit more information from
a client is called…………probing/ questioning……..
74. Severe mental retardation can be represented by an intelligence quotient of
between…20-40…
75. In the description of needs by Maslow, the needs at the bottom are
called….Physiological needs…
76. A counseling session is concluded by ………Summarizing……………. the main
points.
77. ……………Illusion……………. refer to misinterpretations of real external sensory
stimuli.
78. Perception in the absence of real external stimuli
called……..Hallucination.......................
79. Trichotilomania.. is a condition characterized by an overwhelming urge to pluck out
specific hairs.
80. The term schizophrenia was first coined by a swiss psychiatrist by the name of
…Eugen Bleurer…. In 1911.

82………Psychosis/ Psychoses…………… is a serious mental disorder characterized

buy loss of contact with the reality, hallucinations delusions, abnormal thinking, and
disrupted work and social functioning.

83………kleptomania…………………is a disorder in which the individual

impulsively steals things which they may not need or use. 84…Depression……is a
state of low mood and aversion to activity that can affect a person‘s thoughts,
behaviour, feelings and sense of well-being

85. A ……Skill………………………… is an ability to do an activity or job well,

especially because you have practiced it.
86……Nursing …………… Skills utilize the principles of classical conditioning,
operant conditioning, and social learning to change the behaviour of patients.

[Link] term used in psychiatry for loss of interest by a client in activities which were
previously pleasurable is called……Anhedonia……………….

88. The branch of psychiatry that deals with the assessment and treatment of mentally
disordered offenders and includes those area where psychiatry interacts with the
law is called …Forensic Psychiatry
89. The reduction of the number of existing mental illnesses through screening, early
diagnosis, prompt treatment and education of signs and symptoms is known
as…….....Mental health Promotion..........................
90. Chronic heavy alcohol drinkers exhibit a cluster of common symptoms that form a
syndrome called…………Korsakoff syndrome………
91. Attention-Deficit Hypersensitivity is a chronic psychiatric condition manifested by
the following three (3) characteristics; attention difficulty, impulsiveness and
……….Hyperactivity.....................
92. A patient who is unresponsive, akinetic, mute and fully conscious is said to be in a
…catatonic stupor
93. The term used to refer to behaviour where there is ―acting out‖ of problems and
loss of or poor control of impulses is called ......Hysteria.....
94. The term used for sexual excitation which arises from inanimate objects such as
material or colour is
called…………Fetishism……………………………………………
95. A disorder in which there is insufficient quantity and quality of sleep is
called…insomnia....
[Link] unlawful and malicious destroying and damaging of property by setting fire
is called…pyromania

96. Adding a reward stimulus as a consequence of a behaviour, thus increasing the

probability that it will occur again is referred to as………positive
reinforcement………………..
97. The structural way of observing and describing a patient‘s current state of mind is
referred to as …………mental state examination........
98. …Assertiveness……. Is to exercise ones rights, opinion and feeling without
denying the rights of others.
99. The types of depression where the cause is considered to be coming from outside is
called…………exogenous depression……………………
[Link] act or an instance of taking one‘s own life voluntarily and intentionally
common in depression is called……Suicide……………………………
[Link] type of phobia in which there is persistent fear of heights which leads to
embarrassment and avoidance of such situations is
called………Acrophobia………………
[Link] between people and their environment based on stimuli and responses is
known as-------------------------------
Ans Communication
[Link] Rhodesia had no psychiatric hospital and most of the patients were
looked after in the general hospitals known as----------------------------------------
Ans Mental annex
[Link] member of parliament who suggested that psychiatric patients can best be
nursed at home, here in Zambia than at Ingutsheni in Southern Rhodesia in 1957
was----------------------------------------------------
Ans Sir Steward Gobrown
[Link] ability to do an activity or job well, especially because you have practiced it is
called
Ans A skill.
[Link] acronym that best demonstrates and summarises behaviours during a
counseling/ therapeutic relationship with a client is called-------------------------------
-
Ans SOLER.
[Link] inward to understand oneself and objectively without bias, examine one‘s
beliefs, values, attitudes, motivations, strengths and limitations is called--------------
-------- Ans Self awareness
[Link] skill a nurse uses to examine thoughts and observable behaviour of a client
during counseling that is self defeating and change such thoughts and behaviour for
the better is known as---------------------------------------
Ans Challenging skill
[Link] knowledge and skills people need to have to live in the community is called----
----------------------- Ans Social skill.
[Link] term used to describe an individual‘s reaction to any change that requires an
adjustment or response is -------------------------------------------- Ans Stress.

[Link] use of coping strategies, ways or methods that protect the individual from
harm in response to stressful situations or stressors is called-----------------------------
--------------
Ans Stress management.
[Link] a rewarding stimulus as a consequence of a behaviour, thus increasing the
probability that it will occur again is referred to as----------------------------------------
--
Ans Positive reinforcement.
[Link] interaction between two people (usually a caregiver and a care receiver) in
which input from both parties contributes to a climate of healing, growth
promotion, and illness prevention is known as---------------------------------------------
----- Ans Therapeutic relationship.
114.A n examination that is conducted the first time a psychiatric patient comes to the
health facility with a complaint is referred to as------------------------------------------
Ans Physical assessment.
[Link] type of admission where a patient is willing to be admitted and knows that
he/she has a problem, and the medical officer in charge of the mental hospital sees
that the patient really needs it is called-------------------------------------------
Ans Voluntary Admission.
[Link] type of admission where the patient is not willing to be admitted and does not
accept treatment, or is unable to give consent for treatment, but he or she has a
problem, illness or he is a potential abscondee is------------------------------------------
----
Ans Involuntary or Compulsory Admission
[Link] type of admission where the employers writes a letter to the hospital requesting
the medical officers who in turn consult the psychiatrist where applicable, to
examine the patient thoroughly and come up with a report to say whether that
person can continue working or be retired on medical grounds is called---------------
----------------------
Ans Admission under medical board
[Link] transition ( passing from mental hospital to the community) in which the
patient is discharged and given a review date for continuity of care is known as-----
--
 -----------------------------------
Ans Termination phase.
[Link] discharge planning, where the admitting nurse and multi disciplinary team
holds a meeting with the client and relatives on admission in which they together
begin to plan for the patient‘s eventual discharge upon recovery is---------------------
----------
Ans Introduction or admission phase
[Link] the patient has stabilized the nurse meets with relatives and the rest of the
mult disciplinary team to review / evaluate patient‘s progress, ascertain his/her
suitability for discharge, and to further prepare patient for discharge is called--------
-
-------------------- Ans Working or treatment phase
[Link] are unable to recall long periods of their lives and sometime deny any
knowledge of their previous life or personality identity is--------------------------------
----------
Ans Dissociative amnesia
[Link] type of depression also known as exogenous depression where the cause is
considered to be coming from outside is called--------------------------------------------
-----
Ans Reactive depression
[Link] affective disorder which presents with elation of mood and increased
psychomotor activities is referred to as ----------------------------------------
Ans Mania
124.A psychiatric syndrome in which specific psychological symptoms lead, in most
cases, to disintegration of personality is known as----------------------------------------
-----
Ans Schizophrenia.
[Link] term that describes symptoms of a large group of illnesses that cause a
progressive decline in a person‘s functioning such as loss of memory, intellect,
rationality and social skills is called---------------------------------------------------------
Ans Dementia.

[Link] type of personality disorder which is characterized by a pattern of irrational

suspicion, mistrust of others, Interprets innocent actions to be negative and
defensive is------------------------------------------------
 Ans Paranoid Personality

[Link] type of personality disorder which is characterized by lacks of interest and

avoids social relationships, restricted emotional expression, apathetic, and enjoys
solitary activities is---------------------------------------------
Ans Schizoid personality disorder
[Link] type of personality disorder which is characterized by a pervasive pattern of
grandiosity, attention seekers and always asks for favours is called--------------------
----------------
Ans Narcissistic personality disorder

[Link] disorder in which a person‘s overall intellectual functioning is well below

average, with an intelligence quotient (IQ) around 70 or less is-------------------------
-

Ans Mental Retardation.

[Link] abnormal, sudden excessive, uncontrolled electrical discharge of neurons within

the brain that may result in alteration in consciousness, motor, or sensory ability
and or behaviour is referred to as--------------------------------------------- Ans Seizure
[Link] phase before the actual fit (epileptic) which is characterized by a change in the
patient‘s mood and may last for hours to days is ---------------------------------------
Ans Prodromal phase
[Link] phase during an epileptic fit where stiffening of the body, jaw closes tight and
the patient may utter a sound mistaken for a cry as there is partial closure of the
epiglottis is called-------------------------------------
Ans Tonic stage
[Link] stage of violent convulsions, frothing from the mouth due to increased
salivation and patient can chew his tongue during an epileptic fit is--------------------
--------
Ans Clonic stage
[Link] recurrent seizures without any recovery period is referred to as------------------
--
Ans Status epilepticus
[Link] type of abuse that involve hitting, shaking, throwing, poisoning, burning or
scalding, drowning, suffocating, or otherwise causing harm to a child is--------------
----------
 Ans Physical abuse.
[Link] persistent failure to meet a child‘s basic physical and/or psychological needs,
likely to result in the serious impairment of the child‘s health or development is
called-------------------------------------- Ans Neglect
[Link] staff in a home or other institutions sacrifice the needs, wishes and lifestyle
of a disabled child in favour of the institution's regime is known as--------------------
-
-
Ans Institutional abuse.
[Link] process of enabling a mentally ill person to return to the highest possible level
of functioning is -------------------------------------------- Ans Rehabilitation.
[Link] various types of support a person gets from friends, family and medical or
mental health professionals, that keeps one mentally strong in difficult times is
called--------------------------------- Ans Social support.
[Link] use or treatment of someone wrongly or badly, especially in a way that is to
your own advantage is referred to as----------------------------------------------
Ans Abuse
[Link] reserve supply of money, labour, materials, psychological capability to solve
problems is known as-------------------------------------- Ans Resources
[Link] failure to achieve an erection in full view of normal agreement of a sexual act
between two mature individuals of the opposite sex is------------------------------------
---
Ans Psychosexual disorder
[Link] inability to achieve or maintain an erection sufficient for successful sexual
intercourse is called------------------------------------
Ans Impotence or Erectile dysfunction
[Link] inability of the female to express sexual satisfaction is referred to as------------
-----------------
Ans Frigidity
[Link] recurrent and persistent pain during coitus in either the man or the women is
called---------------------------------------
Ans Dyspareunia
[Link] involuntary constriction of the outer one third of the vagina that prevents
penetration, insertion and coitus is--------------------------------------------------
 Ans Vaginismus
[Link] attraction for sexual relation with persons of the same sex is----------------------
Ans Homosexuality
[Link] gratification by genital exposure in public is referred to as----------------------
Ans Exhibitionism
[Link] deviation in which there is unusual sexual interest directed towards children
of either sex is called------------------------------------------------ Ans Pedophilia
[Link] gratification from observing others engaged in sexual activity is---------------
-----------
Ans Voyeurism
151.A male sexual deviation in which the deviant is unable to love a person sexually
because of immature sexual development is------------------------------------------------
Ans Fetishism
[Link] sexual dysfunction that involves sexual arousal and satisfaction by wearing
the clothes appropriate to the opposite sex is ----------------------------------------------
- Ans Transvestitism
[Link] gratification from inflicting of pain on one's sexual partner is -----------------
---------------
Ans Sadism
154.A persistent sense of discomfort about one‘s anatomic sex and wish to live as a
member of the opposite sex referred to as------------------------------------------- Ans
Transsexualism
[Link] enjoyment of pain, humiliation and punishment by the sexual partner is called
-----------------------------------------------
Ans Masochism.
[Link] sexual gratification through contact with animals is ------------------------
--------------
Ans Zoophilia (bestiality)
[Link] sexual encounter resulting from violence and the lack of consent by the sexual
partner is called---------------------------------------------
Ans Rape
[Link] sexual encounter resulting from union of close relatives is-------------------------
-----------
 Ans Incest
[Link] sexual drive or desire in females is known as---------------------------------
Ans Nymphomania
[Link] sexual drive or desire in males is called----------------------------------------
Ans Satyriasis.
[Link] gratification which is achieved by telephoning someone and making
rude/vulgar remarks or remaining silent on the line is called----------------------------
----------
Ans Telephone scatology.
[Link] excitement which is achieved by touching and rubbing against a non
consenting person and even ejaculating on that person or woman is referred to as---
--------------------------------
Ans Frotteurism
[Link] branch of psychiatry that deals with the assessment and treatment of mentally
disordered offenders and includes those areas where psychiatry interacts with the
law is called---------------------------------------- Ans Forensic psychiatry
[Link] means of reaching the goal of good mental health through actions that are
taken for the purpose of fostering, protecting and improving mental health is--------
-----------------
Ans Mental health promotion.
[Link] reduction of the number of existing mental illnesses through screening, early
diagnosis, prompt treatment and education of signs and symptoms is known as------
-------------------------------
Ans Secondary prevention.
[Link] to reduce the severity of a mental disorder and its associated disability
through rehabilitation activities is referred to as------------------------------------- Ans
Tertiary prevention

ESSAY NMCZ STANDARD NOTES AND QUESTIONS

Psychiatry: A specialized or branch of medicine that deal in the diagnosis and management of
mental disorders.
Mental health: ‗Wright Taylor 1970‘ defines mental health as being happy, efficient,
lack of anxiety, maturity, able to adjust, practicing autonomy and self-esteem is high.
Health: A state of well-being, but not merely the absence of disease or infirmity
Psychiatric nursing is a branch of nursing concerned with identification, prevention
and care of people suffering from mental illness
Mental health nursing is a specialized nursing involved in identification, diagnosis
and management of psychiatric disorders. This definition is synonymous with
psychiatric nursing (Townsend, 2011).

PRINCIPLES OF PSYCHIATRIC NURSING

• Allow a client an opportunity to set own pace in working with problems.

• Nursing interventions should center on the client as a person, not on control of symptoms.
Symptoms are important, but not as important as the person having them.

• Recognize your own feelings towards clients and deal with them.

• Go to the client who needs help the most.

• Do not allow a situation to develop or continue in which a client becomes the focus of attention in a
negative manner.

• If client‘s behavior is bizarre, base your decision to intervene on whether the client is endangering
self or others.

• Ask for help-do not try to be a hero when dealing with a client who is out of control.

• Avoid a highly competitive activity that is having one winner and a room full of losers.

• Make frequent contact with clients- it lets them know they are worth your time and effort.

• Remember to assess the physical needs of your client.

• Have patience, move at the client‘s pace and ability.

• Suggesting, requesting, or asking works better than commanding.

 • Therapeutic thinking is not thinking about or for, but with the client.

• Be honest so the client can rely on you.

• Make reality interesting enough that the client prefers it to his or her fantasy.
• Compliment, reassure and model appropriate behavior.

ROLE OF THE PSYCHIATRIC NURSE

The Resource Person: A resource person provides specific answers to questions

usually formulated with relation to a larger problem‖ In the role of resource person, the
nurse explains, in language that the client can understand, information related to the
client‘s health care.

The Teacher: In this sub role, the nurse identifies learning needs. And provides information
required by the client or family to improve the health situation.

The Leader: According to Peplau, ―democratic leadership in nursing situations

implies that the patient will be permitted to be an active participant in designing nursing
plans for him‖. Autocratic leadership promotes overvaluation of the nurse and clients‘
substitution of the nurse‘s goals for their own. Laissez-faire leaders convey a lack of
personal interest in the client.

The Surrogate: Outside of their awareness, clients often perceive nurses as symbols of
other individuals. They may view the nurse as a mother figure, a sibling, a former
teacher, or another nurse who has provided care in the past. This occurs when a client
is placed in a situation that generates feelings similar to ones he or she has experienced
previously. Peplau (1991) explains that the nurse–client relationship progresses along a
continuum. When a client is acutely ill, he or she may incur the role of infant or child,
while the nurse is perceived as the mother surrogate.

The Counselor: The nurse uses ―interpersonal techniques‖ to assist clients to learn to
adapt to difficulties or changes in life experiences. Peplau states, ―Counseling in
nursing has to do with helping the patient to remember and to understand fully what is
happening to him in the present situation, so that the experience can be integrated with,
rather than dissociated from, other experiences in life‖

a) i.)Define psychiatric nursing.

(5 marks)
ii.) Mention five (5) qualities of a mental health and psychiatric nurse.
(10 Marks)

b) State five (5) principles of psychiatric nursing.

(15 Marks)
c) Explain the (3) three levels of prevention in relation to psychiatry and mental health.
(15 marks)
d) Discuss in details 10 (Ten) roles of a mental health and psychiatry nurse in the
community. (20 Marks)
e) Discuss 5 points why home visits are cardinal for and as part of after care in patients who
have been discharged from a psychiatry unit.
(15 Marks)
f) Discuss 5 points on how a public health nurse or a community mental health and
psychiatry nurse can mobilize resources for the community mental health
programs. (20 Marks)

MANIA

Definitions

• Mania is a mental condition with distinct period during which mood is abnormally and persistently
elevated, expansive, or irritable. Typically, this period lasts about 1 week (unless the person is
hospitalized and treated sooner), but it may be longer for some individuals
• This is an affective or mood disorder resulting from various factors such as increased levels of
neurotransmitters (dopamine, serotonin) in the brain characterized by flight of ideas, elation,
disorganized speech, distractibility, insomnia and psychotic symptoms which lasts for a week or
more if patient is not hospitalized.
• Mania is a disordered mental state of extreme excitement hyperactivity, euphoria and hyperverbal
behavior
• Hypomania
 Hypomania is a clinical syndrome similar to Mania but less severe than that demonstrated in a
full-blow manic episode
• Cyclothymic Personality
Cyclothymic personality is a personality disorder where there is mood disturbance
involving numerous hypomanic episodes and numerous episodes of depression

FACTORS ATTRIBUTED WITH ONSET OF MANIA

Factors attributed with onset of Mania are closely related to factors influencing the onset of
Schizophrenia

AETIOLOGY OF MANIA

The exact cause of Mania is not known but risk factors exists;

• Family Theories: This theory postulates that this mental illness, just like any other mental illness
has a tendency to run in the family. People diagnosed as Mania are likely to have at least one parent
with the same diagnosis. Children can inherit the trait from their parent. Usually, first degree
relatives (siblings) are the most affected. The home environment of fights and quarrels can also
influence the onset of the condition, especially in individuals who have the trait. Lack of a loving
and nurturing caregiver, inconsistent family behaviors, and faulty communication patterns are
thought to be responsible for mental problems in later life.

• Biochemical Factors: Dopamine, a neurotransmitter (also known as a feel-good hormone) is

produced in the brain (hypothalamus) and facilitates the physiology of the central nervous system.
A dopamine hypothesis suggests that Mania is caused by functional hyperactivity of the dopamine
system. Thus it is believed that dopamine hyperactivity causes schizophrenic symptoms as it bring
about hyperactivity of the brain leading to overexcitement (euphoria)

• Alcohol/Drug Abuse: Alcohol and drug abuse has been implicated in the onset of Mania. Alcohol
and drugs influences the dopamine release and may lead to chemical imbalance as well as neuro
degeneration. This may eventually lead to brain degeneration (brain damage)

• Stress: Stress resulting from social problems has also been implicated to influence the onset of
schizophrenia. Stress may influence chemical (dopamine) imbalance in the brain. Chemical
 imbalance has been implicated to be the major contributing factor, especially in individuals who
have the trait

• Psychological Factors: Psychological factors have been identified and linked to mental disorders
and the notable ones include; severe psychological trauma suffered as a child, such as emotional,
physical, or sexual abuse, an important early loss, such as the loss of a parent, neglect, poor ability
to relate to others.

SIGNS AND SYMPTOMS OF MANIA

• Disorganized speech
• Insomnia
• Delusions
• Elations
• Hallucinations
• Hyperactivity
• Distractibility
• Flight of ideas

• Excitement

• Grandiosity

MEDICAL MANAGEMENT

AIMS

• To promote recovery
• To prevent extrapyramidal side effects
• To prevent relapse

History-Taking
• I will do history taking-taking which will reveal patient abusing drugs.
• I will do history taking which will reveal patient having insomnia

Physical Examination
 • I will do physical examination which will reveal patient being unkempt on inspection.
Mental State Examination

Supportive Investigations

Liver Function Tests: abnormal liver functions tests may be an indication of chronic substance
abuse.

Blood analysis: may show macrocytosis which will highly suggest alcohol abuse

TREATMENT OF MANIA

Depending on the severity of the condition, treatment of Mania, usually may include three
(3) modes;

Antipsychotic drugs

Lithium carbonate

 Dose: 125mg – 1g/12 hourly

 Route: orally

Haloperidol (Serenase)

 Dose: 0.5 – 10mg 12 hourly

 Route: orally or intramuscularly or intravenously.

Note: Lithium therapy has numerous side effects & no longer in use in Zambia.

Carbamazepine (Tegretol)

 Dosage: 800 – 1000mg

 Route: orally

Chlordiazepoxide (Librium)
 Dose: 10mg

 Route: Orally

Chlorpromazine

 Dose: 50 – 600mg in 24 hours

  Route: oral or intramuscular

Benzhexol (artane)

 Dose: 2- 5mg

 Route: orally

Psychotherapy

Is the treatment of emotional and psychological problems by individual or group

interaction. Psychotherapy is aimed at enabling the individual or groups to understand
and analyze their own problems and those of other group members.

Electroconvulsive therapy

Electroconvulsive Therapy is a form of treatment in which a grand mal seizure is

artificially induced in patient by passing electrical current through electrodes applied to
the persons head

NURSING CARE

AIMS
• To admit the patient
• To observe the patient To prevent injury
• To promote patient‘s nutritional intake.
• To promote rest and sleep
• To educate patient and family and community.
• Establish a trusting relationship;

ENVIRONMENT/ADMISSION
I will nurse the patient in a Psychiatric unit to Provide Psychiatric in-patient care to him.
I will Nurse him in a Psychiatric unit near the Nurse‘s station for quick response to his
needs. I will nurse him in a clean environment by dump-dusting articles in it with Jik
0.5% to prevent nosocomial infections. I will Nurse him in a well ventilated room by
opening nearby windows to promote free air circulation. I will nurse him in a quiet room
by restricting visitors to promote rest.

CREATE A NURSE PATIENT RELATIONSHIP

I will formulate a nurse-patient relation with the patient based on trust and empathy to
create rapport. I will involve him in his care to promote care ownership. I will keep
him informed on matters related to his care to increase his confidence in me. I will not
reveal information he entrusts me with, without his consent to promote trust. I will
spend quality time with him during my working shift to promote familiarity. I will
announce my absence during knocking off time to prevent negative misperception
that he is left alone. I will allow him to contribute in decision making regarding his
condition to promote autonomy. I will explain the nature of all medical or nursing
procedures to be done on him to gain corporation and informed consent.

MAINTENANCE OF SAFETY
I will remove sharps and articles such as drip stands, from the room where the patient
will be nursed from to prevent him from using such to harm himself or others. I will not
allow competitive games in the ward such as chess where one wins and others lose to
prevent jealousy related aggressive behavior. I will monitor him for signs of impending
violence such as profane speech to determine when to quickly sedate him thereby
preventing him from harming self or others, I will ensure that he takes oral medication
each time in my presence to prevent drug storage for future poisoning. I will call for
help whenever he becomes violent to effectively sedate him thereby prevent other
directed harm. I will nurse him in a room with doors which are lockable from outside
to avoid him from absconding when isolated thereby preventing him from harming
others.

PSYCHOLOGICAL CARE
I will offer crisis counselling to the patient as necessary to promote resilience. I will
encourage him to participate in decision making regarding his care to promote
autonomy. I will explain the nature of his condition to him and offer him reassurance for
positive outcomes to instill hope for recovery in him. I will advise his family members
to spend quality time with him to meet his social needs. I will describe the disease
process and contents to his family members to impart knowledge. I will advise his family
to participate in his care to acquire skills needed for care continuity at home.

OBSERVATIONS
I will assess the patient‘s behavioral patterns through mental state examination to note
for any positive changes. I will monitor his ability to carry out activities of daily living
such as washing clothes and socialization to determine his readiness for discharge. I
will monitor his feeding pattern using a feeding chart to note for altered nutrition if
present. I will monitor the intake and output of fluid and record on the fluid balance
chart to determine his renal function. I will check his vital signs such as temperature,
pulse, respirations and blood pressure which will act as baseline data for future
reference.

NUTRITION
I will serve the patient nutritious foods rich in carbohydrates, proteins and vitamins to
meet his body‘s nutritional needs. I wills serve him foods rich in carbohydrates such as
nshima to provide him with energy for metabolism. I will serve him foods rich in
proteins such as fish to promote tissue repair and growth. I will offer him food rich in
vitamins to help boost his immune system.

HYGIENE
I will assess the patient‘s ability to carry out activities of daily living such as bathing
and oral care to determine whether to assist him or allow him to do it for himself. If he
is unable to, I will assist him in taking a shower with prescribed antiseptic soap such as
dettol to remove his body dirt. I will assist him in doing oral care using a tooth brush
and tooth paste to relieve and prevent halitosis. I will assist him in doing hair care using
shampoo to prevent pediculosis capitis. I will assist him in doing nail care using a nail
cutter to prevent harboring of microbes thereby preventing autoinfection. I will change
linen whenever soiled to prevent infection, formation of bedsores and to maintain
comfort.

MEDICATION
I will administer prescribed medications to promote quick recovery. I will monitor the
side effects of the medications he is on, to note for adverse reactions such as movement
disorders (tardive dyskinesia).I will advise him not to take any unprescribed
medications to prevent drug poisoning. I will explain the treatment guidelines and
expectations to impart knowledge and promote drug compliance. I will administer mood
stabilizers such as Lithium Carbonate to him as prescribed to help regulate his mood. I
will administer anxiolytics such as Diazepam as prescribed to promote sedation thereby
relieving anxiety. I will administer prescribed Antidepressants to him such as
Imipramine to improve his vitality. I will administer antipsychotics to him as prescribed
such as chlorpromazine to relieve psychotic features such as hallucinations.

REST
I will nurse the patient in a quiet room by restricting visitors to promote rest. I will
ensure that his bed is made with clean comfy linen to maintain comfort thereby
promoting rest. I will give him simple tasks to keep him busy during the day if he has
insomnia so that he could sleep at night as he would be tired. I will administer sedatives
to him such as Diazepam as prescribed if he experiences difficulty in sleeping to induce
sleep.

ELIMINATION
If he is immobile, I will offer a bed pan to promote bowel elimination. I will offer him
a urinal if he is immobile to promote urination as necessary. I will serve him high fiber
foods such as spinach to prevent constipation. I will guide and teach him on how to
flush the toilet after use to promote hygiene and stool disposal.

ADVISE ON DISCHARGE/REHABILITATION
I will the patient to return to the health facility on recommended review dates to promote
continuity of care. I will advise him to continue taking prescribed medications to
prevent relapses. I will advise him to join any mental health support group such as
Zambia Therapeutic Arts to instill a feeling of belonging. I will advise him to continue
displaying to acceptable standards of behavior such as assertiveness to promote
community integrations, I will advise him to avoid use of psycho-active drugs such as
cannabis to prevent mental illness relapse. I will advise him to join the Mental
Association of Zambia for life skills training to help him make ends meet thereby
preventing poverty induced mental illness relapse.

Mr Taizya Siame, a 30 year old male is brought by the aunt to the psychiatric unit with
complaints of insomnia, restlessness. Mental State examination reveals pressure of
speech. A provisional diagnosis of mania is made.

a. Define mania
5 marks
b. List five signs and symptoms of mania other than those in the stem. 5 marks
c. Describe the following terms associated with mania 20 marks
i. Hypo mania ii. Delusion of
grandeur iii. Euphoria iv.
Cyclothymic personality
d. Using Loper Rogan‘s and Thieny model of activities, describe how you will nurse
Mr. Siame using the model 50 marks
e. Discuss five points in your Information, education and communication which you will give to Mr.
Siame on discharge from the Psychiatric Unit 20 marks.

ANXIETY

• This is a diffuse apprehension that is vague in nature and is associated with feelings of
uncertainty and helplessness (Townsend, 2009).
• Anxiety is a state in which the individual is frightened but the source of the danger is not known,
not recognized, or inadequate to account for the symptoms (Fadem, 2000).
CAUSES/RISK FACTORS

Causes of neurotic disorders like anxiety may be linked to the following:

• Emotional conflict
 • Maladjustment to life situations
• Some genetic factors
• excessive caffeine intake
• substance abuse
• Cardiac arrhythmia, anemia and pulmonary disease.

SIGNS & SYMPTOMS

• Shakiness and sweating

• Palpitations (subjective experience of tachycardia).

• Tingling in the extremities and numbness around the mouth

• Dizziness and syncope (fainting)

• Mydriasis (pupil dilation)

• Gastrointestinal and urinary disturbances (e.g., diarrhoea and urinary frequency).

LEVELS OF ANXIETY

Anxiety falls on a continuum. It ranges from:

• Mild

• Moderate

• Severe

• Panic State

MILD

This level of anxiety is seldom a problem for the individual. It is associated with the
tension experienced in response to the events of day-to-day living. It prepares people
for action. It sharpens the senses, increases motivation for productivity, increases the
perceptual field, and results in a heightened awareness of the environment. Learning is
enhanced and the individual is able to function at his or her optimal level.
MODERATE

The moderately anxious individual is less alert to events occurring in the environment.
Individual‘s attention span and ability to concentrate decrease. May still attend to
needs with direction. Assistance with problem solving may be required. Increased
muscular tension restlessness are evident.

SEVERE ANXIETY

The perceptual field of the individual is greatly diminished. Concentration centers on

one particular detail only or on many extraneous details. Attention span is extremely
limited. The individual has much difficulty completing even the simplest task.
Characterized by Physical & emotional symptoms. Discomfort is experienced to the
degree that virtually all overt behavior is aimed at relieving the anxiety.

PANIC ANXIETY

The most intense state of anxiety. The individual is unable to focus on even one detail
in the. Misperceptions are common and loss of contact with reality may occur. The
individual may experience hallucinations or delusions. Behavior may be characterized
by wild and desperate actions or extreme withdrawal. Human functioning and
communication with others is ineffective. Associated with a feeling of terror, and
individuals may be convinced that they have a life-threatening illness. May fear that
they are ―going crazy‖ or losing control (APA, 2000).

QUESTIONS ON ANXIETY

1. Patricia Chanda 23 year old 3rd year nursing student is brought to your ward with history
of unexpected attacks of palpitations, headache and constriction in the chest. She keeps
walking up and about on the ward. A diagnosis of severe anxiety is made by the admitting
physician from outpatient department.

a) Define anxiety (5 marks)

b) List five (5) signs and symptoms of severe anxiety other than those in the stem. (10
marks)
c) Describe four (4) levels of anxiety
(20 marks)
 d) Discuss how you are going to manage Patricia Chanda from admission till discharge (35
marks).
e) Discuss any 5 (five) counseling skills
(10 marks)
f) Explain how the following events may cause stress to an individual (20
marks)
• New marriage
• Having a child for the first time (first born)
• New job
• Moving to a new country
• Moving to a new school

DEPRESSION
• It is an affective disorder characterized by a feeling of intense sadness that is out of proportion
to the event that triggers it, and persists beyond an appropriate length of time.

• A painful, subjective mood state characterized by feelings of sadness, discouragement,

loneliness, worthlessness and isolation.
• Depression is a condition in which there is disturbance of mood involving loss of interest or
pleasure in the usual activities with evidence of interference in social and occupational
functioning for at least 2 weeks.

TYPES OF DEPRESSION
a) Major depression

b) Atypical depression

c) Psychotic depression

d) Dysthmia depression

e) Manic depression
 a) Major depression

Most common type of depression

Symptoms
• Depressed mood
• Loss of interest and enjoyment
• Reduced energy and increased fatigability
• Decreased concentration
• Feeling worse in morning
• Reduced concentration and attention
• Reduced self-esteem and self-confident
• Ideas or acts of self-harm or suicide
• Disturbed sleep
• Early morning waking
• Low appetite
• Decreased enjoyment
• Decreased libido
• Constipation and psychomotor retardation
• Early morning wakening (2hrs or more before usual time)
• Diurnal variation of mood
• Psychomotor retardation or agitation
• Loss of appetite
• Loss of weight (5% or more body weight in past month)
• Loss of libido

b) Atypical depression

Associated with happiness and joy. Depression symptoms include:

• Over eating

• Weight gain
 • People with atypical depression think that it is external factors that control their mood

• A person suffering from this type of depression will suffer for months or may live with
it forever.

c) Psychotic depression

• A person believes that he was seeing and hearing things that were not there

• Hallucinations are more common

d) Dysthmia depression

• A person runs around looking really sad

• An individual will not realize he has the condition but he is affected

e) Manic depression

• Associated with rapid mood swing

• Also associated with high rate of suicide

CAUSES OF DEPRESSION/RISK FACTORS TO DEPPRESSION

• Family history of depression because of genetic predisposition
• Psychological factors: Early childhood experiences such as loss of a parent, lack of parental care,
parental alcoholism, antisocial traits, childhood sexual abuse; personality traits such as anxiety,
impulsivity, obsession; and negative cognitions can predispose to depression.
• Social Factors: Social circumstances such as marital status affect mental health status. Men have
low rates of depression when married whereas women show high rates of depression when married
due to marital disharmony, separation or divorce.

• Stress weight: Failure to cope with stress can lead to depression

• Substance abuse: Substance abuse due to disruption of the nerve
• Comorbidity: Depression may exist alongside another mental illness in about two thirds of
patients. Such illnesses include anxiety disorders, alcohol dependency, personality disorders.
MEDICAL MANAGEMENT

AIMS
• To promote rest and sleep
• To alleviate anxiety
• Establish a trusting relationship;
• To establish clear, consistent, and open communication

INVESTIGATIONS
History-Taking:
• I will do history taking which will reveal history depression in the family
• I will do history taking which will reveal patient having insomnia
• I will do history taking which will reveal the patient not having appetite

Physical Examination

I will do physical examination which will reveal unkempt hair on inspection.

I will do physical examination which will reveal being weak due to lack of eating

MINI MENTAL STATE EXAMINATION

APPEARANCE: Patient looks unkempt
SPEECH: Slow
MOOD: Sad
AFFECT: Inappropriate

TREATMENT
Anti-depressants
• Amitryptiline 25mg to 75mg

Side Effects: Sedation; arrhythmia; constipation; urinary retention; May make a

seizure more possible in patients with an existing seizure disorder

Or

• Imipramine 75 mg nocte up to 150mg

Side Effects: Sedation; arrhythmia; constipation; urinary retention; May make a
seizure more possible in patients with an existing seizure disorder

Or

• Fluoxetine 20mg once/day and maximum 60mg

NURSING CARE PLAN

Problems Nursing Goal Intervention Evaluation
identified Diagnosis
 Risk of 1. 1. Ask client Client
[Link] of suicide Client directly: will be
able to
suicide Related/Ris will seek
―Have you verbalise
k Factors out staff thought feelings of
[Depressed about self harm.
when
mood] harming
feeling yourself In
Grief; urge to any way? If
hopelessnes so, what do
s; social
isolation harm you plan to
History of self. do? Do you
prior
have the
suicide 2.
attempt Means to
Client
carry out this
will
plan?‖ The
make
risk of
shortterm
suicide is
verbal
greatly
(or
increased if
written
the client has
) developed a
contra ct plan and
with particularly
nurse not if means
to harm exist for the
self. client to
execute the
3.
plan.
Client
will not 2. Create a
harm
safe
self.
environment
for the
client.

Remove all
potentially
harmful
objects from
client‘s
access (sharp
objects,
that contract
expires, make
another, and so
forth. Discussion
of suicidal
feelings with a
trusted
individual
Provides some
relief to the
client. A
contract gets the
subject out in
the open and
places some of
the

responsibility
for the client’s
safety with the
client. An
attitude of
acceptance of
the client as a
worthwhile
individual is

Conveyed.
4. Secure
promise from
client that he or
she will seek out
 a staff member
or support
person if
thoughts of
suicide emerge.
Suicidal clients
are often very
ambivalent
about Their
feelings.
Discussion of
feelings with a
trusted
individual may
provide
assistance before
the client
experiences a
crisis situation.

Problems Nursing Goal Intervention Evaluation

identified Diagnosis
5. Maintain close
observation of
client.

Depending on
level of suicide
precaution,
provide one-to-
one contact,
constant visual
observation, or
every-15-minute
checks. Place
client in room

close to nurse’s
station; do not
assign to private
room.

Accompany
client to off-unit
activities if
attendance is
indicated. May
need to
accompany

client to
bathroom. Close
observation is
necessary to
ensure that
client does not
harm self in any
way. Being alert
for suicidal and
escape attempts
facilitates being
able to prevent
or interrupt
harmful
behaviour.
6. Maintain
special care in
administration
of medications.
Prevents saving
up to overdose
or discarding
and not taking.
7. Make rounds
at frequent,
irregular
intervals
(especially at
night, toward
early morning,
at change of
shift, or other
Predictably busy
times for staff).
Prevents staff
surveillance
from becoming
predictable. To
be aware of
client’s location
is important,
especially when
 staff is busy,
unavailable, or
less observable.
8. Encourage
verbalizations of
honest feelings.

Through
exploration and
discussion, help
client to identify
symbols of hope
in his or her life.

Problems Nursing Goal Intervention Evaluation

identified Diagnosis
9. Encourage
client to express
angry feelings
within
appropriate
limits. Provide
safe method of
hostility release.
Help client to
identify true
source of anger
and to work on
adaptive coping
skills for use
outside the
 treatment
setting.

Depression and
suicidal
behaviors may
be viewed as
anger turned
inward on the
self. If this anger
can be
verbalized in a
nonthreatening
environment,
the client may be
able to
eventually
resolve these
feelings.

10. Identify
community

resources that
client may use as
support system .

Problems Nursing Goal Intervention Evaluation

identified Diagnosis
 Low self esteem 1. Within 1. Be accepting 1. Client is able
reasonable of client and his to verbalize
2. Low self ―related to
esteem time or her positive aspects
[Feelings of
abandonment by period, negativism. An of self.
significant client will attitude of 2. Client is able
other] discuss acceptance to communicate
assertively with
fear of enhances
[Numerous others.
failure
failures (learned feelings of
helplessness)] with nurse.
selfworth.
2. Within
2. Spend
reasonable
time time with client
period, to convey
client will acceptance and
verbalize
contribute
things he
or she likes toward feelings
about self. of self-worth.

3. Help
client to
recognize and
focus on
strengths and
accomplishment
s. Minimize
attention given
to past (real or
perceived)
failures. Lack of
attention may
help to eliminate
negative
ruminations.
4. Encourage
participation in
group activities
relationships)] determined 2. Develop a
Disturbed . therapeutic
thought nurse-client
processes relationship
[delusional through
thinking] [Fear frequent, brief
of rejection or contacts and an
failure of the accepting
interaction] attitude. Show
[Impaired unconditional
cognition positive regard.
fostering Your presence,
negative view acceptance, and
of conveyance of
positive regard
self
enhance the

client’s feelings
of self-worth.

3. After
client feels
comfortable in a
one-to-one
relationship,
encourage
attendance in
group activities.
May need to
attend with
client the first
few times to
offer support.
Accept client’s
decision to
remove self from
group situation
if anxiety
becomes too
great. The
presence of a
trusted
individual
provides
emotional
security for the
client.
4. Verbally
acknowledge
client’s absence
from any group
activities.
Knowledge that
his or her
absence was
noticed may
reinforce the
client’s feelings
of self-worth.
5. Teach
assertiveness
techniques.
 Interactions
with others may
be discouraged
by client use of
passive or
aggressive

Problems Nursing Goal Intervention Evaluation

identified Diagnosis
 Imbalanced Client will 1. In 1. Client
3. nutrition less gain 1kilo collaboration has shown a
per week
IMBALANCED than body with dietician, slow,
requirement for the next
NUTRITION, 3 weeks. determine progressive
related to
LESS THAN Inability to number of weight gain
BODY ingest food calories required during
because of: to provide Hospitalizat ion.
REQUIREMENT
[Depressed
S adequate
mood] [Loss of 2. Vital
appetite] nutrition and
signs, blood
evidenced by realistic
pressure, and
Loss of weight
Lack of interest (according to laboratory
in food Pale body serum studies
mucous structure and are
membranes
height) weight
Within normal
gain.
limits.
2. To prevent
3. Client is
constipation,
able to verbalize
ensure that diet
importance of
includes foods
adequate
high In fibre
nutrition and
content.
fluid intake.
Encourage client
to increase fluid
consumption and
physical exercise
to promote
normal bowel
functioning.
Depressed clients
are particularly
vulnerable to
constipation
because of
psychomotor
retardation.
Constipation is
also a common
side effect of

many
antidepressant
medications.

3. Keep strict
documentation
of intake, output,
and calorie
count. This
information is
necessary to
make an
 accurate
nutritional
assessment and
maintain client
safety.
4. Weigh client
daily. Weight
loss or gain is
important
assessment
Information.
5. Determine
client’s likes and
dislikes, and
collaborate with
dietician to
provide
favourite foods.
Client is more
likely to eat food
that he or she
particularly
enjoys.

AIMS
• To prevent injury
• To promote patient‘s nutritional intake.
• To promote rest and sleep
• To educate patient and family and community.
• Establish a trusting relationship;
 • To alleviate anxiety;
• To establish clear, consistent, and open communication
NURSING CARE:
MAINTAINING A SAFE ENVIRONMENT

I will remove all sharps from the environment to prevent injury. I will ensure drugs are
taken and observe for hoarding of drugs that can be used to commit suicide. I will take
close observations and record every behavior of the client depending on the condition.
E.g. 1hr, 30 min. etc to detect any signs of suicide. I will sign a contract with the client
stating that he won‘t harm self or others to prevent injury to others and himself. I will
nurse the patient in a lit room to prevent hallucinations from reoccurring. I will make
some restrictions for instance patient should not spend long periods alone to prevent the
patient from feeling avoided.

CREATE A NURSE PATIENT RELATIONSHIP

I will formulate a nurse-patient relation with the patient based on trust and empathy to
create rapport. I will involve him in his care to promote care ownership. I will keep him
informed on matters related to his care to increase his confidence in me. I will not reveal
information he entrusts me with, without his consent to promote trust. I will spend
quality time with him during my working shift to promote familiarity. I will announce
my absence during knocking off time to prevent negative misperception that he is left
alone. I will allow him to contribute in decision making regarding his condition to
promote autonomy. I will explain the nature of all medical or nursing procedures to be
done on him to gain corporation and informed consent.

REST AND SLEEP;

I will maintain a quiet environment at night (non- stimulating environment) to promote

rest. I will provide rest periods after activity, as fatigue can also intensify feelings of
depression. I will offer warm baths in the evening to promote rest. I will provide clean
linen and comfortable linen to promote rest.
NUTRITION
I will offer food rich in fiber to prevent constipation. I will give mixed diet snacks that
are appetizing throughout the day and evening in small amounts to promote appetite
and prevent malnutrition. I will give fluids rich in calories and protein frequently to
prevent dehydration. I will advise the patient to do oral care to prevent halitosis and
promote appetite.

HYGIENE

I will encourage and remind the client to bath in order to promote comfort, blood
circulation and prevent infection. I will cut the client‘s nails and shave where necessary
to prevent auto infection. I will encourage the patient to maintain good personal hygiene
and grooming to promote comfort and prevent infection. I will provide the client with
toiletries to prevent infection. I will change linen whenever soiled to prevent infection

WORK AND PLAY (RECREATION)

I will do one to one activities with client to minimize anxiety. Later on I will increase the
number to two or more others to promote interaction.

INFORMATION, EDUCATION AND COMMUNICATION

I will teach the family and client about illness to increase knowledge levels and avoid
stigmatization. I will educate the family on the causes, triggers and prolonging factors
to prevent recurrence. I will emphasize the importance of compliance to drugs to
promote recovery. I will encourage the patient on coming back as per review date to
monitor progress or recovery. I will teach the patient on the side effects of drugs to allay
anxiety and promote compliance. I will teach the family to observe for relapse so that
they bring the client back to the hospital for quick intervention. I will teach the family
to accept the client as they are human though ill to prevent stigmatization.

QUESTION ON DEPRESSION
 1. Mrs. Mweemba a 35 year old woman is brought to your ward with a history of sad
mood for over two weeks, loss of appetite, suicidal ideas, hallucinations, insomnia,
restlessness, and self-care deficit.

a) Define Depression. 5%
b) Discuss the nursing care you will give to Mrs. Mweemba until discharge.
35%.
c) Discuss what you will include in your IEC for Mrs. Mweemba 10%
2. Ms Nelly Mwanamuke a 32 year old woman, a teacher at Litoya Basic School is
admitted to female Psychiatric ward with the history of isolating herself from
people, not eating, not talking to people ,not sleeping, refusing to go for work, not
able to do house chores and not able to bath. The onset of the problem started a
month ago after a business man who wanted to marry her was involved in accident
and died.

a. What impression will you give to Ms Nelly‘s condition

5%
b. State two major types of the condition mention above
10%

e) Discuss the medical management of Nelly‘s condition under the following headings;
1. Investigations 10%
2. Medication Nelly received during hospitalization (2 individual drugs; class,
presentation, indication, dosage, mode of action, side effects, nursing implication)
25%

c.) Nursing Care 50%

SCHIZOPHRENIA
Is defined as characteristic disturbance in thought processes, perception and affect
invariably result in severe deterioration of social and occupational functioning.
Schizophrenia is a serious mental disorder characterized by severe disturbance of
thinking, perception, mood and volition. (Namboodiri, 2005).

Schizophrenia: It is the disorder comprising the group of clinical syndromes that

reveals alterations in the content band organization of thoughts, perception of sensory
inputs, affects or emotional tone, sense of identity, volition, psychomotor behavior and
the ability establish satisfactory interpersonal relationships. (Rawlings et. al, 1993).

Schizophrenia is the serious mental disorder characterized by loss of contact with

reality hallucination, delusions, abnormal thinking and disrupted work and social
functioning (Berkow et al 1997).

Schizophrenia is a psychiatric diagnosis that describes a mental illness characterized

by impairment in the perception or expression of reality most commonly manifesting
as hallucination, paranoid or bizarre delusion

AETIOLOGICAL FACTORS

Idiopathic but risk factors are as follows:

• Hereditary/familiar
• Biochemical imbalance of neural transmitters such as dopamine
• Psychological stress
• Toxic substances
• Childhood experience e.g. Emotional deprivation
• Physical illness especially those that impair metabolism.

TYPES OF SCHIZOPHRENIA

There four (4) major types of schizophrenia, namely;

I. Simple type
II. Hebephrenic type
III. Catatonic type
IV. Paranoid type.
i. Simple type

Is a type of schizophrenia that is characterized by indifference, inaccessibility, lack of

interest in the opposite sex and inability to accept responsibility. There is also
wandering tendency, self-absorbed, idle and aimless activity.

ii. Hebephrenic type (Disorganized schizophrenia)

This type is characterized by; disorganized speech and behavior, flat or inappropriate
affect extreme social withdrawal, unpredictable laughter and grimaces. Onset in this
type tends to occur at a young age and chronic course without significant remission is
common.

iii. Catatonic type

It is a type of schizophrenia which is characterized by psychomotor disturbances. It is

manifest by periods of stupor or excitement or rapidly alternating periods of both
behaviors. Catatonic stupor is associated with generalized inhibition characterized by
rigidity, mutism, negativity, waxy flexibility and posturing. Catatonic excitement is
associated with excessive sometimes violent motor activity and agitation that seem to
be purposeless and not influenced by external stimuli.

iv. Paranoid type

The onset of this type of schizophrenia tends to occur later in life and features are more
stable over a period of time. It is associated with personality or grandiose delusions or
hallucinations with persecutory or grandiose contents. The coping mechanism mostly
used by the paranoid client is projection – attributes or characteristics the client cannot
accept within self. There is also suspicion, argumentativeness, jealousies, mistrust of
others and excessive religion. The client may display doubts about gender identity or
fears of being thought of being homosexual or being approached by homosexuals.

CLINICAL FEATURES OF SCHIZOPHENIA

Schizophrenia can be grouped as:
 1. Schizophrenia with positive symptoms.
2. Schizophrenia with negative symptoms.
Positive symptoms of schizophrenia are:

1. Delusions
2. Hallucinations
3. Bizarre behavior
4. Aggressions
5. Agitation
6. Suspiciousness
7. Hostility
8. Excitement
9. Grandiosity
10. Conceptual disorganization
Negative symptoms of schizophrenia are:

1. Apathy
2. Avolition
3. Social withdrawal
4. Diminished emotional responsiveness
5. Blunted affect
6. Stereotyped thinking
7. Artificial gestures/ detachment
8. Lack of spontaneity
There are fundamental groups of signs and symptoms which may occur singly or
together in various clinical patterns. The groups of symptoms are:

1. Thought disturbance
2. Autistic behavior
3. Volitional disturbance
4. Emotional disturbance (affective)
5. Perceptual disturbance
 6. Behavioral disturbance

Nursing care for schizophrenia

1. Impaired verbal communication. Decreased, reduced, delayed, or absent ability to

receive, process, transmit, or use a system of symbols.

Due to or May be related to:

• Altered perceptions.

• Biochemical alterations in the brain of certain neurotransmitters.

• Psychological barriers (lack of stimuli).

• Side effects of medication.

Possibly evidenced by

• Difficulty communicating thoughts verbally.

• Difficulty in discerning and maintaining the usual communication pattern.

• Disturbances in cognitive associations (e.g., perseveration, derailment, poverty of

speech, tangentiality, illogicality, neologism, and thought blocking).

• Inappropriate verbalization.

Desired Outcomes

• Patient will express thoughts and feelings in a coherent, logical, goal-directed manner.

• Patient will demonstrate reality-based thought processes in verbal communication.

• Patient will spend time with one or two other people in structured activity neutral
topics.

• Patient will spend two to three 5-minute sessions with nurse sharing observations in
the environment within 3 days.
• Patient will be able to communicate in a manner that can be understood by others with
the help of medication and attentive listening by the time of discharge.
 • Patient will learn one or two diversionary tactics that work for him/her to decrease
anxiety, hence improving the ability to think clearly and speak more logically.

Nursing Interventions Rationale

Assess if incoherence in Establishing a baseline facilitates

speech is chronic or if it is the establishment of realistic
more sudden, as in an goals, the foundation for
exacerbation of symptoms. planning effective care.

Identify the duration of the Therapeutic levels of an

psychotic medication of the antipsychotic aids clear thinking
client. and diminishes derailment or
looseness of association.

Keep voice in a low manner High-pitched/loud tone of voice

and speak slowly as much as can elevate anxiety levels while
possible. slow speaking aids
understanding.

Keep environment calm, Keep anxiety from

quiet and as free of stimuli as escalating and
possible. increasing confusion and
hallucinations/delusions.
Plan short, frequent periods Short periods are less stressful,
with a client throughout the and periodic meetings give a
day. client a chance to develop

familiarity and safety.

Use clear or simple words, Client might have difficulty
and keep directions simple as processing even simple sentences.
well.

Use simple, concrete, and Minimizes misunderstanding

literal explanations. and/or incorporating those
misunderstandings into delusional
systems.

Focus on and direct client‘s Helps draw focus away from

attention to concrete things in delusions and focus on
the environment. realitybased things.

Look for themes in what is

said, even though spoken Often client‘s choice of words is
words appear incoherent symbolic of feelings.

(e.g., fearful, sadness, guilt).

When you do not understand a Pretending to understand limits

client, let him/her know you your credibility in the eyes of your
are having difficulty client and lessens the potential for
understanding. trust.

When client is ready,

introduce strategies that can
minimize anxiety and lower
Helping client to use tactics to
voices and ―worrying‖
lower anxiety can help enhance
thoughts, teach client to do the functional speech.
following:

Focus on meaningful
activities.
 • Learn to replace
negative thoughts with
constructive thoughts.

• Learn to replace irrational

thoughts with rational
statements.

• Perform deep breathing

exercise.

• Read aloud to self.

• Seek support from a staff,

family, or other
supportive people.

• Use a calming
visualization or listen to
music.

Use therapeutic techniques

(clarifying feelings when Even if the words are hard to
speech and thoughts are understand, try getting to the
disorganized) to try to feelings behind them.
understand client‘s concerns.

2. Impaired Social Interaction: The state in which an individual participates in an

insufficient or excessive quantity or ineffective quality of social exchange.

Due to or May be related to

• Difficulty with communication.

 • Difficulty with concentration.

• Exaggerated response to alerting stimuli.

• Feeling threatened in social situations.

• Impaired thought processes (delusions or hallucinations).

• Inadequate emotional responses.

• Self concept disturbance (verbalization of negative feelings about self).

Possibly evidenced by

• Appears upset, agitated, or anxious when others come too close in contact or try to
engage him/her in an activity.

• Dysfunctional interaction with others/peers.

• Inappropriate emotional response.

• Observed use of unsuccessful social interactions behaviors.

• Spends time alone by self.

• Unable to make eye contact, or initiate or respond to social advances of others.

• Verbalized or observed discomfort in social situations.

Desired Outcomes

• Patient will attend one structured group activity within 5-7 days.

• Patient will seek out supportive social contacts.

• Patient will improve social interaction with family, friends, and neighbors.

• Patient will use appropriate social skills in interactions.

• Patient will engage in one activity with a nurse by the end of the day.

• Patient will maintain an interaction with another client while doing an activity (e.g.,
simple board game, drawing).
• Patient will demonstrate interest to start coping skills training when ready for
learning.
 • Patient will engage in one or two activities with minimal encouragement from nurse
or family members.

• Patient will state that he or she is comfortable in at least three structured activities that
are goal directed.

• Patient will use appropriate skills to initiate and maintain an interaction.

Nursing Interventions Rationale

Assess if the medication Many of the positive symptoms of

has reached therapeutic schizophrenia (hallucinations,
levels. delusions, racing thoughts) will
subside with medications, which
will facilitate interactions.

Identify with client Increased anxiety can intensify

symptoms he experiences agitation, aggressiveness, and
when he or she begins to suspiciousness.
feel anxious around others.

Keep client in an Client might respond to noises and

environment as free of crowding with agitation, anxiety,
stimuli (loud noises, and increased inability to
crowding) as possible. concentrate on outside events.

Avoid touching the client. Touch by an unknown person can

be misinterpreted as a sexual or
threatening gesture. This
particularly true for a paranoid

client.
Ensure that the goals set Avoids pressure on the client and
are realistic; whether in sense of failure on part of
the hospital or nurse/family. This sense of failure
community. can lead to mutual withdrawal

Structure activities that Client can lose interest in activities

work at the client‘s pace that are too ambitious, which can
and activity. increase a sense of failure.

Structure times each day

to include planned times for Helps client to develop a sense of
brief interactions and safety in a non-threatening
activities with the client on environment.
one-on-one basis

If client is unable to respond

verbally or in a
coherent manner, spend An interested presence can provide
frequent, short period with a sense of being worthwhile.
clients.

If client is found to be very Client is free to choose his level of

paranoid, solitary or one- interaction; however, the
on-one activities that concentration can help minimize
require concentration are distressing paranoid thoughts or
appropriate. voice.

If client is Even simple activities help draw

delusional/hallucinating or client away from delusional
is having trouble thinking into reality in the
concentrating at this time, environment.
provide very simple
concrete activities with
client (e.g., looking at a
picture or do a painting).

If client is very
withdrawn, one-on-one Learn to feel safe with one person,
activities with a ―safe‖ then gradually might participate in a
person initially should be structured group activity.
planned.

Try to incorporate the

strengths and interests the
client had when not as Increase likelihood of client‘s
impaired into the activities participation and enjoyment.
planned.

Teach client to remove

himself briefly when
feeling agitated and work Teach client skills in dealing with
on some anxiety relief anxiety and increasing a sense of
exercise (e.g., meditations, control.
rhythmic exercise, deep
breathing exercise).

Useful coping skills that These are fundamental skills for

client will need include dealing with the world, which
conversational and everyone uses daily with more or
assertiveness skills. less skill.

Remember to give
 Recognition and appreciation go a
acknowledgment and
long way to sustaining and
recognition for positive

steps client takes in increasing a specific behavior.

increasing social skills and
appropriate interactions
with others.

Provide opportunities for

the client to learn adaptive
social skills in a
nonthreatening
environment.
Initial social skills training Social skills training helps client
could include basic social adapt and function at a higher level
in society, and increases client‘s
behaviors (e.g., appropriate
quality of life.
distance, maintain good eye
contact, calm

manner/behavior, moderate
voice tone).

As client progresses,
provide the client with
graded activities
according to level of Gradually the client learns to feel
tolerance e.g., (1) simple safe and competent with increased
games with one ―safe‖ social demands.
person; (2) slowly add a
third person into ―safe‖.
As client progresses, Increases client‘s ability to derive
Coping Skills Training social support and decrease
should be available to loneliness. Clients will not give up
him/her (nurse, staff or substance of abuse unless they have
others). Basically the alternative means to facilitate

process: socialization they belong.

1. Define the skill to be

learned.

2. Model the skill.

3. Rehearse skills in a
safe environment, then
in the community.

4. Give corrective
feedback on the
implementation of
skills.

Eventually engage other

clients and significant
others in social
interactions and activities Client continues to feel safe and
with the client (card games, competent in a graduated hierarchy
ping pong, sing-asongs, of interactions.
group sharing activities) at
client‘s level.
3. Disturbed Sensory Perception: Change in the amount or patterning of incoming
stimuli accompanied by a diminished, exaggerated, distorted or impaired response to
such stimuli.

Due to or May be related to

• Altered sensory perception.

• Altered sensory reception; transmission or integration.

• Biochemical factors such as manifested by inability to concentrate.

• Chemical alterations (e.g., medications, electrolyte imbalances).

• Neurologic/biochemical changes.

• Psychological stress.

Possibly evidenced by

• Altered communication pattern.

• Auditory distortions.

• Change in a problem-solving pattern.

• Disorientation to person/place/time.

• Frequent blinking of the eyes and grimacing.

• Hallucinations.

• Inappropriate responses.

• Mumbling to self, talking or laughing to self.

• Reported or measured change in sensory acuity.

• Tilting the head as if listening to someone.

Desired Outcomes

• Patient will learn ways to refrain from responding to hallucinations.

 • Patient will state three symptoms they recognize when their stress levels are high.

• Patient will state that the voices are no longer threatening, nor do they interfere with
his or her life.

• Patient will state, using a scale from 1 to 10, that ―the voices‖ are less frequent and
threatening when aided by medication and nursing intervention.

• Patient will maintain role performance.

• Patient will maintain social relationships.

• Patient will monitor intensity of anxiety.

• Patient will identify two stressful events that trigger hallucinations..

• Patient will identify to personal interventions that decrease or lower the intensity or
frequency of hallucinations (e.g, listening to music, wearing headphones, reading out
loud, jogging, socializing).

• Patient will demonstrate one stress reduction technique.

• Patient will demonstrate techniques that help distract him or her from the voices.

Nursing Interventions Rationale

Accept the fact that the

voices are real to the client, Validating that your reality does
but explain that you do not not include voices can help client
hear the voices. Refer to the cast ―doubt‖ on the validity of
voices as ―your voices‖ or his or her voices.
―voices that you hear‖.
Be alert for signs of Might herald hallucinatory
increasing fear, anxiety or activity, which can be very
agitation. frightening to client, and client
might act upon command
hallucinations (harm self or
others).

Explore how the Exploring the hallucinations and

hallucinations are sharing the experience can help
experienced by the client. give the person a sense of power
that he or she might be able to
manage the hallucinatory voices.

Help the client to identify Hallucinations might reflect

the needs that might underlie needs for:
the hallucination. What other
ways can these needs be met? • Anger.
• Power.

• Self-esteem.

• Sexuality.

Help client to identify times Helps both nurse and client

that times that the identify situations and times that
hallucinations are most might be most anxiety producing
prevalent and frightening. and threatening to the client.
If voices are telling the client
to harm self or others, take
necessary environmental
precautions.

Notify others and police,

physician, and
administration
according to People often obey hallucinatory
unit protocol. commands to kill self or others.

Early assessment and intervention

• If in the hospital, use unit
might save lives.
protocols for suicidal or
threats of violence if
client plans to act on
commands.

• If in the community,
evaluate the need for
hospitalization.

Clearly document what

client says and if he/she is a
threat to others, document
who was contacted and
notified (use agency protocol
as a guide).

Stay with clients when they

are starting to hallucinate, Client can sometimes learn to push
and direct them to tell the voices aside when given repeated
―voices they hear‖ to go instructions. especially within the
away. Repeat often in a framework of a trusting
matter-of-fact manner. relationship.

Decrease environmental Decrease potential for anxiety that

stimuli when possible (low might trigger hallucinations.
noise, minimal activity).
Helps calm client.
Intervene with one-on-one, Intervene before anxiety begins to
seclusion, or PRN medication escalate. If the client is already out
(As ordered) when of control, use chemical or
appropriate. physical restraints following unit
protocols.

Keep to simple, basic, reality- Client‘ thinking might be confused

based topics of conversation. and disorganized; this intervention
Help client focus on one idea helps client focus and comprehend
at a time. reality-based issues.

Work with the client to find If clients‘ stress triggers

which activities help reduce hallucinatory activity, they might
anxiety and distract the client be more motivated to find ways to
from a hallucinatory remove themselves from a

material. Practice new skills stressful environment or try

with the client. distraction techniques.
Engage client in realitybased Redirecting client‘s energies to
activities such as card acceptable activities can decrease
playing, writing, drawing, the possibility of acting on
doing simple arts and crafts hallucinations and help distract
or listening to music. from voices.

4. Disturbed thought process: Disruption in cognitive operations and activities.

Due to or May be related to

• Chemical alterations (e.g., medications, electrolyte imbalances).

• Inadequate support systems.

• Overwhelming stressful life events.

• Possibility of a hereditary factor.

• Panic level of anxiety.

• Repressed fears.

Possibly evidenced by

• Delusions.

• Inaccurate interpretation of environment.

• Inappropriate non-reality-based thinking.

• Memory deficit/problems.

• Self-centeredness.

Desired Outcomes

• Patient will verbalize recognition of delusional thoughts if they persist.

• Patient will perceive environment correctly.

• Patient will demonstrate satisfying relationships with real people.

• Patient will demonstrate decrease anxiety level.

 • Patient will refrain from acting on delusional thinking.

• Patient will develop trust in at least one staff member within 1 week.

• Patient will sustain attention and concentration to complete task or activities.

• Patient will state that the ―thoughts‖ are less intense and less frequent with the help
of the medications and nursing interventions.

• Patient will talk about concrete happenings in the environment without talking about
delusions for 5 minutes.

• Patient will demonstrate two effective coping skills that minimize delusional
thoughts.

• Patient will be free from delusions or demonstrate the ability to function without
responding to persistent delusional thoughts.

Nursing Interventions Rationale

Attempt to understand the Important clues to underlying

significance of these beliefs to fears and issues can be found in
the client at the time of their the client‘s seemingly illogical
presentation. fantasies.

Recognizes the client‘s Recognizing the client‘s

delusions as the client‘s perception can help you
perception of the understand the feelings he or she
environment. is experiencing.

Identify feelings related to When people believe that they

delusions. For example: are understood, anxiety might
lessen.
If client believes
 someone is going to harm
him/her, client is
experiencing fear.

If client believes someone

or something is
controlling his/her
thoughts, client is
experiencing
helplessness.

Explain the procedures and try When the client has full
to be sure the clients knowledge of procedures, he or
understand the procedures she is less likely to feel tricked by
before carrying them out. the staff.

Interact with clients on the

basis of things in the
environment. Try to distract When thinking is focused on
client from their delusions by reality-based activities, the client
engaging in reality-based is free of delusional thinking
activities (e.g., card games, during that time. Helps focus
simple arts and crafts projects attention externally.
etc).
Do not touch the client; use Suspicious clients might
gestures carefully. misinterpret touchas either
aggressive or sexual in nature and
might interpret it as threatening
gesture. People who are
psychotic need a lot of personal
space.

Initially do not argue with the Arguing will only increase

client‘s beliefs or try to client‘s defensive position,
convince the client that the thereby reinforcing false beliefs.
delusions are false and unreal. This will result in the client
feeling even more isolated and
misunderstood.

Encourage healthy habits to

optimize functioning:

Maintain medication
regimen.
All are vital to help keep the
• Maintain regular sleep client in remission.
pattern.

• Maintain self-care.

• Reduce alcohol and drug

intake.

Show empathy regarding the The client‘s delusion can be

client‘s feelings; reassure the distressing. Empathy conveys
client of your presence and your caring, interest and
acceptance. acceptance of the client.
Teach client coping skills that
minimize ―worrying‖
thoughts. Coping skills

include: When client is ready, teach

strategies client can do alone.
• Going to a gym.

• Phoning a helpline.

• Singing or Listening to a
song.

• Talking to a trusted
friend.

• Thought-stopping
techniques.

Utilize safety measures to During acute phase, client‘s

protect clients or others, if the delusional thinking might dictate
to them that they might have to
client believe they need to
hurt others or self in order to be
protect themselves against a safe. External controls might be
specific person. needed.

Precautions are needed.

5. Defensive Coping: Repeated projection of falsely positive self-evaluation based on a

self-protective pattern that defends against underlying perceived threats to positive self-
regard.

Due to or May be related to

• Perceived lack of self-efficacy/vulnerability.

• Perceived threat to self.

 • Suspicions of the motives of others.

Possibly evidenced by

• Denial of obvious problems.

• Difficulty in reality testing of perceptions.

• Difficulty establishing/maintaining relationships.

• False beliefs about the intention of others.

• Fearful.
• Grandiosity.

• Hostile laughter or ridicule of others.

• Hostility, aggression, or homicidal ideation.

• Projection of blame/responsibility.

• Rationalization of failures.

• Superior attitude towards others.

Desired Outcomes

• Patient will avoid high-risk environments and situations.

• Patient will interact with others appropriately.

• Patient will maintain medical compliance.

• Patient will identify one action that helps client feel more in control of his or her life.

• Patient will demonstrate two newly learned constructive ways to deal with stress and
feeling of powerlessness.

• Patient will demonstrate learn the ability to remove himself or herself from situations
when anxiety begins to increase with the aid of medications and nursing interventions.

• Patient will demonstrate decreased suspicious behaviors regarding with the interaction
with others.
 • Patient will be able to apply a variety of stress/anxiety-reducing techniques on their
own.

• Patient will acknowledge that medications will lower suspiciousness.

• Patient will state that he/she feels safe and more in control with interactions with
environment/family/work/social gatherings.

Nursing Interventions Rationale

Explain to client what you are Prepares the client beforehand

going to do before you do it. and minimizes
misinterpreting your intent as
hostile or aggressive.

Assess and observe clients

regularly for signs of increasing Intervene before client loses
anxiety and hostility. control.

Use a nonjudgemental, There is less chance for a

respectful, and neutral approach suspicious client to
with the client. misinterpret intent or meaning
if content is neutral and
approach is respectful and
non-judgemental.

Use clear and simple language Minimize the opportunity for

when communicating with a miscommunication and
suspicious client. misconstruing the meaning of
the message.
Diffuse angry verbal attacks When staff become defensive,
with a non defensive stand. anger escalates for both client
and staff. a nondefensive and
non-

judgemental attitude provides

an atmosphere in which
feelings can be explored more
easily.

Set limits in a clear matter-of-

fact way, using a calm tone. Calm and neutral approach
Giving threatening remarks to may diffuse escalation of
Jeremy is unacceptable. We can anger. Offer an alternative to
talk more about the proper ways verbal abuse by finding
in dealing with your feelings. appropriate ways to deal with
feelings.

Be honest and consistent with Suspicious people are quick to

client regarding expectations and discern honesty. Honesty and
enforcing rules. consistency provide an
atmosphere in which trust can
grow.

Maintain low level of stimuli

and enhance a non-threatening Noisy environments might be
environment (avoid groups). perceived as threatening.

Be aware of client‘s tendency to

have ideas of reference; do not do Suspicious clients will
things in front of client that can automatically think that they
are the target of the interaction
be misinterpreted:
and interpret it in a negative
manner (e.g., you are laughing
• Laughing or whispering.
or whispering about them).
• Talking quitely when client
can see but not hear what is
being said.

Initially, provide solitary, If a client is suspicious of

noncompetitive activities that others, solitary activities are
take some concentration. Later a the best. Concentrating on
game with one or more client that environmental stimuli
takes concentration (e.g., minimizes paranoid

chess checkers, thoughtful card rumination.

games such as ridge or rummy).

Provide verbal/physical limits

when client‘s hostile behavior
escalates: We cannot allow you to Often verbal limits are
verbally attack someone here. effective in helping a client
gain self control.
If you cant held/control yourself,
we are here in order to help you.

6. Interrupted Family Process: Change in family relationships and/or functioning.

Due to or May be related to

Developmental crisis or transition.

• Family role shift.

 • Physical or mental disorder of a family member.

• Shift in health status of a family member.

• Situational crisis or transition.

Possibly evidenced by

• Changes in expression of conflict in family.

• Changes in communication patterns.

• Changes in mutual support.

• Changes in participation in decision making.

• Changes in participation in problem solving.

• Changes in stress reduction behavior.

• Knowledge deficit regarding community and health care support.

• Knowledge deficit regarding the disease and what is happening with ill family
member (might believe client is more capable than they are).

• Inability to meet the needs of family and significant others (physical, emotional,
spiritual).

Desired Outcomes

• Family and/or significant others will recount in some detail the early signs and
symptoms of relapse in their ill family member, and know whom to contact in case.

• Family and/or significant others will state and have written information identifying
the signs of potential relapse and whom to contact before discharge.

• Family and/or significant others will state that they have received needed support
from community and agency resources that offer education, support, coping skills
training, and/or social network development (psycho educational approach).
• Family and/or significant others will state what medications can do for their ill family
member, the side effects and toxic effects of the drugs, and the need for adherence to
medication at least 2 to 3 days before discharge.

• Family and/or significant others will name and have a complete list of community
supports for ill family members and supports for all members of the family at least 2
days before the discharge.

• Family and/or significant others will attend at least one family support group (single
family, multiple family) within 4 days from onset of acute episode.

• Family and/or significant others will be included in the discharge planning along with
the client.

• Family and/or significant others will meet with nurse/physician/social worker the first
day of hospitalization and begin to learn about neurologic/biochemical disease,
treatment, and community resources.
• Family and/or significant others will problem-solve, with the nurse, two concrete
situations within the family that all would like to discharge.

• Family and/or significant others will recount in some detail the early signs and
symptoms of relapse in their ill family member, and know whom to contact.

• Family and/or significant others will demonstrate problem-solving skills for handling
tensions and misunderstanding within the family member.

• Family and/or significant others will have access to family/multiple family support
groups and psychoeducational training.

• Family and/or significant others will know of at least two contact people when they
suspect potential relapse.

• Family and/or significant others will discuss the disease (schizophrenia)

knowledgeably: o Know about community resources (e.g., help with self care
activities, private respite).

o Support the ill family member in maintaining optimum health. o

Understand the need for medical adherence.

Nursing Interventions Rationale

Assess the family members‘ Family might have

current level of knowledge misconceptions and
about the disease and
medications used to treat the misinformation about
disease. schizophrenia and
treatment, or no knowledge
at all. Teach client‘s and
family‘s level of
understanding and

readiness to learn.

Inform the client family in

clear, simple terms about
psychopharmacologic Understanding of the
therapy: dose, duration, disease and the treatment of
indication, side effects, and the disease encourages
toxic effects. Written greater family support and
information should be given client adherence.
to client and family members
as well.

Identify family‘s ability to

cope (e.g., experience of loss, Family‘s need must be
caregiver burden, needed addressed to stabilize family
supports). unit.
Teach the client and family the Rapid recognition of early
warning symptoms of relapse. warning symptoms can help
ward off potential relapse
when immediate medical
attention is sought.

Provide information on
disease and treatment Meet family members‘
needs for information.
strategies at family‘s level of
understanding.

Provide an opportunity for

Nurses and staff can best
the family to discuss feelings intervene when they
related to ill family member understand the family‘s
and identify their immediate

concerns. experience and needs.

Provide information on client Schizophrenia is an
and family community overwhelming disease for
resources for the client and
both the client and the
family after discharge: day
hospitals, support groups, family. Groups, support
organizations, psycho groups, and psycho
educational programs, educational centers
community respite centers
can help:
(small homes), etc.

• Access caring.

• Access resources.

• Access support.

• Develop family skills.

• Improve quality of life

for all family members.

• Minimizes isolation.

QUESTIONS ON SCHIZOPHRENIA

2. Mr. Siame a 30 years old man is admitted to a mental health unit with
Schizophrenia
a) Define Schizophrenia (5%)
b) Discuss five Predisposing factors to schizophrenia (15%)
c) Discuss 3 (Three) types of schizophrenias (15%)
d) Identify five (5) problems that Mr. Siame will present with and manage the
identified problems using a nursing care plan. (50 %)
e) Discuss five roles of a community psychiatry nurse (15 %)

CHILD ABUSE
DEFINITIONS

Child: A Child is any person below the age of 18 years (according to UNICEF and ILO)
Child Abuse: Child Abuse is defined as the physical, emotional, or psychological
mistreatment or neglect of a child.
Abuse: mistreatment that can be physical, emotional, psychological or sexual.
Neglect: Failure to provide for children‘s basic emotional and physical needs.
Exploitation: The use of a child for another person‘s advantage.

FORMS OF CHILD ABUSE

There are basically four (4) forms of child abuse;
1. Physical abuse
2. Psychological and emotional abuse
3. Sexual abuse
4. Child neglect
PHYSICAL ABUSE
This type of abuse is among the most common forms of Child abuse. It is the physical
aggression directed at a child by an adult. It can involve punching, striking, kicking,
shoving, slapping, pulling ears or hairs or stabbing, beating, drowning and shaking a
child

PSYCHOLOGICAL ABUSE
This could include name-calling, ridicule, degrading, destruction of personal belonging,
or destruction of a pet, excessive criticism. Inappropriate or excessive demands from a
child, with holding communication, labeling, comparisons or humiliation. It also
involves overprotectiveness/limiting child‘s play and learning

SEXUAL ABUSE
It is a form of child abuse in which an adult abuses a child for sexual stimulation like;
• Asking or pressuring a child to engage in sexual activities
 Indecent exposure of the genitals to a child
• Displaying pornographic material to a child

• Physical contact with the child‘s genitals

CHILD NEGLECT
This is where the responsible person for providing the needs of a child fails to meet
their obligation, which may include;
• Not providing adequate food, clothing or hygiene
• Not providing emotional support, like not providing nurturing or affection
• Not providing educational needs, like not enrolling a child or taking them to
school.
• Not providing medical needs, like not taking care of the health needs of the child
or taking them to the health facility, when needed

CONTRIBUTING FACTORS TO CHILD ABUSE

• Pregnancy was not wanted
• Parent has a background of abuse when growing up
• Young, unsupported mother who has low education
• Parents have unrealistic expectations of the child
• Parent has a mental illness
• Parents who abuse drugs or alcohol
• Foster families; adopted children
• Economic factors, like poverty
EFFECTS/CONSEQUENCES OF CHILD ABUSE
• Suicides/Deaths (child)
• Poor school performance/drop-outs
• Mental retardation/Psychiatric illnesses
• Social withdrawal
• Bodily injuries
• Streetism
 Drug/substance abuse
• Violent children
• Poor physical health
• Post-traumatic stress disorder (PTSD)
WARNING SINGS OF CHILD ABUSE
• Excessively withdrawn, fearful or anxious about doing something wrong.
• Shows extremes in behavior (extremely passive or aggressive) Does not seem
to be attached to the parent or caregiver.
• Acts either inappropriately adult (taking care of other children) or
inappropriately infantile (rocking, thumb-sucking, tantruming).
• Frequent injuries or unexplained bruises, welts, or cuts.

• Is always watchful and ―on alert,‖ as if waiting for something bad to happen.
Injuries appear to have a pattern such as marks from a hand or belt.
• Shies away from touch or seems afraid to go home.
• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on
hot days.
• Trouble walking or sitting.
• Displays knowledge or interest in sexual acts inappropriate to his or her age, or
even seductive behavior.
• Makes strong efforts to avoid a specific person, without an obvious reason
• Does not want to change clothes in front of others or participate in physical
activities.
• An STD or pregnancy, especially under the age of 16 years.
• Runs away from home.
ROLES OF A COMMUNITY MENTAL HEALTH NURSE IN PREVENTING
AND DEALING WITH CHILD ABUSE

• Consultative role: giving advice to other professionals in the community about

the type and level of nursing care required for given groups of suspected child
abused clients
 Clinical role: providing direct nursing care to the abused children in the
community through home visits.
• Therapeutic role: employing psychotherapeutic and behavioral methods for
management of suspected abused children
• Advocacy: nurses speak out for the rights and interests of clients in the
community by raising awareness of clients‘ needs in places of employment,
school and markets.

• Preventive roles: through primary, secondary and tertiary levels of prevention.

• Educator: creating awareness in the community about child abuse and mental
illness with special focus on vulnerable groups
• Trainer/facilitator: training of other professional community leaders, school
teachers and other care giving professionals in the community about the effect of
child abuse.

• Manager/Administration: manager of the resources, planning and co-ordination

of the required services to abused children

QUESTIONS ON CHILD ABUSE

1. The cases of child abuse are on a rise and this has posed a great health and social
challenges in the community

a) Define the terms;

i. A Child 5 marks ii.
Child abuse 5 marks
b) Outline five (5) factors that contribute to Child abuse 20 marks
c) Explain four (4) types of Child abuse 20 marks
d) Explain five (5) effects of Abuse on the child 20 marks
e) List ten (10) consequences 10 marks
f) Discuss five (5) roles of the community Mental Health Nurse in preventing and
dealing with abuse 20 marks

2. You are working in an acute male psychiatry ward and you admit Mr. Chalwe aged
35years from Mtendere compound shouting and threatening violence to his fellow
patients and members of staff he is a known case of Schizophrenia.

a) Define aggression 5 marks

b) Discuss three (3) types of aggression 15 marks
c) Outline five (5) causes of aggression in psychiatric patients 20 marks
d) Discuss the detailed management of Mr Chalwe during an episode of aggression
50 marks

3. Ms. Thokozile Gondwe aged 25 years old, recently divorced is brought to the
hospital with history of increased incontinence. History reveals that she cannot find the
toilet and wonders away from home constantly. On admission, the Doctor conduct a
Mental State Examination and a diagnosis of Dementia is made.

DEMENTIA
• Dementia is defined as global or total intellectual decline of sufficient severity to
impair social and/or occupational functioning that occurs in normal
consciousness, (Steele,2010 :3).

• The term dementia describes symptoms of a large group of illnesses that cause a
progressive decline in a person‘s functioning such as loss of memory, intellect,
rationality and social skills.

• Dementia is an acquired global impairment of intellect, memory and personality

but without impairment of consciousness
Key Elements to the Definition of Dementia
There are four key elements to the definition of dementia,( Steele,2010:5):
 • Global impairment.
• Decline.
• Severity.
• Normal consciousness.

CAUSES OF DEMENTIA
There are many brain disorders that cause dementia (Steele, 2010).
• Alzheimer‘s dementia 60 %
• Vascular dementia 10%
• Frontal-Temporal Lobe 15%
• Dementia with Lewy bodies 15%
• Other 10%
Dementia can be caused by a number of disease processes.
• (i)Alzheimer’s disease, a consequence of degenerative brain changes as an
individual age.
• (ii) Vascular dementia result from small brain infarcts; small brain
haemorrahges.
• (iii) Parkinson’s disease
• (iv) Excessive alcohol consumption is another prevalent cause.
Other illnesses (such as
• (v) multiple sclerosis,
• (vi) HIV/AIDS,
• (vii) Huntington’s disease
• (viii) Creutzfeldt-Jacob disease) are less common

Alzheimer Disease
The Four A’s of Alzheimer Disease
• Amnesia: Memory impairment
• Aphasia: Communication impairment
• Apraxia: Impairment in performing motor movements
 • Agnosia: Impairment in recognition of what is taken in through the senses
CLINICAL FEATURE FOR ALZEHIMER’S TYPE
• Personality changes; lack of interest in day to day activities, easy mental
fatigability, self centered, withdrawn, decreased self care
• Memory impairment; recent memory is prominent affected.
• Cognitive impairment; disorientation, poor judgment, difficulty in abstraction,
decreased attention span.
• Affective impairment; labile mood, irritableness depression.
• Catastrophic reaction; agitation, attempt to compensate for defects by using
strategies to avoid demonstrating failures in intellectual performances such as
changing the subject, cracking jokes, or otherwise diverting the interviewer

• Sundowner syndrome; it is characterized by drowsiness, confusion, ataxia,

accidental falls may occur at night when external stimuli such light and
interpersonal orienting cues are diminished.

SIGNS AND SYMPTOMS OF DEMENTIA

a) Define Dementia 5 marks

b) Explain five (5) causes/predisposing factors of Dementia 25 marks
c) Outline two (2) main causes of Dementia 10 marks
d) Describe five (5) cardinal signs of Dementia 20 marks
e) Discuss how you are going to nurse Mrs. Gondwe during his stay in hospital 50
marks

5. Mr. Nkamba is an 80 years old man. During the past four years, Mr Nkamba has
been experiencing mood swings and being violent towards relatives and friends.
a. i. Define Mental Health 5 marks ii. Define Mental Illness 5 marks
b. State the five 5 causes of Mental Illness 10 marks
c. Explain three (5) levels of mental illness prevention 9 marks
d. Identify five (5) nursing problems which Mr. Nkamba is likely to experience and
using a nursing care plan, discuss how you will manage him 50 marks
e. Explain five (5) measures which can be adopted to improve and reduce mental
illnesses in Zambia 21 marks
6. Mr. Chembe is an epileptic patient; married with 2 children has been brought to the
ward following grandma seizures two days ago. The patient had generalized
movements of the body and confusion ensued thereafter. Since then the patient just
stares blankly in the environment, withdrawn and has hallucinations and illusions.
Patient is also neglecting himself and not eating.

EPILEPSY

Definition

• Epilepsy is a neurological disorder characterised by recurrent seizures with or

without loss of consciousness due to an abnormal electrical discharge in the
brain.
• Epilepsy is a group of chronic paroxysmal neurologic disorder characterized by
abnormal, uncontrolled, electrical discharge from the neurons of the cerebral
cortex in response to a stimulus.
• It is a CNS disorder characterized by recurrent attacks of seizures due to an
abnormal electrical discharge by the cerebral cortex with or without loss of
consciousness.

CAUSE OF EPILEPSY

• Idiopathic (Unknown)

However, risk factors associated with onset of Epilepsy exists

RISK FACTORS TO EPILEPSY

• Congenital defects like Cerebral Palsy

• Hydrocephalus
• Head injury of any sort
• Subarachnoid haemorrhage
• Cerebral Vascular Accident (CVA)
• Intracranial tumour
• Meningitis
 Exposure to toxins
• Cerebral Hypoxia
Birth complications like Asphyxia and RDS
• Birth Injuries
• Metabolic and endocrine disorders like hypoglycaemia and
hyperglycaemia

CLASSIFICATION OF EPILEPSY

PRIMARY EPILEPSY

Its cause remains known. But it has a tendency to run in families. It is hereditary. It
usually starts early in life

SECONDARY EPILEPSY

It develops later in life. These are due to existing structural or physiological defects
following cerebral cranial injury or disease. It does not run in families

NEURAL TRANSMISSION

The process of normal neuronal firing takes place as a communication between

neurons through electrical impulses. Such information is passed from neuron to
neuron via the axons, which act like the cable or wires in your house

PHASES/STAGES OF EPILEPTIC SEIZURES

AURAL (WARNING) STAGE

• May take serious forms in different people
 • Some may experience numbness or tingling sensation in any part of the body.
• Patient may have strange taste or smell.
• May be very brief that may not give room for the patient to prepare oneself

TONIC STAGE

• Patient loses consciousness

• Falls to the ground
• May produce an epileptic cry.
• All the muscles become stiff/rigid
• The jaws close

• Pupils dilate

• Head turned on one side

• Breathing ceases which may lead to cyanosis

• It lasts for 20-30 seconds

CLONIC STAGE

• Lasts for 30 seconds or longer.

• Violent jerking or convulsive movements of the body and limbs.
• The jaws open and close
• The tongue may be bitten during this time
• Frothing at the mouth
• Sweating due to muscular spasms
• Incontinence of urine and stool
• Breathing re-established

COMA (POSTICTAL) STAGE

• Patient relaxes for few minutes
Goes into deep sleep
• Wakes up later and fails to explain what had happened.
May go into fugue/automatism

• In this state patient may perform actions which he/she fail to account for
because of unconsciousness.

• Patient may go into status epilepticus if not recovering from the first thirty
minutes of seizures.
CLASSIFICATION OF EPILEPTIC SEIZURES
Epileptic seizures are classified in two according to their severity;

1. Partial (Focal) Seizures

2. Generalised Seizures

1. PARTIAL (FOCAL) SEIZURES

These are further classified into four (4) categories;

• Simple Partial (Jacksonian) Seizures

• Complex Partial (Temporal Lobe) Seizure Complex Partial Generalised
Tonic-clonic
• Absence Seizures (Petitmal)

ABSENCE SEIZURES (PETITMAL)

 Starts in early childhood and ceases in adolescence or develops into a Grandmal
in some patients
In this condition, there is brief loss of consciousness.
Sudden brief loss of attention and awareness

• May drop whatever he/she holding due to loss of power in limbs

• May experience blackout and suddenly falls down

• There is no post-ictal period

COMPLEX PARTIAL GENERALISED TONIC-CLONIC

• Here the consciousness is impaired

• May progress from complex partial and then go Tonic-Clonic.
• The post-ictal is always present in this type
• The duration is very brief and consciousness is not lost or impaired.
• Speech is arrested or patient becomes mute.
• Patient may experience visual sensations such as seeing light
• Patient is able to remember events afterwards Patient may interact with others.

SIMPLE PARTIAL (JACKSONIAN) SEIZURES

• This type does not impair the patient‘s consciousness.

• These are localized twitching of the extremities, usually around the face, hand,
lower limbs, or eyes.

• Loss of motor activity

• Patient stares blankly in the sky with eyes rolling upwards

 • Patient may stop whatever he/she has been doing

COMPLEX PARTIAL (TEMPORAL LOBE) SEIZURE

• Consciousness is impaired
Condition may begin as Simple Partial seizures and progress to complex partial
seizures.
There is automatic behavior such as, lip smacking, chewing, or picking at
clothes. There may be post – ictal state
2. GENERALISED SEIZURES???

Generalised seizures are further grouped into three (3) categories;

1. Atonic Seizures

2. Myoclonic Seizures

3. Toni-Clonic Seizures

ATONIC SEIZURES

• There is impairment of consciousness for the first few seconds

• Brief loss of muscle tone which may cause the patient to fall
• Drop something from the hand -―Drop Attack‖.
• No post – ictal period

MYOCLONIC SEIZURES

• Impaired consciousness for only few seconds or not at all

• Brief jerking of muscle group may occur and cause patient to fall No post-ictal
period

TONIC-CLONIC (GRAND MAL)

• Here the seizures occur in well defined stages

 • There is loss of consciousness
• There is post-ictal period

COMPLICATIONS OF EPILEPSY

• Status Epilepticus: the more severe form of Epilepsy which is characterised by

repetitive attacks with longer duration due to severe brain damage
Mental Retardation: severe damage to the brain leads to poor IQ and poor
performance at school
Accident related injuries: this happens during and attack
Psychosis: this is due to brain damage as a result of brain hypoxia during fits as
well as brain shaky syndrome
• Dementia: this is due to brain damage

HOW DO WE MANAGE EPILEPSY

DIAGNOSIS OF EPILEPSY

• History: will reveal previous epileptic attacks of familiar predisposition.

• Physical examination: previous scars of burns/injuries due to previous attacks
or patient may have a seizure in the presence of the examiner
• Electro encephalogram (EEG): will show increased electrical activity
Computed Tomographic Scan (CT scan): may show spinal or cerebral lesion.
• Lumbar puncture (LP): to rule out meningitis and any other infection of CNS.
• Magnetic Resonance Imaging (MRI): to rule structural lesion
• Skull X- RAY: will show spinal or skull fracture or tumors
• Glucose test: to rue out hyperglycaemia or Hypoglycaemia

TREATMENT OF EPILEPSY

a. Barbiturates
• Phenobarbitone 60 – 180mg as per prescription.
• Phenobarbitone 200mg – 400mg as per prescription. In children give 5.8mg/kg
body weight.
b. Hydantoins
• Phenytoin Sodium (Epanutin) 150 – 300mg as per prescription In children,
give 3-4mg/kg body weight.
• Give carbamazepine 100 – 300mg as per prescription

• In status epilepticus give IV Diazepam 10mg – 30mg.

 • Give Dextrose 5%-10% IV 1 litre in 24 hours for energy.

• Offer any supportive treatment when necessary, like Paracetamol

NURSING CARE

AIMS OF CARE

• To prevent injury
• To establish and maintain a patent airway
• To offer psychological care
• To promote hygiene

NURSING CARE DURING AN EPLEPTIC ATTACK (CONVULSIONS)

EMERGENCY MANAGEMENT

Emergency management during an attack has three (3) pillars (Aims):

1. Safety and prevention of injury

2. Establishment and maintenance of airway

3. Monitoring and observation

PREVENTION OF INJURY

A seizure cannot be stopped once it has started. It is self-limiting and no immediate

treatment will shorten it. Proper reasoning is required during the fit so as to save life.
Therefore, the following measures should be instituted;

I will ensure total privacy during the attack. I will nurse the patient in a safe
environment, with no obstacles to prevent injuries. I will nurse the patient in a low
bed with rails or possibly on a floor bed to prevent injuries from falls. I will pad side
rails of the bed to prevent injury. If the patient is up and has not already fallen, I will
place him in semi prone position and provide a folded blanket or towel under the head
to prevent injury during clonic phase. I will ensure the airway is clear and maintain it
clear throughout the seizure. I will insert Padded spatula between teeth to prevent
teeth clenching. I will not restrain the jerking limbs forcefully to avoid fractures or
dislocations. I will, ensure patient lies flat on the lateral side to avoid chocking with
secretions. I will not place a heater near his bed to avoid burns or electric fan or lamp.
I will stay with the patient for safety to make observations and record the events. I
will provide a fit chart to monitor the frequency of seizures. I will observe and record
the time the seizure start and end on the fit chart for continuity of care. I will observe
the time of initiation, duration and source of the seizure for continuity of care. I will
keep assuring the family throughout the period to alley anxiety and gain their
cooperation

MAINTAINING A PATENT AIRWAY

I will not attempt to insert anything between clenched teeth for fear of risk of pushing
tongue unto the oropharynx which may cause airway obstruction and injury to the
teeth and soft tissue. I will loosen restrictive clothing at the neck to maintain patent
airway. I will wipe out any froth (saliva) from the mouth to avoid accumulation
which may block the airway. I will suction if necessary to paten airway. I will turn the
patient on the side to promote drainage of secretions and prevent aspiration as soon as
the clonic stage begins to subside. I will ensure that the unit has free air circulation by
opening nearby windows. I will not overcrowd the patient by limiting the number of
people if i need assistance to promote free air circulation.

OBSERVATIONS

The following observations should be made;

• The mode of onset-did the patient indicate an aura?

• Was there a cry?
• In what part of the body did the initial phase start?
• Did the head and eyes deviate to one side?

• Are the seizure movements localised or generalized?

• Are the seizure movements localised or generalized?

• If generalized are they symmetrical or asymmetrical?

• Is the patient cyanosed

• Are the teeth clenched and is there frothing at the mouth

• Is there incontinence of urine and faeces.

• How long did the seizure last?

SUBSEQUENT NURSING CARE

PSYCHOLOGICAL CARE

Initially, patients are often sad, depressed and feel embarrassed after an episode. I will
assess the psychic status of the patient for baseline. I will let the patient express their
anger, fears, worries and concerns and attend to them. I will give an explanation of the
event to make the patient understand what happened to him and diffuse self blame by
giving adequate information. I will assure them that they can still lead a normal life to
alley anxiety and lack of self esteem. I will incorporate the patient and relatives in care
to instil a sense of self esteem in the patient. I will involve the ccupational therapist to
allay any anxieties about loss of a job. I will allow friends, family and church to offer
support to promote selfesteem

MAINTENANCE OF HYGIENE

I will remove and change any soiled linen and clothing to promote self esteem and
prevent infection. I will dispose off any stool or urine to prevent odour smell in the
room, promote self-esteem and prevent infections. I will advise the patient to clean the
mouth or use mouth wash to prevent halitosis ad promote appetite. I will encourage the
patient to take a shower or bath to promote blood circulation, promote self esteem and
prevent infection. I will involve the caretaker for continuum of care at home.

REST AND ACTIVITY

I will encourage the patient to rest as seizures usually leave patient exulted,. I will
nurse the patient in a noise free environment for rest. I will restrict visitations to
promote rest. I will do procedures in block to promote rest

PATIENT/FAMILY EDUCATION
I will provide adequate information about prescribed anticonvulsant to promote
adherence to drugs.. I will alert the client and family to the potential side-effects and
advise them to get in touch with the doctor if they occur for quick interventions and
prevention of complications. I will emphasize on treatment compliance to promote
healing. I will encourage the patient to honour review and appointments date to
monitor progress. I will discourage the patient from being around water bodies,
climbing heights, driving and operating heavy machines to prevent putting their lives
at risk as seizures happen suddenly. I will teach significant other about first aid
measures during an attack, like prevention of injury to prevent injuries
QUESTIONS ON EPILEPSY

1. Chembe is an epileptic patient, married with two (2) children has been brought to
the ward following a grandmal seizure two days ago. The patient had generalized
movement of the body and confusion ensued thereafter. Since then, the patient just
stares blankly in the environment, withdrawn and has hallucinations and illusions.
Patient is also neglecting himself and not eating.

a. Define epilepsy
5%
b. Outline 5 types of epileptic seizures
20%
c. Describe the management of chembe 50%
d. Explain (5) five points you would include in your Information, Education and
Communication to the community on epilepsy.
25%

a. i. Define epilepsy 5 marks ii. Explain the

psychiatric aspect of epilepsy 10 marks b. Outlive
five (5) types of epileptic seizure 20 marks
c. Describe the detailed nursing management of Mr. Chembe during the period of
hospitalisation 50 marks
d. Explain five (5) points you would include in your information, education and
communication (IEC) to Mr. Chembe on Epilepsy 15 marks

7. Chama an 18 year old school leaver who recorded only a pass in Civic Education at
grade 12 examination is brought to your facility in an unconscious state. History reveals
that an opened bottle of an insecticide (doom) nears the bed.

a) Define Suicide 5 marks

b) Mention five (5) causes of Suicide 10 marks
c) List five (5) signs of an impending Suicide 10 marks
d) Explain four (4) types of Suicides 20 marks
e) Discuss how you are going to manage Chama during the period of hospitalization,
under the following headings;
i. Emergency management 10 marks
ii. Subsequent management 30 marks
f. Explain five (5) measures which can be adopted in order to prevent Suicides in Zambia
15 marks

CHILD DEFILEMENT
DEFINITIONS
Child: A Child is any person below the age of 18 years (according to UNICEF and ILO)
Child Defilement: Defilement is having sexual intercourse with a person (which
includes both boys and girls) under the age of 18 years, with or without their consent
(according to UNICEF and ILO).
Child Defilement: Defilement is having sexual intercourse with a person (which
includes both boys and girls) under the age of 16 years, with or without their consent
(according to Zambian Law).

NOTE
The major determinant in Child defilement is age, therefore, it doesn‘t matter whether
the person has given consent or not

CONTRIBUTING FACTORS TO CHILD DEFILEMENT

• Indecent dressing and inappropriate Behaviour: Small girls patronizing clubs and
taverns and drinking alcohol while implicitly dressed could be the main reasons why
you find even big men are being tempted to have carnal knowledge with small girls.

• Sex boosters or Libido enhancers: Traditional medicines and concoctions sold by

traditional healers to men, especially to have their sexual enlarged and libido
enhancers may eventually drive an adult to have sexual intercourse with a child.
• Psychiatric disorders: Some perpetrators are known to be ―paedophiles‖ which is
sexual perversion in which children are the preferred sexual objects for reasons they
may not even comprehend while other mentally ill individuals may also defile
children.

• Sexual perversity: This is a situation where those that are involved have no control
over their sexual desires and therefore, take advantage of young children left in their
care.

• Lack of adequate institutional day care centres: Prohibitive fees for day care
centers tend to create a situation where children, especially those with working
mothers are left in the care of relatives or others who tend to abuse them.

• Beliefs that sex with a minor cures HIV/AIDS : Witchdoctors were wrongfully
advising HIV and AIDS patients to have sexual intercourse with minors in order to be
cured, the prevalence of HIV and AIDS, this has also lead to many minors being
infected with HIV
• Quest for wealth: Traditional healers are wrongfully advising people that having
sexual intercourse with a minor can make someone wealthy and boost their businesses

• Lack of parental care: The inability of most parents to provide for their children due
to poverty forces girls into sexual relations, street vending as well as putting children
in the hands of extended family members and day care centres which may put the
child at risk of being defiled.

• Watching pornographic videos: With the coming of the internet, pornography is

more common than it used to be and depiction of scenes of heterosexual, rape, oral,
anal and group sex, and incest may increase an adults sexual obsession with a minor.

• Traditional and customary practices: Initiation ceremonies and early marriages

perpetuate defilement of the girl-child because the lessons given during initiation
ceremonies include seductive scenes which the girl has to imitate thereby engaging in
sexual relationships at an early age
 • Inadequacy in housing: It is argued that child defilement are more common in
extended families as some adult family members are more likely to have canal
knowledge with the minor and usually the cases are not even reported to law
enforcers.

WARNING SIGNS OF CHILD DEFILEMENT

• Excessively withdrawn, fearful or anxious about doing something in a group of
people.
• Shows extremes in behavior (extremely passive or aggressive) Does not seem to be
attached to the parent or caregiver.
• Acts either inappropriately adult (taking care of other children) or inappropriately
infantile (rocking, thumb-sucking, tantruming).
• Frequent injuries or unexplained bruises, welts or cuts.
• Is always watchful and ―on alert,‖ as if waiting for something bad to happen.
• Shies away from touch or seems afraid to go home.
• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even
seductive behavior.
• Significant or sudden changes in mood or behavior, like sadness, tearfulness, lethargy,
anger or mood swings may suggest that the child has been defiled
• Presence or recurrent sexually transmitted infections and urinary tract infections
• Makes strong efforts to avoid a specific person, without an obvious reason Child
becomes pregnant, especially under the age of 18 years.
• Runs away from home for fear of experiencing another episode of defilement.
• Is always watchful and ―on alert,‖ as if waiting for something bad to happen.
• Shies away from touch or seems afraid to go home, especially if a defiler stays there.
• Child may fail to walk due to pain resulting from injuries on the sexual organs

EFFECTS OF CHILD DEFILEMENT

• Suicides/Deaths (child)
• Poor school performance/drop-outs
• Mental retardation/Psychiatric illnesses
 • Bodily injuries
• Streetism
• Drug/substance abuse
• Violent children
• Poor physical health
• Social withdrawal
• Sexually Transmitted Infection, including HIV
• Abortions
• Post traumatic stress disorder (PTSD)
• Early pregnancies
PREVENTION OF DEFILEMENT
• Formulation of stiffer laws for offenders to deter the would be offenders
• Families should be educated on child defilement and that all cases should be reported
• Strict laws should be formulated not to allow minors to be patronizing drinking places
• Policies should be formulated to protect, especially the girl child who is mostly
vulnerable
• Strictly monitoring of the wellbeing of the child and not to entrust the child with
strangers or other extended family members with a questionable characters
• Teaching children about some of the signals which an adult may show, like touching
the private parts, showing reproductive organs to the child or watching pornographic
materials and that the child need to be taught on how to immediately runaway from
danger and report the incident
• Traditional healers should be educated and be warned about the myths of telling
people to have sexual intercourse with the minor as cure for HIV and for accumulating
wealth
• Strengthening family ties and enable each one to be the brother‘s keeper
• Educate the community on the dangers of taking sex boosters, drugs and substance
abuse which may play a role in reducing the incidences of child defilement
• Traditional leaders should be educated about the effects of early marriages and the
influence of traditional ceremonies/customs

QUESTIONS ON DEFILEMENT
You work in a community where there are a lot of defilement cases. Most of these cases
go unreported to the police and as a community mental health nurse you are concerned
about this situation and you decide to intervene.

a) Define defilement 5 marks

b) Outline five (5) factors that could have contributed to the development of this problem
(defilement) in the community 20 marks
c) Explain five (5) signs and symptoms that you could observe in a child that has been
defiled 15 marks
d) As a community mental health nurse, explain six (6) of your roles in addressing the
situation in the community 30 marks
e) Explain six (6) measures that government could put in place to prevent child defilement
30 marks

9. Mr. Andrew Kaira aged 30 years has been referred to your out patients department
with a history of increasing anxiety. This follows a positive HIV test results a few
weeks before his wedding day Mr. Kaira needs crisis intervention

a) i. Define a crisis 5 marks

ii. Define crisis management 5 marks

b) Outline three (3) types of crises 15 marks
c) Describe the four (4) phases of a crisis 16 marks
d) Discuss the detailed immediate intervention to help [Link] in resolving the crisis
35 marks
e) Discuss six (6) basic counselling skills 24 marks
DRUG AND SUBSTANCE ABUSE

QUESTIONS ON SUBSTANCE ABUSE AND DRUG ABUSE

The issue of Drug and Substance Abuse has raised concern among the Government and
Stake Holders.

a). Define Substance Abuse 5 marks

b). Outline five (5) factors that contribute to Substance Abuse 15 marks
c). Explain five (5) effects of Substance Abuse on an individual 25 marks
d). Discuss eight (8) measures which the government should adopt to curb/stop substance
abuse 40 marks
11. Mr. Patela a 33-year-old man, a known psychiatric patient with Dementia is
discharged from Chainama Hospital. Upon arriving in the community, community
members started running away from him and his friends refused to continue playing
with him. He is being stigmatized.

a) i. Define stigma 5 marks

ii. Define discrimination 5 marks
b) State clearly any five (5) misconception concerning clients with mental disorders 10
marks
c) Explain five (5) points you will include in your Information, Education and
Communication (IEC) that you would give to the community and Mr. Patela‘s friends
in the reduction of stigma on psychiatric patients 20 marks
d) Outline six (6) points on the disadvantages or effects of stigmatizing psychiatric patients
in the community 30 marks
e) Explain using six (6) points how you may improve nurse-patient relationship at
Chainama Hospital 30 marks
12. Mr Siame a 50 year old man is admitted to a mental health unit with Schizophrenia

13. Mwiza is admitted to your mental health unit with history of attempting suicide
following the death of her husband. A diagnosis of depression is made.

a) Define Depression 4 marks

b) State five (5) predisposing factors to depression 15 marks
c) Explain the five (5) stages the grieving process 20 marks
d) Discuss the four (4) quadrants of the Johari Window in self-awareness 16 marks
e) Discuss the nursing care you will provide to Mwiza throughout hospitalisation 45
marks
14. Mrs. Siame reports that their 9 years old boy has difficulties in learning and that
the boy delayed in walking and talking. Upon assessment, you suspect the child has
mental retardation.
a) Define mental retardation 5 marks
b) i. State five (5) causes of mental retardation 25 marks

ii Explain four (4) types of mental retardation 20 marks

c) Discuss the management of mental retardation in terms of Primary prevention,
secondary prevention and tertially prevention 30 marks
d) Explain the five (5) p0ints you may include in your health education you will
give to Mrs. Siame before allowing them to go home 20 marks
15. While working in a psychiatric unit, you notice a 43 year old woman staring at the
wall and stands on one leg for hours together in addition to this she remains mute and
does not respond to questions.
a. From this description above identify the type of Schizophrenia this patient is suffering
from 5 marks
b. Explain third person personality 5 marks
c. Explain three (3) indications for psychiatric admissions 15 marks
d. Outline six (6) types of psychiatric admissions 30 marks
e. Explain in details how you will carry out Mental State Examination on Mr. Mwase
25 marks
f. Explain five (5) measures which should be employed to improve mental health in
Zambia 20 marks

16. Mr. Njovu, aged 43 years married with six children is admitted to Chainama
hospital C ward with history of alcohol abuse in an unconscious state. The wife said
that her husband sometimes experiences tremors. He is on suspension at work for
absenteeism. The wife explained that he has impaired thinking and hallucinations as
well. On examination a provisional diagnosis of alcoholism was made.

a) Define alcohol abuse 5 marks

b) Explain five (5) social effects of alcohol abuse 15 marks
c) State five (5) stages of alcohol intoxication 15 marks
d) Explain the pathophysiology of alcohol intoxication 15 marks
e) Describe in details the immediate management of Mr. Njovu 25 marks
f) Discuss five (5) ways of how alcohol abuse can be prevented 15 marks
g) List any five (5) agencies in inter-sectoral corroboration and their roles in management
and rehabilitation of clients with alcoholism 10 marks

17. Patricia Chanda 23 year old 3rd year nursing student is brought to your ward with
history of unexpected attacks of palpitations, headache and constriction in the
chest. She keeps walking up and about on the ward. A diagnosis of severe anxiety
is made by the admitting physician from outpatient department.

18. Psychiatric nursing is one of the specialty in nursing fraternity.

a. Define Psychiatric nursing

5 marks
b. Explain fully the five (5) cardinal qualities of a mental health and psychiatric nurse
20 marks
c. State five (5) principles of psychiatric nursing
15 marks
d. Narrate the history of mental Health services in Zambia
15 marks
e. Describe the counseling process/discharge planning
20 marks
f. Describe any five (5) counseling skills
20 marks

19. Chanza Nanyangwe is a schizophrenic patient admitted to Chainama hospital for

the past 5 years. She is observed to have developed the symptoms of being
institutionalised.

a) Define institutionalisation
5 marks
b) Explain five features of institutionalization on the patient
15 marks
c) Explain five measures you would take to prevent patients developing symptoms of
institutionalisation 20 marks
d) Describe ten (10) points you would include in the rehabilitation program for Ms
Chanza Nanyangwe who is institutionalized 40 marks

20. Mr. Taizya Siame a 25 years old male third year student is brought to
Psychiatric unit with complaints of insomnia, restlessness. Mental state examination
reveals pressure of speech. A provisional diagnosis of stress is made. a) Define
stress 5 marks
b) Discuss five (5) major life circumstances that may significantly cause high stress
levels 15 marks
c) Discuss five (5) coping mechanisms which an individual can use to cope with stress
20 marks
d) Explain any five (5) defense mechanisms which humans use when faced with a
stressful circumstances 15 marks
e) Discuss the management of stress in a psychiatric patient
45 mark
21. Advocacy is cardinal in the provision of quality mental health services. Advocacy
is one of the roles of a nurse.
a. i. Define advocacy
5 marks
ii. Define Forensic psychiatry
5 marks
b. State five (5) barriers to the provision of quality mental health services in Zambia
20 marks
c. Explain any five (5) principles of Advocacy
15 marks
d. State any five (5) types of Advocacy
15 marks
e. Outline the five (5) steps of a successful Advocacy
20 marks
f. You have been appointed as a district mental health coordinator at Mpanshya
District Health Office and you discover that patients with mental health disorders are
receiving substandard health care. Identify two (2) Internal and two (2) external
partners/stakeholders you will work with and state clearly how you will engage them
to solve this problem in your district 20 marks

22. Mr. Mainza has been brought to your Psychiatric Unit. Relatives narrate to you
that lately, they have noticed a bizarre behavior in him as he sometimes collect and
gather garbage in his bedroom. Further examinations are done and a diagnosis of
Acute Psychosis is arrived at.
a. Define Psychosis
5 marks
b. State any five (5) causes of Psychosis
20 marks
c. State any five (5) clinical manifestations of Psychosis
15 marks
d. Outline six (6) Psychiatric nursing skills which should be taught to Mr. Mainza on
discharge in order to improve his life 30 marks
e. Explain any five (5) principles of Psychiatric nursing
15 marks
f. List any five (5) rights of the patient
10 marks

1. Mr. Njovu, aged 43 years married with six children is admitted to Chainama
hospital C ward with history of alcohol abuse. The wife said that her husband
sometimes experiences tremors. He is on suspension at work for absenteeism. The
wife explained that he has impaired thinking and hallucinations as well. On
examination a provisional diagnosis of alcoholism was made.

a) Define alcohol abuse. 5%

b) (i). List 10 signs and symptoms of alcoholism which Mr. Njovu is going to present
with other than the ones mentioned in the stem. 10% (ii). List any five effects of
alcoholism on Mr. Njovu. 5%
c) Discuss 5 predisposing factors to alcohol and substance abuse. 10%

d) Identify 5 problems which Mr. Njovu is going to present with and using a nursing
care plan discuss how you are going to nurse or manage Mr. Njovu. 50%

e) Discuss any 4 agencies in inter-sectoral corrabolations and their roles in management

and rehabilitation of clients with alcoholism. 20%
2. Mr. Sichula went through various stages of grieving process after losing his
wife and made several attempts to take his life. He is admitted to the acute ward
for suicidal attempts.

a) Define suicidal attempt. 5%

b) Explain three (3) significant loses that may lead to grieving. 15%
c) Outline five (5) stages of the grieving process. 25%

d) Explain four (4) types of suicide. 20%

e) Discuss the specific management of Mr. Njavwa while on the ward. 35%

3. Psychiatric nursing is one of the Specialty in nursing fraternity.

a) i.)Define psychiatric nursing. 5%

ii.) List Ten (10) qualities of a mental health and psychiatric nurse. 10%
b) State five (5) principles of psychiatric nursing. 15%

c) Discuss any five (5) predisposing factors to Mental Illness or psychiatric conditions
25%

d) Explain five (5) types of admission in psychiatric nursing. 20%

e) Describe any five (5) basic counseling skills. 25%

PSYCHIATRY NURSING QUESTIONS END OF THE YEAR EXAMS

MULTIPLE CHOICE QUESTIONS

1. The special request from the court to seek medical advice or treatment on a
person to ascertain whether can stand trial in court is_____________
210. Court Jurisdiction
211. Voluntary admission
212. Detention orders
213. Bail
2. The maximum days for the medical report to be prepared for a person admitted
under court request is ____________
e) 26 days
f) 28 days
g) 10 days
h) 14 days
3. _____________is the major type of mental disorder where a person lacks insight
a) Schizophrenia
b) Psychosis
c) Mood bipolar
d) Schizo affective

4. A mental disorder in which a patient has insight into the illness, has only part
of his or her personality involved in the disorder ,this is referred to as_________
e) Neurotic disorder
f) Psychotic disorder
g) Schizophrenia
h) Delusion
5. _______Refer to the patient who is mute and immobile but fully conscious
because of the eyes which are open and may follow objects.
e) Stupor
f) Mutism
g) Blunted affect
h) Destructibility

6. The false sensory perception in the absence of a real external stimulus

is____________
e) Derealization
f) Depersonalization
g) Delusion
h) Hallucination
7. A mental disorder which is said to be more common and severe among women
who are immature or whose pregnancy is unplanned or who are denying
 pregnancy is ________
e) Peuperal psychosis
f) Postpartum maternity ―blues‘
g) Hyperemesis gravidurum
h) Peuperal depression

8. A tendency of carrying rubbish and moving with them around as demonstrated by

schizophrenic patient is called__________
e) Echoplaxia
f) Euphoria
g) Hoarding
h) Flight of ideas
9. The direct expression of feelings and needs in a way that respects the rights of
others and the self is called___________
e) Aggressiveness
f) Humiliation
g) Assertiveness
h) Desperation

10. Thoughts which persist despite attempts to forget them are called
214. Delusion
215. Delirium
216. Compulsion
217. Obsession
11. Catatonic schizophrenia is differentiated from other types of schizophrenia in
behavior. The symptoms include__________
e) Stupor, excitement and posturing
f) Apathy, poverty of speech and social withdrawal
g) Delusions, thought disorders and hallucinations
h) Loss of interest, idleness and aimlessness
12. A condition characterized by the episodes of weeping, feeling of depression,
anxiety, irritability and feeling separate and distant from the baby.
218. Postpartum maternity ‗blues‘
219. Postnatal puerperal depression
220. Puerperal psychosis
221. Hyperemesis gravidarum
13. Psychosis whose onset is after six weeks up to one year post delivery is known
as_________
e) Postpartum psychosis
f) Postpartum maternity ‗blues‘
g) Hyperemesis gravidarum
h) Postnatal puerperal depression
14. __________an act deliberately undertaken by a patient who imitates the act of
suicide, but which does not result in a fatal outcome a) Para suicide
b) Dysthymia
c) Suicide
d) Cyclothymia
15. __________is a syndrome characterized by impairment of recent and remote
memory with preservation of immediate recall in the absence of cognitive
impairment.
a) Amnesic syndrome
b) Dysthymia
c) Cyclothymia
d) Aphasia
16. The type of amnesia where there is inability to recall events that occurred
before to the onset of the illness is known as__________________ a) Amnesic
syndrome
b) Dysthymia
c) Retrograde
d) Anterograde
17. Unpleasant feeling and sustained emotion that colors the person‘s perception of
the world is______
e) Mood
f) Affect
g) Mutism
h) Stammering
18. To manage a mental patient experiencing mood swings, a clinician will
prescribe____________
e) New antipsychotic
f) Anti depressants
g) Anti cholinergic
h) Antiepileptic or anticonvulsants
19. The following are examples of typical antipsychotics drugs except? e)
fluphenazine,
f) Trifluoperizine,
g) Chlorpromazine
h) Clozapine
20. Typical (old) antipsychotic drugs are known to cause major side effects in a mental
patient. This drug reaction is commonly referred to as_________________
210. Anticholinergic reaction
211. Extrapyramidal reaction
212. Agranulocytosis
213. Korsakoff‘s syndrome
21. Artane helps to bring the rapid relief to the patient experiencing extrapyramidal
side effects but it should not be given where_______________ are present.
e) Dystonia and Neuroleptic malignant syndrome
f) Tardive dyskinesia and parkinsonism
g) Dystonia and parkinsonism
h) Anti cholinergic reactions
22. A disorder where there is an occurrence of at least one episode of mania and
depressive episode_________
e) Schizo-affective
f) Bipolar disorder
g) Manic exhaustion
h) Endogenous depression
23. _____________ is a mental disorder that involves multipltle cognitive deficits,
initially, memory impairment.
e) Delirium
f) Dementia
g) Pakinsonism
h) Depression

24. _________________ is a disorder caused by the deficiency in thiamine in the brain

a) Korsakoff syndrome
b) HIV induced psychosis
c) Amnisitic syndrome
d) Alcohol intoxication

25. _____________ is a disorder which occurs after four days of a period of heavy
drinking especially if a person does not eat enough food.
e) Delirium tremens
f) Delirium
g) Dementia
h) Intoxication
26. ._______________ is a state of complete physical, mental and social wellness,
not merely the absence of disease or infirmity according to World Health
Organization.
a) Mental Health
b) Normality
c) Mental sound
d) Physical wellness
27. Unpleasant sensory and emotion experience associated with actual or potential
tissue damage is called __________
a) Pain
 b) Trauma
c) Accident
d) Shock
28. The chronic syndrome of many physical symptoms with no adequate medical
explanations , which is associated with social problems and leads to a person
seeking medical help is____________
a) Somatization
b) Hypochondriasis
c) Dysmorphic disorder
d) Dissociative disorder
29. The preoccupation with some imagined defect of appearance in a normal
appearing person is refered to __________
a) Body dysmorphic
b) Dissociative disorder
c) Somatization
d) Hypochondriasis
30. Benzodiazepines such as Valium should not be prescribed to induce sleep for more
than 10 nights or as a sedative for 4 weeks, due to the risk of ____________________

222. Hypotension
223. Dependency
224. Causing Potential distress
225. Drowsiness
31. The following are examples of Dementia except?
a) Delirium
226. Alzheimer‘s disease
227. vascular dementia
228. Pick‘s disease
32. The treatment of mental and/ or emotional disorders through psychological rather
than physical methods is called
a) Pharmacotherapy
b) Psychotherapy
c) Group therapy
d) Phototherapy
33. All of the following are disorders of speech except?
a) Neologism
b) Echolalia
c) Clang association
d) Waxy flexibility
34. The following drugs given in high dose can help to control violent behavior in
mental patient____________
200. Chlorpromazine and diazepam
201. Artane and haloperidol
202. Stelazine and flouxitine
203. Fluphenazine and benzhexol

35. The ability to enter into someone‘s private perceptional world and becoming
thoroughly at home in it is ____________________
i) Empathy
j) Sympathy
k) Counseling
l) Assertiveness

36. A condition of arrest mental development characterized by intelligence

below the expected level of age is___________
214. Retardation
215. Average
216. Disability
217. Handicap
37. Immediate treatment is required to a mental patient experiencing extrapyramidal
side effects. Which two drugs will bring rapid relief to the patient?
 e) Anticholinergic and benzodiazepines
f) Antidepressant and antipsychotics
g) Anticholinergic and moodstablizers
h) Antidepressant and moodstablizers

38. Benzodiazepines such as Valium should not be prescribed to induce sleep for more
than 10 nights or as a sedative for 4 weeks, this is due to the risk of
____________________
a) Hypotension
b) Dependency
c) Causing Potential distress
d) Drowsiness
39. During the termination phase of the therapeutic nurse/client relationships, the
following task must be accomplished except
e) Confronting the reality of termination
f) Supporting independent functioning by the client
g) Evaluating and summarizing the relationship
h) Creating an environment conducive or interaction
40. The most common drug used in the management of alcohol withdrawal in Zambia
229. Carbamazapine
230. Benzhexol
231. Diazepam
232. Promethazine

41. In mental state assessment of memory, the following is a sequence

e) Recent, immediate and remote

f) Remote, recent and immediate
g) Immediate, recent and remote
h) Immediate, remote and recent

42. All of the following are examples of disorders of movements except .

 e) Wax flexibility
f) Compulsion
g) Stupor
h) Tactile

43. The repeated failure to resist impulses to steal objects that are not required for personal
use or monetary gain is referred to_________

e) Kleptomania
f) Gambling
g) Arson
h) Homicide

44. Predisposing factors of mood disorders (both depressive episodes and bipolar
disorders) include_____________

a) Genetic factors and personality disorders

b) Physical illness and psychosocial stressors

233. Psychological factors and social factors

234. Neurotransmitters and psychoneuroendocrinological factors

45. The schizophrenia where there are episodes of symptoms of depression and
schizophrenic symptoms is known as ___________________

e) Chronic schizophrenia
f) Paranoid schizophrenia
g) Simple schizophrenia
h) Schizoaffective disorder

46. The schizophrenia characterized by delusion of persecution, reference and bodily

change is____________________

e) Hebephrenic schizophrenia
f) Paranoid schizophrenia
g) Catatonic schizophrenia
h) Chronic schizophrenia
47. Depression triggered by external stressors e.g. divorce, loss of employment is
refered to as

i) Exogenous Depression
j) Depressive stupor
k) Endogenous Depression
l) Masked depression

48. A disorder where a person feels a loss of or changes in bodily function arising from
psychological conflict or need and cannot be explained by medical disorder is called

235. Conversion disorder

236. Dissociative fugue
237. Anxiety hysteria
238. Hypochondriasis
49. A procedure that involves passing electrical current through the frontal lobe to
induce convulsions is commonly known as

e) Electro Convulsive therapy

f) Phototherapy
g) Chemotherapy
h) Psychotherapy

50. The branch of medicine dealing with mental disorder and its treatment is called

m) Psychotherapy
n) Psychiatry
o) Psychodynamics
p) Psychiatry nursing

NURSING CARE PLAN FOR MANIA

Problem Nursing Goal Intervention Evaluation

diagnosis
1. Risk for Risk for To prevent • Remove all Patient‘s safety
injury to self injury to self patient from injurious objects maintained,
and others and others injuring him/ evidenced by
from the
related to herself and patient
hallucinations others patient‘s room exhibiting no
evidenced by throughout to prevent physical injury
breaking up hospitalisation injuries. obtained while
windows and experiencing
beating up • Put the patient hyperactive
people in seclusion
room when

she/he is
violent.

• Administer
 tranquilizers behaviour
such as
haloperidol or
chlorpromazine
to quickly relief
agitation.

• Reduce
environmental
stimuli, ensure
soft lighting,
low noise and
simple room
décor

• limit group
activities and
observe
patient‘s
behaviour
frequently

• Stay with the

client when calm
and offer
support and
provide a feeling
of security.
 .

[Link] Imbalanced To improve • Provide the Patient

nutrition less nutrition client with high nutritional
the patient‘s
than body related to status improved
nutrition by nutritious finger
requirements patient‘s evidenced by
ensuring meals and patient gaining
inability to sit
adequate
long enough drinks that can and maintaining
intake
to eat meals be consumed on weight during
throughout
evidenced by hospitalization
hospitalization the run
loss of and patient‘s
weight, poor • Ensure ability to
muscle tone verbalize the
and pale availability of importance of
mucous snakes on the good nutrition.
membranes unit all the time

• Maintain
accurate record
of intake and
output.

• Weigh the
patient daily to
asses‘
nutritional
status.

• Determine the
patient‘s
favourite foods
and ensure they
are provided

• Administer
 vitamins and
mineral
supplements
prescribed by
the physician

• As agitation
reduce sit with
the patient and
encourage the
patient to eat.

• Educate the
client on the
importance of
adequate
nutrition.
3. Impaired Impaired To improve • Encouraged Patients‘
social social social her family to interaction with
interaction interaction others improved
interaction. support the
related to with other and maintained
confusion, people and patient. evidenced by
stigma relatives in the patient‘s
• Encourage the
evidenced by hospital and ability to open
patient to
patient after up to others and
interact with
isolating discharge. relatives,
others by
him/herself
involving
from others,
patient in
group
Discomfort in activities. relating with
social • Set limits on others well
without
situations and manipulative manipulating
vebal behaviours and them for
manipulation explain to client selfgratification.
of others what you expect
and what the
consequences

are if the limits

are violated.

• Avoid arguing,
bargain, or try to
reason with the
client, instead
follow through
with
consequences

if limits are
violated as
consistency is
essential for
success of this
intervention.

• Provide positive
reinforcement
for
nonmanipulative
behaviours.
 • Help client
recognize
consequences
of own
behaviours and
refrain from
attributing
them to others.

• Help client
identify
positive aspects
about self,
recognize

accomplishmen
ts, and feel good
about them to
stop patient
from
manipulating
others for
selfgratification.

[Link] Insomnia To improve Provide a quiet The patient‘s

related to environment, sleep pattern
the patient‘s
excessive with a low level improved
sleeping
hyperactivity of stimulation evidence by the
patterns
evidenced by to promote patient‘s ability
throughout
difficulty in sleep to sleep
hospitalization.
falling asleep • Monitor the for 6 to 8 hours
and pacing in patient‘s per night
the hall during without
sleeping
sleeping medication.
hours. patterns.

• Provide
structured
schedule of
activities that
includes
established
times for naps or
rest.

• Asses client‘s
activity level
and intervene as
patient may
collapse from
high levels of
exhaustion.

• Before bedtime,
provide nursing
measures that
promote sleep,
such as back
rub; warm bath;
warm,
nonstimulating
 drinks; soft
music; and
relaxation
exercises.

• Prohibit intake
of caffeinated
drinks, such as
tea, coffee, and
Colas to avoid
stimulating the

CNS which
may interfere
with the client‘s
achievement of
rest and sleep.

• Administer
sedative
medications, as
ordered, to assist
client achieve
sleep until
normal sleep
pattern is
restored

[Link] Disturbed To improve Observe client The patient‘s

sensory sensory for signs of sensory
the patient‘s
perception perception sensory hallucinations perception
related to perception such as laughing normalized,
within the first evidenced by
or talking to self
Biochemical 72 hours of the patient‘s
hospitalization and intervene ability
imbalance
early. differentiate
And Sleep between reality
• Avoid and unrealistic
deprivation
touching the events or
evidenced by situations and
client before
Hallucinations the patient‘s
warning him or
and ability to refrain
her that you are from
about to do so responding to
Disorientation
false sensory
as client may
perceptions.
perceive touch
as threatening
and respond in
an aggressive
manner

• Portray an
attitude of
acceptance to
encourage the
client to share
the content of
the
hallucination
with you in
order to
prevent
possible injury
to the client or
others from
command
hallucinations.
Avoid
reinforcing the
hallucination
by using words
such as ―the
voices‖ instead
of ―they‖ when
referring to the
hallucination
because Words
like ―they‖
validate that
the voices are
real.
Try to distract
the client away
from the
misperception
by
Involvement in
interpersonal
activities and
 explanation of
the actual
situation, this
will bring the
client back to
reality.

6. Self-care Self-care To improve • Encourage the The patient‘s

deficit deficit related and maintain patient to bath hygiene status
to cognitive improved and
the patient‘s and supervise
impairment maintained
evidenced by hygiene the patient evidenced by
patient throughout during bathing. the patient
looking hospitalization looking, smart
untidy. • Encourage the all the time .
patient to wash
his/her clothes
when dirty.

• Encourage the
patient to brush
teeth every
after each meal

• Encourage and
supervise the
patient in
maintaining
her/his hair.
[Link] Disturbed To normalize • Convey your The patient‘s
thought thought the patient‘s acceptance of thought
processes thought processes
processes client‘s need
processes improved
related to within 1 week for the false evidenced by
of belief, while the patient‘s
Biochemical
hospitalization letting him/her ability to
alterations
reflect an
and Sleep know that you
accurate
deprivation
don‘t share the interpretation
evidenced by
delusion. of the
decreased
environment.
ability to
• Do not argue or
grasp ideas ,
deny the belief
Impaired
to avoid
jeopardizing
ability to the
make development of
a trusting
decisions,
relationship.
delusions of
grandeur and • Use reasonable

persecution doubt as a
therapeutic
technique: e.g.

―I understand
that you
believe this is
true, but I
personally find
it hard to
accept.

• Reinforce and
focus on reality
by talking about
real events and
real people. Use
real situations
and events to
divert patient
from long,
tedious,
repetitive
verbalizations
of false ideas.
• Give positive
 reinforcement
to enhances
self-esteem as
client begins to
differentiate
between
reality-based
and non–
reality-based
thinking.

Nursing care for schizophrenia

2. Impaired verbal communication. Decreased, reduced, delayed, or absent ability to

receive, process, transmit, or use a system of symbols.

Due to or May be related to:

• Altered perceptions.

• Biochemical alterations in the brain of certain neurotransmitters.

• Psychological barriers (lack of stimuli).

• Side effects of medication.

Possibly evidenced by

• Difficulty communicating thoughts verbally.

• Difficulty in discerning and maintaining the usual communication pattern.

• Disturbances in cognitive associations (e.g., perseveration, derailment, poverty of

speech, tangentiality, illogicality, neologism, and thought blocking).

• Inappropriate verbalization.

Desired Outcomes
 • Patient will express thoughts and feelings in a coherent, logical, goal-directed manner.

• Patient will demonstrate reality-based thought processes in verbal communication.

• Patient will spend time with one or two other people in structured activity neutral
topics.

• Patient will spend two to three 5-minute sessions with nurse sharing observations in
the environment within 3 days.

• Patient will be able to communicate in a manner that can be understood by others with
the help of medication and attentive listening by the time of discharge.

• Patient will learn one or two diversionary tactics that work for him/her to decrease
anxiety, hence improving the ability to think clearly and speak more logically.

Nursing Interventions Rationale

Assess if incoherence in Establishing a baseline

speech is chronic or if it is facilitates the establishment of
more sudden, as in an realistic goals, the foundation
exacerbation of symptoms. for planning effective care.

Identify the duration of the Therapeutic levels of an

psychotic medication of the antipsychotic aids clear thinking
client. and diminishes derailment or
looseness of association.

Keep voice in a low manner High-pitched/loud tone of voice

and speak slowly as much as can elevate anxiety levels while

possible. slow speaking aids

understanding.
Keep environment calm, Keep anxiety from escalating
quiet and as free of stimuli as and increasing confusion and
possible. hallucinations/delusions.

Plan short, frequent periods Short periods are less stressful,

with a client throughout the and periodic meetings give a
day. client a chance to develop
familiarity and safety.

Use clear or simple words, Client might have difficulty

and keep directions simple as processing even simple
well. sentences.

Use simple, concrete, and Minimizes misunderstanding

literal explanations. and/or incorporating those
misunderstandings into
delusional systems.

Focus on and direct client‘s Helps draw focus away from

attention to concrete things in delusions and focus on
the environment. realitybased things.

Look for themes in what is

said, even though spoken Often client‘s choice of words is
words appear incoherent symbolic of feelings.

(e.g., fearful, sadness, guilt).

When you do not understand Pretending to understand limits

a client, let him/her know your credibility in the eyes of
you are having difficulty your client and lessens the
understanding. potential for trust.
When client is ready,
introduce strategies that can
minimize anxiety and lower
voices and ―worrying‖
thoughts, teach client to do
the following:

• Focus on meaningful
activities.

• Learn to replace
negative thoughts with
constructive thoughts.
• Learn to replace Helping client to use tactics to
irrational thoughts with lower anxiety can help enhance
functional speech.
rational statements.

• Perform deep breathing

exercise.

• Read aloud to self.

• Seek support from a

staff, family, or other
supportive people.

• Use a calming
visualization or listen to
music.
Use therapeutic techniques Even if the words are hard to
(clarifying feelings when understand, try getting to the
speech and thoughts are feelings behind them.

disorganized) to try to
understand client‘s concerns.

2. Impaired Social Interaction: The state in which an individual participates in an

insufficient or excessive quantity or ineffective quality of social exchange.

Due to or May be related to

Difficulty with communication.

• Difficulty with concentration.

• Exaggerated response to alerting stimuli.

• Feeling threatened in social situations.

• Impaired thought processes (delusions or hallucinations).

• Inadequate emotional responses.

• Self concept disturbance (verbalization of negative feelings about self).

Possibly evidenced by

12. Appears upset, agitated, or anxious when others come too close in contact or try to
engage him/her in an activity.

13. Dysfunctional interaction with others/peers.

14. Inappropriate emotional response.

15. Observed use of unsuccessful social interactions behaviors.

16. Spends time alone by self.

17. Unable to make eye contact, or initiate or respond to social advances of others.
 18. Verbalized or observed discomfort in social situations.

Desired Outcomes

• Patient will attend one structured group activity within 5-7 days.

• Patient will seek out supportive social contacts.

• Patient will improve social interaction with family, friends, and neighbors.

• Patient will use appropriate social skills in interactions.

• Patient will engage in one activity with a nurse by the end of the day.

• Patient will maintain an interaction with another client while doing an activity (e.g.,
simple board game, drawing).

• Patient will demonstrate interest to start coping skills training when ready for learning.

• Patient will engage in one or two activities with minimal encouragement from nurse or
family members.

• Patient will state that he or she is comfortable in at least three structured activities that
are goal directed.

• Patient will use appropriate skills to initiate and maintain an interaction.

Nursing Interventions Rationale

Assess if the medication Many of the positive symptoms of

has reached therapeutic schizophrenia (hallucinations,
levels. delusions, racing thoughts) will
subside with medications, which
will facilitate interactions.

Identify with client Increased anxiety can intensify

symptoms he experiences agitation, aggressiveness, and
when he or she begins to suspiciousness.
feel anxious around
others.

Keep client in an Client might respond to noises and

environment as free of crowding with agitation, anxiety,
stimuli (loud noises, and increased inability to
crowding) as possible. concentrate on outside events.

Avoid touching the client. Touch by an unknown person can

be misinterpreted as a sexual or
threatening gesture. This
particularly true for a paranoid
client.

Ensure that the goals set Avoids pressure on the client and
are realistic; whether in sense of failure on part of
the hospital or community. nurse/family. This sense of failure
can lead to mutual withdrawal

Structure activities that Client can lose interest in activities

work at the client‘s pace that are too ambitious, which can
and activity. increase a sense of failure.

Structure times each day to Helps client to develop a sense of

include planned times for safety in a non-threatening
brief interactions and environment.
activities with the client on
one-on-one basis
If client is unable to An interested presence can provide
respond verbally or in a a sense of being worthwhile.
coherent manner, spend
frequent, short period with
clients.

If client is found to be very Client is free to choose his level of

paranoid, solitary or one- interaction; however, the
on-one activities that concentration can help minimize
require concentration are distressing paranoid thoughts or
appropriate. voice.

If client is
delusional/hallucinating or
is having trouble Even simple activities help draw
concentrating at this time, client away from delusional
provide very simple thinking into reality in the
concrete activities with environment.
client (e.g., looking at a
picture or do a painting).

If client is very
withdrawn, one-on-one Learn to feel safe with one person,
activities with a ―safe‖ then gradually might participate in
person initially should be a structured group activity.
planned.

Try to incorporate the

strengths and interests the
client had when not as Increase likelihood of client‘s
impaired into the activities participation and enjoyment.
planned.

Teach client to remove

Teach client skills in dealing with
himself briefly when anxiety and increasing a sense of
feeling agitated and work control.
on some anxiety relief
exercise (e.g., meditations,

rhythmic exercise, deep

breathing exercise).

Useful coping skills that These are fundamental skills for

client will need include dealing with the world, which
conversational and everyone uses daily with more or
assertiveness skills. less skill.

Remember to give
acknowledgment and
recognition for positive Recognition and appreciation go a
steps client takes in long way to sustaining and
increasing social skills and increasing a specific behavior.
appropriate interactions
with others.

Provide opportunities for

the client to learn adaptive
social skills in a
nonthreatening
environment.
Initial social skills training Social skills training helps client
could include basic social adapt and function at a higher level
behaviors (e.g., appropriate in society, and increases client‘s
distance, maintain good quality of life.
eye contact, calm
manner/behavior, moderate
voice tone).

As client progresses, Gradually the client learns to feel

provide the client with safe and competent with increased
graded activities social demands.

according to level of
tolerance e.g., (1) simple
games with one ―safe‖
person; (2) slowly add a
third person into ―safe‖.

As client progresses,
Coping Skills Training
should be available to
him/her (nurse, staff or
others). Basically the
process:
 5. Define the skill to be Increases client‘s ability to derive
learned. social support and decrease
loneliness. Clients will not give up
6. Model the skill. substance of abuse unless they have
alternative means to facilitate
7. Rehearse skills in a socialization they belong.
safe environment, then
in the community.

8. Give corrective
feedback on the
implementation of
skills.

Eventually engage other

clients and significant Client continues to feel safe and
others in social interactions competent in a graduated hierarchy
and activities with the of interactions.
client (card games, ping
pong, sing-a-

songs, group sharing

activities) at client‘s level.

a. Disturbed Sensory Perception: Change in the amount or patterning of

incoming stimuli accompanied by a diminished, exaggerated, distorted or
impaired response to such stimuli.

Due to or May be related to

• Altered sensory perception.

 • Altered sensory reception; transmission or integration.

• Biochemical factors such as manifested by inability to concentrate.

• Chemical alterations (e.g., medications, electrolyte imbalances).

• Neurologic/biochemical changes.

• Psychological stress.

Possibly evidenced by

• Altered communication pattern.

• Auditory distortions.

• Change in a problem-solving pattern.

• Disorientation to person/place/time.

• Frequent blinking of the eyes and grimacing.

• Hallucinations.

• Inappropriate responses.

• Mumbling to self, talking or laughing to self.

• Reported or measured change in sensory acuity.

• Tilting the head as if listening to someone.

Desired Outcomes

• Patient will learn ways to refrain from responding to hallucinations.

• Patient will state three symptoms they recognize when their stress levels are high.

• Patient will state that the voices are no longer threatening, nor do they interfere with
his or her life.

• Patient will state, using a scale from 1 to 10, that ―the voices‖ are less frequent and
threatening when aided by medication and nursing intervention.

• Patient will maintain role performance.

 • Patient will maintain social relationships.

• Patient will monitor intensity of anxiety.

• Patient will identify two stressful events that trigger hallucinations..

• Patient will identify to personal interventions that decrease or lower the intensity or
frequency of hallucinations (e.g, listening to music, wearing headphones, reading out
loud, jogging, socializing).

• Patient will demonstrate one stress reduction technique.

• Patient will demonstrate techniques that help distract him or her from the voices.

Nursing Interventions Rationale

Accept the fact that the

voices are real to the client, Validating that your reality does
but explain that you do not not include voices can help
hear the voices. Refer to client cast ―doubt‖ on the
the voices as ―your validity of his or her voices.
voices‖ or ―voices that
you hear‖.

Be alert for signs of Might herald hallucinatory

increasing fear, anxiety or activity, which can be very
agitation. frightening to client, and client
might act upon command
hallucinations (harm self or
others).

Explore how the Exploring the hallucinations and

hallucinations are sharing the experience can help
experienced by the client. give the person a sense of power
that he or she might be able to
manage the hallucinatory voices.
Help the client to identify Hallucinations might reflect
the needs that might needs for:
underlie the hallucination.
What other ways can these • Anger.
needs be met?
• Power.

• Self-esteem.

• Sexuality.
Help client to identify times Helps both nurse and client
that times that the identify situations and times that
hallucinations are most might be most anxiety producing
prevalent and frightening. and threatening to the client.

If voices are telling the

client to harm self or others, People often obey hallucinatory
take necessary commands to kill self or others.
Early assessment and
environmental precautions.
intervention might save lives.

Notify others and police,

physician, and
 administration
according to unit
protocol.

• If in the hospital, use

unit protocols for
suicidal or threats of
violence if client plans
to act on commands.

• If in the community,
evaluate the need for
hospitalization.

Clearly document what

client says and if he/she is a
threat to others, document
who was contacted and
notified (use agency
protocol as a guide).

Stay with clients when they

are starting to hallucinate, Client can sometimes learn to
and direct them to tell the push voices aside when given
repeated instructions. especially
―voices they hear‖ to go within the framework of a
away. Repeat often in a trusting relationship.
matter-of-fact manner.

Decrease environmental Decrease potential for anxiety

stimuli when possible (low that might trigger hallucinations.
noise, minimal activity).
Helps calm client.
Intervene with one-on-one, Intervene before anxiety begins
seclusion, or PRN to escalate. If the client is
already
medication (As ordered) out of control, use chemical or
when appropriate. physical restraints following unit
protocols.

Keep to simple, basic, Client‘ thinking might be

reality-based topics of confused and disorganized; this
conversation. Help client intervention helps client focus
focus on one idea at a time. and comprehend reality-based
issues.

Work with the client to find If clients‘ stress triggers

which activities help reduce hallucinatory activity, they might
anxiety and distract the be more motivated to find ways
client from a hallucinatory to remove themselves from a
material. Practice new skills stressful environment or try
with the client. distraction techniques.

Engage client in Redirecting client‘s energies to

realitybased activities such acceptable activities can
as card playing, writing, decrease the possibility of acting
drawing, doing simple arts on hallucinations and help
and crafts or listening to distract from voices.
music.

b. Disturbed thought process: Disruption in cognitive operations and

activities.

Due to or May be related to

• Chemical alterations (e.g., medications, electrolyte imbalances).

• Inadequate support systems.

• Overwhelming stressful life events.

 • Possibility of a hereditary factor.

• Panic level of anxiety.

• Repressed fears.

Possibly evidenced by

• Delusions.

• Inaccurate interpretation of environment.

• Inappropriate non-reality-based thinking.

• Memory deficit/problems.

• Self-centeredness.

Desired Outcomes

• Patient will verbalize recognition of delusional thoughts if they persist.

• Patient will perceive environment correctly.

• Patient will demonstrate satisfying relationships with real people.

• Patient will demonstrate decrease anxiety level.

• Patient will refrain from acting on delusional thinking.

• Patient will develop trust in at least one staff member within 1 week.

• Patient will sustain attention and concentration to complete task or activities.

• Patient will state that the ―thoughts‖ are less intense and less frequent with the help of
the medications and nursing interventions.

• Patient will talk about concrete happenings in the environment without talking about
delusions for 5 minutes.

• Patient will demonstrate two effective coping skills that minimize delusional thoughts.

• Patient will be free from delusions or demonstrate the ability to function without
responding to persistent delusional thoughts.
Nursing Interventions Rationale

Attempt to understand the Important clues to underlying

significance of these beliefs fears and issues can be found in
to the client at the time of the client‘s seemingly illogical
their presentation. fantasies.

Recognizes the client‘s Recognizing the client‘s

delusions as the client‘s perception can help you
perception of the understand the feelings he or
environment. she is experiencing.

Identify feelings related to

delusions. For example:

If client believes someone

is going to harm
him/her, client is
experiencing fear. When people believe that they
are understood, anxiety might
If client believes someone lessen.
or something is
controlling his/her
thoughts, client is
experiencing
helplessness.

Explain the procedures and When the client has full

try to be sure the clients knowledge of procedures, he or
understand the procedures she is less likely to feel tricked
before carrying them out. by the staff.
Interact with clients on the When thinking is focused on
basis of things in the reality-based activities, the
environment. Try to distract client is free of delusional
client from their delusions by thinking during that time. Helps

engaging in reality-based focus attention externally.

activities (e.g., card games,
simple arts and crafts
projects etc).

Do not touch the client; use Suspicious clients might

gestures carefully. misinterpret touchas either
aggressive or sexual in nature
and might interpret it as
threatening gesture. People who
are psychotic need a lot of
personal space.

Initially do not argue with Arguing will only increase

the client‘s beliefs or try to client‘s defensive position,
convince the client that the thereby reinforcing false beliefs.
delusions are false and This will result in the client
unreal. feeling even more isolated and
misunderstood.

Encourage healthy habits to

optimize functioning:

Maintain medication
regimen.
 All are vital to help keep the
• Maintain regular sleep client in remission.
pattern.

• Maintain self-care.

• Reduce alcohol and drug

intake.

Show empathy regarding the The client‘s delusion can be

client‘s feelings; reassure the distressing. Empathy conveys
client of your presence and your caring, interest and
acceptance. acceptance of the client.

Teach client coping skills

that minimize ―worrying‖
thoughts. Coping skills
include:

Going to a gym.
• Phoning a helpline. When client is ready, teach
strategies client can do alone.
• Singing or Listening to a
song.

• Talking to a trusted
friend.

• Thought-stopping
techniques.
Utilize safety measures to During acute phase, client‘s
protect clients or others, if delusional thinking might
dictate to them that they might
the client believe they need
have to hurt others or self in
to protect themselves against order to be safe. External
a specific person. controls might be needed.

Precautions are needed.

c. Defensive Coping: Repeated projection of falsely positive self-evaluation

based on a self-protective pattern that defends against underlying perceived
threats to positive self-regard.

Due to or May be related to

• Perceived lack of self-efficacy/vulnerability.

• Perceived threat to self.

• Suspicions of the motives of others.

Possibly evidenced by

• Denial of obvious problems.

• Difficulty in reality testing of perceptions.

• Difficulty establishing/maintaining relationships.

• False beliefs about the intention of others.

• Fearful.

• Grandiosity.

• Hostile laughter or ridicule of others.

• Hostility, aggression, or homicidal ideation.

• Projection of blame/responsibility.

• Rationalization of failures.
 • Superior attitude towards others.

Desired Outcomes

• Patient will avoid high-risk environments and situations.

• Patient will interact with others appropriately.

• Patient will maintain medical compliance.

• Patient will identify one action that helps client feel more in control of his or her life.

• Patient will demonstrate two newly learned constructive ways to deal with stress and
feeling of powerlessness.
• Patient will demonstrate learn the ability to remove himself or herself from situations
when anxiety begins to increase with the aid of medications and nursing interventions.

• Patient will demonstrate decreased suspicious behaviors regarding with the interaction
with others.

• Patient will be able to apply a variety of stress/anxiety-reducing techniques on their

own.

• Patient will acknowledge that medications will lower suspiciousness.

• Patient will state that he/she feels safe and more in control with interactions with
environment/family/work/social gatherings.

Nursing Interventions Rationale

Explain to client what you are Prepares the client

going to do before you do it. beforehand and minimizes
misinterpreting your intent as
hostile or aggressive.

Assess and observe clients

regularly for signs of increasing Intervene before client loses
anxiety and hostility. control.

Use a nonjudgemental, There is less chance for a

respectful, and neutral approach suspicious client to
with the client. misinterpret intent or
meaning if content is neutral
and approach is respectful
and non-judgemental.

Use clear and simple language Minimize the opportunity for

when communicating with a miscommunication and
suspicious client. misconstruing the meaning of
the message.

Diffuse angry verbal attacks When staff become defensive,

with a non defensive stand. anger escalates for both client
and staff. a nondefensive and
nonjudgemental attitude
provides an atmosphere in
which feelings can be
explored more easily.

Set limits in a clear matter-of-

fact way, using a calm tone. Calm and neutral approach
Giving threatening remarks to may diffuse escalation of
Jeremy is unacceptable. We anger. Offer an alternative to
can talk more about the verbal abuse by finding
proper ways in dealing with appropriate ways to deal with
your feelings. feelings.
Be honest and consistent with Suspicious people are quick
client regarding expectations to discern honesty. Honesty
and enforcing rules. and consistency provide an
atmosphere in which trust can
grow.

Maintain low level of stimuli

and enhance a non-threatening Noisy environments might be
environment (avoid groups). perceived as threatening.

Be aware of client‘s tendency to Suspicious clients will

have ideas of reference; do not automatically think that they
do things in front of client that are the target of the
interaction and interpret it in a
can be misinterpreted:
negative manner (e.g., you are
laughing or whispering about
• Laughing or whispering.
them).
• Talking quitely when client
can see but not hear what is
being said.

Initially, provide solitary,

noncompetitive activities that If a client is suspicious of
take some concentration. Later a others, solitary activities are
game with one or more client the best. Concentrating on
that takes concentration (e.g., environmental stimuli
chess checkers, thoughtful card minimizes paranoid
games such as ridge or rummy). rumination.

Provide verbal/physical limits

when client‘s hostile behavior
escalates: We cannot allow you Often verbal limits are
to verbally attack someone here. effective in helping a client
If you cant held/control yourself, gain self control.
we are here in order to help you.

d. Interrupted Family Process: Change in family relationships and/or

functioning.

Due to or May be related to

Developmental crisis or transition.

• Family role shift.

• Physical or mental disorder of a family member.

• Shift in health status of a family member.

• Situational crisis or transition.

Possibly evidenced by

• Changes in expression of conflict in family.

• Changes in communication patterns.

• Changes in mutual support.

• Changes in participation in decision making.

• Changes in participation in problem solving.

• Changes in stress reduction behavior.

• Knowledge deficit regarding community and health care support.

• Knowledge deficit regarding the disease and what is happening with ill family member
(might believe client is more capable than they are).
 • Inability to meet the needs of family and significant others (physical, emotional,
spiritual).

Desired Outcomes

• Family and/or significant others will recount in some detail the early signs and
symptoms of relapse in their ill family member, and know whom to contact in case.

• Family and/or significant others will state and have written information identifying the
signs of potential relapse and whom to contact before discharge.

• Family and/or significant others will state that they have received needed support from
community and agency resources that offer education, support, coping skills training,
and/or social network development (psycho educational approach).
• Family and/or significant others will state what medications can do for their ill family
member, the side effects and toxic effects of the drugs, and the need for adherence to
medication at least 2 to 3 days before discharge.

• Family and/or significant others will name and have a complete list of community
supports for ill family members and supports for all members of the family at least 2
days before the discharge.

• Family and/or significant others will attend at least one family support group (single
family, multiple family) within 4 days from onset of acute episode.

• Family and/or significant others will be included in the discharge planning along with
the client.

• Family and/or significant others will meet with nurse/physician/social worker the first
day of hospitalization and begin to learn about neurologic/biochemical disease,
treatment, and community resources.

• Family and/or significant others will problem-solve, with the nurse, two concrete
situations within the family that all would like to discharge.

• Family and/or significant others will recount in some detail the early signs and
symptoms of relapse in their ill family member, and know whom to contact.

• Family and/or significant others will demonstrate problem-solving skills for handling
tensions and misunderstanding within the family member.
 • Family and/or significant others will have access to family/multiple family support
groups and psychoeducational training.

• Family and/or significant others will know of at least two contact people when they
suspect potential relapse.

• Family and/or significant others will discuss the disease (schizophrenia)

knowledgeably: o Know about community resources (e.g., help with self care activities,
private respite).
o Support the ill family member in maintaining optimum health.

o Understand the need for medical adherence.

Nursing Interventions Rationale

Assess the family members‘ Family might have

current level of knowledge misconceptions and
about the disease and misinformation about
medications used to treat the schizophrenia and
disease. treatment, or no
knowledge at all. Teach
client‘s and family‘s level
of understanding and
readiness to learn.

Inform the client family in

clear, simple terms about
psychopharmacologic Understanding of the
therapy: dose, duration, disease and the treatment
indication, side effects, and of the disease encourages
toxic effects. Written greater family support and
information should be given client adherence.
to client and family
members as well.

Identify family‘s ability to

cope (e.g., experience of Family‘s need must be
loss, caregiver burden, addressed to stabilize
needed supports). family unit.

Teach the client and family Rapid recognition of early

the warning symptoms of warning symptoms can
relapse. help ward off potential
relapse when immediate
medical attention is
sought.

Provide information on
disease and treatment Meet family members‘
strategies at family‘s level of needs for information.
understanding.

Provide an opportunity for

the family to discuss feelings Nurses and staff can best
related to ill family member intervene when they
and identify their immediate understand the family‘s
concerns. experience and needs.
Provide information on Schizophrenia is an
client and family community overwhelming disease for
resources for the client and
both the client and the
family after discharge: day
hospitals, support groups, family. Groups, support
organizations, psycho groups, and psycho
educational programs, educational centers can
community respite centers
help:
(small homes), etc.

• Access caring.

• Access resources.

• Access support.

• Develop family skills.

• Improve quality of life

for all family
members.

Minimizes isolation.

What is Major Depression?

Major depression (or major depressivedisorder) is classified under mood disorders

which are characterized by disturbances in the regulation of mood, behavior, and affect
that go beyond the normal fluctuations that most people experience.

You can learn more about major depression in our study guide here.

Nursing Care Plansfor Major Depression

Nursing care plan goals for patients with major depression includes determining a
degree of impairment, assessing the client‘s coping abilities, assisting the client to deal
with the current situation, providing for meeting psychological needs, and promote
health and wellness.

Here are nine (9) nursing care plans (NCP) and nursing diagnosis for major
depression:

1. Risk For Self-Directed Violence

2. Impaired Social Interaction

3. Spiritual Distress

4. Chronic Low Self-Esteem

5. Disturbed Thought Processes

6. Self-Care Deficit

7. Grieving

8. Hopelessness
9. Deficient Knowledge
1 - Risk For Self-Directed Violence2 - Impaired Social Interaction3 - Spiritual
Distress4 - Chronic Low Self-Esteem5 - Disturbed Thought Processes6 - Self-Care
Deficit7 - Grieving8 - Hopelessness9 - Deficient Knowledge
ADVERTISEMENT
1: Risk For Self-Directed Violence
Nursing Diagnosis

• Risk for self-directed violence

Risk factors

• Anhedonia, helplessness, hopelessness

• Loneliness

• Social isolation

• Severe personality disorder/ depression/ psychosis, substance abuse

Possibly evidenced by

• Previous attempts of violence.

• Suicidal plan (clear, specific, lethal method and available means).

• Suicidal behavior (attempts, ideation, plan and available means).

• When depression begins to lift, clients may have energy to carry out suicidal plan.
Desired Outcomes

• Patient will seek help when experiencing self-destructive impulses.

• Patient will have a behavioral manifestation of absent depression.

• Patient will have satisfaction with social circumstances and achievements of life
goals.
• Patient will identify at least two-three people he/she can seek out for support and
emotional guidance when he/she is feeling self-destructive before discharge.

• Patient will not inflict any harm to self or others.

• Patient will identify support and support groups with he/she is in contact within one
month.

• Patient will state that he/she wants to live.

• Patient will start working on constructive plans for the future.

• Patient will demonstrate compliance with any medication or treatment plan within
the next two weeks.

• Patient will demonstrate alternative ways of dealing with negative feelings and
emotional stress.
Nursing Interventions Rationale

Nursing Assessment

Identify the level of

suicideprecautions
needed. If there is a high-
risk, does a hospitalization A client with a
requires? Or if there is a low high-risk will
require a
risk, will the client be safe to
constant
go home with supervision supervision
from a family member or a and a safe
friend? For example, does environment.

client:

Admit previous
suicideattemp ts.

• Abuse any substances.

Have no peers/friends.

• Have any suicide plan.

Check for the availability of Normally, a
required supply of suicidal
medications needed. client‘s
medical supply
should be
limited to 3-5
days.

Therapeutic Interventions
Encourage clients to express Clients can
feelings (anger, sadness, learn
guilt) and come up with alternative
alternative ways to handle ways of
feelings of anger and dealing with
frustration. overwhelming
emotions and
gain a sense of
control over
his/her life.

Contact the family, arrange Clients need a

for crisis counseling. Activate network of
links to self-help groups. resources to
help diminish
personal
feelings of

helplessness,
worthlessness,
and isolation.

If, hospitalized, follow unit There are

protocols. different
measures for
the suicidal
client in either
the hospital,
clinic, and
community.
Implement a written Reinforces
nosuicide contract. action the
client can take
when feeling
suicidal.

2: Impaired Social Interaction

Nursing Diagnosis

• Impaired Social Interaction

May be related to

• Altered thought processes.

• Anergia (lack of energy and motivation).

• Feelings of worthlessness.

• Fear of rejection.
• Lack of support system.

• Self-concept disturbance.
Possibly evidenced by

• Dysfunctional interaction with family, peers, and/or others.

• Family reports change of style or patterns of interaction.

• Verbalized discomfort in social situations.

• Remains feelings of seclusion, avoids contact with others and lacks eyecontact.
Desired Outcomes

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 • Patient will identify feelings that lead to poor social interactions.

• Patient will interact with family/friends/peers.

• Patient will participate in certain community social activities (e.g.,leisure activity,

church member).

• Patient will participate in one activity by the end of the day.

• Patient will discuss two-three alternative ways to take when feeling the need to
withdraw.

• Patient will identify two-three personal behaviors that might discourage others from
seeking contact.

• Patient will eventually voluntarily attend individual/group therapeutic meetings

within a therapeutic milieu (community or hospital).

• Patient will verbalize that he/she enjoys interacting with others in activities and one-
on-one interactions to the extent they did before becoming depressed.

• Patient will state and demonstrate progress in the resumption of sustaining

relationships with friends and family members within one month.
Nursing Rationale

Interventions

Initially,
provide Depressed people lack
activities that concentration and
require memory. Activities that
minimal have no ―right or
concentration wrong‖ or ―winner or
(e.g., drawing, loser‖ minimizes
playing simple opportunities for the
board games). client to put
himself/herself down.
Involve the
client in gross
motor Such activities will aid in
activities that relieving tensions and
might help in elevating
call for very
the mood.
little

concentration
(e.g.,walking).

When the
client is at the
most
depressed Maximizes the potential
state, Involve for interactions while
the client in minimizing anxietylevels.
one-toone
activity.

Eventually
involve the
client in group Socialization minimizes
activities (e.g., feelings of isolation.
group Genuine regard for others
discussions, art can increase feelings of
therapy, dance self-worth.
therapy).

Eventually
maximize the
client‘s

contacts with Contact with others

others (first distracts the client from
one other, then self-preoccupation.
two others,
etc.).

Refer the
client and The client and the family
family to can gain tremendous
selfhelp groups support and insight from
in the people sharing their
community. experiences.

3: Spiritual Distress
Nursing Diagnosis
• Spiritual Distress May be related to

• Chronic illness of self or others.

• Death or dying of self or others.

• Lack of purpose in life.

• Life changes.

• Pain.

• Self-alienation.

• Sociocultural deprivation.
Possibly evidenced by

• Expresses intense feelings of guilt.

• Expresses feelings of hopelessness and helplessness.

• Expresses being abandoned by or having anger towards God.

• Expresses concern with meaning of life/death or belief systems.

• Expresses lack of hope, meaning, or purpose in life, forgiveness of self, peace,

serenity, acceptance.

• Inability to pray.

• Inability to express previous state of creativity (e.g., writing, drawing, singing).

• Inability to participate in religious activities Lack of interest in art.

• Questions meaning of own existence.

• Refuses interaction with families, friends or religious leaders.

• Searching for a spiritual source of strength.

Desired Outcomes
• Patient will feel the connectedness with others to share thoughts, feelings, and
beliefs.

• Patient will feel the connectedness with the inner self.

• Patient will participates in spiritual rites and passages.

• Patient will discuss with nurse two things that gave his or her life meaning in the
past within 3 days.

• Patient will talk to a nurse or a spiritual leader about spiritual conflicts and concern
within 3 days.

• Patient will keep a journal tracking thoughts and feelings for one week.

• Patient will state that he/she feels a sense of forgiveness.

• Patient will state that he/she wants to participate in former creative activities.

• Patient will state that he/she gained comfort from previous spiritual practices.
Nursing
Interventions Rationale

Nursing Asse ssment

Assess what Evaluates

spiritual neglected
practices areas in the
have offered person‘s life
comfort and that, if
meaning to reactivated,
the client‘s might add
life when not comfort and
ill. meaning
during a
painful

depression.

Therapeutic Interventions
Encourage This will help
client to write in identifying
a journal important
expressing personal
thoughts and issues and
reflections one‘s thought
daily. and feelings
surrounding
spiritual
issues.
Writing a
journal is a
good way to
explore
deeper
meanings in
life.

If the client is Often

unable to speaking
write, provide aloud helps a
a tape person clarify
recorder. thinking and
explore

issues.
Discuss with When
the client depressed,
what has clients
given comfort usually are
and meaning having a hard
to the person time
in the past. searching for
meaning in
life and
reasons to go
on when
feeling
hopelessness
and
despondent.

Suggest that Spiritual

the spiritual leaders are
leader familiar in
affiliated with dealing
the facility spiritual
contact the distress and
client. can offer
comfort to the
client.

Provide When
information hospitalized,
on referrals, spiritual
when tapes and
needed, for readings can
religious or be useful;
spiritual when the
information
client is in the
(e.g., community,
client might
readings,
express other
programs, needs.
tapes,

community
resources).

4: Chronic Low Self-Esteem

Nursing Diagnosis

• Chronic Low Self-Esteem

May be related to

• Biochemical/neurophysiological imbalances.

• Feelings of shame and guilt.

• Impaired cognitive self-appraisal.

• Repeated past failure.

• Unrealistic expectation of self. Possibly evidenced by

• Evaluates self as unable to deal with events.

• Inability to recognize own achievement.

 • Negative view of self and abilities.

• Repeated expression of worthlessness.

• Rejection of a positive feedback.

• Self-negating verbalizations. Desired Outcomes

• Patient will express belief in self.

• Patient will maintain self-esteem.

• Patient will demonstrate a zest for life and ability to enjoy the present.

• Patient will identify one or two strengths by the end of the day.

• Patient will identify two unrealistic self-expectations and reformulate more realistic
life goals with nurse by the end of the day.

• Patient will identify three judgemental terms (e.g., ―I am lazy‖) client uses to
describe self and identify objective terms to replace them (e.g., ‖ I do not feel
motivated to).

• Patient will keep a daily load and identify on a scale of 1 to 10 (1 being the lowest,
10 being the highest) feelings of guilt, shame, self-hate.

• Patient will report decreased feelings of guilt, shame and self-hate by using a scale
of 1 to 10 (1 being the lowest, 10 being the highest).

• Patient will demonstrate the ability to modify unrealistic self-expectations.

• Patient will give an accurate and nonjudgmental account of four positive qualities as well as identify two areas
he or she wishes to improve.
Nursing Interventions Rationale

Nursing Assessment
Assess the self-esteem level Signs of a low
of the patient. selfesteem includes
withdrawal from social
relationships, feeling
of inadequacy, neglect
of personal hygiene
and dress, and
rejecting self which all
may indicate a
negative thought
pattern.

Therapeutic Interventions

Allow the patient to perform Paying attention to

personal care activities. grooming serves as a
first step towards
achieving positive self-
image.

Give positive feedback after a Positive reinforcement

task is achieved. has a big part in
building self-esteem.

Allow the patient to engage in Patient may feel

simple recreational activities, overwhelmed at the
advancing to a more complex start when
activities in a group participating in a group
environment. setting.
Teach visualization To promote a
techniques that can help the healthier and more
client replace negative realistic self-image by
selfimages with more positive helping the client
images and thought. choose more positive
thoughts and actions.

Encourage the client to To minimize the

participate in a group therapy feelings of isolation
where the members share the and provide an
same situations/feelings that atmosphere where
they have. positive feedback and
a more realistic
appraisal of self are
available.

Evaluate client‘s need for

assertiveness training tools to Low self-esteem
pursue things he or she wants individuals often have
or needs in life. Arrange for feelings of
training through community- unworthiness and have
based programs, personal difficulty determining
counseling, literature etc. their needs and wants.

Role model assertiveness. Clients can follow

examples/role models.
Involve the client in activities Feelings of low
that he or she wants to selfesteem can
improve by using problem- interfere with usual
solving skills. problemsolving
abilities.

Assess and evaluate the need

for more teaching in this area.
Work with the client to Cognitive distortions
identify cognitive distortions reinforce negative,
that encourage negative inaccurate perception
selfappraisal. For example: of self and the world.

1. Discounting positive 1. Focus on

attributes. negative
qualities.
2. Mind reading.

3. Overgeneralizations. 2. Assuming others

―do not like
4. Self-blame.
me‖. for
example,
without any real
evidence that
assumptions are
correct.

3. Taking one fact

or event and
making a
general rule out
of it. (―He
always‖, I
never‖).

4. Consistent
selfblame for
 everything perceived
as negative.

5: Disturbed Thought Processes

Nursing Diagnosis

• Disturbed Thought Processes

May be related to

• Biologic/medical factors.

• Biochemical/neurophysical imbalances.

• Persistent feelings of extreme guilt, fear or anxiety.

• Prolong grief reaction.

• Overwhelming life circumstances.

• Severe anxiety or depressed mood.

Possibly evidenced by

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• Decreased problem-solving abilities.

• Hypovigilance.
 • Impaired ability to grasp ideas or orders thoughts.
• Impaired attention span/easily distracted.

• Impaired insight.

• Impaired judgment, perception, decision making.

• Inaccurate interpretation of the environment.

• Memory problems/deficits.

• Negative ruminations. Desired Outcomes

• Patient will process information and makes appropriate decisions.

• Patient will accurately recall recent and remote information.

• Patient will exhibit organized thought process.

• Patient will identify two goals he or she wants to achieve from treatment, with aid
of nursing intervention, within 1 to 2 days.

• Patient will discuss with nurse two irrational thoughts about self and others by the
end of the first day.

• Patient will reframe three irrational thoughts with the nurse.

• Patient will remember to keep appointments, attend activities, and attend to

grooming with minimal reminders from others within 1 to 3 weeks.

• Patient will identify negative thoughts and rationally counter them and/or reframe
them in a positive manner within 2 weeks.

• Patient will show improved mood as demonstrated by the Beck Depression

Inventory.

• Patient will give examples showing that short-term memory and concentration have
improved to usual levels.

• Patient will demonstrate an increased ability to make appropriate decisions when

planning with the nurse.
Nursing
Interventions Rationale
Nursing Assessm ent

Determine the
client‘s previous Establishing a
level of cognitive baseline data
functioning (from allows for
client, family, evaluation of
past medical client‘s progress.
records).

Therapeutic Inte rventions

Use simple, Slowed thinking

concrete words. and difficulty
concentrating
impair
comprehension.

Allow the client Slowed thinking

to have plenty of necessitates time to
time to think and formulate a
frame responses. response.

Allow more time Usual tasks might

than usual for the take long periods of
time; demands that
client to finish
the client hurry only
usual activities of increase anxiety and
daily living slow down ability to

(ADL)
(e.g.,eating, think clearly.
dressing).
Help the client to Making rational
postpone major life decision
important major requires optimal
life decision psychophysiological
making. functioning.

While the client is

severely Decreases feelings of
depressed, guilt, anxiety and
minimize client‘s pressure.
responsibility.

Help the client Negative

identify negative ruminations add to
thinking/thoughts.
feelings of
Teach the client to
reframe and/or hopelessness and are
refute negative part of a depressed
thoughts. person‘s faulty
thought processes.

Intervening in this
process helps in
healthier and more
useful outlook in life.

Help client and A fairly and

family structure nondemanding
an environment repetitive routine is
that can help easier to both follow
reestablish set and remember.
schedules and
predictable
routines during
severe
depressions.

6: Self-Care Deficit Nursing

Diagnosis

• Self-Care Deficit
May be related to

• Anergia (Decreased or lack of motivation).

• Perceptual or cognitive impairment.

• Severe anxiety.

• Severe preoccupation.
Possibly evidenced by

• Awakening earlier or later than desired.

• Body odor/hair unwashed and unkempt.

• Constipation related to lack of exercise, roughage in diet, and poor fluid intake.

• Consuming insufficient food or nutrients to meet minimum daily requirements.

• Decreased ability to function secondary to sleep deprivation.

 • Inability to organize simple steps in hygiene and grooming.
• Persistent insomnia or hypersomnia.

• Weight loss.
Desired Outcomes

• Patient will groom and dress appropriately with help from a nursing staff and/ or
family.

• Patient will regain more normal elimination pattern with aid of foods high in
roughage, increased fluid intake, and exercise daily (also with the aid of
medications).

• Patient will sleep between 4 to 6 hours with aid of nursing measures and/or
medications.

• Patient will gain 1 pound a week with encouragement from family, significant
others, and/or staff if significant weight loss is noted.

• Patient will demonstrate progress in the maintenance of adequate hygiene and be

appropriately groomed and dressed (shave/makeup, clothes clean and neat).

• Patient will experience normal elimination with the aid of diet, fluids, and exercise
within 3 weeks.

• Patient will sleep between 6 to 8 hours per night within one month.

• Patient will gradually return to weight consistent for height and age or baseline
before illness.
Nursing Interventions Rationale

Bathing and/or Hygiene Self-CareDef icit:

Encourage the use of soap, Being clean and well

washcloth, toothbrush, shaving groomed can
equipment, make-up etc. temporarily increase
self-esteem.

Give step-by-step reminders Slowed thinking and

 such as ―Brush the teeth difficulty concentrating
―Clean the outer surfaces of make organizing simple
your upper teeth, then your tasks difficult.
lower teeth. . .‖
Constipation

Monitor intake and output, Most of the depressed

especially the bowel clients are constipated.
movements. If this problem is not
addressed, it can lead to
fecal impaction.

Encourage the intake of Fluids can help prevent

nonalcoholic and noncaffeinated constipation.
fluids, 6 to 8 glasses a day.

Offer fiber-rich foods and periods Roughage and exercise

of exercise. stimulate peristalsis and
help evacuation of fecal
material.

Evaluate the need for laxatives These prevent the

and enemas. occurrence of fecal
impaction.

Disturbed Sleep Pattern

Provide rest periods after Fatigue can intensify

activities. feelings of depression.

Encourage relaxationmeasures These measures induce

in the evening (e.g., drinking sleep and relaxation.
warm milk, back rub, or tepid
bath).
 Encourage the client to get up Minimize sleep during
and dress and to stay out of bed the day increases the
during the day. likelihood of sleep at
night.

Reduce environmental and Decreasing caffeine

physical stimulants in the and epinephrine levels
evening; Provide decaffeinated increases the possibility
coffee, soft music, soft lights of sleep.
and quiet activities.

Imbalanced Nutrition

Weight the client weekly and Give the information

observe the eating patterns of needed for revising the
the client. intervention.

Encourage eating with others. Increases socialization,

decrease focus on the
food.

Serve foods or drinks the client Clients are more likely

likes. to eat foods they like.

Encourage small, high-calorie, Minimize weight loss,

and high-protein snacks and constipation, and
fluids frequently throughout the dehydration
day and evening if weight loss is
noted.

7: Grieving
Nursing Diagnosis

•Grieving
May be related to

• Actual, perceived, or anticipated loss Possibly evidenced by

• Anger

• Changes in activity level

• Changes in immune function

• Depression

• Detachment

• Disorganization

• Emotional distress

• Giving meaning of the loss

• Psychological distress

• Sleep disturbance

• Suffering
Desired Outcomes

• Patient will engage in self-care activities at his or her own pace.

• Patient will demonstrate improvement in handling with the stages of grief at his or
her own pace.

• Patient will verbalize a sense of improvement toward resolution of hope and grief in
the subsequent time.
Nursing
Interventions Rationale
Nursing Assessme nt

Ask the patient Individuals tend to not

about the losses recognize the
that happen in his significance of a loss.
or her life. Discuss They fail to accept or
how the patient talk about their pain
view them. and seems that all is
well. Denialnecessitate
physical and psychic
energy. When people
becomes depressed,
they likely do so in a
physically and
emotionally depleted
state.

Assess the
patient‘s religious Religious beliefs and
beliefs and cultural cultural practices
practices in terms influence how people
of how they handle express and accept the
their previous grievingprocess.
losses.

Therapeutic Inter ventions

Allow the patient Expressing feelings in
to recognize and a nonthreatening
express feelings environment can aid
and determine the patients in handling
connection unresolved issues that
between the may be partly
feelings and the responsible for the

event. depression. It can also

aids patient relate the
feeling to the event.

Suggest alternative
methods to
determine and cope Allows individuals to
with underlying explore more ways in
feelings of anger, handling such
hurt, and rejection. situation.

If indicated, Provides potential

mention stories of solutions and also
how others have gives comfort to the
dealt with the same patient since the
experience. problem can be
managed.

Discuss and
educate patient the
normal stages of This allows the patient
grief and accept the the acknowledge these
reality of related normal feelings and
feelings such as remove some of the
guilt, anger, and guilt caused by these
powerlessness. feelings.

Assist the patient Before individuals can

to determine the admit to change, they

problem, recognize need clearness about

the need to address what the problem is.
the problem
differently, and
thoroughly
describe all facet of
the problem.

Assist the patient

in recognizing
early signs of This actively involves
depression and the patient and
identify methods to conveys the message
mitigate these that the patient is not
signs. If the powerless but rather
symptoms persist that options are
or worsen, suggest available.
other professional
support.

8: Hopelessness
Nursing Diagnosis

• Hopelessness
May be related to

• Losses, stressors, and the burdensome symptoms of depression

Possibly evidenced by
• Decreased affect

• Decreased judgment

• Impaired decision making

• Inability to establish goals

• Loss of interest in life

• Passivity, decreased verbalization

• Sleep disorders

• Socially repressed
 • Suicidal thoughts

• Negative ruminations Desired Outcomes

• Patient will express feelings and acceptance of life events over which he or she has
no control.

• Patient will demonstrate independent problem-solving techniques to take control

over life, and does not verbalize or demonstrate suicidality.
Nursing Interventions Rationale

Nursing Assessment

Assess individual signs of This aids focus

hopelessness. attention on
aspects of
individual
needs. These
signs may
include social
withdrawal,
decreased

physical
activity, and
comments made
by patient that
indicate despair
and
hopelessness.
Assess destructive behaviors The patient may
used to handle with feelings have tried to
such as withdrawal,
overcome
avoidance, substance abused.
feelings of
hopelessness
with harmful
and ineffective
behaviors.

Acknowledging
these behaviors
provides an
opportunity for
change.

Therapeutic Interventions

Allow the patient to express The process of

feelings and perceptions recognizing
feelings that
underlie and
drive behaviors
allows patient to
start taking

control of their
lives.
Express hope to the patient Patients may
with realistic comments about feel hopeless,
the patient‘s strengths and but it is helpful
resources. to hear positive
expression from
others.

Assist the patient determine An individual‘s

aspect of life that are under emotional state
his or her control.
may interfere
with problem
solving.

Support may be
required to
identify areas
that are under
his or her
control and to
have calrity
about options
for taking
control.

Allow the patient to assume Helping patient

responsibility for self-care, set realistic
such as setting realistic goals, goals increases
schedulingactivities, and feelings of
making independent control and
decisions. provides
satisfaction
when goals are
achieved,
thereby
decreasing
feelings of
hopelessness.

Aid the patient determine The patient

aspects of life events that are needs to
not within his or her ability to recognize and
control. Discuss feelings resolve feelings
related with this lack of related with
control. inability to
control certain
life situations
before
acceptance can
be achieved and
hopefulness
becomes
possible.

Encourage the patient to Some people

examine spiritual supports find that
that may provide hope. spiritual beliefs
and practices are
a great
 source of hope.

Conduct a suicide assessment High risk will

to identify the level of suicide require
risk. hospitalization.

Educate the patient about It is essential to

crisis intervention services give patients
such as suicide hotlines and with resources
other resources. for safety and
support when
feelings and
thoughts about
suicide become
hard to manage.

Administer antidepressants as Suicidal

indicated. thinking is a
symptom of
depression that
is managed
through proper
medication.

9: Deficient Knowledge Nursing

Diagnosis

• Deficient Knowledge
May be related to
• Unfamiliarity with the causes, signs and symptoms, and management of depression
Possibly evidenced by

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• Verbalizing inaccurate information

• Inaccurate follow-through of instruction

• Inappropriate behaviors (e.g., agitated, apathetic, hysterical, hostile)

• Questioning members of health care team Desired Outcomes

• Patient and significant other will verbalize accurate information about at least two
of the possible causes of depression, three-four of the signs and symptoms of
depression, and use of medications, psychotherapy, and electroconvulsive therapy
as treatment.
Nursing
Interventions Rationale

Nursing Assessm ent

Assess the Depression is a

patient‘s and mood disorder
significant caused by the
other‘s cumulative factors
knowledge of ongoing stressful
regarding events, genetics
depression and and chemical
its causes. imbalances in the
brain.

Therapeutic Interventions
Explain to the A major depressive
patient and episode is typically
significant others presented by the
regarding the following
major symptoms symptoms:
of depression. persistent sadness,
loss of pleasure in
normal activities,
decreased energy,
feelings of guilt,
hopelessness or
worthlessness, sleep
disturbances,
changes in apetite,
trouble thinking or
making decisions
and frequent
thoughts of death or
suicidal attempts.

Inform the Common

patient and treatment for
significant others depression are the
that depression use of
can be treated antidepressants.
through
While
medications and
psychotherapy. psychotherapy
(cognitivebehavioral
therapy,
interpersonal
therapy) alone is
given for patients
with mild
depression
associated with
situational cause.

A combination of
medications and
psychotherapy can
relieve severe
chronic cases of
depression.

Discuss the Electroconvulsive

purpose of therapy (ECT) is a
electroconvulsive medical procedure
therapy (ECT) if given to patients
indicated. who are
unresponsive with
other treatments
(medications and
psychotherapy). It is
performed for about
6 to 12 sessions
over 3 to 6 weeks.
The doctor will
place two electrodes
on sides of the
patient‘s scalp
where an electric
current is passed
between the
electrodes until a
seizure occurs. It is
usually last between
30 to 60 seconds