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EXAM INFORMATION
Total Questions: 60
Recommended Time: 90 Minutes
Passing Threshold: 80%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Professional Decision-Making Questions
Difficulty Level: Dynamically Determined Based on Exam Scope
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SECTION 1: Therapeutic Communication and the Nurse-Patient Relationship
Question 1: A client diagnosed with major depressive disorder states, "I just feel so
empty inside, like nothing matters anymore." Which response by the practical nurse
demonstrates the most effective use of therapeutic communication?
A. "You should try to think about all the good things in your life."
B. "Tell me more about what it feels like to be empty inside."
C. "I know exactly how you feel; I have been depressed before too."
D. "Have you talked to your doctor about increasing your medication?"
Correct Answer: B
,Rationale: Therapeutic communication involves active listening, empathy, and
encouraging the client to express feelings. Option B uses an open-ended statement that
invites the client to elaborate on their emotional experience without judgment. Option A
minimizes the client's feelings and offers unsolicited advice. Option C shifts the focus
to the nurse's personal experience, which is not therapeutic. Option D changes the
subject to medication rather than addressing the client's expressed feelings.
Question 2: During a group therapy session, a client with borderline personality disorder
becomes angry and shouts, "You nurses are all the same! You pretend to care but you
really don't!" Which response by the practical nurse is most therapeutic?
A. "I can see that you are upset. Let's talk about what is bothering you."
B. "That is not true. I do care about you and your progress."
C. "If you continue to yell, you will need to leave the group session."
D. "Why do you think that none of the nurses care about you?"
Correct Answer: A
Rationale: Option A validates the client's emotion while setting a calm, professional tone
and inviting further discussion. Option B becomes defensive, which can escalate
conflict. Option C is punitive and may increase the client's sense of abandonment.
Option D uses the non-therapeutic technique of asking "why," which can make the client
feel interrogated or criticized.
,Question 3: A client with schizophrenia tells the practical nurse, "The voices are telling
me not to take my medication because it is poison." Which nursing response is most
appropriate?
A. "I do not hear any voices. The medication is safe and you need to take it."
B. "What do the voices sound like and how long have you been hearing them?"
C. "I understand the voices are frightening you, but the medication will help you feel
better."
D. "If you do not take your medication, you will have to stay in the hospital longer."
Correct Answer: C
Rationale: Option C validates the client's experience of the hallucination without arguing
about its reality, while providing a therapeutic reason for medication adherence. Option
A argues with the hallucination, which is non-therapeutic and can increase the client's
distress. Option B focuses on the characteristics of the hallucination rather than
addressing the immediate concern about medication. Option D uses threats, which is
coercive and damages the therapeutic relationship.
Question 4: A practical nurse is caring for a client who has just received news of a
terminal diagnosis. The client states, "I can't believe this is happening. I have so much
left to do." The nurse recognizes this statement as indicative of which stage of grief?
A. Denial
B. Anger
C. Bargaining
D. Depression
, Correct Answer: A
Rationale: The client's statement reflects disbelief and difficulty accepting the reality of
the diagnosis, which are characteristic of the denial stage of grief according to
Kubler-Ross. Denial serves as a protective mechanism that buffers the initial shock of
bad news. Anger would involve expressions of rage or blame. Bargaining involves
attempts to negotiate for more time. Depression involves profound sadness and
withdrawal.
Question 5: A client with bipolar disorder in the manic phase is pacing rapidly around
the unit, talking loudly, and interrupting other clients' conversations. Which nursing
intervention is the priority?
A. Engage the client in a competitive card game to redirect energy.
B. Provide a quiet environment and set clear, consistent limits on behavior.
C. Ask the client to write down all thoughts to process them later.
D. Allow the client to continue pacing until fatigue naturally occurs.
Correct Answer: B
Rationale: During the manic phase, clients have decreased ability to concentrate and are
easily overstimulated. Providing a quiet environment reduces external stimuli, and
setting clear, consistent limits maintains safety and structure for the client and others.
Option A could increase stimulation and agitation. Option C is unrealistic given the
client's current level of distractibility. Option D ignores the need for intervention and
could lead to exhaustion or injury.