NURS 241 Exam 1
Quiz Q: Which of the following shows that the nurse understands the predisposing factors for hyperosmolar hyperglycemic syndrome (HHS).
"HHS occurs more oen with type 2 diabetes than type 1" "HHS occurs more oen in young adults" "HHS has high glucose because there is not enough insulin" "HHS paents can be dehydrated due to increased glucose and osmolality in the extracellular fluid" "DKA is more fatal than HHS"
Quiz Q: The parents of a 20-year-old female client diagnosed with paranoid schizophrenia admitted 4 days ago are attending a family psychoeducation group in the hospital. Which of the following statements by the mother indicates that she understands her daughter's illness and management?
"I know that I'll have to do everything for my daughter when she comes home. >>"Tasks as simple as getting out of bed and showering in the morning may be difficult for her." "I know that visits from her friends at home should be discouraged for a while." "She won't experience a relapse as long as she takes her prescribed medication."
Quiz Q: The nurse is teaching the patient receiving regular insulin. Which of the following paent statements indicates a need for further teaching? The patient will be self administering a dose at 0800.
"I will watch for signs of hypoglycemia at 2000" " I will watch for signs of hypoglycemia at 0830" >>"I will watch for signs of hypoglycemia at 1100" "I will watch for signs of hypoglycemia at 1800"
Quiz Q: A client diagnosed with schizophrenia is being switched to risperidone long-acting injection (Risperdal Consta). He is told that he will remain on his oral dose of risperidone daily for approximately 1 month. The client says, "I didn't have to take pills when I was on Prolixin shots." Which of the following responses by the nurse is most accurate?
"Taking Prolixin orally and by injection would not be as effective as the injection alone." "Risperdal Consta is less potent than Prolixin Decanoate." "The doctor didn't believe you would take both the pills and Prolixin shots." >>Risperdal Consta initially takes a little longer to reach the ideal blood level."
Major Assessment Areas to Consider for Fluids and Electrolyte Include:
*#1 Cognition*, and sensory perception. Neurological responses and cellular regulation Muscle Assessment and mobility (twitches, etc) Elimination Circulation and Perfusion
Hypotonic Solutions (Crystalloids)
*0.45% NS, D5W, D5.45 NS* -Causes fluid to move from interstitial spaces into cells *Helpful in*: dehydration, hypernatremia, excessive diuretic use, renal disorders "Caution in*: SIADH, hyponatremia, head trauma, CHF, Increased CVP, Pulmonary Edema, Edema
Isotonic Solutions (Crystalloids)
*0.9% NS, Lactated Ringers* -No movement of fluid between spaces (equal) *Helpful in*: hemorrhage, hypovolemia, shock, hypotension, dehydration *Caution in*: CHF, HTN *Avoid LR in*: DKA COPD Hyperthermia Febrile Head Trauma Metformin Use
*Maximum Potassium IV Rate*
*20mEq per hour* Safety concern if it is any higher
Hypertonic Solutions (Crystalloids)
*3.0% NS, D5.9% NS, D10* -Causes fluid to move out of cells and into intravascular space. *Helpful in*: Head trauma, increased ICP, hyponatremia, edema, acid/base imbalances *Caution in*: Increased PAWP, increased CVP, JVD, hemoconcentration
Colloids
*Albumin, blood, plasma, dextran 40* -Increases intravascular space without excess fluid. -Causes intravascular expansion "Helpful in*: edema, expansion of intravascular spaces, improving tissue perfusion, prevention of vasospasm, severe anemia *Caution in*: CHF, hypervolemia, hemoconcentration
*Sodium Treatment Nugget*
*Don't raise sodium levels more than 10 mEq/L in 24 hours.* i.e. going from 130 to 140 within 24 hours. *This can cause LIFE THREATENING cerebral edema or even paralysis*. Continue to stay on top of labs, VS, mental status and orders
*Tardive Dyskinesia*
*Earliest Sign is slow, worm like movement of the tongue* Symptoms: writhing worm like movements of tongue and face, lip-smacking, tongue thrusts. *There is no reliable treatment and it can become permanent, important to watch for because it can interfere with speech, eating, and socialization* Prevention includes: lowest dose of drugs possible or switching to SGA may help
*Magnesium Treatment Nugget*
*May lower neuropathic pain: consider this for post surgical patients such as masectomy; Mg can also improve sleep and cognition: boosting Mg improves memory*
*Potassium Treatment Nugget*
*Replace 20-60 mEq gradually over 24 hours; if administered too quickly arrhythmia can occur. It can burn veins, so we dilute it with a mainline IV and run slowly
Second Generation Antipsychotics (Examples)
-*Clozapine (Clozaril)* -Quetiapine (Seroquel) -Paliperidone (Invega) -Olanzapine (Zyprexa) -Aripipazole (Abilify) -Ziprasidone (Geodon) -Risperidone (Risperidal) -Asenapine (Saphris)
First Generation Antipsychotics (Examples)
-*Haloperidol (Haldol)* -Trifluoperazine (Stelazine) -*Chlorpromazine (Thorazine)* -Loxapine (Laxitane) -Fluphenazine (Prolixin) -Perphenazine (Trilofon) -Thioridazine (Mellaril) -Thiothixene (Navene)
*Akathisia*
-*Inability to sit still* -the most common extrapyramidal symptom of the neuroleptic medications Treated with beta blockers, benzodiazepines, and anticholinergic drugs or switching to a low potency FGA
Treatment of Hyponatremia
-Add sodium to diet via IV -Restrict fluids to further concentrate the sodium amount -Give isotonic or hypertonic solution *(Ensure replacement is given slowly because the body cannot quickly adjust and it can cause seizures and neuro changes)* -Monitor I&O and daily weight -Seizure precautions -Recheck sodium when it is reasonable for treatment option
Anticholinergic Agents (Examples)
-Cogentin -Parlodel -Artane -Benadryl
Common IV Line Problems
-Infiltration -Phlebitis -Hypothermia -Local Infection (abscess) *Hourly check if actively infusing*
Difference Between Ca and Ionized Ca
-Ionized is "free", not bound to albumin -Ionized is more "specific" -If Ca level is low check ionized to track replacement so we don't over replace -Low ionized calcium is caused by: vitamin D deficiency, and hypothyroidism -high ionized calcium is caused by hyperthyroidism, and too much calcium carbonate -Low calcium is caused by kidney failure and/or malnutrition -high calcium can be caused by cancers, bone fractures, too much calcium or vitamin D
Second Generation Antipsychotics (Atypical) (-apine or -idone)
-Less likely to cause EPS and TD -Higher risk of *metabolic effects*: weight gain, diabetes, dyslipidemia, cardiac changes -*Agranulocytosis with clozapine) -Increased risk of death when used to treat dementia related psychosis in older adults
First Generation Antipsychotics (Conventional) (-azines)
-Low, medium, or high potency classifications -MOA: Block receptors for dopamine, ACH, histamine, norepinephrine -*Adverse Effects: MC EPS and Tardive dyskinesia (TD), sedation, orthostasis, elevated prolactin levels, anticholinergic side effects* -EPS includes: acute dystonia, Parkinsonism, akathisia. Treated with Beztropine (cogentin) or diphenhydramine (benadryl)
Hypercalcemia Treatment
-May treat with diuretics and saline solution to aid in excretion of calcium -IV hydration generally helps with high calcium r/t concentration -*Monitor for reflexes and neuro status* -*Treat for constipation with high calcium* -*May give IV calcitonin which decreases calcium in serum and increases calcium excretion* -*Recheck serum blood levels after several hours*
Hypermagnesemia Treatment
-Monitor VS especially HR and BP -*May give Ca as it is an antagonist to Mg -Monitor pt's heart rhythm -Discontinue Mg containing medications like maalox -Monitor muscle involvement -*Recheck serum blood levels in a couple of hours*
Treatment of Hypernatremia
-Monitor VS especially HR and BP -Monitor I&O and daily weight -Increase fluids -Monitor Neuro assessment -Check for edema -Give Isotonic IV fluids: *change sodium levels cautiously!* 0.9%, D5W, or maybe Lactated Ringers -Recheck sodium when it is reasonable for treatment option
Hyperkalemia Treatment
-Monitor VS, especially HR and BP -Monitor I&O and daily weight -Monitor heart rhythm (tele) -Give meds like diuretics, kayexelate -*For critical values may give insulin and glucose IV, may dialyze, may give bicarb IV -*Recheck serum blood levels when pt is symptomatic; then anywhere from 4 hours to the next morning based on treatment*
Hypocalcemia Treatment
-Monitor pt's heart rhythm -May replace IV (calcium gluconate) if very low -Monitor VS, especially HR and BP -Can give oral calcium: *Give with vitamin D to help absorption* -*Foods high in calcium are yogurt, cheese, canned fish, some nuts, and seeds* -*Recheck serum blood levels in several hours to overnight*
Hypokalemia Treatment
-Monitor pt's heart rhythm -May replace orally (K-dur) or IV (potassium chloride bolus) With caution! -Monitor VS, especially HR and BP. Put pt on telemetry -Monitor I&O and daily weight -Add potassium to pt's natural diet (Bananas, melon, green leafy vegetables) -*Recheck serum blood levels q 4, 6, 8, 12, etc based on replacement method*
Hypomagnesemia Treatment
-Monitor pt's heart rhythm -Replace orally or IV -Monitor VS especially HR and BP -*Monitor renal function and labs* -*Add Mg to natural diet in nuts, avocado, whole grains* -*Recheck serum blood levels in a couple of hours*
*Calcium Treatment Nugget*
-Oral replacement is usually calcium carbonate -*Beta blockers (atenolol) can interfere with calcium: space out these meds (hours)!* -IV replacement is usually Calcium chloride (best in shock) or calcium gluconate (less corrosive to veins) -*Give CAREFULLY! Have the pt on a cardiac monitor, and check VS!*
*Schizophrenia Risk Factors*
-Season of birth (late winter/early spring) -Growing up in an urban environment -Stressful life events -Cannabis use -Sibling with disease -Pregnancy and birth complications (hypoxia, greater paternal age) -Viral infection -Malnutrition -Maternal Diabetes -Familial hx of mood disorder -Later age of onset -Female Gender -Abrupt onset of symptoms following precipitating factor -Low socioeconomic status
Schizophrenia Pathophysiology
-Still uncertain -Possibility of dopamine excess -Viral infection (prenatal exposures) -Anatomic abnormalities such as ventricular enlargement, thinning of the prefrontal cortex (last part of the brain to develop), lack of symmetry, reduction in brain volume (could also be from longterm antipsychotic use)
Anticholinergic Agents
-used to treat EPS resulting from antipsychotic medication use. Can be given orally and IM if needed in an emergency
Normal Creatinine
0.5-1.2
Dehydration occurs with ___% or more body mass lost as fluid?
1%
Quiz Q: The nurse has a new admission paent with a history of Type 1 diabetes who is awake and stang severe abdominal pain and who also appears to be breathing very deeply and labored with a respiratory rate of 24. The provider has not seen the paent. Put the following nursing acons in order from first acon to last acon.
1. Assess airway, breathing, and SaO2 2. Assess perfusion with blood pressure and pulse measurement 3. Check blood sugar 4. Call the provider 5. Inquire about dates of toe fungus treatment
Quiz Q: The following are all interventions for DKA. Put them in the right therapeutic order.
1. Obtain serum glucose 2. Infuse 0.9% NS at 250 mL/hr x 1 liter 3. Initiate potassium therapy 4. Initiate insulin therapy
Normal Urine Specific Gravity
1.010-1.030
Normal Magnesium (Mg) Value
1.8-2.6
Insensible Fluid Loss Per Day Is. . .
1100 mL without illness or injury
Normal Sodium (Na) Value
135-145 mEq/L
1 Liter = _____ pounds
2.2 lb/1kg
Normal Serum Osmolarity
280-300 mOsm/kg
Normal Potassium (K) Value
3.5-5.0 mEq/L
Normal BUN
6-25
Glomerular Filtration Rate (GFR)
90-120 mL/min
Quiz Q: Which of the following patient statements indicates the need for more education regarding diabetic ketoacidosis (DKA)?
>> "My body is making at least a little insulin" "When I go home, I need to check my blood sugar every day, and maybe more frequently when I am stressed or super busy" "If my family says my breath smells funny, I should check my blood sugar" >> "I need to watch for flushed skin, dry mouth, and weight gain to know when my blood sugar is elevated"
Quiz Q: A client has been perceiving her roommate's stuffed animal as her own dog at home. The nurse determines that this misperception of reality (illusion) is improving when the client makes which of the following statements?
>>"Myrtle's stuffed dog looks somewhat like my dog Phoebe." "Myrtle's dog and my dog could be twins." "I wish Myrtle hadn't had my dog stuffed." "I guess Myrtle needs a dog as much as I do."
Quiz Q: Match the following nursing interventions as correct or incorrect nursing interventions for DKA.
>>0.9% NS at 100 mL/hour (good rate) >>Recheck Glucose every hour and PRN (timely!) Recheck glucose every 6-12 hours 0.9% NS at 350 mL/hour >>Drop glucose slowly to avoid complications such as changes in ICP Drop glucose as fast as possible to avoid complications such as changes in ICP
Quiz Q: Which of the following best represents the symptoms the nurse should assess for and prioritize with diabetic ketoacidosis (DKA).
>>Blood sugar 650, confusion, vision changes Blood sugar 650, fluid volume excess, vision changes Blood sugar 65, confusion, nausea, vomiting Blood sugar 65, nausea and vomiting, agitation
Quiz Q: A client with a long history of paranoid schizophrenia is readmitted voluntarily after missing his last two injections of haloperidol decanoate. He reports, "I'm not sleeping much and my friend says I smell from not showering. God is telling me to protect myself from others. My parents are sick and tired of me and my illness. They wish I was dead." Which of the following admission notes by the nurse contains assumptions and potentially false accusations? Select all that apply.
>>Client has been noncompliant with his medications, causing decreased sleep and activities of daily living, increased auditory hallucinations and paranoid delusions about his parents harming him. Client has missed two injections of haloperidol decanoate and was admitted voluntarily. He reports he has decreased sleep and showering and that he hears God's voice telling him to protect himself from others. He stated, "My parents are sick and tired of me and my illness. They wish I was dead." >>Client has missed two doses of haloperidol decanoate. He's not sleeping and showering. Has strained relationship with his parents and delusions that they want him dead. voluntary admission to restart haloperidol decanoate. >>Client admitted for noncompliance with haloperidol decanoate injections, sleep disturbance, poor hygiene, auditory hallucinations, and suspiciousness of his parents. Needs to be monitored for suicidal and homicidal ideation. >>Client admitted because of hallucinations and delusions. His parents may be abusing him. He states he has not taken his medications for 2 days.
Quiz Q: Match the following as correct or incorrect components of diabetic ketoacidosis (DKA).
>>Posive ketones pH>7.45 Negave ketones Fluid volume excess >>pH <7.30 >>Fluid volume deficit
Quiz Q: One of the important aspects of the client's rights is the right to treatment in the least restrictive environment. The nurse observes this principle when making which decisions? Select all that apply.
>>Referring a client to a group home or supervised apartment living. Releasing client information to a primary care physician or a relative. >>Placing a client in seclusion or restraints. Respecting the client's right to accept or refuse treatment. >>Placing a committed client in a daily outpatient group or a weekly self-help group.
Quiz Q: 1. Which of the following nursing interventions would the nurse perform for the client with psychosis/schizophrenia? Select all that apply.
>>a. Assess home medications and current doses, and verify proper administration/dosing with patient >>b. Assess labs including electrolytes and any substance abuse toxicity reports >>c. Look for S/sx of suicidal ideation, thoughts, or plans. >>d. Assess any available MRI or CT scans to rule out injury
Quiz Q: 1. Which of the following predisposing factors are most prevalent in the development of psychosis?
>>a. White/Caucasion ethnicity b. High income >>c. Substance Abuse d. Age 65+ >>e. Encephalitis and/or other infections
Quiz Q: During a home visit, the nurse discovers that the client is less verbal, less active, less responsive to directions, and severely anxious. The nurse interprets these findings to indicate that the client needs which intervention?
A sleep aid. A clinic appointment. Increased dose of medication. >>Hospitalization.
DSM Schizophrenia Criteria
A: Two or more of the following during a one month period for a significant amount of time -Delusions -Hallucinations -Disorganized Speech -Grossly disorganized or catatonic behavior -Negative Symtpoms B: Decreased level of functioning in: -Work -Interpersonal Relationships -Self-care C: Continuous signs of the disturbance for at least 6 months (possibly why it takes 6 months to diagnose) D: Other mood disorders ruled out E: the disturbance is not attributable to effects of medications or other medical conditions F: Hx of autism, an additional diagnosis is only made when prominent delusions or hallucinations are present
Negative Symptoms
Altered affect (facial expression), lack of goal directed behaviors (including grooming and self-care), lack of energy, social isolation, lack of emotion, slowed speech, lack of abstract thought, changes in movement (Akithesia: inability to sit still). Harder to treat than positive symptoms.
Quiz Q: A client is brought to the emergency department by the police after threatening to kill her ex-husband. She states emphatically, "The police should bring him in, not me. He's paranoid about my dating and has been stalking us for weeks. He's probably off his medicines. His case manager and the police won't do anything." Which are the most urgent priorities for this client? Select all that apply.
Ask about the marital problems leading to the divorce. >>Assess her risk for harm to herself and others. Obtain the name of her ex-husband's case manager. >>Ask the police about the client's reports of stalking by her ex-husband. Request a psychiatric consult for the client. >>Interview the client about her current situation and her immediate needs.
Quiz Q: The nurse notes that a client sitting in a chair has not gotten up in 1 hour. The client does not respond to verbal directions, and her arm has been extended over the armrest for 30 minutes. Which of the following should the nurse do next?
Assist the client out of the chair to lead her back to bed. >>Give p.r.n.-ordered doses of haloperidol and lorazepam. Ask the client to describe what is being experienced right now. Sit quietly with the client until she begins to respond.
Quiz Q: When preparing the teaching plan for a client who is to start clozapine, which of the following is crucial to include?
Description of akathisia and drug-induced parkinsonism. Measures to relieve episodes of diarrhea. The importance of reporting insomnia. >>An emphasis on the need for weekly blood tests.
*Acute Dystonia*
Develops within the first few days of therapy; often within hours of the first dose Severe spasm of the muscles of the tongue, face, neck, or back. Laryngeal dystonia can cause respiratory distress Treated with benztropine and diphenhydramine. Symptoms resolve in minutes.
Quiz Q: The nurse knows that which of the following are the best medication interventions for DKA? Pick the correct medications in the correctly priorized order.
Insulin 100 units subcutaneously for loading then titrated IV insulin infusion to maintain stable blood sugars, potential potassium replacement Insulin 5 units subcutaneously for loading then titrated IV insulin infusion to maintain stable blood sugars, potential potassium replacement Titrated IV infusion to gain control then switch to subcutaneous insulin to maintain stable blood sugars, potential magnesium replacement >>Titrated IV infusion to gain control then switch to subcutaneous insulin to maintain stable blood sugars, potential potassium replacement
Normal Intake and Output/day in mL
Intake: 2000 mL Output: 800-2000 mL
Calcium is responsible for. . .
Maintaining bone mass and strength (ionized Ca is more accurate bc it = free Ca). It also binds with albumin. Works with phosphorus and Mg. (inversely r/t phosphorus)
Normal Hemoglobin (Men and Women)
Men: 13.5-17.5 Women: 12-15.5
Normal Hematocrit (Men and Women)
Men: 38.8-50 Women: 34.9-44.5
Normal Calcium (Ca) Value (Ionized and non)
Non-Ionized: 9-10.5 Ionized: 4.64-5.28
Schizophrenia Stages
Phase I: Premorbid phase signs occur before clear evidence of disease and include personality changes, poor relationships, poor academic performance and antisocial behaviors Phase II: Prodromal signs manifest as developing schizophrenia such as decrease in functional ability, withdrawn, signs of cognitive impairment emergence Phase III: Psychosis Phase IV: Residual phase in which symptoms are less severe or no longer present, intermittent periods of remission
*Neuroleptic Malignant Syndrome*
Rare but serious; If pt is experiencing high fever and EPS severely this should be suspected. Take patient off off antipsychotic IMMEADIATELY Symptoms: "lead pipe" ridgity, sudden high fever, sweating, autonomic instability, dysrhythmias, seizures, coma. Most common with high potency FGAs If continuing therapy 1) wait 2 weeks before resuming 2) lowest effective dose should be used 3) Avoid high potency agents (more common with them)
Positive Symptoms
Schizophrenic symptoms that involve behavioral excesses or peculiarities, paranoid, bizarre behavior, and wild flights of ideas. Loose associations in speech, word salad, echolalia (repeat things like "I need help") -Hallucinations: Auditory are the most common,. If hallucinations are present the nurse should attempt to discern the content of the hallucinations are ensure pt that they are not real. *Under no circumstances should the nurse reinforce the hallucinations!* -Delusions: false, fixed beliefs that cannot be altered by use of logic or reasoning. *Persecution*: pt believes they're being followed by the government. *Grandeur*: "I am the president". *Reference*: "The news anchor is sending me a message".
Hypomagnesemia S/Sx & Causes
Signs: -*Can cause severe cardiac rhythm disturbances like Torsades* -*May not have symptoms* -Twitches, tremors, muscle cramps, hyperreflexia Can be caused from: -Can occur from alcoholism or malabsorption such as with bowel surgery -*Drugs that harm the kidneys like ATB can cause over excretion of Mg*
Hypermagnesemia S/Sx & Causes
Signs: -Can cause severe cardiac rhythm disturbances like heart blocks and long QT intervals -may see muscle weakness and diminished relfexes Can be caused from: -High antacid and laxative use -Seen with DKA
Hyponatremia S/Sx & Causes
Signs: -Change in CNS (NEURO). Assess for confusion. -Change in muscle control (leg cramps/twitching) -*RISK FOR SEIZURE* Can be caused from: -Low salt diet -hypotonic fluid deficit -Diaphoresis, CHF, wound drainage *More common than hypernatremia*
Hypocalcemia S/Sx & Causes
Signs: -Muscles, nerves and heart conduction affected -Assess for hyperreflexia, hyperactive bowel sounds -Confusion -More common with malnutrition, hypothyroid, decreased vitamin D, or decreased Mg Can be caused from: -Associated with low protein -low ionized Ca is less affected by protein levels because it is not in the bone -Inversely r/t phosphorus
Hypercalcemia S/Sx & Causes
Signs: -Tiredness, weakness, lethargy -Cardiac rhythm changes (its a muscle) -Low Phosphorus levels Can be caused from: -Can be seen with hyperthyroidism -Can be seen with cancer, especially bone or mets -Can be seen in total care patients who don't move
Hyperkalemia S/Sx & Causes
Signs: -With acidosis, will see high K+ -*May have numbness/tingling* -*May have palpitations* -May have nausea/vomiting Can be caused from: -Seen with / caused by chronic kidney disease, type I diabetes -*Caused by ACEI (-prils) (THINK INCREASED K+)* -Caused by overuse of supplements -Caused by burns and traumas
Hypernatremia S/Sx & Causes
Signs: -high serum osmolality (thicker bc blood is concentrated; high you're dry) -Confusion -Muscle twitches -seizures Can be caused from: -Nausea c difficulty swallowing -Diuretic use -High sodium diet -Dehydration (concentrated) -high protein low fluid diet -ADH imbalance -Abnormal Kidney function (excretion) *Less common than hyponatremia*
Hypokalemia S/Sx & Causes
Signs: -low potassium is seen with alka"LOW"sis -*Assess for weakness, tiredness, cramping* -*May have palpitations* heart "skipping beats" -Can cause nausea/vomiting Can be caused from: -Seen with / caused by chronic kidney disease -Associated with diarrhea, excessive laxative use, excessive vomiting -Caused by diuretics, bariatric surgery, alcoholism
Neuro Involvement Electrolyte
Sodium
Quiz Q: A common starting insulin titration dose is regular insulin 0.1 units/kg/hr. An insulin to help transition someone from insulin infusion to subcutaneous insulin might be insulin glargine 0.25 units/kg. This is protective against rebound hyperglycemia while protecting against hypoglycemia. >> = appropriate dose
Subcutaneous insulin glargine 52 units for 300 pound patient. >>Insulin infusion 8.4 units/kg/hour for 185 pound pt >>Subcutaneous insulin glargine 22 units for 195 pound pt >>a 165 pound paent is receiving an insulin infusion of 7.5 units per hour A 275 pound pt is receiving a regular insulin infusion of 19.5 units per hour Insulin infusion of 7.5 units/kg/hr for 120 pound pt
Mg Note
When replacing Mg we prefer it at the higher end in cardiac patients because they do better. We may still give it if values are "normal" because of this.
Schizophrenia
a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression; life long disease present in all cultures and populations. Peak onset is early to mid 20's!
Quiz Q: 1. The nurse is taking care of the client with schizophrenia who has current visual hallucinations of seeing bats in the room. Which of the following statements indicate that the nurse understands therapeutic communication techniques for the situation. Select all that apply.
a. "I'm sure it will get better when your meds kick in" >>b. "So what you are saying is that you are seeing small flying animals" c. "Let's see what's on TV" >>d. "I am not seeing bats in the activity room" >>e. "I will just sit here quietly with you. If you want to talk about it, that's ok."
Quiz Q: 1. Which interventions should you anticipate for a patient with isotonic dehydration?
a. 0.45% NS >>b. 0.9% NS c. Dextrose 10% in water d. Dextrose 5% in water
Quiz Q: 1. Which of the following best represents accurate, prioritized, initial nursing assessment of the client with psychosis who has fasciculation's (muscle twitching) of the arms and legs?
a. Assess medication hx, intake and output, and birth hx b. Assess mental health hx, electrolytes and heart tones >>c. Assess medication hx, electrolytes, and cranial nerves d. Assess mental health hx, BUN/creatinine, general appearance
Quiz Q: 1. The nurse is taking care of a new admission patient with known schizophrenia who has been having diarrhea for 3 days from a new medication regimen. The patient is restless agitated and has twitching in their face and hands. The patient states "They can't go on like this". Put the following nursing interventions in order or prioritization:
a. Assess that the patient is safe and free from imminent danger including suicidal ideation b. Assess patient vital signs, intake and output, and basic neurological orientation c. Assess lab values including magnesium and sodium d. Notify the provider of findings e. Start IV fluids of 0.9 NS with 20 mEq K (THESE ARE ALREADY IN THE CORRECT ORDER)
Quiz Q: The nurse is taking care of the patient with acute paranoid schizophrenia. Which of the following medication orders is the most correct?
a. Haldol deconate/haloperidol 0.15 mg IM x 1 for acute psychosis b. Haldol deconate/haloperidol 15 mg IM x 1 for acute psychosis >>c. Haldol deconate/haloperidol 1.5 mg orally every 12 hours d. Haldol deconate/haloperidol 150 mg orally every 12 hours
Quiz Q: 1. Match the lab profile with the most likely fluid imbalance.
a. Hgb 13.2 yesterday. 10.1 today; urine specific gravity 1.001 >>(Fluid volume excess) b. Na 148; Hct 40% yesterday, 49% today; serum osmolality 308 >>(Fluid volume deficit) c. BUN 45; Cr 0.7 >>(Fluid Volume Deficit)
Quiz Q: 1. Your patient is a 67 year old unconscious patient with a fever, saline lock IV site, and orders for 1000 mL tube feeding q 24 hours. Does the data from this case point to FVD or FVE?
a. Neither fluid volume deficit or excess >>b. Fluid volume deficit c. Fluid volume excess
Quiz Q: 1. Which assessment finding best indicates that fluid resuscitation therapy for the patient with hypertonic dehydration has achieved the desired effect?
a. Serum osmolality has changed from 375m/Osmol/kg to 400m/Osmol/kg >>b. Serum osmolality has changed from 375m/Osmol/kg to 300m/Osmol/kg c. Pulse ox shows oxygen sat of 95% d. Peripheral pulses changed from 1+ to 3+ e. Neck veins slightly distended at 30 degrees
*Parkinsonism*
bradykinesia, mask-like faces, rigidity, shuffling gait, drooling, tremors, cog wheeling Treated with benztropine, diphenhydramine, amantadine temporarily until resolution or switch to SGA
Oculogyric Crisis
fixation of the eyeballs in an upward position
Give Hypertonic Fluids Post Operative Because. . .
it helps with excretion and that is why we want patients to use the bathroom and excrete after surgeries
Sodium is responsible for. . .
maintenance of ECF, and essential for neurological function
Potassium is responsible for. . .
maintenance of ICF, and essential for muscle contraction
Oliguria
urine output < 500 mL per day
Quiz Q: A client is sitting in the corner of the dayroom cocking his head to one side as if he hears something, but no one is nearby. The nurse suspects he is having auditory hallucinations. Which of the following questions should the nurse ask first?
"Are you seeing someone other than me?" >>"What are you hearing right now?" "What is going on with you right now?" "Do you want to go to the recreation room?"
