NURS 2500 Chapter Review Questions and NTKs from my notes

A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern?

"Do you feel afraid that people are trying to hurt you?"

Lester and Eileen have always enjoyed gambling. Lately, Eileen has discovered that their savings account is down by $50,000. Eileen insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states:

"Gambling activates the reward pathways in my brain."

Which client response indicates the that the client is in denial of having an addiction to marijuana and shows use of another defense mechanism?

"I only smoke when I'm stressed. It's not an everyday thing for me"

A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when stating what?

"I realize that there is a higher power that can help me." Rationale: Coming to believe that a power greater than oneself could help restore sanity reflects the second step of AA. Admitting to one's self and others about wrongdoings reflects step 5 of AA. Admitting powerlessness over alcohol is step 1. Making amends is part of step 9.

When teaching a patient with HIV infection about transmission of the virus to others, which statement made by the patient would indicate a need for further teaching?

"I will need to isolate any tissues I use so as not to infect my family."

A patient was recently diagnosed with a sinus infection and prescribed a 10-day course of an antibiotic. After 3 days the patient felt back to normal and informed the nurse that he decided to stop the antibiotics and save the rest of the antibiotics in case he gets another infection. Which statement would the nurse include when providing education to the patient?

"If you are prescribed antibiotics, you should complete the entire course of treatment because you may create drug resistance by stopping early."

Which statement made by a family member tends to support a diagnosis of delirium rather than dementia?

"She was fine last night but this morning she was confused."

The nurse is reinforcing teaching with a patient newly diagnosed with amyotrophic lateral sclerosis (ALS). Which statement would be appropriate to include in the teaching?

"This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

A pregnant woman is newly diagnosed with human immunodeficiency virus (HIV) infection is upset. What would the nurse teach this patient about her baby's risk of being born with HIV infection?

"Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."

Which statement made by the primary caregiver of a patient diagnosed with dementia demonstrates accurate understanding of providing the patient with a safe environment?

"We've installed locks on all the outside doors."

the nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggest to the nurse that the client has a need for additional information?

"When I have command hallucinations, I'll call a friend for help."

Darnell is an 84-year-old widower who has lived alone since his wife died 6 years ago. A neighbor called Darnell's son to tell him that Darnell was trying to start his car from the passenger's side. He became angry and aggressive when the car would not start. After a medical assessment, Darnell was diagnosed with a major neurocognitive disorder. The nurse realized additional family teaching is necessary when Darnell's son states:

"With person-centered care, my father will be able to remain in his home."

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes?

"You say you hear voices, what are they telling you?"

A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication?

"reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."

The nurse is teaching a new LPN about therapeutic communication with a heroin addict. The nurse knows the teaching is effective when he states:

"teach the patient about harmful effects of drug use, support groups, and methadone"

Exemplar: Anaphylaxis

- IgE induced exaggerated immune response 1. Cellular and metabolic changes leading to rapid systemic decline-death 2. Treatment algorithm aa. airway protection, oxygen, intubation bb. epinephrine cc. H1 (diphenhydramine) and H2 blockers (Cimetidine; Ranitidine; Famotidine; Nizatidine) dd. corticosteroids (Beclomethasone; Budesonide; Circlesonide; Flunisolide; Fluticasone; Mometasone; Triamcinolone) ee. IVF ff. antiemetics, symptomatic care gg. albuterol hh. monitor, watch, educate

*NTK S/S of Primary Immunosuppression (There are 70 types)

- What are the warning signs?-four or more new ear infections within 1 year; -two or more serious sinus infections within 1 year; -2 or more months of taking antibiotics with little effect; -two or more pneumonias within 1 year; -failure of an infant to gain weight or grow normally; -recurrent, deep skin or organ abscesses; -persistent thrush in mouth or fungal infection on skin; -need for intravenous antibiotics to clear infections; -two or more deep-seated infections; -family history of primary immunodeficiency

Creatinine =

0.7 to 1.3 (men); 0.6 to 1.1 (women)

Exemplar: Systemic Lupus Erythematous (SLE, Lupus)

1. Autoimmune (inflammatory) disorder 2. Childbearing aged women, AF and Asian. Post sun, medication, environmental exposures 3. Systemic organs effected, primarily skin, kidneys, joints, heart. BH and cognitive problems 4. Symptoms: diffuse. Classic butterfly rash, fatigue, HA, joint pain, fatigue 5. Assessment & diagnostics: ANA titer, Sm titer, DNA titers, biopsies 6. Intraprofessional care aa. drugs: NSAIDs, Plaquenil, careful steroids with acute flares, biologics, methotrexate bb. tailored plan to organs affected cc. supportive, chronic care of client with activities of daily living affected

Exemplar: Myasthenia Gravis

1. Autoimmune disease (affecting acetylcholine receptors) 2. Pathophysiology 3. Symptoms 4. Intraprofessional care aa. diagnostics: Anti-AChR titers, Tensilon test, electromyography bb. drugs: pyridostigmine, steroids, biologics. Avoidance of choleresterace drugs. cc. care during myasthenia crisis aimed at airway protection and avoiding aspiration dd. nursing care: rest, adherence, disease education, aspiration avoidance

*NTK Early warning signs developed by The National Institute of Aging and Alzheimer's Association

1. Memory loss that affects job skills 2. Problems with abstract thinking 3. Difficulty performing familiar tasks 4. Problems with language 5. Disorientation to time and place 6. Poor or ↓ judgment 7. Misplacing things 8. Changes in mood 9. Changes in personality 10. Loss of initiative

*NTK AST (aspartate transaminase, a liver enzyme)

10 to 40 U/L

CIWA is for

10-item scale used in the assessment and management of alcohol withdrawal; the total value of the 10 items correlates to the severity of alcohol withdrawal

Sodium =

135 to 145

Hgb =

14 to 18 (men); 12 to 16 (women)

*NTK Normal range for ammonia levels

15 to 45 mcg/dL

CO2 =

23 to 29

Potassium =

3.5 to 5

A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?

4 to 12 Rationale: Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake.

The nurse is providing care to a client who has abused alcohol for several years and is monitoring the client for signs of alcohol withdrawal, anticipating that they would begin within how many hours after the client has the last drink?

4 to 12 hours Rationale: In clients with alcoholism and in chronic drinkers, the alcohol withdrawal syndrome usually begins within 12 hours after abrupt discontinuation or attempt to decrease consumption.

ALT =

4 to 36

AST =

40 to 50

Hct =

41 to 50% (men); 36 to 48% women

BUN =

6 to 24

*NTK max score for CIWA is

67

*NTK ALT (alanine transaminase, a liver enzyme)

7 to 56 U/L

*NTK Bilirubin =

< 1 mg/dL (will be elevated with hepatitis; causes jaundice and dark urine)

Which client is exhibiting the effects of alcohol tolerance?

A 22-year-old who now drinks nine or ten drinks in order to get the same effect that the client used to get from drinking a six pack Rationale: Tolerance is a symptom of alcohol dependence, which is an alcohol use disorder. Alcohol withdrawal and organic brain damage are problems that result directly from the effects of alcohol on the central nervous system and are considered alcohol-induced disorders.

Which patient is most at risk for developing delirium?

A 78-yr-old man admitted to the medical unit with complications of heart failure

*NTK Which Hepatitis' do we have immunoglobins and vaccines for?

A and B

The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) infection for several years. Which assessment finding would the nurse recognize as being a sign of an acute exacerbation of the disease?

A sharp decrease in the patient's CD4+ count

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention?

A structured program of activities in which the client can participate

Nancy is a nurse. After talking with her mother, she became concerned enough to drive over and check on her. Her mother's appearance is disheveled, words are nonsensical, smells strongly of urine, and there is a stain on her dressing gown. Nancy recognizes that her mother's condition is likely temporary due to:

A urinary tract infection

*NTK What are liver enzymes?

ALT 7 to 56 U/L and AST 10 to 40 U/L

*NTK 7 to 56 U/L =

ALT normal range (alanine transaminase, a liver enzyme)

*NTK 10 to 40 U/L =

AST normal range (aspartate transaminase, a liver enzyme)

In a person having an acute rejection of a transplanted kidney, what would help the nurse understand the course of events?

Acute rejection can be treated with OKT3; Repeated episodes of acute rejection can lead to chronic rejection; Acute rejection is common after a transplant and can be treated with drug therapy.

A client is being hospitalized after passing out from binge drinking. The client appears calm, but the family is anxious. The client's mother begins to cry and states "My son is destroying his brain. His habits are hard to deal with. The nurse should recommend the family attend which of the following support groups?

Al-Anon

The nurse should recommend which of the following self-help groups for a 14-year-old recovering heroin addict that was sold into prostitution?

Alateen

To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition?

Alcohol use disorder; Major depressive disorder; Polydipsia; Metabolic syndrome

The nurse teaches the staff that standard precautions would be used when providing care for which type of patient?

All patients regardless of diagnosis

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?

Always afraid another student will steal her belongings.

Most common form of dementia?

Alzheimer's disease (AD)

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:

Anxiety and depression.

The nurse is caring for a patient admitted to the hospital with pneumonia that has a history of misusing a variety of sedative-hypnotic drugs. Which manifestations noted by the nurse could be attributed to withdrawal?

Anxiety; Tremors; Seizures; Delirium

In the 2 months after his wife's death, Aaron, aged 90 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate?

Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.

*NTK Maintenance.

As unhealthy behaviors are incrementally replaced with healthier ones, they may join a support group to discuss keeping up their efforts long term.

The nurse is providing care for a patient admitted with alcohol withdrawal delirium. Which intervention would be the first priority for the nurse?

Asking the patient about his last alcohol intake

A patient is admitted to the emergency department (ED) with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. If the nurse suspects the patient is at risk for HIV infection, what nursing assessments will help identify HIV as the cause of the patient's manifestations?

Assessment of sexual behavior; Assessment of drug and syringe use

Association between HLA antigens and diseases is most commonly found in what disease conditions?

Autoimmune disorders

Disulfiram has been prescribed for a client receiving treatment for alcoholism. Which should be included in the client's plan of care?

Avoid all products containing alcohol Rationale: The client must read product labels carefully because any product containing alcohol can produce symptoms, such as sweating, nausea and vomiting, and severe hypotension. The medication does not affect motor response. The client will not need weekly blood alcohol levels drawn.

A client is unwilling to go to his church because his ex-girlfriend goes there, and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care the address is which personality disorder?

Avoidant

*NTK Why is liver function monitored with the four-drug TB treatment regimen?

Because all 4 drugs can cause non-viral hepatitis (these drugs are Isoniazid, Rifampin, Pyrazinamide, and Ethambutol)

Safe alcohol withdrawal usually is accomplished with the administration of which medication classification?

Benzodiazepines Rationale: Benzodiazepines are used for safe withdrawal of alcohol.

*NTK Opioid Intoxication

Bradycardia (slow pulse) Hypotension (low bp) Hypothermia (low body temp) Sedation Meiosis (pinpoint pupils) Hypokinesis (slowed movement) Slurred speech Head nodding Euphoria Analgesia (pain-killing effects) Calmness

Cocaine =

CHF and vasospasms with MI

A client is brought to the emergency department by a friend who tells the staff that the friend thinks the client has overdosed on cocaine. Which findings would help support this situation? Select all that apply.

Cardiac dysrhythmia Seizures Respiratory depression Chest pain Rationale: Signs of overdose include cardiac dysrhythmias or arrest, increased or lowered blood pressure, chest pain, vomiting, seizures, psychosis, confusion, dyskinesias, dystonias, and coma. Nystagmus is a sign of inhalant overdose.

Given prophylactically to bacterial meningitis exposure

Ceftriaxone

*NTK What is an emergency situation that is sometimes caused by use of the TB treatment drug, Ethambutol?

Changes in color vision or acuity **top tip NCLEX loves**

A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?

Chlordiazepoxide Rationale: Chlordiazepoxide would be the drug of choice to manage alcohol withdrawal.

Medications for Alzheimer's Disease - _____ are given for decreased memory and cognition.

Cholinesterase inhibitors i.e. donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne) and N-methyl-D-aspartate (NMDA)—blocks action of glutamate i.e. memantine (Namenda)

A nurse was accidently stuck with a needle used on a patient with human immunodeficiency virus (HIV) infection. After reporting the incident, what care would the nurse receive first?

Combination antiretroviral therapy

A patient admitted for scheduled surgery has a positive brief screening test result for an alcohol use disorder. Which initial action is most important?

Complete a detailed alcohol use assessment

CMP =

Comprehensive metabolic panel

The patient is diagnosed with vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions would the nurse use to prevent transmission of the infection to others?

Contact precautions

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit and run accident. When diagnostic testing cannot identify an organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition?

Conversion disorder

*NTK Wrap (Wellness Recovery Action Plan) helps people to:

Decrease and prevent intrusive or troubling feelings and behaviors

A patient with human immunodeficiency virus (HIV) infection is being taught by the nurse about health promotion activities such as good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the reason for these interventions?

Delaying disease progression

Onset: Abrupt, can be subtle at first Progression: Abrupt with fluctuations Duration: Hours to days to weeks Thinking: Disorganized, distorted, slow or accelerated incoherent speech Perception: Distorted, delusions, and hallucinations Psychomotor Behavior: Pace, hyperactive, may not be able to perform task or movements when asked Sleep-Wake Cycle: Disturbed sleep; reversed sleep-wake cycle

Delirium (manifestations)

*NTK What are the differences between dementia, delirium, and depression?

Delirium occurs suddenly (over a matter of hours or days) and the symptoms tend to fluctuate throughout the day; depression describes a negative change in mood (often coincides with life changes, often abrupt) which is variable, rapid to slow but may be uneven; and the onset of dementia is generally slow and insidious.

Which are effects of alcohol withdrawal syndrome? Select all that apply.

Delirium tremens Hand tremors Seizures Increased pulse Rationale: Effects of alcohol withdrawal syndrome include course hand tremors, seizures, increased pulse and blood pressure, and delirium tremens.

Onset: Usually insidious (gradual) Progression: Slow Duration: Years Thinking: Difficulty with abstract thinking, impaired judgement, words difficult to find Perception: Misperceptions, delusions, and hallucinations Psychomotor Behavior: Pace, hyperactive, may not be able to perform task or movements when asked Sleep-Wake Cycle: Sleeps during day. Frequent awakenings at night. Fragmented sleep.

Dementia (manifestation)

Which is the most common defense mechanism used by a client diagnosed with a substance use problem?

Denial Rationale: Substance use typically includes the use of defense mechanisms, especially denial. Clients may deny directly having any problems or may minimize the extent of problems or actual substance use.

A client who has used IV heroin every day for the past 10 years says, "I don't have a drug problem. I can quit whenever I want." Which defense mechanism is being used by the client?

Denial Rationale: The client who says the client can quit a heroin addiction whenever the client wants is utilizing the defense mechanism of denial.

Onset: Often coincides with life changes, often abrupt Progression: Variable, rapid to slow but may be uneven Duration: Months to years Thinking: Intact but with apathy, fatigue, indecisive, hopelessness, may not want to live Perception: May deny or be unaware of depression. Feelings of guilt Psychomotor behavior: Often withdrawn and hypoactive Sleep-wake cycle: Disturbed, often with early morning awakening

Depression (manifestations)

Anti-AChR titers, Tensilon test, electromyography

Diagnostics for Myasthenia Gravis

Clonidine is most effective for which symptom of opioid withdrawal?

Diarrhea Rationale: Clonidine is most effective against nausea, vomiting, and diarrhea but produces modest relief from muscle aches, anxiety, and restlessness.

*NTK adverse effects!! First-Generation Antipsychotics -

Disadvantages -Anticholinergic side effects (can't see, pee, spit, s**t) -Tardive dyskinesia (TD) and extrapyramidal side effects (EPS) -Weight gain, sexual dysfunction, endocrine disturbances ■Men: decreased libido, gynecomastia ■Women: amenorrhea

The nurse is assessing a client 24 hours following at cholecystectomy. The nurse notes that the T tube has drained 750 MLS of green-brown drainage since surgery which nursing intervention is most appropriate?

Document the findings

The nursing diagnosis ineffective denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply.

Does not perceive danger of substance use or gambling; Minimizes symptoms; Refuses healthcare attention; Unable to admit impact of disease on life pattern

The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?

Dopamine Rationale: The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a "high" that is a reinforcing, or positive, experience.

*NTK Isoniazid (one of the 4 drugs used to treat TB) cannot be used with

ETOH (ethanol i.e. alcohol) because it may cause hepatotoxicity)

A minute client begins to make sexual advances toward visitors in the day room period when the nurse firmly states that this is inappropriate and will not be allowed the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of the situation, which intervention should the nurse implement?

Escort the client to their room, with the assistance of other staff

TB drug can cause color vision change or acuity

Ethambutol

Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse nursing stress, as well as

Expressing emotions by journaling; Engage in exercise and relaxation activities; Having realistic patient expectations

Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse nursing stress, as well as:

Expressing emotions by journaling; Engage in exercise and relaxation activities; Having realistic patient expectations

*NTK Termination.

Finally, they're able to experiment with other nutritious diets and dive even deeper into more rigorous workout plans. They're fully committed to living with these changes. Recurrence

Haloperidol (Haldol) & Thorazine

First generation antipsychotics - target pos. symptoms of schizophrenia

A patient was exposed to the human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection?

Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

A patient arrives to the emergency department with a reported overdose of diazepam. Which medication would the nurse prepare to administer as an antidote?

Flumazenil

The nurse manager has noted a recent increase in the number of hospital care-associated infections (HAIs) on the unit. Which nursing action would be a priority in response to this increase?

Frequent and thorough hand washing

*NTK We do not have immunoglobins or vaccines for Hepatitis C, D, or E; however, there is something we can do for Hepatitis D and E. What can we do?

Give A and B immunoglobulins to D and E (D goes with B and E goes with A)

Meningitis vaccine given at birth

HIB

Ecstasy is an example of which type of substance?

Hallucinogen Rationale: Ecstasy is an example of a hallucinogen.

The nurse is teaching a community health class about the prevention of antibiotic-resistant infections. What would be included in the teaching plan?

Hand washing can prevent many infections.

Direct-acting antiviral drug for Hep B and Hep C

Harvoni

CAGE Questions

Have you felt you needed to Cut down on your drinking?

*NTK Ammonia levels will be elevated with _____ and lead to changes in _____.

Hepatitis; mental status

This drug can appear white, brown, or black and sticky. Known as black tar _____.

Heroin

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention?

Hold his medication and contact his prescriber; Wipe him with a washcloth wet with cold water or alcohol.

What accurately describes rejection after transplantation?

Hyperacute reaction can be avoided if crossmatching is done before transplantation.

the Primary Health care provider has determined that a client has contracted hepatitis A based on flu like symptoms and jaundice. Which statement made by the client supports the medical diagnosis?

I ate shellfish about two weeks ago at a local restaurant

When planning the discharge of a client with chronic anxiety, which is the most appropriate maintenance goal?

Identifying anxiety producing situations

*NTK CAGE (test for alcohol use disorder in adults)

If they answer yes to 2 or more, they are at risk (for alcohol)

*NTK Hypersensitivity to bee stings, food allergies, seasonal rhinitis, and asthma is IgE mediated and can lead to anaphylaxis/shock

IgE mediated and can lead to anaphylaxix/shock

The reason newborns are protected for the first 3 months of life from bacterial infections is because of the maternal transmission of

IgG.

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a patient with human immunodeficiency virus (HIV) infection. What laboratory result indicates ART is effective?

Increased CD4+ T-cell count

*NTK Stimulant Intoxication: Short Term -

Increased energy; decreased appetite; mental alertness; increased heart rate/pressure; dilated pupils

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day?

Increases input throughout the day

*NTK What are the two phases of TB treatment?

Initial treatment which is 8 weeks and continuation treatment which is 18 weeks *Not there is also a one-drug treatment that takes 9-12 months to complete

What side effects should the nurse monitor for when caring for a patient prescribed donepezil (Aricept)?

Insomnia; Bradycardia; Signs of dizziness; Reports of headache

A patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply.

Intense nausea; diaphoresis; Confusion; Dyspnea

*NTK What are the long-term effects of stimulant intoxication?

Irregular heartbeat; chest pains; increased risk of heart attack; panic attacks, depression; delusions/hallucinations; "Cocaine bugs" (skin sensation)

Which statements identify positive aspects of methadone as a substitute for heroin? Select all that apply.

It is controlled by a health care provider. It is available in tablet form. It is a legal medication. Rationale: Methadone is safer than heroin because it is legal, controlled by a health care provider, and available in tablet form. It is not available in IV form.

A 25-year-old woman with a history of drug abuse tells the nurse during care that she does not communicate well with her family because they always tell her what she has done wrong. The nurse understands that families of addicts can be?

Judgmental

CIWA (alcohol)

KNOW THE RANGES FOR THE TEST; Max score is 67; Mild= less than or equal to 10; Moderate= 11-15; Severe= greater than 16

*NTK How does Hepatitis A and E spread?

Lack of food hygiene, contaminated water, and substandard sanitary facilities

*NTK Drug administered for high ammonia levels?

Lactulose (this drug also causes diarrhea)

An older adult client with liver disease is experiencing alcohol withdrawal. Based on the nurse's understanding of drug therapy, which of the following would the nurse expect to be prescribed?

Lorazepam Rationale: Antianxiety and sedating drugs, such as benzodiazepines, are titrated downwardly over several days as a substitution for the alcohol. Chlordiazepoxide (Librium) and diazepam (Valium) have longer half-lives and smoother tapers. Lorazepam (Ativan) is better for the older adult and people with liver impairment. Fluoxetine is not used.

Which medication is used to prevent alcohol withdrawal symptoms?

Lorazepam (Ativan) Rationale: Benzodiazepine

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expects expected assessment finding?

Malaise

Name of PPD test

Mantoux

A client is experiencing severe alcohol withdrawal. Which would the nurse most likely assess? Select all that apply.

Marked diaphoresis Auditory hallucinations Gross uncontrollable tremors Rationale: A person experiencing severe alcohol withdrawal would exhibit marked diaphoresis, auditory and visual hallucinations, a heart rate between 120 and 140 beats/min, gross uncontrollable tremors, and a complete inability to eat or drink.

When considering the pathophysiology responsible for both delirium and dementia, which intervention is appropriate for delirium specifically?

Monitor neurological status on an ongoing basis.

COWS

NTK THE RANGES FOR THIS ONE for the test; Scores 5-12= mild withdrawal; Scores 36 or more= severe withdrawal - For opiate withdrawal

Which drug reverses opioid toxicity?

Naloxone Rationale: Naloxone reverses opioid toxicity.

The following meds are given for opiate toxicity or narcotic withdrawal

Narcan

*NTK Are ammonia levels on a CMP (comprehensive metabolic panel)?

No, they're on a separate test

first generation antipsychotics - Black box warning

Not approved for dementia-related psychosis, increased mortality risk in elderly dementia patients due to infection or cardiovascular events

Terry is a young male in a chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is:

Not ready to change

A patient admitted to the hospital early in the morning for elective surgery asks the nurse if they can go outdoors to have one last cigarette before surgery. What action would the nurse take?

Notify the surgeon that the patient may need an over-the-counter nicotine replacement agent.

Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. He is cachexic, has multiple scabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald along with an expected outcome is:

Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs

*NTK How do you have the patient lay after a liver biopsy?

On their right side; this will help stop the bleeding from the biopsy as the liver is located on the right side therefore laying on the right side creates pressure against bleeding

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?

Paranoia

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first?

Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0- to 10 scale

The patient tells the nurse that he has used cannabis regularly for the past 20 years. What would the nurse expect to find in the history and physical assessment?

Productive cough; Impaired memory

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurses immediate priority of care?

Provide safety for the client and other clients on the unit

Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? Select all that apply.

Pupils are dilated; Extreme anxiety

*NTK Pneumonic for TB drugs

RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol)

The nurse is completing and admission assessment for a client admitted with acute alcohol intoxication. When asked to describe drinking pattern and amount, the client states, "I only drink when I am under a lot of stress." The clients response indicates what defense mechanism?

Rationalization

TB drug that causes orange excretions

Rifampin

*NTK Four-drug regimen (all can cause non-viral hepatitis; liver function monitored)

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

*NTK What drugs are used for the treatment of Tuberculosis?

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?

Screening a group of males between the ages of 15 and 25 for early symptoms.

A client is brought to the emergency department after having overdosed on cocaine. When assessing the client, which would the nurse expect to find? Select all that apply.

Seizures Cardiac arrhythmia Rationale: Manifestations of cocaine overdose include cardiac dysrhythmias or arrest, increased or lowered blood pressure, respiratory depression, chest pain, vomiting, seizures, psychosis, confusion, dyskinesia, dystonia, and coma. Euphoria, paranoia, and dilated pupils are effects of cocaine.

The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?

Setting limits on the client's behavior

A patient is receiving lorazepam to prevent the occurrence of delirium tremens. Which manifestation would suggest the patient has received an overdose of this medication?

Shallow respirations

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?

She should experience a reduction in hallucinations.

The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention?

Sit beside the client in silence with simple open-ended questions

Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner recognizes that Ophelia seems to have a deficit in:

Social cognition

*NTK Not yet considering change or is unwilling or unable to change; primary task: raising awareness

Stage 1 of Change: Precontemplation

*NTK Sees the possibility of change but is ambivalent and uncertain; primary task: resolving ambivalence/ helping to choose change

Stage 2 of Change: Contemplation

*NTK Committed to changing. Still considering what to do; primary task: help identify appropriate change strategies

Stage 3 of Change: Determination

*NTK Taking steps toward change but hasn't stabilized in the process; primary task: help implement change strategies and learn to eliminate potential relapses

Stage 4 of Change: Action

*NTK Has achieved the goals and is working to maintain change; primary task: develop new skills for maintaining recovery

Stage 5 of Change: Maintenance

*NTK Experienced a recurrence of the symptoms; cope with consequences and determine what to do next

Stage 6 of Change: Recurrence

The nurse is providing postoperative care for a patient with human immunodeficiency virus (HIV) infection who had an appendectomy. What type of precautions would the nurse implement to prevent HIV transmission?

Standard precautions

*NTK Opioid withdrawal symptoms

Tachycardia (fast pulse) Hypertension (high bp) Hyperthermia (high body temp) Insomnia Mydriasis (enlarged pupils) Diaphoresis (sweating) Piloerection (gooseflesh) Increased respiratory rate Lacrimation (tearing), yawning Rhinorrhea (runny nose) Muscle spasms Abdominal cramps, nausea, vomiting, diarrhea Bone and muscle pain Anxiety Think Flu symptoms for opioid withdrawal; you will notice no confusion & seizures, but will have anxiety and muscle spasms

When admitting a patient to the emergency department who reports chest pain, which assessment findings would alert the nurse to possible cocaine use?

Tachycardia; Restlessness; Hyperthermia

A patient has human immunodeficiency virus (HIV) infection, and the viral load is reported as undetectable. What patient teaching would the nurse provide related to this laboratory study result?

The patient has the virus, but the infection is well controlled.

Which statement(s) accurately describe(s) mild cognitive impairment?

The person may appear normal to the casual observer; Family members may see changes in the patient's abilities; The person is usually aware that there is a problem with his or her memory

*NTK Precontemplation.

The person may initially think there's nothing wrong with them, and that their doctor is overreacting to one bad test result.

*NTK When your patient has liver problems and you see a mental status change, what should you look at?

Their ammonia levels

A parent does not want their child to have any extra immunizations for diseases that no longer occur. What teaching about immunization would the nurse provide the parent?

There is a reemergence of some of the infections, such as pertussis.

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:

They are not actually ill.

*NTK Action.

They begin a new nutritious meal plan and a daily workout.

*NTK Contemplation.

They start asking folks close to them, who have tried overhauling their own health habits before, for advice. They might also start making a pros and cons list about switching to a nutritious diet and exercising daily.

*NTK Preparation.

They start looking up specific heart-healthy diets and researching exercise programs that will work for them.

When caring for a patient with acute intoxication and a history of chronic alcohol use, the nurse will anticipate administering which drug?

Thiamine

Which medication is used to prevent Wernicke-Korsakoff syndrome?

Thiamine (vitamin B1) Rationale: Thiamine is used to prevent Wernicke-Korsakoff syndrome. Folic acid, lorazepam, and cyanocabalamin are not used for this disease process.

Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

To have a less positive outcome

Opioid use disorder is characterized by:

Tolerance

The patient describes their needing a larger dose of a drug to get the same effect. How would the nurse document what the patient is experiencing?

Tolerance

Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?

Tolerance break Rationale: After continued heavy drinking, the person experiences a tolerance break, which means that very small amounts of alcohol intoxicate the person. A blackout is an episode during which the person continues to function but has no conscious awareness of his or her behavior at the time or any later memory of the behavior. Tolerance occurs when the person needs more alcohol to produce the same effect. Intoxication is use of a substance that results in maladaptive behavior.

*NTK For Active TB disease

Treatment is aggressive; Two phases of treatment = Initial (8 weeks), Continuation (18 weeks), One drug treatment: 9-12 months

Treatment interventions to assist the client with a current history of drug and alcohol abuse and prevent relapse include:

Twelve step program b. self-help group; lifestyle changes; individual therapy

A client diagnosed with delirium becomes disoriented and confused at night. Which intervention should the nurse implement initially?

Use an indirect light source and turn off the television

A heterosexual patient is concerned that they may contract human immunodeficiency virus (HIV) from a bisexual partner. What would the nurse include when teaching about preexposure prophylaxis?

Use condoms for risk-reducing sexual relations; Take emtricitabine and tenofovir (Truvada) regularly; Have regular HIV testing for the patient and partner

*NTK Antibiotic treatment for meningitis (all ages)

Vancomycin plus ampicillin plus ceftriaxone or cefotaxime plus vancomycin*

*NTK Antibiotic treatment for meningitis for those with impaired cellular immunity

Vancomycin plus ampicillin plus either cefepime or meropenem

*NTK Antibiotic treatment for meningitis for those with recurrent meningitis

Vancomycin plus cefotaxime or ceftriaxone

A patient has been diagnosed with human immunodeficiency virus (HIV) infection. What information about antiretroviral therapy with multiple drugs would the nurse provide to the patient to improve adherence?

Viral replication will be inhibited.

What would the nurse teach the patients in an assisted living facility in order to decrease their risk for antibiotic resistant infection?

Wash hands frequently; Take antibiotics as prescribed; Take the antibiotic until it is gone

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client?

Writing

*NTK Airborne isolation (Single-occupancy room with 6-12 airflow exchanges per hour); Health care workers wear high-efficiency particulate air (HEPA) masks; Immediate medical workup; Appropriate drug therapy is how you handle acute care for

a TB infected environment

*NTK Systemic Lupus Erythematous (SLE) is

a chronic inflammation resulting from an autoimmune disease - has no cure

*NTK Typically, symptoms of opioid withdrawal feel like

a cold or the flu, but other measures like pulse or blood pressure can help a clinician monitor the severity of the experience.

When admitting a pt. the nurse must assess the patient for substance use based on the knowledge that long-term use of addictive substance leads to

a higher risk for complications from underlying health problems

A patient with intracranial pressure monitoring has a pressure of 12 mm Hg. The nurse understands that this pressure reflects

a normal balance among brain tissue, blood, and cerebrospinal fluid.

*NTK Anti-acetylcholine receptor (AChR) antibody is

a sensitive test used to confirm diagnosis of Myasthenia Gravis

Drug avoided by client with hepatitis

acetaminophen

The nurse would suspect cocaine toxicity in the patient who is experiencing

agitation, dysrhythmias, and seizures

*NTK Type of precautions used with TB

airborne (Tier 2)

nursing care for myasthenia gravis:

airway protection and avoiding aspiration

*NTK Tier 1 precautions =

aka Standard precautions; i.e. proper hand hygiene, proper PPE when antricipating interaction with blood or body fluid; proper disposal of sharps; respiratory hygiene and cough etiquette i.e. covering nose or mouth when coughing and sneezing

Disorders that may be present with heroin abuse are:

alcohol abuse; depression; anxiety disorders; PTDS

• anxiety and agitation • tremors • nausea and vomiting • sweating • increased body temperature • tachycardia • hypertension • insomnia • seizures • increasing apprehension ranging from fear to terror or paranoia • delirium tremens - in severe cases ...these are indicative of

alcohol withdrawal

Vasogenic cerebral edema increases intracranial pressure by

altering the endothelial lining of cerebral capillaries.

Which people demonstrate risk factors for an addiction?

an abused 10-year-old with poor body image; a middle aged, recently divorced, balding, white man, who lost his business in a fire, and his dog died, his kids hate him, he has uncontrolled diabetes, syphilis, he's missing an eye and top teeth, he has gout, and his mom is pretty sick and might not make it, who hates himself.

*NTK Medications for Hepatitis are

antivirals to hit the virus at different replication cycles; particularly interferon

*NTK TB usually attacks the lungs BUT can also attack

any part of the body such as the kidney, spine, bones, brain, and exocrine glands (glands that make sweat, tears, saliva, milk, and digestive juices, and releases them through a duct or opening to a body surface)

Nursing management of a patient with a brain tumor includes

assisting and supporting the family in understanding any changes in behavior; planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs.

The nurse is caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention should the nurse include?

avoid using a whisper voice in front of the client

A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient's success?

b. Manage the patient's withdrawal symptoms well.

A client has been using paint thinner and glue to receive a "high." The nurse knows that these are what type of substances?

b. inhalants. Rationale: Inhalants include paint thinner, glue, gasoline, and spray paint.

Why would you lean toward Myasthenia Gravis being the problem over other possibilities?

bc of the symmetric upper extremity weakness

Why do we need to know the following drugs? Cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne); N-methyl-D-aspartate (NMDA)—blocks action of glutamate such as memantine (Namenda)

because when you are working and see clients with these mediations ordered you'll automatically know they have some form of dementia

The function of monocytes in immunity is related to their ability to

capture antigens by phagocytosis and present them to lymphocytes.

A chronic alcoholic is admitted to the medical unit for pneumonia. Which medication would the nurse expect the health-care provider to prescribe to prevent delirium tremors?

chlordiazepoxide (Librium)

A 50-yr-old man reports recurring headaches. He describes them as sharp, stabbing, and around his left eye. He says his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect he has

cluster headaches

Vascular dementia is associated with

cognitive changes secondary to cerebral ischemia.

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior?

communicate expected behaviors to the client; assist the client in identifying ways of setting limits on personal behaviors; follow through about the consequences of behavior in a non-punitive manner; have the client state the consequences for behaving in ways that are viewed as unacceptable

A nurse is caring for a client who has a history of opioid and heroin abuse and monitoring for signs of withdrawal. which clinical manifestations are associated with heroin and opioid withdrawal

compulsive itching; diaphoresis (sweating); yawning and sneezing; insomnia; cramps and diarrhea

opioid and narcotic risk factors include but are not limited to:

constipation; endocarditis; fatal overdose; HIV

*NTK Type of precaution used with hepatitis

contact (blood and body fluid precautions)(Tier 2)

A nursing measure that can reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is

controlling fever with prescribed drugs and cooling techniques.

What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder?

d. Confront her about your concerns and/or report your concerns to a supervisor immediately.

A factor used to make the differentiation between a social drinker and an alcoholic would be :

degree of need

*NTK Simulant withdrawal

depression; hypersomnia (or insomnia); fatigue; anxiety; irritability; poor concentration; psychomotor retardation; increased appetite; paranoia; drug craving

The nurse knows that the children of parents who abuse substances are at risk for:

developing substance abuse problems

The nurse is alerted to a possible acute subdural hematoma in the patient who

develops decreased level of consciousness and a headache within 48 hours of a head injury.

Possible social effects of a chronic neurologic disease include

divorce; job loss; depression; role changes; loss of self-esteem

*NTK Type of precaution used with meningitis

droplet (Tier 2)

*NTK Tier 2 precautions =

droplet, airborne, contact, protective environment

pyridostigmine, steroids, biologics. Avoidance of choleresterace drugs

drugs for myasthenia gravis

The most common cause of secondary immunodeficiencies is

drugs.

The nurse is alerted to possible anaphylactic shock immediately after a patient has received IM penicillin by the development of

edema and itching at the injection site.

A nurse plans care for the patient with increased intracranial pressure with the knowledge that the best way to position the patient is to

elevate the head of the bed to 30 degrees.

Classic symptoms of hepatitis =

elevated liver enzymes and bilirubin (so *NTK the normal ranges - ALT = 7-56; AST = 10-40)

Meth =

endocarditis

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in treatment to

exchange her plasma that contains antinuclear antibodies with a substitute fluid.

A patient is suspected of having a brain tumor. The signs and symptoms include memory deficits, visual changes, weakness of right upper and lower extremities, and personality changes. The nurse determines that the tumor is most likely located in the

frontal lobe.

Avoid raw fish with this disease

hepatitis

*NTK Lactulose is administered for

high ammonia levels (it also causes diarrhea)

*NTK Hep A, B, and HIV are

highly prevalent in Africa and South America

Complications of meningitis include

hydrocephalus, vision and hearing loss, delayed growth and development, seizures, subdural effusions, and cranial nerve palsy. Vigilant assessment by the nurse and prompt notification of the physician can facilitate initiation of effective interventions if complications do occur.

The nurse tells a friend who asks him to administer his allergy shots that

immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

ALL stimulant withdrawals have problems with

insomnia (but no seizures or vomiting)

Knowing that C.M.'s confusion and restlessness overnight may indicate acute alcohol withdrawal, you perform a more thorough assessment. Your assessment reveals a score of 11 on the Clinical Institute Withdrawal Assessment for Alcohol Scale. To prevent alcohol delirium, you plan to give which medication per the HCP's order?

lorazepam

A priority goal of treatment for the patient with Alzheimer's disease is to

maintain patient safety.

Traits that may be seen in an addict are:(select all)

manipulative; impulsive; anxious

Signs and symptoms of fetal alcohol syndrome include:

microcephaly; growth retardation; short palpebral fissures; maxillary hypoplasia (underdeveloped maxillary)

*NTK Less than or equal to 10 CIWA score =

mild alcohol withdrawal

*NTK 5-12 on COWS means

mild withdrawal from opiates

Substance use problems in older adults are usually related to

misuse of prescribed and otc medications and alcohol

*NTK CIWA score of 11 to 15 =

moderate alcohol withdrawal

While caring for a patient who is experiencing alcohol withdrawal, the nurse should

monitor neurologic status on a routine basis; pad the side rails and place suction equipment at the bedside; orient the patient to environment and person with each contact; give antiseizure drugs and sedatives to relieve withdrawal symptoms

The following people would benefit from attending al-anon meetings:

mother of an addict; grandson of a recovering addict; husband of an addict who has been sober for 22 years; sister of an addict who is actively using.

Catapres (clonidine) has been shown to relieve symptoms of narcotic withdrawal. which symptoms does this drug dismiss?

muscle aches; salivation; abdominal cramping

Personality traits associated with drug abuse include:

narcissistic behavior and; low self-esteem

Morphine, Codeine, and Methadone have a high potential for abuse or physiological/psychological dependency. Which class of drugs do they belong in?

narcotics

COWS is for

opiate withdrawal

*NTK Rifampin (one of the four drugs used to treat TB) side effects =

orange body secretions, GI distress, increased drug resistance

The nurse is caring for an older patient who has been receiving antiretroviral therapy (ART) for HIV infection for many years. The nurse is aware that complications of long-term ART use include

osteoporosis; insulin resistance; cardiovascular disease

Dementia with Lewy bodies (DLB) is characterized by

parkinsonian symptoms, including muscle rigidity.

During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for

patency of airway.

The clinical diagnosis of dementia is based on

patient history and cognitive assessment.

The nurse finds an 87-yr-old patient is continually rubbing, flexing, and kicking her legs throughout the day. The night shift reports this same behavior escalates at night, preventing her from obtaining sleep. The next step the nurse should take is to

perform an assessment, suspecting a disorder such as restless legs syndrome.

A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is

promoting physical exercise and a well-balanced diet.

Dry skin

pruritis

The most appropriate nursing intervention for a patient who is being treated for an acute exacerbation of COPD who is not interested in quitting smoking is to

realize that some smokers never quit, and trying to assist them increases the patient's frustration

In a type I hypersensitivity reaction the primary immunologic disorder appears to be

release of chemical mediators from IgE-bound mast cells and basophils.

care during myasthenia crisis aimed at:

rest, adherence, disease education, aspiration avoidance

*NTK Prophylactic treatment for someone with a family member that has tested positive PPD, but not infected =

rifampin for 6 -9 months

*NTK CIWA score greater than or equal to 16 =

severe alcohol withdrawal

*NTK 36 or more on COWS means

severe withdrawal from opiates

The AUDIT (Alcohol Use Disorders Identification Test) is a

simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder.

People who use opioids to treat pains sometimes get addicted after taking the meds by mouth. They may alter the route of administration by:

snorting; injecting

Dementia is defined as a

syndrome characterized by cognitive dysfunction and loss of memory.

An effective communication technique with an addict would be:

teach the patient about the physical impact of drugs and alcohol

*NTK When suspecting Alcohol Withdrawal you should look for signs and symptoms such as

tremors (6-8 hours after alcohol cessation); agitation, lack of appetite, nausea, vomiting, insomnia, impaired cognition, mild perceptual changes; increase in bp, pulse, and body temperature.

Given via IV in bacterial meningitis

vancomycin

*NTK first generation antipsychotics (typical)

■Dopamine antagonists (D2 receptor antagonists) ■Target positive symptoms of schizophrenia ■Advantage: Less expensive, very effective Haloperidol (Haldol) & Thorazine