NI 8th week PREP & PREPU assignment questions
What is renin?
An enzyme secreted by the kidneys that converts angiotensin to angiotensin I
What is prinzmetal's angina?
Often occurs at rest in response to coronary artery spasm It may be relieved by moderate exercise or disappear spontaneously
What is systemic vascular resistance?
The force which opposes the movement of blood within the vessels. It is affected by the diameter (constriction or dilation) of the vessel. Constricted vessels increase SVR, which increases BP.
What is Troponin?
A cardiac-specific muscle protein released following cardiac damage. Levels rise within 3-12 hours, peak at 24-48 hours, and return to normal in 5-15 days.
What is ischemia?
A deficiency of blood to an area due to constriction or blockage of an artery. If prolonged, this may result in tissue death.
What is C-reactive protein?
A glycoprotein produced by the liver in response to acute inflammation. It disappears rapidly when inflammation resolve; its continued presence is a marker for inflammation associated with atherosclerosis
What is a Swan-Ganz catheter?
A multi-lumen central line catheter with a balloon tip on the distal lumen for measuring pulmonary and cardiac pressures.
What is myoglobin?
A non-cardiac specific muscle protein released within hours of cardiac injury. It returns to normal within 24 hours
What is a hypertensive crisis?
A sudden elevation in BP defined as diastolic BP >140mmHG
What is a coronary artery bypass graft (CABG)?
A surgery to restore circulation to ischemic areas of the heart. A section of the internal mammary or saphenous veins is often used, but the radial, gastroepiploic, or inferior gastric arteries may also be used. The graft is placed between the aorta or other major artery and an area distal to the occlusion.
Kristin Anderson is a 52-year-old white woman who presented to the clinic complaining of chest discomfort. She states it occurs when she is under stress and occasionally after heavy meals. Recently, Ms. Anderson joined a health club, and she reports experiencing chest discomfort before she finished exercising. She states she has "always been in good health" and has not been to an MD, except for annual Gynecological visits, for years. The MD diagnoses her with chronic stable angina. Ms. Anderson asks the nurse to explain chronic stable angina. Which of the following are accurate responses from the nurse? A. "You will experience irreversible ischemia" B. "There are unpredictable precipitating factors" C. "The primary cause is coronary artery disease (CAD)" D. "Angina produces pain that can be relieved only by narcotics"
A. "You will experience irreversible ischemia" C. "The primary cause is coronary artery disease (CAD)" Rationale: CAD, with its atherosclerotic plaques, narrows the coronary arteries reducing blood flow and O2 supply to the myocardium. The patient with chronic stable angina will experience chest discomfort or pain when there is increased demand for O2 or a decreased supply of O2 to the myocardium during times when demand is increased. The patient experiences ischemia that is resolved by rest and the use of nitroglycerin. There are predictable precipitating factors. It is important that the patient identify her precipitating factors and make lifestyle and medication schedule adjustments accordingly. Pain is usually relieved by nitroglycerin, not narcotics.
Ms. Anderson wonders how so many different factors can contribute to her chest pain: What increases her heart rate and myocardial O2 demand? A. Exercise B. Stress C. Heavy Meals
A. Exercise
If a patient is found delirious and semi-conscious, which complication of a hypertensive crisis are they exhibiting symptoms of? A. Hypertensive encephalopathy B. Renal insufficiency C. Rapid cardiac decompensation D. Aortic dissection
A. Hypertensive encephalopathy Hypertensive encephalopathy manifests as a sudden rise in BP and may be associated with headache, nausea and vomiting, confusion, seizures, stupor and coma. Rapid cardiac decompensation may manifest as chest pain and dyspnea. Symptoms of renal insufficiency vary depending on severity. Aortic dissection may manifest as extreme chest and back pain, diaphoresis, and loss of pulses in extremities.
Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)? A. A teenage boy who has begun to be the object of bullying inside and outside the classroom B. A middle-aged woman with a history of anxiety who suffered a random physical assault C. A 12-year-old girl who has recently moved cross-country and desperately misses her old friends D. An adult male client who has been admitted to the hospital three times for complications of surgery
ANSWER: B. A middle-aged woman with a history of anxiety who suffered a random physical assault RATIONALE: Women are twice as likely as men to develop PTSD, and a history of anxiety is a known risk factor. Physical assault is among the most common precursors to PTSD. Each of the other listed individuals is facing a crisis that has the potential to result in trauma, but none has the same constellation of risk factors as the middle-aged woman.
Ms. Anderson is worried that she might have a heart attack while exercising at her health club. As the nurse, what could you tell Ms. Anderson about exercise and angina? (choose all that apply) A. Medications and modification of your exercise program will help reduce your angina attacks B. You are experiencing irreversible ischemia, a precursor for heart attacks C. Continuing to exercise will reduce your risk factors for CAD, the primary cause of angina D. You should stop exercising and take your sublingual NTG if you experience angina while exercising
A. Medications and modification of your exercise program will help reduce your angina attacks C. Continuing to exercise will reduce your risk factors for CAD, the primary cause of angina D. You should stop exercising and take your sublingual NTG if you experience angina while exercising Heart attacks occur when there is irreversible ischemia resulting in tissue death, but chronic stable angina results in reversible ischemia with reperfusion to the affected areas (so B is not a correct answer). Ms. Anderson's new beta-blocker should help reduce the incidence of exercise-induced angina; if it does not, she should tell her MD, who may be able to increase the dosage. Ms. Anderson should stop exercising and take her sublingual NTG if experiences angina while exercising. She may need to consider modifying her exercise program to a level that will not induce angina. Isometric exercises of the arms (weight lifting) are particularly prone to inducing angina.
What are the main teaching points for a patient's home blood pressure monitoring program? (choose all that apply) A. Do not smoke or drink caffeine shortly before taking BP B. Rest quietly before taking BP C. While measuring BP, sit with both feet on the floor with forearm supported D. Wrap cuff snugly in the region just in front of the elbow E. Wait at least 1 minute before taking another reading
ALL are correct
The nurse is caring for a client with complex posttraumatic stress disorder (CPTSD). The client asks, "Why was I diagnosed with CPTSD instead of PTSD? What's the difference?" What information should the nurse include in the response? Select all that apply. A. "Interpersonal problems can be more intense in CPTSD." B. "Symptoms around negative self-concept are more pronounced in CPTSD." C. "CPTSD symptoms include the core symptoms of PTSD." D."Symptoms of CPTSD are not as severe as symptoms of PTSD." E. "CPTSD means that you are only exhibiting some of the symptoms normally present in people with PTSD."
ANSWER: A. "Interpersonal problems can be more intense in CPTSD." B. "Symptoms around negative self-concept are more pronounced in CPTSD." C. "CPTSD symptoms include the core symptoms of PTSD." RATIONALE: The nurse should include the statements, "Symptoms around negative self-concept are more pronounced in CPTSD," "CPTSD symptoms include the core symptoms of PTSD," and, "Interpersonal problems can be more intense in CPTSD." Complex posttraumatic stress disorder (CPTSD) symptoms include the core posttraumatic stress disorder (PTSD) symptoms plus emphasis on symptoms of affective dysregulation, negative self-concept, and interpersonal problems. The statements, "CPTSD means that you are only exhibiting some of the symptoms normally present in people with PTSD," and, "Symptoms of CPTSD are not as severe as symptoms of PTSD," should not be included in the nurse's response, because they are not true of CPTSD.
When presenting a discussion of posttraumatic stress disorder (PTSD) to a group of emergency department nurses, the psychiatric-mental health nurse provides examples of traumatic events that may precede PTSD. Which event(s) does the nurse include? Select all that apply. A. Personal assault by a family member B. Falling off a playground swing C. Surviving an EF 4 tornado D. Urinary incontinence due to a prolapsed bladder E. Military combat mission where there were casualties
ANSWER: A. Personal assault by a family member C. Surviving an EF 4 tornado E. Military combat mission where there were casualties RATIONALE: Examples of traumatic events are violent personal assault, rape, military combat, natural disasters, terrorist attacks, being taken hostage, incarceration as a prisoner of war, torture, an automobile accident, or being diagnosed with a life-threatening illness. Falling off a swing is not necessarily a trauma, but a typical accident common to many children. Prolapsed bladder is not a traumatic event and can be easily corrected with various surgical procedures.
A client with PTSD has been prescribed sertraline. While educating this client about possible side effects, a nurse should stress that they need to call their health care provider if they experience which sign(s)/symptom(s)? Select all that apply. A. Fatigue B. Muscle twitching C. Dry eyes D. Tachycardia E. Constipation
ANSWER: B. Muscle twitching D. Tachycardia RATIONALE: The client/family should be taught to notify their health care provider if severe agitation, hallucinations, coordination problems, muscle twitching, racing heartbeat, high or low blood pressure, muscle rigidity, sweating or fever, nausea, vomiting, or diarrhea occur.
The nurse is interviewing a client who witnessed a fatal accident at the workplace and was unable to save a colleague. What assessment findings would support a diagnosis of posttraumatic stress disorder (PTSD)? Select all that apply. A. The accident took place 2 weeks ago B. The client has nightmares about the accident C. The client says the client is "unable to face that place again" D. Management is blaming the client for the accident E. The client says the client's family describes the client now as "edgy" and "irritable"
ANSWER: B. The client has nightmares about the accident C. The client says the client is "unable to face that place again" E. The client says the client's family describes the client now as "edgy" and "irritable" RATIONALE: Diagnostic criteria for PTSD include avoidance of the site of the trauma, hyperarousal, and nightmares. However, the 2-week time period suggests a diagnosis of acute stress disorder rather than PTSD. The response of management is a stressor but is not among the diagnostic criteria.
A client with a diagnosis of posttraumatic stress disorder (PTSD) has been brought to the emergency department (ED) by concerned family members, who state that the client is experiencing a "nervous breakdown." The ED nurse should prioritize what aspect of care during the initial care of the client? A. Assessing the client's current drug regimen and allergy status B. Assessing the client's risk for self-harm and ensuring safety C. Identifying the client's coping ability and functional status D. Developing therapeutic rapport with the client and family
ANSWER: B. Assessing the client's risk for self-harm and ensuring safety RATIONALE: In an emergency context, the assessment of suicidality and the risk for self-harm is a priority. The nurse should perform each of the other listed actions, but measures to ensure the client's safety are paramount.
Why would the nurse be concerned about a patient with hypertension complaining of blurry vision? A. It indicates he has increased his alcohol intake B. It signals possible target organ damage C. It is a sign of hydrochlorothiazide toxicity D. It is not of concern; he simply needs new eyeglasses
B. It signals possible target organ damage
A nurse is reviewing the medical records of several clients who have come to the community health center. The nurse most likely identifies a client experiencing which event as being at risk for developing posttraumatic stress disorder (PTSD)? Select all that apply. A. Watching televised segments of the moment when the plane hit the second tower on 9/11 B. Being stranded at the office during a typical winter storm that was anticipated C. Being hidden in a closet and hearing the entire family murdered by someone who broke into the home D. Being a survivor of a tsunami that resulted in thousands of deaths E. Being a marine in a combat situation where the entire platoon was wiped out, except for one person
ANSWER: C. Being hidden in a closet and hearing the entire family murdered by someone who broke into the home D. Being a survivor of a tsunami that resulted in thousands of deaths E. Being a marine in a combat situation where the entire platoon was wiped out, except for one person RATIONALE: Examples of events that may cause PTSD include someone experiencing, witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or an assault. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine in a combat situation where the entire platoon was wiped out except for one person, and being hidden in a closet and hearing the entire family murdered by an intruder would be situations where the person was exposed to an event that posed actual death or threatened death or serious injury and responded with intense fear, helplessness, or terror. Being stranded at the office is much less likely to be perceived as a risk for death or injury, so it is unlikely to result in PTSD.
A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. Which will the nurse assess for when determining the major elements of posttraumatic stress disorder (PTSD)? Select all that apply. A. Occurring 2 weeks after the trauma B. Feeling mildly anxious C. Showing emotional numbing such as feeling detached from others D. Being on guard, irritable, or experiencing hyperarousal E. Reexperiencing the trauma through dreams or recurrent and intrusive thoughts
ANSWER: C. Showing emotional numbing such as feeling detached from others D. Being on guard, irritable, or experiencing hyperarousal E. Reexperiencing the trauma through dreams or recurrent and intrusive thoughts RATIONALE: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts; showing emotional numbing such as feeling detached from others; and being on guard, irritable, or experiencing hyperarousal. Feeling mildly anxious is not a major element of PTSD as the person is likely to feel very anxious. Occurring 2 weeks after the trauma would likely be acute stress disorder, as PTSD symptoms occur 3 months or more after the trauma.
The advanced practice psychiatric mental health registered nurse is leading a support group for adolescents who have recently experienced disruptions in their life. What participant most warrants further assessment for posttraumatic stress disorder? A. An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother B. An adolescent who often redirects the conversation to the subject of the adolescent's sister's death C. An adolescent who began smoking in the weeks after discovering a dead body in a park D. An adolescent who states "I've lost my soulmate" after the death of a boyfriend or girlfriend in an accident
ANSWER: A. An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother RATIONALE: Adolescents with PTSD may act out by engaging in disruptive behavior. The adolescent redirecting discussion to the dead sister and the adolescent who lost a relationship because of death from an accident are expressing uncomplicated grief. The adolescent who began smoking requires intervention but is not necessarily experiencing PTSD.
The family members of a client with posttraumatic stress disorder (PTSD) state that they are "constantly walking on eggshells" because the client reacts so strongly to stressors that seem inconsequential to them. What is the nurse's best response? A. Educate the family about the client's hyperarousal B. Arrange for respite so that the family can have their emotional needs met C. Assess each member of the family for signs and symptoms of PTSD D. Educate the family about the need to set limits assertively but empathically
ANSWER: A. Educate the family about the client's hyperarousal RATIONALE: The client is likely in a state of hyperarousal and educating the family about this phenomenon would be a useful starting point. There is no obvious need for the family to focus on setting limits with the client. Similarly, there is no clear indication of caregiver burnout that would necessitate respite. The family members' sentiment does not indicate a risk of PTSD.
The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support? A. Facilitate the client's participation in a support group B. Provide the client with educational resources that promote the client's self-worth C. Encourage the client to make new friends D. Facilitate a meeting between the client and the client's family members
ANSWER: A. Facilitate the client's participation in a support group RATIONALE: A support group can be a valuable source of social support. If the client states that the client is estranged from the client's family, it would be inappropriate for the nurse to independently broach this barrier. Making new friends is difficult for a client experiencing PTSD. Educational resources can be valuable but are not a substitute for social support.
Posttraumatic stress disorder (PTSD) has been diagnosed in a sexually assaulted female client. Which of the following manifestations is the most consistent with PTSD? A. Flashbacks B. Denial C. Humiliation D. Self-blame
ANSWER: A. Flashbacks RATIONALE: In PTSD, the person re-experiences all or some of the traumatic event through dreams or waking recollections and responds defensively to these flashbacks. Denial, humiliation, and self-blame are normal feelings of rape.
A nurse is caring for a client who has a diagnosis of posttraumatic stress disorder (PTSD) and has been referred for care. During the client interview, what statement by the client should the nurse prioritize for follow-up? A. Sometimes I feel like I can't even cope unless I've had a few drinks to calm my nerves. B. I thought I could do this on my own, but I can see now why the doctor suggested medication. C. I've never been a person who has trouble sleeping, but I wake up so early in the morning these days. D. I understand why I feel this way, but that certainly doesn't make it any easier.
ANSWER: A. Sometimes I feel like I can't even cope unless I've had a few drinks to calm my nerves. RATIONALE: All of the client's statements are significant, of course, but the statement implying habitual alcohol use warrants priority because of the high prevalence and harmful consequences of substance abuse among people with PTSD.
A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action? A. Facilitate cognitive restructuring therapy B. Make efforts to demonstrate empathy to the client C. Avoid communicating with the client until the client initiates D. Arrange for the client to receive cognitive processing therapy
ANSWER: B. Make efforts to demonstrate empathy to the client RATIONALE: Exhibiting empathy often helps to build therapeutic rapport, especially with a client who is reluctant to engage with the nurse. Cognitive behavioral therapy would not be an initial action. It is unrealistic and ineffective for the nurse to avoid communication with the client.
A client has just adopted a child whose traumatic history resulted in a diagnosis of reactive attachment disorder. What nursing action best addresses this child's diagnosis? A. Teaching the client about the factors that cause resilience B. Planning activities where the client and the child can bond C. Teaching the client how to provide culturally safe care for the child D. Modeling interactions that address disruptive behavior disorders
ANSWER: B. Planning activities where the client and the child can bond RATIONALE: Reactive attachment disorder is characterized by the inability to form positive attachments due to prior neglect. Culturally safe care is always necessary but does not address this child's diagnosis. Teaching about resilience is also relevant but similarly does not address this particular diagnosis that the child already has. Disruptive behavior disorder is not a primary consideration.
The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize? A. Nutrition assessment B. Sleep assessment C. Respiratory rate and breath sounds D. Bowel sounds and last bowel movement
ANSWER: B. Sleep assessment RATIONALE: All of the listed components should be included in a comprehensive physical assessment. However, sleep is a major concern in clients with PTSD and is likely disrupted to a greater degree than respiratory function, bowel function, or nutrition.
Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. The client watched the client's spouse burn to death from the helicopter. The client continues to have nightmares and is fearful that the client will die in a fire. An appropriate nursing diagnosis for the client is what? A. Anxiety related to illusions B. Sleep pattern disturbance related to recurrent nightmares C. Unrealistic fear of fire related to conversion reaction D. Ego disintegration related to severe anxiety
ANSWER: B. Sleep pattern disturbance related to recurrent nightmares RATIONALE: The appropriate nursing diagnosis is sleep pattern disturbance. The client is not having illusions, nor is the client's fear of the fire unrealistic. The client is not experiencing ego disintegration.
What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation? A. The client experiences awakenings during the night and is unable to fall asleep again B. The client is often "staring into space" and has no idea how much time has passed C. The client states that usual coping mechanisms are ineffective D. The client states that the client's mood is "alright" when appearing to be in some distress
ANSWER: B. The client is often "staring into space" and has no idea how much time has passed RATIONALE: "Spacing out" is an example of dissociation (depersonalization). It is not uncommon for the client with PTSD to experience failure of coping skills, sleep disturbances, and reluctance to acknowledge moods, but these are not evidence of dissociation.
A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan? A. Administration of monoamine oxidase inhibitors (MAOIs) as prescribed B. Vigilant monitoring for potential indications of self-harm C. Education to the client about appropriate social interactions D. Frequent assessment for delusional thinking or hallucinations
ANSWER: B. Vigilant monitoring for potential indications of self-harm RATIONALE: The risk for suicide or other forms of self-harm is high in clients with PTSD. MAOIs are not used to treat the disorder, and delusions and hallucinations rarely occur. Social isolation is common among patients with PTSD; inappropriate social interactions, however, are less common.
A psychiatric nurse is assessing a client with post-traumatic stress disorder (PTSD). During the psychosocial component of the assessment, what assessment question should the nurse include? A. "Do you feel like treatment has been beneficial so far?" B. "Have you been having any side effects from your medication?" C. "How are your symptoms affecting your day-to-day routines?" D. "How would you describe the quality of your sleep these days?"
ANSWER: C. "How are your symptoms affecting your day-to-day routines?" RATIONALE: Assessing the effect of a client's PTSD on his or her daily routines is a major focus of psychosocial assessment. Sleep is a component of a physical assessment, as are medication side effects. Eliciting the client's opinion of treatment so far is important, but this is not situated solely within the psychosocial domain.
Which statement made by a client diagnosed with posttraumatic stress disorder (PTSD) leads a nurse to believe that the client is experiencing dissociative symptoms? A. "It's like I'm having flashbacks every time I fall asleep." B. "I feel guilty that I survived the attack and my friend didn't." C. "I describe my feelings like I'm having an out-of-body experience." D. "Loud noises always make me a little jittery now."
ANSWER: C. "I describe my feelings like I'm having an out-of-body experience." RATIONALE: Dissociation is a disruption in the normally occurring linkages among subjective awareness, feelings, thoughts, behavior, and memories. A person who dissociates is making them "disappear." That is, the person has the feeling of leaving their body and observing what happens to it from a distance. During trauma, dissociation enables a person to observe the event while experiencing no pain or only limited pain and to protect themselves from awareness of the full impact of the traumatic event. Flashbacks are common with PTSD; loud noises associated with the trauma cause flashbacks. Guilt is common for survivors.
What medication is used for angina to prevent blood clots?
ASA (aka Aspirin) Aspirin (ASA) and other anti-platelet medicines prevent blood clotting. This makes it easier for blood to flow through narrowed heart arteries. Acetylsalicylic acid (ASA) inhibits platelet function via cyclooxygenase inhibition. The selective inhibition of platelet cyclooxygenase is possible with the use of low doses of ASA due to presystemic acetylation of the platelet enzyme in the portal circulation.
The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal? A. "My spouse seems to sleep and sleep, even when there's no reason why my spouse should be tired." B. "My spouse's libido has completely dropped off, and that's not at all like my spouse." C. "My spouse always seems so irritated now, which isn't like my spouse." D. "My spouse seems to overeat at almost every meal, and then snack all the time too."
ANSWER: C. "My spouse always seems so irritated now, which isn't like my spouse." RATIONALE: Irritability is a hallmark of hyperarousal. Overeating, loss of sexual interest, and hypersomnia are not associated with hyperarousal.
When explaining dissociative disorders to a client, what feature of these disorders would a nurse describe? A. Disinhibited social engagement, being overly friendly with strangers B. Total amnesia of the events that caused the disorder C. Failure to integrate identity, memory, and consciousness D. Overuse of sedatives like alcohol
ANSWER: C. Failure to integrate identity, memory, and consciousness RATIONALE: The essential feature of these disorders involves a failure to integrate identity, memory, and consciousness. That is, unwanted intrusive thoughts disrupt one's contact with the here and now, or memories that are normally accessible are lost. These disorders are closely related to trauma- and stressor-related disorders but are categorized separately.
When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing which condition? A. Emotional numbness B. Dissociative amnesia C. Posttraumatic stress disorder D. Paranoia
ANSWER: C. Posttraumatic stress disorder RATIONALE: When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing posttraumatic stress disorder, not emotional numbness, dissociative amnesia, or paranoia.
The nurse is dialoguing with a client who has been referred after witnessing a workplace accident several weeks ago that resulted in a coworker's death. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)? A. The client avoided the coworker's family in the days after the event. B. The client's work performance has suffered after the event. C. The client states that the client is often "awake for hours and hours each night." D. The client had to take several sick days in the days after the event.
ANSWER: C. The client states that the client is often "awake for hours and hours each night." RATIONALE: Sleep disturbances are key diagnostic characteristics of PTSD. Each of the other assessment findings should be addressed, but none is a diagnostic criterion for PTSD.
A client who has been diagnosed with post-traumatic stress disorder is scheduled to begin stress inoculation training. The nurse should document what desired outcome related to this therapy? A. The client will acknowledge his diagnosis to family and close friends B. The client will use benzodiazepines and SSRIs safely C. The client will demonstrate anxiety-reduction strategies D. The client will express a willingness to visit the site of the trauma
ANSWER: C. The client will demonstrate anxiety-reduction strategies RATIONALE: Stress inoculation therapy aims to instill strategies for reducing anxiety. A willingness to visit the site of the trauma would be an indirect outcome. Acknowledging a diagnosis is important, but is not directly related to stress inoculation therapy and the focus on anxiety management. Medications are unrelated to stress inoculation therapy.
The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed posttraumatic stress disorder (PTSD). The nurse observes that the client's nonverbals are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret this client's behavior? A. The client has likely responded poorly to prior treatments B. The client's PTSD is affecting the client's cognition and information processing C. The client's trauma likely has an impact on the client's ability to trust D. The client has likely had a series of negative interactions with health providers
ANSWER: C. The client's trauma likely has an impact on the client's ability to trust RATIONALE: Persons whose trauma resulted from sexual assault are likely to be reluctant to trust. It is possible that the client has had negative encounters with health care providers, but issues related to trust are more likely, given the nature of the client's trauma. Cognitive deficits are less likely, and mistrust is not necessarily indicative that treatment is ineffective.
Three years ago, the nurse's parent died in an intensive care unit (ICU). The nurse is caring for a client in the ICU with the same diagnosis and similar features to the nurse's parent. Which manifestation of posttraumatic stress disorder (PTSD) did the nurse likely experience when feeling a sense of panic confronting the client? A. emotional numbing B. derealization C. a flashback D. hyperarousal
ANSWER: C. a flashback RATIONALE: This nurse was experiencing a flashback, whereupon similar circumstances triggered a sensation that the stressful experience was happening again. Hyperarousal is the general sense of sympathetic stimulation that accompanies PTSD, and emotional numbing is a blunting of affective responses. Derealization is a feeling that is described as "being in a dream state" but being aware of what is going on around the person.
A client with posttraumatic stress disorder (PTSD) suffered injuries in a workplace fire several months ago and now admits that the client is reluctant to join family members on a camping trip. The client states, "The last place I want to be is sitting around a bonfire, pretending to have a good time." The nurse should recognize the characteristics of: A. derealization. B. depersonalization. C. avoidance. D. numbing.
ANSWER: C. avoidance. RATIONALE: The client's reluctance to be around a fire is a clear example of avoiding reminders of a trauma. This avoidance is not an example of numbing, derealization (feelings of unreality), or depersonalization.
One major difference between posttraumatic stress disorder (PTSD) and the other anxiety disorders is that ... A. the person has physiological reactions, not just psychological ones. B. Prozac usually works best with PTSD. C. symptoms begin after exposure to a traumatic stressor. D. The person experiences acute anxiety with feelings of panic.
ANSWER: C. symptoms begin after exposure to a traumatic stressor. RATIONALE: There is an easily identifiable stressful event preceding the onset of PTSD symptoms. When symptoms of ASD continue for more than 1 month and are accompanied by functional impairment or stress, the diagnosis changes to acute posttraumatic stress disorder (PTSD). Symptoms include generalized anxiety, intrusive thoughts or images of the trauma, flashbacks, nightmares, and other sleep disturbances.
The nurse is assessing a client who has recently received a diagnosis of posttraumatic stress disorder. When conducting this assessment, the nurse should: A. reassure the client that the client will eventually have a full recovery. B. corroborate the client's statements with a trusted friend or family member. C. try to identify any strengths or skills that can be applied during recovery. D. prioritize psychological findings over physical findings.
ANSWER: C. try to identify any strengths or skills that can be applied during recovery. RATIONALE: During assessment, it is important to note any strengths that can be integrated into the client's care. Psychological findings do not always take priority over physical findings and it is unnecessary to confirm everything that the client says with another individual. The nurse must avoid false reassurance; full recovery is never guaranteed.
A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response? A. "It's more likely that the client is experiencing anxiety, which will likely decrease with time." B. "Actually, she won't meet the diagnostic criteria for PTSD until 3 months after the attack." C. "If the client doesn't receive treatment right away, the client might not recover from the PTSD." D. "Acute stress disorder is a possibility, which might develop into PTSD."
ANSWER: D. "Acute stress disorder is a possibility, which might develop into PTSD." RATIONALE: A diagnosis of PTSD requires 1 month of symptoms. Acute stress disorder exists closer to the traumatic event and may develop into PTSD if not resolved. Anxiety is not necessarily self-limiting.
A client with post-traumatic stress disorder (PTSD) tells the nurse, "Every morning I wake up with a vicious hangover and swear I'll never drink like that again. Yet, every night I somehow end up at the bar." The nurse should consider the possibility of what nursing diagnosis? A. Impaired social interaction B. Complicated grieving C. Defensive coping D. Ineffective impulse control
ANSWER: D. Ineffective impulse control RATIONALE: This client is acknowledging that he or she is unable to manage the behaviors surrounding alcohol abuse. This is not necessarily a form of defensive coping, though it is certainly an unhealthy coping strategy. Grieving is more closely related to death and loss than PTSD. Problems with social interaction are not at the essence of the client's statement.
The nurse's assessment of a child from a dysfunctional family background suggests that the child lacks resilience. What outcome should the nurse identify after performing appropriate interventions? A. The child states that the child is comfortable being alone for short periods of time B. The child is able to set appropriate boundaries with people the child has recently met C. The child states that the child's current stress levels are manageable D. The child demonstrates that the child is empowered to solve life problems
ANSWER: D. The child demonstrates that the child is empowered to solve life problems RATIONALE: Resilience is enhanced by empowerment that leads to self-worth and self-concept. It is not directly related to boundary setting in relationships, comfort in solitude. High resilience confers protection against stress, but it is only one component of coping and stress management.
A male combat veteran with a diagnosis of post-traumatic stress disorder has been prescribed prazosin. What outcome would most clearly indicate the effectiveness of this treatment? A. The client states that he is more willing to discuss his trauma. B. The client reports greater energy for accomplishing daily tasks. C. The client's family describes him as "more relaxed". D. The client reports fewer and less intense nightmares.
ANSWER: D. The client reports fewer and less intense nightmares. RATIONALE: Prazosin is used in the treatment of PTSD to improve sleep and relieve nightmares. Outcomes such as increased energy, less hyperarousal and emotional openness would be indirect outcomes of the effects on sleep and nightmares.
A psychiatric-mental health nurse is teaching the family members of a client about strategies for engaging with their family member who has recently been diagnosed with posttraumatic stress disorder (PTSD). The nurse should encourage the client's family to: A. expect that the client will sleep for short periods of time, several times per day. B. ensure the client takes benzodiazepines at the same time each day. C. create social interaction for the client even if the client is actively opposed to socializing. D. anticipate that the client is likely to be irritable and withdrawn at times.
ANSWER: D. anticipate that the client is likely to be irritable and withdrawn at times. RATIONALE: Clients with PTSD are prone to irritability and social withdrawal. In most cases, it is counterproductive and unethical to force a client into social situations if he or she is openly opposed to them. Sleep disruptions are expected, but there is no recognized pattern of frequent naps; insomnia is typical. Benzodiazepines are not normally used for the treatment of PTSD.
A client with post-traumatic stress disorder is found to have a high propensity for fear. This characteristic is most likely the result of: A. pituitary hypofunction combined with overstimulation of the thalamus. B. deficient levels of the neurotransmitter N-methyl-D-aspartate (NMDA). C. hypofunction of the client's parasympathetic nervous system. D. characteristics of the client's amygdala and hippocampus.
ANSWER: D. characteristics of the client's amygdala and hippocampus. RATIONALE: The amygdala and hippocampus are known to be significant contributors to fear conditioning. NDMA is necessary for fear conditioning. The parasympathetic nervous system and the pituitary gland are not major contributors to fear conditioning.
A client who is a bus driver was involved in an accident in which two of her passengers died. The client blames herself for their death even though she was exonerated in the follow-up investigation. To help the client see the event more realistically, the nurse should: A. discuss the possibility of benzodiazepines with the primary care provider. B. arrange for the client to receive eye movement, desensitization, and reprocessing (EMDR) therapy C. discuss the possibility of SSRIs with the primary care provider. D. facilitate a referral for cognitive restructuring therapy.
ANSWER: D. facilitate a referral for cognitive restructuring therapy. RATIONALE: Cognitive restructuring aims to help the client reframe an event in a more realistic way. EMDR addresses the emotional impact of the events. Medications aid with anxiety and mood but do not directly change the client's view of events.
What is Hypertension?
Approximately 30% of Americans have hypertension. Hypertension places people at increased risk for cardiovascular and renal disease and for stroke. Primary hypertension is the most prevalent form, however people may also suffer from secondary hypertension, isolated systolic hypertension, or pseudohypertension. Some people may develop resistant hypertension.
A patient reports that they have stopped taking their BP meds because they have experienced ED and would rather deal with the BP issues than have ED. How should the nurse respond to the patient's concerns about his ED? A. All hypertensives have this side effect B. Let's talk to your doctor about switching to a drug that does not have this side effect C. It's not from your antihypertensive, it's a normal aging change D. You have to take your BP medication, so I guess you'll have to learn to live with this
B. Let's talk to your doctor about switching to a drug that does not have this side effect Some classes of antihypertensives (including thiazides and beta blockers) can cause sexual dysfunction, including ED, loss of libido and decreased ejaculation. There are other classes of drugs the patient could try that do not have this potential side effect.
Which of the following assessments would the nurse perform on the patient being treated for hypertensive encephalopathy? A. Monitor neuro signs once a shift B. Monitor BP every 2 to 3 minutes during the initial administration of sodium nitroprusside C. Monitor urine output every 4 hours D. Get patient up to the commode to void
B. Monitor BP every 2 to 3 minutes during the initial administration of sodium nitroprusside Rationale: Lowering BP more than 25% in the first hour could lead to stroke, MI or renal failure. Urine output should be monitored hourly until stable to assess for renal function. The patient should remain on bedrest until stable. Neurologic signs should be monitored at least hourly until stable.
Ms. Anderson wonders how so many different factors can contribute to her chest pain: What stimulates the sympathetic nervous system and increases cardiac workload? A. Exercise B. Stress C. Heavy Meals
B. Stress Stress stimulates the SNS, increasing cardiac workload and O2 demand.
What is the rationale for changing a patient's medication to a combination drug? A. The medications are more effective together because they enhance each other B. The drugs are from two different classes and correct different pathophysiologic factors for HTN C. It's more cost effective to supply a combination drug
B. The drugs are from two different classes and correct different pathophysiologic factors for HTN
What blood work and/or tests would be done to assess heart conditions?
C-Reactive Protein (CRP) Troponin Myoglobin CBC Chemistry panel Renal panel Lipid panel Stress test with thallium-201
Ms. Anderson wonders how so many different factors can contribute to her chest pain: What diverts blood, decreasing blood flow in the coronary artery system? A. Exercise B. Stress C. Heavy Meals
C. Heavy Meals Heavy meals divert blood to the GI tract, decreasing flow to the coronary arteries.
What expectation should the nurse have regarding Ms. Anderson's chest tube drainage? A. It will decrease to 0mL within 24 hours B. It will be sanguinous with tissue shreds C. It will change in color from sanguinous to serosanguinous to serous. D. It will be 500mL to 600mL for the first 6 hours
C. It will change in color from sanguinous to serosanguinous to serous. Rationale: Chest tube drainage should be no more than 200mL for the first 6 hours and it would be expected to begin to decrease after this. It will be sanguinous at first, changing to serosanguinous and to serous as the drainage amount decreases.
Which of the following statements about cardiac stress tests with thallium-201 confirming a diagnosis of angina is true? A. The patient will continue the stress test for 1 minute after the onset of pain B. The patient will be on radioactive precautions for 24 hours C. Perfusion is restored to ischemic areas within 3 hours D. TI is taken up by ischemic cardiac tissue
C. Perfusion is restored to ischemic areas within 3 hours Rationale: TI is not taken up by ischemic cardiac tissue, and shows as "cold spots" on imaging. TI will move into the ischemic tissue (shows up as "hot spots") indicating perfusion to the area if the patient experienced angina ischemia during the stress test. Unresolved "cold spots" indicate a probable MI. TI involves no more radiation than a normal x-ray study. Cardiac stress testing is interrupted and stopped if the patient experiences pain, extreme fatigue, has drops in BP or pulse, or has S-T segment changes or dysrhythmias on her continuous ECG.
What questions should the nurse ask Ms. Anderson to assess her pain and chest discomfort? A. Let the patient decide what types of pain to discuss B. Use the pain rating scale to assess quality and quantity C. Use the PQRST mnemonic to assess complete pain symptoms
C. Use the PQRST mnemonic to assess complete pain symptoms Rationale: using the PQRST mnemonic will ensure that the nurse fully evaluates the patient's pain; this will assist in the medical diagnosis and treatment of the condition and will provide the assessment data for the development of a nursing care plan.
What initial assessments would be done for a patient who is just being admitted to a step-down unit from the ICU after CABG surgery?
Cardiac Status Measurements → Cardiac rate and rhythm → ECG pattern → BP → Peripheral pulses → Cardiac labs Tube Assessments → Check that foley, chest tubes and NG are all connected and patent → Record output and character from each tube Respiratory Assessments → Respiratory rate → Respiratory rhythm → Auscultate all lung fields for adventitious sounds → Assess patient knowledge of incentive spirometry and encourage → Monitor O2 saturations Fluid and Electrolyte balance → Check that correct IV is hanging at correct rate → Check that IV site is patent and symptom-free → Monitor labs → Measure output from all tubes
What are modifiable risk factors for hypertension?
Obesity (BMI >30) A diet high in salt and fats Physical inactivity Alcohol consumption Cigarette smoking Stress
What is nocturnal angina?
Occurs only at night; Not necessarily during sleep
What is decubitus angina?
Occurs only when lying down and is relieved by standing
What are the different types of angina?
Chronic Stable Angina Silent Angina Nocturnal Angina Decubitus Angina Prinzmetal's Angina
The nurse receiving Ms. Anderson from the ICU after her CABG operation notes that her K+ level is 6.0. What is the most likely cause for this? A. Inadequate fluid intake B. NG tube suctioning C. K+ added to IV bag D. Hemolysis from the cardiopulmonary bypass machine
D. Hemolysis from the cardiopulmonary bypass machine Rationale: The CPB can cause hemolysis. Lysis of the RBCs will release K+ from the intracellular space resulting in serum hyperkalemia. Excessive NG tube drainage would cause hypokalemia. While it is likely that the IV potassium additive would have been discontinued, this is not the most likely cause of the patient's hyperkalemia. Inadequate fluid intake would lead to hypokalemia.
____, or splitting from self, is a form of coping with extreme anxiety.
Dissociation
What is resistant hypertension?
Failure to reach blood pressure goal while taking 3 antihypertensive medications (including a diuretic).
True or False All persons diagnosed with PTSD develop chronic symptoms.
False
What are non-modifiable risk factors for hypertension?
Family history Ethnicity (incidence in African Americans is twice that in caucasians) Insulin resistance Hyperinsulinemia Sex (HTN is more prevalent in young and middle-aged men but then becomes more prevalent in women over age 65) Hyperlipidemia (sometimes) Low socioeconomic status
What is primary hypertension?
HTN that occurs without an identifiable underlying reason.
What are considerations for nitroglycerin use?
Headache, palpitations & dizziness (especially after changing positions) are common side effects after using nitroglycerin. Nitroglycerin relieves angina pain by relaxing the smooth muscle of the vasculature. Dilation of the vessels reduces systemic vascular resistance (SVR) and afterload & it decreases the amount of blood returning to the heart, thereby decreasing preload. The nurse emphasizes that nitroglycerin should be kept in the original glass container to protect it from light and moisture. The cotton ball inside should be discarded and the bottle dated when opened. The medication should be discarded 6 months after opening to ensure full potency.
After a traumatic experience, the stress alert system goes to a permanent alert, as if danger might return, and is referred to as ____.
Hyperarousal
Expected abnormalities in serum studies confirming angina include which of the following options? A. Increased CRP B. Decreased LDL C. Increased Myoglobin D. Increased Troponin
Increased CRP Rationale: Elevated CRP indicates inflammation; inflammation of the endothelium of the coronary arteries is a probable factor in the development of CAD; CAD is the primary cause of angina. Increased troponin and increased myoglobin indicate MI. LDL would likely be elevated in CAD.
In PTSD, ____ is defined as involuntary appearance of thoughts, memories, or dreams of traumatic events that cause psychological and sometimes physiologic distress.
Intrusion
What is silent angina?
Ischemia without symptoms. Often occurs in diabetic patients with neuropathy
What medication is used for angina to lower cholesterol levels?
Lipitor Statins (including lipitor) lower cholesterol and reduce the risk for CAD, the primary cause of angina.
What medication is used for angina to delay the onset of exercise-induced ischemia?
Lopressor Beta-adrenergic blockers (including lopressor) reduce cardiac O2 demand by decreasing heart rate, blood pressure, vascular resistance, and myocardial contractility → these actions help delay the onset of exercise-induced angina.
What medication is used for angina to relieve acute angina-related pain?
NTG (Nitroglycerin) Nitrates (Imdur and sublingual NTG) dilate veins (and, in large doses, the arteriole bed), which decreases cardiac workload and myocardial O2 demand. A common side effect of nitrates is headache, so Tylenol may be taken with it to prevent this.
What is the PQRST mnemonic for assessing pain?
P → Position & Provocation → "Can you point to your pain?" & "What are you doing when the pain begins?" Q → Quality & Quantity → "Describe your pain (dull, burning, etc.)" & "Has it changed in quality since it first began?" & "How long does the pain last? Is it constant?" R → Radiation → "Does the pain move to another spot after it begins? S→ Severity → "Can you rate the pain (# scale or visual analog)?" & "What makes it better/worse?" T → Timing → "How long ago did the pain first start?" & "How often do you experience this pain?"
____ trauma is an emotional injury caused by an overwhelmingly stressful event that threatens one's survival and sense of security.
Psychological
____ is the capacity to withstand stress and catastrophe.
Resilience
Ms. Anderson is not experiencing irreversible ischemia, the hallmark of MI. Medications and modification of her exercise program will help reduce her angina attacks. Continuing to exercise will reduce her risk factors for CAD, the primary cause of angina. The nurse gives Ms. Anderson instructions on the use of her sublingual NTG; fill in the blanks below with the correct information She should ____ (Chew a tablet, allow a tablet to dissolve, or swallow a whole tablet) at the first sign of chest pain. She may take up to ____ (2, 3 or 5) tablets at least ____ (5, 10 or 15) minutes apart if needed. If the pain is not better after taking the maximum NTG dosage, she should ____ (Call her primary physician, go to the hospital immediately, schedule an appointment for the next day)
She should ALLOW A TABLET TO DISSOLVE in her mouth at the first sign of chest pain. She may take up to 3 tablets at least 5 minutes apart if needed. If the pain is not better after taking the maximum NTG dosage, she should GO TO THE HOSPITAL IMMEDIATELY.
What are precipitating factors for chronic stable angina?
Stress Exercise Heavy Meals Temperature extremes Tobacco use Legal and Illicit pharmaceuticals Circadian rhythms (more occur in the morning after awakening)
What is preload?
The amount of blood returning to the heart from general circulation.
What is afterload?
The amount of resistance against which the left ventricle must pump blood. This is determined by the amount of blood in the left ventricle and by systemic vascular resistance (SVR). If afterload is decreased, cardiac output increases.
What is Chronic Stable Angina?
The most important cause of angina is coronary artery disease (CAD), causing 75% or more blockage of at least one coronary artery. Precipitating factors lead to either an increased demand for cardiac O2 or a decreased supply of cardiac O2 — both conditions lead to myocardial ischemia. Perfusion to the ischemic areas in chronic stable angina is restored by rest and/or sublingual NTG (Nitroglycerin)
What are clinical manifestations of angina?
They can range from: Mild chest discomfort to crushing pain Feelings of anxiety to feelings of impending death Women are more likely to experience atypical symptoms → fatigue → weakness → SOB Elderly individuals may simply experience dyspnea
What is secondary hypertension?
This type of HTN results from a number of disorders and is related to the underlying disease. It may be caused by renal vascular disease, pheochromocytoma, primary hyperaldosteronism, Cushing's syndrome, or dysfunction of the thyroid, pituitary, or parathyroid glands. It may also result from coarctation of the aorta, pregnancy, and neurologic disorders.
True or False Many persons with PTSD escape situations by altering their state of consciousness or numbing.
True
True or False The person with PTSD is primarily treated in the community rather than a medical facility as an inpatient.
True
True or False When an older adult experiences trauma, memories of a lifetime of previous traumas and abuse influence the current experience.
True
True or False Women are twice as likely as men to experience PTSD.
True
What is pseudohypertension?
When sclerotic arteries give falsely high BP readings. An intra-arterial catheter is the only accurate measure of BP in this condition.
What is isolated systolic hypertension?
When the average systolic BP is greater than 140 with average diastolic BP less than 90. This is more common in older adults and can be related to the loss of elasticity in large arteries due to atherosclerosis.