1538 test 4
Creat.
0.6-1.2
development of mental abilities
language use, intelligence, information processing
2 months
language/communication milestones: coos, makes gurgling sounds turns head towards sounds
discoid lupus
skin only circular rashes and splotches
6 months
cognitive milestones: looks around at things nearby brings things to mouth shows curiosity about things and tries to get things that are out of reach begins to pass things from one hand to the other
atypical antipsychotics
used to relieve symptoms such as delusions, hearing voices, hallucinations, paranoia, or confusion associated with some mental illnesses.
infliximab
used to treat RA and ulcerative colitis or Crohn's disease.
prednisone
used to treat UC, arthritis, SLE, etc.
take the client outside and sit with her in the garden area.
a nurse is caring for a client who has bipolar disorder and is running around the unit asking people to dance with her. which of the following interventions should the nurse take?
ibd teaching
importance of rest and diet management perianal care action and side effects of drugs symptoms of recurrence when to seek medical care use of diversional activities to reduce stress
TB
in US, higher prevalence in areas with large population of native americans.
add and adhd
inconsolable tantrums
lupus nephritis manifestations
increased BUN hematuria decreased output nocturia edema dark, foamy urine
corticosteroid side effects
increased blood sugar increased risk of infection slow healing
erikson school age
industry vs. inferiority
school age
industry vs. inferiortiy
anaphylaxis teaching
medic alert bracelet use of epipen to administer IM epinephrine
crohn's
meds are more expensive and the disease is more difficult to treat b/c it involves so many layers
rifampin
monitor LFTs, serum creatinine, cbc
isoniazid
monitor baseline and peridioc LFTs, sputum cultures monthly, monitor AST and ALT
pyrazinamide
monitor periodic LFTs, serum uric acid, sputum culture, and chest x-ray
ethambutol
monitor vision testing in individual eyes and together
maoi
monoamine oxidase inhibitors that inhibit the activity of one or both MAO enzymes and are best known as powerful antidepressants.
late childhood
3-5 years
Alb
3.5-5
phallic stage
4-6 years
ulcerative colitis
areas of inflamed mucosa form pseudopolyps
death
SSRI + MAOI
epithelial cells
few
tyramine
bananas, figs, raisins
piaget's cognitive theory
development of mental abilities language use intelligence information processing assimilation: encounter and react to new situations accommodation: ability to solve problems adaptation: coping behaviors
piaget
development of mental abilities: language use, intelligence, information processing assimilation: encounter and react to new situations accommodation: ability to solve problems adaptation: coping behaviors
basophils
0-1%
eosinophils
0-4%
RBCs
0-5
WBCs
0-5
Bilirubin
0.2-1.2
lithium therapeutic range
0.6-1.2
INR
0.8-1.2 baseline 2.0-3.0 therapeutic
urine specific gravity
1.002-1.030
Mg
1.8-2.6
BUN
10-20
AST
10-40
PT
11-16
female hgb
11.7-16.0
adolescence
12-20 years
erikson adolescence
12-20 years
male hgb
12.4-17.4
Na
135-145
platelets
140000-400000
erikson young adulthood
15-25 years
young adulthood
15-25 years
Prealbumin
16-35
anal stage
18 months to 3 years
early childhood
18 months to 3 years
erikson early childhood
18 months to 3 years
SSRI
1st line drug for bipolar disorder
monocytes
2-8%
PO4
2.4-4.4
lymphocytes
20-40%
aPTT
21-35
HCO3
22-26
adulthood
25-65 years
erikson adulthood
25-65 years
pOSM
275-295
erikson late childhood
3-5 years
K
3.5-5.0
PaCO2
35-45
female hct
36-48%
ibd nutritional therapy
dietary consultant provide adequate nutrition without exacerbating symptoms correct and prevent malnutrition replace f/e losses prevent weight loss
HgbA1C
4.4-6.4%
urine pH
4.5-8
male hct
42-52%
wbc
4500-10000
neutrophils
4500-11000
freud
5 stages: oral - birth to 1.5 years. conflict: weaning anal - 1.5 to 3 years. conflict: toilet training. phallic - 4-6 years. conflict: child identifies with parent of opposite sex latency - 6-puberty. conflict: developing same sex friendships. genital - puberty and after. conflict: full sexual maturity, relationship outside of family and achieve independence.
freud
5 stages: oral, anal, phallic, latency, genital
uOSM
50-1200
latency phase
6 years to puberty
erikson school age
6-12 years
school age
6-12 years
Amylase
60-125
maturity
65 to death
eriskon maturity
65+
ALT
7-56
pH
7.35-7.45
FBS
70-110
erikson
8 stages
PaO2
80-100
Ca
9-11
Cl
96-106
Troponin
<0.04
Lactate
<1.0
CRP
<10
BNP
<100
Lipase
<140
Dig
<2.0
D dimer
<250
Sed rate/ESR
<30
lithium toxicity
> or = 1.5
RA education
if sex is painful, modify positions
anaphylaxis nursing interventions
Airway Breathing Circulation
etiology and pathophysiology of TB
if the cellular immune system is activated, tissue granuloma forms and the bacteria are contained, preventing replication and spread of disease
ibd postop care
ileostomy - monitoring of stoma viability, mucocutaneous juncture, and peristomal skin integrity
tb clinical manifestations
TB disease - extrapulmonary - clinical manifestations depend on the part of the body affected. I.e. kidney = hematuria, meninges = headache and confusion, spine = back pain, larynx = hoarseness
lithium
a mood stabilizer that is used to treat or control the manic episodes of bipolar disorder and it also helps to prevent or lessen the intensity of manic episodes.
RA DMARD therapy
BUN of 44 methotrexate hydroxychloroquine used to prevent inflammation and joint damage
ibd meds
immunosuppressants to suppress immune response and maintain remission after induction therapy
ibd nursing diagnoses
impaired skin integrity anxiety ineffective coping ineffective self health management imbalanced nutrition: less than body requirements
i should provide counseling for the family following the suicide of a loved one.
a nurse working in suicide prevention is discussing suicide interventions with a newly hired nurse. which of the following statements indicates that the newly hired nurse understands when a tertiary intervention is needed?
phenelzine
an MAOI that is used to treat symptoms of atypical depression.
second gen antipsychotics - atypical
quetiapine aripiprazole ziprasidone lurasidone olanzapine
escitalopram
an antidepressant belonging to the group called SSRIs that affects chemicals in the brain that may be unbalanced in people with depression or anxiety.
sertraline
an antidepressant in the SSRI group that attacks chemicals in the brain that may be unbalanced in people with depression, panic, anxiety, or OCD symptoms.
bupropion
an antidepressant used to treat major depressive disorder and seasonal affective disorder.
IBD biologic therapies
anti TNF agents: infliximab, adalimumab, certolizumab pegol, natalizumab
aminosalicylates
anti-inflammatory agents used to treat IBD and some forms of arthritis.
ethambutol
antibiotic that prevents the growth of TB bacteria
isoniazid
antibiotic used to treat TB
pyrazinamide
antibiotic used to treat TB in adults and children that must be used with other TB meds.
phenelzine
NOT used for treating severe depression or bipolar disorder.
rifampin
antibiotic used to treat or prevent TB infections
biologics
antibodies grown in a lab that stop certain proteins in the body from causing inflammation
bipolar meds
antidepressants antipsychotics mood stabilizers
blurred vision, intention tremor, and urinary hesitancy.
a 33 year old patient presents at the clinic with complaints of weakness, incoordination, dizziness, and loss of balance. the patient is hospitalized and diagnosed with MS. what sign or symptom, revealed during the initial assessment, is typical of MS? a. diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes. b. flexor spasm, clonus, and negative babinskis reflex. c. blurred vision, intention tremor, and urinary hesitancy. d. hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs.
chronic illness.
a charge nurse is conducting a staff education in service about depressive disorders. which of the following should the nurse identify as a risk factor for depression?
performing life saving measures following a suicide attempt.
a charge nurse is discussing suicide interventions with nursing staff. which of the following should the nurse identify as an example of a secondary intervention?
have the child eat a good breakfast and snacks late in the day and at bedtime.
a child with ADHD complains to his parents that he does not like the side effects of his medicine, adderall. the parents ask the nurse for suggestions to reduce the medication's negative side effects. the nurse can best help the parents by offering which advice? a. give the child his medicine at night. b. have the child eat a good breakfast and snacks late in the day and at bedtime. c. limit the number of calories the child eats each day. d. let the child take daytime naps.
increased impulsivity or hyperactive behavior.
a child with attention deficit hyperactivity disorder is taking methylphenidate (ritalin) in divided doses. if the child takes the first dose at 8 a.m., which behavior might the school nurse expect to see at noon? a. increased impulsivity r hyperactive behavior. b. lack of appetite for lunch. c. sleepiness or drowsiness. d. social isolation from peers.
SSRIs
a class of antidepressants that work by increasing the levels of serotonin in the brain
stating, "medications help your brain function better, but the therapy helps you achieve lasting behavior change."
a client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. which would be the most therapeutic nursing intervention? a. stating, "the effects of medications will not last forever. you will need to eventually learn to function without them." b. stating, "medications help your brain function better, but the therapy helps you achieve lasting behavior change." c. stating, "both are recommended. since your insurance covers both, that is the best plan for you." d. asking, "do you have reservations about going to therapy?"
identify cues in the client's behavior that might have warned that he was contemplating suicide.
a client commits suicide in an acute mental health facility. which of the following is the priority intervention for the staff following the incident?
approximately 2 weeks after starting antidepressant medication.
a client has just been diagnosed as having major depression. at which time would the nurse expect the client to be at highest risk for self-harm? a. immediately after a family visit b. on the anniversary of significant life events in the client's life. c. during the first few days after admission. d. approximately 2 weeks after starting antidepressant medication.
anhedonia, feelings of worthlessness, and difficulty focusing
a client is admitted for major depression. what should the nurse expect to find during assessment? a. anhedonia, feelings of worthlessness, and difficulty focusing b. depressed mood, guilt, and pressured speech c. changes in sleep pattern, tired, and grandiose mood d. difficulty focusing, feelings of helplessness, and flight of ideas
drink a 2L bottle of decaffeinated fluid daily. do not alter dietary salt intake. see the doctor if you get the flu.
a client is being discharged on lithium. the nurse encourages the client to follow which health maintenance recommendations? select all that apply. a. weigh self weekly at the same time of day. b. drink a 2L bottle of decaffeinated fluid daily. c. do not alter dietary salt intake. d. see the doctor if you get the flu. e. restrict involvement in intensive exercise.
take the medication at night.
a client who has been discharged home on celexa calls the nurse complaining that the medication causes her to feel too drowsy. the nurse should make which of the following suggestions? a. make an appointment to change to a different medication. b. take the medication at night. c. be patient while this early side effect subsides. d. skip a dose if drowsiness is excessive.
inspect the cuts for debris.
a client who has bipolar disorder approaches the nurse and reveals fresh, self inflicted, superficial cuts going up and down his right arm. which of the following actions should the nurse take first?
are you thinking of harming yourself?
a client who has major depressive disorder states to the nurse that he and his family would be better off if he were gone. which of the following is the nurse's priority response?
you are feeling really sad right now. it's a hard time.
a client who is depressed begins to cry and states, "i'm just really sick of feeling this way. nothing ever seems to go right in my life." which would be the most appropriate response by the nurse? a. don't cry. try to look at the positive side of things. b. you are feeling really sad right now. it's a hard time. c. hang in there. your medication will start helping in a few days. d. nothing ever goes right.
are you planning to commit suicide?
a client who is depressed states, "i think my family would be better off without me. they don't need to worry." which would be the most appropriate response by the nurse? a. are you planning to commit suicide? b. what do you think they are worried about? c. where are you going? d. you don't mean that. your family loves you.
please slow down. i'm not sure what you need first.
a client who is manic states, "what time is it? i have to see the doctor. is breakfast here yet? i've got to see the doctor first. can i get my cereal out of the kitchen?" which would be the most appropriate response by the nurse? a. please slow down. i'm not sure what you need first. b. you will have to be quiet and have breakfast after the doctor comes. c. are you hungry? d. your thoughts seem to be racing this morning.
setting limits on aggressive and intimidating behavior.
a client who is manic threatens others on the unit. which would be the initial nursing action in response to this behavior? a. administering a sedative that has been prescribed to be used PRN. b. insisting the client take a time out in his room. c. clearing the area of all other clients. d. setting limits on aggressive and intimidating behavior.
risk for suicide related to a highly lethal plan
a client who just went through an upsetting divorce is threatening to commit suicide with a handgun. the client is involuntarily admitted to the psychiatric unit. which nursing diagnosis has the highest priority? a. hopelessness related to recent divorce. b. ineffective coping related to inadequate stress management. c. spiritual distress related to conflicting thoughts about suicide and sin. d. risk for suicide related to a highly lethal plan.
decrease the client's environmental stimuli.
a client with bipolar disorder is admitted to the psychiatric unit. the client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. which nursing intervention should occur first? a. decrease the client's environmental stimuli. b. give the client feedback about his behavior. c. introduce the client to other staff on the unit. d. tell the client about hospital rules and policies.
the nurse gave the client a chance to calm down before resuming the meal.
a client with dementia gets angry and begins to yell at the nurse during mealtime. the nurse leaves the client's side for 5-10 minutes and then returns. which of the following best explains the nurse's behavior? a. the nurse was unsure of how to calm the client. b. the nurse was frustrated and needed to take a time out. c. the nurse gave the client a chance to calm down before resuming the meal. d. the nurse stepped away to verify the safety of other clients.
tacrine (cognex)
a client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. the client has a history of moderate but steady alcohol use over the past 45 years. which medication should the nurse question as least suitable for this client? a. tacrine (cognex) b. memantine (namenda) c. donepezil (aricept) d. rivastigmine (exelon)
agnosia
a client with dementia is unable to recognize ordinary objects, such as a pen or notebook. which would this be a symptom of? a. agnosia b. amnesia c. apraxia d. aphasia
structuring the activity to facilitate completion of one specific task.
a client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. which nursing intervention is most likely to help the client successfully participate? a. allowing the client to direct her participation at her own pace. b. giving the client several choices of projects, so she can choose her favorite. c. staying away from the client during the session to encourage free expression. d. structuring the activity to facilitate completion of one specific task.
accompany the client to his or her room to get dressed.
a client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. which nursing intervention would be most appropriate at this time? a. accompany the client to his or her room to get dressed. b. put the client in seclusion for his or her own protection. c. tell other clients to ignore the behavior because it is harmless. d. tell the client that the behaviors have to stop right now.
other clients need to be protected from the intrusive behavior.
a client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. the nurse's intervention should be based on which rationale? a. as soon as lunch is over, the client will calm down. b. other clients need to be protected from the intrusive behavior. c. the client's behavior is not an imminent threat to anyone's physical safety. d. the client needs food and fluids in any way possible.
encourage her to have her pharmacy replace the tops with alternatives that are easier to open.
a clinic nurse is caring for a patient diagnosed with RA. the patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. how can the nurse best facilitate the patients adherence to her medication regimen? a. encourage the patient to store the bottles with their tops removed. b. have a trusted family member take over the management of the patients medication regimen. c. encourage her to have her pharmacy replace the tops with alternatives that are easier to open. d. have the patient approach her PCP to explore medication alternatives.
the patients functional status
a community health nurse is performing a visit to the home of a patient who has a history of RA. on what aspect of the patients health should the nurse focus most closely during the visit? a. the patients understanding of RA. b. the patients risk for cardiopulmonary complications. c. the patients social support system. d. the patients functional status.
taking unnecessary risks
a concerned family member tells the nurse, "i'm concerned about my brother. he has been acting very different lately." knowing the family has a history of bipolar disorder, the nurse inquires further about this. which behavior during the past week might indicate that the brother has bipolar disorder? a. taking unnecessary risks b. sleeping more c. intense focus d. showing low self esteem
prednisone
a corticosteroid that prevents the release in the body that cause inflammation and suppresses the immune system.
auranofin
a form of gold that reduces some of the effects of the inflammatory process in the body and is used to treat RA.
difficulty in coordination
a middle aged woman has sought care from her primary care provider and undergone diagnostic testing that has resulted in a diagnosis of MS. what sign or symptom is most likely to have prompted the woman to seek care? a. cognitive declines b. personality changes. c. contractures. d. difficulty in coordination.
there has been no research to establish a relationship between vaccines and autism.
a mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. the mother states that she has heard reports that they cause autism. the most appropriate response by the nurse is, a. it is recommended that you wait until the child is older to vaccinate. b. there are safer alternative immunizations available now. c. there has been no research to establish a relationship between vaccines and autism. d. the risks do not outweigh the benefits of immunization against childhood diseases.
echolalia
a nurse asks an assigned client, "how are you doing today?" the client responds with "doing today, doing today, doing today." which speech pattern disturbance is this an example of? a. reactive attachment disorder. b. stereotypic movement disorder. c. selective mutism. d. echolalia.
use clarification to determine what the client is feeling.
a nurse in a mental health facility is interacting with a client who is angry and becoming increasingly aggressive. which of the following actions should the nurse take?
establish a reward system for positive behavior.
a nurse in a special education program is planning care for a child who has autism spectrum disorder. which of the following interventions should the nurse include in the plan of care?
previous suicide attempt.
a nurse in an ED is caring for an adolescent following a suicide attempt. after reviewing the client's history, the nurse should determine that which of the following is a priority risk factor for suicide completion?
i see that you have on clean clothes and have combed your hair.
a nurse in an acute mental health facility is caring for a client who has major depressive disorder. since her admission 3 days ago, she has not put on clean clothes, washed her hair, or participated in any of the unit activities. on this day, the nurse observes that she is wearing clean clothes and has combed her hair. which of the following responses should the nurse make?
a private room in a quiet location on the unit.
a nurse is admitting a client who is in the manic phase of bipolar disorder. the nurse should plan to make which of the following room assignments for the client?
blurred vision.
a nurse is assessing a client who has SLE and is taking hydroxychloroquine. the nurse should report which of the following adverse effects to the provider immediately?
i will take my medicines as i should and know to call the number you gave me if i have bad thoughts.
a nurse is assessing a client who has a mood disorder to determine his readiness for discharge. which of the following statements by the client indicates he is ready for discharge?
evidence shows minimal benefits from most CAM therapies.
a nurse is assessing a patient with RA. the patient expresses his intent to pursue complementary and alternative therapies. what fact should underlie the nurses response to the patient? a. new evidence shows CAM to be as effective as medical treatment. b. CAM therapies negate many of the benefits of medications. c. CAM therapies typically do more harm than good. d. evidence shows minimal benefits from most CAM therapies.
large building blocks.
a nurse is caring for a 12 month old toddler who is hospitalized and confined to a room with contact precautions in place. which of the following toys should the nurse recommend in order to meet the developmental needs of the client?
liver function tests must be monitored.
a nurse is caring for a client who has bipolar disorder and a new prescription for valproate. which of the following instructions should the nurse give the client about the use of this medication?
talking in rapid, continuous speech. interacting with others in a flirtatious way. spending large sums of money.
a nurse is caring for a client who has bipolar disorder. which of the following actions by the client should the nurse interpret as displaying manic behavior? select all that apply.
explain that antidepressants often take several weeks to be fully effective.
a nurse is caring for a client who has major depressive disorder and was prescribed citalopram 2 weeks ago with a planned dosage increase 1 week ago. the client reports having an improved appetite, but still feels very depressed and is still having trouble sleeping. which of the following actions should the nurse take?
sleep disturbances.
a nurse is caring for a client who has major depressive disorder. which of the following findings should the nurse expect?
I will assist you in getting out of bed and getting dressed.
a nurse is caring for a client who is depressed and refuses to participate in group therapy or perform activities of daily living. which of the following statements should the nurse make to the client?
epinephrine
a nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. which of the following medications should the nurse administer first?
history of gastric ulcers
a nurse is caring for a female client who has RA and asks the nurse if it is safe for her to take aspirin. the nurse should recognize which of the following findings in the client's history is a contraindication to this medication?
irritability. insomnia. low self esteem. chronic pain.
a nurse is caring for an adolescent who is experiencing indications of depression. which of the following findings should the nurse expect? select all that apply.
erythrocyte sedimentation rate (ESR)
a nurse is caring for an older adult client who has RA and is taking aspirin 650 mg every 4 hours. which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication?
reading
a nurse is educating a group of elderly community members about cognitive disorders. which would the nurse include as a measure most likely to prevent alzheimer's disease and other dementias? a. crafts b. cooking c. watching television d. reading
hydroxychloroquine
antimalarial used to treat RA and discoid or systemic lupus erythematosus.
metronidazole
antimicrobial used to treat IBD and is a primary therapy for crohn's
joint stiffness, especially in the morning.
a nurse is performing the health history and physical assessment of a patient who has a diagnosis of RA. what assessment finding is most consistent with the clinical presentation of RA? a. cool joints with decreased range of motion. b. signs of systemic infection. c. joint stiffness, especially in the morning. d. visible atrophy of the knee and shoulder joints.
butterfly rash
a nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus. what skin manifestation would the nurse expect to observe on inspection? a. petechiae. b. butterfly rash. c. jaundice. d. skin sloughing.
determine the clients need for assistance with grooming.
a nurse is planning care for a client newly admitted with major depressive disorder. which of the following actions should the nurse plan to take?
have consistent unit routines.
a nurse is planning care for a client who is in the manic phase of bipolar disorder. which of the following interventions should the nurse include in the client's plan of care?
visual changes
a nurse is planning patient education for a patient being discharged home with a diagnosis of RA. the patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self monitor for what adverse effect? a. tinnitus. b. visual changes. c. stomatitis. d. hirsutism.
systemic lupus erythematosus
a nurse is providing care for a patient who has a rheumatic disorder. the nurses comprehensive assessment includes the patients mood, behavior, LOC, and neurologic status. what is this patients most likely diagnosis? a. OA b. systemic lupus erythematosus. c. RA d. gout
methotrexate
a nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. the nurse should anticipate the administration of which of the following? a. hydromorphone. b. methotrexate. c. allopurinol. d. prednisone.
the client runs 4 miles outdoors every afternoon.
a nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. the nurse should teach the client that which of the following factors puts her at risk for lithium toxicity?
it is important for parents of children with ADHD to learn how to rebuild their child's self esteem. because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help.
a nurse is providing education to a group of parents who have children with ADHD. which of the following statements would be accurate and should be included in the education? select all that apply. a. medication alone will adequately treat children with ADHD. b. it is important for parents of children with ADHD to learn how to rebuild their child's self esteem. c. because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. d. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help. e. children with ADHD do not qualify for special school services under the individuals with disabilities education act.
you should change positions slowly while taking this medication.
a nurse is providing medication teaching to a client who has a new prescription for phenelzine. which of the following statements should the nurse include in the teaching?
do not drink alcohol while taking this medication. report unexplained bruising to the provider. avoid people with infections.
a nurse is providing teaching to a client who has RA and a new prescription for methotrexate. which of the following instructions should the nurse include? select all that apply.
paroxetine. lithium. valproate. carbamazepine.
a nurse is reviewing medication records for several clients who have bipolar disorder. the nurse should recognize that which of the following medications are used to treat clients who have bipolar disorder? select all that apply.
more difficulty seeing due to a greater sensitivity to glare. decreased cough reflex. decreased bladder capacity. dehydration of intervertebral discs.
a nurse is teaching a class of older adults about the expected physiologic changes of aging. which of the following changes should the nurse include in the discussion? select all that apply.
exercise.
a nurse is teaching a female client who has a new diagnosis of SLE. the nurse should recognize the need for further teaching when the client identifies which of the following as a factor that can exacerbate SLE?
give the dose in the morning to help prevent insomnia.
a nurse is teaching the parents of a school age child who has ADHD about atomoxetine. which of the following instructions should the nurse include in the teaching?
diagnosis of schizophrenia. age greater than 55. male gender.
a nurse manager is discussing suicide with nursing staff. which of the following should the manager identify as risk factors for suicide? select all that apply.
you must be very upset about something.
a nurse who works in a psychiatric unit is caring for a client who has bipolar disorder. the client comes to the nurses' station at 0300 demanding that the nurse call the provider immediately. which of the following responses by the nurse is appropriate?
the clients may not recognize their family when they come to visit.
a nurse working in an assisted living facility is holding an in service for the nursing assistants. the nurse reviews common behaviors associated with cognitive deterioration associated with dementia. which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? a. the clients should be able to ask us for items they need. b. the clients may not recognize their family when they come to visit. c. the clients who are ambulatory can still carry out activities of daily living independently. d. the clients should know when to come to the dining room for meals.
ibd drug therapy
antimicrobials corticosteroids: decrease inflammation, used to achieve remission, and helpful for acute flareups
preserve and increase range of motion while limiting joint stress.
a nurses plan of care for a patient with RA includes several exercise based interventions. exercises for patients with rheumatoid disorders should have which of the following goals? a. maximize range of motion while minimizing exertion. b. increase joint size and strength. c. limit energy output in order to preserve strength for healing. d. preserve and increase range of motion while limiting joint stress.
the child interrupts others.
a parent is concerned that his child might suffer from attention deficit hyperactivity disorder. which of the following behaviors reported by the parent would be consistent with this diagnosis? a. the child interrupts others. b. the child has been hoarding objects. c. the child has lots of friends. d. the child is excelling academically in school.
explore the use of antipsychotic medications to control tantrums.
a parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. which option should the nurse inform the parents that may be appropriate? a. give the child rewards for resisting tantrums. b. reason with the child why tantrums are not effective. c. place the child in a time out when tantrums occur. d. explore the use of antipsychotic medications to control tantrums.
tofu
a patient admitted with IBD asks the nurse for help with menu selections. what menu selection is most likely the best choice for this patient? a. spinach b. tofu c. multigrain bagel d. blueberries
decreased muscle spasms in the lower extremities.
a patient diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. included in the admission orders is baclofen. what should the nurse identify as an expected outcome of this treatment? a. reduction in the appearance of new lesions on the MRI. b. decreased muscle spasms in the lower extremities. c. increased muscle strength in the upper extremities. d. decreased severity and duration of exacerbations.
infection
a patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide. the nurses subsequent assessments should address what potential adverse effect? a. infection. b. acute confusion. c. sedation. d. malignant hyperthermia.
arthrocentesis
a patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. the nurse knows that which of the following procedures will be involved? a. angiography. b. myelography. c. paracentesis. d. arthrocentesis.
fatigue related to anemia
a patient who has been newly diagnosed with systemic lupus erythematosus has been admitted to the medical unit. which of the following nursing diagnoses is the most plausible inclusion in the plan of care? a. fatigue related to anemia. b. risk for ineffective tissue perfusion related to venous thromboembolism. c. acute confusion related to increased serum ammonia levels. d. risk for ineffective tissue perfusion related to increased hematocrit.
establish a timed voiding schedule.
a patient with MS has been admitted to the hospital following an acute exacerbation. when planning the patients care, the nurse addresses the need to enhance the patients bladder control. what aspect of nursing care is most likely to meet this goal? a. establish a timed voiding schedule. b. avoid foods that change the pH of urine. c. perform intermittent catheterization q6h. d. administer anticholinergic drugs.
position the patient upright during feeding.
a patient with MS has developed dysphagia as a result of cranial nerve dysfunction. what nursing action should the nurse consequently perform? a. arrange for the patient to receive a low residue diet. b. position the patient upright during feeding. c. suction the patient following each meal. d. withhold liquids until the patient has finished eating.
arrange for the patient to be assessed in her home environment.
a patient with RA comes into the clinic for a routine checkup. on assessment the nurse notes that the patient appears to have lost some of her ability to function since her last office visit. which of the following is the most appropriate action? a. arrange a family meeting in order to explore assisting living options. b. refer the patient to a support group. c. arrange for the patient to be assessed in her home environment. d. refer the patient to social work.
taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working.
a patient with SLE asks the nurse why she has to come to the office so often for check ups. what would be the nurses best response? a. taking care of you in the best way involves seeing you face to face. b. taking care of you in the best way involves making sure you are taking your medication the way it is ordered. c. taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working. taking care of you in the best way involves drawing bloodwork every month.
inform the primary care provider that a friction rub may be present.
a patient with SLE has come to the clinic for a routine check up. when auscultating the patients apical heart rate, the nurse notes the presence of a distinct scratching sound. what is the nurses most appropriate action? a. reposition the patient and auscultate posteriorly. b. document the presence of S3 and monitor the patient closely. c. inform the primary care provider that a friction rub may be present. d. inform the PCP that the patient may have pneumonia.
you seem like you're feeling angry. is that something we could talk about?
a patient with an exacerbation of systemic lupus erythematosus has been hospitalized on a medical unit. the nurse observes that the patient expresses anger and irritation when her call bell isn't answered immediately. what would be the most appropriate response? a. you seem like you're feeling angry. is that something that we could talk about? b. try to remember that stress can make your symptoms worse. c. would you like to talk about the problem with the nursing supervisor? d. i can see you're angry. i'll come back when you have calmed down.
ibd meds
antimicrobials and corticosteroids which are used to decrease inflammation and achieve remission
i'll make sure to monitor my body temperature on a regular basis.
a patient with systemic lupus erythematosus is preparing for discharge. the nurse knows that the patient has understood health education when the patient makes what statement? a. i'll make sure i get enough exposure to sunlight to keep up my vitamin D levels. b. i'll try to be as physically active as possible between flare ups. c. i'll make sure to monitor my body temperature on a regular basis. d. i'll stop taking my steroids when i get relief from my symptoms.
the drug should be used for as short a time as possible.
a patients RA has failed to respond appreciably to first line treatments and the primary care provider has added prednisone to the patients drug regimen. what principle will guide this aspect of the patients treatment? a. the patient will need daily blood testing for the duration of treatment. b. the patient must stop all other drugs 72 hours before starting prednisone. c. the drug should be used at the highest dose the patient can tolerate. d. the drug should be used for as short a time as possible.
rheumatoid arthritis
a patients decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. this patient has been diagnosed with what health problem? a. rheumatoid arthritis. b. systemic lupus erythematosus. c. osteoporosis. d. polymyositis.
an absence of blood in stool
a patients health history is suggestive of IBD. which of the following would suggest crohns disease rather than ulcerative colitis as the cause of the patients signs and symptoms? a. a pattern of distinct exacerbations and remissions. b. severe diarrhea. c. an absence of blood in stool. d. involvement of the rectal mucosa.
none of the kids at school like me, and i don't like them either.
a school nurse is talking with a 13 year old female at her annual health screening visit. which of the following comments made by the adolescent should be the nurse's priority to address?
tb treatment plan: critical
a specific treatment and monitoring plan is developed with the local health department inadequate treatment can lead to ongoing transmission and drug resistance directly observed therapy is a core TB management strategy that requires watching the patient swallow drugs and preferred to ensure adherence
minocycline
a tetracycline antibiotic that fights bacteria in the body.
etanercept
a tumor necrosis factor blocker that is used in adults to prevent joint damage caused by RA.
pour the soda into a plastic cup.
a visitor comes to see a client who is suicidal. upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. which action should the nurse take at this time? a. confiscate the soda can as a restricted item. b. pour the soda into a plastic cup. c. ask the visitor to place the soda can at the nurse's desk until he or she leaves. d. ask the visitor not to bring outside items on the unit in the future.
accommodation
ability to solve problems.
crohn's disease
abscesses and fistulas may form
tb nursing implementation
acute intervention: - airborne isolation - appropriate drug therapy - immediate medical workup teach patient: - cover nose and mouth with tissue when coughing, sneezing, or producing sputum - hand washing after handling sputum soiled tissues
crohn's
affects all layers and occurs in cecum and TI
amitriptyline
affects certain chemical messengers (neurotransmitters) that communicate between brain cells and help regulate mood.
leflunomide
affects the immune system and reduces swelling and inflammation in the body.
tyramine
aged, processed, and smoked meat; liver
serotonin syndrome s/s
agitation or restlessness confusion rapid heart rate and high blood pressure dilated pupils loss of muscle coordination or twitching muscles muscle rigidity heavy sweating diarrhea headache shivering goose bumps
crohn's disease
all layers of the bowel wall
anaphylaxis causes
allergies
epinephrine
alpha and beta adrenergic agonist. rapid production of bronchodilation and vasoconstriction
sulfasalazine
also used to treat RA in children and adults who have used other arthritis meds that did not work or stopped working.
tb nursing implementation
ambulatory and home care: - ensure that patient can adhere to treatment - teach symptoms of recurrence
IBD medications
aminosalicylates antimicrobials corticosteroids immunosuppressants biologic and targeted therapies
ibd drug therapy
aminosalicylates antimicrobials corticosteroids immunosuppressants biologic and targeted therapies
stop that right now
an 8 year old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. what should be the nurse's first step? a. i need to talk to you. b. stop that right now. c. you are going to hurt yourself. d. why are you jumping off the bed?
i can't call the psychiatrist now, but you and i can talk about your request for a pass.
at 1 a.m., the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. what would be the nurse's most therapeutic response? a. go to the day room and wait while i call your psychiatrist. b. don't be unreasonable. i can't call the psychiatrist at this time of night. c. i can't call the psychiatrist now, but you and i can talk about your request for a pass. d. you must really be upset to want a pass immediately. i'll give you some medication.
ibd description
autoimmune disease antigen initiates the inflammation; actual tissue damage results from inappropriate sustained immune response environmental factors play a role more prevalent in whites
erikson early childhood
autonomy vs shame and doubt
early childhood
autonomy vs. shame and doubt
discoid lupus education
avoid the sun and wear protection
phenelzine
avoid tyramine as it induces hypertensive crisis
anaphylaxis primary prevention
avoidance of allergen and prevention after exposure
warning signs of autism
babbling by 12 months gesturing (pointing, waving bye-bye) by 12 months saying single words by 16 months saying two word spontaneous phrases by 24 months (not just echoing) losing any language or social skills at any age.
tyramine
beer, red wine, vermouth
ibd meds
biologic therapies: infliximab, adalimumab, certolizumab pegol, and natalizumab
crohn's treatments
biologics
infancy
birth to 18 months
infancy stage
birth to 18 months
oral stage
birth to 18 months
antihistamines
block histamine from attaching to receptor cells
corticosteroids
block leukotrienes and prostaglandins
tyramine
broad bean pods, soy beans, tofu
autism language
cannot start or maintain a social conversation communicates with gestures instead of words develops language slowly or not at all does not adjust gaze to look at objects that others are looking at does not refer to self correctly (using you instead of "i")
pleural effusion
caused by bacteria in pleural space inflammatory reaction with pleural exudates of protein rich fluid
lupus nephritis
causes swelling in the legs, ankles, and feet with swelling of the arms or hands less frequent.
IBD lab values
cbc - iron deficiency anemia from blood loss WBC - inflammation, elevated EBC may indicate toxic megacolon, or perforation Na, K, Cl, bicarb, Mg - decreased levels are due to fluid and electrolyte losses from diarrhea and vomiting hypoalbuminemia - present as a result of poor nutrition or protein loss ESR - elevated, may reflect inflammation stool culture - to determine if infection is present (examine for blood, pus, and mucus) double contrast barium enema, small bowel series, CT, MRI, ultrasound, colonoscopy
ibd
characterized by periods of remission interspersed with periods of exacerbation
tyramine
cheese and sour cream
tyramine
chocolate, caffeine containing beverages, non alcoholic beer and wine
ibd
chronic inflammation of the GI tract
TB
chronic, recurrent, infectious disease caused by mycobacterium tuberculosis that most often affects the lungs but may also affect lungs, kidneys, bone/joints, brain, GU tract, meninges
9 months
cognitive milestones: watches the path of something as it falls looks for things he sees you hide plays peek a boo puts things in mouth moves things smoothly from one hand to the other picks up things like cereal o's between thumb and index finger
3 years
cognitive milestones: can work toys with buttons, levers, and moving parts plays make believe with dolls, animals, and people does puzzles with 3 or 4 pieces understands what two means copies a circle with pencil or crayon turns book pages one at a time builds towers of more than 6 blocks screws and unscrews jar lids and turns door handles
5 years
cognitive milestones: counts 10 or more things can draw a person with at least 6 body parts can print some letters or numbers copies a triangle and other geometric shapes knows about things used everyday like money and food
1 year
cognitive milestones: explores things in different ways like shaking, banging, throwing finds hidden things easily looks at the right picture or thing when it's named copies gestures starts to use things correctly; drinks from a cup, brushes hair bangs two things together puts things in a container, takes them out lets things go without help pokes with index finger follows simple directions like pick up that toy
2 years
cognitive milestones: finds things even when hidden begins to sort shapes and colors completes sentences and rhymes in familiar books plays simple make believe games builds towers of 4 or more blocks might use one hand more than the other follows two step instructions such as pick up your shoes and put them in the closet names items in a picture book such as cat, bird, dog
18 months
cognitive milestones: knows what ordinary things are; telephone, brush, spoon points to get the attention of others shows interest in a doll or stuffed animal by pretending to feed points to one body part scribbles on his own can follow 1 step verbal commands without any gestures; sits when you say sit down
tb clinical manifestations
cough for more than 3 weeks extreme tiredness weight loss sweating at night fever no appetite
4 months
cognitive milestones: lets you know if happy or sad responds to affection reaches for toy with one hand uses hands and eyes together such as seeing a toy and reaching for it follows moving things with eyes from side to side watches faces closely recognizes familiar people and things at a distance
4 years
cognitive milestones: names some colors and numbers understands the idea of counting starts to understand time remembers parts of a story understands the idea of same or different draws a person wtih 2 or 4 body parts uses scissors starts to copy some capital letters plays board or card games tells you what he thinks is going to happen next in a book
2 months
cognitive milestones: pays attention to faces begins to follow things with eyes and recognize people at a distance begins to act bored (cries, fussy) if activity doesn't change
pyrazinamide
common side effect: pain in large and small joints
sulfasalazine
common side effects: gastric distress headache nausea oligospermia vomiting anorexia fever
infliximab
common side effects: abdominal pain, back pain, chest pain, and nausea.
prednisone
common side effects: aggression agitation blurred vision dizziness fast/slow/irregular hr headache mood changes
metronidazole
common side effects: agitation back pain blindness blurred vision tingling of hands or feet confusion depression dizziness nausea headache
haloperidol
common side effects: akathisia, blurred vision, constipation, weight gain, and xerostomia.
leflunomide
common side effects: alopecia diarrhea increased serum alanine aminotransferase, increased serum aspartate aminotransferase
bupropion
common side effects: anxiety, dry mouth, hyperventilation, irregular heartbeats, irritability, restlessness, shaking, trouble sleeping.
lamotrigine
common side effects: ataxia, skin rash, headache, insomnia, nausea.
rituximab
common side effects: black tarry stools, bleeding gums, bloating or swelling of the face, arms, hands, legs, or feet, blood in urine or stools, blurred vision.
methotrexate
common side effects: black, tarry stools blood in urine diarrhea joint pain stomach pain
etanercept
common side effects: chills cough fever sneezing sore throat
phenelzine
common side effects: chills, cold sweats, confusion, dizziness, overactive reflexes.
isoniazid
common side effects: clumsiness dark urine loss of appetite n/v weakness/tiredness blurred vision
valproic acid
common side effects: congenital anomalies, infection, abdominal pain, asthenia, drowsiness, tremor, dizziness, etc.
sertraline
common side effects: diarrhea, dizziness, drowsiness, dyspepsia, fatigue, insomnia, loose stools, nausea, tremor, headache, paresthesia, anorexia, decreased libido, delayed ejaculation, diaphoresis, ejaculation failure, or xerostomia.
escitalopram
common side effects: diarrhea, drowsiness, ejaculatory disorder, headache, insomnia, nausea, and delayed ejaculation
escitalopram
common side effects: diarrhea, drowsiness, ejaculatory disorder, headache, insomnia, nausea, and delayed ejaculation.
auranofin
common side effects: diarrhea, pruritis, skin rash, stomatitis, loose stools, n/v.
abatacept
common side effects: headache and nasopharyngitis
azathioprine
common side effects: infection, nausea, leukopenia, and vomiting.
bupropion
common side effects: insomnia, nausea, pharyngitis, weight loss, constipation, dizziness, headache, xerostomia
aminosalicylates
common side effects: mild stomach pain/cramps, nausea, loss of appetite, diarrhea, dizziness, headache.
adalimumab
common side effects: upper respiratory tract infection, headache, injection site reaction, skin rash, antibody development, sinusitis, and pain at the injection site.
anaphylaxis nursing assessment
comprehensive history including: previous history of allergy or anaphylaxis recent exposures physical/psychological clinical manifestations mucocutaneous respiratory cardiovascular GI second phase reactions
phallic stage
conflict: child identifies with parent of opposite sex
latency phase
conflict: developing same sex friendships
genital phase
conflict: full sexual maturity, relationship outside of family and achieve independence
anal stage
conflict: training
oral stage
conflict: weaning
adaptation
coping behaviors
prednisone
corticosteroid for IBD
SLE meds
corticosteroids, immunosuppressants, NSAIDs
tb clinical manifestations
cough becomes frequent; hemoptysis is not common and is usually associated with advanced disease dyspnea is unusual
ibd pediatric considerations
differs from adult onset more common in males than females crohn's disease is more common than ulcerative colitis which is the opposite of adults crohn's location - ileocolonic or colonic disease increases incidence of hematochezia (blood in stool) crohn's inflammatory nonstricturing, nonpenetrating disease
SLE
disorder of immune function with variable progression
isoniazid
do not take with food especially those containing tyramine or histamine
autism social interaction:
does not make friends or play interactive games is withdrawn: shows a lack of empathy may not respond to eye contact or smiles, or may avoid eye contact. may treat others as if they are objects; prefers to spend time alone, rather than with others.
autism response to sensory information
does not startle at loud noises may find normal noises painful and hold hands over ears overly sensitive in sight, hearing, touch, smell, or taste
ibd collaborative care
drug therapy sulfasalazine sulfapyridine and 5 ASA decreases GI inflammation effective in achieving and maintaining remission mild to moderately severe attacks
let's go to the conference room and talk for a while.
during report, the nurse learns that a client with mania has not slept since admission 2 days ago. on entering the day room, the nurse finds this client dancing to loud music. which would be the most appropriate statement by the nurse? a. do you think you could sit still for a few minutes so we can talk? b. how are you ever going to get any rest if you keep that music on? c. let's go to the conference room and talk for a while. d. turn the radio down so we can hear ourselves talk.
therapeutic management of autism
early identification is critical create an environment that facilitates interaction and promotes replacement of stereotypical behaviors with more normal behaviors. communication skills.
RA early symptom
early morning stiffness
tyramine
eggplant, avocados, beets, sauerkraut
erikson
eight stages
RA knot
elbows, joints, etc.
assimilation
encounter and react to new situations
ipaa
entire colon and rectum are removed pouch is formed from the terminal ileum pouch is brought into pelvis and anastomosed to the anal canal ileostomy is made and maintained 2-3 months to allow anal anastomosis to heal ileostomy closed for BM thru anus
common SSRIs
escitalopram and sertraline
anaphylaxis
exaggerated immune response classified as type 1 hypersensitivity reaction that does not occur in everyone (only susceptible persons) and is caused by an allergen that triggers the response conditions that increase risk for are predisposition to allergy or exposure
ibd planning and goals
experience a decrease in number and severity of acute exacerbations maintain normal f/e balance free from pain or discomfort comply with medical regimen improve quality of life
SLE clinical manifestations
fever fatigue painful/swollen joints malar rash - butterfly rash across cheeks and nose
bacteria and parasites
few
ibd evaluation
fewer, firmer stools decreased anxiety use of effective coping strategies maintenance of body weight no evidence of skin breakdown healthy coping behaviors
haloperidol
first gen antipsychotic
tyramine
fish, caviar, shrimp paste, salted herring
mania assessment findings
flight of ideas pressured speech delusional thoughts
autistic child interventions
focus on abilities maintain routine and schedule
RA
focus on functional status - ADLs
TB diagnosis
for the with suspected disease - obtain medical history - physical exam - mantoux tuberculin skin test - cxr - afb sputum smear - sputum culture - definitive diagnosis - sensitivity testing - identification of appropriate therapy
it is much more difficult to diagnose psychiatric disorders in children and adolescents
for which reason is it critical for nurses to advocate for children and adolescents regarding psychiatric disorders? a. it is much more difficult to diagnose psychiatric disorders in children and adolescents. b. it is not necessary because psychiatric disorders do not occur in children and adolescents. c. children and adolescents experience some of the same mental health problems as adults. d. psychiatric disorders in children manifest themselves very quickly.
children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level.
for which reasons is it more difficult to diagnose psychiatric disorders in children than in adults? select all that apply. a. children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. b. because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. c. behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level. d. sometimes, children outgrow psychiatric disorders. e. children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults.
atypical antipsychotics
generally known as major tranquilizers and neuroleptics.
adulthood
generatively vs. stagnation
erikson adulthood
generatively vs. stagnation
lupus risk factors
genetic link - twins african american females women of childbearing age pregnancy causes exacerbations smoking UV rays stress
labs to monitor for IBD
h&h, wbcs, etc.
rifampin
hard on kidneys strict I+Os urine is red
TB
health care workers are considered to be at high risk.
IBD complications: GI tract
hemorrhage strictures perforation fistulas toxic megacolon
tb collaborative care
hospitalization not necessary for most patients drug therapy used to prevent or treat active disease prophylactic treatment is used to prevent active TB close household contact w/ positive patient
inflammatory bowel disease
ibd
freud
id, ego, and superego
freud
id, ego, and superego all must work together
adolescence
identity vs. role confusion
erikson adolescence
identity vs. role confusion
erikson's 8 stages
infancy - trust vs. mistrust, early childhood - autonomy vs. shame, late childhood - initiative vs. guilt, school age - industry vs. inferiority, adolescence - identity vs. confusion, young adulthood - intimacy vs. isolation, adulthood - generatively vs. stagnation, maturity - integrity vs. despair
erikson
infancy birth to 18 months: trust vs. mistrust early childhood 18 months to 3 years: autonomy vs. doubt late childhood 3 years to 5 years: initiative vs. guilt school age 6-12 years: industry vs. inferiority adolescence 12-20 years: identity vs. role conflict young adulthood 15-25 years: intimacy vs. isolation adulthood 25-65: generatively vs. stagnation maturity 65-death: integrity vs. despair
ulcerative colitis
inflammation and ulcerations occur in the mucosal layer
erikson late childhood
initiative vs guilt
late childhood
initiative vs. guilt
eriskon maturity
integrity vs. despair
maturity
integrity vs. despair
methotrexate
interferes with growth of certain cells in the body; used to treat certain types of leukemia and also IBD
methotrexate
interferes with the growth of certain cells of the body, especially those that reproduce quickly.
erikson young adulthood
intimacy vs. isolation
young adulthood
intimacy vs. isolation
nystagmus
involuntary eye movements
ileal pouch anal anastomosis
ipaa
extra intestinal complications of IBD
joints skin mouth eye gallstones liver disease kidney stones osteoporosis thromboembolism
RA monitoring parameters
kidney and liver function
TB risk factors
lack of knowledge about infection prevention
9 months
language/communication milestones: understands no makes a lot of different sounds like mamamama and babababa copies sounds and gestures of others uses fingers to point at things
4 months
language/communication milestones: begins to babble babbles with expression and copies sounds he hears cries in different ways to show hunger, pain, or being tired
3 years
language/communication milestones: follows instructions with 2 or 3 steps can name most familiar things understands words like in, on, and under says first name, age, and sex names a friend says words like i, me, we, and you and some plurals talks well enough for strangers to understand most of the time carries on a conversation using 2 to 3 sentences
4 years
language/communication milestones: knows some basic rules of grammar such as correctly using he or she sings a song or says a poem from memory such as the itsy bitsy spider or the wheels on the bus tells stories can say first and last name
2 years
language/communication milestones: points to things or pictures when they are named knows names of familiar people and body parts says sentences with 2 to 4 words follows simple instructions repeats words overheard in conversation points to things in a book
1 year
language/communication milestones: responds to simple spoken requests uses simple gestures, like shaking head no or waving bye makes sounds with changes in tone says mama and dada and exclamations like uh oh tries to say words you say
6 months
language/communication milestones: responds to sounds by making sounds strings vowels together when babbling and likes taking turns with parent while making sounds responds to own name makes sounds to show joy and displeasure begins to say consonant sounds
18 months
language/communication milestones: says several single words says and shakes head no points to show someone what he wants
5 years
language/communication milestones: speaks very clearly tells a simple story using full sentences uses future tense; grandma will be here. says name and address
miliary TB
large numbers of organisms invade the bloodstream and spread to organs - acute or chronic symptoms
two tb related conditions
latent TB infection - infected w/ M. tuberculosis - do not have symptoms of disease - cannot infect others TB disease - have symptoms - are infectious - can transmit M. tuberculosis to others
TB risk factors
lifestyle behaviors
SLE complications
lupus nephritis pericarditis
hgb
male 12.4-17.4 female 11.7-16.0
hct
male 42-52% female 36-48%
autism risk factors
maternal rubella and other prenatal, perinatal, and postnatal conditions hazardous chemical exposures genetic mutation
isoniazid
may cause false positive urine glucose test
ethambutol
may cause joint pain or swelling
clinical manifestations of autism
may excel in math, music, or memory overly sensitive in sight, hearing, touch, smell, or taste have unusual distress when routines are changed perform repeated body movements; rubs surfaces, ticks objects acts up with intense tantrums gets stuck on a single topic or task has a short attention span and narrow interests stereotyped body movements such as spinning, head banging, rocking, and flapping
ibd etiology
may occur at any age peaks between 15 and 25 years 2nd peak in 6th decade equally affects both sexes
lithium
mood stabilizer
lamotrigine
mood stabilizing antiepileptic drug
valproic acid
mood stabilizing antiepileptic drug
hallucinations
most likely associated with post partum psychosis
1 year
movement/physical development milestones: gets to a sitting position without help pulls up to stand, walks holding on to furniture may take a few steps without holding on may stand alone
2 months
movement/physical development milestones: can hold head up and begins to push up when lying on tummy makes smoother movements with arms and legs
3 years
movement/physical development milestones: climbs well runs easily pedals a tricycle walks up and down stairs one foot on each step
4 years
movement/physical development milestones: hops and stands on 1 foot up to 2 seconds catches a bounced ball most of the time pours, cuts with supervision, and mashes own food
6 months
movement/physical development milestones: rolls over in both directions begins to sit without support when standing, supports weight on legs and might bounce rocks back and forth, sometimes crawling backward before moving forward
5 years
movement/physical development milestones: stands on one foot for 10 seconds or longer hops may be able to skip can do a somersault uses a fork and spoon and sometimes a table knife can use the toilet on her own swings and climbs
2 years
movement/physical development milestones: stands on tiptoe kicks a ball begins to run throws ball overhand makes or copies straight lines and circles climbs onto and down from furniture without help walks up and down stairs holding on
9 months
movement/physical development milestones: stands, holding on can get into sitting position sits without support pulls to stand crawls
18 months
movement/physical development milestones: walks alone may walk up steps and run pulls toys while walking can help undress himself drinks from a cup eats with a spoon
4 months
movement/physical milestones: holds head steady pushes down on legs when feet are on hard surface may be able to roll over from tummy to back can hold a toy and shake it and swing at dangling toys brings hands to mouth pushes up at elbows when lying on stomach
baclofen
muscle relaxer and antispasmodic that is used to treat RA muscle spasms
SLE patient education
no live vaccines such as MMR, chicken pox, or nasal flu
ibd gerontologic considerations
occurs around 50s distal colon is usually involved in ulcerative colitis less recurrence of crohn's disease in older patients treated with surgical resections
infliximab
often used when other medications have not been effective.
freud's 5 stages
oral, anal, phallic, latency, genital
ibd physiologic process
organism injures lining of the intestines leading to disease
latent TB
organisms persist for years and few ever develop TB
autism
out of this world tantrums
TB risk factors
overcrowded institutions
induration
palpable, raised, hardened area of swelling
tb nursing interventions
patient education to prevent/control medical, environmental, and lifestyle risk factors for TB disease patient education to prevent TB in individuals with latent TB infection (Prophylactic treatment) patient education to increase knowledge of prevention of transmission of TB among high risk populations
tb drug therapy: active disease
patients should be taught about side effects and when to seek medical attention liver function should be monitored
death
phenelzine + MAOI
genital phase
puberty and after
empyema
pus in the pleural cavity
adalimumab
reduces the effects of a substance in the body that can cause inflammation.
immunosuppressants
require regular cbc monitoring
ibd goal of treatment
rest the bowel control inflammation combat infection correct malnutrition alleviate stress relieve symptoms improve quality of life
TB
resurgence: high rates of it with HIV infection and multidrug resistant strains of M. tuberculosis.
RA complications
rheumatoid knots carpel tunnel syndrome
IBD diagnostic studies
rule out other diseases with similar symptoms
TB
second most common cause of death from infectious disease
SSRI
selective serotonin reuptake inhibitor
prednisone
should be used for as short a period of time as possible
anaphylaxis symptoms
skin - hives, swelling, warmth, redness respiratory - coughing, wheezing, sob, hay fever symptoms GI - nausea, stomach pain/cramps, vomiting, diarrhea cardiovascular - dizziness, weak pulse, fainting, shock, loss of consciousness neurological - anxiety, feeling of impending doom
TB diagnostic studies
skin testing - intradermal PPD test (mantoux test) - the TST is performed by injecting 0.1 mL of tuberculin purified protein derivative into the inner surface of the forearm - the skin test reaction should be read between 48 and 72 hours after administration - the reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling)
crohn's disease
skip lesions
2 months
social/emotional milestones: begins to smile at people can briefly calm himself tries to look at parent
3 years
social/emotional milestones: copies adults and friends shows affection for friends without promptin takes turns in games shows concern for crying friend understands the idea of mine and his or hers shows a wide range of emotions separates easily from mom and dad may get upset with major changes in routine dresses and undresses self
2 years
social/emotional milestones: copies others gets excited when with other children shows more independence shows defiant behavior plays mainly beside other children, but is beginning to include them such as in chase games
4 years
social/emotional milestones: enjoys doing new things plays mom and dad is more and more creative with make believe play would rather play with other children than by himself cooperates with other children often can't tell what's real and what's not talks about what she likes and what she is interest in
1 year
social/emotional milestones: is shy or nervous with strangers cries when mom or dad leaves has favorite things and people shows fear in some situations hands you a book when he wants to hear a story repeats sounds or actions to get attention puts out arm or leg to help with dressing plays games such as peek a boo and pat a cake
6 months
social/emotional milestones: knows familiar faces and begins to know if someone is a stranger likes to play with others, especially parents responds to other people's emotions and often seems happy likes to look at self in mirror
18 months
social/emotional milestones: likes to hand things to others as play may have temper tantrums may be afraid of strangers shows affection to familiar people plays simple pretend such as feeding a doll may cling to caregivers in new situations points to show others something interesting explores alone but with parent close by
9 months
social/emotional milestones: may be afraid of strangers may be clingy with familiar adults has favorite toys
4 months
social/emotional milestones: smiles spontaneously, especially at people likes to play with people and might cry when playing stops copies some movements and facial expressions like smiling and frowning
5 years
social/emotional milestones: wants to please friends wants to be like friends more likely to agree with rules likes to sing, dance, and act is aware of gender can tell what's real and what's not shows more independence is sometimes demanding and sometimes very cooperative
TB risk factors
socioeconomic status - poverty, homelessness, immigration
etanercept
sometimes used with another medication called methotrexate to treat RA.
tyramine
spoiled foods, processed foods, broths, large amounts of nuts, soy sauce, meat tenderizer, teriyaki, miso soup, monosodium gluconate, yeast
etiology and pathophysiology of TB
spread via airborne droplets when infected person: coughs, speaks, sneezes, sings spread: not by hands or objects; brief exposure rarely causes infection; transmission requires close, frequent, or prolonged exposure to clients with active TB.
etiology and pathophysiology of TB
spread: inhaled bacilli pass down bronchial system and implant themselves on bronchioles or alveoli; multiply with no initial resistance replicates slowly and spreads via the lymphatic system
escitalopram
ssri antidepressant
tb drug therapy
standard treatment - 4 drug therapy for 6-9 months - first line drugs are isoniazid, rifampin, ethambutol, and pyrazinamide - second line drugs are added or substituted based on drug resistance
ulcerative colitis
starts in the rectum and moves toward cecum
RA meds
steroids NSAIDs
ibd surgical therapy - crohn's disease
strictureplasty to widen areas of narrow bowel sometimes necessary to resect bowel emergency surgery may be needed
crohn's disease
structures may cause bowel obstruction
ibd meds
sulfasalazine and sulfapyridine for mild to moderate attacks
ulcerative colitis
superficial layers and lower tract; bleeding is more common
ibd immunosuppressants
suppress immune response maintain remission after corticosteroid induction therapy require regular cbc monitoring
ostomy
surgically created opening between intestine and the abdominal wall allowing passage of fecal material with a stoma (surface opening)
types of lupus
systemic drug-induced discoid
bupropion education
take in the morning
escitalopram education
take with food
pyrazinamide
tb can become resistant to this treatment if used alone.
go along with her though of it having been a busy day, but do not refer to her work.
the adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. the mother has not worked in over 20 years. which is the best guidance that the nurse could offer? a. ask her to explain what she did at work today that kept her busy. b. go along with her thought of it having been a busy day, but do not refer to her work. c. reorient her that she is at home and did not go to work. d. give her 5-10 minutes of rest, and she will have no memory of the incident.
do not swing at me again. if you cannot control yourself, we will helpyou.
the client with mania attempts to hit the nurse. which is the best response by the nurse? a. do not swing at me again. if you cannot control yourself, we will help you. b. if you do that one more time, you will be put in seclusion immediately. c. stop that. i didn't do anything to provoke an attack. d. why do you continue that kind of behavior? you know i won't let you do it.
ibd gerontologic considerations
the colon rather than the small intestine tends to be involved in crohn's disease older adults are more vulnerable to inflammation careful assessment of f/e status
here is the number of a caregiver's support group. how do you think you would feel talking with others in the same situation?
the daughter of a client with dementia has been the primary caregiver for 5 months. the daughter expresses to the nurse, "at times it is so overwhelming! i feel i do not have a life anymore!" which is the most helpful response by the nurse? a. are you saying you don't want to care for your mother anymore? b. i know it is really hard. it takes a lot of work and you are doing such a good job. c. your mother really appreciates what you do for her. you are the best one to care for her. d. here is the number of a caregiver's support group. how do you think you would feel talking with others in the same situation?
symptoms of dementia gradually get worse. unfortunately she will not be independent again.
the daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. which would be the most appropriate response by the nurse? a. you sound like you aren't ready for her to be dependent on caregivers. b. her confusion is a temporary complication of her physical illness and should subside when the illness gets better. c. symptoms of dementia gradually get worse. unfortunately she will not be independent again. d. with early treatment, mild dementia can be reversed. it may be possible.
his behaviors reflect normal growth and development
the mother of a 15 year old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. she asks if it is healthy for a 15 year old to be so independent. which is valid information for the nurse to offer the mother? a. his behaviors reflect normal growth and development. b. he is overly independent. c. it sounds like he is trying to avoid her. d. she should observe for signs of substance abuse.
it must be difficult to handle your son at home.
the mother of a 6 year old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. the nurse would be most therapeutic by saying which of the following? a. your son is a cute child, but he needs to calm down. b. it must be difficult to handle your son at home. c. you need to take a firmer approach with your son. d. your son sure is active.
serve meals in small, bite size pieces.
the nurse encourages the client with dementia to meet nutritional needs. which is the best approach to assist in meeting adequate dietary intake? a. sit with the client as long as necessary to complete the meal. b. provide entertainment during meals such as television or music. c. avoid between meal snacks to encourage appetite. d. serve meals in small, bite size pieces.
try to remember that the parents are trying to the best of their ability to carry out the suggestions.
the nurse has been working with the family of a small child with a psychiatric disorder. the nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. what is the best action for the nurse at this time? a. review effective disciplinary practices with the parents again. b. refer the parents to a family therapist. c. try to remember that the parents are trying to the best of their ability to carry out the suggestions. d. explore alternative living arrangements for the child.
the child displays little eye contact with others. the child makes few facial expressions toward others. the child does not like repetition.
the nurse is assessing a 16 month old child during a well baby checkup. which of the following behaviors would be consistent with the autism spectrum disorder? select all that apply. a. the child displays little eye contact with others. b. the child thrives on changes in routine. c. the child makes few facial expressions toward others. d. the child does not like repetition. e. the child answers questions verbally.
recent memory
the nurse is assessing a client with early signs of dementia. what is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning? a. orientation b. food preferences c. recent memory d. remote memory
break tasks into small steps.
the nurse is assisting a child with ADHD to complete his ADLs. which is the best approach for nurse to use with this child? a. break tasks into small steps. b. let the child complete tasks at his own pace. c. offer rewards when all tasks are completed. d. set a time limit to complete all tasks.
possible nursing home placement. increasing disability becoming a burden on the family.
the nurse is caring for a 77 year old woman with MS. she states she is very concerned about the progress of her disease and what the future holds. the nurse should know that elderly patients with MS are known to be particularly concerned about what variables? select all that apply. a. possible nursing home placement. b. pain associated with physical therapy. c. increasing disability. d. becoming a burden on the family. e. loss of appetite.
ensure that suction apparatus is set up at the bedside.
the nurse is caring for a patient who is hospitalized with an exacerbation of MS. to ensure the patients safety, what nursing action should be performed? a. ensure that suction apparatus is set up at the bedside. b. pad the patient's bed rails. c. maintain bed rest whenever possible. d. provide several small meals each day.
resting in an air conditioned room whenever possible.
the nurse is caring for a patient with multiple sclerosis. the patient tells the nurse the hardest thing to deal with is the fatigue. when teaching the patient how to reduce fatigue, what action should the nurse suggest? a. taking a hot bath at least once daily. b. resting in an air conditioned room whenever possible. c. increasing the dose of muscle relaxers. d. avoiding naps during the day.
viewing photos is a form of reminiscence therapy for the client.
the nurse is caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. which best describes the usefulness of viewing photos when caring for the dementia client? a. viewing photos is a form of reminiscence therapy for the client. b. sharing photos will encourage interaction with other clients. c. this can help the children to correctly identify old photographs. d. talking about the photos will encourage the client to live in the past.
instruct the patient in daily muscle stretching.
the nurse is creating a plan of care for a patient who has a recent diagnosis of MS. which of the following should the nurse include in the patients plan of care? a. encourage the patient to void every hour. b. order a low residue diet. c. provide total assistance with all ADLs. d. instruct the patient on daily muscle stretching.
an activity with the nurse
the nurse is developing interventions to promote socialization in a client with moderate dementia. which would provide a safe and secure environment for the client? a. a card game with other clients. b. an activity with the nurse. c. decorating a bulletin board with the group. d. morning stretch group with musing.
demonstrate the exercises while clients simultaneously perform them.
the nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. which technique will most likely result in the greatest amount of participation? a. show an instructional video just prior to the activity. b. describe the exercise immediately before performing it. c. demonstrate the exercises while clients simultaneously perform them. d. perform the same routine daily to avoid the need for repeated instruction.
the client will independently carry out activities of daily living.
the nurse is planning care for a client with major depression. which is an appropriate expected outcome? a. the client will avoid causing harm to others. b. the client will be free from stress. c. the client will independently carry out activities of daily living. d. the client will not experience agitation.
anticholinergic medications 30 minutes before a meal.
the nurse is providing care for a patient whose IBD necessitated hospital treatment. which of the following would most likely be included in the patients medication regimen? a. anticholinergic medications 30 minutes before a meal. b. antiemetics on a PRN basis. c. vitamin b12 injections to prevent pernicious anemia. d. beta adrenergic blockers to reduce bowel motility.
i never knew depression could just happen for no specific reason.
the nurse is teaching a 70 year old man about his depression. which statement by the client would indicate that teaching has been effective? a. all old people get depressed at times. b. i'm glad i'll feel better in 2 or 3 days. c. i never knew depression could just happen for no specific reason. d. when i reduce the stress in my life, the depression will go away.
ms is a progressive demyelinating disease of the nervous system
the nurse is working with a patient who is newly diagnosed with MS. what basic information should the nurse provide to the patient? a. ms is a progressive demyelinating disease of the nervous system. b. ms usually occurs more frequently in men. c. ms typically has an acute onset. d. ms is sometimes caused by a bacteria.
move to a chair a little further away and say, "we can just sit together quietly."
the nurse observes a client sitting alone at a table, looking sad and preoccupied. the nurse sits down and says, "i saw you sitting alone and thought i might keep you company." the client turns away from the nurse. which would be the most therapeutic nursing intervention? a. move to another chair closer to the client and say, "the staff is here to help you." b. move to a chair a little further away and say, "we can just sit together quietly." c. remain in place and say, "how are you feeling today?" d. say, "i'll visit with you a little later," and leave the client alone for a while.
teach the parents age appropriate expectations of the child
the nurse understands that when working with a child with a mental health problem, the family must be included in the care. which is one of the best ways the nurse can advocate for the child? a. support transferring the child to a healthy living environment. b. teach the parents age appropriate expectations of the child. c. reinforce the parents' expectations of the child's behavior. d. interpret the child's thoughts and feelings to the parent.
i think suicide is wrong and selfish.
the nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal? a. i just don't understand why anyone would want to kill themselves. b. i think suicide is wrong and selfish. c. i get frustrated when my client negates all the positives i try to point out. d. i can see how much my client is hurting inside.
plan for the same caregivers to provide care to individuals as much as possible.
the nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. which should the nurse include in planning the living environment? a. plan for the same caregivers to provide care to individuals as much as possible. b. open the windows and doors to allow fresh air to circulate through the environment. c. provide a buffet style menu with many food choices. d. assign peer led exercise activates on a daily basis.
use time out for behavior control. give verbal reprimands for negative behavior. use a point system for positive and negative behavior.
the parents of a child with ADHD express to the nurse, "we get so frustrated when our son never minds us." which parenting strategies should the nurse discuss with the parents? select all that apply. a. use time out for behavior control. b. provide occasional rewards and consequences for behavior. c. give verbal reprimands for negative behavior. d. resist giving praise until fully compliant with requests. e. use a point system for positive and negative behavior.
your child will probably always have some autistic traits.
the parents of an autistic child ask the nurse, "will my child ever be normal?" which would be the most appropriate response by the nurse? a. you seem worried about your child's future. b. autistic children can fully recover with the right treatment and education. c. your child should outgrow autistic traits by adolescence. d. your child will probably always have some autistic traits.
OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.
the patient is undergoing diagnostic testing to determine the etiology of recent joint pain. the patient asks the nurse about the difference between osteoarthritis and rheumatoid arthritis. what is the best response by the nurse? a. OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. b. OA and RA are very similar. OA affects the smaller joints such as the fingers and RA affects the larger, weight bearing joints like the knees. c. OA originates with an infection. RA is a result of your body's cells attacking one another. d. OA is associated with impaired immune function. RA is a consequence of physical change.
anaphylaxis
the patient's surgery is nearly finished and the surgeon has opted to use tissue adhesives to close the surgical wound. this requires the nurse to prioritize assessments related to what complication? a. hypothermia. b. anaphylaxis. c. infection. d. malignant hyperthermia.
ibd surgical therapy: chronic ulcerative colitis
total colectomy - surgical resection and removal of the colon
amitriptyline
tricyclic antidepressant
tca
tricyclic antidepressant
infancy
trust vs. mistrust
infancy stage
trust vs. mistrust
ulcerative colitis and crohn's disease
types of IBD
hypertensive crisis
tyramine + phenelzine
crohn's disease
ulcerations have cobblestone appearance
tb favorable environments for growth
upper lobes of lungs kidneys epiphyses of bone cerebral cortex adrenal glands
anaphylaxis critical skill
use of epipen
ibd nursing assessment
use of prescribed and OTC medications family history diarrhea (presence of blood?) weight loss anxiety, depression
rituximab
used alone or in combination with other medications to treat non-hodgkin's lymphoma or chronic lymphocytic leukemia and RA.
lamotrigine
used to delay mood episodes in adults with bipolar disorder.
minocycline
used to treat different types of bacterial infections such as UTIs, respiratory infections, skin infections, severe acne, chlamydia, tick fever, and others. Also used for gonorrhea, syphilis, and other infections as a second line drug in those with a penicillin allergy.
methotrexate
used to treat leukemia, RA, and IBD.
adalimumab
used to treat many inflammatory conditions such as ulcerative colitis, RA, etc.
haloperidol
used to treat schizophrenia
abatacept
used to treat symptoms of RA and to prevent joint damage it causes.
azathioprine
used to treat symptoms of RA, but the primary use is to keep the body from rejecting organ transplants.
leflunomide
used to treat the symptoms of RA.
sulfasalazine
used to treat ulcerative colitis and to decrease the frequency of UC attacks.
valproic acid
used to treat various types of seizure disorders and is sometimes used together with other seizure meds. is also used to treat manic episodes related to bipolar disorder.
rifampin
used with isoniazid may cause serious side effects with the liver.
auranofin
usually given when other meds have been tried without successful treatment of symptoms.
RA
usually symmetric starting with smaller joints then progressing to larger joints
dopamine
vasopressor for hypotension
IV fluids
volume expander for hypotension
TB risk factors
weakened immune system
we'll have him do his homework at the kitchen table with his brothers and sisters.
when teaching the parents of a child with ADHD, which statement by the parents would indicate the need for further teaching? a. we'll have him do his homework at the kitchen table with his brothers and sisters. b. we'll make sure he completes one task before going on to another. c. we'll set up rules with specific times for eating, sleeping, and playing. d. we'll use simple, clear directions and instructions.
assist the child and the parents to develop coping mechanisms.
when the prognosis of improvement in a child with psychiatric disorders is poor. what can the nurse do to positively influence children and adolescents and their parents? a. continue to remind the child and parents that the prognosis for improvement is very poor. b. encourage the parents to believe that the child will recover spontaneously. c. assist the child and the parents to develop coping mechanisms. d. focus on their problems instead of their strengths and assets.
the clients do not retain explanations or instructions, so the nurse must repeat the same things continually. the nurse may get little or no positive response or feedback from clients with dementia. it can be difficult to remain positive and supportive to clients and family because the outcome is so bleak. the client's may seem not to hear or respond to anything the nurse does.
which are possible sources of frustrations for nurses caring for persons with dementia? select all that apply. a. the clients do not retain explanations or instructions, so the nurse must repeat the same things continually. b. the nurse may get little or no positive response or feedback from clients with dementia. c. it can be difficult to remain positive and supportive to clients and family because the outcome is so bleak. d. it can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses. e. the clients may seem not to hear or respond to anything the nurse does.
decreased serotonin and norepinephrine activity
which best explains the neurochemical processes responsible for depression: a. increased activity of dopamine b. decreased glucocorticoid activity c. decreased serotonin and norepinephrine activity d. potentiating of the kindling process
a client who has a private gun collection
which client is at highest risk for carrying out a suicide plan? a. a client who plans to take a bottle of sleeping pills. b. a client who says, "my life is over." c. a client who has a private gun collection. d. a client who says, "i'm going to jump off the next bridge i see."
dementia has a gradual onset and is progressive in course.
which distinguishes delirium from dementia? a. delirium has an acute onset and is progressive in course. b. delirium has a gradual onset and can be resolved. c. dementia has a gradual onset and is progressive in course. d. dementia has an acute onset and can be resolved.
a 71 year old male, alcohol user, independent minded
which individual is at highest risk for committing suicide? a. 71 year old male, alcohol user, independent minded b. 16 year old female, diabetic, two best friends. c. 47 year old male, schizophrenic, unemployed. d. 57 year old female, depression, active in church.
depression is anger turned inward
which is a freudian explanation of the etiology of depression? a. depression is a reaction to a distressing life experience. b. depression results from being raised by rejecting or unloving parents. c. depression results from cognitive distortions. d. depression is anger turned inward.
manic episodes are a defense against underlying depression. the id takes over the ego and acts as an undisciplined hedonistic being (child).
which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? select all that apply. a. norepinephrine levels may be increased in mania. b. manic episodes are a defense against underlying depression. c. acetylcholine seems to be implicated in mania. d. the id takes over the ego and acts as an undisciplined hedonistic being (child).
the relative's suicide offers a sense of "permission" or acceptance of suicide as a method of escaping a difficult situation.
which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide? a. the relative's suicide offers a sense of "permission" or acceptance of suicide as a method of escaping a difficult situation. b. many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation. c. suicide is more likely to occur in april when natural energy from increased sunlight may give the client the energy to act on suicidal ideation. d. the relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.
negative societal view of suicide. feeling inadequate and anxious about suicide and/or his or her own mortality. having personally considered suicide but decided against it and not having dealt with the associated anxiety. being unaware of his or her own feelings and beliefs about suicide.
which may contribute to a staff person being less effective in dealing with a person who is at increased risk of suicide? select all that apply. a. negative societal view of suicide. b. feeling inadequate and anxious about suicide and his/her own mortality c. having personally considered suicide but decided against it and not having dealt with the associated anxiety. d. being unaware of his/her own feelings and beliefs about suicide. e. implementing nursing interventions to decrease the risk of suicide.
ham sandwich, cheese slices, milk
which meal would the nurse provide to best meet the nutritional needs of a client who is manic? a. peanut butter sandwich, chips, cola b. fried chicken, mashed potatoes, milk c. ham sandwich, cheese slices, milk d. spaghetti, garlic bread, salad, tea
social phobia bipolar disorder major depression alcohol dependence
which of the following are common coexisting psychiatric disorders for adults with ADHD? select all that apply. a. social phobia. b. bipolar disorder. c. obsessive compulsive disorder. d. major depression. e. alcohol dependence.
phonologic disorder
which of the following disorders involves problems with forming sounds associated with speech? a. phonologic disorder. b. mixed repetitive expressive language disorder. c. expressive language disorder. d. stuttering.
inattentiveness overactivity impulsiveness
which of the following symptoms are characteristics of ADHD? select all that apply. a. enuresis. b. inattentiveness. c. encopresis. d. overactivity. e. impulsiveness.
palilalia
which of the following terms describes the repeating of one's own words or sounds? a. coprolalia b. palilalia c. echolalia d. none of the above.
direct observation of the child interviewing the client's parents interviewing the client's teachers assessing the client in a group of peers.
which of the following would be important circumstances to gather assessment data for a child with ADHD? select all that apply. a. direct observation of the child. b. reviewing the client's record. c. interviewing the client's parents. d. interviewing the client's teachers. e. assessing the client in a group of peers.
ensuring the child's safety and that of others.
which one of the following nursing interventions should take priority for a child with ADHD? a. structured daily routine. b. ensuring the child's safety and that of others. c. simplifying instructions and directions. d. improved role performance.
parents feel empowered and relieved to have specific strategies that can help them and their child be more successful.
which one of the following statements about educating parents of a child with ADHD is true? a. it is unimportant to educate the family members about ADHD as they already know the problem too well. b. parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. c. it is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents. d. if the child receives special school services under the individuals with disabilities education act, there is no need for further services.
a 90 year old male who has experienced progressive mental decline that started with forgetfulness.
which patient is most likely suffering from dementia? a. a 90 year old male who has experienced progressive mental decline that started with forgetfulness. b. an 80 year old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff. c. a 6 year old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes. d. a 22 year old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is.
yes, it is important to spend some time relaxing and doing what you like to do. this will help you to be better prepared to manage the demands of the caregiver role.
which statement by the nurse would be most appropriate to the family member who is the primary caregiver to the client with dementia? a. most people seek help when they really need it. b. what is wrong with your family? can't they see you need help? c. you should be grateful that you still have your family member around. d. yes, it is important for you to spend some time relaxing and doing what you like to do. this will help you to be better prepared to manage the demands of the caregiver role.
i know things are upsetting and confusing right now, but your confusion should clear as you get better.
which statement made by the nurse would be most appropriate to an 89 year old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection? a. you are likely to become progressively more confused now. b. this should be just a temporary situation. c. don't worry about it; everyone is confused when they are in the hospital. d. i know things are upsetting and confusing right now, but your confusion should clear as you get better.
we'll be sure to record his weight on a weekly basis.
which statement would indicate that medication teaching for the parent's of a 6 year old child with ADHD has been effective? a. we'll teach him the proper way to take the medication, so he can manage it independently. b. we'll be sure he takes ritalin at the same time every day, just before bedtime. c. we're so glad that ritalin will eliminate the problems of ADHD. d. we'll be sure to record his weight on a weekly basis.
after starting antidepressant therapy but not having reached the therapeutic level. if the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed. if the client does not adhere to the medication regimen and takes antidepressant medications irregularly. prior to initiating antidepressant therapy but before the depression results in lack of energy.
which time periods during antidepressant therapy are persons most likely to commit suicide? select all that apply. a. after starting antidepressant therapy but not having reached therapeutic level. b. after having reached the therapeutic level of antidepressants and maintained it for several years. c. if the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed. d. if the client does not adhere to the medication regimen and takes antidepressant medications irregularly. e. prior to initiating antidepressant therapy but before the depression results in lack of energy.
mood disorder in first degree relatives divorced
which variables represent the highest risk for developing major depressive disorder? select all that apply. a. male gender. b. mood disorder in first degree relatives c. substance abuse d. divorced e. older adult
