Semester 3 Unit 5 Exam**

What does the term "smokeless tobacco" refer to? Select all that apply. A. A substitute for cigarettes B. Tobacco products that are safe for adolescents C. Tobacco products that produce less smoke D. Tobacco products with carcinogenic chemicals E. Tobacco products placed in mouth but not ignited

A. A substitute for cigarettes D. Tobacco products with carcinogenic chemicals E. Tobacco products placed in mouth but not ignited "Smokeless tobacco" is the term used for tobacco products that are cigarette substitutes. These items are consumed by placing them in mouth, but they are not ignited. Smokeless tobacco contains carcinogenic agents that are not safe in adolescents. Tobacco products that produce less smoke are not considered smokeless.

A nurse is caring for several clients who are going through withdrawal from alcohol. What is the primary reason for the ingestion of alcohol by clients with a history of alcohol abuse? A. Are dependent on it B. Lack the motivation to stop C.Have no other coping mechanism D. Enjoy the associated socialization

A. Are dependent on it Alcohol causes both physical and psychological dependence; the individual needs and depends on the alcohol to function. The theory that alcoholics have no other coping mechanism is a myth that often is associated with alcoholism; the individual needs to learn how to use other coping mechanisms more consistently and effectively. People with alcoholism commonly drink alone or feel alone in a crowd.

Which medications are used to treat generalized anxiety disorder (GAD)? Select all that apply. A. Duloxetine B.Venlafaxine C. Clonazepam D. Escitalopram E. Clomipramine

A. Duloxetine B.Venlafaxine D. Escitalopram Duloxetine, venlafaxine, and escitalopram are antidepressants approved for the treatment of generalized anxiety disorder (GAD). Clonazepam and clomipramine are used to treat panic disorders.

A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine? A. Risk for self-injury B. Potential for seizure C. Danger of dehydration D. Probability of injuring others

A. Risk for self-injury The greatest risk in cocaine withdrawal is risk for self-injury. The risk for seizure is increased while a person is under the influence of cocaine, not during withdrawal. Although dehydration may occur during cocaine use and withdrawal, it is not the priority concern. People in cocaine withdrawal, although irritable, are more apt to hurt themselves than others.

A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply. A. Stillbirth B. Ebstein anomaly C. Neural tube defects D. Spontaneous abortion E. Intellectual disabilities

A. Stillbirth D. Spontaneous abortion E. Intellectual disabilities Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to antiseizure drugs during pregnancy.

What is the planned effect of naloxone when it is administered for a heroin overdose? A. To compete with opioids for occupancy of opioid receptors B. To prevent excessive withdrawal symptoms as heroin wears off C. To accelerate metabolism of heroin and stimulate respiratory centers D. To stimulate cortical sites that control consciousness and cardiovascular function

A. To compete with opioids for occupancy of opioid receptors Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist. Preventing excessive withdrawal symptoms as heroin wears off is not the specific action of this drug. Naloxone does not accelerate the metabolism of heroin. Stimulating cortical sites that control consciousness and cardiovascular function is not the action of naloxone. One adverse reaction of naloxone is cardiovascular irritability.

A client with a known history of opioid addiction is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing what phenomenon? A. Tolerance B. Habituation C. Physical addiction DPsychological dependence

A. Tolerance Tolerance is a phenomenon that occurs in addicted individuals in which increasing amounts of the drug of addiction are needed to satisfy need; the client should receive adequate analgesia after surgery. Drug habituation is a mild form of psychological dependence; the individual develops a habit of taking the substance. A physical addiction is related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance for usual function. Psychological dependence is emotional reliance on the substance to maintain a sense of well-being.

Naltrexone (ReVia)

Antagonist that blocks euphoric effects of opioids Reduces or eliminates alcohol craving

A nurse is counseling a client who abuses cocaine. The nurse recognizes that this drug is representative of which drug category? A. An opioid B. A stimulant C. A barbiturate D. A hallucinogen

B. A stimulant Cocaine is classified as a stimulant. It is inhaled in its powdered form or smoked as crack; its use creates experiences similar to but more intense than those experienced with the amphetamines, and its withdrawal results in a deeper crash. Opioids and barbiturates are central nervous system depressants. Hallucinogens produce cerebral excitation that can yield a state similar to psychosis.

A nurse is planning care for a client with substance-induced persisting dementia resulting from long-term alcohol use. Which nutritional problem, in addition to the effect of alcohol on brain tissue, has contributed to substance-induced persisting dementia? A. Increase in serotonin B. Deficiency of thiamine C. Reduction in iron intake D. Malabsorption of riboflavin

B. Deficiency of thiamine Substance-induced persistent dementia is caused by a prolonged deficiency of vitamin B1 (thiamine) and the direct toxic effect of alcohol on brain tissue. Increase in serotonin, reduction in iron intake, and malabsorption of riboflavin are problems that are unrelated to substance-induced persisting dementia caused by alcoholism

During a community health survey, the nurse is conducting a survey about the language development in preschoolers. What behavior is the nurse able to document in preschoolers? Select all that apply. A. Preschoolers start to understand riddles and jokes. B. Preschoolers want to know the reason behind an event. C. Preschoolers have a vocabulary of 8,000 to 14,000 words. D. Preschoolers know that words may have arbitrary meanings. E. Preschoolers cannot distinguish between phonetically similar words

B. Preschoolers want to know the reason behind an event. C. Preschoolers have a vocabulary of 8,000 to 14,000 words. E. Preschoolers cannot distinguish between phonetically similar words Preschoolers start to question "Why?" and "How come?" Their vocabulary increases rapidly and they can define their feelings by using 8,000 to 14,000 words. School-aged children are able to understand riddles and jokes. This is not seen in preschool children. School-aged children clearly understand that words have arbitrary meanings. This is not seen in preschoolers. Preschoolers get confused between phonetically similar sounds. They are not able to understand the difference between die and dye or wood or would. Therefore, the nurse will not document this behavior with preschoolers.

A nurse is caring for a client who has abruptly stopped taking a barbiturate. What withdrawal complication does the nurse anticipate that the client may experience? A. Ataxia B. Seizures C. Diarrhea D. Urticaria

B. Seizures Seizures are a serious side effect that may occur with abrupt withdrawal from barbiturates. Ataxia, diarrhea, and urticaria are not associated with barbiturate withdrawal

Which sedative-hypnotics are used to treat insomnia effects associated with a panic disorder? Select all that apply. A. Phenelzine B. Paroxetine C. Alprazolam D. Imipramine E. Clonazepam

C. Alprazolam E. Clonazepam Alprazolam and clonazepam are examples of benzodiazepines, a class of sedative-hypnotics used to treat clients with insomnia effects associated with panic disorders. Phenelzine is a monoamine oxidase inhibitor used to treat panic disorders and promote sleep. Paroxetine is a selective serotonin reuptake inhibitor used to treat panic disorders and promote sleep. Imipramine is a tricyclic antidepressant used to treat panic disorders and promote sleep.

A 20-year-old carpenter falls from a roof and sustains fractures of the right femur and left tibia. The client reveals a history of substance abuse. What is the primary consideration for the nurse who is caring for this client? A. Confronting the client about substance abuse B. Avoiding calling attention to the client's drug abuse C. Determining the amount and time of last use of the substance D. Realizing that this client will need more pain medication than a nonabuser

C. Determining the amount and time of last use of the substance Determining the amount and last use of the substance is the priority. Nurses should base their treatment of withdrawal symptoms on the time and amount of last use. Confronting the client is not the nurse's responsibility at this time. The client must be helped to recognize that a problem with drugs exists, but this is not the priority. Because of cross-tolerance the client may need larger doses of analgesia for pain relief than a nonabuser would, but this is not the priority.

A client with a history of gambling is experiencing legal difficulties for embezzling money and has been required to obtain counseling. During an intake interview the client says, "I never would have done this if I'd been paid what I am worth." What factor will create the greatest difficulty in helping this client develop insight? A. Feelings of boredom and emptiness B. Grandiosity related to personal abilities C. Projection of reasons for difficulties onto others D. Anger toward those who are in authority positions

C. Projection of reasons for difficulties onto others The development of insight is impeded by the client's unwillingness or inability to face his own contribution to a problem. Feelings of boredom and emptiness will not impede the development of insight. Such feelings are common in clients with borderline personality disorders. Grandiosity will not impede the development of insight. It is often a cover for feelings of inadequacy, which are threatening to the client; these feelings usually disappear with insight. Anger will not impede the development of insight. It is not the anger itself but instead how the anger contributes to interpersonal difficulty that the client must recognize.

The nurse is assessing a patient for possible substance abuse. Which assessment finding indicates possible use of amphetamines? a. Lethargy and fatigue b. Cardiovascular depression c. Talkativeness and euphoria d. Difficulty swallowing and constipation

c. Talkativeness and euphoria

A client is responding within 5 minutes of receiving naloxone to combat respiratory depression from an overdose of heroin. Why will a nurse continue to closely monitor this client's status? A. The drug may cause peripheral neuropathy. B. Naloxone and heroin can cause cardiac depression when combined. C. Symptoms of the heroin overdose may return after the naloxone is metabolized. D. Hyperexcitability and amnesia may cause the client to thrash about and become abusive

C. Symptoms of the heroin overdose may return after the naloxone is metabolized. When naloxone is metabolized and its effects are diminished, the respiratory distress caused by the original drug overdose returns. A combination of these drugs does not cause cardiac depression. There are no reports of peripheral neuropathy or hyperexcitability and amnesia with naloxone.

CAGE screening

C: Have you ever felt you ought to CUT down on drinking? A: Have people ANNOYED you by criticizing your drinking? G: Have you ever felt bad or GUILTY drinking? E: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? (As an EYE OPENER)

Methylphenidate (Ritalin)

CNS stimulant for ADHD se: Sleep disturbances and weight loss

A nurse who is assigned to care for a patient who has been admitted with an opiate overdose tells the nursing supervisor, "This is a waste of my time. The patient will be back on the needle right after being discharged." The most appropriate response by the nursing supervisor is a."Your lack of professionalism will make it difficult for you to provide adequate care." b."You know we are obligated to provide appropriate care no matter how we feel." c."Since you feel so strongly, perhaps you should be assigned to care for a different patient." d."It is important to recognize these feelings and then figure out how to deal with them."

Correct Answer: D Rationale:To provide nonjudgmental care for substance-abusing patients, nurses must examine their own values and feelings. This statement validates the nurse's feelings but recognizes the need to care for the patient in a nonjudgmental way. The response beginning, "Your lack of professionalism" is critical of the nurse and is unlikely to lead to a change in the nurse's attitude. The response beginning, "You know we are obligated to provide appropriate care" is accurate but does not encourage the nurse to examine his or her own values. The response beginning, "Since you feel so strongly" would solve the immediate problem but would not encourage self-examination.

What score on the EPDS would promote the to suspect possible depression and need further assessment A. 2 B. 5 C. 10 D. 15

D. 15 A maximum score 30 Scores of 12 or higher → possible depression and need further assessment.

A nurse is caring for a 42-year-old client who is scheduled for an amniocentesis during the fifteenth week of gestation because of concerns regarding Down syndrome. What other fetal problem does an examination of the amniotic fluid reveal at this time? A. Diabetes B. Lung maturity C. Cardiac anomalies D. Errors of metabolism

D. Errors of metabolism Inherited errors of metabolism may be detected if marker genes for a disease such as Tay-Sachs and thalassemia are present. Fetal diabetes and cardiac disorders cannot be detected with amniocentesis. Fetal lung maturity cannot be determined until after 35 weeks' gestation.

A client with recurrent episodes of depression comes to the mental health clinic for a routine follow-up visit. The nurse suspects that the client is at increased risk for suicide. What is a contributing factor to the client's risk for suicide? A. Psychomotor retardation B. Decreased physical activity C. Deliberate thoughtful behavior D. Overwhelming feelings of guilt

D. Overwhelming feelings of guilt Overwhelming feelings of guilt contribute to the client's risk for suicide. The client may ruminate over past or current failings, and extreme guilt can assume psychotic proportions. Psychomotor retardation and decreased physical activity are clinical findings associated with depression and usually do not lead to suicide because the client does not have the energy for self-harm. Impulsive behaviors, not deliberate thoughtful behaviors, contribute to the client's risk for suicide.

4 hours after a difficult labor and birth, the patient refer uses to feed her baby, stating she needs to rest. the nurse should A. Tell the women she can rest after she feeds her baby B. Reorganize this as a behavior as postpartum C. Recognize the behavior as ineffective material-newborn attachment D. Take the baby back to the nurse, reassure the patient that her rest is priority

D. Take the baby back to the nurse, reassure the patient that her rest is priority

Opioid withdrawal symptoms

Excessive sweating, restlessness, and dilated pupils (mydriasis) Agitation, goose bumps, tremor, and violent yawning Increased heart rate and blood pressure Nausea/vomiting and abdominal cramps and pain Muscle spasms and weight loss Anxiety

flooding therapy

Exposure to fear but start with most frightening fear first

A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) does the nurse anticipate that the primary healthcare provider may prescribe? Haloperidol Fluvoxamine Imipramine Benztropine

Fluvoxamine Fluvoxamine inhibits central nervous system neuron uptake of serotonin but not of norepinephrine. Haloperidol is not an SSRI; it is an antipsychotic that blocks neurotransmission produced by dopamine at synapses. Imipramine is a tricyclic antidepressant, not an SSRI. Benztropine is an antiparkinsonian agent, not an SSRI.

Anhedonia

Inability to experience pleasure, associated with some mood and schizophrenic disorders.

Dsythymia

Less severe depressive symptoms for at least 2 years with periods of no more than 2 months at a time symptom free -2.5% of adult population -Chronic

Busiprone (BuSpar)

Mainly used for GAD: Non-benzodiazepine for Anxiety Takes several weeks for maximal effect (not for acute txt) Partial 5HT AGONIST in brain;has central Dopamine Receptor effects. Minimal abuse liability, relieves anxiety without marked sedation, can cause adverse effects of dizziness, rash, fatigue

MAOIs

Monoamine oxidase Inhibitors Antidepressants isocarboxazid (Marplan) phenelzine (Nardil) selegiline (Emsam) tranylcypromine (Parnate) *Tyramine restriction Dont mix meds!

Wernicke's encephalopathy

Occurs in alcoholics. A brain disorder caused by thiamine deficiency and characterized by visual disturbances, ataxia, somnolence, stupor, and without thiamine replacement, death.

echolalia

The uncontrollable and immediate repetition of words spoken by another person

cognitive-behavioral therapy (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

Serotonin Syndrome

With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist).

Terry is a young male in a chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is: a. Bored b. Depressed c. Bipolar d. Not ready to change

d. Not ready to change

Anergia

deficiency of energy

Desensitization

reducing fear or anxiety by repeatedly exposing a person to emotional stimuli while the person is deeply relaxed

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.) 1. parallel play 2. social interaction 3. gross motor development 4. inability to maintain eye contact 5. language as used in social communication

2. social interaction 4. inability to maintain eye contact 5. language as used in social communication Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.

While walking to the examination room with the nurse, a toddler with autism suddenly runs to the wall and starts banging the head on it. What should the nurse's initial action be 1. Allowing the toddler to act out feelings 2. Asking the toddler to stop this behavior 3. Restraining the toddler to prevent head injury 4. Telling the toddler that the behavior is unacceptable

3. Restraining the toddler to prevent head injury The child with autism needs protection from self-injury. Permitting the child to act out is possible only if the acting out does not place the child in jeopardy. The child with autism has difficulty following directions, especially when out of control. The child with autism cannot separate self from behavior; a punitive approach will decrease the child's self-esteem.

transcranial magnetic stimulation (TMS)

A new technique that permits scientists to temporarily enhance or depress activity in a specific area of the brain. TCM treatments take about 30 minutes. Treatments are usually 5 days a week. Patients are awake and alert during the procedure. After the procedure, patients may experience a headache and lightheadedness. No neurological deficits or memory problems have been noted.

(pharm book) A patient with a feeding tube will be receiving risperidone (Risperdal) 8 mg in 2 divided doses via the feeding tube. The medication is available in a 1 mg/mL solution. How many milliliters will the nurse administer for each dose?

7.4 per ml

Intellectual Developmental Disorder (IDD)

A disorder marked by intellectual functioning and adaptive behavior that are well below average. Previously called mental retardation. does not meet normal developmental milestones

After a client on the mental health unit with a known history of opioid addiction has a visit from several friends, a nurse finds the client in a deep sleep and unresponsive to attempts at arousal. The nurse assesses the client's vital signs and determines that an overdose of an opioid has occurred. Which findings support this conclusion? A. Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min B. Blood pressure of 180/100 mm Hg, tachycardia, and respiratory rate of 18 breaths/min C. Blood pressure of 120/80 mm Hg, regular pulse, and respiratory rate of 20 breaths/min D. Blood pressure of 140/90 mm Hg, irregular pulse, and respiratory rate of 28 breaths/min

A. Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min Opioids cause central nervous system depression, resulting in severe respiratory depression, hypotension, tachycardia, and unconsciousness. The other findings, particularly the respirations, are not indicative of an overdose of an opioid

A nurse knows that individuals who are alcoholics use alcohol for what reason? A. Blunt reality B. Precipitate euphoria C. Promote social interaction D. Stimulate the central nervous systems.

A. Blunt reality Alcohol, by depressing the central nervous system and distorting or altering reality, reduces anxiety. Alcohol depresses the central nervous system; it may cause lability of mood, impaired judgment, and aggressive actions rather than euphoria. Although alcohol is used as a social lubricant, alcoholics frequently drink in isolation. Also, alcohol can lead to inappropriate and aggressive behavior that may impair social interaction. Alcohol depresses the central nervous system; amphetamines and cocaine are stimulant

A nurse is teaching a group of recently hired staff members about conscious and unconscious defense mechanisms that are used to defend the self against anxiety. What is an example of a conscious defense mechanism that the nurse should include? A. Undoing B. Projection C. Suppression D. Intellectualization

C. Suppression Suppression is a conscious measure used as a defense against anxiety; the affected person intentionally avoids thinking about disturbing problems, wishes, feelings, or experiences. Undoing is an unconscious defense mechanism; it is the use of words or behavior to make amends symbolically for unacceptable thoughts, feelings, or actions. Projection is an unconscious defense mechanism; it is the false attribution to others of one's own unacceptable impulses, feelings, attitudes, or thoughts. Intellectualization is an unconscious defense mechanism; it is the use of thinking, ideas, or intellect to avoid emotionally charged feelings.

cognitive restructuring

a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs

The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitates the action of GABA? a. Benzodiazepines b. Antihistamines c. Anticonvulsants d. Noradrenergic

a. Benzodiazepines

A patient is experiencing withdrawal from opioids. The nurse expects to see which assessment finding most commonly associated with acute opioid withdrawal? a. Elevated blood pressure b. Decreased pulse c. Lethargy d. Constipation

a. Elevated blood pressure

Which patient has an increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply. a. Exacerbation of asthma signs and symptoms b. History of peanut and strawberry allergies c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injury

a. Exacerbation of asthma signs and symptoms c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injury

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

a. Pupils are dilated d. Extreme anxiety

What is a priority nursing intervention in the care of a drug-dependent mother and infant? a. Supporting the mother's positive responses toward her infant b. Requesting that family members share responsibility for infant care c. Keeping the infant separated from the mother until the mother is drug free d. Helping the mother understand that the infant's problems are a result of her drug intake

a. Supporting the mother's positive responses toward her infant A nurse should attempt to support the mother-child relationship; the mother is experiencing a developmental crisis while coping with drug addiction and possibly guilt. It is the client's right to decide who will share in the care of her child. The client needs contact with her new infant to facilitate bonding. Helping the mother understand that the infant's problems are a result of her drug intake will make the client feel guilty and will not facilitate positive action at this point.

Benzodiazepines

aka tranquilizers prescribed type of medication for anxiety, work quickly, typically bringing relief within 30 minutes to an hour. alprazolam (Xanax) Clonazepam (klonopin) chlordiazepoxide (Librium) diazepam (Valium) lorazepam (Ativan) All Classy Characters Die Last Used for alcohol withdrawal

Korsakoff's psychosis

alcoholic patients, caused by severe deficiency of thiamine - syndrome of confusion - loss of recent memory - confabulation (memory are unconsciously filled with fabricated, misinterpreted, or distorted information)

Lester and Eileen have always enjoyed gambling. Lately, Eileen has discovered that their savings account is down by $50,000. Eileen insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states: a. "I understand that I am a bad person for depleting our savings." b. "Gambling activates the reward pathways in my brain." c. "Gambling is the only thing that makes me feel alive." d. "We have always enjoyed gaming. I do not know why Eileen is so upset."

b. "Gambling activates the reward pathways in my brain."

Which statement(s) made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply. a. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tension." b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

(pharm book ) In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants

b. Benzodiazepines

A nurse is teaching a group of clients with peripheral vascular disease about a smoking cessation program. Which physiologic effect of nicotine should the nurse explain to the group? a. Constriction of the superficial vessels dilates the deep vessels. b. Constriction of the peripheral vessels increases the force of flow. c. Dilation of the superficial vessels causes constriction of collateral circulation. d. Dilation of the peripheral vessels causes reflex constriction of visceral vessels.

b. Constriction of the peripheral vessels increases the force of flow. Constriction of the peripheral blood vessels and the resulting increase in blood pressure impairs circulation and limits the amount of oxygen being delivered to body cells, particularly in the extremities. Nicotine constricts all peripheral vessels, not just superficial ones. Its primary action is vasoconstriction; it will not dilate deep vessels. Nicotine constricts rather than dilates peripheral vessels.

Which interventions does the nurse implement to empower a family who has a child with Down syndrome? Select all that apply. a. Ask the family to engage in spiritual activities. b. Help the family recognize the possible stressors. c. Encourage the use of problem-solving strategies. d. Encourage more out-of-home activities for the parents. e. Refer the family to support groups and Internet resources.

b. Help the family recognize the possible stressors. c. Encourage the use of problem-solving strategies. e. Refer the family to support groups and Internet resources. The nurse understands that the family experiences multiple stressors and helps the family recognize those stressors. The nurse encourages the family to use effective problem-solving skills that convey support and care and have a calming influence on the child. The nurse also identifies proper support groups for the family to relieve stress. The use of Internet resources will help the family understand more about the child's disorder. Asking the family to engage in spiritual activities is not appropriate, because spirituality is a personal lifestyle choice. The nurse encourages the parents to spend more time at home to provide care for the child, as opposed to engaging in more out-of-home activities.

Samantha is a new patient to the mental health clinic and is seeking assistance for what she describes as "severe anxiety." In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse knows that kava is associated with inhibiting P450 and orders which of the following tests? a. Electrocardiogram b. Liver enzymes c. Glomerular filtration rate d. Complete blood count

b. Liver enzymes

5. A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient's success? a. Restrict visitors to family members only. b. Manage the patient's withdrawal symptoms well. c. Provide the patient a low stimulus environment. d. Advocate for at least 3 months of treatment.

b. Manage the patient's withdrawal symptoms well.

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states: a. "I would like to try a benzodiazepine for my anxiety." b. "If I study harder, my anxiety level will go down." c. "Mild anxiety is okay because it helps me to focus." d. "I have fear that I will fail at college.

c. "Mild anxiety is okay because it helps me to focus."

(pharm book ) The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications.

b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. f. The patient should be told to check with the prescriber before taking any over-the-counter medications.

The nurse is teaching a class about the effects of alcohol. Long-term excessive use of alcohol is associated with which of these problems? (Select all that apply.) a. Coronary artery disease b. Wernicke's encephalopathy c. Polyneuritis d. Seizures e. Cirrhosis of the liver f. Korsakoff's psychosis

b. Wernicke's encephalopathy c. Polyneuritis e. Cirrhosis of the liver f. Korsakoff's psychosis

During treatment for withdrawal from opioids, the nurse expects which medication to be ordered? a. amphetamine (Dexedrine) b. clonidine (Catapres) c. diazepam (Valium) d. disulfiram (Antabuse)

b. clonidine (Catapres)

A homebound patient diagnosed with agoraphobia has been receiving therapy in the home. The nurse evaluates patient teaching is effective when the patient states: a. "I may never leave the house again." b. "Having groceries delivered is very convenient." c. "My risk for agoraphobia is increased by my family history." d. "I will go out again, someday, just not today."

c. "My risk for agoraphobia is increased by my family history."

(pharm book ) After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient? a. Weakness b. Hallucinations c. Suicidal ideation d. Difficulty with urination

c. Suicidal ideation

Opioid use disorder is characterized by: a. Lack of withdrawal symptoms b. Intoxication symptoms of pupillary dilation, agitation, and insomnia c. Tolerance d. Requiring smaller amounts of the drug to achieve a high over time

c. Tolerance

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has been recently prescribed an antianxiety medication? a. Eating high protein foods. b. Using acetaminophen without first discussing it with a healthcare provider c. Taking medications after eating dinner or while having a bedtime snack d. Buying a large coffee with sugar and extra cream each morning on the way to work

d. Buying a large coffee with sugar and extra cream each morning on the way to work

As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, premature separation of the placenta, and stillbirth? a.Heroin b.Alcohol c.PCP d.Cocaine

d.Cocaine Cocaine is a powerful central nervous system stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

cirrhosis of the liver

is caused by overworking the liver trying to assimilate large amounts of alcohol, severe medical condition where scar tissue in the liver replaces functional tissue.

Anxiety symptoms

physical (heart rate changes, sob, hot flashes...), emotional (irritable, keyed-up, problems sleeping...), Tension (restless, fatigue, twitch/tremble/shake)

atlantoaxial instability (AAI)

- 1-2% Down syndrome pts with upper motor neuron findings - increased laxity C1 and C2--> compression of spinal cord - can lead to dislocation, SCI, neurological problems - should not hyperflex neck or do front rolls

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply). of, inattention, and impulsivity have to be apparent: 1.Low frustration tolerance 2.Poor school performance 3.Impulsive behaviors 4.Easily intimidated 5.Mood swings

1.Low frustration tolerance 2.Poor school performance 3.Impulsive behaviors 5.Mood swings Individuals with ADHD show an inappropriate degree of inattention, impulsiveness, and hyperactivity. Attention problems and hyperactivity contribute to low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self-esteem. ADHD is not generally characterized by meekness or by being easily intimidated

Edinburgh Postnatal Depression Scale (EPDS)

10 questions - Sadness, Sleep, Anxiety, Blame Administer at 2 week, 2 month baby or 6-8 week maternal check Identifies feelings over past 7 days At risk patients identified - Referral required

A female client with obsessive-compulsive disorder has become immobilized by her elaborate handwashing and walking rituals. Which feelings does the nurse recall are often the basis of obsessive-compulsive disorder? A. Anxiety and guilt B. Anger and hostility C. Embarrassment and shame D. Hopelessness and powerlessness

A. Anxiety and guilt Ritualistic behavior seen in this disorder is aimed at controlling feelings of anxiety and guilt by maintaining an absolute set pattern of action. Although the person with an obsessive-compulsive disorder may be angry and hostile, the feelings of anger and hostility do not precipitate the rituals. Although the person with an obsessive-compulsive disorder may be embarrassed and ashamed by the ritual or feel hopeless and powerless to the ritual, the basic feelings precipitating the rituals are usually anxiety and guilt.

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. A. Lethargy B. Ambivalence C. Emotional lability D. Increased appetite E. Long periods of sleep

A. Lethargy B. Ambivalence C. Emotional lability Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is also associated with postpartum depression.

Which teratogens affecting fetal growth and development should the nurse include in a teaching session for pregnant clients? Select all that apply. A. Rubella B. Varicella C. Swordfish D. Phenytoin E. Acetaminophen

A. Rubella B. Varicella C. Swordfish D. Phenytoin Teratogens are noxious materials such as viruses, chemicals, and drugs that pass from mother to child during pregnancy that can affect fetal growth and development. Rubella, varicella, swordfish (due to high mercury content), and phenytoin are all teratogens that the nurse should educate pregnancy clients to avoid. Acetaminophen is not a teratogen.

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? A. Sertraline B. Fluoxetine C. Amphetamine D. Carbamazepine

A. Sertraline Sertraline (SSRI) is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.

mild anxiety

Adaptive and motivates for change/Awareness heightened/Learning enhanced/Seldom a problem

While playing with a toy car, a toddler accidentally hits the wall and falls down. The toddler then gets angry at the wall for making him fall. Which characteristic of preoperational thought does this behavior indicate? a. Animism b. Centration c. Egocentrism d. Irreversibility

Animism is an act of attributing lifelike qualities to inanimate objects. When a toddler scolds the wall for making him or her fall, it indicates animism. Centration is focusing on one aspect rather than considering all possible alternatives. Egocentrism is the inability to envision situations from perspectives other than one's own. Irreversibility is the inability of toddlers to reverse actions that are physically initiated.

A client tells the nurse, "All my friends experiment with drugs. I like the high I get when I huff paint. Nothing bad is going to happen to me." What is the best response by the nurse? A. "Inhalants can cause a mild state of intoxication." B. "Huffing paint can damage your lungs, kidneys, and liver." C. "Withdrawal problems will start if you continue huffing paint." D. "Limiting the type of inhalant used decreases respiratory irritation.

B. "Huffing paint can damage your lungs, kidneys, and liver." Inhaled toxins become systemic and cause damage to major organs such as the lungs, liver, and kidneys. Inhalants tend to produce euphoria, not just a mild state of intoxication. Huffing paint will not produce major withdrawal symptoms. All toxic substances that are inhaled become systemic and cause damage to major organs such as the lungs, liver, and kidneys

The mother of an infant with Down syndrome asks the nurse what causes the disorder. Before responding, the nurse recalls that the genetic factor of Down syndrome results from what? A. An intrauterine infection B. An X-linked genetic disorder C. Extra chromosomal material D. An autosomal recessive gene

C. Extra chromosomal material Down syndrome (trisomy 21) results from extra chromosomal material on chromosome 21. Down syndrome does not result from a maternal infection. Down syndrome is not related to an X-linked or Y-linked gene. An autosomal recessive gene is not the cause of Down syndrome, although translocation of chromosomes 15 and 21 or 22 is a genetic aberration found in some children with Down syndrome.

A patient has a history of opioid abuse and is hospitalized after a fall down a flight of stairs. After a visit by a friend, the nurse finds the patient unresponsive with pinpoint pupils. Which of these ordered medications will the nurse administer? a.Clonidine (Catapres) b.Methadone (Dolphine) c.Naloxone (Narcan) d.Diazepam (Valium)

Correct Answer: C Rationale:The patient's assessment indicates an opiate overdose, and Narcan should be given to prevent respiratory arrest. The other medications may be used to decrease symptoms associated with opioid withdrawal but would not be appropriate for an overdose.

The husband of a woman who gave birth to a baby 2 weeks ago calls the postpartum unit at the hospital, seeking assistance for his wife. He reports that he found his wife in bed and that the baby was wet, dirty, and crying in the crib. He says, "She says she just can't do it." What is the best response by the nurse? A. Encouraging him to express his feelings about the situation B. Telling him to schedule an appointment with the gynecologist C. Asking whether he can afford a home health aide for several weeks D. Informing him that he should seek emergency intervention for his wife

D. Informing him that he should seek emergency intervention for his wife The inability to care for herself or her infant is a significant sign that the wife is depressed and in need of immediate intervention. The wife, not the husband, is the priority at this time. The wife has an emotional, not physiologic, problem at this time. Asking whether the family can afford a home health aide for several weeks is not the priority at this time; the wife's emotional condition is the priority.

polyneuritis

Occurs in alcoholics. inflammation involving two or more nerves, often caused by a nutritional deficiency, such as lack of thiamine

A client's hands are raw and bloody from a ritual involving frequent hand washing. Which defense mechanism does the nurse identify? Undoing Projection Introjection Suppression

Undoing is an act that partially negates a previous one; the client is using this primitive defense mechanism to reduce anxiety. Clients who wash their hands compulsively may be having thoughts that they consider "dirty." Projection is the attribution of one's thoughts or impulses to another. Introjection is treating something outside the self as if it is actually inside the self. Suppression is a process that is often listed as a defense mechanism, but it is actually a conscious, intentional exclusion of material from one's awareness.

A patient has been admitted to the emergency department after a suspected overdose of benzodiazepines mixed with alcohol. The patient is lethargic and cannot speak. The nurse expects which immediate measures to be implemented? (Select all that apply.) a. Prepare to administer naloxone (Narcan). b. Prepare to administer flumazenil. c. Monitor the patient for convulsions. d. Prepare for potential respiratory arrest. e. Apply restraints.

a. Prepare to administer naloxone (Narcan). b. Prepare to administer flumazenil. c. Monitor the patient for convulsions. d. Prepare for potential respiratory arrest. Flumazenil is a benzodiazepine antagonist.

severe anxiety

an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly; person with severe anxiety has trouble thinking and reasoning trouble sleeping light headed nausea tremors sense of impending doom

(perry) A women in childbearing years should have at least how much folic acid daily?

at least 0.4 mg (400 mcg) of folic acid daily in addition to consuming a diet rich in folate-containing foods

The nursing diagnosis ineffective denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply. a. Reports inability to cope b. Does not perceive danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit impact of disease on life pattern

b. Does not perceive danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit impact of disease on life pattern

Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks? a. Alprazolam (Xanax) b. Fluoxetine (Prozac) c. Clonazepam (Klonopin) d. Venlafaxine (Effexor)

b. Fluoxetine (Prozac)

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially when attempting to help the patient deescalate their anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began to increase?" d. "Are you feeling anxious right now?"

c. "Can you identify what was happening when your anxiety began to increase?"

Panic level of anxiety

characterized by markedly disturbed behavior; client is not able to process what is occurring in the environment and may lose touch with reality; extreme fright and horror; dysfunction in speech, inability to sleep, delusions, and hallucinations

(pharm book ) Patient teaching for a patient receiving an MAOI would include instructions to avoid which food product? a. Orange juice b. Milk c. Shrimp d. Swiss cheese

d. Swiss cheese MAOIs break down excess tyramine in the body. Blocking this enzyme helps relieve depression. If you eat high-tyramine foods can cause a serious spike in blood pressure and require emergency treatment. Strong or aged cheese and cured meat contain high levels of tyramine.

SSRIs

selective serotonin reuptake inhibitors fluoxetine (Prozac) fluvoxamine (Luvox) paroxetine (Paxil, Pexeva) sertraline (Zoloft) citalopram (Celexa) escitalopram (Lexapro) (FLashbacks PARalyze SEnior CITizens) take about 3 weeks to work Used for OCD

Suicide Ideation

thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones

postpartum psychosis (PPP)

variant of bipolar disorder and is the most serious form of postpartum mood disorders

fetal alcohol syndrome symptoms

•Growth retardation •hypotonia (less muscle tone) •Maxillary hypoplasia (underdevelopment of the bones of the upper jaw, small eyes with epicanthic folds •Distinctive facial features (upturned nose, thin upper lip) •microcephaly (small head) •CNS abnormalities •weigh less and be shorter than normal •abnormal joints and limbs •poor coordination •problems with learning •short memories

Tricyclic Antidepressants (TCAs)

Amitriptyline. Amoxapine. Desipramine (Norpramin) Doxepin. Imipramine (Tofranil) Nortriptyline (Pamelor) Muscarinic blockage leads to anticholinergic effects such as blurred vision, dry mouth, tachycardia, urinary retention, and constipation. Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Several weeks to take affect. Not for geriatric patients.

fetal alcohol syndrome (FAS)

A primary nursing goal for the newborn diagnosed with fetal alcohol syndrome is to establish nutritional balance after birth. These newborns may exhibit hyperirritability, vomiting, diarrhea, or an uncoordinated sucking and swallowing ability. A quiet environment with minimal stimuli and handling would help establish appropriate sleep-rest cycles in the newborn as well.

A client who is a polysubstance abuser is mandated to seek drug and alcohol counseling. What is an appropriate initial outcome criterion for this client? A. Verbalizes that a substance abuse problem exists B. Discusses the effect of drug use on self and others C. Explores the use of substances and problematic behaviors D. Expresses negative feelings about the current life situation

A. Verbalizes that a substance abuse problem exists The client must first acknowledge that a substance abuse problem exists and is creating chaos; verbalizing that a problem exists indicates that the client is not in denial and is taking the first step toward change. Once a problem is identified, the numerous ways in which drug use has controlled the client's life and the resulting lifestyle problems can be explored, and the nurse can help the client express and process negative feelings.

A primary healthcare provider prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement? A. Complimenting the client's appearance B. Starting preparations for the client's discharge C. Arranging for constant supervision of the client D. Adding privileges to the client's plan of care as a reward

C. Arranging for constant supervision of the client A change in behavior that seems positive may actually indicate that the client has worked out a plan for suicide; the potential for suicide increases when physical energy returns. Increased supervision is needed. Complimenting the client's appearance may increase the client's feelings of inadequacy, because it implies that the client did not look good before. It is inappropriate to consider discharge simply because of a change in behavior. Many factors should be considered in the decision to discharge a client. The addition of privileges is not indicated at this time.

Which drug is used to treat both generalized anxiety disorder and depression? A. Fluoxetine B. Bupropion C. Duloxetine D. Mirtazapine

C. Duloxetine Duloxetine is an antidepressant drug used to treat both generalized anxiety disorder and depression. Fluoxetine is used to treat depression. Bupropion is used to treat depression and also aid in smoking cessation. Mirtazapine is used in the treatment of depression and also helpful in reducing the adverse sexual side effects in the male client receiving selective serotonin reuptake inhibitors therapy.

What should the nurse keep in mind about rituals when planning care for a client who uses ritualistic behavior? They help the client control anxiety. They are under the client's conscious control. They are used by the client primarily for secondary gains. They help the client focus on the inability to deal with reality.

They help the client control anxiety. The rituals used by a client with obsessive-compulsive disorder help control the anxiety level by maintaining a set pattern of action. The client cannot consciously control the ritual. Rituals are used primarily to handle feelings of anxiety and generally are seen by the client as illogical; they provide few secondary gains. Rituals are a means of diverting attention from feelings of anxiety.

Neonatal Abstinence Syndrome (NAS)

a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use

Generalized Anxiety Disorder (GAD)

a disorder characterized by chronic excessive worry accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance

A client reports to the primary healthcare provider with a complaint of becoming panicked and having irrational fear of public talking. Which drug does the nurse anticipate to be prescribed by the primary healthcare provider? a. Buspirone b. Alprazolam c. Diazepam e. Lorazepam

b. Alprazolam Alprazolam (a benzodiazepine) is a short-acting anxiolytic drug used to treat those clients with panic disorders and the irrational fear of talking openly in public (agoraphobia). Buspirone, an anxiolytic drug that is different both chemically and pharmacologically from the benzodiazepines, is always administered on a scheduled basis (not "as-needed") for the treatment of anxiety. Diazepam is an anxiolytic drug commonly prescribed for the treatment of anxiety but has generally been replaced by short-acting benzodiazepines. Lorazepam is an intermediate-acting anxiolytic drug used in the treatment of acutely agitated clients.

A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When unable to do this, the client becomes upset. What should the nurse do? a. Distract the client, which will help the client forget about touching the chairs b. Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in c. Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one d. Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed

d. Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because the client uses the ritual as a defense against anxiety.

Down syndrome symptoms

- *Intellectual Disability* (#1 Cause) - Epicanthal Folds (Eyes) - Flat Facies - *Single Palmar Crease* - *Gap Between 1st-2nd Toe* - *Duodenal Atresia* (constipation) - Hirschsprung Disease - *Heart Disease* (Septal Defects) - high-arched, narrow palate; - protruding tongue - transverse palmar creases - fingers are stubby - muscle tone is hypotonic (stiff) - Dysplastic (low set) ears - reduced growth in both height and weight - overweight by 3yo

chorionic villus sampling (CVS)

- A technique for diagnosing genetic and congenital defects in a fetus by removing and analyzing a sample of the fetal portion of the placenta. - may be performed between 10 and 12 weeks' gestation - prenatal test provides the earliest diagnosis and rapid test results - (amniocenteses usually 14 weeks)

A client comes to the clinic for a 6-week postpartum check-up. She confides that she is experiencing exhaustion that is not relieved by sleep and feelings of failure as a mother because the infant "cries all of the time." When asked whether she has a support system, she replies that she lives alone. Which response would provide the most accurate information? A. Providing information about a local support group B.Explaining that it is normal to feel depressed after childbirth C.Asking the client questions, using a postpartum depression scale D. Suggesting that the client find someone who can take care of the baby for 24 hours

C. Asking the client questions, using a postpartum depression scale A postpartum depression scale is a validated tool for identifying women who might be experiencing postpartum depression. The most widely used and validated tools are the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale. Although providing community resources of a local support group may be helpful, it is not useful in assessing the client's current emotional status. Although postpartum blues caused by hormonal changes soon after pregnancy might be common, feelings of depression and fatigue 6 weeks after childbirth is a matter of concern. The client may not have anyone else who can provide child care, or the client may not follow through on the recommendation. In addition, this intervention does not provide any information on the client's current emotional status.

A nurse spends time in individual sessions helping a depressed, suicidal client verbalize feelings. For what themes should the nurse particularly listen? Select all that apply. A. Anger B. Control C. Isolation D. Dominance E. Hopelessness F. Indecisiveness

C. Isolation E. Hopelessness Feelings of isolation compound feelings of hopelessness and helplessness and may provide the client with the impetus to act on suicide ideation. The main factor leading to acting on suicidal impulses is the feeling of hopelessness, that there is nothing to live for. Anger may be associated with depression; however, a depressed person usually does not have the energy to act out suicidal ideation. The struggle for control or dominance is not an important risk factor for suicide. Indecisiveness may be associated with depression, but an indecisive individual is usually unable to make the decision to commit suicide.

On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding? A. The client's feelings will pass after she has bonded with her infant. B. The client is probably suffering from postpartum depression and needs special care. C. A cesarean birth may be a traumatic experience, but most women know that it is a possible outcome. D. A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.

D. A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this. The client's response is appropriate to the situation, reflecting disappointment in not achieving her goal; in addition, this is the time when "postpartum blues" occurs. The client's feelings may or may not pass after she has bonded with her infant; there is no indication that the feeling will pass or that bonding is involved. The client's statement is not indicative of depression. With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment a client may feel over not reaching her goal.

A patient experiencing ethanol withdrawal is beginning to show severe manifestations of delirium tremens. The nurse will plan to implement which interventions for this patient? (Select all that apply.) a. Doses of an oral benzodiazepine b. Doses of an intravenous benzodiazepine c. Restraints if the patient becomes confused, agitated, or a threat to himself or others d. Thiamine supplementation e. Oral disulfiram (Antabuse) treatment f. Monitoring in the intensive care unit

b. Doses of an intravenous benzodiazepine c. Restraints if the patient becomes confused, agitated, or a threat to himself or others d. Thiamine supplementation f. Monitoring in the intensive care unit

Tyramine foods

- Fruits and Veggies are okay except remember salad BAR, avoid Bananas, Avocados, Raisins, - Grains are okay except for active yeast, - No fermented alcohol (wine, beer) - No pickles, sauerkraut - aged cheese (cheddar, blue cheese, swiss - cured meats (salami, sausages, pepperoni) - SOY - fava beans

Autism Spectrum Disorder (ASD)

- a disorder that appears in childhood w/ deficiencies in communication and social interaction and rigidly fixated interests and repetitive behaviors - abnormalities in the production of speech, such as a monotone voice or echolalia, or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.

moderate anxiety

- tensions, palpitation, increase heart rate, sweating - grasp less information and reduces problem-solving ability to a less-than-optimal level

postpartum depression symptoms

-Depressed mood or severe mood swings -Excessive crying -Difficulty bonding with your baby -Withdrawing from family and friends -Loss of appetite or eating much more than usual -Inability to sleep (insomnia) or sleeping too much -Overwhelming fatigue or loss of energy -Reduced interest and pleasure in activities you used to enjoy -Intense irritability and anger -Fear that you're not a good mother -Feelings of worthlessness, shame, guilt or inadequacy -Diminished ability to think clearly, concentrate or make decisions -Severe anxiety and panic attacks -Thoughts of harming yourself or your baby -Recurrent thoughts of death or suicide

Alcohol withdrawal symptoms

-appear within 4-12 hrs -abd cramping -vomiting -tremors -restlessness -inability to sleep -TACHYCARDIA -HTN -transient hallucinations or illusions -anxiety -increased RR, temp -tonic clonic seizures -diaphoresis

After a child's visit to a healthcare provider, the parent tells the nurse, "I'm so upset! The doctor prescribed an antidepressant!" What is the best response by the nurse? A. "Tell me more about what's bothering you." B. "Weren't you told why your child needs an antidepressant?" C. "You need to speak with the healthcare provider about your concerns." D. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?"

A. "Tell me more about what's bothering you." "Tell me more about what's bothering you" provides an opportunity to explore the parent's feelings. It is the nurse's responsibility, not the healthcare provider's, to assess the parent's concerns before planning further interventions. "Weren't you told why your child needs an antidepressant?" is a confrontational response that may put the parent on the defensive. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?" is a judgmental, nontherapeutic response that may worsen the parent's concerns.

A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy? a. Alcohol b. Cocaine c. Heroin d. Marijuana

A. alcohol The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions. Heroin use in pregnancy frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

Alprazolam is prescribed for a client with the diagnosis of panic disorder. The client refuses to take the medication because of fears of addiction. What should the nurse do initially? A. Provide the client information about alprazolam. B. Assess the client's feelings about alprazolam further. C. Ask the practitioner about changing the client's medication. D. Have the practitioner speak with the client about the safety of this medication.

B. Assess the client's feelings about alprazolam further. Before deciding how to ease the client's fears of addiction, the nurse must explore the full extent of the client's knowledge and feelings about taking this medication. Information may or may not be helpful; the client's feelings are what must be addressed. Although the nurse may eventually ask the practitioner to consider changing the medication or to speak with the client about its safety, neither is the priority at this time.

A 45-year-old client who recently completed alcohol detoxification reports plans to begin using disulfiram (Antabuse) as part of the alcoholism treatment regimen. What important client teaching does the nurse share regarding this drug? A. Voluntary compliance with the disulfiram regimen is very high. B.A single dose of oral disulfiram will be effective for up to 72 hours C. Disulfiram may be taken intramuscularly and will be effective for as long as 7 days. D. Foods, medications, and any topical preparation containing alcohol should be avoided.

D. Foods, medications, and any topical preparation containing alcohol should be avoided. Disulfiram causes unpleasant physical effects when mixed with alcohol. Any substance that contains alcohol may trigger an adverse reaction. Voluntary compliance with the use of disulfiram is often very low because of the negative physical effects experienced by the individual if alcohol is ingested. For disulfiram to be effective, it must be taken orally every day. Disulfiram is not administered intramuscularly.

The HCP ordered Sertaline (zoloft) after 3 days, says the med is not working. The RN should respond a. cheer up, you have so much to be happy about b. sometimes its takes 4-6 weeks to see improvements in symptoms C. Give it 2 days and you should see improvements in your symptoms D. I'll call the HCP and get an order to change the medication

b. sometimes its takes 4-6 weeks to see improvements in symptoms

A patient who is taking disulfiram as part of an alcohol treatment program accidentally takes a dose of cough syrup that contains a small percentage of alcohol. The nurse expects to see which symptom as a result of acetaldehyde syndrome? a. Lethargy b. Copious vomiting c. Hypertension d. No ill effect because of the small amount of alcohol in the cough syrup

b. Copious vomiting

Maxwell is a 30-year-old male who arrives at the emergency department stating, "I feel like I am having a stroke." During the intake assessment, the nurse discovers that Maxwell has been working for 36 hours straight without eating and has consumed eight double espresso drinks and 12 caffeinated sodas. The nurse suspects: a. Fluid overload b. Dehydration and caffeine overdose c. Benzodiazepine overdose d. Sleep deprivation syndrome

b. Dehydration and caffeine overdose

ADHD (Attention-Deficit Hyperactivity Disorder)

a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity

A patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply. a. Intense nausea b. Diaphoresis c. Acute paranoia d. Confusion e. Dyspnea

a. Intense nausea b. Diaphoresis d. Confusion e. Dyspnea throbbing in the head and neck, nausea, copious vomiting, diaphoresis, dyspnea, hyperventilation, vertigo, blurred vision, and confusion

Thiamine (vitamin B 1) and niacin (vitamin B 3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan? a. Neuronal activity b. Bowel elimination c. Efficient circulation d. Prothrombin development

a. Neuronal activity Thiamine and niacin help convert glucose for energy, and therefore influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacture of prothrombin

A client consumes alcohol during pregnancy. Which condition does the nurse anticipate to be seen in the newborn? a. Stillbirth b. Heart defects c. Growth delay d. Multiple defects

a. Stillbirth

Typical signs of neonatal abstinence syndrome related to opioid withdrawal usually begin within 24 hours after birth. What characteristics should the nurse anticipate in the infant of a suspected or known drug abuser? Select all that apply. a. Tremors b. Dehydration c. Hyperactivity d. Muscle hypotonicity e. Prolonged sleep periods

a. Tremors c. Hyperactivity Opioid dependence in the newborn is physiologic; as the drug is cleared from the body, signs of drug withdrawal become evident. Tremors and hyperactivity are typical signs of cerebral irritability. Dehydration is a result of inadequate feeding, not a direct result of opioid withdrawal. Muscle hypertonicity, not hypotonicity, occurs with opioid withdrawal. Signs of opioid withdrawal include excessive activity and sleep disturbances.

What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder? a. Accompany the staff member when she is giving patient care. b. Offer to attend rehabilitation counseling with her. c. Refer her to a peer assistance program. d. Confront her about your concerns and/or report your concerns to a supervisor immediately.

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

A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience? a. Dizziness b. Breathlessness c. Abdominal cramps d. Increased alertness

d. Increased alertness Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.