Exam 5 (SEM 3) Focused Exam Questions

A patient admitted with shortness of breath and chest pain who is a pack-a-day smoker tells the nurse, "I am just not ready to quit smoking yet." Which response by the nurse is appropriate for the patient's stage of change?

"Are you familiar with nicotine replacement products?"

A nurse is using cognitive therapy to help a client who experiences panic attacks. What is the goal of this therapy? 1 Preventing future panic attacks 2 Helping the client hide the panic attacks 3 Stopping the panic attacks once they begin 4 Decreasing the fear of having panic attacks

4 It is the fear of having an attack as much as the panic attack itself that is debilitating. Once the client's fear of future attacks is diminished, the number of attacks usually decreases as welL

A client is admitted to the psychiatric unit with the diagnosis of obsessive-compulsive disorder. The client washes her hands more than 20 times a day, and they are raw and bloody. What defense mechanism does the nurse conclude that the client is using to ease anxiety? 1 Undoing 2 Projection 3 Introjection 4 Displacemen

1 Undoing is an act that partially negates a previous one; the client is using this defense mechanism to atone for unacceptable acts or wishes

A 37-year-old man has been remanded by the court to the drug rehabilitation unit of a psychiatric facility for treatment of cocaine addiction. When taking his health history, what characteristics should the nurse expect the client to report? Select all that apply. 1 Anxiety 2 Palpitations 3 Weight loss 4 Sedentary habits 5 Difficulties with speech

1 2 3

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. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite

1 2 3

A 12-year-old child with Down syndrome is admitted to the hospital for intravenous antibiotics for pneumonia. Which clinical findings associated with Down syndrome should the nurse expect when performing a physical assessment? Select all that apply. 1 Saddle nose 2 Thin fingers 3 Inner epicanthic folds 4 Hypertonic musculature 5 Transverse palmar crease

1 3 5

The nurse assessing a newborn suspects Down syndrome. Which characteristics support this conclusion? Select all that apply. 1 Hypotonia 2High-pitched cry 3 Rocker-bottom feet 4 Epicanthal eye folds 5 Singe transverse palmar creas

1 4 5

A breastfeeding mother requires treatment for depression. Which drug would be safe to use if the mother wishes to continue breastfeeding the newborn? 1 Fluoxetine 2 Paroxetine 3 Valproic acid 4 Methotrexate

2

A young adult being treated for substance abuse asks the nurse about methadone. The nurse responds that methadone is useful in the treatment of opioid addiction because it has what characteristic? 1 Is a nonaddictive drug 2 Has an effect of longer duration 3 Does not produce a cumulative effect 4 Carries little risk of psychological dependence

2

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? 1 Provide the client information about alprazolam. 2 Assess the client's feelings about alprazolam further. 3 Ask the practitioner about changing the client's medication. 4 Have the practitioner speak with the client about the safety of this medication.

2

Which interventions does the nurse implement to empower a family who has a child with Down syndrome? Select all that apply. 1Ask the family to engage in spiritual activities. 2 Help the family recognize the possible stressors. 3Encourage the use of problem-solving strategies. 4Encourage more out-of-home activities for the parents. 5 Refer the family to support groups and Internet resources.

2 3 5

A client with a diagnosis of panic disorder who had a panic attack on the previous day says to the nurse, "That was a terrible feeling I had yesterday. I'm so afraid to talk about it." What is the most therapeutic response by the nurse? 1 "Okay; we don't have to talk about it." 2 "Why don't you want to talk about it?" 3 "What were you doing yesterday when you first noticed the feeling?" 4 "I understand, but don't be concerned; that feeling probably won't come back."

3

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? 1 Distract the client, which will help the client forget about touching the chairs 2 Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in 3 Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one 4 Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed

4 it is important to set limits on the behavior, but it is also important to involve the client in the decision-making

An older client with depression is prescribed a tricyclic antidepressant. What is the priority nursing intervention in this situation?

Requesting that the physician change the drug

Which assessment finding would alert the nurse to ask the patient about alcohol use?

Abdominal tenderness

Which goal for treatment of alcoholism should the nurse address first?

Achieve physiologic stability. the individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treat

A patient who has inhaled cocaine is admitted to the emergency department with palpitations and shortness of breath. What should the nurse do first? a. Infuse normal saline. b. Check oxygen saturation. c. Draw blood for drug screening. d. Obtain a 12-lead echocardiogram (ECG).

B

A patient who is admitted to the hospital for wound debridement admits to using fentanyl (Sublimaze) illegally. What withdrawal signs does the nurse expect? a. Tremors and seizures c. Lethargy and disorientation b. Vomiting and diarrhea d. Delusions and hallucinations

B Symptoms of opioid withdrawal include gastrointestinal symptoms such as nausea, vomiting, and diarrhea

22. A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate?

Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, be self-reliant, and practice honesty

The mother of a neonate with Down syndrome visits the clinic 1 week after delivery. She explains to the nurse that she is having problems feeding her baby. What is the probable cause of these feeding difficulties?

Tongue thrust

A parent objects to the child's getting vaccinated because she believes that vaccinations can cause autism. However, a nurse gives the child the vaccination injection against the wishes of the mother. What legal charge may be brought against the nurse?

BATTERY

The parents of a newborn are told that their neonate may have Down syndrome and that additional diagnostic studies will be done to confirm this diagnosis. What procedure does the nurse expect to be performed?

Buccal Smear

A patient with alcohol dependence is admitted to the hospital with back pain following a fall. Twenty-four hours after admission, the patient becomes tremulous and anxious. Which action by the nurse is appropriate? a. Encourage increased oral intake. b. Insert an IV line and infuse fluids. c. Provide a quiet, well-lit environment. d. Administer opioids to provide sedation.

C and a quiet and well-lit environment will help decrease agitation, delusions, and hallucinations

The child with Down syndrome should be evaluated for what characteristic before participating in some sports?

Children with Down syndrome are at risk for atlantoaxial instability.

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is:

Congenital heart disease.

A nurse is caring for a child with autism. Which intervention is most appropriate in an attempt to promote socialization for this child?

Imitating and participating in the child's activities

1. A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first?

Lower the patient's current anxiety.

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client?

Sertraline

A 6-year-old child who has autism exhibits frequent spinning and hand-flapping behaviors. What should the nurse teach the parents to do to limit these actions?

Use another activity to distract the child.\

24. Symptoms of withdrawal from opioids for which the nurse should assess include:

nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of:

Down syndrome.

A 6-year-old child with autism is nonverbal and makes limited eye contact. What should the nurse do initially to promote social interaction?

Engage in parallel play while sitting next to the child

A lactating woman takes fluoxetine to treat depression. Her newborn developed tremors, seizures, and fever. Which drug-induced physiologic alterations may be responsible for the central nervous system effects of the drug on the neonate?

Immature blood-brain barrier

The parent of a child with a tentative diagnosis of attention deficit-hyperactivity disorder (ADHD) arrives at the pediatric clinic insisting on getting a prescription for medication that will control the child's behavior. What is best response by the nurse?

It must be frustrating to deal with your child's behavior.

A nurse is teaching the parents of a child with attention deficit hyperactivity disorder (ADHD) about the prescribed medication methylphenidate. When will the daily dose be administered?

Just after breakfast

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?

Overwhelming feelings of guilt

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident?

Rationalization

caring for a group of children with the diagnosis of autism. Which signs and symptoms are associated with this disorder? Select all that apply.

Repetitive activities Self-injurious behaviors Lack of communication with others

16. A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic?

lorazepam (Ativan) a benzodiazepine used to treat anxiety.

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping?

Encourage the patient to participate in social activities.' promotion of involvement with other people and activities is necessary to improve coping

The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should:

consider each diagnosis primary and provide simultaneous treatment.

Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient:

has a high tolerance to alcohol.

A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to:

reduce loneliness and increase self-esteem.

A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n):

sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

An adult client is brought to the emergency department after an accident. The client has limitations in mental functioning related to Down syndrome. How can the nurse best assess the client's pain level?

wong pain face scale

A new mother's laboratory results indicate the presence of cocaine and alcohol. Which craniofacial characteristics indicate to the nurse that the newborn has fetal alcohol syndrome (FAS)? Select all that apply. 1 Thin upper lip 2Wide-open eyes 3Small upturned nose 4Larger-than-average head 5Smooth vertical ridge in the upper lip

1 3 5

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. The nurse is confident that the medication information discussed has been understood when the client takes which action? 1 Removes the pepperoni from a pizza 2 Asks for an extra bottle of flavored water to drink with dinner `3 Requests a prescription for oral birth control before being discharged 4 States that chewable antacids may be taken to relieve heartburn

3 Benzodiazepines increase the risk of congenital anomalies and so should not be taken by pregnant women

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?

Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is:

Neonatal abstinence syndrome scoring.

An older adult patient who has been taking alprazolam (Xanax) calls the clinic asking for a refill of the prescription 1 month before the alprazolam should need to be refilled. Which response by the nurse is best?

d. "I am concerned that you may be overusing those. Let's make an appointment for you with the health care provider."

Which information is most important for the nurse to report to the health care provider about a patient who has been using varenicline (Chantix)?

The patient complains of new-onset sadness and depression. Adverse effects of varenicline include depression and attempted suicide

What strategy should the nurse employ to be effective when using play therapy with a 6-year-old child with autism?

Use mechanical and inanimate objects for play

38. A careful review of the literature on the various recreational and illicit drugs reveals that:

More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs.

A 37-year-old woman agrees to have a prenatal test done in order to diagnose fetal defects. There is a history of Down syndrome in her family. Which invasive prenatal test provides the earliest diagnosis and rapid test results?

Chorionic villus sampling may be performed between 10 and 12 weeks' gestation

A patient admitted to the hospital after an automobile accident is alert and does not appear to be highly intoxicated. The blood alcohol concentration (BAC) is 110 mg/dL (0.11 mg%). Which action by the nurse is appropriate? a. Restrict oral and IV fluids. b. Maintain the patient on NPO status. c. Administer acetaminophen for headache. d. Monitor for hyperreflexia and diaphoresis.

D

Which factor presents the highest risk for a child to develop a psychiatric disorder?

Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition.

Appropriate interventions to facilitate socialization of the cognitively impaired child include to:

Provide peer experiences such as Special Olympics when older.

A plan of care for an infant experiencing symptoms of drug withdrawal should include:

Swaddling the infant snugly and holding the baby tightly to reduce self-stimulation behaviors and protect the skin from abrasions.

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate?

Teach the person to use positive self-talk techniques.