NUR 326 Exam 2

What is the goal of motivational interviewing?

To increase the person's motivation to change, then to have the person make the commitment to change.

Normal creatinine level.

0.5-1.3 mg/dL

What is a normal alkaline phosphatase range?

20-90 U/L

What is the onset for severe alcohol withdrawal? How long may it last? Mortality rate?

3-5 days. May last 1 week or more. 15%.

What is a normal albumin range?

4-6 g/dL

List the two manifestations of Korsakoff syndrome (Irreversible)

1. Amnesia 2. Confabulation

List 4 signs a nurse would look for to identify addiction.

1. Appearance older than stated age 2. Undernourished 3. Physical manifestations of withdrawal 4. Failure of standard doses of sedative to have a therapeutic effect (Due to tolerance)

List four common medications that are used for opiate detox/withdrawal.

1. Buprenorphine 2. Methadone 3. Clonidine 4. Naltreoxone

What two cardiovascular alterations may be consequences of chronic substance use?

1. Cardiomyopathy 2. Hypertension

List two antidepressants that may help decrease the desire for alcohol and craving.

1. Citalopram (Celexa) 2. Ondanestron (Zofran)

List three surgical/radiographic interventions for treating PAD.

1. Debridement (The removal of damaged tissue or foreign objects from a wound.) 2. Angioplasty (A procedure done to widen the artery occluded. It involves the doctor threading a small tube into the artery that has a balloon attached to it, and the balloon is inflated open to widen the artery and increase blood flow.) 3. Bypass (Surgery done to reroute the blood supply around a blocked artery in your leg.)

What three medications can help maintain alcohol abstinence?

1. Disulfiram/Antabuse (Creates unpleasant reaction to alcohol) 2. Naltrexone (Opiate antagonist, also works for alcohol) 3. Acamprosate (Reduces desire to drink alcohol)

What are the two main screening questions of the Alcohol Screening and Brief Intervention assessment tool?

1. Do you sometimes drink beer, wine, or other alcoholic beverages? 2. (If yes) Have you in the past year had 4(women) or 5(men) or more alcoholic drinks in one day 1 or more times?

List some clinical manifestations associated with venous insufficiency.

1. Edema 2. Hemosiderin staining (Brown stains on their legs due to blood pooling in the legs and the capillaries break as a result, when the RBCs break the iron is released, which causes brown/reddish discoloring of the skin.) 3. Thick, hardened skin, leathery 4. Easily breakable skin 5. Capillary refill <3

Describe the general diagnostic criteria for personality disorders. (6)

1. Enduring pattern of inner experience and behavior that deviates from person's culture and is manifested in at least two of the following: cognition, affect, interpersonal functioning or impulse control. 2. Inflexible and pervasive across personal and social situations 3. Pattern is stable and of long duration and can be traced back to adolescence or early adulthood. 4. Leads to clinically significant distress or impairment in social, occupational or other important areas of functioning. 5. Pattern is not better accounted for by another mental disorder Pattern is not due to the direct physiological effects of a substance or medical condition.

List some common addiction symptoms.

1. Fatigue 2. Insomnia 3. Headaches 4. Anorexia 5. Reported sexual dysfunction 6. Reported change in mood 7. Reported weight loss 8. Vague physical complaints

List 3 alterations of the liver that can be seen with chronic substance use.

1. Fatty liver disease 2. Alcoholic hepatitis 3. Cirrhosis

List the four questions associated with the CAGE screening tool for alcoholism.

1. Have you ever felt you should *Cut* down on your drinking? 2. Have people *Annoyed* you by criticizing your drinking? 3. Have you ever felt bad or *Guilty* about your drinking 4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover *(Eye opener)*?

List the three manifestations of Wernicke encephalopathy (Reversible)

1. Nystagmus 2. Ataxia 3. Confusion

List the 5 cancers that may be consequences of chronic substance use.

1. Oral 2. Esophageal 3. Large intestine/rectal 4. Liver 5. Pancreas

What are the main two causes for diabetic foot ulcers?

1. Peripheral neuropathy (60%) 2. Ischemia from peripheral vascular disease

What four infectious diseases may be a consequence of chronic substance abuse?

1. Pneumonia 2. Tuberculosis 3. Hepatitis (HBV, HCV) 4. HIV/AIDS

List two lab values that are lowered with alcohol use.

1. RBC (Anemia) 2. Electrolytes (Magnesium, phosphate, potassium)

What four mediations are prescribed for patients with borderline personality disorder?

1. SSRIs 2. Mood stabilizers 3. Antipsychotics (Ex. Quetiapine) 4. Naltrexone (Decreases cutting tendencies)

List 7 classes of medications that are effective in treating anxiety disorders.

1. SSRIs (first line) 2. SNRIs (also effective) 3. Benzodiazepines (Short-term use only) 4. Buspirone (Good anti-anxiety that can be used long term) 5. Beta blockers 6. Antihistamines 7. Anticonvulsants

What two psychiatric disorders are very common with substance abuse disorders?

1. Schizophrenia 2. Bipolar

List 8 manifestations of a panic attack.

1. Shortness of breath 2. Choking or smothering sensation 3. Fear of dying 4. Chest pain, or manifestations of a heart attack 5. Chills or hot flashes 6. Tachycardia and increased BP 7. Complete lack of control and focus 8. Syncope

List collaborative care methods for venous insufficiency. How do you treat it? (6)

1. TED hose 2. Moist environment dressings 3. High protein diet 4. Elevation 5. Anticoagulants 6. Hyperbaric support

List the clinical manifestations of opiate withdrawal. (11)

1. Tachycardia 2. Sweating 3. Unable to sit still/Frequent shifting 4. Dilated pupils 5. Bone or joint aches, patient might be rubbing joints or muscles and is unable to sit still 6. Runny nose or tears streaming from eyes 7. GI upset: Stomach cramps, nausea or loose stool, vomiting or diarrhea 8. Tremors 9. Yawning frequently 10. Irritability and anxiety 11. Gooseflesh skin

List 8 non-pharmacologic interventions used for anxiety disorders.

1. Talking about what is causing anxiety 2. Guided imagery 3. Deep breathing 4. Music therapy 5. Aroma therapy 6. Meditation 7. Coloring or writing 8. Allow support person to be present during anxious situations.

What 3 neuropsychiatric consequences may occur with chronic substance abuse?

1. Wernicke-Korsakoff Syndrome (Common with alcoholics) 2. Peripheral neuropathy 3. Depression/suicide

What are two treatments that can be implemented on patients with diabetic foot ulcers?

1. Wound debridement 2. Offloading

Normal hemoglobin level for men. For women?

13.5-18 g/dL. 12-16 g/dL.

A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? Select all that apply. a. Impulsiveness b. Lability of mood c. Ritualistic behavior d. psychomotor retardation e. Self-destructive behavior

A B E

What BMI do patients with bulimia nervosa typically have?

A BMI of a normal range or slightly overweight, usually 18.5-30

A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (Select all that apply.) a. "What is your relationship like with your family?" b. "Why do you want to lose weight?" c. "Would you describe your current eating habits?" d. "At what weight do you believe you will look better?" e. "Can you discuss your feelings about your appearance?"

A C E

A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply.) a. Difficulty getting along with other members of a group b. Belief in the ability to become invisible during times of stress c. Display of defense mechanisms when routines are changed d. Claiming to be more important that other persons e. Difficulty understanding why it is inappropriate to have a personal relationship with staff

A C E (Difficulty with social and professional relationships is a personality characteristic that can be seen with all personality disorder types. Clients who has schizotypal personality disorder can display magical thinking or delusions. However, this is not associated with all personality types. Maladaptive response to stress is a personality characteristic that can be seen with all personality disorder types. Clients who have narcissistic personality disorder can display grandiose thinking. However, this is not associated with all personality disorder types. Difficulty understand personal boundaries is a personality characteristic that can be seen with all personality disorder types.)

The healthcare provider is teaching a class on obsessive-compulsive disorder (OCD). Which of the following will be included in the teaching? Choose all answers that apply: a. Obsessions and compulsions are time-consuming b. The patient often hears voices that direct the behavior c. The behavior is sometimes related to substance abuse d. The obsessions are intrusive and unwanted e. Repeating words silently is an example of an obsession f. Hair pulling or skin picking are common features

A D (OCD is characterized by intrusive thoughts or urges and by repetitive mental or behavioral acts. If the patient's behaviors are related to substance abuse, the patient is not diagnosed with OCD. Patients diagnosed with OCD do not experience hallucinations. Hair pulling and skin picking are different disorders and not characteristic of OCD. OCD is characterized by intrusive thoughts or urges (obsessions) that compel the patient to perform repetitive mental or behavioral acts (compulsions). The obsessions and compulsions are typically time-consuming and often impair social, occupational, or other important areas of functioning.)

A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply.) a. Excessive worry for 6 months b. Impulsive decision making c. Delayed reflexes d. Restlessness e. Need for reassurance

A D E

An older adult patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply.)? a. Fluid balance history b. Attitude about surgery c. Foods the patient dislikes d. Current mobility problems e. Current cognitive function f. Patient's opinion about the surgeon

A D E (Preoperative fluid balance history is especially critical for older adults because they have reduced adaptive capacity that puts them at greater risk for over- and underhydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognition function is especially crucial for intraoperative and postoperative evaluation because they are more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon are important for all patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more important for older patients than it is for all patients.)

What is a normal uric acid range for men? Women?

4.0-8.5 mg/dL. 2.7-7.3 mg/dL.

Normal RBC count.

4.2-6.2 million/mm3

Normal BUN level.

6-20 mg/dL

How many hours after your last drink does early withdrawal onset? When does it peak?

6-24 hours. 24-36 hours.

What is a normal MCV lab value?

76-100 (Elevated with alcoholism)

Grand mal seizures may occur how long after your last drink? When does it peak?

8-24 hours. 24-48 hours.

What is a normal AST range for men? Women?

8-46 U/L. 7-34 U/L.

Normal chloride levels?

95-105 mEq/L

What is a normal amylase level?

<130 U/L

A coping mechanism used excessively by clients with anorexia nervosa is a. denial. b. humor. c. altruism. d. projection.

A

A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? a. "I'm scared that you're going to leave me." b. "I'll go to group therapy if you'll let me smoke." c. "I need to feel that everyone admires me." d. "I sometimes feel better if I cut myself."

A

An 85-year-old patient is assessed to have a score of 16 on the Braden Scale. Based on this information, how should the nurse plan for this patient's care? a. Implement a 1-hr turning schedule with skin assessment. b. Place DuoDerm on the patient's sacrum to prevent breakdown. c. Elevate the head of bed to 90 degrees when the patient is supine. d. Continue with weekly skin assessments with no special precautions.

A

Mike, a 43-year old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with stress. His current concern is calf pain during minimal exercise that decreased with rest. The nurse assesses Mike's symptoms as being associated with peripheral arterial occlusive disease. The nursing diagnosis is probably: A. Alteration in tissue perfusion related to compromised circulation B. Dysfunctional use of extremities related to muscle spasms C. Impaired mobility related to stress associated with pain D. Impairment in muscle use associated with pain on exertion

A

Your patient has a reddened area on the right lateral foot from pressure. The skin surface is intact. The area of redness does not pale when compressed. How do you document this pressure injury? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

A

Your patient has a reddened area over the left sacral area that does not blanch with lightly applied pressure. Epidermal skin is intact. How do you document this? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

A

A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is: A. Normal because of the increased blood flow through the leg B. Slightly deteriorating and should be monitored for another hour C. Moderately impaired, and the surgeon should be called. D. Adequate from the arterial approach, but venous complications are arising.

A (An expected outcome of surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. Options 2, 3, and 4 are incorrect interpretations.)

A nurse is caring for an unconscious patient who has just been admitted to the postanesthesia care unit after abdominal hysterectomy. How should the nurse position the patient? a. Left lateral position with head supported on a pillow b. Prone position with a pillow supporting the abdomen c. Supine position with head of bed elevated 30 degrees d. Semi-Fowler's position with the head turned to the right

A (An unconscious patient should be placed in the lateral "recovery" position to keep the airway open and reduce the risk of aspiration. When conscious, the patient is usually returned to a supine position with the head of the bed elevated to maximize expansion of the thorax by decreasing the pressure of the abdominal contents on the diaphragm.)

A nurse notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers? A. Lack of honesty B. Belief in superstitions C. Show of temper tantrums D. Constant need for attention

A (Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by lying.)

In planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? A. Binge eating B. Memory loss C. Cult membership D. Delusional thinking

A (Clients with borderline personality disorder are likely to develop dysfunctional coping and act out in self-destructive ways such as binge eating.)

Which of the following assessment findings is seen in a client diagnosed with borderline personality disorder? A. Abrasions in various healing stages B. Intermittent episodes of hypertension C. Alternating tachycardia and bradycardia D. Mild state of euphoria with disorientation

A (Clients with borderline personality disorder tend to self-mutilate and have abrasions in various stages of healing.)

Which of the following nursing interventions has priority for a client with borderline personality disorder? A. Maintain consistent and realistic limits B. Give instructions for meeting basic self-care needs C. Engage in daytime activities to stimulate wakefulness D. Have the client attend group therapy on a daily basis

A (Clients with borderline who are needy, dependent, and manipulative will benefit greatly from maintaining consistent and realistic limits. They don't tend to have difficulty meeting their self-care needs. They enjoy attending group therapy because they often attempt to use the opportunity to become the center of attention. They don't tend to have sleeping difficulties.)

A patient diagnosed with an anxiety disorder is prescribed a benzodiazepine. When teaching the patient about the medication, which of the following information would the healthcare provider include? a. "Call our office right away if you experience increased restlessness or agitation." b. "Decreasing your daily caffeine intake is not necessary when taking this medication. c. "You should avoid taking aspirin while you are taking this medication." d. "It's important that you discontinue this medication if you begin to feel drowsy."

A (Decreased anxiety and a feeling of drowsiness are expected effects of benzodiazepines. Patients should be advised of a possible paradoxical reaction of restlessness or agitation.)

Which of the following is experienced by the patient who is under general anesthesia? a. The patient is unconscious b. The patient is awake c. The patient experiences slight pain d. The patient experiences loss of sensation in the lower half of the body

A (During general anesthesia, the patient is unconscious, with complete analgesia (relief of pain). Loss of sensation in the lower half of the body is experienced by the patient who received spinal anesthesia.)

In planning postoperative interventions to promote repositioning, ambulation, coughing, and deep breathing, which action should the nurse recognize will best enable the patient to achieve the desired outcomes? a. Administering adequate analgesics to promote relief or control of pain b. Asking the patient to demonstrate the postoperative exercises every 1 hour c. Giving the patient positive feedback when the activities are performed correctly d. Warning the patient about possible complications if the activities are not performed

A (Even when a patient understands the importance of postoperative activities and demonstrates them correctly, it is unlikely that the best outcome will occur unless the patient has sufficient pain relief to cooperate with the activities.)

A client with avoidant personality disorder says occupational therapy is boring and doesn't want to go. Which action would be best? A. State firmly that you'll escort him to OT. B. Arrange with OT for the client to do a project on the unit. C. Ask the client to talk about why OT is boring D. Arrange for the client not to attend OT until he is feeling better

A (If given the chance, a client with avoidant personality disorder typically elects to remain immobilized. The nurse should insist that the client participate in OT. Arranging for the client to do a project on the unit validates and reinforces the client's desire to avoid getting to OT. Addressing an invalid issue such as the client's perceived boredom avoids the real issue: the client's need for therapy.)

The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be: A. Ineffective coping B. Impaired adjustment C. Personal identity disturbance D. Sensory/perceptual alterations

A (Ineffective coping is the impairment of a person's adaptive behaviors and problem-solving abilities in meeting life's demands; ritualistic behavior fits under this category as a defining characteristic.)

Mr. Johnson is newly admitted to a psychiatric unit because of severe obsessive compulsive behavior. Which initial response by the nurse would be most therapeutic for him? A. Accepting the client's ritualistic behaviors B. Challenging the client's need for rituals C. Expressing concern about the harmfulness of the client's rituals D. Limiting the client's rituals that are excessive

A (It is important to accept the client's need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client.)

A possible outcome criterion for a client diagnosed with anxiety disorder is a. Client demonstrates effective coping strategies. b. Client reports reduced hallucinations. c. Client reports feelings of tension and fatigue. d. Client demonstrates persistent avoidance behaviors.

A (Option A is the only desirable outcome listed.)

Nurse Tara is teaching a community group about substance abuse. She explains that a genetic component has been implicated with which of the following commonly abused substances? A. Alcohol B. Barbiturates C. Heroin D. Marijuana

A (Several chromosomes (1, 3, and 7) have been implicated in increased vulnerability to alcohol abuse. Statistics have shown that risk for alcohol abuse in first-degree relatives of alcohol abusers is as high as 40% to 60%. Most of the genetic research has been done related to alcohol. Definitive data regarding genetic transmission is not available at this time for barbiturates, heroin, and marijuana.)

The nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors? A. Hypertension, changes in LOC, hallucinations B. Hypotension, ataxia, hunger C. Stupor, agitation, muscular rigidity D. Hypotension, coarse hand tremors, agitation

A (Some of the symptoms associated with delirium tremors typically are anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, and changes in LOC, agitation, fever, and delusions.)

The circulating nurse is caring for a patient during a colon resection. What observation made by the nurse is immediately recognized as a violation of aseptic technique? a. A glove contacts the leg of the table that supports the sterile field. b. The cuff of the scrub nurse's sterile gown contacts the sterile field. c. The sterile field was established at 0650, and the current time is 0900. d. Bacteria are present in the nares and upper respiratory passages of the nurse.

A (Tables are sterile only at tabletop level. Areas below this are considered contaminated. The sterile gown below the point 2 inches above the elbow is considered sterile. The passage of time in and of itself does not necessarily render a field contaminated. Bacteria are inevitable in the respiratory passages of team members, but they present a threat to sterility only if they are not confined by attire.)

A client has been hospitalized with anorexia nervosa. The client's weight is 65% of normal body weight. For this client, a realistic short-term goal for the first week of hospitalization would be that the client will: a. Gain a maximum of 3 lb. b. Develop a pattern of normal eating behavior c. Discuss fears and feelings about gaining weight d. Verbalize awareness of the sensation of hunger

A (The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema)

A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements should the nurse make? a. "Tell me how you are feeling right now." b. "You should focus on the positive things in your life to decrease your anxiety." c. "Why do you believe you are experiencing this anxiety?" d. Let's discuss the medications your provider is prescribing to decrease your anxiety."

A (The greatest risk to a client who has an anxiety or obsessive-compulsive disorder is self-harm or suicide. Therefore, the first action the nurse should plan to take is to assess the client's risk for self-harm to ensure that the client is provided with a safe environment.)

A patient with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy. Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe." Which response by the nurse is the most appropriate? a. "Tell me what you know about your surgery and the risks involved." b. "Any surgery has risks, but we will be here to take good care of you." c. "You seem anxious. After you sign the consent, I can give you a sedative." d. "You do not need to be concerned. Your surgeon has not had any complaints."

A (The health care provider performing the surgery is responsible for obtaining the patient's consent. The nurse may witness the patient's signature on the consent form. As a patient advocate, the nurse should verify that the patient understands the surgery and the risks involved. If the nurse determines that the patient is unclear about operative plans, the nurse should contact the health care provider about the patient's need for more information. The other options provide false reassurance or do not respond to the patient's concern.)

The nurse is providing discharge teaching to a patient who has had a laparoscopic cholecystectomy at an ambulatory surgery center. Which statement, if made by the patient, indicates an understanding of the discharge instructions? a. "I will have someone stay with me for 24 hours in case I feel dizzy." b. "I should wait for the pain to be severe before taking the medication." c. "Because I did not have general anesthesia, I will be able to drive home." d. "It is expected after this surgery to have a temperature up to 102.4º F."

A (The nurse must assess understanding of discharge instructions and the ability of the patient and caregiver to provide for home care needs. A responsible adult caregiver must accompany the patient. The patient may not drive after receiving anesthetics or sedatives. The patient should understand how to manage pain, and pain medication should be taken before the pain becomes severe. The patient should understand symptoms to be reported, such as a fever.)

The nurse is preparing the preoperative client for surgery. The following statements that indicate the client is knowledgeable about his impending surgery, except: a. "After surgery, I will need to wear the pneumatic compression device while sitting in the chair" b. "The skin prep area is going to be longer and wider than the anticipated incision" c. "I cannot have anything to drink or eat after midnight on the night before the surgery" d. "To ensure my safety, a 'time out' will be conducted in the operating room"

A (The pneumatic compression device is worn during bed rest, not during ambulation. The informed consent document should be signed before preoperative medication administration and before the client enters the operating room.)

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? a. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. b. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. c. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. d. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

A (The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. The other options would not be safe for the patient.)

A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? a. "Life isn't worth living if I gain weight." b. "Don't pretend like you don't know how fat I am." c. "If I could be skinny, I know I'd be popular." d. "When I look in the mirror, I see myself as obese."

A (This statement reflects the cognitive distortion of catastrophizing because the client's perception of her appearance or situation is much worse than her current condition. B reflects the cognitive distortion of personalization. C reflects the cognitive distortion of overgeneralization. D reflect a perception of distorted body image.)

A diabetic patient who had undergone abdominal surgery experiences wound evisceration. Which of the following is the most appropriate immediate nursing action? a. Cover the wound with sterile gauze moistened with sterile normal saline b. Cover the wound with sterile dry gauze c. Cover the wound with water-soaked gauze d. Leave the wound uncovered and pull the skin edges together

A (Wound evisceration should be covered with sterile dressings moistened with normal alien to prevent drying and necrosis of protruding abdominal organs.)

Your patient has a pressure injury that is approximately 11 cm in length and 3 cm in width. Subcutaneous fat is visible in the wound bed. No tendon, bone or muscle is visualized. Slough is present at the left proximal wound edge. The slough does not obscure the depth of tissue loss. How would you document this pressure injury? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

C

Your patient has an area of tissue loss that extends into subcutaneous tissue. The wound is 5 cm in length, 3 cm in width and 0.6 cm in depth. The wound bed contains granulation tissue. How do you document this? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

C

The loss of full control of bodily movements.

Ataxia

Hardening and plaque buildup of arteries and veins, *the leading cause of PAD.*

Atherosclerosis

This personality disorder is characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection. They are often very anxious in social situations.

Avoidant personality disorder (Cluster C)

A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is a(n) a. increase in the red blood cell count. b. disruption of the fluid and electrolyte balance. c. elevated serum potassium level. d. elevated serum sodium level.

B

A nurse is caring for a patient who has a pressure ulcer that is treated with debridement, irrigations, and moist gauze dressings. How should the nurse anticipate healing to occur? a. Tertiary intention b. Secondary intention c. Regeneration of cells d. Remodeling of tissues

B

A nurse is caring for a patient with diabetes who is scheduled for amputation of his necrotic left great toe. The patient's WBC count is 15.0 × 106/µL, and he has coolness of the lower extremities, weighs 75 lb more than his ideal body weight, and smokes two packs of cigarettes per day. Which priority nursing diagnosis addresses the primary factor affecting the patient's ability to heal? a. Imbalanced nutrition: obesity related to high-fat foods b. Impaired tissue integrity related to decreased blood flow secondary to diabetes and smoking c. Ineffective peripheral tissue perfusion related to narrowed blood vessels secondary to diabetes and smoking d. Ineffective individual coping related to indifference and denial of the long-term effects of diabetes and smoking

B

A patient diagnosed with obsessive-compulsive disorder (OCD) continually carries a toothbrush, and will brush and floss up to fifty times each day. The healthcare provider understands that the patient's behavior is an attempt to accomplish which of the following? A. Avoid interacting with others B. Relieve anxiety C. Promote oral health D. Experience pleasure

B

A patient who overdosed on oxycodone is given naloxone. When assessing the patient, the healthcare provider would anticipate which of these clinical manifestations of opioid withdrawal? Choose 1 answer: A. Bradycardia and hyporthermia B. Irritability and nausea C. Hyperthermia and euphoria D. Depressed respirations and somnolence

B

A person with antisocial personality disorder has difficulty relating to others because of never having learned to: A. Count on others B. Empathize with others C. Be dependent on others D. Communicate with others socially

B

Emergency medical personnel bring an unconscious patient to the emergency department. The patient's pupils are pinpoint and respirations are depressed. Intoxication of which of the following substances could contribute to these clinical signs? Choose 1 answer: a. Methamphetamine b. Methadone c. Cocaine d. Ecstasy

B

Mr. H. is a 73 year old male who is chairbound. A pressure injury is observed on the right ischial tuberosity. The wound is shallow with a red wound bed. No slough is observed. Tissue loss extends into the dermis. How do you document this? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

B

To prevent complications of immobility, which activities would the nurse plan for the first postoperative day after a colon resection? a. Turn, cough, and deep breathe every 30 minutes around the clock b. Get the client out of bed and ambulate to a bedside chair c. Provide passive range of motion three times a day d. It is not necessary to worry about complications of immobility on the first postoperative day

B

Which of the following assessment findings in a patient's health history supports a diagnosis of substance dependence? Choose 1 answer: a. Numerous legal problems and interpersonal conflicts b. Withdrawal symptoms when not using the substance c. Impaired judgment and risk-taking behaviors d. Continued tardiness and absenteeism from work

B

With peripheral arterial insufficiency, leg pain during rest can be reduced by: A. Elevating the limb above heart level B. Lowering the limb so it is dependent C. Massaging the limb after application of cold compresses D. Placing the limb in a plane horizontal to the body

B

Your patient has a left sacral pressure injury that extends into the dermis. The wound bed is pink red and periwound skin is reddened. How do you document this? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

B

A postoperative client receives a dinner tray with gelatin, pudding, and vanilla ice cream. Based on the foods on the client's tray, what would the nurse anticipate the client's current diet order to be: a. Bland diet b. Soft diet c. Full liquid diet d. Regular diet

C (A full liquid diet includes and foods that are liquid at room temperature)

A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? a. Chlordiazepoxide b. Bupropion c. Disulfiram d. Carbamazepine

C (A, B, and D are medications used for acute alcohol withdrawal. Disulfiram is used to prevent relapse.)

A patient requests that the nurse give his hearing aid to a family member so it will not be lost in surgery. What is the appropriate action by the nurse? a. Give the hearing aid to the wife as he wishes. b. Tape the hearing aid to his ear to prevent loss. c. Encourage the patient to wear it for the surgery. d. Tell the surgery nurse that he has his hearing aid out.

C (Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before he returns home for recovery.)

A patient is brought to the emergency department (ED) by a friend. The patient is unresponsive and respirations are slow and shallow. Which of the following is the priority intervention? Choose 1 answer: a. Check the patient's blood glucose level b. Administer naloxone, per protocol c. Administer 100% oxygen per nasal cannula d. Ask the friend if they were using illicit drugs

C (Because the patient is showing signs of impaired respirations, the priority intervention is to administer oxygen and support respirations (use the ABCs - airway, breathing, circulation - to determine the priority action). Knowing more about the patient's history (e.g. Is the patient diabetic? Were drugs involved?) will be helpful in directing the patient's continuing care. Naloxone may be indicated, depending on the cause of the patient's presentation.)

The nurse is admitting a patient to the operating room. Which of the following nursing actions should be given highest priority by the nurse? a. Assessing the patient's level of consciousness b. Checking the patient's vital signs c. Checking the patient's identification and correct operative permit d. . Positioning and performing skin preparation to the patient

C (Checking the patient's identification and correct operative permit should be given highest priority when admitting a patient to the operating room. This ensures that the right patient undergoes the right surgical procedures.)

Which of the following statements is typical for a client diagnosed with a paranoid personality disorder? A. "I understand you're the one to blame." B. "I must be seen first; it's not negotiable." C. "I see nothing humorous in this situation." D. "I wish someone would select the outfit for me."

C (Clients with paranoid personality disorder tend to be extremely serious and lack a sense of humor.)

Alex has panic disorder with agoraphobia. He displays many avoidance behaviors, but is able to go to the store every week. While on a recent trip to the grocery store, Alex got into a small fender bender in the parking lot. He had accidentally backed up into another car, but neither car had any damages. The owner of the other car was very understanding and told Alex not to worry about it. Alex was so upset by the incident that he was barely able to drive himself home. For the next few days, he went over the scene many times in his head. Alex's anxiety over the situation continued to escalate, and he concluded that he could no longer take himself to the store. What type of ego defense mechanism does this situation represent? a. Overgeneralization b. Magnification c. Fortune-telling d. All-or-nothing thinking

B (Alex's fears and anxiety became worse as he continued to magnify the accident. Certainly, it can be anxiety-provoking to get into even the smallest of accidents. However, Alex may have felt better if he considered the positives of the situation instead of minimizing them. No one was hurt and the other driver did not even think the accident was substantial enough to pursue for damages. Unless he stops expanding his fearful thoughts about the situation, Alex's panic symptoms and worries will only continue to escalate.)

A nurse discusses job possibilities with a client with schizoid personality disorder. Which suggestion by the nurse would be helpful? A. "You can work in a family restaurant part-time on the weekend and holidays." B. "Maybe your friend could get you that customer service job where you work only on the weekends." C. "Your idea of applying for the position of filing and organizing records is worth pursuing." D. "Being an introvert limits the employment opportunities you can pursue."

C (Clients with schizoid personality disorder prefer solitary activities, such as filing, to working with others. Working as a cashier or in customer service would involve interacting with many people.)

Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in: A. abdominal cramps and diarrhea. B. drowsiness and decreased respiration. C. flushing, vomiting, and dizziness. D. increased pulse and blood pressure.

C (Disulfiram (Antabuse) prevents complete alcohol metabolism in the body. Therefore when alcohol is consumed, the client has a hypersensitivity reaction. Flushing, vomiting, and dizziness are associated with the incomplete breakdown of alcohol metabolites. Other choices are not associated with the use of disulfiram along with alcohol.)

Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because: a. Jerry may become addicted faster than younger patients. b. Jerry is at risk for falls. c. Jerry has a history of nonadherence with medications. d. Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

B (An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.)

The nurse is performing a preoperative assessment for a patient scheduled for a surgical procedure. What is the rationale for the nurse's careful documentation of the patient's current medication list? a. Some medications may alter the patient's perceptions about surgery. b. Many anesthetics alter renal and hepatic function, causing toxicity of other drugs. c. Some medications may interact with anesthetics, altering the potency and effect of the drugs. d. Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

C (Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that it has been communicated to the anesthesia care provider. Routine medications may or may not be prescribed for use the day of surgery.)

If a patient is experiencing delirium after waking up from surgery, what is the first condition we should suspect is causing the delirium? a. "Waking up Wild" b. Alcohol withdrawal c. Hypoxia d. Pain

C (Hypoxia can cause an altered level of consciousness, and should be the first thing the nurse assesses for if the patient is experiencing delirium.)

While performing preoperative teaching, the patient asks when he is no longer able to eat or drink. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, what is the best response by the nurse? a. "Stay NPO after midnight." b. "Maintain NPO status until after breakfast." c. "You may drink clear liquids up to 2 hours before surgery." d. "You may drink clear liquids up until she is moved to the OR."

C (Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.)

A patient is receiving care after being diagnosed with generalized anxiety disorder (GAD). Which of these statements made by the patient indicate to the healthcare provider that the patient is beginning to show signs of improvement? A. "As long as I take my medication, I can deal with anxiety." B. "Situations that cause anxiety can always be avoided." C. "I can tell when I'm beginning to experience anxiety." D. "Now I know that my anxiety is caused by a lack of sleep."

C (Recognizing when symptoms of anxiety occur is an initial goal for the patient. Once anxiety is recognized, the patient can employ coping skills to manage the anxiety. Mediations can be helpful in managing GAD, but should be used in conjunction with cognitive-behavioral therapies.)

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? A. Antisocial behavior B. Suspicious behavior C. Relationship problems D. Auditory hallucinations

C (Relationship problems can precipitate a crisis because they bring up issues of abandonment. Clients with borderline personality disorder aren't usually suspicious; they're more likely to be depressed or highly anxious.)

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? A. "I won't get involved in another relationship." B. "I'm determined to look for the perfect partner." C. "I've decided to use better communication skills." D. "I'm going to be an equal partner in a relationship."

B (Clients with borderline personality disorder would decide to look for a perfect partner. This characteristic is a result of the dichotomous manner in which these clients view the world. They go from relationship to relationship without taking responsibility for their behavior. It's unlikely that an unsuccessful relationship will cause clients to make a change. They tend to be demanding and impulsive in relationships. There's no thought given to what one wants or needs from a relationship. Because they tend to blame others for problems, it's unlikely they would express a desire to learn communication skills.)

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of a. altruism. b. denial. c. undoing. d. suppression.

B (Denial involves escaping unpleasant reality by ignoring its existence.)

Kendall, the sister of a client with a substance-related disorder, tells the nurse she calls out sick for her sister Kylie occasionally when the latter has too much to drink and cannot work. this behavior can be described as: A. caretaking. B. codependent. C. helpful. D. supportive.

B (Enabling behaviors that inadvertently promote continued use of a substance by the person abusing substances is known as codependency. The sister's behavior is not an example of caretaking or support. She is taking responsibility for the client's behavior and allowing her to avoid the consequences of his abuse problem. The behavior is unhelpful and unsupportive.)

Which of the following is most the dangerous complication during induction of spinal anesthesia? a. Cardiac arrest b. Hypotension c. Hyperthermia d. Respiratory paralysis

B (Hypotension is the most dangerous complicating of induction of spinal anesthesia. This is due to paralysis of vasomotor nerves.)

Elsa is being treated in a chemical dependency unit. She tells the nurse that she only uses drugs when under stress and therefore does not have a substance problem. Which defense mechanism is the client using? A. Compensation B. Denial C. Suppression D. Undoing

B (Individuals who have substance problems often use denial. Compensation, suppression, and undoing are incorrect and do not fit the situation described.)

The nurse is circulating for a surgical procedure. What clinical manifestation would indicate to the nurse that the patient may be experiencing malignant hyperthermia? a. Hypocapnia b. Muscle rigidity c. Decreased body temperature d. Confusion upon arousal from anesthesia

B (Malignant hyperthermia is a metabolic disease characterized by hyperthermia with rigidity of skeletal muscles from altered control of intracellular calcium occurring as a result of exposure to certain anesthetic agents in susceptible patients. Hypoxemia, hypercapnia, and ventricular dysrhythmias may also be seen with this disorder.)

A group of community nurses sees and plans care for various clients with different types of problems. Which of the following clients would they consider the most vulnerable to post-traumatic stress disorder? A. An 8 year-old boy with asthma who has recently failed a grade in school B. A 20 year-old college student with DM who experienced date rape C. A 40 year-old widower who has recently lost his wife to cancer D. A wife of an individual with a severe substance abuse problem

B (Post-traumatic stress disorder is caused by the the experience of severe, specific trauma. Rape is a severely traumatic event. Although the situations in options A, C, and D are certainly stressful, they are not at the level of severe trauma.)

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is a. projection. b. repression. c. displacement. d. reaction formation.

B (Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness.)

A patient diagnosed with general anxiety disorder (GAD) reports ongoing nausea and abdominal bloating. A physical examination fails to confirm a medical illness to explain these symptoms. The healthcare provider suspects these findings are a result of which of the following? A. Derealization B. Somatization C. Dysthymia D. Dissociation

B (Somatization is a means of coping with psychosocial distress by developing physical symptoms (soma = body). Dysthymia is a persistent depressive disorder that may occur together with anxiety and somatization. Derealization is a sense of detachment from reality. Dissociation is impaired awareness of one's body, self, or environment, and may include derealization.)

Jordan is a client with a fear of air travel. She is being treated in a mental institution for phobic disorder. The treatment method involves systematic desensitization. The nurse would consider the treatment successful if: A. Jordan plans a trip requiring air travel. B. Jordan takes a short trip in an airplane. C. Jordan recognizes the unrealistic nature of the fear of riding on airplanes. D. Jordan verbalizes a decreased fear about air travel.

B (Systematic desensitization is a behavioral technique in which the client with a specific phobia is gradually able to work through hierarchal fears until the most fearful situation is encountered. In this case, the most fearful is riding an airplane. The responses in options A and D may occur earlier in treatment, but not indicative of success. Generally, a phobic individual recognizes that his fear is disproportionate to the things he fears.)

The nurse will provide preoperative teaching on deep breathing, coughing and turning exercises. When is the best time to provide the preoperative teachings? a. Before administration of preoperative medications b. The afternoon or evening prior to surgery c. Several days prior to surgery d. Upon admission of the client in the recovery room

B (The best time to provide preoperative teaching is the afternoon or evening prior to surgery. This time, the patient had finished undergoing different laboratory and diagnostic procedures. Therefore, he/she can now concentrate on the teachings. Teachings given days before surgery may tend to be forgotten. Teachings given before administration of preoperative medications may not be understood anymore because the anxiety level more likely is high during this time.)

Which of the following behaviors by a client with dependent personality disorder shows the client has made progress toward the goal of increasing problem solving skills? A. The client is courteous B. The client asks questions C. The client stops acting out D. The client controls emotions

B (The client with dependent personality disorder is passive and tries to please others. By asking questions, the client is beginning to gather information, the first step of decision making.)

The nurse is caring for a first day postoperative surgical client. Prioritize the patient's desired dietary progression. Arrange in sequence the dietary progression from 1 to 4: 1. Full liquid; 2. NPO; 3. Clear liquid; 4. Soft a. 1, 2, 3, 4 b. 2, 3, 1, 4 c. 2, 1, 4, 3 d. 4, 3, 2, 1

B (The client's status is NPO immediately after surgery. Desired diet progression advances to clear liquid, full liquid, soft and finally a regular diet as tolerated by the client)

The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia care unit (PACU). What should the nurse's initial action be upon the patient's arrival? a. Assess the patient's pain. b. Assess the patient's vital signs. c. Check the rate of the IV infusion. d. Check the physician's postoperative orders.

B (The highest priority action by the nurse is to assess the physiologic stability of the patient. This is accomplished in part by taking the patient's vital signs. The other actions can then take place in rapid sequence.)

Postoperatively, if a patient is unconscious, which position should the patient be placed in? a. Prone b. Lateral c. Supine d. High-fowlers

B (The lateral "recovery" position should be used when a patient is still unconscious from surgery.)

A patient having abdominal surgery had an estimated blood loss of 400 mL and received 300 mL of 0.9% normal saline. Postoperatively, the patient's blood pressure is 70/48 mm Hg. What treatment does the nurse anticipate administering? a. Blood administration b. IV fluid administration c. An ECG to check circulatory status d. Return to surgery to check for internal bleeding

B (The nurse should anticipate restoring circulating volume with IV infusion. Although blood could be used to restore circulating volume, there are no manifestations in this patient indicating a need for blood administration. An ECG may be done if there is no response to the fluid administration, there is a past history of cardiac disease, or cardiac problems were noted during surgery. Returning to surgery to check for internal bleeding would only be done if patient's level of consciousness changes or the abdomen becomes firm and distended.)

When reviewing the preoperative forms, the nurse notices that the informed consent form is not present or signed. What is the best action for the nurse to take? a. Have the patient sign the consent form. b. Have the family sign the form for the patient. c. Call the surgeon to obtain consent for surgery. d. Teach the patient about the surgery and get verbal permission.

C (The informed consent for the surgery must be obtained by the physician. The nurse can witness the signature on the consent form and verify that the patient (or caregiver if patient is a minor, unconscious, or mentally incompetent to sign) understands the informed consent. Verbal consents are not enough. The state's nurse practice act and agency policies must be followed.)

Lorazepam (Ativan) 1 mg IV is ordered for a patient before surgery. What is the most appropriate action for the nurse to take before the administration of this medication? a. Ask the patient about an allergy to iodine or shellfish. b. Encourage or assist the patient to the bathroom to void. c. Explain that the medication is used to prevent postoperative nausea. d. Check the laboratory results for the most recent serum potassium level.

B (The nurse should instruct the patient to void before administering preoperative medications that may interfere with balance and increase the fall risk when ambulating to the bathroom. Lorazepam is a benzodiazepine that may be used for sedation and amnesia before surgery. Lorazepam does not affect serum potassium, is not contraindicated in patients with allergies to iodine or shellfish, and is not indicated to prevent or treat nausea.)

The initial nursing action for a newly admitted anxious client is to a. assess the client's use of defense mechanisms. b. assess the client's level of anxiety. c. limit environmental stimuli. d. provide antianxiety medication.

B (The priority nursing action is the assessment of the client's anxiety level.)

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? a. "Thanks for checking in." b. "I will accompany you to the bathroom." c. "Let me know when you get back to the day room." d. "I'll stand outside your door to give you privacy."

B (The response, "I will accompany you to the bathroom," is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior.The response, "Thanks for checking in," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom.The response, "Let me know when you get back to the day room," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom.The response, "I'll stand outside your door to give you privacy," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.)

A client with a diagnosis of narcissistic personality disorder has been given a day pass from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30." The nurse would be most therapeutic by telling the client to: A. Return immediately, to demonstrate control B. Return on time or restrictions will be imposed C. Come back at 6:45, as a compromise to set limits D. Come back as soon as possible or the police will be sent

B (This sets limits, points out reality, and places responsibility for behavior on the client.)

The nurse is positioning a patient after a surgical procedure. What is the best position unless contraindicated, for this patient to be placed in to prevent respiratory complications? a. Supine b. Lateral c. Semi-Fowler's d. High-Fowler's

B (Unless contraindicated by the surgical procedure, an unconscious patient is positioned in a lateral "recovery" position. This recovery position keeps the airway open and reduces the risk of aspiration if the patient vomits. Once conscious, the patient is usually returned to a supine position with the head of the bed elevated.)

Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina. Which problems are related to thiamin deficiency? A. Cardiovascular symptoms, such as decreased hemoglobin and hematocrit levels B. CNS symptoms, such as ataxia and peripheral neuropathy C. Gastrointestinal symptoms, such as nausea and vomiting D. Respiratory symptoms, such as cough and sore throat

B (Wernicke's encephalopathy is a CNS disorder caused by acute thiamin deficiency in people who abuse alcohol. Other symptoms, besides ataxia and peripheral neuropathy, are acute confusion or delirium. Cardiovascular and gastrointestinal symptoms are associated with alcohol abuse; they are not caused by thiamin deficiency. Respiratory problems are not usually directly related to alcohol.)

A patient is experiencing withdrawal from benzodiazepine dependence. The healthcare provider will monitor the patient for which of the following symptoms? Choose all answers that apply: a. Hypersomnia b. Tremors c. Anxiety d. Yawning e. Seizures

B C E

Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply.)? a. Documenting intraoperative care b. Keeping track of irrigation solutions for monitoring of blood loss c. Passing instruments and supplies to the surgeon by anticipating his or her needs d. Coordinating the flow and activities of members of the surgical team in the surgical suite e. Performing the count of sponges, needles, and instruments used during the surgical procedure

B C E (Both the scrub nurse and circulating nurse participate in the counting of surgical sponges, needles, and instruments. Passing instruments to the surgeon and other sterile activities are the exclusive responsibility of the scrub nurse. The circulating nurse takes primary responsibility for the coordination of the surgical suite and documentation.)

A patient who is addicted to heroin begins a methadone maintenance program. Which of the following statements made by the healthcare provider correctly explains the rationale for treating this patient's substance abuse disorder with methadone. Choose all answers that apply: a. "It isn't possible for you to become addicted to methadone." b. "Methadone reduces the craving for heroin." c. "It's much safer to give methadone in large doses." d. "Methadone reduces the high that is felt with heroin." e. "If you take heroin while on methadone you'll get sick."

B D (If the patient takes heroin when the opioid receptors are occupied by the methadone, the euphoric effects will be reduced and craving is reduced. Methadone is a controlled substance with potential for abuse. Methadone does not cause a disulfiram-like reaction if heroin is used.)

A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) a. Bradycardia b. Fine tremors of both hands c. Hypotension d. Vomiting e. Restlessness

B D E (You would see tachycardia, tremors, hypertension, nausea and vomiting, and restlessness.)

Nurse Rob has observed a co worker arriving to work drunk at least three times in the past month. Which action by Nurse Rob would best ensure client safety and obtain necessary assistance for the co worker? A. Ignore the co worker's behavior, and frequently assess the clients assigned to the co worker. B. Make general statements about safety issues at the next staff meeting. C. Report the coworker's behavior to the appropriate supervisor. D. Warn the co worker that this practice is unsafe.

C (The nurse is obligated by ethical considerations of client safety, as well as by nurse practice acts in many states, to report substance abuse in health care workers. Most healthcare facilities have an employee assistance program to help workers with substance abuse problems. Ignoring the co worker's behavior would be a form of enabling behavior (codependency) on the staff nurse's part. Making general statements about safety in a staff meeting avoids dealing with the problem. Warning the co worker is inadequate; it does not ensure client safety or help him receive necessary help.)

The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus; weighs 146 kg; and is 5 feet 8, inches tall. Which patient assessment is a priority related to anesthesia? a. Has hemoglobin A1C of 8.5% b. Has several seasonal allergies c. Has a body mass index of 48.8 kg/m2 d. Has a history of postoperative vomiting

C (The patient's body mass index is the priority because it indicates the patient is severely obese. The patient's size may impair the anesthesiologist's ability to ventilate and medicate the patient properly, as well as the surgery room staff's ability to position the patient safely. The other factors are not the priority.)

Marlyn is diagnosed of anorexia nervosa and is admitted in the special eating disorder unit. The initial treatment priority for her is: A. to determine her current body image. B. to identify family interaction patterns. C. to initiate a refeeding program. D. to promote the client's independence.

C (The physical need to reestablish near-normal weight takes priority because of the physiologic, life-threatening consequences of anorexia.)

A client with antisocial personality is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. Which of the following responses is the most appropriate? A. "I believe we need to sit down and talk about this." B. "Don't you know better than to try to bend the rules?" C. "What you're asking me to do is unacceptable." D. "Why don't you bring this request to the community meeting?"

C (These clients often try to manipulate the nurse to get special privileges or make exceptions to the rules on their behalf. By informing the client directly when actions are inappropriate, the nurse helps the client learn to control unacceptable behaviors by setting limits. By sitting down to talk about the request, the nurse is telling the client there's room for negotiating when there is none.)

An adult client with a borderline personality disorder become nauseated and vomits immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The most appropriate initial response by the nurse would be to: A. Promptly notify the attending physician B. Immediately initiate suicide precautions C. Sit quietly with the client until nausea and vomiting subsides D. Assess the client's vital signs and administer syrup of ipecac

C (This intervention demonstrates the nurse's caring presence which is vital for this client. (1) Although the treatment team does need to know about the event, notification is not the immediate concern. (2) This is premature and it reinforces the client's predisposition to manipulative behavior. (4) This medication is inappropriate in this situation; vomiting would be expected after the ingestion of shampoo.)

A patient is admitted to the postanesthesia care unit (PACU) after abdominal surgery. Which assessment, if made by the nurse, is the best indicator of respiratory depression? a. Increased respiratory rate b. Decreased oxygen saturation c. Increased carbon dioxide pressure d. Frequent premature ventricular contractions (PVCs)

C (Transcutaneous carbon dioxide pressure (PtcCO2) monitoring is a sensitive indicator of respiratory depression. Increased CO2 pressures would indicate respiratory depression. Clinical manifestations of inadequate oxygenation include increased respiratory rate, dysrhythmias (e.g., premature ventricular contractions), and decreased oxygen saturation.)

Marty is pacing and complains of racing thoughts. Nurse Lally asks the client if something upsetting happened, and Marty's response is vague and not focused on the question. Nurse Lally assess Marty's level of anxiety as: A. mild. B. moderate. C. severe. D. panic.

C (When the client has difficulty focusing and exhibits excessive motor activity, the level of anxiety is severe. Mild anxiety is characterized by increased alertness and problem-solving ability. Moderate anxiety is characterized by the ability to focus on central concerns but the inability to problem-solve without assistance. Panic level of anxiety is characterized by complete inability to focus and reduced perceptions.)

Which of these clinical manifestations would the healthcare provider anticipate observing in a patient experiencing an acute panic attack? Choose all answers that apply: a. Decreased thyroid b. Bronchoconstriction c. Elevated blood pressure d. Dilated pupils e. Hypoglycemia

C D (Sympathetic nervous system activation results in fight-or-flight responses such as increased blood sugar (through increased glucocorticoid release from adrenal glands), bronchodilation, increased blood pressure, pupillary dilation, and increased thyroid hormone release.)

This type of eating disorder is characterized by clients recurrently eating large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa. It should occur at least once per week for 3 months. It is most common in ages 46-55. The weight gain associated with this eating disorder puts the client at risk for other disorders such as type II DM, hypertension, and cancer.

Binge eating disorder

This type of personality disorder is characterized by the instability of interpersonal relationships, self-image/self of self, and affect, and impulsivity. They have a small social circle. They are manipulative, have splitting behaviors, and a fear of abandonment. They often self harm or are suicidal. Females: Very dramatic. If there is no chaos, they create chaos. Fear of abandonment. Males: Lots of moodiness, don't like to be alone so they have long lasting relationships. Usually substance abuse or physical abuse with a false sense of self.

Borderline personality disorder (Cluster B)

This type of eating disorder is characterized by eating large quantities of food over a short period of time, which can be followed by inappropriate compensatory behaviors, such as self-induced vomiting, to rid the body of the excess calories. This should occur on average once per week for three months. Clients have a sense of lack of control over eating.

Bulimia nervosa

A nurse is planning a staff education program ons substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? a. Older adults require higher doses of a substance to achieve a desired effect. b. Older adults commonly use rationalization to cope with a substance use disorder. c. Older adults are at an increase risk for substance use following retirement. d. Older adults develop substance use to mask manifestations of dementia.

C

An 82-year-old man is being cared for at home by his family. A pressure ulcer on his right buttock measures 1 × 2 × 0.8 cm in depth, and pink subcutaneous tissue is completely visible on the wound bed. Which stage would the nurse document on the wound assessment form? C a. Stage I b. Stage II c. Stage III d. Stage IV

C

What scale do we use when someone is detoxing on benzodiazepines?

CIWA scale

What assessment tool is used for opiate withdrawal?

COW scale

What class of medications are the first line of treatment for anxiety and obsessive-compulsive disorders?

SSRIs

What medication class is prescribed for cluster C personality disorders?

SSRIs

An example of this type of wound healing process would include a pressure ulcer. A longer period of time is needed to heal because the wound heals from the bottom up. The edges are not well approximated and granulation tissue is needed to fill in the gap.

Secondary intention

Where are PAD ulcers commonly found? What do they look like? Is there drainage?

Tips of toes, foot, or *lateral* malleolus. They are rounded, smooth, the hole usually looks "punched out". The edges are more demarcated. There is minimal drainage. There is black eschar or pale pink granulation. The ulcer may or may not be painful.

In order to receive the desired effect, the user must increase the dosage over the same amount of time.

Tolerance

True or false: A substance disorder or psychiatric illness should be considered 'secondary' only if it resolves when the co-occurring disorder is at baseline.

True

True or false: Normal LFTs do not always mean liver is normal. A person with cirrhosis and bleeding esophageal varies can have normal LFTs.

True

True or false: When mental illness and substance disorder coexist, both diagnoses should be considered primary, and simultaneous primary treatment for both disorders is required.

True

What is another word for your mind going blank?

Tunnel vision

A defense mechanism in which a person tries to 'undo' an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior. For example, after thinking about being violent with someone, one would then be overly nice or accommodating to them. After flirting with her male secretary, a woman brings her husband tickets to a show.

Undoing

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Unstageable pressure ulcer

Which vitamin deficiency can be commonly seen in someone with chronic substance use?

Vitamin B1 (Thiamine)

Soft, moist avascular tissue that adheres to the wound bed in strings or thick clumps; may be white, yellow, tan or green.

Slough

The failure in a person's thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole. It is a common defense mechanism used by many people. Also known as all-or-nothing thinking or black-and-white thinking. Commonly seen in people with personality disorders. The client tends to characterize people or things as all good or all bad at any particular moment. The client might say, "You are the worst person in the world." Later that day, they might say, "You are the best, but the nurse from the last shift is absolutely terrible."

Splitting

Intact skin with non-blanchable redness of a localized area, usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. It doesn't turn white when pressed.

Stage I pressure ulcer

Full thickness skin loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining/tunneling.

Stage III pressure ulcer

Full thickness skin loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Stage IV pressure ulcer

You view a negative event as a never-ending pattern of defeat. "I always get the bad nurse."

Overgeneralization

What alteration in the pancreas can be seen with chronic substance use?

Pancreatitis

People divert their unwanted impulses into socially approved thoughts, feelings or behaviors. For example, a person with high of aggression becomes a soldier, or a woman who has been rebuked by her boss writes a short story about a heroic woman.

Sublimation

Repeated use of chemical substances, leading to clinically significant impairment during a 12-month period.

Substance use disorder

The conscious refusal to think or feel/express emotions about a traumatic experience.

Suppression

You blame yourself for something you weren't entirely responsible for, or you blame other people and overlook ways that your own attitudes and behavior might contribute to a problem. An example would be when a woman received a note that her child was having difficulties at school, she told herself, "This shows what a bad mother I am."

Personalization and blame

List one common barbiturate that helps treat alcohol withdrawal symptoms.

Phenobarbital

The body develops a need for the drug but there is no mental craving or compulsion to use more than prescribed.

Physical dependence

What anticonvulsant is commonly used for alcohol withdrawal?

Tegretol (Carbamazepine)

Which medication is prescribed for patients with antisocial personality disorder?

Tegretol/Carbamapezine (May decrease anger/impulsivity)

Addictions that do not involve substances

Process addictions

A form of defense in which unwanted feelings are displaced onto another person, where they then appear as a threat from the external world. The classic example often used to explain this defense mechanism is that of the husband or wife who feels a strong sense of attraction to a third person. Their inner values tell them that this is unacceptable, so they direct these feelings onto their spouse and accuse them of being unfaithful.

Projection

This type of wound healing process takes the longest. The wound healing is delayed and occurs when the wound that was previously opened is now closed. We open it for a bit, then we close it. It's usually associated with large infected and contaminated wounds. Very wide scar.

Tertiary intention

Defense mechanism in which a person perceives their true feelings or desires to be socially or, in some cases, legally unacceptable, and so they attempt to convince themselves or others that the opposite is true--often in a very exaggerated performance. Example: Recovering alcoholic constantly preaches about the evils of drink. Mother who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development.

Reaction-formation

An unconscious defense mechanism, which causes the temporary or long-term reversion of the ego to an earlier stage of development (instead of handling unacceptable impulses in a more adult manner). Examples: Four-year-old with a new baby brother starts sucking his thumb and wanting a bottle. Man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late for meetings.

Regression

Symptoms and lab values of alcoholic hepatitis can mimic what other condition?

Cholecystitis

List one common antihypertensive that helps treat alcohol withdrawal symptoms.

Clonidine

This personality disorder involves odd or eccentric behaviors. Includes paranoid, schizoid, and schizotypal.

Cluster A personality disorder

This personality disorder involves dramatic, emotional, or erratic behaviors. It includes antisocial, borderline, histrionic, and narcissistic.

Cluster B personality disorder

This type of personality disorder involves fearful and anxious behaviors. Includes dependent, obsessive-compulsive, and avoidant.

Cluster C personality disorder

Usually a family member or loved one who feels responsible for the addict. This person needs will require help too.

Co-dependence

Which medication do you give when a patient is experiencing EPS from antipsychotics?

Cogentin (Like Benadryl)

A defense mechanism whereby one covers up, consciously or unconsciously, weaknesses, frustrations, desires, or feelings of inadequacy or incompetence in one life area through the gratification or (drive towards) excellence in another area. Example: Short man becomes assertively verbal and excels in business.

Compensation

A disturbance of memory, defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive.

Confabulation

A mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. Ex. Student is unable to take a final examination because of a terrible headache. Man becomes blind after seeing his wife flirt with other men.

Conversion

A client is scheduled for surgery in the morning. Preoperative orders have been written. What is the most important to do before surgery? a. Remove all jewelries or tape wedding ring b. Verify that all laboratory work is complete c. Inform family or next of kin d. Have all consent forms signed

D

A client who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. The nursing diagnosis for this client would be a. death anxiety. b. ineffective denial. c. disturbed sensory perception. d. imbalanced nutrition: less than body requirements.

D

A patient is diagnosed with agoraphobia. Which of the following would the healthcare identify as a characteristic of this disorder? a. Avoids being in the presence of clowns b. Avoids interacting with strangers c. Refuses to use a public restroom d. Fears the use of public transportation

D

A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is a. lanugo. b. hypotension. c. 25-lb weight loss. d. fear of gaining weight.

D

All of the following factors ensure validity of informed written consent, except: a. The patient is of legal age with proper mental disposition b. If the patient is a child, secure consent from the parents or legal guardian c. The consent is secured before administration of preoperative medications d. If the patient is unable to write, the nurse signs the consent for the patient

D

During a panic attack, a patient states, "I feel like I'm going to die!" The patient is hyperventilating, tachycardic, and reports feeling upper extremity numbness and tingling. Based on this patient's presentation, the healthcare provider would anticipate which additional clinical manifestation of the panic attack? A. Respiratory acidosis B. Hypercapnia C. Kussmaul respirations D. Respiratory alkalosis

D

A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? a. Discuss new relaxation techniques b. Show the client how to change his behavior c. Distract the client with a television show d. Stay with the client and remain quiet

D (During a panic attack, the nurse should quietly remain with the client. This promotes safety and reassurance without additional stimuli. The client is unable to concentrate on learning new information. They should avoid further stimuli that can increase the client's level of anxiety.)

When caring for a patient during an acute panic attack, which of the following actions by the healthcare provider is most appropriate? a. Ask open-ended questions to encourage communication b. Explore common phobias associated with panic attacks c. Use distraction techniques to change the patient's focus d. Offer the patient reassurance of safety and security

D (During the panic attack, the patient's focus is on the distressing physical symptoms caused by the anxiety. Distraction techniques, open-ended questioning, or exploration of phobias will not be helpful during an acute attack. Because the patient may experience a feeling of impending doom and fears for his or her life, reassurance of safety and security is the best initial intervention for this patient.)

A patient is being prepared for a surgical procedure. What is the priority intervention by the nurse prior to the start of the procedure according to the National Patient Safety Goal (NPSG)? a. Prevention of infection b. Improved staff communication c. Identify patients at risk for suicide. d. Patient, surgical procedure, and site are checked.

D (During the surgical time-out, the Universal Protocol is used to verify the patient's identity, surgical procedure, and site to prevent mistakes in surgery. Prevention of infection is to be done at all times. Improved staff communication relates to getting important test results to the right staff on time. Identifying patient's safety risks for suicide is not usually vital before surgery and does not occur during the time-out.)

The perioperative nurse is reviewing the chart of a patient who is being admitted into the operating room for a laminectomy. What information obtained from the chart review should the nurse discuss with the anesthesiologist? a. The patient's grandmother developed hypothermia during a craniotomy. b. The patient's mother developed contact dermatitis related to a latex allergy. c. The patient's brother developed nausea after surgery with general anesthesia. d. The patient's father developed an elevated temperature during a recent surgery.

D (Malignant hyperthermia (MH) is an autosomal dominant disorder characterized by hyperthermia with rigidity of skeletal muscles that can result in death. It may occur if an affected individual is exposed to certain general anesthetic agents. To prevent MH, it is important for the nurse to obtain a careful family history. The patient known or suspected to be at risk for MH can be anesthetized with minimal risks if appropriate precautions are taken.)

Which medication is commonly used in treatment programs for heroin abusers to produce a non euphoric state and to replace heroin use? A. diazepam B. carbamazepine C. clonidine D. methadone

D (Methadone maintenance programs are used to provide a heroin-depleted individual with a medically controlled dose of methadone to produce a non euphoric state that will prevent withdrawal symptoms. This method of treatment is advocated to help heroin abusers avoid criminal activities associated with obtaining heroin; it also prevents diseases associated with I.V. use of heroin. Diazepam and carbamazepine may be used for withdrawal from alcohol, barbiturates, and benzodiazepines. Clonidine can be used in acute withdrawal from heroin to avoid norepinephrine rebound when opiates are stopped.)

A nurse notices that a client is mistrustful and shows hostile behavior. Which of the following types of personality disorder is associated with these characteristics? A. Antisocial B. Avoidant C. Borderline D. Paranoid

D (Paranoid individuals have a need to constantly scan the environment for signs of betrayal, deception, and ridicule, appearing mistrustful and hostile. They expect to be tricked or deceived by others.)

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to: a. reinforce the preoperative teaching by restating it slowly. b. have Lana read the teaching materials instead of verbal instruction. c. have a family member read the preoperative materials to Lana. d. not attempt any teaching at this time.

D (Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.)

In which surgical area will the patient's surgical skin scrub prep be performed for surgery, and what clothing is appropriate for the nurse performing the scrub to wear? a. Surgical suite wearing a lab coat b. Preoperative holding area wearing street clothes c. Postanesthesia care unit (PACU) wearing scrubs d. Operating room wearing surgical attire and masks

D (Surgical attire includes pants and shirts (or scrubs), a cap or hood, masks, and protective eyewear. All surgical attire is worn when the patient's skin is being prepped in the operating room to avoid contamination of the site. The surgical suite includes all unrestricted, semirestricted, and restricted areas of the controlled surgical environment. The staff usually wears a lab coat over their scrubs when they leave the surgical area. The staff will not wear street clothes in the preoperative holding area, although the family may. The holding area and PACU will not include prepping the patient for surgery.)

A patient diagnosed with agoraphobia is scheduled for a functional magnetic resonance imaging (fMRI) study of the brain. The healthcare provider anticipates that the scan will show increased activity in which of the following areas of this patient's brain? a. Medulla b. Parietal lobe c. Cerebellum d. Amygdala

D (The amygdala is affected with anxiety disorders.)

All of the following are members of the sterile team in the operating room, expect: a. Surgeon b. Scrub nurse c. Radiology technician d. Circulating nurse

D (The anesthesiologist and circulating nurse are not members of the sterile surgical team. The surgeon, radiology technician, and scrub nurse directly come in contact with the sterile field.)

The patient donated a kidney, and early ambulation is included in the plan of care, but the patient refuses to get up and walk. What rationale should the nurse explain to the patient for early ambulation? a. "Early walking keeps your legs limber and strong." b. "Early ambulation will help you be ready to go home." c. "Early ambulation will help you get rid of your syncope and pain." d. "Early walking is the best way to prevent postoperative complications."

D (The best rationale is that early ambulation will prevent postoperative complications that can then be discussed. Ambulating increases muscle tone, stimulates circulation that prevents venous stasis and venous thromboembolism, speeds wound healing, and increases vital capacity and maintains normal respiratory function. These things help the patient be ready for discharge, but early ambulation does not eliminate syncope and pain. Pain management should always occur before walking.)

A symptom commonly associated with panic attacks is a. obsessions. b. apathy. c. fever. d. fear of impending doom.

D (The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur.)

A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions should the nurse include in the client's plan of care? a. Allow the client to select preferred meal times b. Establish consequences for purging behavior c. Provide the client with a high-fat diet at the start of treatment d. Implement one-to-one observation during meal times

D (The nurse should closely monitor the client during and after meals to prevent purging.)

Which of the following defense mechanisms may be observed in a patient diagnosed with obsessive-compulsive disorder (OCD)? a. Regression b. Projection c. Denial d. Undoing

D (Undoing is a way of symbolically canceling out (negating) an experience that the patient finds intolerable. The compulsive behavior is designed to counteract or undo the patient's obsession.)

A client is admitted with a venous stasis leg ulcer. A nurse assesses the ulcer, expecting to note that the ulcer: A. Has a pale colored base B. Is deep, with even edges C. Has little granulation tissue D. Has brown pigmentation around it

D (Venous leg ulcers, also called stasis ulcers, tend to be more superficial than arterial ulcers, and the ulcer bed is pink. The edges of the ulcer are uneven, and granulation tissue is evident. The skin has a brown pigmentation from accumulation of metabolic waste products resulting from venous stasis. The client also exhibits peripheral edema. (options 1, 2, and 3 are due to tissue malnutrition; and thus us an arterial problem))

An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply.)? a. Information about various options for reconstructive surgery b. Information about the risks and benefits of her particular surgery c. Information about risk factors for breast cancer and the role of screening d. Information about where in the hospital she will be taken postoperatively e. Information about performing postoperative deep-breathing and coughing exercises

D E (During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The specific risks and benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory.)

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue

Deep tissue injury

If a client is purging, what alteration in dental status might you see?

Dental erosion and possibly cavities

This type of personality disorder is characterized by the excessive need to be taken care of, submissive and clinging, and the fear of separation. There is an urgent search to find a replacement when one relationship ends.

Dependent personality disorder (Cluster C)

A cognitive-behavioral therapy used for clients who exhibits self-injurious behavior, such as seen with personality disorders. It focuses on gradual behavior changes and provides acceptance and validation for these clients.

Dialectical behavior therapy

An unconscious defense mechanism whereby the mind substitutes either a new aim or a new object for goals felt in their original form to be dangerous or unacceptable. Example: Patient criticizes a nurse after his family fails to visit.

Displacement

Your patient has a pressure injury over the coccyx. The wound bed is covered in eschar and slough and cannot be visualized. How do you document this pressure injury? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

E

Agents that soften skin or treat dry skin

Emollient

You assume that your negative emotions necessarily reflect the way things really are. "I feel terrified about going on airplanes. It must be very dangerous to fly." Or "I feel angry. This proves I', being treated unfairly."

Emotional reasoning

Your patient has a localized area of discolored skin on the lateral right heel. A crescent shape portion of this skin is deep maroon in color. The skin surface is intact. How do you document this? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

F

True or false: Arterial, venous, and diabetic ulcers are forms of pressure ulcers.

False!

Anxiety disorders are more prominent with what gender, not including hoarding disorders?

Females

Predicting the future. "I'm going to fail the exam tomorrow because I'm a failure." or "Because I'm depressed, I'll never get better."

Fortune telling (Part of jumping to conclusions)

Brown stains on their legs due to blood pooling in the legs and the capillaries break as a result, when the RBCs break the iron is released, which causes brown/reddish discoloring of the skin

Hemosiderin staining

List some psychosocial consequences of chronic substance use.

1. Accidents 2. Crime 3. Spouse/child abuse 4. Job loss 5. Marital difficulties 6. Legal problems

List 5 examples of CNS depressants that are addictive.

1. Alcohol 2. Opiates 3. Sedatives 4. Hypnotics 5. Anxiolytics (Ex. Barbiturates, benzodiazepines)

List some examples of ego defense mechanisms for anxiety.

1. Compensation 2. Denial 3. Displacement 4. Dissociation 5. Identification 6. Repression 7. Splitting 8. Projection

List 4 GI consequences of chronic substance abuse.

1. Esophageal bleeding/varices 2. Gastritis/Gastric ulcers 3. Intestinal malabsorption 4. Malnourishment

The combination of what two elevated lab values identifies 90% of patients with alcohol dependence?

1. GGT (LFT) 2. MCV (Mean corpuscle volume)

List 8 manifestations of early OPIATE withdrawal.

1. Muscle aches 2. Tearing 3. Runny nose 4. Yawning 5. Insomnia 6. Agitation 7. Anxiety 8. Sweating

List some medications used for opiate relapse prevention.

1. Naltreoxone 2. Suboxone 3. Nalmefene

List some clinical manifestations of PAD.

1. Paresthesia (Numbness or tingling in the toes or feet) 2. Thin, shiny taut skin. 3. Loss of hair on legs. 3. Diminished or absent pedal, popliteal or femoral pulses. 4. *Intermittent claudication* 5. Reactive hyperemia of foot with dependent position 6. Chronic: Rest pain 7. Cold, pale extremities 8. Longer capillary refill

Pain with exercise that is relieved by rest. If there is not a lot of blood flow to extremities, especially while exercising, there is pain from hypoxia and a buildup of lactic acid. Classic with arterial.

Intermittent claudication

Where are ulcers found with venous insufficiency? What does it look like? Is there drainage?

Medial malleolus. It will look irregularly shaped and there will be a moderate to large amount of drainage. There is a yellow slough or dark red, "ruddy" granulation.

Only paying attention to certain types of evidence, noticing our failures but not seeing our successes

Mental filter

Imagining we know what others are thinking. "They were laughing when I walked by them so they were definitely laughing at me."

Mind reading (Part of jumping to conclusions)

You shrink the importance of something inappropriately

Minimization

List 3 characteristics of mild anxiety.

1. Restlessness 2. Increased motivation 3. Irritability

What four characteristics should be included in the documentation of a newly discovered pressure ulcer?

1. Size 2. Depth 3. Appearance 4. Location

List 6 characteristics of severe anxiety.

1. Somatic complaints (subjective) generalized somatic pain. 2. Crying 3. Claustrophobia 4. Inability to function 5. Ritualistic behavior 6. Unresponsive

List three other lab values that are elevated with alcohol use.

1. Uric acid 2. HDL 3. MCV (Mean corpuscle volume)

What is the normal length that you should be away from someone?

1.5-3 ft

What is a normal ALT range?

10-30 IU/mL

What is a normal platelet count?

150,000-450,000/mm3

How often should the nurse monitor signs and symptoms of alcohol withdrawal?

q4h

This type of personality disorder is characterized by perfectionism with a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task.

Obsessive-compulsive personality disorder (Cluster C)

What age group are anxiety disorders more prevalent in?

30s-50s

Normal hematocrit level for men. For women?

40-54%. 38-47%.

What is a normal LDH (lactic dehydrogenase) lab range?

50-150 U/L

What is a normal WBC count?

5000-10,000/mm3

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." The nurse understands this defense is known as: A. Splitting B. Ambivalence C. Passive aggression D. Reaction formation

A (Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others.)

A postoperative patient has a bronchial obstruction resulting from retained secretions and an oxygen saturation of 87%. What condition does the nurse suspect is occurring? a. Atelectasis b. Bronchospasm c. Hypoventilation d. Pulmonary embolism

A (The most common cause of postoperative hypoxemia is atelectasis, which may be the result of bronchial obstruction caused by retained secretions or decreased respiratory excursion. Bronchospasm involves the closure of small airways by increased muscle tone, whereas hypoventilation is marked by an inadequate respiratory rate or depth. Pulmonary emboli do not involve blockage by retained secretions.)

Select the appropriate interventions for caring for the client in alcohol withdrawal. A. Monitor vital signs B. Provide stimulation in the environment C. Maintain NPO status D. Provide reality orientation as appropriate E. Address hallucinations therapeutically

A D E (When the client is experiencing withdrawal of alcohol, the priority of care is to prevent the client from harming himself or others. The nurse would provide a low stimulating environment to maintain the client in as calm a state as possible. The nurse would monitor vital signs closely and report abnormal findings. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake needs to be maintained.)

A chronic disease of the brain whose dysfunction leads to cravings, inability to stop use, and the pursuit of reward and pleasure seeking through the use of more substance.

Addiction

This type of anxiety disorder is characterized by an extreme fear of certain places (such as the outdoors or being on a bridge) where the client feels vulnerable or unsafe.

Agoraphobia

Which phobia do half of people with anxiety disorders have?

Agoraphobia

What lab test may be used to see if someone is malnourished from chronic substance abuse?

Albumin or prealbumin test

What should benzodiazepines never be taken with?

Alcohol because benzos increase the toxicity of alcohol

Which manifestation of alcohol withdrawal is a medical emergency and may precede grand mal seizures and continuation of early symptoms but with greater severity?

Alcohol withdrawal delirium (DTs)

What vital sign alterations are seen in patients with anorexia and bulimia nervosa? What about with binge eating disorder?

Anorexia and bulimia: -Lowered BP with possible OH -Decreased pulse and body temperature Binge eating: -Hypertension

Persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health. You have a fear of gaining weight or becoming fat and there is a disturbance in self-perceived weight or shape.

Anorexia nervosa

What integumentary alterations are seen in a client with anorexia nervosa? What about bulimia nervosa?

Anorexia: -Fine, downy hair (lanugo) on face and back -Yellowed skin, mottled cool extremities -Poor skin turgor Bulimia: -Calluses or scars on hand

You look at things in absolute, black and white categories. "If I'm not perfect I have failed." "Either I do it right or not at all."

All-or-nothing thinking

Acting out of concern for the well-being of others, without regard to your own self-interest.

Altruism

What medication class is prescribed for cluster A personality disorders?

Antipsychotics

This personality disorder is characterized by a disregard for others with exploitation, lack of empathy, and repeated unlawful actions, deceit, and failure to accept personal responsibility. They are manipulative, impulsive, seductive, and verbally charming and engaging, sweet talkers. They have no traditional morals and values. Ex. Ted Bundy.

Antisocial personality disorder (Cluster B)

The defense mechanisms that can only be used in healthy ways include a. suppression and humor. b. altruism and sublimation. c. idealization and splitting. d. reaction formation and denial.

B (Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.)

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal a. tachycardia. b. hypokalemia. c. hypercalcemia. d. hypolipidemia.

B

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply.) a. Amenorrhea b. Hypokalemia c. Mottling of the skin d. Slightly elevated body weight e. Presence of lanugo on the face

B D (Amenorrhea is an expected finding of anorexia nervosa rather than bulimia. Hypokalemia is an expected finding of bulimia nervosa. Mottling of the skin is an expected finding of anorexia nervosa. Most clients who have bulimia nervosa maintain a weight within a normal range or slightly higher. Lanugo is an expected finding of anorexia nervosa.)

Which medication do you give to a client detoxing from alcohol?

Benzodiazepines

The nurse in an ambulatory surgery center has administered the following preoperative medications to a patient scheduled for general surgery: diazepam, cefazolin, and famotidine. What mode of transportation to the operating room (OR) would be the most appropriate for the nurse to arrange for this patient? a. Seated in a wheelchair accompanied by a responsible family member b. Ambulatory and accompanied by a hospital escort and a family member c. Stretcher with side rails up and accompanied by OR transportation personnel d. Ambulatory accompanied by an OR staff member or transportation personnel

C (The patient has received a sedative (diazepam) and should be transported either by stretcher (with side rails raised) or wheelchair and accompanied by either OR staff, OR transport personnel, or the nurse.)

When caring for a client with a diagnosis of schizotypal personality disorder, the nurse should: A. Set limits on manipulative behavior B. Encourage participation in group therapy C. Respect the client's needs for social isolation D. Understand that seductive behavior is expected.

C (These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may encourage the eventual development of a therapeutic alliance. Group therapy would increase this client's anxiety; cognitive or behavioral therapy would be more appropriate.)

Which anti anxiety medication should never be taken with grapefruit juice?

Buspar

Which of the following conditions is likely to coexist in clients with a diagnosis of borderline personality disorder? A. Avoidance B. Delirium C. Depression D. Disorientation

C (Chronic feelings of emptiness and sadness predispose a client to depression. About 40% of the clients with borderline struggle with depression.)

A nurse at Nurseslabs Medical Center is developing a care plan for a female client with post-traumatic stress disorder. Which of the following would she do initially? A. Instruct the client to use distraction techniques to cope with flashbacks. B. Encourage the client to put the past in proper perspective. C. Encourage the client to verbalize thoughts and feelings about the trauma. D. Avoid discussing the traumatic event with client.

C (Planning care for a client with post-traumatic stress disorder would involve helping the client to verbalize thoughts and feelings about the trauma. This will help the client work through the strong emotions connected with the trauma and, therefore foster the belief that she is able to cope. Avoiding discussion and using distraction techniques would be inappropriate. Option B may be possible later, after the client is able to verbalize strong emotions.)

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating a. projection. b. rationalization. c. reaction formation. d. undoing.

C (Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.)

When assessing a patient's surgical dressing on the first postoperative day, the nurse notes new, bright-red drainage about 5 cm in diameter. What is the priority action by the nurse? a. Recheck in 1 hour for increased drainage. b. Notify the surgeon of a potential hemorrhage. c. Assess the patient's blood pressure and heart rate. d. Remove the dressing and assess the surgical incision.

C (The first action by the nurse is to gather additional assessment data to form a more complete clinical picture. The nurse can then report all of the findings. Continued reassessment will be done. Agency policy determines whether the nurse may change the dressing for the first time or simply reinforce it.)

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following intervention should the nurse identify as the priority? a. Orient the client frequently to time, place, and person. b. Offer fluids and nourishing diet as tolerated. c. Implement seizure precautions. d. Encourage participation in group therapy sessions.

C (The greatest risk to the client is injury. Implementing seizure reactions is the priority intervention.)

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when the client a. weighs 10% below ideal body weight. b. has a serum potassium level of 3 mEq/L or greater. c. has a heart rate less than 60 beats/min. d. has systolic blood pressure less than 70 mm Hg.

D

Your patient has a pressure injury on the left ear from a medical device. Cartilage can be seen in the wound base. How do you document this? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

D

Your patient has a pressure injury over the left buttock that has exposed muscle tissue. Tunneling is present. How do you document this pressure injury? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 e. Unstageable f. Deep Tissue Pressure Injury g. Mucosal Membrane Pressure Injury

D

A client with schizotypal personality disorder is sitting in a puddle of urine. She's playing in it, smiling, and softly singing a child's song. Which action would be best? A. Admonish the client for not using the bathroom B. Firmly tell the client that her behavior is unacceptable C. Ask the client if she's ready to get cleaned up now D. Help the client to the shower, and change the bedclothes.

D (A client with schizotypal personality disorder can experience high levels of anxiety and regress to childlike behaviors. This client may require help needing self-care needs. The client may not respond to the other options or those options may generate more anxiety.)

A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the unit's rules. This behavior should be confronted because it will help the client: A. Control anger B. Reduce anxiety C. Set realistic goals D. Become more self-aware

D (Client's must first become aware of their behavior before they can change it. Option C occurs after the client is aware of the behavior and has a desire to change the behavior.)

Which of the following characteristics or client histories substantiates a diagnosis of antisocial personality disorder? A. Delusional thinking B. Feelings of inferiority C. Disorganized thinking D. Multiple criminal charges

D (Clients with antisocial personality disorder are often sent for treatment by the court after multiple crimes or for the use of illegal substances.)

When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: A. Controlling anxiety B. Terminating the session on time C. Accepting the psychiatric diagnosis D. Setting mutual goals for the relationship

D (Clients with borderline personality disorders frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals.)

The surgical team in the operating room performs a surgical time-out just before starting hip replacement surgery. Which action would be part of the surgical time-out? a. Assess the patient's vital signs and oxygen saturation level. b. Check the chart for a signed consent form for the procedure. c. Determine if the patient has any questions about the procedure. d. Verify the procedure and the location of the surgery.

D (During a surgical time-out, the surgery team will stop all activities right before the procedure to verify the patient identification, surgical procedure, and surgical site. Proper identification will be accomplished by asking the patient to state name, birth date, and operative procedure and location. In addition, the surgical team will compare the hospital ID number with the patient's own ID band and chart.)

Which patient would be at highest risk for hypothermia after surgery? a. A 42-yr-old patient who had a laparoscopic appendectomy b. A 38-yr-old patient who had a lumpectomy for breast cancer c. A 20-yr-old patient with an open reduction of a fractured radius d. A 75-yr-old patient with repair of a femoral neck fracture after a fall

D (Patients at highest risk for hypothermia are those who are older, debilitated, or intoxicated. Also, long surgical procedures and prolonged anesthetic administration increase the patient's risk for hypothermia.)

This type of anxiety disorder is characterized by uncontrollable, excessive worry for at least 6 months.

Generalized anxiety disorder (GAD)

What type of wound dressing should be used with a pressure ulcer?

Moist dressing to enhance re-epithelializaiton

A vision condition in which the eyes make repetitive, uncontrolled movements. These movements often result in reduced vision and depth perception and can affect balance and coordination. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. *Commonly seen with alcoholics who have Wernicke's symptoms.*

Nystagmus

Telling yourself, "I'm a jerk," or "a fool," or "a loser."

Labeling

You blow things way out of proportion

Magnification

Brain based changes in structure and function that lead to *dependence/addictive behavior*

Reinforcement

The psychological attempt made by an individual to direct one's own desires and impulses toward pleasurable instincts by excluding the desire from one's consciousness and holding or subduing it in the unconscious. An example of this would be a child who is abused by a parent later has no recollection of the events, but has trouble forming relationships.

Repression

Are you more likely to need an amputation with PAD or chronic venous insufficiency?

PAD due to them not healing very well and gangrene occurring.

What is our nation's fastest growing drug problem?

Pain killers

This type of personality disorder involves being distrustful and suspiciousness of everyone.

Paranoid personality disorder (Cluster C)

This type of personality disorder is characterized by detachment from social relationships and a restricted range of expression. They are emotionally detached and have a disinterest in close relationships, and indifferent to praise or criticism.

Schizoid personality disorder (Cluster C)

This type of personality disorder is characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations.

Schizotypal personality disorder (Cluster C)

What enzyme of the pancreas is elevated with alcohol use?

Serum amylase

You tell yourself that things should be the way your hoped or expected them to be. After playing a difficult piece on the piano, a gifted pianist told herself, "I shouldn't have made so many mistakes." This made her feel so disgusted that she quit practicing for several days.

Should statements

Partial thickness loss of dermis presenting as a shallow open ulcer with a red/pink wound bed, without slough. May also present as an intact or open/ruptured serum filled blister. No fat, granulation, slough, or eschar will be present.

Stage II pressure ulcer

Obsessive compulsive overuse of substance leading to intoxication and often withdrawal symptoms.

Substance use disorder

Describe the physiologic process of dependence/addiction

The addictive substance being used links to your reward center in the brain, and interacts with the neurochemicals within the reward center such as dopamine, GABA, acetylcholine, and serotonin. This interaction causes addiction.

Brain based changes in structure and function that lead to *tolerance and withdrawal*

Neuroadaptation

Wernicke-Korsakoff is caused by what deficiency?

Thiamine (Vitamin B1)

List the clinical manifestations of alcohol withdrawal. (10)

1. Nausea and vomiting 2. Auditory and visual hallucinations 3. Visible tremors 4. Diaphoresis 5. Restless and pacing 6. Altered level of consciousness 7. Fever >100.5 8. Hypertension 9. Tachycardia 10. Increased sensitivity to sound and light

List 5 manifestations of late OPIATE withdrawal.

1. Nausea and vomiting 2. Chills/goosebumps 3. Diarrhea 4. Abdominal cramps 5. Dilated pupils

List 4 characteristics of moderate anxiety.

1. Not able to multitask 2. Agitation 3. Muscle tightness 4. Decrease in concentration

List the 6 neurotransmitters involved in the reward system of the brain.

1. Dopamine 2. GABA 3. Glutamate 4. Acetylcholine 5. Norepinephrine 6. Serotonin

List preventative measures for diabetic foot ulcers. (7)

1. Control blood sugar. 2. Take care of your feet and inspect the bottom of them daily. 3. Wear protective foot wear, don't walk around barefoot, use closed toed closed heeled shoes. 4. Don't use external heat! 5. Have corns and calluses professionally removed. 6. Avoid the cold, caffeine, nicotine, and constrictive garments. 7. Routine professional foot care.

List some examples of coping mechanisms for mild anxiety.

1. Crying, sleeping, eating 2. Yawning, laughing, cursing, exercise, etc. 3. Smoking and drinking

List four clinical manifestations of liver cirrhosis, which is commonly seen with chronic substance use, such as alcohol.

1. Jaundice 2. Ascites 3. Easily bruised 4. Swelling in face and ankles, pitting edema

List the 5 LFT that are elevated with alcohol use.

1. LDH 2. ALP 3. GGT 4. AST 5. ALT 6. Ratio of AST to ALT > 1 or 2

List three common benzodiazepines used for alcohol withdrawal.

1. Librium (Chlordiazepoxide) 2. Valium (Diazepam) 3. Ativan (Lorazepam)

A patient is involved in a motor vehicle accident in which a friend was killed. The patient reports difficulty concentrating and admits to being irritable and angry most of the time. Which of the following additional findings support a diagnosis of post-traumatic stress disorder (PTSD)? Choose all answers that apply: a. Self-medication with drugs or alcohol b. Tendency to sleep 12 - 14 hours each day c. Excessive attachment to friends or loved ones d. Flashbacks or nightmares e. Reluctance to drive a motor vehicle f. Signs of sympathetic hyperactivity

A D E F (PTSD is caused by psychological trauma which affects the patient's cognitive, physiological, emotional, and behavioral functions. The traumatic event is repeatedly re-experienced by the patient, which causes extreme anxiety and a physiological reaction. The patient will avoid situations that remind them of the traumatic event. DREAMS is a handy mnemonic to help you remember some of the common clinical manifestations of PTSD: Detachment - refers to feeling detached from others or unresponsive emotionally; Re-experiencing the event - the patient often experiences intrusive recollections, flashbacks, or nightmares about the event; Emotional effects - the event causes the patient to experience significant emotional distress; Avoidance - the patient will tend to avoid situations or even close friends that remind them of the event; Medication - the patient may self-medicate with alcohol or other drugs in an attempt to deal with the psychological trauma; Sympathetic hyperactivity - refers to a hypervigilant or hyper-aroused state, irritability, and difficulty falling or staying asleep.)

Overtime, what develops with CNS depressant substances?

Cross-tolerance

This term means that as tolerance develops to one drug, it also develops to other drugs in the same category, ex. CNS depressants.

Cross-tolerance

This type of personality disorder is characterized by emotionality and attention seeking behavior. They are sexually provocative and flirtatious. Ex. Marilyn Monroe

Histrionic personality disorder (Cluster B)

Black, brown or tan devitalized tissue that adheres to the wound bed or edges and may be firmer or softer than the surrounding skin.

Necrosis/Eschar

This type of personality disorder is characterized by arrogance, grandiose views of self-importance, and the need for consistent admiration, and a lack of empathy for others that strains most relationships. They are often sensitive to criticism.

Narcissistic personality disorder (Cluster B)

What is offloading?

Offloading is used on people with foot ulcers to redistribute pressure on the ulcer to a different area. This can be done with total contact casting, half shoes, removable cast walkers, wheelchairs, and crutches.

An example of this type of wound healing process would include a laceration or surgical incision. This process has the most rapid healing. The wound margins are well approximated and are touching.

Primary intention