Semester 3 Unit 6 Exam

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

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

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

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

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

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

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

c. Suicidal ideation

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

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

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

C. The client will perceive an ideal body weight and shape as normal.

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

c. Talkativeness and euphoria

A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse gives: a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.

If a peripheral parenteral nutrition (PPN) formula bag empties before the next solution is available, a 5% dextrose solution (based on the amount of dextrose in the peripheral PN solution) may be administered to prevent hypoglycemia

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

7.4 per ml

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

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

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

b. Liver enzymes

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

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

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

a. Pupils are dilated d. Extreme anxiety

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

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

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

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

A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) 1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 2. "In this disorder, binge eating occurs, on average, at least once a week for three months." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 4. "In this disorder, distress regarding binge eating is present." 5. "In this disorder, distress regarding binge eating is absent."

1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 5. "In this disorder, distress regarding binge eating is absent."

A nurse is caring for several clients with the diagnosis of bulimia nervosa. What primary feeling does the nurse anticipate that these clients experience after an episode of bingeing? 1. Guilt 2. Paranoia 3. Euphoria 4. Satisfaction

1. Guilt A sense of being out of control accompanies the consumption of large amounts of food, resulting in guilt, depression, and disgust with one's self. Paranoia is associated with paranoid schizophrenia, not with bulimia nervosa. After bingeing, a person with bulimia nervosa usually feels depressed rather than euphoric or satisfied.

A 17-year-old client is found to have anorexia nervosa. The psychiatrist, in conjunction with the client and the parents, decides to institute a behavior modification program. What does the nurse recall is a major component of behavior modification? 1. Rewarding positive behavior 2. Reducing necessary restrictions 3. Deconditioning fear of weight gain 4. Reducing anxiety-producing situations

1. Rewarding positive behavior In behavior modification , positive behavior is reinforced, and negative behavior is not reinforced or punished. Reducing the number or complexity of necessary restrictions, deconditioning the fear of weight gain, and reducing the number of anxiety-producing situations may all be part of the program, but none is a major component.

A teenager with anorexia nervosa is admitted to the adolescent unit of a mental health facility and signs a contract calling for the client to gain weight or lose privileges. There is no weight gain after a week. What should the nurse explain to the client? 1. The prearranged consequences will go into effect. 2. Death from starvation could occur if the client does not eat. 3. Stricter goals will be instituted if the initial goals are not met. 4.It may be necessary to become involved with meal preparation.

1. The prearranged consequences will go into effect. The imposition of the prearranged consequences reinforces the agreed-upon contract; a behavior modification program must follow through consistently on issues of cause and effect. The threat of death from starvation is not therapeutic. Goals are not changed; prearranged consequences are instituted when goals are not met. Working with food will not stimulate the client's eating; this is not therapeutic or productive.

What nursing intervention is the priority in the period immediately after an emaciated 13-year-old child's admission to the hospital for starvation resulting from anorexia nervosa? 1. Ensuring that rest and nutrition needs are met 2. Correcting the child's fluid and electrolyte imbalances 3. Obtaining more data about the child's diet and exercise program 4. Completing an assessment of the child's physical and mental status

2. Correcting the child's fluid and electrolyte imbalances Anorexic children are usually severely malnourished and have severe fluid and electrolyte imbalances. Unless these imbalances are corrected, cardiac irregularities and death may occur. Rest and nutrition, information on diet and exercise, and assessment of physical and mental status are important, but none is the priority at this time

What should the nurse do when an adolescent with the diagnosis of anorexia nervosa starts to discuss food and eating? 1. Listen to the client's list of favorite foods and secure these foods for the client. 2. Tell the client gently but firmly to direct the discussion of food to the nutritionist. 3. Use the client's current interest in food to encourage an increase in food intake. 4.Let the client talk about food as long as the client wants and limit discussion about eating

2. Tell the client gently but firmly to direct the discussion of food to the nutritionist. All food issues should be discussed with the nutritionist, thereby removing a potential source of conflict between the nurse and client. Listening to the client's list of favorite foods and securing these foods will accomplish little, because the client's failure to eat is not based on food likes or dislikes. Using the client's current interest in food to encourage an increased food intake will increase the conflict between the nurse and client. Letting the client talk about food as long as the client wants and limiting discussion about eating may be self-defeating, because a discussion of food will be the major focus of all nurse-client interactions.

Evaluation of clients with anorexia nervosa requires reassessment of behaviors after admission. Which finding indicates that the therapy is beginning to be effective? 1. Food is hidden in the client's pockets. 2. The client states that the hospitalization has been helpful. 3. The client has gained 6 lb (2.7 kg) since admission 3 weeks ago. 4. The client remains in the dining room eating for 1 hour after others have left.

3. The client has gained 6 lb (2.7 kg) since admission 3 weeks ago. Weight gain of 6 lb (2.7 kg) since admission 3 weeks ago is objective proof that the client's eating behaviors have improved. "Stashing" of food is a characteristic of an eating disorder, not a sign of improvement. The statement that the hospitalization has been helpful is subjective information and may be manipulative. "Marathon meals" with little actual food ingestion are common in people with anorexia.

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

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

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

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

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

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

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

D. "I don't know why people are worried. I need to lose this weight." When the client states, "I don't know why people are worried. I need to lose this weight," the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

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

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

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

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

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

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

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

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

Place in order the substrates the body uses for energy during starvation, beginning with 1 for the first component and ending with 4 for the last component. a. visceral protein, skeletal protein, fat, glycogen .b. glycogen, skeletal protein, fat stores, visceral protein c. visceral protein, fat stores, glycogen, skeletal protein d. fat stores, skeletal protein, visceral protein, glycogen.

Initially, the body selectively uses carbohydrates (e.g., glycogen) rather than fat and protein to meet metabolic needs. These carbohydrate stores, found in the liver and muscles, are minimal and may be totally depleted within 18 hours. After carbohydrate stores are depleted, skeletal protein begins to be converted to glucose for energy. Within 5 to 9 days, body fat is fully mobilized to supply much of the needed energy. In prolonged starvation, up to 97% of calories are provided by fat, and protein is conserved. Depletion of fat stores depends on the amount available, but fat stores typically are used up in 4 to 6 weeks. After fat stores are used, body or visceral proteins, including those in internal organs and plasma, can no longer be spared and rapidly decrease because they are the only remaining body source of energy available.

The percentage of daily calories for a healthy person consists of a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.

a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. The 2005 Dietary Guidelines for Americans recommend that 45% to 65% of total calories should come from carbohydrates. Ideally, 10% to 35% of daily caloric needs should come from protein. Individuals should limit their fat intake to 20% to 35% of total calories. Additional recommendations focus on the type of fat consumed because diets high in excess calories, usually in the form of fats, contribute to the development of obesity. Individuals should consume less than 10% of calories from saturated fatty acids, limit intake of fat and oils high in trans fatty acids, and should limit intake of dietary cholesterol to 300 mg/day.

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

a. Elevated blood pressure

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

b. clonidine (Catapres)

(lewis book) A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for a. hyperkalemia. b. hypoglycemia. c. hypercalcemia. d. hypophosphatemia.

d. hypophosphatemia. Refeeding syndrome is characterized by fluid retention, electrolyte imbalances (e.g., hypophosphatemia, hypokalemia, hypomagnesemia), and hyperglycemia. Conditions that predispose patients to refeeding syndrome include long-standing malnutrition states such as those induced by chronic alcoholism, vomiting and diarrhea, chemotherapy, and major surgery. Refeeding syndrome can occur any time a malnourished patient is started on aggressive nutritional support. Hypophosphatemia is the hallmark of refeeding syndrome, and it is associated with serious outcomes, including cardiac dysrhythmias, respiratory arrest, and neurologic disturbances (e.g., paresthesias).

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

b. Benzodiazepines

A nurse, the family, and an adolescent client with anorexia nervosa are planning appropriate outcomes for the client. What is an appropriate short-term goal for the client? 1. Eat planned nutritious meals. 2. Gain 10 lb (4.5 kg) within 1 month. 3. Continue the same diet eaten at home. 4. Add 100 calories of carbohydrates to each meal.

1. Eat planned nutritious meals. Ingesting planned nutritious meals is a realistic goal that is likely to evoke the least anxiety in the short term. A person with anorexia nervosa has great anxiety about weight gain and responds best to nutritious foods when he or she has input into planning. The thought of gaining 10 lb (4.5 kg) within 1 month will overwhelm the client and increase anxiety. The diet eaten at home was probably a very low-calorie diet that promoted weight loss. Adding 300 calories a day will increase the client's anxiety and probably result in nonadherence to the planned regimen.

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

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

An adolescent with the diagnosis of anorexia nervosa is admitted to the psychiatric unit of a local hospital. What should the nurse include in the plan of care? 1. Limited opportunities for decision-making 2. Provision of supervision during and after mealtimes 3. Arrangements for a physical exercise program and time to complete it 4. A request that parents keep their visits to a minimum early in treatment

2. Provision of supervision during and after mealtimes Clients with anorexia nervosa often throw out or hide food and purge after eating. The client should be supervised to ensure that the client eats and does not vomit after meals. Limiting opportunities for decision-making fosters dependence, which is not desirable. The client's physical expenditure should be reduced because of malnutrition; exercise is usually limited. The parents are an important part of treatment and should be encouraged to visit unless visiting privileges are revoked because of insufficient weight gain.

The parents of an adolescent child are worried about their daughter's use of laxatives. Which other behavior in the child does the nurse associate with bulimia nervosa? 1. The child is underweight for her age. 2. The child indulges in binge eating. 3. The child is obsessed with being thin. 4. The child prefers to starve to lose weight.

2. The child indulges in binge eating. Bulimia nervosa is an eating disorder characterized by binge eating and the use of laxatives and self-induced vomiting to prevent weight gain. Anorexia nervosa is a clinical syndrome with both physical and psychosocial components. Clients with anorexia nervosa refuse to maintain body weight at the minimal normal weight for their age and height. An individual with anorexia nervosa has an intense fear of gaining weight. This individual often starves to lose weight.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment

3. The home environment is overprotective and demands perfection

While admitting a young client with anorexia nervosa to the unit, the nurse finds a bottle of assorted pills in the client's luggage. The client tells the nurse that they are antacids for stomach pains. What is the best initial response by the nurse? 1"Let's talk about your drug use." 2"These pills don't look like antacids." 3"Some people take pills to lose weight." 4"Tell me more about these stomach pains."

4"Tell me more about these stomach pains." "Tell me more about these stomach pains" is a nonthreatening, open-ended response that focuses discussion and leaves the channel of communication open. Although "Some people take pills to lose weight" is a true statement, this response does not encourage discussion. Although "Let's talk about your drug use" and "These pills don't look like antacids" do not quite accuse the client of lying, both are threatening responses that question the client's truthfulness.

A 16-year-old high school student who has anorexia nervosa tells the school nurse that she thinks she is pregnant even though she has had intercourse only once, more than a year ago. What is the most appropriate inference for the nurse to make about the student? 1. Using magical thinking 2. Submitting to peer pressure 3. Lying about the last time she had intercourse 4.Lacking knowledge that anorexia can cause amenorrhea

4.Lacking knowledge that anorexia can cause amenorrhea The loss of body fat from anorexia can cause amenorrhea; the client needs information. No data are available to support the fact that the client is using magical thinking, which is characterized by the belief that thinking or wishing something can cause it to occur; in light of the client's diagnosis of anorexia, this is not the first conclusion. Submitting to peer pressure is not related to this type of concern. Although the nurse should question the timeline again, the client's nutritional status should be explored first.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

b. Copious vomiting

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

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

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

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

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

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

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

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

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

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

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

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

A nurse is planning health teaching for a 14-year-old girl hospitalized with the diagnosis of anorexia nervosa. What does the nurse assume is likely true of the client? 1. Is somewhat concerned that the eating behavior may threaten life 2. Has some understanding of anorexia nervosa because of media publicity 3. Has minimal awareness that reduced caloric intake has lethal implications 4. Is demonstrating an unconscious desire for death by selecting refusal of food as the method

3. Has minimal awareness that reduced caloric intake has lethal implications Even though anorexia nervosa is a popular media topic and people with the disorder may intellectually understand the lethal implications of not eating, they do not recognize it as their problem even when they are dying of starvation. People with anorexia nervosa are unconcerned with the physiologic danger of the consequences of their behavior and focus only on being fat. Adolescents typically feel indestructible and immortal; also, individuals with anorexia nervosa believe being fat is unhealthy and must be avoided at any cost.

The multidisciplinary team decides to use a behavior modification approach for a young client with anorexia nervosa. Which planned nursing intervention is an appropriate approach to use with this client? 1. Having the client role-play interactions with the parents 2. Providing the client with a high-calorie, high-protein diet 3. Restricting the client to the room until a 2-lb (0.9-kg) weight gain is achieved 4. Forcing the client to talk about favorite foods for 1 hour a day

3. Restricting the client to the room until a 2-lb (0.9-kg) weight gain is achieved Restricting the client to the room until a 2-lb (0.9-kg) weight gain is achieved reinforces behaviors that will assist in the achievement of specific goals. Having the client role-play interactions with the parents is not part of a behavior modification program. Providing the client with a high-calorie, high-protein diet is not part of a behavior modification program. Anorexic clients talk freely about food; the problem is ingestion, not discussion.

What is a major recognizable difference between anorexia nervosa clients and bulimia nervosa clients? 1. Anorexia nervosa clients tend to be more extroverted than clients with bulimia. 2. Anorexia nervosa clients seek intimate relationships, whereas clients with bulimia avoid them. 3. Anorexia nervosa clients are at greater risk for fluid and electrolyte imbalances than are clients with bulimia. 4. Anorexia nervosa clients deny the problem, whereas clients with bulimia generally recognize that their eating pattern is abnormal.

4. Anorexia nervosa clients deny the problem, whereas clients with bulimia generally recognize that their eating pattern is abnormal. The client with anorexia nervosa denies the illness; the client with bulimia nervosa hides the behavior because she recognizes that the behavior is a problem. Clients with anorexia nervosa are more introverted and tend to avoid relationships. Clients with bulimia are at a greater risk for fluid and electrolyte problems because of the purging; clients with anorexia nervosa are at greater risk for severe nutritional deficiencies.

An adolescent is admitted to the psychiatric service in stable physical condition with the diagnosis of anorexia nervosa. The adolescent has lost 20 lb (9.1 kg) in 6 weeks and is very thin but is excessively concerned about being overweight. What is the most important initial nursing intervention? 1. Complimenting the physical appearance of the adolescent 2. Explaining the value of adequate nutrition to the adolescent 3. Exploring the reasons that the adolescent does not want to eat 4. Attempting to establish a trusting relationship with the adolescent

4. Attempting to establish a trusting relationship with the adolescent The problem is psychological. Therefore the nurse's initial approach should be directed toward establishing trust. The client is convinced about being overweight; complimenting the client will not change self-perception. The client is not ready for nutrition information. Exploring the reasons that the adolescent does not want to eat may be appropriate after trust has been established.

A nurse is caring for an adolescent with the diagnosis of anorexia nervosa. The plan of care should include helping the client do what? 1. Plan nutritious meals. 2. Change attitudes about nutrition. 3. Understand that more food must be eaten. 4. Recognize how the need to control influences behavior

4. Recognize how the need to control influences behavior The client's focus on controlling eating redirects attention away from those areas that are felt to be out of the client's control. This is how life's more difficult problems and challenges are avoided. Planning nutritious meals may not be productive, because these clients believe that they are eating nutritious meals. It is not the client's attitudes or beliefs about food but instead the distorted self-image that is the problem. Understanding that more food must be eaten may not be productive, because these clients believe that they are eating enough food.

The nurse notes that a young client with anorexia nervosa telephones home just before each mealtime. The client ignores reminders to eat and continues talking until the other clients are finished eating. The client then refuses to eat food that has gotten cold. What should the nurse do initially? 1. Insist that the client eat the food. 2. Revoke the client's telephone privileges. 3. Hang up the telephone when meals are served. 4. Schedule a family meeting to discuss the problem

4. Schedule a family meeting to discuss the problem By talking to the client on the telephone at mealtimes, the family is enabling the client to continue the self-destructive behavior; the client and family must be included in discussion of and possible solutions to the problem. Insisting that the client eat the food is a punitive approach that does not address the underlying problem. Revoking the client's telephone privileges is a behavior modification approach that may be used if talking to the family does not produce needed change. Hanging up the telephone when meals are served is a punitive approach that does not address the underlying problem.

A client with bulimia nervosa eats two sandwiches, two salads, and four desserts for lunch. What client behavior should the nurse anticipate after the meal is consumed? 1. Excessive exercise 2. Hoarding of more food for a later binge 3. Active socializing with small groups of clients 4. Withdrawing from the group to go to the bathroom

4. Withdrawing from the group to go to the bathroom Bulimia is characterized by the binge-purge cycle; most clients withdraw from others and vomit after an eating binge. Although some individuals with bulimia may exercise to excess, this is a more common finding with the diagnosis of anorexia nervosa. Although individuals with bulimia may hoard food, this behavior commonly occurs later, when limits are put on their intake. Most individuals with bulimia do not seek support or socialization after a binge, although they may socialize at other times.

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

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

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

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

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

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

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

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

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

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

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

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

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

C. This therapy will provide the client with control over behavioral choices.

A nurse is assigned to care for an adolescent who has been admitted to the psychiatric hospital with a diagnosis of anorexia nervosa. What should the nurse's initial intervention be? A. Scheduling an endocrinology consult because of amenorrhea B. Confronting those behaviors that reflect an inflated self-importance C. Arranging for psychotherapy sessions to help develop a desire to accommodate others D. Developing a contract to achieve a weekly weight gain, with consequences for nonachievement

D. Developing a contract to achieve a weekly weight gain, with consequences for nonachievement Treatment usually includes a contract for weight gain, signed by the client, whereby privileges are revoked if the weight is not gained; the diet and the amount of food eaten are not the focus of care. Menstruation usually ceases because of severe malnutrition, not because of endocrine pathology. These clients have a low self-esteem and usually do not feel important.

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

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

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

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

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

a. Benzodiazepines

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

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

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

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

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

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

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

a. Stillbirth

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

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

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

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

Which method is best to use when confirming initial placement of a blindly inserted small-bore NG feeding tube? a. x-ray. b. air insufflation. c. observing patient for coughing. d. pH measurement of gastric aspirate.

a. x-ray. The nurse should obtain x-ray confirmation to determine whether a blindly placed nasogastric or orogastric tube (small bore or large bore) is properly positioned in the gastrointestinal tract before administering feedings or medications.

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

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

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

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

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

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

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

b. Fluoxetine (Prozac)

(lewis book) Which of the following is the only FDA-approved antidepressant for treating bulimia nervosa a. Paroxetine (Paxil) b. Fluoxetine (Prozac) c. Clomipramine (Anafranil) d. Sertraline (Zoloft)

b. Fluoxetine (Prozac) Fluoxetine (Prozac) is the only FDA-approved antidepressant for treating bulimia nervosa. It may not be appropriate in all patients with bulimia

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

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

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

b. Manage the patient's withdrawal symptoms well.

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

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

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

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

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

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

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

d. Swiss cheese

A complete nutritional assessment including anthropometric measurements is most important for the patient who a. has a BMI of 25.5 kg/m2. b. complains of frequent nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months.

d. reports an unintentional weight loss of 10 lb in 2 months A loss of more than 5% of usual body weight over 6 months, whether intentional or unintentional, is a critical indicator for further assessment.