Unit 4 Semester 4

Three main elements must be considered when evaluating lethality:

(1) Is there a specific plan with details? (2) How lethal is the proposed method? (3) Is there access to the planned method? People who have definite plans for the time, place, and means are at high risk.

Skin testing may be done by three different methods:

(1) a scratch or prick test, (2) an intradermal test, or (3) a patch test.

Factors that influence ICP under normal circumstances are changes in

(1) arterial pressure; (2) venous pressure; (3) intraabdominal and intrathoracic pressure; (4) posture; (5) temperature; and 1315(6) blood gases, particularly CO2 levels.

Cerebral perfusion pressure

(CPP = MAP − ICP)

otorrhea

(CSF leakage from the ear)

Rhinorrhea

(CSF leakage from the nose)

Concussion

(a sudden transient mechanical head injury with disruption of neural activity and a change in the LOC) is considered a minor diffuse head injury. The patient may or may not lose total consciousness with this injury. Typical signs of concussion include a brief disruption in LOC, amnesia regarding the event (retrograde amnesia), and headache. The manifestations are generally of short duration

cerebral edema

(increased accumulation of fluid in the extravascular spaces of brain tissue)

Grandiosity

(inflated self-regard) is apparent in both the ideas expressed and the person's behavior.

Cushing's triad

(systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, and irregular respirations) may be present but often do not appear until ICP has been increased for some time or is suddenly and markedly increased (e.g., head trauma). Always recognize Cushing's triad as a medical emergency, since this is a sign of brainstem compression and impending death.

subacute subdural hematoma usually occurs within

2 to 14 days of the injury. After the initial bleeding, a subdural hematoma may appear to enlarge over time as the breakdown products of the blood draw fluid into the subdural space.

Which behavior would be most characteristic of a client during a manic episode? A. Going rapidly from one activity to another B. Taking frequent rest periods and naps during the day C. Being unwilling to leave home to see other people D. Watching others intently and talking little

A. Going rapidly from one activity to another

If a suicidal client is to be treated outside the hospital, which intervention would be of high priority? A. Have the client identify three people to call if he is overwhelmed by hopelessness. B. Make sure the client has food enough to last for 2 to 3 days. C. Arrange for a police visit every 24 hours. D. Provide a 1-week supply of antidepressant medication.

A. Have the client identify three people to call if he is overwhelmed by hopelessness.

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? A. How long the client has been suicidal B. Whether the plan has specific details C. Whether the method is one that causes death quickly D. Whether the client has the means to implement the plan

A. How long the client has been suicidal

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? A. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock

A. Increased food intake

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A. Onset of action is from 1 to 6 weeks. B. They tend to be more effective for men. C. Recent memory impairment is commonly observed. D. They often cause the client to have diurnal variation.

A. Onset of action is from 1 to 6 weeks.

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.

A. mood shifts, impulsivity, and splitting.

The nurse is doing a neurologic assessment on a 2-month-old infant following a car accident. Moro, tonic neck, and withdrawal reflexes are present. The nurse should recognize that these reflexes suggest: A. neurologic health. B. severe brain damage. C. decorticate posturing. D. decerebrate posturing.

A. neurologic health.

bipolar I disorder

A mood disorder that is characterized by at least one week-long manic episode that results in excessive activity and energy. Manic episodes may alternate with depression, hypomania, or a mixed state of agitation and depression.

Lithium therapeutic levels

A small increment exists between the therapeutic and toxic levels of lithium. Lithium levels should be measured at least 5 days after beginning lithium therapy and after any dosage change, until the therapeutic level has been reached (Perlis, 2008). After therapeutic levels have been reached, blood levels are determined every month. After 6 months to a year of stability, measurement of blood levels every 3 months may suffice. Blood should be drawn in the morning, 8 to 12 hours after the last dose of lithium is taken.

hypervigilance

A state of extraordinary alertness that results in an exaggerated startle response.]]

abnormal ICP

A sustained pressure greater than 20 mm Hg is considered abnormal and must be treated.

What is the usual progression of Alzheimer's disease? A. A single, sort episode followed by years of normal function B. Recurring remissions and exacerbations C. Progressive deterioration D. There is no usual progression

C. Progressive deterioration

Maternal and neonatal risks associated with gestational diabetes mellitus are: A. maternal premature rupture of membranes and neonatal sepsis. B. maternal hyperemesis and neonatal low birth weight. C. maternal preeclampsia and fetal macrosomia. D. maternal placenta previa and fetal prematurity.

C. maternal preeclampsia and fetal macrosomia.

Beck's cognitive theory suggests that the etiology of depression is related to A. sleep abnormalities. B. serotonin circuit dysfunction. C. negative processing of information. D. a belief that one has no control over outcomes.

C. negative processing of information.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client A. has poor retention of recent events. B. experienced a weight loss from anorexia. C. obtains no pleasure from previously enjoyed activities. D. has difficulty with tasks requiring fine motor skills.

C. obtains no pleasure from previously enjoyed activities.

The suicide intervention that has the greatest impact on a client's safety is A. educating visitors about potentially dangerous gifts. B. restricting the client from potentially dangerous areas of the unit. C. one-on-one observation by the staff. D. removal of personal items that might prove harmful.

C. one-on-one observation by the staff.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with A. senile dementia. B. hypertensive crisis. C. psychomotor agitation. D. central serotonin syndrome.

C. psychomotor agitation.

The nurse is caring for a child with multiple injuries who is comatose. The nurse should recognize that pain: A. cannot occur if the child is comatose. B. may occur if the child regains consciousness. C. requires astute nursing assessment and management. D. is best assessed by family members who are familiar with the child.

C. requires astute nursing assessment and management.

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. The most appropriate short-term goal would be that while hospitalized, the client will A. reclaim any prized possessions that were given away. B. name three personal strengths. C. seek help when feeling self-destructive. D. participate in a self-help group.

C. seek help when feeling self-destructive.

Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.

C. sees things as divided into "all good" or "all bad."

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal A. good memory and concentration. B. delusions of persecution. C. self-deprecatory ideation. D. sexual preoccupation.

C. self-deprecatory ideation.

It is likely that a client diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the A. fall. B. winter. C. spring. D. summer.

C. spring.

A client diagnosed with Alzheimer's disease has become more forgetful and has difficulty performing familiar tasks like bathing and dressing. The nurse would assess the client as being in the stage of Alzheimer's disease labeled A. stage 1, mild. B. stage 2, moderate. C. stage 3, moderate-severe. D. stage 4, end.

C. stage 3, moderate-severe.

Some of the most important characteristics of staff members who work with suicidal clients are A. the ability to be consistently organized. B. the ability to teach problem-solving skills. C. warmth and consistency when interacting. D. interview and counseling skills.

C. warmth and consistency when interacting.

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. FIRST the nurse should: A.determine what the child has eaten. B.administer diphenhydramine (Benadryl). C.move the child to the nurse's office or hallway. D.have someone call for an ambulance/paramedic rescue squad.

D.have someone call for an ambulance/paramedic rescue squad.

Diabetes insipidus treatment

DI may occur after intracranial trauma. In DI there are large amounts of diluted urine and the accompanying danger of dehydration. Adequate replacement of fluids is essential, and observation of electrolyte balance is necessary to detect signs of hypernatremia and hyperosmolality. Exogenous vasopressin may be administered.

prenant dka

DKA may occur with blood glucose levels barely exceeding 200 mg/dL, compared with 300 to 350 mg/dL in the nonpregnant state

Minor head injury

GCS 13-15

Severe head injury

GCS 3-8

Moderate head injury

GCS 9-12

Lithium toxicity treatment

Gastric lavage and treatment with urea, mannitol, and aminophylline can hasten lithium excretion. Hemodialysis may also be necessary in extreme cases.

MAP

SBP+2(DBP)/3

The preferred method for determining a diagnosis of borderline personality disorder is the semistructured interview obtained by clinicians.

Self-report inventories, such as the well-known Minnesota Multiphasic Personality Inventory (MMPI), are useful because they have built-in validity and reliability scales for the clinician to refer to when interpreting test results.

urticaria

Urticaria (hives) is a cutaneous reaction against systemic allergens occurring in atopic people. It is characterized by transient wheals (pink, raised, edematous, pruritic areas) that vary in size and shape and may occur all over the body. Urticaria develops rapidly after exposure to an allergen and may last minutes or hours. Histamine causes localized vasodilation (erythema), transudation of fluid (wheal), and flaring. Flaring is due to dilated blood vessels on the edge of the wheal. Histamine is responsible for the pruritus associated with the lesions.

Laboratory findings DKA include

a blood glucose level greater than or equal to 250 mg/dL (13.9 mmol/L), arterial blood pH less than 7.30, serum bicarbonate level less than 16 mEq/L (16 mmol/L), and moderate to large ketones in the urine or serum.

To reduce risk of kidney injury, discontinue metformin

a day or two before the procedure.

patient with an acute stroke may require

a higher BP, increasing MAP and CPP, in order to increase perfusion to the brain and prevent further tissue damage.

mania,

a person constantly goes from one activity, place, or project to another.

A 78-yr-old man has confusion and temperature of 104° F (40° C). He is a diabetic with purulent drainage from his right heel. After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40 mm Hg; heart rate 110; respiratory rate 42 and shallow; CO 8 L/minute; and PAWP 4 mm Hg. This patient's symptoms are most likely indicative of a. sepsis. b. septic shock. c. multiple organ dysfunction syndrome. d. systemic inflammatory response syndrome.

b. septic shock.

Children younger than 2 years of age require special evaluation

because they are unable to respond to directions designed to elicit specific neurologic responses. Early neurologic responses in infants are primarily reflexive; these responses are gradually replaced by meaningful movement in the characteristic cephalocaudal direction of development.

Children with open fontanels compensate for icp

by skull expansion and widened sutures. However, at any age the capacity for spatial compensation is limited. An increase in ICP may be caused by tumors or other space-occupying lesions, accumulation of fluid within the ventricular system, bleeding, or edema of cerebral tissues. When compensation is exhausted, any further increase in the volume of the cranium results in a rapid rise in ICP.

Lithium 0.4-1.0 mEq/L (therapeutic level)

expected side effects Fine hand tremor, polyuria, and mild thirst Symptoms may persist throughout therapy. Mild nausea and general discomfort Symptoms often subside during treatment. Weight gain Weight gain may be helped with diet, exercise, and nutritional management.

The most common causes of head injury are

falls and motor vehicle accidents.

Poor glycemic control later in pregnancy, particularly in women without vascular disease, increases the rate of

fetal macrosomia. Macrosomia has been defined as a birth weight more than 4000 to 4500 g or greater than the 90th percentile. It occurs in approximately 40% of pregestational diabetic pregnancies and up to 50% of pregnancies complicated by GDM

If in doubt and no testing can be done

give kid simple carbs as this will correct hypoglycemia and will do little harm if they are hyperglycemic

Will glucose or insulin cross the placenta

glucose crosses the placenta, insulin does not.

Maintain the patient with increased ICP in the

head-up position. Position the bed so that it lowers the ICP while optimizing the CPP and other indices of cerebral oxygenation.

brain bleeds

hemorrhage manifests as a space-occupying lesion accompanied by unconsciousness, hemiplegia on the contralateral side, and a dilated pupil on the ipsilateral side.

What are type 1 diabetics prone to in first trimester

hypoglycemia

The primary action of metformin is to

reduce glucose production by the liver.

Diabetes mellitus

refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Tertiary intervention (or postvention)

refers to interventions with the circle of survivors of a person who has completed suicide

What inulin is given iv

regular

epidural hematoma

results from bleeding between the dura and inner surface of the skull Classic signs of an epidural hematoma include an initial period of unconsciousness at the scene, with a brief lucid interval followed by a decrease in LOC. Other manifestations may be a headache, nausea and vomiting, or focal findings. Rapid surgical intervention to evacuate the hematoma and prevent 1329cerebral herniation, along with medical management for increasing ICP, can dramatically improve outcomes.

Nursing diagnosis for borderline

self mutilation, Risk for suicide, Risk for self-directed violence, Risk for other-directed violence, Social isolation, Impaired social interaction, Disturbed personal identity, and Ineffective coping

To test the oculocephalic reflex (doll's eye reflex)

turn the patient's head briskly to the left or right while holding the eyelids open. A normal response is movement of the eyes across the midline in the direction opposite that of the turning. Next, quickly flex and then extend the neck. Eye movement should be opposite to the direction of head movement—up when the neck is flexed and down when it is extended. Abnormal responses can help locate the intracranial lesion. This test should not be attempted if a cervical spine problem is suspected.

risks of receiving lithium

two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidney's ability to concentrate urine; therefore, a person receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function.

Can borderline run in families

yes

Serotonin syndrome

•Hyperactivity or restlessness •Tachycardia → cardiovascular shock •Fever → hyperpyrexia •Elevated blood pressure •Altered mental states (delirium) •Irrationality, mood swings, hostility •Seizures → status epilepticus •Myoclonus, incoordination, tonic rigidity •Abdominal pain, diarrhea, bloating •Apnea → death

Treatment serotonin syndrome

•Remove offending agent(s) •Initiate symptomatic treatment: •Serotonin-receptor blockade with cyproheptadine, methysergide, propranolol •Cooling blankets, chlorpromazine for hyperthermia •Dantrolene, diazepam for muscle rigidity or rigors •Anticonvulsants •Artificial ventilation •Induction of paraly

Seclusion is warranted when documented data collected by the nursing and medical staff reflect the following points:

•Substantial risk of harm to others or self is clear. •The patient is unable to control his or her actions. •Problematic behavior has been sustained (continues or escalates despite other measures). •Other measures have failed (e.g., setting limits beginning with verbal de-escalation or using chemical restraints).

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital (select all that apply)? a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

a. Insulin administration b. Elimination of sugar from diet d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment

A medication teaching plan for a patient receiving lithium should include: a. Periodic monitoring of renal and thyroid function. b. Dietary teaching to restrict daily sodium intake. c. The importance of blood draws to monitor serum potassium level. d. Discontinuing the drug if weight gain and fine hand tremors are noticed.

a. Periodic monitoring of renal and thyroid function.

A nurse plans care for the patient with increased intracranial pressure with the knowledge that the best way to position the patient is to a. keep the head of the bed flat. b. elevate the head of the bed to 30 degrees. c. maintain patient on the left side with the head supported on a pillow. d. use a continuous-rotation bed to continuously change patient position.

b. elevate the head of the bed to 30 degrees.

Polydipsia and polyuria related to diabetes mellitus are primarily due to a. the release of ketones from cells during fat metabolism. b. fluid shifts resulting from the osmotic effect of hyperglycemia. c. damage to the kidneys from exposure to high levels of glucose. d. changes in RBCs resulting from attachment of excessive glucose to hemoglobin.

b. fluid shifts resulting from the osmotic effect of hyperglycemia.

Serotonin

Low serotonin levels are related to depressed mood. Studies have found low levels of serotonin or its metabolites in the cerebrospinal fluid of patients who are suicidal

Borderline Personality Disorder Treatment Options

1. Individual psychotherapy 2. Dialectical behavior therapy 3. Group therapy 4. Antipsychotics may control anger and brief psychosis 5. Antidepressants such as SSRIs and MAOIs 6. Benzodiazepines help anxiety

Borderline Personality Disorder Nursing guidelines

1. Set realistic goals; use clear action words. 2. Be aware of manipulative behaviors (flattery, seductiveness, instilling of guilt). 3. Provide clear and consistent boundaries and limits. 4. Use clear and straightforward communication. 5. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment. 6. Avoid rejecting or rescuing. 7. Assess for suicidal and self-mutilating behaviors, especially during times of stress.

there are four cardinal features of delirium:

1.Acute onset and fluctuating course 2.Reduced ability to direct, focus, shift, and sustain attention 3.Disorganized thinking 4.Disturbance of consciousness

Four major types of ICP monitors are:

1.Intraventricular catheter with fibroscopic sensors attached to a monitoring system 2.Subarachnoid bolt (Richmond screw) 3.Epidural sensor 4.Anterior fontanel pressure monitor.

A client with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to A. anger. B. fear. C. an unmet physical need. D. the need for social interaction.

B. fear.

acute subdural hematoma manifests within

24 to 48 hours of the injury. The signs and symptoms are similar to those associated with brain tissue compression in increased ICP and include decreasing LOC and headache

Somogyi effect.

A high dose of insulin produces a decline in blood glucose levels during the night. As a result, counterregulatory hormones (e.g., glucagon, epinephrine, growth hormone, cortisol) are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia

how long before meal should regular insulin be given

30 min

cyclothymic disorder

A disorder characterized by symptoms of hypomania that alternate with symptoms of mild to moderate depression for at least 2 years in adults and 1 year in children. Neither set of symptoms constitutes an actual diagnosis of either disorder, yet the symptoms are disturbing enough to cause social and occupational impairment.

Normal ICP ranges from

5 to 15 mm Hg

bipolar II disorder

A form of bipolar disorder in which hypomanic episodes alternate with major depression.

How fast can you bring bgl down with out complications

A blood glucose reduction of 36 to 54 mg/dL/hr (2 to 3 mmol/L/hr) will avoid complications.

flight of ideas

A continuous flow of speech in which the person jumps rapidly from one topic to another. Sometimes the listener can keep up with the changes; at other times, it is necessary to listen for themes in the incessant talking. Themes often include grandiose and fantasized evaluation of personal sexual prowess, business ability, artistic talents, and so forth.

borderline personality disorder

A disorder characterized by disordered images of self, impulsive and unpredictable behavior, marked shifts in mood, and instability in relationships with others.

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? A. Constant 24-hour, one-to-one observation at arm's length B. One-to-one observation while client is awake C. Every 15-minute observation around the clock D. Seclusion with 15-minute observation

A. Constant 24-hour, one-to-one observation at arm's length

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) A. Do not reuse needles B. Inject insulin when it is cold C. Flex or tense the muscle during injection D. Remove all bubbles from the syringe before injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

A. Do not reuse needles D. Remove all bubbles from the syringe before injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

Which side effects of lithium can be expected at therapeutic levels? A. Fine hand tremor and polyuria B. Nausea and thirst C. Coarse hand tremor and gastrointestinal upset D. Ataxia and hypotension

A. Fine hand tremor and polyuria

The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled for upon returning to the unit? A. Rest B. Group therapy C. A protein-based snack D. Unstructured private time

A. Rest

Which statement is descriptive of clients with a personality disorder? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.

A. They are resistant to behavioral change.

A desirable short-term goal for the nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors would be A. making no attempts at self-harm within 12 hours of admission. B. sleeping soundly for 12 of the next 24 hours. C. willingly taking prescribed medication as offered by staff within 24 hours of admission. D. demonstrating psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission.

A. making no attempts at self-harm within 12 hours of admission.

The nurse is explaining that the destruction of pancreatic â-cells is the cause of which disorder? A. Type 1 diabetes B. Type 2 diabetes C. Impaired glucose tolerance D. Gestational diabetes

A. Type 1 diabetes

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 2 Alzheimer's disease? (Select all that apply.) A. Willingness to respond directly to questions posed by nurse B. Charming behavior designed to hide memory deficit C. Confabulation to compensate for forgotten information D. Avoidance of questions by subject changing

A. Willingness to respond directly to questions posed by nurse C. Confabulation to compensate for forgotten information

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? A. Withhold medication and notify the physician. B. Continue to administer medication as ordered. C. Advise the client to limit fluids for 12 hours. D. Advise the client to curtail salt intake for 24 hours.

A. Withhold medication and notify the physician.

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly A. agitation. B. lethargy. C. depression. D. mania.

A. agitation.

The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should A. allow him to use the razor under staff supervision. B. tell him he must use a safety razor provided by the unit. C. suggest that this would be a good time to grow a beard. D. give him the razor and ask him to return it when he is finished.

A. allow him to use the razor under staff supervision.

The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be A. day care. B. acute care hospitalization. C. long-term institutionalization. D. group home residency.

A. day care.

A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning she is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with A. delirium. B. dementia. C. amnesic disorder. D. selective inattention.

A. delirium.

Dementia in an older adult is often a misdiagnosis for A. depression. B. cerebral emboli. C. normal effects of aging. D. poor nutritional status.

A. depression.

The nurse is planning care for a child recently diagnosed with diabetes insipidus. The plan should include: A. encouraging the child to wear medical identification. B. discussing with the child and family ways to limit fluid intake. C. teaching the child and family how to do required urine testing. D. reassuring the child and family that this is usually not a chronic or life-threatening illness. Rationale

A. encouraging the child to wear medical identification. Because of the unstable nature of the child's fluid and electrolyte balance, this is an extremely important intervention. With diabetes insipidus the child should have unrestricted access to fluid. There is no required urine testing with diabetes insipidus. Diabetes insipidus is both lifelong and life threatening. The medication must be taken, and the effects monitored closely.

Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by A. having a staff member sit at the door and check packages as visitors enter. B. having a staff member make frequent rounds during visiting hours to inspect gifts. C. asking all visitors to report to the nurse's station before visiting a client. D. asking clients to give staff any unsafe item that might have been left by a visitor.

A. having a staff member sit at the door and check packages as visitors enter.

A client tells the nurse that he believes his situation is intolerable. The nurse assesses that the client is isolating socially. A nursing diagnosis that should be considered is A. hopelessness. B. deficient knowledge. C. chronic low self-esteem. D. compromised family coping.

A. hopelessness.

The nurse who is concerned about increased intracranial pressure in an infant should assess for: A. irritability. B. photophobia. C. pulsating anterior fontanel. D. vomiting and diarrhea.

A. irritability.

An initial intervention the nurse might suggest to the family members of a client diagnosed with Alzheimer's disease who has begun incontinence would be to A. label the bathroom door with a picture. B. provide toileting on an as-needed basis. C. apply disposable diapers. D. encourage hourly toileting.

A. label the bathroom door with a picture.

The first-line drug used to treat mania is A. lithium carbonate (Lithium). B. carbamazepine (Tegretol). C. lamotrigine (Lamictal). D. clonazepam (Klonopin).

A. lithium carbonate (Lithium).

An identical twin recently committed suicide. The parent tells the nurse, "Thank heavens suicide does not run in families. I won't have to worry about my other son." The nurse's response will be based on the understanding that this optimism is A. not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. B. justified because twin studies suggest no genetic factor is involved in suicide. C. unjustified because the parent has failed to consider the importance of the "copycat" factor. D. likely evidence of her denying the possibility of a parental role in the causation of the suicide.

A. not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide.

.The term "perceptual disturbance" refers to difficulty A. processing information about one's internal and external environment. B. changing one's way of thinking to accommodate new information. C. performing purposeful motor movements. D. formulating words appropriately.

A. processing information about one's internal and external environment.

The nurse is doing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. The MOST appropriate nursing assessment in this case is: A. reactivity of pupils. B. doll's head maneuver. C. oculovestibular response. D. funduscopic examination to identify papilledema.

A. reactivity of pupils.

A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be A. risk for injury. B. acute confusion. C. imbalanced nutrition. D. impaired environmental interpretation syndrome.

A. risk for injury.

The priority nursing diagnosis for a hyperactive manic client during the acute phase is A. risk for injury. B. ineffective role performance. C. risk for other-directed violence. D. impaired verbal communication.

A. risk for injury.

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by A. suggesting, "Let's look at what you just said, that you can 'never do anything right.'" B. querying, "Tell me what things you think you are not able to do correctly." C. asking, "Is this part of the reason you think no one likes you?" D. saying, "That is the most unrealistic thing I have ever heard."

A. suggesting, "Let's look at what you just said, that you can 'never do anything right.'"

To plan care for a manic client the nurse must consider that lithium cannot be started until A. the physical examination and laboratory tests are analyzed. B. the initial doses of antipsychotic medication have brought behavior under control. C. seclusion has proven ineffective as a means of controlling assaultive behavior. D. electroconvulsive therapy can be scheduled to coincide with lithium administration.

A. the physical examination and laboratory tests are analyzed.

The primary goal of milieu therapy for clients diagnosed with personality disorders is A. to manage the effect the behavior has on the entire group. B. to provide one-on-one therapy for each member of the milieu. C. to help the client remain uninvolved with other patients. D. to promote a laissez-faire attitude among the staff members.

A. to manage the effect the behavior has on the entire group.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to A. wait quietly for the client to reply. B. prompt the client if the reply is slow. C. repeat the question if the client does not answer promptly. D. review the client's medical record to support the client's response.

A. wait quietly for the client to reply.

When a client reports that lithium causes an upset stomach, the nurse suggests taking the medication: A. with meals B. with an antacid C. 30 minutes before meals D. 2 hours after meals

A. with meals

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to A. write in a diary. B. exercise in the gym. C. direct unit activities. D. orient a new client to the unit.

A. write in a diary.

alcohol diabetes

Alcohol inhibits gluconeogenesis (breakdown of glycogen to glucose) by the liver. This can cause severe hypoglycemia in patients on insulin or oral hypoglycemic medications that increase insulin secretion. Create a trusting environment where patients feel comfortable being honest about their use of alcohol because its use can make blood glucose more difficult to manage.

Giving immunotherapy

Always administer the allergen extract in an extremity away from a joint so that a tourniquet can be applied for a severe reaction. Rotate the site for each injection. Aspirate for blood before giving an injection to ensure that the allergen extract is not injected into a blood vessel. An injection directly into the bloodstream can potentiate an anaphylactic reaction. After giving the injection, carefully observe the patient for 20 to 30 minutes, since systemic reactions are most likely to occur immediately. However, warn the patient that a delayed reaction can occur as long as 24 hours later.

delirium

An acute, usually reversible alteration in consciousness typically accompanied by disturbances in thinking, memory, attention, and perception; has multiple causes.

What does CO2 do to the blood vessels

An increase in the partial pressure of CO2 in arterial blood (PaCO2) relaxes smooth muscle, dilates cerebral vessels, decreases cerebrovascular resistance, and increases CBF. A decrease in PaCO2 constricts cerebral vessels, increases cerebrovascular resistance, and decreases CBF.

mania

An unstable elevated mood in which delusion, poor judgment, and other signs of impaired reality testing are evident. During a manic episode patients have marked impairment of social, occupational, and interpersonal functioning.

Abx in sepsis

Antibiotics are an important and early component of therapy. They should be started within the first hour of severe sepsis or septic shock. Every hour delay has shown to significantly decrease survival.19 Obtain cultures (e.g., blood, wound exudate, urine, stool, sputum) before antibiotics are started. However, this should not delay the start of antibiotics within the first hour. Broad-spectrum antibiotics are given first. More specific antibiotics may be ordered once the organism has been identified.

Antipyretics and tbi

Antipyretic agents are usually ineffective with hyperthermia as a result of traumatic brain injury; therefore external cooling should be used

Lithium Severe Toxicity 2.0-2.5 mEq/L

Ataxia, giddiness, serious electroencephalographic changes, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension, coma. Death is usually secondary to pulmonary complications. Hospitalization is indicated. The drug is stopped, and excretion is hastened. If patient is alert, an emetic is administered.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is A. "That is a good observation. Depression does mostly strike people older than 50 years." B. "Depression is seen in people of all ages, from childhood to old age." C. "Depression is most often seen among the middle adult age group." D. "The age of onset for most depressive episodes is given as 18 years."

B. "Depression is seen in people of all ages, from childhood to old age."

An statement that would show acceptance of a depressed, mute client would be A. "I will be spending time with you each day to try to improve your mood." B. "I would like to sit with you for 15 minutes now and again this afternoon." C. "Each day we will spend time together to talk about things that are bothering you." D. "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

B. "I would like to sit with you for 15 minutes now and again this afternoon."

Which is the greatest protective factor against the risk of suicide? A. One or more previous suicide attempts B. A sense of responsibility to family, including spouse and children C. Fear of dying D. A cultural belief that suicide is a shameful resolution for a dilemma

B. A sense of responsibility to family, including spouse and children

Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation? A. Constipation B. Death anxiety C. Activity intolerance D. Self-care deficit: bathing/hygiene

B. Death anxiety

What statement about the comorbidity of depression is accurate? A. Depression most often exists in an individual as a single entity. B. Depression is commonly seen in individuals with medical disorders. C. Substance abuse and depression are seldom seen as comorbid disorders. D. Depression may coexist with other disorders but is rarely seen with schizophrenia.

B. Depression is commonly seen in individuals with medical disorders.

An assessment tool that is useful to nurses in rating suicide risk is the A. AIMS scale. B. Sad Persons scale. C. CAGE questionnaire. D. Mini-Mental Status Examination.

B. Sad Persons scale.

The family of a client diagnosed with Alzheimer's disease mentions to the nurse that seeing his loss of function has been very difficult. A nursing diagnosis that might be considered for such a family would be A. ineffective denial. B. anticipatory grieving. C. disabled family coping. D. ineffective family therapeutic regimen management.

B. anticipatory grieving.

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that is A. dark colored and modest. B. colorful and outlandish. C. compulsively neat and clean. D. ill-fitted and ragged.

B. colorful and outlandish

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of A. anger. B. denial. C. confusion. D. sympathy.

B. denial.

A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? A. The side-effects are unpleasant. B. The voices tell the client to stop taking it. C. The client prefers to feel "high" and energetic. D. The client feels well and denies the possibility of recurrence.

B. The voices tell the client to stop taking it.

The nurse should recognize that, when a child develops diabetic ketoacidosis, it is: A. an expected outcome. B. a life-threatening situation. C. best treated at home. D. best treated at the practitioner's office/clinic.

B. a life-threatening situation.

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will A. exhibit optimistic, energetic, playful behavior. B. adhere to follow-up medical appointments. C. take medication more than 50% of the time. D. use alcohol to moderate occasional mood "highs."

B. adhere to follow-up medical appointments.

A client diagnosed with Alzheimer's disease looks confused when the phone rings and cannot recall many common household objects by name, such as a pencil or glass. The nurse can document this loss of function as A. apraxia. B. agnosia. C. aphasia. D. anhedonia.

B. agnosia.

When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is A. hallucinating. B. experiencing an illusion. C. hypervigilant. D. demonstrating agnosia.

B. experiencing an illusion.

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat A. avocado salad plate. B. fruit and cottage cheese plate. C. kielbasa and sauerkraut. D. liver and onion sandwich.

B. fruit and cottage cheese plate. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident.

With regard to the classification of neonatal bacterial infection, nurses should be aware that: A. congenital infection progresses slower than health care-associated infection. B. health care-associated infection can be prevented by effective handwashing; early onset cannot. C. infections occur with about the same frequency in boy and girl infants, although female mortality is higher. D. the clinical sign of a rapid, high fever makes infection easier to diagnose.

B. health care-associated infection can be prevented by effective handwashing; early onset cannot.

An outcome for a manic client during the acute phase that would indicate that the treatment plan was successful would be that the client A. reports racing thoughts. B. is free of injury. C. is highly distractible. D. ignores food and fluid.

B. is free of injury.

The nurse is discharging a 10-year-old patient admitted to the hospital in diabetic ketoacidosis. The child has been newly diagnosed with type 1 diabetes mellitus (DM) on this admission. The nurse should teach the child and parents which signs of type 1? (Select all that apply.) A. weight gain B. nocturia C. irritability D. cool, clammy skin E. blurred vision

B. nocturia D. cool, clammy skin E. blurred vision

A suicidal individual calls a suicide hot line. This represents the level of intervention classified as A. primary. B. secondary. C. tertiary. D. quaternary.

B. secondary.

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to A. question the client's motive. B. set verbal limits. C. initiate physical confrontation. D. prepare the client for seclusion.

B. set verbal limits.

Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.

B. splitting.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: A. with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. at birth, the neonate of a diabetic mother is no longer at any greater risk.

B. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

he nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the client's A. energy level. B. weekly weights. C. observed eating patterns. D. statement of appetite.

B. weekly weights.

Bipolar 1 and 2

Bipolar 1 more common in men Bipolar 2 more common in women Women with bipolar disorders are more likely to abuse alcohol, commit suicide, and develop thyroid disease; men with bipolar disorder are more likely to have legal problems and commit acts of violence.

breast feeding sepsis newborns

Breastfeeding (medically stable infants) or feeding the newborn expressed breast milk from the mother is encouraged. Breast milk provides protective mechanisms. Colostrum contains IgA, which offers protection against infection in the GI tract. Human milk contains iron-binding protein that exerts a bacteriostatic effect on E. coli. Human milk also contains macrophages and lymphocytes. The vulnerability of infants to common mucosal pathogens such as RSV may be reduced by passive transfer of maternal immunity in the colostrum and breast milk. There is evidence that early enteral feedings with human milk are beneficial in establishing a natural barrier to infection in ELBW and VLBW infants (Hanson, 2007). Human milk is also thought to provide some degree of protection from NEC.

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with post-partum depression. A. Impaired parenting B. Ineffective role performance C. Health-seeking behaviors D. Risk for impaired parent/infant/child attachment

C. Health-seeking behaviors

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of A. self-blame. B. catatonia. C. learned helplessness. D. discounting positive attributes.

C. learned helplessness.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be A. "What an offensive thing to suggest!" B. "I don't have sex with clients." C. "It's time to work on your art project." D. "Let's walk down to the seclusion room."

C. "It's time to work on your art project."

Hallucinations

are false sensory stimuli

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The nurse's BEST reply is: A. "The pills work with an adult pancreas only." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

C. "Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. In type 1 diabetes, the b-cells have been destroyed. It is necessary to supply the insulin that they no longer produce. In type 1 diabetes, the b-cells are destroyed. Without a pancreas b-cell transplant, it is unlikely that insulin would be produced.

Which room placement would be best for a client experiencing a manic episode? A. A shared room with a client with dementia B. A single room near the unit activities area C. A single room near the nurses' station D. A shared room away from the unit entrance

C. A single room near the nurses' station

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? A. γ-Aminobutyric acid B. Dopamine C. Serotonin D. Acetylcholine

C. Serotonin

A 17-year-old boy with diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. The nurse should: A. Tell him not to do this. B. Ask him why he is drinking alcohol. C. Teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake. D. Recommend counseling so he understands the serious consequences of alcohol consumption.

C. Teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake.

The temperature of an adolescent who is unconscious is 105° F. The PRIORITY nursing action is to: A. continue to monitor temperature. B. initiate a pain assessment. C. apply a hypothermia blanket. D. administer acetaminophen or ibuprofen.

C. apply a hypothermia blanket.

The priority nursing intervention for a client diagnosed with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.

C. assess for suicidal and self-mutilating behaviors.

The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has A. paranoid personality disorder and is suspicious of his neighbors. B. narcissistic personality disorder and is highly self-important. C. borderline personality disorder and is impulsive. D. dependent personality disorder

C. borderline personality disorder and is impulsive.

A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of A. bipolar II disorder. B. bipolar I disorder. C. cyclothymia. D. seasonal affective disorder.

C. cyclothymia.

The nurse is caring for a 2-year-old girl who is unconscious but stable following a car accident. Her parents are staying at the bedside most of the time. An appropriate nursing intervention is to: A. suggest that the parents go home until she is alert enough to know that they are present. B. use ointment on her lips but do not attempt to cleanse her teeth until swallowing returns. C. encourage the parents to hold, talk, and sing to her as they usually would. D. position her with proper body alignment and head of bed lowered 15 degrees.

C. encourage the parents to hold, talk, and sing to her as they usually would.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on knowledge that: A. exercise is contraindicated. B. soccer and baseball are too strenuous, but swimming is acceptable. C. exercise is not restricted unless indicated by other health conditions. D. the level of activity depends on the type of insulin required.

C. exercise is not restricted unless indicated by other health conditions.

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of: A. birth injury. B. hypocalcemia. C. hypoglycemia. D. seizures.

C. hypoglycemia.

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit A. frequent episodes of psychosis. B. constant involvement with the needs of significant others. C. inflexible and maladaptive responses to stress. D. abnormal ego functioning.

C. inflexible and maladaptive responses to stress.

Inaccurate ICP readings can be caused by

CSF leaks around the monitoring device, obstruction of the intraventricular catheter (from tissue or blood clot), a difference between the height of the catheter and the transducer, kinks in the tubing, and incorrect height of the drainage system relative to the patient's reference point. Bubbles or air in the tubing can also dampen the waveform.

Lithium Advanced Signs of Toxicity 1.5-2.0 mEq/L

Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographic changes, incoordination, sedation Interventions outlined above or below should be used, depending on severity of circumstances.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: A. mother's age. B. number of years since diabetes was diagnosed. C. amount of insulin required prenatally. D. degree of glycemic control during pregnancy.

D. degree of glycemic control during pregnancy.

Insulin drip for kids

Continuous IV regular insulin is given at a dosage of 0.1 units/kg/hr.

Lithium Severe toxicity >2.5 mEq/L

Convulsions, oliguria, and death can occur In addition to the interventions above, hemodialysis may be used in severe cases.

Type II:

Cytotoxic hypersensitivity reactions involving the direct binding of IgG or IgM antibodies to an antigen on the cell surface. A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. Naturally acquired antibodies to antigens of the ABO blood group are in the recipient's serum but are not present on the erythrocyte membranes (see Table 29-8). For example, a person with type A blood has anti-B antibodies, a person with type B blood has anti-A antibodies, a person with type AB blood has no antibodies, and a person with type O blood has anti-A and anti-B antibodies.

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be A. "That will be fine. I'll have you sign our hospital release form." B. "Because we do not have a copy of durable power of attorney, we cannot release them to you." C. "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." D. "I would like to have your mother wear them. It will help her to be less confused."

D. "I would like to have your mother wear them. It will help her to be less confused."

Which statement is a fact about suicide? A. More women than men commit suicide. B. Suicide is the tenth leading cause of death in the United States. C. Native Americans and Alaskan Natives have low suicide rates. D. A client with schizophrenia is at great risk for attempting suicide.

D. A client with schizophrenia is at great risk for attempting suicide.

Which type of dementia has a clear genetic link? A. Alcohol-induced dementia B. Multi-infarct dementia C. Creutzfeldt-Jakob disease D. Alzheimer's disease

D. Alzheimer's disease

Which problem is NOT considered a causative agent in delirium? A. Elevated blood urea nitrogen levels B. Infection C. Anticholinergic drugs D. Antibiotic therapy

D. Antibiotic therapy

What nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? A. Suctioning child frequently B. Providing environmental stimulation C. Turning head side to side every hour D. Avoiding activities that cause pain or crying

D. Avoiding activities that cause pain or crying

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray? A. Plastic plate B. Cloth napkin C. Styrofoam cup D. Metal utensils

D. Metal utensils

The nurse is caring for an infant who is suspected to have neonatal sepsis. Which neonatal risk factor for an infant with suspected neonatal sepsis would the nurse expect to observe? A. Large for gestational age (LGA) and an infant of a diabetic mother B. Small for gestational age (SGA) and intrauterine growth restriction C. Singleton gestation and female D. Multiple gestation and low birth weight

D. Multiple gestation and low birth weight

Why are infants particularly vulnerable to acceleration-deceleration head injuries? A. The anterior fontanel is not yet closed. B. The nervous tissue is not well developed. C. The scalp of the head has extensive vascularity. D. Musculoskeletal support of head is insufficient.

D. Musculoskeletal support of head is insufficient.

Which event would a client with early stage 4 Alzheimer's disease have greatest difficulty remembering? A. His or her high school graduation B. The births of his or her children C. The story of a teenage escapade D. What he or she ate for breakfast

D. What he or she ate for breakfast

v]The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with A. antihypertensives. B. benzodiazepines. C. immunosuppressants. D. acetylcholinesterase inhibitors.

D. acetylcholinesterase inhibitors.

When working with a client who may have made a covert reference to suicide, the nurse should A. be careful not to mention the idea of suicide. B. listen carefully to see whether the client mentions it a second time. C. ask about the possibility of suicidal thoughts in a covert way. D. ask the client directly if he or she is thinking of attempting suicide.

D. ask the client directly if he or she is thinking of attempting suicide.

Dysthymia cannot be diagnosed unless it has existed for A. at least 3 months. B. at least 6 months. C. at least 1 year. D. at least 2 years.

D. at least 2 years.

rapid cycling

Experiencing four or more mood episodes in a 12-month period.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: A. oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. B. dietary modifications and insulin are both required for adequate treatment. C. glucose levels are monitored by testing urine 4r times a day and at bedtime. D. dietary management involves distributing nutrient requirements over three meals and two or three snacks.

D. dietary management involves distributing nutrient requirements over three meals and two or three snacks.

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions that she will take the medication along with the St. John's wort she uses daily. The nurse should A. agree that taking the drugs at the same time will help her remember them daily. B. caution the client to drink several glasses of water daily. C. suggest that the client also use a sun lamp daily. D. explain the high possibility of an adverse reaction.

D. explain the high possibility of an adverse reaction.

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying A. flight of ideas. B. distractibility. C. limit testing. D. grandiosity.

D. grandiosity.

When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse will include information related to local A. day care centers. B. family support groups. C. professional counseling. D. legal professionals.

D. legal professionals.

The nurse proposes that a suicidal client enter into a no-suicide contract. Such a contract would contain a provision that the client promises A. never to attempt suicide. B. to alert someone if he or she has made an attempt. C. not to consider suicide for 72 hours. D. not to attempt suicide in the next 24 hours.

D. not to attempt suicide in the next 24 hours.

When a client experiences four or more mood episodes in a 12-month period, the client is said to be A. dyssynchronous. B. incongruent. C. cyclothymic. D. rapid cycling.

D. rapid cycling.

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should A. say "I understand" and allow the client to close the door. B. keep the door open, but step to the side out of the client's view. C. leave the client's room and wait outside in the hall. D. say "For your safety I can be no more than an arm's length away."

D. say "For your safety I can be no more than an arm's length away."

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that A. no research exists to suggest genetic transmission. B. much depends on the socioeconomic class of the individuals. C. highly creative people tend toward development of the disorder. D. the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

D. the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

A depressed client tells the nurse he is in the "acute phase" of his treatment for depression. The nurse recognizes that the client has been in treatment A. for more than 4 months. B. that is directed toward relapse prevention. C. that focuses on prevention of future depression. D. to reduce depressive symptoms.

D. to reduce depressive symptoms.

Clinical Manifestations DKA

Dehydration occurs in DKA with manifestations of poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyes become soft and sunken. Abdominal pain may be present and accompanied by anorexia, nausea, and vomiting. Kussmaul respirations (rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess CO2.

Type IV:

Delayed Hypersensitivity Clinical examples of a delayed hypersensitivity reaction include contact dermatitis; hypersensitivity reactions to bacterial, fungal, and viral infections; and transplant rejections.

Nutrition post brain injury

Early feeding after brain injury may improve patient outcome.9 Nutritional replacement should begin within 3 days after injury to reach full nutritional replacement within 7 days after the injury is sustained.

What causes sepsis in new borns

Early-onset sepsis is acquired in the perinatal period; infection can occur from direct contact with organisms from the maternal GI and genitourinary tracts. The most common infecting organisms are Escherichia coli and group B streptococcus (GBS) . coli, which may be present in the vagina, accounts for approximately half of all cases of sepsis caused by gram-negative organisms. GBS is an extremely virulent organism in neonates, with a high (50%) death rate in affected infants. Other bacteria noted to cause early-onset infection include Haemophilus influenzae, Citrobacter and Enterobacter organisms, coagulase-negative staphylococci, and Streptococcus viridans. Other pathogens that are harbored in the vagina and may infect the infant include gonococci, Candida albicans, herpes simplex virus (HSV) type 2, and chlamydia.

Caloric test, or oculovestibular response (RS)—

Elicited with the child's head up (head of bed is elevated 30 degrees) by irrigating the external auditory canal with 10 mL of ice water for 20 seconds, which normally causes conjugate movement of the eyes toward the side of stimulation. This movement is lost when the pontine centers are impaired, thus providing important information in assessment of the comatose patient.

Illness with diabetes

Even common illnesses such as a viral upper respiratory tract infection or the flu can cause this response. Encourage patients with diabetes to check blood glucose at least every 4 hours during times of illness. Acutely ill patients with type 1 diabetes with a blood glucose greater than 240 mg/dL (13.3 mmol/L) should also check urine for ketones every 3 to 4 hours. When illness causes patients to eat less than normal, they can continue to take OAs, noninsulin injectable agents, and/or insulin as prescribed while supplementing food intake with carbohydrate-containing fluids. Examples include low-sodium soups, juices, and regular, sugar-sweetened decaffeinated soft drinks. It is important to tell the patient to contact an HCP if he or she is unable to keep down food or fluid.

Glucose in sepsis

Glucose levels should be maintained below 180 mg/dL (10.0 mmol/L) for patients in shock

(glycogenolysis)

Glycogen stores are rapidly converted to glucose

Tx for anaphylaxis

IM epinephrine is the first drug of choice to treat anaphylactic shock.7,8 It causes peripheral vasoconstriction and bronchodilation and opposes the effect of histamine. Diphenhydramine and ranitidine (Zantac) are given as adjunctive therapies to block the ongoing release of histamine from the allergic reaction. Nebulized bronchodilators are highly effective. Aerosolized epinephrine can also be used to treat laryngeal edema. Endotracheal intubation or cricothyroidotomy may be necessary to secure and maintain a patent airway.

Prevention of somogyi

If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 and 4:00 AM for hypoglycemia will help determine if the cause is the Somogyi effect. The patient may report headaches on awakening and recall having night sweats or nightmares. A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect. treatment for Somogyi effect is less insulin in the evening

Fixed pupils

If pupils are fixed bilaterally for more than 5 minutes, brainstem damage is usually implied. Dilated and nonreactive pupils are also seen in hypothermia, anoxia, ischemia, poisoning with atropine-like substances, or prior instillation of mydriatic drugs. The sudden appearance of a fixed and dilated pupil(s) is a neurologic emergency.

What can happen if you give insulin in hypokalemia

If the patient is hypokalemic, insulin administration will further decrease the potassium levels, making early potassium replacement essential. Although initial serum potassium may be normal or high, levels can rapidly decrease once therapy starts as insulin drives potassium into the cells, leading to life-threatening hypokalemia.

What happens if pt gets incompatible blood

If the recipient is transfused with incompatible blood, antibodies immediately coat the foreign erythrocytes, causing agglutination (clumping). The clumping of cells blocks small blood vessels in the body, uses existing clotting factors, and depletes them, leading to bleeding. Within hours, neutrophils and macrophages phagocytize the agglutinated cells. The complement system is activated and cell lysis occurs, which causes the release of hemoglobin into the urine and plasma. Acute kidney injury can result from the hemoglobinuria.

Type I:

IgE-Mediated Anaphylactic reactions are type I reactions that occur only in susceptible people who are highly sensitized to specific allergens. IgE antibodies, produced in response to the allergen, have a characteristic property of attaching to mast cells and basophils In this process, the mediators that are released attack target tissues, causing clinical symptoms of an allergic response. These effects include smooth muscle contraction, increased vascular permeability, vasodilation, hypotension, increased secretion of mucus, and itching.

Type III:

Immune-Complex autoimmune diseases Type III reactions may be local or systemic and immediate or delayed. The clinical manifestations depend on the number of complexes and the location in the body. Common sites for deposit are the kidneys, skin, joints, blood vessels, and lungs. Severe type III reactions are associated with autoimmune disorders such as systemic lupus erythematosus, acute glomerulonephritis, and rheumatoid arthritis

Another disruptive trait common in persons with borderline personality disorder is impulsivity.

Impulsivity is manifested in acting quickly in response to emotions without considering the consequences. This impulsivity results in damaged relationships and even in suicide attempts.

Motor function

In patients with cerebellum abnormalities heel-to-toe walking is difficult. Patients with cerebellar ataxia have an unsteady, broad-based gait. All motor functions should be described rather than labeled.

What happens when pt has delirium and has dementia

In patients with preexisting cognitive impairment (for example, dementia), there is an acceleration of cognitive decline.

What is happening to your pt when giving insulin

Insulin allows water and potassium to enter the cell along with glucose and can lead to a depletion of vascular volume and hypokalemia, so monitor the patient's fluid balance and potassium levels.

How long can you keep insulin once open

Insulin bottles that have been "opened" (i.e., the stopper has been punctured) should be stored at room temperature or refrigerated for up to 28 to 30 days. After 1 month, these vials should be discarded.

Insulin drip dose

Insulin is immediately started at 0.1 U/kg/hr by a continuous infusion

The glucose-lowering effects of exercise can last up to 48 hours after the activity, so it is possible for hypoglycemia to occur long after the activity.

It is recommended that patients who use medications that can cause hypoglycemia schedule exercise about 1 hour after a meal or that they have a 10- to 15-g carbohydrate snack and check their blood glucose before exercising. They can eat small carbohydrate snacks every 30 minutes during exercise to prevent hypoglycemia. Patients using medications that place them at risk for hypoglycemia should always carry a fast-acting source of carbohydrate, such as glucose tablets or hard candies, when exercising.

Ketones in urine should be tested

It is recommended that urine be tested for ketones every 3 hours during an illness or whenever the blood glucose level is over 240 mg/dL when illness is not present.

OD's on psyc meds

Lethal overdose is nearly impossible with selective serotonin reuptake inhibitors (SSRIs); however, overdose remains a concern with tricyclic antidepressants and monoamine oxidase inhibitors.

Basilar skull fracture

Manifestations can evolve over the course of several hours; vary with the location and severity of fracture; and may include cranial nerve deficits, Battle's sign (postauricular ecchymosis), and periorbital ecchymosis (raccoon eyes). This fracture generally is associated with a tear in the dura and subsequent leakage of CSF.

non-suicidal self-injury

Manifested by deliberate and direct attempts to cause bodily harm with no intent to cause death.

treatment for icp

Mannitol decreases the ICP in two ways: plasma expansion and osmotic effect. The immediate plasma-expanding effect reduces the hematocrit and blood viscosity, thereby increasing CBF and cerebral O2 delivery. Hypertonic saline solution is another drug treatment used to manage increased ICP. It produces massive movement of water out of edematous swollen brain cells and into blood vessels. This movement of water out of the brain can reduce swelling and improve cerebral blood flow. Hypertonic solution infusion requires frequent monitoring of BP and serum sodium levels because intravascular fluid volume excess can occur. Corticosteroids (e.g., dexamethasone) are used to treat vasogenic edema surrounding tumors and abscesses. However, these drugs are not recommended for traumatic brain injury. High doses of barbiturates (e.g., pentobarbital, thiopental) are used in patients with increased ICP refractory to other treatments. Barbiturates decrease cerebral metabolism, causing a decrease in ICP and a reduction in cerebral edema. When this treatment is used, monitor the patient's ICP, blood flow, and EEG.

What should you always suspect as cause of delirium

Medications should always be suspected as a potential cause of delirium (

Lithium Early Signs of Toxicity 1.5 mEq/L

Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, and fine hand tremor Medication should be withheld, blood lithium levels measured, and dosage reevaluated.

how do infants fight infection

Neonatal neutrophils are present in term infants but have decreased functional capabilities; response to infections is sluggish. Phagocytosis is less efficient.

Normal CPP

Normal CPP is 60 to 100 mm Hg

K+ in kids

Serum potassium levels may be normal on admission, but after fluid and insulin administration, the rapid return of potassium to the cells can seriously deplete serum levels, with the attendant risk for cardiac dysrhythmias. As soon as the child has established renal function (is voiding at least 25 mL/hr) and insulin has been given, vigorous potassium replacement is implemented. The cardiac monitor is used as a guide to therapy, and configuration of T waves should be observed every 30 to 60 minutes to determine changes that might indicate alterations in potassium concentration (widening of the QT interval and the appearance of a U wave following a flattened T wave indicate hypokalemia; an elevated and spreading T wave and shortening of the QT interval indicate hyperkalemia).

Borderline Personality Disorder Characteristics

Shows separation anxiety Manifests ideas of reference Impulsive (suicide, self-mutilation) Engages in splitting (adoring then devaluing persons)

Bicarb in kids

Sodium bicarbonate is used conservatively; it is used for pH less than 7.0, severe hyperkalemia, or cardiac instability. Because sodium bicarbonate has been associated with an increased risk for cerebral edema, children receiving this substance must be carefully monitored for changes in level of consciousness

hypersensitivity reactions

Sometimes the immune response is overreactive against foreign antigens or reacts against its own tissue, resulting in tissue damage.

splitting

Splitting refers to the inability to view both positive and negative aspects of others as part of a whole. This results in viewing someone as either a wonderful person or a horrible person.

What happens with low po2 and acidotic states

The combination of a severely low partial pressure of O2 in arterial blood (PaO2) and an elevated hydrogen ion concentration (acidosis), which are both potent cerebral vasodilators, may produce a state in which autoregulation is lost and compensatory mechanisms fail to meet tissue metabolic demands.

Fastest absorption for sq insulin

The fastest subcutaneous absorption is from the abdomen, followed by the arm, thigh, and buttock. Although the abdomen is often the preferred injection site, other sites also work well

test for csf

The first method is to test the leaking fluid with a Dextrostix or Tes-Tape strip to determine whether glucose is present. CSF gives a positive reading for glucose. If blood is present in the fluid, testing for glucose is unreliable because blood also contains glucose. In this event, look for the halo or ring sign

Hydration guidelines for pedi dka

The initial hydrating solution is 0.9% saline solution. Traditionally, deficits have been replaced at a rate of 50% over the first 8 to 12 hours and the remaining 50% over the next 16 to 24 hours.

Patients who are undergoing surgery or any radiologic procedures that involve the use of a contrast medium are instructed to temporarily discontinue metformin before surgery or the procedure.

They should not resume the metformin until 48 hours afterward, once their serum creatinine has been checked and is normal.

Lithium must reach therapeutic levels in the patient's blood to be effective.

This usually takes 7 to 14 days, or longer for some patients.

MAP and cerebral blood flow

The lower limit of systemic arterial pressure at which autoregulation is effective in a normotensive person is a mean arterial pressure (MAP) of 70 mm Hg. Below this, CBF decreases, and symptoms of cerebral ischemia, such as syncope and blurred vision, occur. The upper limit of systemic arterial pressure at which autoregulation is effective is a MAP of 150 mm Hg. When this pressure is exceeded, the vessels are maximally constricted, and further vasoconstrictor response is lost.

Nursing interventions child dka

The priority is to obtain a venous access for administration of fluids, electrolytes, and insulin. The child should be weighed, measured, and placed on a cardiac monitor. Blood glucose and ketone levels are determined at the bedside, and samples are obtained for laboratory measurement of glucose, electrolytes, BUN, arterial pH, PO2, PCO2, hemoglobin, hematocrit, white blood cell count and differential, calcium, and phosphorus.

treatment dawn phenomenon

The treatment for dawn phenomenon is an increase in insulin or an adjustment in administration time.

syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH frequently accompanies CNS diseases such as head injury, meningitis, encephalitis, brain abscess, brain tumor, and subarachnoid hemorrhage.

The treatment of SIADH consists of restriction of fluids until serum electrolytes and osmolality return to normal levels.

what maternal drugs increase risk for dka in gestational diabetes pts

The use of beta-mimetic drugs such as terbutaline (Brethine) for tocolysis to stop preterm labor or corticosteroids given to enhance fetal lung maturation may also contribute to the risk for hyperglycemia and subsequent DKA

Many patients with asthma have an allergic component to their disease.

These patients frequently have a history of atopic disorders (e.g., infantile eczema, allergic rhinitis, food intolerances)

Drugs for lithium resistance

Valproate (available as divalproex sodium [Depakote] and valproic acid [Depakene]) is useful in treating lithium nonresponders who are in acute mania, experience rapid cycles, are in dysphoric mania, or have not responded to carbamazepine

Tx for septic shock

Volume resuscitation of 30 to 50 mL/kg is usually done with isotonic crystalloids to achieve adequate fluid resuscitation. Albumin 4% to 5% may be added when patients require substantial volumes. A fluid challenge technique (e.g., to achieve a minimum of 30 mL/kg of crystalloids) is used and repeated until hemodynamic improvement (e.g., increase in MAP and/or CVP, change in SVV) is noted presents predetermined end points of fluid resuscitation along with methods to reassess volume status. If the patient remains hypotensive after initial volume resuscitation with minimally 30 mL/kg and the patient is no longer fluid responsive, vasopressors may be added. The first drug of choice is norepinephrine.

Localized reaction

When the mediators remain localized, a cutaneous response termed the wheal-and-flare reaction occurs. A classic example of a wheal-and-flare reaction is the mosquito bite.

Post partum psychosis

Women who experience a severe postpartum psychosis within two weeks of giving birth have a four times greater chance of subsequent conversion to bipolar disorder

Self-destructive behaviors

are prominent in this disorder. Ineffective and often harmful self-soothing habits, such as cutting, promiscuous sexual behavior, and numbing with substances are common and may result in unintentional death. Chronic, suicidal ideation is also a common feature of this disorder and influences the likelihood of accidental deaths.

Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to one drink." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose-lowering medication." d. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

a. "I will limit my alcohol intake to one drink."

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mm Hg c. FBG 130 mg/dL (7.2 mmol/L) d. LDL cholesterol 100 mg/dL (2.6 mmol/L)

a. A1C 9%

You are admitting Joel, a 39-year-old patient with depression. Which assessment statement(s) would be appropriate to ask Joel to assess suicide risk? Select all that apply. a. Do you ever think about suicide? b. Are you thinking of hurting yourself? c. Do you sometimes wish you were dead? d. Has it ever seemed as if life is not worth living? e. If you were to kill yourself, how would you do it? f. Does it seem as if others might be better off if you were dead?

a. Do you ever think about suicide? b. Are you thinking of hurting yourself? c. Do you sometimes wish you were dead? d. Has it ever seemed as if life is not worth living? e. If you were to kill yourself, how would you do it? f. Does it seem as if others might be better off if you were dead?

The reason newborns are protected for the first 6 months of life from bacterial infections is because of the maternal transmission of a. IgG. b. IgA. c. IgM. d. IgE.

a. IgG.

Dysfunction of cranial nerves IX and X places the child at risk for

aspiration and cardiac arrest; therefore the child is positioned to prevent aspiration of secretions, and the stomach is emptied to reduce the likelihood of vomiting

Which intervention(s) maximize the safety of a patient who is actively suicidal on an inpatient mental health unit? Select all that apply. a. Place the patient on every-15-minute checks. b. Place the patient in a room near the nurses' station. c. Allow the patient periods of time alone for reflection to promote self-awareness. d. Install breakaway curtain rods, coat hooks, and shower rods. e. Allow the patient to keep personal objects such as a razor and hair dryer in his room to demonstrate trust. f. Assign the patient to a private room to facilitate monitoring.

a. Place the patient on every-15-minute checks. b. Place the patient in a room near the nurses' station. d. Install breakaway curtain rods, coat hooks, and shower rods.

You are preparing Genevieve, an 86-year-old patient diagnosed with Alzheimer's disease, for discharge and giving discharge education to Genevieve's family, who will be caring for her. Which of the following intervention(s) would be beneficial to teach Genevieve's family? Select all that apply. a. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other physical care of the patient. b. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them. c. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic. d. Recognize that the patient can no longer successfully interact with others; provide a darkened, quiet room for her to spend her time. e. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care. f. If the patient is prone to wandering away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description.

a. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other physical care of the patient. b. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them. c. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic. e. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care. f. If the patient is prone to wandering away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description.

A major principle the nurse should observe when communicating with a patient experiencing elated mood is to: a. Use a calm, firm approach. b. Give expanded explanations. c. Make use of abstract concepts. d. Encourage lightheartedness and joking.

a. Use a calm, firm approach.

Which are appropriate therapies for patients with diabetes mellitus (select all that apply)? a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy

a. Use of statins to reduce CVD risk c. Use of ACE inhibitors to treat nephropathy e. Use of laser photocoagulation to treat retinopathy

The nurse is alerted to possible anaphylactic shock immediately after a patient has received IM penicillin by the development of a. edema and itching at the injection site. b. sneezing and itching of the nose and eyes. c. a wheal-and-flare reaction at the injection site. d. chest tightness and production of thick sputum.

a. edema and itching at the injection site.

During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for a. patency of airway. b. presence of a neck injury. c. neurologic status with the Glasgow Coma Scale. d. cerebrospinal fluid leakage from the ears or nose.

a. patency of airway.

Predisposing factors for delirium include

age, lower education level, sensory impairment, decreased functional status, comorbid medical conditions, malnutrition, and depression

gluconeogenesis

amino acids are converted to glucose (gluconeogenesis)

cardinal symptoms of delirium are

an alteration in level of consciousness, which manifests as altered awareness and an inability to direct, focus, sustain, and shift attention; an abrupt onset with clinical features that fluctuate (including periods of lucidity); and disorganized thinking and poor executive functioning. Other characteristics include disorientation (often to time and place and rarely to first person), anxiety, agitation (motor restlessness), poor memory (recall), delusional thinking, and hallucinations, usually visual.

Persons with borderline personality disorder often respond to the following treatments all are off label uses

anticonvulsant mood-stabilizing medications, low-dose antipsychotics, and omega-3 supplementation for mood and emotion dysregulation symptoms. Naltrexone, an opioid receptor antagonist has been found to reduce self-injuring behaviors.

Illusions

are errors in perception of sensory stimuli. A person may mistake folds in the bedclothes for white rats or the cord of a window blind for a snake.

Primary injury occurs

at the initial time of an injury (e.g., impact of car accident, blunt-force trauma) that results in displacement, bruising, or damage to any of the three components.

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? a. A low starting dose of a tricyclic antidepressant b. An SSRI given initially with an MAOI c. Electroconvulsive therapy to treat suicidal thoughts d. Elavil to address the patient's agitation

b. An SSRI given initially with an MAOI

Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply. a. Focus primarily on developing solutions to the problems that are leading the patient to feel suicidal. b. Assess the patient thoroughly, and reassess the patient at regular intervals as levels of risk fluctuate. c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

b. Assess the patient thoroughly, and reassess the patient at regular intervals as levels of risk fluctuate. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

Josie, a 27-year-old patient, complains that most of the staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect? a. Obsessive-compulsive b. Borderline c. Antisocial d. Schizotypal

b. Borderline

For assessment purposes, the nurse should identify the body system most at risk for decompensation during a severe manic episode as: a. Renal b. Cardiac c. Endocrine d. Pulmonary

b. Cardiac

Intervention(s) appropriate for Evelyn and other hospitalized patients experiencing delirium include which of the following? Select all that apply. a. Immediately placing the patient in restraints if she begins to hallucinate or act irrationally or unsafely b. Ensuring that a clock and a sign indicating the day and date are displayed where the patient can see them easily c. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care d. Preventing sensory deprivation by placing the patient near the nurses' station and leaving the television and multiple lights turned on 24 hours per day e. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety f. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering

b. Ensuring that a clock and a sign indicating the day and date are displayed where the patient can see them easily c. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care e. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety f. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering

Griffin is a 19-year-old student who volunteers for a depression screening at his college. He identifies himself as gay. Which of the following is true based on current knowledge of the gay, lesbian, and bisexual community and suicide risk? a. Griffin's sexual preference has no bearing on suicide risk. b. Griffin has a higher suicide risk than his heterosexual peers. c. Griffin has a lower suicide risk than his heterosexual peers. d. Griffin may experience a threefold risk for a mood disorder in his lifetime because of his sexual preference.

b. Griffin has a higher suicide risk than his heterosexual peers.

Nadia has been diagnosed with bipolar disorder. Which is an outcome for Nadia in the continuation of treatment phase of bipolar disorder? a. Patient will avoid involvement in self-help groups. b. Patient will adhere to medication regimen. c. Patient will demonstrate euphoric mood. d. Patient will maintain normal weight.

b. Patient will adhere to medication regimen.

Evelyn, a 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated and from laughing to angry shouting. Her daughter reports that the patient "was never like this at home." What is the most likely explanation for the situation? a. Pneumonia has worsened the patient's early-stage dementia. b. The patient is experiencing delirium secondary to the pneumonia. c. The patient is sundowning due to the decreased stimulation of the intensive care unit. d. The patient does not want to be in the hospital and is angry that staff will not let her leave.

b. The patient is experiencing delirium secondary to the pneumonia.

Which statement about persons with personality disorders is accurate? a. They, unlike those with mood or psychotic disorders, are at very low risk of suicide. b. They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. c. They are believed to be purely psychological disorders, that is, disorders arising from psychological rather than neurological or other physiological abnormalities. d. Their symptoms are not as disabling as most other mental disorders; therefore, their care tends to be less challenging and complicated for staff.

b. They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them.

Which symptom related to communication is likely to be present in a patient experiencing mania? a. Mutism b. Verbosity c. Poverty of ideas d. Confabulation

b. Verbosity

Vasogenic cerebral edema increases intracranial pressure by a. shifting fluid in the gray matter. b. altering the endothelial lining of cerebral capillaries. c. leaking molecules from the intracellular fluid to the capillaries. d. altering the osmotic gradient flow into the intravascular component.

b. altering the endothelial lining of cerebral capillaries.

What can cause dka

• Undiagnosed diabetes mellitus • Inadequate treatment of existing diabetes mellitus • Insulin not taken as prescribed • Infection • Change in eating, insulin, or exercise plan • Malfunction of insulin pump/nondelivery of insulin

Immunocompetence

exists when the body's immune system can identify and inactivate or destroy foreign substances. When the immune system is incompetent or underresponsive, severe infections, immunodeficiency diseases, and malignancies may occur. 197When the immune system overreacts, hypersensitivity disorders such as allergies and autoimmune diseases may develop.

Which person is at the highest risk for suicide? a. A 50-year-old married white male with depression who has a plan to overdose if circumstances at work do not improve. b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager. c. A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. d. An older Hispanic male who is Catholic, is living with a debilitating chronic illness, is recently widowed, and states: "I wish that God would take me too."

c. A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden

What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. Call the physician. b. Administer insulin as ordered. c. Check the patient's blood glucose level. d. Assess for other neurologic symptoms.

c. Check the patient's blood glucose level.

The nurse is alerted to a possible acute subdural hematoma in the patient who a. has a linear skull fracture crossing a major artery. b. has focal symptoms of brain damage with no recollection of a head injury. c. develops decreased level of consciousness and a headache within 48 hours of a head injury. d. has an immediate loss of consciousness with a brief lucid interval followed by decreasing level of consciousness.

c. develops decreased level of consciousness and a headache within 48 hours of a head injury.

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of a. polyuria. b. severe dehydration. c. rapid, deep respirations. d. decreased serum potassium

c. rapid, deep respirations.

One function of cell-mediated immunity is a. formation of antibodies. b. activation of the complement system. c. surveillance for malignant cell changes. d. opsonization of antigens to allow phagocytosis by neutrophils.

c. surveillance for malignant cell changes.

Anaphylaxis

can occur when mediators are released systemically (e.g., after injection of a drug, after an insect sting). The reaction occurs within minutes and can be life threatening because of bronchial constriction and subsequent airway obstruction and vascular collapse.

Women with gestational diabetes have a higher risk for

cesarean delivery, and their babies have increased risk for perinatal death, birth injury, and neonatal complications.

Lacey, a 19-year-old patient, shows you multiple fresh, serious (but non-life-threatening) self-inflicted cuts on her forearm. Which response would be most therapeutic? a. "I'm so sorry you felt so bad that you cut yourself! Let's discuss what led up to this action while I take care of your wounds." b. "I will take care of the wounds first, then you will have to be searched for anything else you could injure yourself with." c. "I can give you some Band-Aids for you to put on your cuts, but you need to stop this attention-seeking behavior." d. "After I care for your wounds, I'd like you to write down what you were thinking and feeling before you cut yourself; then we will discuss it."

d. "After I care for your wounds, I'd like you to write down what you were thinking and feeling before you cut yourself; then we will discuss it."

A nurse is educating a patient about the causes of depression. Which statement lets the nurse know the patient understands the neurobiological theory of depression? a. "My depression is made worse because my marriage is stressful." b. "Sometimes I believe that I can't help myself. That's why I get so depressed." c. "I'm depressed because my parents were depressed." d. "If I take these medications as prescribed, I should start to think clearly and feel energized."

d. "If I take these medications as prescribed, I should start to think clearly and feel energized."

Metabolic syndrome has five components:

elevated glucose levels, abdominal obesity, elevated BP, high levels of triglycerides, and decreased levels of high-density lipoproteins (HDLs). An individual with three of the five components is considered to have metabolic syndrome

primary features of borderline personality disorder is

emotional lability, that is, rapidly moving from one emotional extreme to another.

Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate? a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him. b. Meet with family and support persons to help them accept, anticipate, and prepare for the progression of his stage II dementia. c. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. d. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.

d. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.

Association between HLA antigens and diseases is most commonly found in what disease conditions? a. Malignancies b. Infectious diseases c. Neurologic diseases d. Autoimmune disorders

d. Autoimmune disorders

Which statement about dementia is accurate? a. The majority of people over age 85 are affected by dementia. b. Disorientation is the dominant and most disruptive symptom of dementia. c. People with early dementia do not tend to be distressed by symptoms. d. Hypertension, diminished activity levels, and head injury increase the risk of dementia.

d. Hypertension, diminished activity levels, and head injury increase the risk of dementia.

The nurse is caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, "I hear voices of aliens trying to contact me." The nurse should recognize this presentation as which type of major depressive disorder (major depression)? a. Seasonal Affective Disorder b. Dysthymic Disorder c. Premenstrual Dysphoric disorder d. Psychotic

d. Psychotic

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis. b. The patient has islet cell antibodies that have destroyed the pancreas's ability to produce insulin. c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections. d. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

d. The patient may have sufficient endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome.

A patient with intracranial pressure monitoring has a pressure of 12 mm Hg. The nurse understands that this pressure reflects a. a severe decrease in cerebral perfusion pressure. b. an alteration in the production of cerebrospinal fluid. c. the loss of autoregulatory control of intracranial pressure. d. a normal balance between brain tissue, blood, and cerebrospinal fluid.

d. a normal balance between brain tissue, blood, and cerebrospinal fluid.

The function of monocytes in immunity is related to their ability to a. stimulate the production of T and B lymphocytes. b. produce antibodies on exposure to foreign substances. c. bind antigens and stimulate natural killer cell activation. d. capture antigens by phagocytosis and present them to lymphocytes.

d. capture antigens by phagocytosis and present them to lymphocytes.

The nurse advises a friend who asks him to administer his allergy shots that a. it is illegal for nurses to administer injections outside of a medical setting. b. he is qualified to do it if the friend has epinephrine in an injectable syringe provided with his extract. c. avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective. d. immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

d. immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are a. blood pressure, pulse, and respirations. b. breath sounds, blood pressure, and body temperature. c. pulse pressure, level of consciousness, and pupillary response. d. level of consciousness, urine output, and skin color and temperature.

d. level of consciousness, urine output, and skin color and temperature.

In a type I hypersensitivity reaction the primary immunologic disorder appears to be a. binding of IgG to an antigen on a cell surface. b. deposit of antigen-antibody complexes in small vessels. c. release of cytokines used to interact with specific antigens. d. release of chemical mediators from IgE-bound mast cells and basophils.

d. release of chemical mediators from IgE-bound mast cells and basophils.

Immunodeficiency is diagnosed

if the lymphocyte count is below 1200/µL

The eosinophil count is elevated

in type I hypersensitivity reactions involving IgE. The serum IgE level is also generally elevated in type I hypersensitivity reactions and serves as a diagnostic indicator of atopic diseases.

Primary intervention

includes activities that provide support, information, and education to prevent suicide

If family member commits suicide

increased risk factor for other family members

Immunotherapy

involves administration of small titers of an allergen extract in increasing strengths until hyposensitivity to the specific allergen is achieved.

Diabetes mellitus (DM)

is a chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both

Goodpasture syndrome

is a disorder involving the lungs and kidneys. An antibody-mediated autoimmune reaction occurs involving the glomerular and alveolar basement membranes. The circulating antibodies combine with tissue antigen to activate the complement system, which causes deposits of IgG to form along the cell basement membranes of the lungs or kidneys. This reaction may result in pulmonary hemorrhage and glomerulonephritis

insulin resistance

is a glucose-sparing mechanism that ensures an abundant supply of glucose

Angioedema

is a localized cutaneous lesion similar to urticaria but involving deeper layers of the skin and submucosa. The principal areas of involvement include the eyelids, lips, tongue, larynx, hands, feet, GI tract, and genitalia.

dawn phenomenon

is also characterized by hyperglycemia that is present on awakening. Two counterregulatory hormones (growth hormone and cortisol), which are excreted in increased amounts in the early morning hours, may be the cause of this phenomenon. The dawn phenomenon affects a majority of people with diabetes and tends to be most severe when growth hormone is at its peak in adolescence and young adulthood.

A CPP of less than 50 mm Hg

is associated with ischemia and neuronal death.

Diabetic ketoacidosis (DKA)

is caused by a profound deficiency of insulin and is characterized by hyperglycemia, ketosis, acidosis, and dehydration. It is most likely to occur in people with type 1 diabetes but may be seen in people with type 2 diabetes in conditions of severe illness or stress when the pancreas cannot meet the extra demand for insulin. Precipitating factors include illness and infection, inadequate insulin dosage, undiagnosed type 1 diabetes, poor self-management, and neglect.

Bipolar disorder

is marked by shifts in mood, energy, and ability to function. The course of the illness is variable, and symptoms range from severe mania—an exaggerated euphoria or irritability—to severe depression. Periods of normal functioning may alternate with periods of illness (highs, lows, or a combination of both); however, many individuals continue to experience chronic interpersonal or occupational difficulties even during remission.

Intracranial pressure (ICP)

is the hydrostatic force measured in the brain CSF compartment.

Suicide

is the intentional act of killing oneself by any means. A history of suicide attempts puts a person at a high probability of actually completing the suicide in the future, particularly in the 24 months following the attempt.

Suicidal ideation

is the manifestation of inner pain, hopelessness, and helplessness suffered by individuals.

level of consciousness (LOC)

is the most sensitive and reliable indicator of the patient's neurologic status.

The gold standard for monitoring ICP

is the ventriculostomy, in which a specialized catheter is inserted into the lateral ventricle and coupled to an external transducer. This technique directly measures the pressure within the ventricles, facilitates removal and/or sampling of CSF, and allows for intraventricular drug administration. In this system the transducer is external, and it is important to ensure that the transducer of the ventriculostomy is level with the foramen of Monro (interventricular foramen). The ventriculostomy system must also be at the ideal height. A reference point for this foramen is the tragus of the ear. Every time the patient is repositioned, the system must be assessed to ensure it is level.

Secondary intervention

is treatment of the actual suicidal crisis. It is practiced in clinics, hospitals, jails, and on telephone hotlines.

Diffuse axonal injury (DAI)

is widespread axonal damage occurring after a mild, moderate, or severe TBI. The damage occurs primarily around axons in the subcortical white matter of the cerebral hemispheres, basal ganglia, thalamus, and brainstem The clinical signs of DAI are varied but may include a decreased LOC, increased ICP, decortication or decerebration, and global cerebral edema. Approximately 90% of patients with DAI remain in a persistent vegetative state

A CPP of less than 30 mm Hg results in

ischemia and is incompatible with life.

The goal of long-term immunotherapy is to

keep "blocking" IgG levels high. By increasing the IgG levels, the IgE is blocked from binding to the allergen.

Ketonuria is a process that occurs when

ketone bodies are excreted in the urine. During this process, electrolytes become depleted as cations are eliminated along with the anionic ketones in an attempt to maintain electrical neutrality.

Birth injuries are more common in infants born to mothers with diabetes compared with mothers who do not have diabetes

macrosomic fetuses have the highest risk for this complication. Common birth injuries associated with diabetic pregnancies include brachial plexus palsy, facial nerve injury, humerus or clavicle fracture, and cephalhematoma. Most of these injuries are associated with difficult vaginal birth and shoulder dystocia

Suicide more common in men or women

men

submersion injury has replaced

near-drowning to include any person who experiences distress from submersion or immersion in liquid that results either in death (drowning) or survival at least 24 hours after submersion (near-drowning)

antiviral treatment in pedi

neonates may also be treated with antiviral medications such as acyclovir and ganciclovir

Can you mix long acting insulin

no

Cushings in children

not common late sign rare

What should you do before starting insulin in dka

obtain potassium level

subdural hematoma

occurs from bleeding between the dura mater and arachnoid layer of the meninges

Personality disorders,

particularly borderline personality disorder, are associated with non-suicidal self-injury in adolescence and adulthood

Assessment findings in dka

• Dry mouth • Thirst • Abdominal pain • Nausea and vomiting • Gradually increasing restlessness, confusion, lethargy • Flushed, dry skin • Eyes appearing sunken • Breath odor of ketones • Rapid, weak pulse • Labored breathing (Kussmaul respirations) • Fever • Urinary frequency • Serum glucose >250 mg/dL (13.9 mmol/L) • Glucosuria and ketonuria

Primary defense mechanism of borderline personality

splitting

CPP Intracranial pressure curve

stage 1 on the curve, there is high compliance. The brain is in total compensation, with accommodation and autoregulation intact. stage 2, the compliance is beginning to decrease, and an increase in volume places the patient at risk of increased ICP and secondary injury. At stage 3, there is significant reduction in compliance. Any small addition of volume causes a great increase in ICP. Compensatory mechanisms fail, there is a loss of autoregulation, and the patient exhibits manifestations of increased ICP (e.g., headache, changes in level of consciousness or pupil responsiveness). stage 4, the ICP rises to lethal levels with little increase in volume. Herniation occurs as the brain tissue is forcibly shifted from the compartment of greater pressure to a compartment of lesser pressure. In this situation, intense pressure is placed on the brainstem, and if herniation continues, brainstem death is imminent

Sudden drops in bgl can cause what

sudden drop in glucose that can be associated with cerebral edema.

Cerebral blood flow (CBF) is

the amount of blood in milliliters passing through 100 g of brain tissue in 1 minute. The global CBF is approximately 50 mL/min/100 g of brain tissue

mixed insulin

the first number indicating the percentage of intermediate-acting insulin and the second number the percentage of rapid-acting insulin.

Vasogenic cerebral edema,

the most common type of cerebral edema, occurs mainly in the white matter and is characterized by leakage of large molecules from the capillaries into the surrounding extracellular space.

Compression of cranial nerve (CN) III,

the oculomotor nerve, results in dilation of the pupil on the same side (ipsilateral) as the mass lesion, sluggish or no response to light, inability to move the eye upward and adduct, and ptosis of the eyelid. These signs can be the result of the brain shifting from midline, compressing the trunk of CN III, and paralyzing the muscles controlling pupillary size and shape. In this situation, a fixed, unilateral, dilated pupil is considered a neurologic emergency that indicates herniation of the brain.

euphoria,

the patient may state that he or she is experiencing an intense feeling of well-being, is "cheerful in a beautiful world," or is becoming "one with God." The overly joyous mood may seem out of proportion to what is going on, and cheerfulness may be inappropriate for the circumstances. This mood may change quickly to irritation and anger when the person is thwarted. The irritability and belligerence may be short-lived, or it may become the prominent feature of the manic phase of bipolar disorder.

Secondary injury is

the resulting hypoxia, ischemia, hypotension, edema, or increased ICP that follows the primary injury. Secondary injury, which could occur several hours to days after the initial injury, is a primary concern when managing brain injury. Nursing management of the patient with an acute intracranial problem must include management of secondary injury and thus increased ICP.

Specific questions to ask about suicidal ideation include the following

•Have you ever felt that life was not worth living? •Have you been thinking about death recently? •Did you ever think about suicide? •Have you ever attempted suicide? •Do you have a plan for completing suicide? •If so, what is your plan for suicide?

DKA treatment

• Ensure patent airway. • Administer O2 via nasal cannula or non-rebreather mask. • Establish IV access with large-bore catheter. • Begin fluid resuscitation with 0.9% NaCl solution 1 L/hr until BP stabilized and urine output 30-60 mL/hr. • Begin continuous regular insulin drip 0.1 U/kg/hr. • Identify history of diabetes, time of last food, and time and amount of last insulin injection. Ongoing Monitoring • Monitor vital signs, level of consciousness, cardiac rhythm, O2 saturation, and urine output. • Assess breath sounds for fluid overload. • Monitor serum glucose and serum potassium. • Administer potassium to correct hypokalemia. • Administer sodium bicarbonate if severe acidosis (pH < 7.0). • Add dextrose to IV fluid for blood glucose <250 mg/dL.

Overt Statements suicide statements

• "I can't take it anymore." • "Life isn't worth living anymore." • "I wish I were dead." • "Everyone would be better off if I died."

Covert suicide Statements

• "It's okay now. Soon everything will be fine." • "Things will never work out." • "I won't be a problem much longer." • "Nothing feels good to me anymore and probably never will." • "How can I give my body to medical science?"