NCLEX quesitons
A client with generalized anxiety disorder is referred to outpatient mental health department for cognitive behavioral therapy (CBT). The CBT includes which interventions and strategies? Select all that apply. 1.Desensitization to a specific stimulus or situation 2.Discussing the interpersonal difficulties that have led to the client's psychological problems 3.Helping the client develop insight into the psychological causes of the disorder 4.Relaxation techniques 5.Self-observation and monitoring 6.Teaching new coping skills and techniques to reframe thinking
ANS: 1,4,5,6 Cognitive behavioral therapy (CBT) can be effective in treating anxiety disorders, eating disorders, depressive disorders, and medical conditions such as insomnia and smoking. These types of disorders are characterized by maladaptive reactions to stress, anxiety, and conflict. CBT requires that the client learn the skill of self-observation and to apply more adaptive coping interventions. CBT involves 5 basic components: Education about the client's specific disorder Self-observation and monitoring - the client learns how to monitor anxiety, identify triggers, and assess the severity Physical control strategies - deep breathing and muscle relaxation exercises Cognitive restructuring - learning new ways to reframe thinking patterns, challenging negative thoughts Behavioral strategies - focusing on situations that cause anxiety and practicing new coping behaviors, desensitization to anxiety-provoking situations or events
The nurse develops a teaching plan for a client prescribed isoniazid, rifampin, ethambutol, and pyrazinamide to treat active tuberculosis (TB). Which of the following instructions associated with the adverse effects of rifampin is most important for the nurse to include? 1.Notify the health care provider if your urine is red 2.Take acetaminophen every 6 hours for drug-associated joint pain while taking this medication 3.Wear eyeglasses instead of soft contact lenses while taking this medication 4.You can stop taking the medications as soon as one sputum culture comes back normal
ANS: 3 Active TB is treated with combination drug therapy. Isoniazid causes hepatotoxicity and peripheral neuropathy. Rifampin (Rifadin) also causes hepatotoxicity. Therefore, baseline liver function tests should be obtained. Clients should be advised to watch for signs and symptoms of hepatotoxicity (eg, jaundice, anorexia). Ethambutol causes ocular toxicity, and clients will need frequent eye examinations. A teaching plan for a client prescribed rifampin includes these additional instructions: Rifampin changes the color of body fluids (eg, urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored. Client should wear eyeglasses instead of soft contact lenses while taking this medication. Women should use nonhormonal birth control methods while taking this drug as it can decrease the effectiveness of oral contraceptives.
During a routine assessment of a developmentally normal 18-month-old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention? 1.Check the child for parasitic infections 2.Consult a pediatric nutritionist for suspected eating disorder 3.Educate the parent about physiologic anorexia 4.Notify the primary health care provider
ANS: 3 Physiologic anorexia occurs when the very high metabolic demands of infancy slow down to keep pace with the moderate growth of toddlerhood. During this phase, toddlers are increasingly picky about their food choices and schedules. Although to the parents it may appear that the child is not consuming enough calories, intake over several days actually meets nutritional and energy needs. Parents should be educated concerning what constitutes a healthy diet for toddlers and which foods they are more likely to consume. Some strategies for dealing with a toddler during a stage of physiologic anorexia and pickiness include: Set and enforce a schedule for all meals and snacks Offer the child 2 or 3 choices of food items Do not force the child to eat Keep food portions small Expose the child repeatedly to new foods on several separate occasions Avoid TV and games during meals or snacks
The community health nurse prepares a teaching plan for a client with latent tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse include? Select all that apply. 1.Avoid drinking alcohol 2.Expect body fluids to change color to red 3.Report yellowing of skin or sclera 4.Report numbness and tingling of extremities 5.Take with aluminum hydroxide to prevent gastric irritation
Isoniazid (INH) is a first-line antitubercular drug prescribed as monotherapy to treat latent tuberculosis infection. Combined with other drugs, INH is also used for active tuberculosis treatment. Two serious adverse effects of INH use are hepatotoxicity and peripheral neuropathy. A teaching plan for a client prescribed INH includes the following: Avoid intake of alcohol and limit use of other hepatotoxic agents (eg, acetaminophen) to reduce risk of hepatotoxicity (Option 1) Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy Avoid aluminum-containing antacids (eg, aluminum hydroxide (Maalox)) within 1 hour of taking INH Report changes in vision (eg, blurred vision, vision loss) Report signs/symptoms of severe adverse effects such as:Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue) (Option 3)Peripheral neuropathy (eg, numbness, tingling of extremities) (Options 4)
A nurse is admitting a child who has leukemia. Several rooms are available on the pediatric unit. Which client could share a room with this child? 1.A client recovering from a ruptured appendix 2.A client with cystic fibrosis 3.A client with minimal change nephrotic syndrome 4.A client with rheumatic fever
Leukemia is characterized by unrestricted proliferation of abnormal white blood cells (lymphoblasts), resulting in depression of normal bone marrow activity. This disorder is the most common form of childhood cancer. Infection is a major concern due to neutropenia. In addition, anemia occurs due to decreased red blood cell production, and bleeding is common as a result of decreased platelet production. It would be appropriate for this client with leukemia to share a room with a client with minimal change nephrotic syndrome (MCNS). MCNS is a non-infectious condition of the glomeruli and poses no risk to a client with leukemia. (Option 1) Appendicitis is a result of viral or infectious processes and can lead to rupture of the appendix. A client recovering from a ruptured appendix poses a threat of infection to the child who has leukemia. (Option 2) A client with cystic fibrosis has pulmonary complications due to thick mucus that traps bacteria. The tracheobronchial tree is colonized with bacteria and respiratory infections are a lifelong problem. This client poses a threat of infection to the child with leukemia. (Option 4) Rheumatic fever occurs following pharyngitis caused by group A β-hemolytic Streptococcus. A client with this condition poses a threat of infection to the child with leukemia. Educational objective:Leukemia is a cancer of the blood and organs involved in hematologic function. Due to myelosuppression, clients are at risk for problems related to infection, anemia, and bleeding.
A nurse is admitting a child and observes multiple irregular bruises. Which action should the nurse take next? 1.Ask parents to leave the room during the admission process 2.Continue with a detailed interview and physical examination ( 3.Notify the charge nurse and the social worker 4.Promise not to tell anyone if the child reveals abuse
ans: 2
Rifampin (Rifadin)
Antitubercular. Use: prevention and treatment of TB. red orange discoloration of bodily fluids
A client with active pulmonary tuberculosis is prescribed 4-drug therapy with ethambutol. The community health nurse instructs the client to notify the health care provider immediately if which adverse effect associated with ethambutol occurs? 1.Blurred vision 2.Dark-colored urine 3.Difficulty hearing 4.Yellow skin
Ethambutol (Myambutol) is used in combination with other antitubercular drugs (eg, isoniazid, rifampin, pyrazinamide) to treat active tuberculosis. The client must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect. The client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination. (Options 2 and 4) Dark-colored urine and yellow skin can indicate the presence of hepatotoxicity, which is associated with many drugs used to treat tuberculosis (eg, isoniazid, pyrazinamide, rifampin). However, hepatotoxicity is not common with ethambutol. (Option 3) Difficulty hearing (tinnitus, subjective hearing loss) is an adverse reaction to streptomycin. Streptomycin, an aminoglycoside antibiotic, is a second-line drug sometimes used to treat multi-drug-resistant tuberculosis, with ototoxic and nephrotoxic adverse effects. Educational objective:Clients taking ethambutol must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect.
The nurse dons personal protective equipment (PPE) before providing care for a client in airborne transmission-based precautions. Place the steps for donning PPE in the appropriate sequence. All options must be used. 4. Hand hygiene 3. Gown 2. Goggles or face shield 5. Mask or respirator 1. Gloves
hand hygiene gown mask respiratory googles face shield gloves
The nurse attempts to flush a client's subclavian vein central venous access device with normal saline using a 10-mL syringe, but meets resistance, is unable to aspirate blood, and suspects an occlusion. What should the nurse do next? 1.Flush and lock with heparinized saline flush 2.Flush with normal saline using a 5-mL syringe 3.Notify the health care provider 4.Reposition the client
reposition client
