Sem 3 - Unit 1
Which medications are used to treat generalized anxiety disorder (GAD)? Select all that apply. 1 Duloxetine 2 Venlafaxine 3 Clonazepam 4 Escitalopram 5 Clomipramine
1, 2, 4 Duloxetine, venlafaxine, and escitalopram are antidepressants approved for the treatment of generalized anxiety disorder (GAD). Clonazepam and clomipramine are used to treat panic disorders.
What does the term "smokeless tobacco" refer to? Select all that apply. 1 A substitute for cigarettes 2 Tobacco products that are safe for adolescents 3 Tobacco products that produce less smoke 4 Tobacco products with carcinogenic chemicals 5 Tobacco products placed in mouth but not ignited
1, 4, 5 "Smokeless tobacco" is the term used for tobacco products that are cigarette substitutes. These items are consumed by placing them in mouth, but they are not ignited. Smokeless tobacco contains carcinogenic agents that are not safe in adolescents. Tobacco products that produce less smoke are not considered smokeless.
`A nurse is caring for a client who has abruptly stopped taking a barbiturate. What withdrawal complication does the nurse anticipate that the client may experience? 1 Ataxia 2 Seizures 3 Diarrhea 4 Urticaria
2 Seizures Seizures are a serious side effect that may occur with abrupt withdrawal from barbiturates. Ataxia, diarrhea, and urticaria are not associated with barbiturate withdrawal.
Which sedative-hypnotics are used to treat insomnia effects associated with a panic disorder? Select all that apply. 1 Phenelzine 2 Paroxetine 3 Alprazolam 4 Imipramine 5 Clonazepam
Correct 3 Alprazolam and 5 Clonazepam Alprazolam and clonazepam are examples of benzodiazepines, a class of sedative-hypnotics used to treat clients with insomnia effects associated with panic disorders. Phenelzine is a monoamine oxidase inhibitor used to treat panic disorders and promote sleep. Paroxetine is a selective serotonin reuptake inhibitor used to treat panic disorders and promote sleep. Imipramine is a tricyclic antidepressant used to treat panic disorders and promote sleep.
Alprazolam is prescribed for a client with the diagnosis of panic disorder. The client refuses to take the medication because of fears of addiction. What should the nurse do initially? 1 Provide the client information about alprazolam. 2 Assess the client's feelings about alprazolam further. 3 Ask the practitioner about changing the client's medication. 4 Have the practitioner speak with the client about the safety of this medication.
2 Assess the client's feelings about alprazolam further. Before deciding how to ease the client's fears of addiction, the nurse must explore the full extent of the client's knowledge and feelings about taking this medication. Information may or may not be helpful; the client's feelings are what must be addressed. Although the nurse may eventually ask the practitioner to consider changing the medication or to speak with the client about its safety, neither is the priority at this time.
A nurse spends time in individual sessions helping a depressed, suicidal client verbalize feelings. For what themes should the nurse particularly listen? Select all that apply. 1 Anger 2 Control 3 Isolation 4 Dominance 5 Hopelessness 6 Indecisivenes
3 - Isolation 5 - Hopelessness Feelings of isolation compound feelings of hopelessness and helplessness and may provide the client with the impetus to act on suicide ideation. The main factor leading to acting on suicidal impulses is the feeling of hopelessness, that there is nothing to live for. Anger may be associated with depression; however, a depressed person usually does not have the energy to act out suicidal ideation. The struggle for control or dominance is not an important risk factor for suicide. Indecisiveness may be associated with depression, but an indecisive individual is usually unable to make the decision to commit suicide.
A nurse is teaching a group of recently hired staff members about conscious and unconscious defense mechanisms that are used to defend the self against anxiety. What is an example of a conscious defense mechanism that the nurse should include? 1 Undoing 2 Projection 3 Suppression 4 Intellectualization
3 Suppression Suppression is a conscious measure used as a defense against anxiety; the affected person intentionally avoids thinking about disturbing problems, wishes, feelings, or experiences. Undoing is an unconscious defense mechanism; it is the use of words or behavior to make amends symbolically for unacceptable thoughts, feelings, or actions. Projection is an unconscious defense mechanism; it is the false attribution to others of one's own unacceptable impulses, feelings, attitudes, or thoughts. Intellectualization is an unconscious defense mechanism; it is the use of thinking, ideas, or intellect to avoid emotionally charged feelings.
Thiamine (vitamin B 1) and niacin (vitamin B 3) are prescribed for a client with alcoholism. Which body function maintained by these vitamins should the nurse include in a teaching plan? 1 Neuronal activity 2 Bowel elimination 3 Efficient circulation 4 Prothrombin development
1 Neuronal activity Thiamine and niacin help convert glucose for energy, and therefore influence nerve activity. These vitamins do not affect elimination. These vitamins are not related to circulatory activity. Vitamin K, not thiamine and niacin, is essential for the manufacture of prothrombin.
A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine? 1 Risk for self-injury 2 Potential for seizure 3 Danger of dehydration 4 Probability of injuring others
1 Risk for self-injury The greatest risk in cocaine withdrawal is risk for self-injury. The risk for seizure is increased while a person is under the influence of cocaine, not during withdrawal. Although dehydration may occur during cocaine use and withdrawal, it is not the priority concern. People in cocaine withdrawal, although irritable, are more apt to hurt themselves than others.
The nurse is providing instructions to a client who is on isocarboxazid for depression. Which statements made by the client indicate effective learning? Select all that apply. 1 "I will include yogurt in my diet." 2 "I will avoid soy sauce in my diet." 3 "I will avoid pepperoni in my diet." 4 "I will include cream cheese in my diet." 5 "I will avoid fermented bean curds in my diet."
1 "I will include yogurt in my diet." 4 "I will include cream cheese in my diet." 5 "I will avoid fermented bean curds in my diet." Isocarboxazid is a monoamine oxidase (MAO) inhibitor used to treat depression. Clients on MAOIs should avoid foods containing high amounts of tyramine. Yogurt and cream cheese are foods containing low to no tyramine content. Fermented bean curds are high tyramine-containing foods that should be avoided. Soy sauce and pepperoni are high tyramine foods that should be avoided.
After a child's visit to a healthcare provider, the parent tells the nurse, "I'm so upset! The doctor prescribed an antidepressant!" What is the best response by the nurse? 1 "Tell me more about what's bothering you." 2 "Weren't you told why your child needs an antidepressant?" 3 "You need to speak with the healthcare provider about your concerns." 4 "Are you sure it's an antidepressant and not a drug for attention deficit disorder?"
1 "Tell me more about what's bothering you." "Tell me more about what's bothering you" provides an opportunity to explore the parent's feelings. It is the nurse's responsibility, not the healthcare provider's, to assess the parent's concerns before planning further interventions. "Weren't you told why your child needs an antidepressant?" is a confrontational response that may put the parent on the defensive. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?" is a judgmental, nontherapeutic response that may worsen the parent's concerns.
A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client? 1 Sertraline 2 Fluoxetine 3 Amphetamine 4 Carbamazepine
1 - Sertraline Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.
A nurse is caring for several clients who are going through withdrawal from alcohol. What is the primary reason for the ingestion of alcohol by clients with a history of alcohol abuse? 1 Are dependent on it 2 Lack the motivation to stop 3 Have no other coping mechanism 4 Enjoy the associated socialization
1 - are dependent of it Alcohol causes both physical and psychological dependence; the individual needs and depends on the alcohol to function. The theory that alcoholics have no other coping mechanism is a myth that often is associated with alcoholism; the individual needs to learn how to use other coping mechanisms more consistently and effectively. People with alcoholism commonly drink alone or feel alone in a crowd.
A nurse is teaching a group of clients with peripheral vascular disease about a smoking cessation program. Which physiologic effect of nicotine should the nurse explain to the group? 1 Constriction of the superficial vessels dilates the deep vessels. 2 Constriction of the peripheral vessels increases the force of flow. 3 Dilation of the superficial vessels causes constriction of collateral circulation. 4 Dilation of the peripheral vessels causes reflex constriction of visceral vessels.
2 Constriction of the peripheral vessels increases the force of flow. Constriction of the peripheral blood vessels and the resulting increase in blood pressure impairs circulation and limits the amount of oxygen being delivered to body cells, particularly in the extremities. Nicotine constricts all peripheral vessels, not just superficial ones. Its primary action is vasoconstriction; it will not dilate deep vessels. Nicotine constricts rather than dilates peripheral vessels.
A nurse is planning care for a client with substance-induced persisting dementia resulting from long-term alcohol use. Which nutritional problem, in addition to the effect of alcohol on brain tissue, has contributed to substance-induced persisting dementia? 1 Increase in serotonin 2 Deficiency of thiamine 3 Reduction in iron intake 4 Malabsorption of riboflavin
2 Deficiency of thiamine Substance-induced persistent dementia is caused by a prolonged deficiency of vitamin B1 (thiamine) and the direct toxic effect of alcohol on brain tissue. Increase in serotonin, reduction in iron intake, and malabsorption of riboflavin are problems that are unrelated to substance-induced persisting dementia caused by alcoholism.
What characteristics are commonly associated with adolescent depression? Select all that apply. 1 - Exercising daily 2 - Having suicidal ideation 3 - Exhibiting tearfulness 4 - Having poor muscle tone 5 - Avoiding previously enjoyed activities and relationships
2 - Having suicidal ideation 3 - Exhibit tearfulness 5 - Avoiding previously enjoyed activities and relationships Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.
A nurse is concerned when an 11-month-old infant is brought to the pediatric clinic weighing 9 lb 3 oz (4167 g). The nurse suspects that the infant is suffering from physical and emotional neglect. What observations lead the nurse to suspect maltreatment? Select all that apply. 1 Stranger anxiety 2 Inappropriate clothing 3 Social unresponsiveness 4 Frequent rocking motions 5 Adequate personal hygiene
2 - Inappropriate clothing 3 - Social unresponsiveness 4 - Frequent rocking motions Stranger anxiety begins around 5 to 6 months, when infants become responsive to the caregivers who have met both physical and emotional needs. When strangers speak to them or reach out to hold them they seem fearful, cling to the caregiver, and cry. Infants whose needs have not been met adequately have no reason to be fearful of others. A typical sign of physical neglect is the wearing of dirty clothes or clothing that is not suitable to the environment. The infant who has not experienced social responsiveness from the caregiver has not learned how to be socially responsive to others. Infants who experience emotional deprivation resort to self-stimulating behaviors in an effort to meet their emotional needs. Infants who experience physical neglect are more likely to be unclean, with signs of unattended skin lesions such as diaper rash or bruises.
Which symptoms of depression, often overlooked in the older adult client, should the nurse include in the assessment process? Select all that apply. 1 - Anxiety 2 - Insomnia 3 - Weight loss 4 - Weight gain 5 - General fatigue
2 - Insomnia 5 - general fatigue Insomnia and general fatigue are symptoms of depression that are often overlooked for the older adult client. Anxiety, weight loss and weight gain are all symptoms of depression; however, these symptoms are not often overlooked for the older adult client.
A client reports to the primary healthcare provider with a complaint of becoming panicked and having irrational fear of public talking. Which drug does the nurse anticipate to be prescribed by the primary healthcare provider? 1 Buspirone 2 Alprazolam 3 Diazepam 4 Lorazepam
2 Alprazolam Alprazolam (a benzodiazepine) is a short-acting anxiolytic drug used to treat those clients with panic disorders and the irrational fear of talking openly in public (agoraphobia). Buspirone, an anxiolytic drug that is different both chemically and pharmacologically from the benzodiazepines, is always administered on a scheduled basis (not "as-needed") for the treatment of anxiety. Diazepam is an anxiolytic drug commonly prescribed for the treatment of anxiety but has generally been replaced by short-acting benzodiazepines. Lorazepam is an intermediate-acting anxiolytic drug used in the treatment of acutely agitated clients.
A client is responding within 5 minutes of receiving naloxone to combat respiratory depression from an overdose of heroin. Why will a nurse continue to closely monitor this client's status? 1 The drug may cause peripheral neuropathy. 2 Naloxone and heroin can cause cardiac depression when combined. 3 Symptoms of the heroin overdose may return after the naloxone is metabolized. 4 Hyperexcitability and amnesia may cause the client to thrash about and become abusive.
3 When naloxone is metabolized and its effects are diminished, the respiratory distress caused by the original drug overdose returns. A combination of these drugs does not cause cardiac depression. There are no reports of peripheral neuropathy or hyperexcitability and amnesia with naloxone.
A 45-year-old client who recently completed alcohol detoxification reports plans to begin using disulfiram (Antabuse) as part of the alcoholism treatment regimen. What important client teaching does the nurse share regarding this drug? 1 Voluntary compliance with the disulfiram regimen is very high. 2 A single dose of oral disulfiram will be effective for up to 72 hours. 3 Disulfiram may be taken intramuscularly and will be effective for as long as 7 days. 4 Foods, medications, and any topical preparation containing alcohol should be avoided.
4 Foods, medications, and any topical preparation containing alcohol should be avoided. Disulfiram causes unpleasant physical effects when mixed with alcohol. Any substance that contains alcohol may trigger an adverse reaction. Voluntary compliance with the use of disulfiram is often very low because of the negative physical effects experienced by the individual if alcohol is ingested. For disulfiram to be effective, it must be taken orally every day. Disulfiram is not administered intramuscularly.
An older client who lost a spouse 20 years ago comes to the community health center with a vague list of complaints and a brief life history. The couple's only child died at birth. The client lives alone and is able to perform all the activities of daily living. The client has had an active social life in the past but has outlived many friends and family members. What is an important question for the nurse to ask when taking this client's health history? 1 "Are you all alone?" 2 "How did your son die?" 3 "Do you still miss your spouse?" 4 "How do you feel about your life now?"
4 - "How do you feel about your life now?" "How do you feel about your life now?" The answer to "How do you feel about your life now?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Are you all alone?" is probing and provides little information for the nurse to use in planning care. "How did your son die?" and "Do you still miss your spouse?" are both probing, disregard the client's present situation, and provide little information for the nurse to use in planning care.
A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When unable to do this, the client becomes upset. What should the nurse do? 1 Distract the client, which will help the client forget about touching the chairs 2 Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in 3 Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one 4 Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed
4 - Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because the client uses the ritual as a defense against anxiety.
A client with recurrent episodes of depression comes to the mental health clinic for a routine follow-up visit. The nurse suspects that the client is at increased risk for suicide. What is a contributing factor to the client's risk for suicide? 1 Psychomotor retardation 2 Decreased physical activity 3 Deliberate thoughtful behavior 4 Overwhelming feelings of guilt
4 Overwhelming feelings of guilt Overwhelming feelings of guilt contribute to the client's risk for suicide. The client may ruminate over past or current failings, and extreme guilt can assume psychotic proportions. Psychomotor retardation and decreased physical activity are clinical findings associated with depression and usually do not lead to suicide because the client does not have the energy for self-harm. Impulsive behaviors, not deliberate thoughtful behaviors, contribute to the client's risk for suicide.
A client is experiencing a panic attack. In light of the information shown, select the appropriate nursing intervention. 1 Remaining with the client until crisis is over 2 Reinforcing for the client the fact that a panic attack is rarely fatal 3 Communicating with the client with the use of short, concise sentences 4 Introducing soft, soothing music into the environment to distract the client
1 Remaining with the client until crisis is over It is appropriate to remain with the client during a panic attack while being mindful of the need for a low-stimulus environment. The client experiencing a panic attack is not capable of analyzing complicated communication. The client will not benefit from hearing that a panic attack is rarely fatal because the ability to think rationally may be greatly impaired. Additional environmental stimuli are not advisable and are likely to increase the client's anxiety level.
A client who is a polysubstance abuser is mandated to seek drug and alcohol counseling. What is an appropriate initial outcome criterion for this client? 1 - Verbalizes that a substance abuse problem exists 2 - Discusses the effect of drug use on self and others 3 - Explores the use of substances and problematic behaviors 4 - Expresses negative feelings about the current life situation
1 Verbalizes that a substance abuse problem exists The client must first acknowledge that a substance abuse problem exists and is creating chaos; verbalizing that a problem exists indicates that the client is not in denial and is taking the first step toward change. Once a problem is identified, the numerous ways in which drug use has controlled the client's life and the resulting lifestyle problems can be explored, and the nurse can help the client express and process negative feelings.
When working with a client who is depressed, what should the nurse do initially? 1 Accept what the client says. 2 Attempt to keep the client occupied. 3 Keep the client's surroundings cheery. 4 Try to prevent the client from talking too much.
1 - Accept what the client says. Because clients cannot be argued out of their feelings, it is best to initially accept what they say; it also encourages communication. Attempting to keep the client occupied delays discussing the client's feelings, and the client's low energy level may prevent involvement in activities. Keeping the client's surroundings cheery has little effect on the depressed client; it can increase depression. The depressed client does very little talking and needs to be encouraged to communicate.
A female client with obsessive-compulsive disorder has become immobilized by her elaborate handwashing and walking rituals. Which feelings does the nurse recall are often the basis of obsessive-compulsive disorder? 1 Anxiety and guilt 2 Anger and hostility 3 Embarrassment and shame 4 Hopelessness and powerlessness
1 - Anxiety and Guilt Ritualistic behavior seen in this disorder is aimed at controlling feelings of anxiety and guilt by maintaining an absolute set pattern of action. Although the person with an obsessive-compulsive disorder may be angry and hostile, the feelings of anger and hostility do not precipitate the rituals. Although the person with an obsessive-compulsive disorder may be embarrassed and ashamed by the ritual or feel hopeless and powerless to the ritual, the basic feelings precipitating the rituals are usually anxiety and guilt.
After a client on the mental health unit with a known history of opioid addiction has a visit from several friends, a nurse finds the client in a deep sleep and unresponsive to attempts at arousal. The nurse assesses the client's vital signs and determines that an overdose of an opioid has occurred. Which findings support this conclusion? 1 Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min 2 Blood pressure of 180/100 mm Hg, tachycardia, and respiratory rate of 18 breaths/min 3 Blood pressure of 120/80 mm Hg, regular pulse, and respiratory rate of 20 breaths/min 4 Blood pressure of 140/90 mm Hg, irregular pulse, and respiratory rate of 28 breaths/min
1 - Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min Opioids cause central nervous system depression, resulting in severe respiratory depression, hypotension, tachycardia, and unconsciousness. The other findings, particularly the respirations, are not indicative of an overdose of an opioid.
A hospitalized, depressed, suicidal client has been taking a mood-elevating medication for several weeks. The client's energy is returning, and the client no longer talks about suicide. What should the nurse do in response to this client's behavior? 1 - Keep the client under close observation. 2 - Arrange for the client to have more visitors. 3 - Engage the client in preliminary discharge planning. 4 - Observe the client for side effects of the medication
1 -Keep the client under close observation. As the client's motivation and energy return, the likelihood that suicidal ideation will be acted out increases. There are no data regarding visitation rights; the priority concern is the greater risk for suicide. Although engaging the client in preliminary discharge planning eventually will be done, the priority is determining the potential for suicide. Although the client should be observed for side effects of the medication, the greater risk of suicide takes precedence.
A female client is admitted to the hospital after attempting suicide. She reveals that her desire for sex has diminished since her child's birth 3 years ago. What is most directly related to the client's loss of interest in sex? 1 Depression 2 Dependency 3 Marital stress 4 Identity confusion
1 Depression Decreased sexual desire is a major symptom of clinical depression. Other vegetative signs of depression include changes in bowel elimination, eating habits, and sleeping patterns. Although depression is often related to unmet dependency needs, the decreased sexual desire is associated with the depression, not the unmet dependency needs. The sexual difficulties are associated with the depression, and the depression, not the sexual difficulties, may be the major cause of marital stress. Also, there are no data indicating marital stress. Role confusion, not identity confusion, is usually associated with depression.
During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite 5 Long periods of sleep
1 Lethargy 2 Ambivalence 3 Emotional lability Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is also associated with postpartum depression.
When the nurse is managing the care of an acutely depressed client, which intervention demonstrates that the nurse recognizes the client's fundamental mental health need? 1 Role modeling a hopeful attitude regarding life and the future 2 Sharing that life has presented depressing situations for all of us at times 3 Devoting time with the client and trying to focus on happy, positive memories 4 Identifying the client's personal weaknesses and designing interventions to strengthen them
1 Role modeling a hopeful attitude regarding life and the future Role modeling has been shown to be an excellent tool in molding adaptive behavior. Depression affects the individual's ability to see hope in the future, and role modeling will help provide adaptation to similar feelings. Affirming that everyone has depressive situations in their lives does not foster a positive response in the depressed client. Reminiscing about happier times and events is likely to highlight the client's current loss of happiness rather than foster positive feelings. The depressed client generally has low self-esteem and is often too tired to engage in physical activities. When a client is depressed, the nurse should identify the client's personal strengths, not weaknesses, and focus on interventions to reinforce those strengths. Focusing on a client's weaknesses when the client is already depressed may initiate a deeper depression.
What is a priority nursing intervention in the care of a drug-dependent mother and infant? 1 Supporting the mother's positive responses toward her infant 2 Requesting that family members share responsibility for infant care 3 Keeping the infant separated from the mother until the mother is drug free 4 Helping the mother understand that the infant's problems are a result of her drug intake
1 Supporting the mother's positive responses toward her infant A nurse should attempt to support the mother-child relationship; the mother is experiencing a developmental crisis while coping with drug addiction and possibly guilt. It is the client's right to decide who will share in the care of her child. The client needs contact with her new infant to facilitate bonding. Helping the mother understand that the infant's problems are a result of her drug intake will make the client feel guilty and will not facilitate positive action at this point.
What is the planned effect of naloxone when it is administered for a heroin overdose? 1 To compete with opioids for occupancy of opioid receptors 2 To prevent excessive withdrawal symptoms as heroin wears off 3 To accelerate metabolism of heroin and stimulate respiratory centers 4 To stimulate cortical sites that control consciousness and cardiovascular function
1 To compete with opioids for occupancy of opioid receptors Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist. Preventing excessive withdrawal symptoms as heroin wears off is not the specific action of this drug. Naloxone does not accelerate the metabolism of heroin. Stimulating cortical sites that control consciousness and cardiovascular function is not the action of naloxone. One adverse reaction of naloxone is cardiovascular irritability.
A client with a known history of opioid addiction is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing what phenomenon? 1 Tolerance 2 Habituation 3 Physical addiction 4 Psychological dependence
1 Tolerance Tolerance is a phenomenon that occurs in addicted individuals in which increasing amounts of the drug of addiction are needed to satisfy need; the client should receive adequate analgesia after surgery. Drug habituation is a mild form of psychological dependence; the individual develops a habit of taking the substance. A physical addiction is related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance for usual function. Psychological dependence is emotional reliance on the substance to maintain a sense of well-being.
Typical signs of neonatal abstinence syndrome related to opioid withdrawal usually begin within 24 hours after birth. What characteristics should the nurse anticipate in the infant of a suspected or known drug abuser? Select all that apply. 1 Tremors 2 Dehydration 3 Hyperactivity 4 Muscle hypotonicity 5 Prolonged sleep periods
1 Tremors 3 Hyperactivity Opioid dependence in the newborn is physiologic; as the drug is cleared from the body, signs of drug withdrawal become evident. Tremors and hyperactivity are typical signs of cerebral irritability. Dehydration is a result of inadequate feeding, not a direct result of opioid withdrawal. Muscle hypertonicity, not hypotonicity, occurs with opioid withdrawal. Signs of opioid withdrawal include excessive activity and sleep disturbances.
A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply. 1 Stillbirth 2 Ebstein anomaly 3 Neural tube defects 4 Spontaneous abortion 5 Intellectual disabilities
1, 4, 5 Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to antiseizure drugs during pregnancy.
A newly immigrated older Chinese adult is brought to a mental health clinic when family members become concerned that their parent is depressed. In an attempt to conduct a culturally competent assessment interview, the nurse asks certain questions. Which questions does the nurse ask? Select all that apply. 1 "What brought you here for treatment today?" 2 "What do you believe is the cause of your depression?" 3 "Does religion have a role in your perception of health and wellness?" 4 "Do you have insurance that includes coverage of mental health issues?" 5 "Have you ever sought treatment for a mental health problem previously?"
1,2,3, 5 Determining the client's perception of the problem is an appropriate question that allows cultural factors to be included. Encouraging the client to discuss the problems will facilitate a clearer understanding of the factors involved. Religion often plays a significant role in a client's view of health, wellness, and recovery. Knowing whether a client has ever undergone treatment for a mental health problem reveals mental health history and how previous issues were addressed. Insurance coverage is not pertinent to the issue and is an inappropriate topic of questioning by the nurse.
A 20-year-old carpenter falls from a roof and sustains fractures of the right femur and left tibia. The client reveals a history of substance abuse. What is the primary consideration for the nurse who is caring for this client? 1 Confronting the client about substance abuse 2 Avoiding calling attention to the client's drug abuse Correct3 Determining the amount and time of last use of the substance 4 Realizing that this client will need more pain medication than a nonabuser
3 Determining the amount and last use of the substance is the priority. Nurses should base their treatment of withdrawal symptoms on the time and amount of last use. Confronting the client is not the nurse's responsibility at this time. The client must be helped to recognize that a problem with drugs exists, but this is not the priority. Because of cross-tolerance the client may need larger doses of analgesia for pain relief than a nonabuser would, but this is not the priority.
A client with a history of gambling is experiencing legal difficulties for embezzling money and has been required to obtain counseling. During an intake interview the client says, "I never would have done this if I'd been paid what I am worth." What factor will create the greatest difficulty in helping this client develop insight? 1 Feelings of boredom and emptiness 2 Grandiosity related to personal abilities 3 Projection of reasons for difficulties onto others 4 Anger toward those who are in authority positions
3 Projection of reasons for difficulties onto others The development of insight is impeded by the client's unwillingness or inability to face his own contribution to a problem. Feelings of boredom and emptiness will not impede the development of insight. Such feelings are common in clients with borderline personality disorders. Grandiosity will not impede the development of insight. It is often a cover for feelings of inadequacy, which are threatening to the client; these feelings usually disappear with insight. Anger will not impede the development of insight. It is not the anger itself but instead how the anger contributes to interpersonal difficulty that the client must recognize.
A primary healthcare provider prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement? 1 Complimenting the client's appearance 2 Starting preparations for the client's discharge 3 Arranging for constant supervision of the client 4 Adding privileges to the client's plan of care as a reward
3 - Arranging for constant supervision of the client A change in behavior that seems positive may actually indicate that the client has worked out a plan for suicide; the potential for suicide increases when physical energy returns. Increased supervision is needed. Complimenting the client's appearance may increase the client's feelings of inadequacy, because it implies that the client did not look good before. It is inappropriate to consider discharge simply because of a change in behavior. Many factors should be considered in the decision to discharge a client. The addition of privileges is not indicated at this time.
A client comes to the clinic for a 6-week postpartum check-up. She confides that she is experiencing exhaustion that is not relieved by sleep and feelings of failure as a mother because the infant "cries all of the time." When asked whether she has a support system, she replies that she lives alone. Which response would provide the most accurate information? 1 Providing information about a local support group 2 Explaining that it is normal to feel depressed after childbirth 3 Asking the client questions, using a postpartum depression scale 4 Suggesting that the client find someone who can take care of the baby for 24 hours
3 Asking the client questions, using a postpartum depression scale A postpartum depression scale is a validated tool for identifying women who might be experiencing postpartum depression. The most widely used and validated tools are the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale. Although providing community resources of a local support group may be helpful, it is not useful in assessing the client's current emotional status. Although postpartum blues caused by hormonal changes soon after pregnancy might be common, feelings of depression and fatigue 6 weeks after childbirth is a matter of concern. The client may not have anyone else who can provide child care, or the client may not follow through on the recommendation. In addition, this intervention does not provide any information on the client's current emotional status.
An older adult who is undergoing follow-up treatment for mild depression at a local walk-in mental health clinic reports the onset of nausea, headache, and episodes of double vision during the past few weeks. In light of the assessment information, what is the nurse's priority? 1 Performing an in-depth cardiac assessment 2 Arranging for an ophthalmic consultation immediately 3 Initiating a conversation about the son's cancer diagnosis 4 Inquiring when the client began therapy for hypertension
4 Inquiring when the client began therapy for hypertension Calcium channel blockers such as diltiazem can cause neurotoxin symptoms like the ones the individual is describing when taken in combination with a selective serotonin reuptake inhibitor (SSRI) such as citalopram. Although the client is taking a calcium channel blocker for hypertension, there is no indication that there is a cardiac cause of the symptoms. Diplopia (double vision) is an abnormal condition and will require further attention but is not the priority at this point in time. The son's cancer diagnosis is a potential source of anxiety and depression, but the physical symptoms are not classically seen in either of those emotional states.
On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding? 1 - The client's feelings will pass after she has bonded with her infant. 2 - The client is probably suffering from postpartum depression and needs special care. 3 - A cesarean birth may be a traumatic experience, but most women know that it is a possible outcome. 4- A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.
4 - A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this. The client's response is appropriate to the situation, reflecting disappointment in not achieving her goal; in addition, this is the time when "postpartum blues" occurs. The client's feelings may or may not pass after she has bonded with her infant; there is no indication that the feeling will pass or that bonding is involved. The client's statement is not indicative of depression. With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment a client may feel over not reaching her goal.
The registered nurse instructed the nursing student to care for a client who suffers from depression. During a follow up visit, the registered nurse finds that the client's symptoms have not improved. Which activity of the nursing student would the registered nurse relate this to? 1 Modifying the environment 2 Limiting the client's choices of diet and clothing 3 Encouraging fluid intake 4 Discouraging social interaction to avoid the client's distraction from outside environment
4 - Discouraging social interaction to avoid the client's distraction from outside environment Discouraging social interaction to avoid the client's distraction from outside environment The nursing student's act of discouraging interactions due to fear of the client's distraction may result in a lack of improvement. Social interactions should be encouraged instead. Modifying the environment may help to provide better healthcare. The nurse should limit the client's choices of food and clothing to relieve any decision-making stress. The nurse should also encourage fluid intake.
A client tells the nurse, "All my friends experiment with drugs. I like the high I get when I huff paint. Nothing bad is going to happen to me." What is the best response by the nurse? 1 "Inhalants can cause a mild state of intoxication." 2 "Huffing paint can damage your lungs, kidneys, and liver." 3 "Withdrawal problems will start if you continue huffing paint." 4 "Limiting the type of inhalant used decreases respiratory irritation."
Correct 2 "Huffing paint can damage your lungs, kidneys, and liver." Inhaled toxins become systemic and cause damage to major organs such as the lungs, liver, and kidneys. Inhalants tend to produce euphoria, not just a mild state of intoxication. Huffing paint will not produce major withdrawal symptoms. All toxic substances that are inhaled become systemic and cause damage to major organs such as the lungs, liver, and kidneys.
A nurse is counseling a client who abuses cocaine. The nurse recognizes that this drug is representative of which drug category? 1 An opioid 2 A stimulant 3 A barbiturate 4 A hallucinogen
Correct 2 A stimulant Cocaine is classified as a stimulant. It is inhaled in its powdered form or smoked as crack; its use creates experiences similar to but more intense than those experienced with the amphetamines, and its withdrawal results in a deeper crash. Opioids and barbiturates are central nervous system depressants. Hallucinogens produce cerebral excitation that can yield a state similar to psychosis.
Which drug is used to treat both generalized anxiety disorder and depression? 1 Fluoxetine 2 Bupropion 3 Duloxetine 4 Mirtazapine
Correct 3 Duloxetine Duloxetine is an antidepressant drug used to treat both generalized anxiety disorder and depression. Fluoxetine is used to treat depression. Bupropion is used to treat depression and also aid in smoking cessation. Mirtazapine is used in the treatment of depression and also helpful in reducing the adverse sexual side effects in the male client receiving selective serotonin reuptake inhibitors therapy.
A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience? 1 Dizziness 2 Breathlessness 3 Abdominal cramps 4 Increased alertness
Correct 4 Increased alertness Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.