NR 326 CMS Exam(questions and answers completed)2022

What is Nurse John likely to note in a male client being admitted for alcohol withdrawal? A. Perceptual disorders B. Impending coma C. Recent alcohol intake D. Depression with mutism Option A: Frightening visual hallucinations are especially common in clients experiencing alcohol withdrawal June has agreed to take amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do? A. Withhold the drug B. Record the client’s response C. Encourage client to tell the physician D. Suggest that it takes awhile before seeing the results. Option D: The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached. 00:28 01:27 In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle knows that succinylcholine (Anectine) will be administered for which therapeutic effect? A. Short acting anesthesia B. Decreased oral and respiratory secretions C. Skeletal muscle paralysis D. Analgesia Option C: Succinylcholine (Anectine)is a depolarizing muscle relaxant causing paralysis. It is used to reduce the intensity of muscle contractions during the convulsive stage, thereby reducing the risk of bone fractures or dislocation Nurse Gina is aware that the dietary implications for a client in manic phase of bipolar disorder is: A. Serve the client a bowl of soup B. Increase calories, decrease fat, and decrease carbohydrates C. Give the client pieces of cut up steak, potatoes, peas D. Increase calories, increase carbohydrates, and increase protein Option D: This client needs increased protein for tissue building and increased calories to replace what is burned up (usually via carbohydrates); preferable, portable d/t acute mania sx Potatoes- does not indicate if portable What parental behavior toward a child during an admission procedure should cause Nurse Ron to suspect child abuse? A. Flat affect B. Expressing guilt C. Acting overly solicitous toward the child D. Ignoring the child Option C: Acting overly solicitous (overly concerned, mindful, anxiously concerned) toward the child This behavior is an example of reaction formation, a coping mechanism. Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior? A. By designating times during which the client can focus on the behavior B. By urging the client to reduce the frequency of the behavior as rapidly as possible C. By calling attention to, or attempting to prevent the behavior D. By discouraging the client from verbalizing anxieties CORRECT - Option A: The nurse should designate times during which the client can focus on the compulsive behavior or obsessive thoughts. Option B: The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. Option C: She shouldn’t call attention to, or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror to the client. Option D: The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior. After seeking help at an outpatient mental health clinic, Ruby, who was raped while walking her dog, is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby? A. Recommending a high protein, low-fat diet B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle C. Allowing the client time to heal D. Exploring the meaning of the traumatic event with the client CORRECT - Option D: The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse. Option A: A special diet isn’t indicated unless the client also has an eating disorder or a nutritional problem. Option B: The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. Option C: The client must explore the meaning of the event and won’t heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client’s anxiety and induce sleep. Exposure therapy may also be indicated. Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, “Why has this happened to me?” What is the nurse’s best response? A. “You’ve developed this paralysis so you can stay with your parents. You must deal with the conflict if you want to walk again.” B. “It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical.” C. “Your problem is real but there is no physical basis for it. We’ll work on what is going on in your life and why it’s happened.” D. “It isn’t uncommon for someone with your personality to develop a conversion disorder during times of stress.” CORRECT - Option C: The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear. Option A: Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn’t help her understand and resolve the underlying conflict. Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer the client’s question; knowing that the cause is psychological wouldn’t necessarily make her feel better. Nurse Trina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD): A. Benztropine (Cogentin) and diphenhydramine (Benadryl) B. Chlordiazepoxide (Librium) and Diazepam (Valium) C. Fluvoxamine (Luvox) and Clomipramine (Anafril) D. Divalproex (Depakote) and Lithium (Lithobid) CORRECT - Option C: The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Option B: Librium and Valium may be helpful in treating anxiety related to OCD but aren’t drugs of choice to treat the illness. Options A and D: The other medications mentioned aren’t effective in the treatment of OCD. Alfred was newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following? A. A warning about the drug’s delayed therapeutic effect, which is from 14-30 days B. A warning about the incidence of neuroleptic malignant syndrome (NMS) C. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug D. A warning that immediate sedation can occur with a resultant drop in pulse CORRECT - Option A: The client should be informed that the drug’s therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Option B: NMS hasn’t been reported with this drug, but tachycardia is frequently reported. Option C: Blood level checks aren’t necessary Which medications have been found to help reduce or eliminate panic attacks? A. Antidepressants B. Anticholinergics C. Antipsychotics D. Mood stabilizers CORRECT - Option A: Tricyclic and monoamine oxidase (MAO) inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn’t clearly understood. Option B: Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don’t relieve the anxiety itself. Option C: Antipsychotic drugs are inappropriate because clients who experience panic attacks aren’t psychotic. Option D: Mood stabilizers aren’t indicated because panic attacks are rarely associated with mood changes. A 65 years old client is in the first stage of Alzheimer’s disease. Nurse Patricia should plan to focus this client’s care on: A. Offering nourishing finger foods to help maintain the client’s optimal nutritional status. B. Providing emotional support and individual counseling. C. Monitoring the client to prevent minor illnesses from turning into major problems. D. Suggesting new activities for the client and family to do together. CORRECT - Option B: Clients in the first stage of Alzheimer’s disease are aware that something is happening to them and may become overwhelmed and frightened. Therefore, nursing care typically focuses on providing emotional support and individual counseling. Options A, C, and D: The other options are appropriate during the second stage of Alzheimer’s disease when the client needs continuous monitoring to prevent minor illnesses from progressing into major problems and when maintaining adequate nutrition may become a challenge. During this stage, offering nourishing finger foods helps clients to feed themselves and maintain adequate nutrition. The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent? A. Combativeness, sweating, and confusion B. Agitation, hyperactivity, and grandiose ideation C. Emotional lability, euphoria, and impaired memory D. Suspiciousness, dilated pupils, and increased blood pressure CORRECT - Option C: Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory. Option A: Phencyclidine (PCP) overdose can cause combativeness, sweating, and confusion. Option B: Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation. Option D: Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure. Nurse Amy is providing care for a male client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: A. Barbiturates B. Amphetamines C. Methadone D. Benzodiazepines CORRECT - Option C: Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn’t have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Options A, B, and D: Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment. Nurse Marco is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? A. Restrict visits with the family and friends until the client begins to eat B. Provide privacy during meals C. Set up a strict eating plan for the client D. Encourage the client to exercise, which will reduce her anxiety CORRECT - Option C: Establishing a consistent eating plan and monitoring the client’s weight are very important in this disorder. Option A: The family and friends should be included in the client’s care. Option B: The client should be monitored during meals-not given privacy. Option D: Exercise must be limited and supervised. Mickey is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: A. Avoid shopping for large amounts of food B. Control eating impulses C. Identify anxiety-causing situations D. Eat only three meals per day CORRECT - Option C: Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety.