AM
HESI FUNDAMENTALS EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
Terms in this set (319)
to allow the client to autonomy to make choices when appropriate. keep
the purpose of therapeutic interaction
statements value-free, advice free, and reassurance-free
what action should the nurse take in a assess. example: if a client has schizophrenia complains of chest pain take their
psychiatric situation when the blood pressure
client
describes a physical problem?
establish trust, nonjudgemental attitude,active listening, offer self, accept client's
basic communication principles
feelings, validate client's statements, matter of fact approach
nausea is a common complaint after ECT vomiting by an unconscious can lead to aspiration. maintain a paten airway
increased heart rate, and blood pressure, rapid shallow respirations, dry mouth, tight
common physiological responses to
feeling in throat, tremors, muscle twitching, anorexia, urinary frequency, palmar
anxiety
sweating
anxiety is contagious, nurse needs to asses on anxiety level and remain calm. it
nurse-client anxiety
helps gain control, decrease anxiety, and increase feelings of security
is the nursing intervention for phobia disorders. --assess client to recognize the
factors associated with feared stimuli.
desensitization -teach and practice with client alternative coping strategies
-expose client to feared stimuli
-provide positive reinforcement
the nurse should place an anxious quiet area of the unit away from the nurse's station
client where there are reduced
environmental stimuli
the best time for interaction with a client the client's anxiety is lowest at this time and its an optimal time for learning
is at the completion of the performed
ritual
compulsive acts are used in response to its the nurse's responsibility help alleviate anxiety, interfering will increase the anxiety
anxiety, which may or may not be related
to the obsession. its the nurse's
responsibility help alleviate anxiety
-actively listen to the clients obsessive themes
as long as the client's acts are free of -acknowledge the effects that ritualistic acts have on the client
violence: nurse should.... -demonstrate empathy
-avoid being judgmental
-actively listen to client's stories of experiences surrounding the traumatic event
-assess suicide risk
-assist client to develop objectivity about the event and problem solve regarding
ford clients with PTSD, the nurse should....
possible means of controlling anxiety related to the event
-encourage group therapy with other clients who have experienced the same
traumatic event
be aware of your own feelings when the pain is real to the person experiencing it
dealing with this somatoform clients.
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theses disorders cannot be explained -acknowledge the symptom or complaint
medically, it results from internal conflict. -reaffirm that diagnostic test results reveal no organic pathology
the nurse should... -determine the secondary gains acquired by the client
avoid giving clients with dissociative the various types of amnestic that accompany dissociative disorders provide
disorders too much information about past protection from pain and too much to soon can cause decompensation
events at one time
personality disorders are long standing persons with personality disorders are usually comfortable with their disorders and
behavioral traits that are maladaptive believe that they are right and the world is wrong and have little motivation
responses to anxiety and that cause
difficulty in relating to and working with
other individuals
people with anorexia gain pleasure from these behaviors reinforce their perception of self-control. don not allow these
providing others with food and watching clients to plan or prepare food for unit-based activities
them eat
individuals with Bulimia often use syrup of because heart failure is not usually seen in this age group, it is often overlooked.
ipecac to induce vomiting. if ipecac is not assess for edema and listen to breath sounds
vomited and is absorbed, cardiotoxicity
may occur and cause conduction
disturbances, cardiac dysrhythmias, fatal
myocarditis, and circulatory failure
physical assessment and nutritional family therapy is most effective because issues of control are common in these
support are a priority, the physiological (eating disorders.) therapy is usually long term
implication are great. nursing
interventions should
increase self-esteem and develop a
positive body image.
the most important s/s of depression are a the client has a sustained loss
depressed mood with a loss of interest in
the pleasures in life
-significant change in appetite
-insomnia
-fatigue or lack of energy
s/s of depression
-feelings of hopelessness
-loss of ability to concentrate
-preoccupation with death or suicide
depressed clients have difficulty hearing comment on signs of improvement by noting behavior
and accepting compliments because of
their lowered self-concept
the nurse knows depressed clients are begin to take an interest in their appearance or begin to perform self-care activities
improving when they
the nurse should suspect an imminent be aware a happy affect may signify the the client feels relieved that a plan has
suicide attempt if a depressed been made and is prepared for the suicide attempt
client becomes "better"
when dealing with a depressed client the this helps to promote self-esteem and a sense of control
nurse should assist with personal
hygiene tasks and encourage the client
to initiate grooming activities even when
they dont feel like doing so
nursing intervention for depressed client sit quietly with the client, offering your support with your presence
side effects of antianxiety drugs sedation, drowsiness
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