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74 Cards in this Set

  • Front
  • Back
Determination of whether an event is a stressor is based on a per-
son’s
a. tolerance.
b. perception.
c. adaptation.
d. stubbornness.
perception
The nurse recognizes that a patient with newly diagnosed breast cancer is using an emotion-focused coping process when she
a. joins a support group for women with breast cancer.
b. considers the pros and cons of the various treatment options. c. delays treatment until her family can take a weekend trip
together.
d. tells the nurse that she has a good prognosis because the tumor
is small.
joins a support group for women with breast cancer.
The nurse would expect which findings in a patient as a result of the physiologic effect of stress on the reticular formation?
a. An episode of diarrhea while awaiting painful dressing changes
b. Refusal to communicate with nurses while awaiting a cardiac
catheterization
c. Inability to sleep the night before beginning to self-administer
insulin injections
d. Increased blood pressure, decreased urine output, and hypergly-
cemia after a car accident
inability to sleep the night before beginning to self-administer
insulin injections
The nurse uses knowledge of the effects of stress on the immune
system by encouraging patients to
a. sleep for 10 to 12 hours per day.
b. avoid exposure to upper respiratory tract infections.
c. receive regular immunizations when they are stressed.
d. use emotion-focused rather than problem-focused coping strat-
egies.
avoid exposure to upper respiratory tract infections.
The nurse recognizes that a person who is subjected to chronic
stress could be at higher risk for a. osteoporosis.
b. colds and flu.
c. low blood pressure.
d. high serum cholesterol.
colds and the flu
During a stressful circumstance that is uncontrollable, which type of coping strategy is the most effective?
a. Avoidance
b. Coping flexibility
c. Emotion-focused coping
d. Problem-focused coping
Emotion-focused coping
An appropriate nursing intervention for a hospitalized patient who states she cannot cope with her illness is
a. controlling the environment to prevent sensory overload and

b. promote sleep.
c. encouraging the patient’s family to offer emotional support by frequent visiting.
d. arranging for the patient to phone family and friends to main- tain emotional bonds.
asking the patient to describe previous stressful situations and how she managed to resolve them.
arranging for the patient to phone family and friends to main- tain emotional bonds.
asking the patient to describe previous stressful situations and how she managed to resolve them.
A cluster of neuronal structures in the middle of the brainstem, called the reticular activating system (RAS), is asso- ciated with?
generalized cortical activation and behavioral arousal. Various neurotransmitters (glutamate, acetylcholine, norepinephrine, dopamine, histamine, serotonin) promote wake behavior.5
Sleep is best described as a
a. loosely organized state similar to coma.
b. state in which pain sensitivity decreases.
c. quiet state in which there is little brain activity.
d. state in which an individual lacks conscious awareness of the
environment.
state in which an individual lacks conscious awareness of the
environment.
Which statement is true regarding rapid eye movement (REM)
sleep?
a. The EEG pattern is quiescent.
b. It occurs only once in the night.
c. It is separated by distinct physiologic stages.
d. The most vivid dreaming occurs during this phase.
The most vivid dreaming occurs during this phase.
nsufficient sleep is associated with (select all that apply) a. increased body mass index.
b. increased insulin resistance.
c. impaired cognitive functioning.
d. increased immune responsiveness.
e. increased daytime body temperature.
a

&

b

&

C
When teaching the patient with primary insomnia about sleep hygiene, the nurse should emphasize
a. the importance of daytime naps.
b. the need to exercise before bedtime.
c. the need for long-term use of hypnotics.
d. avoiding caffeine-containing beverages 6 to 9 hours before
bedtime.
avoiding caffeine-containing beverages 6 to 9 hours before
bedtime.
While caring for a patient with a history of narcolepsy with cata-
plexy, the nurse can delegate which activity to the unlicensed assis- tive personnel (UAP)?
a. Teaching about the timing of medications
b. Walking the patient to and from the bathroom
c. Developing a plan of care with a family member
d. Planning an appropriate diet that avoids caffeine-containing
foods
Walking the patient to and from the bathroom
A patient with sleep apnea would like to avoid using a nasal CPAP device if possible. To help him reach this goal, the nurse suggests that the patient
a. lose excess weight.
b. take a nap during the day.
c. eat a high-protein snack at bedtime.
d. use mild sedatives or alcohol at bedtime.
lose excess weight.
A patient on the surgical unit has a history of parasomnia (sleep- walking). What statement describes parasomnia?
a. Hypnotic medications reduce the risk of sleepwalking.
b. The patient is often unaware of the activity on awakening.
c. The patient should be restrained at night to prevent personal harm.
d. Thepotentialforsleepwalkingisreducedbyexercisebeforesleep.
The patient is often unaware of the activity on awakening.
Strategies to reduce sleepiness during nighttime working include a. exercising before work.
b. taking melatonin before working the night shift.
c. sleeping for at least 2 hours immediately before work time.
d. walking for 10 minutes every 4 hours during the night shift.
sleeping for at least 2 hours immediately before work time.
defines pain?
an unpleasant sensory and emotional experience asso- ciated with actual or potential tissue damage, or described in terms of such damage.”2
Nociception is?
the physiologic process by which information about tissue damage is communicated to the central nervous system (CNS).
Nociception involves four processes??
1) transduction, (2) transmission, (3) perception, and (4) modulation (Fig. 9-1)
Transduction involves?
the conversion of a noxious mechanical, thermal, or chemical stimulus into an electrical signal called an action potential.
For example, nonsteroidal antiinflam- matory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Naprosyn, Aleve), and corticosteroids, such as dexa- methasone (Decadron), exert their analgesic effects by?
blocking pain-sensitizing chemicals.
Drugs that stabilize the neuronal membrane and inactivate peripheral sodium channels inhibit production of?
the nerve impulse.
Transmission is the process by
which pain signals are relayed from the periphery to the spinal cord and then to the brain.
A-delta fibers are ?
small, myelinated fibers that conduct pain rapidly and are responsible for the initial, sharp pain that accompanies tissue injury.
C fibers are ?
small, unmyelinated fibers that trans- mit painful stimuli more slowly and produce pain that is typi- cally aching or throbbing in quality.
allodynia?
people experience significant pain from touch or tactile stimu- lation in and around the areas of tissue or nerve injury
acute, unrelieved pain leads to chronic pain through the process of ?
central sensi- tization.
Neuroplasticity refers to processes that?
allow neurons in the brain to compensate for injury and adjust their responses to new situations or changes in their environment.
Perception occurs when?
pain is recognized, defined, and assigned meaning by the individual experiencing the pain.
it is believed that the reticular activating system (RAS) is responsible for ?
warning the individual to attend to the pain stimulus
Modulation involves the activation of?
descend- ing pathways that exert inhibitory or facilitatory effects on the transmission of pain
Nociceptive pain is caused by?
damage to somatic or visceral tissue.
Visceral pain comes from the activation of nociceptors in the?
internal organs and lining of the body cavities such as the tho- racic and abdominal cavities.
Neuropathic pain is caused by?
damage to peripheral nerves or structures in the CNS
One particularly debilitating type of neuropathic pain is?
complex regional pain syndrome (CRPS).
End-of-dose failure?
is pain that occurs before the expected duration of a specific analgesic.
Pain medications generally are divided into three categories:
nonopioids, opioids, and adjuvant drugs.
Nonopioid analgesics include?
acetaminophen, aspirin and other salicylates, and NSAIDs
Opioids (Table 9-9) produce their effects by bind- ing to receptors in the CNS. This results in ?
(1) inhibition of the transmission of nociceptive input from the periphery to the spinal cord, (2) altered limbic system activity, and (3) activation of the descending inhibitory pathways that modulate transmission
most common side effect of opioids.?
Constipation
equianalgesic dose refers to?
a dose of one analgesic that is approximately equivalent in pain- relieving effects to a given dose of another analgesic
Neuroablative techniques destroy nerves?
thereby inter- rupting pain transmission.
Pain is best described as
a. a creation of a person’s imagination.
b. an unpleasant, subjective experience.
c. a maladaptive response to a stimulus.
d. a neurologic event resulting from activation of nociceptors.
an unpleasant, subjective experience.
A patient is receiving a PCA infusion after surgery to repair a hip fracture. She is sleeping soundly but awakens when the nurse speaks to her in a normal tone of voice. Her respirations are 8 breaths/minute. The most appropriate nursing action in this situ- ation is to
a. stop the PCA infusion.
b. obtain an oxygen saturation level.
c. continue to closely monitor the patient.
d. administer naloxone and contact the physician.
continue to closely monitor the patient.
Which words are most likely to be used to describe neuropathic pain (select all that apply)?
a. Dull
b. Mild
c. Burning d. Shooting e. Shock-like
c & D & E
Unrelieved pain is
a. expected after major surgery.
b. expected in a person with cancer.
c. dangerous and can lead to many physical and psychologic com-
plications.
d. an annoying sensation, but it is not as important as other phys-
ical care needs.
dangerous and can lead to many physical and psychologic com-
plications.
A cancer patient who reports ongoing, constant moderate pain
with short periods of severe pain during dressing changes is
a. probably exaggerating his pain.
b. best treated by referral for surgical treatment of his pain.
c. best treated by receiving both a long-acting and a short-acting
opioid.
d. best treated by regularly scheduled short-acting opioids plus
acetaminophen.
best treated by receiving both a long-acting and a short-acting
opioid.
An example of distraction to provide pain relief is
a. TENS.
b. music.
c. exercise.
d. biofeedback.
music.
Appropriate nonopioid analgesics for mild pain include (select all that apply)
a. oxycodone.
b. ibuprofen (Advil).
c. lorazepam (Ativan).
d. acetaminophen (Tylenol).
e. codeine with acetaminophen (Tylenol #3).
B & D
An important nursing responsibility related to pain is to a. leave the patient alone to rest.
b. help the patient appear to not be in pain.
c. believe what the patient says about the pain.
9.
10.
d. assume responsibility for eliminating the patient’s pain.
believe what the patient says about the pain
Providing opioids to a dying patient who is experiencing moderate to severe pain
a. may cause addiction.
b. will probably be ineffective.
c. is an appropriate nursing action.
d. will likely hasten the person’s death.
is an appropriate nursing action.
A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects
a. a belief that will contribute to appropriate pain management.

b. an accurate statement about pain mechanisms and an expected goal of pain therapy.
c. a belief that will have no effect on the type of care provided to people in pain.
d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management.
a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain
Palliative care is?
any form of care or treatment that focuses on reducing the severity of disease symptoms, rather than trying to delay or reverse the progression of the disease itself or provide a cure.
The major difference between palliative care and hospice care is that palliative care allows?
a person to simultaneously receive curative and palliative treatments.
Noisy, wet-sounding respirations, ?
death rattle
Advance directives are?
he written documents that provide information about the patient’s wishes and his or her designated spokesperson
1. An 80-year-old female patient is receiving palliative care for heart
failure. Primary purpose(s) of her receiving palliative care is (are) to (select all that apply)
a. improve her quality of life.
b. assess her coping ability with disease.
c. have time to teach patient and family about disease.
d. focus on reducing the severity of disease symptoms.
e. provide care that the family is unwilling or una
A & D
Wernicke’s encephalopathy?
an inflammatory, hemorrhagic, degenerative condition of the brain. Wernicke’s encephalopathy is caused by a thiamine deficiency
Wernicke’s encephalopathy may lead to Korsakoff’s psychosis…which is?
an irreversible form of amnesia characterized by loss of short-term memory and an inability to learn.
A person who injects heroin to experience the euphoria that it
causes is demonstrating a. abuse.
b. addiction.
c. tolerance.
d. addictive behavior.
addictive behavior
When admitting a patient, the nurse must assess the patient for
substance use based on the knowledge that long-term use of addic- tive substances leads to
a. the development of coexisting psychiatric illnesses.
b. a higher risk for complications from underlying health prob-
lems.
c. increased availability of dopamine, resulting in decreased sleep
requirements.
d. potentiation of effects of similar drugs taken when the individ-
ual is drug free.
a higher risk for complications from underlying health prob-
lems.
The nurse would suspect cocaine overdose in the patient who is
experiencing
a. craving, restlessness, and irritability.
b. agitation, cardiac dysrhythmias, and seizures.
c. diarrhea, nausea and vomiting, and confusion.
d. slow, shallow respirations; hyporeflexia; and blurred vision.
agitation, cardiac dysrhythmias, and seizures.
The most appropriate nursing intervention for a patient who is being treated for an acute exacerbation of chronic obstructive pul- monary disease who is not interested in quitting smoking is to
a. accept the patient’s decision and not intervene until the patient
expresses a desire to quit.
b. realize that some smokers will never quit, and trying to assist
them increases the patient’s’ frustration.
c. motivate the patient to quit by describing how continued
smoking will worsen the breathing problems.
d. ask the patient to identify the relevance, risks, and benefits of
quitting and what barriers to quitting are present.
ask the patient to identify the relevance, risks, and benefits of
quitting and what barriers to quitting are present.
While caring for a patient who is experiencing alcohol withdrawal, the nurse should (select all that apply)
a. monitor neurologic status on a routine basis.
b. provide a quiet, nonstimulating, dimly lit environment.
c. pad the side rails and place suction equipment at the bedside. d. orient the patient to environment and person with each contact. e. administer antiseizure drugs and sedatives to relieve symptoms
during withdrawal.
A & C & D
Substance abuse problems in older adults are usually related to
a. use of drugs and alcohol as a social activity.
b. misuse of prescribed and over-the-counter drugs and alcohol.
c. continuing the use of illegal drugs initiated during middle age.
d. a pattern of binge drinking for weeks or months with periods of
sobriety.
misuse of prescribed and over-the-counter drugs and alcohol.
An 80 year old female patient is receiving palliative care for heart failure. Primary purpose of her receiving palliative care is (are) to (select all that apply)

a. improve her quality of life
b. assess her coping ability with disease
c. focus on reducing the severity of disease symptoms
d. provide care that the family is unwilling or unable to give
A & D
The primary purpose of hospice is to?
provide comfort and support for dying patients and their families
A 67 year old woman was recently diagnosed with inoperative pancreatic cancer. Before the diagnosis she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating?

a. peacefulness
b. decreased socialization
c. decreased decision making
d. anxiety about unfinished business
decreased socialization.
For the past five years Tom has repeatedly asked his mother to donate his deceased father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing?

a. adaptive
b. disruptive
c. anticipatory
d. prolonged
b. disruptive
The home health nurse visits a 40 year old patient with metastatic breast cancer who is receiving palliative care. The pt is experiencing pain at a level of 7 out of 10. In prioritizing activities for the visit, the nurse should first do which?

a. auscultate breath sounds
b. admin PRN pain meds
c. check pressure points for skin breakdown
d. ask about patient's food and fluid intake
b. admin PRN pain meds
While caring for his dying wife, the husband states that his wife is a devout Roman Catholic but he is a baptist. Who is considered the most reliable source for spiritual preferences concerning EOL care for the dying wife?
dying wife
The family attorney informed a patient's adult children and wife that the patient did not have an advanced directive after he suffered a serious stroke. Who is responsible for making the decision about EOL measures when the patient cannot communicate his or her specific wishes?

a.notary and attorney
b. physician and wife
c. wife and adult children
d. physician and nursing staff
wife and adult children
The children caregivers of an elderly patient whose death is imminent have not left the bedside for the past 36 hours. In the nurse's assessment of the family, what findings indicate the potential for an abnormal grief reaction? (all that apply)

a. family cannot express their feelings to one another
b. Dying patient is becoming more restless and agitated
c. A family member is going through a difficult divorce
d. siblings who were estranged from each other have now reunited
A & C
A nurse has been working full time with terminally ill patients for 3 years. He has been experiencing irritability and mixed emotions when expressing sadness since four of his patients died on the same day. To optimize the quality of his nursing care, he should examine his own?

a. full-time work schedule
b. past feelings towards death
c. patterns for dealing with grief
d. demands for involvement in patient care
Patterns for dealing with grief