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166 Cards in this Set

  • Front
  • Back
Communication can be defined as
the exchange of information
Symptoms of anxiety in relation to speech may include
slowed speech, excess speech and speech blocking
According to Freud, all psychic energy comes from the
The most important skill the nurse can develop for her patient is
clinical skills
A simple goiter is most likely caused by
iodine deficiency
The most critical concern in the postoperative care of a patient who has undergone thyroidectomy would be
respiratory distress caused by edema or hemorrhage
When dealing with a severely depressed patient, the best way to initiate communication would be to say
“I’m going to sit here with you for a little while”
Signs and Symptoms of diabetes insipidus include these three
polyuria, polydypsia and polyphagia
What behavior would you expect of a child with autism?
noneffective verbal communication
According to psychoanalytic theory, the inability to break ties with one’s mother would indicate which stage has not been successfully completed?
Three examples of increased autonomy would be
encouraging the patient to make choices in food selection, promoting an unhurried atmosphere during meal time to allow for self-feeding and encouraging the patient to do as much of this as possible
A Russian-speaking gentlemen who knows only few words in English is admitted to your floor following a motor vehicle accident. He is expected to be discharged within 48 hours. The most appropriate intervention would be
use an interpreter for initial baseline interview, important instructions for procedures, and discharge instructions
To be most successful in the role of parental surrogate, the nurse should
respect the patient’s needs for dependence and allow it
When Mrs. Roxelle is admitted to the psychiatric unit she has a rosary in her hands and is constantly fingering it. You should
allow her to keep it unless it may pose a threat to her safety
While pointing to another patient, Mr. Brown states, “The lady is going to murder me. I know she is out to get me.” Your best response would be
“I will stay with you for a while. Let’s take a walk.”
The best way to terminate an initial interview is for the nurse to
summarize topics discussed
A patient told her counselor that she plans to commit suicide so a staff member is assigned to keep the patient in sight at all times. The patient asks “Why are you following me around today?” Your reply would be
“I’m sorry if I appear to be following you. I just want to make certain you are all right”
What advice you give a patient who reports “My heart is racing and I just can’t breathe.”
see a doctor immediately
What would be an example of unresolved grief in a woman whose husband died 14 months ago?
going to the cemetery daily
Which statement would indicate that an adolescent is establishing her identity
“My father wants me to be an accountant but I’m going to be a ballerina”
Prolixin is most commonly used as an
What do you watch for in the patient who has suffered a blunt liver trauma?
hemorrhage, loss of bowel sounds and hematuria
Which therapy would be most likely lead to lithium toxicity
diuretic therapy
A female patient has developed hirsutism secondary to steroid therapy. What is an indication that she is beginning to adjust to the changes?
she looks at herself in the mirror
Imitation without any meaning attached, and motions made by others would be termed
The most common side-effect of Thorazine is
extrapyramidal symptoms
Cushing’s syndrome would be suspected in a patient with which symptoms?
hirsutism, acne, hyperglycemia, muscle weakness, emotional liability, changes in external sex characteristics
You work in a busy walk-in clinic and go out into the crowded waiting room to take blood pressure. As you are taking blood pressure, you ask the patient, “What’s bothering you today?” Which basic rule of interviewing have you violated?
provision of privacy
A psychiatric patient on a phenothiazine-type drug (Levodopa) and develops a slow, shuffling gait. What type of drug would you expect to give to control the symptoms?
When assessing a rape victim’s ability, which should be assessed first?
extent of physical injuries
Your patient who had a laryngectomy and has been doing well with his own stoma care suddenly refuses to do his own stoma care and is restless and agitated. The most therapeutic nursing intervention would be to say
“Something seems to be bothering you today. Tell me about it."
Which landmark is best to use when measuring for ascites?
When caring for a patient with renal calculi of unknown origin, the nurse should encourage
plenty of water and other fluids
The most common pattern seen in a bulimic patient is to
have a very distorted body image
Mrs. Sammy cleans her house from top to bottom every day even though it is immaculate to start with. This is an example of
A person is on steroid therapy should be checked frequently for
sign and symptoms of infection
The neurotic person most needs
feelings of belonging and acceptance
A patient who is on Antabuse drinks alcohol and then calls you. What symptoms would you tell her to expect?
As you walk into Mr. Golden’s room he declares, “I hate them!” Your best response would be
“You hate them?"
Increased calcium levels would be responsible for
renal calculi
The main goal in disciplining children is
inhibition of antisocial, impulsive behavior
Which of the following normal physiologic changes occurs first?
closure of the epiphyses (The end regions of the bone; regions of secondary ossification.)
Which child most likely has a serious disturbance in language development?
a one year old who does not imitate speech sounds or babble
When caring for a withdrawn patient, it would be most beneficial in developing a trusting relationships to
encourage small group activity
Painful memories and disagreeable desires that appear as physical symptoms are the results of
conversion reaction
What type of medication would be prescribed for a patient with cogwheel rigidity, with twisting of the face upward and other extrapyramidal effects?
When experiencing difficulty in communication with a patient, a method that is sometimes helpful would be to
involve the patient in a concurrent activity (e.g., jigsaw puzzle)
Extrapyramidal symptoms are commonly associated with what disease?
Parkinson’s disease
An example of a good support system for Mrs. Main, a newly diagnosed insulin dependent diabetic, would be
her husband is planning to diet with her
Mrs. Jones continued crying throughout the entire initial nursing interview. After questioning, you found out that her husband died recently. She is most likely in which stage of grief?
Discharge instruction for a patient with cirrhosis should include which information regarding skin care?
Keep skin clean and well lubricated to dryness and itching.
A Type II diabetic who normally takes Orinase orally is put on insulin during and following a surgical procedure. You should tell the patient
Oral administration of Orinase will most likely be resumed after the initial post-operative period has passed
Evidence that therapy with Cephulac has been successful would be
the patient has 3-4 soft stools daily and his orientation is improving
Distonic reactions secondary to Haldol administration can best be controlled by
antiparkinsonism drugs (e.g., Cogentin)
The patient who has just received outpatient RAI (radioactive iodine) therapy should be taught
to avoid prolonged contact with others during first few days
The most widely held theory of schizophrenia attributes symptoms to
increased dopamine levels and/or dopamine receptors in the body
Which statement best describes the onset of Alzheimer’s disease?
Symptoms stem from normal everyday events and develop insidiously into, the typical abnormal changes in behavior seen in Alzheimer’s patients.
A common symptom of post-traumatic stress syndrome is
increased startle reflex
Following administration of DDAVP, the nurse should expect
decreased urinary output
The laboratory finding most indicative of acute glomerulonephritis would be
increased antistreptolysin (ASO) titer
The erythrocyte sedimentation rate (ESR) is increased during
inflammatory processes
The least likely side effect seen in patients receiving corticosteroid administration is
The mother of a terminally ill three year old says to you. “I hate all of you and all the other incompetent doctors and nurses. The statement which would be most therapeutic is
“You are having some really strong feelings right now. Let’s talk about how you feel”
A terminally ill patient in a hospice is wanting to give a large cash donation to the hospice. She is most likely exhibiting what type of behavior?
Which finding would most likely be inconsistent with nephrotic syndrome?
The most common side-effect following ECT treatment is
short-term memory loss
A teenage traumatic amputee keeps his eyes tightly shut during dressing changes and only talks in monosyllables. The most appropriate nursing goal (outcome) at this time would be to
acknowledge and accept his loss
As you are serving breakfast, a schizophrenic patient says to you. “There are snakes coming out of my arms and legs.” The most therapeutic nursing response would be
“I cannot see any snakes coming out of your arms or legs.”
What would be the reason for a patient to have increased hallucinations during the termination phase of the nurse-patient relationship?
The patient is having difficulty dealing with separation anxiety.
A woman cleans her house from 6am to 8pm every day of the week. She is most likely
displacing her anxiety
When caring for a patient who exhibits compulsive behaviors, the most therapeutic nursing intervention would be to
allow the patient time to complete rituals
“Birds of a feather flocked together” is an example of?
psychiatric proverb
Which type of thought patterns is least typical of schizophrenic thought patterns
abstract thoughts
The best nursing intervention for a patient with anorexia nervosa would be to
provide her with her favorite foods in small quantities several times a day
The best diet for a patient suffering from bipolar disorder during the hypermanic phase would be
regular meals with frequent snacks given away from other patients
Which statement about dealing with patients who are experiencing delusions of grandeur is most accurate?
The nurse should encourage the patient to talk about his feelings but not the specifics of his delusion.
The most appropriate intervention to use when dealing with a patient who is having hallucinations would be to
reinforce reality and simply, but clearly state, that others are not seeing or hearing what he is perceiving
Evidence that therapy with antidepressant drugs is succeeding would be an
improvement in mood
The most important nursing intervention to use when a depressed patient’s mood begins to lift would be to
observe closely for suicide attempt
The best way to keep a patient from committing suicide is to
formulate a “no-suicide contract” contract with him
Which statement by an adolescent indicates the greatest need for follow-up psychosocial therapy?
“I have no friends.”
Patients taking a MAO inhibitor should avoid all except
A 33 year old woman who has an intense fear of dirt washes her hands so many times a day, her hands are red, raw and bleeding. Your main nursing goal (outcome) should be
decrease the number of hand washings per day
The primary nursing goal when caring for a patient with ulcerative colitis is to
decrease stress
When a patient on a tyramine restricted diet “cheats” the nurse must be observant for
hypertensive crisis
The classic symptom of nephrotic syndrome is
During the manic phase of bipolar disorder, the primary goal of treatment is to
keep the patient from hurting himself or others
The most reliable way to help a patient overcome a stressful event is to help him
identify coping measures that were successful in the past
A patient with organic brain disease was recently admitted to the city nursing home and now frequently states, "Where am I?” The most therapeutic nursing response would be to say
“You are in the city nursing home.”
The family of a 39-year-old female with Cushing’s Syndrome reports that she is having severe mood swings making family life difficult and unpredictable. Which statement is most accurate?
The corticosteroid medication she is taking frequently causes mood swings.
Patients who are taking lithium should be instructed in the importance of
monthly testing for lithium levels
A patient who has been drinking heavily states. “You would drink a lot too if your job was as stressful as mine.” He is using which type of coping mechanism?
A 24 year old patient is getting ready to come in for an outpatient ECT treatment. After the treatment, he should be told to expect
to be groggy and slightly confused for a few hours
A patient with gall bladder disease will most likely report pain in
sub-scapular area of the back
A young man goes through an elaborate ritual every time he is asked to leave his room. He has a scheduled appointment with the psychiatrist for 2 pm. Your best nursing intervention to assure that he get to the appointment on time would be to
allow him sufficient time to complete his rituals
Maslow describes self-actualization as
realizing one’s potential
Symptoms of impending alcohol withdrawal include tremors, diaphoresis and
tachycardia, hypertension
A patient repeating the actions of another is
Waxy flexibility is a sign of
Catatonic Schizophrenia
In Diabetes Insipidus the urine specific gravity is
1.001 - 1.005
Bulimia is
binge eating
Keep a tracheostomy set in the patients room for ____ hours for emergency use after thyroidectomy
In corticosteroids therapy, the plan of care is to
prevent infection
Prior to IV pyelogram, the nurse needs to ask the patient
If he has allergies
Buffalo hump is an abnormal adipose tissue distribution in _________ syndrome
Synthroid is replacement therapy in
Acne vulgaris is one of the predisposing factors in hormonal changes during adolescence from
androgenic stimulation of sebum production
Synthroid should not to be taken with _____ since this may interfere with absorption.
Tofranil with concomitant use may lead to
GI complications
Patient on Synthroid therapy should report
Five signs and symptoms of hyperkalemia are
muscle weakness, hypotension, shallow respiration, apathy, and anorexia
A patient who has good control of diabetes may show a 2 hour postprandial blood sugar result of
139 mg/dl
Patient with hypothyroidism has
cold intolerance
In diabetes mellitus, the patient should do what with their feet?
Bathe their feel daily in warm water and dry feet carefully, especially between toes
A 21 year old getting married in 3 weeks stated ‘I’m not sure if I want to go through it”. What is Ericson's stage?
Intimacy vs. Isolation
Alcoholism - the psychosexual stage of development is
Acute pancreatitis clinical manifestation is
a constant epigastric abdominal pain radiating to the back and flank, which is more intense in supine position
A patient has a positive outlook on surgery. Which goal has been met?
What signs and symptoms should be reported immediately to the physician for a patient on Lithium Therapy?
Diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination.
What is the therapeutic serum level for Lithium therapy maintenance?
0.6 - 1.2 mEq/L (< 1.5 mEq/L is toxic)
Obsessive-compulsive disorder is an _____ related disorder?
Alanon is a support group for families of
The treatment for phobia (irrational fear) is called
After ECT treatment, how is the patient positioned
on her side or have her head turned to one side
Define delusion
a fixed false belief
Giving away personal possessions is one of the tell-tell signs of
suicide ideation
Mild anxiety is the level to
keep alert
Agoraphobia is fear of
open, crowded spaces
A personality disorder that manifests hostilities into others is
Diabetic neuropathy is a long term complication of
Diabetes Mellitus
To assess a patient's judgment, ask the patient what to do if he found a stamped envelope, the patient should respond
that he would drop it into the mail
After ECT, the patient should be monitored for
post shock amnesia
Patient on Lithium therapy, should have
adequate sodium diet and intake of fluid (2,500-3,000 mild).
The doctor pronounced that the child is dead, and the mother is still performing CPR, the mother is showing
Transvestitism is
a desire to wear clothes of the opposite sex
Portal vein hypertension is associated with
liver cirrhosis
After thyroidectomy, assess for
laryngeal damage that is manifested by hoarseness
Patient with hypoparathyroidism has
Tardive dyskinesia is
excessive blinking; vermiform tongue movement, abnormal involuntary sucking, chewing. licking, and pursing movements of tongue and mouth
Artane and Cogentin are given to
counteract extrapyramidal side-effects
Patient taking an MAOI should avoid foods like
aged cheese, caffeine, beer, yeast, chocolate, liver, processed foods and MSG to prevent hypertensive crisis
Three examples of extrapyramidal symptoms are
dystonia, akathisia (ants in the pants), and tardive dyskinesia
A manic depressive should be given what portion of foods to supply adequate nutrition
finger foods
What is the ideal diet for a patient with chronic pancreatitis?
low fat, bland diet
What are two symptoms of Diabetic Ketoacidosis?
kussmauls breathing and acetone breath
After a thyroidectomy, the nurse should check for signs of hemorrhage by
rolling patient to side and checking the back of the neck
In a woman diagnosed with cancer, the usual reaction is
The husband had a problem at work and came home and hit his wife, the defense mechanism is
Schizophrenia patient - How do you know if he is improving in his social activity
Attends group activity but doesn’t talk.
According to Erickson's theory, when is trust established?
For a manic patient, which signs needs intervention
Weight loss
Clinical manifestation of Thyroid storm or crisis is
Korsakoffs syndrome is due to the deficiency of
Vitamin B1 (Thiamine).
A common way to prevent lipodystrophy when giving insulin to a diabetic patient is to
change site of injection
Patient receiving Levodopa for the treatment of parkinsonism develops
a controlled shuffling gait
Clinical signs of esophageal varices are
One way to deal with a patient who is having anxiety is to
reduce stimuli
Chemical process that occurs to cause ketones to appear in urine
fat destruction (burning fat)
Peripheral vascular problems in diabetic patient - examine the skin daily for
Definitive diagnostic test for diabetes is
GTT (Glucose Tolerance Test)
Father lost his job and was very upset - which should be assessed first?
previous coping mechanism
Foods contraindicated with MAOI are
foods containing Tyramine
Patient with esophageal varices - check for
portal hypertension
Patient with obsessive compulsive disorder usually recognizes
senselessness of behavior
Drug of choice for manic-depressive is
Before Liver biopsy, check these two
PT (Prothrombin Time) and platelets