RECALLS 9 - NP5

Nurse Liza is assigned to care for the client. Which of the following medications prescribed by the physician should nurse Liza prepare to diagnose myasthenia gravis?

A. Atropine sulfate

B. Tensilon

C. Mestinon

D. Isuprel

Tensilon

A client is brought to the Emergency Department complaining of generalized weakness of all extremities and facial muscles and drooping of the eyelids since a week ago His condition fluctuates from day to day. The examining physician tested the client with an acetylcholinesterase inhibitor test to diagnose myasthenia gravis.

Thirty minutes after injection, nurse Liza noted an immediate Improvement in the muscle strength. This can be interpreted as a:

A. Autoimmune disorder

B. Positive test confirming the diagnosis

C. Negative failure

D. Negative for myasthenia gravis

Positive confirmatory diagnosis

The client asked if he will take Tensilon for MG treatment. Nurse Liza answered "NO" because:

A. It is toxic to the body

B. It is only short-acting

C. It causes adverse effects

D. It crosses the blood-brain barrier

It is only short acting

Nurse Liza noticed the client suddenly developed cramps and sweating. In a situation like this, which of the following drugs must be made available to control the side effects of he tested drug?

A. Prednisone

B. Mestinon

C. Atropine sulfate

D. Potassium supplement

Atropine Sulfate

Nurse Liza is administering pyridostigmine (Mestinon) orally to the client. Which of the following nursing intervention indicates safety measure before administering the medication?

A. Instructing the client to be in bed when taking the medication

B. Determining client's ability to swallow

C. Positioning the client to lie down on his left side

D. Requiring the client to lie still in bed

Determine client's ability to swallow

Abbey is a 40-year-old wife who was brought by neighbors to the emergency room confused and crying with body bruises and swollen eyes. She claimed that she was physically abused by her husband who was intoxicated with alcohol. She is admitted for brief hospitalization for further observation and crisis intervention.

The admitting nurse is aware that the following should be carefully documented EXCEPT:

A. Quote of Abbey's account of the incident that led to the injuries

B. Specific and factual assessment of physical injuries incurred by Abbey

C. Photographs of Abbey's physical injuries

D. Neighbors claim regarding estranged relationship of Abbey and husband

Neighbors claim regarding estranged relationship of Abbey and husband

The nurse did a process recording of an interaction with Abbey. The following descriptions about process recording are true EXCEPT:

A. Recording of the verbatim account of the entire interaction, including verbal and non-verbal

B. Tool to improve interpersonal communication techniques

C. A form of documentation for professional development

D. Helps the nurse in analyzing content of interaction

A form of documentation for professional development

Which of the following information about Abbey is LEAST ESSENTIAL FOR CRISIS INTERVENTION?

A. Abbey perception of the event

B. Longitudinal life history

C. How Abbey is coping with the present situation

D. Availability of friends or family for support

Longitudinal life history

9. Abbey asked the nurse if she may have a photocopy of her records. The nurse is aware that client records belong to the:

A. Health facility

B. Health team members

C. Family of the client

D. Client

Health Facility

Potential benefits of the use of computers in documentation have been recognized, however clients are MOST concerned about:

A. Validity

B. Accuracy

C. Reliability

D. Confidentiality

D. Confidentiality

A 67 year old female client is diagnosed with Senile Nuclear Cataract OU (both eyes) H25.1; Dry Eye Syndrome.

The nurse is conducting nursing assessment and preparing a nursing history. Which of the following clinical manifestations of the client gathered by the nurse is characteristic of cataracts?

A. Narrow anterior chamber

B. Optic nerve damage

C. Painless blurry vision

D. Age factor

Painless blurry vision

A 67 year old female client is diagnosed with Senile Nuclear Cataract OU (both eyes) H25.1; Dry Eye Syndrome.

Based from the information gathered the nursing diagnosis is:

A. Self-care deficit related to impaired vision

B. Disturbed sensory perception related to visual impairment

C. Acute pain related to eye dysfunction

D. Anxiety related to possible vision loss

Disturbed sensory perception related to visual impairment

The physician scheduled the client for Phacoemulsification with intraocular lens implantation surgery. The physician informed the client of the nature of the procedure and what to expect after surgery. The client verbalized to the nurse," I have never had surgery before". Given this situation, the nurse appropriate expected outcome for the client to:

A. Maintain asepsis aids in protecting the surgical site form infection and complications

B. Know sign and symptoms of complications that are to be reported to physician immediately

C. Verbalize preoperative routine activities and postoperative procedures and expectations

D. Understand handwashing and aseptic technique for postoperative eyes car

Verbalize preoperative routine activities and postoperative procedures and expectations

The admitting order include: Phacoemulsification with intraocular lens implantation surgery right eye local anesthesia 7:00AM OPD. Start Sanmyd - P Ophthalmic Solution 1 drop every 5 minutes to right eye once the client is admitted. The client demonstrates understanding of the pre - operative medication when she states that the

A. Reduce intraocular pressure

B. Minimize swelling

C. Dilate the pupils

D. Relieve pain

Dilate the pupils

The client is given post - cataract surgery instructions consisting of instillation of eye meds, Tobrex, 1 drop every 3 hours (waking hours), Pred Fortre - 1 drop every 3 hours (waking hours): oral meds for pain including health teaching and other instructions. Client education guide should include the following EXCEPT:

A. Not rubbing the right eye nor lifting objects

B. Placing plastic eye shield when sleeping. Using eyeglasses while awake

C. Having regular baths and washing of face but no swimming

D. Taking aspirin or drugs containing aspirin

Taking aspirin or drugs containing aspirin

When doing an otoscopic examination, the nurse should observe the following EXCEPT:

A. Make sure the patient avoids moving the head

B. Hold the handle of the otoscope in the space between the thumb and index finger.

C. Make sure the radial side of the nurse's hand rests against the patient's head

D. Insert the scope while pulling the auricle upward and backward in the adult and older child.

Make sure the radial side of the nurse's hand rests against the patient's head

Upon examination of the ear, the nurse agrees with the diagnosis of mastoiditis if the tympanic membrane is:

A. Pink-colored

B. Grey-colored

C. Transparent and clear

D. Red and dull

Red and Dull

The following are correct statements regarding mastoiditis

A. Results from untreated chronic or acute otitis media

B. Pain is relieved by myringotomy

C. Mastoidectomy with tympanoplasty is the most common treatment

D. Abducens and facial cranial nerve damage is a possible complication

Pain is relieved by myringotomy (surgical incision into the eardrum to relieve pressure)

antibiotic therapy is usually the first line of treatment for mastoiditis.

Vertigo occurs as a complication of mastoiditis if:

A. Mastoiditis is untreated

B. Brain abscess occurs

C. The infection spreads into the labyrinth

D. The infection spreads into the ear canal

The infection spreads into the labyrinth

After some clearance, Fidel underwent mastoidectomy. Some postoperative interventions include the following except:

A. Prepare for wound dressing change 1 day postoperatively

B. Bed rest with bedside commode privileges for 24 hours as prescribed

C. Monitor for signs of meningitis and for other complications

D. Position the client prone for drainage.

Position the client prone for drainage.

Positioning the client entirely prone (face down) can put pressure on the ear and potentially strain the incision area.

Depression is often overlooked especially adults because of the belief that it is normal for older adults to be less active, less engaged and somatically preoccupied. Which of the following repercussions of this belief warrant the MOST urgency for health care professionals to consider?

A. Older persons suffer in silence, remaining either undiagnosed or misdiagnosed

B. Greater risk for developing heart disease

C. It can mean suicide

D. Longer hospital stays and decreased ability to follow health regimens

Older persons suffer in silence, remaining either undiagnosed or misdiagnosed

Virginia is reluctant to be interviewed by the nurse. In order to assess mental health issues, it is MOST important for the nurse to create an environment of:

A. Kind firmness and control

B. Respect, compassion and reassurance

C. Psychological safety and security

D. Privacy and confidence

Respect, compassion and reassurance

Virginia's verbalizations prompt the nurse to assist her to become aware of the existential aspects of depression such as:

A. Denial and cognitive dissonance

B. Little or no social support

C. Death, isolation and meaninglessness

D. Somatic complaint

Death, isolation and meaninglessness

Pharmacotherapy is the mainstay treatment for older adults with moderate to severe depression. Nurses should observe caution in the administration of monoamine oxidase inhibitors because of the risk of:

A. Orthostatic hypotension

B. Neuromalignant syndrome

C. Hypertensive crisis

D. Serotonin syndrome

Hypertensive crisis

Older adults like Virginia respond slowly to antidepressants, and clinicians should assess for response at:

A. 8-12 weeks

B. 2-3 weeks

C. 4-6weeks

D. 12-16 weeks

2 - 3 weeks

Nurse Researcher Kai is planning to create a phenomenological study. Before starting, he wanted to review the methods for descriptive phenomenology.

26. This method requires that intersubjective agreement be reached with other expert judges.

A. Colaizzi

B. Giorgi

C. Van Kaam

D. Warm and cool

Van Kaam

This method calls for a validation of results by returning to study participants.

A. Colaizzi

B. Giorgi

C. Van Kaam

D. Warm and coo

Colaizzi

This method relies solely on researchers. The proponent believes that it is inappropriate either to return to participants to validate findings or to use external judges.

A. Colaizzi

B. Giorgi

C. Van Kaam

D. Warm and coo

Giorgi

As a nurse researcher, Kai understands that according to Lincoln and Guba (1985), _______ of qualitative research parallel the standards of reliability and validity in quantitative research.

A. Dependability

B. Trustworthiness

C. Complexity

D. Triangulation

Trustworthiness

Triangulation: This is a technique used in qualitative research to enhance the credibility and validity of findings by using multiple data collection methods or sources. It can be a tool to contribute to trustworthiness, but it's not synonymous with it.

According to Lincoln and Guba, this refers to the potential for congruence between two or more independent people about the data's meaning.

A. Credibility

B. Dependability

C. Confirmability

D. Transferability

Confirmability

A 56 year old male client is admitted to the hospital and diagnosed with subarachnoid hemorrhage secondary to ruptured cerebral aneurysm.

The physician ordered aneurysm precautions. Which of the following measures should be instituted by the nurse to prevent increased intracranial pressure?

A. Provide bright lights

B. Give enema as needed

C. Encourage entertainment using TV and radio

D. Reduce environment stimuli

Reduce environmental stimuli

A relative accompanying the client asks the nurse if he can bring the client to the cafeteria for a snack before going straight to his room. Which of the following measures should the nurse use why the client should directly get to his room?

A. Minimize environmental stimuli

B. Client is anxious and needs rest

C. Require isolation precaution

D. Rest in a priority to promote healing

Minimize environmental stimuli

day after admission the client becomes restless and anxious. The nurse assesses further the client and notices nuchal rigidity. The nurse knows that nuchal rigidity is:

A. Resistance to extension of the neck while hip is flexed

B. Lockjaw

C. Neck stiffness

D. Flexion of the neck and knees in response to hip flexion

Neck Stiffness

The client has a leaking cerebral aneurysm. He is scheduled for surgery. Which of the following should the nurse implement prior to surgery?

A. Up in bed at least twice a day

B. Allow bathroom privileges

C. Offer bedside commode when needed

D. Strict bedrest

Strict bedrest

The client is recovering from surgery but has become irritable and angry regarding limitations. Which of the following is the MOST appropriate approach to assist client overcome limitations and succeed?

A. Secure trust and confidence of the client

B. Refer the client to physician psychiatrist

C. Support and praise client for accomplishments

D. Accept the client's behaviour

Secure trust and confidence of the client

During discharge planning for Vilma, a patient whose symptoms of manic disorder are remitting, the patient asks, "do I have to take lithium even though I'm high any longer?". The MOST appropriate response is:

A. "You can stop the medication 1 week after discharge"

B. "Usually patients take medication for 6months after discharge"

C. "You will need to take medication for about 12 weeks"

D. "Taking the medication daily will help you avoid relapses and recurrences"

"Taking the medication daily will help you avoid relapses and recurrences"

Valium (Diazepam) is prescribed to Rhodora, an extremely anxious client. She is afraid to take this drug because she heard that it is addicting. The nurse's responses is based on the knowledge that anti-anxiety drugs:

A. May result in physical but not psychological dependence

B. Rarely causes dependence

C. Can potentially cause both physical and psychological dependence

D. May result in psychological but not physical dependence

Can potentially cause both physical and psychological dependence

When taking care of a client anxiety drug like Vallum (diazepam), the nurse's concern would be on:

A. Motor incoordination

B. Abrupt withdrawal

C. Changes in bowel habits

D. Hypertension

Abrupt withdrawal

Diazepam (Valium): This benzodiazepine medication acts on the central nervous system (CNS) to produce a calming effect.

Motor incoordination: A common side effect of diazepam is motor incoordination, which can manifest as clumsiness, stumbling, slurred speech, or difficulty with balance. This can increase the risk of falls and accidents.

Abrupt withdrawal: This is definitely a concern, but it's more relevant if the client has been taking diazepam for a long time and then suddenly stops. The nurse would educate the client about the importance of tapering off the medication gradually under medical supervision to avoid withdrawal symptoms.

Alvin, a client, is taking Lorazepam (Ativan) for his anxiety. Since he goes to work daily, special instructions are given to him for his safety. The client understood the nurse's health instructions if while taking this medication he

A. Reduces her salt intake to protect her kidney

B. Stays indoor

C. Takes over the counter cough syrup

D. Avoids driving a car while under medication

Avoids driving a car while under medication

Ramon has been taking Vallum to help him calm down when he experiences nightmares and flashbacks after experience of being robbed 3 weeks ago. While at the doctor's clinic, you observe the following confusion, slurred speech, dizziness, ataxia. What is the MOST appropriate nursing action for you to take?

A. Teach the client how to relax using a tape and breathing exercises

B. Recommend to the doctor the need to increases dosage so he can sleep

C. Provide safety measures since he is having a flashback

D. Inform his doctor about possible excessive use of the medication

Inform his doctor about possible excessive use of medication

Confusion, slurred speech, dizziness, and ataxia (lack of muscle coordination) are all potential signs of overdose or excessive use of Valium (diazepam).

George, 25 years old, has been diagnosed with undifferentiated schizophrenia. He is the next to youngest of eight children. According to him he has a twin brother who has also major mental illness. In an interview with George, he stated, "my mama had schizophrenia for 10 years then God saved her". George recalled that his father used to beat his mother and the children. He described a beating he received from his father that left him bleeding. When asked why his father beat him, he responded, "he got mad a lot. I forgot to wash the car like he asked me to." He thinks back to his past and remembers molestation, cruelty and punishment.

George was observed to be extremely withdrawn. What is the appropriate nursing diagnosis for the patient?

A. Disturbed thought process

B. Complicated grieving

C. Impaired social interaction

D. Self-care deficit

Impaired Social Interaction

George, 25 years old, has been diagnosed with undifferentiated schizophrenia. He is the next to youngest of eight children. According to him he has a twin brother who has also major mental illness. In an interview with George, he stated, "my mama had schizophrenia for 10 years then God saved her". George recalled that his father used to beat his mother and the children. He described a beating he received from his father that left him bleeding. When asked why his father beat him, he responded, "he got mad a lot. I forgot to wash the car like he asked me to." He thinks back to his past and remembers molestation, cruelty and punishment.

When asked about his relationship with his mother, he said that she left the rest of the family after his father died. A therapeutic response would be to:

A. Confront him his evasive response

B. Remain quiet

C. Change the subject

D. Assist him to focus

D. Assist him to focus

George talks about his experiences of molestation, cruelty and punishment from his father and also from his peers. The nurse is using therapeutic communication if she says:

A. "Let's look at that a little closer."

B. "Everything will fall into places."

C. "That's good. I am glad that you are telling me this."

D. Tell me how your father abused you when you were a child

A. "Let's look at that a little closer."

George verbalized, "when I was little, I started hearing voices after those boys did awful things to me. I was fixing my bicycle and I heard the devil talk to me over and over. The nurse notes this as:

A. Hallucination

B. Illusion

C. Delusion

D. Obsession

Hallucination

Twin studies have repeatedly demonstrated high concordancy rates (50%). The fact that there is not 100% concordancy suggest:

A. Maternal exposure to great stress

B. Nongenetic variables in schizophrenogenesis

C. Infection during pregnancy

D. Exposure to toxins prenatally

Nongenetic variables in schizophrenogenesis

Twin studies: These studies compare the risk of developing a condition in identical twins (who share 100% of their genes) versus fraternal twins (who share 50% of their genes).

High concordancy rates (50%): If genetics were the sole factor in schizophrenia, identical twins would always both develop the condition if one twin has it (100% concordance rate). However, the observed rate is around 50% for identical twins.

Nurses need to be diligent in their observations of those possibly experiencing post-incident stress especially in which of the following client situations?

A. Young adult with history of rejection in love affairs

B. Teen age girl who has been gang-raped

C. Young boy with early exposures to illicit drugs

D. Child with a history of conflicted family life

Teenage girl who has been gangraped

Among helping professionals and first responders to stressful and traumatic incidents, like calamities, fires, typhoons and crime scenes, the individuals who are MOST likely to fall to substance abuse are those who:

A. Have history of trauma in the past

B. Tell their stories to friends and relative

C. Rely on self-help to cope with their experiences

D. Ignore signs and symptoms of traumatic exposure

Rely on self-help to cope with their experinces

The community nurse led a monthly informal discussion group among police officers in the local government police headquarters. The theme of the group sharing was on the use of alcohol to cope with the emotional impact of their job. Which of the following police's responses need crucial individual follow-up?

A. "Sometimes I cannot avoid the invitation of my team and I choose what I drink"

B. "I must admit I drink sporadically just to relax a little bit"

C. "Occasionally I need to unwind while we share our personal experiences."

D. "I drink alone and a shot of wine in my coffee perks me up every morning."

"I drink alone and a shot of wine in my coffee perks me up every morning."

Nurses can do the following EXCEPT:

A. Establish a peer support group in the community.

B. Provide alternative methods to handle stresses inherent in trauma work

C. Conduct debriefing or incident stress management

D. Provide detoxification Intervention for alcohol and substance abuse

Provide detoxification intervention for alcohol and substance abuse

Nursing in community based trauma health intervention facilities daily encounter clients who need to be helped with emotional stress of being too overwhelmed to cope with the realities of life they witnessed. As a self-management intervention, it is therapeutic that the nurses must:

A. Be constantly aware of the effects of compassion fatigue leading to burnout.

B. Have a personal value system anchored on the family system

C. Clearly define role in addressing the confounded effects of trauma and addiction

D. Provide stress management guideline

Be constantly aware of the effects of compassion fatigue leading to burn out

The following are true regarding brain attack except:

A. It can be caused by thrombosis or embolism

B. The use of oral contraceptive increases the risk of having a brain attack

C. Cerebral anoxia lasting longer than 20 minutes causes irreversible damage.

D. Airway patency is always a priority

Cerebral anoxia lasting longer than 20 minutes causes irreversible damage.

5 mins

Lexie's father, Thatcher, asks the nurse if his daughter's initial diagnosis is different from "hemorrhagic stroke" which his late grandfather experienced years ago. The nurse answers correctly if she answers:

A. Yes, ischemic stroke patients may experience severe headaches, while hemorrhagic patients may not.

B. Yes, ischemic stroke is more common and occurs when a blood vessel is blocked by a clot or thrombosis; while hemorrhagic stroke occurs when a blood vessel bursts and bleeds into the brain causing hemorrhage.

C. No, they are generally the same.

D. No, because manifestations of different types of stroke are similar.

Yes, ischemic stroke is more common and occurs when a blood vessel is blocked by a clot or thrombosis; while hemorrhagic stroke occurs when a blood vessel bursts and bleeds into the brain causing hemorrhage.

The nurse is aware that the following should be implemented during the acute phase of stroke except:

A. Maintaining a quiet environment

B. Placing antiembolism stockings

C. Administering oxygen

D. Inserting a urinary catheter

Placing antiembolism stockings

Visual-perceptual disturbances can occur in stroke. The nurse should encourage the client to:

A. Provide eye care for visual deficits

B. Approach from the affected side

C. Approach from the unaffected side

D. Turn the head to scan the complete range of vision

Turn the head to scan the complete range of vision

Lexie, 52 years of age, was brought to the ED due to numbness on her left face and a confused mental state. The physician's initial diagnosis is ischemic stroke

What is the most ideal position of Lexie when eating?

A. Sitting in a chair or up in bed, with the head and neck positioned slightly forward and flexed.

B. Sitting in a chair or up in bed, with the head positioned slightly forward and flexed.

C. Sitting in a chair or up in bed, with the neck positioned slightly forward and flexed.

D. High-fowler

Sitting in a chair or up in bed, with the head and neck positioned slightly forward and flexed.

Nurses have an important role in establishing an environment that satisfies the biological, psychosocial, and spiritual needs of clients. They are often challenged with issues and problems in creating therapeutic environment for clients.

56. In structuring a therapeutic environment, it is MOST important for the nurse to:

A. Safeguard physical safety and psychological security.

B. Keep an effective social order that recognizes authority.

C. Keep a restrictive environment to prevent patient assaultiveness.

D. Maintain a closed-door policy to instill order and discipline.

Safeguard physical safety and psychological security.

Environment as referred to in 'milieu therapy' refers to the:

A. Building and grounds where patients interact.

B. People with different personalities who relate with one another.

C. Physical environment and relationships of people within.

D. Immediate physical surroundings that create an ambience for the patients

Physical environment and relationships of people within

Physical environment: This includes the physical surroundings of the therapeutic community, such as the building itself, the furniture, and the overall layout of the space. Ideally, the physical environment should be safe, comfortable, and conducive to interaction and therapeutic activities.

Relationships of people within: This refers to the social and interpersonal aspects of the environment. It includes the relationships between patients, the relationships between patients and staff, and the overall group dynamics within the therapeutic community.

Attitude therapy safeguards the therapeutic application of attitudes toward patients. Rico, seeks attention from the staff by repeatedly deviating and not participating in structured activities. It is BEST for the nurse to:

A. Respond: "it is okay for as long as you don't bother anyone"

B. Have a patient watcher monitor him closely.

C. Ignore the behavior.

D. Respond: "we have agreed on a schedule. I expect you to follow."

Respond: "we have agreed on a schedule. I expect you to follow."

The nurse is aware that these patients are likely to be exploited in a group setting. These are the patients who are:

A. Suspicious

B. Sociable

C. Withdrawn

D. Hostile

Sociable

A therapeutic community aims to:

A. Have team leaders to check physical presence and attendance of patients in ward activities.

B. Constantly monitor implementation of ward policies and rules.

C. Encourage patient interactions, group problem solving and decision making.

D. Encourage patients to police themselves and impose sanctions on ward violations

Encourage patient interactions, group problem solving and decision making

A nurse researcher in the Psychiatric unit is undertaking a study on the relationship between depressive symptoms and motivation to lose weight among high school overweight teens in selected schools at the National Capital Region.

The study design to be used by the researcher is:

A. Experimental

B. Predictive correlational

C. Non-experimental

D. Descriptive correlational

Descriptive correlational

62. Which of the following is true about the study design being used by the researchers?

A. There is no researcher intervention.

B. It is safe to infer causal relationships in this study design

C. It proves causation.

D. Effective means of collecting data

There is no researcher intervention

Which of the following inclusion criteria should be observed by the researcher in selecting the subjects?

A. Current diagnosis of major depression.

B. High school students with body mass index of 25 or greater.

C. Enrolled in high school in NCR.

D. High school students with aged limit of 16 - 20 years.

High school students with body mass index of 25 or greater.

The independent variable for this study is:

A. Weight loss

B. Not applicable

C. Depressive symptoms

D. Motivation

Depressive symptoms

One of the statistical approaches to be used by the researcher in analyzing whether a relationship exists between the number of depressive symptoms and motivation to lose weight is:

A. Chi square test

B. Analysis of covariance

C. Pearson's coefficient of correlation

D. Product moment correlation

Chi square test - shows relationship

Justine is 12 years old, looks like she is 9 and acts she is 4. She has lightning - quick hands and can grab things off the desk, out of the staff's pockets and off food trays in the blink of an eye. She is cute and known for getting black eyes and bruises. Wherever she is, there is trouble, but according to her, it is always someone else's fault. She loves to run away from the Child and Adolescent Unit of the hospital and being chased by young staff members.

From the behavior of Justine, the nurse infers that a fundamental issue is Justine's:

A. Difficulty developing stable relationships

B. Inability to learn from past experiences

C. Withdrawn attention

D. Suspiciousness and mistrustful of others

Difficulty developing stable relationship

With other children in the unit, Justine smiles with glee watching adult staff struggle to take time to fix the place and put things in order every time she and other children create chaos. This pattern of behavior is:

A. Assaultive

B. Demanding

C. Hostile

D. Manipulative

Manipulative

Justine is 12 years old, looks like she is 9 and acts she is 4. She has lightning - quick hands and can grab things off the desk, out of the staff's pockets and off food trays in the blink of an eye. She is cute and known for getting black eyes and bruises. Wherever she is, there is trouble, but according to her, it is always someone else's fault. She loves to run away from the Child and Adolescent Unit of the hospital and being chased by young staff members.

The psychodynamics of Justine's behavior most likely would point to:

A. Lack of social support for growing children from the local government.

B. Lack of parenting, stressful and stormy family life.

C. Failure of the school system to provide early education.

D. Excessive media that portray sex and violence in TV programs.

Lack of parenting, stressful and stormy family life.

Justine is 12 years old, looks like she is 9 and acts she is 4. She has lightning - quick hands and can grab things off the desk, out of the staff's pockets and off food trays in the blink of an eye. She is cute and known for getting black eyes and bruises. Wherever she is, there is trouble, but according to her, it is always someone else's fault. She loves to run away from the Child and Adolescent Unit of the hospital and being chased by young staff members.

In creating a therapeutic environment of Justine and kids of the same situation, it is foremost to:

A. Develop a positive self-image.

B. Give high calorie rich nutritional intake.

C. Provide safety and security.

D. Provide remedial education

Provide safety and security

In the unit, it is not common to hear loud bangs and thuds with yelling, screaming, and cursing of these children with the company of Justine. A therapeutic activity that the staff can provide is:

A. Leisurely and active gardening.

B. Active ball games that are not competitive.

C. Sports that foster cooperation and teamwork.

D. Organizing book clubs for interaction.

Organizing book clubs for interaction.

Awareness of the varied responses of trauma and stress is a primary consideration in recognizing problems of helping professionals. Which of the following stress responses are cognitive in nature?

A. Intrusive thoughts and reliving the incident, reduced ability to concentrate or mental confusion.

B. Substance use, withdrawal from others, or acting out behaviors.

C. Unfounded or unusual anger, depressive feelings, or anxiety reactions

D. Fatigue, recurring headaches, or inability to sleep or eat.

A. Intrusive thoughts and reliving the incident, reduced ability to concentrate or mental confusion.

Characteristic features of posttraumatic stress disorder include hyperarousal, i.e., exaggerated startle response, numbing effects and re-experiencing physiological and psychological reactions. The nurse notes that the duration of these symptoms MUST persist for at least:

A. 2 days

B. 1 month

C. 2 weeks

D. 3 days

1 month

Effects of compassion fatigue can be observed among emergency mental health professionals. This easily leads to:

A. Somatic reactions

B. Burnout

C. Psychoses

D. Neuroses

Burnout

The idea of self - medication to cope with stress and trauma is common in helping professionals and first responders. This practice if it becomes pervasive has potential for:

A. Substance use and abuse

B. Behavioral changes and abuse

C. Malpractice

D. Avoidance behavior

Substance use and abuse

A group strategy that allows processing of emotional effects of traumatic exposure is:

A. Alcoholic anonymous

B. Milieu therapy

C. Psychodrama

D. Avoidance behavior

C. Psychodrama

Nina, an adolescent, participating in a behavior therapy group cried while relating her experience of "cutting" on her skin, "the pain is so bad, this is the only way to get it out". Nina is a survivor of sexual abuse perpetuated by her own father. She has history of repeated admission at Psychiatric Emergency Unit with repeated history of self - mutilation. She was diagnosed as Borderline Personality Disorder.

Nina verbalized the intensity of her emotional pain and anger, desperation and anxiety that escalate to a feeling of mounting tension. With this overwhelming anxiety, she may resort to dissociation which is characterized by:

A. Feelings of emptiness and numbness and experience of depersonalization

B. Retreat to an earlier developmental stage

C. Use of excessive reasoning rather that reacting or changing

D. Blame of others for one's own feelings and thoughts

Feelings of emptiness and numbness and experience of depersonalization

Nurses may perceive clients like Nina with strong countertransference reactions and feelings of frustration, betrayal, anger, and disgust. To work therapeutic with clients who self -mutilate, it is MOST important for nurses to:

A. Do - self disclosure and solicit understanding from clients

B. Acknowledge and overcome strong emotions

C. Suppress reactions to maintain professionalism

D. Engage in constructive activities to dissipate strong emotions.

Acknowledge and overcome strong emotions

Nina has a pattern of "cutting " as a self - mutilating act. All of the following are therapeutic interventions EXCEPT:

A. Offer sympathy, and additional attention to the behavior while cleaning the wound

B. Care for the wounds in a matter-of-fact manner

C. Allow the client to express angry feelings

D. Problem-solve the situation with the client

Offer sympathy, and additional attention to the behaviour while cleaning the wound

Giving excessive sympathy or focusing heavily on the cutting behavior itself might unintentionally reinforce it.

Which of the following is a necessary initial step in determining interventions for Nina?

A. Explore her coping behaviors

B. Determine the meaning of her personal crisis

C. Assess her developmental level and experience

D. Let her identify current stressors

Correct answer

C. Assess her developmental level and experience

Assess her developmental level and experiences

The nurses involved in the care of Nina feel caught in a bind because there is a need to rescue in the event that she cuts herself again and a need not to be manipulated by her. It is MOST therapeutic for the nursing team to recognize:

A. Being strict regarding imposition of external controls

B. Writing a "no cutting on self" contract

C. Developing of a trust relationship

D. Taking self- responsibility by signing a waiver

Developing a trust relationship

A 10-month-old infant has developmental dysplasia of the hip following confirmation of the diagnosis by ultrasonography. She is placed in Pavlik Harness. Which of the following should you expect the infant to be positioned?

A. Supine

B. Trendelenburg

C. Flexed abduction

D. Flexed adduction

Flexed abduction

Flexed abduction: This position involves flexing the knees and hips and keeping the legs apart. This allows the femoral head to be gently pushed into the acetabulum encouraging proper alignment and growth.

With the application of the pavlik harness, the nurse should keep in mind the following EXCEPT?

A. Assess skin daily.

B. The baby should wear the harness at all times except while bathing

C. Harness should be worn above the clothing continually.

D. Instructing the parents on the practicalities of daily care and continuous support

Harness should be worn above the clothing continually.

The infant did not respond to treatment with Pavlik Harness. A surgical program is undertaken. She was admitted into hospital for a 1-week period of gallows traction.

The mother asks the nurse what Gallows traction is. The nurse responds correctly if she states:

A. It is a skin traction applied to the legs which are flexed at a 90-degree angle at the hips.

B. The child's head provides counter traction.

C. Type of traction with the legs in an extended position

D. Uses skin traction on the lower leg and a padded sling under the knee

It is a skin traction applied to the legs which are flexed at a 90-degree angle at the hips.

same as Bryant's traction

The nurse should pay particular attention to which part of the body of the infant in gallows traction?

A. Back

B. Hips

C. Lower extremities

D. Skin

Lower extremities

The tractions is removed after 1 week and the infant is bathed prior to surgery. Which of the following constitute this intervention?

A. Bathing is necessary for hygienic measures

B. Cleanse the skin and allows for the gentle removal of the adhesive traction

C. Allows for adequate physical preparation

D. A routine procedure prior to surgery to prevent complications

B. Cleanse the skin and allows for the gentle removal of the adhesive traction

Nurse Liza functions as a team leader and coordinates a small group of nurses in the psychiatric unit to provide care to a small group of patients.

As coordinator of the team her main function is to:

A. Allow team members to practice high degree of authority

B. Encourage the growth and training of each member

C. Know the condition and needs of all the patients assigned to the team

D. Assume responsibility of the team for planning, directing and evaluating the patient's care

Know the condition and needs of all the patients assigned to the team

As team leader, Nurse Liza assumes which of the following duties?

A. Assessing patients and planning care

B. Directing and assisting team members

C. Giving direct patient care

D. Coordinating patient activities

Coordinating patient activities

Nurse Liza's team is using a team nursing model. Weighing things, this model has advantages and also disadvantages. Of the following choices, which one is the ADVANTAGE:

A. Use of each team member special expertise in caring for patients

B. Direct patient care provided by a few nurses

C. Team leader direct the team for effective care

D. Provide total patient care

Use of each team member special expertise in caring for patients

To make team nursing succeed, nurse Liza as coordinator of the team MUST possess which of the following?

1. Good communication skills

2. Delegation ability

3. Strong clinical skills

4. Create a cooperative working environment

A. 2,3,and 4

B. 1 and 3

C. all except 4

D. all

Aota

Nurse Liza brings together the members to work as a group. She has successfully accomplished teamwork by means of:

A. Expertise of each member

B. Well define goals and objectives of the team

C. Clinical skills of team members

D. Adequate planning and control

Well define goals and objectives of the team

Depressed mood or loss of interest in pleasure and activities in depressive disorder is with duration of at least:

A. A month

B. Two weeks

C. 2-3 days

D. one week

2 weeks

Romina has been withdrawn and appears sad. Which of the following approaches validate your initial impression?

A. "I noticed that you've been withdrawn. Describe your mood for me"

B. "what happened that brought your sadness?"

C. "in a scale of 1 - 10, 10 being the highest, what level is your feeling sad?"

D. "how long have you been feeling sad?

I've noticed that you've been withdrawn. Describe your mood for me

Romina describes feeling like her body is "numb" and feels "helpless to do anything to feel better". The nursing diagnosis is:

A. Anxiety

B. Risk for injury

C. Acute confusion

D. Powerlessness

Powerlessness

Structuring a therapeutic environment places urgency in providing:

A. Cheerful environment to counteract depression

B. Access to security personnel

C. Adequate fluids and nutrition

D. Precautions regarding self-harm

Precaution regarding self-harm

Romina is being treated with SSRI; /selective serotonin reuptake inhibitor. The nurse watches for serotonin syndrome characterized by:

A. Tremors, seizures, nausea, vomiting, and confusion

B. Robot like inflexible movements

C. Bizarre behavior like hallucinations and delusions

D. Agranulocytosis, jaundice, signs of infection

Tremors, seizures, nausea, vomiting, and confusion

Patient Santino is being treated for his bipolar disorder. He is prescribed with Eskalith. As a nurse, which of the following should you exclude from your health teachings?

A. Medication can be administered with food.

B. He is allowed to drink coffee every morning.

C. Notify the physician if fever occurs.

D. He can take the missed dose within 2 hours of the scheduled time.

He is allowed to drink coffee every morning

Caffeine can interact with lithium and potentially decrease its absorption or effectiveness.

While reviewing about Eskalith, you know that severe lithium toxicity is manifested by:

A. Anuria

B. Severe diarrhea

C. Apathy

D. Muscle twitching

Anuria

D. Muscle twitching

Patient Cleo's chart states that dystonia is noted on her while taking antipsychotic medications. Which manifestations do you expect to see?

A. Dysphagia, facial grimacing

B. Oculogyric crisis, increased heart rate, drooling

C. Twisting of the torso

D. Drowsiness, restlessness

Twisting of the torso

The most characteristic finding associated with most forms of dystonia is twisting, repetitive movements that affect the neck, torso, limbs, eyes, face, vocal chords and/or a combination of these muscle groups. Certain forms such as laryngeal dystonia are not associated with abnormal postures.

Fluoxetine is prescribed to Patient Mark Lee. How should it be administered?

A. On full stomach

B. On an empty stomach

C. At the same time each morning

D. At the same time each evening

C. At the same time each morning

You can take fluoxetine at any time, but it's best to stick to the same time every day. If you have trouble sleeping, try taking it in the morning.

A mother of a child with ADHD asked you the most effective medication in controlling the disorder. Your answer would be:

A. CNS stimulants

B. CNS depressants

C. Donepezil

D. Rivastigmine

CNS stimulant