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Friday, August 29, 2008

Nclex Tips 14 (Pearson Nclex)

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Dimenhydrinate (Dramamine) is used to treat and prevent the symptoms of dizziness, vertigo, and nausea and vomiting that accompany motion sickness.

Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory medications (Naprosyn and ibuprofen). The client should take acetaminophen for pain relief. Medication includes lansoprazole (Prevacid).

A client who has a long history of antisocial and acting-out behavior needs to demonstrate the motivation to change behavior, not just verbalization that change will occur. The nurse would be therapeutic by assisting the client to look at the behaviors that indicate the motivation to change.

A client in prison is knowledgeable about the rules for behavior in the correctional setting. Many clients will test the nurse’s capacity to be victimized and will make inappropriate statements. These behaviors need to be verbally confronted directly and then carefully documented in the client’s chart.

Acute toxicity of MAO inhibitors is manifested by restlessness, anxiety, and insomnia. Dizziness and hypertension may also occur.

The nurse working with chronically mentally ill clients in crisis should focus on the client’s strengths, modify and set realistic goals with the client, take an active role in assisting the client in the problem-solving process, and provide direct interventions that the individual might be able to do.

Methylphenidate hydrochloride (Ritalin) is a central nervous system (CNS) stimulant and can cause insomnia. Its usually prescribed to clients with ADHD. Taking the medication at breakfast and lunch and avoiding taking the medication in the evening can prevent insomnia. It is taken orally 30 to 45 minutes before breakfast and lunch.

When depressed, a client sees the negative side of everything. Neutral comments such as :You are wearing a new dress this morning" will avoid negative interpretations.

In psychomotor agitation, it is best to provide activities that involve the use of hands and gross motor movements. These activities include Ping-Pong, volleyball, finger-painting, drawing, and working with clay. These activities provide the client a more appropriate way of discharging motor tension than pacing or ringing the hands.

When a client is manic, solitary activities requiring a short attention span or mild physical exertion activities are best initially. These include writing, painting, finger-painting, woodworking, or walks with the staff. Solitary activities minimize stimuli, and mild physical activities release tension constructively. When less manic, the client may join one or two other clients in quiet, nonstimulating activities. Competitive games should be avoided because they can stimulate aggression and cause increased psychomotor activity.

An inappropriate affect refers to an emotional response to a situation that is not congruent with the tone of the situation. A flat affect is an immobile facial expression or blank look. A blunted affect is a minimal emotional response and expresses the client’s outward affect. It may not coincide with the client’s inner emotions. A bizarre affect such as grimacing, giggling, and mumbling to one’s self is marked when the client is unable to relate logically to the environment.

Poverty of speech is speech that is restricted in amount and ranges from brief to monosyllabic one-word answers. Poverty of content of speech is speech that is adequate in amount but conveys little information because of vagueness, empty repetitions, or use of stereotypes or obscure phrases. Thought blocking is when the client stops talking in the middle of a sentence and remains quiet.

When caring for a paranoid client, the nurse must avoid any physical contact and not touch the client. The nurse should ask the client’s permission if touch is necessary, because touch may be interpreted as a physical or sexual assault. The nurse should use simple and clear language when speaking to the client to prevent misinterpretation and to clarify the nurse’s intent and actions. A warm approach is avoided because it can be frightening to a person who needs emotional distance. Anger and hostile verbal attacks are diffused with a nondefensive stand. The anger a paranoid client expresses is often displaced, and when a staff member becomes defensive, anger of both the client and staff member escalates. A nondefensive and nonjudgmental attitude provides an environment in which feelings can be explored more easily.

In a paranoid client, The nurse should arrange solitary noncompetitive activities that take some concentration such as crossword puzzles, picture puzzles, photography, and typing. When the client feels less threatened, games such as bridge or chess or playing cards with another client may be appropriate. When the client is extremely distrustful of others, solitary activities are best and activities that demand concentration keep the client’s attention on reality and minimize hallucinatory and delusional preoccupation.

Propantheline (Pro-Banthine) is an antimuscarinic anticholinergic medication that decreases gastrointestinal secretions. It should be administered 30 minutes prior to meals.

The nurse would most appropriately assess the client’s eating patterns and food preferences and concerns about eating. Assessing previous and current coping skills is most appropriately related to a nursing diagnosis of Ineffective Coping. Assessing the client’s feelings about self and body weight is most appropriately related to a Disturbed Body Image. Assessing the client’s lack of control about the treatment plan is most closely related to the nursing diagnosis of Powerlessness.

Repetition of words or phrases that are similar in sound and in no other way (rhyming) is one altered thought and language pattern used by clients with schizophrenia. Clang associations often take the form of rhyming. Echolalia is the pathological repeating of another’s word by imitation and is often seen in people with catatonia. “Word salad” is a phrase used to identify a mixture of phrases that is meaningless to the listener and perhaps to the speaker as well. Thought broadcasting is the belief that others can hear one’s thoughts.

Whenever a client has been identified as a victim of abuse, priority must be placed on ascertaining whether the person is in any immediate danger. If so, emergency action must be taken to remove the person from the abusing situation.

A social phobia is characterized by a fear of appearing inadequate or inept in the presence of others and of doing something embarrassing. Thus, the client becomes anxious as the center of attention.

Physical assessment findings such as bruises, along with the other assessment findings noted in the question, should alert the nurse to the potential for elder abuse.

Tertiary prevention involves the reduction of the amount and degree of disability, injury, and damage following a crisis. Primary prevention means keeping the crisis from ever occurring, and secondary prevention focuses on reducing the intensity and duration of the crisis during the crisis itself. A precrisis level of prevention is similar to primary prevention.

Thioridazine hydrochloride (Mellaril), an antipsychotic medication, has a higher likelihood of producing impotence than other neuroleptics

A nurse who is preparing a medication-teaching plan for a client who is receiving fluphenazine decanoate would be certain to advise the client to immediately report any clinical manifestations such as a sore throat or fever, because these signs could signal the onset of agranulocytosis. In addition, any extrapyramidal symptoms also require the physician’s immediate attention.

Trifluoperazine (Stelazine) can cause the client’s urine to turn pink to reddish-brown. This condition is not harmful; it disappears when the medication is discontinued. Nevertheless, the nurse will want to instruct the client to report its occurrence to the nursing staff or the medical staff.

One of the side effects of antipsychotic agents is that they decrease moisture around the eyes. This can cause difficulty for clients who wear contact lenses. Because the client has emphasized the importance of these lenses, it is a potential problem that may occur and lead to medication noncompliance by the client.

The most commonly occurring side effects of antipsychotic agents include dry mouth, blurred vision, nasal stuffiness, and weight gain. Additional side effects include difficulty in urinating, constipation, risk of infection, decreased sweating and increased sensitivity to heat, increased sensitivity to sunlight, yellowing of the eyes (especially the whites of the eyes), and decreased moisture around the eyes. Painful or interrupted menstruation, vaginal dryness, dizziness, drowsiness, breast enlargement/lactation, skin rash or itchy skin, and anhedonia can also occur.

Lithium and sodium, similar in chemical structure, compete to occupy sites within the body. Therefore, sodium levels often decrease, which causes lithium to be reabsorbed. When this happens, it increases the amount of lithium in the body, causing side effects. For this reason, the nurse instructs the client to drink 2 to 3 liters of water each day and eat a diet that is adequate in sodium. Once the client’s lithium level is established (usually within 2 weeks), a blood lithium level will be drawn every 1 to 2 months.

The most therapeutic response for the nurse to make to effectively teach the client about lithium is the one that emphasizes the necessity that the client does not discontinue the medication even if feeling an upset stomach. Clients who are taking this medicine are instructed to take their medication with meals to minimize the occurrence of an upset stomach.

Depersonalization constitutes a symptom that displays disturbance in the client’s sense of self. A flat affect is a symptom of schizophrenic disturbance in affect. Magical thinking is a symptom of the content of thought in schizophrenia. Word salad is a schizophrenic disturbance in the form of thought.

Fluphenazine decanoate (Prolixin) can decrease the normal bacteria in the oral cavity and increase sensitivity to infection. This can be prevented by instructing the client to avoid high-sugar foods; increase the frequency of mouth care (brushing, including the tongue, flossing, and gargling with mouthwash); and frequently inspect the tongue for a thick, white coating, which signals infection.

Lithium is contraindicated in pregnancy and for breastfeeding mothers. The client will be taught that breastfeeding is not possible while taking this medication and will be instructed to notify the physician immediately if pregnancy is even suspected or is being planned.

Tranylcypromine (Parnate), an antidepressant, can cause serious and potentially fatal adverse reactions if used with other antidepressants. Its use is avoided within 2 weeks of another antidepressant.

For clients with somatoform disorder, they are told to exercise because it helps to release endorphins, which enhance the feeling of well-being.

If a client who is taking an antidepressant complains of tiredness, the nurse instructs the client to report the side effect to the psychiatrist, take medication at hour of sleep (except fluoxetine hydrochloride [Prozac], which must be taken in the morning), and avoid alcohol or alcohol-containing foods (even over-the-counter medications that contain alcohol). The client should also be instructed to lie down and rest.

Some of the side effects of benzodiazepines are drowsiness, lethargy and confusion, dizziness, blurred vision, rash or “itchy” skin, unusual irritability or nervousness, headache, and nausea.

The Abnormal Involuntary Movement Scale (AIMS) scale is used to assist the nurse to recognize tardive dyskinesia. The three areas of examination are facial and oral movements, extremity movements, and trunk movement. Tardive dyskinesia can occur from the use of antipsychotics.

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