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Friday, September 5, 2008

Nclex Tips 16 (Nclex Test Bank)

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Clozapine is an antipsychotic medication with no demonstrated extrapyramidal side effects. The risk of extrapyramidal effects with the other medications listed is moderate (chlorpromazine) to high (haloperidol, loxapine).

Denial is a response by the rape victim. It is described as an adaptive and protective reaction. Projection is blaming or “scapegoating.” Rationalization is justifying the unacceptable attributes about himself or herself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking.

Agoraphobia is a fear of open spaces and the fear of being trapped in a situation in which there may not be an escape. Agoraphobia includes the possibility of experiencing a sense of helplessness or embarrassment if a phobic attack occurs. Avoidance of such situations usually results in reduction of social and professional interactions. Social phobia focuses more on a specific situation, such as the fear of speaking, performing, or eating in public. Claustrophobia is a fear of closed in spaces. Clients with hypochondriacal symptoms focus their anxiety on physical complaints and are preoccupied with their health.

Appropriate nursing diagnosis for a client scheduled to have electroconvulsive theraphy (ECT) is Risk for aspiration. Aspiration is safeguarded against by keeping the client NPO for 6 to 8 hours before the procedure, removing dentures, and administering glycopyrrolate (Robinul) or atropine sulfate as prescribed.

When analyzing data obtained from a client suspected of family violence, the physiological well-being of the client is always considered first.

During the acute phase of the rape crisis, the client can display a wide range of emotional and somatic responses. All of the symptoms noted in the question indicate a normal reaction to a very intensely difficult crisis event. Although the client’s initial reactions may be predictive of later problems, they do not indicate an abnormal initial response.

Finding the right drug at the right dose that provides the least side effects for the client, providing clients with the injectable, long-acting form of the medication, and including the family in the medication planning process are measures that will promote compliance. Not all medications can be given on a once-per-day dosing regimen due to a short half-life of some medications. Lithium carbonate is an example of one such medication that must be taken throughout the day to maintain steady serum drug levels.

Obsessions are defined as persistent thoughts that are intrusive and that the person tries to ignore or suppress. This client wants to “snap out of” this daily review, but the thoughts continue for hours. Compulsions are defined as repetitive behaviors that the client feels driven to perform, such as changing clothes frequently until he gets it “just right.”

Al-Anon support groups provide a supportive opportunity for spouses and significant others to learn what to expect about successful behavioral changes.

Any clear threats by psychiatric clients to harm specific people must be reported to the authorities (law enforcement) and the intended victims by mental health care providers and psychotherapists.

Major depression occurs twice as frequently in females as in males. Reacting to loss by experiencing altered sleep for 1 week is a normal grief response. While depression is often associated with substance abuse, it would not, in and of itself, constitute a major depression.

A conversion disorder is an alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. It is thought to be an expression of a psychological need or conflict. In this scenario, the client witnessed an accident that was so psychologically painful that the client became blind. Psychosis is a state in which a person’s mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the person’s capacity to deal with life demands. A dissociative disorder is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness. Repression is a coping mechanism in which unacceptable feelings are kept out of awareness.

Ego defense mechanisms are operations outside of a person’s awareness that the ego calls into play to protect against anxiety. Displacement is the discharging of pent-up feelings on persons less dangerous than those who initially aroused the emotion. In this scenario, the nurse manager reprimands the unit secretary for overusing clerical supplies. The secretary lashes out at the temporary secretary and student nurses for wasting supplies. These are much “safer targets” to become angry with than the nurse manager. Denial is the blocking out of painful or anxiety-inducing events or feelings. Suppression is consciously keeping unacceptable feelings and thoughts out of awareness. Repression is unconsciously keeping unacceptable feelings out of awareness.

Taking time to discuss the client’s concerns is as important a nursing action in many instances as any intervention for physical care. Therapeutic communication should focus on the client’s nonverbal cues and encourage the client to express feelings or concerns about surgery.

When a client harms himself, immediate 1:1 nursing supervision is instituted. This meets the safety needs of the client. After doing this, the psychiatrist is notified of the incident. The client should not be restrained or placed in seclusion.

Tardive dyskinesia, the involuntary movements of the tongue, jaw, lips, and facial muscles, is a manifestation of EPS. Flaccid muscles are not a characteristic of EPS. Agraphia, the inability to read or write, is not a characteristic of EPS. Dystonia is characterized by acute spasms of the tongue, neck, face, and back, laryngospasms, torticollis, and eyes locked upwards.

The dosage of lithium carbonate needs to remain constant to maintain blood levels between 0.6 mEq/L and 1.2 mEq/L. There is a narrow margin between therapeutic and toxic levels. Blood levels are necessary to assess this narrow range. Adequate salt and fluids are necessary to prevent toxicity. Vomiting and diarrhea could be signs of toxicity and need to be reported. Dosages should never be adjusted.

Amitriptyline (Elavil) has a sedative effect, and a single maintenance dose should be taken at bedtime. This also precludes the need for insomnia medication.

Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI). Clients taking MAOIs should report any headache to the physician, because it may signal an impending hypertensive crisis. A low tyramine diet needs to be consumed. Dry crackers can be eaten if the client gets nauseated. Chewing sugarless gum is appropriate.

The client needs to be able to put the trauma into a new context. The client needs to realize that the trauma did not occur because he or she did something wrong, used poor judgment, or somehow deserved it. The client will often express feelings of guilt, but the goal will be to assist to put it in perspective and eventually to be able to work through the feelings of guilt.

A situational crisis arises from external rather than internal sources. External situations that could precipitate crisis include loss of or change of a job, the death of a loved one, abortion, a change in financial status, divorce, the addition of new family members, pregnancy, and severe illness.

An adventitious crisis is not a part of every day life, is unplanned, and accidental.

As with all loss experienced by individuals and families, opening up the communication channels is a key factor in successful grieving and surviving. Often, estrangement occurs in families because well-meaning relatives and friends do not know how to respond. This uncertainty and fear causes relatives and friends to isolate when communication and an opportunity to grieve with support are crucial. Joining a survivor-victim group is a positive outcome, but if the client is not talking with his or her family members, it is likely that maximum benefit from the group will not be achieved.

Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid specific stimulus. Counselors will not be available for all anxiety-producing situations.

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