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Wednesday, September 3, 2008

Nclex Tips 17 (Pediatric Nclex Questions)

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Sertraline hydrochloride (zoloft), a selective serotonin reuptake inhibitor, can cause a dry mouth that is alleviated by sucking on sugarless hard candy and chewing gum. Foods such as cheese, wine, and chocolate contain an amino acid, tyramine that reacts with monoamine oxidase inhibitors. Monthly blood levels are usually required for clients who are receiving lithium carbonate (Eskalith) therapy. Sertraline is usually taken with meals.

Central nervous system depressants such as alcohol will produce an addictive effect if taken with diazepam, which can be lethal. Diazepam can cause initial drowsiness. It should not be discontinued abruptly, because the client may develop withdrawal symptoms. Many of the over-the-counter medications used to treat the flu contain medication that should not be taken when a client is taking diazepam.

Clients who are taking monoamine oxidase inhibitors (MAOIs) must maintain a low tyramine diet and receive health teaching regarding the foods, beverages, and medications that must be avoided. Foods with aged cheese can cause a hypertensive crisis if taken with MAOIs.

Fluoxetine hydrochloride (Prozac) tends to improve the energy level, and if it is taken late in the day, insomnia may occur. Many clients suffer from sexual dysfunction throughout treatment, such as decreased libido. Side effects can be expected to some degree with any medication. The lag time from the time the medication is started until therapeutic effects are achieved is anywhere from 2 to 4 weeks or longer. This is true with any antidepressant.

Sodium depletion will decrease renal excretion of lithium, thereby causing the medication to accumulate and potentiating toxicity. Clients need to be instructed to maintain a normal sodium intake. Diuretics promote sodium loss, and these medications need to be used with caution in the client taking lithium. Sodium loss secondary to diarrhea can cause lithium accumulation, and the client should be forewarned of this possibility.

Chlorpromazine blocks dopamine neurotransmission at postsynaptic dopamine receptor sites, reversing psychotic symptoms.

Lithium is an antimanic medication and is used to treat the manic phase of a manic-depressive disorder.

Neuroleptic malignant syndrome is a serious and potentially fatal reaction to antipsychotics. The classic symptoms include hyperthermia; severe extrapyramidal symptoms, such as muscular rigidity; and autonomic dysfunction, such as hypertension and tachycardia.

The first priority in planning care for a client with dysfunctional grieving is to assess the risk for violence toward self and others. The plan will include efforts to work toward resolving the grief through emotional, cognitive, and behavioral means.

Ensuring safety is a major aspect in the plan of care for the abused elder. The nurse may need to contact the social worker to plan care for the client, but this is not the priority action.

In all child abuse cases, the primary concern is the health and safety of the child.

Adventitious crises are the unpredictable tragedies that occur without warning. A maturational crisis involves the normal life transition that creates changes with individuals and how they perceive themselves, their role, and their status. A situational crisis occurs when a specific, external event disturbs an individual’s psychological equilibrium. An individual may experience a crisis; however, there is no formal type of crisis known as individual crisis.

In the ECT suite, blood pressure, cardiac, and electroencephalographic monitors are placed on the client to assess vital functions. Whenever ECT is administered, emergency equipment, including oxygen, suction, and a cardiac arrest cart, must also be available.

In the norming stage, members express intimate personal opinions and feelings around personal tasks. In the forming or initial stage, the members are identifying tasks and boundaries. Storming involves responding emotionally to tasks. In the performing stage, members direct group energy toward the completion of tasks.

Feelings of low self-esteem and worthlessness are common symptoms of the depressed client. Reminders of the client’s recent accomplishments or personal successes are ways to interrupt the client’s negative self-talk and distorted cognitive view of self.

In a client with a diagnosis of delirium. It is important to provide a consistent daily routine and a low stimulating environment when the client is disorientated. Noise, including radio and television, can add to the confusion and disorientation. A well-lit room will increase stimulation.

In the immediate post-disaster period, it is important that a nurse go to places where victims are likely to gather, such as morgues, hospitals, and shelters. Rather than waiting for people to publicly identify themselves as being unable to cope with stress, it is suggested that nurses work with the American Red Cross. The nurse should talk to people waiting to receive assistance, go door to door, or go to a relocation site. The nurse should ask people how they are managing their affairs and explore their reactions to stress.

If a client is in the act of preparing to commit suicide, the most appropriate nursing activity is to communicate with the client and attempt to develop a therapeutic relationship. The nurse should communicate hope, and hope is most often the most therapeutic element in any nursing intervention with a suicidal patient.

Identification is the process by which a person tries to become like someone he or she admires by taking on thoughts, mannerisms, or tastes of that person. Intellectualization is excessive reasoning or logic used to avoid experiencing disturbed feelings. Projection is attributing one’s thoughts or impulses to another person. Regression is retreating to a behavior characteristic of an earlier level of development.

Direct expressions of self-hate or low self-esteem can include the client’s expression of self-criticism. The client will exhibit negative thinking and believe that he is doomed to failure. The underlying goal of the client is to demoralize himself or herself. The client may describe himself as stupid, no good, or a born loser. The client will view the normal stressors of life as impossible barriers and become preoccupied with self-pity.

It is the nurse’s responsibility to tell a client that secrets cannot be kept and also that any disclosures that reveal behavior that may be harmful to the client will need to be communicated to the appropriate professionals in the health care team.

To de-escalate aggressive behavior, the nurse should manage the environment by persuading the client to move to another area. This will help prevent anxiety contagion and protect others. The nurse should also give the client clear instructions that are brief and assertive and should also negotiate options with the client. This shows the nurse’s confidence and leadership and also avoids misunderstandings in regard to not knowing what to do. Negotiating options allows the client to feel that he or she has some room in exercising the options. The nurse must allow the client body space and should not stand closer than about 8 feet to the client. Standing close to the client will convey a threat.

Recreational therapy helps clients with personality disorders explore ways to enjoy themselves without the use of self-destructive behaviors, such as abusing alcohol or drugs. This modality is helpful to clients who have difficulty socializing, because recreation strengthens social skills. Movement therapy may be helpful for clients who become “numb” when experiencing intense feelings. Art therapy may be helpful for the client who is angry. The client who is exhibiting violent behavior may require medication therapy.

Concentration and memory are poor in severe depression. When a client has a diagnosis of severe depression, the nurse needs to provide activities that require little concentration. Activities that have no right or wrong choices or activities that require minimal decision making minimize opportunities for clients to put themselves down.

When the client demonstrates calm behavior and communicates that he or she is no longer a threat to self or others, the nurse would gather additional assessment data to determine if the client is safe to come out of seclusion.

Social phobia focuses on a specific situation, such as the fear of speaking, performing, or eating in public. Agoraphobia is a fear of open spaces and the fear of being trapped in a situation from which there may not be an escape. Claustrophobia is a fear of closed places. Clients with hypochondriacal symptoms focus their anxiety on physical complaints and are preoccupied with their health.

It is most therapeutic for the nurse to empathize with the client’s experience. Disagreeing with delusions may make the client more defensive and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.

If a client with severe anxiety is left alone, he or she may feel abandoned and become overwhelmed. Placing the client in a quiet room is also important, but the nurse must stay with the client. It is not possible to teach the client deep breathing exercises until the anxiety decreases. Encouraging the client to discuss the accident would not take place until the anxiety has decreased.

Systematic desensitization is a form of therapy used when the client is introduced to short periods of exposure to the phobic object while in a relaxed state. Gradually, exposure is increased, until the anxiety about or fear of the object or situation has ceased.

If a client is monopolizing the group, it is important that the nurse be direct and decisive. The best action is to suggest that the client stop talking and try listening to others.

Using therapeutic communication techniques, the nurse acknowledges the husband’s concerns and conveys that the client’s symptoms are common with myxedema. With thyroid hormone therapy, these symptoms should decrease, and cognitive function often returns to normal within 2 weeks.

When a nurse delegates aspects of a client’s care to another staff member, the nurse assigning the tasks is responsible for ensuring that each task is appropriately assigned on the basis of the educational level and competency of the staff member. Noninvasive interventions can be assigned to a nursing assistant.

A drop in blood pressure and rise in pulse rate could indicate postoperative bleeding, which is a complication of a parathyroidectomy. Because bleeding might not be observed on the front of the dressing due to the effects of gravity, the nurse must check underneath it as well.

Democratic leadership is a people-centered approach that is primarily concerned with human relations and teamwork. This leadership style facilitates goal accomplishment and contributes to the growth and development of the staff. In autocratic leadership, the leader retains all authority and is primarily concerned with task accomplishment. Situational leadership is a comprehensive approach that incorporates the leader’s style, the maturity of the work group, and the situation at hand. Laissez faire is a permissive style of leadership in which the leader gives up control and delegates all decision making to the work group.

To promote adequate healing and to meet continued high metabolic needs, the client with a major burn should eat a diet that is high in calories, protein, and carbohydrate. This type of diet also keeps the client in positive nitrogen balance.

Autocratic leadership is an approach in which the leader retains all authority and is primarily concerned with task accomplishment. It is an effective leadership style to implement in an emergency or crisis situation. The leader assigns clearly defined tasks and establishes one-way communication with the work group, making all of the decisions alone. Situational leadership is a comprehensive approach that incorporates the leader’s style, the maturity of the work group, and the situation at hand. Laissez faire is a permissive style of leadership in which the leader gives up control and delegates all decision making to the work group. Democratic leadership is a people-centered approach that is primarily concerned with human relations and teamwork. This leadership style facilitates goal accomplishment and contributes to the growth and development of the staff.

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