Nokea
The nurse reviews various treatment options with the group members. Which of the following are considered most therapeutic in treating obsessive-compulsive disorder (OCD)? Select all that apply.
- A. Selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine (Luvox)
- B. Electroconvulsive therapy (ECT)
- C. Cognitive-behavioral therapy
- D. Surgical prefrontal lobotomy
- E. Tranquilizers such as diazepam (Valium)
- F. A self-help class on the Internet
Correct Answer: A,C
Rationale: SSRIs and cognitive-behavioral therapy, particularly exposure and response prevention, are evidence-based treatments for OCD, targeting symptoms effectively.
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If the client's pain is the result of a panic attack, which findings will the nurse most likely note during the physical assessment? Select all that apply.
- A. Tachycardia
- B. Hypotension
- C. Increased salivation
- D. Constricted pupils
- E. Sweating
- F. Unsteady gait
Correct Answer: A,E
Rationale: Panic attacks typically cause tachycardia and sweating due to sympathetic nervous system activation, reflecting acute anxiety.
The client expresses ambivalence about quitting smoking and also the fear of “getting fat” and “looking like a cow.” The client wonders if that is worse than smoking. Which response by the nurse is most helpful?
- A. “We could set up a diet for you to start at the same time to prevent you from gaining any weight.”
- B. “Don’t you think it would be much better to breathe more easily even if you gain a little weight?”
- C. “You don’t want to quit smoking because you think you might gain weight. Do you see yourself as overweight?”
- D. “It sounds like you are afraid of weight gain. Tell me about the good and bad things that might happen if you give up smoking.”
Correct Answer: D
Rationale: Acknowledging weight gain fear and exploring pros/cons (D) aids decision-making. Dieting (A) risks relapse health focus (B) dismisses fear closed question (C) limits discussion.
The nurse is caring for the client who is 2 days postadmission to a medical unit and has a long history of heavy alcohol abuse. The nurse should monitor for which acute complications related to alcohol abuse? Select all that apply.
- A. Seizures
- B. Pancreatitis
- C. GI bleeding
- D. Exophthalmos
- E. Delirium tremens
Correct Answer: A ,B ,C, E
Rationale: Seizures (A) pancreatitis (B) GI bleeding (C) and delirium tremens (E) are acute risks. Exophthalmos (D) is unrelated.
What suggestion can the nurse make if the client complains of feeling dizzy when taking doxepin (Sinequan) at bedtime as prescribed?
- A. Place a cool compress on your forehead.
- B. Get up slowly from a seated position.
- C. Remain in bed with your feet elevated above your heart.
- D. Take some deep breaths before getting out of bed.
Correct Answer: B
Rationale: Rising slowly minimizes orthostatic hypotension, a common side effect of doxepin, reducing dizziness.
Which response by the nurse is best in this situation?
- A. That is something to discuss with your physician.
- B. It sounds like you're feeling discouraged.
- C. But you're about your lack of progress.
- D. You need to practice a little more patience.
Correct Answer: B
Rationale: Acknowledging discouragement validates the client's feelings, fostering therapeutic communication and emotional support.