Nokea
A client continually repeats phrases that others have just said. The nurse recognizes this behavior as:
- A. Autistic.
- B. Ecopraxic.
- C. Echolalic.
- D. Catatonic.
Correct Answer: C
Rationale: Echolalia is the repetition of words or phrases heard from others.
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An inflammatory bowel disorder in which the patient develops abdominal pain, bloody diarrhea, tenesmus (feeling of incomplete defecation), and weight loss is
- A. Crohn's disease.
- B. Diverticulitis.
- C. Ulcerative colitis.
- D. Appendicitis.
Correct Answer: C
Rationale: Ulcerative colitis typically presents with these symptoms.
Tom reports a history of carpal tunnel syndrome. What else would you expect to find in his history?
- A. Crepitus (grating feeling on palpation over joint during range of motion) due to loss of articular cartilage and bony overgrowth in joint.
- B. Excessive forward curvature of the thoracic spine (kyphosis) due to pathologic vertebral fractures and collapsing of the anterior portion of the vertebral bodies in the thoracic area.
- C. Pain and numbness or tingling sensation in the hand over the palmar surface of the thumb, index, and middle fingers, and lateral aspect of the ring finger, that is worse at night.
- D. Acute onset of excruciating pain in joint due to accumulation of uric acid within the joint.
Correct Answer: C
Rationale: Carpal tunnel syndrome affects the median nerve, causing pain and numbness in specific areas.
A patient who completed detoxing from heroin tells you that his or her family members who are not substance abusers do not understand how it feels to go through withdrawal. He or she asks you for advice. Which of the following is the best response?
- A. Tell your family members to attend Alcoholics Anonymous.
- B. Ask your family members if they ever had the flu. Tell them that withdrawal is like having the worst flu they ever had.
- C. Tell your family member that going through withdrawal is like going on a diet.
- D. Tell your family member to try heroin once.
Correct Answer: B
Rationale: Comparing withdrawal to a severe flu helps family members understand the physical symptoms without trivializing the experience.
What is the correct term for a fear of having panic attacks in public places?
- A. Social phobia
- B. Acrophobia
- C. Nyctophobia
- D. Agoraphobia
Correct Answer: D
Rationale: Agoraphobia specifically refers to the fear of being in public spaces or situations where escape might be difficult.
While suctioning the endotracheal tube of a client on a ventilator, the nurse notices an increase in the client's heart rate from 86/min to 110/min, with irregularity. What should the nurse do next?
- A. Obtain a cardiology consult.
- B. Suction the client less frequently.
- C. Administer an antidysrhythmic medication.
- D. Perform pre-oxygenation prior to suctioning.
Correct Answer: D
Rationale: The correct answer is D: Perform pre-oxygenation prior to suctioning. In this scenario, the increase in heart rate and irregularity could be due to hypoxia resulting from suctioning. Pre-oxygenation helps to ensure adequate oxygenation before the procedure, preventing hypoxia-induced dysrhythmias. By providing oxygen before suctioning, the nurse can minimize the risk of further complications.
Choice A (Obtain a cardiology consult) is incorrect because immediate action is required to address the potential hypoxia, which can be managed by pre-oxygenation.
Choice B (Suction the client less frequently) is incorrect as it does not address the immediate concern of potential hypoxia leading to dysrhythmias.
Choice C (Administer an antidysrhythmic medication) is incorrect as it is not the initial intervention needed in this situation; addressing the underlying cause of potential hypoxia is essential before considering antidysrhythmic medications.