Nokea
A client's history documents that there have been examples of indirect self-destructive behavior. Which nursing assessment data supports this diagnosis?
- A. Client has attempted suicide on three other occasions.
- B. Reports of abusing alcohol since the age of 16.
- C. Client experiences episodes of hypoglycemia on a regular basis.
- D. While acknowledging suicidal thoughts, the client denies any plan.
Correct Answer: B
Rationale: The correct answer is B because reports of abusing alcohol since the age of 16 indicate a pattern of indirect self-destructive behavior. This behavior can lead to physical harm and other negative consequences. Option A directly mentions suicide attempts, not indirect behavior. Option C is unrelated to self-destructive behavior. Option D, while acknowledging suicidal thoughts, does not demonstrate a pattern of indirect self-destructive behavior like long-term alcohol abuse.
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Why are tricyclic antidepressants infrequently used?
- A. Have many side effects
- B. Have many interactions with other medications
- C. Can cause cardiac problems
- D. Lethal in overdose
Correct Answer: A
Rationale: The correct answer is A because tricyclic antidepressants have numerous side effects such as dry mouth, constipation, weight gain, and sedation. These side effects can be intolerable for patients, leading to poor adherence. Choices B, C, and D are incorrect because while tricyclic antidepressants can have interactions with other medications, cause cardiac problems, and be lethal in overdose, these factors alone do not fully explain why they are infrequently used compared to other antidepressant options. The primary reason for their limited use lies in their significant side effect profile.
It is the judgment of personal performance compared with the self-ideal:
- A. Self-concept
- B. Self-identity
- C. Self-assessment
- D. Self-esteem
Correct Answer: D
Rationale: Self-esteem is the comparison between actual performance and ideal self, per Rogers.
The Joint Commission on the Accreditation of Healthcare Organizations mandates standardized “hand of†change of shift reporting. Which of the following is a standardized “hand off†change of shift reporting system that you may want to consider for implementation on your nursing care unit?
- A. The Four P's
- B. UBAR
- C. ISBAR
- D. MAUMAR
Correct Answer: C
Rationale: ISBAR is a widely recognized handoff communication tool.
During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, 'After discharge, I’m sure everything will be just fine.' Which remark by the nurse will be most helpful to the spouse?
- A. It is good that you’re supportive of your spouse’s sobriety and want to help maintain it.'
- B. Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol.'
- C. It will be important for you to structure life to avoid as much stress as possible. You will need to provide social protection.'
- D. Remember that alcoholism is a disease of self-destruction. You will need to observe your spouse’s behavior carefully.'
Correct Answer: B
Rationale: The correct answer is B because it acknowledges the spouse's optimism while also gently highlighting the potential challenges that may arise during the recovery process. By pointing out that new problems may emerge as the patient adjusts to a life without alcohol, the nurse prepares the spouse for potential difficulties and encourages realistic expectations.
Choice A is incorrect because it only acknowledges the spouse's support without addressing the potential challenges ahead. Choice C is incorrect because it focuses solely on stress avoidance rather than preparing for the overall adjustment process. Choice D is incorrect because it emphasizes monitoring the patient's behavior rather than addressing the spouse's outlook and potential struggles.
The theorist associated with social learning theory is
- A. Sigmund Freud
- B. B.F. Skinner
- C. Albert Bandura
- D. Ivan Pavlov
Correct Answer: C
Rationale: Bandura's social learning theory emphasizes observation.