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Which assessment findings would alert the nurse that an older patient may have an increased risk for development of geriatric alcohol abuse? Select one tha does not apply.
- A. Mild recent memory impairment
- B. Eighth grade education
- C. Death of spouse
- D. Retirement
Correct Answer: A
Rationale: Geriatric problem drinking often begins in response to stressors like retirement (D), loss of spouse (C), and loneliness (E), with risk factors including less than high school education (B). Mild memory impairment (A) is not a predisposing factor.
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A 35-year-old woman is being assessed related to suspected battering. In interviewing this patient, it is important for the nurse to keep in mind that: (Select all that apply.)
- A. The nurse's demeanor should be one of concern and caring.
- B. Professional terminology should be used and taught to the patient.
- C. All noted injuries should be thoroughly and explicitly documented.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A because when assessing a patient related to suspected battering, the nurse should demonstrate concern and caring to establish trust and encourage the patient to open up. This approach helps build rapport and facilitates communication, leading to a more accurate assessment and better support for the patient. Choice B is incorrect because using professional terminology might intimidate the patient and hinder effective communication. Choice C is incorrect because documenting injuries without sensitivity and consideration for the patient's emotional well-being can further traumatize the individual. Choice D is incorrect as the nurse's demeanor and approach are crucial in addressing cases of suspected battering.
The nurse is assessing a client who will be having an orthopedic surgery. The client takes an antipsychotic medication and shares that he has recently started using two herbal preparations for his nerves. The nurse should:
- A. Ask for the specific names of the herbal compounds
- B. Go on to another interview question since herbal compounds are not important
- C. Tell him to stop using the herbal preparations because they are not effective
- D. Explain that his physician will not be happy with his self-prescribing
Correct Answer: A
Rationale: Rationale:
A: Asking for the specific names of the herbal compounds is important to assess potential interactions with the antipsychotic medication.
B: Ignoring the herbal compounds could lead to adverse effects or interactions during surgery.
C: Telling him to stop may not be appropriate without knowing the specific compounds and their effects.
D: Discussing the physician's viewpoint is not as crucial as gathering information on potential interactions.
Attention Deficit Hyperactivity Disorder (ADHD) is equally common in boys and girls
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: ADHD is more commonly diagnosed in boys than girls, though it affects both genders.
A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse? The patient who:
- A. consumes 1 glass of wine nightly with dinner
- B. began drinking alcohol daily after retirement and says, 'A few drinks keep my mind off my arthritis.'
- C. drank socially throughout adult life and continues this pattern, saying 'Ive earned the right to do as I please.'
- D. abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA)
Correct Answer: B
Rationale: Alcohol abuse and dependence can develop at any age, and the geriatric population is particularly at risk. Losses, such as retirement, widowhood, and loneliness, are often related. The distracters describe patients with a lower risk for alcohol abuse.
A patient who takes lithium phones the nurse at the clinic to say, "I've had diarrhea for 4 days. I feel weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" Which instruction by the nurse is appropriate?
- A. Have someone bring you to the clinic immediately.
- B. Restrict food and fluids for 24 hours and stay in bed.
- C. Drink a large glass of water with 1 teaspoon of salt added.
- D. Take antidiarrheal medication hourly until the diarrhea subsides.
Correct Answer: A
Rationale: The correct answer is A: Have someone bring you to the clinic immediately. The patient is experiencing symptoms of lithium toxicity, including diarrhea, weakness, unsteadiness, and worsening hand tremor. These symptoms indicate a potential lithium overdose, which can be life-threatening. Bringing the patient to the clinic immediately is crucial for assessment, monitoring, and intervention.
Choice B is incorrect because restricting food and fluids can worsen dehydration and electrolyte imbalances. Choice C is incorrect as adding salt to water can exacerbate electrolyte abnormalities in lithium toxicity. Choice D is incorrect as taking antidiarrheal medication can further worsen the symptoms and delay appropriate medical treatment.