Nokea
Which response would best assist the chemically impaired client in dealing with issues of guilt?
- A. Addiction usually causes people to feel guilty. Don't worry, it is a typical response due to your drinking behavior.
- B. What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?
- C. Don't focus on your guilty feelings. These feelings will only lead you to drinking and taking drugs.
- D. You've caused a great deal of pain to your family and close friends, so it will take time to undo all the things you've done.
Correct Answer: B
Rationale: The correct response is, 'What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?' This response encourages the client to reflect on their actions, identify sources of guilt, and develop a plan to address and reduce these feelings constructively. Choice A is incorrect as it dismisses the client's guilt as typical, potentially invalidating their emotions. Choice C is incorrect as it suggests avoiding guilty feelings by turning to substance use, which is counterproductive. Choice D is incorrect as it focuses on the negative consequences of the client's actions without offering a constructive way to address and alleviate guilt.
You may also like to solve these questions
When assessing a child admitted to the hospital with pyloric stenosis, which symptom would the nurse likely find when asking the parent about the child's symptoms?
- A. Watery diarrhea
- B. Projectile vomiting
- C. Increased urine output
- D. Vomiting large amounts of bile
Correct Answer: B
Rationale: In pyloric stenosis, hypertrophy of the circular muscles of the pylorus causes narrowing of the pyloric canal between the stomach and the duodenum. The hallmark symptom of pyloric stenosis is projectile vomiting, which is the forceful expulsion of stomach contents. Other common symptoms include irritability, hunger and crying, constipation, and signs of dehydration. Watery diarrhea (Choice A) is not a typical symptom of pyloric stenosis. Increased urine output (Choice C) is not directly associated with this condition. Vomiting large amounts of bile (Choice D) is not a characteristic symptom of pyloric stenosis; instead, the vomitus in pyloric stenosis is non-bilious.
A client with schizophrenia is receiving Haloperidol (Haldol) 5 mg t.i.d.. The client's family is alarmed and calls the clinic when 'his eyes rolled upward.' The nurse recognizes this as what type of side effect?
- A. Oculogyric crisis
- B. Tardive dyskinesia
- C. Nystagmus
- D. Dysphagia
Correct Answer: A
Rationale: Oculogyric crisis is a known side effect of antipsychotic medications like Haloperidol (Haldol) and is characterized by involuntary upward deviation of the eyes. This condition can be distressing to both the client and their family. Tardive dyskinesia (Choice B) is a different side effect characterized by repetitive, involuntary movements, especially of the face and tongue, which can occur with long-term antipsychotic use. Nystagmus (Choice C) is an involuntary eye movement that is rhythmic and can occur for various reasons but is not specific to Haloperidol use. Dysphagia (Choice D) refers to difficulty swallowing and is not typically associated with the use of Haloperidol.
Following mitral valve replacement surgery, a client develops PVCs. The healthcare provider orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mg/minute. The IV solution contains 2 grams of Lidocaine in 500 mL of D5W. The infusion pump delivers 60 microdrops/mL. What rate would deliver 4 mg of Lidocaine per minute?
- A. 60 microdrops/minute
- B. 20 microdrops/minute
- C. 30 microdrops/minute
- D. 40 microdrops/minute
Correct Answer: A
Rationale: To calculate the rate needed to deliver 4 mg/minute of Lidocaine, first, convert 2 grams to milligrams: 2 grams = 2000 mg. Then, set up a ratio between the total amount of Lidocaine (2000 mg) and the total volume of IV solution (500 mL): 2000 mg / 500 mL = 4 mg / x mL. Solving for x, x = 1 mL. Since the infusion pump delivers 60 microdrops per mL, multiplying by 60 microdrops/mL gives the correct rate of 60 microdrops/minute. This rate ensures the desired 4 mg of Lidocaine is delivered per minute. Choices B, C, and D are incorrect as they do not align with the accurate calculation based on the provided information.
When asked to describe in layman's terms an overview of the condition called osteomyelitis, what would be the nurse's best response?
- A. Osteomyelitis is a gradual breakdown and weakening of your bones. It's most often age-related.
- B. Osteomyelitis is caused by not having enough Vitamin D, which in turn causes your bones to be softer and demineralized.
- C. Osteomyelitis is an infection in the bone. It can be caused by bacteria reaching your bone from outside or inside your body.
- D. This is a question that should be directed to your healthcare provider.
Correct Answer: C
Rationale: Osteomyelitis is an infection in the bone that can be caused by bacteria reaching the bone either from outside the body (such as through an open fracture) or inside the body (such as through the bloodstream). This response provides a concise and accurate explanation of osteomyelitis, making it the best choice. Choices A and B provide inaccurate information about the condition, attributing it to age-related bone breakdown and Vitamin D deficiency, which are not correct causes of osteomyelitis. Choice D deflects the question instead of providing the patient with a clear explanation, making it an inappropriate response.
After an endoscopic procedure with general anesthesia, what is a priority nursing consideration for a patient in the day surgery center?
- A. Raise the siderails of the patient's bed
- B. Do not offer fluids, food, or any oral intake
- C. Check the temperature of the patient
- D. Teach the patient to avoid aspirin or NSAIDS
Correct Answer: B
Rationale: After an endoscopic procedure with general anesthesia, the priority nursing consideration is to not offer fluids, food, or any oral intake to the patient. Endoscopies involve passing a tube through the mouth into the esophagus or upper GI. Anesthesia is often given to inactivate the gag reflex, making the patient vulnerable to aspiration. Raising the siderails of the patient's bed is important for safety but not the immediate priority. Checking the patient's temperature may be important but is not the priority immediately after the procedure. Teaching the patient to avoid aspirin or NSAIDS is important for post-procedure care but is not the priority immediately after the endoscopic procedure.