Nokea
While caring for a family, the nurse determines that first-order changes have occurred with which of the following?
- A. The children are all in school, and the parent returns to work.
- B. The daughter leaves home to attend college.
- C. The son marries his long-time sweetheart and moves into his own home.
- D. The grandmother who has been living in the household dies.
Correct Answer: A
Rationale: The correct answer is A because first-order changes refer to small, incremental adjustments within the system. In this scenario, the parent returning to work while the children are all in school signifies a gradual shift in the family dynamic. The other choices involve significant and more disruptive changes like a daughter leaving for college, a son getting married and moving out, and the death of a family member, which are considered second-order changes that lead to more substantial shifts in the family system.
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When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to
- A. report drowsiness.
- B. eat a tyramine-free diet.
- C. avoid alcoholic beverages.
- D. adjust dose and frequency based on anxiety level.
Correct Answer: C
Rationale: The correct answer is C: avoid alcoholic beverages. This is because alprazolam is a central nervous system depressant, and alcohol also has depressant effects. Combining the two can potentiate sedation and respiratory depression. Reporting drowsiness (A) is important but not specific to alprazolam. Eating a tyramine-free diet (B) is relevant for certain medications like MAOIs, not alprazolam. Adjusting dose and frequency based on anxiety level (D) is not recommended as it can lead to misuse or dependence.
Which statement by a patient would lead the nurse to suspect unsuccessful completion of the psychosocial developmental task of infancy?
- A. I know how to do things right, so I prefer jobs where I work alone rather than on a team.'
- B. I do not allow other people to truly get to know me.'
- C. I depend on frequent praise from others to feel good about myself.'
- D. I usually need to do things several times before I get them right.'
Correct Answer: C
Rationale: The correct answer is C because depending on frequent praise from others to feel good about oneself indicates a lack of self-confidence and self-esteem, which are key components of successful completion of the psychosocial developmental task of infancy according to Erikson's theory. This statement suggests an inability to develop a sense of autonomy and self-reliance, which are crucial in the infancy stage.
Choice A is incorrect because preferring to work alone rather than on a team may indicate a preference for autonomy, which is a positive trait related to the successful completion of the task of autonomy vs. shame and doubt in infancy.
Choice B is incorrect because not allowing others to truly get to know oneself could indicate introversion or privacy preferences, which may not necessarily suggest unsuccessful completion of the infancy developmental task.
Choice D is incorrect because needing to do things several times before getting them right may indicate a learning style or perfectionism rather than a sign of unsuccessful completion of the psychosocial developmental task of infancy.
A client with a long history of alcohol use disorder has been diagnosed with Wernicke-Korsakoff syndrome. With which member of the mental health-care team would the nurse collaborate to meet this client's described need?
- A. The psychiatrist to obtain an order for neurocognitive disorder medications.
- B. The psychologist to set up counseling sessions to explore stressors.
- C. The dietitian to help the client increase consumption of thiamine-rich foods.
- D. The social worker to plan transportation to Alcoholics Anonymous.
Correct Answer: C
Rationale: The correct answer is C: The dietitian to help the client increase consumption of thiamine-rich foods. Wernicke-Korsakoff syndrome is caused by thiamine deficiency, commonly seen in individuals with alcohol use disorder. Thiamine supplementation is essential in managing this condition. Collaborating with a dietitian can ensure the client receives proper education and guidance on increasing thiamine intake through diet.
Incorrect choices:
A: The psychiatrist for neurocognitive disorder medications - While medications may be prescribed for symptoms, addressing the underlying thiamine deficiency is crucial.
B: The psychologist for counseling sessions - Counseling can be beneficial, but addressing the nutritional deficiency is a priority.
D: The social worker for transportation to AA - Important for ongoing support, but addressing the nutritional needs comes first to manage Wernicke-Korsakoff syndrome.
A client with signs and symptoms of double pneumonia states,"I will not agree to hospital admission unless my shaman is allowed to continue helping me." Which would be an appropriate nursing intervention?
- A. Tell the client that the shaman is not allowed in the emergency department.
- B. Have the shaman meet the attending physician at the hospital.
- C. Have the family talk the client into admission without the shaman.
- D. Explain to the client that the shaman is responsible for the client's condition.
Correct Answer: B
Rationale: The correct answer is B. Having the shaman meet the attending physician at the hospital is the most appropriate nursing intervention because it allows for collaboration between traditional beliefs and modern medical care. This approach respects the client's cultural and spiritual preferences while ensuring the client receives necessary medical treatment. It also helps establish a supportive and holistic care environment.
Choice A is incorrect because denying the shaman access may lead to resistance from the client and hinder effective communication and trust-building. Choice C is inappropriate as it disregards the client's autonomy and may create conflict within the family. Choice D is incorrect as blaming the shaman for the client's condition is disrespectful and unprofessional.
A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?
- A. Diphenhydramine (Benadryl)
- B. Propranolol (Inderal)
- C. Risperidone (Risperdal)
- D. Aripiprazole (Abilify)
Correct Answer: A
Rationale: The correct answer is A: Diphenhydramine (Benadryl). Dystonic reactions are extrapyramidal side effects commonly seen with antipsychotic medications. Diphenhydramine is a first-line treatment for dystonic reactions due to its anticholinergic properties. It helps block the excessive dopamine activity in the brain that causes these reactions. Propranolol (B) is a beta-blocker and not typically used for dystonic reactions. Risperidone (C) and Aripiprazole (D) are antipsychotic medications themselves and would not be used to treat dystonic reactions caused by antipsychotic medications.