Defense Mechanisms /Stress
A nursing student, who has always been social & participated in group study sessions, has been told that their work is unsatisfactory. The student now stays home, skips lectures, and lays in their dark bedroom all day. What defense mechanism is being used?
A: denial
B: conversion
C: regression
D: displacement
C: Regression
Rationale: this behavior is associated with an earlier developmental period.
When caring for a patient with drug or alcohol abuse issues it is important that the nurse portrays and attitude of:
A: pessimism
B: negativity
C: acceptance
D: optimism
C: ACCEPTANCE
A nurse who portrays _____ is most effective to care for a patient with severe anxiety.
A: flexibility
B: Calmness
C: Sincerity
D: narcissism
B: Calmness Rationale: people who are anxious need a calm orderly environment.
Why is lorazepam (Ativan) often given to patients in withdrawal?
Decreases anxiety & has anticonvulsant qualties to provide safe withdrawal.
Thiamine deficiency in chronic ETOH use often causes: A: depression
B: neurologic impairments
C: obesity
D: manic behaviors
B: NEUROLOGIC IMPAIRMENTS often experience neuropathy.
A student gets sick every semester during finals week. What stage of stress is this?
A: alarm
B: Exhaustion
C: Resistance
D: latency
B: Exhaustion finals is end of the term and stress & coping has been worn down causing the illness.
When a person feels as if they NEED to have a drug everyday this is called:
A: overdose
B: Dependence
C: Intoxication
D: Tolerance
B: DEPENDENCE
Manic patients are often at risk for non-compliance with med therapy why is this?
Manic patients often prefer the "high" feeling over the low/normal or depressed feelings when on meds.
What vitamins are commonly given for treatment of withdrawal?
A: Chromium & selenium
B: Riboflavin & iron
C: thiamine (B1) & folic acid
D: zinc & iron
C: THIAMINE & FOLIC ACID PLUS MVI Rationale: these vitamins prevents Wernicke's encephalopathy & corrects vitamin deficiencies from ETOH abuse.
An appropriate goal for a patient with Bipolar disorder in a manic state is "patient will sit and color for 15 minutes without getting distracted by the end of my shift" True False
TRUE Rationale: manic patients are highly distractable. Getting them to focus on an activity is a great goal that shows improvement of the manic symptoms.
Mandatory OT, long shifts with no breaks, poor staffing, & difficult patients contribute to stress for nurses? True False
True
Identify several assessment components of the CIWA tool that is used to assess the level of withdrawal symptoms.
Nausea & vomiting, tremors, paroxysmal sweats, anxiety, agitation, tactile visual & auditory disturbances, headache, orientation.
Score of <8 is minimal withdrawal symptoms, 9-15= moderate and >16 severe withdrawal symptoms with increased risk of DT's and seizures.
An Alzheimer's patient is in the dining room and stares at their food. What is the best response by the nurse?
A: monitor I&O
B: tell patient to take a bite
C: feed the patient
D: provide different meal
B: tell patient to take a bite
Rationale: cueing patients to eat promotes independence. Certainly the other are options but if we can promote independence that is priority.
How long does it take for antidepressants to reach therapeutic effects?
A: 1-2 days
B: 2-6 hours
C: 2-6 weeks
D: 10 days
C: 2-6 weeks depending on the medication the range varies for therapeutic effects to take place. Important to teach our patients this.
A schizophrenic patient hears staff laughing and becomes aggressive toward the staff. To reassure the patient the staff should give the patient a hug to reassure them they weren't laughing at him.
True False
False Rationale:
schizophrenic patients are paranoid and may feel threatened by touch. More appropriate to talk calmly and quietly and offer medication to help calm down.
Name some potential stressors for older patients.
health problems, unfamiliar surroundings, cost of healthcare, loss of independence, fear, lack of knowledge, change in functional status, loss of family & friends.
Substance abuse in older adults is often related to binge drinking and recreational drugs.
True or False
FALSE substance abuse is most often r/t misuse of prescribed and OTC drugs and alcohol.
A depressed patient has a sudden change in mood the nurse knows this is:
A: a sign the antidepressant is working
B: warning sign of increased suicide risk
C: need for different antidepressant
D: indicating signs of manic behavior
B: warning sign of increased suicide risk Sudden changes in mood are usually indicative that the person has made up their mind (suicide). Pressure is off of them so they are happy because decision is made.
A patient has a history of an opioid addiction/abuse presents to ER unresponsive, pinpoint pupils, and respirations of 6 bpm. What med would you expect be given?
A: caffeine
B: naloxone (narcan)
C: methadone
D: lorazepam
B: Naloxone
Rationale: this is an opioid antagonist. Reverse effects of opioids/narcotics. Side effects can be sudden withdrawal from the drug.
Name some maladaptive responses to stressors.
consume excess caffeine, ETOH abuse, smoking, avoidance of social acitvities, abuse of OTC meds, street drug use.
An 85 year old has been diagnosed with rheumatoid arthritis and decides to see a nutritionist and signs up for a yoga class. What type of response is this?
A: adaptive response
B: stress response
C: maladaptive response
D: resistant response
A: Adaptive response
Rationale: adaptive behaviors contribute to resolution of stress or are health beneficial whereas maladaptive lead to further problems (drug ETOH abuse).
A patient has been admitted for 3 days and suddenly begins having agitation, visual hallucinations, confusion, fever, and diaphoresis. The nurse suspects what condition?
Delirium Tremens
Asking a patient if they are suicidal increases their risk of committing suicide.
True or False
False
You are facing the problem and showing concern also helps determine the severity of the problem. Do they have a plan or not yet?
Tricyclic antidepressants are often given at bedtime because:
A: they are absorbed better on empty stomach
B: a side effect is sedation and helps pt's sleep
C: prevent falls from hypotension
D: allow them to wake up happier
B: tricyclic's cause sedation so patients with depression often don't sleep well so the side effect of sedation is therapeutic as well.
A person becomes very agitated over the auditory hallucinations they are experiencing. What are some important things to remember when dealing with agitated behaviors?
Validate feelings "the voices must be scary but I don't hear anything" remain calm, don't turn your back, place yourself by an exit, don't enter room alone, safety is priority, inform them of things being done "I'm going to touch you now for your b/p". Keep distance