Vulnerability and Empowerment
Give an example of a health disparity.
Higher prevalence of chronic disease in low-income individuals compared to higher income individuals.
During a regular home health visit to an elderly client, the nurse observes that the client has feelings of hopelessness and despair. The client states, "I am old, in pain and I just wish I could sleep and not wake up, but please don't tell anyone". How should the nurse respond?
a) "Don't worry, I won't tell anyone else."
b) "I'm sorry, but I can't keep that kind of secret."
c) "Let's talk about something to cheer you up."
d) "What can we do to help you feel better?"
b) "I'm sorry, but I can't keep that kind of secret."
Rationale: The patient is reporting a whish to be dead. That cannot be kept secret. The nurse would also need to assess active suicidal thoughts.
Ans:
Harm reduction techniques do not aim to prevent or treat drug addiction; instead, they aim to reduce the harm that drug addiction causes. Buprenorphine therapy is a drug treatment meant to maintain abstinence; drug abuse resistance campaigns are primary prevention.
A client is experiencing a sever panic attack. Which nursing intervention would meet this client's immediate need?
a) Teach deep breathing relaxation exercises
b) Place the client in a trendelenburg position
c) Stay with the client and offer reassurance of safety
b) Administer the ordered buprenorphine to the client
Answer: Stay with the client and offer reassurance of safety
A provider is working with a pregnant client to identify an appropriate medication for medication assisted treatment of alcohol use disorder. Which order in the client's chart should the nurse question?
a) Acamprosate
b) Disulfiram
c) Naltrexone
d) Multivitamin
a) Acamprosate due to risk of fetal malformation
A public health nurse is working with the community of Flint, Michigan and references what tool to guide their interventions:
a) Social Ecological Model
b) Minnesota Intervention Wheel
c) Transactional Model
d) COWS
b) Minnesota Intervention Wheel
Individuals and populations are at higher risk for maladaptive coping when: Select all that apply.
They have previous trauma
ACES scores are high
They have impaired cognition
Which of the following drugs decreases the craving for alcohol and acts as an opiate receptor antagonist?
Ans: Naltrexone
A client is prescribed lorazepam for an anxiety disorder. What client history should cause the nurse to question this order?
a) History of hypertension
b) History of opioid use disorder
c) History of depression
d) An allergy to morphine
b) History of opioid use disorder
Which of these patients should be highest priority (red tag) during triage for a wildfire?
A) 88 y/o client who is confused but has no visible injuries
B) 55 y/o client who is unresponsive, not breathing and has no pulse
C) 25 y/o client with an eye injury
D) 45 y/o client who has an open femur fracture, thready pulse and is unable to follow directions.
D) 45 y/o client who has an open femur fracture, thready pulse and is unable to follow directions.
A nurse is triaging clients after a disaster. What color should the following client be tagged?
A 40-year-old ambulating with a sprained ankle and bruising on their lower calf reporting pain 4/10.
Green
A client's is being transferred to a new job in a city far away from her close friends. She copes with her anxiety by explaining to her friends the advantages associated with the move. Which defense mechanism is the client using?
a) Intellectualization
b) Denial
c) Sublimation
d) Isolation
Intellectualization
Rationale:
Intellectualization: An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, & analysis.
Denial: Refusing to acknowledge the existence of a real situation or the feelings associated with it.
Sublimation: Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive.
A pregnant client who is 30 weeks pregnant comes into the midwifery clinic for the first time. She admits to a history of alcohol and opiate abuse. She decided to come into the clinic shortly after she started using methamphetamine as well. She tells the nurse, “I’m sorry, I know I should have come in sooner, but it has been so hard!” Which of the following is the best response by the nurse?
Ans:
Answer A is alarmist, anxiety-provoking, and not based on assessment findings. Answer B is judgmental (it is tempting to say this, but we need to bracket these thoughts for the sake of the mom and baby). Answer C may be true to a degree, but is judgmental and shaming. Answer E is an important question, but fails to center the pregnancy. Only answer D projects a non-judgmental and welcoming attitude, which is crucial to the success of the care interaction.
A college students has been diagnosed with a panic disorder. Which of the following symptoms should a nurse expect this client to exhibit during a panic attack. Select all that apply
a) Bradycardia
b) Palpitations
c) Chest pain
d) Low body temperature
e) Fear of dying
b) Palpitations
c) Chest pain
e) Fear of dying
A client with a history of anxiety disorder enters the clinic complaining of fatigue, increased heart rate and nausea. Vital signs are BP 155/90, HR 118, RR 26. Based on this information, which statement below is correct:
a) The client is exhibiting signs of an exacerbation of their anxiety disorder
b) The client's signs and symptoms are due to an underlying medical condition
c) A physical examination is need to determine the cause of the client's symptoms
d) The client's needs a medication for their anxiety
c) A physical examination is need to determine the cause of the client's symptoms
Define health inequities
Health Inequities are differences in health that are avoidable, unfair, and unjust.
List three physiological symptoms of a stress response
Increased heart rate, BP, Cardiac output, Blood glucose
Immunosuppression, weakness, chest pain, difficulty breathing, GI disturbances etc
Which of the following is the priority nursing diagnosis for somebody experiencing delirium tremens (DTs)?
Ans: E- Potential for injury. All of these diagnoses are relevant for a person who is suffering from alcoholism. Potential for injury, however, is a priority diagnosis because of the nightmares, agitation, impaired judgment, agitation, delusions, and seizures that are common with alcohol withdrawal. Of the others, fluid volume deficit is also acute, but immediate threats to safety demand that potential for injury be addressed first.
A nurse administered lorazepam to the four clients below. Which of the following clients should a nurse prioritize following administration of the medication:
a) A pregnant client who received the medication for anxiety
b) A client who is increasingly lethargic 30 minutes after medication administration
c) A client with a history of chronic respiratory issues who is no acute distress
d) A client who can't remember events after taking the medication
A client who is increasingly lethargic 30 minutes after medication administration is exhibiting signs of benzodiazepine overdose/toxicity
Which of these is not an example of a nurse effectively empowering a community?
A team of public health nurses have been tasked with locating populations at risk of severe illness from COVID to provide education and connect them with resources. Which intervention will the public health nurses be implementing?
a) Case finding
b) Outreach
c) Social marketing
d) Surveillance
Answer: B Outreach
Rationale:
Outreach- locates populations-of-interest or populations-at-risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained.
Case Finding- locates individuals and families with identified risk factors and connects them to resources.
Surveillance- ongoing monitoring of diseases
Social market- Social marketing is a process that uses marketing principles and techniques to change target audience behaviors, to influence the knowledge, attitudes, values, beliefs, behaviors, & practices of the population of interest or, to benefit society as well as the individual.
Describe the difference between emotion-focused and problem-focused coping.
Emotion-focused coping is a type of stress management that attempts to reduce negative emotional responses associated with stress. Problem-focused coping strategies involve activities directly aimed at eliminating the source of stress
The following effects of alcohol intoxication fall along a continuum from a low blood-alcohol level to a high blood-alcohol level. List the effects in order of the blood-alcohol level at which they occur, from low to high.
Ans: Euphoria (0.05%), motor clumsiness (0.08%), emotional outbursts (0.2%), respiratory depression (0.4%), respiratory arrest (0.5%)
Describe the mechanism of action of benzodiazepines and two indications for benzodiazepine use.
Benzodiazepines enhance the inhibitory effects of GABA resulting in CNS depression
Anxiety, insomnia, seizures, muscle spasticity, alcohol withdrawal, anesthesia
Which of the following client should a nurse prioritize?
a) A client experiencing moderate levels of anxiety
b) A client with a CIWA score of 20
c) A client with a COWS score of 20
d) A pregnant client with a substance use disorder
The CIWA-Ar scores of less than 8 to 10 indicate minimal to mild withdrawal. Scores of 8 to 15 indicate moderate withdrawal (marked autonomic arousal); and scores of 15 or more indicate severe withdrawal (impending delirium tremens).
COWS: 5- 1 2 = mild; 1 3-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal
The risk of complications is greater for Client B, compared to A C, or D.