Nursing Fundamentals
What is an example of a primary level of prevention?
Immunization
What is the most accurate method for checking a patient's temperature?
Rectal
A client says, "I don't want to live anymore." What is the nurse's best response?
Have you had thoughts of harming yourself or others?
Which neurotransmitter is primarily associated with depression?
Serotonin
A client reports restlessness, muscle stiffness, and drooling after starting haloperidol. What is the nurse’s priority action?
Administer benztropine (Cogentin) - treatment for EPS
What is the therapeutic range for lithium (Eskalith)?
0.6-1.2 (toxicity at 1.5)
What complication is a client with a nasogastric (NG) tube at the most risk for?
Aspiration
Which type of therapy is best for helping clients change negative thought patterns?
Cognitive Behavioral Therapy (CBT)
What is the hallmark symptom of schizophrenia?
Hallucinations
Extrapyramidal symptoms (EPS) are most commonly associated with which class of drugs?
Typical antipsychotics (haloperidol)
What position should a nurse assume to lift a patient?
Bend at the knees
Which pulse site is best for assessing circulation to the lower leg?
Posterior Tibial
Which therapeutic communication technique is being used when the nurse says, “Tell me more about how you’re feeling”?
Open-ended question
Which disorder is characterized by alternating periods of depression and mania?
Bipolar disorder
What is the most important consideration when administering lithium?
Monitor sodium levels and hydration
What term describes a legal wrong committed by one person against another?
Tort
What would a pressure injury over the sacrum with full-thickness skin loss exposing bone be classified as?
Stage 4 (exposure of bone)
What is the priority nursing action for a client experiencing a panic attack?
Stay with the client and provide reassurance
The term “flight of ideas” is most associated with what condition?
Mania
A client is on clozapine. What serious side effect should the nurse monitor for?
Agranulocytosis
What is the correct order of the Nursing Process?
Assessment, Diagnosis, Planning, Implementation, Evaluation
To maintain a sterile field, where should the nurse place their hands?
Keep the hands above waist level
Which nursing intervention is appropriate for a client with dementia who is disoriented?
Reorient frequently using calendars and clocks
Which adverse effect is life-threatening and requires immediate discontinuation of antipsychotic medication?
Neuroleptic malignant syndrome (NMS) - high fever, rigidity, altered mental status
What foods should a patient taking phenelzine (Nardil) avoid?
Tyramine - hypertensive crisis