Nurs 303 Compatible Mode Exams – Questions And Answers

NURS 303 COMPATIBLE MODE EXAMS – QUESTIONS AND ANSWERS Chp 22 Substance-Related and Addictive Disorders (34 points) • Recognize effects of alcohol and withdrawal symptoms • Effects of Alcohol (80 - 100 mg / 0.08 - 0.10 g/dl) • Two Drinks: slower motor performance, decreased thinking ability, altered mood, and reduced ability to multitask • Three Drinks: Impaired judgements, exaggerated behavior, euphoria, and lower alertness • Four Drinks: Poor muscle coordination, altered speech and hearing, difficulty detecting danger, impaired judgement, poor self-control, and decreased reasoning • Five Drinks: Slurred speech, poor coordination, and slowed thinking • Six Drinks: Vomiting (unless high tolerance) and major loss of balance • Eight to Ten Drinks: Memory blackouts, nausea, and vomiting • More than 10 Drinks: Reduction of body temperature, blood pressure, respiratory rate, sleepiness and amnesia • 400 / 0.40 mg/dl: Impaired vital signs and possible death!!! • Alcohol Withdrawal Symptoms: • The classic signs of alcohol withdrawal is tremulousness, commonly called the shakes or the jitters, that begins 6-8 hours after alcohol cessation. • Mild to moderate includes agitation, lack of appetite, nausea, vomiting, insomnia, impaired cognition, and mild perceptual changes. • Both systolic and diastolic blood pressure increases, as does pulse and body temperature. • Symptoms of heroin withdrawal • Mood dysphoria, nausea, vomiting, diarrhea, muscle aches, fever, and insomnia. • Other classic symptoms are lacrimation (watery eyes), rhinorrhea (runny nose), pupillary dilation, and yawning. • Symptoms of cocaine intoxication • Hypervigilant, sensitive, anxious, tense, and angry. • Physical Symptoms (2 or more): chest pain, cardiac arrhythmias, high or low blood pressure, tachy or bradycardia, respiratory depression, dilated pupils, perspiration, chills, nausea/vomiting, weight loss, psychomotor agitation or retardation, weakness, confusion, seizures, or coma. • General interventions for substance use/abuse • Psychosocial Interventions: • Promoting safety and sleep are essential first line interventions. • Gradually reintroducing healthy food and hydration helps support the body systems and neurological functioning. • Support and encouragement for self-care will help improve self-esteem in individuals who may have long neglected themselves. • Pharmacological Interventions: • Nurses administer medications and provide ongoing assessment of their efficacy and side effects after administration. Monitor vital signs frequently. • Health Teaching and Health Promotion • Theories on why people abuse substances • Genetic • Appears to be a genetic underlying vulnerability to addiction that expresses itself in a variety of substances. Substance use disorders such as cannabis, cocaine, and opiates definitely run in families. • Neurochemical • There are neurotransmitters for all substances except alcohol. The major neurotransmitters involved in developing substance use disorders are the opioid, catecholamine, and GABA. • Environmental • Poverty raises the risk of an unfavorable living environment, lack of parental supervision, poor educational resources, and impaired support systems. • Bad coping mechanisms • Influence by peers • Sociocultural • Substance use may create a sense of community and belonging in otherwise isolated individuals. • Behavioral characteristics of the phases of disordered use • Phase 1 prodromal phase • First signs of addictive behaviors arise; first blackouts, increased tolerance, sneaks substance, hurried ingestion, avoiding reference to drinking or substance. • Phase 2 crucial phase • Phase where there is most hope for intervention • Guilt and remorse • Behavioral loss of control, family or friend loss • More frequent use or periodic abstinence of use • Denial or minimization of use • Medical intervention • Phase 3 chronic phase • Pt either dies or gets help • More profound loss of control, can't stop behavior • Tremors, malnutrition, OD, decreased tolerance, and physiological problems associated with substance (liver failure). • Assessing readiness for change • Precontemplation- denial • Contemplation- weighing all options • Preparation- preparing to change (trying) • Action- changing behaviors • Maintenance - commitment and planning • Codependency • Involves the family of the alcoholic • They will do things for others that the person could easily on their own • The brain and addiction • The prefrontal cortex is the part of the brain that is affected • Also the ventral tegmental area in the midbrain • Tolerance-drug doesn’t respond the same in the body over time • Addiction- neurons adapt and only function in the presence of the drug Chp 34 Therapeutic Groups (16 points) • Advantages of group therapy • Multiple members can be in treatment at the same time. • Members of a therapeutic group benefit from the knowledge, insights, and life experiences of both the leader and the participants. • A therapeutic group can be a safe setting to learn new ways of relating to other people and to practice new communication skills. • Groups can promote feelings of cohesiveness. • Characteristics of a highly functioning group • Task roles • Maintenance roles • Individual roles • Styles of leadership (p. 615) • Autocratic Leadership: • Exert control over the group and do not encourage much interaction among members. • Democratic Leadership: • Support extensive group interaction in the process of problem solving. • Laissez-Faire Leadership: • Allow the group members to behave in any way they choose and do not attempt to control the direction of the group. • Types of therapeutic groups (Table 34.5) • Psychoeducational Group- to increase knowledge on a specific topic • Medication Education- nurse often leads • Health Education- nurse often leads and topic is related to sex education and STI awareness • Dual Diagnosis- mental illness and substance use disorders • Symptom Management-teach coping skills and self control • Stress Management- relaxation, mindfulness • Therapeutic Community Meetings- patient rights and advocacy, nurses are ideal to lead • Support and Self-Help- demonstrates universality, members tell their story • Characteristics of each phase of group development • Planning Phase: • The name of the group • Objectives of the group • Types of individuals for inclusion • Group schedule • Physical Setting- most important • Setting Configuration • Description of leader and member responsibilities • Methods or means of evaluating • Orientation Phase: • The group is forming. The group leader’s role is active in structuring an atmosphere of respect, confidentiality and trust. • Working Phase: • The leader facilitates communication, the flow of group processes, and group conduct. The group leader’s role is to encourage focus on problem solving consistent with the purpose of the group. • Storming • Refers to the disagreements, attempts at dominance, and personality clashes that must be addressed in order for the work of the group to be done. • Norming • Occurs when personality clashes and disagreement are resolved and a spirit of cooperation emerges. • Performing • Groups have established norms and roles. Group members focus on achieving goals. • Termination Phase: • The leader ensures that each member summarizes personal accomplishments, shares new insights and identifies future goals. • Feedback • Recognize group leader communication techniques • Table 34.6 (pg. 617) • Active Listening- ex. Eye contact and head nods • Ask Questions- ex. “When was the last time you did that?” • Giving Information- ex. How long meds take to start working • Clarification- ex. “What do you mean?” • Confrontation- ex. “You say nothing is wrong but you are crying” • Empathizing- ex. “I see how that is painful” • Reflection- ex. “What are you feeling right now?” • Summarization- ex. Summarize and say how to help next time • Support- ex. “It took a lot of courage, thank you for sharing” Chp 18 Eating and Feeding Disorders (20 points) • Recognize signs & symptoms of anorexia and bulimia • Anorexia Nervosa S/S • Low weight • Amenorrhea (absence of menstruation) • Yellow skin • Lanugo • Cold extremities • Peripheral edema • Muscle weakening • Constipation • Abnormal lab values (low triiodothyronine-T3, thyroxine levels) • Cardiovascular abnormalities (HTN, bradycardia, heart failure) • Impaired renal function • Hypokalemia (3.5 mEq/L) • Anemic pancytopenia • Decreased bone density • Bulimia Nervosa S/S • Normal to slightly low weight • Dental caries, tooth erosion • Parotid swelling • Gastric dilation, rupture • Calluses, scars on hand (Russell’s sign) • Peripheral edema • Muscle weakening • Abnormal lab values (electrolyte imbalance, hypokalemia, hyponatremia) • Cardiovascular abnormalities (cardiomyopathy, electrocardiographic changes) • Heart failure • Nursing diagnoses for anorexia and bulimia • Nursing Diagnosis for Anorexia: • Imbalanced Nutrition: less than body requirements • Decreased Cardiac Output • Risk for Injury (electrolyte imbalance) • Risk for Imbalanced Fluid Volume • Disturbed Body Image • Ineffective Coping • Chronic Low Self-Esteem • Powerlessness • Nursing Diagnosis for Bulimia: • Decreased Cardiac Output • Disturbed Body Image • Ineffective Coping • Powerlessness • Chronic Low Self-Esteem • Social Isolation • Nursing interventions for anorexia and bulimia • Intervention For Anorexia: • After resolving acute symptoms, the patient with anorexia begins a weight restoration program that allows for incremental weight gain. Based on the patient’s height, a treatment goal is set at 90% of ideal body weight. • No drugs approved by the FDA yet, but SSRI fluoxetine (Prozac) has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. • Self-Care activities • An organized milieu. The highly structured environment includes precise mealtimes, adherence to the selected menu, observation during and after meals, and regularly scheduled weighing. • Interventions For Bulimia: • Antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. • Fluoxetine (Prozac) has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. • Topiramate (Topamax) have been studied for binge suppression. • Tricyclic antidepressants help reduce binge eating and vomiting. • Counseling • Health Teaching and Health Promotion • Meal planning, use of relaxation techniques, maintenance of a healthy diet and exercise, coping skills, the physical and emotional effects of binging and purging, and the impact of cognitive distortions. Chp 24 Personality Disorders (24 points) • Recognize characteristics/behaviors of each personality disorder • Cluster A • Paranoid Personality Disorder • Characterized by a longstanding distrust and suspiciousness of others based on the belief, which is unsupported by evidence, that others want to exploit, harm, or deceive the person. These individuals are hypervigilant, anticipate hostility, and may provoke hostile responses by initiating a counterattack. • Schizoid Personality Disorder • Exhibit a lifelong pattern of social withdrawal. They are somewhat expressionless and operate with a restricted range of emotional expression. • Schizotypal Personality Disorder • Do not blend in with the crowd. Their symptoms are strikingly strange and unusual. Magical thinking, odd beliefs, strange speech patterns, and inappropriate affect are hallmarks of this disorder. • Cluster B • Histrionic Personality Disorder • They are excitable and dramatic yet are often high functioning. Classic characteristics of this population include extroversion, flamboyancy, and colorful personalities. Despite this bold exterior, they tend to have limited ability to develop meaningful relationships. • Narcissistic Personality Disorder • Characterized by feelings of entitlement, an exaggerated belief in one’s own importance and a lack of empathy. In reality, people with this disorder suffer from a weak self-esteem and hypersensitivity to criticism. • Cluster C • Avoidant Personality Disorder • They are extremely sensitive to rejection, feel inadequate, and are socially inhibited. They avoid interpersonal contact due to fears of rejection or criticism. • Pathological personality traits are low self-esteem associated with functioning in social situations, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people. • Dependent Personality Disorder • Characterized by a pattern of submissive and clinging behavior related to an overwhelming need to be cared for. This need results in intense fear of separation. • Obsessive-Compulsive Personality Disorder • Characterized by limited emotional expression, stubbornness, perseverance, and indecisiveness. Preoccupation with orderliness, perfectionism and control are the hallmarks of this disorder. • Nursing interventions for each personality disorder • Paranoid Personality Disorder • First line treatment- Psychotherapy (individual therapy) • Group therapy • Antianxiety diazepam (Valium)- reduce anxiety and agitation • Antipsychotic haloperidol (Haldol)- manage mildly delusional thinking or severe agitation • First generation antipsychotic pimozide (Orap)- reduce paranoid ideation • Schizoid Personality Disorder • Psychotherapy • Group therapy • Antidepressant bupropion (Wellbutrin)- help increase pleasure in life • Second generation antipsychotics risperidone (Risperdal) or olanzapine (Zyprexa)- improve emotional expressiveness • Schizotypal Personality Disorder • Psychotherapy • Antipsychotic agents- treat psychotic like symptoms (ideas of reference or illusions) • Antidepressant and antianxiety agents- treat depression and anxiety • Histrionic Personality Disorder • Psychotherapy • Group therapy • Antidepressants- used for depressive or somatic symptoms • Antianxiety agents- treat anxiety • Antipsychotics- used for derealization or illusions • Narcissistic Personality Disorder • Individual Cognitive Behavioral therapy • Group therapy • Lithium (Eskalith, Lithobid)- treat mood swings • Antidepressants- treat symptoms of depression • Avoidant Personality Disorder • Individual and group therapy • Psychotherapy • Antianxiety agents • Beta-adrenergic receptor antagonists (atenolol)- reduce ANS hyperactivity • Antidepressants such as SSRIs citalopram (Celexa) and SNRIs venlafaxine (Effexor)- reduce social anxiety • Serotonergic agents- feel less sensitive to rejection • Dependent Personality Disorder • Psychotherapy • Cognitive-Behavioral therapy • Antidepressant and Antianxiety agents- treat depression and anxiety • Tricyclic antidepressant imipramine (Tofranil)- helps treat panic attacks • Obsessive-Compulsive Personality Disorder • Group therapy and behavioral therapy • Clomipramine (Anafranil)- reduce obsessions, anxiety, and depression (Serotonergic agent fluoxetine (Prozac) may also be effective) • Borderline Personality Disorder • Antidepressants such as SSRIs, anticonvulsants, and lithium- treat mood and emotional dysregulation symptoms • Opioid receptor antagonist naltrexone (Revia, Vivitrol)- reduce self injurious behaviors • Second generation antipsychotics- control anger and brief psychosis • Cognitive behavioral therapy • Dialectical behavior therapy • Schema focused therapy • Antisocial Personality Disorder • Lithium or valproic acid (Depakote)- helps with aggression, depression, and impulsivity • SSRIs fluoxetine (Prozac) and sertraline (Zoloft)- used to decrease irritability and help with anxiety and depression • Benzodiazepines- help with anxiety (use with caution because they are addictive agents) • Psychotherapy • Therapeutic responses to client statements • Table 24.2 (pg. 463) • Be clear about purpose • Use open-ended statements • Redirect to present problems • Explore situation • Encourage description • Validate meaning • Identify feelings and explore threat • Set limits on behavior • Show understanding and suggest means of coping • Personality in general • Personality - is an individual’s characteristic pattern of relatively permanent thoughts, feelings, and behaviors that define her or her quality of experiences and relationships. Chp 6 Legal and Ethical Considerations (4 points) • Ethical principles • Beneficence • The duty to act to benefit or promote the good of others (spending extra time to help calm an anxious patient) • Autonomy • Respecting the rights of others to make their own decisions (acknowledging the patient's right to refuse medication supports autonomy) • Justice • The duty to distribute resources or care equally, regardless of personal attributes (an ICU nurse devotes equal attention to someone who has attempted suicide as to someone who suffered a brain aneurysm) • Fidelity (nonmaleficence) • Maintaining loyalty and commitment to the patient and doing no wrong to the patient (maintaining expertise in nursing skill through continuing nursing education) • Veracity • The duty to communicate truthfully (describing the purpose and side effects of psychotropic medications in a truthful and non-misleading way)