Exam (elaborations) Medical surgical exams -new update

MED Exam 2 • The alcoholic patient says to the nurse, I am not an alcoholic. I can quit any time I want to. The nurse recognizes the defense mechanism of: o Denial. • The wife of an alcoholic tells the nurse, “My husband only drinks on the weekends to relax. He has a very stressful job. The nurse recognizes the defense mechanism of: o Rationalization. • The nurse explains the difference between an enabler and a co-dependent is that a codependent: o Covers up the behavior of the substance abuser. • The nurse explains that, no matter whether you drink a 12-ounce beer, a 6-ounce glass of wine, or 1.5 ounces of straight liquor, it takes approximately minutes for the body to metabolize it. o 60 minutes. • A person in jail for public intoxication has been without alcohol for 12 hours. The jail nurse would be alert for withdrawal signs of: o Irritability. • A patient who is still intoxicated has been admitted for detoxification at the treatment center. The nurse takes into consideration that the patient will be supported in his withdrawal with the use of: o Symptomatic relief until substance has cleared from his system. • After detoxification from substance abuse, the patient says, I feel better than I have in years! All I needed was some rest. I am not an alcoholic. The nurse should respond to this by saying: o What were you doing that got you admitted to the detoxification center? • The nurse explains that an alternative to disulfiram (Antabuse) is the drug naltrexone (ReVia), which can: o Block craving and prevent relapse. • The nurse encourages the recovering alcoholic to participate in group therapy because of the major and long-lasting benefit of: o Increasing self-discipline. • The nurse is aware that when Korsakoff's syndrome is suspected from behavioral cues, the syndrome can be confirmed by: o Brain scan. • The nurse uses the CAGE challenge to alcoholics who persist in denial. The G in the set of questions form CAGE stands for: o Do you feel Guilty about your drinking? • The nurse is aware that the newly admitted patient who overdosed on lorazepam (Ativan) will show signs of withdrawal in hours. o 72 hours. • The nurse is concerned about a coworker who exhibits a sign of amphetamine abuse, such as: o Excited speech. • The nurse is aware that many people who abuse Cannabis (marijuana) rationalize their use because of the drugs ability to: o Expand their senses. • When a patient is admitted after abusing a hallucinogenic substance, the care plan must be altered to include interventions for: o Provision of safety to reduce injury. • To better ensure successful rehabilitation from substance abuse, it is essential that the patient, family, and medical professional: o Collaborate on goals for treatment. • The nurse is aware that before nurses can be effective in dealing with substance abusers, nurses must: o Examine their own bias relative to substance abuse. • A patient who has been given naloxone (Narcan) for an overdose of opiates is rapidly recovering from the effect of his heroin overdose when suddenly he relapses, and his level of consciousness and respirations decrease. The nurse should: o Repeat the Narcan. • The nurse is caring for an undernourished alcoholic patient. The nurse is helping the patient to select items from the menu. The patient's diet should ideally: o Contain at least 50% carbohydrates. • The nurse is caring for a patient who is undergoing detoxification from alcohol. Which supplement can the nurse expect to be included in the prescribed medications? o Thiamine. • The nurse is caring for a patient who has a heightened risk for seizures during his alcohol detoxification. Which medication may be included in the patient’s care? o Magnesium sulfate. • The nurse lists the diagnostic criteria for the diagnosis of substance abuse, which are: o Failure to meet obligations (School, work, relationships). o Putting self and others in potential harm (Speeding, recklessness). o Conflict with law enforcement authorities. • The nurse reviews the criteria for the diagnosis of alcohol dependency, which include: o Identifiable withdrawal signs and symptoms. o Altered family relationships. o Blackouts or amnesia pertinent to drinking episodes. o Altered occupational productivity. • The nurse cautions the recovering alcoholic who is on disulfiram (Antabuse) that even teh smallest exposure to alcohol can cause: o Chest pain. o Nausea and vomiting. o Blinding headache. • The nurse assesses indications that the recovering alcoholic may be developing Wernicke's encephalopathy when the nurse observes: o Confusion. o Seizures. • The nurse encourages a substance abuser to join a support group because the purpose of a support group is to: o Provide healthy relationships. o Offer opportunity to practice new coping skills. o Decrease stress and anxiety. o Improve social skills. o Provide opportunity for catharsis. • The nurse is aware that users of inhalants and hallucinogens are a danger to themselves and others because these drugs cause: o Distortion of senses. o Impaired sense of time. o Uncontrolled flashbacks. o Panic. o Severely impaired judgement. • The nurse reminds a family that the decision to become substance free is difficult because it involves commitment to: o A lifestyle change. o New coping skills. o Honesty in communication. o Awareness of possible periods of relapse. • Needs substance to prevent symptoms of withdrawal: Addiction. • Symptomatology related to cessation of drug: Withdrawal. • Needs substance to feel good: Psychological dependence: • Uses psychoactive drugs in nontherapeutic manner: Abuse. • Needs increasing amounts of substance to achieve desired effect: Tolerance. • A percentage of the population that is 85 years of age and older who have some stage of Alzheimer’s disease is %. o 50%. • An 85-year-old man is admitted to the hospital with gastroenteritis and dehydration after a hiking trip to Mexico. He is given a dose of meclizine hydrochloride, an anticholinergic, for vomiting. He begins to hallucinate and talk to his wife, who has been dead for 10 years. The nurse assesses this behavior to be: o Delirium related to side effect of anticholinergic. • The nurse is aware the older adult is at risk for drug-induced delirium because of: o Overall reduced metabolism. • The nurse is aware that the memory lapses seen in early stages of Alzheimer’s disease (AD) are related to the pathophysiology of: o Frontal lobe atrophy. • The nurse notes that newly admitted patient with Alzheimer’s disease has significant anomia. An appropriate intervention for this problem would be to: o Wait for the patient to find the word he wants. • When assisting the patient with middle-stage Alzheimer’s disease (AD) to dress, the nurse should: o Lay out clothing and coach patient to dress self. • The nurse differentiates vascular dementia from Alzheimer's dementia in that vascular dementia is related to: o Emboli in cerebral vessels. • The nurse will record that the patient with Alzheimer’s disease exhibited agnosia when the patient: o Attempted to comb her hair with a spoon. • The patient with Alzheimer's disease has been on donepezil (Aricept) for several weeks. The nurse suspects an overdose when the patient: o Is unable to grasp a glass tightly enough to prevent dropping it. • When communicating with a patient with moderate Alzheimer’s dementia, the nurse should speak: o Clearly. • The nurse takes into consideration that the patient with AIDS dementia complex (ADC) is at risk for injury due to: o Numbness and muscle weakness • The nurse takes into consideration that the patient with moderate Alzheimer’s disease in a longterm care facility who sundowns would benefit from: o Social interaction activities in the morning. • The patient with Alzheimer’s wakes up at 2:00 AM moaning and frightened and begs that her husband's coffin be removed from her room. The nurse should: o Turn the light on, assist patient to the bathroom, and say, “This is your dresser”. • The CNA approaches the older adult in the long-term care facility and says, “Oh, look at your pretty dress. It is all icky with food spots! Come with me, sweetie, we’ll put on that special party dress so you will look cute.” The CNA is using: o Simplistic elderspeak. • The home health nurse counseling a family who will be caring for a relative with moderate-stage Alzheimer’s disease will stress the need for: o A consistent routine to provide structured environment. • The exhausted caregiver to a patient with moderate Alzheimer's disease asks what respite care entails. The nurse replies that respite care is: o Placing the patient in a long-term care facility for a short period of time for the caregiver to rest. • Donepezil (Aricept) has been prescribed for a patient with Alzheimer’s disease. Which statement by the patient and spouse indicates an understanding of the medication? o The medication should be taken with meals. • A recently licensed nurse is orienting to the Alzheimer’s disease care unit. The nurse is caring for a patient who is transitioning from oral rivastigmine (Exelon) to the medication patch. Which action observed by the nurse’s preceptor indicates an understanding of the medication? o The nurse explains to the patient and family that the sites of application will need to be rotated. • The nurse is caring for a patient who has dementia and has been getting up out of bed at night. What action by the nurse will be most therapeutic? o The nurse places the mattress on the floor. • The nurse explains that postmortem brain examinations of people with Alzheimer’s disease have revealed that there are: o Tangled nerve cells. o Abnormal buildup of proteins. • Criteria established for the diagnosis of dementia include: o Evidence of cognitive deficits. o Evidence of aphasia, apraxia, or agnosia. o Impairment in social function. o Impairments of occupational function. o Neurologic signs and symptoms, such as ataxic gait. • The nurse uses the Mini-Mental Status Exam (MMSE) frequently to assess: o Orientation. o Memory. o Ability to follow directions. • The nurse is aware the resident with global amnesia in the late stage of Alzheimer’s disease will benefit from: o Music therapy. o Pet therapy. • The home health nurse assesses a family who is caring for a person with a cognitive deficit for responses that indicates exhaustion, which include: o Irritability with other family members and the patient. o Report of sleep disturbances. o Anger at patient and self. o Depression. o Fatigue. • A patient who has been experiencing memory deficits questions the nurse about foods that are associated with better memory. What selections are linked to enhanced memory? o Salmon o Leafy green vegetables. o Fruits. • An acute alteration in cognition: Delirium. • Characterized by slow onset: Dementia. • Experiences an illusion: Delirium. • Uses confabulation to cover memory gaps: Dementia. • Results from cerebrovascular accident: Delirium. • Processes of perception, memory, and judgement: Cognition.