Mental Health and Psychiatric Nursing NCLEX Practice Quiz #1: 75 Questions

Mental Health and Psychiatric Nursing NCLEX Practice Quiz #1: 75 Questions 1. 1. Question Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, nurse Gina should be prepared for which common adverse effect? o A. Seizures o B. Shivering o C. Anxiety o D. Chest pain Incorrect Correct Answer: A. Seizures Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Benzodiazepine reversal has correlations with seizures. Seizures may happen more frequently in patients who have been on benzodiazepines for long-term sedation or in patients who are showing signs of severe tricyclic antidepressant overdose. The required dosage of Flumazenil should be measured and prepared by the practitioners to manage seizures. Flumazenil use requires caution in patients relying on a benzodiazepine for seizure control. o Option B: Shivering is not an adverse effect of flumazenil. Monitor the patient for the possible return of sedation, mostly in those who are tolerant of benzodiazepines. Patients should have monitoring for respiratory depression, benzodiazepine withdrawal, and other residual effects of benzodiazepines for at least 2 hours. o Option C: Anxiety is a rare adverse effect for people using flumazenil. Flumazenil has some associations with precipitation of seizures in patients with benzodiazepine dependence with a history of seizures. Flumazenil overdose is extremely rare. There is no precise antidote for flumazenil toxicity. In mild to severe toxicity, symptomatic and supportive treatment should be a consideration. o Option D: An overdose of flumazenil in a patient who is not a chronic benzodiazepine user would not be expected. Chronic benzodiazepines users may experience withdrawal with abrupt discontinuation of the drug. Administration of benzodiazepines or barbiturates may be necessary for seizure control. 2. 2. Question Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: o A. Avoid shopping for large amounts of food. o B. Control eating impulses. o C. Identify anxiety-causing situations. o D. Eat only three meals per day. Incorrect Correct Answer: C. Identify anxiety-causing situations Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Bulimia nervosa is a condition that occurs most commonly in adolescent females, characterized by indulgence in binge-eating, and inappropriate compensatory behaviors to prevent weight gain. o Option A: Controlling shopping for large amounts of food isn’t a goal early in treatment. It is important to educate patients who abuse laxatives that these medications work in the gastrointestinal tract after the areas where caloric absorption has occurred primarily. It is crucial to inform patients that a period of edema and weight gain may follow up to several weeks after discontinuation of purging behavior. o Option B: Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues. The primary objective of treatment is a cessation of the binging and purging behavior. Selective serotonin reuptake inhibitors such as fluoxetine, citalopram, and sertraline have shown to reduce symptoms of bulimia nervosa. Fluoxetine is the only FDA approved medication for bulimia nervosa. It appears that a higher dose (60 mg) is significantly better than a placebo in decreasing the frequency of binge and vomiting episodes. o Option D: Eating three meals per day isn’t a realistic goal early in treatment. Patients with bulimia nervosa who purge by vomiting often brush their teeth immediately after purging, which can accelerate dental erosion. The clinician should instruct the patients who persist in vomiting to rinse their mouths with water or fluoride rather than brushing their teeth within 30 minutes of each episode. Consider consulting a dentist to address dental issues associated with vomiting. 3. 3. Question A female client who’s at high risk for suicide needs close supervision. To best ensure the client’s safety, Nurse Mary should: o A. Check the client frequently at irregular intervals throughout the night. o B. Assure the client that the nurse will hold in confidence anything the client says. o C. Repeatedly discuss previous suicide attempts with the client. o D. Disregard decreased communication by the client because this is common with suicidal clients. Incorrect Correct Answer: A. Check the client frequently at irregular intervals throughout the night Checking the client frequently but at irregular intervals prevents the client from predicting when observation will take place and altering behavior in a misleading way at these times. Once the patient is deemed to be at risk for suicide, then intervention steps must be initiated right away. The individual must not be left alone. Enlist the help of a support person while at home. The suicidal individual must be treated in a safe and secure place. In addition, the place has to be monitored. o Option B: This may encourage the client to try to manipulate the nurse or seek attention for having a secret suicide plan. Assessing the individual’s judgment is critical. One should try and determine how the individual can handle stress. Does he or she have an impairment in decision making? Does the individual know that jumping in front of a train is dangerous? Reflect empathy and concern. Offer a hand to help. Provide the patient with confidence that he or she can overcome the issues. o Option C: This may reinforce suicidal ideas. Help develop internal coping strategies (e.g., exercise, journaling, reading, developing a hobby). Utilize the help of healthcare professionals to follow up on therapy. Once the individual is safe as an inpatient or outpatient, a formal treatment plan should be established. The next step is to refer all patients deemed to be at higher risk for suicide to a mental health counselor as soon as possible. Every state has laws and procedures regarding this process which must be incorporated into the clinical practice when addressing individuals at high suicide risk. o Option D: Decreased communication is a sign of withdrawal that may indicate the client has decided to commit suicide; the nurse shouldn’t disregard it. In some cases, assessment of the mental status may provide a clue to the individual’s potential for self-harm. Depressed patients will often tend to appear unclean and unkempt. The clothing may not be ironed or dirty. The risk of suicide is often high in people who appear very anxious or depressed. The patient may exhibit a flat affect or no emotions at all. Some depressed patients may develop hallucinations that may be telling him or her to kill themselves. The majority of these hallucinations are auditory. 4. 4. Question Which of the following drugs should Nurse Mary prepare to administer to a client with a toxic acetaminophen (Tylenol) level? o A. Deferoxamine mesylate (Desferal) o B. Succimer (Chemet) o C. Flumazenil (Romazicon) o D. Acetylcysteine (Mucomyst) Incorrect Correct Answer: D. Acetylcysteine (Mucomyst) The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites. Acetaminophen (N-acetyl-para-aminophenol, paracetamol, APAP) toxicity is common primarily because the medication is so readily available, and there is a perception that it is very safe. More than 60 million Americans consume acetaminophen on a weekly basis. All patients with high levels of acetaminophen need admission and treatment with N-acetyl-cysteine (NAC). This agent is fully protective against liver toxicity if given within 8 hours after ingestion. o Option A: Deferoxamine mesylate is the antidote for iron intoxication. Desferal is indicated for the treatment of acute iron intoxication and chronic iron overload due to transfusion-dependent anemias. Desferal is an adjunct to, and not a substitute for, standard measures used in treating acute iron intoxication, which may include the following: induction of emesis with syrup of ipecac; gastric lavage; suction and maintenance of a clear airway; control of shock with intravenous fluids, blood, oxygen, and vasopressors; and correction of acidosis. o Option B: Succimer is an antidote for lead poisoning. Succimer is an oral heavy metal chelating agent used to treat lead and heavy metal poisoning. Succimer has been linked to a low rate of transient serum aminotransferase elevations during therapy, but its use has not been linked to cases of clinically apparent liver injury with jaundice. Succimer does not significantly chelate essential metals such as zinc, copper, or iron, and its specificity, safety and oral availability make it preferable to other chelating agents for treating lead poisoning such as Ca-EDTA which must be given intravenously and dimercaprol (British anti-Lewisite [BAL) which requires intramuscular administration. o Option C: Flumazenil reverses the sedative effects of benzodiazepines. Flumazenil is a benzodiazepine antagonist. Flumazenil is also indicated for the management and treatment of benzodiazepine overdose in adults. It is useful in reversing coma due to benzodiazepine overdose. Flumazenil is more effective in reversing sedation or coma in patients with benzodiazepine intoxication rather than in patients with multiple drug overdoses. 5. 5. Question A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is Nurse Alice most likely to administer to reduce the symptoms of alcohol withdrawal? o A. Naloxone (Narcan) o B. Haloperidol (Haldol) o C. Magnesium sulfate o D. Chlordiazepoxide (Librium) Incorrect Correct Answer: D. Chlordiazepoxide (Librium) Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Chlordiazepoxide is a long-acting benzodiazepine and is an FDA approved medication for adults with mild-moderate to severe anxiety disorder, preoperative apprehension and anxiety, and withdrawal symptoms of acute alcohol use disorder. Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and weak analgesic actions. It binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex and enhances GABA’s inhibitory effects. o Option A: Naloxone (Narcan) is administered for narcotic overdose. Naloxone is indicated for the treatment of opioid toxicity, specifically to reverse respiratory depression from opioid use. It is useful in accidental or intentional overdose and acute or chronic toxicity. Naloxone is a pure, competitive opioid antagonist with a high affinity for the mu-opioid receptor, allowing for reversal of the effects of opioids. The onset of action varies depending on the route of administration but can be as fast as one minute when delivered intravenously (IV) or intraosseous (IO). o Option B: Haloperidol (Haldol) may be given to treat clients with psychosis, severe agitation, or delirium. Haloperidol is a first-generation (typical antipsychotic) which exerts its antipsychotic action by blocking dopamine D2 receptors in the brain. When 72% of dopamine receptors are blocked, this drug achieves its maximal effect. Haloperidol is not selective for the D2 receptor. It also has noradrenergic, cholinergic, and histaminergic blocking action. The blocking of these receptors is associated with various side effects. o Option C: Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal. Magnesium sulfate administration can be oral (PO), intramuscular (IM), intraosseous (IO), or intravenous (IV). For every 1 gram of magnesium sulfate, it contains 98.6 mg or 8.12Eq of elemental magnesium. Magnesium sulfate can be combined with dextrose 5% or water to make intravenous solutions. 6. 6. Question During postprandial monitoring, a female client with bulimia nervosa tells the nurse, “You can sit with me, but you’re just wasting your time. After you had sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.” What is the nurse’s best response? o A. “I trust you not to purge.” o B. “How are you purging and when do you do it?” o C. “Don’t worry. I won’t allow you to purge today.” o D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.” Incorrect Correct Answer: D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.” This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Since recovery involves patients having to face their deepest, most painful, and traumatic thoughts and emotions, supporting them as they go through treatment can be emotionally challenging for nurses. This emotional challenge can be exacerbated when the patient has also been diagnosed with Obsessive-Compulsive Disorder (OCD), depression, or substance abuse, as these may require more intensive one-to-one support. o Option A: Because their therapeutic relationships with caregivers are less important than their need to purge, they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it. As this might take nurses out of their comfort zone or clinical remit, worksheets are available for nurses to use in efforts to help patients challenge and overcome their obsessive and ritualistic behaviors and to adopt a more flexible perspective in day-to-day life.6 These can be supplemented by nurses familiarising themselves with the detailed guidelines and resources offered by NICE. o Option B: Learning motivational interviewing techniques can help facilitate communication with those who might be resistant to discussing topics related to food, weight, and recovery. Such techniques can help develop the skills of empathic understanding, rolling with resistance, and gently assisting patients to make their own, autonomous decision to work towards recovery. Often, the aim is to help patients learn new and healthier ways of coping, and nurses can achieve this through a mix of emotional support, education, and signposting. o Option C: An authoritarian or challenging response may trigger a power struggle between the nurse and client. Assisting patients to remain strong and adhere to treatment requires nurses to develop a relationship that is caring, empathetic and trusting, and in line with the person-centered approach to care. Patients affected by eating disorders require individualized support to better understand their condition, rediscover their identity, learn to accept themselves, enhance a positive body image and sense of self-worth, and achieve a balance in their lives so that they can move towards better health and wellbeing. 7. 7. Question A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, “It felt so wonderful to get high.” Which of the following is the most appropriate response? o A. “If you continue to talk like that, I’m going to stop speaking to you.” o B. “You told me you got fired from your last job for missing too many days after taking drugs all night.” o C. “Tell me more about how it felt to get high.” o D. “Don’t you know it’s illegal to use drugs?” Incorrect Correct Answer: B. “You told me you got fired from your last job for missing too many days after taking drugs all night.” Confronting the client with the consequences of substance abuse helps to break through denial. Present reality by spending time with the client to facilitate reality orientation because your physical presence is the reality. Be simple, direct, and concise when speaking to the client. Talk with the client about concrete or familiar things; avoid ideological or theoretical discussions. The client’’s ability to process abstractions or complexities is impaired. o Option A: Making threats isn’t an effective way to promote self-disclosure or establish a rapport with the client. Motivational counseling works according to the idea that motivation for change is dynamic rather than static. Professional uses may influence change by developing a therapeutic relationship to increase therapeutic alliance, developing insight, and coping skills to resolve ambivalence, and change health-related behavior. o Option C: Although the nurse should encourage the client to discuss feelings, the discussion should focus on how the client felt before, not during, an episode of substance abuse. Encouraging elaboration about his experience while getting high may reinforce the abusive behavior. Persons may withdraw from their environment with regressive behavior, fail to engage with others, or even notice physical illness and pain. Social exclusion and homelessness may ensue. In the longer term, psychosis and its potential disruption of the capacity to fulfill social roles can result in further burdens. o Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this effect is unlikely to alter behavior. Drug addiction exacerbates social alienation and increases potential for violent lashing out and low self-esteem, along with poor coping skills. Under these circumstances, emotional, social, or symptom-related cues can provoke recourse to available substances and suicidal ideation. They may also contribute to psychosocial instability, self-image issues, and achievement motivation. In some cases, social hostility and rejection may result. 8. 8. Question For a female client with anorexia nervosa, Nurse Jimmy is aware that which goal takes the highest priority? o A. The client will establish adequate daily nutritional intake. o B. The client will make a contract with the nurse that sets a target weight. o C. The client will identify self-perceptions about body size as unrealistic. o D. The client will verbalize the possible physiological consequences of self-starvation. Incorrect Correct Answer: A. The client will establish adequate daily nutritional intake. According to Maslow’s hierarchy of needs, all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need. Treatment for anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Refeeding syndrome can occur following prolonged starvation. As the body utilizes glucose to produce molecules of adenosine triphosphate (ATP), it depletes the remaining stores of phosphorus. Also, glucose entry into cells is mediated by insulin and occurs rapidly following long periods without food. Both cause electrolyte abnormalities such as hypophosphatemia and hypokalemia, triggering cardiac and respiratory compromise. Patients should be followed carefully for signs of refeeding syndrome and electrolytes closely monitored. o Option B: Recovery from an eating disorder can be a long process that requires not only a qualified team of professionals but also the love and support of family and friends. It is not uncommon for someone who suffers from an eating disorder to feel uncertain about their progress or for their loved ones to feel disengaged from the treatment process. These potential roadblocks may lead to feelings of ambivalence, limited progress, and treatment dropout. o Option C: Anorexia nervosa is a psychiatric disease in which patients restrict their food intake relative to their energy requirements through eating less, exercising more, and/or purging food through laxatives and vomiting. Despite being severely underweight, they do not recognize it and have distorted body images. They can develop complications from being underweight and purging food. Diagnose by history, physical, and lab work that rules out other conditions that can make people lose weight. Treatment includes gaining weight (sometimes in a hospital if severe), therapy to address body image, and management of complications from malnourishment. o Option D: The nurse may give lesser priority to goals that address long-term plans, self-perception, and potential complications. Eating disorders can affect every organ system in the body, and people struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. 9. 9. Question When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem? o A. The injury isn’t consistent with the history or the child’s age. o B. The mother and father tell different stories regarding what happened. o C. The family is poor. o D. The parents are argumentative and demanding with emergency department personnel. Incorrect Correct Answer: A. The injury isn’t consistent with the history or the child’s age. When the child’s injuries are inconsistent with the history given or impossible because of the child’s age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. Physical indicators may include injuries to a child that are severe, occur in a pattern or occur frequently. These injuries range from bruises to broken bones to burns or unusual lacerations. The child may present for care unrelated to the abuse, and the abuse may be found incidentally. o Option B: The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question, this is a clue that child abuse may be a problem. Physical abuse should be considered in the evaluation of all injuries of children. A thorough history of present illness is important to make a correct diagnosis. Important aspects of the history-taking involve gathering information about the child’s behavior before, during, and after the injury occurred. History-taking should include the interview of each caretaker separately and the verbal child, as well. The parent or caretaker should be able to provide their history without interruptions in order not to be influenced by the physician’s questions or interpretations. o Option C: Child abuse occurs in all socioeconomic groups. All races, ethnicities, and socioeconomic groups are affected by child abuse with boys and adolescents more commonly affected. Infants tend to have increased morbidity and mortality with physical abuse. Multiple factors increase a child’s risk of abuse. These include risks at an individual level (child’s disability, unmarried mother, maternal smoking or parent’s depression); risks at a familial level (domestic violence at home, more than two siblings at home); risks at a community level (lack of recreational facilities); and societal factors (poverty). o Option D: Parents may argue and be demanding because of the stress of having an injured child. To diagnose a patient with child maltreatment is difficult since the victim may be nonverbal or too frightened or severely injured to talk. Also, the perpetrator will rarely admit to the injury, and witnesses are uncommon. Physicians will see children of maltreatment in a range of ways that include the perpetrators may be concerned that the abuse is severe and bring in the patient for medical care. 10. 10. Question For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? o A. They tend to overprotect their children. o B. They usually have a history of substance abuse. o C. They maintain emotional distance from their children. o D. They alternate between loving and rejecting their children. Incorrect Correct Answer: A. They tend to overprotect their children. Clients with anorexia nervosa typically come from a family with parents who are controlling and overprotective. These clients use eating to gain control of an aspect of their lives. Similarly, issues like anxiety, depression, and addiction can also run in families, and have also been found to increase the chances that a person will develop an eating disorder. Many people with anorexia report that, as children, they always followed the rules and felt there was one “right way” to do things. o Option B: Substance abuse and eating disorders frequently co-occur, with up to 50% of individuals with eating disorders who abuse alcohol or illicit drugs, a rate five times higher than the general population. Substance abuse problems may begin before or during an eating disorder, or even after recovery. Those struggling with co-occurring substance use and disordered eating should speak with a trained professional who can understand, diagnose, and treat both substance use disorders and eating disorders. o Option C: Loneliness and isolation are some of the hallmarks of anorexia; many with the disorder report having fewer friends and social activities, and less social support. Whether this is an independent risk factor or linked to other potential causes (such as social anxiety) isn’t clear. o Option D: Eating disorders are complex and affect all kinds of people. Risk factors for all eating disorders involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, so two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Still, researchers have found broad similarities in understanding some of the major risks for developing eating disorders. 11. 11. Question In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client’s husband arrives, shouting that he wants to “finish the job.” What is the first priority of the health care worker who witnesses this scene? o A. Remaining with the client and staying calm. o B. Calling a security guard and another staff member for assistance. o C. Telling the client’s husband that he must leave at once. o D. Determining why the husband feels so angry. Incorrect Correct Answer: B. Calling a security guard and another staff member for assistance. The health care worker who witnesses this scene must take precautions to ensure personal as well as client safety but shouldn’t attempt to manage a physically aggressive person alone. Therefore, the first priority is to call a security guard and another staff member. Domestic violence is defined as a pattern of abusive behaviors by one partner against another in an intimate relationship such as marriage, dating, family, or cohabitation. In this definition, domestic violence takes many forms, including physical aggression or assault, sexual abuse, emotional abuse, controlling or domineering behavior, intimidation, stalking, passive/covert abuse, and economic deprivation. o Option A: After doing this, the health care worker should inform the husband what is expected, speaking in concise statements, and maintaining a firm but calm demeanor. This approach makes it clear that the health care worker is in control and may diffuse the situation until the security guard arrives. Nurses can play an important role in working toward the creation of a violence-free community but they must first become informed. They must then insist the organizations in which they work to accept this responsibility and work together to create environments that support people experiencing domestic violence. o Option C: Telling the husband to leave would probably be ineffective because of his agitated and irrational state. Although the exact rates are widely disputed, especially within the United States, there is a large body of cross-cultural evidence that women are subjected to domestic violence significantly more often than men. In addition, there is broad consensus that women are more often subjected to severe forms of abuse and are more likely to be injured by an abusive partner. According to a report by the United States Department of Justice, a survey of 16,000 Americans showed 22.1 percent of women and 7.4 percent of men reported being physically assaulted by a current or former spouse, cohabiting partner, boyfriend, girlfriend, or date in their lifetime. o Option D: Exploring his anger doesn’t take precedence over safeguarding the client and staff. Gender roles and expectations play a role in abusive situations, and exploring these roles and expectations can be helpful in addressing abusive situations. Likewise, it can be helpful to explore factors such as race, class, religion, sexuality, and philosophy. However, studies investigating whether sexist attitudes are correlated with domestic violence have shown conflicting results. 12. 12. Question Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? o A. Fill out the client’s menu and make sure she eats at least half of what is on her tray. o B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal. o C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal. o D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count. Incorrect Correct Answer: C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal Allowing the client to select her own food from the menu will help her feel some sense of control. Assisting patients to remain strong and adhere to treatment requires nurses to develop a relationship that is caring, empathetic and trusting, and in line with the person-centered approach to care. Patients affected by eating disorders require individualized support to better understand their condition, rediscover their identity, learn to accept themselves, enhance a positive body image and sense of self-worth, and achieve a balance in their lives so that they can move towards better health and wellbeing. o Option A: She must then eat 100% of what she selected. During the early stages of treatment when patients are still new to recovery, they look to nurses to provide them with a highly structured environment, which sometimes involves nurses making food and behavioral decisions on their behalf. While this might not be an ongoing issue for primary care nurses, they may still be required to offer decisive advice on these areas. Here, it is imperative that nurses offer such advice with a clear message that patients have the power to make these decisions themselves. o Option B: Remaining with the client for at least 1 hour after eating will prevent purging. As treatment progresses, patients eventually grow to appreciate nurses who act as role models and educate them on how to normalize their diet and involvement in social activities. Towards the end of treatment, nurses become more of a support system, encouraging the patient to move forward autonomously, while providing them with guidance on where to seek help if it is needed. o Option D: Bulimic clients should only be allowed to eat food provided by the dietary department. From awareness of the eating disorder to recovery maintenance, the role of the primary care nurse evolves, but what doesn’t change is the positive influence nurses can have on those with an eating disorder. With the skills of listening, empathy, adaptability, and communication, primary care nurses can assist in identifying at-risk individuals and optimizing the delivery of a multidisciplinary and holistic approach to care. 13. 13. Question Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurse’s highest care priority? o A. Assessing the client’s home environment and relationships outside the hospital. o B. Exploring the nurse’s own feelings about suicide. o C. Discussing the future with the client. o D. Referring the client to a clergyperson to discuss the moral implications of suicide. Incorrect Correct Answer: B. Exploring the nurse’s own feelings about suicide. The nurse’s values, beliefs, and attitudes toward self-destructive behavior influence responses to a suicidal client; such responses set the overall mood for the nurse-client relationship. Therefore, the nurse initially must explore personal feelings about suicide to avoid conveying negative feelings to the client. o Option A: Assessment of the client’s home environment and relationships may reveal the need for family therapy; however, conducting such an assessment isn’t a nursing priority. A clear and complete evaluation and clinical interview provide the information upon which to base a suicide intervention. Although risk factors offer major indications of the suicide danger, nothing can substitute for a focused patient inquiry. However, although all the answers a patient gives may be inclusive, a therapist often develops a visceral sense that his or her patient is going to commit suicide. The clinician’s reaction counts and should be considered in the intervention. o Option C: Discussing the future and providing anticipatory guidance can help the client prepare for future stress, but this isn’t a priority. If suicidal ideation is present, the next question must be about any plans for suicidal acts. The general formula is that more specific plans indicate greater danger. Although vague threats, such as a threat to commit suicide sometime in the future, are the reason for concern, responses indicating that the person has purchased a gun, has ammunition, has made out a will, and plans to use the gun are more dangerous. The plan demands further questions. If the person envisions a gun-related death, determine whether he or she has the weapon or access to it. o Option D: Referring the client to a clergyperson may increase the client’s trust or alleviate guilt; however, it isn’t the highest priority. The only way to prevent suicides is to work in an interprofessional team that includes a mental health nurse, psychiatrist, the primary care provider, social worker, and nurse practitioner. Practitioners must work with the patient’s family and friends, as well as with the other patients who knew the client. 14. 14. Question A 24-year old client with anorexia nervosa tells the nurse, “When I look in the mirror, I hate what I see. I look so fat and ugly.” Which strategy should the nurse use to deal with the client’s distorted perceptions and feelings? o A. Avoid discussing the client’s perceptions and feelings. o B. Focus discussions on food and weight. o C. Avoid discussing unrealistic cultural standards regarding weight. o D. Provide objective data and feedback regarding the client’s weight and attractiveness. Incorrect Correct Answer: D. Provide objective data and feedback regarding the client’s weight and attractiveness By focusing on reality, this strategy may help the client develop a more realistic body image and gain self-esteem. Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. The mental health nurse should educate the patient on changes in behavior, easing stress, and overcoming any emotional issues. o Option A: This is inappropriate because discussing the client’s perceptions and feelings wouldn’t help her to identify, accept, and work through them. Since recovery involves patients having to face their deepest, most painful, and traumatic thoughts and emotions, supporting them as they go through treatment can be emotionally challenging for nurses. This emotional challenge can be exacerbated when the patient has also been diagnosed with Obsessive-Compulsive Disorder (OCD), depression, or substance abuse, as these may require more intensive one-to-one support. o Option B: Focusing discussions on food and weight would give the client attention for not eating. During the early stages of treatment when patients are still new to recovery, they look to nurses to provide them with a highly structured environment, which sometimes involves nurses making food and behavioral decisions on their behalf. While this might not be an ongoing issue for primary care nurses, they may still be required to offer decisive advice on these areas. Here, it is imperative that nurses offer such advice with a clear message that patients have the power to make these decisions themselves. o Option C: This is inappropriate because recognizing unrealistic cultural standards wouldn’t help the client establish more realistic weight goals. Furthermore, learning motivational interviewing techniques can help facilitate communication with those who might be resistant to discussing topics related to food, weight, and recovery. Such techniques can help develop the skills of empathic understanding, rolling with resistance, and gently assisting patients to make their own, autonomous decision to work towards recovery. Often, the aim is to help patients learn new and healthier ways of coping, and nurses can achieve this through a mix of emotional support, education, and signposting. 15. 15. Question Nurse Alice is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products? o A. Carbonated beverages o B. Aftershave lotion o C. Toothpaste o D. Cheese Incorrect Correct Answer: B. Aftershave lotion Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Close monitoring of adverse events is necessary, in particular, in patients with polysubstance abuse. Patients taking disulfiram require monitoring for signs and symptoms of hepatitis, including fatigue, weakness, anorexia, nausea, vomiting, jaundice, malaise, and dark urine. o Option A: Disulfiram is one of three drugs approved by the FDA for the treatment of alcohol dependence. It is a second-line option (acamprosate and naltrexone are first-line treatments) in patients with sufficient physician supervision. Disulfiram is safe and efficient in supervised short-term and long-term treatment of individuals dependent on alcohol but who are motivated to discontinue alcohol use. o Option C: Disulfiram irreversibly inhibits aldehyde dehydrogenase (ALDH1A1) by competing with nicotinamide adenine dinucleotide (NAD) at the cysteine residue in the active site of the enzyme. ALDH1A1 is a hepatic enzyme of the major oxidative pathway of alcohol metabolism converting ethanol to acetaldehyde. At therapeutic doses of disulfiram, alcohol consumption results in increased serum acetaldehyde, causing diaphoresis, palpitations, facial flushing, nausea, vertigo, hypotension, and tachycardia. o Option D: Patients receiving metronidazole, paraldehyde, alcohol, or alcohol-containing preparations (sauces, cough mixtures, vinegar) should not receive disulfiram and should be educated in advance to avoid a disulfiram-alcohol reaction. Never administer to a patient if alcohol use is suspected or without the patient’s consent and understanding of disulfiram-alcohol reaction. 16. 16. Question Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? o A. Restrict visits with the family until the client begins to eat. o B. Provide privacy during meals. o C. Set up a strict eating plan for the client. o D. Encourage the client to exercise, which will reduce her anxiety. Incorrect Correct Answer: C. Set up a strict eating plan for the client. Establishing a consistent eating plan and monitoring the client’s weight is important for this disorder. Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in himself and feels in control of the environment is more likely to eat preferred foods. o Option A: The family should be included in the client’s care. Involve patients in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. It provides a structured eating situation while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain. o Option B: The client should be monitored during meals — not given privacy. Provide one-to-one supervision and have a patient with bulimia remain in the day room area with no bathroom privileges for a specified period (2 hr) following eating, if contracting is unsuccessful. Prevents vomiting during and after eating. Patients may desire food and use a binge-purge syndrome to maintain weight. Note: Patients may purge for the first time in response to the establishment of a weight gain program. o Option D: Exercise must be limited and supervised. Monitor exercise programs and set limits on physical activities. Chart activity and level of work (pacing and so on). Moderate exercise helps in maintaining muscle tone, weight and combating depression; however, patients may exercise excessively to burn calories. 17. 17. Question Nurse Taylor is aware that the victims of domestic violence should be assessed for what important information? o A. Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation). o B. Readiness to leave the perpetrator and knowledge of resources. o C. Use of drugs or alcohol. o D. History of previous victimization. Incorrect Correct Answer: B. Readiness to leave the perpetrator and knowledge of resources. Victims of domestic violence must be assessed for their readiness to leave the perpetrator and their knowledge of the resources available to them. Nurses can then provide the victims with information and options to enable them to leave when they are ready. Training and support programs for clinicians and administrative staff have been shown to improve identification of women experiencing domestic violence and referral to advocacy services. Use of a domestic violence advocate in the ED resulted in a higher incidence of detection of incidents of acute violence than the data reported in the literature. o Option A: The reasons they stay in the relationship are complex and can be explored at a later time. Reportedly, at least 40% of domestic violence victims never contact the police. Of female victims of domestic violence homicide, 44% had visited an ED within 2 years of their murder. o Option C: The use of drugs or alcohol is irrelevant. Since substance abuse may develop or worsen as a result of domestic violence, it is appropriate to consider domestic violence when evaluating a patient for alcohol intoxication, drug toxicity, or drug overdose. A family history of alcohol and drug abuse or similar history in the patient’s partner is also an important risk factor. o Option D: There is no evidence to suggest that previous victimization results in a person’s seeking or causing abusive relationships. The frequency and severity of previous attacks indicate the degree of present danger. Threats are as important as any actual injury. The presence of weapons in the home is a risk factor. In addition to threats and physical abuse, relationships with high risk for injury or death commonly feature exaggerated forms of coercion and manipulation to maintain the partner’s dependence. This may result in the Stockholm syndrome. 18. 18. Question A male client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from: o A. Acetate accumulation o B. Thiamine deficiency o C. Triglyceride buildup. o D. A below-normal serum potassium level Incorrect Correct Answer: B. Thiamine deficiency Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake. Treatment includes reducing alcohol intake, correcting nutritional deficiencies through diet and vitamin supplements, and preventing such residual disabilities as foot and wrist drop. o Option A: When thiamine stores are depleted (which takes about 4 weeks after stopping intake), symptoms start to appear. When evaluating for thiamine deficiency, the typical history may include poor nutritional intake, excessive alcohol intake, or the patient belonging to the special populations of individuals previously mentioned (pregnant women, recipients of bariatric surgery, patients with prolonged diuretic use, anyone with poor overall nutritional status, etc.). o Option C: Initial symptoms of B1 deficiency include anorexia, irritability, and difficulties with short-term memory. With prolonged thiamine deficiency, patients may endorse loss of sensation in the extremities, symptoms of heart failure including swelling of the hands or feet and chest pain related to demand ischemia, or feelings of vertigo, double vision, and memory loss. Additionally, close friends and family of the patient may describe confusion or symptoms of confabulation. o Option D: Detection of thiamine deficiency relies on relevant history and physical exam findings and follow up with laboratory testing for confirmation. Functional enzymatic assay of transketolase activity is the activity of transketolase measured before and after the addition of thiamine pyrophosphate; >25% stimulation response is abnormal. Measurement of thiamine or the phosphorylated esters of thiamine in serum or blood using high-performance liquid chromatography is used. Urine studies exist but are not a reliable test for the evaluation of total body thiamine. 19. 19. Question A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused? o A. The child cries uncontrollably throughout the examination. o B. The child pulls away from contact with the physician. o C. The child doesn’t cry when the shoulder is examined. o D. The child doesn’t make eye contact with the nurse. Incorrect Correct Answer: C. The child doesn’t cry when the shoulder is examined. A characteristic behavior of abused children is the lack of crying when they undergo a painful procedure or are examined by a healthcare professional. Therefore, the nurse should suspect child abuse. Physical abuse may include beating, shaking, burning, and biting. The threshold for defining corporal punishment as abuse is unclear. Rib fractures are found to be the most common finding associated with physical abuse. Any child younger than two years old for whom there is a concern of physical abuse should have a skeletal survey. Additionally, any sibling younger than two years of age of an abused child should also have a skeletal survey. A skeletal survey consists of 21 dedicated views, as recommended by the American College of Radiology. o Option A: The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm. o Option B: Physical abuse should be considered in the evaluation of all injuries of children. A thorough history of present illness is important to make a correct diagnosis. Important aspects of the history-taking involve gathering information about the child’s behavior before, during, and after the injury occurred. History-taking should include the interview of each caretaker separately and the verbal child, as well. The parent or caretaker should be able to provide their history without interruptions in order not to be influenced by the physician’s questions or interpretations. o Option D: The second most common type of child abuse after neglect is physical abuse. Eighty percent of abusive fractures occur in non-ambulatory children, particularly in children younger than 18 months of age. The most important risk factor for abusive skeletal injury is age. There is no fracture pathognomonic for abuse, but there are some fractures that are more suggestive of abuse. These include posterior or lateral rib fractures and “corner” or “bucket handle” fractures, which occur at the ends of long bones and which result from a twisting mechanism. Other highly suspicious fractures are sternal, spinal and scapular fractures. 20. 20. Question When planning care for a client who has ingested phencyclidine (PCP), nurse Wayne is aware that the following is the highest priority? o A. Client’s physical needs o B. Client’s safety needs o C. Client’s psychosocial needs o D. Client’s medical needs Incorrect Correct Answer: B. Client’s safety needs The highest priority for a client who has ingested PCP is meeting safety needs of the client as well as the staff. Drug effects are unpredictable and prolonged, and the client may lose control easily. Phencyclidine (PCP) is a dissociative anesthetic that is a commonly used recreational drug. PCP is a crystalline powder that can be ingested orally, injected intravenously, inhaled, or smoked. PCP is available as a powder, crystal, liquid, and tablet. It produces both stimulation and depression of the CNS. PCP is a non-competitive antagonist to the NMDA receptor, which causes analgesia, anesthesia, cognitive defects, and psychosis. o Option A: Depending on the dose and route of administration, PCP can have a wide range of central nervous system (CNS) manifestations. Emergency department providers should become familiar with how to manage patients with PCP toxicity since rhabdomyolysis, hypoglycemia, seizures, hypertensive crisis, coma, and trauma are several of the complications that can arise with PCP use o Option C: PCP blocks the uptake of dopamine and norepinephrine, leading to sympathomimetic effects such as hypertension, tachycardia, bronchodilation, and agitation. PCP can also cause sedation, muscarinic, and nicotinic signs by binding to acetylcholine receptors and GABA receptors. Sigma receptor stimulation by PCP causes lethargy and coma. o Option D: Most patients survive PCP intoxication with supportive care. Airway, breathing, circulation, and hemodynamic monitoring are essential to the care of patients with PCP toxicity. Intubation with ventilatory support may be required for airway protection. Gastrointestinal decontamination is generally unnecessary in PCP ingestions; however, activated charcoal may be beneficial with a massive ingestion of PCP or a dangerous coingestion. Activated charcoal therapy should only be started within one hour from the time of ingestion. The activated charcoal dose is 1 g/kg, with a maximum dose of 50 g. 21. 21. Question The nurse is aware that the outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder? o A. Accept responsibility for own behaviors. o B. Be able to verbalize own needs and assert rights. o C. Set firm and consistent limits with the client. o D. Allow the child to establish his own limits and boundaries. Incorrect Correct Answer: A. Accept responsibility for own behaviors Children with oppositional defiant disorder frequently violate the rights of others. They are defiant, disobedient, and blame others for their actions. Accountability for their actions would demonstrate progress for the oppositional child. Oppositional defiant disorder (ODD) is a type of childhood disruptive behavior disorder that primarily involves problems with the self-control of emotions and behaviors. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main feature of ODD is a persistent pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness toward others. o Option B: This is incorrect as the oppositional child usually, focuses on his own needs. Temperamental factors such as irritability, impulsivity, poor frustration, tolerance, and high levels of emotional reactivity are commonly associated with ODD. While not all children diagnosed with ODD show callous and unemotional traits, it has been shown that such traits are highly heritable and may be seen more frequently in a subset of children with more significant disruptive behaviors. o Option C: Treatment of oppositional defiant disorder is multimodal and should involve the patient, family, school, and community. Identifying and treating comorbidities (like ADHD, depression, and anxiety) and modifiable risk factors (such as bullying and learning difficulties) should be done. Treatment may also vary based on whether oppositional behavior primarily occurs in specific contexts or if the behavior is pervasive and thus requires more intensive treatment. o Option D: This is not an outcome criterion but an intervention. Parent Management Training or PMT is based on the principles of social learning theory and is the main treatment for oppositional behaviors. The guiding principle in PMT is the use of operant conditioning (using the role of positive reinforcement in changing behaviors) to decrease unwanted behaviors and promote prosocial behaviors. Methods include teaching parents to identify problem behaviors as well as positive interactions and to apply punishment or reinforcement as appropriate. 22. 22. Question A male client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, he sits staring blankly at his bleeding wrists while staff members call for an ambulance. How should Nurse Anuktakanuk approach her initially? o A. Enter the room quietly and move beside him to assess his injuries. o B. Call for staff back-up before entering the room and restraining him. o C. Move as much glass away from him as possible and sit next to him quietly. o D. Approach him slowly while speaking in a calm voice, calling his name, and telling him that the nurse is here to help him. Incorrect Correct Answer: D. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her Ensuring the safety of the client and the nurse is the priority at this time. Therefore, the nurse should approach the client cautiously while calling her name and talking to her in a calm, confident manner. Nursing’s hands-on approach to patient care and our ability to create therapeutic connections with patients enables us to pick up on key cues. Identifying these cues starts with understanding that suicidal behaviors are neither considered an illness nor a condition, but rather a complex set of behaviors that actually exists on a continuum that ranges from ideas/thoughts to eventual actions. o Option A: The nurse should keep in mind that the client shouldn’t be startled or overwhelmed. After explaining that the nurse is there to help, the nurse should observe the client’s response carefully. The promotion of a care environment that is safe and conducive to their full recovery is essential in carrying out comprehensive care in mental health. The first step is qualified listening, but it cannot be immersed in a bigoted discourse, full of judgment. One must consider that not always the person is willing to express or externalize what they really feel, and so a new challenge to the health professional emerges, which is the careful observation of the reality of the patient and the listening of silence when the person is not willing to talk. o Option B: If the client shows signs of agitation or confusion or poses a threat, the nurse should retreat and request assistance. For the care to surpass the technical focus, the psychological care and the continuous observation of patients and family members are also necessary, aiming to prioritize the communication in accordance with the qualified listening, as these patients are often insecure. It is important to highlight that all people who attempted suicide should receive professional care due to the emotional fragility in which they find themselves. The competence of the emergency team is saving lives, considering not only the physical aspects but also the psychological aspects involved in the process of caring o Option C: The nurse shouldn’t attempt to sit next to the client or examine injuries without first announcing the nurse’s presence and assessing the dangers of the situation. There are some essential behaviors that nursing can use to meet a person who attempted suicide or has suicidal ideation, namely: listen carefully, be empathetic, convey non-verbal messages of acceptance, express respect for the opinion of another, talk honestly, show concern, and focus on the feelings of the person. The mere interaction with the patient has a great potential to calm down, prevent, or minimize the severity and intensity of the symptoms. Still, the team should try to establish a bond of trust from the start, whereas, on the other hand, the idea that the patient attempted suicide to manipulate others should be abandoned. 23. 23. Question A female client with anorexia nervosa describes herself as “a whale.” However, the nurse’s assessment reveals that the client is 5′ 8″ (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client’s unrealistic body image, which intervention should nurse Angel be included in the plan of care? o A. Asking the client to compare her figure with magazine photographs of women her age. o B. Assigning the client to group therapy in which participants provide realistic feedback about her weight. o C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift. o D. Telling the client of the nurse’s concern for her health and desire to help her make decisions to keep her healthy. Incorrect Correct Answer: D. Telling the client of the nurse’s concern for her health and desire to help her make decisions to keep her healthy A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about health. Respond (confront) with reality when a patient makes unrealistic statements. The patient may be denying the psychological aspects of their own situation and is often expressing a sense of inadequacy and depression. o Option A: Instead of protecting the client’s health, option A may serve to make the client defensive and more entrenched in her unrealistic body image. Allow the patient to draw a picture of self. It provides an opportunity to discuss the patient’s perception of self and body image and realities of an individual situation. o Option B: Encourage personal development program, preferably in a group setting. Provide information about the proper application of makeup and grooming. Learning about methods to enhance personal appearance may be helpful to a long-range sense of self-esteem and image. Feedback from others can promote feelings of self-worth. o Option C: Establish a therapeutic nurse-patient relationship. Within a helping relationship, the patient can begin to trust and try out new thinking and behaviors. Assist the patient to assume control in areas other than dieting and weight loss such as management of their own daily activities, work, and leisure choices. Feelings of personal ineffectiveness, low self-esteem, and perfectionism are often part of the problem. The patient feels helpless to change and requires assistance to problem-solve methods of control in life situations. 24. 24. Question Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. Nurse Melinda should suspect: o A. A postoperative infection o B. Alcohol withdrawal o C. Acute sepsis. o D. Pneumonia. Incorrect Correct Answer: B. Alcohol withdrawal The client’s vital signs and hallucinations suggest delirium tremens or alcohol withdrawal syndrome. Alcohol withdrawal symptoms occur when patients stop drinking or significantly decrease their alcohol intake after long-term dependence. Withdrawal has a broad range of symptoms from mild tremors to a condition called delirium tremens, which results in seizures and could progress to death if not recognized and treated promptly. o Option A: GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter in the central nervous center. GABA has particular binding sites available for ethanol, thus increasing the inhibition of the central nervous system when present. Chronic ethanol exposure to GABA creates constant inhibition or depressant effects on the brain. Ethanol also binds to glutamate, which is one of the excitatory amino acids in the central nervous system. When it binds to glutamate, it inhibits the excitation of the central nervous system, thus worsening the depression of the brain. o Option C: Alcohol withdrawal can range from very mild symptoms to the severe form, which is named delirium tremens. The hallmark is autonomic dysfunction resulting from the excitation of the central nervous system. Mild signs/symptoms can arise within six hours of alcohol cessation. If symptoms do not progress to more severe symptoms within 24 to 48 hours, the patient will likely recover. o Option D: Although pneumonia may arise as postoperative complications; it wouldn’t cause this client’s signs and symptoms and typically would occur later in the postoperative course. Mild symptoms can be insomnia, tremulousness, hyperreflexia, anxiety, gastrointestinal upset, headache, palpitations. Moderate symptoms include alcohol withdrawal seizures (rum fits) that can occur 12 to 24 hours after cessation of alcohol and are typically generalized in nature. There is a 3% incidence of status epilepticus in these patients. About 50% of patients who have had a withdrawal seizure will progress to delirium tremens. 25. 25. Question Clonidine (Catapres) can be used to treat conditions other than hypertension. Nurse Sally is aware that the following conditions might the drug