NR 326 CMS Exam ACTUAL EXAM 100 QUESTIONS AND CORRECT ANSWERS

NR 326 CMS Exam ACTUAL EXAM 100 QUESTIONS AND CORRECT ANSWERS What is Nurse John likely to note in a male client being admitted for alcohol withdrawal? A. Perceptual disorders B. Impending coma C. Recent alcohol intake D. Depression with mutism Option A: Frightening visual hallucinations are especially common in clients experiencing alcohol withdrawal June has agreed to take amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do? A. Withhold the drug B. Record the client’s response C. Encourage client to tell the physician D. Suggest that it takes awhile before seeing the results. Option D: The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached. In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle knows that succinylcholine (Anectine) will be administered for which therapeutic effect? A. Short acting anesthesia B. Decreased oral and respiratory secretions C. Skeletal muscle paralysis D. Analgesia Option C: Succinylcholine (Anectine)is a depolarizing muscle relaxant causing paralysis. It is used to reduce the intensity of muscle contractions during the convulsive stage, thereby reducing the risk of bone fractures or dislocation Nurse Gina is aware that the dietary implications for a client in manic phase of bipolar disorder is: A. Serve the client a bowl of soup B. Increase calories, decrease fat, and decrease carbohydrates C. Give the client pieces of cut up steak, potatoes, peas D. Increase calories, increase carbohydrates, and increase protein Option D: This client needs increased protein for tissue building and increased calories to replace what is burned up (usually via carbohydrates); preferable, portable d/t acute mania sx Potatoes- does not indicate if portable What parental behavior toward a child during an admission procedure should cause Nurse Ron to suspect child abuse? A. Flat affect B. Expressing guilt C. Acting overly solicitous toward the child D. Ignoring the child Option C: Acting overly solicitous (overly concerned, mindful, anxiously concerned) toward the child This behavior is an example of reaction formation, a coping mechanism. Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior? A. By designating times during which the client can focus on the behavior B. By urging the client to reduce the frequency of the behavior as rapidly as possible C. By calling attention to, or attempting to prevent the behavior D. By discouraging the client from verbalizing anxieties CORRECT - Option A: The nurse should designate times during which the client can focus on the compulsive behavior or obsessive thoughts. Option B: The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. Option C: She shouldn’t call attention to, or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror to the client. Option D: The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior. After seeking help at an outpatient mental health clinic, Ruby, who was raped while walking her dog, is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby