NR 326 CMS Exam ACTUAL FINAL EXAM 100 QUESTIONS AND CORRECT ANSWERS (WITH RATIONALE) . GRADED A+

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? A. Recommending a high protein, low-fat diet B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle C. Allowing the client time to heal D. Exploring the meaning of the traumatic event with the client CORRECT - Option D: The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse. Option A: A special diet isn’t indicated unless the client also has an eating disorder or a nutritional problem. Option B: The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. Option C: The client must explore the meaning of the event and won’t heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client’s anxiety and induce sleep. Exposure therapy may also be indicated. Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, “Why has this happened to me?” What is the nurse’s best response? A. “You’ve developed this paralysis so you can stay with your parents. You must deal with the conflict if you want to walk again.” B. “It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical.” C. “Your problem is real but there is no physical basis for it. We’ll work on what is going on in your life and why it’s happened.” D. “It isn’t uncommon for someone with your personality to develop a conversion disorder during times of stress.” CORRECT - Option C: The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear. Option A: Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn’t help her understand and resolve the underlying conflict. Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer the client’s question; knowing that the cause is psychological wouldn’t necessarily make her feel better. Nurse Trina knows that the following drugs have been known to be effective in treating obsessivecompulsive disorder (OCD): A. Benztropine (Cogentin) and diphenhydramine (Benadryl) B. Chlordiazepoxide (Librium) and Diazepam (Valium) C. Fluvoxamine (Luvox) and Clomipramine (Anafril) D. Divalproex (Depakote) and Lithium (Lithobid) CORRECT - Option C: The antidepressants flu