AUDIO CASE STUDY
Listen to the audio case study available on Davis Edge and then answer the following questions.
Grace and Enteral Feedings
1. What care for feeding tubes and enteral tube-feeding systems was used to prevent complications?

2. How was placement of the feeding tube verified?

3. What positioning was used during the feedings?

4. What is done for pneumonia prevention during the feedings?

FUNCTIONS OF THE GASTROINTESTINAL SYSTEM
Fill in the blanks with the appropriate parts of the gastrointestinal (GI) system.
1. The lower _______ sphincter prevents backup of stomach contents into the esophagus.
2. The _______ valve prevents backup of fecal material from the large intestine into the small intestine.
3. The _______ sphincter prevents backup of duodenal contents into the stomach.
4. The absorption of most of the end products of digestion occurs in the _______ intestine.
5. The digestion of protein begins in the _______.
6. Water and the vitamins produced by the normal flora are absorbed in the _______ intestine.
7. The _______ intestine is the site of action of bile and pancreatic enzymes.
8. The passageway for food into the stomach from the mouth is the _______.
9. Voluntary control of defecation is provided by the _______ anal sphincter.
10. The watery secretion that permits taste and swallowing is produced by the _______ glands.
11. The process of mechanical digestion is accomplished by the _______ and _______ in the mouth.
12. The structures in the small intestine that contain capillaries and lacteals for absorption are the _______.
13. The part of the colon that contracts in the defecation reflex is the _______.
14. The digestive function of the liver is the production of _______ by the hepatocytes.
VOCABULARY
Unscramble the letters to identify the word described by the definition.
1. Flexible or rigid device consisting of a tube and optical system for observing the inside of a hollow organ or cavity _______ donscepeo
2. Gurgling and clicking heard over the abdomen caused by air and fluid movement from peristaltic action that can be classified as normal, hypoactive, hyperactive, or absent _______ wlebo onudss
3. Examination of the colon with an endoscope _______ locnooscypo
4. Feeding via a tube placed in the stomach _______ gvaaeg
5. Immovable accumulation of feces in the bowels _______ mipcaitno
6. Blood not visible in feces _______ ccoltu
7. Device consisting of a fluorescent screen that makes the shadows of objects interposed between the tube and the screen visible _______ ulfroocspeo
8. Fatty stools _______ estaotrhrae
9. A test performed to measure secretions of hydrochloric acid and pepsin in the stomach. _______ stgairc naayliss
10. Examination of the stomach and abdominal cavity by use of an endoscope. _______ stgarsopcoy
LABORATORY TESTS
Match the test with its definition.
1. _____ Stool for fat (lipids)
2. _____ Stool cultures
3. _____ Stool for occult blood
4. _____ Carcinoembryonic antigen
5. _____ Stool for ova and parasites
1. Levels may indicate colorectal or other cancer.
2. Testing stool for blood that is not visible to the eye.
3. Testing stool for intestinal infections caused by parasites.
4. Testing stool for the presence of pathogenic organisms in the GI tract.
5. Testing stool for excessive amounts of fat.
BOWEL PREPARATION
Circle the eight errors in the following paragraph, and insert the correct information.
A stomach preparation is required for several procedures that visualize the lower bowel. This preparation is important for effective test results. An incomplete bowel preparation may prevent the test from being done or cause the need for it to be repeated. This can result in the patient’s early discharge and cost savings. The patient usually receives a soft diet 24 hours before the test. A laxative may be given. Enemas may be given once. Young or debilitated patients should be carefully monitored during the administration of multiple enemas, which can fatigue the patient and increase electrolytes. In patients with bleeding or constipation, the bowel preparation may not be ordered by the health care provider.
PANCREAS
Identify the pancreatic enzyme by its function.
1. Digests polypeptides to short chains of amino acids.

2. Digests emulsified fats to fatty acids and glycerol.

3. Digests starch to maltose.

LIVER
Fill in the blanks with the appropriate words.
1. Liver or gallbladder disease may cause pale or _____ -colored stools.
2. Liver disease may cause _____ disorders.
3. A liver scan records the amount of _____ material taken up by the liver to form a composite “picture” of the liver.
4. After a liver biopsy, the patient lies on the right side for the first _____ hours.
5. After a liver biopsy, nursing care focuses on monitoring for _____.
CRITICAL THINKING
Read the following case study and answer the questions.
Mrs. Davis is a 41-year-old schoolteacher who is admitted to your unit with esophageal cancer. Her health care provider orders enteral nutrition through her gastrostomy tube.
1. Before beginning the feeding, what action should you take for patient-centered care?
2. How will you verify the correct placement of the gastrostomy tube?
3. How should the patient be positioned during the feedings? Why?
4. What actions should you take to set up the feeding safely?
5. Why should a controller pump be used for a continuous feeding?
6. What action can you take to prevent patient dehydration? What health care team member should you consult for this?
7. Describe tube flushing. What are two benefits of tube flushing?

REVIEW QUESTIONS—CONTENT REVIEW
Choose the best answer unless directed otherwise.
1. Which of the following structures are connected by the ileocecal valve?
1. Duodenum to the stomach
2. Colon to the small intestine
3. Stomach to the esophagus
4. Ileum to the jejunum
2. Mechanical digestion in the stomach is accomplished by which of the following structures?
1. Mucosa
2. Smooth muscle layers
3. Striated muscle layers
4. Gastric glands
3. Gastric juice contributes to the digestion of which of the following types of nutrients?
1. Proteins
2. Fats
3. Starch
4. The enzymes of the small intestine contribute to the digestion of which of the following types of nutrients?
1. Starch
2. Fats
3. Disaccharides
5. Which of the following structures carries bile and pancreatic juices to the duodenum?
1. Pancreatic duct
2. Cystic duct
3. Hepatic duct
4. Common bile duct
6. Which of the following is a function of the liver?
1. Synthesis of plasma proteins
2. Elimination of carbohydrates
3. Concentration of bile
4. Secretion of cholecystokinin
7. Which of the following diagnostic procedures on stool specimens must the nurse collect using sterile technique?
1. Stool for ova and parasites
2. Stool for occult blood
3. Stool for culture
4. Stool for lipids
8. Which of the following colors would the nurse recognize as an expected finding for the patient’s stools immediately after a barium enema?
1. Brown
2. Black
3. Green
4. White
REVIEW QUESTIONS—TEST PREPARATION
Choose the best answer unless directed otherwise.
9. The nurse evaluates the patient as understanding the primary reason that food and fluids are held until the gag reflex returns after an esophagogastroduodenoscopy procedure if the patient states which of these?
1. “To rest the vocal cords.”
2. “To prevent aspiration.”
3. “To keep the throat dry.”
4. “To prevent vomiting.”
10. What action should the nurse take prior to initiating an enteral feeding using a newly inserted nasogastric feeding tube?
1. Auscultate bowel sounds.
2. Flush the feeding tube.
3. Review chest x-ray results.
4. Review abdominal x-ray results.
11. The nurse auscultates the patient’s abdomen and finds it to be silent. The nurse would document the bowel sounds findings as which of these?
1. Absent
2. Hyperactive
3. Hypoactive
4. Normal
12. When teaching patients about diagnostic procedures, the nurse would include food and fluid restrictions prior to the test for which of these? Select all that apply.
1. Barium swallow
2. Flat plate of the abdomen
3. Esophagogastroduodenoscopy
4. Magnetic resonance imaging
5. Endoscopic retrograde cholangiopancreatography
6. Barium enema
13. The nurse would evaluate the patient as understanding teaching if the patient replied that which of the following can occur following a barium swallow? Select all that apply.
1. Dysphagia
2. Constipation
3. Diarrhea
4. Pain
5. White stool
14. What actions can the nurse take to ensure patient safety when providing an enteral feeding? Select all that apply.
1. Use adequate room lighting.
2. Trace all lines back to their origins.
3. Check connections during patient handoff.
4. Reconnect a patient’s tubing to assist another nurse.
5. Route all tubes in the same direction.
6. Do not interfere with equipment safety features.

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Joe works in a community centre where Susannah attends English language classes. She has three children who attend a play group at the centre. Joe has noticed that Susannah has bruises on her face and arms and that two of the children have bruises on the backs of their legs.
Joe is concerned about Susannah and her children. He is finding it hard to sleep at night and is staying back at the community centre after his shift finishes so that he can spend a few minutes talking to Susannah. He has offered to drive her home and to pick her and the children up in the morning. Joe has also approached a police officer who is a friend of his and told him about his concerns. He has given the police officer Susannah’s address and asked him to drive past her house and check on her welfare.
question 1-4
1.Identify where Joe can find information about his legal responsibilities in relation to child protection and to domestic and family violence (DFV), and describe the specific information he needs in order to manage this situation. (Approx. 75 words).
2.Describe the specific information Joe should check to identify the scope of his legal responsibilities. (Approx. 50 words that you can present in a bullet point list if you wish).
3.Describe three ways that Joe has breached his work role boundaries as well as the legal and ethical requirements of his role. (Approx. 65 words that you can present in a bullet point list if you wish).
4.How should Joe address his concerns while working within the boundaries of his professional role, legal requirements and his organisation’s policies and procedures? Suggest at least four ways Joe can address his concerns in your answer. (Approx. 75 words that you can present in a bullet point list if you wish).
Susannah’s husband Andrew has found out that Joe has been offering lifts to Susannah and the children. He has made a formal complaint to Joe’s supervisor, Betsy. He has threatened to stop his wife and children attending the centre if Joe continues to work with Susannah and has requested a female worker to support his family.
Susannah has requested a female support worker, saying she would feel more comfortable and says her husband will allow her to continue attending the centre if she has a female support worker.
Jenny is appointed as Susannah’s support worker. Susannah asks for some information about Domestic Family Violence (DFV) services in the local area. She has also asked if she can come to Jenny’s house if she feels unsafe in her own home at any time. Jenny has explained that she cannot offer Susannah accommodation in her house, but she can refer her to a women’s refuge service if Susannah needs this. Jenny feels very strongly about DFV issues and when she was younger she was in a violent relationship herself.
question 5-9
5.escribe four things Betsy should do when responding to the complaint. (Approx. 85 words that you can present in a bullet point list if you wish).
6.Describe two ways Jenny can ensure she obtains legal, valid informed consent from Susannah. (Approx. 25 words that you can present in a bullet point list if you wish).
7.What is Jenny’s responsibility regarding mandatory reporting requirements? (Approx. 25 words).
8. Access and review the Australian Community Work Practice Guidelines (Links to an external site.).
For Indicators 1.5, 3.4, 4.1 and 6.3 explain how Jenny has or can ensure she is upholding the practice guidelines in relation to the services.
9.What rights does Susannah have in this situation? Identify at least three rights that Susannah has in your answer. (Approx. 15 words that you can present in a bullet point list if you wish).
Mary is a resident in a refuge for women and children. Her husband has threatened her life and the life of her son and she has been granted a violence restraining order. Her 10-year-old son, Frederick, is very angry about being separated from his father.
Frederick approaches Beryl, a new part-time refuge worker. He confides in her how much he misses his father and how desperately he wants to see him, or even just talk to him. He persuades Beryl to let him use the phone in the office to contact his father. Beryl agrees as long as she remains in the office with him. Frederick blurts out the address of the refuge before Beryl can stop him. She realises she will be in trouble from her supervisor, so she doesn’t say anything to her.
Later that night Frederick’s father arrives at the refuge and attempts to break in. When Frederick’s father is questioned by the police, he tells them that Beryl let Frederick call him and tell him the address. Beryl faces a severe reprimand from her supervisor.
question 10-12
10. Describe one way that Beryl breached organisational procedures after the incident occurred. (Approx. 15 words).
11. When Frederick approached Beryl to ask to use the phone, what was the potential breach that Beryl should have identified? (Approx. 15 words).
12.Because Beryl did not identify the potential breach, what actual breaches occurred? Identify two breaches in your answer. (Approx. 40 words).
Alice works in a women’s refuge. She has strong religious beliefs and is a supporter of the right to life movement. Imogen has been living at the refuge and is 10 weeks pregnant. She has decided that she wants a termination.
Alice has been asked by her manager to accompany Imogen to an appointment at a women’s health centre to discuss her options. The refuge has a policy that supports self-determination and empowerment, and uses person-centred approaches to service provision.
Alice’s job role description requires her to provide emotional and practical support and to encourage people to make decisions and take control of their own lives. Alice plans to take Imogen to a pregnancy counselling service which is run by an anti-abortion organisation before taking her to the women’s health centre.
Imogen has told Jasmine, one of the other refuge support workers, that Alice is going to take her to the anti-abortion pregnancy counselling service. She says that she is worried they will persuade her to change her mind about having a termination. She also says Alice has been leaving anti-abortion literature in her room and has also asked her to attend a religious service with her. Alice has also suggested referring Imogen for counselling. As there is a long waiting list for subsidised counselling services, Alice has offered to refer Imogen to her cousin, who is in private practice as a psychologist.
question 13-18
13.As a support worker, list at least two sources of information Alice should use to ensure she upholds her ethical responsibilities to Imogen in her work role. (Approx. 10 words).
14.Describe two professional ethical responsibilities Alice must uphold within the scope of her role. (Approx. 30 words that you can present in a bullet point list if you wish).
15.Identify two sources of information about legal and ethical policy frameworks Alice could refer to. (Approx. 30 words).
16.In working with Imogen, describe one way Alice can ensure non-judgmental service provision in spite of her conflicting personal values and attitudes. (Approx. 35 words)
17.Provide one action that indicates that Alice is behaving unethically and one way that Jasmine could respond to Alice’s unethical conduct. (Approx. 50 words).
18.Describe the conflict of interest in this situation and provide one way that Alice should manage it. (Approx. 70 words).
John works in a residential group home for adults with physical disability. The routine includes a weekly group outing for the residents. All residents must attend, as staffing levels do not provide for staff to remain at the group home to supervise residents who do not participate in the group outing.
Not all residents get their first choice of outing and John tries to make this a bit fairer by allowing residents to take it in turns to choose the outing each week, but residents are not happy with this.
John has discovered that the low levels of staffing in the group home have come about because the manager agreed to share his allocation of staff with another group home which is supervised by his fiancée.
John is aware that this is an ethical issue which impacts on service and practice standards.
question 19-21
19.What are two indicators John can use to identify work practices need to be improved? (Approx. 25 words).
20.Describe how John should go about developing a new policy regarding the activities. (Approx. 45 words).
21.What actions could John take to engage the residents in the review of the current activity process? List and describe three things he could do in your answer. (Approx. 15 words).

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Simulation Perfusion
Course: NUR ____2025_____ Concept/Exemplar: ___Heart Failure/Chronic renal insufficiency Hours: 1.5
Scenario Identify the Top 3 client areas for the nurse to assess.
An 89-year-old female client is admitted to a telemetry unit with a diagnosis of heart failure exacerbation. She reports a medical history of osteoarthritis, chronic renal insufficiency, and coronary artery disease including a myocardial infarction and coronary artery bypass surgery 22 years ago. She is alert and her daughter is at her bedside. The nurse’s initial client assessment findings include:
Oriented to person only, follows simple commands
Clear speech
Sinus tachycardia
Respirations of 26 breaths/min
Oxygen saturation of 90% on room air
Breathing labored with use of accessory muscles
Productive cough with pink frothy sputum
Crepitus in bilateral knee joints
Enlarged body nodes on hands
Hemoglobin = 12.4 g/dL
Hematocrit = 39%
White blood cell count = 12,ooo mm3
Next GEN NCLEX: What matters most? Noticing, Tanner’s Clinical Judgement model
Indicate which nursing action listed on the far left column is appropriate for each potential heart failure complication. Note that not all actions will be used, but there is only one appropriate action for each complication and they can be used only once.
Nursing Action Potential Heart Failure Complication Appropriate Nursing Action for each potential heart failure complication
Reduce sodium intake to 1g daily.
Acute pulmonary edema
Administer oxygen therapy
Fatigue
Weight the client each morning on the same scale
Hypokalemia
Administer furosemide 20 mg IV push.
Cardiac dysrhythmia
Encourage the client to drink at least 3L of fluid daily
Hypoxemia
Teach the client pursed-lip breathing techniques.
Administer potassium supplements
Monitor electrocardiogram, oxygen saturation, and serum electrolyte levels.
Reposition every 2 hours while in bed.
Consult a cardiac rehabilitation specialist.
Example:
Complication
Example:
Appropriate actions for complication: #3
Complete a Medication template for each of the following medications: (1) Potassium PO, (2) Furosemide IV push
Case Study Progress
The 80-year-old client will be discharged today and will move in with her daughter until she feels well enough to go home alone. Which of the following discharge instructions will the nurse provide the client and her daughter? Select all that apply
“Weight yourself each day at the same time on the same scale to monitor for fluid retention”
Contact your primary health care provider if you experience cold symptoms lasting more than 3 days.”
Exertion can cause another episode of heart failure, so help your mother by assisting her with daily activities.”
Notify your primary health care provider if you experience shortness of breath or chest pain while resting.”
“Do not use table salt, avoid salty foods, and read labels on all food items to ensure your diet is low in sodium.”
“Do not take metoprolol if your heart rate is less than 60 beats per minute.”
“Heart failure is a chronic condition, so you don’t need to be alarmed when you experience heart palpitations.”
Case Study Progress
The client was discharged 2 weeks ago and is with her daughter for her follow up primary health care provider visit. For each assessment finding, use an X to indicate whether the interventions are Effective (helped to meet expected outcomes), Ineffective (did not help to meet expected outcomes), or Unrelated (not related to the expected outcomes).
Assessment finding Effective Ineffective Unrelated
States that she has had no shortness of breath since hospital discharge
Has 2+ pitting edema in both ankles and feet
Blood pressure of 134.76 mm Hg
Has had no chest pain since hospital discharge
Reports feeling like she has more energy now when compared with before her hospital stay
Has new onset fungal skin infection
Simulation Perfusion
Course: NUR ____2025_____ Concept/Exemplar: ___Heart Failure/Aortic stenosis _ Hours: 1.5
Scenario Identify the Top 3 client areas for the nurse to assess.
A 72-year-old male client is admitted to a telemetry unit after a fall at home. The clients is experiencing severe weakness in his lower extremities and states, “I got out of bed at 0430 this morning, my legs gave out on my way to the bathroom, and I was unable to get up.” Emergency medical services transported the client to the hospital. Past medical history provided by the client includes high cholesterol, aortic valve stenosis, and residual lower extremity muscle pain and weakness secondary to poliomyelitis as a child. He saw his cardiologist and had an echocardiogram completed 3 weeks ago. He also received his influenza and pneumococcal vaccines this year. The client is married and has two adult children. He lives in a single-story home, ambulates with a cane, and completes ADLs independently. His echocardiogram reports moderate heart failure with an ejection fraction (EF) of 38%. The client’s wife provides a list of his current medications, but the list is not complete. Choose the most likely options for the information missing from the paragraph by selecting from the lists of options provided.
Next GEN NCLEX: What matters most? Noticing, Tanner’s Clinical Judgement model
Medication Dose, Route, Frequency Drug Class Indication
aspirin 1 Salicylate Prevention of platelet aggregation
Atorvastatin 20 mg orally once a day Statin 2
3 12.5 mg orally twice a day Beta-adrenergic blocker Management of hypertension and heart failure
Ibuprofen 400 mg orally every 6-8 hr as needed Nonsteroidal anti-inflammatory drug 4
5 0.125 mg orally once a day Cardiac glycoside Increase myocardial contractile force
lisinopril 2.5 mg orally once a day 6 Management of heart failure
Options for 1 Options for 2 Options for 3
0.25 mg orally twice a day Management of angina carvedilol
81 mg orally every 4-5 hr as needed for pain Treatment of bronchospasm hydrochlorothiazide
200 mg subcutaneously every 8 hours Management of heart failure furosemide
325 mg orally once a day Management of hyperlipidemia nesiritide
1000 mg transdermal patch every 2 days Prevention of pulmonary hypertension verapamil
Options for 4 Option for 5 Option for 6
Treatment for decreased cardiac output enalapril Aldosterone antagonist
Prevention of dyspnea spironolactone Angiotensin-converting enzyme inhibitor
Management of extremity pain digoxin Calcium channel blocker
Treatment of pyrexia losartan Histamine blocker
Prevention of tachycardia metroprolol Thiazide diuretic
Case Study Progress
After completing the medication reconciliation with the patient’s wife, the nurse completed the initial assessment. The nurse’s findings include:
Alert and oriented
Blurred vision
Reports lower extremity stiffness; Ambulates with crutches
Sinus rhythm with preventricular contractions (PVCs); Cardiac murmur
Reports dyspnea on exertion; Bilateral basilar crackles
Blood urea nitrogen (BUN) = 11 mg/dL and Creatinine kinases 1200 U/L
Potassium 5.3 mg/dL
Circle or place a check mark next to the assessment findings that require follow-up by the nurse.
Case Study Progress
The provider arrives to the telemetry unit to discuss the diagnosis and plan with the patient and wife. The client is diagnosed with rhabdomyolysis. Prescriptions to place a large-bore intravenous catheter and administer normal saline 0.9% at 125 mL/hr are received. Choose the most likely options for the information missing from the paragraph by selecting from the lists of options provided.
When caring for a client who has left ventricular dysfunction, the nurse assesses for _____1_____ related to inadequate cerebral perfusion, _____2______ related to inadequate myocardium perfusion, and _____3______
related to inadequate renal perfusion. The nurse monitors a client who has heart failure closely for complications of pulmonary congestion when administering intravenous fluids. Manifestations of pulmonary congestion include _____4_____, _____5_____, and _____6_____. If the client experiences acute pulmonary edema, the nurse would place the client in a sitting position and administer _____7_____ and _____8_____.
Options for 1, 2, and 3 Options for 4, 5, and 6 Options for 7 and 8
Confusion Crackles Albuterol nebulizer
Chest pain Dyspnea chest percussion
nausea Fatigue Lorazepam orally
oliguria Jugular vein distention Morphine intravenous push
orthopnea Stridor Nitroglycerin sublingual
pallor Tachypnea Supplemental oxygen
polyuria Weight gain Furosemide intravenous push

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1. In the table below complete the personal development plan, setting goals and personal objectives that will enable you to improve on your own work practice / nursing career.
You can review the following example[1] to assist with this task
Personal Development Plan
Strengths Areas for further development
Opportunities What is stopping you
Setting Goals – discuss a minimum of three (3)
What do I want to learn?
What do I have to do?
What support and resources do I need?
How will I measure success?
Target date for review
Personal objectives
Short term goals (next 12 months)
Medium term goals (next 1 – 3 yrs.)
2. Discuss how you can measure the progress of this plan and the importance of measuring the progress. (Word Count Range: 50-100 words, reference)
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3. Once you have completed your personal development plan, undertake a self-evaluation of the plan by discussing it with a colleague you work with or one of your peers, then answer the following question.
Write a short self-evaluation of your personal development plan including any feedback you have received from your discussion of this plan with others (Word Count Range: 100-150 words)
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4a. Identify a time when you received feedback from an employer, peer or facilitator on vocational placement and discuss how the conversation went – show a 2-way open conversation about feedback, explain if the feedback was descriptive or evaluative and give a rationale (Word Count Range: 100-150 words, reference)
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4b. Now that you have discussed your personal plan, obtained feedback and completed a self-evaluation, outline at least two (2) areas that you feel could be improved upon. (Word Count Range: 50-100 words)
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5. Provide a short reflection on the feedback you have actively sought and received so far from your clinical placements, either from your facilitators or staff where you did placement. (Word Count Range: 50-100)
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6. Outline two (2) ways that you can regularly participate in the review processes at a place of employment that will show your commitment to upgrading your skills and knowledge (Word Count Range: 50-100 words, reference)
(Please note that this can relate to any employment that you are currently in or have been in)
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7. As you progress as a nurse there will be many opportunities to enhance your learning development. Outline three (3) ways you can seek specialist advice or further training (Word Count Range: 50-100 words, reference)
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[1] https://www.managers.org.uk/~/media/Files/Checklists/Personal-Development-Plan-Example-Guide.pdf

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Mr. Y is a 78-year old man who was born in Korea and moved to the US with his wife 50 years ago. Together, the couple opened a floral shop and ran the business for 40 years. Mrs. Y enjoyed watching her husband’s talent and love of nature come out in his flower arrangements.
When Mr. Y was in his late 60’s, he started having difficulty making his favorite flower arrangements. Their son also noticed Mr. Y misplacing tools, losing paper orders, and forgetting important pick-up times. At home, Mrs. Y noticed her husband having problems remembering recent events, and waking up at odd hours in the night thinking it was time to open the shop. Mr. Y was becoming irritable at home and at the shop.
When Mr. Y was 70 years old, the family decided to sell the business. Their healthcare providers confirmed that Mr. Y was presenting with early stage Alzheimer’s disease. The family decided that Mrs. Y would be appointed as her husband’s Power of Attorney for personal care and property. She continued to care for her husband at home.
When Mr. Y turned 75-years old, he was having increased difficulty remembering where things were in the house. He often woke his wife at odd hours of the night thinking it was time to get up and ready. When Mrs. Y reoriented her husband that it was still night-time, he would get confused an easily upset. Mr. Y was also becoming more physically weak, but did not perceive his limitations. He was home, forgetting where he had to go and which house was his.
Their son recognized that his mother was as happy as she used to be. She was constantly worrying about her husband’s increasing care needs, and could not enjoy activities she used to do. She was stressed and was not sleeping properly. With support from their healthcare providers the family decided that a long-term care setting would benefit Mr. Y and Mrs. Y’s well-being.
Admission to long-term care
At the admission conference, the long term care home’s social worker and charge nurse met Mr. Y and his family, and learned more about his history and preferences. His medical diagnosis includes moderate Alzheimer’s disease and osteoarthritis, with a history of urinary tract infections. Mr. Y hears well, uses reading glasses, and wears upper and lower dentures. Mr. Y also requires reminders to use his walker properly. Mrs. Y always prompted her husband for toileting, as well as when to eat and take medications. Mr. Y requires limited assistance from his wife during activities of daily living, such as dressing or transfers. As for his preferences, Mr. Y loves homemade Korean food, pastries, and warm drinks. He had always enjoyed baths in the evenings.
Mr. Y’s first week
During the first week in LTC, the staff noticed Mr. Y pacing the hallways, pushing locked doors, entering other residents’ rooms. When approached by the nursing staff, he had repetitive questions: “Who are you?”, “What do I do?”, “Where do I go?” Mr. Y required frequent reminders that this was his new home. During meals, Mr. Y ate little despite encouragement and staff offering assistance. During personal care such as changing, toileting and showering, Mr. Y kicked, scratched, grabbed and screamed at the staff. Two staff were required during these care activities.
Socially, Mr. Y actively participated in group craft activities and exercise classes when the therapists and staff coached him. During the times with no scheduled activities, Mr. Y paced the hallways and asked staff: “What do I do?”, “Where do I go?”
Mr. Y’s second week
At the end of the second week in the LTC, Mr. Y was no longer pacing the halls. He was often found napping in his room during the days. One afternoon, a staff nurse went into Mr. Y’s room and found him sleeping. She tried to gently wake Mr. Y, but he was not easy to arouse. She tried a second time and asked very loudly, “Mr. Y, it’s lunch time, are you ready to go?” Mr. Y slowly opened his eyes. The staff nurse repeated the question, and Mr. Y replied slowly, “Oh, I ate last week.” The staff nurse then asked “I know you had breakfast this morning, now it’s lunch time. Are you hungry?” Mr. Y paused and closed his eye. The staff nurse gently woke him again by rubbing his arm and repeated her question. Mr. Y slowly replied, “Yes, my wife is cooking, I will eat.” Together, they walked slowly to dining room.
In the dining room, Mr. Y stared out the window and did not answer the staff nurse when they asked him for his lunch preference. When approached a third time, Mr. Y rambled slowly in English and in Korean to the staff nurse. He continued to speak Korean to the staff nurse as they tried to assist him with his lunch, but he was unfocused and inattentive. He was unable to finish his meal because of his behavior. The staff were worried that he was not eating or drinking enough since admission.
When there were group activities, the therapists found it harder to encourage Mr. Y to attend and participate like he had been doing before. It took a lot of encouragement and assistance to have him attend. During the activity, he did not participate or sometimes fell asleep in the middle of the exercise or social program.
A few nights in a row, he was found wandering outside his bedroom without his walker. One time, he told the staff nurse, “Someone is looking for me.” The PSW reassured him that he is safe, and tried to direct him back to his room. But Mr. Y walked past the staff nurse and said, “I have to go to the bus stop.” After a few attempts, the staff nurse was able to direct Mr. Y to his room to sleep, and reoriented him to the use of the call bell. This behavior continued with increasing disorientation. The sleep disturbances resulted in Mr. Y being too drowsy in the mornings, and not able to eat any breakfast.
Although Mrs. Y was kept informed of her husband’s condition since admission to long-term care, it was not until her first visit during Mr. Y’s third week in long-term care when she realized how much her husband had changed. She was alarmed and asked the staff, “What is happening? What will be done for him? How can I help?”
Behavioral and psychological symptoms of dementia is a term used to describe the way a person with dementia expresses their unmet needs and presents symptoms of dementia. It is important to explore what is going on for the person. Looking at Mr. Y’s first week in long-term care:
He is wandering a lot, and staff has to re-orient him many times. What do you think is happening and why might he be reacting this way?
Mr. Y’s Alzheimer’s has progressed to Middle-stage Alzheimer’s which makes him forgetful of events or personal history, confused about where he is or what day it is, and shows an increased tendency to wander and become lost.
In Middle-stage Alzheimer’s Mr. Y starts to demonstrate personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior. He may get frustrated or angry and act in unexpected ways, such as refusing to bathe.
I would assess their pain, infections, electrolyte imbalances or metabolic disorders, urinary retention, constipation, cerumen, and others.
During Mr. Y’s personal care, what might be happening for him and why might he be reacting this way?
What other things can you do to explore underlying causes of a person’s behavioral and psychological symptoms of dementia?
A range of non-pharmacological approaches to care have been found to be effective at managing behavioral and psychological symptoms of dementia, but not all approaches are effective or appropriate for everyone. It is important to tailor a care plan to meet the person’s needs and preferences. What non-pharmacological approaches have you used to manage behavioral and psychological symptoms of dementia? Would you want to use these for Mr. Y?
Caring for people with dementia requires effective communication skills. Which strategies might work for Mr. Y? What are some communication strategies that have worked for you in the past?
There are several strategies to preserve Mr. Y’s abilities and promote living well with dementia.
What are some activities that long-term care staff can offer that you think Mr. Y will enjoy? Think of what he liked to do at home.
How can we promote Mr. Y’s social life?
It is important to promote a healthy lifestyle. How can we support Mr. Y’s nutrition?
How can we improve his quality of sleep?
Are there any issues surrounding Mr. Y’s safety? What can we do to make the environment safer?

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Principles of Mental Health
1.During a client’s admission, the nurse realizes the boundaries of the nurse-client relationship have blurred when the nurse sees the following occur:
Allowing the client to hold the nurse’s hand during a procedure
The nurse agrees to keep a secret shared by the client
The nurse asks the client about their religion
The nurse focuses the conversation on the client
2. A client has been involuntarily admitted to an inpatient behavioral health unit. During this admission which of the following right dose the client still retain? (Select all that apply)
The right to refuse medications
The right to keep all personal items
The right to informed consent
The right to choose the nurse assigned to them
The right to leave upon request
3. According to Maslow’s hierarchy of needs, which of the following client actions would be considered most basic?
A client feels lonely and is seeking to share life experiences
A client begins to realize his or her full potential
A client is role-playing a situation with a nurse to practice assertiveness skills
A client seeks shelter at a center for battered woman
4. A newly admitted male client has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for further education about the use of restraints?
If his behavior warrants restraints, he will need to be monitored closely the entire time he’s restrained
If he is restrained, be sure he is offered food and fluids regularly
I’ll call the primary provider and get an as needed (prn) seclusion/restraint order
Remember that physical restraints are our last resort
5. Which of the following presents a liability concern for the Licensed Practical Nurse?
Restraining a combative client who is stabbing himself with a pencil
Reporting threats of violence made by a client against his employer
Calling the psychiatric nurse practitioner to clarify an order for an antipsychotic
Placing a client who talks constantly and loudly into a secluded room alone
6. A female client staggers to day treatment smelling strongly of alcohol. When questioned, which response by the client reflects the use of rationalizations as a defense mechanism?
I have not drunk anything in the last day
I can’t worry about that problem right now
I have to drink to relax to come to day treatment
Why does it matter to you if I drink
7. A client involuntarily admitted to a psychiatric until after calling a friend and saying “I’ve got a gun and I’m going to shoot myself, “which of the following rights has the client lost while admitted?
The right to communicate with family members
Freedom of speech
The right to refuse medications
The right to leave the hospital without medical approval
8. A nurse is reviewing a client chart and reads the following: “Adam is focused on his belief that the government is following him. He mentioned multiple times that he believed the interview was being recorded by CIA. “The nurse recognizes with component of the Mental Status Exam (MSE) is being evaluated?
Mood and Affect
Appearance
Thought Content
Emotional Stability
9. A client who is experiencing acute alcohol intoxication is being admitted to the unit. Which of the following best describes the approach that should be taken when working with this client?
Remain nonjudgmental
Avoid the topic of alcohol use when asking questions
Provide sympathetic support
Express disapproval of the substance abuse
10. The nurse is working on an inpatient psychiatric unit. Which of the following shows an understand of a therapeutic milieu?
Allowing client to watch TV pass the scheduled time
Orienting client to their right and responsibilities
Having the client decide when group therapy will occur
Refusing a client time to pray
11. A 22-year-old college student is admitted to a hospital following a suicide attempt and state, “No one will ever love a loser like me.” According to the Erikson’s theory of personality development, a nurse should recognize a deficit in which developmental stage?
Trust versus mistrust
Ego integrity versus despair
Intimacy versus isolation
Initiative versus guilt
12. A nurse counsels a widow whose husband died 4 years ago. The widow says, “if I’d done more, he would still be alive.” Select the nurse’s therapeutic response.
I understand how you feel after such a significant loss
That was a long time ago. Your husband would want you to move on with your life
I am sure you did a very good job of caring for him, especially since he was sick so long
You husband was 82 years old with sever chronic obstructive pulmonary disease
13. The theory of interpersonal relationships developed by Hildegard Peplau was strongly influenced by the Interpersonal Relationship Theory of which following theorist?
Sigmund Freud
Erik Erikson
Harry Stack Sullivan
Jean Piaget
14. A client on an inpatient psychiatric unit is suffering from major depression. He has poor appetite and poverty of speech. Which response by the nurse demonstrates offering self?
I know just how you feel, I have had several traumatic things happen in my life
I would like to sit with you for a while to help you get comfortable talking to me
Why don’t you just tell me why you are refusing to eat or talk?
If I were in your situation, I would not want to eat either
15. A brother calls to the speak to his sister who has been admitted to the psychiatric unit. The nurse connects him to the community phone and the sister is summoned. Later the nurse realizes that the brother was not on the client’s approval call list. What law has the nurse broken?
The notional Alliance for the Mentally III Act
The Tarasoff Ruling
The Health Insurance Portability and Accountability Act
The Good Samaritan Law
16. The following question. “If you had a fever and vomiting for 3 days, what would you do?” represents which section of the mental status examination?
Behavior
Cognition
Affect and mood
Perceptual disturbances
17. A nurse is preparing to administer ziprasidone 10 mg IM every 6 hr. Available is ziprasidone 20 mg/mL. How many mL should the nurse administer per dose?
0.25
0.5
1
1.5
18. Disulfiram (Antabuse) is a medication used for which type of treatment?
A mild sedative for insomnia
To decrease the side effects of antipsychotic medications
A mood stabilizer
Aversion therapy for alcoholics
19. A nurse overhears a coworker ask a client, “This is your third admission. Why did you stop taking your medication?” Which statement to the coworker would identify the concern with using “why” questions?
Asking “why” may have implied criticism and could have the effect of making the client feel defensive.
Asking “why” may invite the client to shar thoughts and feelings regarding the client’s non-adherence.”
Asking “why” can recognize and acknowledge the client’s reasons for his or her action
Asking “why” can focus the client on the topic to gain further specific information
20. According to Freud, which statement should a nurse associate with predominance of the superego?
No one is looking, so I will take three cigarettes from Mom’s pack
I don’t ever cheat on test; it is wrong
I think I may skip school today; I need a break
Dad wont’s miss this little bit of vodka
21. A client admitted yesterday believes the window blinds are snakes trying to get in the room. The client is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?
A benzodiazepine, such as lorazepam
A prostaglandin analogs, such as latanoprost
A monoamine oxidase inhibitor, such as phenazine
A narcotic analgesic, such as codeine
22. The nurse believe that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility?
By asking directly if the client has ever had a problem with alcohol
By holistically assessing the client, using the Clinical Institute Withdrawal Assessment scale
By using a screening tool such as the CAGE questionnaire
By referring the client for physician evaluation
23. When communication with a client, using techniques such as paraphrasing restating, reflecting and exploring are used for what purpose?
Completing the Mental Status Exam (MSE)
Clarifying verbal communication
Presenting reality to delusional client
Conducting a physical assessment
25. A nurse is educating a client about the difference between mental health and mental illness. Which statement by the client reflects an accurate understanding of mental health?
Mental health is the absence of any stressors
Mental health is the successful adaptation to stressors
Mental health is inconsistency between thought, feelings, and behavior
Mental health is a diagnostic category in the DSM-5.
26. A client is ready for discharge from an alcohol abuse recovery program. Which of following outpatient support would be appropriate? (Select all that apply.)
A 12-step recovery program such as AA
Individual therapy
Group therapy for family
Commuter assistance
Medication compliance
27. A client states. “My father spanked me often.” Which therapeutic response would be an example of restating?
Tell me more about that
I’m sure it was in your best interest
Your father was a harsh disciplinarian
Why were you spanked so much
28. A client who is experiencing acute alcohol intoxication is being admitted to the unit. Which of the following best describes the approach that should be taken when working with this client?
Remain nonjudgmental
Addiction
Withdrawal
Tolerance
29. Which intervention by a psychiatric nurse best reflects the ethical principle of autonomy?
The nurse stays with a client who is demonstrating a high level of anxiety
The nurse suggests that two clients who were fighting be restricted to the unit
The nurse explores alternative solutions with a client, who then makes a choice
The nurse intervenes when a self-mutilating client attempts to harm self
30. A client on substance use disorder states, “I used to be able to get a buzz with a few beers. Now it takes a six-pack.” The nurse recognizes this statements as an example which condition associated with substance use disorders?
Addiction
Withdrawal
Tolerance
Intoxication
31. A nurse is preparing to administer imipramine 200 mg PO daily divided equally every 12 hr. The amount available is imipramine 25 mg tablets. How many tablets should the nurse administer with each dose?
2
3
4
5
32. A client with known history of chronic alcohol use, reports last drink was at 12:00 noon the prior day. The nurse anticipates for withdrawal symptoms to peak:
Within 2-4 days of cessation
Within a few hours of cessation
Within 1-2 day of cessation
If they have not started, they will not
33. There is one bed available on an inpatient psychiatric unit. The nurse should advocate for emergency commitment of which individual?
An individual who is persistently mentally ill and was evicted from an apartment
An individual treated in the emergency department for generalized anxiety disorder
An individual who is delusional and has a plan to kill his wife
An individual who rates mood 4/10 and is participating in a no-harm safety plan
34. A client is prescribed lorazepam (Ativan) 0.5 mg four times a day and 1 mg prn q8h. The maximum daily dose of lorazepam should not exceed 4 mg daily. This client would be able to receive___prn doses as the maximum number of prn lorazepam doses.
1
2
3
4
35. A nurse is planning care of a newly admitted client who has a history of alcohol use disorder. The client states that his last drink was six hours ago. Which of the following goals is the highest priority?
The client will acknowledge alcohol dependence and need for treatment
The client will rebuild damaged interpersonal relationships
The client will implement alternative strategies for managing anxiety
The client will withdrawal from alcohol without complications
36. Alicia is flirting with peers on the unit and offers her nurse a backrub in exchange for receiving her 10:00pm Xanax an hour early. Which response (s) to such behaviors would be most therapeutic?
Advise the other client that Alicia is being manipulative and that they should ignore her when she behaves that way.
Bargain with Alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line.
Explain that such behavior is unacceptable and give Alicia specific examples of consequences that will be enacted if the behavior continues
Ignore the behavior for the time being so Alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, way to meet her needs
37. A nurse is caring for a client who has a history of alcohol use disorder and has been hospitalized for detoxification. The nurse enters the room and finds the client shouting in a terrified voice, “Get these bugs of me!” Which of the following responses by the nurse is appropriate?
I’m sure that the bugs you see will not harm you
Tell me more about the bugs you see in your room
I don’t see any bugs, but you seem very frightened
Why do you think there are bugs on you
38 A 17-year-old client asks a nurse conducting an assessment interview, “Why should I tell you anything? You’ll just tell my parents whatever you find out.” The nurse’s best reply would be which of the following?
That isn’t tree. What you tell us is private and held in strict confidence. Your parents have no right to know
Yes, your parents may find out what you say, but it is important that they know about your problems
What you say about feelings are private, but some things, like suicidal thinking must be reported to the treatment team
It sounds as though you are not ready to work on your problems
39. The concept of false imprisonment is one that has legal implications for healthcare providers and is violation of client rights. Which of the following is not considered false imprisonment?
Intent to confine to a specific area
Indefensible use of seclusion or restraints
Detaining a client who is voluntary admission without justification to do so
Providing client access to a quiet are in the unit
40. Which communication technique would yield positive outcome 3ihtin context of a therapeutic relationship?
Making value judgements
Giving approval
Asking “why”
Summarizing
41. In a psychiatric inpatient setting, the nurse observes an adolescent client’s peer calling the client names. In this context, which statement by the nurse exemplifies the concept of empathy?
I can see that you are upset. I am here to listen if you would like to talk
Your peers are being insensitive. I would be upset also
I used to be called names as a child. I know it can hurt feeling
I get angry when people are treated cruelly
42. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson’s theory, which developmental task should a nurse assist the client to accomplish?
Establishing the ability to control emotional reactions
Establishing a strong sense of ethics and character structure
Establishing and maintaining self-esteem
Establishing a career, personal relationships, and societal connections
45. A client is admitted for acute alcohol withdrawal. Which of the following clinical manifestations are associated with acute alcohol withdrawal?
Myopia, hypothermia, and elevated mood
Bradycardia, hypotension, and drowsiness
Decreased reflexes, somnolence, and hypothermia
Tachycardia, paranoid delusions, and elevated blood pressure
46. A nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a “general lead”?
Do you know why you are here
Are you feeling depressed or anxious?
Yes, I see Go on
Can you chronologically order the events that led to your admission?
47. Cocaine is a center nervous system stimulant. Which of the following symptoms would a nurse recognize as intoxication from use of cocaine? (Select all that Apply.)
Constricted pupils
Decreased blood pressure
Insomnia
Elevated heart rate
Depressed mood
48. All client have a right to privacy and confidentiality. However, if a client makes any type of threat to harm another person, nurse have a legal obligation to alert that person of the threat that was made. This is known as the duty to warn. Although each state may have different wording, in general the duty to warn includes the same criteria. Which of the following not included in the duty to warn?
Assessing and predicting the client’s danger or violence toward a third party
Identification of the person or person or persons being threatened
Calling the local news to report the threat
Taking the appropriate action to protect the intended victim
49. Which nontherapeutic communication technique is used in the following example? Client: “I am really upset about being discharged.” Nurse: Why? You should be happy to leave”
Minimizing feelings
Now that I’ve detoxed, my recovery is complete
I understand the goal is to decrease my drinking
I will only need to attend one meeting a week to prevent relapse
50. A client who continues to use alcohol states “I can’t stop drinking. Every time I try to stop, I feel terrible and get sweaty and sick.” The nurse understands the client is describing which of the following?
Addiction
Withdrawal
Intoxication
Enabling
51. A student nurse tells the instructor, “I’m concerned that when a client asks me for advice, I won’t have a good solution.” Which should be the nursing instructor’s best repose?
It’s scary to feel put on the spot by a client. Nurses don’t always have the answer
Remember, clients, not nurses, are responsible for their own choices and decisions
Just keep the client’s best interests in mind and do best that you can
Set a goal to continue to work on this aspect of your practice
52. A nurse evaluated a client who participated reluctantly, answered questions with minimal responses, and rarely made eye contact. What data should be included when documenting the evaluation?
Only data obtained from the client’s verbal responses
The observation that the client was uncooperative
Analysis of why the client did not respond openly during the interview
A description of the client’s behavior during the interview
53. A client has received education on alcohol use disorder recovery. Which statement by the client indicates that learning has occurred?
Now that I’ve detoxed, my recovery is complete
I understand the goal is to decrease my drinking
I will only need to attend one meeting a week to prevent relapse
I realize that recovery is a lifelong process which will come in steps
54. Each client has their own individual medical record. Nurses enter data into this record daily during a client’s inpatient stay. Which of the following statements accurately describes the purpose of the medical record? (Select all that apply.)
A legal record of the client’s treatment
A communication tool
A tool to measure client outcomes
A tool for nurses to express opinions
A tool to document unit staffing issues
56. A nurse is preparing to administer clozapine 300 mg PO daily to a client who has schizophrenia. The amount available is clozapine 200 mg tablets. How many tablets should the nurse administer?
0.5
1.5
2
2.5
58. A nurse is teaching a group of clients regarding the use of naltrexone (ReVia) in treating alcoholism. What should be included about the effectiveness of this drug?
It prevents withdrawal symptoms
It diminishes alcohol cravings
It diminishes feelings of anxiety
It improve mood
59. A voluntarily hospitalized client tells the nurse, “Get me the forms for discharge against medical advice so I can leave now.” What is the nurse best respond?
I can’t give you those forms without your health care provider’s knowledge
I’ll get the forms for you right now and bring them to your room
Since you signed your consent for treatment, you may leave if you desire
I will get them for you, but let’s talk about your decision to leave the hospital
60. A nurse enters the room of an elderly client and notices a try of uneaten food on the bedside table. The client states, “oh, don’t bother with me. I do not have much time left in this would. And I don’t have much to live for anyway.” Which response by the nurse would be considered non-therapeutic?
You don’t have much to live?
Now, you don’t mean that
Can you tell me what you mean by “you don’t have much time left?”
Are feeling as though you are ready to die?
61. Which of the following client would meet the criteria for an involuntary admission?
A client who has a previous suicide attempt
A client who is homeless
A client who has threatened to harm their sister
A client who cannot afford medication
62. A male client frequently inquiries about the female student nurse’s boyfriend, social activities, and school experiences. Which action by the student nursing would be appropriate?
The student requests assignment to a client of the same gender as the student
The student limits sharing personal information and stresses the client-centered focus of the conversation
The student shares information to make the therapeutic relationship more equal
The student explains that if he persists in focusing on her, she cannot work with him
63. A nurse is working with a newly admitted client explaining the unit rules and daily schedule. Which of the following describes a consistent routine and a daily structure?
Hospital policy
Meaningful rounding
Therapeutic milieu
Recovery model
64. All client have legal right. Clients who have been admitted to a psychiatric facility, whether voluntarily or involuntarily have the same legal rights as any other client. Which of the following are legal rights of all clients? (Select all that apply.)
The right to treatment
The right to refuse treatment
The right to informed consent
The right to jeopardize the safety of others
The right to least restrictive form of restraint
65. During a nurse-client interaction, which nursing statement may belittle the client’s feelings and concerns?
Don’t worry. Everything will be alright
You appear uptight, through you’ve stated, “I’m fine”
I notice you have bitten your nails to the quick
Tell me more about your feelings
66. A client is admitted with a diagnosis of Major Depressive Disorder and Alcohol Abuse disorder. Which of the following defines the client’s diagnoses?
Co-dependency
Dual diagnosis
Addiction
Relapse
68. A client disclose several concerns and associated feelings. If the nurse wishes to seek clarification, which comment would be most appropriate?
What are the common elements here?
Tell me again about your experiences
Am I correct in understanding that your feeling upset?
Tell me everything from the beginning
69. A nurse is caring for a client who is prescribed haloperidol 4 mg orally on admission. An oral suspension of haloperidol 2 mg/mL is reviewed from the pharmacy. What amount of the oral suspension should the nurse administer to the client?
0.5
1
1.5
2
70. A nurse is reviewing a client’s chart and reads the following: He appeared unshaven with unkempt hair. His clothes were clean and ironed. Adam appeared to be underweighted for his height. The nurse recognizes which component of the Mental Status Exam (MSE) is being evaluated?
Behavior
Mood and affect
Appearance
Cognition
71. An inpatient psychiatric physician treating clients selects different treatment options for those without insurance. Which violation of an ethical principle should a nurse recognize in situation?
Autonomy
Beneficence
Non-maleficence
Justice
73. A client with history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical appearance support the suspicion tha that the client has relapsed?
Intense nausea
Dry mouth
Acute paranoia
Increased appetite
74. A nurse is admitting a client to an alcohol abuse program. The client states. “I’m here because of my boss haves part of my job to go to parties and drink with clients.” The client’s statement is an example of which of the following defense mechanisms?
Reaction-formation
Denial
Suppression
Rationalization
75. A nurse says to a client. “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
The therapeutic technique of giving advice
The therapeutic technique of defending
The nontherapeutic technique of presenting reality
The nontherapeutic technique of giving reassurance
76. A client on a psychiatric unit tells the nurse, “I am all alone in the world now, and I have no reason to live.” Which repose by the nurse would encourage further communication by the client?
You sound like your feeling lonely and frightened
Why do you think that suicide is the answer to you loneliness?
I live by myself and know it can be very lonely and frightening
Just hag in there and you’ll see; things will work out
78. A nurse is preparing to administer haloperidol 75 mg IM per week. Available is haloperidol decanoate 100mg/mL for injection. How many mL should the nurse administer per dose?
0.25
0.75
1.25
1.5
79. Which of the following statements best indicates a client is utilizing an individualized relapse prevention plan as part of recovery from alcohol dependence?
I can stay sober on my own, without a support system because I am strong-willed
I have to work on my own recovery once a week
I need to identify what situations I have difficulty handling
I limit myself. I only go to the bars to socialize with other people
80. During an intake interview, which question would assist the nurse in gathering data about the client’s judgment?
Do you know what day and season it is now?
On a scale of 1 to 10, how would you rate your stress level?
What does the phrase “a rolling stone gathers no moss” mean to you?
If you found a stamped, addressed envelope in the street, what would you do?
90. A nurse say to preparing to administer diphenhydramine 50 mg PO every 6 hr to a client who has acute dystonia. Available is diphenhydramine 25 mg tablets. How many tablets should the nurse administer per dose?
0.5
1
1.5
2
91. Which theories established the foundation for the professional practice of psychiatric nursing?
Harry Stack Sullivan
Hildegard Peplau
Erik Erikson
Ivan Pavlov
100. A Mexican American client puts a picture of the Virgin Marry on the bedside table. Under which section of the assessment should the nurse document this behavior?
Ethnicity
Culture
Verbal communication
Non-verbal communication
101. A client thought to be cheeking/pocketing their medication is prescribed lithium syrup 900mg bid. The syrup contains 300 mg of lithium per 5 mL. At 0800, how many milliliters would the nurse administer?
7.5
10
15
20
102

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A nurse is admitting a client who has generalized anxiety disorder. Which of the following actions should the nurse plan to take first?
Provide the client with a quiet environment
Determine how the client handles stress.
Teach the client to use guided imagery
Ask the client to identify her strengths
A nurse is conducting an admission interview with a client who is experiencing mania. Which of the following should the nurse report to the provider?
States that he hasn’t bathed in 2 days
Reports eating twice in the past two weeks.
Makes inappropriate sexual comments.
Speaks in rhyming sentences.
A nurse is planning care for a client who has obsessive-compulsive disorder. Which of the following recommendation should the nurse include in the clients plan of care?
Validation therapy
Thought stopping
Operant conditioning
Reality orientation therapy
A nurse is caring for a client who has bipolar disorder and is experiencing a manic episode. Which of the following actions should the nurse take?
Encourage the client to join group activities
Dim the lights in the client’s room
Provide detailed explanations to the client
Administer methylphenidate
A nurse is providing behavior therapy for a client who has obsessive-compulsive disorder. The client repeatedly checks that the doors are locked at night. Which of the following instructions should the nurse give the client when using thought stopping technique?
Snap a rubber band on your wrist when you think about checking the locks.
Ask a family member to check the locks for you at night.
Focus on abdominal breathing whenever you go to check the locks.
Keep a journal of how often you check the locks each night.
A nurse is caring for a client who is starting treatment for substance use disorder. Which of the following actions indicate the nurse is practicing the ethical principle of nonmaleficence?
Provide the client with quality care regardless of their ability to pay for treatment.
Educating the client about legal rights concerning treatment.
Withholding the prescribed medication that is causing adverse effects for the client.
d. Being truthful with the client about the manifestations of withdrawal.
A nurse in a group home facility is caring for a client who is developmentally disabled. The client has been stealing belongings from other clients. Which of the following techniques should the nurse use?
Crisis intervention to decrease anxiety.
Aversion therapy to provide distraction
Positive reinforcement to increase desired behavior.
d. Systematic desensitization to extinguish the behavior.
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take?
Ask the client to discuss precipitating events
Speaks to the client in a high-pitched voice.
Place the client in seclusion
Have the client breathe into a paper bag.
The nurse is caring for a client following a physical assault. The client states “I don’t remember what happened to me.” The nurse should recognize that the client is using which of the following defense mechanisms?
Repression
Displacement
Rationalization
Denial
A nurse is teaching a client who has schizophrenia about her new prescription for risperidone. Which of the following statements should the nurse include in the teaching?
“You should continue this medication if you develop muscle rigidity”.
“You will experience weight loss while taking this medication.”
“You will notice your symptoms improve within 24 hours of taking this medication.”
“You should increase your consumption of complex carbohydrates.”
A nurse is leading a crisis intervention group for adolescents who witnessed the suicide of a classmate. Which of the following actions should the nurse take first?
Initiate referrals
Review community resources
Identify prior coping skills
Discuss the importance of confidentiality
A nurse overhears a client saying, “I am a spy, a spy for the FBI. I am an I, an eye for an eye in the sky. Sky is up high.” The nurse should document the client’s statement as which of the following speech alterations?
Echolalia
Word salad
Neologism
Clang association
An older adult client is brought to the mental health clinic by her daughter. The daughter reports that her mother is not eating and seems uninterested in routine activities. The daughter states “I’m so worried that my mother is depressed” which of the following responses should the nurse make?
Everyone gets depressed from time to time.
You shouldn’t worry about this because depressive disorder is easily treated.
Older adults are usually diagnosed with depressive disorder as they age.
Tell me the reasons you think your mother is depressed.
A nurse is planning care for an adolescent who has autism spectrum disorder. Which of the following outcomes should the nurse include in the plan care?
Meets own needs without manipulating others.
Initiates social interactions with caregivers.
Changes behavior as a result of peer pressure.
Acknowledges his delusions are not real.
A nurse is caring for a client who has anorexia nervosa. Which of the following findings require immediate intervention by the nurse?
+2 edema of the lower extremities
BUN 21 mg/dL
Lanugo covering the body
Blood pH 7.60
A nurse is caring for a client in a mental health facility. The client is agitated and threatens to harm herself and others. Which of the following is the priority intervention?
Place the client in restraints
Administer an anti-anxiety medication to the client
Put the client in seclusion
Set limits on the client’s behavior
Dosage Calculation Question.
A nurse is caring for a client who was involuntarily committed and is scheduled to receive electroconvulsive therapy (ECT). The client refuses the treatment and will not discuss why with the health care team. Which of the following actions should the nurse take?
Ask the clients family to encourage the client to receive ECT
Inform the client that ECT does not require a consent.
Document the client’s refusal of the treatment in the medical record.
d. Tell the client he cannot refuse the treatment because he was involuntarily committed.
A nurse in the emergency department is caring for a client who reports feeling sad, worthless, and hopeless 9 months after the death of her son. Which of the following actions should the nurse take first?
Request a mental health consult for the client.
Ask the client if she has thought about harming herself.
Encourage the client to attend a grief support group.
Discuss the clients’ coping skills.
A nurse is caring for a client who has borderline personality disorder and has been engaging in self-mutilation. The nurse should encourage the client to participate in which of the following groups.
Dual diagnosis treatment group
Dialectical treatment group
Desensitization therapy
Co-dependents support group.
The nurse is reviewing the medication administration record of a client who has schizophrenia. The nurse should plan to initiate the Abnormal Involuntary Movement Scale to monitor for adverse effects of which of the following medications.?
Amantadine
Diphenhydramine
Benztropine
Haloperidol
A nurse is counseling a client following the death of a client’s partner 8 months ago. Which of the following client statements indicates maladaptive grieving? a. I am so sorry for the times I was angry with my partner.
I find myself thinking about my partner often.
I still don’t feel up to returning to work.
I like looking at his personal items in the closet.
A nurse is caring for a client who has borderline personality disorder. Which of the following outcomes should the nurse include in the treatment plan?
The client will report a decrease in hallucinations.
The client will communicate needs
The client will verbalize improved mood
The client will attend to personal hygiene.
A nurse is caring for a client who is prescribed massage therapy to treat panic disorder. The client states “I can’t stand to be touched by another person.” Which of the following responses should the nurse make?
Why don’t you like to be touched by others?
Don’t worry about it. Your anxiety will lessen once the massage begins.
I will tell your provider you would like a treatment other than a massage.
I will request that the massage therapist wear gloves during your treatment.
A nurse is creating a plan of care for a client who has major depressive disorder. Which of the following interventions should the nurse include in the plan?
Encourage physical activity for the client during the day
Discourage the client from expressing feelings of anger
Keep a bright light on in the client’s room at night.
Identify and schedule alternative group activities for the client.
A nurse is providing counseling for a family that consists of two parents and their two adolescent children. Which of the following family members should the nurse identify as acting in the role as the monopolize?
The mother who expresses hostility toward her spouse.
The adolescent son who refuses to share personal feelings.
The father who intervenes whenever the siblings argue.
The adolescent daughter who attempts to dominate the conversation.
A nurse is developing a teaching plan for the family of an older adult client who is to receive transcranial magnetic stimulation. Which of the following information should the nurse include in the teaching plan?
The client might have a headache after treatment.
The client will experience seizure during treatment.
The client will require intubation after treatment.
The client is at risk for aspiration during treatment.
A nurse is providing teaching about disulfiram to a client who has a history of alcohol use. Which of the following instructions should the nurse include in the teaching? (Select all that apply)
“You will need to take the medication once daily”
“You will receive treatment in an inpatient setting”
“You should avoid using mouthwash that contains alcohol”
“You should avoid drinking carbonated beverages while taking the medication”
“You can expect to develop a physical dependence to the medication”
A nurse is caring for a client who is in the manic phase of bipolar disorder. Which of the following actions should the nurse take?
Avoid power struggles by remaining neutral
Allow the client to set limits for his behavior
Provide in-depth explanation of nursing expectations
Encourage the client to participate in group activities
A nurse is assessing a young adult female client for schizophrenia. Which of the following findings should the nurse identify as a risk factor for this condition?
Environmental stress
Gender
Depression
Birth order
A nurse is providing discharge teaching about manifestations of relapse to the family of a client who has schizophrenia. Which of the following information should the nurse include in the teaching?
The client exhibits an inflated sense of self
The client develops an inability to concentrate
The client increases participation in social activities
The client begins sleeping more than usual
A nurse is assessing a client who is restless and constantly mutters to himself. Which of the following findings should lead the nurse to suspect delirium?
The client is unable to recognize objects.
The client manifestations developed suddenly
The client has a flat affect
The client’s speech is slow and repetitious
A nurse is caring for a client in an inpatient mental health facility. The client tells the nurse that the government is reading her mail. Which of the following responses should the nurse make?
“You know that’s not true, because it is against the law for others to read your mail”
“All of your letters come sealed, so that seems unlikely”
“It must be frightened to think that someone is reading your mail”
“Why do you think the government wants to read your mail?”
A nurse is assessing a client who has neuroleptic malignant syndrome. Which of the following clinical findings should the nurse expect?
Heart rate 48/min
Temperature 40 C (104 F)
WBC 3,000/mm3
Hypotonicity
A nurse is reviewing the medical record of a client who is taking clozapine. For which of the following findings should the nurse withhold the medication and notify the provider? (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.)
WBC count
Blood glucose level
Report of photosensitivity
Heart Rate
A nurse is caring for a client who has personality disorder and is using transference to cope. Which of the following behaviors should the nurse expect?
Talking negatively about other staff members
Expressing frustration regarding unit rules
Reacting to the nurse as though she were his mother
Refusing to participate in group activities
A nurse in a mental health facility is caring for a newly admitted client. Which of the following resources should the nurse recommend to help the client adapt to the health care setting?
A community meeting
A medication group
A self-help meeting
A symptom-management group
A nurse is assisting with obtaining informed consent for a client who has been declared legally incompetent. Which of the following actions should the nurse take?
Request that the client’s guardian sign the consent
Ask the charge nurse to obtain informed consent
Contact the facility social worker to obtain the consent
Explain implied consent to the client’s family
A nurse is caring for a client who has cocaine use disorder. Which of the following manifestations should the nurse expect the client to have during withdrawal?
Hand tremors
Rapid speech
Fatigue
Seizures
A nurse is providing teaching about disorder management for a client who has posttraumatic stress disorder (PTSD). Which of the following statements should the nurse include in the teaching?
“Avoiding stimuli that trigger memories of the trauma can help you overcome your PTSD”
“Talking about the traumatic experience is recommended”
“Response prevention is an effective treatment for PTSD”
“You should try to limit the number of hours that you sleep each day”
A nurse is assessing a client who has bipolar disorder and is taking lamtropine. Which of the following findings is the nurse’s priority?
Thyroid-stimulating hormone (TSH) 4.0 microunits/mL
Alanine transaminase (ALT) 20 IU/L
Skin rash
Epistaxis
A nurse is caring for a client who has schizophrenia and displays severe negative symptoms of the disorder. Which of the following actions should the nurse take?
Manage the client’s loud, rambling, and incoherent communication patterns
Direct the client to perform her own daily hygiene and grooming tasks
Assist the client to identify somatic and thought-broadcasting delusions
Use medication to decrease frequency of auditory and visual hallucination.
A nurse is beginning a therapeutic relationship with a client. The nurse should plan to accomplish which of the following tasks during the working phase?
Inform the client about confidentiality rights
Establish boundaries between the nurse and the client
Set short and long-term objectives for the future
Evaluate progress toward predetermined goals
A nurse in a mental health facility is making plans for a client’s discharge. Which of the following interdisciplinary team members should the nurse contact to assist the client with housing placement?
Clinical nurse specialist
Recreational therapist
Occupational therapist
Social worker
A nurse is caring for a client who reports that he is angry with his partner because she thinks he is just trying to gain attention. When the nurse attempts to talk to the client, he becomes angry and tells her to leave. Which of the following defense mechanism is the client demonstrating?
Denial
Displacement
Compensation
Rationalization
A charge nurse is discussing the care of a client who has a substance use disorder with a staff nurse. Which of the following statements by the staff nurse should the charge nurse identify as countertransference?
“The client is just like my brother who finally overcame his habit”
“The client needs to accept responsibility for his substance used”
“The client generally shares his feelings during group therapy session”
“The client asked me to go on a date with him, but I refuse”
A nurse is caring for a client who is admitted to a mental health facility after attempting suicide. Which of the following actions should the nurse take first?
Establish a rapport to foster trust
Implement continuous one-to-one observation
Ask the client to sign a no-suicide contract
Encourage the client to participate in group therapy
A nurse is providing teaching for a newly licensed nurse about the constructive use of defense mechanism. Which of the following examples should the nurse include in the teaching?
A student who is upset with her teacher writes a story about an excellent student
A school-age child whose mother died 2 years ago talks about her in present tense.
A woman who has health concern postpones a medical appointment until after a vacation.
An adult who was sexually abused as a child is unable to remember the incident
A nurse in an inpatient mental health facility is assessing a client who has schizophrenia and is taking haloperidol. Which of the following clinical findings is the nurse’s priority?
High fever
Urinary hesitancy
Insomnia
Headache
A nurse is planning care for a client who has a recent diagnosis of antisocial personality disorder. Which of the following outcomes should the nurse include in the care plan?
The client recognizes the importance of others
The client conforms to social norms regarding clothing choices
The client reduces self-dramatization
The client treats others with respect
A nurse is planning care for a newly admitted client who has anorexia nervosa. Which of the following interventions should the nurse include in the plan?
Negotiate with the client how much weight she should gain each week.
Decrease the client’s daily intake of fiber
Weight the client weekly for the first month
Notify the client about designated time for meals
A client is fearful of driving and enters a behavioral therapy program to help him overcome his anxiety. Using systematic desensitization, he is able to drive down a familiar street without experience a panic attack. The nurse should recognize that to continue positive results, the client should participate in which of the following?
Therapist modeling
Positive reinforcement
Frequent practice
Biofeedback
A nurse in the emergency department is counseling a client who reports experiencing intimate partner violence. Which of the following actions should the nurse take?
Request permission from the client to take photographs of the injuries
Offer to help the client escape form the partner the next time violence occurs
Determine what the client did to trigger the violent incident
Tell the client that staying with the partner shows a lack of judgment
A nurse is caring for a client who has prescription for phenelzine. The nurse should instruct the client to avoid which of the following over-the-counter medications?
Ranitidine
Pseudoephedrine
Ibuprofen
Docusate sodium
A nurse is caring for a client who is experiencing active auditory hallucinations. Which of the following actions should the nurse take?
Avoid asking direct questions about the client’s experience
Convey sympathy for the client’s experience
Tell her client her experience is not real
Focus the client on reality-based activities
A nurse is caring for a client who has just returned to the unit after receiving an electroconvulsive therapy treatment. Which of the following assessments is the nurse’s priority?
First voiding
Short-term memory
Presence of gag reflex
Return of bowel sounds
A nurse is talking to a client following a group therapy session. The client tells the nurse that one of the other clients in the group made an inappropriate comment. Which of the following responses should the nurse make?
“I think you should ignore the comment”
“You sound upset about today’s session”
Why do you think that he said that to you?”
“I agree that the comment was inappropriate”
A nurse is assessing a client who is experiencing acute alcohol withdrawal. Which of the following findings should the nurse expect?
Hypotension
Insomnia
Bradycardia
Diminished reflexes
A nurse is teaching a client who has bipolar disorder and a new prescription for lithium carbonate. Which of the following statements by the client indicates an understanding of the teaching?
. “I should drink at least 6 liters of water per day”
“I should be on a low-sodium diet”
“I will call my doctor if I have diarrhea”
“I will see my doctor to check my lithium levels annually”
A nurse in an acute care mental health facility is planning discharge care for a client who sustained a traumatic brain injury. For which of the following needs should the nurse collaborate with a clinical psychologist?
The client needs a prescription for medication to promote nighttime sleep while in the facility
The client needs to find a place to live after discharge
The client needs to begin a group therapy program prior to discharge
The client needs to relearn how to perform skill that require fine motor coordination
A nurse is reviewing the laboratory report of a client who is taking carbamazepine for bipolar disorder. Which of the following laboratory results should the nurse report to the provider?
Urine specific gravity 1.029
Platelets 90,000/mm3
Urine pH 5.6
RBC 4.7/mm3
A nurse is teaching the caregiver of a client who has advanced Alzheimer’s disease about home safety. Which of the following statements by the caregiver indicates an understanding of the teaching?
I will ensure the bedroom is dark while he is sleeping at night
I will place a sliding bolt lock just above the doorknob
I will notify law enforcement within 2 hours if he cannot be found
I will give his most recent photo to the police
A nurse is teaching a client who has a new prescription for phenelzine to treat depression. The nurse instructs the client to avoid foods with tyramine to prevent which of the following?
Hypertensive crisis
Cardiac toxicity
Serotonin Syndrome
Urinary retention
A nurse in an outpatient clinic is assessing a client who has anorexia nervosa. Which of the following findings indicates the need for hospitalization?
Potassium 3.8mEq/L
Heart Rate 56/min
Temperature 35.6C (96.1F)
Weight 10% below ideal weight
A nurse us obtaining a medical history from a client who is requesting a prescription for bupropion for smoking cessation. Which of the following assessment finding in the client’s history should the nurse report to the provider?
Hepatitis B Infection
Hypothyroidism
Knee arthroplasty 1 month ago
Recent head injury
A nurse is providing crisis intervention for a client who was involved in a violent mass causality situation in the community. Which of the following actions should the nurse take during the initial session with the client?
helps the client focus on a wide variety of topics regarding the crisis
identify the client’s usual coping style
tells the client that his life will soon return to normal
encourages the client to display anger toward the cause of the crisis
A nurse in the community health facility is interviewing a client who recently lost his job. The client states “I was fired because my boss doesn’t like me” Which of the following defense mechanisms is the client displaying?
Rationalization
Displacement
Dissociation
Repression
A nurse is providing teaching to a client who has depressive disorder and a new prescription for doxepin. Which of the following instructions should the nurse include in the teaching?
sits on the side of the bed for a few minutes before standing
decreases the prescribed dose by half when mood improves
avoid over the counter magnesium when taking this medication
eat a snack before going to bed
A nurse is planning care for a client who has dementia. Which of the following interventions should the nurse include in the plan?
give detailed instructions for completion of self-care activities
confront the client when he exhibits inappropriate behavior
provide finger foods to enhance caloric intake
remove clocks from the client’s room
A nurse is planning overall strategies to address problems for a client who has borderline personality disorder. Which of the following strategies is the priority for the nurse to incorporate in the plan of care?
discuss the appropriate use of assertive behavior with the client
encourage the client to attend weekly support group meetings
assist the client to maintain awareness of her thoughts and feelings
implement measures to prevent intentional self-inflicted injury

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1, A nurse is caring for a client who had a vaginal delivery 1 day ago. The nurse determines that the client’s fundus is firm, located 2 fingerbreadths above the umbilicus. And deviated to the left. Which of the following actions should the nurse take first?

A, Notify the provider.
B, Administer a prescribed analgesic.
C, Monitor perineal pads for clots.
D, Assist the client to empty her bladder.
2, A nurse is reinforcing teaching about an amniocentesis with a client who is at 34 weeks of gestation. Which of the following instructions should the nurse include in the teaching?

A, “You should report uterine contractions following the procedure to your provider.”
B, “You should take milk of magnesia the night prior to the procedure.”
C, “You will have blood work drawn before the procedure.”
D, “You should anticipate a small amount of leakage of fluid following the procedure.”

3.A nurse on a postpartum unit is caring for a client who delivered vaginally 24hr ago. Which of the following should the nurse expect to find when collecting data?

A, Frequent urges to urinate
B, Moderate lochia serosa on perineal pads
C, Colostrum expressed from the breast
D, Uterine fundus 2 finger widths above the umbilicus

4. A nurse is assisting in the care of a client who is experiencing an unruptured ectopic pregnancy that is at 8 weeks of gestation. Which of the following medications should the nurse expect the provider to prescribe?

A, Methotrexate
B, Calcium gluconate
C, Terbutaline
D, Magnesium sulfate

5. A Nurse in a prenatal clinic is reinforcing teaching with a client about expected physiological changes during pregnancy. Which of the following statements by the client indicates an understanding of the teaching?

A, “I may have developed discoloration on my cheeks from hormonal changes.”
B, “I should expect my fingers and face to be swollen.”
C, “I may have an infection if I develop a dark line in the middle of my abdomen.”
D ” I should expect to have burning when I urinate during the third trimester.”

7. A nurse is collecting data from a newborn who was born 2 hr ago. Which of the following findings should the nurse report to the provider?

A, Blood glucose level 40 mg/dl
B, Hypotonia
C, Overlapping suture lines
D, Acrocyanosis

8.A nurse in a clinic is discussing contraceptive methods with a client. Which of the following methods should the nurse recommend as having the lowest failure rate?

A, Intrauterine device
B, Diaphragm
C, Contraceptive sponge
D, Oral contraceptives

9. A nurse is reinforcing teaching about car seat safety with a new parent. Which of the following statements should the nurse include in the teaching?

A, “You should place the shoulder harness at the level of your baby’s shoulders.”
B, “You should keep the car seat rear facing unit when your baby is 6 months old .”
C, “You should position your baby in the car seat at a 30- degree angle.”
“D, You should place the retainer clip at the level of your baby’s abdomen.”

10.A nurse working on a postpartum unit is collecting data from four clients.Which of the following findings should the nurse report to the provider?

A, A client who reports their perineal pad every2 hr?
B, Aclient who reports painful uterine contractions during breastfeeding
C, A client who has a reddened area on their right calf
D, A client who has a urinary output of 125 mL in 4 hr

11. A Nurse in an antepartum clinic is reinforcing teaching with a client who is pregnant and has a new prescription for oral ferrous sulfate. Which of the following statements by the client indicates an understanding of the teaching?
A, “I will take this medication with a glass of orange juice.”
B, “I will take this medication with breakfast.”
C, “I will take this medication with a glass of milk.”
D, “I will take this medication with my middy meal.”

12 A nurse is collecting data from a newborn who is 1 hr old and was born at 43 weeks of gestation. Which of the following findings should the nurse expect?

A, Long hard nails
B, Excessive lanugo
C, Absent vernix
D, Dry,cracked skin
E, Hypotonia

14. A nurse is planning care for a newborn who is large for gestational age.Which of the following actions should the nurse include in the plan of care?

A, Check the newborn’s blood glucose level.
B, Obtain a stool sample of meconium.
C, Check the newborn’s skin for ecchymosis.
D, Assist with administering a blood transfusion to the newborn.

15. A nurse is preparing to administer metronidazole 2 g po. The amount available is 500mg tablets. How many tablets should the nurse administer? (Round the answer to the nearest whole number.Use a leading zero if it applies. Do not use a trailing zero.)
————-tablets.

17. A nurse is reinforcing teaching about home safety precautions with the guardian of a newborn. Which of the following instructions should the nurse include?

A, Wash the newborn’s face with a warm, soapy washcloth.
B, Ensure the crib has soft bumper pads on the inside.
C, Place a small pillow under the newborn’s head during naps.
D, Set the temperature on the water heater to 48.8dgree C (120 degree.F).

18.A nurse is collecting data from an adolescent who is postoperative following a cesarean birth and is reviving morphine for pain. Which of the following findings is the nurse’s priority?

A, Urinary retention
B, BP 105/62 mm Hg
C, Respiratory rate 11/min
D, Blurred vision

19. A nurse is collecting data from a term newborn who is 12hr old. Which of the following findings should the nurse report to the provider?
A, Abdominal breathing
B, Irregular respirations
C, Respiratory rate 55/min
D, Grunting

20.A home health nurse is caring for a client who has unilateral mastitis and is experiencing discomfort in the affected Breast.Which of the following instructions should the nurse include?

A, Tell the client to apply hydrocortisone ointment to the affected area of the breast.
B, Encourage the client to limit oral fluid intake to decrease milk production.
C, Suggest the client apply warm compresses to the affected breast .
D, Recommend the client avoid wearing a nursing bra until symptoms resolve.

21. A nurse is preparing to collect a specimen for the newborn screaming. Which of the following actions should the nurse take?

A, Warm the newborn’s heel for 5to 10 min before the puncture.
B, Apply an antiseptic to the newborn’s heel after collecting the specimen.
C, Use a lancet to puncture the inner aspect of the newborn’s heel.
D, Leave the newborn’s heel open to the air after the puncture.

22. A nurse is reinforcing teaching about outpatient resources for a client who is recovering from a molar pregnancy. Which of the following statements by the client indicates an understanding of the teaching?
A, “I will need an amniocentesis within 1 month.”
B, “I will need home panative services after I am discharged from the hospital.”
C, “I will need to start chemotherapy immediately.”
D, “I will need to attend a support group when I get home .”
23. A nurse is contributing to the plan of care for a newborn who required phototherapy for hyperbilirubinemia.Which of the following interventions should the nurse recommend including in the plan?

A, Imposition the newborn every2 to 3 hr.
B, Monitor the newborn’s blood glucose level every 2 hr .
C, Apply a water- based ointment to the newborn’s skin every 4 to 6hr.
D, Gave the newborn 30 mL of distilled water after each feeding.

24. A Nurse is collecting data from a client who is receiving terbutaline to treat preterm labor. Which of the following findings should the nurse report to the provider?

A, Dizziness
B, Nausea
C, Termos
D, Crackies

26.A nurse on the postpartum unit is caring for a client who delivered vaginally 3 hr ago. Which of the following manifestations is a possible indication of postpartum hemorrhage?
A, Apical pulse 66 min
B, Blood pressure 156/80 mm Hg
C, Respiratory rate 32/min
D, Temperature 38.3dgree C(101 degreeF)

27. A nurse is collecting data from a client at a 6-week postpartum checkup. The client tells the nurse.”I am breastfeeding and would like to use a birth control pill.” Which of the following statements should the nurse make?

A, ” Birth control pills are contraindicated for breastfeeding clients.”
B, “Progestin-only birth control pills are preferred for contraception during lactation.”
C, “You do not need a birth control pill as long as you are lactating.”
D, “Taking birth control pills while breastfeeding can increase your risk for breast cancer.”

29. A nurse is reinforcing teaching about safety measures for preventing newborn abduction with a client who is postpartum. Which of the following statements should the nurse make?

A, “Carry your baby in your arms when you go for a walk in the hallway.”
B, ” If your baby’s identification band slips off. Place it in the drawer of the bassinet.”
C, “Make sure anyone caring for or transporting your baby is wearing an identification badge.”
D, “Place your baby in the bassinet in your room by the bed when you use the bathroom.”
32. A nurse is auscultating fetal heart tones with a Doppler device for a client who is at 12 weeks of gestation . Where should the nurse expect to auscultate the fetal heart tones?

A, Umbilical area
B, Below the liver border on the right abdomen
C, Above the left iliac crest
D, Suprapublic area

33. A nurse is reinforcing teaching about laboratory testing with a client who is at 6 weeks of gestation. Which of the statements should the nurse include?

A, “You will have a group B strep culture at 36 weeks of gestation.”
B “You will have Maternal serum alpha-fetoprotein screening at 6 weeks of gestation.”
C, “You will have a screening for gestational diabetes at 12 weeks of gestation.”
D, “You will have to produce a clean catch urine specimen every 2 months.”

35. A nurse is caring for a client who is 34 weeks of gestation and is preparing to undergo a nonstress test.
A, Instruct the client that oxytocin is administered during the procedure.
B, Ensure the client has been NPO for 6hr prior to the procedure.
C, Assist the client to a lateral tilt position prior to the procedure.
D, Inform the client that this procedure assists in indicting Down syndrome .

36. A nurse is collecting data from a client who is receiving epidural anesthesia. Which of the following findings indicates an adverse effect of this method of pain management?

A, Tachycardia
B ,Tachypnea
C, Fever
D, Hypertension
37. A nurse is preparing to administer phytonadione to a newborn. Which of the following actions should the nurse take?

A, Check the mother’s Rh factor prior to administration.
B, Administer the medication 12 hr after birth.
C, Administer the medication with a 25-gauge needle.
D, Administer the medication into the deltoid muscle.

38. A nurse is caring for a client who is in the early stages of labor and requests non pharmacological interventions for pain. Which of the following actions should the nurse take?

A, Assist the client in remaining awake between contractions.
B, Encourage the client to vold often.
C, Minimize the clients position changes .
D, Limit the amount of the time the support person remains in the room.

40. A nurse is assisting a provider with a pelvic examination of a client during her first prenatal visit. Which of the following actions should the nurse take?

A, Assist the client into a Sim’s position prior to the procedure.
B, Instruct the client to tighten her pelvic muscles during the procedure.
C, Ask the client to empty her bladder prior to the procedure.
D, Encourage the client to take rapid,shallow breaths during the procedure.

41. A nurse is preparing to collect a blood specimen from a newborn via a heel stick.Identify the sequence of steps the nurse should follow. (Move the steps into the box on the
right . Placing them in the order of performance . Use all the steps.)

Conform the newborn’s identity.
Apply gentle pressure to the site with dry gauze.
Cleanse the site with an antiseptic.
Warm the newborn’s heel.
Pierce the newborn’s heel.

42. Anurse is assisting with the care of a client who is in labor and has an epidural infusion for pain management. The client’s blood pressure is 80/40 mm Hg. Which of the following actions should the nurse take

A, Administer methylergonovine IM.
B, Place the client in a knee-chest position.
C, Give a bolus of lactated Ringer’s.
D, Assist the clients to empty her bladder.

43. A nurse is caring for a client who reports discomfort due to afterpains following breastfeeding. Which of the following actions should the nurse take?

A, Administer ibuprofen to clients.
B, Place the client in a side-lying position.
C, Apply a cool compress to the client’s abdomen.
D, Encourage the client to perform Kegel exercises.

44. A nurse in the provider’s office is collecting data from a client who is at 34 weeks of gestation and reports having a sudden gush of vaginal fluid. Which of the following manifestations is the priority ?

A, Fetal heart tones 98/min
B, Maternal temperature 38.3dgree C (101dgree F)
C, foul smelling vaginal discharge
D, Amniotic fluid with meconium noted

45.A nurse on a postpartum unit is caring for a client who is breastfeeding and experiencing breast engorgement. Which of the following interventions should the nurse plan to implement to promote comfort for his client?

A, Have the client apply purified lanolin to her breasts.
B, Advise the client to avoid using a breast pump.
C,Provider the client with ice packs for her breasts.
D, Encourage the client to wear a loose- fitting bra.

46. A nurse is assisting with a prenatal class discussion about newborn safety. Which of the following understandings of the teaching?

A, “I should replace the batteries in my smoke detector twice per year”.
B, “I should use baby powder with each diaper change”.
C, “I should elevent my baby’s head on a cushion when she is sleeping”.
D, “I should set my hot water heater to 130 degrees Fahrenheit”.

47. A nurse is caring for a client who is postpartum and experiencing excessive vaginal bleeding. Which of the following medications should the nurse plan to administer?

A, Nifedipine
B, Terbutaline
C, Betamethasone
D, Oxytocin

48. A nurse is caring for a client who asks about the purpose of a papanicolaou test. Which of The following responses should the nurse make ?

A, “This test detects the presence of endometriosis.”
B, “This test determines your ovulation status.”
C, “This test detects the presence of cervical cancer.”
D, This test allows for the removal of uterine fibroids.”

49, A nurse is caring for a newborn whose mother had gestational diabetes. The newborn has a blood glucose level of 30mg =/ dL and is asymptomatic. Which of the following actions should the nurse take?

A, Administer glucagon.
B, Check urine for ketones.
C, Encourage additional feeding.
D, Recheck blood glucose in 4 hr .

50. A nurse in a clinic is reinforcing teaching about signs of breastfeeding with a client who has a 5-day -old newborn. Which of the following. Statements by the client demonstrate an understanding of the teaching?

A, “My baby will have at least six wet diapers every day.”
B, “I should be able to feel my baby swallowing during breastfeeding .”
C, I should expect moderate tenderness during breastfeeding.”
D, “My baby will have at least one bowel movement every day.”

52. A nurse is assisting in the care of a client who is in labor and whose membranes ruptured 6hr ago. Which of the following is an appropriate nursing intervention for this client?

A, Prepare for a forceps delivery.
B, Obtain consent for a cesarean birth.
C, Position the client supine.
D, Monitor for infarction.

53. A nurse in a prenatal clinic is collecting data from four clients. Which of the following findings is the nurse’s priority to report to the provider?

A, Varicose veins
B, Leukorrhea
C, Dysuria
D, Gingivitis
54. A nurse is reinforcing teaching with a client about the care of their newborn’s umbilical cord. Which of the following statements by the client indicates an understanding of the teaching?

A, “I should clean the cord with antibacterial soap with each diaper change.”
B, “I should keep the cord covered with my baby’s diaper.”
C “I should notify my baby’s provider if there is odor coming from the cord.”
D, ” I should expect some bright red bleeding from the cord until it falls off .”

55. A nurse is caring for a full-term newborn who is 1 day old.Which of the following laboratory findings should the nurse report to the provider?

A, Glucose 60 mg/dL
B, Platelets 225,000/mm3
C, Hgb9.5g/dL
D, WBC 10,000/mm3

56. A nurse in a prenatal clinic is reinforcing teaching with a client who is at 20 weeks of gestation and has a low calcium level. Which of the following foods should the nurse recommend the client increase in her diest?

A, Long-grain rice
B, Peanut butter
C, Avocados
D, Yogurt

57. A nurse is reinforcing teaching about perineal care to a client who is 2hr postpartum and has an episiotomy and hemorrhoids.Which of the following statements by the client indicates understanding of the teaching?

A, “I will use the numbing spray prior to cleansing the area.”
B, “I will apply witch hazel pads after urination.”
C, “I will place a heat pack in the area several times a day.”
D, “I will remain in the sitz bath for 10 minutes.”

58. A nurse is caring for a client who is postpartum. The client is experiencing excessive vaginal bleeding and has a boggy uterus. Which of the following actions should the nurse take first?

A, Initiate fundal massage.
B, Administer methylergonovine0.2mgIM.
C, Encourage the client to empty her bladder.
D, Appy oxygen via non-rebreather mask at 8 L/min

59. A nurse in a provider’s office is collecting data from a client who is requesting a prescription for a transdermal contraceptive patch. The nurse should recognize that which of the following client findings is a contraindication for this method of contraception?

A, Weight 98kg (216lb)
B, BP 120/70 mm Hg
C, History of spontaneous abortion
D, Peptic ulcer disease

60. A nursing is planning to reinforce nutritional teaching with a client who is in her first trimester of pregnancy. The nurse should recommend an increase in which of the following nutrients to support an increase in maternal blood volume during pregnancy?
A, Vitamin E
B, Vitamin D
C, Iron
D, Calcium

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Oxygen Therapy

Many of the clients you encounter will require the use of oxygen (O2) as part of their treatment. Oxygen is a gas that is vital to life— without it, tissue cells can die in four to six minutes. With proper handling and storage techniques, it is a safe and effective therapy.

How is it decided that a client requires oxygen?

Oxygen must be prescribed by a physician and is therefore treated like a drug: the PSW may not administer Oxygen; however, they may assist clients with their therapy. If the PSW should have any questions or concerns, they should immediately notify their supervisor.

In order to decide whether or not a client will require Oxygen therapy, several factors must be considered. The first thing is the client’s oxygen saturation (you might hear this called the “O2 sat”). A special monitor is attached to a client’s finger or toe, and a sensor measures how much oxygen is in the blood (how much oxygen has saturated the blood). This measurement is read as a percentage. Most healthy people have an O2 sat in the high nineties to 100 range. Anything consistently below 90% is usually a sign that the client will need O2 therapy.

Chronic breathing illnesses causing lung damage, like Bronchitis, or COPD (chronic obstructive pulmonary disease), as well as cigarette smoking, are major causes of low O2 sats. These clients are usually placed on long-term, continuous O2 therapy.

Sometimes people are admitted to hospital with a breathing crisis, such as pneumonia or another respiratory infection. Their O2 sat would be low and O2 immediately given. This is not considered long term therapy because once the crisis is over, their O2 sat should recover and, therefore, the need for oxygen will be gone.

It is important to remember that every client is different and will be prescribed oxygen therapy on an individual basis. The PSW’s observations and input regarding the client’s status and how well they manage their treatment are key factors in the successful use of O2 therapy.

What is the difference between intermittent and continuous therapy?

Intermittent therapy is used only when the client’s symptoms require it. An example of this might be when a client becomes short of breath after activity. At rest, they don’t require O2. However, the activity will increase their need for it.

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Continuous therapy is used when clients require O2 24 hours a day. Usually these clients have a chronic type of respiratory illness that results in a low O2 saturation. They will generally feel tired, sluggish, and have a low activity tolerance— all of these should stabilize as treatment progresses.

Always remember that the client with breathing difficulties may have a tendency to be somewhat anxious, which can, in turn, increase shortness of breath! Many state they feel like they’re “suffocating,” or that something bad is going to happen to them. Oxygen therapy can be very reassuring to them. Support from the PSW is a vital part of the therapy. Helping to keep calm, staying with them, and making sure they are using the equipment safely are part of the PSW role.

Who decides how much oxygen a client receives?

Again, because oxygen is considered a drug, the physician not only decides what type of therapy the client receives, but also how much.

Oxygen is delivered at a specific flow rate. This flow rate is measured in liters per minute (L/min). All oxygen is turned on, and then the flow meter is dialed to the appropriate number (e.g. a client is prescribed 2L/min per NP). Clients and family members are instructed on how to use and regulate the flow meter.

It is important to understand that the PSW’s role is only to assist with this aspect of oxygen therapy. The PSW should never adjust or prescribe a different flow rate. Many clients and family members will ask the PSW to do this for a good number of reasons. They might say, “but I’m so short of breath. If the 2L isn’t helping me, shouldn’t I try the 3L? It’s not much more!” If the family or PSW has concerns regarding the client’s breathing status, they should notify the doctor and nursing supervisor immediately.

How is oxygen supplied to the client?

Several different methods are used. In some facilities, there will be a central storage area for oxygen, and the users simply plug their O2 tubing into a wall outlet. This is not practical in a smaller facility or in a private home.

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Portable oxygen tanks (cylinders) are an option when your client is mobile. Large tanks are available for use inside the home/facility. Long, extendable tubing is attached so that the client may freely move about the area. Caution should be used to avoid tripping over the tubing!

When clients wish to venture to another location outside of the home/facility, smaller, portable cylinders are available. These cylinders may be moved on a cart or carried in a special carrying device. They don’t last as long as the larger cylinders, but do give clients the freedom to travel, keep appointments, and escape the four walls of their home! These small cylinders are also handy in an emergency situation, or whenever a client is being moved from one area to another.

It is important to note that the oxygen we have been discussing has been in the form of gas. Liquid oxygen is also available. Large canisters (similar to tanks) are used to store the cold (-294 degrees F) liquid oxygen. The client and family may be trained to fill smaller, portable canisters from a larger, main unit. The O2 supplier would be scheduled to refill the main unit on a regular basis.

Perhaps the most cost-efficient and commonly used system in the community is the oxygen concentrator. It is an electrical device that takes room air, extracts the oxygen, and delivers it to the patient. Since it is powered by electricity and is not portable, the client should have an alternate source of O2 available (such as a canister of O2). The “backup” system could be used in the event of a power failure, or if they wish to leave the home and must keep their oxygen on. Lengthy O2 tubing could be attached to the concentrator to allow the client mobility within their home.

Some clients may be concerned about the added cost of electricity on their monthly hydro bill. Using the current rate, the cost for one client on 24hr/day O2 concentrator therapy would amount to approximately $260.00 per year, or approximately $21.60 per month. This can be a burden to someone who is living on a fixed income. The Assistive Devices Program is designed to help clients cope with the added financial burden by providing partial or full financial assistance.

How does the oxygen get from the source to the client?

Before the oxygen actually reaches the client a couple of things must happen first. Think about the respiratory system: what happens to the air you breathe before it gets in your lungs? First, the little hairs in your nose and bronchus filter out many of the microscopic particles of dirt and other materials. Second, the air is warmed and moistened by passing over the mucous membranes that line the structures of the respiratory system.

Since we are not using “room air” in most cases, the oxygen the client receives has no real need to be filtered, because the oxygen concentrator will filter the room air before delivering it to

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 4 | 11
the client. However, the oxygen remains very dry and needs to have some humidity added to it. This procedure is usually done by attaching a humidifier (“water bottle”) to the oxygen source before the oxygen is sent through the tubing. This way, the client receives oxygen that has already been moistened.
Note: It is important to remember that even though this “humidity” has been added, O2 can still be very drying to the client’s mucous membranes. This may result in complaining of a dry nose, sore nose, nosebleeds, or a dry mouth. It is important that these complaints be listened to: if we ignore them, the client is less likely to be compliant with their treatment. Dealing with these problems will be discussed later on in this assignment.

There are two main ways to get the oxygen to the client. The first method is by using a face mask. This mask should cover both the nose and mouth. Small holes on the sides of the mask allow CO2 (Carbon dioxide – a waste material from breathing) to escape when the client breathes out, and room air to enter when the client breathes in.

The face mask has a tendency to be uncomfortable for some clients. Some people find the pressure from the mask constantly on their skin very bothersome. Others find that having the mask on their face feels as if they are going to suffocate. The mask will also interfere with a person’s eating, drinking, and conversation. It is beneficial for clients who are on a high-flow rate of O2.

In some cases, a special colour-coded plastic device at the base of the tubing will determine the percentage of O2 that the client receives. This will be ordered by the physician and is not to be determined by the PSW. The PSW’s role is to follow the client’s normal routine for oxygen use. If this routine changes, they should notify their supervisor.

The second method used in nasal cannula: these are often referred to as nasal prongs, NP for short. This is the most widely used method. This device will look like a very long piece of oxygen tubing with two little “prongs” sticking out. These two prongs will curve slightly and should be placed in the nostrils (nares) so that the prongs point downward— otherwise, it will be very uncomfortable and irritating for your client and may hamper the flow of oxygen. The tubing is then placed behind the ears to hold the prongs in place. A small, sliding plastic “holder” can be slid up the neck portion of the tubing to secure the prongs in place, much like a hat that fits under the chin. Some clients prefer the tubing to be placed behind their head, going down their back: this would be most comfortable for clients who are immobile.

Nasal cannula allow a great deal more freedom than a mask. A client would be free to wander, eat, drink, talk, and complete their ADLs. By attaching one or more pieces of extension tubing to the cannula, you can allow the client to go further distance. Caution should be used with the use of canes and walkers— you don’t want them to get tangles in the tubing! Tubing may be pinned or taped to the client’s clothing to keep it free of kinks and from getting in the way.

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 5 | 11
Although cannulas are used with lower flow rates of O2, clients may still complain of the drying effects. They may also complain of irritation from the tubing on the face or behind the ears. This can be dealt with by gently padding the area with some gauze.

It is important to understand that although clients are prescribed continuous O2 therapy, they will not die if they go without it for a short while. Many clients will have their face mask or nasal prongs fall off while they are asleep and not notice until a couple of hours later. Removing the oxygen while they dress or bathe is generally not a problem either. Just remember that some clients get extremely anxious, and the PSW should be there to support and reassure them.

What do I need to know to handle oxygen safely?

The greatest risk that O2 use presents is that of fire. Although O2 itself will not burn, it will help or accelerate other materials to do so. In fact, a fire will generally not continue without the presence of oxygen. Listed below are some of the safety measures that can be used by the client/family/PSW:

1. Any flammable materials and/or heating sources should be kept a minimum of 5-10 feet away from O2 equipment. Such items may include: curling irons, heating pads, hair dryers, electric blankets, and electric razors.

2. Do not attempt to lubricate equipment. Leave this for the professionals! Oil and grease based lubricants easily explode. Also, aerosolized sprays often contain particles that can be dangerous if inhaled by a client with breathing difficulties.

3. Avoid the use of aerosol sprays around oxygen equipment. These cans are under pressure and can easily explode. Also, aerosolized sprays often contain particles that can be dangerous if inhaled by a client with breathing difficulties.

4. Petroleum based products should be avoided. These include: Vaseline (petroleum jelly), Nivea cream, or any combination cream that contains petroleum. Clients may wish to use these products to moisturize areas left dry and irritated by the use of O2 equipment. Water based products can be used as safe alternatives: Muko, KY Jelly, or Secaris can be used inside a dry nose instead of Vaseline. Vaseline Intensive Care Lotion or a similar product may be used on other areas.

5. Keep all equipment in a well-ventilated area. Doing this will prevent an accumulation of O2 that could be a fire hazard

6. Liquid oxygen units should always be kept airtight. This will prevent an accumulation of O2 that could be a fire hazard.

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7. Oxygen tubing should never be obstructed or “kinked.” Never place the tubing underneath carpeting, furniture, blankets, or clothing as this may allow O2 to accumulate, causing a fire hazard.

8. Use caution when transporting O2. The oxygen supply company should be consulted on how to safely “move” O2 cylinders and tanks: this should be reviewed when the O2 therapy is initiated. The tanks/cylinders should not be stored in an area without ventilation, such as the trunk of the car.

9. Avoid smoking in the area where the oxygen is being used. Smoking near O2 poses an EXTREME risk for fire, explosion, or injury. The following are some situations you may encounter:

a. Client smokes well away from O2 equipment that has been turned off. There is no real immediate hazard with this, but it is possible that the client may forget to turn off the O2 at some point. Be sure to notify your supervisor and document carefully.

b. Client smokes with O2 on. This is EXTREMELY dangerous! If the client is doing this when you arrive for your visit, you MUST ask them to put out their cigarette, etc. If they refused your request, you must leave the premises for your own safety. Your supervisor must be notified IMMEDIATELY!

c. Client who is cognitively impaired and states that they still smoke while they are on O2 therapy. As long as the client is not doing this while you are visiting, it is safe for you to stay. However, safety rules should be reviewed with the client and their family as well as notifying your supervisor.

These guidelines also apply to family members and visitors in the home. It is suggested that if family or visitors wish to smoke, they do so at least 10 feet from the oxygen— even better would be to go outside. A warning sign may be obtained from the oxygen supply company and posted on the door to warn all visitors that oxygen is in use.

When it comes right down to it, oxygen safety is mostly about common sense. If you are ever in doubt about how to handle a situation, contact your supervisor or even the oxygen supply company and ask its advice. Educate yourself about safe handling practices and you will be able to pass their knowledge along to your clients.

This learning package was designed to help you become familiar with the basics of oxygen therapy. If possible, you should try to get some “hands-on” experience while completing your

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 7 | 11

clinical rotation. Be certain to let your instructor and the clinical staff know that you are interested so they will be on the lookout for learning opportunities for you.

The following pages contain your oxygen therapy assignment and are to be completed outside of classroom time and handed in on the due date given by your instructor. Please keep this reading assignment in your notes for future reference.

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 8 | 11
Oxygen Therapy Hand-in Assignment /30

1. Define the term oxygen saturation. (1 Mark)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

2. List two causes that can contribute to a low O2 sat reading. (2 Marks)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

3. Define the term “continuous oxygen therapy” and explain why it is beneficial for people with chronic breathing difficulties. (2 Marks)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

4. Why is humidity added to the oxygen source before it is breathed by the client? (1 Mark)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 9 | 11

5. You are assigned to Mr. Cy Hendriks to provide assistance with ADLs. This client has emphysema and there is oxygen equipment in the home. While preparing to assist him with his morning bath, you notice that he smells of cigarette smoke, although you don’t notice any cigarettes or ashtrays nearby. How would you proceed with this situation? (3 Marks)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

6. List two possible hazards that occur when clients/family members smoke near oxygen. Describe two actions the PSW could take to avoid these hazards in the workplace and ensure their safety as well as the client’s. (4 Marks)

Hazard one______________________________________________________
_______________________________________________________________

Hazard two______________________________________________________
_______________________________________________________________

Actions_________________________________________________________
_______________________________________________________________

7. What is the PSW’s role regarding the client’s use of oxygen therapy? (1 Mark)
_____________________________________________________________________
_____________________________________________________________________

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 10 | 11
8. During your home visit with Mrs. Emma Rock, she complains that the nasal cannula she has been wearing is irritating her cheeks and behind her ears. What are two ways the PSW could assist her? (2 Marks)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

9. Name two products that should be avoided when a client is using oxygen. For each product name a safer alternative. (4 Marks)

Product to be avoided Alternative product

10. List three ways that oxygen may be supplied to the client. (3 Marks)
______________________, ____________________, ____________________

11. When clients have dyspnea (difficult or painful breathing), they are often anxious and upset. What are two interventions the PSW could do to help reduce their anxiety? (2 Marks)
________________________________, _______________________________

12. Name three breathing illnesses that may require the client to use oxygen on either a temporary or continuous basis. (3 Marks)
____________________, ____________________, _____________________

13. Your client complains he is SOB and asks you, his PSW, to turn their oxygen up “just a bit.” The oxygen is currently running at the prescribed amount of 3L per minute. How do you respond to your client? (2 Marks)
_______________________________________________________________
________________________________________________________________

© N A C C 2 0 1 7 V . 4 Section IV. Module 12. Health Conditions 11 | 11

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1.
Question:
During a session, the PMHNP asks a patient with a history of sexual
abuse to recall the relationship she had as a child with her parents. The patient
responds by saying she has a headache and her stomach hurts, and starts talking
about her physical ailments. What is the appropriate response by the PMHNP?
2.
Question:
A PMHNP is assessing ego functioning of his 40-year-old patient by
asking what she feels is the cause of her problems. She attributes her problems to
her overprotective parents not letting her have enough freedom growing up. Based
on her answer, the PMHNP is testing _____________.
3.
Question:
A 28-year-old male patient is experiencing distress related to the
workplace. What might the PMHNP ask to assess affective development?
4.
Question:
The PMHNP has been treating a 15-year-old patient with a history of
abuse and neglect. Thirty minutes into their therapy session the patient jumps up
and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s
best action would be to:
5.
Question:
The PMHNP understands that anxiety and depression are two
disorders in which their symptoms may overlap. When discussing this, you explain
that the autonomic nervous system is activated and further helps distinguish anxiety
symptoms by making the following points:
6.
Question:
A PMHNP is taking a history and wants to assess how the patient
copes with adversity. To do so, the therapist asks questions about the patient’s belief
system. What would be an appropriate question to ask?
7.
Question:
A PMHNP is caring for a 21-year-old woman who is suffering from
anxiety and is having difficulty managing stress. Which of the following would be an
appropriate step by the PMHNP?
8.
Question:
Your patient is a 65-year-old male who has a strained relationship with
his son and daughter. His children refuse to participate in a family session. The
PMHNP asks the patient to draw his family genogram as a next step to
_______________.
9.
Question:
A new patient has been … of the limits of confidentiality, and has …
consent forms. No consent, however, has been obtained for voluntary “Release of
Information.” The patient is 20 years old and still lives at home with his parents. He
is being … for depression, which he attributes to the trouble he’s had finding
employment.
True or false: If the patient’s mother calls the PMHNP to check up on her son to see
how he is doing, the therapist is required to protect patient confidentiality and not
disclose information.
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10.
Question:
The PMHNP is working with an adult patient who has somatic
complaints … by a history of childhood abuse. As part of the therapeutic process,
what does the PMHNP do to assess and organize a trauma history?
11.
Question:
The PMHNP is caring for a patient who has acute stress disorder after
experiencing a traumatic event 1 week prior. The PMHNP wants to begin with a
therapeutic framework that follows the adaptive information processing (AIP) model.
What is the priority action for the PMHNP to take?
12.
Question:
A patient who has borderline personality disorder is meeting with the
PMHNP. When asked about future goals, the patient responds, “I’d like to go back to
school to do what
you
You know, talk to people all day about their problems. It
seems pretty easy.” How does the PHMNP respond to the client in a way that is free
from any stigmatizing beliefs or judgments?
13.
Question:
The PMHNP is treating a 35-year-old male officer in the military. He
discloses that both of his parents are deceased and that he loved them. However, he
says that he had feelings of inadequacy because his parents held him to a standard
that he could never achieve. He went on to say that nothing he did ever felt good
enough. The PMHNP assesses that this patient has perfect creases in his uniform
with no strings or tags out of place; she also notices that he has perfect posture and
questions him about ritualistic behaviors. She suspects that this patient has
maladaptive responses to the expectations placed on him as a teenager and young
adult. Which statements made by the patient would verify the PMHNP’s suspicion?
14.
Question:
During a therapy session with an 18-year-old female the PMHNP
learns that she has lived in six different foster homes in the last 24 months. She
states that her mother is in a correctional facility for drug abuse and prostitution.
During the assessment, the PMHNP notices multiple superficial cuts to each wrist.
The patient appears tearful, withdrawn, and never makes direct eye contact. The
PMHNP believes that this patient may have feelings of insecurities as well as
abandonment issues and is aware that which diagnosis is likely possible?
15.
Question:
An 11-year-old patient has been exhibiting low self-esteem at school
and acting out. According to Maslow’s hierarchy of needs, which of the following
questions would best be addressed first by the PMHNP?
16.
Question:
When completing this exam, did you comply with Walden University’s
Code of Conduct including the expectations for academic integrity?
17.
Question:
The PMHNP has a session with a patient who was injured and
traumatized from an explosion at the industrial plant where he used to work. During
the session, an outside noise startles the patient and he experiences a flashback of
the loud
boom
from the explosion. The PMHNP witnesses the patient present with
anxiety and belabored breathing. What is the appropriate action of the PMHNP?
18.
Question:
The PMHNP is working with a veteran who has posttraumatic stress
disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in
allowing the patient to focus on the here and now. What strategies can the PMHNP
use to develop dual awareness in the patient?
19.
Question:
A patient named Steve is seeking therapy to get help with his home
situation, stating that he has been stressed since his mother-in-law moved into the
house. What can the PMHNP do to assist the patient in constructing a narrative?
20.
Question:
The PMHNP is meeting with a 38-year-old … , single mother who has
been seeing the PMHNP for anxiety and anger management. During one of the
sessions, the patient tells the PMHNP that she is having a problem getting her child
support payments from her ex-husband, which is triggering increased anxiety and
anger, which she admittedly takes out on her children. How does the PMHNP
respond in a way that upholds the supportive psychodynamic psychotherapy
approach?
21.
Question:
When a PMHNP is seeing a patient for the first time, what is an
important step to assure that the patient and provider understand the limits of their
discussion?
22.
Question:
During cognitive behavioral therapy (CBT), a 64-year-old male patient
states, “I get so frustrated sometimes and I just blow up at everybody!” Which
response by the PMHNP demonstrates translation of Socratic dialogue (SD)?
23.
Question:
During a therapy session the patient is … how she currently deals
with stress, and she says, “Well, I don’t. I just let it build and build.” The PMHNP
responds by asking how well this has been working out for her. The patient states,
“Well, to be honest, it just feels like I’m drowning, you know what I mean.”
Illustrating idiosyncratic meaning, the PMHNP responds with:
24.
Question:
The PMHNP is working with a school-aged child who has been … with
depression. The child has attended several sessions with the PMNHP, but recently
presents with avoidant behavior by showing increased distress and being late to
sessions. What approach does the PMHNP need to employ with the child to continue
making therapeutic progress?
25.
Question:
The PMHNP is working with a patient who is living in poverty and
abusing substances. According to the treatment hierarchy framework, what needs
does the PMHNP need to attend to first?
26.
Question:
During cognitive behavioral therapy (CBT), a 64-year-old male
patient, states, “My wife hates me! She’s just waiting for me to die.” Using Socratic
dialogue (SD) the PMHNP demonstrates understanding of analysis when she
responds:
27.
Question:
The patient is a 56-year-old female patient … with panic disorder and
reports symptoms that include heart palpitations, frequent trembling, and feelings of
choking in stressful situations. What special consideration does the PMHNP make?
28.
Question:
A 62-year-old patient has been … with borderline personality disorder.
Upon assessment, the PMHNP learns that he
participates in spending sprees and
occasional binge eating, accompanied by rapid changes in self-image. Which
evidence-based psychotherapeutic model does the PMHNP identify as effective and
beneficial?
29.
Question:
The PMHNP is meeting with a new patient who is a young veteran
back from serving two tours overseas. When reviewing the patient’s health history
file that was sent from the VA, the PMHNP learns that several months ago, the
patient was … with PTSD, but never followed up with treatment for it. After a
comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis
and understands that which therapeutic approach will be the most effective as a
first-line treatment modality?
30.
Question:
The PMHNP is working with a patient who experiences anxiety around
her parents that later leads to poor impulse control. What will the PMHNP do to
employ psychodynamic psychotherapy properly for this patient?
31.
Question:
The PMHNP is treating a patient with a substantial fear of feeling … in
(claustrophobia). Thus, the patient will not get into an elevator. The office where he
works is on the 10th floor and this requires that he walk up and down the stairs in
the morning and evening to get to his office. With permission from the patient, the
PMHNP is beginning systematic desensitization to address the patient’s need to use
the elevator. What is the PMHNP’s best plan of action?
32.
Question:
True or false: If after a third round of processing … by stabilization, a
patient has increased anxiety that requires further interventions aimed at
stabilization, the therapeutic relationship can no longer successfully provide
therapeutic change.
33.
Question:
One of the strategies the PMHNP wants to try includes sleep
restriction. What will the PMHNP suggest to follow sleep restriction therapy?
teach the safe-place exercise to create a feeling of calm. In order to walk the patient
through the exercise, the PMHNP first says:
47.
Question:
A 41-year-old male patient is meeting with the PMHNP and reveals
that he is homosexual. He begins telling the PMHNP about his feelings as a
homosexual, middle-aged man. The PMHNP nods understandingly. Before long, the
patient asks, “Are you gay? Are you married? Do you have kids?” What is the best
response by the PMHNP?
48.
Question:
In your office, you see a 58-year-old patient with PTSD who reports
having nightmares, making it impossible for her to sleep. What recommendations
based on principles of sleep hygiene will the PMHNP make?
49.
Question:
The PMHNP is caring for a patient with borderline personality disorder.
Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify
the patient’s transference to enhance emotional processing by:
50.
Question:
The PMHNP is working with a patient who seems … with the
therapeutic relationship. The PMHNP invites the patient to discuss her feelings
regarding the PMHNP openly and honestly. It becomes clear to the PMHNP that they
are experiencing an alliance rupture. How does the PMHNP repair the therapeutic
alliance?
51.
Question:
The PMHNP has been assisting a shy and timid 23-year-old male
patient struggling with esteem and self-concept issues. Over the weekend, this
patient was given the task of completing an exercise that would usually cause him
distress and shame, also called a shame-attacking exercise. The PMHNP determines
that this task has successfully been achieved when the patient states:
52.
Question:
The PMHNP is working with a 43-year-old male patient who develops
idiosyncratic transference over weeks of therapy. The best way for the PMHNP to
respond to this patient is to ___________
:
53.
Question:
A PMHNP is treating a 50-year-old patient who suffers from
depression. When he was growing up, he was often responsible for taking care of his
three younger siblings. Since then, the patient puts other people’s needs before his
own. Based on this information, the PMHNP would conclude that his interpersonal
style is __________.
54.
Question:
The PMHNP is working with a patient who has insomnia and battles
going to sleep. The patient reports consistent self-defeating behaviors, and hates
trying to go to sleep. Which action made by the PMHNP demonstrates the use of a
paradoxical intervention?
55.
Question:
During a clinical assessment of a 15-year-old patient, the PMHNP
asks, “How can I help you?” The patient answers by saying, “Honestly, I don’t really
think I need any help.” Which of the following is the most appropriate response by
the PMHNP?
56.
Question:
The PMHNP is meeting with a 42-year-old man with depression
brought on by the recent passing of his wife. As he describes the circumstances
surrounding his late wife’s death, the PMHNP begins to feel sad. The sadness lingers
for several hours, and the PMHNP finds it difficult to focus on other patients for the
rest of the day. What is the most appropriate explanation for the reaction that the
PMHNP is experiencing?
57.
Question:
You are seeing a 29-year-old widow whose husband recently died
overseas while serving his country in the military. She has been mourning the loss of
her husband for several months, and continues to grieve. She refuses to go to group
grieving sessions, but reports that she is still able to go to work and her fitness
classes sometimes, and even makes attempts to stay social. She says, “Sometimes
it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve
seen him. It’s hard to talk about this type of stuff with my girlfriends, especially
since all of their husbands are still alive.” The PMHNP understands that it is
appropriate to employ which therapeutic principle?
58.
Question:
A PMHNP’s patients have already … confidentiality agreements,
including limits that will be imposed on confidentiality. Months later, the state’s laws
have changed that affect confidentiality promises the PMHNP has already made.
What is an appropriate step for the PMHNP to take after finding out this information?
59.
Question:
A 35-year-old patient has been seeking treatment for depression for
several months. The PMHNP does an assessment to see if processing has led to
adaptive change. The patient’s self-references are positive in relation to past events,
work is productive, relationships are adaptive, and there is congruence between
behavior, thoughts, and affect. Based on this information, the PMHNP decides the
patient ____________.
60.
Question:
The PMHNP meets with a 47-year-old male patient who is fearful of
leaving the house after having witnessed his neighbor getting run over by a car.
When the PMHNP asks why he is afraid to leave his house, the patient replies,
“Because another accident might occur.” Which cognitive behavioral therapy (CBT)
strategy does the PMHNP employ?
61.
Question:
The PMHNP is working with a patient who experiences abreactions
when discussing …feelings of his sexual abuse as a child. What can the PMHNP do to
manage the patient’s intense emotional reactions?
62.
Question:
A 16-year-old female patient has had a stable therapeutic relationship
with the PMHNP for several months. The PMHNP notices what appears to be fresh
cigarette burns on the patient’s arm. When asked, the patient admits to this self-
injurious behavior. Although the patient is still depressed, her mood seems to be
somewhat better this week. True or false: The PMHNP would most likely consider this
patient stabilized and ready to move to Stage II.
63.
Question:
The PMHNP is assessing a patient who grew up in a foster home
because she was … and abused by her birth parents at a young age. The patient
admits to having difficulty forming and maintaining relationships throughout her life.
Understanding maladaptive schemas, which statement does the PMHNP predict that
the patient is likely to make?
64.
Question:
The PMHNP is caring for a patient with dissociated self-state that the
PMHNP identifies as being associated with traumatic experiences in the patient’s
past. What approach does the PMHNP use with the patient that is crucial to the
psychodynamic therapy process?
65.
Question:
When conducting an initial assessment, a PMHNP has finished
conducting a mental status examination with 10 minutes left in the session. The
patient is distressed and would like to continue sharing her personal history.
True or false: An appropriate response that the PMHNP might tell the patient is, “I
understand that you are upset. [Summarizes … , treatment recommendations, and
follow-up plan.] We can continue the conversation next week. How does this time
next Monday work for you?”
66.
Question:
True or false: A PMHNP may ask his patient to describe her
relationship with her father, both as a child and now, in order to assess interpersonal
style.
67.
Question:
The PMHNP is working with a patient who … her father pass away
after suffering for several months from terminal cancer. The PMHNP sees this as a
traumatic event. The patient reports sometimes feeling out of touch with
surroundings; almost as if things feel like a dream. “Sometimes that sensation
lingers for a while,” the patient says, “and other times I snap out of it quickly.” What
does the PMHNP infer about the condition based on psychotherapy concepts for
trauma?
View answer and explanation
68.
Question:
A PMHNP has been working with a young female patient who suffers
from depression to change self-defeating behaviors. By creating a presence of
acceptance and using good listening skills, the PMHNP’s overall goal is to __________.
69.
Question:
An initial evaluation reveals that an 11-year-old patient has moved to
a new school after her parents’ recent divorce, and is having trouble making friends.
The patient has normal mental status and exhibits appropriate behavior. What is the
most appropriate scale for the PMHNP
to use to get more information?
70.
Question:
When the patient comes into the office, she says, “I just saw a friend
of mine out in the waiting room. What’s wrong with him?” The PMHNP says, “He’ll be
fine. He has mild depression.” Which of the following statement is correct … to
confidentiality rights?
71.
Question:
An elderly patient in a nursing home has been losing interest in
activities and now refuses to leave his room. After a physical exam, he is … to a
PMHNP for an initial assessment.
True or false: After speaking with the patient, an appropriate screening tool for the
PMHNP
to use would be the Geriatric Depression Scale.
72.
Question:
A middle-aged man who works over 50 hours a week is being for
depression and anger management. He states, “I am even more… when I come
home and my wife wants to argue about stupid stuff. All I want to do is come home,
take a shower, and eat. Is that too much to ask?” The PMHNP explains that people
can be assertive, aggressive, and passive. She encourages the patient to be more
assertive and begins role-play with assertive training. The PMHNP determines that
the patient is beginning to understand when he states:
73.
Question:
At the initial interview with a patient, the PMHNP reviews the
condition of receiving services, including limits that will be imposed on
confidentiality. During the discussion, the patient shares information that the PMHNP
is legally … to report.
True or false: If the PMHNP does not report information that s/he is legally required to
report, state laws govern the consequences which include penalties for not
reporting, especially child and elder abuse.
74.
Question:
The PMHNP is working with a patient who has dissociative disorder
and requests pharmacological interventions for dealing with her trauma. What
education does the PMHNP provide to the patient regarding medication therapy?
75.
Question:
The PMHNP is having a therapy session with Charlotte, a 20-year-old
victim of date rape. The patient states, “I shouldn’t have been there; I should have
just gone home. This was all my fault; how could I have been so stupid?” Using the
Socratic method, what is the PMHNP’s best response?
76.
Question:
The PMHNP is caring for a patient who the PMHNP believes would
benefit from a relational psychodynamic approach to therapy. Which action made by
the PMHNP demonstrates appropriate use and understanding of the relationship
psychodynamic model?
Please help me the answers. Thank you.

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