Application Questions Flashcards
The nurse is caring for a patient diagnosed with generalized anxiety disorder (GAD) and a priority hypothesis of impaired sleep. The nurse chooses the expected outcome: The patient will report improved symptoms of anxiety by the follow-up appointment. The nurse assesses the patient at the follow-up appointment and determines the outcome was met.
Choose from the list of options to complete the sentence.
The patient reports they have been taking their
a. ondansetron
b. Lisinopril
c. buspirone
as prescribed and that they are able to sleep at least
a. 3
b. 7
c. 12
hours per night.
c. buspirone
b. 7
Main explanation
The nurse should use clinical judgment to evaluate actions related to generalized anxiety disorder (GAD) by comparing observed outcomes against expected outcomes. The patient in this scenario has met the outcome when they reported taking their buspirone as prescribed and sleeping at least 7 hours per night. Buspirone is an anxiolytic medication that treats GAD. Lisinopril is a calcium channel blocker used to treat high blood pressure, and ondansetron is an antiemetic used to treat nausea, neither of which would help the patient with anxiety. Additionally, sleeping 7 hours per night indicates that buspirone is successfully controlling the patient’s anxiety and allowing them to sleep. If the patient reports sleeping for 3 hours, this would indicate that the anxiety is not well controlled, and sleeping for 12 hours indicates possible sedation from the medication.
A client visits their primary care provider’s office for ongoing depression. During the review of their medical history, the client tells the nurse they have a history of an irregular heartbeat, but cannot recall the name of the condition they have. The client undergoes an electrocardiogram (ECG) while at the office. Which data indicates that the client may have a contraindication to selective serotonin reuptake inhibitors (SSRIs)?
a. Regular R-R interval
b. Prolonged QT interval
c. Heart rate 76/min
d. Left ventricular hypertrophy (LVH)
b. Prolonged QT interval - CORRECT ANSWER
Selective serotonin reuptake inhibitors (SSRIs) are contraindicated in clients taking monoamine oxidase inhibitors (MAOIs). In addition, these medications should be used with caution during pregnancy, as well as in clients with renal or hepatic disease, diabetes, or glaucoma. Finally, SSRIs and SNRIs should be used with caution in clients with risk factors for QT prolongation, as well as those who have had a myocardial infarction, or who are severely depressed or present with suicidal thinking.
a. Regular R-R interval
-A regular R-R interval means the ventricles are beating at a regular rate. This is a sign of a normal heart beat, and is not a contraindication of antidepressant therapy with an SSRI.
c. Heart rate 76/min
Normal heart rate for an adult is 60-100/min. A heart rate of 76/min is considered a normal heart rate and would not be a contraindication for antidepressant therapy with an SSRI.
d. Left ventricular hypertrophy (LVH) - LVH is a sign that the heart may be working harder to pump blood to the body due to enlargement of the left ventricle. Clients struggling with mental health conditions and high levels of stress may have resulting cardiac damage over time. Although SSRIs should be used cautiously in clients with who have had a myocardial infarction, LVH is not a contraindication for treatment.
A female client was admitted to the inpatient behavioral health unit after a panic attack. Which nursing diagnosis should the nurse identify as the priority for this client?
A. Risk for spiritual distress related to feelings of despair
B. Failure to thrive related to impaired grieving processes
C. Ineffective coping related to the inability to manage stress
D. Risk for self-directed violence related to hopelessness
C. Ineffective coping related to the inability to manage stress
EXPLANATION
Clients with anxiety disorders have an inability to cope with stressful situations and may make unsound decisions to address the situations. Clients often lack the coping mechanisms to adequately manage stress. Per Maslow’s hierarchy of needs, physiological needs should be ranked first, followed by psychological needs.
While reviewing a client’s chart, a nurse notes posttraumatic stress disorder (PTSD) listed in the client’s medical history. The nurse recognizes that this condition is typically characterized by which clinical feature?
A. Recurrent episodes of mental and physical distress
B. Abnormally elevated mood, activity, and energy level
C. Obsessive thoughts and compulsory actions
D. Depressed mood and lack of interest in pleasurable activities
A. Recurrent episodes of mental and physical distress
PTSD is characterized by the recurrence of mental and physical distress, triggered by a memory of a past traumatic event.
A client who has had generalized anxiety disorder (GAD) for over ten years is describing complications of the disorder to the nurse. Which statement(s) made by the client suggest the client is experiencing long-term complications of GAD? Select all that apply.
A. “I write my feelings down in a journal every day.”
B. “It is so difficult for me to concentrate at work.”
C. “The only time I don’t feel anxious is when I’m drunk.”
D. “On a typical night, I usually get about two hours of sleep.”
E.“I used to love to go fishing and now I don’t even bother.”
B, C, D, E
Substance abuse, depression, difficulty concentrating, and insomnia are long-term complications of anxiety disorders. Anxiety activates the stress response in the body, which causes an imbalance in neurotransmitters. The imbalance of neurotransmitters and altered chemical responses causes depression, difficulty concentrating, and insomnia. Clients often begin abusing substances to prevent the feelings or worry, anxiety, or dread. Instead of decreasing anxiety, clients often become addicted and experience severe anxiety when withdrawing from substances.
A nurse on a telemetry unit is caring for a client receiving treatment for anorexia nervosa and recurrent atrial fibrillation. The client is prescribed a regular diet, but is consuming less than 25% of each meal. Which action should the nurse take?
A. Obtain an order for total parenteral nutrition (TPN)
B. Educate the client of the importance of adequate nutrition
C. Obtain capillary glucose every 4 hours
D. Inform the client’s family members
Correct Answer
C. Obtain capillary glucose every 4 hours
Routinely monitoring blood glucose levels is important for clients who are not consuming adequate portions of their meals. Clients with anorexia nervosa may already have low glycogen stores which may cause hypoglycemia. Because this client is not consuming more than 25% of their meals, the nurse should check blood glucose levels as ordered to ensure the client is not hypoglycemic. The provider should be notified immediately if a low blood glucose reading is obtained.
A nurse is caring for a client who is brought to the emergency department after a suspected overdose on illicit substances. The client is obtunded, and it is not clear what substances were used by the client. Which pharmacological treatment should the nurse prepare to administer?
Use the list of options from the drop down lists to complete the following sentence.
The appropriate antidote for a benzodiazepine overdose is
a. bromocriptine
b. Enalapril
c. flumazenil
, while the antidote for opiate overdose is
a. naloxone
b. naltrexone
c. methadone
.
c. flumazenil
a. naloxone
