NCLEX Review About The Aging Eye (1-6)

4:29 AM    

NCLEX Review About The Aging Eye

Situation: Mang Tomas is a 60 year old man who has just had cataract surgery performed on his right eye.

1. The physician has prescribed Cyclogel preoperatively to:

a) prevent dryness of the cornea and conjunctiva
b) reduce the inflammation of the iris and choroids
c) paralyze the ciliary muscle
d) promote drainage of aqueous humor from the chamber of the eye

2. After discharge, Mang Tomas attends the eye clinic for follow-up visits. When he receives his cataract glasses, it is important that the nurse advise him that:

a) his peripheral vision will be increased
b) objects will appear closer than they really are
c) magnification by the lens is only about 10%
d) daily eye drops are required with these lenses

3. The nurse should instruct a client preparing for eye surgery that which of these activities will be restricted post-operatively?

a) bending with the knees flexed
b) bending from the waist
c) keeping the head in a neutral position
d) lying flat

4. Nursing care for Mang Tomas during the first 48 hours after surgery will include:

a) maintain bed rest
b) changing the dressing daily
c) encouraging coughing and deep breathing
d) lie on the unoperated side


Situation: Mang Ben is diagnosed with glaucoma and is scheduled for surgery.

5. Which symptoms are associated with acute closed-angle glaucoma?

a) diplopia and photophobia
b) episodic blindness and no pain
c) blurred vision and colored rings around lights
d) sensation of curtain drawn across the visual field

6. Which order for Mang Ben before surgery will the nurse question:

a) demerol (meperidine) 50 mg IM
b) atropine sulfate 0.4 mg IM
c) valium (diazepam) 2 mg IM
d) phenergan (promethazine) 25 mg IM




NCLEX Review About The Aging Eye:
ANSWERS AND RATIONALE

1) C
- another preoperative eye drop that is usually prescribed to patient awaiting cataract surgery is tropicamide (mydriacyl) which is a dilating agent.

2) B
- cataract surgery is performed to remove the opacified lens. After surgery, a new artificial lens will be inserted at the posterior chamber or the client will be left without a lens. Aphakia or the absence of lens can be corrected to restore normal vision by eye glasses, contact lenses or intraocular lenses.
Eye glasses are the safest and least expensive alternative. The nurse should inform the patient that the eyeglasses will be thick and will cause objects to appear closer than they really are and vertical lines will also appear curved.
Contact lenses provide better visual correction than eye glasses but the patient must learn how to insert, clean and replace the lenses correctly. This can be difficult for elderly clients afflicted with arthritis, Parkinson's disease and Alzheimer's.
Intraocular lenses are implants that provide the best visual correction. However, it is associated with more postoperative complications.

3) B
- during the postoperative period of eye surgery, activities that increase intraocular pressure should be avoided:
  • instruct patient to avoid bending over
  • avoid vomiting - give antiemetics
  • avoid coughing - give antitussives, avoid conditions that stimulate coughing
  • avoid sneezing - avoid allergens that stimulate sneezing such as powders, dusts etc.
  • avoid straining - use stool softener
  • avoid lifting heavy objects
4) D
- Cataract is clouding or opacity of the lens which prevents light rays from reaching the retina. Cataract is not due to trauma tends to occur bilaterally but they do not mature at the same time.

Immature cataracts are not completely opaque and thus allow some light to pass providing the patient with some useful vision.

Mature cataract occurs when the lenses are completely opaque and vision is greatly reduced or absent.

Intumescent cataract occurs when the lens absorbs water and increases in size resulting in glaucoma.

Hypermature cataract occurs when the lens protein breaks down into short chain polypeptides and leak through the lens capsules. The proteins are engulfed by macrophages and may lead to phacolytic glaucoma.

The cause are:
  • congenital cataract - heredity
  • traumatic cataract - exposure heat
  • senile cataract - aging, most common cause
  • secondary cataract - caused by another disease

It is manifested by:
  • blurred vision
  • photophobia - client complains to glare
  • progressive loss of vision
  • opaque or cloudy white pupil
  • difficulty to identify colors
  • indirect opthalmoscpe - red reflex is distorted or absent
  • patient does not experience pain

Instructions after Cataract Surgery include:
  • leave ocular dressing/eye patch in place, it is usually removed after 24 hours
  • limit activity for 24 hours
  • avoid reading
  • avoid rubbing eyes
  • wear eye glasses for protection during the day
  • avoid lifting more than five pounds
  • avoid straining and any activity that increase IOP
  • lie on unoperated side
  • avoid aspirin or any drug containing aspirin
  • use eye shield to protect eyes
  • pain and itching after surgery is normal and can be relieved with acetaminophen. Report persistent and unrelieved pain.
  • report redness around the eye, nausea and vomiting
  • avoid touching and rubbing of eyes
  • avoid closing of eyes tightly
After surgery, instruct client to return for follow-up care. If the surgery is out-patient, first clinic visit is after 24 hours, then after one week and then after one month.

5) C
- Glaucoma is due to increased ocular pressure (normal is 10-20 mm/Hg) from accumulation of aqueous humor in the eye that damages the optic nerve resulting in irreversible blindness. Aqueous humor is produced by the ciliary body, nourishes the cornea and lens and flows out of the eye through the trabecular meshwork via the canal of Schlemm.

Two kinds of Glaucoma:

1. Close Angle/Narrow/Acute - caused by narrowing of the anterior chamber or blockage that occurs between cornea and iris. This type of glaucoma can develop only in one eye and occurs suddenly. It is common in people of Asian ancestry and associated with aging.
Symptoms include:
  • intermittent episodic attacks characterized by severe eye pain, headache, face pain and abrupt decrease of visual acuity that occur when pupils dilate such as during emotional upset and when patient is adjusting vision in darkness
  • blurred vision to loss of vision
  • rainbow halos around lights
  • nausea and vomiting
  • rapid rise of intraocular pressure
  • cloudy cornea
  • reddened conjunctiva
2. Open angle/chronic/simple - caused by blockage in the trabecular meshwork and the canal of Schlemm. this type of glaucoma is usually bilateral, with insidious onset, and often hereditary. it is the most common type of glaucoma in adults.
Symptoms include:
  • appearance early in the disease of scotoma or blind spots
  • gradual loss of peripheral vision
  • gradual increase of intraocular pressure especially upon awakening and when lying flat
  • halos around lights
  • mild headaches
  • difficulty focusing on near objects and adapting in the dark
  • affects both eyes but progression of the disease is not the same
  • vague symptoms so that it is often called "thief of the night" glaucoma because patient is unaware until visual acuity is greatly reduced.
6) B
- drugs which cause pupils to dilate should be avoided by persons having angle closure glaucoma as they increase flow of fluid, and thus, the intraocular pressure.
This includes:
  • atropine
  • anticholinergics
  • patient should also avoid caffeine
Drugs used in Glaucoma are:

1. Betablockers: Timolol/Betaxolol
  • action: decreases production of aqueous humor
  • side effects: bradycardia, hypotension
  • contraindication: asthma, heart block, COPD
2. Carbonic Anhydrase: Acetazolamide/Mannitol
  • action: decreases production of aqueous humor
  • side effects: allergy (do not give if with sulfa allergy), weight loss, electrolyte imbalance, depression, impotence
3. Cholinergics: Pilocarpine/Carbachol
  • action: increases outflow of aqueous humor
  • side effects: pain, blurry vision, diminished vision at dark
4. Adrenergics: Epinephrine/Dipivefrin
  • action: decreases production of aqueous humor
  • side effects: tremors, headache, redness and itching


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Mood Disorders Practice Exam/Test (9-15)

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9. Most people respond emotionally to the thought of electric current passing through their brain. When discussing the subject with the patient, the nurse should:

a) use the term "shock" in a neutral, calm manner
b) refer to the procedure as the patient's "treatment" instead of "shock therapy"
c) refer to it as ECT
d) explain how the convulsions are artificially induced

10. B. and her husband begin to express concern about the proposed ECT treatment. Which nursing action is most appropriate initially?

a) refer all questions to the physician who will actually administer ECT treatment
b) listen for misconceptions and clarify any confusing information
c) orient B. and her husband to the ECT unit so they become familiar and comfortable with the surroundings
d) provide B. and her husband with booklets explaining the procedure in simple, understandable terms

11. By providing B. and her husband with an opportunity to discuss ECT treatment openly and directly, the nurse communicates the idea that:

a) ECT should not be feared
b) ECT will reverse the depression
c) ECT is a positive treatment alternative
d) ECT is a safe procedure

12. B. ask the nurse, "Why do I have to sign a consent form?" Which response is most appropriate?

a) it indicates that you have been fully informed about the procedure and the risk involved
b) your physician should have explained this to you yesterday. Didn't he tell you about signing a consent?
c) it's just a hospital rule. Sign here please
d) most of the medications used can be dangerous. Your consent is required

13. When B. returns to her room after awakening from the ECT treatment, the nurse should:

a) place a "No visitors" sign on the door so she can rest undisturbed
b) perform a complete physical examination
c) orient her to person, place and time
d) remain with her until all confusion disappears

14. Which other nursing action should the nurse perform after the patient returns from ECT treatment?

a) take vital signs every 15 minutes for the next 2 hours
b) open all locked closets so the patient can have access to her belongings
c) offer the patient a cigarette if she smokes, to help her relax
d) touch the patient by grasping her hand or massaging her shoulders while talking to her

15. Which side effects are most common among ECT treatment?

a) headache and dizziness
b) diarrhea and urinary incontinence
c) nausea and vomiting
d) temporary memory loss and confusion




ANSWERS AND RATIONALE

9) B
- to emphasize the therapeutic value of ECT, the nurse should refer to it as the patient's "treatment." Although "ECT" is medically correct terminology, this term should not be used unless the patient is familiar and comfortable with it; referring to the procedure as ECT may cause the patient to focus on the disturbing elements of this treatment. Such terms as "convulsions" and "shock" tend to increase a patient's anxiety and should therefore be avoided.

10) B
- although controversial, ECT is an effective treatment for depression. Many people have negative images about ECT treatment that may have arisen from reading about ECT or watching movies in which it is portrayed as barbaric or inhumane. The nurse can be most helpful by listening carefully to the patient to assess her fears and needs and then determining how to intervene. If needed, the patient then can be referred to the physician, oriented to the area, or given booklets explaining the procedure. The patient has the right to make an informed consent and, if competent, to refuse any treatment, including ECT.

11) C
- openly discussing the proposed ECT treatment places an appropriate emphasis on accepting the therapeutic value of the procedure. The nurse should be supportive while realistically discussing the treatment outcomes, the patient's fears, and any potential untoward effects of the ECT treatment. Because ECT involves the use of an anesthetic and the passing of an electric current through thee brain, fear is a normal, expected outcome. Although ECT has proved to be an effective treatment for lessening the degree of depression, it is not guaranteed to reverse the depression. In the role of patient advocate, the nurse cannot imply that there are no safety concerns. Although uncommon, such adverse effects as permanent memory loss, periodic hypertension, and stroke can occur.

12) A
- the nurse should estate the purpose of signing a consent form, which is to ensure that the patient has been informed of the benefits and risks of the procedure. The patient probably is anxious and may have forgotten what she was told earlier. The consent form is an important legal document, and the patient has the right to know its purpose; even if the physician explained the procedure, the patient must understand what she is signing before she signs it. The patient's signature indicates awareness and understanding, not just compliance with hospital policy. Because ECT involves risks other than those associated with medication, these risks must be fully understood.

13) C
- a patient returning from ECT treatment typically is confused and disoriented. The nurse's task is to reassure the patient by orienting her to person, place, and time. Although the patient will be tired, she can received visitors. A complete physical assessment is not needed after ECT treatment. The nurse cannot remain with the patient until all confusion disappears because this may take several days.

14) D
- touch reinforces verbal encouragement, demonstrates caring, strengthens interactions, and establishes the nurse's presence and availability. Vital signs are monitored in the recovery room until the patient is stable. Until the patient is fully alert and ambulatory, the nurse should keep the closets locked to protect the patient's valuables. The patient should not be permitted to smoke until she can safely go to smoking area.

15) D
- temporary memory loss and confusion are the most common side effects of ECT treatment and occur in all age-groups. Many patients experience some degree of headache, but dizziness is not a common complaint. Diarrhea and urinary incontinence generally do not occur. Some patients become nauseated and may require an antiemetic medication, but this side effect is rarely seen.



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Online Nursing Practice Test about Renal Disorders (1-7)

4:11 AM    

Welcome to the Online Nursing Practice Test about Renal Disorders. Before you begin answering this questions, I recommend that you read this special offer that will surely help you to pass your NCLEX Licensure Examination:


Enjoy answering and I hope that this site: NCLEX Review and Secrets can somehow help you in your future nursing licensure examination. Good Luck.


Situation: Ms. Elsa Cruz has fever with severe flank pain was brought to the ER.

1. Urinalysis was ordered for her, with instruction about the examination, when can you collect urine specimen for culture?

a) noon time if specimen is available
b) evening before retiring
c) anytime as soon as there is specimen
d) A.M. only

2. Intravenous pyelography was ordered, your nursing preparation would include the following. Except:

a) enema on the morning of the test
b) check for history of allergies
c) hydrating Mrs. Cruz orally four hours before the procedure
d) NPO 8 hours before the test

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Mood Disorders Practice Exam/Test (1-8)

7:28 AM    





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 Situation: B., age 42, is brought to the hospital by her husband, who reports that she has been neglecting her housework and family responsibilities and eating very little and has not left the house for the past 2 months. She is 5'7" (170 cm) tall and normally weighs 147 lbs. (66.7kg), but during the past 8 weeks, she has lost 20 lb (9.1kg). Mrs. B.'s history reveals that her 7 months old daughter recently died of sudden infant death syndrome (SIDS). She is admitted to the psychiatric unit with a diagnosis of depression.

1. Immediately after admission, B. isolates herself in her room. The nurse should approach the patient with the understanding that:

a) depressed patients like B. commonly are suicidal and establishing a trusting relationship is key to preventing suicide
b) B. probably believes she is not ill and therefore will not socialize with others at this point
c) B. is isolating herself because her family is not available to support her
d) B.'s illness and hospitalization for emotional problems have a negative impact on her and her family

2. The nurse helps B. to settle in. While observing B. unpack, the nurse expects her to exhibit:

a) fast, hurried movements
b) slow, restarted movements
c) a desire to initiate a conversation with her roommates
d) a desire to unpack and arrange her belongings without assistance

3. Early that evening, B. tearfully tells the nurse, "I feel so guilty. I left the window open in my daughter's room. Maybe she got chilled during the night. Perhaps the crib should have been on the other side of the room." How should the nurse respond?

a) you're still young. You and your husband can have another child if you want
b) I don't think that's what caused your daughter's death. You have other children you should be concerned about
c) you shouldn't feel guilty, B. Why don't you try to forget about such sad memories
d) your daughter died of SIDS B. It was not your fault

4. The following day, the nurse finds B. pacing the hallways, wringing her hands, picking at her hair and skin and saying, "I don't know what to do. I don't know what to do." The most appropriate nursing action at this time is to:

a) take the patient back to her room and encourage her to rest
b) calmly tell the patient to pull herself together
c) encourage the patient to help water the plant in the dayroom
d) permit the patient to continue her behavior until she eels less anxious

5. After 1 week, B. states, "Now that my baby is dead and I'm too old to have another one, I don't want to live anymore." The nurse should respond by saying:

a) life doesn't look very promising to you right now, but let's talk about this
b) you shouldn't feel so hopeless. many women are having babies in their forties
c) I care about you, and I want you to live
d) What about your husband and other children? Don't you think they need you?

6. B. is started on imipramine (tofranil) 75 mg orally at bedtime. The nurse should tell the patient that:

a) the medication may be habit forming, so it will be discontinued as soon as she feels better
b) the medication has no serious side effects
c) she should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication
d) the medication may initially cause some tiredness, which should become less bothersome over time

7. The nurse should inform B. that the full therapeutic benefits of imipramine may not take effect for:

a) 3 to 7 days
b) 2 to 3 weeks
c) 3 to 4 weeks
d) 2 months or more

8. B. does not respond to the medication. At a team conference, staff members recommend electroconvulsive therapy (ECT). When should nursing interventions begin?

a) as soon as the patient and her family are presented with this treatment alternative
b) the night before ECT scheduled
c) immediately after ECT is administered
d) when the patient returns to the unit after ECT therapy
  




ANSWERS AND RATIONALE

1) A
- preventing suicide takes priority over other needs. Once a trusting relationship is established, B. will more readily discuss her fears. If the patient senses that the nurse is concerned and can be trusted, she will feel less alone and believe that someone understands. The patient's perception of her illness is unknown, as is the level of family support and the impact of her hospitalization. All other needs are secondary to the patient's safety needs at this time.

2) B
- the behavior of the depressed patient is typically slow, retarded, and fatiguing. Such a patient also has difficulty interacting, making decisions, and initiating independent actions. Nursing interventions should be planned to assist and support the patient as needed to meet her needs. Although increased activity may be observed in patients with agitated depression (depression with frantic pacing), it is more common in those with mania.

3) D
- the nurse should restate and reinforce that the child's death was not B.'s fault, nor was it related to her actions. Sudden infant death syndrome strikes unexpectedly; it has no symptoms or warning signs. Denying the patient's feelings of loss is both nontherapeutic and insensitive.

4) C
- a simple task like the plants provides a purposeful activity to focus the patient's energy as well as human contact and a sense of accomplishment. By encouraging assistance in this activity, the nurse attempts to increase B.'s self-esteem. Isolating the patient in her room, telling her to pull herself together, and ignoring her distress by not intervening are nontherapeutic aprroaches.

5) A
- reflecting the patient's feeling by responding :Life doesn't look very promising right now..." validates how the patient feels and encourages her to ventilate further. Although the nurse should let the patient know that she cares and will protect her, such responses as "You shouldn't feel so hopeless," "What about your husband and children," or even simply "I care" deny the patient's feelings, cut her off, and shift the focus to how others feel. The nurse should provide an opportunity for the patient to express her feelings.

6) D
- sedation is a common early side effect of the tricyclic antidepressant imipramine (tofranil) and usually decreases as tolerance develops. Antidepressants are not habit forming; do not cause physical or psychological dependence. However, after they are taken at high doses for long periods, the dosage should be decreased gradually to avoid mild withdrawal symptoms. Serious side effects, although rare, can occur; they include myocardial infarction, congestive heart failure, and tachycardia. Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a patient taking monoamine oxidase (MAO) inhibitors, not tricyclic antidepressants.

7) C
- antidepressant agent such as imipramine usually produce a noticeable effect in 2 to 3 weeks but do not reach full therapeutic effectiveness until 3 to 4 weeks after initiation of therapy. If no improvement is noted by that time, the medication is considered ineffective and a new drug is tried. The nurse must be sure to teach the patient that the drug's effect will occur gradually and that discontinuing it before peak effectiveness is achieved will render the drug useless. She also must encourage and support the patient during this time because the depressed patient may expect more immediate relief from the medication.

8) A
- the nurse is responsible for assessing the patient's and family members' response to electroconvulsive therapy (ECT) and for providing opportunities for communication regarding their feelings and concerns as soon as the treatment is proposed. ECT is rarely an initial treatment for depression; it is used when a patient responds poorly to medication. It involves inducing a seizure in the patient by passing electric current through the brain (seizures are thought to produce changes in neurotransmitters and receptor sites similar to those produced by antidepressant medications). Before the treatment, the patient is given a short-acting barbiturate to induce anesthesia. After the procedure, the patient typically awakens quickly but remains confused and light-headed, necessitating close nursing supervision until these effects subside.


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Anxiety Disorders Practice Exam/Test (20-26)

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Situation: A young man is brought to the local emergency department by the police. He approached a police officer in a large metropolitan bus depot stating "I don't know who or where am I am. I have no identification with me. Can you help me?" The young man appears to be in good physical health and between age 18 to 22. He is clean and neatly groomed. The physical examination reveals no evidence of trauma or other abnormal findings. Staff members refer to him as X.

20. In the absence of physical findings to explain X.'s memory loss, the most likely diagnosis is:

a) schizophrenia
b) personality disorder
c) somatoform disorder
d) dissociative disorder

21. X. is admitted to the psychiatric unit for further evaluation and treatment. He probably will react to his inability to recall his identity by exhibiting:

a) intense preoccupation with discovering who he is
b) depression
c) anger and frustration
d) complacency

22. In working with X., the nurse should direct her first intervention toward:

a) establishing a climate of trust and acceptance
b) identifying the cause of the patient's memory loss
c) encouraging the patient to remember events leading to the memory loss
d) helping the patient recall his first name

23. Nursing interventions for X. should be based on the understanding that:

a) once the patient's anxiety is alleviated, his memory will return
b) memory loss usually is precipitated by severe psychologic stress
c) the patient could remember his identity if he really wanted to
d) the patient probably will regain his memory slowly but have an incomplete recall of immediate events

Situation: P., a 40 year old mother of two children ages 6 and 9, is admitted for a surgical biopsy of a suspicious lump in her left breast.

24. The admitting nurse wants to assess P.'s perceptions about her admission and proposed treatment. Which question is the best way to initiate such a discussion?

a) what has your physician told you about the reason for your admission
b) have you discussed the treatment alternatives available to you if the lump is malignant
c) what questions do you have about your admission and treatment?
d) what is your understanding of the reasons for your admission and the possible courses of treatment?

25. P. says to the nurse, "I don't want to be put to sleep for this biopsy. I want to be awake and aware of what's happening. That's the best way to do this, isn't it?" How should the nurse respond?

a) everyone reacts differently, but I agree with you. I'd want to be awake, too
b) you will be medicated to help you feel relaxed. I wouldn't worry about it
c) that's really between you and your surgeon. You'd better discuss this with him
d) tell me more about your thoughts on being awake or asleep during the biopsy

26. When the nurse comes to take P. to surgery, she finds her tearfully finishing a letter to her children. P. says "I want to leave this for them in case anything goes wrong today." The nurse's best answer would be:

a) in case anything goes wrong? What are your thoughts right now?
b) I can understand that you're nervous, but this is really a minor procedure. You'll be back in your room before you know it
c) try and take a few deep breaths and relax. I have some medication that will help[
d) I'm sure your children know how much you love them. You'll be able to talk to them on the phone in a few hours




ANSWERS AND RATIONALE

20) D
- the patient in this situation is probably suffering from a dissociative disorder, which is characterized by a temporary alteration in consciousness, identity, or motor behavior in response to stress, anxiety, or perceived danger. Psychogenic amnesia, a sudden inability to recall extensive amounts of personal data because of a physical or psychological trauma, is an example of this type of disorder. Schizophrenia, a type of psychosis in which the patient responds to overwhelming anxiety through a disintegration of ego functioning, is characterized by impaired communication and loss of contact with reality. X. shows no evidence of thought disorder or other psychotic symptoms, so a diagnosis of schizophrenia is not indicated. A personality disorder typically originates within the character structure of the individual and is evidences by a life-long pattern of maladaptive behavior rather one or acute onset. Examples include such conditions as antisocial and borderline personality. A somatoform disorder is characterized by multiple physiological complaints or symptoms having no organic basis.

21) D
- because a patient with psychogenic amnesia is successfully blocking a traumatic or severe anxiety-producing event, he will probably react to his inability to recall his identity with complacency. he will not have an intense desire to discover who he is because learning his identity would force him to remember the event and confront the anxiety he so fears. For the same reason, X. will not exhibit depression or anger, both of which are associated with anxiety-producing events.

22) A
- because the patient is defending himself against severe anxiety, the nurse must first establish a warm, trusting, and accepting climate. After gaining the patient's trust, the nurse can help him learn ways to deal with his anxiety. Prodding X. to recall events or remember his name is not helpful at this time. Identifying the cause of the patient's memory loss may be impossible.

23) B
- psychogenic amnesia usually is precipitated by severe psychologic stress that causes the patient to repress (block out) painful events or experiences. Both the stressful event and the anxiety that it produced have been blocked from X.'s memory. Until the stressful event is identified, the accompanying anxiety cannot be alleviated. Forgetting one's identity is an unconscious act, and willing oneself to remember is not enough to be successful. Slow return of memory with impaired recall of the amnesia period is characteristic of memory loss caused by head injury.

24) D
- by asking the patient to explain her understanding of the situation, the nurse can assess both her knowledge and her emotional reactions. Often, the anxiety produced by being told one might have cancer is so great that the patient cannot absorb further details given by a physician. Asking P. what the physician has said or what questions she might have can be done later to clarify and evaluate her initial responses.

25) D
- the nurse needs to explore the patient's statement further before responding. The nurse's role is not to agree or disagree with the patient's choices. Telling the patient not to worry about the procedure would be inappropriate; the nurse should explore the patient's concerns, not minimize them. Although the final decision is between the patient and her surgeon, the nurse can help the patient explore and clarify her feelings at this time.

26) A
- by acknowledging how the patient feels, the nurse encourages further expression of the patient's thoughts. Minimizing feelings or offering empty reassurance is not therapeutic or helpful. Deep breathing or preoperative medications are appropriate after the patient's fears have been expressed and dealt with.


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Online Nursing Practice Test about Respiratory Diseases (7-10)

2:08 AM    









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Situation: Jonas, 32 year old has returned from Honk Kong and was admitted to St. John of God Hospital and was tentatively diagnosed to have SARS.

7. Jonas is expected to have which of the following symptoms

a) fever, rapid progressive respiratory compromise
b) fever and dyspnea
c) fever and productive cough
d) fever and cyanosis

8. Incubation period of SARS

a) 2-8 days
b) 5-11 days
c) 1-10 days
d) 1-5 days

9. What is the causitive agent of SARS?

a) corona virus
b) retro virus
c) rhabdo virus
d) influenza virus

10. The following countries where SARS originated includes the following except:

a) China
b) Canada
c) Philippines
d) Australia


ANSWERS AND RATIONALE

7) B
- initial manifestation of SARS includes high fever, chills, headache, body malaise and muscular aches.
After 3 to 7 days. SARS manifestations appear which include nonproductive cough, dyspnea, shortness of breath and possible hypoxemia.

8) A
- the incubation period of SARS is 2-10 days and maybe as long as 10 days in some people

9) A
- the causative agent is a newly identified corona virus which is transmitted by:
  • close person to person contact
  • direct contact with infected person or contaminated object
  • exposure of the eyes or mucous membrane to respiratory secretions of SARS patient

Risk Factors of SARS
  • close contact with person who is diagnosed or suspected with SARS
  • recent travel (within 10 days before appearance of signs and symptoms) to area with suspect or confirmed community transmission of SARS
10) C
- SARS cases were first identified in ASIAN countries in 2002. Countries initially affected by SARS include China, Singapore, Hong Kong, Australia, North America and Europe. The high risk age groups are those between 25-70 years old. About 3 patients in every 100 SARS cases die of the disease.


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Anxiety Disorders Practice Exam/Test (10-19)

5:46 PM    





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Situation: W., a 20 year old college junior is admitted to a medical-surgical unit in a small community hospital after she has a sudden onset of paralysis in both legs. Extensive examination and testing reveal no physical basis for the paralysis. The medical diagnosis is conversion disorder.

10. The nurse plans interventions for W. based on which correct statement about conversion disorder?

a) the symptoms are a conscious attempt to control others in the environment
b) the patient will exhibit a high level of anxiety in response to the conversion symptom
c) the conversion symptom typically has some symbolic meaning for the patient
d) the patient will respond positively to confrontational approaches by the nurse

11. W. reveals that her boyfriend has been pressuring her to have sex with him. She says, "I love him, but I'm frightened about getting pregnant or getting some disease like AIDS. What should I do?" The nurse best response would be:

a) there are ways to protect yourself against pregnancy and sexually transmitted diseases. I can refer you to the clinic if you like
b) you shouldn't let anyone pressure you into sex. Perhaps he doesn't care about you as much as you think he does
c) it sounds like this problem may be related to your paralysis
d) your concerns are realistic. How do you feel about being pressured by your boyfriend?

12. During her hospitalization, W. develops insight into her response to threatening situations. When she is discharged, she plans to continue psychotherapy that will focus on:

a) preventing further incidents of paralysis
b) learning new strategies for dealing with stress and conflict
c) breaking off her stress-inducing relationship with her boyfriend
d) developing a healthier attitude toward her sexuality


Situation: S., a 19 year old sophomore, makes an appointment at the college health service, where he tells the nurse that he recently has been having trouble concentrating in class. He reports that his grades have suffered because he has been so "out of it." He forgets to do assignments and cannot remember when tests are scheduled. He also reports insomnia, loss of appetite, headaches, and constant fatigue.

13. S. says to the nurse, "I don't know what's wrong. Either there's something seriously wrong with me, or I must be going crazy." What would be the best response in this situation?

a) you look healthy to me. I'm sure there is nothing seriously wrong with you
b) it's best not to jump to conclusions. We'll do some tests that should give us a clearer picture of what the problem is
c) we have an excellent health service here. Whatever the problem is, we will help you
d) tell me more about when you begin experiencing these symptoms and feelings

14. The results of S's physical examination and laboratory tests are negative. Two weeks after his initial visit, S. reports that he continues to suffer from nightmares that cause insomnia. He says, "I don't know what to do. Finals are coming up, and I can't study. I'm so exhausted." Which reply by the nurse is best?

a) you mentioned you are having nightmares. tell me more about hem
b) I understand your frustration. It's terrible not being able to sleep. I can get you a prescription for sleep medications
c) have you talked with your professors? Perhaps if they were aware of your problem, you could get extensions for your homework
d) you're exhausted? In what way?

15. S. reveals that he was in an automobile accident during final exam week in his freshman year. Although he suffered only minor cuts and bruises, a young man in the other car was killed. In light of this information, the nurse suspects that S. is experiencing:

a) conversion disorder
b) panic disorder
c) phobic disorder
d) post-traumatic stress disorder

16. Which therapeutic approach is most effective in helping S.?

a) helping him to relax to pass his final exams
b) asking the physician to prescribe an antianxiety medication
c) providing new coping mechanisms
d) strengthening current coping mechanisms

Situation: Y. periodically has panic attacks. These attacks are unpredictable and do not seem to be associated with any specific object or situation.

17. Y. might experience any of the following symptoms during anacute panic attack except:

a) increased perceptual field
b) increased blood pressure
c) decreased blood pressure
d) impaired attention

18. Which intervention would be most helpful for Y. when she experience a panic attack?

a) encouraging her to identify what precipitated the attack
b) promoting interaction with others to reduce her anxiety through diversion
c) staying with her and remaining calm, confident, and reassuring
d) reducing intolerable stimuli by encouraging her to stay in her room alone until she feels less anxious

19. Which medications have recently been found helpful in reducing or eliminating panic attacks?

a) antidepressants
b) anticholinergics
c) antipsychotics
d) mood stabilizers



ANSWERS AND RATIONALE

10) C
- a conversion disorder, sometimes called hysteria, is a type of somatoform disorder in which the patient exhibits a symptom (such as tic, tremor, or paralysis) that symbolically represents a conflict the patient is experiencing. The manifested symptom is not a conscious attempt to control others. Instead of being anxious, the patient characteristically exhibits indifference to the symptoms. This reaction initially represent's an unconscious control of anxiety. Confrontation threatens the patient's defense against anxiety and is therefore nontherapeutic.

11) D
- because conversion disorders commonly arise from conflicts and tension associated with sexual drives. W. must be encouraged to explore her concerns about having sex with her boyfriend. The nurse should acknowledge the patient's feelings and encourage her to discuss them. The other options may helpful, but they do not promote exploration of the realistic aspects of the patient's conflict.

12) B
- the patient needs to learn new and more adaptive coping strategies, such as talking about her feelings and not denying them, to help her deal with life's many stressors. Paralysis is only a symptom of W.'s underlying problem and would not be the focus of psychotherapy. Unless W. learns to cope with the conflict associated with her sexual drives, her next relationship also will result in stress. Her problem is not her sexuality but the stress associated with it.

13) D
- the nurse needs to find out more about the onset of the patient's symptoms. To fully assess the patient, she should determine how long the symptoms have been present, when it started, and whether there were any precipitating events, such as breakup with girlfriend. Options A and B may be true, but they cut off further exploration of the patient's symptoms. They also may be viewed as false reassurance and an attempt to deny the validity of the patient's feelings. Option C focuses on the health service and not on S's problem.

14) A
- exploring the content of S.'s nightmare can provide clues to his underlying conflict. For example, a veteran may have recurring nightmares related to his war experiences. Acknowledging the patient's feelings without exploring them further is not enough. Offering sleep medication is inappropriate because this is only a temporary measure; S. should be encouraged to explore the underlying stressors and to find effective ways of coping rather than dismiss his symptoms with medication. Focusing on S.'s exhaustion is not as helpful as exploring its possible causes. Although talking with his professors may help S. to get an extension on his school work, doing so will not address his underlying problems or help him to sleep better.

15) D
- post-traumatic stress disorder (PTSD) is a form of anxiety disorder in which an individual relives an extremely stressful experience with accompanying guilt and dysfunction. PTSD can cause a delayed response to a traumatic event -- in S.'s case, the fatal automobile accident. In a conversion disorder, the patient's anxiety is temporarily managed by his symptoms, and distress is not apparent. In a panic disorder, the patient typically experiences severe anxiety resulting in feelings of impending death. In a phobic disorder, the patient characteristically experiences fear of an object or situation that presents no real danger.

16) C
- to deal with his traumatic memories, S. needs to learn new coping strategies -- for instance, systematic desensitization. Helping S. to relax enough so that he can pass his final exams may or may not be realistic and is secondary to the overall treatment goals. Medication should be used only if necessary; although drugs can relieve some of the symptoms of anxiety, they do not remove its underlying causes. The inadequacy of S.'s current coping skills has led him to seek help.

17) A
- panic is the most severe level of anxiety. During a panic attack, the patient experiences a decrease, not increase, in perceptual field. She becomes more focused on herself and is less aware of what is happening around her. The patient becomes unable to process information from her environment. The decreased perceptual field contributes to impaired attention and the inability to concentrate. Increased blood pressure related to stimulation of the sympathetic nervous system or decreased blood pressure related to stimulation of the parasympathetic nervous system can also occur.

18) C
- a panic-stricken patient requires the assistance of a calm person who can provide support and direction. This is particularly important because the patient already feels frightened and out of control. Having someone remain with the patient prevents feelings of isolation and desertion. Encouraging the patient to identify what precipitated the attack is futile because the patient is too anxious to focus on precipitating factors. When the patient feels extremely anxious, interaction with others is difficult. Reducing stimuli can be helpful, but having the patient stay alone may increase her anxiety.

19) A
- tricyclic and MAO inhibitor antidepressants have been found effective in treating patients with panic attacks. Why these drugs control the attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, help relieve the physical symptoms of anxiety but do not relieve the anxiety itself. Patients who experience panic attacks are not psychotic, so antipsychotic drugs are inappropriate. Mood stabilizers are not indicated because mood changes are not usually associated with panic attacks.


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Online Nursing Practice Test about Respiratory Diseases (1-6)

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Situation: A 20 year old client is being treated for pneumonia. he has persistent cough and complained severe pain on coughing.
1. Which of the following organisms most commonly causes community acquired pneumonia in adults?

a) haemophilus influenzae
b) klebsiella pnemoniae
c) streptococcus pneumoniae
d) staphylococcus aureus

2. What type of instruction could be given to help the client reduce the discomfort he is ahving?

a) hold in your cough as much as possible
b) place the head of your bed flat to help with coughing
c) restrict fluids to help decrease the amount of sputum
d) splint your chest wall with pillow for comfort

3. A diagnosis of pneumonia is typically achieved by which of the following diagnostic test?

a) ABG analysis
b) chest x-ray
c) blood cultures
d) nutritional intake

4. The client has been treated with antibiotic therapy for left lower lobe pneumonia for 10 days. Which of the following physical findings would lead the nurse to believe it is appropriate to discharge the client?

a) continued dyspnea
b) temperature of 102 F
c) respiratory rate of 32 bpm
d) vesicular breath sounds in left base

5. A nurse is caring for a client with chest-tube drainage system. The nurse notes constant bubbling in the suction control chamber. Which of the following nursing actions is most appropriate?

a) reposition the client
b) notify the physician
c) this is normal, expected finding and no action is necessary
d) turn off suction machine

6. The nurse determines that influenza vaccine must be given regularly to clients with

a) hypertension
b) diabetes mellitus
c) urinary calculi
d) chronic illness



Try to read the latest type of cancer, it might be included in the exam --> Mesothelioma Cancer
ANSWERS AND RATIONALE

1) C
- pneumonia is inflammation of the bronchioles and alveoli that is usually accompanied by increased interstitial or alveolar fluid. Infectious pneumonia is caused by the following microorganisms:
Microorganisms that causes Pneumonia
  • Streptococcus pneumoniae - most common cause of community acquied pneumonia
  • Mycoplasma pneumoniae and hemophillus influenza - are other causes of community acquired pneumonia
  • Pneumocystiis carinii - affects immunocompromised individuals such as those with AIDS
  • Staphylococcus aureus, kleibsiella pneumoniae, P. aeruginosa and E. coli are common caused of nosochomial pneumonia.
Non-infectious pneumonia is caused by aspiration of gastric contents (aspiration pneumonia) and inhalation of toxic gases, dusts, smoke or chemicals.

2) D
- Nursing care for patients with Pneumonia includes:
  • pleuritic chest pain may prevent the patient from coughing and performing deep breathing exercises effectively. To minimize the patient's discomfort the nurse can teach the patient to splint the chest wall with pillow during coughing. Pleuritic chest pain is sharp localized chest pain that occurs with breathing and coughing.
  • place patient in fowler's or high fowler's position to promote lung expansion and facilitate breathing.
  • change position every 2 hours in patient's who have altered level of consciousness to mobilize secretions, preferably placed in side lying to prevent aspiration with the head of the bed raised to 45 degrees.
  • activity intolerance may result due to impaired oxygen and carbon dioxide exchange. Schedule patient's activity after treatment and medication. Activity of the patient should be according to tolerance
  • chest physiotherapy including percussion, vibration and postural drainage is performed to reduce lung consolidation and prevent atelectasis. These activities help to mobilize secretions.
  • suctioning, coughing and deep breathing to clear airways
  • provide liberal fluid intake of 2,500 to 3,000 ml a day to help liquefy secretions.
Diagnostic Test used to determine Pneumonia
  • Chest x-ray - is ordered to determine the extent and pattern of lung tissue involvement. On chest x-ray, areas of pneumonia appear as consolidation. On auscultation, bronchial breath sounds will be heard over consolidated areas. Presence of fluids, atelectasis and infiltrates will also be seen with x-ray.
  • Sputum culture and sensitivity - not blood culture, is ordered for pneumonia to identify the infecting microorganism and determine which antibiotic would be most effective in destroying the pathogenic agent.
  • ABG analysis - is ordered to assess the patient's gas exchange as areas of consolidated tissue will not be able to exchange carbon dioxide and oxygen properly with blood which could result in impaired gas exchange. The ABG is abnormal is arterial oxygen tension (PO2) is less than 80mmHg. This indicates the need to place patient under oxygen therapy.
3) B
- the major diagnostic tests used to identify the extent of the lung tissue affected by pneumonia is chest x-ray and to identify the causitive agent is sputum culture and microscopy.

4) D
- Common Manifestation of pneumonia includes fever, headache, chills, sweating, pleuritic chest pain, cough, sputum production, dyspnea, muscle pain and fatigue. On auscultation limited breath sounds crackles or rales maybe heard over the affected part of the lungs. Pleural friction rub may also be heard.

Type of Pneumonia and its Manifestations:

1. Pneumococcal pneumonia
  • sudden onset of chills
  • fever
  • stabbing pleuritic chest pain
  • dyspnea
  • tachypnea
  • high WBC
  • consolidation on chest x-ray
  • productive cough - rusty brown or blood streaked purulent sputum turns yellow and mucoid
2. Bronchopneumonia
  • gradual onset with cough
  • scattered crackles
  • minimal dyspnea
  • low grade fever
  • patchy areas of consolidation on chest x-ray
3. Legionaires's disease
  • gradual onset with chills
  • fever
  • body malaise
  • headache
  • confusion
  • lack of appetite
  • diarrhea
  • muscle and joint pain
  • dyspnea
  • elevated WBC
  • dry cough -scant mucoid or blood tinged sputum
4. Staphylococcal pneumonia
  • sudden onset with fever
  • multiple chills
  • pleuritic pain
  • dyspnea
  • rales
  • decreased breath sounds
  • chest x-ray may show patcht infiltrates
  • empyema
  • abscesses and pneumothorax
  • elevated WBC
  • productive cough - purulent golden yellow or blood streaked sputum
5. Viral pneumonia
  • sudden or gradual onset with flulike symptoms
  • fever
  • muscle aches
  • normal to slightly elevated WBC
  • dyspnea
  • breath sounds maybe normal or with occasional wheezing and crackles
  • dry cough - with scant mucoid that turns to purulent sputum
6. Pneumocystis carinii pneumonia
  • abrupt onset with tachypnea
  • shortness of breath
  • fever
  • respiratory distress
  • dry cough
5) C
- Rationale: constant bubbling in the suction control bottle is normal. It indicates proper functioning of the apparatus

6) D
- Rationale: clients with chronic illness have low resistance to infection. Therefore, they should receive influenza vaccine yearly


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    Anxiety Disorders Practice Exam/Test ( 1-9)

    2:19 AM    No comments

    Situation: T. is the nurse-manager of an oncology unit on the 18th floor of a large urban medical center. Recently, she has been increasingly afraid of riding in the elevator. This morning, she experienced shortness of breath, palpitations, dizziness, and trembling while in the elevator. T. was examined by an emergency department physician, who could find no physiologic basis for her symptoms.

    1. Based on the above findings, T. is most likely suffering from:

    a) dissociative disorder
    b) phobic disorder
    c) obsessive-compulsive disorder
    d) somatization disorder

    2. T. begins outpatient counseling sessions with a psychiatric clinical nurse specialist. Which nursing intervention would be most helpful in reducing T.'s anxiety level?

    a) psychoanalytically oriented psychotherapy
    b) group psychotherapy
    c) systematic desensitization
    d) referral for evaluation for electroconvulsive therapy

    3. An anxious patient like T. also may benefit greatly from:

    a) muscle relaxation
    b) psychodrama
    c) confrontation
    d) biofeedback

    4. Because of the severity of T.'s anxiety, the nurse refers her to a psychiatrist for medication evaluation. Which psychotropic drug regimen is most likely to prescribed on a short-term basis?

    a) diazepam (valium) 5 mg orally three times a day
    b) benztropine mesylate ( cogentin) 2 mg orally twice a day
    c) chlorpromazine hydrochloride ( thorazine) 25 mg orally three times a day
    d) thioridazine hydrochloride ( mellaril) 100 mg orally four times a day

    Situation: B., age 45, is admitted to a psychiatric inpatient unit for treatment of severe obsessive-compulsive disorder.

    5. B. has a compulsive bedtime ritual that includes making and remaking his bed 26 times before he can retire. Occasionally, he does not get to bed until 3:00 a.m. Which nursing intervention is most helpful?

    a) discussing the ridiculousness of his repetitive behavior
    b) taking turns making and remaking the bed with B. to conserve his energy and allow him to retire sooner
    c) prohibiting B. from carrying out his bedtime ritual
    d) suggesting that he begin his ritual earlier in the evening so he can retire by 11:30 pm

    6. Besides performing his nightmare ritual. B. has recently begun a morning bed-making ritual. To help B. limit and potentially alter this maladaptive behavior, all of the following nursing interventions are therapeutic except:

    a) having B. engage in constructive activities that leave less time for compulsive behaviors
    b) verbalizing tactful, mild disapproval of his behavior
    c) providing positive reinforcement of nonritualistic behavior
    d) offering reflective feedback, such as "I see you have remade your bed many times. You must be exhausted"

    7. The nurse must recognize that obsessive-compulsive rituals are an attemp to:

    a) increase self-esteem
    b) control others
    c) express anxiety
    d) avoid severe anxiety

    8. An appropriately stated short-term goal for this patient is that after 1 week, B. will:

    a) demonstrate decreased anxiety
    b) participate in daily exercise group
    c) identify the underlying reasons for his rituals
    d) state that his activities is irrational

    9. The psychiatrist order lorazepam (ativan) 1 mg orally three times a day. While B. is taking this medication, the nurse should remind him to:

    a) avoid caffeine
    b) avoid aged cheese
    c) stay out of the sun
    d) maintain an adequate salt intake



    ANSWERS AND RATIONALE

    1) B
    - a phobic disorder is characterized by a persistent fear of some object or situation that presents no real danger or that magnifies the danger out of proportion. An example of this disorder is T.'s fear of riding in the elevator. A dissociative disorder occurs when a patient blocks off from consciousness some aspect of his life because of the threat of overwhelming anxiety. Amnesia is an example of dissociative disorder. An obsessive-compulsive disorder is manifested by repetitive thoughts or recurring impulses to perform certain acts -- for example, frequent hand washing. A somatization disorder occurs when a patient experiences some physical dysfunctioning resulting from profound anxiety over a repressed drive, such as the sexual drive. An example of this disorder is that of a patient who experiences blindness after becoming aroused by accidentally seeing his sister in the shower.

    2) C
    - phobias commonly are viewed as learned responses to anxiety that can be unlearned through certain techniques, such as behavior modification. Systemic desensitization, a form of behavior modification, attempts to reduce anxiety and thereby eradicate the patient's phobia through gradual exposure to anxiety producing stimuli. For example, a patient who is afraid of flying could be desensitized by first viewing pictures of airplanes, then going to the airport, and later just sitting in a plane before attempting to fly. Psychoanalytically oriented therapy also may be effective in this situation because recall of childhood experiences can help the patient clarify and understand her phobia. However, such therapy requires years of treatment. Group psychotherapy, which involves treating patients in groups, could be used as an adjunct treatment to help increase the patient's self-esteem and lower her generalized anxiety. Electroconvulsive therapy, the use of electric current to produce a convulsive seizure, is primarily reserved for patients with severe depression or psychosis who have responded poorly to other treatments. It usually is not indicated for phobic disorders.

    3) A
    - muscle relaxation techniques -- the systematic tensing and relaxing of major muscle groups -- decrease anxiety and relax thee body. They are an important adjunct to systematic desensitization. Psychodrama is the dramatization of a patient's interactions and problems. Confrontation involves calling attention to discrepancies, such as the inconsistency between a patient's affect and his verbal expressions. Psychodrama and confrontational approaches are primarily used to resolve interpersonal issues. Biofeedback attempts to bringg certain autonomic functions, such as heart rate and blood pressure, under voluntarily control. Biofeedback training is more useful for reducing stress associated with physiologically based disorders, such as hypertension, asthma, and gastritis.

    4) A
    - diazepam (valium) is the most appropriate medication for this patient because of its antianxiety properties. Benztropine mesylate (cogentin) is an antiparkinsonian agent used to control the extrapyramidal side effects of such antipsychotic medications as chlorpromazine hydrochloride (thorazine) and thioridazine hydrochloride (mellaril). Chlorpromazine and thioridazine are used to control the severe symptoms (hallucinations, thought disorders, agitation) seen in patients with psychosis.

    5) D
    - at present, B. needs this behavioral pattern to keep his anxiety within tolerable bounds. Suggesting that he begin the ritual during free time in the evening sets some limits but allows him to continue performing the behavior. Patients such as B. usually are aware of irrationality of their actions yet feel unable to stop them. Helping with the ritual is nontherapeutic reinforcement of the behavior. Attempting to prevent B. from performing his ritual would increase his anxiety and possibly precipitate panic.

    6) B
    - verbalizing even minimal disapproval of B.'s behavior would increase his anxiety and consequently reinforce his need to perform the rituals. Engaging B. in constructive activity provides an outlet for his energy without channeling it into compulsive behavior. Providing positive reinforcement on nonritualistic behavior trends to strengthen these constructive activities. Reflective feedback lets B. know that the nurse recognizes the behavior and understands how tiring it can be.

    7) D
    - obsessive-compulsive rituals are an attempt to avoid increasing anxiety to a severe level. Although the patient may feel the need to increase his self-esteem, this is not the primary reason for performing obsessive-compulsive rituals. the patient is not attempting to control others because he is anxious and preoccupied with his own behaviors. The patient's ritualistic behavior is not a means of expressing anxiety but a way to avoid it.

    8) B
    - participating in a daily group refocuses the patient's time toward adaptive activities and may reduce anxiety. "Demonstrate decreased anxiety" is not stated specifically enough to allow for evaluation. For this goal to be measurable, specific objectives must be stated, such as that B. will verbalize he is feeling less anxious. Insight into the underlying reasons for the rituals takes time to develop and is not a realistic goal after 1 week. A patient with an obsessive-compulsive disorder typically is well aware of the irrationality of the ritual but is unable to stop it.

    9) A
    - ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Aged cheeses must be avoided when taking monamine oxidase (MAO) inhibitors. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for patient receiving lithium.


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