Nội dung text RECALLS 12 - NP5 - SC
2 | Page 11. Nurse Rico is aware that the major advantage of observation over interview is that _____________. A. Observation may be recorded and scrutinized later B. Observations enable the recording of actual behaviors, rather than subjects' interpretations C. Observation is scientific, unlike interviews which necessary involve personal interactions D. Observations are unbiased and do not elicit reactions in human subjects. 12. Participant observation may be defined as: A. The observation of participants in the study B. The observation of the researcher’s input to a study C. Participation in a group while studying it D. The study of observational and clinical techniques 13. One of the major problems associated with the use of participant observation as a research strategy is that: A. It is more expensive than experimental approaches to implement. B. It does not allow "in-depth" study of any phenomena C. The results cannot be replicated D. May cause unrest among samples Situation: Two weeks ago, Alice began to exhibit manic behavior. She appears to be jumping from one topic to another and is very talkative. Excited as she was, she has not eaten or slept for 3 days. Nurse Queenie was assigned in the psychiatric ward when an incident occurred involving Alice and another patient. 14. While inside the psychiatric ward, Alice threatens to hit another patient. The most appropriate response from Nurse Queenie would be? A. "Stop that. No one did anything to provoke an attack by you." B. "If you do that one more time, you will be secluded immediately." C. "Do not hit anyone. If you are unable to control yourself, we will help you." D. "You know we will not let you hit anyone. Why do you continue this behavior?" 15. Nurse Queenie plans to establish a nursing diagnosis which applies to Alice. With the nursing diagnosis of imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days, the most appropriate outcome for the patient will be to: A. Ask staff for assistance with feeding within 4 days B. Drink six servings of a high-calorie, high-protein drink each day C. Consistently sit with others for at least 30 minutes at mealtime within 1 week D. Consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit 16. Alice develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine (Zyprexa). Nurse Queenie understands that the addition of Olanzapine to the medication regimen will: A. Minimize the side effects of lithium B. Bring hyperactivity under rapid control C. Enhance the antimanic actions of lithium D. Provide long-term control of hyperactivity 17. During a manic episode, Nurse Queenie will initiate what initial nursing intervention as a priority? A. Allow the patient to act out his or her feelings. B. Set limits on the patient’s behavior as necessary. C. Provide verbal instructions to the patient to remain calm. D. Restrain the patient to reduce hyperactivity and aggression. 18. Desmond, diagnosed with bipolar disorder, has been hospitalized for 7 days. He has taken lithium 6 times daily. Throughout confinement, Nurse Sky observed increased agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. What is the Nurse Sky’s best intervention? A. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. B. Continue to monitor and document the patient's speech patterns and motor activity. C. Ask the health care provider to prescribe an increased dose and frequency of lithium. D. Consider the need to check the lithium level. The patient may not be swallowing medications. Situation: Mila is set undergo cataract removal of the left eye. Nurse Kiara is assigned to assist her in the process. The following question applies. 19. Which drug should Nurse Kiara anticipate from the surgeon to administer given the situation? A. Atropine Sulfate (Tropin) B. Glycopyrrolate (Robinul) C. Acetazolamide (Diamox) D. Pralidoxime (Protopam) 20. Nurse Kiara should instruct Mila on activities that can impact her intraocular pressure. After an eye surgery all of the following activities greatly increases the client's intraocular pressure, EXCEPT? A. Sneezing, coughing and blowing the nose B. Straining to have a bowel movement C. Wearing tight shirt collars D. Sexual intercourse 21. On one hand, Nurse Kiara also knows that increased intracranial pressure (ICP) is manifested by which earliest sign? A. Abnormal respiratory pattern B. Rising systolic and widening pulse pressure C. Contralateral hemiparesis and ipsilateral dilation of the pupils D. Progression from restlessness to confusion and disorientation to lethargy Situation: Nurse Coraline is tasked to manage the case of Mr. Tirso, a 62-year-old patient, who was brought to the hospital due to right sided weakness and slurring of speech. 22. Nurse Coraline takes the pharmacologic regimen into consideration for the Mr. Tirso. Which statement is incorrect in the management of a client with cerebrovascular accident (CVA)? A. Osmotic diuretics and corticosteroids are given to decrease cerebral edema B. Anticonvulsants are given to prevent seizures C. Thrombolytics are most useful within three hours of an occlusive CVA D. Aspirin is used in the acute management of a complete ischemic stroke. Situation: Kendrick, a 20-year-old fine arts student thinks that his roommate is trying to poison him. He was admitted in the psychiatric ward because this has affected his performance in school and his classmates were afraid that he might hurt them. Nurse Maya is assigned during his stay. The following questions apply. 23. Kendrick refused all hospital meals for 3 days already. Nurse Maya is planning on ways in order to feed him. Which intervention is most likely to be acceptable to the patient? A. Allow Evan to have supervised access to food vending machines B. Allow Evan to telephone a local restaurant to deliver meals C. Offer to taste each portion on the tray for Evan D. Begin tube feedings or total parenteral nutrition for Evan 24. Kendrick blurted out "The voices are bothering me. They yell and tell me I'm bad. I have got to get away from them." The most appropriate response from Nurse Maya would be _____________. A. "Do you hear the voices often?" B. "Do you have a plan for getting, away from the voices?" C. "I will stay with you. Focus on what we are talking about, not the voices."
4 | Page 39. Nurse Terrence knows that the prevalent observable changes that occurs with osteoporosis is seen in which of the following bones? A. Facial bones B. Long bones C. Vertebral column D. Joints of the hands and feet 40. The correct rationale behind the administration of levodopa (L-dopa) to Elnix is that this drug will ___________________________. A. Activates enzymes to degrade dopamine B. Blocks the release of dopamine C. Provides the precursor of dopamine D. Inhibits the synthesis of dopamine 41. A client is being switched from levodopa to carbidopa- levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? A. Confusion B. Symptoms of diabetes C. Vital sign fluctuation D. Jaundice 42. A client with Parkinson’s disease complains of “choking” when he swallows. Which intervention will approve the client’s ability to swallow. A. Withholding liquids until after meals B. Providing semi-liquid foods when possible C. Providing a fully liquid diet D. Offering small, more frequent meals 43. Nora has been admitted with relapsing-remitting multiple sclerosis (MS). Which of the following should be the focus of the nursing assessment and history? A. Level of consciousness B. Evoked potentials of the optic pathways C. Bladder function D. Rate of ascending paralysis 44. What would Nurse Lilian suggest as an appropriate intervention for Nora in order to avoid episodes of urinary incontinence? A. Limit fluid intake to 1000 mL/day B. Administer prophylactic antibiotics as ordered C. Insert an indwelling urinary catheter D. Establish a regular voiding schedule 45. A client with Alzheimer’s disease. What color should you repaint the hallway to provide safety? A. Black and white B. Cream and White C. Blue and Green D. Red and Yellow Situation: Darlene, a psychiatric nurse, deals with different cases of psychiatric disorders in the psychiatric ward. 46. Marilyn, a 40-year-old client, comes to the clinic with superficial cuts on the left wrist. The patient paces around the room sobbing but cringes when approached and responds to questions with only shrugs or monosyllables. What is Darlene’s best initial statement? A. “Everything is going to be alright. You are here at the clinic, and the staff will keep you safe.” B. “I see you are feeling upset. I am going to stay and talk with you to help you feel better”. C. “You need to try to stop crying so we can talk about your problems”. D. “Let’s set some guideline and goals for you visit here”. 47. Marilyn suddenly exclaimed, "I'm in a terrible situation. I don't know what to do." Nurse Darlene can initially assume that the patient is: A. suicidal. B. anxious and fearful. C. misperceiving reality. D. potentially homicidal. 48. While Marilyn was anxious, Nurse Darlene held her hand for one minute. Which type of touch is this? A. Love/ Intimacy B. Friendship/Warmth C. Social/Polite D. Functional/Professional 49. When Marilyn recovered, she realized that Nurse Darlene was the daughter of her enemy a few years ago. This prompted Marilyn to tell Nurse Darlene to back off, and to stop invading her personal space. In terms of proxemics, all are correct statements, EXCEPT? A. Public space is 12 ft and beyond B. Social space is 4 to 12ft C. Personal space is 6 to 8ft D. Intimate space is 1.5 ft and less 50. Upon discharge, Marilyn began to take a CNS depressant to cope with problems. All of the following are considered as CNS depressants, EXCEPT? A. Heroin B. Codeine C. Barbiturates D. LSD Situation: Tricia, a 34-year-old female client, assisted by her boyfriend Gerry is admitted in the emergency room. She was hyperventilating, her palms placed over her chest while experiencing hand tremors. Furthermore, she is having diaphoresis. When asked what happened to her, she was unable to explain herself clearly. 51. Nurse Chesca wishes to teach Nina alternative coping strategies. Nurse Chesca will initially perform which action? A. Verify the patient's learning style. B. Create outcomes and a teaching plan. C. Lower the patient’s current, anxiety level. D. Assess how the patient uses defense mechanisms. 52. As Tricia’s anxiety went down, she verbalized, "I feel undone." An appropriate response for the nurse would be: A. "Why do you suppose you are feeling anxious?" B. "What would you like me to do to help you?" C. "I'm not sure I understand. Give me an example." D. "You must get your feelings under control before we can continue." 53. The next day, Nurse Chesca saw Tricia with a high level of motor activity. She runs from chair to chair and cries, "They’re coming! "They’re coming!”. Tricia does not follow instructions or respond to verbal interventions from start. The initial nursing intervention of highest priority for Nurse Chesca would be to __________________. A. provide for patient safety. B. increase environmental stimuli. C. respect the patient's personal space. D. encourage the clarification of feelings. 54. Tricia experiences episode of severe anxiety. Which of the following is most appropriate to administer as a PRN anxiolytic medication? A. Buspirone (BuSpar) B. Lorazepam (Ativan) C. Amitriptyline (Elavil) D. Desipramine (Norpramin) 55. When Tricia was discharged, she has been unable to leave her home that week because of severe anxiety, and she says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate for Nurse Chesca to initiate? A. Teach the person to use positive self-talk. B. Assist the person to apply for disability benefits. C. Ask the person to explain why the fear is so disabling. D. Advise the person to accept the situation and use a companion. Situation: A finance director, Mr. Enrile, 55 was brought to the hospital for diagnostic workup after he had experienced seizure in his office. Nurse Henry was assigned to him. 56. Just as Nurse Henry was entering the room, the patient who was sitting on his chair begins to have seizure. Which of the following must the nurse do FIRST? A. Ease the patient to the floor B. Lift the patient and put him on the bed C. Insert a padded tongue depressor between his jaws.