Health Differences 2 practice exam A

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What is the term for stringing together words because of their rhyming sounds, without regard to their meaning?

Clang Association

What is the term for a false and fixed belief that cannot be corrected by reasoning?

Delusional thinking

what is the term for a continuos flow of accelerated speech with abrupt changes from one topic to another?

flight of ideas

What is the term for haphazard and confused thinking that is manifested in jumbled and ilogical speech and reasoning?

Loose associations

social isolation, difficulty with appetite and sleep and loss of interest in usual activities indicates a high risk for what?

suicide

Delusions are manifestations of what?

psychosis

Hyperactivity is seen in what 2 things?

mania, and ADD

Social withdrawal is a symptom of what?

depression

Mood disturbances of depression are related to deficiences of what neurotransmitter?

seratonin

What is the term for a neurotransmitter and hormone involved in local immune responses, in regulating stomach acid and in allergic reactions?

Histamine

What is the term for a neurotransmitter associated with Parkinsons and may be involved in the development of depression but is not the primary contributor?

Dopamine

A decrease in ____ is associeted with anxiety disorders, schizophrenia, and huntingtons?

GABA

What is the term for the deelopmental change from behavior that is externally controlled to behavior that is controlled by internal standards and principles? This term is concerned with self-generated standards and not with the effects of behavior on others.

internalization

"Following socially sanctioned guidelines when making decisions" is an example of ______ reasoning which occurs in the 2nd level in Kohlberg's theory of moral development

Conventional Reasoning

A CNS stimulant should be administered at what time of the day?

early in the day so it doesnt interfere with sleep

What nursing measures should be used to address the vegetative signs of major depression?

monitor the patients eating and sleeping

A standard antipsychotic medication such as haldol is most effective in modifying which symptom of schizophrenia?

delusions of persecution

A severe reduction in emotional expressiveness is known as what?

flat affect

WHat three sx of schizophrenia is effectively treated by the newer atypical antipsychotics such as clozapine, risperidone, and olanzapine?

flat affect, social withdrawal, & lack of motivation

Social withdrawal caused by schizophrenia is commonly treated by what 3 drugs?

clozapine, risperidone, and olanzapine

Which drug is the traditional antipsychotic that targets the sx of schizophrenia such as hallucinations, delusions, disordered thinking, and paranoia?

Haldol

A patient taking lithium who experiences NVD should stop taking the medication why?

because dehydration can raise lithium levels

A. Should a patient taking lithium follow a low Na+ diet? B. Why or why not?

A. No
B. a low Na+ intake causes an increase in lithium retention which can lead to toxicity

How often are lithium levels monitored from the blood?

monthly

Can a patient taking lithium take OTC meds?

no

What action would be an appropriate foucs of therapy for a nurse working with the family of a patient with anorexia nervosa?

improve communication among family members

Persistant feelings of detachment from others is a common sx of what disorder?

PTSD

The manic symptoms of a patient with bipolar disorder can be managed by which drug?

tegretol

What is the therapeutic blood level for tegretol?

6-8 mg/dl

Amitriptyline is what kind of drug and how long does it take to start working?

trycyclic antidepressant, 10-14 days

Which direction should the nurse provide to someone who complains of fatigue while taking an antidepreessant?

take the medication at bed time

How can setting limits with a patient who is manipulative benefit the patient?

at 1st the pt will result in having negative feelings but then the patient will gain self-empowerment in relationships with others. The pt will understand of how the minupulative behavior is based on immediate gratification and the associated disregard for the rights of others.

"A pt w/ depression suddenly seems less depressed and more cheerful and active on the unit." What would be an appropriate nursing response to this change?

Reassess the patient for suicide potential

A person with borderline personality disorder would most likely engage in self-destructive behavior if faced with which stressor?

threat of seperation or rejection

What are the internal feelings of a person with borderline personality disorder?

they feel bad or unworthy, feels unfairly misunderstood or mistreated, bored, empty and have little idea who they are.

A patient with borderline personality disorder who feels isolated or rejected may act on what type of behavior?

self destructive behavior

Signs of autism are able to be seen as early as what age?

4 months old, such as lack of social responsiveness

Autism is usually diagnosed by what age?

3

When a person has unresolved anger what can it become?

depression

WHen anxiety is suppressed how may it present?

as anger

What is the term for disruptions of consciousness such as memory, identity, and perception of the environment?

Dissociative sx

"I must not gain weight or I will never get a date" is an example of what type of thinking?

catastrophizing (magnifying the outcome of an event)

What is the term for which a single event affects an unrelated situation?
ex. weighing less than 90 lbs=being popular

overgeneralization

WHat is the term for overinterpretation of events as having personal meaning?

personalization

What is most important for a nurse to evaluate in a patient who is manic?

nutritional status, if pt is dehydrated or malnourished along with having faulty judgement, the pt will be at risk for injury

What is the term for fusion or blending together of individuals so the distinct person fails to emerge?
ex. "You should have known what I really meant when I said that."

enmeshed boundaries

A person stateing "You dont know how hard it is for me to trust you anymore" is an example of what?

double blind

A person stating "if you bring that up again I will tell everyone about your drug problem" is an example of what?

triangulation

A person stating "I would live up to your expectations if you didn't make me so nervous" is an example of what?

scapegoating

What is the term for a rare and potentially fatal side effect of antipsychotic medications?

neuroleptic malignant syndrome

What are 3 sx for nueroleptic malignant syndrome?

1. High fever
2. Muscle Rigidity
3. urinary incontinence

What is the term for thickened bile or bile plugs in the small biliary passages of the liver?

cholestatic jaundice

Cholestatic jaundice can be a side effect of what?

antipsychotic medication

What is depersonalization disorder?

alteration in the perception of self so that the usual sense of one's own reality is temporarily lost or changed; it may be a manifestation of a neurosis or another mental disorder or can occur in mild form in normal persons

What would a desired outcome be for a person with depersonalization disorder?

expresses satisfaction of interactions with friends, related to the alleviation of social isolation

What is generalized anxiety disorder?

a pattern of frequent , persistent worry and anxiety about several events during at least a 6 month period. The worry/anxiety is out of proportion to the actual impact of the event

What is a pain disorder?

persistent and chronic pain unrelated to a medical condition

What is somatization disorder?

multiple physical complaints that persists for years involving any body system. Most fequently, the complaints involve chronic pain and problems with the digestive, nervous, & reproductive systems

What are the 3 initial nursing diagnosis that take priority in a pt with borderline personality disorder?

1. self-mutilation
2. anxiety
3.ineffective coping

A need for sameness is a charaacterics of which mental disorder?

autism

What diagnostic tool is used to reveal structural and biochemical abnormalities associated with mental illness by using radioactive tag material to trace physiological and biochemical changes in brain tissue?

PET scan

Which scan provides gross anatomical details through a series of slice x rays of the brain?

CT scan

What provides a record of electrical activity in the brain? But not commonly used for mental illness.

EEG

What provides gross anatomical details through a 3 dimensional visualization of brain structure generated by applying a magnetic field?

MRI

What are 2 sx of the depressive phase of bipolar disorder?
Not seen in the manic phase

psychomotor retardation & anhedonia

What are 2 sx associated with severe lithium toxicity?

acute confusion & ataxia

What is the term for a loss of the ability to coordinate muscular movement?

ataxia

A lithium level of what indicated a maintenance level indicating that the mania would be reduced?

1.2

What is the blood level range for lithium?

0.4-1.3

A therapeutic outcome of lithium allows what?

a modulation of mood and ability to solve problems

What is involved with an ECT?

patient iis restrained in a supine position, procedure takes about 30 minutes, under general anesthesia, may feel groggy & disoriented & may experience memory loss upon awakening

Regular engagement in what type of activiity is most therapeutic for a pt with chronic acute anxiety.

physical exercise

Short-term dynamic psychotherapy is appropriete for what type of person?

a relatively well functioning person who has a specific area of difficulty
ex. PTSD

What is the most important nursing measure for a patient who is experienciing an acute episode of mania?

to prevent physical exhaustion

1. In the 2nd stage of dementia pts begin losing what?
2. In the 3rd stage of dementia what occurs?

1. instrumental ADL's
2. deterioration of all ADL's

What is the term for reawakening an older adults interest in their environment so that they may consider an alteration of lifestyle practices?

remotivation therapy

What is an expected outcome of reminiscing therapy for an older adult?

increased self-esteem

What is an appropriate discharge instruction for the family of a patient who has dementia?

provide a structured, consistent environment

Understanding the statement "Birds of a feather flock together" requires what type of thinking?

abstract

In early-stage alzheimer dementia is the pt aware of their lost abilities?

yes

What factor is associated with increased physical and mental health problems among older adults?

having limited financial resources

What term involves making up answers to preserve self-esteem?

confabulation

What term involves repetetive behavior (ex. using the same phrase or asking the same question) especially in the presence of stress.

perseveration

What cognitive disorder has the strongest evidence of genetic involvement includiing 4 genes?

alzheimers disease

Major depression must include what 2 factors in order to occur?

environmental and genetic

What causes personality disorders?

there is no singlle cause, there are intersecting environmental, biological, and psychological influences

If a patient in a nursing home suddenly becomes withdrawn, resistant, and disoriented the nurses initial assesment should focus on what?

is the patient physically ill

A day treatment center is a good opportunity for what type of cognitively impaired patient?

alzheimers

Esophageal Varices is usually caused by what?

portal hypertension--which in turn is due to the obstruction of the portal venous circulation within the damaged liver

What are the earliest sx of hepatic encephalopothy?

minor mental chances such as disorientation

What 3 things can cause jaundice?

1. impairment of hepatic uptake
2. conjugation of bilirubin
3. excretion of bilirubin into the biliary system

What nursing measure should a nurse perform for a patient with ascites?

measure patients abdominal girth, pt should be weighed on a daily basis, monitor serum ammonia and electrolyte levels, keep pt in a lying position

Why should a patient with ascites never be in an upright position?

it could cause the activation of the renin-angiotensin-aldosterone system and may reduce renal glomerular filtration and sodium excretion

What % of a diet for a patient with diabetes should be in the form of carbohydrates?

50-60%

What is the purpose of administering pancrelipase (pancrease) to a patient with pancreatitis?

to aid in digestion of fats, carbs, and tryglicerides, proteins

What is pancrease is used to treat?

pancreatic enzyme deficiency

Pancrease is often prescribed to people with what type oof medical problems?

cystic fibrosis, chronic inflammation of the pancreas, or blockages of the pancreas or common bile duct caused by cancer, & also taken by people who have had gastrointestinal bypass surgery

Which is an advantage of the glycosylated hemoglobin test over the fasting blood sugar test for patients with diabetes?

it allows for an assesment of patient compliance with treatment regimen, it provides a record of the patients blood sugar control over the past 2 to 3 months

fasting blood sugars and glycosylated hemoglobin are tested by which route?

from the blood

What test measures the amount of glucose in the blood that binds itself to the hemoglobin (not the amount of insulin)?

glycosylated hemoglobin test

What are daily insulin needs guided by?

daily blood glucose monitoring

Postop nursing care for a patient who has a T-tube in place following an open cholecystectomy should include which intervention?

monitor the stool for return of pigmentation

How often should a T Tube be monitored & emptied?

when full

Postop nursing care for a patient who has a T-tube in place following an open cholecystectomy should follow what type of diet?

NPO or on a clear liquid diet

Is the t tube attached to a drainage bag or a wall suction?

drainage bag

What intervention will improve respiratory function in a patient with acute pancreatitis?

maintain patient in semi-fowlers position to decrease pressure on the diaphragm

What is the best way to improve pulmonary function?

have patient perform coughing and deep breathing techniques every 2 hours

WHat type of diet should a patient with acute pancreatitis be on?

NPO

Diabetes type II is usually diagnosed in people over what age?

30

Who is at risk for diabetes type II?
A. elevated BP with high pulse
B. overweight

a. this person is not at risk
b. this person is at risk

patient admiteed in an acute state of cirrhosis of the liver would exhibit what main sign?

ascites related to fluid volume excess

Demerol is rarely used because of what side effects?

seizures, and central nervous system irritability

What is the drug of choice for pain management in patients with pancreatitis?

morphine

What is Talwin used for?

For the relief of moderate to severe pain. It may also be used for preoperative or preanesthetic medication and as a supplement to surgical anesthesia.

What is sublimaze used for?

anesthesia and sometimes in a patient with pancreatitis for pain control

What are the health benefits of nutrititional supplements?

they provide calories for energy and protein for healing

What type of medications should be questioned when ordered for a patient with end stage hepatic dysfunction?

analgesics and sedatives, can precipitate hepatic encephalopathy and should be monitored closely

Is it appropriate for a patient with end stage hepatic dysfunction to take antihypertensives?

yes

What is the best diagnostic test for diagnosing chronic pancreatitis?

(ERCP) endoscopic retrograde cholangiopancreatography

Why is a serum amylase dx test not the best test for diagnosing chronic pancreatitis?

becuase an elevated serum amylase signifies that the pt has acute pancreatitis. The amylase level will not be elevated with chronic pancreatitis unless there is an acute exacerbation

What does an ERCP allow visulazation of?

structuures and visualization of the pancreatic ductal system

WHy should a nurse plan to meet with a diabetic pt at frquent intervals who neglects to follow the diet or check blood sugar levels?

to provide support and assistance and to identify barriers to following the diet and checking blood sugar levels.

What should a nurse do befor accepting adherance level for a noncompliant diabetic pt in regards to checking b.s. levels and diet?

first try to meet with the patient to provide support and assistance regularly

Whhat would be a great indicator that a patient is participatng well in a therapeutic relationship when being treated for diabetes?

pt asks nurse questions about insulin administration

What lab test should be monitored during treatment of diabetic ketoacidosis to avoid a serious potential complication of rapid fluid infusion and why?

serium potassium
because, during rehydration, the serum potassium level drops as potassium reenters the cells. This is caused by the increased plasma volume which decreases the concentration of serum potassium.

WHat information does glycosolated hemoglobin levels provide?

a record of the patients blood sugar control over the past 2-3 months

What coexisting condition should a nurse recognize as a problem in the patient with acute pancreatitis?

pleural effusion

Will a pt with acute pancreatitis by hypo or hypertensive?

hypotensive

WHat type of blood sugar will a pt with acute pancreatitis usually have?

greater than 200

Will a pt with acute pancreatitis usually have renal stones?

no, unrelated

A pt with diabetes with a serum glocose of 500 an elevated blood urea nitrogen (BUN) and a PH of 7.4 with hypotension, dry mucous membranes, tachycardia, and somnolence indicate what diagnoses?

hyperglycemic hyperosmolar nonketotic syndrome

When does a diabetic coma occur?

in a severe stage of hypoglycemia that occurs when a patients blood sugar gets too low and stays low

WHat 3 sx would a pt in diabetic ketoacidosis show?

1. hyperglycemia
2. dehydration
3. acidosis

What blood glucose level indicates hypoglycemia?

less than 50-60

A pt with HHNS will exhibit what type of blood glucose level, ph level, bun, and creatinine?

blood glucose >500
ph level=normal
bun & creatinine level=elevated

What is the rationale for using inderal in the management of pts with cirrhosis of the liver?

prevent bleeding from esophageal varices

What are varicosities that develop from elevated pressure transmitted to all of the veins that drain into the portal system? And what med is prescribed for this?

varices, inderal will reduce the portal pressure by its beta-adrenergic blocking action

In a pt with diabetes type 2 what med creates a high risk for a hypoglycemic reaction?

glucovance, it could cause hypoglycemia

What are the most common side effects of Orinase?

gastrointestinal sx and dermatological reactions

What is the indication for orinase?

an oral hypoglycemic agent in non-insulin-dependent (type 2) Diabetes with adult onset

What is a common side effect of Precose?

lowering of hemoglobin A1c levels

What is the indication for precose and prandin?

management of type 2 diabetes

What is a S.E. of prandin and glucovance? Which is more serious?

1. hypoglycemia
2. more serious when using glucovance because prandin has a short half life

What is a cholecystectomy?

removal of the gallbladder

What is the best way to manage pain in the right shoulder following a cholecystectomy?

apply a heating pad for 15 minutes hourly, and when able pt should sit up or take a walk

What is steatorrhea?

fatty, oily stools, malabsorption of fats and proteins

WHat form of vitamin A, D, and E should be given to a patient with hepatic cirrhosis?

water soluble vitamin for pts with malabsorption

In what procedure will a patient be given a sedative followed by the oral insertion of a scope into the GI tract?

(ERCP) ednoscopic retrograde cholangiopancreatography

During what procedure does a patient swallow some barium?

a barium enema

When a patient recovering from hepatic encephalopathy is being discharged from the hospital what teaching should the nurse give the family to help them assess for signs of recurrent encephalopathy?

obtain a sample of the pts handwriting on a daily basis. In reoccurency they would not be able to drw a symple star figure.

What would be checked daily in an unconscious pt?

Babinski response

What are the 3 main concerns for a discharging pt?

1.prevent injury
2. bleeding
3.infection

Why would you incorporate massage into the plan of care for a pt who has impaired liver function?

a massage with emolients and being turned every 2 hours will promote moobilization of edema

What would you do to avoid ammonia deposits in the skin in a pt w/ impaired liver function?

avoid using soaps and alcohol based lotions

How could a nurse decrease ascitic fluid production in a pt with impaired liver function?

low Na+ diet

A pt with hypothyroidism who is takin HRT may be at risk for the development of which health problem and why?

hyperglycemia because thyroid hormones increase blood glucose levels

DO thyroid hormones affect K+ levels?

no

What is a physiological effect of thyroxine (T4)?

increased neuromuscular response because, thyroxine makes the muscles more responsive to catecholamines

What does thyroxine do to the metabloic rate?

increases it

What hormone is most associate with K+ aand regulates its excretion?

aldosterone

A deficiency of thyroid hormones (hypothyroidism) is associated with what in relation to oxygen?

impaired oxygen utilization

What finding should the nurse expect in a patient with hyperparathyroidism?

fatigue & apathetic, because calcium is concentrating in the blood stream

pts with hyperparathyroidism are likely to experience what in relation to the gastrointestinal tract?

constipation

pts with hyperparathyroidism are likey to have what type of BP?

high

What should be the main concern/intervention in a pt with a thyroid storm with a nsg diagnosis of altered body temp?

apply hypothermia blanket to quicky reduce pt's fever

Which drug is contraindicatd in a pt with hyperthyroidism and why?

aspirin because, it adversely affects thyroid hormones and may exacerbate the metabolism excess

What type of nutritional problem is commonly found in pts with addisons?

anorexia and some other metabolic disorders

Peoplle with thyroiditis have problems with what in relation to food?

dysphagia

In a pt who has edema associated with nephrotic syndrome, the nurse must carefully monitor the used of diuretics for which reason?

reduced plasma volume may precipitate acute renal failure

WHat does the diuretic Aldactone do to the effectiveness of ace inhibitors

enhances the effect

What can the volume of extracellular fluid removed by use of diuretics bring on?

hypovolemia (shock) leading to acute renal failure

The excretion of excess albumin is a defining feature of what ?

nephrotic syndrome

what intervention is 1st priority for a pt with hyperthyroidism who is started on inderal?

monior pulse and pulse pressure, because inderal is a beta blocker that reduces pt's tachycardia and palpitations. A pt with hyperthyroidism who is takin this med should be monitores for signs related to congestive heart failure

Does inderal affect prothromin and bleeding time?

no because it is a beta blocker

Does inderal have a side effect of postural hypertension?

no

Hypocalcemia is associated with what type of disorders?

disorders of the parathyroid

A pt with adrenal insufficiency has what tpe of electrolyte problem?

hyperkalemia

a pt that is dizzy, is experiencing neuromuscular irritability and confusion has classic signns of what electrolyte problem?

hypomagnesemia

A pt with adrenal insufficiency is like to have an excess or decrease in magnesium?

excess

A pt with adrenal insufficiency that is dizzy is experiencing neuromuscular irritability and confusion probably has what type of electrolyte problem?

hyponatremia

WHat is the expected affetc of epoetim alfa in a pt with chronic renal failure?

increase in hematocrit

What are Na+ levels regulated through?

fluid levels and diet

Older adult pts' with hyperthyroidism commonly present with which clinical manifestation?

diffuse pruritus

Moon face is a characteristic of what?

cushings syndrome

What type of heart rate is usually found in hypothyroidism?

bradycardia

A patient with a hx of renal calculi should be discouraged from taking what?

vitamin and mineral supplements, especially vit D and C to prevent further stone formation

High fluid intake is especially important in a pt with what?

renal calculi, especially if pt does lots of physical exertion

Heavy physical exertion and overheating can cause excessive sweating and temporary dehydration which can contribute to what?

the formation of renal calculi

Why is it important to take in sufficient fluid at bedtime?

so that urine concentration is not excessive overnight

What nursing diagnosis is appropriate for a pt with hyperthyroidism (graves disease) who develops exopthalmos

body image disturbance

Lovothyroxine sodium (synthroid) may take u to how long to reach the full level of concentration comparable to the natural thyroid hormone that its replacing?

10 days

What is one oof the most common sx of graves disease?

nervousness

gross tremors are associated with what metabloic problem?

hypoparathyroidism

What will a pt's skin look like in hypo and hyperthyroidsim?

hypo=pale
hyper=flushed

What would be a good outcome for a pt with renal calculi?

maintain urinary output that is equivalent to fluid intake to avoid concentrated urine.

Can renal calculi be accompanied by a fever?

yes

What nursing intervention would be most helpful in providing comfort of a patient with hyperthroidism?

provide a cool environment

How does a pt with hyperthyroidism constantly lose fluid?

through diarrhea and perspiration, encourage fluid intake

Would a moist humidifier be appropriate for a pt with hyperthyroidism?

no, their skin is already moist and sweaty

Is it necessary to restrict the positioning of a patient with hyperthyroidism?

no

Why does a pt with hyperparathyroidism need to remain as physically active as possible?

because decreased mobility may lead to renal calculi because of the kidney involvement. This coupled with excess calcium secretion associated with immobility places the patient at risk for renal calculi

Hyperparathyroidism causes what type of blood pressure?

hypertension

A characterisitc of hyperparathyroidism is what?

muscle weakness

It is dangerous for a pt with renal calculi to consume excessive amouts of which liquid?

milk because renal calculi are usually composed of calcium

WHat liquid should pts w/ renal calculi drink?

water because it flushes the kindeys

What is pheochromocytoma caused by?

it is caused by the pts catecholamine producing tumor

Is pheochromocytoma benign or cancerous?

benign, It can have associated hypertension which can be chronic from damage to blood vessels

what medical condition results in hypersecretion of hormones of the adrenal cortex?

cushings syndrome

What manifestation would the nurse expect to obsrve in a patient with decreased erythropoetin production secondary to end stage renal disease

shortness of breath

The musculoskeletal pain associated with ESRD is what?

bone pain

joint pain is associated with which medical condition?

hyperpituitarism

Headache is a classic sx of what medical condition?

pheochromocytoma

To improve nutritional status of a pt with graves disease the nurse should do what?

provide patient with a quiet atmosphere during meals

following a thyroidectomy, it is important for the nurse to ask the patient which qquestion to assess for bleeding?

"do you have a feeling of fullness at your incision site?", this couuld indicate swelling that could lead to acute respiratory obstruction

Is a sore throat normal after surgical removal of the thyroid gland?

yes

A pt is likely to have a drainage tube following a throidectomy whcih will what?

need to be checked

What sx is most characteristic of acute pyelonephritis?

flank pain

pain radiating to the shoulder coud indicate what?

gall bladder inflammation or myocardial infarction

Pelvic pain often occurs with what urinary problem?

UTI

In a pt with diabetes should fluid be restricted?

yes intake should be limited to output

What is a progressive condition resulting from overproduction of growth hormone?

acromegaly, pics of the past should be provided by the pt

WHy is exercise likely to be restricted in a pt with acromegaly?

bone density is decreased


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