Epilopoulos ch 15, 33 Ch 13 discuss the following factors that may affect client
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Question
Epilopoulos ch 15, 33
Ch 13
discuss the following factors that may affect clients’ self concept:
Gender Developmental level Socioeconomic status Family
Peer relationships Internal locus of control
2. The elder client’s daughter is vice president of a large company. She is experiencing great conflict in trying to care for her mother while managing her work-related responsibilities. In planning to help the daughter, the nurse focuses on which component of the daughter’s self-concept?
a. Body-image b. Role performance
c. Personal identity d. Self-esteem
3. Discuss what areas should be included in the psychosocial assessment of a client
4. In assessing clients who may be experiencing a depressive disorder, the nurse’s top priority is to determine which of the following? a. Onset and severity of symptoms
b. Risk of self-harm
c. Previous history of depression
d. Family and community supports
5. A client with anxiety is completely focused on himself and the need to relieve his problem. He is in which stage of anxiety?
a. Panic anxiety
b. Mild anxiety
c. Moderate anxiety
d. Severe anxiety
Chapter 16
1. The nurse notes on the admission form that the client has indicated “no religious preference.” He understands that
a.. The client does not follow the tenets of a specific faith
b. The client is in denial about his religious beliefs
c. The client does not believe in God or a “higher power”
d. The client will not want to pray or visit with the chaplain
It would be most important for the nurse to instruct the NAP to assist clients of which faith to wash their hands before meals?
a. Christian
b. Jewish
c. Mormon
d. Muslim
Would this statement by the nurse would be correct? “We should pray to God that your cancer goes into remission.” a. Yes b. No
Chapter 31: Comfort/pain
Differentiate between phantom pain and psychogenic pain
Differentiate between acute, chronic and intractable pain and provide examples of medical conditions that may cause each type.
It is most important for the nurse to understand the various ways in which
pain is classified
A. so that he can document the client’s pain using accurate terms
B. so that he can be clear in his communication with the physician
C. so that he can develop an effective pain management plan
D. so that he can educate the client thoroughly
Discuss how the following factors influence pain for clients:
Past experience with pain
Emotions
Developmental stage
Sociocultural factors
Communication skills
Cognitive impairment
5. Discuss the following pain scales:
Visual Analogue Scale (VAS)
Numeric Rating Scale (NRS)
Wong-Baker Faces Pain Rating Scale
6. The nurse is assessing the confused client. In trying to determine the client’s level of pain, the nurse should
be aware that confused clients don’t feel as much pain due to their
confusion
b. observe the client carefully for changes in behavior or vital signs
c. ask the client’s family how much pain the client normally has
use only pain scales that feature numbers or “faces” the client can
point to
7. Discuss Pharmacological Measures to Manage Pain
Nonopioid analgesics
•NSAIDs
•Acetaminophen
Opioid analgesics
•Includes IV, IM, transdermal, and epidural forms
•Client-controlled analgesia pumps
8. Mr. Zenobia's chronic cancer pain has recently increased, and he asks the home health nurse what can be done. In relationship to his long-acting morphine, which of the following is an appropriate response by the nurse?
a. "If you take more morphine, it will not change your pain relief."
b. "I'll call the physician and ask for an increased dose."
c. "The amount you are taking now is all I can give you."
d. "I'm worried if we increase your dose that you will stop breathing.”
Chapter 36
1. Which diagnostic test/exam would best measure a client’s level of hypoxemia?
a. chest x-ray
b. pulse oximeter reading
c. ABG
d. peak expiratory flow rate
2. Describe two ways in which breathing is controlled
What are the major risks to oxygenation for children and adults?
What areas should you include in a nursing history for a patient with oxygenation concerns who is undergoing a comprehensive assessment?
When is a cough significant? What aspects of a cough should be assessed?
In caring for a client with a tracheostomy, the nurse would give priority to the nursing diagnosis of:
a. Risk for ineffective airway clearance
b. Anxiety related to suctioning
c. Social isolation related to altered body image
d. Impaired tissue integrity
2. Describe two ways in which breathing is controlled
What are the major risks to oxygenation for children and adults?
What areas should you include in a nursing history for a patient with oxygenation concerns who is undergoing a comprehensive assessment?
When is a cough significant? What aspects of a cough should be assessed?
In caring for a client with a tracheostomy, the nurse would give priority to the nursing diagnosis of:
a. Risk for ineffective airway clearance
b. Anxiety related to suctioning
c. Social isolation related to altered body image
d. Impaired tissue integrity
Chapter 13:
1. Discuss the following factors that may affect clients’ self concept:
Gender Developmental level Socioeconomic status Family
Peer relationships Internal locus of control
2. The elder client’s daughter is vice president of a large company. She is experiencing great conflict in trying to care for her mother while managing her work-related responsibilities. In planning to help the daughter, the nurse focuses on which component of the daughter’s self-concept?
a. Body-image b. Role performance
c. Personal identity d. Self-esteem
3. Discuss what areas should be included in the psychosocial assessment of a client
4. In assessing clients who may be experiencing a depressive disorder, the nurse’s top priority is to determine which of the following? a. Onset and severity of symptoms
b. Risk of self-harm
c. Previous history of depression
d. Family and community supports
5. A client with anxiety is completely focused on himself and the need to relieve his problem. He is in which stage of anxiety?
a. Panic anxiety
b. Mild anxiety
c. Moderate anxiety
d. Severe anxiety
Chapter 39
Provide examples of a ‘Never Event’
Discuss how surgeries can be classified.
Discuss factors affecting surgical risk
An elderly woman fell at home and fractured her hip. After being admitted to the hospital, the nurse knows that the patient is to be “stabilized” prior to having surgery. This surgery would be classified as
a. urgent
b. elective
c. emergency
d. palliative
5. The nurse is completing a preoperative patient assessment. Which finding indicates the greatest risk
for the development of a postoperative complication?
a. the patient is 60 years old
b. the patient’s blood pressure is 130/88
c. the patient does not understand the surgery
d. the patient has early stage Alzheimer’s
6. Discuss what should be included in a clients’ preoperative teaching plan
7. Describe how to prepare a client physically for surgery
8. Discuss intraoperative safety measures
9. Describe postoperative nursing care including: the initial physical assessment, postoperative teaching, incentive spirometry, pain control and deep vein thrombosis prevention.
10. The nurse knows that the most important reason for controlling postoperative nausea/vomiting in the PACU is
a. to prevent the patient from becoming dehydrated
b. to prevent potential airway issues
c. to prevent the surgical dressing from becoming soiled
d. to prevent the patient from becoming upset
Explanation / Answer
2. The elder client’s daughter is vice president of a large company. She is experiencing great conflict in trying to care for her mother while managing her work-related responsibilities. In planning to help the daughter, the nurse focuses on which component of the daughter’s self-concept?
The data showed that she is suffering from inter-personal role conflict which affects her role performance. It occurs when the expectations of one role compete with the expectations of other roles. The person may feel unable to establish priorities among competing role expectations. So the answer is B. Role performance
3. Discuss what areas should be included in the psychosocial assessment of a client
Psychosocial assessment of a client includes
Demographic data
It includes Name of patient, Age, Sex,Marital Status,Religion, Education,Occupation,Socio-economic status, Monthly Income, Address, Informant,information(Relevant or not), Diagnosis
Chief Complaints/presenting complaints (list with duration)
- In patient’s own words and in informants own words.
E.g. : - Sleeplessness since 3 weeks
- Loss of appetite & hearing voices since 2 weeks
- Talking to self
Present psychiatric history
-Sub acute (within a few days)
-Gradual (within a few weeks)
Past Psychiatric history
Personal History
- Check ups
-Any complications
-Excessive temper tantrums
-Feeding habit
-Neurotic symptoms
-Excretory disorders etc.
-Age of going to School
-Performance in the School
-Relationship with peers
-Relationship with teachers
(Specifically look for learning disability and attention deficit)
-Look for conduct disorders E.g. Truancy,
-Stealing
- Age of joining job
- Relationship with superiors, subordinates &colleagues
- Any changes in the job – if any give details
- Reasons for changing jobs
- Frequent absenteeism
- Age of attaining puberty (female-menstrual cycles are regular)
- Source and extent of knowledge about sex, any exposures
Marital status
Pre morbid personality
Attitude towards others in social, family and sexual relationship
Attitudes to self
Moral and religious attitudes and standards
Mood
Leisure activities and hobbies
Fantasy life
Reaction pattern to stress
Habits
MENTAL STATUS EXAMINATION (MSE)
General Appearance and Behaviour
General Appearance
Attitude towards Examiner
Gait and Posture
Psychomotor Activity
Social Manner and Non-verbal Behaviour
Rapport
Speech
Rate and Quantity of Speech
Volume and tone of speech
Flow and Rhythm of Speech
Mood and Affect
Mood
Affect
Thought
Stream/Flow/Form of Thought Process
Thought Content
Obsessions
Phobia
Suicidal ideas/Homicidal ideation
Pre-occupations
Perception
Illusion
Hallucinations
Depersonalization
Derealization
Cognition
Consciuosness
Orientation
Attention and Concentration
Memory
Intelligence and General Information
Abstract Thinking
Insight
It is rated on 6-point scale from one to six.
Judgement
1. Personal Judgement- future plan.
2.Social Judgement- observed during hospital stay and during interview session.
3.Test Judgement- certain test situation
- house on fire
- Man lying on road
- Sealed, stamped, addressed envelope lying on a street
Judgement is rated as Good/Intact/Normal/Poor/Impaired/abnormal
DIAGNOSTIC IMPRESSIONS(DSM-V)
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V: GAF
4. In assessing clients who may be experiencing a depressive disorder, the nurse’s top priority is to determine which of the following?
Nurse must assess life-threatening behaviour of client such as suicide ie risk for self harm. Safety need is most priority need in depression. So the answer is B. Risk for self harm
5. A client with anxiety is completely focused on himself and the need to relieve his problem. He is in which stage of anxiety?
He is in mild level of anxiety. Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal directed activity.
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