Respiratory & Psych Mental Health

1. Respiratory & Psych Mental Health

2. The nurse is admitting a patient with suspected tuberculosis to the acute care unit. The nurse places the patient in airborne precautions until a confirmed diagnosis of active TB can be made. Which of the following tests is a priority to confirm the diagnosis? • Chest x-ray that is positive for lung lesions • Positive purified protein derivative test • Sputum positive for hemoptysis • Sputum culture positive for Mycobacterium tuberculosis

3. A patient is admitted to a burn unit with second and third degree burns over 18% of the body. An inhalation injury is also suspected. The nurse should monitor which of the following to determine the extent of carbon monoxide poisoning? • Pulse oximetry • Urine myoglobin • Arterial blood gas • Serum carboxyhemoglobin levels

4. A patient with no history of respiratory disease has a sudden onset of dyspnea, chest pain, and tachycardia. A pulmonary embolism is suspected. The nurse anticipates which set of therapeutic orders to be prescribed for this patient? Select all that apply: • Semi-Fowler’s position • Oxygen at 2 L/min • High Fowler’s position • Morphine sulfate 2 mg intravenously • Oxygen at 4 L/min • Meperidine hydrochloride (Demerol) 100 mg intramuscular

5. A patient with pulmonary edema is currently receiving 6 L/min of oxygen per nasal cannula. The most recent arterial blood gas (ABG) results indicate the following: pH=7.30, pCO2=55mm Hg, pO2=56mm Hg, HCO3=24mm Hg. The nurse anticipates that the physician will order which of the following? • Change nasal cannula to face mask at 6 L/min oxygen • Add one ampule of sodium bicarbonate to the patient’s current intravenous fluids • Change nasal cannula to partial rebreather mask at 8 L/min oxygen • Intubate the patient and place on mechanical ventilation

6. A registered nurse is planning the schedule for the day. Which of the following nursing tasks may the nurse delegate to a licensed practical nurse? • Develop instructions for the patient on pursed-lip breathing • Clarify an order with the physician • Instruct a patient on a bronchoscopy • Administer a purified protein derivative (PPD) to a patient

7. The nurse assesses fluctuations in the water seal chamber of a patient’s closed chest drainage system. The nurse evaluates this finding as indicating • The system is functioning properly • An air leak is present • The tubing is kinked • The lung has re-expanded

8. The nurse is preparing a patient with empyema for a thoracentesis. Which of the following should the nurse have available in the event that the procedure is ineffective? • A ventilator • A chest insertion kit • An intubations tray • A crash cart

9. The nurse is admitting a patient who is complains of fever, chills, chest pain, and dyspnea. The patient has a heart rate of 110, respiratory rate of 28, and a nonproductive hacking cough. A chest x-ray confirms a diagnosis of left lower lobe pneumonia. Upon auscultation of the lower lobe, the nurse documents which of the following breath sounds? • Bronchial • Bronchovesicular • Vesicular • Absent breath sounds

10. A patient takes oxtriphylline (Choledyl). Which explanation by the nurse accurately represents the drugs characteristics? • “the medication increases your heart rate to increase the release of oxygen” • “the drug relaxes the lung tissue so that oxygen will pass across it easier” • “the medication is used to dilate your airways and make it easier for you to breathe” • “the medication thins the secretions in your lungs and makes it easier for you to cough”

11. Because a patient with chronic obstructive pulmonary disease had been taking triamcinolone acetamide (Azmacort) 8 mg PO qid at home and currently receiving dexamethasone (Decadron) 4 mg IV q4 hr in the hospital, the nurse should anticipate which of the following in relation to these two medications? • Increase the dose of triamcinolone • Scheduling the drugs so they peak at different times • Increase in symptoms with administration of the two drugs • Smaller dose of triamcinolone and/or dexamethasone

12. When teaching new staff members about mental illness/mental health treatment approaches developed during the 1950’s, the nurse should indicate that which therapeutic approaches were developed at approximately the same point in time? Select all that apply. • Community mental health centers • Antipsychotic medications • Nurse-client relationship. • Psychoanalysis • Cognitive theory

13. The patient says, “I feel like I’ve been abandoned.” The nurse who chooses to use which communication technique might reply, “You feel all alone?” • Focusing • Summarizing • Reflecting • Restating

14. A new staff nurse asked the experience psychiatric mental health nurse to explain the primary purpose for which the psychiatric mental health nurse uses the DSM-IV-TR. The response of the more experienced nurse should be, “Nurses use the DSM-IV-TR to:” • Determine functional categories of physical disabilities of the patient. • Understand the patient’s psychiatric mental health medical diagnosis(es). • Defined categories of nursing diagnoses for the patient. • Specify individualized outcomes for nursing care of the patient.

15. The treatment team has recommended that an individual be committed to a psychiatric inpatient unit. When the family of this individual asked about possible adverse effects or arguments against commitment, the nurse should tell them that: • The family may not be able to care for acutely ill member. • Intervention will ease suffering and, in some cases, save lives. • In many instances, it is the only way to obtain treatment from the public healthcare system. • It reinforces the stigma that mentally ill people are dangerous and unpredictable.

16. A new nurse asked the experience psychiatric mental health nurse about the origins of the community mental health movement. The experience nurse should respond that the community mental health movement resulted primarily from: • Destruction of asylums. • Lack of government housing. • Deinstitutionalization • The need of society to spread the mentally ill all over the country.

17. When planning nursing care, the nurse uses the approach of which theorists when considering motivation and behavior by utilizing a schematic hierarchy of needs? • Sigmund Freud • Hairy Stack Sullivan • Jean Piaget • Abraham Maslow

18. The nurse is planning to conduct reminiscence therapy before a group of older adults. The nurse implements this by doing which of the following? • Encouraging each member to socialize with each other member within the group. • Role modeling adaptive ways to cope with aging. • Encouraging each group member to recall discuss earlier life experiences. • Validating patient’s positive feelings about aging.

19. While an older patient is completing a life review with the nurse, the patient shows despair over life events and injustices that occurred, personal inability to find any meaning in all life, and feelings of hopelessness about the future. The nurse should formulate which of the following as the most appropriate nursing diagnosis? • Spiritual distress • Chronic sorrow • Chronic low self-esteem • Risk for violence, self-directed

20. A patient history of drug abuse verbalizes the need for help during the nursing history. When planning treatment for the patient, what is the most important additional information the nurse should obtain? • How the patient has supported the drug use • The patient’s current height and weight • The patient’s family response to the drug use • The types and quantity of drugs involved

21. The nurse wishes to encourage the patient to express personal feelings and to develop increased awareness about what those feelings mean. Which approach by the nurse would be best? • Challenge the patient • Offer reassurance • Give advice • Offer empathy

22. While the nurse and patient are talking, the patient states, “You are just like my mother; you don’t trust or like me. The two of you wish I were dead.” Nurse interprets the statement is indicating which of the following processes? • Psychosis • Countertransference • Transference • Projection