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RNSG 2539 FINAL EXAM 2023 2024 |
ACTUAL EXAM QUESTIONS AND
ANSWERS | LATEST UPDATE | 2024
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What are the 2 types of symptoms for schizophrenia? -------CORRECT ANSWER--------- ----Positive or hard symptoms
- Negative or soft symptoms What are positive symptoms? -------CORRECT ANSWER------------Manifestations of things that are not normally there. Examples of positive symptoms (9) -------CORRECT ANSWER-------------Ambivalence
- Associative looseness
- Delusions
- Echopraxia
- Flight of ideas
- Hallucinations
- Ideas of reference
- Perseveration
- Bizarre behavior What are negative symptoms? -------CORRECT ANSWER------------Absence of things that are normally present Examples of negative symptoms (9) -------CORRECT ANSWER-------------Alogia
- Anhedonia
- Apathy
- Asociality
- Blunted affect
- Catatonia
- Flat affect
- Avolition or lack of volition
- Inattention Schizophrenia - Speech Patterns (7) -------CORRECT ANSWER-------------Clang associations
- Neologisms
- Verbigeration
- Echolalia
- Stilted language
- Perseveration
- Word salad Types of Hallucinations (8) -------CORRECT ANSWER-------------Auditory
- Command
- Visual
- Olfactory
- Tactile
- Gustatory
- Cenesthetic
- Kinesthetic Schizophrenia - Types of Delusions (7) -------CORRECT ANSWER------------- Persecutory/paranoid delusions
- Grandiose delusions
- Religious delusions
- Somatic delusions
- Sexual delusions
- Nihilistic delusions
- Referential delusions or ideas of reference Types of Burn Depth (4) -------CORRECT ANSWER-------------Superficial*
- Partial thickness*
- Full thickness*
- Full thickness that includes fat, fascia, muscle, and/or bone
Skin involvement
- Epidermis, portion of dermis Wound Appearance
- Blistered, mottled red base
- Disrupted epidermis
- Weeping surface
- Edema Partial thickness burn clinical manifestations -------CORRECT ANSWER-------------Pain
- Hyperesthesia
- Sensitive to air currents Full thickness burn Causes Skin involvement Wound Appearance -------CORRECT ANSWER------------Causes
- Flame
- Prolonged exposure to hot liquids
- Electrical current
- Chemical
- Contact Skin involvement
- Epidermis, dermis, and sometimes subq tissue.
- May involve connective tissue, and muscle Wound Appearance
- Dry
- Pale white, red, brown, leathery, or charred
- Coagulated vessels may be visible
- Edema Full thickness burn clinical manifestations (5) -------CORRECT ANSWER------------- Insensate (no feeling)
- Shock
- Myoglobinuria (Red pigment in urine)
- Possible hemolysis
- Possible contact points (entrance or exit wounds in electrical burns)
Full thickness that includes fat, fascia, muscle and/or bone Causes Skin involvement Wound Appearance -------CORRECT ANSWER------------Causes
- Prolonged exposure or high voltage electrical injury Skin involvement
- Deep tissue, muscle, and bone Wound Appearance
- Charred SAFE Questions S A F E -------CORRECT ANSWER------------Stress/Safety Afraid/Abused Friends/Family Emergency plan SAFE Questions - S (3) -------CORRECT ANSWER------------Stress/Safety
- What stress do you experience in your relationships?
- Do you feel safe in your relationships?
- Should I be concerned for your safety? SAFE Questions - A (6) -------CORRECT ANSWER------------Afraid/Abused
- Have there been situations in your relationships where you have felt afraid?
- Has your partner ever threatened or abused you or your children?
- Have you ever been physically hurt or threatened by your partner?*
- Are you in a relationship like that now?
- Has your partner ever forced you to engage in sexual intercourse that you did not want?
- People in relationships/marriages often fight; what happens when you and your partner disagree?
- Do offer to help the client contact a shelter, the police, or other resources.
- Do accept and respect the victim's decision.
- Do encourage development of a safety plan. Cycle of Abuse -------CORRECT ANSWER------------I--> Violence I V I Honeymoon (Remorseful) Period I V I----Tension Building Tension Building Phase -------CORRECT ANSWER------------•The perpetrator has minor episodes of anger and can be verbally abusive and responsible for some minor physical violence (pushing, shoving). •As tension continues to grow, both partners try to reduce it. •The perpetrator may turn to substances and the victim dismisses the significance of the violence. •The vulnerable person is tense during this stage and tends to accept the blame for what is happening. From Hack's PP The tension-building phase is when there may be arguments, stony silence, or complaints from the husband. The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. Violence (Acute battering Phase) -------CORRECT ANSWER------------•The tension becomes too much to bear, and serious abuse takes place. •The victim may provoke the perpetrator to reduce the unbearable tension. •The vulnerable person can try to cover up the injury or try to get help. •This stage is the most violent and shortest Honeymoon (Remorseful) Phase -------CORRECT ANSWER------------•The situation is defused for a while after the violent episode. •The perpetrator becomes loving, promises to change, and is sorry for the behavior. •The vulnerable person wants to believe this and hopes for a change. •Eventually, the cycle begins again.
Victims of rape fare best when... -------CORRECT ANSWER------------they receive immediate support and can express fear and rage to family members, nurses, physicians, and law enforcement officials who believe them. What are rape treatment centers? -------CORRECT ANSWER-------------Emergency services that coordinate psychiatric, gynecologic, and physical trauma services in one location and work with law enforcement agencies.
- These are very helpful to victims In the emergency setting, the nurse is an essential part of the team in providing ____________ to the victim. -------CORRECT ANSWER------------Emotional support What are ways a nurse can allow a victim to take back control? -------CORRECT ANSWER------------The nurse should allow the woman to proceed at her own pace and not rush her through any interview or examination procedures. Ways to do so include allowing her to make decisions, when possible, about:
- Whom to call,
- What to do next
- What she would like done It is the woman's decision about whether or not to file charges and testify against the perpetrator. The victim must sign consent forms before any photographs or hair and nail samples are taken for future evidence. Who's decision is it whether charges will be filed or not? -------CORRECT ANSWER------ ------It is the woman's decision about whether or not to file charges and testify against the perpetrator. The victim must sign consent forms before... -------CORRECT ANSWER------------any photographs or hair and nail samples are taken for future evidence. What kinds of treatments/teachings will a women get? R/T STDs
Most men who commit rape are between _____ and _____ years of age ------- CORRECT ANSWER------------ 25 - 44 Dynamics of Rape ______% of men who commit rapes are white -------CORRECT ANSWER------------52% Dynamics of Rape Alcohol is involved in _____% of cases -------CORRECT ANSWER------------34% Dynamics of Rape** Almost _____% of arrested rapists have prior criminal histories including: (4) ------- CORRECT ANSWER------------75%*
- Other rapes
- Assaults
- Robberies
- Homicides Dynamics of Rape 4 Categories of Male Rapists -------CORRECT ANSWER-------------Power Assertive Rapist (30%)
- Anger Retaliation Rapist (24%)
- Power Reassurance or Opportunity Rapist (30%)
- Anger Excitement or Sadistic Rapist (16%) Power Assertive Rapist (5) -------CORRECT ANSWER-------------This perpetrator desires to dominate and control the victim
- May cruise bars or the Internet to obtain victims
- Acts macho
- May repeat with the same victim
- 44% of all rapes are in this category. Anger Retaliation Rapist (5) -------CORRECT ANSWER-------------This perpetrator wants to punish victims
- Hates women
- Often causes substantial injury
- Sees self as masculine and action oriented
- Spends time in chatrooms on Internet voicing general hatred for women due to some perceived "injustice." Power Reassurance or Opportunity Rapist -------CORRECT ANSWER------------- Commits rape when opportunity presents itself, often during the commission of some other crime
- Is lonely
- Has low self-esteem
- Keeps souvenirs
- Thinks victim "liked" it Anger Excitement or Sadistic Rapist -------CORRECT ANSWER-------------Wants to hurt the victim
- Often victim is killed
- Acts out fantasies
- Compulsive in personal appearance
- Carries a rape kit
- Learns better ways to stalk
- Seeks victims on the Internet How can elder abuse be prevented? -------CORRECT ANSWER------------Relieving the caregiver's stress and providing additional resources may help to correct the abusive situation and leave the caregiving relationship intact. Hack's PP ***Always provide the primary caregiver with additional resources to meet the elder patient's needs. What must be done if the abuse is intentional? -------CORRECT ANSWER------------ Removal of the elder or caregiver is necessary Categories of Elder Abuse -------CORRECT ANSWER-------------Physical abuse
- Rashes, sores, or lice on the elder
- The elder has an untreated medical condition or is malnourished or dehydrated not related to a known illness
- Inadequate material items, such as clothing, blankets, furniture, and television Elder Abuse - Self-Neglect Indicators (6->3) -------CORRECT ANSWER------------- Inability to manage personal finances, such as: ---Hoarding, ---Squandering ---Giving away money while not paying bills
- Inability to manage activities of daily living, such as personal care, shopping, or housework
- Wandering, refusing needed medical attention, isolation, and substance use
- Failure to keep needed medical appointments
- Confusion, memory loss, and unresponsiveness
- Lack of toilet facilities, or living quarters infested with animals or vermin Elder Abuse - Warning Indicators from Caregiver (6) -------CORRECT ANSWER----------- --The elder is not given an opportunity to speak for self, to have visitors, or to see anyone without the presence of the caregiver
- Attitudes of indifference or anger toward the elder
- Blaming the elder for his or her illness or limitations
- Defensiveness
- Conflicting accounts of elder's abilities, problems, and so forth
- Previous history of abuse or problems with alcohol or drugs Bullying interventions - The Bullied Child (5->4) -------CORRECT ANSWER------------- Educate parents whose children are at risk for being bullied: ---Kids who appear different from the majority ---Kids who act different from the majority ---Kids with low self-esteem ---Kids with mental or psychological problems
- Teach parents to role-play different scenarios the kid may face in school ---Show them different ways to react to being bullied
- Impress upon them that he or she did not cause the bullying
- Develop ways to increase the kid's self-esteem at home
- Discuss the situation with the teacher and develop a plan of care. From Hack's PP
- Nurse Priority for education is to prevent suicide
- Remember when children are cyberbullied, they distance themselves from friends and family and do poorly in school Bullying Interventions - The Bullying Child (5) -------CORRECT ANSWER------------- Educate the parents on reasons why it is important to correct the behavior
- Discuss ways the child can appropriately show his or her anger of feelings
- Have parents help the child to see how it feels to be bullied
- Do not allow fighting at home
- Reward settling of conflicts without violence Cyberbullying -------CORRECT ANSWER------------Utilizing email, text messages, social networking, and instant messaging, to bully someone. From Hacks PP
- Remember when children are cyberbullied, they distance themselves from friends and family and do poorly in school DIC - Lab values Lab name/Normal Range/Increased or Decreased PLT (# of platelets in body)* PT (Extrinsic path clot time)* aPTT (Intrinsic path clot time)* TT (Clot formation) Fibrinogen (Amount avail for clotting) D-Dimer (Local fibrinolysis)* Fibrin degradation products (FDPs) (Fibrinolysis) Euglobulin clot lysis (Fibrinolytic activity) -------CORRECT ANSWER------------Lab name/Normal Range/Increased or Decreased PLT............150,000-450,000.........Decreased PT...............11-12.5 secs.....................Increased aPTT..........23-35 secs.....................Increased TT................8-11 seconds.................Increased Fibrinogen.....170-340....................Decreased D-Dimer..........0-250.........................Increased FDPs............0-5....................................Increased Euglobulin clot lysis.....> or = 2 hrs.......< or = 1 hr
What fluids are used to replace volume when a patient is in shock? -------CORRECT ANSWER-------------Crystalloids (Ex. NS, LR, D5W)
- Colloids (Ex. Albumin)
- Blood Components (Ex. Packed red blood cells, Fresh frozen plasma, Platelets) NS and LR are the most commonly used ones Goals of fluid resuscitation -------CORRECT ANSWER------------•Maintain blood pressure of greater than 100 mm Hg systolic and •Urine output of 30 to 50 mL/hr •Maintain serum sodium at near-normal levels Left Sided Heart Failure - Clinical Manifestations (12-ish) -------CORRECT ANSWER----- -------Remember where the blood is backing up. *Left=Lungs
- Dyspnea
- Orthopnea (SOB when lying down)
- Nocturnal Dyspnea
- Dyspnea on exertion
- Fatigue
- Displaced apical pulse (Hypertrophy)
- S3 heart sound (Gallop)
- Pulm congestion -----Dyspnea -----Cough -----Bibasilar crackles
- Frothy sputum (Possibly blood tinged/pink)
- Altered mental status
- Manifestations of organ failure (ex. oliguria) -----Because blood isn't getting to organs
- Nocturia (Because cardiac workload is decreased at night, perfusion to kidneys goes up thus making the person want to pee)
Right Sided Heart Failure - Clinical Manifestations -------CORRECT ANSWER------------ *Right=Backs up in body
- JVD
- Ascending dependent edema (leg, ankles, sacrum)
- Abd distention/Ascites
- Fatigue
- Weakness
- Nausea
- Anorexia
- Polyuria at rest (nocturnal)
- Liver enlargement (hepatomegaly) and tenderness
- Weight gain AKI Nursing Mgmt (6) -------CORRECT ANSWER-------------Monitoring F&E balance
- Reducing metabolic rate
- Promoting Pulm Fxn
- Preventing infection
- Providing skin care
- Providing psychosocial support AKI - Hyperkalemia -------CORRECT ANSWER-------------One of the most life- threatening F/E changes that can occur in a pt with AKI
- Tx with Kayexalate ---Oral or enema
- Promotes K removal ABG Values pH CO HCO3 -------CORRECT ANSWER------------ ......................A.......................N.............................B pH: .........<7.35.............7.35-7.45..................7.45< CO2: ......>45...................45-35......................35> HCO3:....<22...................22-26.......................26< PE Prevention Guidelines (9)
Situations you need to be aware of that can cause transmission (5) -------CORRECT ANSWER------------#1 Hand hygiene***** Personal protective equipment (PPE) Soiled patient care equipment handling Environmental control Textiles and laundry Needles and other sharps Patient resuscitation What kind of precautions will you use for a patient with HIV? -------CORRECT ANSWER------------Standard. You do not need to use contact precautions. Touching them will not give you HIV. Sepsis prevention (8->2) -------CORRECT ANSWER------------WASH YOUR HANDS!!! Strict infection control practices:
- Thorough hand hygiene
- Implementing programs to prevent central line infection
- Ensuring early removal of invasive devices that are no longer necessary (e.g., indwelling urinary catheters)
- Implementing prevention programs to prevent ventilator associated events and pneumonia
- Promoting early ambulation
- Timely débriding of wounds to remove necrotic tissue-Carrying out standard precautions
- Adhering to infection prevention/control practices including: -----Use of meticulous aseptic technique -----Properly cleaning equipment and the patient environment Sepsis - Medical Mgmt -------CORRECT ANSWER-------------Correct the underlying cause ---You need to ID what infectious source is causing the sepsis ---Take cultures before administering abx
- Pharm therapy ---Broad spectrum abx until pathogen is ID'd ---Fluid therapy and possibly vasopressors to improve tissue perfusion
- Nutritional therapy
---Aggressive nutritional supplementation is needed to address the pt's hypermetabolic state. ---Enteral feedings are preferred to parenteral feedings Sepsis - Correct the underlying cause -------CORRECT ANSWER-------------You need to ID what infectious source is causing the sepsis
- Take cultures before administering abx Sepsis - Pharm therapy -------CORRECT ANSWER-------------Broad spectrum abx until pathogen is ID'd
- Fluid therapy and possibly vasopressors to maintain/improve tissue perfusion Sepsis - Nutritional therapy -------CORRECT ANSWER-------------Aggressive nutritional supplementation is needed to address the pt's hypermetabolic state.
- Enteral feedings are preferred to parenteral feedings Organ transplant Nursing Int -------CORRECT ANSWER-------------Oliguria
- Edema
- Fever
- Increasing BP
- Weight gain
- Swelling/tenderness over transplanted kidney or graft
- If the pt is receiving cyclosporine, the only sign may be a 20% increase in crea. S/S of infection (5) -------CORRECT ANSWER-------------Shaking chills
- Fever
- Rapid heartbeat (tachycardia)
- Rapid respirations (tachypnea)
- Increase or a decrease in WBCs (leukocytosis or leukopenia). Pancreatitis Dx Labs -------CORRECT ANSWER-------------Amylase: Elevated (Returns to normal in 2-3 days)
- Lipase: Elevated (Returns to normal after amylase)
