NCLEX Review About The Aging Eye (7-10)

NCLEX Review About The Aging Eye

7. A physician prescribes "patching" for a child with strabismus of the right eye. A nurse instructs the mother regarding this procedure. Which of the following statements when made by the mother indicates that she understands the instruction?

a) I will place the patch on the right eye
b) I will place the patch on both eyes
c) I will place the patch on the left eye
d) I will alternate the patch from right to left eye hourly

8. The client comments, "I frequently change my eye glasses, none of which is satisfactory and I have difficulty focusing on my work." Which of the following disorders may the client be experiencing?

a) cataract
b) glaucoma
c) detached retina
d) myopia

9. An 85-year old woman complains of pain in her operated eye after cataract removal surgery. The nurse knows that this symptoms is

a) expected, and she should offer analgesic
b) unexpected and may signify a detached retina
c) unexpected and may indicate hemorrhage
d) expected and she should advise the client to be on bed rest

10. The client had just undergone repair of detached retina. Which of the following should be included in the nursing care plan of the client?

a) encourage self-care activities
b) limit movement of his eyes
c) restrict excessive talking
d) limit fluid intake

NCLEX Review About The Aging Eye:

7) C
- In strabismus, patch the good eye. This will train the affected eye.

8) B
- glaucoma is an eye disorder that causes damage to the retina and optic nerve that may lead to blindness. Eye glasses does not improve the vision, so the client frequently changes them.

9) C
- pressure or pain in the eye postop indicates hemorrhage. This should be reported to the physician.

10) B
- limiting eye movement after retinal surgery is done by application of pressure dressing. This is to prevent increase in intraocular pressure.

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NCLEX Review about Cardiac Nursing (1-5)

NCLEX Review about Cardiac Nursing

1. Who among these clients with congenital heart diseases should be cared for first by the nurse?

a) the child with coarctation of aorta with elevated blood pressure in the upper extremity
b) the child with tetralogy of Fallot with clubbing of fingers and elevated red blood cells
c) the child with ductus arteriosus who experiences fatigue after feeding
d) the child with ventricular septal defect who murmurs on auscultation of the chest

2. The child had been diagnosed to have rheumatic fever. Which of the following does the nurse expect to assess in the child?

a) painless nodules in bony prominence
b) decreased antistreptoysin O (ASO) titer
c) desquamation of the skin on the tips of finger and toes
d) high-grade fever that spikes in the morning

3. The nurse teaches the mother on lanoxin (digoxin) administration to an infant. Which of the following statements when made by the mother indicates that the teaching is effective?

a) I can give the medication to my child as long as his heart rate is above to 70 beats per minute
b) I will give the medication one hour before or 2 hours after feeding
c) I will mix the medication with the milk feeding
d) I will mix the medication with mashed fruits

4. Which of the following is most important to monitor in the client after surgery for abdominal aortic aneurysm?

a) intake and output measurement every shift
b) blood pressure every 4 hours
c) body temperature every 4 hours
d) abdominal girth

5. The client experiences intermittent claudification. Which of the following should be included in the nursing care plan of the client to promote comfort and general condition?

a) elevate the legs when sitting or lying supine
b) apply warm compresses to the legs
c) encourage progressive exercises
d) apply elastic bandage on the legs

NCLEX Review about Cardiac Nursing:

1) C
- the client is experiencing hypoxia. Need for oxygenation take priority. Choices A, B and D are expected findings.

2) A
- subcutaneous nodules are painless swellings. Other signs and symptoms of rheumatic fever are: migrating polyarthritis, increased ASO titer, increased ESR, arthralgia, fever. Choice C describes kawasaki disease.

3) B
- digoxin should be given on empty stomach. This ensures adequate absorption of the medication. In an infant, digoxin is not given if the apical pulse is below 90-110 bpm. For older children, if the apical pulse is below 70 bpm, the drug is also withheld.

4) D
- internal bleeding will cause accumulation of blood within the abdominal cavity. Increase in abdominal girth is an accurate indicator of this complication.

5) C
- progressive exercises, especially walking promote arterial collateral circulation (intermittent claudification is a sign of arterial insufficiency).

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NCLEX Review Questions on Cancer (1-3)

Welcome to the NCLEX Review Questions on Cancer. Enjoy answering and I hope that this site: NCLEX Review and Secrets can somehow help you in your future nursing licensure examination. Good Luck.

Situation: Aling Nena is a 60 year old woman with a malignant tumor of the breast, who was admitted for modified radical mastectomy.

1. The physician has ordered 5 flourouracil, 700 mg IV once a week. When Aling Nena hears this, she says to the nurse, "Am I going to lose my hair?" Which is the best response by the nurse?

a) 5-flourouracil usually does nit cause loss of hair
b) hair loss can occur but a wig can be worn until your hair grows back
c) the physician will prescribe a medication to prevent this side effect from occurring
d) losing your hair is less traumatic than losing breast

2. Aling Nena is being assessed of her nutritional status. She weigh 100 lbs and is 5'8 ft. tall. Her assessment would include the following except:

a) a diet history
b) anthropometric measurements
c) food preferences
d) serum protein

3. Which nursing action would best attain the goal of providing and promoting coping for Aling Nena?

a) telling Aling Nena for her strengths and progress
b) planning experienced for her that are conclusive
c) helping her to identify her problems and solutions
d) giving her information on how to handle her problems

Try to read the latest type of cancer, it might be included in the exam --> Mesothelioma Cancer

NCLEX Review Questions on Cancer:

1) B
- the drug can cause alopecia or hair loss but the hair will grow back after treatment. The nurse can advise the patient to wear a wig or other head accessories for coverage. The patient should buy the wig before hair falls out.
5-fluoroucacil or 5-FU is an antineoplastic drug that used for the cancers of the colon, rectum, breast, stomach and pancreas.

The adverse side effects of this drug are:
  • Photosensitivity - advise to avoid prolonged exposure to sunlight and to use highly protective sunlight to prevent inflammatory erythematous dermatitis
  • advise patient she cannot get pregnant or breastfeed while under medication because of its toxic effect
  • advise patient to discontinue drug and report to physician if diarrhea occurs as it is a sign of toxicity
  • Mouth sores (stomatitis) - apply topical anesthetics for comfort, advise oral hygiene to prevent infection of the denuded oral mucosa
  • Nausea, vomiting, and anorexia - give antiemetic before administration
  • Leukopenia, anemia, agranulocytosis - avoid exposure to infection
  • Scaling of the skin, pruritus, desquamative rash of hands and feet, and nail changes - reversible after medication, can be treated with pyridoxine 50-150 mg for 7 days
  • Thrombocytopenia - avoid IM injections when platelet count goes below 50,000
  • if crystals form in the drug - redissolve by warming solution
  • do not use cloudy solution, do not refrigirate, protect from sunlight, discard unused portion after 1 hour
  • use plastic IV bags if to be infused by intravenous route as the drug is more stable in plastic than glass
2) C
- although inquiry about food preferences is history taking, it is not used in the standard nutritional status assessment of the patient.
The information gained during nutritional status assessment are:
  • Anthropometric measurements: height, weight, body mass index (BMI), circumferential measurements
  • Physical examination - clinical signs and symptoms such as pallor, dry skin, brittle hair, mouth sores
  • Diet history - 24 hours diet recall to assess the quality and quantity of food intake
  • Diagnostic tests: hemoglobin, hematocrit, transferring, serum protein, total lymphocyte count, nitrogen balance, d-xylose absorption test, creatinine excretion, serum levels
3) C

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NCLEX Review Questions on Cancer (4-10)

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Online Nursing Practice Test about Respiratory Diseases (11-13)

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Situation: Joey has been brought to the hospital with acute laryngotracheobronchitis. He received epinephrine in the emergency room 2 hours ago.

11. While completing discharge teaching with Joey's parents. The nurse teaches the parents that Joey may have recurrence of uncontrolled coughing. The nurse should instruct the parents that if this happened, they should first:

a) call the emergency room
b) increase his fluid intake to liquefy secretion
c) administer the prescribed dose of guaifenesin
d) sit with the child in the bathroom with a basin of hot water and the door closed

12. Joey became very upset and agitated when he is placed in a mist tent. His aunt, who is staying with him, asks the nurse, "Isn't there something we can do?" The best response for the nurse is:

a) he'll settle down once he get used of it
b) would you like to sit with him under the tent
c) he has to stay here. I'll get him some toys
d) go ahead and take him out, but let him back in the tent when you leave

13. The initial nursing action for the nurse admitting Joey to the pediatric unit is to:

a) familiarize Joey with the unit
b) assess respiratory status
c) offer fluids
d) administered oxygen as ordered


11) D
- Before discharging a child who had a croup attack, the nurse should provide anticipatory guidance to the parent in case croup happens again in the future. Bring child in the bathroom with a basin of hot water to fill the room with steam. This moist warm air will help to cause bbronchodilation and relieve spasms. Another way is to fill the bath tub with hot water or let faucet run with hot water.
Laryngotracheobronchitis or croup is inflammation of the larynx, trachea and bronchi. The most common cause in children below 3 years old is viral infection and between three to six years old, it is often due to H. influenzae.

Signs and symptoms of laryngotracheobronchitis include:

  • begins as a mild upper respiratory infection without fever or low grade fever

  • child awakens during the night in respiratory distress: barking cough, inspiratory stridor, and retractions which frightens the parents who rush the child to the emergency room

  • emergency management in the E.R. is to give the child racemic epinephrine by nebulizer to cause bronchodilation and maintain patent airway.

    • 12) B
      - a child having croup is placed inside the mist tent to promote bronchodilation and liquefy secretions. If the child feels afraid bein inside the plastic enclosure alone, it is allowable to tuck the parent or caregiver inside the mist tent with the child to reduce child's anxiety and prevent crying.
      13) B
      - the major danger of croup is airway occlusion from laryngospasm, therefore it is important to check the respiratory status of the child frequently.

      • the nurse should take the vital signs closely every 15 minutes. Cyanosis, child thrashing, increased respiratory and pulse rate are signs of respiratory obstruction which requires intubation to maintain airway
      • in addition, the nurse should provide comfort to the child and reduce the child's anxiety or fear. She can advise parent to hold child as necessary in order to prevent crying. This is because crying can result in laryngospasm and total occlusion of the aiway
      • it is also contraindicated to stimulate the gag reflex as this can also result in laryngospasm
      • if the child can tolerate it, the child should be allowed to drink or sip fluid from a straw to keep secretions moist.

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      Online Nursing Practice Test/Exam about Endocrine (8-14)

      Welcome to the Online Nursing Practice Test/Exam about Endocrine. Before you begin answering this questions, I recommend that you read this special offer that will surely help you to pass your NCLEX Licensure Examination:

      Enjoy answering and I hope that this site: NCLEX Review and Secrets can somehow help you in your future nursing licensure examination. Good Luck.

      Situation: The nurse is meeting with the parents of 11 year old Irish, who has recently been diagnosed with insulin dependent mellitus (IDDM).

      8. Irish has been hospitalized for the past 3 days. His physiologic condition has been stabilized and he is now on subcutaneous injections of insulin. In developing a plan of care for Irish and his family, which of the following would be the most appropriate nursing diagnosis?

      a) parent knowledge deficit related to newly diagnosed illness
      b) fluid volume deficit related to hypoglycemia
      c) altered nutrition less than body requirements, related to insulin deficiency
      d) compromised family coping related to newly diagnosed illness

      9. Irish's parents stated that they really do not understands exactly what this disease is. Which of the following is the best way to explain IDDM to them?

      a) IDDM is an inborn error in metabolism that makes the child unable to burn, fatty acids without insulin supplement
      b) IDDM is a genetic disorder that makes the child unable to metabolize protein without insulin supplements.
      c) IDDM is a deficiency in the secretions of insulin by the pancreas, which makes the child unable to metabolize carbohydrates without insulin supplements
      d) IDDM is a deficiency in the secretions of the insulin by the gallbladder, which makes the child unable to metabolize carbohydrates without insulin

      10. The mother of Irish is preparing a mixed dose of insulin. The nurse is satisfied with the mother's performance when she:

      a) draws insulin from bottle of clear insulin first
      b) draws insulin from the bottle of delayed acting insulin first
      c) fills both syringes with the prescribed insulin dosage then shake the bottle vigorously
      d) withdraws the delayed action insulin before withdrawing the short acting insulin

      11. Irish complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing interventions should the nurse carry out first?

      a) withhold the client's next insulin injection
      b) test the client's blood glucose level
      c) administer tylenol (acetaminophen) as ordered
      d) offer fruit juice, gelatin and chicken bouillon

      12. The nurse should not instruct Irish mother that after injection of fast acting insulin at 7 in the morning, Irish should avoid exercising and any strenuous activity.

      a) around 9 to 11am
      b) after 4 hours
      c) between 8am and 9am
      d) in the afternoon after taking lunch

      13. The nurse also teaches Irish regarding the relationship of her diet, exercise and insulin requirements. Which of the following statements below is wrong information that the nurse should not give Irish?

      a) Irish should eat a snack before playing volleyball during P.E
      b) Irish should always wear her medic-alert band or ID
      c) Irish should go to school clinic to let the nurse give her insulin shots when its time for her medication
      d) Irish should always carry a prefilled insulin syringe in her bag with instructions

      14. After four months, Irish was brought to the emergency room because she fainted in school during her P.E. class. The nurse should monitor which of the following tests to evaluate the over-all therapeutic compliance of diabetic patient with normal serum hemoglobin?

      a) glycosylated hemoglobin
      b) fasting blood glucose
      c) ketone levels
      d) routine serum chemistry profile


      8) A
      - the most appropriate diagnosis at this point would be knowledge deficit. The parents must be made aware of the nature of their child's illness and the principles of care in order to ensure treatment compliance. Letter B and C is inappropriate as the child's condition is already stable. There is no evidence that family coping is compromised and it is too early to tell if the family is not coping well to the newly diagnosed illness of Irish.

      9) C

      10) A
      - the clear or regular insulin should be withdrawn first before the cloudy insulin or the intermediate insulin

      11) B
      - the first action to take would be to assess the blood glucose level of the patient to find out if the symptoms are due to abnormal glucose level or other causes.

      60-90mg/100ml fasting blood sugar
      60-105mg/100ml before meals
      140-or less mg/100ml one hour after meals
      if hyperglycemic - give insulin
      if hypoglycemic - orange juice, sugar, candy

      12) A
      - the child should avoid exercising during peak hours of insulin action in order to prevent hypoglycemia. Peak action regular insulin occurs after 2-4 hours after administration. For the other types of insulin:
      • short acting/regular (clear) - 2-4 hours
      • intermediate/lente/NPH (cloudy) - 8-12 hours
      • long-acting/ultralente (cloudy) - 18-24 hours
      13) C
      - starting 9 years old, a child has already developed enough finger dexterity to handle a syringe and thus can be taught how to administer her own insulin. If the nurse will see that Irish can and is willing to inject her own insulin, the child need not go to the school clinic. Another important instruction to Irish is to avoid injecting insulin in her arm during P.E. days when she plays volleyball. Exercise increases absorption of insulin. She should, then inject it in her abdomen. If Irene is runner, it would not be advisable to inject it her thigh.
      It is important for the child to eat a carbohydrate snack before engaging in sports as exercise increases glucose utilization and make her hypoglycemic
      Carrying a medic alert band or ID and prefilled syringe with instructions are important in cases of emergency.

      14) A
      - the glycosylated hemoglobin shows the patients blood glucose level during the last three months so iti s the best test that would reflect the patient's compliance to therapy and her glucose control.
      Fasting blood glucose reflects only the current glucose control
      Ketone appears in the urine when blood glucose levels exceed 200 mg'dl
      Routine serum chemistry is not necessary in assessing the therapeutic compliance of a diabetic patient.

      After you reviewed your answers through its rationale, you can now proceed to the next set of questions: Online Nursing Practice Test/Exam about Endocrine (1-7)

      Or go back to the first set of questions: Online Nursing Practice Test/Exam about Endocrine (15-20)

      Psychiatric Nursing Degree Questions - Violent Behavior (18-24)

      Psychiatric Nursing Degree Questions

      Situation: J., age 57, is taken to the emergency department by two police officers after he tried to cut a supermarket manager with a piece of broken glass. He said he did this because he was just laid off from his job, which he held for 27 years. He also said his wife recently left him after 25 years of marriage because of his alcohol abuse and the physical abuse he inflicted on her when he was drunk. In the emergency department, he becomes verbally abusive to nursing staff members and demands to be released. When asked to be seated so the nurse can take his blood pressure, he throws a chair across the room. Four staff members are needed to control and restrain him.
      J. is admitted to the psychiatric unit, placed in seclusion, and given haloperidol (haldol) 5 mg I.M. After 1 1/2 hours, he appears calmer and is released from seclusion. Although still angry, he is able to control himself from becoming physically or verbally abusive. He apologizes for his behavior and says that he hopes he did not hurt anyone.

      18. Which responses to J.'s apology is most therapeutic?

      a) we are here to help you. We understand that you didn't mean to hurt us
      b) let's see how well you can control yourself from now on
      c) it's fortunate no one was hurt. It will not be necessary to use restraints as long as you can control your behavior
      d) it was frightening and very dangerous. It is unpleasant to have to restrain someone

      19. Based on J.'s history, reason for admission, and behavior in the emergency department, the nurse records that the patient has a Potential for Violence directed to others. Which goal is most appropriate for this nursing diagnostic category?

      a) the patient will verbalize anger rather than physical strike out
      b) the patient will not strike out more than once a day
      c) the patient will be placed in seclusion whenever he threatens anyone verbally or physically
      d) the patient will not verbalize anger or strike out at anyone

      20. J. refuses his 5pm 10mg dose of haloperidol P.O. He states, "I'm in control now. I don't need any drugs." The nurse's responses to J. should be based on the understanding that the patient:

      a) has the right to refuse treatment
      b) is potentially violent and must be medicated
      c) can be given haloperidol intramuscularly instead of orally
      d) must receive haloperidol at regular intervals to ensure the drug's effectiveness

      21. The nurse's initial priority when dealing with an assaultive or homicidal patient is to:

      a) keep the patient away from others and under one-to-one supervision
      b) restore the patient's self-control and prevent further loss of control
      c) allow the patient to act out his frustrations, then establish a line of communication
      d) clear the area of objects that might harm the patient or others

      22. One afternoon, the nurse hears J. yelling in the dayroom. He begins pushing chairs into the wall and swings at other patients with a pool cue. The nurse should intervene by:

      a) administering a fast-acting sedative, as ordered
      b) telling the patient to go to his room
      c) restraining the patient, then calling for assistance
      d) following the initial steps of the planned team approach

      23. J. continues to swing the pool cue wildly. Which approach is safest in this situation?

      a) approaching the patients as a team while holding a mattress and gently backing him toward a wall
      b) using chairs or other objects as safety barriers while approaching the patient
      c) keeping away from the patient until he puts the pool cue down
      d) calling hospital security to subdue the patient

      24. Which nursing intervention is most important when restraining a violent patient?

      a) reviewing hospital policy regarding how long the patient can be restrained
      b) preparing a PRN dose of the patient's psychotropic medication
      c) checking that the restraints have been applied correctly
      d) asking the patient if he needs to use the bathroom or is thirsty

      Psychiatric Nursing Degree Questions:

      18) C
      - the most therapeutic response to J.'s apology should incorporate a realistic statement acknowledging, in a nonpunitive but serious manner, the possible consequences of his violent behavior. The nurse should also set clear limits by describing the expected behavior and the consequences the patient will face if he again loses control. Violent behavior is dangerous to both the patient and others and should not be excused or made light by saying "I know you didn't mean to hurt us..." or "Let's see how well you control yourself from now on." Such statements neither reinforce the risk of violently acting out or nor define limits for future behavior. Restraining a patient is unpleasant for all concerned, but disclosing this information to the patient without addressing the dangerousness of his behavior and reinforcing what is expected of him is insufficient.

      19) A
      - verbalizing angry feelings instead of physically striking out is an appropriate treatment goal for this patient. J. needs an outlet for his anger, and as long as he does not express threats of violence, verbalizing his angry feelings is an acceptable way to discharge his emotions. Striking out is an unacceptable behavior at any time. Placing the patient in seclusion in response to his threats is a nursing intervention, not a therapeutic goal.

      20) A
      - when formulating her response, the nurse must recognize that the patient has the right to refuse treatment, including medications. She also should be knowledgeable about state laws and institutional policies regarding this issue. Generally, patients can be treated against their will only in emergencies in which the safety of the patient or others is threatened. A potential for violence is not a sufficient reason to medicate a patient against his will. Even though haloperidol (haldol) can be given intramusclularly instead of orally, the nurse cannot forcibly administer an intramuscular injection to a patient who refuses treatment but poses no immediate physical threat. Although effective blood levels of haloperidol are achieved through regular dosing, this consideration does not override that of the patient's right to refuse treatment.

      21) B
      - the priority nursing intervention in response to an assaultive or homicidal patient is to maintain safety by restoring the patient's self-control and preventing further loss of control. The nurse must quickly assess the situation, then attempt to restore control through interpersonal interventions, such as using a team approach, removing the patient from the situation, encouraging verbalization, setting limits, and talking the patient down -- speaking in a calm, well-modualated voice and providing verbal support and reaasurance that the patient will not be harmed and will not be permitted to hurt himself or others. If such measures fails to control the patient, other interventions, such as seclusion, medication, or restraint, may be neccessary. Acting out violently is dangerous to the patient and others and must be controlled. Unless the patient is in seclusion, clearing the area of potentially harmful objects is unrealistic because the staff or other patients may need access to those objects. Also, one of the goals of therapy is to help the patient develop self-control and learn to coexist with others.

      22) D
      - the treatment team should have a plan for dealing with violent or potentially violent patients, which should be taught to all staff members and received periodically. The plan should clearly define the approach and specify roles for each team member. A show of force by all team members is sometimes sufficient to influence the patient to cooperate. The best plan involves a team leader and four or five additional staff members who are each assigned a specific task, such as securing the patient's left leg, right leg, left arm, and right arm. The leader typically serves as the spokesperson for the team.
      Approaching the patient to administer medication or telling him to go to his room may be unsafe without the support and backup of other team members. The nurse should never attempt to approach or restrain a violent patient by herself.

      23) A
      - the patient's behavior is clearly dangerous and must be stopped before someone is injured. an organized plan to ensure the safety of the patient and the staff is essential. While the patient is striking out, staff members, through a team approach, can be protected from injury by using mattress provides padding to protect the patient as he slowly backed toward the wall and restrained. Trained psychiatric staff members, not hospital security, should handle the restraint of a psychiatric patient.

      24) C
      - the nurse must determine whether the restraints have been applied correctly. This assessment ensures that the patient's circulation and respiration are not restricted and that adequate padding has been used. The nurse should document carefully the patient's response and status after being restrained. All staff members involved in restraining patients should be aware of hospital policy before using restraints. If PRN medication is ordered, it should be given before restraints are in place and with the assistance of other team members. The nurse should attend to the patient's elimination and hydration needs after the patient is properly restrained.

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      Psychiatric Nursing Degree Questions - Violent Behavior (11-17)

      Psychiatric Nursing Degree Questions

      Situation: B. a 50-year old stockbroker, is transferred to the psychiatric unit after treatment for a self-inflicted gunshot wound to the chest. Although he has recovered from the physical injury, he continues to express suicidal ideation. B. was recently divorced by his wife of 25 years, and he is estranged from his 24 year old son and 22 year old daughter.

      11. Which action is the nurse's highest priority during the initial patient interview?

      a) asking B. about the nature of his suicide attempt and whether he still has an active plan for it
      b) allowing B. to talk about his son and daughter
      c) encouraging B. to discuss his medical and psychiatric history
      d) persuading B. to use more appropriate coping mechanisms

      12. B. asks the nurse, "What do I have to live for? My wife left me and my children hate me. I'm all alone." Which response is most therapeutic?

      a) you are a successful businessman. Don't you get satisfaction from your work?
      b) have you tried to contact your family since your accident?
      c) what do you think you have to live for?
      d) you sound so hopeless. Are you saying you think suicide is your only option?

      13. B. is on constant one-to-one observation. He complains that he cannot sleep with someone sitting next to him, looking at him every minute. How should the nurse reply?

      a) you are on strict suicide precautions and must be observed at all times
      b) why don't you discuss this with your physician? Maybe he can assign someone to sit outside your room
      c) your treatment plan requires constant observation for your safety. Where in your room would you prefer the staff member to sit?
      d) I can appreciate what are you saying. I would be uncomfortable in that situation too

      14. B. tells the nursing assistant assigned to one-to-one duty that he is having severe stomach pains, and he asks her to get the nurse quickly. The assistant leaves B. and goes to the nurse's station. How should the nurse respond?

      a) remind the assistant that constant observation means just that, and send her back to B. immediately
      b) go with the assistant to B.'s room immediately
      c) question the assistant's judgment about leaving B. unattended even for a brief time
      d) call the physician to check on B. immediately

      15. Later the same afternoon, the nurse speaks with the nursing assistant about leaving B. alone. The best teaching approach is to:

      a) ask the assistant how the situation could have been handled better
      b) demonstrate how to palpate the abdomen to assess for tenderness and pain
      c) review the procedures for constant observation and explore ways to handle similar situations
      d) discuss the seriousness and legal ramifications of such a lapse in security

      16. B. is taken off one-to-one observation and placed on 15 minute checks. One afternoon, he is found hanging in the shower. Attempts to resuscitate him are ineffective. When the staff meets to discuss B.'s suicide, the focus should be on:

      a) determining who is responsible for the lapse in security
      b) preparing B.'s chart for review by hospital officials
      c) deciding who will speak with the patient's family
      d) ventilating feelings and thoroughly reviewing the case

      17. Staff members meet with the patients to discuss B.'s suicide. The chief rationale for such a meeting is to:

      a) dispel rumors regarding B.'s death
      b) detect other patient's suicidal ideation
      c) help the patients to ventilate their feelings about B
      d) reassure the patients about their own safety and protection

      Psychiatric Nursing Degree Questions:

      11) A
      - the nurse's highest priority during the initial interview is determining whether the patient still has an active plan to commit suicide so that she can assess the likelihood of another suicide attempt. After evaluating this information, the nurse should explore the patient's feelings of inadequacy in coping with the immediate and chronic stresses in his life, his level of hope, and his view of the intolerableness of the situation. Such exploration enables the nurse to formulate nursing diagnoses and an effective plan of care.

      12) D
      - when a patient expresses hopelessness and suicidal intentions, the nurse must ask him directly about possible suicidal plans. Such questioning enables the nurse to assess the patient's level of suicide risk and to tell the patient that she recognizes his distress and wants to help. Even more important, it lets the patient know that talk about his feelings is acceptable. Denying the patient's feelings by commenting on his success as businessman is nontherapeutic and distances the nurse from the patient. Referring to the suicide attempt as an "accident" is nontherapeutic because it denies the patient's desperate situation. A despondent patient would find it too difficult to identify what he has to live for.

      13) C
      - the nurse should respond honestly and emphatically to B.'s complaint. She can accomplish both objectives by explaining the reason for constant observation and working with the patient to identify a place for the staff member to sit that will meet the patient's protection and comfort needs. Telling the patient that he is on suicide precautions and must be observed at all times places blame on the patient for his situation and is not an empathic response. Because constant observation means that the patient must always be in clear view, having the staff member sit outside the room is unacceptable. Mere acknowledgment of the patient's feelings is nontherapeutic because it offers no solution to the problem.

      14) B
      - because B. should not be left alone at any time while on one-to-one constant observation, the nurse should accompany the nursing assistant immediately to B.'s room to assess the situation and ensure his safety. The nurse should not waste time reviewing constant observation procedures, discussing the assistant's judgment, or calling the physician. Such actions may be done after she has had time to assess the patient's status.

      15) C
      - the most effective teaching method in this situation would incorporate a review of the procedures and rationale for constant observation of a suicidal patient. After reinforcing previous learning, the nurse can help the nursing assistant to identify more appropriate responses that could be taken in a similar situation, such as calling for assistance from the patient's room, bringing the patient to the nurse, using the call system or phone, or asking another patient to summon help. Asking the assistant to identify alternative ways of handling the situation may be helpful but would not ensure her understanding of critical aspects associated with institutional procedures, including the legal ramifications of leaving a patient unattended. Teaching abdominal palpation would be inappropriate, since performing a physical assessment is part of the nurse's, not assistant's responsibility.

      16) D
      - after a patient commits suicide, staff members must meet to discuss the event and to ventilate their feelings, which may range from grief, guilt, and anger to failure and inadequacy. Meeting together provides an opportunity to give and receive support. A thorough and careful case review may identify missed clues or errors of judgment in the patient's treatment, which could help protect other patients in the future. Hospital authorities will conduct an indepth case review to determine any liability on the part of staff members. Every patient's chart is an important legal document and should be kept up to date and ready for review at all times. The patient's physician, not a nursing staff member, is responsible for talking with the patient's family.

      17) D
      - when a patient attempts or commits suicide on the unit, staff members must hold a meeting with the patients to discuss the event. Many patients become frightened and believe that their safety is compromised or that they are in danger. They may be afraid that he staff cannot protect them from their own dangerous thoughts and impulses. Therefore, the chief reason for the meeting is to reassure the patients that the staff members can and will protect them. The meeting also can serve to dispel rumors about B.'s death and may lead to discussion of other patient's self-destructive thoughts. Patients also may express their feelings about B. and his death. Regardless of the tone the meeting takes, staff members must send a clear message that the patients will be protected.

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