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Questions and Answers
The contraindications for patient seclusion include medically unstable patients, patients with delirium or dementia, and patients with severe self-injurious tendencies.
The contraindications for patient seclusion include medically unstable patients, patients with delirium or dementia, and patients with severe self-injurious tendencies.
True
Seclusion should be used as a punishment for patients.
Seclusion should be used as a punishment for patients.
False
Patients have the right to refuse seclusion.
Patients have the right to refuse seclusion.
True
Which of the following is NOT a responsibility of the RN when a patient is in seclusion?
Which of the following is NOT a responsibility of the RN when a patient is in seclusion?
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Seclusion should be used as a last resort after less restrictive measures have failed.
Seclusion should be used as a last resort after less restrictive measures have failed.
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Patients have the right to treatment.
Patients have the right to treatment.
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Restraint is a standard treatment method in nursing.
Restraint is a standard treatment method in nursing.
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Which of the following is NOT a therapeutic communication method?
Which of the following is NOT a therapeutic communication method?
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Which of the following is a therapeutic strategy used in mental health settings?
Which of the following is a therapeutic strategy used in mental health settings?
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The SIRS criteria include a temperature of less than 36°C or greater than 38°C.
The SIRS criteria include a temperature of less than 36°C or greater than 38°C.
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A heart rate greater than 90 beats per minute is another SIRS criteria.
A heart rate greater than 90 beats per minute is another SIRS criteria.
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Sepsis is defined as SIRS plus a confirmed or presumed infection.
Sepsis is defined as SIRS plus a confirmed or presumed infection.
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Severe sepsis is sepsis plus organ dysfunction
Severe sepsis is sepsis plus organ dysfunction
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Septic shock is severe sepsis plus refractory hypotension.
Septic shock is severe sepsis plus refractory hypotension.
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The active listening communication method in nursing is defined as engaging without interruptions.
The active listening communication method in nursing is defined as engaging without interruptions.
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Which of the following are examples of Non-Therapeutic Communication Methods to Avoid?
Which of the following are examples of Non-Therapeutic Communication Methods to Avoid?
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What does Reality Orientation mean, and when is it typically utilized?
What does Reality Orientation mean, and when is it typically utilized?
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A client demonstrating behavior that no longer poses a risk is a sign that seclusion can be discontinued.
A client demonstrating behavior that no longer poses a risk is a sign that seclusion can be discontinued.
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An RN initiating seclusion must be completed within 1 hour of the patient's evaluation.
An RN initiating seclusion must be completed within 1 hour of the patient's evaluation.
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The QSOFA Score of 2 or more indicates that the patient is at risk for adverse outcomes.
The QSOFA Score of 2 or more indicates that the patient is at risk for adverse outcomes.
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What is the definition of SIRS, and describe at least two diagnostic criteria used to determine it?
What is the definition of SIRS, and describe at least two diagnostic criteria used to determine it?
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Explain the difference between Sepsis and SIRS.
Explain the difference between Sepsis and SIRS.
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What is meant by 'Mental Health Assessment?'
What is meant by 'Mental Health Assessment?'
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A person exhibiting excessive movements, odd gestures, or pacing as part of their behavior may be exhibiting a sign of a mental illness.
A person exhibiting excessive movements, odd gestures, or pacing as part of their behavior may be exhibiting a sign of a mental illness.
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Match the following mood and affect terms with their appropriate descriptions:
Match the following mood and affect terms with their appropriate descriptions:
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A patient with a narrowed perceptual field may struggle to process multiple pieces of information at once.
A patient with a narrowed perceptual field may struggle to process multiple pieces of information at once.
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What is the main difference between mild and moderate anxiety?
What is the main difference between mild and moderate anxiety?
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Panic is a state of intense and overwhelming fear, often characterized by physical symptoms such as rapid heart rate and shortness of breath.
Panic is a state of intense and overwhelming fear, often characterized by physical symptoms such as rapid heart rate and shortness of breath.
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During a panic attack, a person may feel emotionally paralyzed or behave in an erratic and impulsive way.
During a panic attack, a person may feel emotionally paralyzed or behave in an erratic and impulsive way.
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To communicate effectively with a patient experiencing panic, it is always best to directly confront their anxieties.
To communicate effectively with a patient experiencing panic, it is always best to directly confront their anxieties.
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Which of the following is NOT a recommended intervention for a client experiencing mild to moderate anxiety?
Which of the following is NOT a recommended intervention for a client experiencing mild to moderate anxiety?
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The primary characteristic of depression is a persistent, uncontrollable mood characterized by feelings of hopelessness and worthlessness, as well as a significant decrease in interest in daily activities.
The primary characteristic of depression is a persistent, uncontrollable mood characterized by feelings of hopelessness and worthlessness, as well as a significant decrease in interest in daily activities.
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Individuals who have experienced early trauma or neglect are at an increased risk for developing depression later in life.
Individuals who have experienced early trauma or neglect are at an increased risk for developing depression later in life.
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If the patient's lithium level is high, you must contact the provider immediately.
If the patient's lithium level is high, you must contact the provider immediately.
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The SIG E CAPS acronym is a helpful tool for recognizing symptoms that may indicate clinical depression.
The SIG E CAPS acronym is a helpful tool for recognizing symptoms that may indicate clinical depression.
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Positive symptoms in schizophrenia are characterized by an excess or distortion of normal functions, such as hallucinations and delusions.
Positive symptoms in schizophrenia are characterized by an excess or distortion of normal functions, such as hallucinations and delusions.
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Cognitive impairment, characterized by difficulty concentrating, reasoning, and solving problems, is a hallmark of schizophrenia.
Cognitive impairment, characterized by difficulty concentrating, reasoning, and solving problems, is a hallmark of schizophrenia.
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Describe at least three interventions that are recommended for managing a client with psychosis.
Describe at least three interventions that are recommended for managing a client with psychosis.
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Patients diagnosed with schizophrenia are less responsive to medications than those with other mental health conditions.
Patients diagnosed with schizophrenia are less responsive to medications than those with other mental health conditions.
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A client with substance-induced psychosis should be immediately assessed to rule out underlying medical conditions.
A client with substance-induced psychosis should be immediately assessed to rule out underlying medical conditions.
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When a client is experiencing command hallucinations, the primary focus should be to convince them that the voices are not real.
When a client is experiencing command hallucinations, the primary focus should be to convince them that the voices are not real.
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A client exhibiting fragmented or disorganized beliefs that lack any logical connection is experiencing a symptom that is characteristic of psychosis.
A client exhibiting fragmented or disorganized beliefs that lack any logical connection is experiencing a symptom that is characteristic of psychosis.
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It is essential to rule out any possible physical causes for the client's symptoms before moving forward with a mental health assessment.
It is essential to rule out any possible physical causes for the client's symptoms before moving forward with a mental health assessment.
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A patient experiencing a sudden and acute change in mental status may be experiencing delirium, a condition that often resolves with proper treatment.
A patient experiencing a sudden and acute change in mental status may be experiencing delirium, a condition that often resolves with proper treatment.
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Nursing interventions for a patient experiencing delirium should focus on ensuring their safety by addressing potential fall risks and ensuring adequate hydration and nutrition.
Nursing interventions for a patient experiencing delirium should focus on ensuring their safety by addressing potential fall risks and ensuring adequate hydration and nutrition.
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Which of the following is NOT a common symptom of dementia?
Which of the following is NOT a common symptom of dementia?
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Dementia can often be cured with proper medications.
Dementia can often be cured with proper medications.
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Providing a safe and structured environment for a client experiencing dementia is essential to ensure their well-being and prevent potential injuries.
Providing a safe and structured environment for a client experiencing dementia is essential to ensure their well-being and prevent potential injuries.
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A client diagnosed with Alzheimer's disease typically experiences a rapid deterioration of their cognitive abilities within a short period of time.
A client diagnosed with Alzheimer's disease typically experiences a rapid deterioration of their cognitive abilities within a short period of time.
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A client experiencing advanced Alzheimer's disease may forget how to eat or speak and may exhibit a sucking reflex.
A client experiencing advanced Alzheimer's disease may forget how to eat or speak and may exhibit a sucking reflex.
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Cholinesterase inhibitors are among the medications typically prescribed for the early and moderate stages of Alzheimer's disease.
Cholinesterase inhibitors are among the medications typically prescribed for the early and moderate stages of Alzheimer's disease.
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Memantine is a medication that effectively treats all stages of Alzheimer's diseases.
Memantine is a medication that effectively treats all stages of Alzheimer's diseases.
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SSRIs (selective serotonin reuptake inhibitors) are typically prescribed for patients with Alzheimer's disease to treat the associated anxiety and depression.
SSRIs (selective serotonin reuptake inhibitors) are typically prescribed for patients with Alzheimer's disease to treat the associated anxiety and depression.
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Cognitive stimulation activities, such as reading, puzzles, and simple games, can help to maintain cognitive function and improve quality of life for patients with dementia.
Cognitive stimulation activities, such as reading, puzzles, and simple games, can help to maintain cognitive function and improve quality of life for patients with dementia.
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Patients experiencing a severe case of dementia can typically live independently at home.
Patients experiencing a severe case of dementia can typically live independently at home.
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The primary role of a nurse in caring for a client with dementia is to ensure they are safely cared for and supported in their daily lives.
The primary role of a nurse in caring for a client with dementia is to ensure they are safely cared for and supported in their daily lives.
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Lithium use is not recommended for patients with bipolar disorder as the side effects outweigh the potential benefits.
Lithium use is not recommended for patients with bipolar disorder as the side effects outweigh the potential benefits.
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A patient experiencing alcohol withdrawal may exhibit symptoms such as tremors, agitation, and seizures. This condition can be life-threatening and requires immediate medical attention.
A patient experiencing alcohol withdrawal may exhibit symptoms such as tremors, agitation, and seizures. This condition can be life-threatening and requires immediate medical attention.
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Narcan is a medication commonly used to counteract the effects of opioid overdose.
Narcan is a medication commonly used to counteract the effects of opioid overdose.
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Individuals with a family history of depression are at an increased risk of developing this condition themselves.
Individuals with a family history of depression are at an increased risk of developing this condition themselves.
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When administering medications to a client with a substance use disorder, it is important to use a fixed schedule for medication administration to promote sobriety.
When administering medications to a client with a substance use disorder, it is important to use a fixed schedule for medication administration to promote sobriety.
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When assessing a patient's mental health, it is essential to inquire about any history of trauma or abuse.
When assessing a patient's mental health, it is essential to inquire about any history of trauma or abuse.
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Clients with a history of substance abuse often experience increased risk of developing serious complications from fractures.
Clients with a history of substance abuse often experience increased risk of developing serious complications from fractures.
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Patients with a history of opioid use may experience withdrawal symptoms that include pain, nausea, and diarrhea.
Patients with a history of opioid use may experience withdrawal symptoms that include pain, nausea, and diarrhea.
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The term 'opioid antagonist' refers to medications that block the effects of opioids.
The term 'opioid antagonist' refers to medications that block the effects of opioids.
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Individuals who smoke cigarettes are at an increased risk of developing osteoporosis.
Individuals who smoke cigarettes are at an increased risk of developing osteoporosis.
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Physical therapy is a recommended intervention for patients with osteoarthritis.
Physical therapy is a recommended intervention for patients with osteoarthritis.
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Osteoporosis is a potentially life-threatening condition, as it can lead to serious complications such as fractures, requiring hospitalization and potential surgery.
Osteoporosis is a potentially life-threatening condition, as it can lead to serious complications such as fractures, requiring hospitalization and potential surgery.
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The '6Ps' assessment tool is used to identify and assess compartment syndrome.
The '6Ps' assessment tool is used to identify and assess compartment syndrome.
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The 'RICE' protocol (rest, ice, compression, elevation) is a common recommendation for managing a client experiencing a fracture.
The 'RICE' protocol (rest, ice, compression, elevation) is a common recommendation for managing a client experiencing a fracture.
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The most accurate diagnostic tool for evaluating a fracture is an X-ray.
The most accurate diagnostic tool for evaluating a fracture is an X-ray.
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A PET scan is a highly-specific imaging technique often used to determine the presence and severity of a fracture.
A PET scan is a highly-specific imaging technique often used to determine the presence and severity of a fracture.
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Medications such as antibiotics, anticoagulants, and corticosteroids can often impede a patient's ability to heal from a fracture.
Medications such as antibiotics, anticoagulants, and corticosteroids can often impede a patient's ability to heal from a fracture.
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Hepatitis can be caused by viral infections, excessive alcohol consumption, or exposure to hepatotoxic medications.
Hepatitis can be caused by viral infections, excessive alcohol consumption, or exposure to hepatotoxic medications.
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When assessing a client with hepatitis, monitoring for symptoms of jaundice is a priority.
When assessing a client with hepatitis, monitoring for symptoms of jaundice is a priority.
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The 'RIPE' acronym represents the most commonly prescribed medication regimen for the treatment of tuberculosis.
The 'RIPE' acronym represents the most commonly prescribed medication regimen for the treatment of tuberculosis.
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Acetaminophen (Tylenol) is a safe and effective pain reliever for patients with liver disease.
Acetaminophen (Tylenol) is a safe and effective pain reliever for patients with liver disease.
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Individuals with cirrhosis are at an increased risk for developing complications such as ascites and bleeding due to a decreased production of clotting factors.
Individuals with cirrhosis are at an increased risk for developing complications such as ascites and bleeding due to a decreased production of clotting factors.
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Pancreatitis is an inflammatory condition that affects the pancreas, often causing intense pain and abdominal discomfort.
Pancreatitis is an inflammatory condition that affects the pancreas, often causing intense pain and abdominal discomfort.
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When treating a patient with pancreatitis, administering narcotics for pain management is generally a safe and effective approach.
When treating a patient with pancreatitis, administering narcotics for pain management is generally a safe and effective approach.
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Maintaining adequate hydration is a priority concern for patients with pancreatitis.
Maintaining adequate hydration is a priority concern for patients with pancreatitis.
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Individuals with osteoporosis are at a lower risk for developing complications from fractures.
Individuals with osteoporosis are at a lower risk for developing complications from fractures.
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Weight-bearing exercises, such as walking, dancing, and stair climbing, have been shown to be beneficial for bone health.
Weight-bearing exercises, such as walking, dancing, and stair climbing, have been shown to be beneficial for bone health.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically used to manage pain and inflammation associated with rheumatoid arthritis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically used to manage pain and inflammation associated with rheumatoid arthritis.
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Methotrexate is a chemotherapy drug that has not been shown to be effective in managing rheumatoid arthritis.
Methotrexate is a chemotherapy drug that has not been shown to be effective in managing rheumatoid arthritis.
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Osteoarthritis typically affects weight-bearing joints.
Osteoarthritis typically affects weight-bearing joints.
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Topical medications, such as lidocaine patches and capsaicin cream, can provide effective pain relief in individuals with osteoarthritis.
Topical medications, such as lidocaine patches and capsaicin cream, can provide effective pain relief in individuals with osteoarthritis.
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Nonpharmacological interventions, such as heat packs, cold packs, hot showers, and weight management, can be helpful adjuncts in managing osteoarthritis.
Nonpharmacological interventions, such as heat packs, cold packs, hot showers, and weight management, can be helpful adjuncts in managing osteoarthritis.
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The most significant risk factor for developing osteoarthritis is a family history of this condition.
The most significant risk factor for developing osteoarthritis is a family history of this condition.
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Cancer arises when abnormal cell growth occurs, resulting in cells that divide uncontrollably and spread to other parts of the body.
Cancer arises when abnormal cell growth occurs, resulting in cells that divide uncontrollably and spread to other parts of the body.
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Apoptosis is a process of programmed cell death that helps to eliminate damaged or unnecessary cells, preventing uncontrolled cell growth.
Apoptosis is a process of programmed cell death that helps to eliminate damaged or unnecessary cells, preventing uncontrolled cell growth.
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Tumor lysis syndrome can be a life-threatening condition caused by a rapid breakdown of tumor cells, releasing large amounts of intracellular contents into the bloodstream.
Tumor lysis syndrome can be a life-threatening condition caused by a rapid breakdown of tumor cells, releasing large amounts of intracellular contents into the bloodstream.
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The use of a face mask, frequent handwashing, and avoiding contact with sick individuals are essential precautions to take for clients with neutropenia, a condition caused by low white blood cell counts.
The use of a face mask, frequent handwashing, and avoiding contact with sick individuals are essential precautions to take for clients with neutropenia, a condition caused by low white blood cell counts.
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Zofran is a medication used in the treatment of cancer, primarily for managing side effects such as nausea and vomiting.
Zofran is a medication used in the treatment of cancer, primarily for managing side effects such as nausea and vomiting.
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It is always essential to fully disclose a patient's cancer diagnosis and prognosis to them, even if their provider has not yet done so.
It is always essential to fully disclose a patient's cancer diagnosis and prognosis to them, even if their provider has not yet done so.
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In addition to managing symptoms and providing physical care, it's essential to offer emotional support and care to patients with cancer.
In addition to managing symptoms and providing physical care, it's essential to offer emotional support and care to patients with cancer.
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Acetaminophen (Tylenol) is a safe and effective medication for managing pain in patients with liver disease.
Acetaminophen (Tylenol) is a safe and effective medication for managing pain in patients with liver disease.
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Maintaining adequate hydration is essential for managing pancreatitis.
Maintaining adequate hydration is essential for managing pancreatitis.
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It is always safe to give narcotics to patients with pancreatitis for pain management.
It is always safe to give narcotics to patients with pancreatitis for pain management.
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A consistent and predictable schedule for medication administration can help individuals with substance use disorders maintain their routine and build healthier habits.
A consistent and predictable schedule for medication administration can help individuals with substance use disorders maintain their routine and build healthier habits.
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Study Notes
Week 1: Ethics and Health Care Law
- Nursing Contraindications for Seclusion: Medically unstable patients, those with delirium/dementia, or severe suicidal tendencies. Seclusion should not be used as punishment or convenience for staff.
- Patient Rights Regarding Seclusion: Patients have the right to treatment, to refuse treatment, and to least restrictive measures.
- Seclusion: Involuntary confinement, physically preventing a patient from leaving. Used to manage violent/self-destructive behavior after less restrictive measures fail. Written orders are valid for 24 hours and require a new order every 24 hours. A patient's behavior must be evaluated within one hour of initiating seclusion.
- RN Responsibilities During Seclusion: Assess patient behavior, safety, and physical needs; ensure safety and circulation. RNs should also provide toileting, food, and fluids. Document observations every 15-30 minutes.
- Termination of Seclusion: Seclusion must end when the patient no longer poses a risk.
- Restraint vs. Seclusion: Restraints physically restrict movement, while seclusion is involuntary confinement. Chemical restraint refers to medications used to manage behavior.
Week 3: Communication
- Active Listening: Communicating without interruption, showing empathy, and reflecting patient emotions.
- Open-Ended Questions: Encourages dialogue ("How are you feeling today?").
- Clarification: Asking for understanding ("Can you explain what you mean by...?").
- Giving Advice: Can undermine autonomy. Avoid advice giving.
- Judging or Criticizing: Invalidates the patient's feelings ("You shouldn't feel that way").
- Offering False Reassurance: Diminishes trust ("Everything will be fine").
- Changing the Subject: Dismissing patient concerns.
- Therapeutic Communication Methods: Active listening, empathy, clarifying information and open-ended questions
- Non-Therapeutic Communication Methods to Avoid: Giving advice, judging or criticizing, offering false reassurance, and changing the subject
Week 4: Inflammation/Infection
- Sepsis vs. SIRS: Sepsis is defined by an organism and SIRS criteria, while SIRS is a systemic inflammatory response syndrome with specific criteria.
- Sepsis Diagnostic Criteria: Sepsis must be diagnosed within one hour of criteria detection
- Sepsis Criteria: The patient has two parts to the criteria: the criteria for SIRS and confirmed or suspected infection
- SIRS Criteria: Elevated temperature, heart rate over 90 bpm, respiratory rate over 20, or PaCO2 below 32, low or high white blood cell count.
- Laboratory/Diagnostics for Sepsis: Lactate, ABG, and blood cultures before administering antibiotics. Repeat lactate 4 hours after the initial draw.
- Sepsis Six: Give oxygen to keep oxygen saturation above 94%, administer antibiotics, give fluid replacement, take blood cultures, give fluid resuscitation, and repeat lactate readings.
Week 5: Mental Health Assessment
- Mental health assessments: Important to conduct for DTO/DTS; assess appearance, behavior, speech, mood, and affect (Always conduct a mental health assessment for DTO/DTS). Thought process, perceptual disturbances, cognition. Assess for risks and current feelings.
Week 6-7: Stress/Coping & Anxiety
- Anxiety Levels: Mild, Moderate, Severe, and Panic.
- Mild Anxiety: Sharper focus, effective problem solving, slight discomfort, restlessness.
- Moderate Anxiety: Narrowed perceptual field, less sensory information.
- Severe Anxiety: Learning and problem-solving still occur but are limited. Tension, slight elevations in heart rate and respiration, and mild somatic symptoms.
- Panic Anxiety: Markedly disturbed behavior (emotional paralysis, erratic/impulsive, difficulty remembering or communicating).
Week 7: Mood Affect
- Depression: Characterized by hopelessness, loss of interest, and thoughts of death.
- Risk Factors for Depression: Genetics (family history), biological factors, psychosocial stressors, environmental factors, certain medical conditions/diseases, and social stressors.
Week 10: Addiction
- Opioids: Central nervous system depressants. Symptoms of overdose include pinpoint pupils, slurred speech, incoordination, altered vital signs, and possible death.
- ETOH Withdrawal (ETOHW): Symptoms may occur 6-72 hours after last drink. Symptoms include increased blood pressure, heart rate, temperature, diaphoresis, nausea/vomiting, tremors, seizures, and hallucinations.
- Substance Dependence: Medical emergency requiring immediate attention; seek medical assistance to prevent life-threatening complications.
- Risk Factors for Substance Use Disorders: Genetics, peer pressure, community, culture, societal norms, and environment
Week 8: Psychosis
- Psychosis: Symptoms include hallucinations (auditory, visual, tactile, olfactory), and delusions.
Week 10, 13: Cognition
- Delirium: An acute confusional state that is often reversible.
- Dementia: A gradual, progressive cognitive decline.
- Symptoms of Delirium: Illusion, hallucination, wandering, falling, changes in sleep patterns, hypervigilance, dramatic changes in mood, and labile moods.
- Symptoms of Dementia: Impaired memory, judgment, calculation, attention span, and abstract thinking; agnosia.
Week 10 and 11: Cardiovascular/Respiratory/EKG
- Week 10 and 11 addresses cardiovascular and respiratory processes, as well as relevant EKG considerations.
Week 13: Cognition
- Delirium vs. Dementia: Delirium is a rapid fluctuation of thinking vs. a progressive deterioration of thinking for dementia.
- Assessment: Identify factors contributing to cognitive impairment. Assess for illusions, hallucinations, wandering, and changes in sleep patterns.
- Interventions: Assess and provide support and safety to deal with changes.
Week 15: Mobility, Pain (Fractures).
- Fractures: Symptoms include deformity, swelling, tenderness, ecchymosis, breaking of skin, and loss of function . Treat with immobilization/surgery, pain management, and neurovascular assessment.
Weeks 13, 15: Other
- Information on prioritizing patient care, assessing patient conditions, and recognizing when immediate intervention is needed for a multitude of situations.
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Description
This quiz covers the ethical considerations and legal aspects of seclusion in healthcare settings. It addresses nurse responsibilities, patient rights, and the protocol for using seclusion for medically unstable patients. Test your understanding of how to balance patient safety and ethical care in challenging situations.
