Tuesday 31 July 2018

Q. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?

A. Seizures
B. Shivering
C. Anxiety
D. Chest pain

Correct Answer: A

Explanation: Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

Monday 30 July 2018

Question Of The Day, Psychotic Disorders
Q. At an outpatient visit 3 months after discharge from the hospital, a client says he has stopped his olanzapine (Zyprexa) even though it controls his symptoms of schizophrenia better than other medications. "I have gained 20 lb already. I can't stand any more." Which response by the nurse is most appropriate?

A. "I don't think you look fat, why do you think so?"
B. "I can help you with a diet and exercise plan to keep your weight down."
C. "You can be switched to another medicine."
D. "Your weight gain will level off if you stay on the medication 3 more months."

Correct Answer: B

Explanation: Helping the client control his weight is the most appropriate approach. The nurse's contradiction of the client's complaint is inappropriate. Most atypical antipsychotics cause weight gain and are not a solution to the weight gain. There is little evidence that weight gain from taking olanzapine decreases with time.

Saturday 28 July 2018

Q. Which of the following should the nurse teach a client with generalized anxiety disorder to help the client cope with anxiety?

A. Cognitive and behavioral strategies.
B. Issue avoidance and denial of problems.
C. Rest and sleep.
D. Withdrawal from role expectations and role relationships.

Correct Answer: A

Explanation: A client with generalized anxiety disorder needs to learn cognitive and behavioral strategies to cope with anxiety appropriately. In doing so, the client's anxiety decreases and becomes more manageable. The client may need assertiveness training, reframing, and relaxation exercises to adaptively deal with anxiety.

Friday 27 July 2018

Q. A nurse makes a home visit to a client who was discharged from a psychiatric hospital. The client is irritable and walks about her room slowly and morosely. After 10 minutes, the nurse prepares to leave, but the client plucks at the nurse's sleeve and quickly asks for help rearranging her belongings. She also anxiously makes inconsequential remarks to keep the nurse with her. In view of the fact that the client has previously made a suicidal gesture, which of the following interventions by the nurse should be a priority at this time?

A. Ask the client frankly if she has thoughts of or plans for committing suicide.
B. Avoid bringing up the subject of suicide to prevent giving the client ideas of self-harm.
C. Outline some alternative measures to suicide for the client to use during periods of sadness.
D. To draw out the client, mention others the nurse has known who have felt like the client and attempted suicide.

Correct Answer: A

Explanation: Investigating the presence of suicidal thoughts and plans by overtly asking the client if she is thinking of or planning to commit suicide is a priority nursing action in this situation. Direct questioning about thoughts or plans related to self-harm does not give a person the idea to harm herself. Self-harm is an individual decision. Avoiding the subject when a client appears suicidal is unwise; the safest procedure is to investigate. It would be premature in this situation to outline alternative measures to suicide. Describing other clients who have attempted suicide is too indirect to be helpful and minimizes the client's feelings.

Thursday 26 July 2018

Question Of The Day, School-age Child
Q. According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage?

A. Trust versus mistrust
B. Initiative versus guilt
C. Industry versus inferiority
D. Identity versus role confusion

Correct Answer: C

Explanation: In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative versus guilt. Identity versus role confusion occurs during adolescence.

Wednesday 25 July 2018

Question Of The Day, Preschooler
Q. A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions should the nurse do first?

A. Obtain an order for sedation for the child.
B. Assess for an irregular heart rate and rhythm.
C. Explain to the child that it will only hurt for a short time.
D. Place the child in a knee-to-chest position.

Correct Answer: D

Explanation: The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has a higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

Tuesday 24 July 2018

Q. After teaching a group of parents about temper tantrums, the nurse knows the teaching has been effective when one of the parents states which of the following?

A. "I will ignore the temper tantrum."
B. "I should pick up the child during the tantrum."
C. "I'll talk to my daughter during the tantrum."
D. "I should put my child in time out."

Correct Answer: A

Explanation: Children who have temper tantrums should be ignored as long as they are safe. They should not receive either positive or negative reinforcement to avoid perpetuating the behavior. Temper tantrums are a toddler's way of achieving independence.

Monday 23 July 2018

Q. An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child?

A. Encouraging the infant to hold a bottle
B. Keeping the infant on bed rest to conserve energy
C. Rotating caregivers to provide more stimulation
D. Maintaining a consistent, structured environment

Correct Answer: D

Explanation: The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

Saturday 21 July 2018

Q. Crackles heard on lung auscultation indicate which of the following?

A. Cyanosis.
B. Bronchospasm.
C. Airway narrowing.
D. Fluid-filled alveoli.

Correct Answer: D

Explanation: Crackles are auscultated over fluid-filled alveoli. Crackles heard on lung auscultation do not have to be associated with cyanosis. Bronchospasm and airway narrowing generally are associated with wheezing sounds.

Friday 20 July 2018

Travel nurse pay can be complicated! Negotiating a pay rate and understanding the pay breakdown can be challenging. Did you know that if you extend an assignment, you should be eligible get an increase in compensation? Read on to understand how travel nurse pay works, why you should get an increase in pay with an extension, and how to ask for that money.

Travel Nursing, Nursing Career, Nursing Responsibilities, Nursing Job, Nursing Roles

Understanding the Bill Rate

To better understand why you should get paid more when you extend an assignment, let’s first look at how travel pay works.

As a traveling nurse, you total pay package is broken down into different forms of compensation including:

1. Taxed hourly rate
2. Untaxed housing stipend or company-provided housing
3. Untaxed per diem (aka. “meals and incidentals”)
4. Some agencies offer reimbursements for bonuses, referrals, licenses, moving, etc.

The important thing to remember about travel nursing pay is that it all comes from one place: the bill rate. The bill rate is the amount per hour that a hospital is paying your agency to have you in the building. Everything that you earn over the course of your contract, from start to finish comes out of that bill rate. This includes the cost of moving to an assignment, orientation, drug testing, and anything else that your agency has to pay for over the course of 13-weeks.

A bill rate may include the following:

◈ Contribute to paying for the agency costs to run (staffing costs, office leases, utilities, office supplies, advertising and marketing costs, staff education and training, etc.)

◈ Pay a vendor management service for fees (if any). This is essentially a middleman between the agency and the hospital

◈ Cover the cost of onboarding and your compliance (TB tests, drug screens, physicals, Fit tests, etc.)

◈ Premiums for company-provided health insurance, 401(k)s, life insurance, and any other benefits offered by the agency

◈ Reimbursements for moving

◈ Company-provided housing/car rentals, or a housing stipend

◈ And finally, pay your hourly rate *occurs at the beginning of a contract and not during extensions

Costs That Occur at The START Of A New Contract

From the list above, the items that are starred reflect the expenses that occur only at the beginning of a new contract and NOT during an extension. If you are extending at a location, it means that you do not have to travel to a new location and you probably will not have any physicals or compliance tests to stay at the assignment.

Here is a breakdown of the expenses that may happen at the beginning of a contract. Of course, these expenses may not happen with every contract. You may only have a TB test, physical, and fit test once a year.

◈ TB test with reading: $50
◈ Drug Test: $50
◈ Physical at a walk-in clinic: $75-$150
◈ N95 mask fit testing: $45
◈ Relocation reimbursement: Anywhere from $250-$1000
◈ Criminal background check: $20

Total amount to start a new contract: Anywhere from $240 (if no housing or moving fees were paid) to over $1,250! WOW!

Remember, that is money coming out of YOUR bill rate. Therefore, if you extend a contract, don’t let that money that was used to cover upfront expenses go missing in your extension. Ask to be compensated that money in the form of a pay raise or bonus.

What Do I Do If My Company Refuses to Increase My Pay for an Extension?

Knowing all of the information that you now know, you should be well-equipped to negotiate a pay raise into your next contract extension. The increase in pay should reflect the money that your agency paid in your upfront expenses at the beginning of your contract.

For instance, if your agency paid $1,000 to onboard and move you to your assignment, you would have an extra $1,000 to work with on your extension. You could take that $1,000 and divide it by 13 to determine a fair increase to your weekly pay rate. For $1,000 of upfront expenses, which could be an extra $77 gross dollars per week to your income.

If your agency will not increase your hourly rate, try asking for a one-time bonus at the beginning of the extension. If your moving expenses were $500 at the beginning of your contract, ask for a $500 bonus to be written into your extension.

You could also ask for a bonus in the form of continuing education or licensing reimbursements. Perhaps there is a continuing education class that is a couple of hundreds of dollars. Ask your agency to include a reimbursement for that class into your extension.

Knowing how travel pay works and understanding the bill rate are key elements to help you negotiate more for a travel extension. Next time you extend, use this information to secure more money!
Q. A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs?

A. Breakthrough bleeding.
B. Severe calf pain.
C. Mild headache.
D. Weight gain of 3 lb.

Correct Answer: B

Explanation: Women who take oral contraceptives are at increased risk for thromboembolic conditions. Severe calf pain needs to be investigated as a potential sign of deep vein thrombosis. Breakthrough bleeding, mild headache, or weight gain may be common benign side effects that accompany oral contraceptive use. Clients may be monitored for these side effects without a change in treatment.

Thursday 19 July 2018

Question Of The Day, Basic Psychosocial Needs
Q. The health care provider at a prenatal clinic has ordered multivitamins for a woman who is 3 months' pregnant. The client calls the nurse to report that she has gone to the pharmacy to fill her prescription but is unable to buy it as it costs too much. The nurse should refer the client to:

A. The charge nurse.
B. The hospital finance office.
C. Her hospital social worker.
D. Her insurance company.

Correct Answer: C

Explanation: The social worker is available to assist the client in finding services within the community to meet client needs. This individual is able to provide the names of pharmacies within the community that offer generic substitutes or others that utilize the client's insurance plan. The charge nurse of the unit would be able to refer the client to the social worker. The hospital finance office does not handle this type of situation and would refer the client back to the unit. The client's insurance company deals with payments for health care and would refer the client back to the local setting.

Wednesday 18 July 2018

Q. As a nurse helps a client ambulate, the client says, "I had trouble sleeping last night." Which action should the nurse take first?

A. Recommending warm milk or a warm shower at bedtime
B. Gathering more information about the client's sleep problem
C. Determining whether the client is worried about something
D. Finding out whether the client is taking medication that may impede sleep

Correct Answer: B

Explanation: The nurse first should determine what the client means by "trouble sleeping." The nurse lacks sufficient information to recommend warm milk or a warm shower or to make inferences about the cause of the sleep problem, such as worries or medication use.

Tuesday 17 July 2018

Q. The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on these data, the nurse should?

A. Change the appliance bag.
B. Notify the physician.
C. Obtain a urine specimen for culture.
D. Encourage a high fluid intake.

Correct Answer: D

Explanation: Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.

Monday 16 July 2018

When asked on office visits if they would prefer to see the Nurse Practitioner vs. an MD, more people pick NPs.

Why do patients prefer NPs, and why are so many nurses choosing to go back to school to become NPs?

Here, three popular reasons:

1. NPs Can Be Autonomous Providers.

Nurses who are interested in becoming autonomous providers in healthcare delivery—such as primary care or in a specialty agency like women’s health, pediatrics, cardiology, pulmonary or endocrinology—should consider becoming a Nurse Practitioner. In many states, NPs can own their own practice with a collaborative agreement with a physician. Remember, NPs still have to technically be under the supervision of an MD but depending on the practice, the setting, the relationship between NP and MD, some NPs can find themselves working in a nearly autonomous setting.

2. NPs Are in Demand.

With the current changes in healthcare delivery, becoming an NP will prepare you for a unique opportunity for the future. As an NP, you will be one of the four types of advanced practice nurses who have prescriptive authority and can manage patients holistically.

Editor’s Note: Recent polls have shown that when people are asked if they would prefer to see the Nurse Practitioner versus an MD when they go to an office visit, the percentage of people who would prefer to see an NP has the majority. The reputation stands that NPs spend more time with their patients, form relationships, and care for the patient as opposed to just merely treating the illness. Of course this is all subjective but it is a common belief regarding the advanced practice nurse. And with the emergence of the title, MDs are hiring more and more NPs because having an NP can reduce their workload and is beneficial for the physician, making the advanced practice nurse a profession that is in demand.

3. Financial Aid Is Available.

Financial reimbursement for some percentage of the tuition for a graduate degree is generally available through a nurse’s work setting. There are also loan forgiveness programs through the federal government if an NP graduate works in a federally run community health clinic for two years post-graduation.

An NP’s salary and benefits can vary depending on the type of healthcare and geographic setting, but generally ranges from $75,000 to $110,000, with increased salary and bonuses if the NP owns her own clinic or is a partner in the agency. Benefits such as no weekend or holiday scheduling, extra salary for on-call work and more self-governance also tend to attract nurses to become NPs.
Q. A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or tinnitus
D. Light-headedness or paresthesia

Correct Answer: D

Explanation: The client with respiratory alkalosis may complain of light-headedness or paresthesia (numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may accompany respiratory acidosis. Hallucinations and tinnitus rarely are associated with respiratory alkalosis or any other acid-base imbalance.

Saturday 14 July 2018

Q. After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

A. With the affected hip flexed acutely
B. With the leg on the affected side abducted
C. With the leg on the affected side adducted
D. With the affected hip rotated externally

Correct Answer: B

Explanation: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

Friday 13 July 2018

Question Of The Day, Endocrine and Metabolic Disorders
Q. A client is diagnosed with diabetes mellitus. Which assessment finding best supports a nursing diagnosis of Ineffective coping related to diabetes mellitus?

A. Recent weight gain of 20 lb (9.1 kg)
B. Failure to monitor blood glucose levels
C. Skipping insulin doses during illness
D. Crying whenever diabetes is mentioned

Correct Answer: D

Explanation: A client who cries whenever diabetes is mentioned is demonstrating ineffective coping. A recent weight gain and failure to monitor blood glucose levels would support a nursing diagnosis of Noncompliance: Failure to adhere to therapeutic regimen. Skipping insulin doses during illness would support a nursing diagnosis of Deficient knowledge related to treatment of diabetes mellitus.

Thursday 12 July 2018

Q. A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

A. "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear."
B. "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal."
C. "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year."
D. "I will receive parenteral vitamin B12 therapy for the rest of my life."

Correct Answer: D

Explanation: Because a client with pernicious anemia lacks intrinsic factor, oral vitamin B12 can't be absorbed. Therefore, parenteral vitamin B12 therapy is recommended and required for life.

Tuesday 10 July 2018

Q. A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

A. Wear disposable gloves and protective clothing.
B. Break needles after the infusion is discontinued.
C. Disconnect I.V. tubing with gloved hands.
D. Throw I.V. tubing in the trash after the infusion is stopped.

Correct Answer: A

Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

Monday 9 July 2018

Q. In preparing the client and the family for a postoperative stay in the intensive care unit (ICU) after open heart surgery, the nurse should explain that:

A. The client will remain in the ICU for 5 days.
B. The client will sleep most of the time while in the ICU.
C. Noise and activity within the ICU are minimal.
D. The client will receive medication to relieve pain.

Correct Answer: D

Explanation: Management of postoperative pain is a priority for the client after surgery, including valve replacement surgery, according to the Agency for Health Care Policy and Research. The client and family should be informed that pain will be assessed by the nurse and medications will be given to relieve the pain. The client will stay in the ICU as long as monitoring and intensive care are needed. Sensory deprivation and overload, high noise levels, and disrupted sleep and rest patterns are some environmental factors that affect recovery from valve replacement surgery.

Friday 6 July 2018

Question Of The Day, Intrapartum Period
Q. The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client squatting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next?

A. Tell the client to push between contractions.
B. Provide gentle support to the fetal head.
C. Apply gentle upward traction on the neonate's anterior shoulder.
D. Massage the perineum to stretch the perineal tissues.

Correct Answer: B

Explanation: During a precipitous delivery, after calling for assistance and helping the client lie down, the nurse should provide support to the fetal head to prevent it from coming out. It is not appropriate to tell the client to push between contractions because this may lead to lacerations. The shoulder should be delivered by applying downward traction until the anterior shoulder appears fully at the introitus, then upward pressure to lift out the other shoulder. Priority should be given to safe delivery of the infant over protecting the perineum by massage.

Over the past decade, the use of nurse practitioners (NP’s) in primary care has grown considerably, especially in underserved rural areas, according to a recently published study. With the increasing demand for health services, this is good news for improving healthcare delivery.

The aim of the study, published in the June issue of Health Affairs, was to establish trends in the use of NP’s in primary care practices and how state policies and legislation influenced their use.

Primary care is the first point of contact between the patient and the healthcare provider. It is mostly the point where major health problems are diagnosed and where patients with chronic conditions are helped to manage their disease and improve their quality of life. In the US there is concern over the dwindling number of doctors who choose to go into primary health care, especially in rural areas. Highly qualified nurse practitioners can fill this gap, 87% of whom practice in this field.

Percentages of primary care practices with nurse practitioners (NPs) and the average number of NPs in primary care practices in rural and nonrural areas, 2008–16. Source: healthaffairs.org
The study found that between 2008 and 2016 there was considerable growth in the use of nurse practitioners both in rural and nonrural primary care practices. In 2008, NP’s constituted 17.6% of the healthcare providers in rural and 15.9% in non-rural practices. These figures had increased to 25.2% and 23% respectively by 2016. This implied a 43.2% growth in NP’s in rural areas and also that they represent one in four primary care providers.

The laws relating to the scope of practice of NP’s in primary care vary widely between states. Some allow for full practice authority, allowing nurses to practice without physician supervision. Others require a collaborative agreement with a physician to prescribe medication, thereby restricting the service which the nurses can provide.

“Some states are very restrictive,” explained Hilary Barnes, the lead author of the study. “An NP has to maintain written agreements with a physician to practice and prescribe medication. In the most extreme examples, the law states that an NP must talk about every patient with a physician. Or that the physician has to sign for prescriptions.”

These states undervalue the NP’s ability to provide quality primary care services. This despite the fact that studies have shown that NP’s provide safe and high-quality care, with a high rate of patient satisfaction. Restrictive laws could also deny health care to patients in areas where this is no primary care physician available.

The study found that states with laws that allowed nurses to practice fully according to their scope of practice had the most NP’s. Here the percentage of practices with at least one NP increased from 35 to 45% in rural areas and 26.5% to 36.0% in non-rural areas.

The highest growth had however been in those states with reduced or restricted practice laws. Here the percentage of practices using at least one NP increased from 30.7% to 46.0% in rural areas and from 29.9% to 42.3% in non-rural areas.

For the future, this field appears to be a good choice for nurses to pursue. “Our findings imply that primary care practices are embracing a more diverse provider configuration, which may strengthen health care delivery overall,” the study concludes.

Thursday 5 July 2018

Q. Which medication is considered safe during pregnancy?

A. Aspirin
B. Magnesium hydroxide
C. Insulin
D. Oral antidiabetic agents

Correct Answer: C

Explanation: Insulin is a required hormone for any client with diabetes mellitus, including the pregnant client. Aspirin, magnesium hydroxide, and oral antidiabetic agents aren't recommended for use during pregnancy because these agents may cause fetal harm.

Wednesday 4 July 2018

Question Of The Day, Substance Abuse, Eating Disorders, Impulse Control Disorders
Q. A client with alcohol dependency is prescribed a B-complex vitamin. The client states, "Why do I need a vitamin? My appetite is just fine." Which of the following responses by the nurse is most appropriate?

A. "Your doctor wants you to take it for at least 4 months."
B. "You've been drinking alcohol and eating very little."
C. "The vitamin is a nutritional supplement important to your health."
D. "The amount of vitamins in the alcohol you drink is very low."

Correct Answer: C

Explanation: Stating that the vitamin is a nutritional supplement important to the client's health is the best response. The client is nutritionally depleted, and the B-complex vitamins produce a calming effect on the irritated central nervous system and prevent anemia, peripheral neuropathy, and Wernicke's encephalopathy. Although the statements about drinking alcohol and eating very little and that there is a low amount of vitamins in the alcohol consumed may be true, they fail to address the client's concerns directly and fail to provide the necessary information, as does telling the client that the doctor wants the client to take the vitamin for 4 months.

Tuesday 3 July 2018

Q. Which condition or characteristic is related to the cluster of symptoms associated with disorganized schizophrenia?

A. Odd beliefs
B. Flat affect
C. Waxy flexibility
D. Systematized delusions

Correct Answer: B

Explanation: Flat affect (the lack of facial or behavioral manifestations of emotion) is related to disorganized schizophrenia. Other characteristics of disorganized schizophrenia include incoherence, loose associations, and disorganized behavior. Paranoid residual type schizophrenia is characterized by odd beliefs, unusual perceptions, and systematized delusions. Waxy flexibility, or maintaining the position the client is placed in, is seen in catatonic schizophrenia.

Monday 2 July 2018

Q. A client with major depression sleeps 18 to 20 hours per day, shows no interest in activities he previously enjoyed and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to order:

A. phenelzine (Nardil).
B. thiothixene (Navane).
C. nortriptyline (Pamelor).
D. trifluoperazine (Stelazine).

Correct Answer: C

Explanation: Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't ordered initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, inappropriate for clients with uncomplicated depression.



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