December 2010 Nursing Preboard Examination

KEYWORD of the question: initially. Auditory hallucinations are the most common form of hallucination. If the client verbalizes that she hears voices, the nurse should assess what is the content of the auditory hallucination. If the voices are telling the client to kill her or others, safety for possible violence is implemented. Asking the client what is she thinking is inappropriate in this situation as the client already told the nurse that she hears voices. After knowing the content of the voices it would be appropriate for the nurse to present the reality. Situation: Nursing theories are important for nurses to know. It expected on nurses to integrate the theories governing the field while providing care to clients.

There are two types of nose bleeding (NB), anterior NB and posterior NB. The most common type, anterior NB is managed by proper positioning, pressure (5-10 minutes) and topical vasoconstrictors (neosenephrine). Posterior NB, the rare form can be managed by a cotton tampon, suctioning, and if bleeding is not identified nose packing with gauze impregnated with petroleum jelly or antibiotic ointment may be used. However prior to insertion, a typical spray and decongestant may be used.

Epiglottitis is presented with a muffled cough, drooling and hyperextension of the neck (due to painful swallowing), sits in a tripod position and looks very ill. Cough in epiglottitis is muffled while cough in laryngotrachebronchitis or croup is a croup/barking cough.

A preventive strategy in OR the following should be done: • Maintenance of good communications with each team members. • Establishing a positive rapport with patients. • Documentations of assessments, interventions and evaluations of patient care. • Compliance with legal statutes and standards of accrediting agencies, professional associations and health care facility. • Control of further insult or damage if an injury occurs by reporting problems and taking corrective actions.

Lateral neck radiograph will show an enlarged epiglottis in epiglottitis. Mantoux test is used to signify the exposure to Mycobacterium Tubercle Bacilli. A bronchoscopy is the direct observation of the larynx, trachea and bronchi through a flexible or rigid bronchoscope. This diagnostic test is used in removing a foreign object or to excise lesions and is not used in epiglotitis. ECG is used for cardiovascular disorders.

In epiglottitis Endotracheal tube (ET tube) is prepared at the bedside for possible airway obstruction. Manipulating the airway through the use of tongue depressor is contraindicated for clients with epiglottitis as this can cause further worsening of the condition.

Assault is an unlawful threat to harm another physically while battery is the carrying out of body harm, as by touching the person without authorization or consent. A tort is a legal wrong committed by a person involving injury of another or loss of or damage to personal property. Negligence is defined as failure to use such care as a reasonably prudent and careful person would use under similar circumstances.

Continued education helps the practitioner keep abreast of current trends and practices. It is NOT a measurement of proven competence in practice, but it is the most widely accepted method of self-development. Joining workshops, seminars, conferences and other educational offerings are personal responsibility of professional nurses and surgical technologist.

Medications used to treat Parkinson’s disease are those drugs that decrease the level of acethycholine (anticholinergic drugs) and those that increase dopamine levels (dopaminergic agents). Anticholinergic Drugs includes the ff: (1) Trihexyphenidyl (Artane) (2) Benztropine Mesylate (Cogentin) (3) Biperiden (Akineton) (4) Dipenhydramine (Benadryl) (5) Ethoproprazine (Parsidol) (6) Procyclidine (Kemadrin) while Dopaminergic Drugs are the ff: (1) Dopamine Precursor:LEVODOPA (Dopar, Larodopa) CARDIDOPA-LEVODOPA (Sinemet) (2) Dopamine Receptor Agonist: BROMOCRIPTINE (Parlodel)PERGOLIDE (Permax)(3) Dopamine Metabolism Inhibitor:SELEGILINE (Eldepryl).

Synonyms for someone with a schizoid personality disorder include introvert and loner because the person has no desire for social involvement. The clinical symptoms include a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. The individual avoids close relationships with family or others, chooses solitary activities, has little interest in sexual experiences, does not take pleasure in activities, lacks close friends or confidants, appears indifferent to praise or criticism, and exhibits emotional coldness such as detachment or flattened affect. Attention is usually focused on objects such as books and cars rather than people. He or she may function well in vocations where one generally works alone. FLAT AFFECT and LITTLE EMOTION. Avoidant Personality Disorder - The client with avoidant personality disorder is highly sensitive to rejection, criticism, humiliation, disapproval, or shame, appearing devastated by the slightest amount of disapproval. This extreme sensitivity interferes with participation in occupational activities, development of interpersonal relationships, and the ability to take personal risks or engage in new activities. Social withdrawal occurs because the client views him- or herself as socially inept, personally unappealing, or inferior to others. Antisocial Personality Disorder - Characterized by pervasive pattern of disregard for and violation of the rights of others- and with the central characteristics of deceit and manipulation. Schizotypal Personality Disorder - The classification of schizotypal personality disorder is used to diagnose persons whose symptoms are similar to, but not severe enough to meet, the criteria for schizophrenia. Clients generally exhibit a disturbance in thought processes referred to as magical thinking, superstitiousness, or telepathy (a sixth sense). Pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as cognitive or perceptual distortions and behavioral eccentricities.

Doctrine of informed consent recognizes the physician’s duty to inform the patient and obtain consent before treatment. Failure of doing this may be considered a breach of duty.

Authoritarian - directive style of supervision * Low degree of participation by the people involved * High degree of punitiveness * Pressure placed on the worker for output

Depression is a form of mood dysregulation. Magical thinking, odd beliefs, suspiciousness, ideas of references and low-grade psychotic symptoms are cognitive-perceptual disturbances.

The main purpose of an INTRODUCTION is to introduce the research by presenting its context or background. Introductions usually go from general to specific, introducing the research problem and how it will be investigated). The main purpose of an ABSTRACT is to summarize the research (particularly the objective and the main finding/conclusion), NOT to introduce the research area.

Epiglottitis is usually preceded by an upper respiratory tract infection such as tonsillitis, pharyngitis, sinusitis, common colds, laryngitis and otitis media. In epiglotitis, the affected child suddenly becomes very ill. Cough becoming worst at night is noted with croup or laryngotracheobronchitis. Eating disorders has not been associated with epiglotitis.

a. Paranoid – Cluster A b. Narcissistic – Cluster B c. Dependent – Cluster C d. Passive-aggressive – not classified PD

Preschoolers are under the developmental task of initiative vs. guilt. Phallic is also for preschoolers but it is under the psychosexual development of Sigmund Freud. Autonomy vs. Shame and Doubt – Toddler Latency – (Psychosexual) Schoolage.

The most common cause of nose bleeding is the irritation of the nasal mucosa that resulted to the rupture of tiny, distended vessels. Not all posterior nose bleeding is caused by a deviated nasal septum. Low humidity causes epistaxis. Drinking ASA can cause bleeding tendencies but it is not the common cause of epistaxis.

In the common law of negligence, the doctrine of res ipsa loquitur (Latin for "the thing speaks for itself") states that the elements of duty of care and breach can be sometimes inferred from the very nature of the accident, even without direct evidence of how any defendant behaved. Upon a proof of res ipsa loquitur, the plaintiff need only establish the remaining two elements of negligence—namely, that the plaintiff suffered damages, of which the accident was the legal cause. By the borrowed servant rule, the surgeon is liable for acts of team members only when he or she has the right control and supervise the way in which the an RN or surgical technologist performs the work. Doctrine of respondent superior – an employer is held liable for the employee’s negligent conduct (master-servant employment relationship. Doctrine of corporate negligence – facility is held liable not because of the negligence of the employees but for its own negligence in failing to ensure an acceptable level of care is provided.

Concepts common in the nursing Conceptual models are the person, nursing, environment and health.

Parkinson's disease (also known as Parkinson's, Parkinson disease, or PD) is a degenerative disorder of the central nervous system that impairs motor skills, cognitive processes, and other functions. PD is the most common cause of chronic progressive parkinsonism, a term which refers to the syndrome of tremor, rigidity, bradykinesia and postural instability. Among non motor symptoms are autonomic dysfunction, cognitive and neurobehavioral problems including dementia, and sensory and sleep difficulties. PD usually appears around the age of 60, although there are young-onset cases. Symptoms result from insufficient formation and action of dopamine produced in the dopaminergic neurons of the midbrain (specifically the substantia nigra).

Accepting her self as a unique person and self-awareness is the topmost priority in promoting a therapeutic environment.

Most patients with personality disorders are NOT treated in acute care settings due to the inflexible and maladaptive personality but due to physical injuries or for another major mental illness.

The three primary clinical manifestations of Parkinson’s Disease are 1) tremors (pill-rolling), 2) bradykinesia (slowed retarded movements) and 3) muscular rigidity. Secondary symptoms of Parkinson’s disease include: • Constipation • Dysphagia • Hypersalivation • Excessive sweating • Loss of bladder and bowel control • Loss of intellectual capacity (dementia) – LATE stage • Microphagia (small cramped handwriting) • Hypophonia (soft, whispery voice)

Discharge plan should be formulated on the day of admission.

Maslows hierarchy of needs has five levels top priority is on: 1. Physiologic needs (food, air, water) 2. Safety needs 3. Love and belongingness 4. Self-esteem 5. Self-actualization

Preschoolers (3-5 y.o.) is having a castration anxiety. They are afraid to be cut or wounded. Stranger anxiety – infancy Separation anxiety – toddler Castration anxiety – preschooler

The four D’s of malpractice are: • Duty to demonstrate and deliver a standard of care directly proportional to the degree of specialty training received. • Deviation of that duty by omission or commission. • Damage to the PATIENT or personal property. • Direct cause of a personal injury or damage because of deviation of duty.

Florence Nightingale became the “Mother of Modern Nursing” because she brought light of what a professional nursing is and put up a school of nursing.

Extension doctrine implies that the patient’s explicit consent for surgical procedure serves as an implicit consent for any or all surgical procedures deemed necessary to cope with unpredictable situations that jeopardize the patient’s health. Doctrine of informed consent recognizes the physician’s duty to inform the patient and obtain consent before treatment.

To reduce nasal swelling the client’s upper body part should be elevated (fowler’s position). Lying flat would not provide relief of nasal swelling.

Second-generation cephalosporin (e.g Cefuroxime) may be prescribed by the physician for Epigottitis. Because children with epiglottitis can’t swallow the medication is administered through the IV line. Children like Charles’ case need a prophylactic tracheostomy or endotracheal intubation.

Pressure over the soft tissue of the nose should be continuously done for at least 5 minutes to stop the bleeding. Nursing interventions for epistaxis: • Sit-up, lean forward, head-tipped. • Cold compress • Nasal pack with neosenephrine (3-5 days) Liquid diet, then soft diet Avoid oral-temperature taking Do not blow nose for 2 days after the removal of the nasal pack • Notify physician if epistaxis is recurrent

Cold foods or room temperature foods are better tolerated by a client who is nauseated. Hot food items may increase the nausea because of the aromas emitted. Dry toast and crackers are tolerated by nauseated clients. However, in this case the client is on a clear liquid diet, thus, dry toast should not be given.

The Laissez Faire Leadership Style was first described Lewin, Lippitt, and White in 1938 along with the autocratic leadership and the democratic leadership styles. The laissez faire style is sometimes described as a "hands off" leadership style because the leader provides little or no direction to the followers. The characteristics of the laissez faire style include: • Allows followers to have complete freedom to make decisions concerning the completion of their work or ask questions of the leader • The leader provides the followers with the materials they need to accomplish their goals and answers questions to the follower's questions. Authoritarian - directive style of supervision * Low degree of participation by the people involved * High degree of punitiveness * Pressure placed on the worker for output Democratic Leadership - conducive to the process of exploration and discovery of the individual. MAJOR ELEMENT - MUTUAL TRUST Multi critic - Leader utilizes varying styles depending on the situation.

By 4 years of age you expect a child to button buttons (the child learns to unbutton first before buttoning) and lace shoes. Preschoolers are curious, creative, imaginative and imitative. Complexes are present at this age where the child identifies with the same sex and is attached by the parent of the opposite sex. For Charles, Oedipal complex will be noted where he will identify with his father and will be attached to his mother.

Beginning of toothbrush: 2 ½ years Brushing teeth with little assistance: 3 years Brushing teeth alone: 6 years old.

Charles is 4 years old and is under the preoperational stage of cognitive development. Sensorimotor: 0-24 months Preoperational Stage: 2-7 years old Concrete Operations: 7-11 years Formal Operations: 12- adulthood

A nurse who is practicing nursing without license is guilty of misdemeanor. A tort is a legal wrong committed by a person involving injury of another or loss of or damage to personal property. A malpractice is any professional misconduct, unreasonable lack of skill or judgment, or illegal or immoral act. Negligence is defined as failure to use such care as a reasonably prudent and careful person would use under similar circumstances.

Classification(s) rather than a diagnosis is the topmost priority in IMCI. PRINCIPLES of integrated care:  All sick children must be examined for “general danger signs”.  All sick children must be routinely assessed for: major symptoms, nutritional, Vit A and Immunization status, feeding problems, other potential problems  Only limited number of carefully-selected clinical signs  Classification(s) rather than a diagnosis  Address most, but not all, of the major reasons a sick child is brought to a clinic  Use limited number of essential drugs and encourage active participation of caretakers in the treatment of children  Counseling of caretakers about home management

A dependent variable is a variable that is changed by the interference of an independent variable. In this case, Jane and Danny initiate the study on the effects incomplete laboratory equipments to the level of competency in nursing students. Thus, the incomplete laboratory equipments (independent variable) can have an EFFECT to the level of the competency (dependent variable) of nursing students.

By the borrowed servant rule, the surgeon is liable for acts of team members only when he or she has the right control and supervise the way in which the an RN or surgical technologist performs the work. Doctrine of respondent superior – an employer is held liable for the employee’s negligent conduct (master-servant employment relationship. Doctrine of corporate negligence – facility is held liable not because of the negligence of the employees but for its own negligence in failing to ensure an acceptable level of care is provided. In the common law of negligence, the doctrine of res ipsa loquitur (Latin for "the thing speaks for itself") states that the elements of duty of care and breach can be sometimes inferred from the very nature of the accident, even without direct evidence of how any defendant behaved. Upon a proof of res ipsa loquitur, the plaintiff need only establish the remaining two elements of negligence—namely, that the plaintiff suffered damages, of which the accident was the legal cause.

A common complication is aspiration pneumonia, which is caused by regurgitation of formula contents from the stomach into the respiratory tract. Keeping the head of the bed elevated 30 degrees at all times assists in preventing this complication.

For the administration of blood products 16-, 18- or 19- gauge is used. For peripheral fat emulsion infusions, a 20- or 21- gauge needle is used. A 22- or 23- gauge needle is used for the standard IV solutions. 25-gauge needles are used for subcutaneous injections.

Democratic leadership should not be used when: • There is not enough time to get everyone’s input. • It’s easier and more cost-effective for the manager to make the decision. • The business can’t afford mistakes. • The manager feels threatened by this type of leadership. • Employee safety is a critical concern. Laissez Faire leadership style should not be used when: • It makes employees feel insecure at the unavailability of a manager. • The manager cannot provide regular feedback to let employees know how well they are doing. • Managers are unable to thank employees for their good work. • The manager doesn’t understand his or her responsibilities and is hoping the employees can cover for him or her.

An independent variable is a variable that brings change or affects a dependent variable. Income and economic stability causes a change in the fertility rate in the US from the years 1976-2006. If the income and economic stability is increased the fertility rate also surges. Thus, the income and economic stability is the independent variable as it causes change in the dependent variable (fertility rate).

Aspiration pneumonia is a common complication of NGT feeding. It is caused by the regurgitation of formula contents from the stomach into the respiratory tract. a. Streptococcus pneumonia – bacterial pneumonia b. a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose – viral pneumonia c. Histoplasma capsulatum and blastomyces infestation – fungal pneumonia

Medications given for Parkinson’s disease only manages the symptoms but do not correct or cures the disorder, hence, it is palliative. The cause of PD is unknown, however theories were brought up that absence or defects of dopaminergic receptors in the brain decreases dopamine levels causing the disorder. Other explanations focused on the imbalance between the acetylcholine and dopamine. Thus, the client needs a long-term medication regimen not short-term or 2-4 weeks only. As the disease advances, the continuous use of medications (not a week after) leads to a second stage in which the patient develops motor complications called dyskinesias which make management difficult. Situation: Emma, 18 years old has grossly inappropriate affect. She is introvert and avoids close relationships with family and friends. Her attention is focused on reading books and she functions well when she is alone. Diagnosis: Personality Disorder.

Evaluating the client’s learning needs and his/her readiness to learn is assuming the role of an educator or teacher. A, C, and D are demonstrating advocacy.

Schizoid personality disorder is under Cluster A. Cluster A : odd, eccentric (includes paranoid, schizoid and schizotypal PD) Cluster B: dramatic, emotional or erratic (includes antisocial, borderline, histrionic and narcissistic PD) Cluster C: anxious, fearful (includes avoidant, dependent and Obesseive-Compulsive PD) Not classified PD: passive-aggressive PD and depressive PD