Psychiatric Nursing Exam II

1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness
C. Lack of self-esteem, strong dependency needs, and impulsive behavior
D. Insensitivity to others, sexual acting out, and violence

2.In a toddler, which of the following injuries is most likely the result of child abuse?

A. A hematoma on the occipital region of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity

3. A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:

A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
D. schizophrenia.

4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses to eat. Which of the following statements is the best response from the nurse?

A. "You don't have to eat. It's your choice."
B. "I hope you'll eat your food by mouth. Tube feedings and I.V. lines can be uncomfortable."
C. "Why do you think you're fat? You're underweight. Here — look in the mirror."
D. "You really look terrible at this weight. I hope you'll eat."

5. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most appropriate response?

A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."

6. A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse plans to write a behavioral contract. To best promote compliance, the contract should be written:

A. abstractly.
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.

7. During which phase of alcoholism is loss of control and physiologic dependence evident?

A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase

8. Which of the following is important when restraining a violent client?

A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain the client.
D. Secure restraints to the gurney with knots to prevent escape.

9. A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?

A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood

10. A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the last month. She is 5′ 7" (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?

A. Initiating caloric and nutritional therapy as ordered
B. Instituting behavioral modification therapy as ordered
C. Addressing the client's low self-esteem
D. Regularly monitoring vital signs and weight

11. A client tells the nurse that he is having suicidal thoughts every day. In conferring with the treatment team, the nurse should make which of the following recommendations?

A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment

12. Which of the following etiologic factors predispose a client to Tourette syndrome?

A. No known etiology
B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate nucleus, and genetics
C. Abnormalities in the structure and function of the ventricles
D. Environmental factors and birth-related trauma

13. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?

A. Withdrawal
B. Logical thinking
C. Repression
D. Denial

14. An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:

A. violence on television.
B. passive parents.
C. an internal locus of control.
D. a single-parent family

15. A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:

A. open boundaries are common in violent families.
B. violence usually results from a power struggle.
C. domestic violence and abuse span all socioeconomic classes.
D. violent behavior is a genetic trait passed from one generation to the next.

16. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:

A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.

17. During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on the forearms. What is the nurse's best response?

A. "That's it! You're on suicide precautions."
B. "I'm going to tell your physician. Do you want to tell me why you did that?"
C. "Tell me what type of instrument you used. I'm concerned about infection."
D. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first."

18. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:

A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.

19. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:

A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.

20. Which of the following signs should the nurse expect in a client with known amphetamine overdose?

A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils

21. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority?

A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output
B. Checking the client's medical records for health history information
C. Attempting to contact the client's family to obtain more information about the client
D. Restricting fluids and leaving the client alone to "sleep off" the episode

22. Which nursing action is best when trying to diffuse a client's impending violent behavior?

A. Helping the client identify and express feelings of anxiety and anger
B. Involving the client in a quiet activity to divert attention
C. Leaving the client alone until the client can talk about feelings
D. Placing the client in seclusion

23. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?

A. Abstinence is the basis for successful treatment.
B. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism.
C. For treatment to be successful, family members must participate.
D. An occasional social drink is acceptable behavior for the alcoholic

24. Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?

A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the family
D. Low socioeconomic status

25. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I don't have a drug problem. I can quit whenever I want. I've done it before." Which defense mechanism is the client using?

A. Denial
B. Obsession
C. Compensation
D. Rationalization

26. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:

A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).
D. epinephrine.

27. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?

A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader."
B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends."
C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
D. "I do diet around my periods; otherwise, I just get so bloated."

28. Which is the drug of choice for treating Tourette syndrome?

A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil)

29. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?

A. "Why didn't you get someone else to drive you?"
B. "Tell me how you feel about the accident."
C. "You should know better than to drink and drive."
D. "I recommend that you attend an Alcoholics Anonymous meeting." a

30. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?

A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness

31. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:

A. norepinephrine (Levophed) and lidocaine (Xylocaine).
B. nifedipine (Procardia) and lidocaine.
C. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).
D. nifedipine and esmolol

32. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?

A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strengths

33. A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, the nurse should assess for which behavioral clues?

A. A rigid posture, restlessness, and glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past violent acts

34. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?

A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."
B. "I only spend half of my paycheck at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."

35. A client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse should formulate a nursing diagnosis of:

A. Ineffective individual coping related to feelings of guilt.
B. Situational low self-esteem related to feelings of loss of control.
C. Risk for violence: Self-directed related to impulsive mutilating acts.
D. Risk for violence: Directed toward others related to verbal threats.

36. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?

A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder

37. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:

A. begin after 7 days.
B. not occur at all because the time period for their occurrence has passed.
C. begin anytime within the next 1 to 2 days.
D. begin within 2 to 7 days.

38. The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?

A. Providing one-on-one supervision during meals and for 1 hour afterward
B. Letting the client eat with other clients to create a normal mealtime atmosphere
C. Trying to persuade the client to eat and thus restore nutritional balance
D. Giving the client as much time to eat as desired

39. A client begins to experience alcoholic hallucinosis. What is the best nursing intervention at this time?

A. Keeping the client restrained in bed
B. Checking the client's blood pressure every 15 minutes and offering juices
C. Providing a quiet environment and administering medication as needed and prescribed
D. Restraining the client and measuring blood pressure every 30 minutes

40. Which assessment finding is most consistent with early alcohol withdrawal?

A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mm Hg
D. Blood pressure of 140/80 mm Hg

41. Which client is at highest risk for suicide?

A. One who appears depressed, frequently thinks of dying, and gives away all personal possessions
B. One who plans a violent death and has the means readily available
C. One who tells others that he or she might do something if life doesn't get better soon
D. One who talks about wanting to die

42. Which of the following medical conditions is commonly found in clients with bulimia nervosa?

A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A

43. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?

A. The student discusses conflicts over drug use.
B. The student accepts a referral to a substance abuse counselor.
C. The student agrees to inform his parents of the problem.
D. The student reports increased comfort with making choices.

44. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?

A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)

45. A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?

A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous

46. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to:

A. severely restrict the client's physical activities.
B. weigh the client daily, after the evening meal.
C. monitor vital signs, serum electrolyte levels, and acid-base balance.
D. instruct the client to keep an accurate record of food and fluid intake.

47. A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:

A. antisocial personality disorder.
B. borderline personality disorder.
C. obsessive-compulsive personality disorder.
D. narcissistic personality disorder.

48. A husband and wife seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, the nurse knows they are at risk for repeated violence because the husband:

A. has only moderate impulse control.
B. denies feelings of jealousy or possessiveness.
C. has learned violence as an acceptable behavior.
D. feels secure in his relationship with his wife.

49. A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:

A. manipulate her husband.
B. gain control of one part of her life.
C. commit suicide.
D. live up to her mother's expectations.

50. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:

A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.

51. 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

52. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:

A. avoid shopping for large amounts of food.
B. control eating impulses.
C. identify anxiety-causing situations.
D. eat only three meals per day.

53. A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should:

A. check the client frequently at irregular intervals throughout the night.
B. assure the client that the nurse will hold in confidence anything the client says.
C. repeatedly discuss previous suicide attempts with the client.
D. disregard decreased communication by the client because this is common in suicidal clients.

54. Which of the following drugs should the nurse prepare to administer to a client with a toxic acetaminophen (Tylenol) level?

A. deferoxamine mesylate (Desferal)
B. succimer (Chemet)
C. flumazenil (Romazicon)
D. acetylcysteine (Mucomyst)

55. A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?

A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)

56. During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response?

A. "I trust you not to purge."
B. "How are you purging and when do you do it?"
C. "Don't worry. I won't allow you to purge today."
D. "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."

57. A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response?

A. "If you continue to talk like that, I'm going to stop speaking to you."
B. "You told me you got fired from your last job for missing too many days after taking drugs all night."
C. "Tell me more about how it felt to get high."
D. "Don't you know it's illegal to use drugs?"

58. For a client with anorexia nervosa, which goal takes the highest priority?

A. The client will establish adequate daily nutritional intake.
B. The client will make a contract with the nurse that sets a target weight.
C. The client will identify self-perceptions about body size as unrealistic.
D. The client will verbalize the possible physiological consequences of self-starvation.

59. When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem?

A. The injury isn't consistent with the history or the child's age.
B. The mother and father tell different stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and demanding with emergency department personnel.

60. For a client with anorexia nervosa, the nurse plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?

A. They tend to overprotect their children.
B. They usually have a history of substance abuse.
C. They maintain emotional distance from their children.
D. They alternate between loving and rejecting their children.

61. In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?

A. Remaining with the client and staying calm
B. Calling a security guard and another staff member for assistance
C. Telling the client's husband that he must leave at once
D. Determining why the husband feels so angry

62. The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?

A. Fill out the client's menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.

63. The nurse is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority?

A. Assessing the client's home environment and relationships outside the hospital
B. Exploring the nurse's own feelings about suicide
C. Discussing the future with the client
D. Referring the client to a clergyperson to discuss the moral implications of suicide

64. A client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings?

A. Avoid discussing the client's perceptions and feelings.
B. Focus discussions on food and weight.
C. Avoid discussing unrealistic cultural standards regarding weight.
D. Provide objective data and feedback regarding the client's weight and attractiveness.

65. The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products?

A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese

66. The nurse is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?

A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.

67. Victims of domestic violence should be assessed for what important information?

A. Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation)
B. Readiness to leave the perpetrator and knowledge of resources
C. Use of drugs or alcohol
D. History of previous victimization

68. A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from:

A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium level

69. A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused?

A. The child cries uncontrollably throughout the examination.
B. The child pulls away from contact with the physician.
C. The child doesn't cry when the shoulder is examined.
D. The child doesn't make eye contact with the nurse.

70. When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?

A. Client's physical needs
B. Client's safety needs
C. Client's psychosocial needs
D. Client's medical needs

71. Which outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder?

A. Accept responsibility for own behaviors.
B. Be able to verbalize own needs and assert rights.
C. Set firm and consistent limits with the client.
D. Allow the child to establish his own limits and boundaries.

72. A client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should the nurse approach her initially?

A. Enter the room quietly and move beside her to assess her injuries.
B. Call for staff back-up before entering the room and restraining her.
C. Move as much glass away from her as possible and sit next to her quietly.
D. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her.

73. A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5′ 8" (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should be included in the plan of care?

A. Asking the client to compare her figure with magazine photographs of women her age
B. Assigning the client to group therapy in which participants provide realistic feedback about her weight
C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift
D. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy

74. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:

A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
D. pneumonia.

75. Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered?

A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal

76. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?

A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends

76. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?

A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends by telephone.

77. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond:

A. "You must first stop drinking."
B. "Your physician must refer you to this program."
C. "Admit you're powerless over alcohol and that you need help."
D. "You must bring along a friend who will support you."

78. An attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm's employee assistance program. The nurse knows that the client's behavior most likely represents the use of which defense mechanism?

A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization

79. After completing chemical detoxification and a 12-step program to treat crack addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?

A. "I'm never going to use crack again."
B. "I know what I have to do. I have to limit my crack use."
C. "I'm going to take 1 day at a time. I'm not making any promises."
D. "I will substitue crack for something else"

80. The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:

A. accurately describe the amount consumed.
B. underestimate the amount consumed.
C. overestimate the amount consumed.
D. deny any consumption of alcohol.

81. The nurse is assessing a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?

A. Tachycardia
B. Warm, flushed extremities
C. Parotid gland tenderness
D. Coarse hair growth

82. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:

A. impending coma.
B. manipulating behavior.
C. suppression.
D. perceptual disorders.

83. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder?

A. Wearing tight-fitting clothing
B. Increased blood pressure
C. Oily skin
D. Excessive and ritualized exercise

84. A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?

A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal

85. A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 5′ 8" (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which measure should the nurse take first when caring for this client?

A. Teach the client about nutrition, calories, and a balanced diet.
B. Establish a trusting relationship with the client.
C. Discuss cultural stereotypes regarding thinness and attractiveness.
D. Explore the reasons why the client doesn't eat.

86. A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see:

A. tension and irritability.
B. slow pulse.
C. hypotension.
D. constipation.

87. Which of the following drugs may be abused because of tolerance and physiologic dependence.

A. lithium (Lithobid) and divalproex (Depakote).
B. verapamil (Calan) and chlorpromazine (Thorazine)
C. alprazolam (Xanax) and phenobarbital (Luminal)
D. clozapine (Clozaril) and amitriptyline (Elavil)

88. Which of the following groups are considered to be at highest risk for suicide?

A. Adolescents, men over age 45, and persons who have made previous suicide attempts
B. Teachers, divorced persons, and substance abusers
C. Alcohol abusers, widows, and young married men
D. Depressed persons, physicians, and persons living in rural areas

89. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal tic that involves repeating one's own sounds or words is known as:

A. echolalia.
B. palilalia.
C. apraxia.
D. aphonia.

Please post a comment with your email and ill send you the answers.

Herbal Meds

Chamomile

Uses: Chamomile is often used in the form of a tea as a sedative.

Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin.

Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection.
Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral).

St. John's Wort

Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress.
Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil).

Garlic

Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence to recommend its routine use in clinical practice.")
Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin.

Feverfew

Uses: Most commonly used for migraine headaches.
Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba

Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking.
Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital.

Ginseng

Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as "Ginseng.")
Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in pregnancy is not recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis.

Ginger

Uses: Ginger has been used as a treatment for nausea and bowel spasms.
Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Saw Palmetto

Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections.
Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...")
This listing represents only a small portion of herbal treatments. Nevertheless, the popularity of herbal therapies is unquestionable. Doctors routinely confront the unknown with their patients who are using herbs. Doctors simply do not have any way of helping you to decide whether these herbs are helpful or harmful for you, or whether they are interacting with your current medications. There are no data.

Black Cohosh

Claims, Benefits: A natural way to treat menopausal symptoms.
Bottom Line: Little is known about its benefits and its risks. If you try it, tell your physician, since it might interact with other medications you are taking.

ANTIDOTES

ACETAMINOPHEN ACETYLCYSTEIN MUCOMIST
DIGOXIN DIGIBIND, DIDIFAB
HEPARIN PROTAMINE SULFATE
COUMADIN, WARFARIN VITAMIN K, FRESH FROZEN PLASMA
LOVENOX VITAMIN K
LITHIUM DIAMOX
BENZODIAZEPINE FLUMAZENIL
ATROPINE SULFATE MESTINON
CURARE EDROPHONIUM TENSILON
MORPHINE NALOXONE HCL (NARCAN)
DEMEROL NALOXONE HCL (NARCAN)
METHOTREXATE LEUCOVORINE
NEOSTIGMINE PRALIDOXINE CHLORIDE (PAM)
PENICILLIN EPINEPHRINE
THROMBOLYTIC AMINO CAPROIC ACID
METHYLERGONOVINE MAGNESSIUM SULFATE
OXYTOCIN MAGNESSIUM SULFATE
MAGNESSIUM SULFATE CALCIUM GLUCONATE
YUTOPAR INDERAL
LEAD EDETATE DISODIUM (EDTA)
LEAD DIMERCAPROL (BAL)
LEAD SUCCIMER (CHEMET)
IRON DESFERAL
COPPER PENICILLAMINE
ETHYLENE POISONING FOMEPIZOL (ANTIZOL)
CYANIDE POISONING METHYLENE BLUE

MORPHINE DEMEROL

MI OK OK

SICKLE CELL OK NOT OK

CHOLECYSTITIS NOT OK OK

PANCREATITIS NOT OK OK

MNEMONICS

MNEMONICS CORNER 05

Acid-base—"ROME" (Respiratory Opposite, Metabolic Equal)
Acidosis
» Respiratory (opposite): pH Pco2
» Metabolic(equal): pH HCO3
Alkalosis
» Respiratory (opposite): pH Pco2
» Metabolic(equal): pH HCO3

Alcohol withdrawal: clinical features—"HITS"
Hallucinations (visual, tactile)
Increased vital signs and insomnia
Tremens delirium tremens (potentially lethal)
Shakes/ Sweats/ Seizures/ Stomach pains (nausea, vomiting)

Angina: precipitating factors—"4E's"
Eating
Emotion
Exertion (Exercise)
Extreme Temperatures (Hot or Cold weather)

Anorexia nervosa: clinical features—"ANOREXIC"
Adolescent women/ Amenorrhea
NGT alimentation (most severe cases)
Obsession with losing weight/ becoming fat though underweight
Refusal to eat (5% die)
Electrolyte abnormalities (e.g., K+, cardiac arrhythmia)
X - ercise
Intelligence often above average/ Induced vomiting
Cathartic use (and diuretic abuse)

Appendicitis: assessment—"PAINS"
Pain (RLQ)
Anorexia
Increased temperature, WBC (15,000–20,000)
Nausea
Signs (McBurney's, Psoas)

Neurovascular Occlusion: symptoms— "6 P's"
Pain
Pale
Pulseless
Paresthesia
Poikilothermic
Paralysis

Blood glucose (rhyme)
Symptom Implication
Cold and clammy . . . give hard candy
Hot and dry . . . glucose is high

Blood vessels in umbilical cord—"AVA" (2 arteries and 1 vein)
Artery
Vein
Artery

Cholecystitis: risk factors—"5F's"
Female
Fat
Forty
Fertile
Fair

Cleft lip: nursing care plan (postoperative)—"CLEFT LIP"
Crying, minimize
Logan bow
Elbow restraints
Feed with Brecht feeder
Teach feeding techniques; two months of age (average age at repair)
Liquid (sterile water), rinse after feeding
Impaired feeding (no sucking)
Position—never on abdomen

Cognitive disorders: assessment of difficulties—"JOCAM"
Judgment
Orientation
Confabulation
Affect
Memory

Coma: causes—"A-E-I-O-U TIPS"
Alcohol, acidosis (hyperglycemic coma)
Epilepsy (also electrolyte abnormality, endocrine problem)
Insulin (hypoglycemic shock)
Overdose (or poisoning)
Uremia and other renal problems
Trauma; temperature abnormalities (hypothermia, heat stroke)
Infection (e.g., meningitis)
Psychogenic ("hysterical coma")
Stroke or space-occupying lesions in the cranium

Complication of severe preeclampsia—"HELLP" syndrome
Hemolysis
Elevated Liver enzymes
Low Platelet count

Cushing's syndrome: symptoms—"3S's"
Sugar (hyperglycemia)
Salt (hypernatremia)
Sex (excess androgens)

Diabetes: signs and symptoms—"3P's,"
Polydipsia (very thirsty)
Polyphagia (very hungry)
Polyuria (urinary frequency)

Diet: low cholesterol—avoid the "3C's"
Cake
Cookies
Cream (dairy, e.g., milk, ice cream)

Dystocia: etiology—"3P's"
Power
Passageway
Passenger

Dystocia: general aspects (maternal)—"3P's"
Psych
Placenta
Position

Episiotomy assessment—"REEDA"
Redness
Edema
Ecchymosis
Discharge
Approximation of skin

Eye medications
Mydriatic = dilated pupils
Miotic = tiny (constricted) pupils

Hypertension: complications—"4 C's"
CAD (coronary artery disease)
CHF (congestive heart failure)
CRF (chronic renal failure)
CVA (cardiovascular accident; now called brain attack or stroke)

Hypertension: nursing care plan— "I-TIRED"
Intake and output (urine)
Take blood pressure
Ischemia attack, transient (watch for TIAs)
Respiration, pulse
Electrolytes
Daily weight

Hypoglycemia: signs and symptoms—"DIRE"
Diaphoresis
Increased pulse
Restless
Extra hungry

Infections during pregnancy—"TORCH"
Toxoplasmosis
Other (hepatitis B, syphilis, group B beta strep)
Rubella
Cytomegalovirus
Herpes simplex virus

IUD: potential problems with use—"PAINS"
Period (menstrual: late, spotting, bleeding)
Abdominal pain, dyspareunia
Infection (abnormal vaginal discharge)
Not feeling well, fever or chills
String missing

Manipulation: nursing plan—promote the "3C's"
Cooperation
Compromise
Collaboration

Medication administration—"six rights"
RIGHT medication
RIGHT dosage
RIGHT route
RIGHT time
RIGHT client
RIGHT technique

Melanoma characteristics—"ABCD"
Asymmetry
Border
Color
Diameter

Mental retardation: nursing care plan—"3R's"
Regularity (provide routine and structure)
Reward (positive reinforcement)
Redundancy (repeat)

Myocardial infarction: treatment—"MONA"
Monitor/ Morphine
Oxygen
Nitroglycerin
Aspirin

Newborn assessment components—"APGAR"
Appearance
Pulse
Grimace
Activity
Respiratory effort

Obstetric (maternity) history—"GTPAL"
Gravida
Term
Preterm
Abortions (SAB, TAB)
Living children

Oral contraceptives: signs of potential problems—"ACHES"
Abdominal pain (possible liver or gallbladder problem)
Chest pain or shortness of breath (possible pulmonary embolus)
Headache (possible hypertension, brain attack)
Eye problems (possible hypertension or vascular accident)
Severe leg pain (possible thromboembolic process)

Pain: assessment—"PQRST"
What Provokes the pain?
What is the Quality of the pain?
Does the pain Radiate?
What is the Severity of the pain?
What is the Timing of the pain?

Pain: management—"ABCs"
Ask about the pain
Believe when clients say they have pain
Choices—let clients know their choices
Deliver what you can, when you said you would
Empower/Enable clients' control over pain

Postoperative complications: order—"4W's"
Wind (pulmonary)
Wound
Water (urinary tract infection)
Walk (thrombophlebitis)

Preterm infant: anticipated problems—"TRIES"
Temperature regulation (poor)
Resistance to infections (poor)
Immature liver
Elimination problems (necrotizing enterocolitis [NEC])
Sensory-perceptual functions (retinopathy of prematurity [ROP])

Psychotropic medications: common antidepressives (tricyclics)—"VENT"
Vivactil
Elavil
Norpramin
Tofranil

Schizophrenia: primary symptoms—"4A's"
Affect
Ambivalence
Associative looseness
Autism

Sprain: nursing care plan—"RICE"
Rest
Ice
Compression
Elevation

Stool assessment—"ACCT"
Amount
Color
Consistency
Timing

Tracheoesophageal fistula: assessment—"3Cs"
Coughing
Choking
Cyanosis

Traction: nursing care plan—"TRACTION"
Trapeze bar overhead to raise and lower upper body
Requires free-hanging weights; body alignment
Analgesia for pain, prn
Circulation (check color and pulse)
Temperature (check extremity)
Infection prevention
Output (monitor)
Nutrition (alteration related to immobility)

Transient ischemic attacks: assessment—"3Ts"
Temporary unilateral visual impairment
Transient paralysis (one-sided)
Tinnitus = vertigo

Trauma care: complications—"TRAUMA"
Thromboembolism; Tissue perfusion, altered
Respiration, altered
Anxiety related to pain and prognosis
Urinary elimination, altered
Mobility impaired
Alterations in sensory-perceptual functions and skin integrity (infections)

Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)—"COAT RACK"

Wernicke's encephalopathy (acute phase)
clinical features:
Confusion
Ophthalmoplegia
Ataxia
Thiamine is an important aspect of Tx

Korsakoff's psychosis (chronic phase)
characteristic findings:
Retrograde amnesia (recall of some old memories)
Anterograde amnesia (ability to form new memories)
Confabulation
Korsakoff's psychosis

MNEMONICS CORNER 04

SIGNS OF CANCER
Change in bowel /bladder habits
A sore that doesn’t heal
Unusual bleeding/ Discharge
Thickening of lump – breast or elsewhere
Indigestion/ Dysphagia
Obvious change in wart/ mole
Nagging cough/ hoarseness

Unexplained anemia
Sudden weight loss


FOCUS OF PATIENT CARE IN CLIENTS WITH CANCER
Chemotherapy
Assess body image disturbance (related to alopecia)
Nutritional needs when N/V present
Comfort from pain
Effective response to Tx? (Evaluate)
Rest (for patient and family)

MNEMONICS CORNER 03

Basic MI management - "BOOMAR"
Bed rest
Oxygen
Opiate
Monitoring
Anticoagulation
Reduce clot size

To Remember Immunoglobulins - "GAMED"
IgG
IgA
IgM
IgE
IgD

Location of the heart valve from right to left - "A Permanently Temperamental Man"
Aortic
Pulmonary
Tricuspid
Mitral

"Cut C4, breathe no more"
The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm.

Types of Joint movements - "FEEDPIPE CARDSHARP"
Flexion
Extension
Eversion
Dorsiflexion
Pronation
Inversion
Plantarflexion
Elevation
Circumduction
Abduction
Rotation
Depression
Supination
Hyperextension
Adduction
Retraction
Protraction

Cranial Nerves - "Oh Ohh Ohhh To Try And Fit A Gold Velvet So Heavenly"
Olfactory CN I
Optic CN II
Occulomotor CN III
Trochlear CN IV
Trigeminal CN V
Abducens CN VI
Facial CN VII
Auditory CN VIII
Glasopharyngeal CN IX
Vagus CN X
Spinal/Accessory CN XI
Hypoglossal CN XII

"Point and Shoot!"
For remembering that Parasympathetics are involved with erection and Sympathetics with ejaculation.

Layers of the scalp - "SCALP"
Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium

Carpal bones of the hand (lateral to medial) - "She Looks Too Proud, Try To Chase Her"
Proximal row:
Scaphoid
Lunate
Triquetrum
Pisiform
Distal row:
Trapezium
Trapezoid
Capitate
Hamate

Viruses causing diarrhea - "ACNE CAR"
Adeno virus
Corana virus
Norwak virus
Entero virus
Calci virus
Astro virus
Rota virus

The Krebs cycle - "Can I Actually See Some Filipina Mothers"
Citrate
Isocitrate
alpha Ketoglutarate
Succinyl CoA
Succinate
Fumarate
Malate
Oxaloacetate

Stages of mitosis/meiosis including interphase as a phase - "In Philippines, Men Are Talented"
Interphase
Prophase
Metaphase
Anaphase
Telophase

Order of prevalence of White Blood Cells, most prevalent to least - "Never Let Monkeys Eat Bananas"
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

10 essential amino acids - "PVT. TIM HALL"
Phenylalanine
Valine
Tryptophan
Threonine
Isoleucine
Metheonine
Histidine(semi-essential)
Arginine(semi-essential)
Leucine
Lysine

Uses of Chloroquine (other than malaria) - "RED LIP"
Rheumatoid arthritis
Extra intestinal amoebiasis
Discoid lupus erythematosus
Lepra reaction
Infectious mononucleosis
Photogenic reactions

Bronchodilators - "TO A SIS"
Terbutaline
Orciprenaline
Adrenaline
Salbutamol
Isoprenaline
Salmeterol

Signs of cor pulmonale - "Please Read His Text"
Peripheral edema
Raised JVP
Hepatomegaly
Tricuspid incompetence

Portal hypertension features - "ABCDE"
Ascites
Bleeding (hematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen

Key questions needed in an emergency history taking situation - "AMPLE"
Allergies
Medication
Past medical history
Last meal
Events and environment related to injury

Malignancies that metastisize to bone - "Laging Panalo Kung Taga Bulacan"
Lung
Prostat
Kidney
Thyroid
Breast

Six "S" in Scarlet Fever
Streptococci causal organism
Sorethroat
Swollen tonsils
Strawberry tongue
Sandpaper rash
miliarySudamina vesicles over hands, feet, abdomen

Signs of anti-cholinergic crisis - "SLUD"
Salivation
Lacrimation
Urination
Defecation

Causes of huge spleen - "3M's"
Myelofibrosis
Malaria
Myelogenous leukemia

Cardinal Symptoms of Parkinson's Disease - "TRAP"
Tremor
Rigidity
Akinesia and bradykinesia
Postural Instability

Days of appearance of rashesVaricella(chickenpox) - "Very Sick Patients Must Take Double Exercise"
1st dayScarlet fever
2nd dayPox(smallpox)
3rd dayMumps
4th dayTyphus
5th dayDengue
6th dayEnteric fever(typhoid)

MNEMONICS CORNER 02

SHOCK – HYPOTACHYTACHY
HYPOTENSION
TACHYPNEA
TACHYCARDIA

INCREASE ICP – HYPERBRADYBRADY
CUSHINGS TRIAD
HYPERTENSION (WIDE PULSE PRESSURE)
BRADYCARDIA
BRADYPNEA

HYPOGLYCEMIA
TREMORS, TACHYCARDIA
IRRITABILITY
RESTLESSNESS
EXTREME
DIAPHORESIS

EARLY SIGNS OF HYPOXIA
RESTLESSNESS
AGITATION
TACHYCARDIA

LATE SIGNS OF HYPOXIA
BRADYCARDIA
EXTREME RESTLESSNESS
DYSPNEA
CYANOSIS

CONGESTIVE HEART FAILURE
DIGOXIN
MORPHINE
AMINOPHYLLINE
DOPAMINE
DIURETICS
O2
GASSES – MONITOR (ABG)

MG SO4 TOXICITY
BP DECREASE
URINE OUTPUT DECREASE
RESPIRATORY RATE DECREASE
PATELLAR REFLEX ABSENT

SICKLE CELL DISEASE
HYDRATION
OXYGENATION
PAIN
INFECTION
AVOID HIGH PLACES

PREGNANCY INDUCED HYPERTENSION
HEMOLYSIS
ELEVATED LIVER ENZYMES
LOW
PLATELETS

GI SYMPTOMS AND TOXICITY TO DIGOXIN
VOMITTING
ANOREXIA
NAUSEA
DIARRHEA
ABDOMINAL PAIN

FRACTURE
PRESSURE
REST
ICE
COMPRESSION
ELEVATION

TETRALOGY OF FALLOT
DISPLACED AORTA
RIGHT VENTRICULAR HYPERTROPHY
OPENING INTO THE SEPTUM (VSD)
PULMONARY STENOSIS

HYPOKALEMIA
SKELETAL MUSCLE WEAKNESS
U-WAVE ON ECG
CONSTIPATION
TOXICITY TO DIGOXIN
IRREGULAR WEAK PULSE
OTOSTASIS
NUMBNESS PARESTHESIA

PAIN ASSESSMENT
PROVOCATION
QUALITY
RADIATION, RELIEF
SEVERITY
TIME

NEUROVASCULAR CHECK
PAIN
PULSELESSNESS
PARESTHESIA
PARALYSIS
PALLOR

VIRCHOW’S TRIAD IN DVT
VENUS STASIS
DAMAGE TO VESSELS
HYPERCOAGUABILITY

ABDOMINAL AORTIC ANEURISM (4A)
ASSYMPTOMATIC
ABDOMINAL MASS
ABDOMINAL PULSE
ACHES LOW BACK

ANTI TB DRUGS AND SIDE EFFECTS
RIFAMPICIN – RED-ORANGE URINE
ISONIAZID – PERIPHERAL NEURITIS
PYRAZINAMIDE – INCREASE URIC ACID
ETHAMBUTOL – EYE PROBLEMS
STREPTOMYCIN – OTOTOXIC

MNEMONICS CORNER 01

USE STRAW BECAUSE THESE DRUGS STAIN THE TEETH

L - LUGOL'S SOLUTION
I - IRON
N - NITROFURANTOIN
T - TETRACYCLINE

LR6 - LATERAL RECTUS : CN6
SO4 - SUPERIOR OBLIQUE : CN4
ALL3 - ALL THE REST : CN3

RADIATION TX VIA:
MUSTARD
ESTROGEN
NITROGEN
STEROIDS
ANTIBIOTICS