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CASE STUDY – QUESTION 3 The nurse cares for a 44-year-old male with a known diagnosis of post-traumatic stress disorder (PTSD) in a behavioral health urgent care clinic. Phase Sheet   Name James Wheeler Gender M Age 44 Weight 162 lbs (73.5 kg) Allergies NKDA Preferred language English Marital status Married Clinic Notes   1030/Initial Assessment: Diagnosed with PTSD 5 years ago. Appears disheveled, anxious, and easily startled. Reports increased difficulty sleeping over the last month due to nightmares that cause him to wake up in a panic. Client lost his job two weeks ago due to missing too much time from work and he has not been able to get himself together enough to look for a new one. When he lost his job, he also lost his health insurance. He reports missing 2 scheduled clinic appointments and 3 of his weekly group sessions over the last month. Denies a history of self-harm. He states his wife is supportive, but has been upset with him because he has been so irritable, and he doesn’t blame her. Client states, “She would probably be better off if I wasn’t around.”   1100:  Suicide risk assessment completed. Client admits to fleeting, passive suicidal thoughts. “Sometimes I think it would be better if I went to bed and did not wake up, but I would never kill myself. I couldn’t do that to my family, plus I know God does not want me to do that.”  No history of suicide attempts and client states, “I have been down before, but I have always gotten better.” Vital Signs   Time 1030   T ◦F ( ◦C) 97.8 F (36.6 C)   P 98   RR 20   B/P 138/90   Pulse oximeter 97%  (RA)   Pain Headache 7/10     The nurse reviews the updated clinic notes. What conclusion does the nurse make regarding the client’s suicide risk?

Common signs/symptoms of moderate level of anxiety include which of the following?  Select all that apply:

During a group therapy, a client monopolizes the group by discussing back pain. Which of the following responses by the nurse would be most appropriate? 

Which of the following interventions would be most helpful for a client with dissociative disorder who has difficulty expressing feelings?

A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, “That just can’t be true! My head hurts so bad sometimes that it makes me sick to my stomach.” The nurse’s best response is?

Case Study  A woman diagnosed with gestational diabetes delivered a 7-pound 2-ounce male at 36 weeks after spontaneous rupture of membranes without complications at 0532.  APGARS were 8/8. The mother states that the neonate successfully breastfed for thirty minutes right after birth. Nurses’ Notes 0500: A woman vaginally delivered a 7-pound 2-ounce baby girl at 36 weeks after spontaneous rupture of membranes without complications.  APGARS were 8/8. The mother states that the neonate successfully breastfed for thirty minutes right after birth. 0900: Upon rounding with the pediatrician on the perinatal unit, a nurse notes the newborn is demonstrating fast and shallow breathing, grunting, nasal flaring, chest retracting, and skin color dusky.  The mother states she tried to breastfeed, but the baby did not seem to be interested and is sleeping soundly. The neonate has yet to void or stool.  0910. Blood glucose 34 mg/dl. Newborn is lethargic with poor muscle tone. Passed meconium.  Auscultation of the lungs reveal inspiratory crackle and expiratory grunt. 0940- Transferred to neonatal intensive care unit 1000- Intubated with 3.0 ET tube and placed on mechanical ventilation. Surfactant administered via endotracheal tube. Peripheral IV placed and patent. Repeat blood glucose 44mg/dL. Vital Signs Time 0900 0910 0920 0940 1015 Temp 97 F 97F 97.5 F 97.5 98F HR 156 156 170 170 156 RR 76 76 80 78 58 B/P 70/35 N/A N/A N/A 80/40 Pulse oximeter 91% on RA 90% on RA 93% on 100% 93% on 100% 98% on 60% Pain 0 0 0 grimace 0   Laboratory Results     Lab Results Reference range ABG pH 7.25 7.35-7.45 ABG P02 58 60 -70 mm Hg ABG PC02 52 35-45 mmHg ABG SaP02 88 95-100% ABG HC03 17 22-26 mEq/L Glucose 34 40-60 mg/dl Hematocrit 53 Newborn 46-68% Hemoglobin 18 g/dl Newborn 15.2-23.6 g/dl WBC 10 9.1 – 30.1 x 103 cells/mm3 Blood type O+   Diagnostic Reports   Echocardiogram no congenital heart defect noted. Chest x-ray hypo aeration- ground glass pattern After the intubation and initial dose of surfactant What would you expect to note if the newborn’s respiratory distress syndrome is improving. Select all that apply.

For the infant experiencing acute neonatal abstinence syndrome (NAS), the nurse would anticipate which of the following assessments:  Select all that apply:

Which of the following statements about the treatment of clients with panic disorder is FALSE?

A young woman is newly married and is seeking advice on contraception. Her husband dislikes the feel of condoms. Also, she mentions that she typically experiences dysmenorrhea and has a history of PID. Which method should the nurse recommend?  

A client has sought treatment for a specific phobia: fear of cats. The nurse in the anxiety disorders clinic has established the nursing diagnosis: Anxiety related to exposure to phobic object (cats). Which of the following is a realistic short-term goal for this client?