Which assessment finding best supports dissociative fugue? The patient states:
a. "I cannot recall why I'm living in this town."
b. "I feel as if I'm living in a fuzzy dream state."
c. "I feel like different parts of my body are at war."
d. "I feel very anxious and worried about my problems."
ANS: A
The patient in a fugue state frequently relocates and assumes a new identity while not recalling previous identity or places previously inhabited. The distracters are more consistent with depersonalization disorder, generalized anxiety disorder, or dissociative identity disorder. See relationship to audience response question.
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The nurse discusses dental health with an aging client. Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change?
A) Retraction of the gum's pulp B) Diminished saliva C) Hardened brittle tooth enamel D) Periodontal disease causing tooth loss
A nurse is collecting a post-void residual urine volume for a client. Which of the following volumes would be abnormal?
1. 30 mL 2. 60 mL 3. 95 mL 4. 125 mL
The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What should the nurse include? Select all that apply.
A. Keep the toddler awake and observe for side effects of the medication. B. Keep all medications locked up and stored out of reach of the toddler. C. Use syrup of ipecac immediately if the toddler has ingested medication. D. Call the Poison Control Center for guidance with any medication ingested. E. Teach the toddler that medications are for adult use only.
It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P. is a 60-yearold retired businessman who is married and has three grown children
As you take his health history, he tells you that he began feeling changes in his chest about 10 days ago. He has hypertension (HTN) and a 5-year history of angina pectoris. During the past week, he has had frequent episodes of mid-chest discomfort. The chest pain responds to nitroglycerin (NTG), which he has taken sublingually about 8 to 10 times over the past week. During the week, he has also experienced increased fatigue. He states, "I just feel crappy all the time." A cardiac catheterization done several years ago revealed 50% stenosis of the right coronary artery (RCA) and 50% stenosis of the left anterior descending (LAD) coronary artery. He tells you that both his mother and his father had coronary artery disease (CAD). He is currently taking amlodipine (Norvasc), metoprolol (Lopressor), atorvastatin (Lipitor), and aspirin 81 mg/day. What other information are you going to obtain about his episodes of chest pain?