The husband of one of your assigned clients who is very confused describes to you occasions when his wife's agitation and anger have been out of proportion to the stimulus that prompted the behavior. You recognize this as a(n):
a. hallucinatory reaction
b. perceptual problem
c. paranoid delusion
d. catastrophic reaction
D
A catastrophic reaction is a severe overreaction out of proportion to the stimulus. In some cases one can provide a more soothing and quiet environment or simply remove the person from the source of stimulus to distract the individual. This may result in preventing or halting the overreaction. In addition, a calm tone of voice or a soothing touch may aid in diminishing the catastrophic response.
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A patient in the emergency department says, "I took a drug that makes me feel like I'm outside my body looking at the world. Colors move like music." The nurse should assess that the patient
a. probably has schizophreniform disorder. b. has probably ingested a hallucinogen. c. is experiencing formication. d. is using confabulation.
A child is recovering at home from nephrotic syndrome and is on a regimen of prednisone and antibiotics. The child's parents call the pediatric clinic and tell the nurse that their child is gaining a lot of weight
The nurse will first suspect which of the following possible causes of the weight gain? a. ravenous appetite as a side effect of steroid therapy b. sodium retention and concurrent retention of water c. edema associated with steroid therapy d. worsening or relapse of the nephrotic syndrome
Patients who are discharged from the hospital on new medications should
1. be advised that their local pharmacy will provide them with the drug information and instructions they need. 2. be provided with oral and written drug information and instructions. 3. be provided oral drug information and instructions as opposed to written. 4. be provided with written drug information and instructions only.
A 65-year-old patient who recently suffered a cerebral vascular accident is now unable to recog-nize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding?
a. Hypomimesis b. Agnosia c. Dysphasia d. Echolalia