For the chapter 16 quiz, I understand that the rules are the same as for earlier quizzes.  In particular, I can use anything on paper, but I cannot use any other devices aside from the computer I take the quiz on.

Case Study Question 6 of 6 The nurse cares for a 21-year-old male in the emergency department with cellulitis and uncontrolled pain.   Nurses’ Notes   0930. Client being treated for cellulitis presented with a complaint of right arm pain not controlled by prescription narcotics. The client is alert and oriented but agitated, rating pain 10/10 pain. Denies shortness of breath or chest pain. Informed client of wait times, placed wristband on client, and had him return to the waiting room to be triaged. 1055. Notified by a family in the waiting room that the client was slouched in chair and “seemed dead.” Client was found to be unresponsive with constricted pupils, clammy skin, bradypnea, and circumoral cyanosis. Rt arm is red and swollen with blistered areas. 1100. Emergency response team activated. Vital signs obtained.    1105. Intranasal naloxone administered. Oxygen started at 2L per nasal cannula. Client starting to arouse. 1115. Client respirations returned to expected levels within two minutes, client awake, alert, nauseated, and vital signs improved. 1135. Client is alert and now complaining of severe pain and nausea. Reports he has been taking non-prescribed oxycotin in addition to ordered narcotic pain medications.  Orders received.    Vital Signs   Time 1100 1115 1145   T ◦F/ ◦C 97.1F /36.1C 97.1F/36.1C 98.3/F 36.7C   P 48 56 90   RR 6 12 16   B/P 90/50 94/56 130/88   Pulse oximeter 86% 93% on 2L 96% on 2L   Oxygen RA 2L via NC 2L via NC   Pain Unable to report 6/10 10/10   Orders   Admit to the inpatient unit VS every 30 minutes x 6hrs May repeat intra nasal naloxone 4 mg/0.1 ml every 2-3 minutes as needed Oxygen per NC to keep pulse oximeter greater than 92% Pain management consult Wound nurse consult   The nurse receives orders, reassesses the client, and prepares them for admission. For each client statement, select whether the statement indicates an understanding, or no understanding of teaching provided about opioid addiction.

A sexual assault nurse examiner (SANE) is a caring for a client who experienced sexual assault. Which of the following actions is the priority for the nurse take?

Case Study Question 3 of 6 The nurse cares for a 21-year-old male in the emergency department with cellulitis and uncontrolled pain.   Nurses’ Notes   0930. Client being treated for cellulitis presented with a complaint of right arm pain not controlled by prescription narcotics. The client is alert and oriented but agitated, rating pain 10/10 pain. Denies shortness of breath or chest pain. Informed client of wait times, placed wristband on client, and had him return to the waiting room to be triaged. 1055. Notified by a family in the waiting room that the client was slouched in chair and “seemed dead.” Client was found to be unresponsive with constricted pupils, clammy skin, bradypnea, and circumoral cyanosis. Rt arm is red and swollen with blistered areas. 1100. Emergency response team activated. Vital signs obtained.    Vital Signs   Time 1100   T ◦F/ ◦C 97.1F /36.1C   P 48   RR 6   B/P 90/50   Pulse oximeter 86%   Oxygen RA   Pain Unable to report   Fill in the blank for the following statement: The client is most likely experiencing  #1_____________. Make sure to use the exact wording of the choices below Options for blank 1:  Myocardial Infarction, Opioid Overdose, Sepsis Fill in the blank for the following statement: The priority is to treat #2_____________. Make sure to use the exact wording of the choices below Options for blank 2:  Blood Pressure, Infection, Respiratory Effort _______ Options for blank 2: Blood Pressure, Infection, Respiratory Effort _______

Case Study Question 2 of 6 The nurse cares for a 21-year-old male in the emergency department with cellulitis and uncontrolled pain.   Nurses’ Notes   0930. Client being treated for cellulitis presented with a complaint of right arm pain not controlled by prescription narcotics. The client is alert and oriented but agitated, rating pain 10/10 pain. Denies shortness of breath or chest pain. Informed client of wait times, placed wristband on client, and had him return to the waiting room to be triaged. 1055. Notified by a family in the waiting room that the client was slouched in chair and “seemed dead.” Client was found to be unresponsive with constricted pupils, clammy skin, bradypnea, and circumoral cyanosis. Rt arm is red and swollen with blistered areas. 1100. Emergency response team activated. Vital signs obtained.    Vital Signs   Time 1100   T ◦F/ ◦C 97.1F /36.1C   P 48   RR 6   B/P 90/50   Pulse oximeter 86%   Oxygen RA   Pain Unable to report     Select all the findings that are consistent with opioid overdose.  Select All That Apply

Give an example of a real-life annuity payment: [BLANK-1] What is one of the characteristics of this payment that makes it an annuity? [BLANK-2]

Which was NOT a suggested way to help prevent cancer in young adults in the video from the PBS show Horizon?

Case Study Question 2 of 6 A 23-year-old male with bipolar disorder has a health maintenance appointment with the telehealth nurse. Nurses’ Notes   4/1 Telemedicine visit. Client appeared onscreen in a positive mood, was well groomed; shaved; clothes neat, and non- wrinkled. His speech had a normal cadence, was organized, and logical. No slurring or stuttering. Occasional tongue thrusting noted while speaking that was reported to have started 1 day ago. Fine hand tremor noted when client smoothed hair back during conversation. Client reports that he is still attending school and is doing well. He is working a part time job on weekends for local restaurant.  States that he has been taking his meds as directed, he has no thoughts of self- harm, but he has had difficulty sleeping more than a few hours per night.  He complains that he has gained weight (10 lbs /4.53 kg) recently and has not had the energy to work out. Self-obtained home vital signs of 128/72, HR 82, RR 20. Medications   Medication Dosage/Frequency/ Route         Time   Lithium Carbonate 900 mg twice per day by mouth 0800 1800   Risperidone 2 mg once daily at bedtime by mouth 2100     Laboratory Report      Lab Results Reference range Cholesterol (Total) 220 240 mg/dL high BUN 15 10-20 mg/dL Creatine (Serum) 1.2 0.9 to 1.4 mg/dL Glucose (fasting) 125 Normal 126mg/dL Preterm infants 40mg/dL-60mg/dL HgbA1C 5.7% Normal 6.5% Hematocrit 44 Males: 42-52%;Females: 35-47% Hemoglobin 15 Males: 13-18 g/dL; Females:12-16 g/dL WBC 6 4.5 – 10.5 x 103 cells/mm3 Platelets 180,000 140,000 to 450,000/ mm3 Potassium(serum) 4.2 3.5 to 5 mEq/L Sodium (serum) 140 135 to 145 mEq/L Lithium level 0.8 0.8-1.2 mEq/L Which clinical finding is most concerning?

Case Study Question 4 of 6 A 23-year-old male with bipolar disorder has a health maintenance appointment with the telehealth nurse. Nurses’ Notes   4/1 Telemedicine visit. Client appeared onscreen in a positive mood, was well groomed; shaved; clothes neat, and non- wrinkled. His speech had a normal cadence, was organized, and logical. No slurring or stuttering. Occasional tongue thrusting noted while speaking that was reported to have started  1 day ago. Fine hand tremor noted when client smoothed hair back during conversation. Client reports that he is still attending school and is doing well. He is working a part time job on weekends for local restaurant.  States that he has been taking his meds as directed, he has no thoughts of self- harm, but he has had difficulty sleeping more than a few hours per night.  He complains that he has gained weight (10 lbs / 4.53 kg) recently and has not had the energy to work out. Self-obtained home vital signs of 128/72, HR 82, RR 20. Medications   Medication Dosage/Frequency/ Route         Time Lithium Carbonate 900 mg twice per day by mouth 0800 1800 Risperidone 2 mg once daily at bedtime by mouth 2100   Laboratory Report        Lab Results Reference range Cholesterol (Total) 220 240 mg/dL high BUN 15 10-20 mg/dL Creatine (Serum) 1.2 0.9 to 1.4 mg/dL Glucose (fasting) 125 Normal 126mg/dL Preterm infants 40mg/dL-60mg/dL HgbA1C 5.7% Normal 6.5% Hematocrit 44 Males: 42-52%;Females: 35-47% Hemoglobin 15 Males: 13-18 g/dL; Females:12-16 g/dL WBC 6 4.5 – 10.5 x 103 cells/mm3 Platelets 180,000 140,000 to 450,000/ mm3 Potassium(serum) 4.2 3.5 to 5 mEq/L Sodium (serum) 140 135 to 145 mEq/L Lithium level 0.8 0.8-1.2 mEq/L   The nurse concludes the client is most likely experiencing tardive dyskinesia. Which (2)  interventions should the nurse anticipate to be included in the plan of care?

Case Study Question 5 of 6 A 23-year-old male with bipolar disorder has a health maintenance appointment with the telehealth nurse. Nurses’ Notes   4/1 Telemedicine visit. Client appeared onscreen in a positive mood, was well groomed; shaved; clothes neat, and non- wrinkled. His speech had a normal cadence, was organized, and logical. No slurring or stuttering. Occasional tongue thrusting noted while speaking that was reported to have started 1 day ago. Fine hand tremor noted when client smoothed hair back during conversation. Client reports that he is still attending school and is doing well. He is working a part time job on weekends for local restaurant.  States that he has been taking his meds as directed, he has no thoughts of self- harm, but he has had difficulty sleeping more than a few hours per night.  He complains that he has gained weight (10 lbs / 4.53 kg) recently and has not had the energy to work out. Self-obtained home vital signs of 128/72, HR 82, RR 20. Medications   Medication Dosage/Frequency/ Route         Time Lithium Carbonate 900 mg twice per day by mouth 0800 1800 Risperidone 2 mg once daily at bedtime by mouth 2100 Discontinued 4/1 Laboratory Report      Lab Results Reference range Cholesterol (Total) 220 240 mg/dL high BUN 15 10-20 mg/dL Creatine (Serum) 1.2 0.9 to 1.4 mg/dL Glucose (fasting) 125 Normal 126mg/dL Preterm infants 40mg/dL-60mg/dL HgbA1C 5.7% Normal 6.5% Hematocrit 44 Males: 42-52%;Females: 35-47% Hemoglobin 15 Males: 13-18 g/dL; Females:12-16 g/dL WBC 6 4.5 – 10.5 x 103 cells/mm3 Platelets 180,000 140,000 to 450,000/ mm3 Potassium(serum) 4.2 3.5 to 5 mEq/L Sodium (serum) 140 135 to 145 mEq/L Lithium level 0.8 0.8-1.2 mEq/L   The prescriber discontinues the risperidone, and the nurse teaches the client about the treatment plan. For each possible action, select if the following client education is indicated or not indicated.