282 exam 2 practice questions

For what must the nurse be on the alert with the client who is receiving antidepressant medication?

Suicidal Ideation and Serotonin syndrome.

Specific phobia

The client experiences an irrational fear of a certain object or situation, such as fear of spiders.

Give two examples of Benzodiazepines

Lorazepam (Ativan) and Alprazolam (Xanax)

Name an example of an MAOI found in your ATI textbook

Phenelzine (Nardil)

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority?

Placing the client on one-to-one observation The greatest risk for a client who has MDD and comorbid anxiety is injury due to self-harm. The highest priority intervention is placing the client on one-to-one observation.

A nurse is planning care for a client following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? Select all that apply.

Voice changes Cough Neck pain

The nurse is discussing manifestations of depressive disorder with the client. Which of the following statements should the nurse make?

"You mentioned that you feel depressed. Tell me about what those feelings are like for you."

Relaxation training

With __________, exercises for breathing or muscle groups are taught. This elicits the opposite of the stress response and results in reduced heart rate, respiratory rate and less tense muscles.

Modeling

With the use of __________, the therapist or significant other acts as a role model to demonstrate appropriate behaviors in a feared situation, and then the patient imitates it.

A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? Select all that apply.

Hallucinations Diaphoresis Agitation

A nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the client indicates understanding? Select all that apply.

"I may experience feelings of resentment." "I can expect to experience changes in sleep." "I will probably withdraw from others."

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider?

"Current medications include furosemide for congestive heart failure." When collecting data from a client who is scheduled to begin lithium therapy it is priority to report to the provider the client's use of diuretics (furosemide) because they are contraindicated for use with lithium due to the risk for toxicity. This is the greatest risk for the client and is therefore the highest priority to report to the provider. NCLEX Connection: Pharmacological and Parenteral Therapies, Adverse Effects/Contraindications/Adverse Effects/Interactions

A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication?

"I will need to discontinue this medication slowly." When discontinuing fluoxetine, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome.

A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching?

"I will receive a muscle relaxant to protect me from injury during ECT." When evaluating a client's understanding of ECT, the following information indications an understanding of the procedure by the client. A muscle relaxant (succinylcholine) is administered to reduce the risk for injury during induced seizure activity.

A charge nurse is discussing rTMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

"I will schedule the client for rTMS treatments 3 to 5 times a week for the first several weeks." When evaluating a client's understanding for rTMS, the following information indications an understanding of the procedure by the client. RTMS is commonly prescribed 3 to 5 times a week for the first four to six weeks. RTMS is indicated for the treatment of major depressive disorder that is not responsive to pharmacological treatment.

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

"The client is at greatest risk for suicide during the first weeks of an MDD episode."

A nurse is caring for a client who lost a guardian to cancer last month. The client states, "I'd still have my guardian if the doctor would have made a diagnosis sooner." Which of the following responses should the nurse make?

"You sound angry. Anger is a normal feeling associated with loss." This is a therapeutic response for the nurse to make.

As the nurse, when would you expect the client to begin showing signs of symptomatic relief after the initiation of antidepressant therapy?

6 weeks

Electroconvulsive therapy

A treatment for depression in which a brief electrical current is passed through the brain to produce generalized seizures lasting 25- 150 seconds. Although the exact mechanism of action is unclear, it is known to downregulate beta-adrenergic receptors and produces and upregulation in serotonin

A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following?

AST/ALT and LDH When taking action and discussing routine follow-up needs for a client who has a prescription for valproate, the nurse should inform the client that routine monitoring of liver function tests is necessary due to the risk for hepatotoxicity.

Name an example of a tricyclic antidepressant found in your ATI textbook

Anafranil and doxepin.

Bipolar Medications

Antimanic Mood stabilizers for mania: - lithium carbonate. * Antimanic medications are prescribed for bipolar disorder to stabilize mood and prevent manic episodes. Anticonvulsants Medications for seizures and mood stabilization: - valproic acid, carbamazepine, lamotrigine, oxcarbazepine, topiramate. * Anticonvulsants are used to treat seizures, bipolar disorder, and some pain conditions by affecting the levels of neurotransmitters in the brain. Atypical (2nd & 3rd Gen) Second and third-generation antipsychotics: - olanzapine, risperidone, clozapine, aripiprazole, ziprasidone, quetiapine, asenapine, lurasidone. * Atypical antipsychotics are used to treat schizophrenia, bipolar disorder, and other psychotic disorders by affecting the levels of neurotransmitters in the brain. Antipsychotic Medications Medications for psychosis: - haloperidol, chlorpromazine, fluphenazine, loxapine, thiothixene, perphenazine, olanzapine, risperidone, clozapine, aripiprazole, ziprasidone, quetiapine, asenapine, lurasidone. * Antipsychotic medications are used to treat schizophrenia, bipolar disorder, and other psychotic disorders by affecting the levels of neurotransmitters in the brain.

A nurse is speaking with a client who has schizophrenia when the client suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to themselves. Which of the following actions should the nurse take?

Ask the client, "Are you seeing something on the ceiling?" When taking action, the nurse should ask the client directly about the hallucination to identify client needs and monitor for a potential risk for injury.

​​​​​​​A nurse is speaking with a client who has schizophrenia when the client suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to themselves. Which of the following actions should the nurse take?

Ask the client, "Are you seeing something on the ceiling?" When taking action, the nurse should ask the client directly about the hallucination to identify client needs and monitor for a potential risk for injury.

A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first?

Assess the client's risk for self-harm The greatest risk to a client who has an anxiety or obsessive-compulsive disorder is self-harm or suicide. Therefore, the first action to take is to assess the client's risk for self-harm to ensure that the client is provided with a safe environment.

Alterations in Speech

Associative looseness: Unconscious inability to concentrate on a single thought. Can progress to flight of ideas in which the client's speech moves so rapidly from one thought to another that it is incoherent. Neologisms: Made-up words that have meaning only to the client ("I tranged and flittled"). Echolalia: The client repeats the words spoken to them. Clang association: Meaningless rhyming of words, often forceful, such as, "Oh fox, box, and lox." Word salad: Words jumbled together with little meaning or significance to the listener ("Hip hooray, the flip is cast and wide-sprinting in the forest."). Circumstantiality: Including multiple and unneeded details during a conversation, such as describing in great detail the weather and clothes they are wearing when asked what their plans are for the day. Tangentiality: Starts talking about trivial information rather than focusing on the main topic of conversation, such as talking about what they will have for lunch when the discussion is about discharge medications.

A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons?

Attempt to reduce anxiety When analyzing data the nurse identifies that repetitive behavior in a client who has OCD repeats the behavior in an attempt to suppress persistent thoughts or urges that cause anxiety

A nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the nurse identify as being effectively treated by first-generation antipsychotics? ​​​​​​​ Select all that apply.

Auditory hallucinations Delusions of grandeur Severe agitation

A nurse is assisting the guardians of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following strategies should the nurse recommend? Select all that apply.

Be consistent when addressing unacceptable behavior. Use role-playing to act out unacceptable behavior Encourage the child to participate in school sports.

What class of medication is prescribed to treat acute symptoms of anxiety?

Benzodiazepines

A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion?

Bipolar disorder with rapid cycling When taking action and discussing indications for ECT with a peer group, the nurse should include the following information: ECT is indicated for the treatment of bipolar disorder with rapid cycling.

A nurse is teaching a group of guardians about manifestations of conduct disorder. Which of the following findings should the nurse include? Select all that apply

Bullying of others Threats of suicide Law-breaking activities

The nurse should instruct the client to avoid food containing tyramine because the provider has prescribed Phenelzine..

Contains Tyramine Ripe Avocados Smoke meats​​​​​​​ Liver Does not contain Tyramine Bread Bananas

*DIG FAST* of Bipolar

D = Distractibility (get very distracted) I = Indiscretions (may be hypersexual or may shower and re do makeup a bunch G = Grandiosity (may think they are god or hottest person alive) F = Flight of ideas ( goes off topic a lot) A = Activity S = Sleep deficits T = Talkative 7 days of one of these symptoms = Bipolar disorder 1 may be manic

What is the mechanism of action for benzodiazepines?

Enhancing the neurotransmitter GABA calming CNS depressant

A nurse is involved in a serious and prolonged mass casualty incident in the emergency department. Which of the following strategies should the nurse use to help prevent developing a trauma-related disorder? Select all that apply.

Debrief with others following the incident. Take advantage of offered counseling. Take breaks during the incident for food and water.

A charge nurse is reviewing Kübler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? Select all that apply.

Denial The denial stage is when the client has difficulty believing a terminal diagnosis or loss. This is one of the Kübler-Ross Five Stages of Grief. Anger The anger stage is when the client directs anger toward self, others, or objects. This is one of the Kübler-Ross Five Stages of Grief. Bargaining The bargaining stage is when the client negotiates for more time or a cure. This is one of the Kübler-Ross Five Stages of Grief. Depression The depression stage is when the client mourns and directly confronts feelings related to the loss. This is one of the Kübler-Ross Five Stages of Grief.

A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following findings should the nurse expect? Select all that apply.

Difficulty concentrating on tasks Negative self-image Recurring nightmares

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? Select all that apply.

Difficulty sleeping can indicate a relapse. Participating in psychotherapy can help prevent a relapse. Anhedonia is a clinical manifestation of a depressive relapse.

Describe some common side effects and nursing implications for tricyclic antidepressants.

Drowsiness, fatigue, orthostatic hypotension, SI, urinary retention. Need to monitor for all of these.

Name an example of an SSRI found in your ATI textbook

Escitalopram (Lexapro)

A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? Select all that apply.

Excessive worry for 6 months Sleep disturbance Restlessness When assessing a client who has generalized anxiety disorder, the nurse should expect the following findings: uncontrollable, excessive worry for more than 6 months, restlessness, muscle tension, procrastination in decision making, and the presence of sleep disturbances (the inability to fall asleep). NCLEX Connection: Psychosocial Integrity, Mental Health Concepts

A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following findings are expected for this disorder? Select all that apply.

Fear of being alone Weight gain Aggressiveness

is the most potentially life-threatening adverse effect of MAOIs. What are some symptoms for which the nurse and client must on the alert? What must be done to prevent these symptoms from occurring?

Hypertensive Crisis Symptoms of hypertensive crisis include severe occipital headache, increase in blood pressure, chest pain and coma. Avoid foods with tyramine such as aged cheeses, chocolate, wine and soy sauce.

What are the most common side effects of benzodiazepines?

Hypotension depression amnesia respiratory depression insomnia confusion

Alterations in thought (delusions)

Ideas of reference: Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about them Persecution: Feels singled out for harm by others, such as being hunted down by the FBI Grandeur: Believes that they are all powerful and important, like a god Somatic delusions: Believes that their body is changing in an unusual way, such as growing a third arm Jealousy: Believes that their partner is sexually involved with another individual even though there is not any factual basis for this belief Being controlled: Believes that a force outside their body is controlling them Thought broadcasting: Believes that their thoughts are heard by others Thought insertion: Believes that others' thoughts are being inserted into their mind Thought withdrawal: Believes that their thoughts have been removed from their mind by an outside agency Religiosity: Is obsessed with religious beliefs Magical thinking: Believes their actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes them invisible to others

Depression or mood disorder S/S

Increased or decreased: Sleep distrubance Decreased: Interest loss = Anhedonia Guit/ Worthlessness Decreased: Energy (fatigue) = Anergia Decreased: Concentration/ cognition Increased or decreased: Appetite Psychomotor retardation Suicidal Ideations Increased TSH Decreased T3 T4 = Hypothyriodism

What is the mechanism of action by which antidepressant medications achieve the desired effect (regardless of the different physiological processes by which this action is accomplished)?

Inhibit re-uptake of serotonin.

A nurse is working with a client who has recently lost a guardian. The nurse recognizes that which of the following factors influence a client's grief and coping ability? Select all that apply.

Interpersonal relationships Culture Religious beliefs Prior experience with loss

A nurse is caring for a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? Select all that apply.

Involuntary arm movements Drooling Continual pacing

Light therapy

Involves exposing an individual to an artificial light source during winter months to relieve seasonal depression.

Vagus nerve stimulation

Involves the placement of a permanent implant to stimulate the vagus nerve. Stimulation of the vagus nerve changes the levels of serotonin, norepinephrine, GABA, and glutamate in much the same way that antidepressant medications produce their therapeutic effects.

BC is a 55 year-old male who lost his wife to cancer 18 months ago. Since his wife's death, he continued to live in their family home with his dog. His dog died two weeks ago and he has been despondent since then. His children found him sitting on the side of his bed with a loaded gun. He had already written a note stating that he did not want to be a burden and that his children would be better off without him. On assessment, the nurse notes he is dressed in wrinkled clothes, has a slight body odor, and needs a shave. He reports that he is not hungry and has lost 10 pounds in the past month. He has also been unable to sleep throughout the night since his wife died.

Major Depressive Disorder (MDD)

Lithium carbonate is commonly prescribed for Often times when these individuals are started on lithium therapy, the healthcare provider also orders an antipsychotic medication. Why might he or she do this?

Mania Patient may also have psychosis, be delusional and have difficulty sleeping.

Behaviors shown with bipolar disorders

Mania: An abnormally elevated mood, which can also be described as expansive or irritable; usually requires hospitalization. Manic episodes last at least 1 week. (See the Assessment section in this chapter for specific findings.) Hypomania: A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania. Hospitalization is not required, and the client who has hypomania is less impaired. Hypomania can progress to mania. Rapid cycling: Four or more episodes of hypomania or acute mania within 1 year and associated with increase recurrence rate and resistance to treatment. Comorbidities Substance use disorder Anxiety disorders Borderline personality disorder Oppositional defiant disorder Social phobia and specific phobias Seasonal affective disorder Attention deficit hyperactivity disorder Migraines Metabolic syndrome

A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? Select all that apply.

Memory loss When assessing a client immediately following ECT the nurse should expect the following findings: transient short-term memory loss is an expected finding immediately following ECT. Confusion Confusion is an expected finding immediately following ECT.

Describe some nursing implications for the client on lithium therapy.

Monitor serum lithium levels regularly. Assess fluid intake/output and kidney function. Watch for signs of lithium toxicity (tremors, confusion, etc.). Educate on dietary considerations (consistent sodium/fluid intake). Monitor thyroid function and watch for hypothyroidism symptoms. Provide psychosocial support for mood changes. Educate on adverse effects and ensure compliance such as hand tremors, weight gain, and cognitive changes.

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? Move the interventions into the below categories.

Not Include Provide flexible client behavior expectations. Disregard client concerns. Include Offer concise explanations. Use a firm approach with communication Establish consistent limits

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? Select all that apply.

Polyuria Muscle weakness

Determine which symptom to drag positive or negative symptoms of schizophrenia. Drag each symptom to the desired image

Positive Hallucinations Alteration in speech Delusions Bizarre motor movements Negative Flat affect Anhedonia - lack of pleasure Anergia- lack of energy Avolition - lack of self care

A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect?

Presence of manifestations for at least 2 years When assessing for expected manifestations of persistent depressive disorder, the nurse should identify that it last for at least 2 years in adults.

A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? Select all that apply.

Recent death in client's family Personal history of panic disorder History of chronic bronchitis Family history of depression

A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess?

Repetitive counting

A nurse is caring for a client following the loss of a partner due to a terminal illness. Identify the sequence of Engel's five stages of grief that the nurse should expect the client to experience. Select the stages of grief in order of occurrence. All steps must be used.

Step 1 Shock and disbelief Step 2 Developing awareness Step 3 Restitution Step 4 Recovery Step 5 Resolution of loss

Assessment for Bipolar disorder

Risk Factors Genetics: Having an immediate family member who has a bipolar disorder. Physiological: Neurobiologic and neuroendocrine disorders. Environmental: Increased stress in the environment can trigger mania and depression and increase risk for severe manifestations in genetically-susceptible children. Relapse Use of substances (alcohol, cocaine, caffeine) can lead to an episode of mania. Sleep disturbances can come before, be associated with, or be brought on by an episode of mania. Psychological stressors can trigger an episode of mania. *DIG FAST* of Bipolar D = Distractibility (get very distracted) I = Indiscretions (may be hypersexual or may shower and re do makeup a bunch G = Grandiosity (may think they are god or hottest person alive) F = Flight of ideas ( goes off topic a lot) A = Activity S = Sleep deficits T = Talkative Therapeutic Milieu (within acute care mental health facility) - Provide a safe environment during the acute phase. - Assess the client regularly for suicidal thoughts, intentions, and escalating behavior. - Decrease stimulation without isolating the client if possible. Be aware of noise, music, television, and other clients, all of which can lead to an escalation of the client's behavior. In certain cases, seclusion might be the only way to safely decrease stimulation for the client. - Follow agency protocols for providing client protection (restraints, seclusion, one-to-one observation) if a threat of self-injury or injury to others exists. - Implement frequent rest periods. - Provide outlets for physical activity. Do not involve the client in activities that last a long time or that require a high level of concentration and/or detailed instructions. - Protect client from poor judgment and impulsive behavior, such as giving money away and sexual indiscretions.

What class of medication is known as the 1st line treatment for all anxiety related disorders and commonly used for the long-term maintenance of the symptoms?

SSRI

Give two examples of SSRI

Sertraline (zoloft) and Fluoxetine (Prozac)

A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take?

Stay with the client and remain quiet. When taking action and caring for the client who is experiencing a panic attack, the nurse should quietly remain with the client. This promotes safety and reassurance without additional stimuli

What education should the nurse give to a client taking benzodiaze pines AND what life-threatening situation may happen if the client stops taking the mediation abruptly?

Taper dose slowly to prevent rebound effects CNS depression RR Depression - Respiratory depression, respiratory arrest, drowsiness, confusion, headache, syncope, nausea and vomiting, diarrhea, and tremors.

Major Depressive Disorder (MDD)

The client experiences a depressed mood or loss of interest or pleasure in usual activities resulting in impaired social and occupational functioning that has existed for at least 2 weeks with no history of manic symptoms. Psychotic symptoms, delusions or hallucinations may be present.

Trichotillomania

The client experiences an increased sense of tension and reacts impulsively by pulling out their own hair resulting in noticeable hair loss and this behavior results in a sense of release or gratification.

Acute stress disorder

The client experiences anxiety, detachment and other manifestations, such as, reexperiencing the traumatic event, a general numbing of responsiveness and intrusive recollections or nightmares for at 3 days but, no longer than 1 month following exposure to a traumatic event.

Posttraumatic stress disorder

The client experiences anxiety, detachment and other manifestations, such as, reexperiencing the traumatic event, a general numbing of responsiveness and intrusive recollections or nightmares for longer than 1 month following exposure to a traumatic event.

Adjustment Disorder

The client experiences changes in mood and or problem in functioning due to a reaction to a stressful event that are considered normal life experiences.

Cyclothymic Disorder

The client experiences chronic mood disturbances of at least 2 years duration, involving numerous periods of elevated moods that do not meet criteria for a hypomanic episode and numerous periods of depressed mood that do not meet criteria for major depressive disorder.

Generalized anxiety disorder

The client experiences chronic, unrealistic, and excessive anxiety and worry associated with muscle tension, restlessness, or feeling keyed up or on edge more days than not for at least 6 months.

Seasonal Affective Disorder (SAD)

The client experiences depressive symptoms that occur seasonally, usually during winter, when there is less sunlight.

Agoraphobia

The client experiences intense fear of being in places or situations, such as, being outside of the home alone, from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms.

Premenstrual Dysphoric Disorder

The client experiences marked depressed mood, excessive anxiety, mood swings and decreased interest in activities during the week prior to menses causing impairment in social and occupational functioning.

Bipolar I Disorder

The client experiences mood swings from profound depression to extreme euphoria and increased energy with intervening periods of normalcy. Psychotic symptoms, delusions or hallucinations may be present. The disturbance is severe enough to cause marked impairment in functioning in social and occupational activities and maintaining healthy relationships.

Bipolar II Disorder

The client experiences recurrent bouts of major depression with episodic occurrence of hypomania and never experienced a manic episode.

Panic Disorder

The client experiences recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort.

A nurse is collecting an admission history for a client who has acute stress disorder (ASD). Which of the following client behaviors should the nurse expect?

The client expresses a sense of unreality about the traumatic incident. The client who has ASD often expresses dissociative manifestations regarding the event, which includes a sense of unreality.

Body dysmorphic disorder

The client has an exaggerated belief and preoccupation that their body is deformed or defective in some specific way.

Social Anxiety Disorder (Social Phobia)

The client has an excessive fear of situations in which they might do something embarrassing or be evaluated negatively by others such as, performing or speaking in front of a crowd.

Persistent Depressive Disorder (PDD)/Dysthymia

The client has chronic mild depressed mood that persists for at least 2 years with no evidence of psychosis.

Hoarding Disorder

The client has difficulty parting with possessions, resulting in extreme stress and functional impairments.

Obsessive compulsive disorder

The client has intrusive thoughts of unrealistic obsessions and tris to control these thoughts with compulsive behaviors, such as, repetitive hand washing.

A nurse is caring for a client who has derealization disorder. Which of the following findings should the nurse identify as an indication of derealization?

The client states that the furniture in the room seems to be small and far away. Stating that one's surroundings are far away or unreal in some way is an example of derealization.

Thought stopping

The technique of _____________ involves interrupting a negative thought or obsession. The patient may be instructed to say "Stop" out loud when the idea comes to mind or to snap a rubber band worn on the wrist. This distraction briefly blocks the automatic undesirable thought and cues the patient to select an alternative, more positive idea.

Transmagnetic stimulation

The underlying hypothesis for this treatment is that a time-varying magnetic field will induce an electrical field which activates inhibitory and excitatory neurons, thereby modulating neuroplasticity. Stimulating the brain's prefrontal cortex may help with the symptoms of depression.

There is a narrow margin between the therapeutic and toxic serum levels of lithium carbonate. What is the therapeutic range? List the initial signs and symptoms of lithium toxicity.

Therapeutic acute levels are 1.0-1.5. Therapeutic Maintenance levels are 0.6 to 1.2. Lithium toxicity is seen at Lithium levels greater than 1.5 meq/L. Initial symptoms are blurred vision, tinnitus, nausea, vomiting, severe diarrhea and tremors.

Systematic desensitization

This form of therapy, _______, exposes the patient to a hierarchy of feared situations that the patient has rated from least to most feared. The patient is taught to use relaxation techniques at each step to overcome the resulting anxiety.

Determine to which category each medication listed below belongs. Drag each medicate to the desired image.

Typical antipsychotics Loxapine Haloperidol Atypical antipsychotics Clozapine Olanzapine Risperidone Quetiapine

A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care?

Work with the client on grounding techniques. Grounding techniques (stomping the feet, clapping the hands, or touching physical objects) are useful for clients who have a dissociative disorder and are experiencing manifestations of derealization.

Flooding

_______ is a method that exposes the patient to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response. The client learns through prolonged exposure that survival is possible and the anxiety diminishes spontaneously.

Cognitive behavioral therapy

___________ is a type of therapy in which the individual is taught to control thought distortions that are considered to be a factor in the development and maintenance of emotional disorders.

electroconvulsive therapy (ECT)

a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions Can be useful for some clients who have a depressive disorder and are unresponsive to other treatments. Nursing actions: A specially trained nurse is responsible for monitoring the client before and after this therapy.

BD was a day trader on the stock market. He was initially quite successful and subsequently upgraded his lifestyle with a more expensive car, a luxurious house and a boat. When the stock market declined, BD continued to trade saying that if he could just find the "right stock" he could earn back all of the money he had lost. BD has spent the last 7 days and nights in front of his computer screen, taking little time to eat or sleep. He defaulted on his mortgage, as well as, his car and boat payments. He has been talking non-stop to his wife and noted to irritable and easily agitated.

all symptoms lasting for 7 days indicate a manic episode = Bipolar I

Schizophreniform disorder

is a mental health condition that causes symptoms of psychosis, like hallucinations, delusions and disorganized speech. It lasts fewer than six months. Treatment includes medications and talk therapy