ATI Mental Health

Stage 1 (Mild) Alzheimer's

-memory lapses -losing or misplacing items -short term memory to relatives -still able to perform ADLs

What are the types of cognitive reframing techniques?

-monitoring thoughts: helps a client to be aware of negative thoughts -assertiveness training: teaching client to solve problems in a nonaggressive manor -journal keeping -priority restructuring: assists the client to identify what requires priority, such as devoting energy to pleasurable activites

Silent rape reaction manifestations

-nightmares -changes in sexual behavior and relationships -increased anxiety during interview -sudden onset of phobias -no verbalization of the sexual assault occurrence

Nursing consideration with acute manic episodes of bipolar disorder

-offer concise explanations -establish consistent limits -use a firm approach with communication -implement frequent rest periods

PTSD symptoms in children

-overall same as in adults- detachment from others, sleep probs -loss of interest -difficulty concentrating on tasks -Prone to "act out" and play out the trauma through repetitive play and actions.

What are the difference bt overt and covert suicidal comments?

-overt(direct): "there is just no reason for me to go on living" -covert(indirect): "everything is looking pretty grim for me"

What are the nursing considerations of vagus nerve stimulation?

-performed in an outpatient center -delivers pulsations every 5 min for a duration of 30 seconds -therapeutic antidepressive effects usually takes several weeks to achieve -the client can turn off the VNS device t any time -might be voice changes, dyspnea, and neck pain

What are the adverse effects of St. John's wort?

-photosensitivity, skin rash, rapid heart rate, abdominal pain *potentially fatal serotonin syndrome can result if st john's wort is taken with SSRI's or other types of antidepressants -foods containing tyramine should be avoided

Who is at an increased risk of abuse?

-pregnant women -children under the age of 3 -older adults

What are the nursing considerations of transcraniel magnetic stimulation?

-prescribed daily for a period of 4-6 weeks -can be preformed as an outpatient procedure -procedure lasts 30-40 min -client might feel a tapping sensation of head, scalp skin contraction, and tightening of jaw muscles

Criteria for acute care for eating disorders

-rapid weight loss of greater than 30% over 6 months -HR less than 40/min and systolic bp less than 70

What are the common manifestations of autism?

-repetitive actions -inability to maintain eye contact -strict routines

What should the nurse expect after taking care of a patient who just received ECT?

-short term memory loss -nausea -confusion -headache

What are the nursing considerations of electroconvulsive therapy(ECT)?

-two to three times per week (total of 6-12 treatments) -client receives 100% oxygen after procedure

What should the nurse do first in the orientation phase of establishing a nurse-patient relationship?

nurse should inform the client that their admission is confidential

Transference Behavior

occurs when a client views a nurse as having characteristics of another person in their life

Countertransference behavior

occurs when a nurse displaces characteristics of people in her life onto the client

What is the nursing priority for a patient admitted for bipolar disorder?

offer high caloric finger food snacks -this meal choice is great for a patient who has a short attention span and might not sit down to eat

Methadone is administered to prevent cravings of what substance use disorder?

opiates

What is the defense mechanism, reaction formation?

overcompensating or demonstrating the opposite behavior of what is felt adaptive: a man who is trying to quit smoking repeatedly talks to adolescents about the dangers of nicotine maladaptive: a person who dislikes her neighbor tells others what a great neighbor she is

What's aversion therapy?

pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change of behavior ex. the nurse informs a client with alcohol use disorder, that his new med will cause vomiting if taken with alcohol.

What is the defense mechanism, undoing?

performing an act to makeup for prior behavior adaptive: a kid completes his chores without being prompted after having an argument with his mom maladaptive: a man buys his wife flowers after abusing her the previous night

Difference bt negative and positive symptoms of psychotic disorders

positive- manifestations of things that are not normally present negative- inability of showing emotions and drawing away

What's dysthymic disorder?

presence of depressive symptoms that lasts at least 2 years for adults (1 year for children)

What is psychoanalysis? What's a common focus for this therapy?

process of assessing unconscious thoughts and feelings -past relationships are a common focus for therapy

Primary prevention

promotes health and prevents mental health problems from occurring ex. a nurse teaches a community education program on stress reduction techniques

What are the symptoms of acute mania for bipolar disorder?

-becomes disorganized and chaotic -extremely active and doesn't sleep -highly interactive with other people -pressured speech

Rapid cycling behavior in Bipolar Disorder

four or more episodes of hypomania or mania within a year

What's vagus nerve stimulation?

provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the client's chest -causes increased level of neurotransmitters

What food should the client avoid when taking disulfiram

pure vanilla extract -because it contains alcohol

Why does the nurse administer succinylcholine before electroconvulsive therapy(ECT)?

reduce muscle movements during therapy to prevent injuryW

Thought stopping

teaching a client, when negative thoughts arise, to say "stop," and substitute a positive thought

Respite care

temporary care provided to caregivers of a child or adult -normally for Alzheimer's patients

What is an adverse effect of nicotine gum?

throat irritation

What a trigger for dissociative amnesia?

traumatic event

T or F: cannabis effects can produce the same effects as alcohol use

true

T or F: the client can change hospitalizations following emergency treatment.

true

T or F: during the orientation phase of group therapy, there is discussion of termination phase

true 3 phases: orientation, working, termination

What is the defense mechanism, repression?

unconsciously putting unacceptable ideas and thoughts out of awareness adaptive use: a person preparing to give a speech unconsciously forgets about the time when he was young and kids laughed at him on stage maladaptive use: a person who has a fear of the dentist continually forgets to go to their dental appts

What are some of the adverse effects of amitriptyline?

urinary retention

How is electroconvulsive therapy used in bipolar disorder?

used for severe mania especially when medications like lithium have not worked

What is transcraniel magnetic stimulation? and what's an adverse effect?

uses magnetic pulsations to stimulate the cerebral cortex of the brain; -adverse effect: can cause seizures

What is the clarifying technique of restating?

using the client's exact words ex. client: "I can't sleep. I stay up all night" nurse: "you are having difficulty sleeping?"

What is the defense mechanism, suppression?

voluntarily denying unpleasant thoughts adaptive use: a student puts off thinking about a fight she had with her friend so she can focus on taking her test maladaptive use: a person who lost their job says they will worry about paying bills next week

What is a side effect of paroxetine for panic disorders?

weight gain

What is complicated grief?

when a client has a hard time carrying out daily activities following a loss

What is a situational crisis?

when an unexpected event occurs

What is an adverse effect of buspirone?

xerostomia (dry mouth) and dizziness

What is patient teaching for the ADHD med, methylphenidate?

your child's growth may slow while on this med

What are med interactions of Cholinesterase inhibitor meds given for delium and Alzheimer's ex. of cholinesterase inhibitors: donepezil, rivastigmine, and galantamine

-concurrent use of NSAIDs, such as aspirin, can cause GI bleeding -antihistamines, tricyclic antidepressants, and antipsychotics can reduce therapeutic effects of donepezil

Antidepressant med teaching

-don't stop suddenly -therapeutic effects are no immediately; can take up to several weeks -avoid driving due to potential drowsiness or sedation -avoid alcohol

Lorazapam nursing considerations and why is it given?

-drinking caffeine will decrease the effectiveness of this med -given to decrease high blood pressure

What are the risk factors of depressive disorders?

-female bt the ages of 15-40 -clients over the age of 65 -family history -chronic mental illnessWhat

Stage 2 (Moderate) Alzheimer's

-forgetting events in one's own life -personality and behavioral changes -can wander and get lost

What are barriers to effective therapeutic communication?

-giving advice -giving false reassurance -asking "why" questions -offering personal opinions

Positive findings of psychotic disorders (ex. schizophrenia)

-hallucinations -delusions -alterations of speech -bizarre behavior (such as walking backwards)

What are the nursing considerations for bulimia nervosa?

-identify the client's trigger foods that cause them to binge and purge -limit meal time to 30 min to avoid putting a lot of focus on foods -weigh the client in the morning

Patient teaching for SSRI's antidepressants?

-instruct client to avoid the concurrent use of St. John's wort, which can increase the risk of serotonin syndrome

Stage 3 (Severe) Alzheimer's

-losing ability to converse with others -difficulty with physical abilities (swallowing, walking) -assistance required to ADLs -death frequently related to choking or infection

What are disorders that use electroconvulsive therapy(ECT)?

-major depressive disorder -schizophrenia -acute manic episodes: bipolar

Client teaching for tricyclic antidepressants

-advise the client to change positions slowly to minimize dizziness from orthostatic hypotension -minimize anticholinergic effects

Indications of relapse

-anhedonia: lack of pleasure -irregular sleep patterns *avoid caffeine

Nursing considerations for Alzheimer's?

-assign client room close to nursing station -sit in a room with windows and without mirrors to decrease fear and agitation -provide memory aids (clocks/pics) -keep a consistent daily routine

Negative findings of psychotic disorders (ex. schizophrenia)

-Affect: usually blunted or flat (facial expressions don't change) -Alogia: mumbling speech or vaguely responding -Anergia: lack of energy -Anhedonia: lack of pleasure -Avolition: lack of motivation in activities and hygiene

Alterations of thought in psychotic disorders

-Ideas of reference: misinterpreting events and attaching personal significance to them; ex. believing that a group of kids are talking about you -Persecution: feels singled out for harm by others; ex. believing the FBI is out for you -Grandeur: believes that they are all powerful and godlike -Somatic delusions: believes that their body is changing in an unusual way; ex. such as growing a 3rd arm -Thought broadcasting: believing their thoughts are heard by others

What is the cycle of violence in intimate partners?

-Tension building phase: the abuser has minor episodes of anger and the vulnerable person is tense and tends to accept blame for what's happening -Acute battering phase: this is when abuse takes place -Honeymoon phase: situation is diffused for a while after the violent episode. the abuser becomes loving and promises to change -Periods of escalation and deescalation: usually continue with shorter periods of time bt the two. Repeated episodes of violence lead to feelings of powerless

What are the expected findings of withdrawal of alcohol use disorder?

-abdominal cramping -restlessness -tachycardia and increased bp -hallucination -fine tremors in hands -vomitting

Nursing considerations for dextroamphetamine for ADHD?

-administer meds after breakfast -adverse effect is insomnia so take last dose of med 6 hrs before bedtimeWh

Pt with major depression disorder and a NEW prescription for tranylcypromine. Which OTC med that the pt reports taking should alert the nurse to a potential adverse rxn? A. Phenylephrine B. Napraxon C. Magnesium Sulfate D. Lansoprazole

A. Phenylephrine -clients who are taking tranylcypromine, an MAOI inhibitor, shouldn't take over-the-counter meds for cold and sinus congestion because it can lead to severe HTN

Admitting a pt. who has anorexia nervosa and is at 60% of ideal body weight. Which of the following interventions should the nurse include in the plan of care? A. Encourage the client to drink 125 mL of fluid each hour while awake. B. allow the client to eat independently in their room C. weigh the client twice weekly D. measure the client's vitals twice daily

A. Encourage the client to drink 125 mL of fluid each hour while awake. -the nurse should monitor vitals 3 times/day -weigh the client 3 times/week

For suicide precautions document the patients mood, location, quoted statements, and behavior every _____ minutes

15

Mental status of eating disorders

Overgeneralizations: "other girls don't like me because I'm fat" All-or-nothign thinking: "If I eat any dessert I'll gain 50 lbs" Catastrophizing: "my life is over if I gain weight" Personalization: "when I walk through the hospital hallway, I know everyone is looking at me" Emotional reasoning: "I know I look bad bc I feel bloated"

Which of the following is a protective factor against suicide? A. "I'm a college graduate and make good money." B. "I consider myself a good problem solver." C. "I enjoy restoring old weapons."

B. "I consider myself a good problem solver." -the ability of being a good problem solver and having self esteem is beneficial -having good economic status doesn't imply that you have great mental health

A client has chronic alcohol use disorder and claims that her family is exaggerating the problem. The nurse should identify this behavior as which of the following? A. Denial B. Introjection C. Regression D. Rationalization

A. Denial -the answer is denial because denial is defined as not acknowledging the reality of the situation -introjection is defined as incorporating the feelings to another on yourself

What's a way to promote better sleeping habits? A. eat a light snack containing carbs before bedtime B. take extra naps during the day C. eliminate all caffeinated beverages in your diet

A. eat a light snack containing carbs before bedtime.

A nurse is planning care for a patient with bipolar disorder and acute mania. What should she include in the care plan? A. frequent rest periods B. escort the client to daily group therapy C. limit the client's caffeinated beverages to 12 oz/day

A. frequent rest periods -it will decrease the client's risk of exhaustion because they are constantly active because they are experiencing acute mania -during acute mania, the client shouldn't go to group therapy, and instead participate in one-on-one activities to reduce stimulation -manic patients should completely eliminate caffeine from their diet because it is a stimulant

A nurse is caring for a pt with alcoholic cardiac myopathy. Which of the laboratory values should the nurse expect? A. increased creatinine phosphokinase B. increased LDLs C. decreased fasting blood glucose

A. increased creatinine phosphokinase -this is a muscle enzyme released when muscle tissue is damaged

A nurse is teaching a client about her new prescription for tricyclic antidepressants. What should she include in the teaching? A. it can take 6 weeks to achieve full therapeutic effects B. stop taking this med if it causes dizziness C. limit alcohol to 2 drinks per week

A. it can take 6 weeks to achieve full therapeutic effects -dizziness is a common side effect to this med and will likely go away after the first week

A patient is taking lithium and experiences side effects. What side effect will cause the nurse to withhold the dose? A. nausea and vomiting B. fine hand tremors C. weight gain of 4 lbs

A. nausea and vomiting -vomiting is an early sign of lithium toxicity! -B is incorrect bc fine hand tremors are a common side effect -C is incorrect bc nurses can expect weight gain of 5 lbs on lithium

Which of the following medications can cause orthostatic hypotension? A. phenelzine B. escitalopram C. galantamine D. naltrexone

A. phenelzine -taken to treat depression

Caring for a client who has schizophrenia and was prescribed a conventional antipsychotic medication yesterday. Which of the following findings indicates the nurse should administer benztropine 2 mg IM? A. shuffling gait B. hypotension C. decreased WBC count D. blurred vision

A. shuffling gait -Benzotropine is used to treat parkinson's symptoms like a shuffling gait

A nurse is planning reminiscence therapy. What is the goal for this therapy? A. the client will gain self esteem B. the client will maintain orientation to time and place c. the client will achieve optimal sensory stimulation

A. the client will gain self esteem -this therapy reviews the client's life and is intended to increase their self esteem

Which of the following is a risk factor for maladaptive grieving? A. the death was a result of violence B. this is the client's first experience of a loss of a loved one C. the client demonstrates reorganization behavior

A. the death was a result of violence

What is an example of depersonalization? A. "I am a superhero and am immortal B. "I am no one, and everyone is me" C. "I feel monsters pinching me all over" D. "I know that you are stealing my thoughts"

B. "I am no one, and everyone is me" -A is an example of delusions of grandeur -C is an example of tactile hallucinations -D is an example of thought withdrawal

A nurse is caring for a patient with alcohol toxicity and is unresponsive. What is the priority action of the nurse?

gather supplies for endotracheal intubation -because an expected finding for a pt with alcohol toxicity is respiratory depression

A nurse is proving care for a client who recently lost her mother. Which of the following responses is therapeutic to the client? A. "I want you to let me know if there is anything I can do to help you cope." B. "It must be very difficult to deal with your mother's loss" C. "I know what you're feeling, I just recently lost my father."

B. "It must be very difficult to deal with your mother's loss" -therapeutic bc it acknowledges the client's grief -A isn't therapeutic because it puts stress on the client by assigning a task

A nurse is talking with a client who begins to seem tense. What should the nurse say to the client? A. "Did I say something wrong that made you feel tense?" B. "What what we discussing that made you feel uncomfortable?" C. "Do you often feel tense when talking to healthcare providers?"

B. "What what we discussing that made you feel uncomfortable?" -A is not correct because it is a closed ended question, hindering communication with the client

Assessing a pt who sustained injuries 12 hrs ago following a MVC. The blood alcohol lvl was 325 mg/dL. Findings that indicate alcohol withdrawal? A. pinpoint pupils B. BP 154/96 mm Hg C. blood glucose 210

B. BP 154/96 mm Hg -withdrawal also causes shakes and seizures

The client is taking quetiapine fumarate for schizophrenia. Which of the following blood tests should be performed periodically? A. Calcium B. Glucose C. Potassium

B. Glucose -clients taking quetiapine fumarate are at an increased risk of abnormal glucose metabolism which may cause diabetes

A client is taking thioridazine hydrochloride and reports hand tremors, drooling, and rigid extremities. What should the nurse do? A. administer diazepam B. administer benztropine C. reassure the client that these are expected findings

B. administer benztropine -since the client is experiencing extrapyramidal effects, they should receive benztropine because it counteracts these effects -diazepam is an anti-anxiety drug which will not reduce this effects

The client is going to begin using varencicline for smoking cessation. What past medical history should alarm the nurse? A. type 2 diabetes B. depression C. arthritis

B. depression -varencicline can cause suicidal thoughts

What is a common manifestation of moderate level of anxiety? Client has.. A. heightened perceptual field B. difficulty concentrating C. shortness of breath D. sense of impending doom

B. difficulty concentrating

A patient is taking amptriptyline for their depression. What is an adverse effect of this med that the nurse should watch for? A. hypertension B. drowsiness C. panic attacks D. diarrhea

B. drowsiness

Which of the following indicates a potential adverse reaction to risperidone? A. increased WBC B. elevated blood glucose C. decreased platelet count

B. elevated blood glucose -risperidone can cause diabetes

A client states "I think I have a problem with alcohol." What action should the nurse take? A. provide a 12 step program B. have the client complete the GAGE questionnaire C. teach the client coping mechanisms

B. have the client complete the GAGE questionnaire -a GAGE questionnaire can help determine the impact of alcohol in the person's life -A is incorrect because this is not the first action; the 12 step recovery program is Alcoholics Anonymous

What is a common manifestation of opioid withdrawal? A. hyporeflexia B. muscle spasms C. constipation D. decreased respiratory rate

B. muscle spasms -increased RR and diarrhea are a symptom of opioid withdrawal

The client states that she forgot her partners bday after an argument? Which of the following forms of defense mechanisms is the client displaying? A. splitting B. repression C. conversion D. projection

B. repression -repression is the exclusion of unwanted thoughts or experiences

A nurse is caring for a client taking clozapine. Which symptom causing the nurse to withhold the med? A. gained 3 lbs within the past month B. sore throat C. feeling dizzy getting out of bed D. reports being constipated foe 2 days

B. sore throat -clozapine can cause agranulocytosis so this puts the client at an increased risk of infection because there are decreased WBCs

What is the purpose of a therapeutic relationship? A. therapeutic communication identifies the client's problems B. therapeutic communication builds a relationship that allows for expression of mutual concerns C. therapeutic communication provides a basis for the client's relationship with the provider

B. therapeutic communication builds a relationship that allows for expression of mutual concerns

A nurse is caring for a client with delirium. What should the nurse do to promote optimal cognitive functioning? A. identification bracelet B. wall calendar C. map of the facility

B. wall calendar -a wall calendar can offer the client environmental cues for reorientation and memory -a client with delirium usually still knows who they are and an ID bracelet would only be helping the workers

Erotomanic delusions

Believing that another person is in love with you ex. "i've only met jenny once, but I know she's in love with me"

Assessing a family's dynamics during a counseling session. The nurse should recognize which of the following as an indication of a boundary issue? A. an adolescent who questions parental authority B. a family with 3 generations in the household C. older kids are responsible for their younger siblings D. two adults and kids from prior relationship in the same household

C. older kids are responsible for their younger siblings -because there is no distinction from the roles of family members

Which med is used for PTSD? A. bupropion B. phenelzine C. paroxetine

C. paroxetine

A client states "I'm too depressed and tired to go to group therapy today." How should the nurse respond? A. "I agree with your plan to not go to group therapy until you feel better." B. "It's okay if you're tired today, but you should attend tomorrow." C. "Attending group therapy, even if you're tired is an important part of your treatment plan."

C. "Attending group therapy, even if you're tired is an important part of your treatment plan." -group therapy is beneficial for depression because it focuses on peer support and reducing social isolation

A school age child has attention deficit disorder. What should the nurse instruct his parents about? A. "continue with an activity even when they become frustrated" B. "administer ADHD meds 30 minutes before bedtime" C. "ignore your child's attention seeking behaviors that aren't dangerous." D. "expect you child to gain weight with ADHD meds"

C. "ignore your child's attention seeking behaviors that aren't dangerous." -if the child learns that this behavior will not elicit a specific response, then these behaviors should decrease

What are the manifestations of brief psychotic disorder? A. evidence of self mutilation B. suicidal threats C. disorganized speech

C. disorganized speech -clients with brief psychotic disorder manifest symptoms of confusion, disorganized speech, and hallucinations

A patient with anorexia nervosa should display what symptom? A. preoccupied about concerns of personal health B. avoiding talking about food C. feelings of decreased self worth

C. feelings of decreased self worth -these pts have an altered sense of self image and feelings of self worth on body weight -B is incorrect because these patients are obsessed about thoughts of food

What is the priority finding for the nurse who is taking care of a patient with bipolar disorder? A. inability to concentrate B. poor hygiene C. hyperactivity D. pressured speech

C. hyperactivity -greatest risk to the client is self injury from hyperactivity

A nurse is planning care for a pt with anorexia nervosa. What action is contraindicated for the client? A. explain that a tube feeding may be necessary if they are refraining from eating B. weigh the client every day in the morning C. permitting the client to spend quiet time after eating a meal

C. permitting the client to spend quiet time after eating a meal -the nurse should directly observe the client for an hour after meals because these patients are at risk for purging their food

What is an indication of relapse for a client with a history of mania? A. ritualistic behavior B. anhedonia C. pressured speech

C. pressured speech

A nurse is planning care on a patient that has vegetative signs of depression. What should the nurse include in the plan? A. limit snacks throughout the day B. Schedule regular nap times C. provide decaffeinated beverages D. weigh the client monthly

C. provide decaffeinated beverages -clients who are experiencing vegetative depression are at a high risk of altered sleep

Which over the counter drug is contraindicated with the use of phenelzine? A. acetaminophen B. ranitidine C. pseudoephedrine D. naproxen

C. pseudoephedrine

A nurse providing post-operative care to an older adult client. Who develops delirium which of the following actions should the nurse take? A. dim the lights prior to bedtime B. encourage the client to make decisions about their day C. request a prescription for anti anxiety medication

C. request a prescription for anti anxiety medication -administering a PRN prescription for anti-anxiety can decrease agitation and aggression -the nurse should provide a consistent routine therefore, B is not correct

What's a negative symptom of schizophrenia? A. impaired memory B. dysphoria C. social discomfort

C. social discomfort -inability to enjoy activities

A nurse is caring for a client experiencing panic level anxiety. Which of the following actions should the nurse take? A. speak in a high pitch voice B. remove potentially harmful objects and then leave the patient alone in their room C. speak to the client firmly and authoritatively

C. speak to the client firmly and authoritatively -clients in panic level feel terror, so the nurse has to use an authoritative voice in order for the client to reach goals and to not injury themselves

A person with antisocial personality disorder becomes increasing angry and loud. What should the nurse do? A. confront the client for breaking rules B. escort the client to the nurses' station C. speak to the client with clear, calming, and caring statements

C. speak to the client with clear, calming, and caring statements -A is incorrect because confrontational remarks will escalate the risk of violence

A client is taking a tricyclic antidepressant. Which of the following adverse effects should the nurse report to the provider immediately? A. constipation B. drowsiness C. urinary retention

C. urinary retention -urinary retention can lead to bladder infection

What are the common language symptoms of schizophrenia?

Clang association- rhyme; "I'm red in the head and I'm going to bed. Neologism- words that are made up by the client Word Salad- words are completely meaningless and disorganized Echolalia- client repeats the words of another person

Factitious disorder

Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick

A pt is receiving treatment for alcohol detox. What med will the patient be prescribed?

Diazepam

Reviewing labs for a pt. who has schizophrenia and is taking clozapine. Which values are contraindications for receiving clozapine?

D. WBC 2500/mm3 -clozapine causes agranulocytosis, which can be fatal due to an infection -pts on this med need to get their WBC weelkly

The client states "I just feel completely lost at work these days." The nurse states "you must feel like aren't getting things done." What communication technique is the nurse using? A. presenting reality B. encouraging comparison C. offering general leads D. attempting to translate words into feelings

D. attempting to translate words into feelings -the nurse is attempting to clarify the client's feelings

When teaching parents about ADHD. What should she include in her teaching? A. behaviors associated with ADHD are present prior to age 3 B. this disorder is characterized by argumentativeness C. below average intellectual functioning is associated with ADHD D. because of this disorder, your child is at an increased risk of injury

D. because of this disorder, your child is at an increased risk of injury -behaviors are present before age 12

Which of the following actions should the nurse plan to take when restraining a patient that was threatening to harm another patient? A. obtain a PRN prescription for restraints B. visually observe the client every 10 minutes while in restraints C. ensure 3 finger width between the patient's hands and the cuffs D. document the client's behavior every 15 minutes while restraints are in place

D. document the client's behavior every 15 minutes while restraints are in place -nurse should plan for one-on-one observation while someone is in restraints -the nurse should ensure a 2 fingers width -there shouldn't be a PRN prescription for restraints; they should be current and specific to the patient's needs

A nurse in an acute mental health facility is caring for a client who has bipolar disorder. Which of the following actions is the nurses priority? A. set consistent limits for expected behavior B. administer prescribed meds as scheduled C. provide the client with step by step instructions during activities D. monitor the client for escalating behavior

D. monitor the client for escalating behavior -assessing the client is the primary need for their safety

What's a common side effect of the ADHD med, desipramine? A. hyperactivity B. depression C. diarrhea D. sedation

D. sedation

What's cognitive reframing?

identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace the negative thoughts ex. client- "nothing ever good happened during my marriage" nurse- "what did you learn from your marriage that would help you in the future?"

What patient teaching is required for a patient taking valproic acid? A. you should expect your provider to decrease dosages gradually B. you should take aspirin for pain while on valproic acid C. you should undergo thyroid function tests every 6 months D. you should have your liver function levels monitored regularly

D. you should have your liver function levels monitored regularly -valproic acid treats bipolar disorder

What is the first component of a safety plan?

identify signs of escalation of violence

A nurse is planning care for a pt who is experiencing benzodiazepine withdrawal. What should the nurse identify as a priority?

implement seizure precautions

Planning care for a preschool-age child who has ADHD. Which interventions should be identified as the priority? A. decrease distractions during meal times B. provide positive feedback when child completes a task C. clearly identify consequences for unacceptable behavior D. Remove unnecessary equipment from the child's surroundings

D. Remove unnecessary equipment from the child's surroundings -biggest risk of self harm

A nurse is caring for a pt with alcohol use disorder. The client is no longer experiencing symps of withdrawal. What med should the administer to help maintain abstinence from alcohol?

Disulfiram

What is assertive community treatment (ACT)?

helps to reduce reoccurrences of hospitalizations and provides crisis intervention, assistance with independent living, and info regarding resources for necessary support services ex. works with client's who keep "forgetting" to come in for antipsychotic injection for schizophrenia

What are the selective serotonin reuptake inhibitor meds for eating disorders

Fluoxetine -instruct client that effects can take 1-3 weeks and up to 2 months for max response -avoid hazardous activities such as driving

What are the findings of a patient that just used cocaine?

HTN, increased HR and RR and temp -hypervigilance (paranoid behavior) -dilated pupils

What med is prescribed for opioid withdrawal maintenance?

Naltrexone

What are the meds to control aggressive behavior?

Olanzapine and Haloperidol

What is memantine prescribed for?

Severe alzheimer's

What's the difference bt Stuporous and Comatose?

Stuporous- client requires painful stimuli to elicit a brief response (pinching a tendon or rubbing the sternum) Comatose- unconscious and doesn't respond to painful stimuli

What's an example of assertiveness?

a client expresses to the nurse that her significant other is "pressuring her to move in with him" -the nurse tells her to use assertiveness techniques to assert her feelings and then make a change in the situation

What electrolyte disorder is common in those with bulimia nervosa?

hypokalemia -direct loss of potassium due to vomiting and dehydration

What is an expected physical finding of binge eating disorder?

abdominal pain -caused by eating excessive amounts of food

Recent memory

ability to recall events of the past few days

Manic behavior in Bipolar Disorder

abnormally elevated mood, either expansive or irritable -these episodes last for 1 week -hospitalization is required

What are these extrapyramidal effects? (akathsia, dystonia, tardive dyskinesia, and parkinsonism)

akathsia- restlessness, and inability to sit still dystonia- muscles contract uncontrollably tardive dyskinesia- uncontrolled face and mouth movements parkinsonism- tremor, slow movement, impaired speech or muscle stiffness

What's sundowning?

an increase in confusion of Alzheimer's patients starting in the afternoon until the night -they can become confused, aggressive, or disoriented

Immediate memory

ask the client to repeat a series of numbers or a list of objects

Remote memory

ask the client to state his birthday or mother's maiden name ex. "what year did you graduate high school?"

Aviodant personality disorder

avoiding social situations that require interpersonal contact; despite wanting close relationships due to extreme fear of rejection ex. "I'm scared that you're going to leave me."

What is the defense mechanism, altruism?

behavior that benefits another individual at a cost to oneself adaptive use: a nurse who lost a family member in a fire became a volunteer firefighter

What's conduct disorder and the symptoms?

behavior that violates the rights of others such as aggression to people/animals, destruction of property, and theft symps: -bullies -low self esteem -threatens suicide -temper outbursts

Sign of lithium toxicity

blurry vision, hypotension, ataxia, clonic twitching

derealization disorder

feeling that outside events are unreal or part of a dream; or that objects appear larger or smaller than they should

SSRi antidepressants

first line of treatment for anxiety and obsessive compulsive disorders ex. sertraline, fluoxetine, or citalopram

What are contraindication of electroconvulsive therapy(ECT)?

cardiovascular: recent MI, HTN, heart failure cerebrovascular: history of stroke, brain tumor, hematoma *ECT increases stress of heart and increases intracranial pressure and blood flow through brain due to seizure activity

What are the other meds, besides diazepam, that treat alcohol withdrawal?

chlordiazepoxide and lorazepam

dissociative indentity disorder

client displays two or more separate personalities

What's operant conditioning?

client receives positive rewards for positive behavior

Dissociative fugue

client travels to a new area and is unable to remember one's own identify -nurse should work on grounding techniques with client(such as clapping or stomping feet)

What are common defense mechanisms of Alzheimer's?

confabulation- client can make up stories when questioned about events that they don't remember, this can seem like lying, but it's a subconscious effort to save self esteem preservation- client avoids answering questions by repeating phrases or behavior

What are the symptoms of Wernicke-Korsakoff syndrome due to alcohol use disorder?

confusion and memory loss

What is chlorpromazine used for?

controls symptoms of schzophrenia

Secondary prevention

focuses on early detection of mental illness ex. a nurse screens older adults for depression

Tertiary prevention

focuses on rehab and prevention of further problems in clients previously diagnosed ex. nurse leads a support group for clients who have completed a substance use disorder program

What is an adverse effect of Atomoxetine?

dark urine -greatest risk is liver failure

What is the defense mechanism, sublimation?

dealing with unacceptable feelings by unconsciously substituting acceptable forms of expression adaptive use: a person who has feelings of anger toward his coworker sublimates those feelings by working out at the gym during lunch period

Why does the nurse administer atropine sulfate or glycopyrrolate before electroconvulsive therapy(ECT)?

decrease secretions that could cause aspiration and to counteract vagal stimulation effects, such as bradycardia

Difference bt delirium and dementia

delirium- acute onset; easily distracted dementia- gradual onset

What is the clarifying technique of reflecting?

directs the focus back to the client in order for the client to examine their feelings

Antisocial personality disorder

disregard for others, lack of empathy, repeated unlawful actions, failure to accept personal responsibility(blaming others), manipulation, verbally charming to get their way

What is an adverse effect of alprazolam?

drowsiness

A client is experiencing the adverse effects of chlorpromazine. The nurse should administer benztropine to relieve what symptom?

dystonia (extrapyramidal movements)

SNRI antidepressants

effective in the treatment of anxiety disorders ex. venlafaxine and duloxetine

What are the signs of neuroleptic malignant syndrome?

elevated temperature

Nycotophobia

fear of darkness

depersonalization disorder

feeling detached from one's body or feeling disconnected from their environment -feeling that a person is observing their own body

What is the defense mechanism, splitting, seen in borderline personality disorders?

inability to incorporate positive and negative aspects of oneself or others into a whole image ex. "the nurse on the evening shift is always nice! You are the meanest nurse ever!"

dissociative amnesia

lack of memory that can range from name or date of birth to the client's entire lifetime -inability to recall personal info

Older adults require ______ doses of antidepressants than middle aged adults.

lower

Lithium - what is the expected range?

mood stabilizer for bipolar disorder -take this med with food because it can cause GI upset -normal range: 0.6-1.2 -likely to gain weight while taking lithium

What's the difference bt mood and affect?

mood- provides info about the emotion that she is feeling affect- a client's affect is an objective expression of mood, such as flat affect or lack of facial expression

What is a symptom of heroin withdrawal?

muscle aches

What is the clarifying technique of paraphrasing?

restates the client feelings and thoughts for the client to confirm what has been communicated

What is an adverse effect of benzodiazapine?

sedation, hypotension, and dizziness

Taking sertraline and tranylcypromine concurrently increases the risk of _________.

serotonin syndrome

What is an adverse side effect of Fluoxetine?

sexual dysfunction

What is the defense mechanism, displacement?

shifting feelings related to a person/idea to another less threatening person/idea adaptive: a kid angrily punches a punching bag after losing a game maladaptive: a person who is angry about losing his job destroys his favorite childhood toy ex. "my husband yelled at me, so I made the cat go outside"

Antianxiety medications for short and long term use

short: Benzodiazepines such as diazepam long: buspirone

What are the therapeutic effects of the Cholinesterase inhibitor, donepezil? And when should it be administered

slow cognitive deterioration of Alzheimer's disease in the mild to moderate stages -administered at bedtime

What's free association?

spontaneous, uncensored, verbalization of whatever comes to the client's mind

What are the physical findings of delirium?

tachycardia, sweating, dilated pupils, high bp