ATI: Mental Health

Which of the following is expected with delerium: SATA - Altered LOC - Impaired judgement - Rapid change in personality - Disturbances in perception

- Altered LOC - Rapid change in personality

Dependent, Obsessive-Compulsive, Avoidant? Social inhibition and feelings of inadequacy, hypersensitive to negative evaluation

Avoidant Meeting a friendly, accepting, reassuring approach Do not push client into social situations

Obsessive compulsive disorder

Obsessions: Persistent, intrusive thoughts Compulsions: Repetitive behaviors that a client feels driven to perform (such as hand washing)

Dependent, Obsessive-Compulsive, Avoidant? Preoccupied with orderliness, perfectionism, and control, rigid and inflexible, fears failure

Obsessive compulsive Guard against Power struggles with client as the need to control his high,assess for the client's use of intellectualization, rationalization, and reaction formation is defense mechanisms Be aware of the client's critical nature towards self and others

When a client is in mechanical restraints, the nurses should remove how many restraints at a time as the client regains control

One at a time

What kind of ended questions should a nurse ask when assessing a psych patient?

Open ended questions

Overt vs. Covert

Overt: P's know they're being observed Covert: P's don't know they're being observed

Unable to focus on the environment, may feel unreal, cannot process what is happening, hallucinations or delusions may occur, somatic reports increase What level of anxiety is this

Panic

Paranoid, Schizoid, or Schizotypal? Distrust suspiciousness of others and hypervigilance

Paranoid -- avoid being too nice or too friendly, give clear explanations, warn about changes in treatment plan and explain reasons for delays

Which of the following should be included in the plan of care of a client who is experiencing delirium Permit the client to perform daily rituals to decrease anxiety Maintain environment that has low lighting

Permit the client to perform daily rituals to decrease anxiety

Which of the following indicates the working phase? SATA - identify the clients perception of the reason for the therapy - Ask the client to provide a detailed description of the hallucinations - Assist the clients with the development of problem-solving skills - Explore the client's relationship with family members

- Ask the client to provide a detailed description of the hallucinations - Assist the clients with the development of problem-solving skills - Explore the client's relationship with family members

Which of the following meals should be provided to a manic client: - Spaghetti and meat balls, a salad, and apple pie - Beef and vegetable stew, rice, and vanilla pudding - Chicken nuggets, crackers with cheese sticks, and a cookie - Broiled fish fillets, stewed tomatoes, and ice cream

- Chicken nuggets, crackers with cheese sticks, and a cookie These are easy to handle as they are finger foods

Which of the following is modeling a behavioral intervention strategy? - Demonstrating performance of hand hygiene at scheduled times - Instructing the client to practice muscle relaxation when experiencing the urge to perform hand hygiene

- Demonstrating performance of hand hygiene at scheduled times

What should you do first for an OCD patient? - Encourage the client to verbalize her feelings - Determine anxiety level

- Determine anxiety level

Which of the following is expected with psychosis: - Altered LOC - Impaired judgement - Rapid change in personality - Disturbances in perception

- Disturbances in perception

Identification

Taking on the characteristics of another person

Tertiary prevention

actions taken to contain damage once a disease or disability has progressed beyond its early stages

Somatic delusion

belief that something highly unusual is happening to one's body or internal organs "My internal organs have turned to stone"

How often should a restrained client be visually observed

continuously

Which lithium level is outside the normal range? - 1.2 - 1.6

- 1.6

A nurse has completed medication teaching regarding methylphenidate with a client. Which of the following client statements indicates an understanding of the nurse's teaching? Select one: a. "Avoiding afternoon doses of methylphenidate will help me sleep better." b. "If I don't like how I feel on methylphenidate, I may stop it at any time." c. "Weight gain is common if I take methylphenidate long term." d. "Methylphenidate is a safe drug with very few side effects."

"Avoiding afternoon doses of methylphenidate will help me sleep better." Prolonged therapy with methylphenidate is associated with weight loss because of appetite suppression.

Which of the following is an example of secondary prevention (SATA)? - Offer substance use treatment options for adolescents from low income households - Encourage the use of random testing for substance use for adolescents participating in extracurricular activities - Educate high school teachers about how to detect the manifestations of substance use. - Provide a presentation at area high schools on resisting pressure for substance use

- Encourage the use of random testing for substance use for adolescents participating in extracurricular activities - Educate high school teachers about how to detect the manifestations of substance use.

Which of the following is an covert statement indicating the client's risk for suicide? SATA - Everything will be better soon - Soon no one will have to worry about me - There's no point in living any longer - I want to donate my organs to help others

- Everything will be better soon - Soon no one will have to worry about me - I want to donate my organs to help others

Which of the following is a risk factor for depression - Only child - Female

- Female

Bipolar one

A week long manic episode followed by depression

A nurse is caring for an adolescent client who is recovering from a traumatic below the knee amputation. The day after surgery, the client refuses to look at or touch the affected leg. Which of the following nursing interventions would be most beneficial to this client? Select one: a. Gently examine and redress the stump without frowning or grimacing. b. Insist that the client participate in bathing and examining his affected leg. c. Avoid discussing the amputation until the client initiates conversation. d. Remind the client that full mobility is possible once fitted for a prosthesis.

A. This client is exhibiting avoidance behaviors which are expected with a sudden body image change and should resolve over a period of a few days. It is inappropriate to insist that the client participates in seeing and touching the leg affected leg, especially the first day after surgery.

Introjection

Adopting the values and beliefs of another person

A client presents with nausea involving, tachycardia, diaphoresis, Tremors, Grandma seizures, restlessness, and irritability What drugs are they withdrawing from

Alcohol, barbiturates, or benzodiazepines

What is the purpose of restating in therapeutic communication?

Allows the nurse to mirror covert and overt messages. Client: I can't focus Nurse: "You are having problems focusing?"

Benztropine

Anticholinergic that helps relieve acute dystonia associated with chlorpromazine

Antisocial, Borderline, Narcissistic, or histrionic? Disregard to the rights of others, impulsive risk taking behaviors, lacks empathy

Antisocial -- be aware of and assess for substance abuse. Set clear limits on specific behavior. Be cautious of manipulation through guilt when the client doesn't get what he wants

The client presents with slurred speech, and unsteady gait, drowsiness, and impaired judgment. What drug are they possibly intoxicated with

Barbiturates, benzodiazepines, or alcohol

Reference dolusion

Believing occurrences in the environment are about or because of him

Naltrexone does what

Blocks the pleasurable effects of ETOH

Which of the following is a manifestation of alcohol withdrawal Somnolence Blood pressure 154 over 96

Blood pressure 154 over 96 Somnolence is consistent with alcohol and toxication

Antisocial, Borderline, Narcissistic, or histrionic? Extreme emotional ability, impulsivity, and self-image disproportions that severely impair functioning

Borderline -- provide clear and consistent boundaries, use Clear communication, review therapeutic goals and boundaries when the behavior issues are evidence, and assess for self-mutilating behaviors

A client presents with fatigue, depression, agitation, apathy, anxiety, Cravings, and increase appetite. What drugs are they most likely withdrawing from

Cocaine, amphetamines, and methamphetamines

A client presents with tachycardia, dilated pupils, elevated blood pressure, grandiosity, impaired judgment, paranoia with delusions What drug is this client most likely Intoxicated by

Cocaine, amphetamines, methamphetamines

Suppression

Conscious denial of a disturbing feeling

Delirium or Dementia? Cognition includes impaired memory, judgment, and attention span that can fluctuate

Delirium

Delirium or Dementia? Contributing factors include fever, hypotension, infection, hypoglycemia, adverse drug reaction, head injury, emotional stress, and seizures

Delirium

Delirium or Dementia? Sudden onset, over hours days

Delirium

Delirium versus dementia

Delirium disturbs the Consciousness has a change in cognition that develops over a short period of time Dementia is a progressive deterioration of cognitive functioning and a global impairment of intellect with no change in consciousness

Delirium or Dementia? Cognition includes impaired memory, judgment, and attention span; with abstract thinking

Dementia

Delirium or Dementia? Contributing factors include Alzheimer's disease, neurological disease, vascular disease, alcohol use disorder, and head trauma

Dementia

Delirium or Dementia? Slow onset, over months to years

Dementia

Dependent, Obsessive-Compulsive, Avoidant? Excessive cleaning and need to be taken care of, submissive

Dependent Be aware of counter-transference that can occur due to the clients cleaning Behavior period identify current stresses, and satisfy client needs when setting limits

Cocaine, amphetamines, methamphetamines do what to the pupils

Dilate them

Which of the following is a manifestation of delirium Slow on set Aphasia Confabulation Easily distracted

Easily distracted

How often should a client whose place in seclusion between toileted

Every 30 minutes

What is melatonin do to a client who has delirium

Helps enforce a proper sleep week cycle

A client presents with constricted pupils, decrease respirations, decreased heart rate, decrease blood pressure, and it show your for your Fall by dysphoria. What drugs are they most likely intoxicated from

Heroin, fentanyl, hydromorphone, Meperidine

A client presents with yawning, insomnia, Panic, diaphoresis, cramps, nausea and vomiting, chills, fever, diarrhea. What drugs are they most likely withdrawing from

Heroin, fentanyl, hydromorphone, Meperidine

Antisocial, Borderline, Narcissistic, or histrionic? Attention-seeking, frustrates easily, often melodramatic and seductive

Histrionic -- understand seductive Behavior as a response to distress, assess for suicidal Behavior if admiration is withdrawn, model concrete descriptive versus vague language

Alzheimer's disease

Impaired memory and thinking skills that is classified with three stages Mild; losing or misplacing items, still able to perform ADLs, some difficulty concentrating an organizing Moderate; forgetting events of One's Own history, with difficulty performing tasks that require planning and organizing such as paying bills Severe; losing ability to converse with others, requires assistance for ADLs and has periods of incontinence and losing awareness of their own abilities or environment

Antisocial, Borderline, Narcissistic, or histrionic? Lack of empathy and pairs relationships, may appear arrogant due to over inflated sense of self, difficulty with criticism

Narcissistic -- remain neutral and avoid power struggles, convey unassuming self-confidence

Transcranial Magnetic Stimulation

None of treatment that uses magnetic pulses to stimulate the cerebral cortex period No neurological deficits or memory problems noted

A client is stating the CIA is spying on his every move period is this a positive or negative symptom of schizophrenia

Positive

Panic disorder

Recurrent episodes of panic attacks that can include palpitations, chest pain, breathing difficulties, nausea, and feelings of choking

Displacement

Redirection of thoughts, feelings, and impulses from an object that causes anxiety to an acceptable one. i.e. redirecting anxiety about a poor diagnosis to the staff providing their care.

Paranoid, Schizoid, or Schizotypal? Emotional Detachment, isolate self, few close relationships Content about being an observer

Schizoid -- not impacted by approval rejection of others, do not try to increase socialization

Paranoid, Schizoid, or Schizotypal? May exhibit extreme anxiety and social situations related to severe social and interpersonal deficits

Schizotypal -- respect clients need for social isolation, be aware of client suspicious Behavior, be aware that Superstition magical thinking are common

Greatly reduced perceptual field, problem solving feels impossible, feelings of dread, confusion, chest discomfort, diaphoresis, loud and rapid speech, threats and demands What level anxiety is this?

Severe

Tacrine and donepezil do what

Slow the progression of dementia by inhibiting cholinesterase

Persecutory delusion

Something wants to hurt you something wants to hurt you something wants to hurt you

Nursing interventions for a client who is suffering from schizophrenia

Structured safe environment Ask the client about their hallucinations without agreeing or disagreeing that they exist Do not argue with the client's delusions Attempt to focus conversations on reality based subjects

A nurse is preparing to discharge an older adult client to the home of a family member while recovering from hip surgery. Which of the following may negatively affect the client's adjustment to living with family members? Select one: a. The client is unable to complete all ADLs. b. The family is insisting on maintaining financial control for the client. c. The family is actively involved in the discharge plans. d. Older clients often recover more quickly when encouraged to interact with family.

The family is insisting on maintaining financial control for the client. While gaining independence is very important, the inability to complete all the ADLs would not necessarily interfere with an adaptation to living with family.

Amitriptyline and clomipramine are what kind of rx

Tricyclic antidepressants

Transference

Unconscious displacement of feelings towards the nurse

Countertransference

Unconsciously attributing feelings towards a client, AS THE NURSE

Projection

When the client attributes undesired impulses to another factor.

Dissociation

When the client compartmentalizes undesirable personal attributes

Can benzodiazepines be habit forming?

Yes

Stereotypic Movement disorder

a disorder in which the individual voluntarily repeats nonfunctional behaviors, such as rocking or head banging, that can be damaging to his or her physical well-being

A nurse is caring for an adolescent client admitted to the nursing unit three days ago. The client is withdrawn, unwilling to eat, and does not interact with the staff. The nurse correctly understands which of the following would provide the best support for this client? a. An opportunity to view a popular DVD. b. A call from the client's sibling. c. A visit with a parent. d. A visit with friends from school.

d. A popular DVD may be entertaining and distracting for the adolescent, but will not provide support. A better choice would be to encourage the adolescent to phone a friend.

What is the first stage of grief

denial

Doxepin

depressive disorder, anxiety, insomnia, as well as in the management of skin pruritus. It is in the tricyclic antidepressant class of medications.

grandiose delusions

false, persistent beliefs that one has superior talents and traits

Anhedonia

inability to experience pleasure

Apraxia

inability to perform particular purposive actions, as a result of brain damage.

remote memory

memory for experiences in the distant past

Which of the following is an example of primary prevention? - Educate high school teachers about how to detect the manifestations of substance use. - Provide a presentation at area high schools on resisting pressure for substance use

- Provide a presentation at area high schools on resisting pressure for substance use

What should the RN do for a mom who lost their kid to a MVC? - Stay with the client and allow the client to cry - Express sympathy for the client's loss

- Stay with the client and allow the client to cry

Which of the following is appropriate for a domestic abuse victim: - The next time this occurs, what might you do to ensure your safety? - You need to remove yourself and your children from the abusive situation

- The next time this occurs, what might you do to ensure your safety? Do not provide opinions

Which of the following is assessing a remote memory? - What year did you graduate from high school - What is your favorite childhood memory - What did you have for supper yesterday - What is todays date

- What year did you graduate from high school Remove memory is recalling something in the far past

Which of the following is priority in a client who just started taking an antidepressant? - I have it all figured out. Everything is going to be okay now. - I don't feel like showering. I'd rather just stay in bed today.

- I have it all figured out. Everything is going to be okay now. This indicates the energy needed to carry out suicide.

Which of the following is expected with dementia: - Impaired judgement - Rapid change in personality

- Impaired judgement

Which of the following should the RN do first to a client experiencing panic level anxiety? - Identify the cause of the anxiety - Instruct the client to take slow, deep breaths

- Instruct the client to take slow, deep breaths

Which of the following indicates tardive dyskinesia? - Muscle spasms - Involuntary tongue protrusion

- Involuntary tongue protrusion

Which of the following would indicate an 18 month old is being abused after he endures a femur fx? - My child fell down the stairs - My child was riding a bicycle and fell off

- My child was riding a bicycle and fell off 18 month olds cannot ride bicycles

Which of the following is an example of tertiary prevention (SATA)? - Offer substance use treatment options for adolescents from low income households - Encourage the use of random testing for substance use for adolescents participating in extracurricular activities - Educate high school teachers about how to detect the manifestations of substance use. - Provide a presentation at area high schools on resisting pressure for substance use

- Offer substance use treatment options for adolescents from low income households

Which of the following is a characteristic of anorexia nervosa? - Possesses feelings of decreased self worth - Preoccupied with concerns about personal health

- Possesses feelings of decreased self worth Anorexia patients are concerned about weight WITHOUT REGARD to personal health consequences

Which of the following indicates the orientation phase? - identify the clients perception of the reason for the therapy - Ask the client to provide a detailed description of the hallucinations - Assist the clients with the development of problem-solving skills - Explore the client's relationship with family members

- identify the clients perception of the reason for the therapy

Lithium level

0.6-1.2

The client stop speaking to everyone period is this a positive or negative symptom of schizophrenia

Negative

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors

akathisia

motor restlessness

Confabulation

the act of filling in memory gaps

benzotropine

Muscarinic antagonists Organ systems: CNS Clinical use: Parkinson, acute dystonia "park my Benz"

Can you take benzodiazepines while pregnant?

NO

A flat affect would be a positive for negative schizophrenia symptom

Negative

A nurse has completed medication teaching for disulfiram with an adult child of an alcoholic parent. Which of the following statements made by the adult child indicate an understanding of the nurse's teaching? Select one: a. "My dad's last drink was eight hours ago, so he may take his the first dose immediately." b. "Before being discharged from the hospital, dad will have at least one supervised alcohol-drug reaction." c. "I am so glad my dad has agreed to take this drug, I want it to cure his drinking problem." d. "Dad may have to take this medication for a long time until he gains self-control over alcohol use."

"Dad may have to take this medication for a long time until he gains self-control over alcohol use." Supervised alcohol-drug reactions have largely been abandoned and should never be administered to a client over 50 years of age because of the risk of severity of the reaction.

Which of the following is an overt statement indicating the client's risk for suicide? - Everything will be better soon - Soon no one will have to worry about me - There's no point in living any longer - I want to donate my organs to help others

- There's no point in living any longer

Which of the following is assessing a recent memory? - What year did you graduate from high school - What is your favorite childhood memory - What did you have for supper yesterday - What is todays date

- What did you have for supper yesterday

Compensation

Attempting to focus on a strength to compensate for a perceived weakness

A nurse is planning care for a client newly admitted to an inpatient mental health unit for treatment of a gambling addiction. The client is having difficulty concentrating and is worried about the future. Which initial intervention will maximize the client's success for recovery? a. Administer an anti-anxiety medication to the client. b. Suggest the client replace work out on the treadmill. c. Recommend the client participate in group discussion. d. Arrange for the client to attend Gamblers Anonymous.

Administer an anti-anxiety medication to the client. While attending Gamblers Anonymous may be suggested as par to of the client's recovery process, the initial intervention should be to treat the symptoms of the client's anxiety.

A client diagnosed with schizophrenia and experiencing frequent auditory hallucinations is admitted to an inpatient psychiatric unit. Which of the following would be the most effective, initial strategy for the nurse to implement? Select one: a. Agree with the client that the voices are audible. b. Ask the client to rest in a quiet area until the voices are gone. c. Ask the client to describe the components of the hallucination. d. Explain to the client that the hallucination is not real.

Ask the client to describe the components of the hallucination. Do not attempt to convince the client that the hallucination is not real because it is real to the client. Do not argue with the client or respond directly to the voices.

During a group therapy session on a psychiatric unit, the nurse leader observes that one of the clients frequently interrupts the session. Which of the following nursing actions is the most appropriate for this situation? Select one: a. Ask the client to speak privately with a nurse after the meeting. b. Discuss this observation during the post-meeting evaluation. c. Encourage another group member to reprimand the client. d. Tell the client that the interrupting behavior must be discontinued.

Ask the client to speak privately with a nurse after the meeting. A therapeutic milieu group aims to help increase self-esteem, decrease social isolation, encourage appropriate social behaviors, and educate clients in basic living skills. Confronting the client during the meeting could negatively affect self-esteem and increase social isolation. The behavior needs to be addressed, but not in an openly confrontational way.

Undoing

Attempting to make up an unacceptable action

A nurse is admitting a client diagnosed with posttraumatic stress disorder (PTD) to the mental health unit. The client is confused and disoriented. When developing a plan of care, which of the following would be the priority intervention for this client? Select one: a. Stabilize the client's psychiatric needs. b. Accept and make the client feel safe. c. Explain unit rules to the client. d. Orient the client to the unit.

B. Stabilizing the client's psychiatric needs with therapy and medications will take some time, and therefore this is not the priority.

Sublimation

Conversion of unacceptable drives into socially sanctioned activities

Rationalization

Covering up a perceived problem or weakness "I drink alcohol to forget the pain"

Which of the following indicates moderate anxiety: - Difficulty concentrating - Heightened perceptual field - SOB - Sense of impending doom

Difficulty concentrating

Regression

Dysfunctional attempt to reduce anxiety and conflict by returning to less mature behaviors - such as bed wetting.

Secondary prevention

Efforts to limit the effects of an injury or illness that you cannot completely prevent.

Primary prevention

Efforts to prevent an injury or illness from ever occurring.

A nurse is admitting a client diagnosed with schizophrenia. In order to establish a therapeutic nurse-client relationship with the client, the nurse's initial actions should include which of the following? Select one: a. Maintain consistency b. Develop a contract c. Establish trust d. Provide confidentiality

Establish trust Once the relationship has been established the client has a right to know that shared information will be kept confidential unless something is shared that is harmful to the client, client threatens self-harm, or the client does not intend to follow through with the treatment plan.

Reaction formation

Exhibiting a behavior or emotion that is opposite of what the client actually feels.

Risk factors for major depressive disorder

Female, unmarried, low socioeconomic status, Early Childhood trauma, and postpartum period

What lab value should a schizo patient who takes quetiapine fumarate be monitoring

Glucose

How long do benzodiazepines take to work?

Immediate effect

Splitting

Inability to integrate the positive and negative qualities of oneself or others into a combined idea. I.e. a client with a favorite nurse, the nurse calls in sick, the client then says "He's the worst nurse that's ever taken care of me."

What is the goal of reminiscence therapy for an older adult client?

Increased self esteem

Electroconvulsive therapy

Induce seizure for clients who have major depressive disorder Short-term memory losses common and temporary

Phobias

Irrational fear of an object or situation that persists

Phenelzine

MAOI used to treat depression in people who have not been helped by other medications. Phenelzine is in a class of medications called monoamine oxidase inhibitors (MAOIs). It works by increasing the amounts of certain natural substances that are needed to maintain mental balance.

Heightened perceptual field, alert, and can grasp what is going on, restless, irritable or impatient, foot or finger tapping... What level anxiety is this?

Mild

Narrow perceptual field, voice tremors, difficulty concentrating, increased respiratory and heart rate, pacing, hanging hands on table What level anxiety is this?

Moderate

Anxiety is moderate when the client's perceptual field is narrowed or widened?

narrowed

SOB is a severe level or panic level of anxiety

panic

A sense of impending doom is a severe level or panic level of anxiety

severe

behavior intervention

strategies or actions used to extinguish, change, or redirect an inappropriate behavior, three types are positive reinforcement, negative reinforcement, and aversive reinforcement.

Agnosia

the inability to recognize familiar objects.

How many fingers should be able to fit in restraints?

two