Exam 2

A nurse is assisting with the admission of a client who has a hip fracture to the medical-surgical care unit. The client states, "I've never been in the hospital before, and I'm feeling a lot of anxiety." Which of the following responses should the nurse make?

"You're feeling anxious about being in the hospital for the first time"

MAOIs {phenelzine/Nardil} Contraindications

-Allergy to MAOIs -Client unable to adhere to tyramine-free diet -Suicidal ideation -Renal failure -Liver disorders -Cardiac disease -Client older than 60 years -Children younger than 6 years -Client taking SSRIs -Glaucoma -Alcohol or drug addiction

MAOIs {phenelzine/Nardil} Administration

-Begin with lowest dose and titrate upward -When discontinuing, titrate dose downward to prevent rebound effect: headache, restlessness, increased depression

MAOIs {phenelzine/Nardil} Therapeutic Use

-Depression that has not responded to other classes of antidepressants -Depression in bipolar disorder

Anxiety Screening Tools

-Hamilton rating scale - anxiety -Fear questionnaire - phobias -Panic disorder severity scale -Yale-Brown obsessive compulsive scale -Hoarding scale self-report

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Adverse Effects

-Insomnia -Nervousness -Sexual dysfunction -Headache -Weight gain -Hyponatremia (older adults taking diuretics) -Increased risk for suicidal ideation (children, young adults) -Serotonin syndrome

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Administration

-Start with low doses and titrate upward every 4 days until optimal dosage is reached (venlafaxine) -Give with food to minimize GI symptoms -Make sure patient swallows sustained-release capsules whole

Serotonin Syndrome

-Tachycardia -Hallucinations - liable hypertension -Fever -No coordination -Agitation -hyperthermia - myoclonus Treatment: cyproheptadine

Tricyclic Antidepressants - Amitriptyline Patient Instructions

-Take at bedtime to prevent daytime drowsiness -Do not drive or perform hazardous activities if drowsy -Move slowly from lying to sitting or standing -Urinate before taking the daily dose -Increase fiber and fluids to prevent constipation -Chew gum, suck on hard candy, sip water to prevent dry mouth -Report any feelings of self-harm or worsening of depression -Do not stop taking the drug abruptly -Take the drug exactly as prescribed

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Patient Instructions

-Take drug with food -Report headache -Take OTC analgesics if needed -Have blood pressure checked regularly -Take drug in morning to avoid intergerence with sleep

A nurse is collecting data from a client who has binge-eating disorder. Which of the following findings should the nurse expect?

Abdominal pain

Negative Psychotic Disorder Symptoms

Absence of things that are normally present Affect: narrow range of expression/flat, facial expression never changes Alogia: poverty of thought or speech, client might sit with a visitor but only mumble or respond vaguely to questions Anergia: lack of energy Anhedonia: lack of pleasure or joy Avolition: lack of motivation in activities and hygiene

A nurse is caring for a client who is undergoing electroconvulsive therapy (ECT) to treat major depression. Following the procedure, which of the following actions should the nurse take?

Administer oxygen

Approved med for panic disorder first line

Antidepressants

A nurse in a provider's office is reviewing the laboratory reports of a client who has bulimia nervosa. Which of the following laboratory values indicates a therapeutic response treatment plan?

BUN 15 mg/dL

A nurse on a mental health unit is caring for a client who has depression. Which of the following actions should the nurse take to foster a therapeutic environment for this client?

Build trust with the client by sitting quietly with him

A nurse is assisting with planning care for a client who has major depression and a new prescription for amitriptyline. The nurse should plan to monitor the client for which of the following adverse effects?

Drowsiness

A nurse is collecting data from a client who takes an MAOI for the treatment of depression. Which of the following findings is the priority for the nurse to report to the provider?

Elevated blood pressure

We need to

Gain trust

A nurse on an inpatient mental health unit is caring for a client who is angry and showing signs of potential violence. Which of the following actions should the nurse take to de-escalate the client's anger?

Give the client extra personal space

A nurse is collecting data from a client who was recently admitted following a suicide attempt. Which of the following behaviors is the priority for the nurse to report to the adolescent's treatment team?

Giving away possessions

A nurse in a clinic is collecting data from a client who asks for help with depression. Which of the following questions is the nurse's priority?

Have you thought about harming yourself in any way

A nurse is caring for a client who has bipolar disorder and new prescription for valproic acid. Which of the following actions should the nurse take?

Monitor the client's liver function

A nurse is reinforcing teaching with the caregiver of a child who has pica. Which of the following statements should the nurse identify as an indication that the caregiver understands the teaching?

My child might try to eat dirt when we are at the playground

A nurse on inpatient mental health unit is planning care for a client was admitted following a suicide attempt. Which of the following actions should the nurse include in the plan?

Observe the client swallow medications

A nurse is assisting with the planning of education session about the administration of antidepressant medications to older adult clients. Which of the following pieces of information should the nurse recommend including?

Older adult clients require a lower initial dose of antidepressant medication than adult clients

Benzodiazepine Sedative Hypnotic Acute Toxicity

Oral Toxicity: drowsiness, lethargy, confusion IV toxicity: respiratory depression, severe hypotension, cardiac arrest (diazepam and lorazepam)

A nurse is contributing to the plan of care for a client who has anorexia nervosa. The nurse should identify that which of the following actions is contraindicated for this client?

Permitting the client to spend some quiet time alone after each meal

Intent

Plan stocking up meds or giving stuff away

A nurse is caring for a client with anorexia nervosa who has light skin. Which of the following findings should the nurse expect?

Presence of lanugo -because of malnutrition and starvation

A nurse in a mental health unit is contributing to the plan of care for a client who is receiving treatment for self-inflicted injuries. Which of the following interventions is the priority for this client

Promoting and maintaining client safety

A nurse is preparing to administer a benzodiazepine to a client who has generalized anxiety disorder. The nurse should tell the client to expect which of the following adverse effects?

Sedation

A nurse on an acute mental health unit is collecting data from a client who has an obsessive-compulsive disorder (OCD). Which of the following behaviors should the nurse expect?

Tapping the 4 sides of a light switch

Lethality

Think -do you think about killing self

Tricyclic Antidepressants - Amitriptyline Therapeutic Use

Treatment of major depression

A nurse is collecting data from a client who has panic disorder and has been taking paroxetine. Which of the following assessments should the nurse identify as an adverse effect of the medication?

Weight gain

Moderate/persistent anxiety

excessive, interfere with function irritable

Agoraphobia

extreme fear of certain places, outdoors, being on a bridge, client feels vulnerable or unsafe

Mild anxiety

good for humans, can be motivational

Levels of anxiety

mild moderate severe panic

zoophobia

phobia of animals

Suicide

risk for self-inflicted violence

Bulimia

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise -weight doesn't change -binge in secrete -not gaining weight and eating what they want

Anorexia Nervosa

an eating disorder in which an irrational fear of weight gain leads people to starve themselves -gain 2 pounds a week -fear emotion

Antisocial Personality Disorder cluster b (dramatic, emotional, erratic traits)

characterized by a lack of regard for others' rights, impulsivity, deceitfulness, irresponsibility, and lack of remorse over misdeeds -manipulative, impulsive, seductive behaviors, nonadherence to traditional morals and values, verbally charming and engaging

Paranoid Personality Disorder cluster a (odd, eccentric traits)

characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, deceive the person

Schizoid Personality Disorder cluster a (odd, eccentric traits)

characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism uncooperative

Dependent Personality Disorder cluster c (anxious or fearful traits, insecurity and inadequacy)

characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends

Obsessive-Compulsive Personality Disorder cluster c (anxious or fearful traits, insecurity and inadequacy)

characterized by indecisiveness and perfectionism with a focus n orderliness and control the extent that the individual might not be able to accomplish a given task

Schizotypal Personality Disorder cluster a (odd, eccentric traits)

characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations

Avoidant Personality Disorder cluster c (anxious or fearful traits, insecurity and inadequacy)

characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships due to extreme fear of rejection, have feelings of inadequacy and are anxious in social situations

Parents with children of anorexia

controlling perfectionism body dysmorphia

Therapeutic Milieu Eating Disorders

do not allow them to be alone after they eat

Impaired perception of body image distortion

eating I think I am fat

Positive Psychotic Disorder Symptoms

not normally present -Hallucinations -Delusions -Alterations in speech -Bizarre behavior (walking backward constantly)

Monophobia

phobia of being alone

acrophobia

phobia of heights

Dissociate Disorder

removing self from any emotions or feelings -people with use dissociation as a defense mechanism, pathologically, and involuntary -Teach - coping mechanisms skills to bring emotions forward and deal with them

Conversion Disorder

symptoms become real -physical response to something happening -somatic symptoms patient needs reassurance, respond as though symptoms are real

A nurse is talking with a client who has major depressive disorder. Which of the following client statements should the nurse identify as a covert statement of suicidal ideation

"I won't have to deal with things much longer"

A nurse in a health clinic is reinforcing teaching with a client about binge eating disorder. Which of the following client statements indicates an understanding of the teaching?

"The abdominal pain I often have is due to the amount of food that I eat"

A nurse is reinforcing teaching with the family of a client who is scheduled for electroconvulsive therapy (ECT). Which of the following statements made by a family member indicates an understanding of ECT?

"We won't be alarmed if there is some confusion after the treatment"

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Contraindications

-Allergy to SSRI drug -Children younger than 7 years (fluoxetine) -Use with MAOIs

Tricyclic Antidepressants - Amitriptyline Contraindications

-Allergy to TCAs -children under 12 -Recent myocardial infarction -Cardiac dysrhythmias -Seizure disorder history -Concurrent use with MAOIs

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Contraindications

-Allergy to venlafaxine or other SNRIs -Suicidal ideation -Concurrent administration with MAOIs within 14 days of last dose

Benzodiazepine Sedative Hypnotic Anxiolytics Medications

-Alprazolam -Diazepam -Lorazepam -Chlordiazepoxide -Clorazepate -Oxazepam -Clonazepam

Tricyclic Antidepressants - Amitriptyline Precautions

-Angie closure glaucoma -Prostatic hypertrophy -Liver/renal disorders -History of electroconvulsive therapy -Schizophrenia -Hematologic or respiratory disorders -Diabetes mellitus -Alcohol use disorder

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Administration

-Available in tablets, sustained-release tablets and extended-release tablets, assure client is taking prescribed form -Make sure patient swallows extended and sustained release tablets whole

Tricyclic Antidepressants - Amitriptyline Interactions

-CNS depressants increase sedation -Levodopa/carbidopa and sympathomimetic drugs may cause increased effects of drugs such as hypotension -Administration within 2 weeks of MAOIs may cause hypertensive crisis -Cimetidine (Tagamet) and increase anticholinergic effects -St. John's Wort, kava-kava, valerian, and chamomile adversely affect efficacy of amitriptyline

Tricyclic Antidepressants - Amitriptyline Adverse Effects

-Drowsiness -Sedation -Orthostatic hypotension -Anticholinergic effects: dry mouth, constipation, urinary retention, blurred vision -Increased risk for suicide especially in children and adolescents -Withdrawal symptoms with abrupt discontinuation: anxiety, headache, muscle pain, nausea -High risk for overdose: life-threatening dysrhythmias, confusion, seizures

Anticholinergic Effects {Depression} | Tricyclic Antidepressant

-Dry mouth (mucous membranes) -Urinary Retention -Blurred Vision -Constipation -Tachycardia -Confusion Minimize Effects: chew sugarless gum, eat foods high in fiber, increase fluid intake to 2 to 3 L/day from food and beverage sources Educate - change positions slowly to minimize dizziness from orthostatic hypotension

Monoamine Oxidase Inhibitors {MAOIs} -Phenelzine

-Due to high risk for hypertensive crisis, avoid foods with tyramine }ripe avocados/figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, beer and wine, protein dietary supplements -Due to risk of medication interactions, avoid all medications - over the counter, without talking to provider

MAOIs {phenelzine/Nardil} Precautions

-Epilepsy -Diabetes mellitus -Schizophrenia/mania

Generalized Anxiety Disorder Manifestations

-Excessive worry for majority of days over at least 6 months -Restlessness -Muscle tension -Avoidance of stressful activities or events -Increased time and effort required to prepare for stressful activities/events -Procrastination in decision making -Sleep disturbance

MAOIs {phenelzine/Nardil} Interactions

-Foods containing tyramine, tricyclic antidepressants, and sympathomimetic drugs cause hypertensive crisis -Chocolate and caffeine hypertension -Antihypertensive drugs may cause hypotension -Meperidine (Demerol) causes fever -SSRI antidepressants cause serotonin syndrome

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Interventions

-Give food to minimize GI effects -Weigh weekly -Assess client for physical conditions, other drugs that could promote seizure activity -Monitor for adverse effects -Monitor signs of psychosis, hallucinations, delusions -Notify provider if any occur -Monitor increased depression/suicidal ideation

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Administration

-Give oral tablets, capsules, solutions, sustained release weekly capsules (fluoxetine) -Recognize that it takes 4 to 6 weeks to reach clinical effectiveness -Administer with food if gastrointestinal upset -Give in morning to prevent sleep disruption

Tricyclic Antidepressants - Amitriptyline Administration

-Give orally at bedtime -Monitor therapeutic effects after several weeks -Expect long-term use to control depression

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Patient Instructions

-Instruct client to notify provider for GI effects, weight loss -Advise patient to take as prescribed to avoid overdose -Instruct patient to report CNS symptoms to provider -Advise patient and family to watch for signs of psychosis, hallucination, delusions {Stay with patient if these occur}

MAOIs {phenelzine/Nardil} Patient Instructions

-Instruct patient to rise slowly from lying or sitting position and to lie down if lightheadedness occurs -Report extreme anxiety, insomnia, agitation -Provide client, caregiver, significant other list of foods that may contain tyramine -Instruct client to take with non-tyramine-containing food if GI symptoms occur -Notify provider if it occurs

Panic Disorder Manifestations

-Lasts 10 minutes -Palpitations -Shortness of breath -Choking or smothering sensation -Chest pain -Nausea -Feelings of depersonalization -Fear of dying/insanity -Chills or hot flashes

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Precautions

-Liver and kidney disease -Glaucoma -Cardiac disorders, hypertension

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Precautions

-Liver disease -Older adults -Peptic ulcer disease -Diabetes {may decrease glucose control} -Hyponatremia -Cardiac disease -Suicidal tendencies

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Precautions

-Liver/renal dysfunction -Cardiac disease -Schizophrenia/bipolar disorder -Alcohol use disorder

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Therapeutic Use

-Major Depression -Bipolar disorder -Panic disorder -Obsessive Compulsive disorder -Premenstrual dysphoric disorder -Bulimia nervosa

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Therapeutic Use

-Major depression -Social anxiety -Generalized anxiety

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Interventions

-Monitor for insomnia and nervousness, decreased dosage may relieve symptoms -Monitor for headache and worsening intensity -Monitor weight weekly -Monitor serum sodium periodically -Observe for signs of hyponatremia, lethargy, abdominal cramps, diarrhea, and nausea Monitor increased depression and suicidal ideation -Monitor for mental confusion, difficulty concentrating, fever, agitation, anxiety, hallucinations, incoordination, hyperreflexia, diaphoresis, and tremors -Discontinue drug

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Interventions

-Monitor for nausea and other GI effects -Monitor for weight loss related to anorexia -Monitor for headache and worsening intensity -Monitor blood pressure -Monitor for tinnitus -Monitor for effects, decrease dosage - relieve symptoms -Taper drug over 2-4 weeks when discontinuing -Monitor for increased depression and suicidal ideation

Tricyclic Antidepressants - Amitriptyline Interventions

-Monitor orthostatic vital signs -Monitor for increases in depression and suicidal ideation -Initiate suicide precautions when appropriate -Taper drug over 2 weeks to prevent or minimize withdrawal -Assure client has no more than 1 week supply of drug -For overdose, prepare gastric lavage and administer sodium bicarbonate to treat dysrhythmias

MAOIs {phenelzine/Nardil} Interventions

-Monitor vital signs -Monitor for anxiety, insomnia, agitation -Monitor blood pressure -Give client list of food to avoid -Assess client to determine willingness and ability to follow special diet -If hypertensive crisis occurs, prepare to administer IV phentolamine or sublingual nifedipine -Monitor for increased depression/suicidal ideation

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Adverse Effects

-Nausea, vomiting, anorexia -Headache -Hypertension -Insomnia, nervousness -Withdrawal symptoms with abrupt discontinuation: anxiety, agitation, headache, tachycardia -Increased risk for suicide (children/young adults)

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Adverse Effects

-Nausea, vomiting, weight loss -Increased risk for seizures -CNS effects: insomnia, agitation, tremor, headache -Psychosis, hallucinations, delusions -Risk for suicidal ideation (children and young adults)

Atypical Antidepressants -Bupropion

-Observe for headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, or insomnia } contact provider -Monitor food intake and weight = appetite suppression -Avoid administering if at risk for seizures

MAOIs {phenelzine/Nardil} Adverse Effects

-Orthostatic hypotension -Anxiety, insomnia, agitation -Hypertensive crisis in presence of tyramine-containing foods -Constipation, nausea, vomiting, and other GI symptoms -Suicidal ideation (children and young adults)

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Contraindications

-Previous allergy to bupropion -History of eating disorder -Seizure disorder -Suicidal ideation -Concurrent administration of MAOI antidepressant -Head trauma, tumor in CNS

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Patient Instructions

-Report nervousness and insomnia -Take drug in morning to avoid interference with sleep -Report impotence and decreased libido -Report headache -Take OTC analgesics as needed -Eat healthy diet and increase exercise -Report lethargy, abdominal cramps, diarrhea, and nausea -Understand that this is a risk -Report any worsening depression or thoughts of suicide -Report increased anxiety, fear, excessive sweating, tremors, hallucinations -Stop taking drug

Manic State

-Restlessness -not sleeping -not eating

Benzodiazepine Sedative Hypnotic Adverse Effects

-Sedation -Lightheadedness -Ataxia -Decreased cognitive function

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) {venlafaxine} Interactions

-Taking SNRIs within 14 days of MAOIs, increases risk of serotonin syndrome -Cimetidine (Tagamet), desipramine (Norpramin), and haloperidol (Haldol) increase blood levels of venlafaxine -Trazodone (Desyrel), St. John's Wort, and sour date nut increase the risk of serotonin syndrome

Selective Serotonin Reuptake Inhibitors SSRIs {fluoxetine/Prozac} Interactions

-Taking SSRI within 2 weeks of MAOIs or another SSRI increases the risk of serotonin syndrome -Fluoxetine increases level of tricyclic antidepressants and lithium -NASAIDs increase risk of GI bleeding

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Therapeutic Use

-Treats depression -Prevents seasonal affective disorder (SAD) -Smoking cessation adjunct

Atypical Antidepressants {bupropion hydrochloride/Wellbutrin} Interactions

-Use with MAOI antidepressants may increase risk of bupropion toxicity -May decrease blood levels of cimetidine, phenytoin, Phenobarbital, and carbamazepine (increasing risk for seizures)

If bipolar left untreated

-highest risk for suicide -usually happens in manic state -walk and talk with client -grandiose thinking in manic state

Physiological Manifestations of GAD

-increased heart rate and respiratory rate -sweating -fatigue or exhaustion -difficulty concentrations -GI disturbances -Sleep disruptions

Serotonin Norepinephrine Reuptake Inhibitors {SNRIs} -Venlafaxine -Duloxetine

Adverse Effects: nausea, insomnia, weight gain, diaphoresis, sexual dysfuncton -Caution in administering to pts with history of HTN

Behavioral Therapies Anxiety: Modeling

Allows patient to see a demonstration of appropriate behavior in a stressful situation Goal: patient will imitate behavior

A nurse is collecting data on a client who has paranoid personality disorder. Which of the following manifestations should the nurse expect?

Always on guard around other people

A nurse delegates a newly licensed nurse to provide one-on-one observation for a client who requires suicide precautions. Which of the following actions by the newly nurse indicates the need for further reinforcement of teaching?

Ambulates the client's roommate while the client sleeps

A nurse is caring for a client who spent the past several minutes mumbling about being "doomed to die". The client is now pacing in an increasingly agitated and angry manner. Which of the following actions is the nurse's priority?

Attempt to reduce environment stimuli

A nurse is caring for a client who has depression. The client states, "I am too tired and depressed to attend group therapy today." Which of the following responses should the nurse make?

Attending group therapy, even if you're tired, is an important part of your treatment

A nurse is reinforcing teaching with a client who has anxiety and a new prescription of buspirone. Which of the following pieces of information should the nurse include in the teaching?

Avoid consuming grapefruit juice when taking this medication

Behavioral Therapies Anxiety: Systemic Desensitization

Begins with mastering of relaxation techniques, then patient is exposed to increasing levels of anxiety-producing stimulus and uses relaxation to overcome the resulting anxiety Goal: client able to tolerate a greater and greater level of stimulus until anxiety no longer interferes with function phobias

A nurse is reviewing the medical history of a client who has a new prescription for electroconvulsive therapy (ECT). Which of the following findings should the nurse identify as the priority?

Cardiac arrhythmia

A nurse is caring for a client who has anorexia nervosa. The client states, "If I gain weight, I'll never get a boyfriend." which of the following cognitive distortions is the client displaying?

Catastrophizing

Narcissistic Personality Disorder cluster b (dramatic, emotional, erratic traits)

Characterized by arrogance, grandiose views of self-importance, need for consistent admiration, lack of empathy for others that strains most relationships, sensitive to criticism

Histrionic Personality Disorder cluster b (dramatic, emotional, erratic traits)

Characterized by emotional attention-seeking importance -needs to be center of attention -seductive and flirtatious

Borderline Personality Disorder cluster b (dramatic, emotional, erratic traits)

Characterized by instability of affect, identity, relationships, splitting behaviors, manipulation, impulsiveness, fear of abandonment, self-injurious, potentially suicidal, impulsive

Behavioral Therapies Anxiety: Relaxation training

Control pain, tension, and anxiety

A nurse is caring for a client who has bipolar disorder and is experiencing mania. Which of the following actions is the nurse's priority?

Determine if the client is a danger to herself

A nurse is assisting with the admission of a client who has antisocial personality disorder. Which of the following findings should the nurse expect?

Disregarding the safety of others

A nurse is collecting data from a client who has post-traumatic stress disorder (PTSD) due to a sexual assault that occurred 3 months ago. Which of the following findings should the nurse expect?

Dreaming about the assault

A nurse is reinforcing teaching with a client who has a prescription for lithium. Which of the following instructions should the nurse include in the teaching?

Drink 2 L of fluid each day

A nurse is reinforcing teaching with the partner of a client who has a new diagnosis of bipolar disorder. Which of the following behaviors should the nurse describe as a trigger for a relapse of mania?

Drinking alcohol

A nurse is reinforcing teaching with a client who has generalized anxiety disorder and a new prescription for lorazepam. Which of the following statements should the nurse include?

Drinking caffeinated beverages will decrease the effectiveness of the medication

A nurse is planning care for a newly admitted client who has post-traumatic stress disorder (PTSD). Which of the following interventions should the nurse recommend for this client?

Encourage the client to participate in group therapy

A nurse on an acute mental health unit is caring for a client who is experiencing a manic episode with agitation. Which of the following actions should the nurse take?

Encourage the client to participate in physical activity

A nurse on a mental health unit is caring for a client who has social anxiety disorder and is exhibiting signs of panic. Which of the following actions should the nurse take to reduce the client's level of anxiety?

Encourage the client to practice deep breathing

A nurse is caring for a client who has antisocial personality disorder. Which of the following actions should the nurse take?

Ensure staff members set limits on the client's behavior

A nurse is discussing family therapy with a client. Which of the following statements by the nurse is therapeutic?

Family therapy can bring about change

A nurse on a mental health unit is preparing to discharge a client who has bulimia nervosa. Which of the following medications should the nurse expect the provider to prescribe for the client?

Fluoxetine

Behavioral Therapies Anxiety: Response Prevention

Focuses on preventing patient from performing compulsive behaviors with intent that anxiety will diminish

A nurse is caring for a client who has bipolar disorder. Which of the following manifestations is the priority finding for the nurse to identify?

Hyperactivity

A nurse is reviewing the medical record of a client who has a new prescription for a benzodiazepine. For which of the following findings should the nurse question the provider's prescription?

Hypotension

A nurse is caring for a client who has social anxiety disorder. Which of the following client statements should the nurse expect?

I am embarrassed to eat in public

A nurse is teaching a client who has bipolar disorder and a new prescription for lithium. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

I am likely to gain weight while taking lithium

A nurse is collecting data from a client who has major depressive disorder regarding suicide risk factors and protective factors. Which of the following client statements should the nurse identify as a protective factor that decreases the client's risk for suicide?

I consider myself a good problem-solver

Be concerned with depression medication when

I feel fine/relief = suicide

A nurse is talking with a client who has an anxiety disorder. The client states, "I have something important to tell you, but you have to promise to keep it a secret." Which of the following responses should the nurse make?

I might have to share the information with your provider

A nurse is reinforcing teaching with a client who has acrophobia about the use of systematic desensitization as a method of behavioral therapy. Which of the following client statements following client statements indicates an understanding of the teaching?

I will slowly be exposed to places of increasing height

A nurse is caring for a client who has a depressive disorder. The client states, "I'm no good, spend your time with someone else." Which of the following responses should the nurse provide?

I'm going to stay with you for a while if you would like to talk

A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. Which of the following directions should the nurse provide?

Increase fluid intake to 2000 ml (67.6 oz) daily

A nurse is collecting data from a newly admitted client. To establish trust, which of the following actions should the nurse perform during the orientation phase of the nurse-client relationship?

Inform the client that the admission is confidential

A nurse is reinforcing teaching with a client who has a new prescription for bupropion. The nurse should instruct the client to report which of the following findings as an adverse effect of bupropion?

Insomnia -anxiety, delusions, hypertension, dry mouth, nausea, weight loss or gain, and photosensitivity

A nurse in an acute mental health facility is assisting with the plan of care for a client who has obsessive-compulsive disorder (OCD). Which of the following actions should the nurse recommend?

Instruct the client to practice thought-stopping

A nurse is caring for a client who has bipolar disorder and is experiencing hypomania. During a conversation with other clients, she becomes agitated and begins speaking in a loud, angry voice. Which of the following actions should the nurse take?

Invite the client to take a walk

Behavioral Therapies Anxiety: Flooding

Involves exposing patient to a great deal of undesirable stimulus in an attempt to turn off the anxiety response -Useful for clients who have phobias

A nurse is reinforcing teaching with a client who has a prescription for a tricyclic antidepressant. Which of the following instructions should the nurse share?

It can take 6 weeks to achieve the full therapeutic effect of this medication

A nurse is caring for a client with obsessive-compulsive disorder (OCD) who has been taking fluoxetine for 3 months. The client states, "This medication isn't working. I want to stop taking it" Which of the following responses should the nurse make?

It is best to discontinue the medication slowly over 1 or 2 months

A nurse is caring for a client who has obsessive compulsive disorder and feels that pacing the floor a specific number of times is necessary or else "something bad will happen." Which of the following responses should the nurse provide?

It may help if we talked about why you find it necessary to pace the floor

A nurse is reinforcing teaching about stress management with a client who is experiencing anxiety. Which of the following techniques should the nurse recommend to assist the client in identifying his stressors?

Journaling

Selective Serotonin Reuptake Inhibitors SSRIs -Citalopram -Fluoxetine -Sertraline

Leading treatment for depression Adverse Effects: nausea, headache, CNS stimulation } agitation, insomnia, anxiety -Observe for manifestations of serotonin syndrome} withhold med if any -Avoid the concurrent use of St. John's wort } increase risk of serotonin syndrome -Follow healthy diet and exercise because weight gain can occur

A nurse is caring for a client who has antisocial personality disorder. The client uses manipulation to gain access to a smoking area from which his access has been limited as a behavioral intervention. Which of the following statements should the nurse make?

Let's review the consequences of your actions

Mood Stabilizers

Lithium - toxicity causes dehydration {from diuretics}, food poisoning, sodium imbalance Therapeutic level: 0.5-1.2 No therapeutic effect below 0.25 -blood level drawn daily to avoid toxicity General Toxicity: GI upset, diarrhea, vomiting, muscle twitching, decrease coordination, muscle weakness, slurred speech {levels of 1.5-2.0} -fertility loss -take with food

A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for valproic acid. The nurse should explain that the provider will routinely prescribe which of the following tests while the client is taking valproic acid?

Liver function levels

A nurse is contributing to the plan of care for a client who has borderline personality disorder and self-mutilates. Which of the following treatment approaches should the nurse recommend?

Maintain close observation of the client

A nurse is contributing to the plan of care for a newly admitted client who has bipolar disorder and is experiencing acute mania. Which of the following client goals should the nurse identify as priority?

Maintaining adequate hydration

A nurse is reviewing laboratory reports of a client and is malnourished. Which of the following results should the nurse report to the provider immediately?

Potassium 2.9 mEq/L

Refeeding Syndrome

Potentially fatal complication that occur when fluids, electrolytes, and carbohydrates are introduced to a severely malnourished client

A nurse in an acute mental health facility is caring for a client who is experiencing an acute manic episodes. Which of the following actions is the nurse's priority?

Protect the client from impulsive behavior

A nurse is caring for a client with bipolar disorder who is experiencing a manic episode. Which of the following actions should the nurse take?

Provide high-calorie finger-foods frequently -excessive physical energy and activity

A nurse is assisting with the plan of care for a client who is scheduled for electroconvulsive therapy (ECT). Which of the following interventions should the nurse add to the plan of care for this client?

Reorient the client to the environment after the ECT

A nurse is collecting data from a client prior to the administration of lithium. The client began taking lithium 1 week ago for the treatment of mania. For which of the following findings should the nurse withhold the dose?

Report of nausea with frequent episodes of emesis

A nurse is collecting data from a client who has generalized anxiety disorder (GAD). Which of the following findings should the nurse expect?

Restlessness

A nurse is contributing to the plan of care for a client who has anorexia nervosa. Which of the following actions should the nurse recommend including in the plan?

Schedule specific times for the client to eat

A nurse is contributing to the plan of care for a client who has suicidal ideation and is being transferred to the mental health unit. Which of the following interventions should the nurse recommend?

Search the client and his belongings upon arrival

A nurse is caring for a client who has borderline personality disorder. Which of the following manifestations should the nurse expect?

Self-mutilation -suicidal plans, separation anxiety, splitting behaviors

A nurse in a provider's office is collecting data from a client who has obsessive compulsive disorder (OCD). Which of the following prescriptions should the nurse expect the client to receive?

Sertraline

Benzodiazepine Sedative Hypnotic Therapeutic Uses

Short-term treatment for generalized anxiety disorder and panic disorder -Seizure disorders -Insomnia -Muscle spasm -Alcohol withdrawal - prevention and treatment of acute manifestations -Induction of anesthesia -Amnesic prior to surgery or procedures

Panic attack signs and symptoms

Shortness of breath dizziness feeling faint

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

Speak to the client firmly and authoritatively

A nurse on a mental health unit is caring for a client who has antisocial personality disorder and is becoming increasingly loud and belligerent. Which of the following approaches should the nurse use to manage this client's behavior?

Speak to the client with clear, calm, caring statements

A nurse caring for a client who has borderline personality disorder (BOD). The client states, "You are the best nurse. All of the other nurses are mean." The nurse should identify that the client is demonstrating which of the following manifestations of BPD?

Splitting

A nurse on a mental health unit is planning care for a client who has anorexia nervosa with purging behaviors. Which of the following interventions should the nurse include in the plan?

Stay with client for 1 hour following meals

A nurse is collecting data about lethality of a client's plan for committing suicide. Which of the following plans should the nurse identify as a soft method of suicide?

Swallowing anti-depressant pills

A nurse is reinforcing dietary teaching with a client who has a new prescription for phenelzine, a monamine oxidase inhibitor (MAOI). The nurse should recognize which of the following foods interacts with this medication?

Swiss cheese -high in tyramine and interacts with phenelzine

A nurse is contributing to the plan of care for a client who has a physical dependence on alprazolam and must discontinue the medication. Which of the following actions should the nurse recommend?

Taper the medication gradually over several weeks

Behavioral Therapies Anxiety: Thought Stopping

Teaches patient to say "stop" when negative thoughts or compulsive behaviors arise and substitute a positive thought Goal: with time patient uses the command silently

A nurse is caring for a client who has borderline personality disorder and is expressing concern about needing prolonged hospitalization. Which of the following statements should he nurse provide?

Tell me what concerns you the most about being hospitalized

A nurse in a provider's office is reviewing the medical record of a client who has major depressive disorder and a new prescription for phenelzine. Which of the following items in the client's history should the nurse report to the provider?

The client has frequent headaches

A nurse in a mental health clinic is caring for a client who has anxiety related to post-traumatic stress disorder (PTSD). Which of the following actions by the client indicates a therapeutic responses to treatment?

The client identifies situation that cause anxious

A nurse is collecting data from a client who lost his mother a few months ago and is feeling depressed. Which of the following findings should cause the nurse to suspect the client has major depressive disorder?

The client is unable to express pleasure

A nurse in a provider's office is collecting data on a client who is taking paroxetine for the treatment of social anxiety. Which of the following information from the client should the nurse report to the provider immediately?

The client reports being depressed

A nurse is observing a client who has histrionic personality disorder. Which of the following behaviors should the nurse expect?

The client whispers in the provider's ear

A nurse is reinforcing teaching with a client who reports depression and has a new prescription for an SSRI medication. Which of the following statements should the nurse make?

The effect of the medication may take several weeks to be felt

A nurse is reinforcing teaching with the partner of a client who has conversion disorder. Which of the following statements by the partner shows an understanding of the teaching?

The stress of losing our child caused my partner to go blind

A nurse is reinforcing teaching with a client who has generalized anxiety disorder and a new prescription for venlafaxine. Which of the following statements should the nurse make?

This medication should not be stopped abruptly

A nurse in a mental health facility is meeting with a client who has a diagnosis of major depression. During the conversation, the client stops speaking, and the nurse sits silently next to the client for several minutes. The nurse should identify that the therapeutic communication technique of silence is used for which of the following purposes?

To encourage the client to express feelings or concerns

A nurse is reinforcing teaching with the guardian of a client who has bipolar disorder and a new prescription for olanzapine. Which of the following adverse effects should the nurse instruct the guardian to report to the provider?

Tremors

A nurse is collecting data on a client who has antisocial personality disorder. Which of the following manifestations should the nurse expect in the client's personality?

Unconcerned about obeying the law

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

Use repetition when speaking with the client

A nurse is reviewing the medications of a client who has bipolar disorder and a new prescription for lithium. The nurse can safely administer which of the following medications while the client is taking lithium?

Valproic acid

A nurse is caring for a client who was hospitalized several days ago following a suicide attempt. The client informs the nurse, "I do not want visitors today because I look and feel terrible." Which of the following responses should the nurse make?

Would you like to talk about why you feel this way

A nurse is collecting data from a client who is taking buspirone to treat generalized anxiety disorder. Which of the following findings should the nurse identify as an adverse effect of this medication?

Xerostomia - dry mouth

A nurse is reinforcing teaching with a client who has agoraphobia about systematic desensitization. Which of the following comments should the nurse include in the teaching?

You will slowly be exposed to increasing levels of public spaces