exam 3 psych 1520 part 3- nclex q's

The nurse determines that the wife of an alcoholic client is benefiting from attending and Al-Anon group if the nurse hears the wife make which statement?

"I no longer feel that I deserve the beatings my husband inflicts on me"

Borderline patients assume instant intimacy, are very sexually provocative, polarize staff need to be the center of attention and are predominantly...

75-85% women

Dissociative disorder

A disruption in integrative functions of memory, consciousness, or identity and is associated with exposure to an extremely traumatic event

Levels of anxiety: mild

Associated with the tension of every day life, the individual is alert, the perceptual field is increased, can be motivating, produce growth, and ideas of creativity, and increase learning.

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit and run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. Which condition will be the focus of this consult?

Conversion disorder

The sudden onset of a physical symptom or a deficit suggesting loss of or altered body function related to psychological conflict or a neurological disorder

Conversion disorder

Anti-anxiety medications depress the CNS, increasing the effects of

GABA, which produces relaxation and may depress the limbic system

Defense mechanisms commonly used in phobia

Repression and displacement

When a client unconsciously uses somatizations such as increased attention and decreased responsibility

Secondary gains

Benzodiazepines have anxiety reducing and what other actions?

Sedative hypnotic, muscle relaxing, and anticonvulsant actions

What is splitting?

Sees others is all good or all bad; creates conflict between individuals by playing one person against the other

Dissociative fugue

The client assumes a new identity and a new environment. The disorder may occur suddenly.

Levels of anxiety: moderate

The focus on immediate concerns, tends to lower the perceptual field, selective inattentive loss occurs, but learning and problem solving still occur.

The immediate nursing action for a client with anxiety is

To decrease stimuli in the environment and provide a calm and quiet environment

Ego-dystonic

When the patient wants to change and is uncomfortable with who they are such as a bulimia patient

Symptoms of PTSD

Flashbacks, nightmares, avoidance, isolation, hypervigilance, sleep disturbances, substance-abuse

Benzodiazepines are contraindicated in clients with

Acute narrow angle glaucoma and should be used cautiously in children and older adult use

important implication for nurses for someone with a somatoform disorder is

Allow a specific time. For the client to discuss physical complaints because the client will feel less threatened if this behavior is limited rather then stopped completely. Avoid responding with positive reinforcement about the physical complaints.

Nursing intervention for phobias

Always stay with the client experiencing anxiety to promote safety and security. Never force the client to have contact with the phobic object or situation.

General anxiety disorder a.k.a. GAD

Chronic unrealistic anxiety about all things includes restlessness, fatigues easily, doesn't concentrate well, is tense, irritable, experiences sleep disturbances

What are the nursing interventions for borderline personality disorder?

Collaboration is difficult-use contract, don't give attention and reinforce, safety is a big priority, consistency and limit setting, communication between staff is essential, use matter of fact approach

Most people who work with borderline personality people are trained in

DBT-A very effective behavioral treatment with borderlines. Takes 2-4 years of therapy

In the DSM, personality disorders are which dx?

DSM IV diagnosis, axis II

Symptoms of personality disorders are

Ego-syntonic meaning the person is comfortable with who they are and they think everyone else is the problem

The nurse is monitoring a hospitalized client who abuses alcohol. Which findings would alert the nurse to the potential for alcohol withdrawal delirium?

Hypertension, changes in level of consciousness , hallucinations

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal?

Identifying anxiety producing situations

Borderline personality disorder is characterized by instability in

Interpersonal relationships, unstable mood and self image, and impulsive and unpredictable behavior

Panic

Is associated with fear and a sense of impending doom, personality is disorganized, individual is unable to communicate or function effectively. Increased motor activity occurs, loss of rational thoughts with distorted perception, inability to concentrate, & prolonged panic can lead to exhaustion & death

Abrupt withdrawal of benzodiazepines can be potentially

Life threatening, and withdrawal should occur only under medical supervision

Odd & eccentric: personality disorders (cluster A)

Paranoid, schizoid, schizotypal. Tends not to have good relationships with others often very isolated people, aren't comfortable with others & usually have 1-2 they are close with. Don't tend to see him psych unit.

Obsessive-compulsive

Person who has an obsessive thought like handwashing. If people do not want help with this you let it alone. The only way you treat it is behavior therapist and they have to say they have a problem. Not an easy fix

A client who has been taking buspirone or BuSpar for one month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred?

Rapid heartbeat or anxiety. It is a non habit forming anti anxiety med, so anxiety should be absent.

PTSD

Re-experiencing a traumatic event that involves actual or threatened death or serious injury to self or others

appropriate interventions for caring for a client in alcohol withdrawal?

monitor VS, provide safe environment, address hallucinations therapeutically, provide reality orientation as appropriate.

A disorder characterized by persistent worry or complaints regarding physical illness without support of physical findings,

Somatoform disorders.

Borderline personality disorder have eight diagnosing symptoms which are

1.usually chronically suicidal, 2. bottomless pit for love and attention, 3. self-mutilators, 4.chronic feelings of emptiness, 5. tend to be seductive/promiscuous, 6.attach to others quickly, 7. splitting/ all or nothing -dichotomous thinking 8. Pt gets high off creating chaos in their lives

Levels of anxiety: severe

A feeling that something bad is about to happen, a significant narrowing in the perceptual field occurs, focus is on minute or scattered detail. All behavior is aimed at relieving the anxiety. learning & problem solving are impossible & the individual needs direction to focus.

Characteristics of someone who has borderline personality disorder are

An unclear identity, unstable, intense, extreme shifts in mood, easily angered, easily bored, argumentative , depression, self-destructive behavior, manipulation, inability to tolerate anxiety, chronic feelings of emptiness or fear of being alone, and splitting

Chronic anxiety

Anxiety that persists is a characteristic response to daily activities in this type of anxiety

the home health nurse visits a client at home and determines that the client is dependent on drugs. during the assessment, which action should the nurse take to plan appropriate nursing care?

Ask the client about the amount of drug use and its effect

A client scheduled for discharge will be taking phenobarbital sodium (Luminal)for an extended period. The nurse would place highest priority In teaching a client which point that directly relates to client safety?

Avoid drinking alcohol while taking this medication

The most common conversion symptoms are

Blindness, deafness, paralysis, and the inability to talk

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in one hour. After the nurse discusses the clients concerns with the client, the client dresses in begins to walk out of the hospital room. What action should the nurse take?

Call the nursing supervisor.

A client gives the home health nurse a bottle of clomipramine or Anafranil. The nurse notes that the medication has not been taken by the client in two months. Which behavior observed in the client would validate noncompliance with this medication?

Frequent handwashing with hot soapy water because Anafranil is used to treat obsessive-compulsive disorder.

Dissociative amnesia

Inability to recall important personal information because it provokes anxiety, memory impairment may range from partial to almost complete

Acute anxiety

Precipitated by loss or change that threatens one's sense of security