Foundations and Practice of Mental Health Nursing (Level 2)
The ANA Guidelines on Psychopharmacology emphasizes that psychiatric-mental health nurses understand how psychotropic drugs affect neurotransmitter systems in the brain. Therefore the nurse should know that a decrease in γ-aminobutyric acid (GABA), according to the basic neurotransmitter theory, causes: Anxiety Depression Paranoid schizophrenia Dementia of the Alzheimer type
Anxiety A decrease in GABA results in anxiety, according to the basic neurotransmitter theory; antianxiety drugs activate GABA receptors, thus opening chloride ion channels and easing anxiety. The neurotransmitters norepinephrine and serotonin are thought to be deficient in clients with depression; therefore specific psychotropic drugs cause an increase in the brain's ability to use these neurotransmitters. A simplistic explanation regarding the neurotransmitter system notes an excess in dopamine, which is related to schizophrenia; therefore antipsychotic drugs decrease the brain's ability to use this neurotransmitter. It is believed that a deficiency of acetylcholine, which is noted in dementia of the Alzheimer type, allows the buildup of amyloid; cholinesterase inhibitors such as benztropine (Cogentin) and donepezil (Aricept) slow the natural breakdown of acetylcholine by inhibiting the enzyme cholinesterase, which metabolizes acetylcholine.
When managing the milieu, client autonomy and the need for therapeutic limit setting are concepts that often are in conflict. Which nursing intervention best minimizes this conflict? Establishing unit rules that are appropriate and explained thoroughly Tailoring unit rules to be flexible and individually centered Encouraging the client to be autonomous in decisions affecting the milieu Supporting client autonomy by providing a predictable, stable environment
Establishing unit rules that are appropriate and explained thoroughly Limit setting focuses on assisting a client in the regulation of behaviors through well communicated limits and expectations. A client best maintains autonomy by being supported in his or her ability to make decisions that are reflective of the limits that are set. The concept of milieu structure is supported by a predictable, stable environment. While certain milieu limit setting is not flexible or individualized, the nurse will consider those factors when appropriate.
During a therapy group session, after several members relate traumatic incidents that happened during the week, a client says with a smile, "Things haven't gone well in my life this week either." It is most appropriate for the nurse to: Ask the client to share what has happened this week. Make a note of the incongruity of the client's message but remain silent. Comment, "This seems to have been a bad week for several of our members." Say to the client, "You say things have been bad this week, but you're smiling."
Say to the client, "You say things have been bad this week, but you're smiling." "You say things have been bad this week, but you're smiling" is an open-ended, nonjudgmental response that points out incongruity between the client's verbal and nonverbal communication. Asking the client to share, remaining silent but making a note of the incongruity, or noting that it has been a bad week for several of the group's members will not help the client recognize the incongruity.
A nurse overhears a client in a mental health hospital talking on the unit telephone. The conversation concerns a "fix" to be brought to the unit during visiting hours. The nurse knows that the client, who has a history of drug use, has a contract with the practitioner promising not to use street drugs while being treated in the inpatient unit. What is the best nursing intervention? Phoning the client's practitioner and asking how the situation should be handled Calling an immediate staff meeting to share the information and develop a plan for intervention Calling security to make certain that hospital policies are enforced to maintain a safe environment Confronting the client regarding the telephone conversation, then reporting the incident to the practitioner
Calling an immediate staff meeting to share the information and develop a plan for intervention The nurse must bring this information to the attention of the treatment staff for their information and action; an immediate team approach is necessary. The practitioner may be called after the staff is informed of the situation and the treatment plan is modified. Calling security is premature; this may or may not be necessary. The client will eventually be confronted, but a plan for how and when this will take place needs to be developed; safety is an issue that must be considered.
A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone (Risperdal). Which outcomes indicate that the medication has minimized these symptoms? Select all that apply. There is less agitation. There are fewer delusions. More interest is shown in unit activities. The client reports that the hallucinations have stopped. The client performs activities of daily living independently.
More interest is shown in unit activities. The client performs activities of daily living independently. Apathy is a common type II (negative) symptom; flat affect and lack of socialization are also common. A lack of interest in performing daily self-care activities is a common type II (negative) symptom. More interest in unit activities is a type I (positive) symptom. Fewer delusions is a type I (positive) symptom. The disappearance of hallucinations is a type I (positive) symptom.
A woman who was sexually assaulted by a stranger in the elevator of her apartment building is brought by her husband to the emergency department. What is the priority nursing intervention? Obtaining information about her perception of the incident Notifying legal authorities that a sexual assault has occurred Talking with the husband about his feelings concerning sexual assault Teaching the client how to obtain a midstream clean-catch urine specimen
Obtaining information about her perception of the incident In a crisis situation it is important for the individual to talk about the situation to enable her to move past shock and disbelief. Notifying the legal authorities that a sexual assault has occurred is the client's decision. Although the nurse might talk with the husband, the priority is the woman not the husband. Teaching the client how to obtain a midstream clean-catch urine specimen is contraindicated because the use of water or an antiseptic solution during the procedure will wash away sperm or blood evidence.
A 13-year-old boy who recently was suspended from school for consistently bullying other children is brought to the pediatric mental health clinic by his mother. The child is assessed by the psychiatrist and referred to a psychologist for psychological testing. The day after the tests are completed, the mother returns to the clinic and asks the nurse for results of the tests. The nurse should: Refer the mother to the psychiatrist. Explain to the mother the results of the tests. Suggest that the mother call the psychologist. Teach the mother about the tests that were administered.
Refer the mother to the psychiatrist. It is the responsibility of the psychiatrist, who is the primary care provider, to discuss the test results with the mother. Explaining to the mother the results of the tests is beyond the scope of the nurse's role. The mother should be referred to the psychiatrist, not the psychologist, because the psychiatrist is the leader of this health team. Teaching about the tests should have been done before, not after, the tests were administered.
A 24-year-old secretary who is pregnant for the first time receives from her boyfriend a check for $500 enclosed in a letter saying that he has left town. The client is upset, feels at the end of her rope, and calls the crisis intervention center for help. What reason does the nurse identify for the client to be experiencing a crisis? The client is under a great deal of stress. The client is going to have to raise her child alone. The client's boyfriend left her when she was pregnant. The client's past methods of adapting are ineffective for this situation.
The client's past methods of adapting are ineffective for this situation. A crisis is defined as a situation in which the client's previous methods of adaptation are inadequate to meet present needs. A crisis is not necessarily related to degree of stress; it occurs when past coping mechanisms are ineffective. The client's having to raise her child alone is not the immediate stress for which the client has no coping mechanism. The client's boyfriend's leaving her when she was pregnant is not causing the crisis; the client's lack of coping mechanisms is.
