Mental Health

EMOTIONAL REASONING-

"I know I look bad because I feel bloated"

ALL OR NOTHING THINKING-

"If I eat any dessert, I'll gain 50 pounds"

CATASTROPHIZING-

"My life is over if I gain weight"

OVERGENERALIZATIONS-

"Other girls don't like me because I'm fat"

Tools used to determine aggression warning signs-

(FESAI) The Forensic Early Warning Signs of Aggression. -is valid instrument used to detect behaviors that are early warning signs of aggression in psychiatric clients.

The therapeutic range for Lithium is-

-0.8 to 1.3 mmol/L

Paradoxical effects such as insomnia and excitation can be a side effect of which drug class?

-Benzodiazepines (Alprazolam).

Screening tools used for Anxiety-

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

Protective factors increasing a clients resilience, or ability to resist the effects of stress, include:-

-Physical therapy (exercise increases endorphins). -Strong sense of relief-Religious/spiritual beliefs -Optimism -Hobbies or other outside interests -Satisfying interpersonal relationships -Strong social support systems -Humor

Defense mechanisms used by clients who have personality disorders include-

-Repression- motivated forgetting. -Suppression- conscious forgetting. -Regression- a reversion to immature patterns of behavior. -Undoing- Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her flowers. -Splitting- I either hate you or love you. No in between (borderlines).

Screening tools used for OCD-

-Yale Brown OCD scale -Hamiltons -PEAS (patient adherence scale) is used to determine adherence.

Generalized Anxiety Disorder (GAD)-

-a disorder characterized by chronic excessive worry for >than 6 months; accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. -Increased time and effort required to prepare for stressful activities/events -Procrastination in decision making -Seeks repeated reassurance

The greatest risk for a client with borderline personality disorder is-

DTS or DTO -the priority goal is for the client to refrain from self-mutilation.

Which Cognitive therapeutic strategies are effective when working w/clients who have Personality disorders-

Decatastrophizing, Thought stopping, and Positive self talk.

A nurse is providing teaching to a client who has obsessive-compulsive disorder and performs hand hygiene to decrease anxiety. Which of the following actions by the nurse implements modeling as a behavioral intervention strategy?

Demonstrating performance of hand hygiene at scheduled times. **(This is an example of modeling, which is a behavioral intervention strategy that allows the client to see the expected behaviors performed by the nurse.)

A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern?

Do you feel afraid that people are trying to hurt you?" Rationale- It is most therapeutic for the nurse to empathize with the client's experience.

A nurse is assessing a client who has dissociative amnesia disorder. Which statement made by the client should the nurse recognize as a manifestation of this disorder-

I am unable to remember my address. **this disorder is generally a response to a traumatic or stressful event.

A nurse is assessing a client who has dissociative amnesia disorder. Which statement made by the client should the nurse recognize as a manifestation of this disorder-

I can't seem to remember my address. **the manifestations of this disorder stem from traumatic or stressful events.

The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, "I wish I could, but I feel so terrible." Which of the following approaches should the nurse suggest to encourage activity?

I know this is difficult, but exercise is important. It will be a short walk. **VALIDATION

A nurse is assessing a client who has dissociative identity disorder. Which statement made by the client should the nurse recognize as a manifestation of this disorder-

I sometimes cannot remember large blocks of time. **which manifest from other distinct personalities controlling a clients behavior. The primary personality is unaware of the alter personalities and can therefore, can lose time and memory of events.

When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care?

Ineffective coping

Malingering Disorder is defined as-

Intentionally pretending to be sick or injured to avoid work or responsibility.

The nurse teaches an antisocial client to take a time-out in his room when challenged by another person instigating an argument. What is the main reason for the time-out?

It allows an opportunity for the client to regain control of emotions

Somatic symptom assessment tools-

PATIENT HEALTH QUESTIONNAIRE 15 (PHQ-15): Used to identify the presence of the 15 most commonly reported somatic symptoms -Ab pain -Back pain -Pain in the extremities/joints -Menstrual problems or cramps -Headaches -Chest pain -Dizziness -Fainting -Heart pounding or racing -Dyspnea -Problems w/ pain or sex -Problems w/ bowel elimination -Nausea, indigestion, or gas -Lethargy -Problems sleeping

An emergency room nurse is assessing a client who has an anxiety disorder. The client is flushed, perspiring profusely, and is experiencing palpitations. The client begins to scream, "I am going to die! This is it! I am having a heart attack!" The nurse should determine the client's level of anxiety to be which of the following?

Panic. **(This client's manifestations indicate the panic level of anxiety and indicate manifestations of a panic disorder.)

MMSE (Mini Mental State Examination)-

This exam is used to objectively assess a clients cognitive status by evaluating the following:-Orientation to time&place-Attention span&ability to calculate by counting backward by 7-Registration&recalling of objects-Language, including naming of objects, following commands & ability to write

What is the purpose of a No-self-harm contract-

a client promises to not engage in self-harm and to report to the nurse when he or she is losing control.

Associative looseness (loose association)-

a shift of ideas from one unrelated topic to another; r/t illogical thinking and poor concentration. **My joints ache and my friend is in the joint.

As the client's anxiety decreases and as (OCD)-

a trust relationship builds, talks with the client about the compulsive thoughts and behaviors and how the client feels about them. Rationale-the client needs to learn new ways of managing anxiety so they can deal w/it directly. This will build the clients confidence in managing anxiety and other feelings.

Provide opportunities for the client to participate in activities that are easily (OCD)-

accomplished or enjoyed by the client. Rationale- the client may be limited in the ability to deal with complex activities or in relating to others.

Koro is a culture bound syndrome (Southeast Asia)-

adult males are afraid their penises are going to go back in their bodies

Binge eating disorder affects men&women of all ages, but most common in-

ages 46-55-The weight gain associated w/ binge eating disorder increases the client's risk fr other disorders, including type 2 DM, HTN and cancer

Clients who have binging or purging type eating disorders are at higher risk for-

alcohol and substance abuse due to impulsivity.

Bulemia nervosa is defined as-

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise. **Binge eating and inapprop compensatory behavior both occur on average of once per week for 3 months

Clients who have antisocial personality disorder might perceive friendliness as-

an invitation for manipulative and seductive behavior. This strategy should be used for clients who have avoidant personality disorder.

The medication Cyproheptadine is used for client w/eating disorders to increase-

appetite.

Clients with Schizophrenia, bipolar disorder, dementia, borderline or antisocial personality, head injury, conduct disorder, depression, intermittent explosive disorder and those intoxicated with drugs or alcohol-

are at greatest risk for becoming aggressive.

Treatment of choice for clients for aggressive clients-

are mood stabilizers, and antipsychotics.

Nursing interventions for Paranoid personlaity disorder might include-

assisting the client to start basing decisions and actions on reality.

The main goal in dealing with an aggressive client who has a weapon is to-

avoid personal injury, summons help, leave the area, and protect other clients. This is all that will remain in your control to realistically do.

A nurse is caring for a client who believes her feet are enormous compared with the rest of her body. She has visited an orthopedic surgeon to see if surgery is possible. She spends hours trying to buy shoes that make her feet look smaller, and she prefers social interactions where she can sit with her feet concealed under a table. The nurse assesses that the client's symptoms are consistent with which disorder?

body dysmorphic disorder

Clients who have antisocial personality disorder can seem to be in control of their behavior-

but are manipulative and impulsive and can suddenly become aggressive and assaultive. The nurse should establish clear limits on specific aggressive and demanding behaviors.

Russel's sign is defined as-

calluses/scars on the knuckles or dorsal hand from self-induced vomiting.

A nurse is caring for a client who has obsessive-compulsive disorder. Which of the following actions should the nurse take first?

determine the clients anxiety level.

Which conditions are thought to be attributed to the connection between mind and body for a client with psychosomatic disorder-

diabetes, hypertension, headache, and colitis.

Exposure and Response therapy is a-

first line and EB treatment for OCD.

The client is talking to staff members individually and attempting to manipulate them. Which of the following are important in the limit-setting technique to deal with manipulative behavior?

stating behavioral limits, identifying the consequences if the limit is exceeded, and identifying the expected or desired behavior.

The nurse is teaching a client with schizoid personality to function more comfortably with others in the community. Which nursing intervention would be effective to improve the client's social skills?

teach the client to make necessary requests in writing or over the phone

During therapy for Anorexia Nervosa the nurse should-

weigh the client daily for the first week, then three times a week thereafter. **A client who has anorexia nervosa is likely to want to avoid weighing or seeing the weight.

To promote effectiveness in the treatment of anorexia nervosa of treatment, the nurse should implement actions-

which establish trust and partnership with the client. **Ask the client to agree to talk to a nurse whenever she feels the obcessive urge to exercise.

A nurse is teaching a newly licensed nurse about appropriate actions to take when a client threatens to harm a specific individual. Which of the following statements by the newly licensed nurse indicates understanding?

A health care professional has the duty to warn potential victims of the threat.

Alexithymia (eating disorders) is defined as-

A person's inability to, or difficulty in, describing or being aware of emotions or mood.

The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders-

Antisocial, Narcissist, and Paranoid

Examples of nutrient dense foods are-

Any fruit or vegetable, yogurt, milk, cheese, salmon, nuts, kale, seaweed, potatoes.

Behavioral therapies used in OCD-

CBT- Exposure and response prevention. -Thought stopping, and relaxation techniques.

Side effects for Haloperidol-

EPS (dystonia, Parkinsonism, tardive dyskinesia, nausea, vomiting, constipation, and anorexia.

Somatic Disorder client education-

Encourage client participation in individual and group therapy -Educate clients on prescribed meds -Assist a case manager to develop a followup appointment schedule w/ provider every 4-6 weeks.. this strategy provides the client w/ set appointments and decreases the clients need for unscheduled health care, as well as medical costs associated w/ lab&diagnostics if the client seeks treatment from other providers.

A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement?

Escort the client to their room, with the assistance of other staff. Rationale- The client is at risk for injury to self and others and should be escorted out of the dayroom.

A nurse is assessing a client who has derealization disorder. Which statement made by the client should the nurse recognize as a manifestation of this disorder-

I feel like I am living in a fog. **this disorder is a response to acute stress. Manifestations can come and go or remain constant.

A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse?

I'm here to help you just as all the staff members are.

A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which mental health diagnosis is most probable for this client?

Illness anxiety disorder.

The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate?

Interrupt the client and offer to take her for a walk. Rationale- The nurse must provide for appropriate exercise and place limits on rigorous activities. The correct option stops the harmful behavior yet provides the client with an activity to decrease anxiety that is not harmful.

A nursing student is assisting with the care of a client with a chronic mental illness. The nurse informs the student that a behavior modification approach (operant conditioning) will be used in treatment for the client. Which statement by the student indicates a need for further information about the therapy?

It uses negative reinforcement. Rationale- Operant conditioning entails rewarding a client for desired behaviors and is the basis for behavior modification. It uses a positive reinforcement approach. Positive reinforcement, increased social behaviors, and increased level of self-care are accurate characteristics of this form of therapy.

Bipolar disorder stages consist of-

MANIA:-Abnormally elevated mood, which can also be described as expansive or irritable, usually requires hospitalization-Can last 1 weeks HYPOMANIA:-Less severe episode of mania that lasts at least 4 days accompanied by three+ manifestations of mania-Hospitalization is not required, and the client is less impaired.. can progress to mania RAPID CYCLING:-Four or more episodes of hypomania or acute mania w/in 1 year

The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." What condition might the nurse suspect?

Malingering

Medications used to treat Personality disorders-

Mood stabilizers Anxiolytics Antipsychotics Antidepressants

The nurse has developed a plan of care for a client diagnosed with anorexia nervosa. Which client problem would the nurse select as the priority in the plan of care?

Nutritional imbalance because of lack of intake.

The nurse is caring for a client with anorexia nervosa. Which behavior is characteristic of this disorder and reflects anxiety management?

Observing rigid rules and regulations. Rationale- Clients with anorexia nervosa have the desire to please others. Their need to be correct or perfect interferes with rational decision-making processes. These clients are moralistic. Rules and rituals help these clients to manage their anxiety.

Covert behavior is defined as-

Private behavior (not visible to the outside observer). **passive aggressive.

Cognitive impairments of Schizophrenia include-

Problems w/ thinking make it very difficult for the client to live independently -Disordered thinking -Inability to make decision -Poor problem solving ability -Difficulty concentrating to preform tasks -Memory deficits -Long term memory -Working memory such as inability to follow directions to find an address

Nursing care r/t Anxiety-

Provide a structured interview to keep the client focused on the present -Assess for comorbid condition of substance use disorder -Provide safety and comfort to the client during the crisis period of severe to panic level anxiety are unable to problem solve&focus... clients experiencing panic level anxiety benefit from a calm, quiet environment. -Remain w/ the client during the worst of the anxiety to provide reassurance. -Perform a suicide risk assessment -Provide a safe environment for other clients & staff. -Provide milieu therapy the employs (a structured environment for physical safety and predictability, monitoring for and protection from self harm/suicide, daily activities that encourage the client to share and be cooperative, use of therapeutic comm skills to help the client express feelings of anxiety&validate those feelings, client participation in decision making regarding care) -Use relaxation techniques w/ the client as needed for relief of pain, muscle tension and feelings of anxiety -Instill hope for positive outcomes -Enhance client self esteem by encouraging positive statements and discussing past achievements -Assist the client to identify defense mechs that interfere w/ recovery -Postpone health teaching until after acute anxiety subsides, clients experiencing a panic attack or severe anxiety are unable to concentrate or learn. Problem solving cannot take place until the client is calm.

A client with somatic illness tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth. Which is this evidence of?

Secondary gain.

Coping strategies r/t Eating disorders-

Self monitoring using a journal Relaxation techniques Distraction

Falling-out episodes are defined as-

Southern United States, Caribbean Islands. Sudden collapse; person cannot see or move.

Hwa-byung (Korea) is defined as-

Suppressed anger causes Insomnia, fatigue, panic, indigestion, and generalized aches and pains.

A nurse is caring for a client who has PTSD. Which of the following actions by the client indicates the current treatment plan is effective?

The client reports techniques she uses to promote sleep. **(Clients who have PTSD often experience disrupted sleep; therefore, reporting techniques she uses to promote sleep indicates the current treatment plan is effective.)

During a therapy session a client with a personality disorder says to the nurse, "You look so nice today. I love how you do your hair, and I love that perfume you're wearing." Which response by the nurse would best address this breech of boundaries?

The focus of today's session is on your issues, so let's get started. Rationale- The nurse should confront the client verbally regarding the inappropriate statements and refocus the client back to the issue of the session. Avoid options that may be judgmental and may provide an opening for a verbal struggle or those that are a social response and could be misinterpreted by the client.

Panic Disorder Symptoms-

Typically lasts 15-30 mins. FOUR OR MORE of the following manifestations are present during a panic attack: -Palpitations -SOB -Choking or smothering sensation -Chest pain -Nausea -Feelings of depersonalization -Fear of dying or insanity -Chills or hot flashes

Anxiolytics/Mood Stabilizers include-

Used to treat anxiety often found in clients who have psych disorders, as well as some of the positive&negative symptoms -Valporate -Lamotrigine -Lorazepam -Inform clients of sedative effects -Use these meds w/ caution in older adults

First generational/conventional meds include-

Used to treat mainly positive symptoms -Haloperidol -Loxapine -Chlorpromazine -Fluphenazine -To minimize anticholinergic effects advise ways to promote wetness. -Instruct client about indications of postural hypotension.. if it occurs advise the client to sit or lie down and minimize it by getting up slowly from a lying/sitting position.

Tx for Somatic disorder-reattribution treatment-

Work w/ provider to provide reattribution treatment, which assists clients to identify the link b/w physical manifestations and psychological factors while promoting a sense of caring and understanding. Stage 1: Feeling Understood Stage 2: Broadening the Agenda Stage 3: Making the Link Stage 4: Negotiating Further Treatment

An example of placating behavior is when-

a member of a family takes blame for someone else's actions to avoid argument.

Catharsis is defined as-

a person who expresses their angry feelings by engaging in aggressive, but safe activities to provide a release for their anger.

Rituals or compulsions may include-

checking, counting, washing, scrubbing, praying, chanting, touching, rubbing, ordering, or other repetitive behaviors. **the behaviors are aimed at preventing or reducing anxiety, distress, or preventing some dreaded event or situation.

When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success?

collaborating with the client when establishing treatment goals.

In order to successfully remove a weapon from an aggressive client the nurse should-

distract the client by throwing water in the clients face, or suddenly yell very loudly.

Consistent techniques let each staff member know what to (aggression)-

expect and will increase safety and effectiveness. **in regards to restraints and legal procedure/requirements.

In the Crisis phase nursing interventions include-

experienced, trained staff can use the techniques of seclusion or restraint to deal quickly with the clients aggression.

Body identity integrity disorder (BIID) is identified as-

feeling alienated from a part of the body to the extent of seeking amputation of the identified body part.

Potentially violent people have a body safe zone up to-

four times larger than that of other people. **you need to keep a safe distance so the client doesn't feel trapped or threatened.

Physical Aggression is a behavior meant to-

harm, punish, or force into compliance another person.

Verbal Aggression is defined as-

harming others through threats of physical aggression, name-calling, or hostile teasing.

Decatastrophizing technique in cognitive therapy involves-

helping the client evaluate whether he is overestimating the nature of the situation. **making a mountain out of a mole hill.

Hostility also called verbal aggression is behavior meant to-

intimidate, or cause emotional harm to another and can lead to physical aggression.

If it is necessary to remove the weapon from an aggressive client try to-

kick it out of the clients hand. (never reach for a knife or or other weapon with your hand).

S/S r/t Serotonin Syndrome-

may start 2-72 hours after start of medication. - can be LETHAL -confusion, fever, agitation, anxiety, hallucination, hyper-reflexia, diaphoresis, tremors, hypertension.

Not all situations are within nursing expertise or control; recognizing the (aggression)-

need for outside assistance in a timely manner is essential.

Thought blocking is a-

negative symptom of schizophrenia. RATIONALE- This manifestation is a sudden interruption in a client's thought processes, usually due to an internal stimulus. The client may abruptly stop talking midsentence.

If you are not properly trained to deal with a client who has a weapon you should-

not attempt to remove the weapon. Use a pillow, mattress, or a blanket wrapped around your arm to keep distance between you and the weapon.

Clients w/somatic disorder are often-

over medicated w/analgesic/anxiolytic drugs.

Mild anxiety allows the client to-

perceive reality in sharp focus and actual problem solving becomes more effective.

If a client is feeling threatened or out of control they can (aggression)-

perceive stimuli as a threat. **the client is unable to deal with excess stimuli when agitated.

Severe levels of anxiety result in what?

perceptual field is scattered and the client is not able to focus on anything except relieving the anxiety. **This client's manifestations indicate a high level of anxiety.

Moderate level of anxiety is defined as-

perceptual field narrows, but the client is able to cope with some assistance. This client's manifestations indicate a higher level of anxiety.

Echolalia is a-.

positive symptom of schizophrenia. - It occurs when the client repeats another person's words. It is often seen in a client who has catatonia.

Concrete thinking is a-

positive symptom of schizophrenia. -It describes an inability of the client to think in abstract terms.

Posturing is a-

positive symptom of schizophrenia. -It occurs when a client assumes an unusual or illogical position or facial expression. -Grimacing is commonly exhibited when a client is posturing.

Meditation is an effective technique to-

promote relaxation and is recommended for clients who have anxiety disorders.

A client experiencing the sudden onset of blindness is diagnosed with a conversion disorder. Which nursing intervention would be most appropriate?

provide nursing care in a supportive but matter-of-fact manner

Showing that you are in control without competing with the client can (aggression)-

reassure the client without lowering their self- esteem.

Restricting type of anorexia nervosa is defined as-

refusing to eat and/or engaging in excessive exercise as a way of preventing weight gain

In the Post- Crisis stage nursing interventions include-

reintegrating the client into the milieu.

Dysmorphic body disorder-

related to excessive distress and painful preoccupation with an imagined defect in appearance.

When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do?

respecting the clients boundaries at all times.

Severely malnourished clients with anorexia nervosa may require intensive medical treatment in order to-

restore homeostasis before psychiatric treatment can begin.

A client reports severe pain during intercourse since being sexually assaulted three years ago. Which is the first step in confirming the diagnosis of a pain disorder?

ruling out a physical cause of pain.

Identification of previous accomplishments is an appropriate intervention to promote-

self-esteem.

The recommended strategy used for clients who have schizotypal personality disorder would be-

showing respect for the clients needs of isolation.

Dermatillomania (Excoriation disorder) is defined as-

skin picking. **a form of OCD

In the Trigger phase nursing interventions include-

speaking calmly, and non-threateningly conveying empathy, listening, offering PRN medication, and suggesting retreat to a quiet area.

If an aggressive client has possession of a gun the nurse may need to-

summons outside assistance. When this is done total responsibility is then turned over to the authorities.

The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful?

there is a job posting at the hospital for a file clerk in medical records.

Clients who have antisocial personality disorder do not lack assertiveness, instead-

they tend to act in an aggressive and exploitative manner.

A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder?

this disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened.

OCD is a chronic, progressive disease. Symptoms wax and wane over-

time and increase during periods of stress.

Disorders r/t OCD include-

trichotillomania, dermatillomania, onychophagia, kleptomania, oniomania, body dysmorphic disorder, body identity disorder, and hoarding.

Onychophagia is defined as- (on-ih-koh-FAY-jee-ah)

uncontrollable nail biting that is destructive to fingernails and the surrounding tissue. **a form of OCD.

Factitious Disorder characteristics-

-Clients often have an average or above average IQ, the client is dramatic in the description of the illness, uses proper medical terminology, and is often hesitant for the provider to speak to family members or prior providers -The client often reports new manifestations following negative test results -Factitious disorder differs from malingering, it is a mental illness while malingering isn't... Risk factors r/t- -Dependent/Borderline personality disorders.

Self-management teaching strategies for clients w/BPD-

-Decatastrophizing -Thought stopping -Positive self talk

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings should the nurse expect to note?

-Dental decay -Loss of tooth enamel -Electrolyte imbalance

Which is the primary defense mechanism used in somatoform disorders?

-Internalization.

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is which of the following?

-Neglect.

Rules r/t restraints and seclusion-

-Only use S/R when less restrictive measures have failed. -1-hour rule - requires a "face to face" evaluation by a licensed independent practitioner within 1 hour of the restraint. -Physical, Chemical, Seclusion, Observation, need 1:1 supervision -Nurse can make the judgment call to move to seclusion or restraints if they are in danger of harming themselves or someone else -HAVE TO GET ORDER WITHIN AN HOUR -If they haven't called you back, then you go up the chain of command to get the order until you can get someone to do it. -If you can't get an order then you have to let them out, but continue to find someone if you can't let them out. -Some nurses can be certified to do the face to face assessment in a small hospital with limited doctors -They have to be observed continuously -If they are quiet, calm, cooperative for 30 min then you have to let them out -Medical restraint orders are good for 24 hours -For adult you have to get an order for every 4 hours. -Behavior, readiness for release, and circulation every 15 min document. -Every 2 hr need to do vitals, also right after you put them in, its okay to document they are too violent to take vs but can always get RR. -Have to offer food and toileting, ROM every 2 hr. -On admission need to know if any medical conditions could affect restraints

Medications used to treat OCD-

-SSRI's are the first line choices followed by venlafaxine (Effexor). -TCA's- Amitriptyline. -treatment resistant OCD may respond to second generation antipsychotics (risperidone, quetiapine, or olanzapine).

Conditions for which ECT has NOT been found useful are-

-Substance use disorders -Personality disorders -Dysphoric disorders

Expected behavior r/t OCD-

-ambivalence regarding decisions or choices. -disturbances in normal everyday functioning. -inability to tolerate deviations from standards. -Rumination. -Low self esteem -lack of insight -difficulty or slowness completing ADL's because of ritualistic behaviors.

When should Fluoxetine (an SSRI) be administered?

-first thing in the morning to reduce the risk for insomnia.

An elderly client with dementia lives with her daughter. During the day the client attends a Day Center. The nurse notices the client is unkempt and smells of urine. Upon examining the client, the nurse notes bruising on her arms and back. From the nurse's observations, which of the following is the type of abuse suspected?

-physical abuse.

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention?

A structured program of activities in which the client can participate. Rationale-A client with depression often is withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment.

A client diagnosed with hypochondriasis reports to the nurse that others doubt the seriousness of the client's illness. The client is angry, frustrated, and anxious. Which nursing intervention takes priority?

Acknowledge the client's frustrations without fostering continued focus on physical illness.

The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders?

Body dysmorphic disorder.

A nurse is assessing a client who has a new diagnosis of anorexia nervosa. Which of the following findings should the nurse expect-

Bradycardia and muscle wasting.

The nurse reviews the assessment data of a client admitted to the hospital with a diagnosis of anxiety. The nurse should assign priority to which assessment finding?

Fist clenched, pounding table, fearful. Rationale- Anxiety signs and symptoms may take a physical form and if abnormal should be addressed as a priority for the client.

Primary Gains (DSM-V)-

Gains relating to mental illness obtained through internal motivators. produces positive internal motivations A person will feel less guilty knowing they have a mental disorder causing them to not work efficiently (Primary gains-->motivation improved because not your fault that bad)

A nurse is providing teaching to a client who has schizophrenia and is taking quetiapine (seroquel). The nurse should instruct the client that which of the following lab work should be performed periodically?

Glucose. **(Clients taking quetiapine are at risk for abnormal glucose metabolism, which can result in diabetes mellitus. Therefore, the client should have glucose testing periodically.)

When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach?

Helping the client to examine dysfunctional thoughts and beliefs. Rationale- Cognitive behavioral therapy is used to help the client identify and examine dysfunctional thoughts and to identify and examine values and beliefs that maintain these thoughts.

What is word salad?

Incoherent mixture of words, phrases, and sentences. **My dog blank a boat to supreme heights.

Which of the following is a realistic outcome for the care of a person with a personality disorder?

Outcomes that focus on change in behavior.

Response preventions focuses on-

allowing time for the client to perform rituals and slowly decreasing them over time.

Assertive training helps-

clients express feelings in a socially acceptable manner.

Recognizing the client's spiritual preferences is an appropriate intervention for-

coping enhancement.

Dhat syndrome (India) is defined as-

culture-bound syndrome found in India in which men develop intense fears about losing semen.

This recommended strategy used for clients who have dependent or histrionic personality disorders would be-

to act as a role model for assertiveness.

You need to allow extra time or the client may need (OCD)-

to be verbally redirected to accomplish activities of daily living. Rationale- the clients thoughts and ritualistic behaviors may interfere w/ their ability to complete tasks.

PERSONALIZATION-

"When I walk through the hospital hallway, I know everyone is looking at me."

Maslow's Hierarchy of Needs-

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

Which challenges are posed when working with clients with personality disorders?

**It can take a long time to change their behaviors, attitudes, or coping skills. **The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. **Clients with personality disorders challenge the ability of therapeutic staff to work as a team. **Team members may have differing opinions about individual clients.

A nurse is developing a therapeutic relationship with a client. The nurse should perform which of the following actions during the working phase of a therapeutic relationship?

- Instruct the client about methods to achieve goals; when the nurse and client work together to solve problems and achieve goals.

Undoing: Defense Mechanism

- Symbolically negating or canceling out an experience that one finds intolerable. EX: Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her flowers.

The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?

- ask the client how the bruises occurred.

A nurse is caring for a client who is extremely suspicious of the nursing staff and other clients. Which of the following nursing approaches is appropriate when establishing a therapeutic relationship with this client?

- in order to promote a therapeutic relationship; the nurse should approach the situation w/a neutral non- threatening attitude during care and communication.

A nurse is developing a therapeutic relationship with a client. The nurse should perform which of the following actions during the pre interaction phase of a therapeutic relationship?

- the nurse goes over the clients demographic information.

ECT medical management consists of-

-2-3X a week for a total of 6-12 treatments - provider obtains informed consent. If ECT is involuntary, the provider may obtain consent from next of kin or a court order. MED MANAGEMENT:-30 mins prior to the beginning of the procedure, an IM injection of atropine sulfate/glycopyrrolate is admin to decrease secretions that could cause aspiration& to counteract any vagal stimulation effects -At the time of procedure, an anesthesia provider admins a short acting anesthetic -A muscle relaxant is then admin to paralyze the clients muscles during the seizure activity, which decreases the risk for injury -Severe HTN should be controlled b/c a short period of HTN occurs immed after ECT -Any cardiac conditions should be monitored&treated before the procedure -The nurse monitors VS&mental status before&after the procedure -The nurses assess the clients&familys knowledge&understanding of the procedure and teaches as necessary... many have misconceptions about ECT due to media portrayals of the procedure -IV line is inserted&maintained until full recovery -Electrodes are applied to the scalp for EEG monitoring -The client gets 100% oxygen during&after ECT until return of spontaneous respers -Ongoing cardiac monitoring is provided, including BP, ECG and oxygen saturation. -Clients are expected to become alert about 15 min after procedure ends.

The nurse creating a plan of care for the client demonstrating paranoia should include which interventions in the plan of care?

-Ask permission before touching the client. -Eliminate all unnecessary physical contact with the client. -Defuse any anger or verbal attacks with a non-defensive stance. -Use simple and clear language when communicating with the client.

A nurse is caring for several clients who have mental health disorders. Which of the following clients should the nurse determine needs to be seen by a provider immediately?

-Clozapine is used to treat schizophrenia and can cause life-threatening agranulocytosis. Presence of flu-like manifestations indicates that this is the client at greatest risk; therefore, the nurse should contact this client's provider immediately.

DIG FAST - Mania - GREATER THAN 1 WEEK Dx needs 3 of the following or at least a hospitalization-

-Distractibility -Irresponsibility (hedonism) -Grandiosity -Flight of ideas -Agitation -Sleep need decreases (Insomnia) -Talkativeness

Eating disorders standardized screening tools-

-Eating disorder inventory -Body attitude test -Diagnostic survey for eating disorders -Eating attitude test (detects improvement).

A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior?

-Evidence of the client's disturbed body image. Rationale- Although the client may struggle with ambivalence and show regressed behavior, the client's coping pattern relates to the basic issue of disturbed body image. The nurse should address this need in the support group.

Risk factors r/t Somatic disorder-

-First degree relative who has it. -Decreased level of neurotransmitters (serotonin and endorphins). -Depressive disorder, personality disorder or anxiety disorder. -Childhood trauma, abuse or neglect. -Learned helplessness. -Female gender (ages 16-25).

Nursing care r/t Bipolar disorder-

-Focus is on maintaining physical health&safety -Therapeutic mileu -Provide a safe environment during -Assess the client regularly for suicidal thoughts, intentions and escalating behavior -Decrease stimulation w/out isolating the client if possible.. be aware of noise, music, TV and other clients, all of which can lead to an escalation of the clients behavior... in some cases seclusion may be the only way to safely decrease stimulation -Follow agency protocols for providing client protection if a threat to self or others exist. -Implement frequent rest periods -Provide outlets for physical activity, dont involve the client in activities that last a long time or that require a high level of concentration and/or detailed instructions -Protect client form poor judgement&impulsive behavior MAINTENANCE OF SELF CARE NEEDS:-Monitoring sleep, fluid intake and nutrition -Providing portable, nutritious food b/c the client might not be able to sit down to eat -Supervising choice of clothes -Giving step by step reminders for hygiene and dress COMMUNICATION-Use a calm, matter of fact specific approach -Give concise explanations -Provide for consistency w/ expectations&limit setting -Avoid power struggles&don't react personally to the clients comments -Listen to&act on legit client greivances -Reinforce nonmanipulative behaviors -Use therapeutic comm techniques

Relaxation Techniques for Stress Management include-

-Meditation -Guided imagery -Breathing exercises -Progressive muscle relaxation -Physical exercise

Nursing care r/t Schizophrenia include-

-Mileu therapy is used for clients who have a psychotic disorder both in the acute mental health facilities and in community health facilities -Provide a structured, safe mileu for the client in order to decrease anxiety&to distract the client from constant thinking about hallucinations -PROGRAM OF ASSERTIVE COMMUNITY TREATMENT (PACT): Intensive case management to assist clients w/ community living needs -Promote therapeutic comm to lower anxiety, decrease defensive patterns and encourage participation in the mileu -Establish a trusting relationship w/ the client-Encourage the development of social skills&friendships -Encourage participation in group work&psychoeducation -Use aprop comm to address hallucinations&delusions -Ask the client directly about hallucinations, the nurse should not argue or agree w/ the clients view of the situation, but can offer a comment -Don't argue w/ a clients delusions, but focus on the clients feelings&possibly offer reasonable explanations -Assess the client for paranoid delusions, which can increase the risk for violence against others -If the client is experiencing command hallucinations, provide for safety due to increased risk for harm to self or others -Attempt to focus conversations on reality based subjects -Identify symptom triggers, such as loud noises, hallucinations and situations that seems to trigger conversations about the clients delusions -Be genuine&empathetic in all dealings w/ the client -Assess discharge needs, such as ability to preform ADLs -Promote self care by modeling and teaching self care activities w/in the mental health facility-Relate wellness to the elements of symptom management -Collab w/ the clients to use symptom management techniques to cope w/ depressive symptoms&anxiety -Symptom management techniques include using music to distract from voices, attending activities, walking, talking to a trusted person when hallucinations are most bothersome, and interacting w/ an auditory/visual hallucination by telling it to stop or go away -Encourage med compliance-Provide teaching regarding meds -Whenever possible, incorporate family in all aspects of care

Which of the following are common behavioral and emotional responses to abuse?

-One third of abusive men are likely to have come from violent homes. -Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. -Dependency on the abuser is a common trait found in victims of domestic violence. -It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

Factitious Disorder Nursing care-

-Perform a self assessment prior to care -Avoid confrontation -Build rapport and trust w/ client -Ensure safety of client and vulnerable persons affected by the client -Encourage verbalization of feelings -Educate the client on alternative coping mechs -Educate client on stress management techniques -Communicate openly w/ the health care team re: any suspicions of factitious disorder or disorder imposed on another.. this action can help reduce medical costs and possible unnecessary treatments/surgical procedures.

Eating disorders nursing care-

-Perform a self assessment regarding possible feelings of frustration regarding the clients eating behaviors, the belief that the disorder is self imposed, or the need to nurture rather than care or the client -Provide a highly structured millieu in an acute care unit for the client requiring intensive therapy -Develop and maintain a trusting nurse/client relationship through consistency and therapeutic comm -Use a positive approach and support to promote client self esteem and positive self image -Encourage client decision making&participation in the plan of care to allow for a sense of control -Establish realistic goals for weight loss or gain -Promote cognitive behavioral techniques (cognitive reframing, relaxation techniques, journal writing, desensitization exercises) -Monitor the clients VS, I&O, and weight (2-3 lb/weeks is medically okay) -Use behavioral contracts to modify client behaviors -Reward the client for positive behaviors, such as completing meals or consuming a set number of calories -Closely monitor the client during and after meals to prevent purging, which can necessitate accompanying the client to the bathroom -Monitor the client for maintenance of approp exercise -Teach and encourage self care activities -Incorporate the family when approp in client education& d/c planning -Work w/ a dietitian to provide nutrition education to include correcting misinformation regarding food, meal planning, and food selection -Consider the clients preferences and ability to consume food when developing the initial eating plan -A structured and inflexible eating schedule at the start of therapy, only permitting food during scheduled times, promotes new eating habits&discourages binge or binge purge behavior. -Weigh the client daily (usually first thing in the morning after they have urinated). Clients may try to place objects in their clothing to give the appearance of weight gain. -Provide small, frequent meals, which are better tolerated and will help prevent the client from feeling overwhelmed. -sit w/the client during meals and snacks. -Provide liquid protein supplement if client is un able to finish a meal. -Provide a diet high in fiber to prevent constipation -Provide a diet low in sodium to prevent fluid retention -Limit high fat and gassy foods during the start of treatment -Admin a multivitamin and mineral supplement -Instruct the client to avoid caffeine to reduce the risk for increased energy, resulting in difficulty controlling eating disorder behaviors.. caffeine also can be used by clients as a sub for healthy eating -Make arrangements for the client to attend individual, group and family therapy to assist in resolving personal issues contributing to the eating disorder -encourage self monitoring using a journal (a feelings diary). -relaxation techniques -distraction

Eating disorders criteria for acute care treatment-

-Rapid weight loss or weight loss of greater than 30% of body weight over 6 months -Unsuccessful weight gain in outpatient treatment, failure to adhere to treatment contract -VS demonstrating HR less than 40/min, systolic BP less than 70 mm Hg, body temp less than 36 (96.8) -ECG changes -Electrolyte imbalances -Psychiatric criteria (severe depression, suicidal behavior, ,family crisis or psychosis)

The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client?

-Restating -Listening -Maintaining neutral responses -Providing acknowledgment and feedback

A coherent elderly woman has been financially and emotionally abused by her adult children for the past several years, but has failed to report the abuse to anyone. Which is the most likely reason that the woman neglects to report the abuse?

-She is emotionally close to her children and does not want to bring them harm.

Risk factors r/t Bipolar disorder-

-Substance use disorder -Anxiety -Borderline personality disorder -oppositional defiant disorder -Social phobia and specific phobia -Seasonal affective disorder

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event?

-The death of a loved one. Rationale- A situational crisis arises from external rather than internal sources. External situations that could precipitate a crisis include loss or change of a job, the death of a loved one, abortion, change in financial status, divorce, addition of new family members, pregnancy, and severe illness.

Sentinel events need to be reported for which events?

-physical aggression towards staff made by a client. -having to place a client in seclusion or physical restraints.

Which is the primary gain for a client with conversion disorder?

-relief from emotional conflict.

A nurse is developing a therapeutic relationship with a client. The nurse should perform which of the following actions during the orientation phase of a therapeutic relationship?

-the nurse determines the reason the client sought out care.

A nurse is developing a therapeutic relationship with a client. The nurse should perform which of the following actions during the termination phase of a therapeutic relationship?

-the nurse discussed with the client new skill sets.

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." Which of the following is most likely true of the situation?

-this is characteristic of the tension-building phase of the violence cycle.

Obsessions are defined by-

1) Recurrent & persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2) The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Somatic symptom nursing care-

Accept somatic symptoms as being real to the client -Assess for suicidal ideation and thoughts of self harm -Identify secondary gains from somatic symptoms (attention, distraction from personal obligations or problems) -Report new physical manifestations to the provider -Limit the amount of time allowed to discuss somatic symptoms -Encourage independence in self care -Encourage verbalization of feelings -Educate the client on alternative coping mechs -Educate the client on assertiveness techniques -Encourage daily physical exercise

The client reports laryngitis. Upon assessment with subjective and objective data, the nurse discovers he is an actor and has prepared extensively for his first stage production. Today, the morning of the opening of the play, the actor awakened with laryngitis. From which disorder is the actor most likely suffering?

Conversion disorder

Second generational/conventional meds

Current meds of choice for psych disorders, and the generally treat both positive&negative symptoms -Risperidone -Olanzapine -Quetiapine -Ziprasidone -Clozapine -To minimize weight gain, advise the client to follow a healthy, low cal diet, engage in regular exercise and monitor weight -Adverse effects include- agitation, dizziness, sedation and sleep disruption. Instruct client to report these manifestations b/c the provider might need to change the med -Inform the client of the need for blood tests to monitor for agranulocytosis

Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness?

**The client will assume responsibility for self-care activities. **The client will identify the relationship between stress and physical symptoms. **The client will verbally express emotional feelings. **The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings

A nurse in a mental health clinic is attempting to develop a therapeutic relationship with the client. Which of the following actions should the nurse take?

- the nurse should set professional boundaries with the client through limit setting regarding when and where to meet, roles of the relationship, personal space, and other parameters.

Maslow's Hierarchy of Needs are as follows-

-(level 1) Physiological Needs -(level 2) Safety and Security -(level 3) Relationships, Love and Affection -(level 4) Self Esteem -(level 5) Self Actualization

The nurse has been closely observing a client who has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the client is escalating. Which nursing intervention is most helpful to this client at this time?

-Acknowledge the client's behavior. -Assist the client to an area that is quiet. -Maintain a safe distance from the client. Rationale- During the escalation period, the client's behavior is moving toward loss of control. Nursing actions include taking control, maintaining a safe distance, acknowledging behavior, moving the client to a quiet area, and medicating the client if appropriate.

A nurse is caring for a client who has Schizophrenia and is experiencing a hallucination. Which of the following actions should the nurse take?

-Asking the patient direct questions related to the hallucinations. Rationale- Asking the client direct questions about the hallucination provides important data to identify the client's risk level and current mental status.

A client is unwilling to go to his church because his ex-girlfriend goes there and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder?

-Avoidant -Borderline -Schizotypal -Obsessive-compulsive Rationale- The avoidant personality disorder is characterized by social withdrawal and extreme sensitivity to potential rejection. The person retreats to social isolation

Illness anxiety nursing care-

-Build rapport and trust w/ client -Encourage independence in self care -Encourage verbalization of feelings -Educate clients on alternative coing mechs -Educate clients on stress management techniques. -Encourage client participation in individual and group therapy. -Refer clients to community support groups -Educate clients on prescribed meds -Collab w/ the provider for the client to get bried, frequent office visits

Conversion Disorder Nursing care-

-Build rapport&trust w/ clients -Ensure safety of clients -Encourage verbalization of feelings, assist the client to identify the psychological trigger of the manifestations -Educate client on alternative coping mechs -Educate client on stress management techniques -Understand the incidence of remissions and recurrence. -remission occurs w/.out intervention in approx 95% of clients, especially if the onset of the manifestations is due to an acute stressful event.. recurrence rate is approx 25%, usually w/in one year of initial diagnosis.

A nurse is caring for a client who has severe manifestations of Schizophrenia and is medicated PRN for agitation w/Haloperidol. The nurse should assess the client for which adverse reaction?

-Cardiac dysrhythmias are a risk for clients taking haloperidol and other conventional antipsychotic medications. The client should be monitored for changes in vital signs, tachycardia, and ECG changes, including prolonged QT intervals.

A nurse asks a client who is suicidal to make a safety contract, but the client refuses. Which of the following actions should the nurse identify as the priority?

-The greatest risk to this client is self-injury during unsupervised time; therefore, the nurse should identify the priority action is to assign a staff member to stay with the client at all times. The staff member can monitor all of the client's behaviors and actions and prevent the client from harming herself.

A client experiencing a great deal of stress and anxiety is being taught to use self-control therapy. Which statement by the client indicates a an understanding of the teaching about the therapy?

-This form of therapy can be applied to new situations." -An advantage of this technique is that change is likely to last." -Talking to oneself is a basic component of this form of therapy."

A nurse is caring for a client who has bipolar disorder and has been taking Lithium for 12 mo. Before administration the nurse should check to see that which of the following labs tests have been completed?

-Thyroid. Rationale- Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.

Five-Phases of the Aggression Cycle-

-Triggering- an event or circumstance which initiates a clients to become angry or hostility. -Escalation- escalating behaviors, that indicate a loss of control. -Crisis- the client loses control. -Recovery- the client regains physical and emotional control. -Post-crisis- the client seeks reconciliation and returns to a level of normal functioning.

A nurse is providing teaching for a client who has Schizophrenia and a new Rx for Fluphenazine (antipsychotic). Which of the following information should the nurse provide?

-Urine will turn a reddish/brown. -Orthostatic HTN -May cause leukopenia or agranulocytosis. The client should notify the provider immediately of adverse effects such as sore throat, fever, malaise. -sedation that should improve w/in 7 days.

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information?

-When I have command hallucinations, I'll call a friend and ask him what I should do. Rationale- The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse or health care counselor, not a friend, should be contacted to discuss whether the client has intentions to hurt himself or herself or others.

A woman is in treatment for an anxiety disorder. Her history reveals that she was sexually abused repeatedly by her husband. Which of the following interventions would be appropriate in relation to this piece of data?

-encourage her to talk about her feelings r/t the abuse.

Which of the following is the best explanation for why family violence tends to occur over multiple generations of families?

-family violence may be perpetuated between generations of families by role modeling and social learning.

The client tells the nurse that her husband abuses her often with he drinks, just as his father had beaten him and his mother. He always apologizes and is remorseful after the event. Which stage is this in the cycle of violence?

-honeymoon stage.

Nursing interventions r/t OCD include-

-offer encouragement, support and compassion. -be clear w/the client that you believe he or she can change. -gradually decrease time for the client to carry out ritualistic behavior. -assist the client in using exposure and response prevention behavioral techniques. -encourage the client to manage and tolerate anxiety responses through learned techniques. -assist the client to complete ADL's with agreed upon time limits. -encourage the client to develop and follow a written schedule with specified times and activities.

Negative symptoms of Schizophrenia include-

Absence of things that are normally present, these manifestations are more difficult to treat successfully than positive symptoms. AFFECT: Usually blunted or flat ALOGIA: Poverty of thought or speech, the client might sit w/ a visitor but only mumble/respond vaguely to questions ANERGIA: Lack of energy ANHEDONIA: Lack of pleasure of joy, client is indifferent to things that often make others happy such as looking at beautiful scenery AVOLITION: Lack of motivation in activities&hygiene, the client completes an assigned task, such as making their bed but is unable to start the next common chore /out prompting

Binge Eating Disorder (BED)-

An eating disorder characterized by recurrent episodes of eating more food in a short period of time than most people would eat, during which the person feels a lack of control over eating.

Phases of Bipolar Disorder-

Care of a client who has bipolar disorder will mirror the phase of the disease that the client is experiencing: ACUTE PHASE/MANIA:-Hospitalization can be required -Reduction of mania&client safety are the goals of treatment -Risk of harm to self or others is determined-One to one supervision can be indicated for client safety CONTINUATION PHASE:-Remission of manifestations-Treatment generally is 4-9 months-Relapse prevention through education, med adherence and psychotherapy is the goal of treatment MAINTENANCE PHASE:-Increased ability to function-Treatment generally continues throughout the clients lifetime-Prevention of future manic episodes is the goal of treatment

Risk factors r/t Personality disorders-

Comorbid substance use disorders, and can have a hx of non-violet and violent crimes, including sex offenses. -Psycho social influences, such as childhood abuse or trauma, and developmental factors w/ a direct link to parenting. -Biological influences include genetic and biochemical factors

Communication strategies r/t Personality disorders-

Developing a therapeutic relationship is often challenging due to the clients distrust or hostility toward others, feelings of being threatened or having no control can cause a client to act out toward the nurse: -A firm, yet supportive approach&consistent care will help build a therapeutic nurse client relationship -Offer the client realistic choices to enhance the clients sense of control -Limit setting and consistency are essential w/ clients who are manipulative, especially those who have borderline or antisocial -Clients who have dependent&histrionic often benefit from assertiveness training&modeling -Clients who have schizoid or schizotypal tend to isolate themselves and the nurse should respect this need -For clients who have histrionic and can be flirtatious, it is important for the nurse to maintain professional boundaries&comm at all times -When caring for clients who exhibit dependent behavior, self assess frequently for countertransference reactions.

Risk factors r/t Conversion disorder-

First degree relative who has conversion disorder -childhood physical or sexual abuse -Comorbid psychiatric conditions (depressive disorder, PTSD, Personality disorder, other somatic disorder) -Cormobid medical or neuro condition -Recent acute stressful event-Females -Teens or young adults

Secondary Gains (DSM-V)-

Gains relating to mental illness obtained through external motivators. These are gains that are given to a patient in addition to the illness - Missing work that you don't like due to illness - Getting medications that feel fun - Avoid jail sentence

Common lab abnorms w/ anorexia-

Hypokalemia, especially for those who have bulimia (there is a direct loss of potassium due to purging, dehydration stimulates increased aldosterone production, which leads to NA&H2O retention and K+ excretion) -Anemia&leukopenia w/ lymphocytosis, thrombocytopenia -Possible impaired liver function, evidenced by increased enzyme levels -Hypoalbuminemia-Possible elevated cholesterol -Abnormal thyroid function tests -Elevated carotene levels, which cause skin to appear yellow -Decreased bone density -Abnormal blood glucose level -ECG changes (Prolonged Qt interval) -Possible increase serum bicarb (metabolic alkalosis) related to self induced vomiting -Possible decrease serum bicarb (metabolic acidosis) related to laxative use

Common lab abnorms w/ anorexia-

Hypokalemia, especially for those who have bulimia (there is a direct loss of potassium due to purging, dehydration stimulates increased aldosterone production, which leads to NA&H2O retention and K+ excretion) -Anemia&leukopenia w/ lymphocytosis, thrombocytopenia -Possible impaired liver function, evidenced by increased enzyme levels -Hypoalbuminemia-Possible elevated cholesterol -Abnormal thyroid function tests -Elevated carotene levels, which cause skin to appear yellow -Decreased bone density -Abnormal blood glucose level -ECG changes (Prolonged Qt interval) -Possible increase serum bicarb (metabolic alkalosis) related to self induced vomiting. -Possible decrease serum bicarb (metabolic acidosis) related to laxative use.

The psychiatric home care nurse visits a client diagnosed with a phobia that triggers panic attacks. When teaching the client to use paradoxical intention, which intervention will the nurse demonstrate?

Instructing the client to do what the client fears and, if possible, to exaggerate the outcome of this exposure to the point of humor. Rationale- When this occurs the client is taught to prevent the anxiety by a variety of coping mechanisms. This assists the client to regain an internal locus of control or feeling of empowerment and to master response to the anxiety-provoking issue or situation. Other options describe in vivo therapy, flooding, and systematic desensitization.

A client diagnosed with a borderline personality disorder says to the nurse, "Sometimes I do things to get my parents mad, and sometimes I do them because I'm bored. That's what happened the night I crashed the family car. I wasn't drunk or suicidal or anything like the police thought. It was just for kicks!" Which is the appropriate nursing response?

It is scary when you feel out of control with such feelings of emptiness and anger that you can't stop. Rationale- Reflection, a technique that prompts the client by repeating the major theme in the client's process, is a therapeutic communication technique.

A middle-aged client goes to the physician reporting hip pain. The friend that brought him to the office tells the nurse that the client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis?

Malingering

Conversion Disorder (Functional Neurological Symptom Disorder)-

Manifestations of an alteration in voluntary motor or sensory function MOTOR: Paralysis, movement/gait disorders, seizure like movements SENSORY: Blindness, inability to speak (APHONIA), inability to smell (ANOSMIA), numbness, deafness, tingling/burning sensations -Clients who have an extreme desire to become pregnant can manifest a false pregnancy (psuedocyesis)

Positive symptoms of Schizophrenia include-

Manifestations of things that are not normally present, these are the most easily identified manifestations: -Hallucinations -Delusions -Alterations in speech -Bizarre behavior

The nurse is assessing the client who states he is a spiritual healer. Which term describes the extent to which a person considers himself to be an integral part of the universe?

Self transedence

Which thought process would cause a client with antisocial personality disorder to want to do everything for himself?

Sense of mistrust from others.

The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?

Setting limits on the client's behavior. Rationale- Manic clients may be talkative and can dominate group meetings or therapy sessions by their excessive talking. If this occurs, the nurse initially would set limits on the client's behavior.

What is the appropriate nursing intervention for a client diagnosed with posttraumatic stress disorder and paranoid tendencies who begins to pace and fidget?

Share the observation with the client so the behavior can be recognized.

A supervisor reprimands the charge nurse for not adhering to the unit budget. What behavior by the charge nurse is an example of displacement?

The charge nurse blames staff for wasting supplies. Rationale- Displacement is the discharging of pent-up feelings on individuals less threatening than those who initially aroused the emotion.

When a decision has been made to subdue or restrain a client-

act quickly and cooperatively with other staff members. **tell the client in a matter of fact manner that he will be restrained, subdued, or secluded; allow no bargaining after the decision has been made. **reassure the client that they will not be hurt and that this is only taking place to keep them safe. The client should never feel this is taking place out of punishment. Rationale- firm limits must be set and maintained. If the client is allowed to manipulate or bargain doubt will interject and undermine the limit. **do not help in this process if you are angry (ensure their is adequate staffing). **only staff should help in this event; never another client. **if possible have other staff remove other clients to a room where they can be distracted by other activities. Clients should not witness this taking place if at all possible. Rationale- other clients may feel frightened, agitated, or endangered by the client showing aggression. Everyone needs to feel safe and secure in this situation.

The staffs behavior provides a role model for the client and (aggression)-

communicates that they can and will provide control.

The client may be limited in the ability to deal with (OCD)-

complex activities for in relating to others. Rationale- activities that the client can accomplish and enjoy can enhance self esteem.

Oniomania Disorder is identified as (OCD)-

compulsive buying; possessions are acquired compulsively without regard for cost or need for the item.

Observe the clients eating (OCD)-

drinking, and elimination patterns and assist as necessary. Rationale- the client may be unaware of physical needs, and may ignore feelings of hunger, thirst, or need to use the restroom.

A nurse is caring for a client who has been diagnosed with OCD. The nurse is preparing a plan of care. Which is a safety priority for the nurse to observe?

eating, drinking, and elimination. (PRIORITY INTERVENTION).

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder-

having a tantrum if the client perceives they aren't getting enough attention.

If the client expresses verbally, or non-verbally that they feel hostile or destructive try to (aggression)-

help the client express these feelings in a non destructive way; using communication techniques or take the client to the gym for physical exercise.

During the Recovery phase nursing interventions include-

helping the client to relax, assisting them in regaining control, and discussing the aggressive event rationally.

An example of neologism might be-

her mannerologies are poor. **words that have meaning to the client, but a different or nonexistent meaning to others.

Onset of OCD after age 50 is rare. The incidence of-

hoarding increases w/age.

Side effects for Clozapine are-

hypotension, constipation, granulocytopenia, and hyperglycemia in clients who have DM.

Cocaine is a stimulant that-

increases blood pressure, body temperature, and causes feelings of exhilaration and increased energy. -It also decreases appetite,

Depersonalization/Derealization disorder is defined by-

individuals that feel detached from their own mind and body (depersonalization) or from their surroundings (derealization).

Assess and monitor the clients sleep patterns, and (OCD)-

prepare them for bedtime by decreasing stimuli and providing comfort measures and medications if needed. Rationale- limiting noise and other stimuli will encourage rest and sleep. Comfort measures and medication will enhance the clients ability to relax and sleep.

Accurate and complete documentation is essential r/t-

restraints, seclusion, and assault because they may result in legal action.

A nurse is planning a unit orientation for a newly admitted client who has severe depression. Which of the following should be the nurses approach-

sit with the client and offer simple; direct information. Rationale- Severely depressed clients can have problems with concentration and are easily overwhelmed. A nursing approach that focuses on giving simple information slowly and directly is best for the newly admitted client.

The client often uses attention seeking behaviors. Which of the following nursing interventions are most important in a plan of care for a client with histrionic personality disorder?

teach social skills, and provide factual feedback regarding behavior.

Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality?

team consistency is important to prevent manipulation by the client.

What is reality testing (dissociative disorder)-

testing that involves scanning the surroundings to see if others are afraid and reorientation to time and place. (this can help clients realize that flashbacks aren't real).

Exposure therapy involves assisting-

the client to deliberately confront the situation and stimuli that he or she usually avoids.

Convey honest interest in and concern for (OCD)-

the client w/out flattery or dishonesty. Rationale- your presence and interest will convey your expectance of the client. Genuine praise that the client has earned can foster a healthy sense of self esteem.

Trichotillomania is defined as-

the compulsive, persistent urge to pull out one's own hair. **a form of OCD.

Encourage the client to try to gradually decrease (OCD)-

the frequency of compulsive behaviors. **identify a baseline and keep documentation re; the decrease. Rationale- gradually reducing the frequency will diminish anxiety and encourage success.

A nurse in a mental health facility is caring for a client in the busy dining room during lunchtime when suddenly the client becomes angry and throws a chair. Which of the following interventions should the nurse perform first-

the nurse should use the safety/risk reduction priority-setting framework and to attempt to de-escalate the client's anger and aggression by talking the client down in a calm, nonthreatening manner.

Teach the client social skills, such as appropriate conversation topics and active listening. Encourage them to practice (OCD)-

these skills with staff members and other clients and then offer feedback. Rationale- the client may feel embarrassed by their OCD and have limited contact or social skills which can contribute to their level of anxiety.

Clients who have antisocial personality disorder do not seek isolation, instead-

they show antagonistic behavior toward others and often have a history of criminal misconduct.

OCD involves recurrent, persistent, and unwanted-

thoughts, images, or impulses (obsessions) and ritualistic or repetitive behaviors or mental acts (compulsions) carried out to eliminate the obsessions or to neutralize anxiety.

Perseveration is the tendency to-

use repetition of phrases or behavior and is most often exhibited in clients under stress.

In the Escalation phase nursing interventions include-

using a direct approach, taking control of the situation, using a calm firm voice for giving directions, directing the client to take a time out in a quiet place, offering PRN medications, and making a "show of force."

Overt actions are defined as-

verbal outbursts, physical threats. **in your face.

The nurse needs to be aware of factors that increase the likelihood of (aggression)-

violent behavior and agitation. ** use verbal communication and PRN medication to intervene before the clients behavior reaches a destructive point and physical restraints become necessary.

Tell the aggressive client what you are doing and what-

you are doing as you actually do it. ** I will walk with you to another room to keep you safe or we are taking you to another room where you will be safe. **Use simple, clear, direct speech repeat as necessary. **Do not threaten the client, but state limits and expectations. Rationale- the clients ability to understand and process information is impaired. Clear limits let the client know what is expected and reassurance of safety can lessen the clients perception of harm or threat; especially if they are experieinceing psychotic symptoms.