Mental Health

A nurse is reinforcing teaching about therapeutic relationships with a group of clients in an acute care mental health facility . Which of the following statements should the nurse identify as an indication that one of the clients is in the working phase of group development ? "I am sad that our final meeting is next week" "I like hearing how others have overcome their previous struggles . " "I like that the group leader points out that we all have similarities ." " I would like to review the basic rules of group participation . "

"I am sad that our final meeting is next week"

A nurse is reinforcing teaching with a client who is to undergo transcranial magnetic stimulation ( TMS ) . Which of the following statements by the client indicates an understanding of the teaching ? "I will receive general anesthesia before the TMS procedure " "I might experience lightheadedness after the TMS procedure . " "I might experience short - term memory loss for 4 to 6 weeks after the TMS procedure . " "I will receive TMS treatments twice a week for 8 to 12 weeks"

"I might experience lightheadedness after the TMS procedure . "

A nurse is reinforcing discharge teaching with a client who has agoraphobia and will undergo treatment with systematic desensitization . Which of the following statements should the nurse identify as an indication that the client understands the teaching about this therapy ? "I will learn a relaxation technique before I have exposure to pictures and videos of crowds of people ." "I receive an electric shock when report feelings of anxiety about being in a crowd . " "I will receive tokens as a reward for going into public that I can trade for things I want . " "I will observe the therapist interacting with a group of people in public , and I will imitate their behavior . "

"I will learn a relaxation technique before I have exposure to pictures and videos of crowds of people ."

A nurse is reinforcing teaching with a client who has major depressive disorder and is being voluntarily admitted to an inpatient mental health facility . Which of the following statements should the nurse make ? "You cannot leave the facility until your provider discharges you . " " You will not have the right to refuse prescribed medications . " "You will need to sign a consent for treatment upon admission . " " Your provider will notify your employer of your need for admission"

"You will need to sign a consent for treatment upon admission . " ?

Antianxiety meds

-Benzodiazepines (diazepam) -> for short term use -Buspirone -> for long term use -Beta blockers -Antihistamines -Anticonvulsants

Medications for children & adolescents who have mental health issues

-CNS stimulants -Selective reuptake inhibitors (SNRIs) -Tricyclic antidepressants (TCAs) -Alpha2- adrenergic agonists -Atypical antipsychotics -Selective serotonin reuptake inhibitors (SSRIs) -Lithium, mood-stabilizing antiepileptics, beta adrenergic blockers

Therapeutic procedures

-Cognitive behavioral therapy -Behavioral therapies: relaxation training, modeling, systematic desensitization, flooding, response prevention, thought stopping

Leadership Styles

-Democratic: Supports group interactions, ask for group suggestions then supports discussion -Laissez- faire: observes group w/o interference of control of direction w/ group process -Autocratic: controls direction & structure of group w/o allowing group interaction/ decision

Use the following communication tips when answering questions on NCLEX:

-If the client is anxious or depressed - use open-ended, supportive statements -If the client is suicidal - use direct, yes or no questions to assess suicide risk -If the client is panicked - use gentle guidance and direction -If the client is confused - provide reality orientation -If the client has delusions / hallucinations / paranoia - acknowledge these, but don't reinforce -If the client has obsessive / compulsive behavior - communicate AFTER the compulsive behavior -If the client has a personality or cognitive disorder - be calm and matter-of-fact

Types of communication

-Intrapersonal communication: personal thoughts in head w/o verbalizing it out loud -Interpersonal communication: communication one-on-one with another individual -Small-group communication: b/w 2 or more ppl in small group -Public communication: w/ large groups of people -Electronic communication: like email

Therapeutic strategies for mental health illnesses and disorders can include:

-Medications, talk and behavior therapy, and / or brain stimulation. -Clients undergoing care for mental health disorders may feel pressure to deny behavior or issues to appear 'normal'. -The nurse should always carefully collect data regarding each individual to ensure optimal response to therapies. -Nurses may use strategies such as communication skills, orienting clients, offering self-care assistance, administering medications, modeling appropriate behavior, encouraging development, and monitoring health conditions when working in mental health nursing.

Nursing Interventions for antagonists:

-Monitor for side/adverse effects -Tachycardia and tachypnea -Abstinence syndrome in clients who are physically dependent on opioid agonists -Monitor for cramping, hypertension, and vomiting -Give naloxone by IV, IM, or subcut routes, not orally -Be prepared to address client's pain because naloxone will immediately stop the analgesia effect of the opioid the client had taken -When used for respiratory depression, monitor for return to normal respiratory rate (16-20/min for adults; 40-60/min for newborns)

Family dysfunction

-Scapegoating: family member with little power is blamed for problems w/in family -Triangulation: ex alliance with one child & parent leaving other parent out -Multigenerational issues: emotional issues w/in family that continue for at lease 3 generations

Antidpressants

-Tricyclic antidepressants (TCAs) -Selective serotonin reuptake inhibitors (SSRIs) -Serotonin norepinephrine reuptake inhibitors (SNRIs) -Monoamine oxidase inhibitors (MOAIs) -Atypical antidepressants

Electronconvulsive therapy (ECT) - [brain stimulation therapy]

-Used for major depressive disorders, schizophrenia, or acute manic disorders -Receives therapy 3x/week for 2-3 weeks -Before ECT, screen the client for any home medication use. Lithium, MAOIs, and all seizure threshold meds should be discontinued two weeks prior to ECT. -Before therapy, obtain baseline vital signs and ensure that an IV catheter is in place. -Administer ordered medications -Monitor vital signs continuously throughout the treatment, and after the ECT session is completed. -After therapy, reorient the client as short-term memory loss is common. A headache may be present after ECT.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

-Venlafaxine, duloxetine,desvenlafaxine,levomilnacipran -Mirtazapine -Trazodone

Bipolar disorder medications

-mood stabilizers (lithium carbonate, anticonvulsants) -1st generation antipsychotic meds -2nd generation antipsychotic meds -Antidepressants Therapeutic procedures: -Electroconvulsive therapy (ECT)

Benzodiazepine sedative hypnotic anxiolytics

Alprazolam Diazepam Lorazepam Chlordiazepoxide Clorazepate Oxazepam Clonazepam For short term anxiety disorders & panic disorders, seizures, insomnia, muscle spasms, alcohol w/drawl, anesthesia, amnesic before surgery Complications: CNS depression, anterograde amnesia, oral toxicity (drowsy, lethargy, confusion), IV toxicity (respiratory depression, severe hypotension, cardiac arrest) -> administer flumazenil; paradoxical response, w/drawl effects Contraindicated: sleep apnea, resp. depression, glaucoma Interactions: CNS depressants (alcohol, barbiturates, opioids)

Medications for trauma & stressor- related disorders

Antidepressants: -SSRIs: Paroxetine, sertraline, fluoxetine, escitalopram, fluvoxamine -SSNRIs: Venlafaxine -Tricyclic antidepressants: Amitriptyline, imipramine -MAOIs: Phenelzine -Noradrenergic & specific serotonergic antidepressant: Mirtazapine Beta blockers: Propranolol Peripherally acting alpha blockers: Prazosin Centrally acting alpha 2 agonists: Clonidine

Medications for bipolar disorder

Antiepileptics: -Valproic acid -Carbamazepine -Lamotrigine -Oxcarbazepine -Topiramate Antipsychotics Anxiolytics: clonazepam, lorazepam Antidepressants: bupropion, venlafaxine, SSRIs Mood stabilizers: Lithium carbonate Mood stabilizing antiepileptics: Carbamazepine, Valproate, Lamotrigine

Selective Norepinephrine Reuptake Inhibitors (SNRIs)

Atomoxetine Bupropion For adhd Complications: appetite/ growth suppresion, weight loss, GI effects (nausea, vomit, upper ab. pain), suicidal ideation, hepatoxicity, CNS effects (headache, insomnia, irritable) Contraindicated: CV disorders, suicidal ideation, Atomoxetine contraindicated for angle- closure glaucoma/ pheochromocytoma Interactions: MAOIs, Paroxetine, fluoxetine, quinidine gluconate

Medications for anxiety disorders

Benzodiazepines sedative hypnotic anxiolytics: Lorazepam, alprazolam, clonazepam, diazepam, clorazepate, chlordiazepoxide, oxazepam Atypical anxiolytic/ nonbarbiturate anxiolytic: buspirone Selected antidepressants -SSRIs: Paroxetine, sertraline, fluoxetine, citalopram, escitalopram, fluvoxamine -SSNRIs: Venlafaxine, duloxetine, desvenlafaxine Other antidepressants: -TCAs: Amitriptyline, imipramine, clomipramine -MAOIs: phenelzine -Mirtazapine -Trazodone Antihistamines: -Hydroxyzine pamoate -Hydroxyzine hydrochloride Beta blockers: -Propranolol Centrally acting alpha blockers: Prazosin Anticonvulsants: Gabapentin, Pregabalin

Atypical antidepressants

Bupropion Vilazodone For depression, aid for smoking cessation, prevents seasonal pattern depression Compilations: headache, dry mouth, GI distress, constipation, increased HR, nausea, restless, insomnia, weight loss, seizures Contraindicated: seizure disorders, MAOIs, bupropion(in anorexia nervosa/bulimia nervosa) Interactions: MAOIs (phenelzine), SSRIs

Atypical anxiolytic/nonbarbiturate anxiolytic

Buspirone (Buspar) For anxiety Complications: CMS effects (dizzy, nausea, headache, lightheaded, agitation) Contraindicated: w/ MAOI antidepressants Administer same time of day w/ meals, takes 1-4 weeks for therapeutic effects

Mood stabilizing antiepileptic medications

Carbamazepine Valproic Acid Lamotrigine For bipolar, manic, depressive episodes Complications of Carbamazepine: CNS effects (nystagmus, double vison, vertigo, staggering gait, headache), blood dyscrasias (leukopenia, anemia, thrombocytopenia), hypoosmolality, skin disorders (dermatitis, rash) -> stevens- johnson syndrome Contraindicated: bone marrow suppression/ bleeding disorders Interactions: oral contraceptives, warfarin, grapefruit juice, anticonvulsants Complications for Lamotrigine: double/blurred vision, dizzy, headache, nausea, vomit, serious skin rashes (stevens-johnson syndrome) Interactions: carbamazepine, phenytoin, phenobarbital, valproate, oral contraceptives Complications for Valproic acid: GI effects (nausea, vomiting, indigestion), hepatotoxicity, pancreatitis, thrombocytopenia, weight gain Interactions: Anticonvulsants

10 personality disorders in 3 clusters

Cluster A (odd/ eccentric traits) -Paranoid -Schizoid: emotional detachment, disinterest in close relationships, indifference to praise/criticism, often uncooperative -Schizotypal: odd beliefs, eccentric appearance, magical thinking/ perceptual distortions Cluster B ( dramatic, emotional, erratic traits) -Antisocial -Borderline: instability of affect, identity & relationships, splitting behaviors, manipulation, impulsiveness, fear of abandonment, potential harm, impulsivity -Histrionic: emotional attention seeking behavior, seductive, flirtatious, needs to be center of attention -Narcissistic: arrogance, grandiose, self importance, constant need of admiration, lack of empathy for others, sensitive to criticism Cluster C (anxious/ fearful traits; insecurity& adequacy) -Avoidant: social inhabitation, avoidance of situations due to fear of rejection, anxious in social situations -Dependent: dependency in close relationship, urge to find a replacement when one relationship ends -Obsessive-Compulsive: indecisiveness & perfectionism

Tricyclic Antidepressants (TCAs)

Desipramine, Imipramine, Clomipramine For depression, autism, ADHD, panic disorder, separation anxiety, social phobia, OCD Complications: orthostatic hypotension, anticholinergic effects (dry mouth, blurred vision, photophobia, urinary hesitancy/retention, constipation, tachycardia, weight gain, sedation, decrease seizure threshold, excessive sweating Contraindicated: MI, heart failure history, prolonged QT complex Interactions: MAOIs, antihistamines/ anticholinergic agents, epinephrine, dopamine, alcohol, benzodiazepines, opioids, antihistamines

Selctive Serotonin Reuptake Inhibitors (SSRIs)

Fluoxetine, Citalopram, Escitalopram, Paroxetine, Sertraline For depression, OCD, bulimia nervosa, premenstrual dysphoric disorders, panic disorders, PTSD, bipolar, anxiety Complications: Sexual dysfunction, CNS stimulations (insomnia, agitation, anxiety), weight changes, serotonin syndrome, w/drawl syndrome, hyponatremia, rash, sleepy, faintness, lightheadedness, GI bleeding, bruxism Contraindicated: MAOIs, TCAs Interactions: MAOIs, TCAs, St. John's wort -> increase risk of serotonin syndrome; warfarin, tricyclic antidepressants, lithium, NSAIDs, anticoagulants

first generation antipsychotics

For psychotic, schizophrenia, bipolar, Tourette's, agitation, suppresses nausea + vomiting via blocking dopamine, acetylcholine, histamine, Norepi receptors Chlorpromazine (low potency) Haloperidol (High potency) Fluphenazine (High potency) Thiothixene (High potency) Perphenazine (High potency) Loxapine (Medium potency) Trifluoperazine (High potency) Side effects: Dystonia, Parkinsonism, Akathisia, Tardive dyskinesia, Neuroleptic malignant syndrome, Anticholinergic effects, neuroendocrine effects, seizures, skin sensitivity, orthostatic hypotension, sedation, sexual dysfunction agranulocytosis, dysrhythmias, liver impairment Interactions Anticholinergics, CNS depressants, Levodopa *First generation mainly for positive rather than neg. symptoms*

2nd and 3rd generation antipsychotics

For schizophrenia, psychotic episodes, bipolar, impulse control disorders -Olanzapine -Quetiapine -Clozapine -Asenapine -Lurasidone -Ziprasidone -Paliperidone -Iloperidone -Aripiprazole, brexpiprazole, cariparazine Complications -Diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypertension, anticholinergic effects, agitation, dizzy, sedation, sleep disruption, mild EPS( tremors/ akathisia), elevated prolactin lvls, sexual dysfunction Interactions -Immunosuppressive, alcohol, opioids, antihistamines, antipsychotics, tricyclic antidepressants amiodarone, clarithromycin, barbiturates, phenytoin, fluconazole *2nd generation used for negative symptoms*

Mood stabilizer

Lithium carbonate (Eskalith) For bipolar, acute mania, depression, decreases suicide Complications: GI distress (nausea, diarrhea, ab. pain), fine hand tremors, polyuria, mild thirst, weight gain, renal toxicity, goiter & hypothyroidism, brady dysrhythmias, hypotension electrolyte imbalances, Lithium toxicity *For advanced toxicity (2-2.5mEq/L) -> urea, mannitol, aminophylline prescribed to increase excretion* Contraindicated: severe renal/ cardiac disease, hypovolemia, schizophrenia Interactions: Diuretics, NSAIDs, Anticholinergics (antihistamines, tricyclic antidepressants) Lithium levels obtained in the morning 10-12 hrs after last dose

Opioid withdrawal medications

Methadone clonidine buprenorphine naltrexone levo-alpha-acetylmethadol

CNS stimulants

Methylphenidate, Amphetamine mixture Dextroamphetamine Dexmethylphenidate Lisdexamfetamine dimesylate Increases norepi & dopamine For ADHD Complications: CNS stimulation (insomnia, restless), weight loss, growth supression, CV effects (dysrhythmias, chest pain, high BP, psychotic manifestations (hallucinations & paranoia), w/drawl rxn, hypersensitivity skin rxn to transdermal (hives, papules) Contraindicated: Substance abuse history, CV disorders, severe anxiety, psychosis, Interactions: MAOIs, caffeine, phenytoin, warfarin, Phenobarbitals, OTC cold & decongestant meds

Selective Serotonin Reuptake Inhibitors (SSRIs)

Paroxetine, sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine For first line panic, trauma disorders & stress related disorders may take up to 4 weeks to work Complications: early (nausea, diaphoresis, tremors, fatigue, drowsy), later (sexual dysfunction, weight gain, headache), weight changes, GI bleeding, hyponatremia, serotonin syndrome, bruxism, w/drawl syndrome Contraindicated: MAOIs, TCAs, alcohol Interactions: TCAs, MAOIs, ST. john's wort can cause serotonin syndrome; warfarin, TCAs, lithium, NSAIDs, anticoagulants

Conversion disorder

Patient exhibits neurologic manifestations in the absence of neurologic diagnosis Risk factor: acute stressors, ptsd, history of depression ect

Monoamine Oxidase Inhibitors (MAOIs)

Phenelzine (Nardil) Isocarboxazid (Marplan) Tranylcypromine (Parnate) Selegiline: transdermal patch Increases norepinephrine, dopamine & serotonin For depression, bulimia nervosa, first-line for atypical depression, panic disorder, anxiety, OCD, ptsd Complications: CNS stimulation, orthostatic hypotension, hypertensive crisis, rash, headache Contraindicated: SSRIs, pheochromocytoma, heart failure, CV & cerebral vascular disease, renal insufficiency, transdermal selegiline -> don't use if they're taking carbamazepine/ oxcarbazepine Interactions: Indirect-acting sympathomimetic meds (ephedrine, amphetamine) -> can lead to hypertensive crisis, TCAS, SSRIs, antihypertensive, meperidine, vasopressors, general anesthetics

Characteristics of dimensions of psychotic disorders

Positive symptoms: hallucinations, delusions, alterations in speech, bizarre behavior (walking backwards) -> these are symptoms that are easily identified Negative symptoms: Affect (no facial expressions), alogia (poverty of thought/speech -> mumble), anergia (lack of energy), anhedonia (lack of pleasure/ joy), avolition (lack of motivation in activities/hygiene)

positive & negative of psychotic disorders

Positive: related to behavior, thought, perception & speech: Agitation, bizarre behavior, delusions, hallucinations, flight of ideas, loose associations Negative: Social w/drawl, lack of emotion & energy, flattened affect, decrease motivation, decrease pleasure in activities

Medication for depression

SSRIs: Citalopram, Fluoxetine, Sertraline Tricyclic antidepressants: Amitriptyline Monoamine oxidase inhibitors: Phenelzine Atypical antidepressants: Bupropion Serotonin norepinephrine reuptake inhibitors: Venlafaxine, duloxetine Alternative/complementary therapies: st johns wort, light therapy Therapeutic procedures: Electroconvulsive therapy, transcranial magnetic stimulation vagus nerve stimulation

Medications for eating disorders

Selective serotonin reuptake inhibitors (Fluoxetine)

SSRI antidepressants

Sertraline, paroxetine First line of treatment for anxiety & OCD

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran For depression, panic disorders, generalized anxiety Complications: headache, nausea, agitation, anxiety, dry mouth, sleep disturbances, hyponatremia (esp w/ diuretics), anorexia, hypertension, sexual dysfunction, suicidal thoughts, serotonin syndrome Contraindicated: MAOIs & St johns wort -> causes serotonin syndrome; cns depression (alcohol, antihistamines, sedatives/ hypnotics; NSAIDs + anticoagulants *Don't use duloxetine in pts w/ hepatic disease/ consumed large amounts of alcohol*

Medications for alcohol withdrawal & abstinence

Withdrawal Diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone Abstinence Disulfiram, Acamprosate, Naltrexone,

Nicotine withdrawal and abstinence medications

Withdrawal -Bupropion -nicotine replacement therapy (nicotine gum/ patches) -varenicline -bupropion Abstinence -Varenicline -Rimonabant

BUN levels increase due to

deyhydration

somatic sympton disorder

disorder in which an individual experiences intense and excessive distress or anxiety focused on physical symptoms to the point where daily life is disrupted Affects ages 16-25

Tricyclic Antidepressants (TCAs)

ends in "ine"/ "in" Amitriptyline, imipramine, doxepin, nortriptyline, amoxapine, trimipramine used to treat depressive disorders, neuropathic pain, fibromyalgia, anxiety disorders, insomnia, bipolar disorder, OCD, adhd Complications: orthostatic hypotension, anticholinergic effects (dry mouth, blurred vison, photophobia, urinary hesitancy/ retention, constipation, tachycardia), sedation, decrease seizure threshold, excessive sweating, increase appetite Contraindicated: in seizure disorders *TCAs can increase risk of suicide* Interactions: Concurrent use with MAOIs -> hypertension, antihistamines & anticholinergic agents, direct-acting sympathomimetics, indirect-acting sympathomimetics, alcohol, benzodiazepines, opioids antihistamines

Benzodiazepines antidote

flumazenil

factitious disorder

reporting false physical & psychological manifestations, & possible evidence of self injury/ injury to others

SNRI antidepressants

venlafaxine, duloxetine For anxiety

A nurse is caring for a client who has major depressive disorder . The client tells the nurse , " feel like going to sleep and never waking up . Which of the following responses should the nurse make ? " You shouldn't talk that way . You have a lot to live for . " "You should think about how that would make your loved ones feel . " " Let's talk about what might be making you feel this way . " " Do you want to go to your room ? You'll feel better later . "

" Let's talk about what might be making you feel this way . "

A nurse is reinforcing teaching about durable power of attorney for health care ( DPAHC ) with a client who has a new diagnosis of Alzheimer's disease . Which of the following statements by the client indicates an understanding of teaching ? " My designee from my DPAHC will make medical decisions if I am unable to ." "I need to have my attorney sign my DPAHC" " I need to select my partner to be my designee in my DPAHC . " " My DPAHC becomes invalid if I become terminally ill . "

" My designee from my DPAHC will make medical decisions if I am unable to ."

A nurse is caring for a client who has paranoid schizophrenia . The client tells the nurse that they believe the assistive personnel are putting poison in the water fountain . Which of the following statements should the nurse make ? " I drink the water every day and do not believe it's poisoned . " " That must be a scary feeling . I want to hear more about your concerns . " " You shouldn't worry about that . No one here wants to hurt you . " "Let's talk about why you came to the facility"

" That must be a scary feeling . I want to hear more about your concerns . "

A nurse is reinforcing discharge teaching with a client who has a new prescription for alprazolam . Which of the following instructions is the nurse's priority to include ? "You should avoid drinking beverages that contain caffeine ." " You should not drive until your reaction to the medication is determined . " " You might need occasional blood tests while taking this medication . " " You should take this medication with a light snack . "

" You should not drive until your reaction to the medication is determined . "

A nurse is caring for a client who has major depressive disorder and recently attempted suicide. The client tells the nurse. I wish were dead. Which of the following responses should the nurse make? "Why are you feeling so sad" "Everyone feels down and out now and then" "Are you thinking hurting yourself " "You should attend the next group therapy session"

"Are you thinking hurting yourself " ?

A nurse is collecting data from a client 2 weeks following the death of a family member . Which of the following statements by the client should the nurse identify as a risk factor for delayed grief ? "i was angry for a while , but lately I've just been sad thinking about the death . " "Our culture expects us to get back to normal life as soon as possible " " We know that they lived a long , full life , and are relieved that they passed away in their sleep . " " I have talked to several people from our spiritual group who lost a loved one . "

"i was angry for a while , but lately I've just been sad thinking about the death . "?

Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5)

-DSM-5 establishes diagnostic criteria for mental health disorders -DSM-5 used to plan, implement, evaluate care for pt w/ mental health disorder -DSM-5 identifies expected findings for mental health disorder

There are two types of mental health hospitalizations:

1) Voluntary commitment 2) Involuntary or civil commitment. Involuntary commitment is against the client's will. Despite that, unless proven otherwise, clients are still considered competent and have the right to refuse treatment.

Thought deletion

A belief that one's thoughts have been taken away by another person or are missing

A nurse is reinforcing teaching with a newly licensed nurse about the difference between delirium and dementia Which of the following statements should the nurse make ? " Dementia has a fast onset period of a few hours to days . " " A client who has dementia has frequent hallucinations . " "Delirium is progressive and is not reversible " "A client who has delirium has an altered level of consciousness . "

A client who has delirium has an altered level of consciousness . "

Agonists

A drug that activates certain receptors in the brain Morphine sulfate, codeine, meperidine (Demerol) are opioid agonists that act on the mu receptors to produce analgesia, respiratory depression, euphoria, & sedation.

Antagonist

A drug that blocks opioids by attaching to the opioid receptors without activating them. Antagonists cause no opioid effect and block full agonist opioids. Ex: naltrexone and naloxone Treats opioids overdose, reversal of effects of opioids, or reversal of respiratory depression in an infant

Antidote for Acetaminophen (Tylenol)

Acetylcysteine (Mucomyst)

Adaptive vs Maladaptive Behavior

Adaptive behavior allows individuals to adapt in a positive manner to various situations Maladaptive behavior can be viewed as a negative form of behavior which harms the individual

All clients should have a Mental Status Exam, which includes:

All clients should have a Mental Status Exam, which includes: -Level of consciousness -Physical appearance -Behavior -Cognitive and intellectual abilities

Defense mechanisms

Altruism: dealing with anxiety by reaching out to others Sublimation: dealing w/ unacceptable feelings/ impulses by unconsciously substituting acceptable forms of expression (ex: gyming) Suppression: voluntarily denying unpleasant thoughts & feelings Repression: Unconsciously putting unacceptable ideas, thoughts, emotions out of awareness Regression: Sudden use of childlike behavior Displacement: shifting feelings related to an object, person, situation to something less threatening Reaction formation: over compensating/ demonstrating opposite behavior of what is felt Undoing: preforming an act to make up for pior behavior Rationalization: creating reasonable & acceptable explanations for unacceptable behavior Dissociation: creating temporary compartmentalization/ lack of connection b/w the person's identity, memory, or how they perceive the environment Denial: pretending the truth is not reality to manage unpleasant anxiety causing thoughts/ feelings Compensation: emphasizing strengths to make up for weaknesses Identification: conscious/ unconscious assumption of characteristics of another individual/ group Intellectualization: separation of emotions & logical facts when analyzing or coping with a situation/event Conversion: responding to stress through unconscious development of physical manifestations not caused by physical illness Splitting: showing an inability to reconcile negative & positive attributes to self/ others Projection: attributing to one's unacceptable thoughts & feelings onto another who doesn't have them

TCAs: Tricyclic Antidepressants.

Amitriptyline (Elavil) Anticholinergic effects + orthostatic hypotension + sedation may occur DONT administer with an MAOI or St. John's Wort. Hint: Anticholinergic effects cause the client to 'dry up', so they have blurred vision, urinary retention, dry mouth, and decreased bowel movements.

Bupropion

Antidepressant For major depressive disorder (MDD), seasonal affective disorder (SAD), and (smoking cessation)

A nurse is caring for a client who has antisocial personality disorder and verbalizes anger toward another client . Which of the following actions should the nurse take first ? Place the client in restraints Set limits on the client's behavior . Place the client in seclusion Administer lorazepam IM

B/C

A nurse is caring for a client who is experiencing severe anxiety . The nurse remains with the client until the client feels calm Which of the following ethical principles is the nurse demonstrating ? Beneficence Autonomy veracity Justice

Beneficence

Atypical antidepressants

Bupropion (Wellbutrin) Side effect= appetite suppression Contact provider if= headache, dry mouth DONT use with pts with seizure disorders

The nurse is caring for a client who states "I really want to stop smoking cigarettes" .The nurse should inform the that which of the following medication is used to assist with smoking cessation ? Buprenorphine Chlordiazepoxide Naltrexone Buprenorphine

C/D

Mental status exam

Can use: -Mini-mental status examination (MMSE) -Glasgow Coma Scale may be used as part of the MSE

Autonomy

Clients right to make up their own decision, however the client must accept consequence of those decisions & client must accept consequence of those decisions

Serotonin Norepinephrine Reuptake Inhibitors.

Common SNRIs: -Venlafaxine (Effexor) -Duloxetine (Cymbalta). Adverse: nausea, weight gain, sexual dysfunction *encourage healthy weight + diet *

Defense mechanisms

Defense mechanisms may be healthy or unhealthy. The nurse should assist the client in developing healthy defense mechanisms such as altruism, sublimation, humor, and suppression.

Antidote for: Digoxin, digitoxin

Digoxin immune Fab (Digibind)

Justice

Fair & equal treatment for all

A nurse is reinforcing teaching with a newly licensed nurse about SSRI medications . Which of the following medications should the nurse include ? ( Select all that apply . ) Fluoxetine Aripiprazole Citalopram Valproic acid Paroxetine

Fluoxetine Paroxetine Citalopram

SSRIs (selective serotonin reuptake inhibitors)

For Major depressive disorder, anxiety disorders SSRIs (selective serotonin reuptake inhibitors): CSF Citalopram (Celexa) Sertraline (Zoloft) Fluoxetine (Prozac) -DONT take with St. John's Wort & alcohol -DONT discontinue suddenly -Eat a healthy diet on these meds

Veracity

Honesty when dealing with a client Telling the truth

A nurse is reinforcing teaching about manifestations of schizophrenia with a newly licensed nurse . Which of the following should the nurse identify as a negative symptom of schizophrenia ? Associative looseness Delusions Auditory hallucinations Lack of energy

Lack of energy

Electroconvulsive therapy (ECT)

Medical treatment used in patients with severe major depression/ bipolar disorder that has not responded to other treatments via electrical simulation of brain

A nurse is collecting data from a client who has mild Alzheimer's disease . Which of the following findings should the nurse expect ? ( Select all that apply . ) Misplaces familiar objects Exhibits bowel incontinence Experiences an inability to recall the names of loved ones Experiences difficulty ambulating Exhibits an inability to perform ADLs

Misplaces familiar objects Exhibits incontinences Experiences an inability to recall the names of loved ones Experiences difficulty ambulating Exhibits an inability to perform ADLs

A nurse is caring for a client who has major depressive disorder and does not wish to take part in a research study that has been recommended by their provider . Which of the following actions should the nurse take ? Support the client's decision not to participate in the study . Suggest that the client speak with their loved ones about the study . Encourage the client to participate in the study Inform the client that the provider has their best interests in mind .

Support the client's decision not to participate in the study .

systemic desensitization therapy

Systematic desensitization is an evidence-based therapy approach that combines relaxation techniques with gradual exposure to help you slowly overcome a phobia

Mini-Mental State Examination (MMSE)

Tests: -orientation to time & place -Attention span & ability to calculate via counting backwards by seven (cognitive ability) -Registration & recalling of objects -Language, including naming objects, following commands and ability to write

A nurse is caring for a client who has Alzheimer's disease . Which of the following factors should the nurse identify as placing the client at risk for Injury ? The client spends several hours each day looking at old photographs The client's personal belongings are labeled . The client has been wandering in the evenings . The client's room is near the nurses station .

The client has been wandering in the evenings .

A nurse is caring for a client who has major depressive disorder . Which of the following findings should the nurse identify as a risk factor for this disorder ? The client reports a traumatic childhood experience . The client's partner has a depressive disorder The client reports exposure to environmental toxins . The client's sex is male .

The client reports exposure to environmental toxins .

A nurse is planning to lead a group therapy session . Which of the following actions by the nurse illustrates a democratic leadership style ? The nurse uses external motivation to encourage the group members The nurse recognizes the group members ' need for autonomy . The nurse determines the policies and direction of the group . The nurse encourages group decision -making .

The nurse determines the policies and direction of the group .

Disulfiram (Antabuse)

Treats chronic alcoholism It causes unpleasant effects when even small amounts of alcohol are consumed. The effects include flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety.

Benificence

The quality of doing food can be described as charity

Antianxiety medications

Treats anxiety + panic disorders Alprazolam (Xanax) Buspirone (BuSpar) Diazepam (Valium) Lorazepam (Ativan) (Hint: lams and pams are Antianxiety medications) -Use cautiously in clients with a history of substance abuse and liver disorder. -Buspirone should not be used with MAOIs.

Antipsychotic medications The mnemonic SEA TANS can help remember side and adverse effects of antipsychotic:

Treats schizophrenia and psychosis Conventional or atypical -Conventional= Chlorpromazine (Thorazine) -Atypical= Aripiprazole (Abilify) Use cautiously in pts with BPA & glaucoma

A nurse is caring for a client who has binge eating disorder . The nurse should monitor the client for which of the following complications ? Dental caries Type 2 diabetes mellitus Orthostatic hypotension Hypokalemia

Type 2 diabetes mellitus

Comatose

Unconscious doesn't respond to stimuli -Decorticate rigidity -Decerebrate rigidity

A nurse is collecting data from a client who has major depressive disorder . Which of the following data about the client's current status should the nurse identify as a risk factor for suicide ? Marriage Unemployment Pregnancy Religious affiliation

Unemployment ?

A nurse is contributing to the plan of care for a client who has paranoid personality disorder and a new prescription for ciprofloxacin to treat a urinary tract infection . Which of the following interventions should the contribute to the client's plan of care ? Use simple language when talking to the client . Rotate the assignments of staff members working with the client . Mix the client's antibiotic with food . Limit the client's opportunities to socialize .

Use simple language when talking to the client . ?

Psychobiological intervention

Via monitoring for adverse effects of medication

Antidote for Warfarin (Coumadin)

Vitamin K

A nurse in an outpatient therapy clinic is collecting data from a client who is experiencing mild anxiety . Which of the following findings should the nurse expect ? Selective inattention Urinary frequency Sharpened reality perceptions Voice tremors

Voice tremors

Tangentiality

When a client changes topics frequently when talking; it occurs frequently in clients who have psychosis.

A nurse is collecting data from a client who has a new prescription for disulfiram . Which of the following information is the priority for the nurse to obtain before administering this medication ? Whether the client has the desire to discontinue alcohol use Whether the client has a history of cardiovascular disease Whether the client has consumed alcohol in the past 12 hr Whether the client has a history of liver disease

Whether the client has consumed alcohol in the past 12 hr

A nurse is reinforcing teaching about aversion therapy with a client who has alcohol use disorder . Which of the following client statements indicates an understanding of the teaching ? " I will watch my therapist model good behavior in situations where alcohol is involved . " " I will receive a small reward every time I avoid drinking alcohol . " " I will be exposed to pictures and videos of people drinking alcohol . " " I will take a medicine daily that will make me sick if I drink alcohol . "

c/d

Undoing

denial which is escaping unpleasant or anxiety-causing thoughts or feelings by ignoring their existence.

Antidote for Insulin-induced hypoglycemia

glucagon

A nurse is reinforcing teaching with a newly licensed nurse about the manifestations of opioid withdrawal . Which of the following manifestations should the nurse include in the teaching ? ( Select all that apply . ) Hypotension Rhinorrhea Drowsiness Hyperreflexia Diaphoresis

hypotension Rhinorrhea Diaphoresis Hyperreflexia

Splitting

inability to combine both positive and negative qualities of an individual

Fidelity

loyalty and faithfulness to client and to one's duty (keeping a promise) ex: promising to do something and sticking to that promise

Lithium

mood stabilizer (bipolar disorder)

Confabulation

the unintended false recollection of episodic memories, the act of filling in memory gaps (Alzheimer's pt stating they just got home from work)

chlorpromazine

typical antipsychotic -adverse effect: amenorrhea, gynecomastia (over production of breast tissue)

Repression

unconscious forgetting of an unpleasant/ unwanted experience/ emotion

Sublimation

unconscious mechanism of substituting an unacceptable impulse with one that is acceptable

A nurse Is reinforcing dietary teaching with a client who has schizophrenia and a new prescription for quetiapine. Which of the following statements should the nurse include in the teaching ? "Eat foods such as rice and bananas to prevent diarrhea . "Eat foods low in calories and sugar to prevent weight gain "You should consume a diet low in protein to prevent jaundice." "you should restrict fluid intake to prevent high blood pressure ."

"Eat foods low in calories and sugar to prevent weight gain

A nurse is reinforcing teaching about electroconvulsive therapy with a client who has major depressive disorder . Which of the following statements should the nurse identify as an indication that the client understands the information? " I might continue to have seizures for 2 hours after the procedure . " "I will wake up about 1 hour after the procedure . " "I might have some memory loss for 2 weeks after treatment . " "I will receive two treatments each day for 1 week . "

"I might have some memory loss for 2 weeks after treatment . "

A nurse is reinforcing teaching about methylphenidate with an adolescent who has ADHD . Which of the following statements should the nurse identify as an indication that the client understands the instructions ? "I should take my medication 1 hour before bedtime ." "I should decrease my daily intake of caffeine . " " I should decrease my calorie intake at each meal . " " should expect to gain weight while taking this medication . "

"I should decrease my daily intake of caffeine . "

Mental status exam

-Cognitive (counting back by 7/asking pt to identify president) -Check affect (via observing facial expression) -Check language ability (instruct to write a sentence) -Check Immediate memory (asking pt to repeat list of objects -Check remote memory via (ask pt to tell bday/moms name)

Memory

-Immediate: ask them to do something -Recent:/ Recall = ask how they got to the apt or what apt is for -Remote memory: ask pt to state birthday/ mothers middle name

Schizophrenia

-Impacts thinking, behavior,& ability to perceive reality --Types: paranoid, disorganized, catatonic, and residual --Sudden behavior changes in late teens, early 20s with hallucinations or delusions, profound withdrawal, or bizarre mannerisms should be evaluated by a provider.

Anxiety disorders

Anxiety Disorder, Panic Disorder, Phobias, Obsessive Compulsive Disorder, Posttraumatic stress disorder (PTSD) -Collect data risk factors, triggers, and responses -Untreated anxiety may become severe and lead to panic-level and severe behavior changes.

A nurse is caring for a client who has Parkinson's disease and is taking carbidopa - levodopa . The nurse should report which of the following laboratory findings to the provider ? Hemoglobin ( Hgb ) 15 g / dL Blood urea nitrogen ( BUN ) 20mg / dL Fasting blood glucose 100mg / dL Aspartate aminotransferase ( AST ) 42 units/L

Aspartate aminotransferase ( AST ) 42 units/L

Antidote for : Muscarinic agonists, cholinesterase inhibitors -Bethanechol (Urecholine) -Neostigmine (Prostigmin)

Atropine

A nurse in a mental health facility is caring for a client who witnessed the death of their child . The client does not recall the event and tells the nurse that their child is fine . The nurse should identify that the client is demonstrating which of the following defense mechanisms ? Displacement Projection Denial Regression

Denial

A nurse is contributing to the plan of care for a client who has oppositional defiant disorder and has outbursts of profanity toward others. Which of the following interventions should the nurse include ? Encourage physical activity during times of agitation . Obtain a PRN prescription for restraints . Reassure the client by touching their arm . Discipline the client for verbal outbursts .

Discipline the client for verbal outbursts .

Lithium carbonate (lithium)

For bipolar disorder Therapeutic level for lithium = 0.4-1.0 mEq/L Maintain sodium lvls to avoid profound deydration Side effects: Fine hand tremors, polyuria, weight gain, renal toxicity

HDL (High Density Lipoprotein) vs LDL

HDL helps rid your body of excess cholesterol= good LDL is called "bad cholesterol" because it takes cholesterol to your arteries, where it may collect in artery walls. Too much cholesterol in your arteries may lead to a buildup of plaque known as atherosclerosis.

Disulfiram (Antabuse)

Helps maintain alcohol abstinence, changes how alcohol is metabolized in the body Warfarin and phenytoin doses should be adjusted and therapeutic levels monitored Advise client to not drink during therapy, and all alcohol must be out of blood stream prior to first dose.

A nurse is collecting data from a client who is taking sertraline . Which of the following findings should the nurse identify as the priority to report to the provider ? Insomnia Dry mouth Paresthesia Hyperpyrexia

Hyperpyrexia

A nurse is collecting data from a client who takes haloperidol . Which of the following findings should the nurse identify as the priority ? Dry mouth Blurred vision Lip smacking Muscle rigidity

Muscle rigidity

A nurse is assisting with a mental status examination of a client . Which of the following factors should the nurse use to help evaluate the client's cognitive level ? Affect Abnormal movements Orientation to time Level of hygiene

Orientation to time

MAOIs: Monoamine Oxidase Inhibitors.

Phenelzine (Nardil) Hypertension crisis -> if taken with tyramine food Contract provider when taking any other meds with this class of meds

Antidote for: Anticholinergic drugs -Atropine

Physostigmine (Antilirium)

A nurse assisting with the admission of a client to a mental health facility . Which of the following interventions demonstrates the working phase of the nurse - client relationship ? Identify the client's needs for treatment . Discuss coping methods the client can use in everyday life . Summarize goals for the client to achieve . Promote the client's problem - solving skills .

Promote the client's problem - solving skills .

Antidote for heparin

Protamine sulfate

perseveration

Repeating of words/ behaviors that worsens with stress & can occur in clients who are experiencing dementia

A nurse is contributing to the plan of care for an adolescent who has conduct disorder . Which of the following interventions should the nurse recommended to include in the plan ? Set firm limits on the adolescent's manipulative behavior . Instruct the adolescent about thought - stopping techniques . Determine if the adolescent is experiencing command hallucinations Monitor the adolescent's cognitive status daily .

Set firm limits on the adolescent's manipulative behavior . ?

Adverse effects of antipsychotic: The mnemonic SEA TANS

Side Effects: S - sedation E - EPS A - anticholinergic effect Adverse Effects: T - tardive dyskinesia A - agranulocytosis N - neuroleptic malignant syndrome S - seizures