Mental Health Exam 2

What are important assessment points for a suicidal patients?

§ 1. Identify risk factor: Note those that can be modified to reduce risk. § 2. Identify protective factor: Note those that can be enhanced. § 3. Conduct suicide inquiry: Evaluate suicidal thoughts, plans, behavior, and intent. § 4. Determine risk level and intervention: Choose appropriate intervention to address and reduce level of risk. § 5. Document: Record assessment of risk, rationale, intervention, and follow-up.

What are the differences between the sympathetic and parasympathetic nervous system?

· Divisions of autonomic nervous system o Sympathetic division: Dominant in stressful situations and prepares the body for fight or flight; results in an increase in heart rate and respirations; blood shunted to vital organs and to muscles, dilate pupils o Parasympathetic division: Dominant in relaxed situations; results in a normal heart rate and promotes elimination functions

The nurse is caring for a client who returned 30 minutes ago from having Electroconvulsive Therapy (ECT). The nurse would expect to find: o A confusion o B seizures o C hypertension o D tachypnea

A Confusion It is common for a client after ECT to experience confusion, low blood pressure, headache, nausea, and short-term memory loss of events just prior to the treatment. A seizure is induced and expected with the procedure. Vital signs should not be elevated. There should be no tachypnea.

Which of the following best defines secondary depression? o A Depressive symptoms that occur as a consequence of an adverse side effect of certain medications. o B Depressive symptoms as a result of MDD exacerbation and elevated serotonin levels. o C Depressive symptoms that occur as a result of psychomotor retardation. o D Depressive symptoms that occur with abrupt discontinuation of antidepressants.

A Depressive symptoms that occur as a consequence of an adverse side effect of certain medications.

What is the priority reason for the nurse to perform a full physical health assessment on a client admitted with a diagnosis of Major Depressive Disorder? o A Depression is a symptom of several medical conditions o B Physical health complications are likely to arise from antidepressant therapy o C Depressed clients avoid addressing physical health and ignore medical problems o D The attention during the assessment is beneficial in decreasing social isolation

A Depression is a symptom of several medical conditions Depression can also be seen in other conditions. It could be related to medication side effects, neurological disorders, electrolyte or hormonal disturbances, nutritional deficiencies, and other physiological or psychological conditions. It is important to assess and identify whether the depression is only due to MDD or could be cause by other cases as well.

A nurse in a community health clinic is working with a client that relocated from Florida to Anchorage. The client reports fatigue, loss of joy in hobbies and wants to know why this is happening. What should the nurse say to the client? o A "Have you experienced these symptoms before?" o B "It is common to be stressed with a life change such as a move." o C "This is seasonal affective disorder, it will resolve." o D "Have you taken antidepressants in the past?"

A "Have you experienced these symptoms before?" The nurse cannot diagnose a client. This client is most likely experiencing SAD but the assessment must be completed in full to rule out other types of depression. Option B is an example of giving an opinion. Option C is the nurse diagnosing the client, which is not within a nurse's scope. Option D is assuming right away that the patient has been previously diagnosed in the past.

The nurse is caring for a client with bipolar disorder on the psychiatric unit. Which statement made by the client would be of most concern to the nurse? o A "I won't be here tomorrow for you to worry about." o B "I feel a little bit blue today." o C "I wish I could go home tomorrow." o D "I hate that I have to be here again."

A "I won't be here tomorrow for you to worry about.": This statement is an indirect clue of suicidal thought and planning and should be reported to the provider. "I feel a little bit blue today.": This statement may be a concern but may be the reason the patient is in an inpatient facility. It is not the most concerning. "I wish I could go home tomorrow.": This statement is not concerning; most patients likely want to go home. "I hate that I have to be here again.": This statement is not concerning because it does not suggest suicidal ideation or self-harm.

A nurse is caring for a geriatric patient who within the last two hours has developed delirium.. Which statement indicates the correct etiology? o A "Taking multiple medications may lead to adverse interactions or toxicity." o B "Age-related cognitive changes may lead to alterations in mental status." o C "Lack of rigorous exercise may lead to decreased cerebral blood flow." o D "Decreased social interaction may lead to profound isolation and psychosis."

A "Taking multiple medications may lead to adverse interactions or toxicity." Taking multiple medications may lead to adverse reactions or toxicity and put an older adult at risk for the development of delirium. Symptoms of delirium include difficulty sustaining and shifting attention, impaired memory, and confusion (disorientation to time and place).

The charge nurse received laboratory data for clients in the psychiatric unit. Which client data warrant notifying the psychiatric healthcare provider? o A A client on lithium (Eskalith) whose serum lithium level is 2.0 mEq/L. o B A client on clozapine (Clozaril) whose white blood cell count is 8000 mm3 o C The client on methadone whose potassium level is 4.0 mEq/L.. o D The client on valproic acid (Depakote) whose serum depakote level is 122 µg/mL.

A A client on lithium (Eskalith) whose serum lithium level is 2.0 mEq/L. The client with a lithium level of 2 is at a toxic level and will need emergent action by the healthcare team to prevent death. Normal lithium level: approximately 0.6 to 1.2 mEq/L; anything above that is considered toxic and can be life threatening

A nurse in a psychiatric unit is caring for several clients. Which of the following clients should the nurse recommend for group therapy? o A A client who has been taking risperidone for 6 months for schizophrenia o B A client who recently exhibited psychotic behavior o C A client admitted 12 hours ago for acute mania o D A client who is experiencing alcohol withdrawal hallucinations

A A client who has been taking risperidone for 6 months for schizophrenia Able to distinguish which patient would be appropriate for group therapy and receive the most beneficial session. Most likely, the patient who has been taking an antipsychotic for 6 months will be more appropriate to participate in groups compared to the others who are obviously unstable. Source(s): Skills discussions regarding therapeutic communication, textbook and ATI

Which nursing intervention strategy is most important to implement initially with a suicidal client? o A Ask a direct question such as, "Do you ever think about killing yourself?" o B Ask client, "Please rate your mood on a scale from 1 to 10." o C Establish a trusting nurse-client relationship. o D Apply the nursing process to the planning of client care.

A Ask a direct question such as, "Do you ever think about killing yourself?" The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan. The other responses do not help assess suicide risk.

· A client on an inpatient unit is diagnosed with Bipolar Disorder: Manic Episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. Which should be the nurse's initial intervention? o A Assist the client to move to a calmer location. o B Ask the group to take a vote on alternative weekend events. o C Remind the client to quiet down or leave the dayroom immediately. o D Discuss with the client impulse control problems.

A Assist the client to move to a calmer location. The nurse's initial action should be to move the client to a calmer environment as overstimulation can exacerbate symptoms of acute mania. The client's agitation and extreme hyperactivity place the client and others at risk for injury. The nurse's priority is always safety.

A nurse is admitting a patient who has been diagnosed with a bipolar disorder in the clinical setting. When the nurse questions the client regarding their admission, the client states, "I'm going to bed, feeling red, in my head, I feel dead!" The nurse should document the client's speech pattern as which of the following? o A Clang association o B Appropriate o C Echolalia o D Pressured speech

A Clang association Clang associations occur when words are grouped based on sounds that have similar characteristics, though they have no logical cause for being grouped together.

The client diagnosed with Bipolar I Mania, is being admitted to an inpatient psychiatric facility. Which signs and symptoms would the nurse expect the client to exhibit? o A Flight of ideas, extreme hyperactivity, and sleep disturbances o B Feeling of well being, feeling on a high, and talkativeness o C Calm and cooperative o D Irritable, anxious and makes suicidal gestures

A Flight of ideas, extreme hyperactivity, and sleep disturbances To be admitted to an inpatient unit, the symptoms must be severe enough and should interfere with daily functioning. B suggests hypomania and would not require hospitalization. C may indicate an appropriate behavior and D may indicate depression and does not warrant enough data to hospitalize patient right away.

A nurse is caring for a 17-year-old client with bipolar disorder. The client is standing is talking to another client stating, " I had ice cream for dinner last night. I like you sweater, James is a nice person, I think I forgot to brush my teeth this morning." The nurse recognizes the client is demonstrating which characteristic of bipolar disorder. o A Flight of ideas o B Reality questioning o C Derealization o D Grandiosity E Depression

A Flight of ideas. Flight of ideas is represented by the clients inability to stay on topic. The client rapidly moves from one topic to another.

A nurse suspects that the client is experiencing delirium. What manifestations might the client present with? (Select all that apply) o A Hyperactivity o B Agitation o C Hallucinations o D Increased Focus o E Anxiety

A Hyperactivity, B Agitation, C Hallucinations, E Anxiety. Delirium is an abrupt change in the brain that causes mental confusion and emotional disruption. It makes it difficult to think, remember, sleep, pay attention, and more. You might experience delirium during alcohol withdrawal, after surgery, or with dementia. Nursing assessment of the client with delirium will reveal either hyperactivity and agitation or apathy with a decrease in activity and hallucinations may occur.

A nurse is planning care for a newly admitted client diagnosed with Bipolar Type 1: Currently Manic without Psychosis. Which of the following choices will be a priority action by the nurse? o A Offer frequent high-calorie snacks and drinks. o B Encourage the client to join a group therapy session. o C Allow the client to play basketball with other patients in the gym. o D Educate the client about his prescribed medications.

A Offer frequent high-calorie snacks and drinks. Since most of the time they are in motion, you can give them high-calorie snacks and drinks, specifically finger foods if necessary. It will replenish the energy they've been using and also satisfy their needs temporarily

A client with a diagnosis of dementia is found in the hospital cafeteria attempting to work in the kitchen. What is the nurse's first priority? o A Perform physical assessment o B Document wandering o C Notify family D Fill out an incident report

A Perform physical assessment Always assess first. This client should receive a physical assessment to ensure that they were not injured while wandering. All charting should be completed after assessment in real time. The family should be notified and then an incident report documented.

Which sign/symptom is most important when assessing the client diagnosed with Major Depressive Disorder? o A The client does not find pleasure in life. o B The client is unable to concentrate. o C The client does not have any energy. o D The client is unable to stay asleep.

A The client does not find pleasure in life. The most significant sign of depression is a loss of pleasure in life. The others are symptoms but not the most important

· Which sign/symptom is most important when assessing the client diagnosed with Major Depressive Disorder? o A The client does not find pleasure in life. o B The client is unable to concentrate. o C The client does not have any energy. o D The client is unable to stay asleep.

A The client does not find pleasure in life. The most significant sign of major depressive disorder is a loss of pleasure in life. The others are symptoms but not the most important.

The nurse says to a newly admitted client, "Tell me more about what led up to your hospitalization." What is the purpose of this therapeutic communication technique? o A To explore a subject, idea, experience, or relationship o B To reframe the client's thoughts about mental health treatment o C To put the client at ease o D To communicate that the nurse is listening to the conversation

A To explore a subject, idea, experience, or relationship This is an example of the therapeutic communication technique of exploring. The purpose of exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? SATA or Select all that apply A Install extra locks at the top of exit doors. B Place rugs over electrical cords C Put cleaning supplies on a shelf D Place the client's mattress on a low bed frame or the floor E Install light fixtures above stairs

A, D, E Install extra locks at the top of exit doors. Place the client's mattress on a low bed frame or the floor, Install light fixtures above stairs

The nurse is teaching a client who is being started on Imipramine (Tofranil) about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication? o A During the first week. o B In 2 - 3 weeks. C During the sixth week. o D In 2 months.

B In 2 - 3 weeks. Imipramine medication teaching: antidepressant and nerve pain medication; The maximum therapeutic effects of imipramine may not occur for 2-3 weeks after the medication has been initiated.

What foods should a patient avoid while on MAOIs?

Aged cheese, Overripe fruits, Alcohol, Tenderized meats, spoiled food, soybeans, cured meats, pickled food

What are the names of benzodiazepines?

Alprazolam, lorazepam, diazepam, triazolam, clonazepam, temazepam, midazolam

What are important teaching points with cholinesterase inhibitors?

Alzheimer drugs that takes weeks before reaching effectiveness Do not discontinue abruptly Remember: it does not stop/cure Alzheimer's o e.g., donepezil, rivastigmine, and galantamine) act by inhibiting acetylcholinesterase, which slows the degradation of acetylcholine, thereby increasing concentrations of the neurotransmitter in the brain. Most common side effects include anorexia, dizziness, gastrointestinal upset, fatigue, and headache.

· If Lithium doesn't work or is too much to the patient, what is the drug classification that can be offered to the patient as a 2nd choice for mood stabilization

Anticonvulsants

What are important education points with valproic acid?

Anticonvulstant/mood stabilizer o Valproic Acid (Depakote); therapeutic level 50 to 120 mcg/mL Refrain from discontinuing the drug abruptly. Report the following symptoms to the physician immediately: unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine, and yellow skin or eyes. Do not drive or operate dangerous machinery. Avoid using alcohol and over-the-counter medications without approval from physician. WOF rash = lamotrigine = Stevens Johnson

· A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply.) A Lithium carbonate (mood stabilizer) B Paroxetine (antidepressant) C Risperidone (antipsychotic) D Haloperidol (antipsychotic) E Lorazepam (anxiolytic)

B -Paroxetine (antidepressant) E- Lorazepam (anxiolytic) SSRI antidepressants (paroxetine) may be prescribed to decrease the anxiety and depression of a client who is experiencing a crisis. Benzodiazepines (lorazepam) may be prescribed to decrease the anxiety of a client who is experiencing a crisis.

Hospitalized and diagnosed in the fourth stage of NCD due to AD, a client, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the client exhibiting? A Aphasia B Confabulation C Delirium D Apraxia

B Confabulation is a behavioral reaction to memory loss in which the patient fills in memory gaps with information about events that have not occurred. During the fourth stage of AD, a patient will use confabulation in an effort to maintain self-esteem

The nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement provides supportive evidence of this symptom? o A "I can't stop my sexual urges. They have led me to numerous affairs." o B "I'm the world's most perceptive attorney." o C "My wife is distraught about my overspending." o D "The FBI is out to get me."

B "I'm the world's most perceptive attorney." The statement, "I'm the world's most perceptive attorney," indicates the client is experiencing delusions of grandeur. Hallucinations and delusions (usually paranoid and grandiose) are common symptoms during acute mania. Grandiosity is defined as an unrealistic sense of superiority

· A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates learning has occurred? o A "This disorder is more prevalent in lower socioeconomic groups." o B "This disorder is more prevalent in higher socioeconomic groups." o C "This disorder is equally prevalent in all socioeconomic groups." o D "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups."

B "This disorder is more prevalent in higher socioeconomic groups." According to studies, bipolar disorder is more prevalent in higher socioeconomic groups.

A family member is receiving education about the prescription of memantine (Namenda) for the client. The nurse recognizes a lack of understanding when the caregiver states: o A "This medication will slow the death of the brain cells" o B "This drug will stop the progression of dementia" o C "This medication will require me to watch for dizziness" o D "We can continue to give the donepezil while on this medication"

B "This drug will stop the progression of dementia" This drug will slow but not stop the progression of dementia (no cure). The client can receive this medication while titrated off of another dementia medication.

A client diagnosed with Posttraumatic Stress Disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? o A "What occurred prior to the rape, and when did you go to the emergency department?" o B "What would you like to talk about?" o C "I notice you seem uncomfortable discussing this." o D "How can we help you feel safe during your stay here?"

B "What would you like to talk about?" The nurse's statement "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

A client is scheduled for an initial ECT procedure. Which information will the nurse include when teaching about the potential side effects of ECT? o A "You may experience transient tangential thinking." o B "You may experience some memory deficit surrounding the ECT." o C "You may experience some nausea and vomiting." o D "You may experience a higher risk for subsequent seizures."

B "You may experience some memory deficit surrounding the ECT." The most common side effect of ECT is temporary amnesia following the ECT procedure. Side effects after ECT procedure: Confusion, nausea, short term memory loss/deficit (most common), headache, low blood pressure, shallow breathing

The client diagnosed with Major Depressive Disorder is crying and tells the nurse, "I just don't find any pleasure in life." Which priority intervention should the nurse implement? o A Administer the client's antidepressant medication. o B Offer support by sitting quietly with the client. o C Recommend the client join a support group. o D Encourage the client to exercise daily.

B Offer support by sitting quietly with the client. Sitting quietly with the client offers the support, allows nurse to further assess patient, and can be done right away before performing other interventions. Antidepressant medication take 2-3 weeks to become therapeutic and offering it can be done after assessment. A support group and exercise are appropriate interventions, but the priority is to support the client.

Of the following evaluation criteria, which should the nurse assign as the most important when planning care for a client with dementia? o A Ensuring the client is medication compliant o B Preventing unsupervised wandering o C Preventing further deterioration o D Finding suitable respite care for the family

B Preventing unsupervised wandering. Establishes priority with nursing goals and interventions related to dementia patients. Safety will be the priority. With this client the dangerous of the options is wandering. The other options will be addressed in the POC, and further deterioration is inevitable

The outcome that should be established for an elderly patient with delirium caused by fever and dehydration is that the patient will: o A Demonstrate motor responses to noxious stimuli o B Return to a premorbid level of functioning o C Identify stressors negatively affecting self o D Exert control over responses to perceptual distortions

B Return to a premorbid level of functioning Delirium is an acute phenomena. A nursing priority is to determine what caused the delirium, intervene right away, and return to the premorbid level of functioning.

An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which is the nurse's priority intervention? o A Avoid reinforcement of the behavior o B Set firm limits on the behavior o C Initiate forced-medication protocol o D Help the client to explore the source of anger

B Set firm limits on the behavior. The priority nursing intervention is to set firm limits on the client's behavior. Ignoring the behavior may further upset the client and does not reinforce appropriate behavior.

A nurse is communicating with a client who is cognitively impaired. Which of the following approaches would be best? o A Loud and precise o B Simple and direct o C As nonverbal as possible o D Slow and direct

B Simple and direct. most efficient way and appropriate way to talk to patients with cognitive impairment is through simple and direct communication. Clients with cognitive impairment benefit from statements made one at a time and directions that are simple. The nurse must take care to maintain the client's dignity by treating them as age appropriately as possible throughout the interaction.

· A client is newly admitted to an inpatient psychiatric unit. Which of the following is the most critical assessment when determining risk for suicide? o A Family history of depression o B The client's history of suicide attempts o C The client's orientation to reality o D Family support systems

B The client's history of suicide attempts. Suicide risk is higher for individuals who have made previous suicide attempts. About half of individuals who kill themselves have previously attempted suicide

A client is newly admitted to an inpatient psychiatric unit. Which of the following is the most critical assessment when determining risk for suicide? o A Family history of depression o B The client's history of suicide attempts o C The client's orientation to reality o D Family support systems

B The client's history of suicide attempts. Suicide risk is higher for individuals who have made previous suicide attempts. About half of individuals who kill themselves have previously attempted suicide.

· A suicidal client with a history of manic behavior is admitted to the emergency department. The client's diagnosis is documented as bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder? A The physician does not believe that the patient is suffering from major depression. B The patient has experienced a manic episode in the past. C The patient does not exhibit psychotic symptoms. D There is no history of major depression in the patient's family.

B The patient has experienced a manic episode in the past. The patient's past history of mania and current suicide attempt support the diagnosis of Bipolar I Disorder: Current Episode Depressed. According to the DSM-5 criteria, a manic episode rules out the diagnosis of Major Depressive Disorder

A client diagnosed with Bipolar I Disorder: Manic Episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders? o A Sertraline o B Valproic acid o C Trazodone D Paroxetine

B Valproic acid (Depakote) is an anticonvulsant. For many years, the drug of choice for treatment and management of bipolar mania was lithium carbonate; however, in recent years, anticonvulsant drugs have been found to have mood-stabilizing effects, either alone or in combination with lithium. Sertraline (Zoloft) and paroxetine (Paxil) are selective serotonin reuptake inhibitors (SSRIs) and have the potential to initiate a manic episode. Trazodone (Desyrel) is a sedative hypnotic/antidepressant

A client in the moderate stage of dementia is experiencing embarrassment with bathing. What action can the nurse take to alleviate the client's embarrassment? o A Bathe the client in the evening o B Wash the client under a bath blanket o C Instruct the client to cover their eyes to avoid embarrassment o D Perform perineal care quickly

B Wash the client under a bath blanket Protecting the client's dignity is very important in the plan of care. The most appropriate of the options listed is to have the client covered.

SC is a client in the clinic today with a diagnosis of Bipolar II, depressive episode. The nurse knows that characteristics of Bipolar II include which symptoms? Select all that apply o A extreme manic episodes o B depression o C hypomanic episodes o D suicidal ideation o E uncontrolled yelling that needs emergency medications

B depression, C hypomanic episodes, D suicidal ideations Options A & E: Manic episodes and uncontrolled yelling are examples of manifestations of mania. Bipolar II patients are those that have experienced/met criteria for minor depression, major depression, and hypomania except full blown mania.

What are signs and symptoms of Bipolar 1 disorder?

Bipolar disorder is characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy. Delusions or hallucinations may or may not be part of clinical picture. Onset of symptoms may reflect seasonal pattern. Diagnosis requires that the patient: Is experiencing a manic episode or has a history of one or more manic episodes (lasting at least 1 week) causing marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others May have also experienced episodes of depression Diagnosis is further specified by the current or most recent behavioral episode. The specifier might be single manic episode or current episode manic, hypomanic, mixed, or depressed. Psychotic or catatonic features may also be present

A nurse is educating a patient family member who has just recently been prescribed lamotrigine for the first time. Which response by the family member indicates the teaching was successful? o A " I will notify my provider family member's provider if he requires the need for glasses" o B "I will keep an eye on him for any fine hand tremors" o C " I should be on the look out for rashes" o D " He should come in for weekly blood draws"

C " I should be on the look out for rashes"

Which assessment data suggests a person who appears to have dementia instead has depression and Pseudodementia? o A Demonstrates proper judgement o B Demonstrates increased concentration o C An abrupt onset of confusion and forgetfulness o D Cognitive changes preceded mood changes

C An abrupt onset of confusion and forgetfulness Rationale for Correct Answer: Dementia is usually chronic and progressive. Pseudodementia is acute and can be defined as a condition wherein symptoms of depression are often misdiagnosed as a neurocognitive disorder (NCD) such as memory loss, confused thinking, or apathy.

A nurse is developing a plan of care for a suicidal client. Which documented intervention should the nurse implement first? o A Observe the client. o B Provide a hazard-free environment. o C Assess suicide risk. o D Communicate therapeutically.

C Assess suicide risk. Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment should always be the first step taken when working with depressed or suicidal patients. All the other interventions can be done after risk is assessed.

A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide? o A Encouraging participation in the milieu to promote hope o B Developing a strong personal relationship with the client o C Observing the client at intervals determined by assessed data o D Encouraging and redirecting the client to concentrate on happier times

C Observing the client at intervals determined by assessed data. The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors.

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. Which is the nurse's priority intervention at this time? o A Obtaining an order for locked seclusion until the client is no longer suicidal o B Conducting 15-minute checks to ensure safety o C Placing the client on one-to-one observation while monitoring suicidal ideations o D Encouraging client to express feelings related to suicide

C Placing the client on one-to-one observation while monitoring suicidal ideations Client safety is always the nurse's priority. Every 15-minute checks is usually a standard protocol for all, not only for suicidal patients. Seclusion or restraints are always considered to be last resort measures and when patient is currently harming self/others. The nurse must place the client on one-to-one observation and continue to monitor suicidal ideation since there is a high risk for SI/HI due to command auditory hallucinations. Encouraging client to express feelings can be done but will not be a priority.

The nurse identifies which symptom is not a typical of the fight-or-flight response? o A Decreased Salivation o B Increased Heart Rate o C Pupil Constriction o D Slowed Gastric Motility

C Pupil Constriction During the fight-or-flight response, the heart rate increases in response to the release of epinephrine. Pupils dilate to enhance vision

The nurse notices that Martha, the primary caregiver for her spouse with Alzheimer's disease, seems distracted, and she asks how Martha is doing. "I'm doing OK," said Martha. "I'm just so overwhelmed. I can't seem to get anything done. Just when I think I'm handling everything, something else comes up. Hopefully things will settle down soon, and I can get a break." Which intervention would most help Martha cope with the caregiver strain she's expressing? o A Information about the management of Alzheimer's disease o B Recommending an Alzheimer's-friendly residence facility o C Referrals to support services for Alzheimer's disease

C Referrals to support services for Alzheimer's disease There are several support services available for caregivers of clients with Alzheimer's disease. These include financial assistance, legal assistance, caregiver support groups, respite care, and home health care. All of these support services would help Martha deal with the caregiver strain she is experiencing. Although educating and recommending facilities may ease the strain she is experiencing, it may not be necessary and could add additional strain in terms of finances, guilt, travel, and so forth

A client and a nurse therapist are developing a treatment plan that includes strategies to manage bipolar disorder. Which of the following should not be included? Select all that apply. o A Develop an emergency plan o B Maintain a consistent sleep schedule o C Set a time frame to achieve cure or remission o D Create a daily medication schedule o E Set goals to taper off and eventually stop medications

C Set a time frame to achieve cure or remission E Set goals to taper off and eventually stop medications Clients and families should understand that a process recovery treatment plan should not be confused with a promise of a "cure" or "remission." One strategy to help the individual with bipolar disorder take control of and manage their illness is to take medications regularly. The nurse and client should not make plans to adjust and/or stop medications, that is not an appropriate nursing action and not within the scope of nurses.

Which part of the nervous system should a nurse identify as playing a major role during stressful situations? o A Peripheral nervous system o B Somatic nervous system o C Sympathetic nervous system o D Parasympathetic nervous system

C Sympathetic nervous system The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

The nurse is assessing a client who has a diagnosis of Schizophrenia and takes an antipsychotic agent daily. Which finding requires further nursing assessment? o A Respirations of 22 beats/minute o B Weight gain of 8 pounds in 2 months o C Temperature of 101°F o D Excess salivation

C Temperature of 101°F An elevated body temperature is a sign of an infectious process. Clients taking antipsychotic medications may acquire agranulocytosis, which is characterized by a significant decrease in the WBC count and reduced immunity.

A nurse is making a home visit to a client who is in the late stages of AD. The client's partner, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following actions should the nurse take? A Verify that a current power of attorney is on file B Instruct the client's partner to offer finger foods to increase oral intake C Provide information on resources for respite care (short term relief for primary caregivers; can provide assistance at home, facility, or day care center) D Schedule the client for placement of an enteral feeding tube

C- Provide information on resources for respite care (short term relief for primary caregivers; can provide assistance at home, facility, or day care center)

A nurse is discussing family history with a client admitted for Major Depressive Disorder (MDD). Which response by the client indicates need for further education? o A " There is no single theory to explain my depression" o B "Currently, the transactional model combines genetic, biological and psychosocial influences" o C " I have this disorder because of my strong family history of depression" o D " Being raised in poverty increases my risks for depression"

C. "I have this disorder because of my strong family history of depression"

A client has recently been diagnosed with mild to moderate NCD due to AD. Which medication would the nurse expect the physician to order for this client's cognitive impairment? A Nortriptyline (Pamelor) B Zaleplon (Sonata) C Donepezil (Aricept) D Quetiapine (Seroquel)

C: Donepezil is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer's disease.

What are important teaching points with antidepressants?

Can take 2-3/4-6 weeks to take effect Do not discontinue abruptly Black box warning- risk for suicide Always clarify with physician about multiple antidepressants- risk for serotonin syndrome Report sore throat, fever, malaise, yellow skin, bleeding, bruising, persistent vomiting or headaches, rapid heart rate, seizures, stiff or sore neck, and chest pain to physician.

What is steven-johnson syndrome?

Caused by Anticonvulsant/mood stabilizer A rare, serious disorder of the skin and mucous membranes. A medical emergency, this is often a reaction to medication or an infection. Flu-like symptoms appear first. A painful rash that spreads and blisters follows. WOF rash = lamotrigine = Stevens Johnson SJS has been generally reported with the use of Carbamazepine, Phenobarbital and Phenytoin

What are names of 2nd gen antipsychotics?

Clozapine, risperidone, quetiapine, olanzapine, ziprasidone, aripiprazole, lurasidone

The purpose of a mental status exam (MSE) for neurocognitive disorders is to assess _____?

Cognition & cognitive function

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? o A "Rates mood 8/10. Exhibiting looseness of association. Euphoric." o B "Mood euthymic. Exhibiting magical thinking. Restless." o C "Mood labile. Exhibiting delusions of reference. Hyperactive." o D "Agitated and pacing. Exhibiting grandiosity. Mood labile."

D "Agitated and pacing. Exhibiting grandiosity. Mood labile." The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting signs of irritation accompanied by aggressive behavior. Grandiosity refers to an exaggerated sense of power, importance, knowledge, or identity. The patient was never asked to rate his/her mood. Looseness of association refers to disturbed thought processes characterized by ideas that shift from one unrelated topic to another. Euthymia refers to a relatively stable mood.

A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? o A "Suicidal threats and gestures should be considered manipulative and/or attention-seeking." o B "Suicide is the act of a psychotic person." o C "All suicidal individuals are mentally ill." o D "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

D "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt." It is a fact that between 50 and 80 percent of all people who kill themselves have a history with a previous attempt. The other responses are inaccurate.

The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? o A "Can you chronologically order the events that led to your admission?" o B "Are you feeling depressed or anxious?" o C "Do you know why you are here?" o D "Go on."

D "Go on." General lead questions: allows/encourages client to continue speaking and elaborate further. The nurse's statement is an example of the therapeutic communication technique of a general lead.

What are symptoms/manifestations of the fight or flight response?

Dilated pupils, inhibit GI system, tachycardia, secretions or epinephrine & norepi

A client diagnosed with Major Depressive Disorder states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which statement by the nurse best assesses this client's affective symptoms? o A "Have you been diagnosed with any physical disorder within the last 3 months?" o B "Have you ever felt this way before? o C "People who have mood changes often feel better when spring comes." o D "Help me understand what you mean when you say, 'feeling down'?"

D "Help me understand what you mean when you say, 'feeling down'?" The nurse is using therapeutic communication technique of clarifying to assess the client's symptoms. Open-ended questions elicit more information than closed-ended questions. A closed-ended question which will yield a "yes" or "no" answer. In addition, option C is an example of giving an opinion rather than assessing the patient.

A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? o A "Why don't you consider doing volunteer work in a homeless shelter?" o B "Let's discuss the negative aspects of your life." o C "Things will look better in the morning." o D "It sounds like you are feeling pretty hopeless."

D "It sounds like you are feeling pretty hopeless." This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.

A nurse is caring for a client who has dementia. The client is agitated and is having difficulty staying in his chair. Which of the following actions should the nurse take first? o A Apply a vest restraint on the client o B Sit the client up in bed with the four side rails raised o C Restrain the client o D Administer the client's dose of anxiolytic medication

D Administer the client's dose of anxiolytic medication. Nursing care of the client with a cognitive disorder, the client's PRN medication will help with the agitation, all other choices will restrain the client. Always start with the least restrictive measures first prior to restraining/secluding a patient (always a last resort measure).

A client is admitted into the psychiatric unit with the complaint of pressured and incoherent speech. On further interaction, the nurse finds that the client is suffering from delirium. Which nursing intervention is the priority in this situation? o A Monitor for self-harm behaviors. o B Provide reassurance and reorientation to the client. o C Maintain a low level of stimuli. o D Determine and correct the underlying cause.

D Determine and correct the underlying cause. The priority nursing intervention is to determine and correct the cause of the delirium. After determining the cause, the nurse can provide reassurance, reorientation, and lower the environmental stimuli. The client with delirium does not typically engage in self-harm behaviors due to disorientation/changes in cognition.

A confused client has recently been prescribed sertraline (Zoloft). The client is also taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. Which complication does the nurse suspect, and what could be its possible cause? o A Neuroleptic malignant syndrome caused by ingestion of two different SSRIs o B Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) o C Disturbances in serotonin caused by ingestion of an SSRI and an MAOI o D Disturbances in serotonin caused by ingestion of two different SSRIs

D Disturbances in serotonin caused by ingestion of two different SSRIs. The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

A nurse is caring for a client who has a recent diagnosis of mild Alzheimer's disease. The client's partner asks the nurse about expected manifestations. The nurse should educate the partner to expect which of the following manifestations to occur first? o A Inability to recognize family members o B Confabulation o C Aphasic or unable to communicate to others effectively D Frequently misplacing objects

D Frequently misplacing objects Frequently misplacing objects is an early sign noted in Alzheimer's disease particularly in the 2nd stage

· A client with a history of three suicide attempts has been taking paroxetine for 1 month. The client suddenly presents with a bright affect, is much more communicative, and rates mood at 9/10. Which action should be the nurse's priority at this time? o A Give the client off-unit privileges as positive reinforcement. o B Encourage the client to share mood improvement in group. o C Request that the psychiatrist reevaluate the current medication protocol. o D Increase frequency of client observation.

D Increase frequency of client observation. The nurse should monitor the client more frequently or implement one-to-one observation. A sudden increase in mood rating and change in affect may indicate the client is at serious risk for suicide. Serious suicide risk may occur early during treatment with antidepressants.

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? o A Cognitive behavioral therapy (CBT) in combination with bupropion o B Electroconvulsive therapy (ECT) for recurrent depression o C A low starting dose of citalopram o D Low dose sertraline in combination with isocarboxazid

D Low dose sertraline in combination with Isocarboxazid Sertraline and Isocarboxacid are both antidepressant medications. Taking too much antidepressants can cause an excess of serotonin in the body and can further lead to Serotonin Syndrome. The other responses are all effective treatments for depression.

The nurse notes that a client with paranoid schizophrenia and receiving an antipsychotic medication complains of muscle rigidity. On further assessment ,the nurse finds the client is sweating, has a fever, tachycardia and an increased blood pressure. The nurse suspects that the client is experiencing which medication complication? o A Dystonia. o B Tardive dyskinesia. o C Hypertensive crisis. o D Neuroleptic malignant syndrome.

D Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with a neuroleptic (antipsychotic) medicaiton. It is characterized by dyspnea or tachypnea; tachycardia or irregular pulse rate; fever; blood pressure changes; increased sweating; loss of bladder control; and skeletal muscle rigidity.

Which medication does not require periodic blood-level monitoring? o A lithium carbonate o B valproic acid o C carbamazepine o D paroxetine

D Paroxetine Blood-level monitoring is not usually performed for clients taking paroxetine. Serum lithium levels, valproic acid and carbamazepine levels are monitored regularly to assure a therapeutic range is maintained. Paroxetine is an antidepressant and such class drug classification does not need periodic blood level monitoring.

A client was diagnosed with depression resulting from the loss of her twin sister in a skiing accident. Her parents reported that all the client has done since the accident was lay in her bed and cry, asking why she survived the accident. The physician prescribed Prozac to treat the depression and suggested that the parents "keep a close eye on her." After a week, the client began to show some signs of improvement, even coming out of her room to eat with the family. After 2 months, the client committed suicide despite seeming to come out of the depression. What is the likeliest reason? o A preexisting mental illness was compounded by the death of her sister o B The Prozac prescription was not effective o C The client was not kept under direct supervision o D Suicide risk can increase early in treatment with antidepressants

D Suicide risk can increase early in treatment with antidepressants. Suicide risk may increase early in treatment with antidepressants. One possible reason is that as an individual's energy returns, he or she may have an increased ability to act out self-destructive wishes. Prozac prescription was effective in elevating the client's mood. Direct supervision may have prevented the suicide; however, the most likely reason for the increased risk was related to treatment with an antidepressant

The nurse assesses a client suspected of having Major Depressive Disorder (MDD). Which client symptom would eliminate this diagnosis? o A The client is disheveled and malodorous. o B The client refuses to interact with others. o C The client is unable to feel any pleasure. D The client has maxed-out charge cards and exhibits promiscuous behaviors

D The client has maxed-out charge cards and exhibits promiscuous behaviors. Hypersexuality and excessive spending are symptoms of mania. DSM-5 criteria indicate a diagnosis of MDD is appropriate when there is no history of manic behavior

A client diagnosed with Vascular Dementia is discharged to home under the care of his wife. Which information causes the nurse to question the client's safety? o A His wife works from home in telecommunication. o B The client has worked the night shift his entire career. o C His wife has minimal family support. o D The client smokes one pack of cigarettes per day.

D The client smokes one pack of cigarettes per day. Forgetfulness is an early symptom of VNCD and the client is at risk for burns related to forgotten smoking materials. VNCD is directly related to an interruption of blood flow to the brain. Symptoms result from death of nerve cells in regions nourished by diseased vessels. Hypertension is one of the most significant factors in the etiology. Smoking contributes to hypertension and vasoconstriction.

A nurse is caring for a client threatening to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information will determine the nurse's plan of care for this client? o A After a brief assessment, the nurse should avoid the topic of suicide. o B Clients who talk about suicide never actually commit it. o C Clients who threaten suicide should be observed every 15 minutes. D The more specific the plan is, the more likely the client will attempt suicide.

D The more specific the plan is, the more likely the client will attempt suicide. The risk of suicide is greatly increased if the client has developed a plan with lethal means, particularly if means are accessible for the client to execute the plan. The nurse should ask client directly, "Have you thought about harming yourself in any way? If so, what do you plan to do? Do you have the means to carry out this plan?" and "How strong are your intentions to die?"

A nurse in a long term facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home". Which of the following statements should the nurse make? A You have forgotten that this is your home. B You cannot go outside without a staff member C Why would you want to leave? Aren't you happy with your care? D I am your nurse. Let's walk together to your room and talk about what's going on

D- I am your nurse. Let's walk together to your room and talk about what's going on. It is appropriate to introduce yourself with each new interaction and to promote reality in a calm, reassuring manner.

Which medications require therapeutic blood draws and what are their therapeutic ranges?

o Lithium 0.4-1.2 mEq/L o Valproate: 50-120 ug/mL o Carbamazepine- dont need to know value, just that requires blood draw to check level

· What is agranulocytosis?

o Low WBC count caused by taking antipsychotic clozapine

· A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? o A. A client's verbal threat of suicide is attention-seeking behavior o B. Interventions are ineffective for clients who really want to commit suicide o C. Using the term suicide increases the client's risk for a suicide attempt. o D. A no‑suicide contract decreases the client's risk for suicide

D. a no‑suicide contract decreases the client's risk for suicide. The use of a no‑suicide contract decreases the client's risk for suicide by promoting and maintaining trust between the nurse and the client. However, it should not replace other suicide prevention strategies.

You are the student nurse assigned to care for a patient. You know based on your assessment that a sudden onset of confusion, hallucinations and a diagnosis of pneumonia is a sign of what neurological disorder?

Delirium- a mental state characterized by an acute disturbance of cognition, manifested by short-term confusion, excitement, disorientation, and clouded consciousness

What is secondary depression?

Depressive symptoms that occur as a consequence of an adverse side effect of certain medications.

What are s/s of Bipolar type 2?

Diagnosis requires that the patient: Presents with symptoms (or history) of depression or hypomania lasting at least 4 consecutive days Has never met criteria for full manic episode (mania will last more than 7 days) Has never had symptoms severe enough to cause impairment in social or occupational functioning or to necessitate hospitalization The diagnosis may specify whether the current or most recent episode is hypomanic, depressed, or with mixed features. If the current syndrome is a major depressive episode, psychotic or catatonic features may be present

What are important teaching points with MAOIs?

Ex. Phenelzine May take 4-6 weeks to notice therapeutic effects Do not consume food high in tyramine- alcohol, wine, hotdog etc. as it can lead to hypertensive crisis

What are names of SSRIs?

Fluoxetin, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine

What are names of MAOIs?

Isocarboxazid, phenelzine, selegine

What are important points with lithium and lithium toxicity?

Lithium first choice for bipolar patients Have serum lithium level checked every 1 to 2 months. Normal lithium level 0.4-1.2 mEq/L The nurse should identify muscle weakness as an early indication of lithium toxicity Confusion Nausea, vomiting diarrhea Polyuria Blurred vision, tinnitus, ataxia Hypotension leading to coma/death Do not skimp on dietary sodium and maintain appropriate diet! If sodium levels are low, the body compensates by decreasing lithium excretion, which can lead to toxicity

What are important diagnostic criteria with major depressive disorder?

Most significant sign: the client does not find pleasure in life. Symptoms present consistently for at least 2 weeks No history of manic behavior Cannot be attributed to use of substances or another medical condition Notes: Depression can be a symptom of several medical conditions. Strong evidence has not been established to link depression and genetics Ex: statement patient is depressed due to family history- statement is false/incorrect

What are symptoms of serotonin syndrome?

NM abnormalities Autonomic instability Mental changes Must always clarify if a patient is on 2 antidepressants

What are the 6 cholinesterase inhibitor names?

Physostigmine (Antilirium) Tacrine (Cogex) Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) Memantine (Namenda)

· What symptoms should you look out for Stevens Johnson syndrome

Rash

Why should a patient avoid smoking while on tricyclic antidepressants?

Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect.

Valproic Acid (Depakote) therapeutic drug level for mood stabilization is ____ µg/mL

The therapeutic range for valproic acid (total) is 50-120 mcg/mL (ATI) Valproic acid is used to treat bipolar disorder. It's occasionally used to prevent migraine headaches and can also be used to treat epilepsy.

· Normal lithium level

o 0.4 - 1.2

· Normal Valproic Acid Level

o 50 - 120

· Which nursing intervention strategy is most important to implement initially with a suicidal client? o A Ask a direct question such as, "Do you have any thoughts about killing yourself?" o B Ask client, "Please rate your mood on a scale from 1 to 10." o C Establish a trusting nurse-client relationship. o D Apply the nursing process to the planning of client care.

o A Ask a direct question such as, "Do you have any thoughts about killing yourself?" The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan. The other responses do not help assess suicide risk.

A nurse is caring for a client with primary Neurocognitive Disorder. The nurse recognizes which as the following signs xof the third stage of a primary Neurocognitive Disorder? SATA o A Interference with occupational duties o B Difficulty remembering basic directions while driving. o C Confabulating facts for covering memory loss. o D Loss of ability to perform ADLs o E Inability to recognize family members.

o A Interference with occupational duties B Difficulty remembering basic directions while driving

· Which criteria would eliminate a diagnosis of MDD? o Client maxing out credit cards and promiscuous sexual behavior o Client sleeping more o Client who does not find joy in usual hobbies

o A- Client maxing out credit cards and promiscuous sexual behavior

· A nurse is completing a nursing history for a client who has major depressive disorder. Which of the following client statements indicates a cognitive distortion in the client's thinking? o A. "I never say the right thing to other people."B. "I have been having trouble getting to sleep at night."C. "I've been feeling really sad for about a month."D. "I will miss my family while I'm in the hospital."

o A. "I never say the right thing to other people." Cognitive distortions are negative thoughts that indicate distorted thinking about oneself or the environment. This statement is an example of an automatic all-or-nothing generalization which is negative and unrealistic. Cognitive therapy can assist the client in understanding distortions and, over time, changing thoughts to be more positive and realistic.

· Patient is taking Clozaril and started having flu like symptoms. What is your patient manifesting?

o Agranulocytosis

What are important teaching points for caregivers?

o Apart from educating, refer/help them in establishing resources that will be beneficial such as respite care, home health, support groups

What is pseudodementia?

o Appears like dementia but is not dementia o Some symptoms of depression in the elderly are similar to those in younger adults. However, depressive syndromes are often confused by other illnesses associated with the aging process. o Symptoms of depression are often misdiagnosed as neurocognitive disorder (NCD) when in fact the memory loss, confused thinking, or apathy symptomatic of NCD actually may be the result of depression. This condition is often referred to as pseudodementia. o Depression/pseudodementia: Abrupt onset of confusion and forgetfulness VS. Dementia: confusion and forgetfulness is slow and progressive

What is the purpose of a mental status exam?

o Assess patients' cognition/cognitive function

· SC is a client in the clinic today with a diagnosis of Bipolar II, depressive episode. The nurse knows that characteristics of Bipolar II include which symptoms? Select all that apply o A manic episodes o B depression o C hypomanic episodes o D suicidal ideation o E uncontrolled yelling that needs emergency medication

o B depression, C hypomanic episodes, D suicidal ideation

A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following findings should the nurse expect? SATA. A Gradual memory loss B Family report of personality changes C Hallucinations D Unaltered level of consciousness E Restlessness

o B, C, E- Family report of personality changes, Hallucinations, Restlessness

· When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? o Strong or aged cheese should not be eaten while taking this group of medications. o The full therapeutic potential of tricyclics may not be reached for 4 weeks. o Long-term use may result in physical dependence. o Tricyclics should not be given with anti-anxiety agents.

o B- The full therapeutic potential of tricyclics may not be reached for 4 weeks. A patient needs to be advised that it may take several weeks for tricyclic medications to reach their full therapeutic effect and for relief of symptoms to be noted.

· A nurse is providing teaching to a client who has major depressive disorder and a new prescription for citalopram. Which of the following statements by the client demonstrates an understanding of the teaching? o A. "I will avoid eating cheese or smoked meats while taking this medication." B. "I will need to take this medication for at least 4 months after my symptoms go away." C. "I can expect to feel better after taking this medication for 3 or 4 days." D. "This medication will decrease my nervousness and anxiety."

o B. "I will need to take this medication for at least 4 months after my symptoms go away." To prevent relapse, the client should expect to take an antidepressant, such as citalopram, an SSRI, for 4 to 9 months after manifestations of depression resolve.

· A nurse has arranged to meet with a newly admitted client who has major depressive disorder. When the nurse arrives for the meeting, the client tells the nurse, "I'm just not up to talking today." Which of the following responses should the nurse make? o A. "I think you should try to talk to me, even if it's just for a few minutes." B. "I'll just sit here with you for a few minutes, and you don't need to feel pressure to talk." C. "Don't worry, I'm sure you're doing much better than you were when you were admitted." D. "Why do you feel you aren't up to talking today?"

o B. "I'll just sit here with you for a few minutes, and you don't need to feel pressure to talk." Depression can slow a client's thought processes and also can slow speech. The nurse is planning to use silence as a therapeutic technique to demonstrate caring and begin development

· A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? A Client's educational and economic background B Lethality of the method and availability of means C Quality of the client's social support D Client's insight into the reasons for the decision

o B. Lethality of the method and availability of means. The greatest risk to the client is self‑harm as a result of carrying out a suicide plan. The priority assessment is to determine how lethal the method is, how available the method is, and how detailed the plan is.

What are therapeutic communication techniques for suicidal patients?

o Be EMPATHETIC, not sympathetic! o Promote independence o Avoid why questions o Avoiding close-ended questions o Never argue o Get more info regarding patient o Collaborate with patient o Assess patient further o Stay neutral o A lot of rewording/restating o Clarify if you are on the same page with patient o It is ok to ask patient direct questions § Time, plan, place, or means to carry out plan § Ask more questions if actively suicidal

· Type of Bipolar Disorder wherein patient experienced everything except full blown mania?

o Bipolar Type 2

What are the therapeutic techniques broad opening, general lead, and exploring?

o Broad opening: allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction § "What topic would you like to discuss at the moment?" o General Lead: encourages the client to continue sharing information § "And then?" § "Go on.." o Exploring: to delve further into the subject, idea, experience, or relationship "Tell me more about.."

· A nurse is developing a plan of care for a suicidal client. Which documented intervention should the nurse implement first? o A Observe the client. o B Provide a hazard-free environment. o C Assess suicide risk. o D Communicate therapeutically.

o C Assess suicide risk. Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment should always be the first step taken when working with depressed or suicidal patients. All the other interventions can be done after risk is assessed.

· A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide? o A Encouraging participation in the milieu to promote hope o B Developing a strong personal relationship with the client o C Observing the client at intervals (q15 or 1:1 as needed) determined by assessed data o D Encouraging and redirecting the client to concentrate on happier times

o C Observing the client at intervals (q15 or 1:1 as needed) determined by assessed data. The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors.

· A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. Which is the priority nursing intervention and the rationale for this action? o A Calling an emergency treatment team meeting, because the client's threat must be addressed o B Establishing room restrictions, because the client's threat is an attempt to manipulate the staff o C Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide o D Administering lorazepam prn, because the client is angry about the discovery of the note

o C Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The priority nursing action is to place the client on one-to-one suicide precautions A client with a specific plan is at very high risk of attempting suicide. The appropriate nursing diagnosis for this client is "risk for suicide."

What is the onset and duration of delerium?

o Symptom Onset § Begins abruptly (e.g., head injury, seizure, medications, conditions, infection) § Slower onset (several hours or days of prodromal symptoms) if the underlying cause is a systemic illness or metabolic imbalance. o Duration § Usually 1 week; rarely more than 1 month § Symptoms usually diminish over 3- to 7-day period when underlying causes are eliminated. § The age of the patient and duration of the delirium influence the rate of symptom resolution. o Delirium is associated with a high mortality rate because of the seriousness of the precipitating medical conditions. o At times, delirium may also shift into a more permanent cognitive disorder (major NCD). o Nursing priority: determine underlying cause and reverse it; bring patient back to a normal state

· A client and a nurse therapist are developing a treatment plan that includes strategies to manage bipolar disorder. Which of the following should not be included? Select all that apply. o A Develop an emergency plan o B Maintain a consistent sleep schedule o C Set a time frame to achieve cure o D Create a daily medication schedule o E Set goals to taper off and eventually stop medications

o C Set a time frame to achieve cure, E Set goals to taper off and eventually stop medications. Clients and families should understand that a process recovery treatment plan should not be confused with a promise of a "cure" or "remission." One strategy to help the individual with bipolar disorder take control of and manage their illness is to take medications regularly. The nurse and client should not make plans to adjust and/or stop medications, that is not an appropriate nursing action

· A patient has been diagnosed with major depression. The psychiatrist prescribes Paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching? o Do not eat chocolate while taking this medication. o The medication may cause priapism (prolonged erection). o The medication should not be discontinued abruptly. o The medication may cause photosensitivity

o C The medication should not be discontinued abruptly. Antidepressants, such as paroxetine, must be tapered and not stopped abruptly. All classifications of antidepressants have varying potentials to cause discontinuation syndromes. Abrupt withdrawal from SSRIs, such as paroxetine, may result in dizziness, lethargy, headache, and nausea.

· A nurse is caring for a client who has bipolar disorder and is in the manic phase. The client says he is bored. Which of the following activities is appropriate for the nurse to suggest to this client? o A Watching a video with a group in the day room o B Participating in a basketball game in the gym o C Walking with the nurse in the courtyard; another staff on standby o D Joining a group discussion about a local election

o C Walking with the nurse in the courtyard; another staff on standby. The nurse should limit the client's exposure to groups and crowds because it can increase the client's hyperactivity. Walking with the nurse in the courtyard (correct). Clients who have bipolar disorder are prone to hyperactivity. The nurse should provide activities that provide a way for the client to release physical energy, while avoiding situations that might provoke the client. In addition, walking with the nurse provides an opportunity for therapeutic communication.

· A nurse is planning care for a client who has major depressive disorder and is experiencing loss of appetite, insomnia, and the inability to provide self-care. Which of the following interventions should the nurse include in the plan of care? o A. Have the client sit alone in a quiet atmosphere during meals. B. Encourage stimulating activities and moderate exercise in the evening to promote sleep. C. Give the client step-by-step instructions when performing ADLs. D. Offer the client foods low in fiber to prevent diarrhea.

o C. Give the client step-by-step instructions when performing ADLs. The client who has severe depression often has slowed thinking and lacks energy to perform ADLs. At the same time, daily routines of washing and dressing are important for the client's well-being. The nurse can assist the client by giving one direction at a time and staying with the client while activities are performed.

· A nurse in an acute care mental health facility is caring for a newly admitted client who has major depressive disorder (MDD). The client tells the nurse, "My life is meaningless! I'm going to kill myself tonight." Which of the following actions should the nurse identify as the priority? o A. Search the client's belongings for objects that could cause harm. B. Place the client on suicide precautions. C. Obtain details about the client's suicide plan. D. Ask the client to sign a suicide prevention contract.

o C. Obtain details about the client's suicide plan. The first action the nurse should take when using the nursing process is to assess the client's suicide plan fully by asking about details of the client's plan, lethality of the planned method, and the client's access to it.

· What speech pattern is this? "I'm going to bed, feeling red, in my head, I feel dead!"

o Clang associations

What is agranulocytosis and what drug is it associated with?

o Clozaril (Clozapine) an antipsychotic and the risk for agranulocytosis (low WBC count) Manifestations: sudden fever, chills, sore throat, and muscle weakness *If the question is asking you specifically about Clozapine then it's most likely related to agranulocytosis. If not, it may pertain to neuroleptic malignant syndrome

· Most common side effect of ECT

o Confusion or short term memory loss

· A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? o A "Why don't you consider doing volunteer work in a homeless shelter?" o B "Let's discuss the negative aspects of your life." o C "Things will look better in the morning." o D "It sounds like you are feeling pretty hopeless."

o D "It sounds like you are feeling pretty hopeless." This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.

· A hospitalized client is started on phenelzine for the treatment of depression. The nurse should instruct the client that which food is acceptable to consume while taking this medication? o A Yogurt o B Sausage o C Beer o D Crackers

o D Crackers Phenelzine is a MAOI. The client should avoid ingesting foods that are high in tyramine. Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked and processed meats; red wines; beer; fruits such as avocados, papaya, raisins or figs.

· A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A Assign the client to a private room. B Document the client's behavior every hour. C Allow the client to keep perfume in her room. D Ensure that the client swallows medication.

o D Ensure that the client swallows medication. Ensure that the client swallows medication to prevent hoarding of medication for an attempt to exceed the prescribed dose

· The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? o A Cognitive behavioral therapy (CBT) in combination with bupropion o B Electroconvulsive therapy (ECT) for recurrent depression o C A low starting dose of citalopram o D Low dose sertraline in combination with isocarboxazid

o D Low dose sertraline in combination with isocarboxazid. This is a drug-to-drug interaction (SSRI with MAOI) which can cause Serotonin Syndrome. The other responses are all effective treatments for depression.

What are control, somatic, and nihilistic delusions?

o Delusion of control or influence: The individual believes certain objects or persons have control over his or her behavior (e.g., "The dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do") or the person believes that his or her thoughts or behaviors have control over specific situations or people (e.g., the mother who believes that if she scolds her son in any way, he will die). § This type of delusion is similar to magical thinking, which is common in children (e.g., "The sky is raining because I'm sad"). o Somatic delusion: The individual has a false idea about the functioning of his or her body. § They may believe that they have some type of general medical condition or that there has been an alteration in a body organ or its function (e.g., "The doctor says I'm not pregnant, but I know I am"; "There is an alien force that is eating my brain"). o Nihilistic delusion: The individual has a false idea that the self, a part of the self, others, or the world is nonexistent or has been destroyed (e.g., "The world no longer exists"; "I have no heart").

· Priority nursing intervention for patients going through delirium aside from safety?

o Determine and correct the underlying cause.

What is ECT and side effects of the treatment?

o Electroconvulsive therapy (ECT) is the induction of a grand mal seizure through the application of electrical current to the brain § Last resort for resistant types of depression or mania § Effective with patients who are acutely suicidal and in the treatment of severe depression, particularly in those patients who are also experiencing psychotic symptoms and those with psychomotor retardation and neurovegetative changes. § It should be considered for treatment only after a trial of therapy with antidepressant medication has proved ineffective. § The most common side effect of ECT: temporary amnesia after procedure § Takes about 5-10 minutes, with added time for preparation and recovery. § Can be done as inpatient or outpatient § In the United States, ECT treatments are generally given 2-3 times weekly for 3-4 weeks — for a total of 6-12 treatments § The number and type of treatments you'll need depend on the severity of your symptoms and how rapidly they improve.

What are erotomanic and jealous delusions?

o Erotomanic delusions: Individuals with erotomanic delusions falsely believe that someone, usually of a higher status, is in love with him or her. o Jealous delusions: The content of jealous delusions centers on the idea that the person's sexual partner is unfaithful. § The idea is irrational and without cause, but the individual with the delusion searches for evidence to justify the belief. The sexual partner is confronted (and sometimes physically attacked) regarding the imagined infidelity.

· How many minutes (in intervals) is the standard monitoring for all mental health patients?

o Every 15 minutes

What are important points surrounding bipolar patients and interventions for bipolar disorder?

o Experiences both depression and mania at some point in life o Nursing Process/Interventions—Mania § Offer high calorie foods § Distraction techniques/ways to channel excess energy § Treatment · Individual psychotherapy · Group therapy · Family therapy · Cognitive therapy · Psychopharmacology o First mood stabilization medication of choice is Lithium o 2nd choice: anticonvulsants/mood stabilizers § Example: Valproic Acid/Depakote o The disorder is more prevalent among higher socioeconomic groups o Grandiose delusions could be present: an exaggerated sense of one's importance, power, knowledge, or identity, even if there is little evidence to support the beliefs o Safety is always a priority § When currently manic, the client's agitation and extreme hyperactivity may place the client and others at risk for injury

What are common medications for biopolar disorder?

o For mania- mood stabilizers § Lithium carbonate - 1st choice but has a lot of side effects § Anticonvulsants (for seizures in medical perspective, mood stabilizers in psych perspective) · Example: Valproic Acid (Depakote); therapeutic level 50 to 120 mcg/mL § Verapamil (Ca channel blocker in medical perspective, mood stabilizer particularly helpful for mania in psych) § Antipsychotics (helps with mood stabilization as well) o For depressive phase § Use antidepressants with care § While antidepressants treat depression, a person with bipolar disorder also experiences bouts of mania. For this reason, antidepressants aren't always the most effective treatment. Antidepressants increase the amount of neurotransmitters in the brain.

What are grandiose, paranoid, and reference delusions?

o Grandiose delusions: exaggerated feeling of importance, power, knowledge, or identity. § The individual may believe that he or she has a special relationship with a famous person or even assume the identity of a famous person (believing that the actual person is an imposter). § Grandiose delusions of a religious nature may lead to assumption of the identity of a deity or religious leader (e.g., "I am Jesus Christ"). o Delusion of persecution or Paranoid delusions: These are the most common type of delusion in which individuals believe they are being persecuted or malevolently treated in some way. § Frequent themes include being plotted against, cheated or defrauded, followed and spied on, poisoned, or drugged. Aggression or violence may occur because the individual believes that he or she must defend himself or herself against someone or something perceived to be a threat. o Delusion of reference: Events within the environment are referred by the psychotic person to himself or herself (e.g., "Someone is trying to get a message to me through the articles in this magazine [or newspaper or TV program]; I must break the code so that I can receive the message").

· Preferred diet for Bipolar and currently manic patients

o High-calorie snacks and drinks/finger foods

· What can happen to your patient if he/she takes food rich in Tyramine + Antidepressant (MAOI)?

o Hypertensive Crisis

· Term used for milder form of mania

o Hypomania

What is hypomania?

o Hypomania: A milder form of mania seen with Bipolar II or cyclothymia § It is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization, and it does not include psychotic features § Lasts at least 4 consecutive days (not longer than 7)

How should you therapeutically communicate with MDD patients?

o It is okay to ask open-ended questions in order to assess further

· 1st medication of choice for Bipolar patients

o Lithium

What is the cause and symptoms of vascular dementia?

o NCD occurs as a result of significant cerebrovascular disease. § When blood flow in the brain is impaired, progressive intellectual deterioration occurs. § This disorder is more common in men than women. o More abrupt onset than is seen in AD, and course is more variable § Head trauma/stroke will lead to more rapid decline o Etiology § Hypertension § Cerebral emboli § Cerebral thrombosis o Nursing consideration: avoid things that will impact blood pressure, poor sleep, and smoking. Should exercise and have balanced diet. (similar considerations as those for BP patients) o Focal neurological signs commonly seen with vascular NCD include weaknesses of the limbs, small-stepped gait, and difficulty with speech. o Neuropsychiatric symptoms may include depression, anxiety, mania, apathy, catastrophic reactions, psychosis, or pathological laughing or crying.

· The nurse notes that a client with paranoid schizophrenia and receiving an antipsychotic medication complains of muscle rigidity with accompanying flu-like symptoms. What is this patient experiencing?

o Neuroleptic Malignant Syndrome

What is neuroleptic malignant syndrome?

o Neuroleptic Malignant Syndrome (NMS) - a life-threatening idiosyncratic reaction to antipsychotic drugs characterized by flu-like symptoms: § F=fever § E=encephalopathy § V=vitals unstable § E=elevated CK § R=rigidity of muscles Seen with first generation/conventional/typical antipsychotics

What are assessment and intervention techniques with MDD patients?

o Offer support, sit with client, use silence o Assess further, if necessary, especially if suicidal o Then, may offer medications as needed o Encourage to participate in groups later on

What are red flags with suicidal patients?

o Patient with multiple suicide attempts, specific with plan (has a time, date, place, and means); about 50-80% with previous history kill themselves

What are important care tips for dementia patients?

o Safety as a priority o Simple and direct communication o WOF high risk for falls o Prevent unsupervised wandering o Compliance with medications o Promotion of independence, as much as possible, based on patient's capability o Maintain performance of ADLs based on client's capability o Caregiver teaching education points & burnout o Reminiscing positive memories: will allow the client to retain the positive thoughts and memories longer

What is SAD?

o Seasonal affective disorder: is referred to as a separate condition, although the DSM-5 does not list it as a separate diagnosis. o Occurs at "characteristic times of the year"; most common in fall or winter o Depression disorder

· A syndrome that you need to watch out for if your patient was prescribes with 2 antidepressant medications

o Serotonin Syndrome

What is serotonin syndrome and how is it different from NMS?

o Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe, including a potentiality of death. o NMS and serotonin syndrome are rare, but potentially life-threatening, medicine-induced disorders. Features of these syndromes may overlap making diagnosis difficult. However, NMS is characterized by 'lead-pipe' rigidity, whilst serotonin syndrome is characterized by hyperreflexia and clonus.

· Stage in AD wherein the highlight is ‒ A positron emission tomography (PET) scan can be used to detect these changes

o Stage 1

What are important points with stage 1 and 2 of Alzheimers?

o Stage 1: No apparent symptoms § There is no apparent decline in memory despite changes that are beginning to occur in the brain. A positron emission tomography (pet) scan can be used to detect these changes o Stage 2: forgetfulness § Individual begins to lose things or forget names of people. Losses in short-term memory are common. The individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed; still able to work or live independently

· Stage in AD wherein the highlight is: individual begins to lose things or forget names of people but he/she is still able to work or live independently

o Stage 2

· Stage in AD wherein the highlight is: there's interference with occupational duties and having difficulty remembering basic directions while driving.

o Stage 3

What are important points with stage 3 and 4 of Alzheimers?

o Stage 3: mild cognitive decline § Changes in thinking and reasoning that interfere with work performance and become noticeable to coworkers. The individual may get lost when driving his or her car. Concentration may be interrupted. There is difficulty recalling names or words, which becomes noticeable to family and close associates o Stage 4: mild-to-moderate cognitive decline § He or she may deny that a problem exists by covering up memory loss with confabulation (creating imaginary events to fill in memory gaps)

· Stage in AD wherein the highlight is confabulation

o Stage 4

What are important points with stage 5-7 of Alzheimers?

o Stage 5: moderate cognitive decline § Lose the ability to perform some adls, such as hygiene, dressing, and grooming, and require some assistance to manage these tasks on an ongoing basis; disoriented to time and place o Stage 6: moderate-to-severe cognitive decline § Psychomotor symptoms include wandering, obsessiveness, agitation, and aggression. Symptoms seem to worsen in the late afternoon and evening—a phenomenon termed sundowning o Stage 7: severe cognitive decline § The individual is unable to recognize family members. He or she most commonly is bedfast and aphasic. Problems of immobility, such as decubiti and contractures, may occur.

· Stage in AD wherein the highlight is: Symptoms seem to worsen in the late afternoon and evening—a phenomenon termed sundowning

o Stage 6

· A syndrome that you need to watch out for if your patient takes Lamotrigine

o Stevens Johnson Syndrome

What are the symptoms of delerium?

o Symptoms: § Highly distractible § Disorganized thinking prevails § Speech can be rambling, irrelevant, pressured, and incoherent § Impaired reasoning ability and goal-directed behavior § Disorientation to time and place § Impairment of recent memory § Disturbances in sleep-wake cycle § Hyperactive, Agitated, Hallucinating, Anxious (HAHA) Note: can also be caused by polypharmacy

· Give one example of a benzodiazepine

o Your -lams & -pams, lorazepam, diazepam etc.