mental health final exam
stages of stress
- Alarm (flight of fight) - Resistance - Adaptation - Exhaustion
restricting
- dieting, fasting, or excessive exercising
superego
-in psychoanalytic theory, the part of a person's nature that reflects moral and ethical concepts, values, and parental and social expectations-therefore, it is in direct opposition to the id
SSRIs
-pram; -ine used to treat depression, anxiety, and stress improve the mood by elevating levels of serotonin by inhibiting reuptake.
panic attacks
15-30min of rapid, intense, escalating anxiety
(piaget's theory of cognitive development) stage 2 preoperational phase
2-6yrs - characterized by egocentricism. The child is unable to differentiate different viewpoints of others. - Language develops and symbolisms are better understood. - Reality is given to inanimate objects
(Erikson's Theory of Psychosocial Development) intimacy vs isolation
20-30yrs Goal: to form an intense, lasting relationship or a commitment to another person, a cause, an institution, or a creative effort Achievement = ability to commit Nonachievement= withdrawal, social isolation, and aloneness, inability to form lasting intimate relationships.
(freud's psychosexual stages) phallic stage
3-6 yrs identification w parents OF SAME SEX, developing sexual identity, focused on genital organs
Chlordiazepoxide
A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Of the following, the drug treatment of choice would be what?
Korsakoff's psychosis
A client with a long history of alcohol abuse has presented to the emergency department with hallucinations and an incoherent story about being followed by the police. The client is likely experiencing which physiologic effect of alcohol use?
alcohol use
A client with anxiety is beginning treatment with lorazepam (Ativan). It is most important for the nurse to assess the client's a.motivation for treatment. b.family and social support. c.use of coping mechanisms. d.use of alcohol.
democratic leadership
A form of leadership in which the leader solicits input from subordinates.
elevated temp
A nurse suspects that a client is experiencing alcohol withdrawal based on assessment of which of the following?
Hyperpyrexia, severe hypertension, and diaphoresis
A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs? Fever, hypertension, and diaphoresis are cardinal symptoms of _____ and should be immediately addressed.
frontal
Abnormalities in which lobe is believed to be associated with schizophrenia?
haloperidol side effects
Anticholinergic Blurred vision, bladder retention Constipation Drowsiness EPS = Extra Pyramidal Syndrome = Parkinson's Fotosensitivity = sun burns easily aGranulocytosis = low WBC = report infection, sore throat NMS (neuroleptic malignant syndrome), tardive dyskinesia
Dopamine
Antipsychotics function by blocking receptors of which neurotransmitter?
Express +/- ideas
Assertive communication is: SELECT ALL THAT APPLY a. Guarantees the situation will ALWAYS change b. Ability to express positive and negative ideas c. Focuses on "You" statements d. Feeling in an open, honest, and direct way
tolerate anxiety
Clients with OCD often have exposure/response prevention therapy. Which statement by the client would indicate positive outcomes for this therapy? a."I am able to avoid obsessive thinking." b."I can tolerate the anxiety caused by obsessive thinking." c."I no longer have any anxiety when I have obsessive thoughts." d."I no longer feel a compulsion to perform rituals."
improve community functioning
Clients with a schizotypal personality disorder are most likely to benefit from which nursing intervention? a.Cognitive restructuring techniques b.Improving community functioning c.Providing emotional support d.Teaching social skills
HTN crisis
Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?
Hypersomnolence Disorder
Excessive sleepiness for at least 1 month that involves either prolonged sleep episodes or daily daytime sleeping that causes significant distress or impairment in functioning.. - sleep episodes last 8-12 hrs & difficulty waking up - caused by sleep regulation dysfunctions in the brain - tx: stimulant meds
sexual impulses & desires; sexual energy (libido)
Freud believed that human behavior is motivated by repressed _____ & ______ & that childhood development is based on ____ as the driving force.
dyspareunia
Genital pain associated with sexual intercourse that can occur in males and females. s/s range from mild discomfort to sharp pain
severe extrapyramidal effects
Haloperidol (Haldol) is a potent antipsychotic that is associated with a. severe extrapyramidal effects. b. severe hyperactivity. c. severe hypotension. d. severe anticholinergic effects.
OCD PD (Cluster C)
Have difficulty expression emotions, overly disciplined, perfectionistic, and preoccupied with rules. They are inflexible about the way in which things must be done, difficulty with decision-making
Piaget's Theory of Cognitive Development
His work concerning cognitive development in children is based on the premise that human intelligence is an extension of biological adaptation, or one's ability to adapt psychologically to the environment. He believed that human intelligence progresses through a series of stages that are related to age, demonstrating at each successive stage a higher level of logical organization than at the previous stages.
Primary appraisal of coping
Initial assessment of stressor to determine if stressor is a threat
a, c, d, e; verbalize feelings, practice relaxation, reframing, teach relaxation
Interventions for a client with panic disorder would include a.encouraging the client to verbalize feelings. b.helping the client avoid panic-producing situations. c.reminding the client to practice relaxation when anxiety level is low. d.teaching the client reframing techniques. e.teaching relaxation exercises to the client. f.telling the client to ignore any anxious feelings.
a, c, f; places born, activities for attention, distractions
Interventions for clients with dementia that follow the psychosocial model of care include a.asking the clients about the places where they were born. b.correcting the any misperceptions or delusion. c.finding activities that engage the clients' attention. d.introducing new topics of discussion at dinner. e.processing behavioral problems to improve coping skills. f.providing unrelated distractions when clients are agitated.
false (physician-client relationship most important)
Is the following statement true or false?In the clubhouse model, the relationship between clients is most important.
Bipolar Medications
Live To Dream Always, Lithium Tegretol, Depakote, Abilify - kidney problems, liver problems, monitor blood work
respect for persons
Maintains that humans have an unconditional moral worth that requires us to treat each individual person with great value, dignity, and respect. - Involves autonomy - Involves veracity (veracity = principles of truth telling)
2 weeks
Major depression is characterized by a severely depressed mood that lasts at least...
memantine
NMDA receptor antagonist that can slow the progression of Alzheimer's in the moderate or severe stages
risks for alzheimers
Old age, female, genetics, family history,
preorientation
On an in-patient psychiatric unit, the nurse explores her feelings about working with a woman who continually endures a pattern of physical and verbal abuse from her husband. This interaction would occur in which phase of the nurse-patient relationship? a. Orientation b. Pre-orientation c. Working d. Termination
paradoxical excitement
One week ago, a 74-year-old was started on a benzodiazapine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication? a. paradoxical excitement b. taking too much of the medication (nonadherence) c. allergic reaction to the benzodiazepine d. not taking the medication as ordered (noncompliance)
Antipsychotics
Patients taking this type of pyschotropic medication will need monitoring of their cardiac status A. Antidepressants B. Antipsychotics C. Mood stabilizpers D. Stimulants They can cause various types of cardiovascular complications (e.g., arrhythmias, hypertension, myocarditis, and orthostatic hypotension
(Peplau's Stages of Personality Development) stage 1: learning to count on others
Peplau believed that when nurses provide unconditional care, they help these clients progress toward more mature levels of psych & bio functioning. This involves the role of "surrogate mother," by helping fulfill pt's needs
Delusions, hallucinations, associative looseness
Positive or hard symptoms of psychosis such as Schizophrenia are as follows: SATA a. delusions b. hallucinations c. associstive looseness (people losing their train of thought during conversations.) d. blunt affect change in behavior or thoughts, such as hallucinations or delusions.
sleep terrors
Repeated occurrence of abrupt awakenings from sleep associated with a panicky scream or cry confused and upset upon awakening and have no memory of a dream either at the time of awakening or in the morning tends to go away in adolescence
true
T or F: The primary treatment of ADHD is administration of stimulants.
true
TCAs are contraindicated in patients with recent MI, pregnancy and lactation, concurrent MAOI use. Caution should be used in cardiovascular disorder true or false
exp anxiety w/ out overwhelming
The best goal for a client learning a relaxation technique is that the client will a.confront the source of anxiety directly. b.experience anxiety without feeling overwhelmed. c.report no episodes of anxiety. d.suppress anxious feelings.
1/2 hr (keep pt recumbant to decrease ortho hypotension)
The nurse administers chlorpromazine intramuscularly to a client. The nurse would maintain the client in bed for at least how long after administering the drug? 3 hours 1 hour 2 hours ½ hour
Indifference to being hugged or held
The nurse recognizes which of the following as a common behavioral sign of autism?
tactile hallucinations
The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response?
Psychoanalytic theory
The psychiatrist states that repressed memories in the client's unconscious are causing depression. This reasoning implies that the psychiatrist uses which theory?
Isocarboxazid, Phenelzine, Tranylcypromine
What are the names of the 3 MAIOs?
4 weeks
When haloperidol is given as a depot injection, it has an effectiveness of which duration?
structured schedule of activities
Which would be an appropriate intervention for a client with OCD who has a ritual of excessive constant cleaning? a.A structured schedule of activities throughout the day b.Intense psychotherapy sessions daily c.Interruption of rituals with distracting activities d.Negative consequences for ritual performance
ae insomnia, weight loss, and GI upset
Your patient, a 6-year-old boy, is starting a regimen of methylphenidate (Ritalin) to control an attention deficit disorder. Family teaching should include which of the following?
SSNRIs
a child with an existing diagnosis of ADHD shows s/s of depression. which would most likely be prescribed?
depersonalization
a nurse is seeing a client who is having severe-panic anxiety after a physical assault. the client tells teh nurse "when the panic starts, i feel like i am watching myself through a window". the nurse can most accurately describe the experience as: a feeling of being disconnected from themselves, such as watching oneself.
hypomania
a period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania *does not impair the person's ability to function * no psychotic features (delusions, hallucinations)
poor communication and enmeshed family
at the prompting of friends, a 16yr old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. during the nurse's assessment, the nurse has asked the client to describe the client's family. which family process and characteristic is thought to contribute to eating disorders
pimavanserin (nuplazid)
atypical neuroleptic indicated for Parkinson's disease psychosis tx delusions and hallucinations prolongs the q-t interval
leadership styles
autocratic, democratic, laissez-faire
s/s of tic disorders
coprolalia (use of socially unacceptable words, frequently obscene), palilalia (repeating one's own sounds or words), and echolalia (repeating the last-heard sound, word, or phrase).
United Arab Emirates
country that is at higher risk for binge eating, obesity, emotional eating and body-related guilt
AA and asians
cultures least likely to have EDs Minority women who are younger, better educated, and more closely identified with middle-class values are at increased risk for developing an eating disorder
adolescent adhd
cutting class, speeding tix, failed relationships, risk-taking behaviors, fighting, low self-esteem & peer rejection
bulemia
eating disorder characterized by binging and purging - near normal body weight - exhibit high impulsivity, sensation seeking, novelty seeking, and traits associated with borderline personality disorder - pt is a perfectionist, w above average intelligence, ppl pleasing, seeking approval - hx of impulsive behaviors (substance use, shoplifting, anxiety, depression, PD) onset = - late adolescence- early adulthood; 18-19 yrs is typical age
Erikson's Theory of Psychosocial Development
eight stages of the life cycle during which individuals struggle with developmental "crises." Specific tasks associated with each stage must be completed for resolution of the crisis and for emotional growth to occur.
Harry Stack Sullivan
emphasized Interpersonal socialization of humans throughout their developmental stages Development is somewhat predictable as progression through stages and achieved by means of interactions with others.
2nd gen atypical antipsyschotics
end in -apine & -done treats +/- symptoms of schizophrenia
1st gen typical antipsychotics
end in -zine & haloperidol (haldol) treats + symptoms of schizo phenothiazine thioxanthenes butyrophenone dibenzoxazepine dihydroindole
atypical antidepressants
for pt that doesn't respond well to SSRIs. include venlafaxine (Effexor), duloxetine (Cymbalta), bupropion (Wellbutrin), nefazodone (Serzone), mirtazapine (Remeron), vilazodone
bipolar 1
full manic and major depressive episodes
infants adhd
fussy, tempermental, poor sleep patterns
causes of adhd
genes, prenatal environment, and brain differences - decreased metabolism in frontal lobe
Alzheimer's disease
gradual onset but causes an increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence *most common dementia *more common in women *60% of dementia in US
Schizotypal PD (Cluster A)
ideas of reference, magical thinking, and eccentricity Late schizophrenia Their behaviors odd and eccentric but does not decompensate to the level of schizophrenia
aphasia
impairment of language, leads to agnosia, inability to name familiar objects or people
boderline personality disorder
impulsivity and difficulty controlling anger are characteristics of which mental health diagnosis
social communication disorder
inability to observe social "rules" of conversation, deficits in applying context to conversation, inability to tell a story in an understandable manner, and inability to take turns talking and listening with another
anxiety neurotransmitters
increased NE, decreased GABA and serotonin
causes of schizo
increased dopamine levels illicit substance use environmental toxins genetics
borderline pd (cluster b)
instability in relationships, mood, and self image - a chronic mood that is instable. - difficulty maintaining relationships, and have abandonment issues. - "it's all about me" - a pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes toward other people. - impulsive, self-destructive, and lack a clear sense of identity - more common in women than in men (4:1 ratio) ***most at risk for self harm. will cling on to nurses (inmar?)
sadist
intensely sexually arousing fantasies, sexual urges, or behaviors involving acts in which the psychological or physical suffering of the victim is sexually arousing to the person. It can involve domination restraint, spanking, beating, electrical shock, rape, cutting, and, in severe cases, torture and death. Victims may be consenting
Histrionic PD (Cluster B)
involves constant attention-seeking behavior - colorful, dramatic, and extroverted behavior in excitable,emotional people - difficulty maintaining longlasting relationships, & require constant affirmation, approval, and acceptance from others ex: marilyn monroe
Tourrette Syndrome
involves multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year. more common in boys and is usually identified by 7 years of age. Some people have lifelong problems
chronic psychosis
irreversible develops over months or years
normal BP range
less than 120/80
mild dementia
name recall difficulty, occasional disorientation, memory loss Forgetfulness is the hallmark of beginning, mild dementia difficulty finding words, frequently loses object
adult adhd
nervousness, restlessness, depression, lack of friends, and low frustration tolerance, coexisting psych diagnoses
norepi and serotonin
neurotransmitters associated with stress
critical of self and others
normal adolescent behaviors include being...
70-110 mg/dL
normal blood glucose levels
12-16 gm/dL
normal female hemoglobin range
antipsychotics
olazapine risperdone aripiprazole all mood stabilizers
antidepressants
panic disorder is treated with CBT, deep breathing, and relaxation, in addition to what?
serotonin
people diagnosed with bulimia have lower levels of which neurotransmitter?
(Peplau's Stages of Personality Development) stage 2: Learning to delay satifsfaction
ppl who do not learn delayed gratification will have behaviors such as exploitation, suspisciousness, hoarding, inordinate neatness/ punctuality, changing personality to fit in. When nurses observe these types of behaviors in pts, it is important to encourage full expression and to convey unconditional acceptance. When the client learns to feel safe/ accepted, they're more likely to let go of oppositional behavior.
Pt strength
psychiatric rehabilitation focuses on a. medication compliance b. social skills deficits c. patient's strength d. family support
causes and can be explained
psychoanalytic theory support that all human behavior is .... focuses on discovering the causes of the client's unconscious & repressed thoughts, feelings, & conflicts believed to cause the client anxiety & on helping the client to gain insight into & resolve these conflicts & anxieties
vaginismus
recurring involuntary muscle spasms in the outer third of the vagina that interfere with sexual intercourse
tricyclic antidepressants overdose
s/s: - confusion - agitation - hallucinations - hyperpyrexia, - hyperreflexia - can cause seizures, coma, & cardiovascular toxicity
benzos
safe alcohol withdrawal usually is accomplished with the administration of which medication classification
Peplau's Stages of Personality Development
she dentified four psychological tasks that she associates with the stages of infancy and childhood described by Freud and Sullivan. She relates these stages to the stages in the relationship between clients and the nurse. Peplau believed that nursing is helpful when both the patient and the nurse grow as a result of the learning that occurs in the nursing situation.
satisfaction
sullivan defined ___________ as the fulfillment of all requirements - associated with an individual's physiochemical environment (ex: oxygen, water, rest, etc)
anxiety
sullivan thought that ___________ - is the "chief disruptive force in interpersonal relations and the main factor in the development of serious difficulties in living."
side effects of ECT
temporary memory loss and confusion headache briefly disoriented
positive schizophrenia symptoms
the manifestation of things that arenot normally present SHOULDN'T be there - Distortion/ exaggeration of normal behavior. loose connections - Hallucinations (affects sight, sound, smell, touch, taste) - Delusions (magical thinking)
memory impairment
the prominent early sign of dementia. - difficulty learning new material and forgetting previously learned material
primary gain of anxiety
the relief of anxiety achieved by performing the specific anxiety-driven behavior, such as staying in the house to avoid the anxiety of leaving a safe place. Secondary gain is the attention received from others as a result of these behaviors
TMS (transcranial magnetic stimulation)
the use of strong magnets to briefly interrupt normal brain activity as a way to study brain regions *not effective for mild- moderate depression
carbamezepine (Tegretol)
threat for agranulocytosis - monitor for suppression of WBC (toxicity) serum levels need to be 4 to 12 µg/mL mood stabilizer that tx bipolar
Pseudoparkinsonism
tremor, shuffling gait, drooling, rigidity A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?
false
true or false The nurse should confront a patient's delusions?
Chlorpromazine (Thorazine)
typical antipsychotic -tx schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12, tx nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus. - This medication can cause photophobic skin reactions and damage to the retina of the eye if exposed to direct sunlight. PTs taking this should be reminded to wear protective clothing, apply sunscreen and wear sunglasses when they are outside.
atypicals busirone
use to treat anxiety, ptsd, ocd, panics
occipital
visual integration of information, including color vision, object and facial recognition, and the ability to perceive objects in motion.
2nd generation antipsychotics
weight gain and risk of diabetes increases with the use of these drugs Risperidone Quetiapine Clozapine
Anticholinergic
what classification of drug is Benztropine (cogentin)
benzodiazepine
what classification of drug is Clonazepam (Klonopin)
CNS stimulant
what classification of drug is Methylphenidate (Ritalin)
mood stabilizing anticonvulsant
what classification of drug is carbamazepine (tegretol)
atypical antipsychotics
what classification of drug is quetiapine (Seroquel)?
atypical antipsychotic
what classification of drug is clozapine (clozaril)
liver function
what should be monitored in an older patient taking anxiolytic and hypnotic agent?
limbic system (epinephrine & norepinephrine)
what system is activated by prolonged stress?
meds
when assessing a client with anxiety, the nurse should recognize that anxiety may often be a result of what?
control
when working with the client w bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. feelings that may be arouse in the nurse may include what?
decreased concentration, productivity, and sleep
which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia
cultural influences
which factor is likely to have the greatest impact on how a client responds to gried
overprotective parents
which is a typical characteristic of parents of clients diagnosed with anorexia
divalproex
which is an anticonvulsant used as a mood stabilizer? a. venlafaxine b. divalproex c. bupropion d. phenelzine
consensual validation
"Earlier today you said you were concerned that your son was still upset with you. When I stopped by your room about an hour ago, you and your son seemed relaxed and smiling as you spoke to each other. How did things go between the two of you?" This is an example of which therapeutic communication technique? a.Consensual validation b.Encouraging comparison c.Accepting d.General lead
external source of emotion
"How does Jerry make you upset?" is a nontherapeutic communication technique because it a.gives a literal response. b.indicates an external source of the emotion. c.interprets what the client is saying. d.is just another stereotyped comment.
(freud's psychosexual stages) oral stage
(0-18 months): pleasure focuses on the mouth (id) relief from anxiety through oral gratification of needs
(Mahler's Theory of Object Relations) phase 3b practicing
(10-16mo) W/ increased locomotor function, the child experiences exhilaration from increased independece.
(Mahler's Theory of Object Relations) phase 3c rapprochement
(16-24mo) *Extremely critical to the child's healthy ego development. Here, the child realizes he is a separate individual from mom but still needs her for emotional refueling. Obtaining this emotional support gives them a sense of security that they are loved and will not be abandoned.
(freud's psychosexual stages) anal stage
(18 - 36 months): pleasure involves eliminative functions (ego forms) learning independence and control, with excretory functions
(Mahler's Theory of Object Relations) phase 3d consolidation
(24-36mo) Child can integrate both "good" and "bad". individuality and sense of separateness of self are established.
(Mahler's Theory of Object Relations) phase 3a differentiation
(5-10mo) the child's initial physical movements away from the mother
Causes of Intellectual Disability
* include hereditary conditions * early alterations in embryonic development, such as trisomy 21 or maternal alcohol intake, * pregnancy or perinatal problems such as fetal malnutrition, hypoxia, infections, and trauma; * medical conditions of infancy such as infection or lead poisoning; * environmental influences such as deprivation of nurturing or stimulation. * sometimes unknown or not yet discovered.
suicide interventions
*safety is primary concern - remove any items that can be used to commit suicide - observe clients every 10 min - 1-1 supervision, 2-3 ft away - provide no-suicide or no-self-harm contracts
seasonal affective disorder (SAD)
*winter/ fall onset SAD & spring onset SAD -increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in the extremities
anorexia assessments
- - slow to respond questions - Difficulty deciding what to say - Reluctant to answer questions fully - wear loose-fitting clothes in layers, regardless of the weather, - Eye contact may be limited - seldom smile, laugh, or enjoy any attempts at humor; they are somber and serious most of the time - difficulty identifying and expressing feelings (alexithymia
methylphenidate and adderall (amphetamines) ae
- : insomnia, loss of appetite, and weight loss or failure to gain weight
anorexia meds
- Amitriptyline (Elavil) & antihistamine cyproheptadine cause wieght gain - Olazapine due to antipsychotic effects (on body image distortions) & weight gain - Fluoxetine helps prevent relapse (*caution: may cause weight loss)
adhd care
- Attempting to talk to or reason with a child engaged in a dangerous activity is unlikely to succeed because his or her ability to pay attention and to listen is limited - Explanations should be short and clear - should not use a punitive or belittling tone of voice - structured daily routine
Types of Paraphilias
- Exhibitionism - Fetishism - Frotteurism - Pedophilia - Masochism - Sadism - Transvestic fetishism - Voyeurism - Rape ( 2 types: acquaintances 85% & strangers 15%)
categories of sleep disorders
- Insomnia - Hypersomnia - Sleep-related breathing disorders - Circadian rhythm disorders - Parasomnias
Hildegard Peplau's nursing model
- Nursing is a human relationship between a sick/ in need person & a nurse especially educated to recognize and to respond to the need for help. Nurses have specific roles that include: - Resource person - Counselor - Teacher - Leader - Technical expert (understands various professional devices & has clinical skills) - Surrogate (replace motherly care)
orthorexia nervosa
- Obesession w proper/ healthy eating - *not formally recognized by DSM5 - Behaviors include compulsive checking of ingredients; cutting out increasing number of food groups; inability to eat only "healthy" or "pure" foods; unusual interest in what others eat; hours spent thinking about food, what will be served at an event; and obsessive involvement in food blogs
(piaget's theory of cognitive development) stage 4 formal operations phase
- Think/ reason abstract ideas - Increased logical thinking & problem solving skills - Distinguish ideal & real - Cognitive maturity achieved in late adolescence.
stress drugs
- anxiolytics -hypnotics -antidepressants - psychotherapeutics - muscle relaxants - narcotics - antimigraine agents - SSRIs (commonly used)
Phobia treatment
- behavioral therapy - teaching relaxation techniques, setting goals, - systematic (serial) desensitization - positive reinforcement - flooding (rapid desensitization)
insomnia
- dissatisfaction with sleep quantity or quality. - difficulty falling asleep, maintaining sleep, and/or early-morning wakening with inability to return to sleep. Subtypes - subtypes include: inadequate sleep hygiene, psychophysiological insomnia, paradoxical insomnia, idiopathic insomnia, and insomnia due to a mental disorder, medical conditions, or drug/ substance use.
s/s of delirium
- disturbances of consciousness - develops over short period of time - difficulty paying attention, easily distracted, disoriented - illusions, misinterpretations, & hallucinations - changes in sleep-wake cycle - changes in psychomotor activity - anxiety, fear, irritability, euphoria, apathy - speech is rapid, forced, and usually louder than normal
s/s of autism
- identified by 18 months and no later than 3 years of age - deficits in communication & social interaction - restricted, stereotyped patterns of behavior and interests/activities - little eye contact - few facial expressions - limited gestures - limited capacity to relate to peers or parents - lack spontaneous enjoyment, express no moods or emotional affect, and may not engage in play or make-believe with toys - little intelligible speech - stereotyped motor behaviors, such as hand flapping, body twisting, or head banging
Delirium treatment
- identify and address the underlying cause - optimize brain condition (O2, hydration, pain, etc. - antipsychotics (haldol) - Adequate nutritious food and fluid intake
s/s of dementia
- impaired ability to carry on meaningful conversations - aphasia - repetitive conversations - slurred speech, total loss of language - can't perform familiar tasks (ex: dressing) - making inappropriate jokes, neglect personal hygiene - emotional outbursts or lose emotional affect - verbal or physical aggression, wandering at night, agitation, or other behaviors that seem to indicate a loss of personal control. - ability to think abstractly is impaired, resulting in loss of the ability to plan, sequence, monitor, initiate, or stop complex behavior - may experience bladder and even bowel incontinence
ego
- in psychoanalytic theory, the balancing or mediating force between the id and the superego-represents mature and adaptive behavior that allows a person to function successfully in the world
physical s/s of anorexia
- low body mass (<15%) - emaciation from weight loss, hunger denied - electrolyte imbalance - hypotension - bradycardia - dehydration - lethargy - amenorrhea - constipation - abd pain - muscle weakness - cold intolerance - lanugo - dental caries or esophageal erosion - hand calluses - knuckle abrasions - poor skin turgor - life threatening lab values such as low hemoglobin, hematocrit and potassium
adhd tx
- methylphenidate (Ritalin) and an amphetamine compound (Adderall) - most effective treatment combines pharmacotherapy with behavioral, psychosocial, and educational interventions therapeutic play, dramatic play, creative play,
severe dementia
- personality and emotional changes occur - delusional - wandering at night - forgetting names of s/o - require assistance with ADLs - cannot be without supervision
Narcissistic PD (Cluster B)
- ppl that lack empathy - hypersensitive to evaluation of others. - "entitled" to special consideration -their desire is sufficient justification for possessing whatever they seek - lack humility, being overly self-centered and exploiting others to fulfill their own desires. -do not conceive of their behavior as being inappropriate - "superior" and entitled to special rights & privileges - they may respond with rage, shame, humiliation, or dejection if they don't get the responses they want - characteristics: entitlement, strong need for approval and attention from others, tend to blame others for their failures ex: gaston, trump
binge/ purge
- purging= compensatory behaviors designed to eliminate food by means of self-induced vomiting or misuse of laxatives, enemas, and diuretics . usually done after binging (eating great amounts of food)
depression in teens
- substance abuse - joining gangs - engaging in risky behavior - underachievers/ school drop outs
interpersonal security
- the feeling associated with relief - from anxiety. When all needs have been met, one experiences a sense of total well-being
Anger Retaliation Rapist
- this perpetrator wants to punish victims - hates women - often causes substantial injury - sees self as masculine and action oriented - spends time in chatrooms on internet voicing general hatred for women due to some perceived "injustice"
Causes of delirium
- trauma to CNS - drug toxicity/ withdrawal - metabolic disturbances r/t organ failure -Stress, sleep deprivation, physical restraints -Hypoxia, Anemia -Any loss of internal homeostasis
tic disorder tx
- treated with risperidone (Risperdal) or olanzapine (Zyprexa), which are atypical antipsychotics
GAD
- worries excessively and feels highly anxious at least 50% of the time for 6 months or more - three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations
anxiety tx
-*Cognitive behavioral therapy* -PTSD debriefing -Supportive approach -SSRI's (drug of choice) - decatastrophizing (Splashing the face with cold water, snapping a rubber band) - assertiveness training (using "I" statements)
delirium risk factors
-Advanced age (>65) -Alcohol -Dementia - hearing impairment - decreased food/ fluid intake -Low serum albumin -Multiple severe medical problems -Multiple meds -H/o psychoactive drugs -Surgery -CVA - children w fever
biggest risk factors for ED
-Childhood Adversity defined as physical neglect, sexual abuse, or parental maltreatment that includes little care, affection, and empathy as well as excessive paternal control, unfriendliness, or overprotectiveness.
nursing interventions for delirium
-Maintain the basics (Hydration, safety, comfort) -Decrease environmental stressors -minimize sensorial & sleep factors -Prevent reoccurrence -Avoid medication & restraints -maintain routine -distractibility -gentle predictable touch - speak in low, clear voice and face pt while speaking w short, simple sentences
Phases of Schizophrenia
-Phase I Premorbid Phase- social maladjustment, social withdrawal, irritability, and antagonistic thoughts/ behavior -Phase II Prodromal Phase- certain s/s that precede the characteristic manifestations of the acute, fully developed illness. -Phase III Schizophrenia- active phase + s/s noticeable Phase IV Residual Phase- remission/ exacerbation. negative s/s may remain
depression in children
-Somatic complaints -Angry irritable mood -Arguing w/ parents, teachers, peers (new onset) -Inattentive, hyperactivity -Failure to make expected weight gains -Poor school performance -Boredom/disinterest (anhedonia) - antisocial behaviors
s/s anorexia
-distorted body image -sees and overweight person in the mirror -won't eat, but preoccupied with food -high achiever, perfectionist - ritualistic behaviors about food - hx of ED in family - low norepinephrine - onset usually 14-18 yrs
physiological effects of stress
-elevated blood pressure -decrease in immune system functioning -increased hormonal activity -psychophysiological conditions
id
-in psychoanalytic theory, the part of one's nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses-seeks instant gratification-causes impulsive, unthinking behavior-has no regard for rules or social convention
suicide stats
-men commit approximately 72% of suicides, which is roughly three times the rate of women -Men, young women, whites, and separated and divorced people are at increased risk for suicide -second leading cause of death (after accidents) among people aged 15 to 24 -first 2 years after an attempt represents the highest risk period, especially the first 3 months - most happen in April, on a monday
adverse effects of cns depressants
-sedation -dizziness -confusion -euphoria -muscle weakness -headache -GI upset, constipation
anger excitation rapist
-selects his victims -motivation is pain -very organized -wants them alive for pain response - increases violence -mutilate or disembowel -least common/ most violent
signs of lithium toxicity
-severe vomiting, diarrhea, weakness -lack of coordination, renal failure and coma
(sullivan's interpersonal theory) infancy stage
0-18mo -gratification of needs
(Erikson's Theory of Psychosocial Development) trust vs mistrust
0-18mo Goal: to develop basic trust in the mothering figure & learn to generalize it to others. Achievement= self-confidence, optimism, faith in gratification of needs. The infant learns to trust (when basic needs are met consistently).
(Mahler's Theory of Object Relations) phase 1 normal autism
0-1mo Aka normal autism the child does not perceive the existence of other people or an external environment. The fulfillment of basic needs for survival and comfort is the focus and is merely accepted as it occurs.
(piaget's theory of cognitive development) stage 1 sensorimotor phase
0-2yrs - child priority = satisfying basic needs and comforts. The self isnot differentiated from the external environment. - with increasing mobility and awareness, the mental system is expanded. à leads to understanding objects within the external environment and their effects upon him (aka object permanence)
delirium vs dementia
1. Delirium- Acute, dramatic onset, common causes= illness, toxin, withdrawal, usually reversible. Poor attention and fluctating arousal level. 2. Dementia: Chronic, insidious onset, usually not reversible, attention usually unaffected and normal arousal level.
sexual response cycle
1. Desire 2. Excitement 3. Orgasm 4. resolution
Freud's Psychosexual Stages
1. Oral Stage 2. Anal Stage 3. Phallic Stage 4. Latency Stage 5. Genital Stage
bipolar disorder nursing interventions
1. Providing for Safety* primary role 2. decrease envir. stimulation, establish bedtime routine 3. nutrition: high calorie & protein finger foods, snacks available throughout day 4. monitor food, fluids, sleep 5. provide therapeutic communication- using clear/ simple sentences 6. promoting appropriate behavior 7. managing medications
nursing interventions for depression
1. provide safe environment 2. encourage socialization and participation in program (therapeutic relationships) 3. assess prior coping skills and assess ADLs 4. teach adaptive coping (relaxation, journaling) 5. educate about disorder 6. assess mental status for suicidal thoughts 7. admin meds, as prescribed
(Kohlberg's Theory of Moral Development) level 2: conventional level
10-13yrs - STAGE 3: Interpersonal concordance: behavior guided by expectation of others, approval/ acceptance. - STAGE 4: Law and order orientation: behavior guided by personal respect for authority
(sullivan's interpersonal theory) early adolescent stage
12-14yrs - struggling with developing a sense of identity, the formation of satisfactory relationships with members of the opposite sex- the emergence of lust
(Erikson's Theory of Psychosocial Development) identity vs confusion
12-20yrs Goal: to integrate previous tasks into a secure sense of self Achievement = confidence, emotional stability, and viewing self as a unique individual. Identity achieved when adolescents allowed to make their own decisions (independence) Nonachievement = self-consciousness, doubt, and confusion, lack of commitment & self confidence
(freud's psychosexual stages) genital stage
13-20yrs libido is reawakened as genital organs mature. focus of relationships with members of opposite sex
(Kohlberg's Theory of Moral Development) level 3: postconventional level
14+yrs - STAGE 5: social contracts legalistic orientation Values/ principles have been developed for right vs wrong. Values are guided by this system. - STAGE 6: universal ethical principle orientation Behavior directed by internalized principles of honor, justice, and respect for human dignity. Laws are abstract/ unwritten, (ex: the "Golden Rule")
(sullivan's interpersonal theory) late adolescent stage
14-21yrs - characterized by tasks associated with the attempt to achieve interdependence within the society and the formation of a lasting, intimate relationship with a selected member of the opposite sex. Genital organs are a major focus.
(Erikson's Theory of Psychosocial Development) autonomy vs shame/doubt
18mo-3yrs Goal: to gain self-control & independence Autonomy achieved when parents encourage/ provide opportunities for independent activities. Non-achievement=self-hate, lack of pride, sense of being controlled. Parents set the child up for failure with unrealistic expectations.
(sullivan's interpersonal theory) childhood stage
18mo-6yrs - child learns that interference with fulfillment of personal wishes and desires may lead to delayed gratification- but results in parental approval
restriction and binge/purge
2 subgroups of anorexia
antidepressants
2nd choice of tx for adhd Atomoxetine (Strattera) is the only nonstimulant drug for the treatment; can cause liver damage, so individuals taking the drug need to have liver function tests periodically
dibenzodazepine (clozapine/ Clozaril) side effects
2nd gen atypical drug for schizo
Abilify moa
2nd gen atypical drug that alleviates +/- s/s of schizo. it blocks dopamine & serotonin receptors. indicated for schizo, manic/ bipolar episode, depression
risperidone moa
2nd gen drug that alleviates +/- s/s of schizo. it blocks dopamine & serotonin receptors. indicated for schizo, bipolar, fd
olazepine
2nd gen typical antipsychotic indicated for manic/ acute bipolar
quetiapine/ Seroquel
2ng gen typical antipsychotic for manic episodes of bipolar
(Erikson's Theory of Psychosocial Development) initiative vs guilt
3-6 yrs Goal: develop a sense of purpose & ability to initiate & direct one's own activities Achievement = exercising restraint, self-control, assertiveness. Consciouness develops & control impulse Nonachievement = feeling inadequate, guilt, viewing self as "evil"
(Erikson's Theory of Psychosocial Development) generativity vs stagnation or self absorption
30-65yrs Goal: to achieve life goals established for oneself while also considering the welfare of future generations. Achievement = sense of gratification Nonachievement= withdrawn, isolated, and highly self-indulgent, with no capacity for giving of the self to others.
(Kohlberg's Theory of Moral Development) level 1: preconventional level
4-10yrs - STAGE 1: punishment & obedience orientation Behavior motivated by fear of punishment - STAGE 2: Instrumental relativism orientation Behavior guided by ego-centricism & concern for self. Decisions based on personal benefits.
(Mahler's Theory of Object Relations) phase 3 separation individuation
5-36mo Infant begins to connect with her environment and the people in it. Separation: development of limits and differentiation between herself and the mother individuation = development of ego, sense of identity, and cognitive abilities. 4 sub-phases, in the following order: a. differentiation b. practicing c. rapprochement d. consolidation
(freud's psychosexual stages) latency stage
6-12 yrs sexuality is repressed; children focused on same sex relationships
(piaget's theory of cognitive development) stage 3 concrete operational phase
6-12yrs - Increased logical thinking, but concrete ideas still dominate - Reversibility & spaciality developed - Children start classifying object by their characteristics - Cooperating with others, socializing, & rule consciousness increases
(Erikson's Theory of Psychosocial Development) industry vs inferiority
6-12yrs Goal: to achieve self-confidence by learning, competing, performing successfully, & receiving recognition from loved ones, peers, and acquaintances. Achievement = satisfaction/ pleasure in relationships. Industry achieved when encouragement is given to activities/ responsibilities. Nonachievement = difficulty in interpersonal relationships; cannot cooperate or compromise w/ others.
(sullivan's interpersonal theory) juvenile stage
6-9yrs - formation of satisfactory relationships within peer groups - use of competition, cooperation, and compromise
(Erikson's Theory of Psychosocial Development) ego integrity vs despair
65+ yrs Goal: review one's life & derive meaning from both positive and negative events, while achieving a positive sense of self.
(sullivan's interpersonal theory) preadolescent stage
9-12 yrs - focus on developing relationships with persons of same sex. Love and affection for another person begins at this stage
psychosis
: a change in the brain that disrupts a person's interpretation/ experience of the world secondary to complex neurobiological changes; hallucinations, delusions, and or disorganized thinking. It is a loss of contact with reality. -symptom of medical illness rather than a medical diagnosis
school aged children adhd
: behavioral/ performance interferances, fidgety, tapping, distracted easily, blurts out answers, poor academics due to hurried/ careless mistakes/ failiing to follow directions
(Mahler's Theory of Object Relations) phase 2 symbiotic phase
= "psychic fusion" of mother and child. The child views the self as an extension of the mother.
respiratory disturbances and partial airway obstruction
A 28-year-old patient is to receive a dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for: leukopenia and diplopia. ataxia and confusion. respiratory disturbances and partial airway obstruction. seizures.
eszopiclone (Non-barbiturate hypnotic)
A 45-year-old male client tells the nurse that he has not slept well for the past 2 weeks. Which drug might the physician prescribe for this client? phenytoin norepinephrine eszopiclone loratadine
medulla
A 46-year-old client sustained a closed-head injury 4 hours ago. The client now presents to the emergency department because the client is having difficulty breathing. This is a result of swelling surrounding which brain structure? These areas of the brain control basic, vital functions, such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; the swallowing center, which coordinates the complex swallowing reflex; and the reticular activating system (RAS), which controls arousal and awareness of stimuli and contains the sleep center.
Tremors, headache, flushed face, and hallucinations
A 51-year-old client has been admitted to the detoxification unit with acute symptoms of alcohol withdrawal. Nursing assessment is likely to reveal what?
remove bands & pick at sheets
A 65-year-old has been admitted to the intensive care unit following surgical resection of the bowel. The client has developed a fever. Which additional signs indicate the client has developed delirium?
dizzy, dry mouth, hypotension
A 7-year-old child with ADHD is taking clonidine (Kapvay). Common side effects include a.appetite suppression. b.dizziness. c.dry mouth. d.hypotension. e.insomnia. f.nausea.
require dose adjustment if s/s persist
A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that:
call dr if side effects seen
A Cuban American client has been prescribed an antipsychotic medication. Which response is most important for the nurse to make to this client? In general, non-Whites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects.
remind pt multiple times (that they will soon have a bath)
A care aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of dementia of Alzheimer's type and is prone to agitation, which measure may help in preventing this client's agitation?
elevated liver functions
A child is taking pemoline (Cylert) for ADHD. The nurse must be aware of which of the following side effects? (A) Decreased thyroid-stimulating hormone (B) Decreased red blood cell count (C) Elevated white blood cell count (D) Elevated liver function tests
elevated liver functions test
A child is taking pemoline (Cylert) for ADHD. The nurse must be aware of which side effect? a.Decreased thyroid-stimulating hormone b.Decreased red blood cell count c.Elevated white blood cell count d.Elevated liver function tests
to determine if still needed
A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain? The risk for cumulative adverse effects is greater if the child doesn't have a break. The drug must be occasionally stopped to prevent anticholinergic effects The drug likely needs to be switched to another agent that is less toxic. It needs to be determined if the child still has symptoms that require treatment.
risk for injury
A client appears very drowsy at bedtime and is difficult to arouse. The client is receiving Halcion 0.25 mg PO at bedtime. Based on these findings, what would be the best nursing diagnosis for this client?
8
A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?
affective instability
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?
hypotensive crisis
A client has been prescribed a monoamine oxidase inhibitor (MAOI) by the health care provider. Before administration of the drug, the client wants to know about possible adverse reactions. Which would the nurse expect to describe? Hypertensive crisis Photosensitivity Change in libido Skin rash
weight gain
A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family?
checking blood levels (to be safe and therapeutic dose)
A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment?
temporal
A client has developed deficits involving the senses of smell and hearing. The nurse would correlate this sensory dysfunction with which cerebral lobe?
file for a civil commitment to detain
A client in a psychiatric facility has ideations about killing the client's spouse. This client requests to be discharged from the facility. Which represents the most appropriate action? The health care provider should
Hypothalamus
A client in the operating room goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is what?
monday morning (12 hrs later)
A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin?
Wernicke-Korsakoff syndrome
A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing?
borderline personality disorder
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client?
paranoid thoughts
A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? acute discomfort in social situations and have cognitive or perceptual distortions.
binging
A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?
potential for abuse (Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars.)
A client is being prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD). During health education, the nurse should make the client aware of the black box warning relating to what potential risk issue? Unstable blood glucose levels Kidney failure Stroke with excessive doses Potential for abuse
wbc count
A client is being treated with clozapine. What should the nurse monitor most closely? Cardiac enzymes White blood cell count Urine quantity and quality AST, ALT and bilirubin
cholinergic
A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter?
Marked diaphoresis; Auditory hallucinations; Gross uncontrollable tremors
A client is experiencing severe alcohol withdrawal. Which would the nurse most likely assess? Select all that apply.
0.8-1.4 mEq/L
A client is in the acute phase of mania and is receiving lithium. Which blood concentration of lithium is within the therapeutic range for acute mania?
start another iv in right arm (should not be mixed with any other drugs)
A client is ordered to receive diazepam as part of the treatment for status epilepticus. The client has an intravenous (IV) infusion running, which is being used to administer another drug for seizure control. The IV line is in the client's left arm. Which action by the nurse would be most appropriate? Wait until the other drug is completed to give the diazepam. Start another IV line in the client's right arm. Notify the prescriber that the diazepam cannot be given. Add the diazepam to the current IV infusion.
only 1 wk supply
A client is prescribed clozapine. When developing the teaching plan for this client, the nurse would integrate knowledge of which of the following? Clozapine is a Pregnancy category C drug Only a 1-week supply is dispensed at a time. The drug may cause urinary retention. WBC count has to be performed every month.
anxiety
A client is prescribed midazolam in combination with an opioid in the preoperative phase of a laparoscopic cholecystectomy. What does the administration of midazolam assist in minimizing?
DM (one of the ae)
A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia? Renal calculi Hyperthyroidism Diabetes mellitus Urinary tract infection
bradycardia
A client is receiving a barbiturate intravenously. The nurse would monitor the client for:
bradycardia
A client is receiving a barbiturate intravenously. The nurse would monitor the client for: a. tachypnea. b. bradycardia. c. hypertension. d. bleeding.
bradycardia
A client is receiving a barbiturate intravenously. The nurse would monitor the client for: tachypnea. hypertension. bradycardia. bleeding.
110 to 250 ng/mL (therapeutic level range)
A client is receiving amitriptyline as part of the treatment plan for depression. The health care provider orders a drug plasma level. Which result would the nurse identify as being therapeutic?
extrapyramidal
A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect? Hypotension Extrapyramidal Sedation Anticholinergic
hypothalamus
A client is returning from military service and has been diagnosed with post-traumatic stress disorder (PTSD). Dysfunction in which brain structure contributes to the rage and fear experienced in PTSD? The __________is a part of the limbic system, aka the emotional brain. it is involved in impulsive behavior associated with feelings of anger, rage, or excitement.
tardive dyskinesia
A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what?
benzodiazepines
A client presents at the clinic with symptoms of hyperexcitability and agitation. Which medication would the nurse expect the physician to prescribe? A. Hypnotic B. Benzodiazepine C. Barbiturate D. Other Anxiolytic and Hypnotic Drugs
1200, monitor for at least 3 hrs
A client received lorazepam intravenously at 0900. The nurse should maintain the client on bedrest until approximately what time? 1500 1330 1200 1030
caffeine
A client reports insomnia during a routine visit. What should the nurse assess first regarding the most likely cause? Daily intake of caffeine-containing products Possible use of amphetamines The amount of exercise in which the client engages The family history of insomnia and sleep
call dr, indicates moderate toxicity
A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?
battery (touching another without permission)
A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what?
Risk for suicide
A client who has been depressed and suicidal started taking a tricyclic antidepressant 2 weeks ago and is now ready to leave the hospital to go home. Which is a concern for the nurse as discharge plans are finalized? a.The client may need a prescription for diphenhydramine (Benadryl) to use for side effects. b.The nurse will evaluate the risk for suicide by overdose of the tricyclic antidepressant. c.The nurse will need to include teaching regarding the signs of neuroleptic malignant syndrome. d.The client will need regular laboratory work to monitor therapeutic drug levels.
moderate lithium toxicity
A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect?
increasing GABA
A client who is experiencing acute alcohol withdrawal is being treated with intravenous lorazepam (Ativan). This drug achieves a therapeutic effect by: increasing the amount of serotonin available in the synapses. increasing the effects of the neurotransmitter GABA. affecting the regulation of serotonin and norepinephrine in the brain. inhibiting the action of monoamine oxidase.
encouragement to verbalize feelings
A client with GAD states, "I have learned that the best thing I can do is to forget my worries." How would the nurse evaluate this statement? a.The client is developing insight. b.The client's coping skills have improved. c.The client needs encouragement to verbalize feelings. d.The client's treatment has been successful.
decrease time spent hand washing
A client with OCD is admitted to the hospital due to ritualistic hand washing that occupies several hours each day. The skin on the client's hands is red and cracked, with evidence of minor bleeding. The goal for this client is a.decreasing the time spent washing hands. b.eliminating the hand washing rituals. c.providing milder soap for hand washing. d.providing good skin care.
early effect that subsides
A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." Which is the best response by the nurse? a."Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks." b."It is nothing to worry about unless it continues for the next month." c."Tremors can be an early sign of toxicity, but we'll keep monitoring your lithium level to make sure you're OK." d."You can expect tremors with lithium. You seem very concerned about such a small tremor."
a ask pt to write
A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? a.Ask the client to write about all feelings and experiences related to food. b.Assist the client in making daily meal plans for 1 week. c.Encourage the client to ignore feelings and impulses related to food. d.Teach the client about nutrition content and calories of various foods.
Thiamine, or vitamin B1, deficiency
A client with chronic alcoholism has been found to have Korsakoff's psychosis. This irreversible complication is characterized by what?
hallucinations
A client with delirium is attempting to remove the IV tubing from his arm, saying to the nurse, "Get off me! Go away!" What is the client experiencing? a.Delusions b.Hallucinations c.Illusions d.Disorientation
discuss pictures
A client with late moderate-stage dementia has been admitted to a long-term care facility. Which nursing intervention will help the client maintain optimal cognitive function? a.Discuss pictures of children and grandchildren with the client. b.Do word games or crossword puzzles with the client. c.Provide the client with a written list of daily activities. d.Watch and discuss the evening news with the client.
minimize client's embarrassment
A client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as she did to a.minimize the client's embarrassment about her present behavior. b.keep her from dancing with other clients. c.avoid embarrassing the male clients who are watching. d.teach her about proper attire and hygiene.
helps satisfy cravings
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind? a. Methadone is a not physiologically addictive. b. The drug helps to satisfy the craving for the opioid. c. Methadone is a non-opioid drug d. Methadone simulates the high of heroin.
taper haloperidol
A client with schizophrenia has been taking haloperidol for several years. The care team and the client have collaborated and chosen to transition the client to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the client's risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsychotic, the care team should implement which intervention? Arrange for weekly electroconvulsive therapy (ECT) during the time of transition. Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks. Have a 2- to 3-week "drug holiday" between stopping the haloperidol and starting the atypical antipsychotic. Gradually taper the dose of haloperidol.
have DM
A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may: A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?
SNS
A college student wakes up and notices a racing heart and dilated pupils. The student is scheduled to write an exam later that morning. Which system is responsible for this physiological response?
increased blood glucose
A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention? Decreased libido Increased blood glucose Dry eyes Jittery feeling
monitor fluid/ sodium intake q12
A female client 70 years of age is receiving lithium. Which nursing intervention is appropriate for this client? Instruct the client to use barrier contraceptives. Encourage the client to check daily for weight loss. Check blood glucose levels every six hours. Monitor fluid and sodium intake every 12 hours.
Serotonin (5-HT) syndrome
A female client is brought to the emergency department by her sibling, who reports that the client became very agitated and "started hallucinating." Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The sibling states that the client is taking paroxetine for depression. Which would the nurse most likely suspect? The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI]) suggest ...
exposes pt to ae
A female client is diagnosed with Alzheimer-type dementia. She resides in a long-term care facility. The client's daughter asks the health care provider to prescribe an antipsychotic to control her mother's outbursts of anger and depression. The provider orders a psychiatric consultation for the client. The client's daughter asks, "Why doesn't the provider just order an antipsychotic?" What is the nurse's best response to this family member? Clients with dementia respond poorly to antipsychotic medications." "Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems." "Clients with dementia respond well to antipsychotic medications." "Clients with dementia routinely become agitated due to their disease process."
they don't improve memory
A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development? Antipsychotics increase the risk of long-term memory loss. Antipsychotics do not improve memory loss and may further impair cognitive functioning. Antipsychotics reduce memory loss. Antipsychotics cause a gradual return of cognitive ability.
Lorazepam and Buspirone
A group of nurses is reviewing the various drug classes used to treat psychiatric disorders. The nurses demonstrate understanding when they identify which as examples of antianxiety medications? Select all that apply.
Phentermine
A group of nursing students are reviewing information about CNS stimulants. The students demonstrate understanding of the information when they identify which drug as being used to treat obesity? Modafinil Phentermine Dexmethylphenidate Methylphenidate
Ego
A group of nursing students is reviewing information about Freud's personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of what element of personality?
clomipramine
A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.
closed group
A group that was designed to meet weekly for 10 sessions to deal with feelings of depression would be a(n) a.closed group. b.educational group. c.open group. d.support group.
prescribed to tx excess anxiety interfering w ADLs
A hospitalized client asks the nurse why the health care provider prescribed an anxiolytic medication. What is the nurse's best response?
Laissez-faire leadership
A leadership style that leaves much of the business decision-making to the workforce - a 'hands off' approach and the reverse of the autocratic style
agranulocytosis
A life-threatening drop in white blood cells. This condition is sometimes produced by the atypical antipsychotic drug clozapine. A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?
cyclothymic disorder
A mood disorder characterized by moderate but frequent mood swings that are not severe enough to qualify as bipolar disorder. *between hypomania & depression w/out a loss of social or occupational functioning
major depressive disorder
A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities. 1. depressed mood 2. marked diminished interest/ pleasure 3. significant weight loss/ gain or changes in appetite 4. insomnia 5. psychomotor agitation/ retardation 6. fatigue/ loss of energy 7. worthlessness/ guilt 8. diminished ability to concentrate & indecisiveness 9. recurrent thoughts of death s/s causes distress/ impairment
bipolar disorder
A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. During manic phases, clients are euphoric, grandiose, energetic, and sleepless. They have poor judgment and rapid thoughts, actions, and speech. During depressed phases, mood, behavior, and thoughts are the same as in people diagnosed with major depression *young men in early stages of it are highest at risk for suicide
hippocampus
A neural center located in the limbic system that helps process explicit memories for storage. The client cannot remember anything before an accident yesterday. Which brain structure might be injured?
PET scan
A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what?
Benztropine
A nurse administers haloperidol to a client to promote deescalation. The nurse finds that after administering the drug, the client has started having jerky and involuntary movements of the head and arms. Which medication would be useful in treating this problem? Jerky and involuntary movements of the head and arms are the extrapyramidal side effects
maladaptive expression of emotions
A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent?
anxiety, insomnia, confusion
A nurse caring for an elderly client should monitor the client for what as older clients are more sensitive to the side effects of CNS depressants? (Select all that apply.) Bradycardia Confusion Anxiety Hypotension Insomnia
(a, c, d, f) diet no prob, hx dieting young, rituals, viewing self overweight
A nurse doing an assessment with a client with anorexia nervosa would expect which findings? a.Belief that dieting behavior is not a problem b.Feelings of guilt and shame about eating behavior c.History of dieting at a young age d.Performance of rituals or compulsive behavior e.Strong desire to get treatment f.View of self as overweight or obese
(b, c, d, f) dissatisfied w body, guilt/ shame about eating, near-normal w8, ppl pleaser
A nurse doing an assessment with a client with bulimia would expect which findings? a.Compensatory behaviors limited to purging b.Dissatisfaction with body shape and size c.Feelings of guilt and shame about eating behavior d.Near-normal body weight for height and age e.Performance of rituals or compulsive behavior f.Strong desire to please others
nausea
A nurse has been taught to observe for adverse reactions whenever administering a medication. One non-nervous system reaction after giving a sedative is:
difficulty falling asleep
A nurse has noted that a newly admitted client has been taking ramelteon (melatonin agonist) for the past several weeks. The nurse is justified in suspecting that this client was experiencing what problem prior to starting this drug? Early morning waking Frequent nighttime awakenings Difficulty falling asleep at night Somnambulism
modafinil
A nurse is administering a CNS stimulant to a client with narcolepsy. The nurse understands that this drug does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Which drug is the nurse administering? Dopram Dexmethylphenidate Modafinil Caffeine
respiratory depression
A nurse is administering a prescribed dose of chlordiazepoxide (benzo) to a client. The nurse should closely assess the client for what adverse reaction? urinary retention esophageal bleeding respiratory depression idiopathic thrombocytopenic purpura (ITP)
haloperidol
A nurse is assessing a child with a diagnosis of autism spectrum disorder. The child has severe uncontrollable temper outbursts and repeatedly bangs the head on the wall or door. When considering medication for treatment, the nurse knows which will be the most effective?
midbrain, pons, medulla
A nurse is attending a review class on the neurologic basis of psychiatric disorders. The class also includes a review of the anatomy and physiology of the neurological system. The nurse demonstrates understanding of the information by identifying which structures as components of the brain stem? (Select all that apply.)
edu/ info about meds
A nurse is aware that the likelihood a client will be in adherence with psychotropic medications is affected by what?
calculating math
A nurse is caring for a client who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the client will have difficulty which activity?
induces sleep
A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? a. Eases pain b. Induces sleep c. Improves circulation d. Decreases stress
increased risk for toxic effects (haloperidol is highly protein bound)
A nurse is caring for a patient who is taking haloperidol. The patient has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on a(n): decreased risk for toxic effects of haloperidol therapy. decreased risk for muscular contractions and spasms. high drug efficacy of haloperidol. increased risk for toxic effects of haloperidol therapy.
concept formation
A nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the client will have difficulty with which function?
unemployed high school drop out
A nurse is giving a talk about child abuse to a local community group. When discussing risk factors for child abusers, which would the nurse identify as the most likely profile of the perpetrator of fatal child abuse?
fluoxetine and sertraline
A nurse is preparing a continuing education presentation about various psychopharmacologic agents for a group of psychiatric-mental health nurses. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the nurse include in this group? Select all that apply. venlafafaxine duloxetine fluoxetine sertraline
18 yrs
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age?
substance abuse= illness, cannot use drugs socially
A nurse is preparing an educational session for family members affected by substance abuse. Which point should the nurse include in the session? Select all that apply. A.It is possible to refrain from substance abuse through personal motivation. B.Substance abuse is an illness like any other. C.Families can expect the client to seek treatment independently upon relapse. D.An individual with substance abuse issues typically cannot use drugs socially. E.Beer and wine are less problematic in substance abuse.
nonsuicidal self-injury
A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization?
child abuse
A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder?
dont drink alcohol 2 hrs before, with, or 8hr after taking
A nurse is teaching the client about the new hypnotic drug that the healthcare provider has ordered. Regarding the use of alcohol, what should the nurse instruct the client?
hepatitis c
A nurse obtains a health history from a client who has been prescribed temazepam. Which finding would require immediate follow-up by the nurse? a. Client has a history of bladder infection in the last year. b. Client is diagnosed with hepatitis C. c. Client has history of one spontaneous miscarriage d. .Client recently quit drinking one alcoholic beverage per day.
formal operations
A nursing instructor is integrating Piaget's theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor would identify this age group as in what stage?
respiratory assistance
A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which intervention should the nurse perform? respiratory assistance assistance with movement supportive care safe environment
record daily behaviors
A pediatric client has been admitted to the floor and started on Ritalin therapy for ADHD. The nurse knows that an important daily intervention for this client would be which? Record a daily summary of client's behavior. Perform ROM exercises daily. Weigh the client daily. Suction the client daily.
paradoxical excitement.
A pediatric patient is prescribed phenobarbital preoperatively to relieve anxiety and produce sedation. After giving the injection, you should assess the patient for a. acute Stevens-Johnson syndrome. b. bone marrow depression. c. paradoxical excitement. d. withdrawal syndrome.
damaged hippocampus
A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms?
concrete operations
A psychiatric-mental health nurse is conducting a developmental assessment of a child at the community clinic. As part of the assessment, the nurse pours juice from a short, wide glass into a taller, narrower one and asks the child which one has more juice. The child responds, saying the amount is the same. The nurse determines that the child is in which stage according to Piaget?
associated w social anxiety
A school health nurse is meeting with the parents of a 6-year-old child who has been selectively mute. The nurse is offering the parents education regarding this problem. The nurse can tell the parents that what is true about selective mutism? selective mutism is associated with social anxiety parenting does not play a role in selective mutism selective mutism arises from child abuse children with selective mutism should be home-schooled.
(a, b, d;) sunscreen, sugar free drinks, slow rise
A teaching plan for the client taking an antipsychotic medication will include which instructions? a.Apply sunscreen before going outdoors. b.Drink sugar-free beverages for dry mouth. c.Have serum blood levels drawn once a month. d.Rise slowly from a sitting position. e.Skip any dose that is not taken on time. f.Take medication with food to avoid nausea
instructions short/ simple, keep track of + comments, provide rewards system (C,d, e)
A teaching plan for the parents of a child with ADHD should include a.allowing as much time as needed to complete any task. b.allowing the child to decide when to do homework. c.giving instructions in short simple steps. d.keeping track of positive comments that the child is given. e.providing a reward system for completion of daily tasks. f.spending time at the end of the day reviewing the child's behavior.
discontinue drug (co w hyperthyroid)
A teenage client, treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years, is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions? Discontinue the dextroamphetamine. Discontinue the high-calorie diet. Assess the client for pulmonary edema. Administer a proton pump inhibitor.
d unrealistic perception of body size
A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? a.Guilt and shame about eating patterns b.Lack of knowledge about food and nutrition c.Refusal to talk about food-related topics d.Unrealistic perception of body size
psychoanalytic theory
A theory developed by Freud that attempts to explain personality, motivation, and mental disorders by focusing on unconscious determinants of behavior
ECT for depression
A treatment for depression in which electrodes attached to a patient's head send an electrical current through the brain, causing a seizure. - 6-15 tx scheduled 3x/week *NPO after midnight - remove nail polish *void before procedure *halt anticonvulsant meds
power reassurance rapist
A type of power rapist is the least violent of all the rapists and the least socially competent, suffering from low self-esteem, and feeling inadequacy. Aka gentleman rapists No means yes Don't consider themselves rapists; theyre just having a good time They do this to make themselves feel better 70%
power assertive rapist
A type of power rapist that rapes to express his virility and personal dominance. He has a sense of superiority simply because he is a man and he rapes because he believes he is entitled to do so. He is image conscious, and tends to be a flashy dresser.
Haloperidol (Haldol)
A typical antipsychotic drug thought to block receptor sites for dopamine, making it effective in treating the delusional thinking, hallucinations and agitation commonly associated with schizophrenia.
anger retaliation
A young adult client female is assessed after being raped. The client reports being tied up and beaten while the perpetrator forced sexual intercourse. She recalls the perpetrator saying, "I will make you pay." What most accurately describes this category of rapist?
echolalia
The uncontrollable and immediate repetition of words spoken by another person s/s of dementia
TRUE
The use of agents that alter the concentration of neurotransmitters in the brain is the most effective means of treating depression with drugs. true or false
True
There are various treatment settings and therapeutic programs for the mentally ill population, upon discharge, to assist the person towards survival within the community and to stop the revolving the door of repeated hospital admissions. T or F
Paranoid PD (Cluster A)
They distrust and are suspicious, do not trust motives. They get this from childhood. a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts
hierarchy of needs
Abraham Maslow developed a _______ stating that people are motivated by progressive levels of needs each level must be satisfied before the person can progress to the next level. The levels begin with physiological needs (food, water) & then proceed to safety & security needs, belonging needs, esteem needs, & finally self actualization needs
false
Abstract messages are clear patterns of words which often contain figures of speech which are easy to interpret.
altruism
According to Yalom (2005), there are 11 therapeutic factors through which changes occur in group psychotherapy. Which factor correlates with learning to give to others?
dry mouth, hypotension, and glaucoma
Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include a. insomnia and hypertension. b. dry mouth, hypotension, and glaucoma. c. diarrhea and excessive urination. d. increased sexual drive and improved concentration.
taking at bed
Adverse effects may limit the usefulness of TCAs with some patients. Nursing interventions that could alleviate some of the unpleasant aspects of these adverse effects include a. always administering the drug when the patient has an empty stomach. b. reminding the patient not to void before taking the drug. c. increasing the dose to override the adverse effects. d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects.
tap beer
After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid: Phenelzine is a MAOI. avoid foods high in tyramine: - tap beers matured and aged cheeses - cured, smoked, or processed meats -broad bean pods; -concentrated yeast extract; - pickled or fermented foods (e.g., sauerkraut, tofu); and -soy sauce.
clozapine
After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent? Haloperidol Pimozide Loxapine Clozapine
Overt clues
All of the following are examples of nonverbal communication EXCEPT: a. Facial expression b. Silence c. Overt clues d. Body language e. Eye contact Overt communication consists of two elements: explicit and implicit. Explicit communication refers to words which are used in oral and written communication. Of course, words carry some specific meanings (several, actually), which help to interpret messages.
Agreeing with the patient
All of the following are examples of therapeutic communication techniques EXCEPT: a. Silence, such as: you, the NURSE says not, however, he/she continues to maintain eye contact and conveys interest b. Agreeing with the patient, such as: "that's right" or & "I agree" c. Seeking information, such as I'm not sure I follow" d. Voicing doubt, such as, saying, "Isn't that unusual" "Really" or "that's hard to believe"
True
Amphetamine has the potential for HIGH abuse and may lead to drug dependence. T or F is a central nervous system stimulant marketed under the brand name Evekeo, among others. It is used in the treatment of attention deficit hyperactivity disorder, narcolepsy, and obesity.
delirium r/t underlying medical probs
An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status?
Ego Integrity vs. Despair
An 81-year-old resident of a long-term care facility has confided in the nurse that the client is profoundly fearful of death. Within Erikson's psychosocial theory, this statement may suggest a failure to resolve which developmental conflict?
Is conducive to concentration and problem solving
An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what?
mild
An adolescent who is seeing the school health nurse states, "I won't be able to hang out with my friends on Friday night because I have two essays due Monday." What level of anxiety is the adolescent experiencing?
result of neuro factors
An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology? "In a lot of cases, making improvements to your sleep habits can resolve narcolepsy." "This is something that runs in certain families, and it's not your fault that this has happened." "This usually stems from suppressed emotions, so counseling usually helps greatly." "This is the result of neurologic factors over which you have no direct control."
theophylline (decreases effect)
An increased dosage of a prescribed benzodiazepine may be necessary if the client's current regimen includes what medication? Calcium channel blockers theophylline cimetidine oral contraceptives
beneficence
An obligation to do good by acting in ways that promote the welfare and best interest of others.
pneumonia
An older adult client develops delirium secondary to an infection. Which would be the most likely cause? Delirium in the older adult is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia. Infections of the respiratory tract such as pneumonia or urinary tract are among the most common infection-related causes.
teaching sleeping strategies
An older adult client has been taking diazepam on a daily basis for several years. On the advice of the client's daughter, the client now wants to stop taking it. Due to the possible effects of discontinuation, the nurse should perform what intervention?
lorazepam
An older adult client is brought to the emergency department by family members. The family states the client has been uncharacteristically confused and appears to have abnormal perception of movement. The nurse reviews the client's current medication regimen and suspects the client overdosed on what medication?
lorazepam
An older adult client is brought to the emergency department by family members. The family states the client has been uncharacteristically confused and appears to have abnormal perception of movement. The nurse reviews the client's current medication regimen and suspects the client overdosed on what medication? cephalexin metoprolol acetaminophen lorazepam
excitement, ataxia, confusion
An older adult client is prescribed a hypnotic. The nurse would assess the client closely for which of the following? Select all that apply. Ataxia Diarrhea Excitement Confusion Weight loss *Older adult clients are at greater risk for oversedation, dizziness, confusion, and ataxia as well as a paradoxical reaction evidenced by marked excitement or confusion.
confusion
An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following? headache confusion stress anxiety
confusion
An older adult client is prescribed a sedative for the treatment of insomnia. The nurse would suspect that the client is experiencing an adverse reaction to the drug based on assessment of which of the following? Stress Anxiety Headache Confusion
dizzy & prone to falls
An older adult reports anxiety and is prescribed diazepam by a family physician. The physician asks the office nurse to explain to the client the problematic side effects of this medication. Which instruction about this drug would be most important for the nurse to emphasize? Diazepam is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults.
Aggressive Behavior
Anti-anxiety drugs (Anxiolytics) are used to treat ALL of the following EXCEPT a. Aggressive behavior b. Alcohol withdrawal c. PTSD d. Insomnia e. Depression
cardiac or seizure disorders
Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of: Antidepressants, especially tricyclic antidepressants, can cause cardiac dysrhythmias.
numerous neurological effects
Antipsychotic drugs are also known as neuroleptic drugs because a. they cause numerous neurological effects. b. they frequently cause epilepsy. c. they are also minor tranquilizers. d. they are the only drugs known to directly affect nerves.
CNS stimulants
Attention-deficit/hyperactivity disorder (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are both most effectively treated with the use of a. neuroinhibitors. b. dopamine receptor blockers. c. major tranquilizers. d. CNS stimulants.
traditional vs atypical antipsychotics
Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade. Atypical antipsychotics block both serotonin and dopaminergic receptors.
rapid metabolism and loss of effectiveness
Barbiturates cause liver enzyme induction, which could lead to a. rapid metabolism and loss of effectiveness of other drugs metabolized by those enzymes. b. increased bile production. c. CNS depression. d. the need to periodically lower the barbiturate dose to avoid toxicity
ibuprofen, haldol, thiazides, antacids
Before administering lithium to a patient, the nurse should check for the concomitant use of which drugs, which could cause serious adverse effects? a. Ibuprofen b. Haloperidol c. Thiazide diuretics d. Antacids e. Ketoconazole f. Theophylline
GABA
Benzodiazepines increase which neurotransmitter function? used to treat anxiety and to induce sleep.
adhd risk factors
Born prematurely Very low birth weight Prenatal exposure to alcohol & or nicotine
lithium contraindications
C/O: - compromised renal function - urinary retention -low salt diets or ppl w diuretics - ppl w brain or CV damage
anxiety treatment
CBTs, deep breathing and relaxation, and medications such as benzodiazepines, SSRI antidepressants, tricyclic antidepressants, and antihypertensives such as clonidine (Catapres) and propranolol (Inderal).
s/s of serotonin syndrome
Change in mental state: confusion and agitation •Neuromuscular excitement: muscle rigidity, weakness, sluggish pupils, shivering, tremors, myoclonic jerks, collapse, and muscle paralysis •Autonomic abnormalities: hyperthermia, tachycardia, tachypnea, hypersalivation, and diaphoresis
adhd
Characterized by inattentiveness, overactivity, and impulsiveness - a persistent pattern of inattention and/or hyperactivity and impulsivity more common than generally observed in children of the same age. - More common in boys - Key feature = problematic behavior reoccurant every day, almost all situations, and w/ almost all caregivers.
A, b; Only pos se, typical/ 1st gen
Chlorpromazine (Thorazine), Fluphenazine (Prolixin) and Trifluoperazine (Stelazine) are ALL examples of what classification of psychopharmacology? a. Targets only the positive side effects of schizophrenia b. Typical/first generation antipsychotics c. Third generations antipsychotics d. Targets both positive and negative side effects of schizophrenia e. Atypical/second generation psychotics
antipsychotic
Chlorpromazine is a drug in which classification?
Narcolepsy
Chronic excessive sleepiness characterized by repeated, irresistible sleep attacks. - After sleeping for 10-20 min, they feel refreshed until the next sleep attack. - may also experience cataplexy (sudden episodes of bilateral, reversible loss of muscle tone that last for seconds to minutes) or paralysis of voluntary muscles or dream-like hallucinations - tx: stimulant medication, modafinil (Provigil), and behavioral structuring, such as scheduling naps at convenient times.
report rash
Client teaching for lamotrigine (Lamictal) should include which instructions? a.Eat a well-balanced diet to avoid weight gain. b.Report any rashes to your doctor immediately. c.Take each dose with food to avoid nausea. d.This drug may cause psychological dependence.
general lead
Client: "I had an accident." Nurse: "Tell me about your accident." This is an example of which therapeutic communication technique? a.Making observations b.Offering self c.General lead d.Reflection
Dementia nursing interventions
Clients may become confused or tire easily, so frequent breaks in the interview may be needed - frequent breaks in interview - simple questions - MSE check for: - promo safety - promo adequate sleep & proper nutrition, hygiene, and activity - structure environment and routine (Familiar surroundings and routines help eliminate some confusion and frustration from memory loss) -monitor and manage stimulation - provide emotional support (give gentle touch) - promo interaction & involvement
relaxation
Cognitive restructuring techniques include all of the following, except a.decatastrophizing. b.positive self-talk. c.reframing. d.relaxation
Frotteurism
Compulsion to achieve sexual arousal by touching or rubbing against a nonconsenting person in public situations. Acts of frottage occur most often between the ages of 15 and 25
True
Concrete messages are important for accurate information exchange, explicit word usage and need no interpretation t or f
moderate dementia
Confusion is apparent, along with progressive memory loss. - no longer can perform complex tasks -can't live independently & requires assistance - loss of orientation to time and place
Signs of alcohol withdrawal
Confusion, tachycardia/autonomic instability, seizure, hallucinations
Freud's topographical model
Conscious Mind - fully aware; governed by "secondary process" that is RATIONAL, logical, and cognitive Pre-Conscious Mind - capable of becoming conscious when attention is focused in its direction Unconscious Mind - repressed and unaware; governed by "primary process" that is IRRATIONAL and unrefined; closely linked to emotional states
Dependent PD (Cluster C)
Continuous need for reassurance. Remain dependent on one specific person "pervasive/ excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, allow others to make decisions, helpless when alone, tolerate mistreatment, demeans oneself to gain acceptance, fails to function adequately in situations that require assertive or dominant behavior. ex: ellie
Thioridazine (Mellaril)
Conventional typical antipsychotic associated with *fatal cardiac arrhythmias*
Anorexia treatment
Correct electrolyte imbalance first Plan with pt: regular mealtimes, varied and moderate intake, gradual intro of feared foods Focus on health benefits of food Increase intake slowly
a adequate perception, support, coping
Critical factors for successful integration of loss during the grieving process are a.the client's adequate perception, adequate support, and adequate coping. b.the nurse's trustworthiness and healthy attitudes about grief. c.accurate assessment and intervention by the nurse or helping person. d.the client's predictable and steady movement from one stage of the process to the next.
anxiety nursing assessment
Decreased attention span •Restlessness, irritability •Poor impulse control •Feelings of discomfort, apprehension, or helplessness •Hyperactivity, pacing •Wringing hands •Perceptual field deficits •Decreased ability to communicate verbally more prevalent in women, people younger than 45 years of age, people who are divorced or separated, and people of lower socioeconomic status
Types of Sexual Dysfunction
Delayed Ejaculation, Erectile Disorder, Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, Male Hypoactive Desire Disorder, and Premature (Early) Ejaculation.
neurocognitive disorders (NCDs)
Delirium Mild NCD Major NCD
True
Disulfiram (Antabuse) is used ONLY as a deterrent to drinking alcohol in persons who are motivated to abstain from drinking and NOT impulsive. T/F
psychoanalysis
Dream analysis and free association are techniques in which modality? a.Client-centered therapy b.Gestalt therapy c.Logotherapy d.Psychoanalysis
pemoline
Drug, similar to Ritalin, used to treat ADHD. last line of choice drug cuz it causes liver damage
hypnotics
Drugs that are best used to cause a patient to sleep are called a. hypnotics. b. sedatives. c. antiepileptics. d. anxiolytics.
a, b, d; positioning, safety measures, alert for AE
Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which actions? a. Positioning to decrease discomfort of dyskinesias b. Implementing safety measures to prevent injury c. Encouraging the patient to chew tablets to prevent choking d. Careful teaching to alert the patient and family about this adverse effect e. Applying ice to the joints to prevent damage f. Pureeing all food to decrease the risk of aspiration
inadequate sleep hygiene
Engaging in behaviors not conducive to sleep or interfering directly with sleep including caffeine or nicotine before bed. Treatment modalities include sleep hygiene measures, cognitive-behavioral techniques, and medication.
social & psychosocial
Erik Erikson's theories focused on both ____ & _____ developments across the life span he proposed 8 stages of psychosocial development; each stage includes a developmental task & a virtue to be achieved
secondary appraisal of coping
Evaluation of resources to Overcome the stressor Eliminate the stressor Reduce the stressor
hyperreflexia
Exaggerated reflex response A 36-year-old client has been receiving a selective serotonin reuptake inhibitor for treatment of depression. The client is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which symptom of this syndrome?
exhibitionism
Exposure of the genitals to a stranger occurs before age 18 and is less severe after age 40
Dystonia, akathisia, and pseudoparkinsonism
Extrapyramidal side effects are characterized by a triad of symptoms, including what?
Avoidant PD (Cluster C)
Extreme shyness and fear of rejection, often socially inept
dry mouth
For which adverse reactions should the nurse monitor the patient who has been administered antipsychotic drugs? Skin eruptions Hypertension Dry mouth Bradycardia
peplau
Four levels of anxiety were described by a.Erik Erikson. b.Sigmund Freud. c.Hildegard Peplau. d.Carl Rogers.
conscious, preconscious, unconscious
Freud believed that the human personality functions at what 3 levels of awareness?
0.5-1.5 mEq/L
Identify the serum lithium level for maintenance and safety. a.0.1 to 1 mEq/L b.0.5 to 1.5 mEq/L c.10 to 50 mEq/L d.50 to 100 mEq/L
12 hrs
In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?
a, b, c, e; breathing, hr, fear, decreased ab
In assessing a client who is experiencing anxiety, the nurse would expect to find which conditions? a. Rapid breathing b. Rapid heart rate c. Fear and apprehension d. Constricted pupils e. Decreased abdominal sounds f. Hypotension
ACh
In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning?
i should not want that
In response to a question posed during group meeting, the nurse explains that the superego is that part of the self that says: a. "I like what I want." b. " I want what I want." c. "I should not want that." d. "I can wait for what I want."
suddenly stopping = insomnia/ nightmares
In the discharge instructions for a client who is taking alprazolam, the nurse should include what?
aphasic
Inability generate or understand language due to damage to the brain. Either inability to create words i.e. expressive aphasia; or inability to understand spoken words i.e. receptive aphasia
repression
Incidents of child molestation often are reveled years later when the victim is an adult. Which defense mechanism reflects this situation? a. Isolation b. Repression c. Regression d. Introjection
(Peplau's Stages of Personality Development) stage 4: Developing skills in participation
Includes learning capacity to "compromise, compete, and cooperate" with others, consensual validation, and love of self/ others. Failure to mature these skills leads to difficulty in confronting problems. Nurses meant to help pts develop/ refine skills by helping them identify problems, define goals, and take responsibility
(d, e, f;) limit rituals, teaching relaxation, tolerating feelings
Interventions for a client with OCD would include a.encouraging the client to verbalize feelings. b.helping the client avoid obsessive thinking. c.interrupting rituals with appropriate distractions. d.planning with the client to limit rituals. e.teaching relaxation exercises to the client. f.telling the client to tolerate any anxious feelings.
false (ex of residential tx)
Is the following statement true or false? Board and care homes are an example of a partial hospitalization program.
ego defense mechanisms
Largely unconscious mental strategies employed to reduce the experience of conflict or anxiety. Can be either a therapeutic or a pathological way to manage stress
bipolar meds
Lithium=mood stabilizer Anticonvulsants such as Valproic Acid (Depakote), Clonazapam, Lamitcal, Gabapentin, and Topiramate Benzos such as Lorazepam used on a short term basis SSRIs such as Prozac
HCT levels
M: 42-52% F: 37-47%
schizophrenia nursing care
Maintain safe environment, establish trust. Don't touch pt w/o telling exactly what doing. Postpone procedures until less suspicious or agitated. use accepting, consistent approach and use clear unambiguous language. Assess ability to carry out ADL's. Only do what pt can't do for self. Monitor nutritional status. reward positive behavior. Promote social skills, meaningful relationships.Give meds. Encourage compliance.
community skills training
Managed care provides funding for psychiatric rehabilitation programs to a.develop vocational skills. b.improve medication compliance. c.provide community skills training. d.teach social skills.
Nonmaleficence
Means we should act in ways that avoid harming others. We are required to carry out tx in ways that are unlikely to cause undue risk or needless harm
schizophrenia
Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include a. depression. b. anxiety. c. seizures. d. schizophrenia.
drowsy, decreased muscles, decreased pain, temp sensation
Moderate CNS depression is characterized by: Increasing hyperactivity, excessive talking, nervousness, and insomnia. Wakefulness, mental alertness, and decreased fatigue. Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold. A lack of interest in surroundings and inability to focus on a topic.
A, b, c, d; anhedonia, blunt affect, apathy, alogia
Negative or soft symptoms of schizophrenia a. anhedonia b. blunted affect c. apathy d. alogia e. associative looseness It's negative because it takes away your ability to do something. where people appear to withdraw from the world around then,
depression and adhd
Norepinephrine has been shown to play a role in a person's mood and ability to concentrate. Which are disease processes seen with low levels of norepinephrine? Select all that apply. depression psychosis schizo ADHD
deep breathing and relaxation
Nursing interventions for hospitalized clients with PTSD include A. Encouraging a thorough discussion of the original trauma. B. Providing private solitary time for reflection. C. Time-out during flashback to regain self-control. D. Use of deep breathing and relaxation techniques.
a, c, e, f; allow denial, correct assumptions, attentive presence, past coping
Nursing interventions that are helpful for the grieving client include a.allowing denial when it is useful. b.assuring the client that it will get better. c.correcting faulty assumptions. d.discouraging negative, pessimistic conversation. e.providing attentive presence. f.reviewing past coping behaviors.
expansive and grandiose
On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood?
enzyme degradation
One of the most common ways in which neurotransmitters are deactivated within the nervous system at the neuronal level is:
paradoxical excitement
One week ago, a 74-year-old was started on a benzodiazepine for the treatment of an anxiety disorder. The client comes into the clinic for a follow-up visit and states feeling nervous, is having trouble sleeping, and feels hyperactive. What does the nurse understand may be occurring as a result of this medication?
Phases of nurse client relationship - Peplau
Orientation Identification Exploitation Resolution 1. Orientation phase: client, nurse, and family work together to recognize, clarify, and define the existing problem. 2. Identification phase: pt begins to respond to those who offer help. 3. Exploitation phase: pt takes full advantage of help offered 4. Resolution phase: pt gains independence and can help self.
MAOI examples
Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan)
preop restlessness, nausea and vomit
Phenothiazines such as chlorpromazine are occasionally used for clinical indications not associated with psychiatric illness. What indications would be included? Select all that apply. preoperative restlessness nausea and vomiting peptic ulcer disease postoperative headaches Parkinson's disease
d
Physiologic responses of complicated grieving include a.tearfulness when recalling significant memories of the lost one. b.impaired appetite, weight loss, lack of energy, and palpitations. c.depression, panic disorders, and chronic grief. d.impaired immune system, increased serum prolactin level, and increased mortality rate from heart disease.
false (20-60 min)
Please answer the following statement as true or false. Peak levels of barbiturates occur in 60 to 90 minutes.
anxiety nursing interventions
Provide a safe environment and ensure the client's privacy during a panic attack. •Remain with the client during a panic attack. •Help the client focus on deep breathing. •Talk to the client in a calm, reassuring voice. •Teach the client to use relaxation techniques. •Help the client use cognitive restructuring techniques. •Engage the client to explore how to decrease stressors and anxiety-provoking situations
milieu therapy
Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of: a. Milieu therapy b. Cognitive -behavior therapy c. Behavior therapy d. Interpersonal therapy
a, c, e; react, readjust, reinvest
Rando's six Rs of grieving tasks include a.react. b.read. c.readjust. d.recover. e.reinvest. f.restitution.
masochist
Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer. Some individuals act on masochistic urges by themselves, others with a partner.
voyeurism
Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of undressing, or engaging in sexual activity. usually begins before age 15, is chronic, and may involve masturbation during the voyeuristic behavior
assertive community treatment
Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses
sleepwalking
Repeated episodes of complex motor behavior initiated during sleep, including getting out of bed and walking around. occurs most often in children between the ages of 4 and 8 years & dissipates by adolescence NO TX REQUIRED
nightmare disorder
Repeated occurrence of frightening dreams that lead to waking from sleep. dreams are often lengthy and elaborate, provoking anxiety or terror and causing the individual to have trouble returning to sleep and to experience significant distress and, sometimes, lack of sleep. NO WIDELY ACCEPTED TX
Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered
Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include which nursing interventions?
c death of loved one
Situations that are considered risk factors for complicated grief are a.inadequate support and old age. b.childbirth, marriage, and divorce. c.death of a spouse or child, death by suicide, and sudden and unexpected death. d.inadequate perception of the grieving crisis.
Theory of Moral Development (Kohlberg)
Stages of moral development are not closely tied to specific age groups; they are more accurately determined by the individual's motivation behind the behavior. Psychiatric nurses must be able to assess the level of moral development of their clients in order to be able to help them in their effort to advance in their progression toward a higher level of developmental maturity.
give after meals
Teaching for methylphenidate (Ritalin) should include which information? a.Give the medication after meals. b.Give the medication when the child becomes overactive. c.Increase the child's fluid intake when he or she is taking the medication. d.Check the child's temperature daily.
A, b, c, e;
The Interdisciplinary Team consists of: SATA a. social worker b. mentally health nurse (RN) c. dietician d. psychiatrist/psychologist e.occupational/recreational therapist -An interdisciplinary team is a group of healthcare providers from different fields who work together or toward the same goal to provide the best care or best outcome for a patient or group of patients.
negative schizophrenia symptoms
The absence of things that are normally present SHOULD be there -flat affect -alogia (poverty of speech) -anhedonia (unable to feel pleasure) -apathy -attention deficit -avolition -disorganized speech -socially withdrawn
(a, c, d, e;) rights respected, protects, no to request, needs met
The advantages of assertive communication are a.all persons' rights are respected. b.it gains approval from others. c.it protects the speaker from being exploited. d.the speaker can say no to another person's request. e.the speaker can safely express thoughts and feelings. f.the speaker will get his or her needs met.
a lower
The benzodiazepines are the most frequently used anxiolytic drugs because a. they are anxiolytic at doses much lower than those needed for sedation or hypnosis. b. they can also be stimulating. c. they are more likely to cause physical dependence than older anxiolytic drugs. d. they do not affect any neurotransmitters.
GABA receptor sites
The benzodiazepines react with a. GABA receptor sites in the RAS to cause inhibition of neural arousal. b. norepinephrine receptor sites in the sympathetic nervous system. c. acetylcholine receptor sites in the parasympathetic nervous system. d. monoamine oxidase to increase norepinephrine breakdown.
low NE, dopamine, or serotonin
The biogenic amine theory of depression states that depression is a result of a. an unpleasant childhood. b. gamma-aminobutyric acid (GABA) inhibition. c. deficiency of NE, dopamine, or 5HT in key areas of the brain. d. blockages within the limbic system, which controls emotions and affect.
CNS stimulants
The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment? a. CNS Stimulants b. SSRIs C. ACE inhibitors d. MAOIs
lack of serotonin
The client presents to the mental health clinic with reports of fibromyalgia, migranes, and GI distress. The nurse talks about the different neurotransmitters and what each neurotransmitter does. How would you elaborate on the type of symptoms this client is demonstrating? produces symptoms such as irritability, sleep disturbances, and compulsiveness."
chlorpromazine
The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed? Haloperidol Chlorpromazine Thiothixene Theophylline
antihistamines
The client reports using an over-the-counter (OTC) drug to treat insomnia. What classification of OTC medications is often used for this purpose? antitussives antihistamines salicylates nonsteroidal anti-inflammatory drugs
increased sedative effects
The client suffers from GERD and diverticulosis and has been admitted to a medical floor. The admitting physician orders cimetidine (acid reducer) and a sedative to calm the client. What should the nurse be concerned about? If the client's insurance will cover the two drugs Cost of the drugs Increased sedative effect Decreased sedative effect
latency
The client who hesitates 30 seconds before responding to any question is described as having a.blunted affect. b.latency of response. c.paranoid delusions. d.poverty of speech.
burst of increased anxiety
The client with OCD has counting and checking rituals that prolong attempts to perform activities of daily living. The nurse knows that interrupting the client's ritual to assist in faster task completion will likely result in a.a burst of increased anxiety. b.gratitude for the nurse's assistance. c.relief from stopping the ritual. d.symptoms of depression or suicidality.
behavioral theory
The client's parents have begun a program of therapy that includes giving the client a token each time the client follows directions. Which theoretical framework provides the background for such a program?
confusion or forgetfulness
The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse's best response? Monitor for a yellowish color in the eyes and easy bruising, due to liver damage. Monitor for muscle stiffness and rigid body posture. Monitor his urine output closely, due to the risk of kidney damage. Monitor for increased signs of confusion or forgetfulness.
Qt interval, fever, malaise, leukopenia
The doctor has ordered Clozapine 150mg daily, to a patient being discharged. What patient should be included in the discharge planning by the NURSE, regarding this medication? SELECT ALL THAT APPLY clozapine-antipyschotic a. Lenghtens the QT interval b. May cause fever, malaise and leukopenia c. Weekly WBS's for the 1st six months d. Side effects may manifest within 24 hours after initation of therapy e. None of the above
d
The family of a client with schizophrenia asks the nurse about the difference between conventional and atypical antipsychotic medications. The nurse's best answer may include which information? a.Atypical antipsychotics are newer medications but act in the same ways as conventional antipsychotics. b.Conventional antipsychotics are dopamine antagonists; atypical antipsychotics inhibit the reuptake of serotonin. c.Conventional antipsychotics have serious side effects; atypical antipsychotics have virtually no side effects. d.Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists.
Thioridazine (Mellaril)
The following drugs are ALL classified as atypical antipsychotic EXCEPT: a. Olanzapine (Zyprexa) b. Quetiapine (Seroquel) c. Fazaclo (Clozapine) d. Clozapine (Clozaril) e. Thorazine a first generation antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis.
internal and external responses.
The function of the thalamus and the hypothalamus is to coordinate:
B, c, d, e; facilitate, ID concerns, teach skills, establish relationship
The goals of therapeutic communication are: SELECT ALL THAT APPLY a. Give advice b. Facilitate the patient's expression of emotions c. Identify the patients most important concerns d. teach the patient and family necessary self-care skills e. Establish a therapeutic nurse-relationship
moderate
The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and is concerned only with stating that the client is about to die. The nurse would classify this level of anxiety as what?
acknowledge own behavior
The most important short-term goal for the client who tries to manipulate others would be to a.acknowledge own behavior. b.express feelings verbally. c.stop initiating arguments. d.sustain lasting relationships.
WBC
The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?
ID pic of car
The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ...
paradoxical excitement (opposite of what they want)
The nurse gives a 68-year-old client diphenhydramine to help the client sleep the night before surgery. At midnight, the nurse notes the client is awake and agitated. What pharmacologic principle would be the cause of this reaction?
slow progresssion
The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows that teaching has been effective when the caregiver makes which statement? a."Let's hope this medication will stop the Alzheimer disease from progressing any further." b."It is important to take this medication on an empty stomach." c."I'll be eager to see if this medication makes any improvement in concentration." d."This medication will slow the progress of Alzheimer disease temporarily."
severe insomnia
The nurse is assessing a client who has been prescribed lorazepam. Which of the client's current signs and symptoms should cause the nurse to suspect that the client is experiencing withdrawal? current mood is described as "depressed" unstable blood sugars in recent days severe insomnia for the past several nights uncharacteristic memory lapses
based on rapid onset (of change of consciousness)
The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?
trouble remembering appts
The nurse is assessing an adult client with ADHD. The nurse expects which to be present? a.Difficulty remembering appointments b.Falling asleep at work c.Problems getting started on a project d.Lack of motivation to do tasks
Diphenhydramine
The nurse is caring for a client who has been taking fluphenazine (Prolixin) for 2 days. The client suddenly cries out, his neck twists to one side, and his eyes appear to roll back in the sockets. The nurse finds the following PRN medications ordered for the client. Which one should the nurse administer? a.Benztropine (Cogentin), 2 mg PO, bid, PRN b.Fluphenazine (Prolixin), 2 mg PO, tid, PRN c.Haloperidol (Haldol), 5 mg IM, PRN extreme agitation d.Diphenhydramine (Benadryl), 25 mg IM, PRN
BP
The nurse is caring for a client who is receiving an intravenous barbiturate. What assessment should the nurse prioritize? a. Assessment for bleeding b. Blood pressure c. Oxygen saturation d. Anaphylaxis
102 degree temp (clozapine = agranulocytosis)
The nurse is caring for a client who takes clozapine. The nurse would be most concerned if this client displays what symptom? Weight gain of 1 lb in the last week Blood sugar of 108 Temperature of 102°F Blood pressure of 98/64
Benztropine (antiparkinson agent)
The nurse is caring for a client with schizophrenia who is taking haloperidol (Haldol). The client complains of restlessness, cannot sit still, and has muscle stiffness (EPS effects). Of the following prn medications, which would the nurse administer? a.Haloperidol (Haldol), 5 mg PO b.Benztropine (Cogentin), 2 mg PO c.Propranolol (Inderal), 20 mg PO d.Trazodone, 50 mg PO
assess newborn for withdrawal
The nurse is caring for a neonate whose mother took benzodiazepines for anxiety during the last 2 months of her pregnancy after a family tragedy. What is the nurse's best action? Assess the infant's pupillary reflex. Establish intravenous access. Administer flumazenil to the neonate as prescribed. Assess for newborn withdrawal syndrome.
increased self esteem
The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority?
bp, respirations, skin temp/color
The nurse is doing a physical assessment on admission of a client diagnosed with elevated blood pressure due to anxiety. What are the most important physical assessments for a nurse to perform? Select all that apply. Skin temperature and color Bowel sounds Respiratory rate Hair texture Blood pressure Physiologic manifestations of anxiety can include increased blood pressure and pulse rate, increased rate and depth of respiration, and increased muscle tension. An anxious client may have cool and pale skin.
b healthy coping
The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? a.The client can identify calorie content for each meal. b.The client identifies healthy ways of coping with anxiety. c.The client spends time resting in her room after meals. d.The client verbalizes knowledge of former eating patterns as unhealthy.
assess temp, monitor respirations, docu urinary output
The nurse is monitoring a client for possible neuroleptic malignant syndrome. What interventions will the nurse implement in client care? Select all that apply. Assess temperature every 8 hours. Document urinary output into client records every 8 hours. Perform a daily bedside electrocardiogram (ECG). Monitor bradycardia every 4 hours. Monitor for signs of respiratory distress.
all of the conditions
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to his history of alcohol abuse? a) Pancreatitis, esophagitis, gastritis, and elevated liver enzymes b) Pancreatitis and elevated liver enzymes c) All the conditions are attributable to the alcohol abuse d) Gastritis and elevated liver enzymes
HR and rhythm
The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next? Patterns of activity and rest Heart rate and rhythm Throat and esophagus Condition of mouth and gums
blood drawn for cbc
The nurse is planning discharge teaching for a client taking clozapine (Clozaril). Which teaching is essential to include? a.Caution the client not to be outdoors in the sunshine without protective clothing. b.Remind the client to go to the lab to have blood drawn for a white blood cell count. c.Instruct the client about dietary restrictions. d.Give the client a chart to record the daily pulse rate
image of brain (to look at its blood flow)
The nurse is preparing a client for a functional magnetic resonance imaging (fMRI) scan. When describing this procedure, which information would be most appropriate for the nurse to include?
importance taking immediately before bed (cuz of rapid onset of action)
The nurse is providing education to a client who has been prescribed eszopiclone (hypnotic). What information should the nurse include? the need to supplement the medication with a benzodiazepine the need to have monthly blood work drawn during treatment the importance of taking the drug immediately before going to bed the importance of taking the drug with food
memory loss
The nurse is talking with a woman who is worried that her mother has Alzheimer disease. The nurse knows that the first sign of dementia is a.disorientation to person, place, or time. b.memory loss that is more than ordinary forgetfulness. c.inability to perform self-care tasks without assistance. d.variable with different people.
validate understanding
The nurse is teaching a 12-year-old with intellectual disability about medications. Which intervention is essential? a.Speak slowly and distinctly. b.Teach the information to the parents only. c.Use pictures rather than printed words. d.Validate client understanding of teaching
pizza without pepperoni
The nurse is teaching a client taking an MAOI about foods with tyramine that he or she should avoid. Which statement indicates that the client needs further teaching? a."I'm so glad I can have pizza as long as I don't order pepperoni." b."I will be able to eat cottage cheese without worrying." c."I will have to avoid drinking nonalcoholic beer." d."I can eat green beans on this diet."
Soy, pizza
The nurse is teaching a patient who is taking MAOI's about foods with tyramine that he or she should avoid. Which of the following statements indicate the patient needs further teaching? a. I can eat soy foods to maintain my current diet b. I can eat green beans on this diet. c. I can drink as much non-alcohol beer as I want d. I can eat cottage cheese without worrying e. Im so glad I can have pizza, I dont have to order pepperoni
• "It's best to give it at breakfast every day." (to prevent insomnia)
The nurse is teaching the parents of a child diagnosed with attention-deficit hyperactivity disorder how to administer extended release methylphenidate (Ritalin). What should the nurse teach the parents?• "Contact the school nurse to work out a convenient schedule."• "It's best to give it at breakfast every day."• "It can be given at any time, as long as it's on an empty stomach."• "Giving it at bedtime will minimize the adverse effects."
supervise 2 hours after meals
The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which intervention is indicated? a.Supervise the client closely for 2 hours after meals and snacks. b.Increase the daily caloric intake from 1,500 to 2,000 calories. c.Increase the client's fluid intake. d.Request an order from the physician for fluoxetine.
severe
The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as a.mild. b.moderate. c.severe. d.panic.
psychomotor agitation (increased body movements and thoughts; which includes pacing, accelerated thinking, wringing their hands and having difficulty sitting still, and argumentativeness)
The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which? a. Aggression b. Anger c. Anxiety d. Psychomotor agitation
comatose client
The nurse should not administer sedatives or hypnotic drugs to which client? *should not be given to these kinds of people along w severe respiratory problems, hx of substance abuse, or pregnant/ lactating women
heightened awareness
The nurse understands that a certain level of anxiety is required in a client for effective learning. Which anxiety-related symptom indicates the client may be able to learn effectively?
b, c, d; exploiting, special privileges, superficial friend
The nurse working with a client with antisocial personality disorder would expect which behaviors? a.Compliance with expectations and rules b.Exploitation of other clients c.Seeking special privileges d.Superficial friendliness toward others e.Utilization of rituals to allay anxiety f.Withdrawal from social activities
hypoglycemia (interacts w antidiabetic agents)
The nurse would assess for what in a client with type 2 diabetes using an oral antidiabetic agent and receiving an MAOI? Orthostatic hypotension Hypoglycemia Diabetic ketoacidosis Renal dysfunction
moody, sullen, pouty
The nurse would expect to see all the following symptoms in a child with ADHD, except a.distractibility and forgetfulness. b.excessive running, climbing, and fidgeting. c.moody, sullen, and pouting behavior. d.interrupting others and inability to take turns.
recovery from illness
The overall goal of psychiatric rehabilitation is for the client to gain a.control of symptoms. b.freedom from hospitalization. c.management of anxiety. d.recovery from the illness.
0.8-1.5 mEq/L
The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration since this is an indication of lithium toxicity. therapeutic range for lithium is... *thyroid function test ordered every 6 mo *assess renal status
cognitive behavioral therapy
The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlines: a. Modeling b. Milieu therapy c. Cognitive behavioral therapy d. Interpersonal psychotherapy
promo recovery
The primary purpose of psychiatric rehabilitation is to a.control psychiatric symptoms. b.manage clients' medications. c.promote the recovery process. d.reduce hospital readmissions.
Sullivan's Interpersonal Theory
The purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety. Nurses use the concepts of Sullivan's theory to help clients achieve a higher degree of independent and interpersonal functioning
benzos
The recommended first-line pharmacologic agents for managing severe alcohol withdrawal symptoms are in which class of medications?
vomiting, diarrhea, weakness
The signs of lithium toxicity include which? a.Sedation, fever, and restlessness b.Psychomotor agitation, insomnia, and increased thirst c.Elevated WBC count, sweating, and confusion d.Severe vomiting, diarrhea, and weakness
ae can persist days after stopping meds
Three days after discontinuing diazepam with medical guidance, an older adult continues to demonstrate impaired memory and confusion. The nurse should consider what possible explanation for the client's current status? The client may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. The adverse effects of benzodiazepines can persist for several days after stopping the drug. Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. The client may have decreased liver function.
antipsychotics
Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which type of drug? a.Anticonvulsant mood stabilizers b.Antipsychotics c.Benzodiazepines d.Lithium
behavior
Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure? This part of the brain seems to be largely responsible for the human aspect of brain function. Drug therapy aimed at alleviating emotional disorders, such as depression and anxiety, often involves attempting to alter the levels of epinephrine, norepinephrine, and serotonin.
Acute phase of psychosis
Typical psychotic symptoms emerge. The stage when psychosis is easiest to recognize and diagnose. When most people begin receiving treatment
D, e; clang associations, negologism
Unusual speech patterns which are normally associated with patients diagnosed with psychosis, such as schizophrenia are: SATA a. latency of response- hesitation of speech b. verbigeration- "I want to go home, go home, go home" c. I can eat green beans on this diet d. Clang associations: such as "I'll take apill if I go up the hill, my name is Jill, I don't want to kill." e. Negologims: "I am afraid of grittiz; are you grittis"? (made up word)
have not responded to other antidepressants
Venlafaxine (Effexor) is an antidepressant that might be very effective for use in patients who a. are being treated effectively with a SSRI. b. can tolerate multiple side effects. c. are reliable at taking multiple daily dosings. d. have not responded to other antidepressants and would benefit from once-a-day dosing.
dizzy, drowsy, dry mouth
What are the most common types of side effects from SSRIs? a.Dizziness, drowsiness, and dry mouth b.Convulsions and respiratory difficulties c.Diarrhea and weight gain d.Jaundice and agranulocytosis
when did you have your last drink
What assessment question would be most appropriate when providing care for a client newly prescribed chlordiazepoxide? "How much alcohol have you ingested in the last 8 hours?" "When did you have your last drink of alcohol?" "What is motivating you to stop drinking alcohol?" "How has your alcohol use affected your quality of life?" *Chlordiazepoxide is used primarily when clients are in acute alcohol withdrawal. Assessment should be focused on when the client last consumed alcohol to help in the planning of care.
bringing change in feelings, attitudes, thinking, and behavior
What best describes the use of psychotherapy as a mental health intervention?
not restless or confused
What goal should the nurse identify for a client prescribed chlordiazepoxide (benzo)? The client will be able to verbally express an understanding of alcoholism. The client will not experience unpleasant effects when consuming alcohol. The client will remain in an unresponsive state for at least 6 hours. The client will not appear restless or confused.
cyclert (hepatoxicity)
What is a drug that is never used for ADHD treatment and why?
Fluphenazine (Prolixin)
What is more likely to cause eps and traduce dyskinesia? Which of the following antipsychotic agents can be given IM every 4 to 6 weeks? typical antipsychotic
cerebellum
What part of the brain would be responsible for activities such as walking and dancing? controls and coordinates muscle movement integral to physical activities such as walking and dancing The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain?
dont combine, causes seizures
What should a patient be taught regarding evening primrose and antidepressants?
combo increases risk of serotonin syndrome
What should patients taking antidepressants need to be taught regarding St. John's Wort?
bp, pulse, respirations, weight
What should the nurse's pre-administration physical assessment for the administration of an anxiolytic include? (Select all that apply.) Blood pressure Weight Blood glucose Respiratory rate Pulse
Countertransference
When a nurse develops feelings toward a client that are based on the nurse's past experience, it is called a.countertransference. b.role reversal. c.transference. d.unconditional regard.
control over aggressive impulses
When assessing a client from a Freudian developmental perspective, the nurse determines that the client is functioning in the latency stage based on which behavior?
specific and direct
When assessing a client with anxiety, the nurse's questions should be a.avoided until the anxiety is gone. b.open-ended. c.postponed until the client volunteers information. d.specific and direct.
b, c, f; confusion, impaired LOC, rapid onset
When assessing a client with delirium, the nurse will expect to see a.aphasia. b.confusion. c.impaired level of consciousness. d.long-term memory impairment. e.mood fluctuations. f.rapid onset of symptoms.
enhanced action of GABA
When describing the action of benzodiazepines as anxiolytics, what would the nurse need to keep in mind? Effect on action potentials Depression of the cerebral cortex Enhanced action of gamma-aminobutyric acid Depressed motor output
Acetylcholine
When describing the various neurotransmitters, which would a nurse identify as the primary cholinergic neurotransmitter?
acetylcholine
When describing the various neurotransmitters, which would a nurse identify as the primary cholinergic neurotransmitter?
decreases heroin withdrawal
When discussing methadone treatment with a client, the nurse should include what? It decreases the severity of heroin withdrawal symptoms. The cure rate is extremely high. It takes 1 to 2 years to cure an opiate addict. It is a nonaddictive treatment.
false
When discussing personality disorders, the term "treatment resistant" refers to a lack of response to medications prescribed.
recognizing EPS (extrapyramidal s/s)
When educating a black client regarding newly prescribed antipsychotic medication, it is vital that the nurse address which care issue?
disruption in life
When interviewing any client with a personality disorder, the nurse would assess for which? a.Ability to charm and manipulate people b.Desire for interpersonal relationships c.Disruption in some aspects of his or her life d.Increased need for approval from others
Hildegard Peplau
When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying concepts based on the work of which individual? Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship?
namenda causes elevated bp
When teaching a client about memantine (Namenda), the nurse will include which information? a.Lab tests to monitor the client's liver function are needed. b.Namenda can cause elevated blood pressure. c.Taking Namenda will improve the client's cognitive functioning. d.The most common side effect of Namenda is gastrointestinal bleeding.
Urinary retention, arrhythmias, and constipation
When teaching a patient receiving TCAs, it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of a. increased libido and increased appetite. b. polyuria and polydipsia. c. urinary retention, arrhythmias, and constipation. d. hearing changes, cataracts, and nightmares.
ambivalence
When the client describes fear of leaving his apartment as well as the desire to get out and meet others, it is called a.ambivalence. b.anhedonia. c.alogia. d.avoidance.
paradoxical insomnia
When the individual thinks he or she is awake or is not sleeping even though brain wave activity is consistent with normal sleep *usually due to ruminating worry that follows into sleep
matter of fact
When working with a client with a narcissistic personality disorder, the nurse would use which approach? a.Cheerful b.Friendly c.Matter-of-fact d.Supportive
b, c, d; impaired relationships, no empathy, minimal insight
When working with a client with a personality disorder, the nurse would expect to assess which? a.High levels of self-awareness b.Impaired interpersonal relationships c.Inability to empathize with others d.Minimal insight e.Motivation to change f.Poor reality testing
c, d, e, f; gestures, narrowed fields, selective attention, can't connect thoughts
When working with a client with moderate anxiety, the nurse would expect to see a.inability to complete tasks. b.failure to respond to redirection. c.increased automatisms or gestures. d.narrowed perceptual field. e.selective attention. f.inability to connect thoughts independently.
walk to bathroom
Which action by the new nurse would alert the charge nurse that more education is needed for the new nurse, after administering an anxiolytic to a client? a. Raise the side rails b. Place the call light within reach c. Dim the lights d. Having the client walk to the bathroom
a, b, f; improved mood, making amends, everything better soon
Which actions would indicate an increased suicidal risk? a.An abrupt improvement in mood b.Calling family members to make amends c.Crying when discussing sadness d.Feeling overwhelmed by simple daily tasks e.Statements such as "I'm such a burden for everyone" f.Statements such as "Everything will be better soon"
a, b, e; drawing, modeling, exercise
Which activities would be appropriate for a client with mania? a.Drawing a picture b.Modeling clay c.Playing bingo d.Playing table tennis e.Stretching exercises f.Stringing beads
buspirone
Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety? Meprobamate Buspirone Zaleplon Diphenhydramine
phenelzine
Which antidepressant is potentially lethal in overdose? an MAOI, is potentially lethal in overdose (hypertensive crisis) and poses a potential risk in clients with depression who may be considering suicide.
urine retention, constipation, dry mouth
Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply.
Alprazolam, chlordiazepoxide, lorazepam
Which are examples of benzodiazepine antianxiety drugs? (Select all that apply.) Chlordiazepoxide (Librium) Hydroxyzine (Atarax) Alprazolam (Xanax) Buspirone (BuSpar) Lorazepam (Ativan)
hypothalamus
Which area of the brain has been associated with the symptoms of eating disorders?
Flurazepam
Which benzodiazepine would a nurse expect to administer as a hypnotic? Alprazolam Lorazepam Flurazepam Diazepam
short term memory loss
Which can be identified as a hallmark symptom of dementia?
operant conditioning
Which concept states that if a certain behavior is rewarded with praise, the behavior will probably be repeated?
Tarasoff v. Regents of the University of California
Which court decision or act states that psychotherapists have a duty to exercise reasonable care in protecting the foreseeable victims of their clients' violent actions? the high court said that psychotherapists have a duty to warn the foreseeable victims of their clients' violent actions. The acts listed do not specify a duty to warn.
CBT and drugs
Which intervention has been found to be most effective reducing the initial symptoms of bulimia?
teach problem solving skills
Which intervention is an example of primary prevention implemented by a public health nurse? a.Reporting suspected child abuse b.Monitoring compliance with medications for a client with schizophrenia c.Teaching effective problem-solving skills to high school students d.Helping a client apply for disability benefits
growth suppression
Which is a concern for children taking stimulants for ADHD for several years? a.Dependence on the drug b.Insomnia c.Growth suppression d.Weight gain
hypoglycemia
Which is a metabolic cause of delirium? a. meningitis (infection related) b. hypoglycemia c. encephalitis (infection related) d alcohol intoxication (drug related)
self monitoring
Which is an example of a cognitive-behavioral technique? a.Distraction b.Relaxation c.Self-monitoring d.Verbalization of emotions
correcting body image disturbances
Which is not a goal for treating the severely malnourished client with anorexia nervosa? a.Correction of body image disturbance b.Correction of electrolyte imbalances c.Nutritional rehabilitation d.Weight restoration
EPS & tardive dyskinesia
Which is the most commonly seen adverse side effect of typical antipsychotics?
reduce fear, protect self esteem
Which is the most effective goal for clients who are learning about the adaptive use of the ego defense mechanism?
imipramine
Which is used to treat enuresis? a.Imipramine (Tofranil) b.Methylphenidate (Ritalin) c.Olanzapine (Zyprexa) d.Risperidone (Risperdal)
mild
Which level of anxiety helps the client focus the client's attention to learn, problem solve, think, act, feel, and protect himself or herself?
fluoxetine
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? Lithium Haloperidol Fluoxetine Bupropion
Lorazepam (Ativan)
Which medication is used to prevent alcohol withdrawal symptoms?
Prolixin (it is a phenothiazine this is for mood disorder such as schizophrenia)
Which of the following MD orders would you, the nurse, question for a patient who states, "I am allergic to phenathiazines"? a. Haldol, 5mg POb. b.Navane 10mg PO BID c. Prolixin 5mg PO tidd. d. Risperdal 2mg BID
delusions, hallucinations, disorganized thinking
Which of the following are considered to be positive signs of schizophrenia? a.Anhedonia b.Delusions c.Hallucinations d.Disorganized thinking e.Illusions f.Social withdrawal
(d, f;) discharge plans, feeling angry
Which of the following are examples of a therapeutic communication response? a."Don't worry; everybody has a bad day occasionally." b."I don't think your mother will appreciate that behavior." c."Let's talk about something else." d."Tell me more about your discharge plans." e."That sounds like a great idea." f."What might you do the next time you're feeling angry?"
(a, c, d, e;) intrusive, recurrent, uncontrollable, unwanted
Which of the following characteristics describe the obsessional thoughts experienced by clients with OCD? a.Intrusive b.Realistic c.Recurrent d.Uncontrollable e.Unwanted f.Voluntary
pharmacist
Which of the following disciplines most likely would be included as part of the interdisciplinary team? A. Physician's assistant B. Physical therapist C. Pharmacist D. Dietician
b complaints
Which of the following give cues to the nurse that a client may be grieving for a loss? a.Sad affect, anger, anxiety, and sudden changes in mood b.Thoughts, feelings, behavior, and physiologic complaints c.Hallucinations, panic level of anxiety, and sense of impending doom d.Complaints of abdominal pain, diarrhea, and loss of appetite
journaling
Which of the following interventions would be most helpful for a client with dissociative disorder having difficulty experiencing feelings? A. Distraction B. Reality orientation C. Journaling D. Grounding techniques
books on desk
Which of the following is a concrete message? a."Help me put this pile of books on Marsha's desk." b."Get this out of here." c."When is she coming home?" d."They said it is too early to get in."
c only after receiving permission
Which of the following is true about touching a client who is experiencing a flashback? A. The nurse should stand in front of the client before touching. B. The nurse should never touch a client who is having a flashback. C. The nurse should touch the client only after receiving permission to do so. D. The nurse should touch the client to increase feeling of security
vortioxetine (Brintellix)
Which of the following medications is NOT indicated for obsessive-compulsive disorder, depression, and panic disorder? a. citalopram (Celexa) b. paroxetine (Paxil) c. fluvoxamine (Luvox) d. vortioxetine (Brintellix)
c did not cause
Which of the following statements would indicate family teaching about schizophrenia had been effective? a."If our son takes his medication properly, he won't have another psychotic episode." b."I guess we'll have to face the fact that our daughter will eventually be institutionalized." c."It's a relief to find out that we did not cause our son's schizophrenia." d."It is a shame our daughter will never be able to have children."
manipulative behavior
Which of the following would a nurse expect to assess in a patient with antisocial personality disorder? a. overwhelming empathy b. high self-esteem c. manipulative behaviors d. pervasive suspiciousness
tardive dyskinesia
Which of the following would be considered a neurologic side effect of antipsychotic therapy?A. Blurred visionB. AgranulocytosisC. SedationD. Tardive dyskinesia
Ssris
Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiological dependence? a.Benzodiazepines b.Tricyclics c.Monoamine oxidase inhibitors d.SSRIs
dark urine and nausea
Which of these assessment findings, if identified in a patient who is receiving pemoline (Cylert), should the nurse report to the prescriber immediately?
borderline
Which personality disorder is most commonly found in clinical settings?
culture
Which statement is true? a.Anorexia nervosa was not recognized as an illness until the 1960s. b.Cultures in which beauty is linked to thinness have an increased risk for eating disorders. c.Eating disorders are a major health problem only in the United States and Europe. d.Individuals with anorexia nervosa are popular with their peers as a result of their thinness.
flight of ideas
Which term typifies the speech of a person in the acute phase of mania? a.Flight of ideas b.Psychomotor retardation c.Hesitant d.Mutism
WBC count
Which test should be scheduled every week for a patient taking clozapine? has been associated with severe agranulocytosis, (i.e., decreased white blood cells),
sullivan
Which theorist believed that a corrective interpersonal relationship with the therapist was the primary mode of treatment? a.Sigmund Freud b.William Glasser c.Hildegard Peplau d.Harry Stack Sullivan
remain with pt
Which would be the best intervention for a client having a panic attack? a.Involve the client in a physical activity. b.Offer a distraction such as music. c.Remain with the client. d.Teach the client a relaxation technique.
bulemia
While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from?
NMDA receptor antagonist
While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type? a. NMDA receptor b. atypical antipsychotic c. cholinesterase inhibitors d. benzos
True
Ziprasidone (Geodon) (an Antipsychotic used treat schizophrenia and bipolar disorder.) is contraindicated in patients with a known history of QT prolongation myocardial infraction (heart attack) or compensated heart failure. Therefore, Ziprasidone should NOT be used with other QT prolonging drugs. T or F
dry mouth, blurred vision, constipation (cant see, cant pee, cant shit, cant spit)
a client diagnosed with anxiety disorder has been prescribed benzodiazepines. the nurse explaining the possible side effects of the medications. which side effects of the drug explained by the nurse is correct?
SSRIs
a client diagnosed with panic disorder. when considering the neurochemical theory of the disorder, which would the nurse expect to administer as the drug of choice initially? a. SSRIs b. antihypertensives c. benzos d. TCAs
ask parents to keep a written schedule of activities
a client has a diagnosis of borderline personality disorder and lives at home with the client's parents. the client has been in the psychiatric unit for 2 weeks and is schedule to be discharged tomorrow. which would be the most therapeutic when the client's parents come to discuss discharge plans?
lorazepam
a client with aggressive behavior shows no psychotic symptoms. which medication should the nurse expect to be ordered for this client.
autism
a disorder that appears in childhood and is marked by deficient communication, social interaction, and understanding of others' states of mind characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioral patterns
sexual desire disorders
a disruption in the desire phase of the sexual response cycle. Includes female sexual arousal disorder and male erectile disorder
sexual dysfunction
a disturbance in the processes of the sexual response cycle or by pain associated with sexual intercourse. -may be caused by psychological factors alone or a combination of psychological factors and a medical condition.
distorted sensory awareness
a nurse is assessing a client and determines that the client is experiencing severe anxiety based on which findings a. goal directed behavior b. eagerness for more info c. distorted sensory awareness d. a heightened sense of awareness
mood lability, anger issues, impulsive, fear of abandonment
a nurse is assessing a client with borderline personality disorder. which response pattern would the nurse most likely assess?
tardive duskinesia
a nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. it would be essential for the nurse to monitor the client for a. hypoglycemia b. torticollis c. tardive dyskinesia d. weight loss
Schizoid PD (Cluster A)
a profound defect in the ability to form personal relationships or to respond to others in any meaningful, emotional way Defined as having 2 or more positive or negative symptoms during a 1 month period
Catharsis
a release of emotional tension the open expression of affect to purge or "cleanse" oneself.
tic disorder
a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization - fatigue and stress increase symptoms
Desensitization
a systematic way to replace a panic response with a relaxation response
parietal
ability to recognize objects by touch, calculate, write, recognize fingers of the opposite hands, draw, and organize spatial directions, such as how to travel to familiar places.
parasomnia
abnormal behavioral or psychological events associated with sleep, specific sleep stages, or sleep-wake transition. involve activation of physiological systems, such as the autonomic nervous system, motor system, or cognitive processes, at inappropriate times, as during sleep subtypes include: - nightmare disorder - sleep terror disorders - sleepwalking disorder
sleep related breathing disorders
abnormalities in ventilation during sleep. Include: obstructive sleep apnea (repeated episodes of upper airway obstruction), central sleep apnea (episodic cessation of ventilation without airway obstruction), and central alveolar hypoventilation Tx: surgical, such as tracheotomy, and use of a continuous positive-airway pressure machine during sleep
adolescence
after teaching a group of nurses about Borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group?
genetic syndromes
after teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the student identifies which as the most common etiology?
Opioid withdrawal symptoms
agitation, insomnia, flu-like symptoms, yawning, sweating, diarrhea
First s/s of delirium
altered levels of consciousness -seldom stable and usually fluctuate throughout the day. disoriented to time and place
bipolar 2
alternating periods of extremely depressed and mildly elevated moods (hypomania)
toddlers adhd
always on the go, into everything, dismantle toys, jump/ climb furniture, cannot tolerate sedentary activities
Korsakoff's syndrome
an alcohol related disorder marked by extreme confusion, memory impairment, and other neurological symptoms long term use of alcohol that results in dementia
phobia
an illogical, intense, and persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning reaction is out of proportion to the situation or circumstance. *peak age is in middle adolescence
Valproic Acid (Depakote)
anticonvulsant/mood stabilizer used to tx bipolar Therapeutic levels are monitored periodically to remain at 50 to 125 µg/mL monitor liver function, serum ammonia, platelet, and bleeding times
medication for delirium
antipsychotic or antianxiety medication. haloperidol (Haldol), may be used in doses of 0.5 to 1 mg to decrease agitation and psychotic symptoms, as well as to facilitate sleep delirium induced by alcohol withdrawal, which is usually treated with benzodiazepines
mental disorder
any condition characterized by cognitive and emotional disturbances, abnormal behaviors, impaired functioning, or any combination of these. Such disorders cannot be accounted for solely by environmental circumstances and may involve physiological, genetic, chemical, social, and other factors
Antianxiety Agents
benzodiazepines (Valium): better for intermittent or short-term use in the management of anxiety antihistamines (vistral), carbamate derivatives (mephrohamate) azaspirodecanedione buspirone, paroxetine, venlafaxine: better for long-term use
typical (1st gen) antipsychotic drugs MOA
blocking postsynaptic dopamine receptors - alleviates (+) s/s indicated for: schizo, bipolar, psychosis
causes of tic disorders
caused by 1. genetics 2. Abnormal transmission of dopamine
avoidant personality disorder
characterized as : 1. timid 2. sensitive to negative comments 3. fear of rejection
1st generation antipsychotics
chlorpromazine, fluphenazine, haldol all antagonize D2
hyponatremia
clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. which may occur as a result of water intoxication
psychophysiological insomnia
conditioned arousal associated with the thought of sleep Characteristics include excessive worry about sleep problems, trying too hard to sleep, rumination, increased muscle tension, and other anxiety symptoms. Relaxation therapy, sleep hygiene measures, and stimulus control therapy
tricyclic antidepressants
contraindicated in severe impairment of liver function and in myocardial infarction, *do not give w/ MAOIs *they cause orthostatic hypotension, so FALL RISK *cause sedation, no driving
communication disorders
deficits in language, speech, and communication and is diagnosed when deficits are sufficient to hinder development, academic achievement, or activities of daily living, including socialization - Includes language disorders, speech sound disorders, stuttering, and social communication disorders
Mahler's Theory of Object Relations
describes the separation-individuation process of the infant from the maternal figure this is important in nursing because the emotional problems of many individuals can be traced to lack of fulfillment of the tasks of separation/individuation. Examples include problems related to dependency and excessive anxiety
Selective Mutism
developmental disorder characterized by a consistent failure to speak in specific social situations despite speaking in other situations
physiological s/s of anxiety
difficulty with logical thought, increasingly agitated motor activity, and elevated vital signs
depression
disease caused by a change in norepinephrine
dementia
disease process marked by progressive cognitive impairment with no change in the level of consciousness - multiple cognitive deficits, initially, memory impairment, and later causes aphasia, apraxia, agnosia, and disturbance in executive functioning
panic attack s/s
displays four or more of the following symptoms: palpitations, sweating, tremors, shortness of breath, sense of suffocation, chest pain, nausea, abdominal distress, dizziness, paresthesias, chills, or hot flashes.
Benzodiazepines
drugs that lower anxiety and reduce stress *high potential for abuse and dependence * only use for 4-6 wks * avoid caffeine * do not stop taking drug abruptly
Benzodiazepines
drugs that lower anxiety and reduce stress end in -pam and -lam
haloperidol, olanzapine, risperidone, quetiapine (seroquel)
drugs used to manage psychotic symptoms in dementia. they tx delusions, hallucinations, paranoia, and other behaviors such as agitation and aggression
lithium, carbamazepine, and valproic acid (depakote)
drugs used to manage psychotic symptoms of dementia. help stabilize affective lability and diminish aggressive outbursts
mild
during which type of anxiety does a person's perceptual field actually increase?
agoraphobia
fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic
autocratic leadership
leadership style that involves making managerial decisions without consulting others "I tell you what to do, on my terms"
disruption of ventromedial hypothalamsu
leads to excessive eating, weight gain, & decreased responsiveness to satiety effects of glucose
idiopathic insomnia
lifelong inability to obtain adequate sleep caused by neurologic deficit in the sleep-wake cycle Treatment consists of improved sleep hygiene, relaxation therapy, and the long-term use of sleep-inducing medication
abnormal APOE gene
linked with alzheimer's disease
apraxia
lose the ability to perform routine self-care activities such as dressing or cooking s/s of dementia
Norepinephrine
low levels associated with mania
Community Mental Health Act of 1963
major goal was to Build mental health centers that would provide mental health care within the local
hypertensive crisis
major side effect to watch out for with MAOIs ingested with tyramine containing foods
1 week
mania is a mood that is abnormal, persistently elevated, expansive, or irritable and usually lasts....
delirium
mental disorder marked by confusion; uncontrolled excitement; disturbance of consciousness accompanied by a change in cognition
cholinesterase inhibitors
modest therapeutic effects for dementia that slow its progression
night eating syndrome
morning anorexia, evening hyperphagia and nighttime awakenings (at least once a night) to consume snacks - associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss. - Most ppl w this are obese - Tx = SSRIs
3.5-5.0 mEq/L
normal range of potassium
135-145 mEq/L
normal sodium levels
(Peplau's Stages of Personality Development) stage 3: Identifying oneself
nurses recognize cues that communicate how the client feels about themselves & their medical problems. Nurses need knowledge of their own concept of self in order to accept all pts as they are. Resolution of problems that arise in the interdependent relationship can be the means for client and nurse to reinforce positive personality traits and modify negative views of self
S/S of hypertensive crisis
occipital headache, hypertension, nausea, vomiting, chills, sweating, restlessness, nuchal rigidity, dilated pupils, fever, and motor agitation. These can lead to hyperpyrexia, cerebral hemorrhage, and death. *give antihypertensives if this occurs
panic disorders
recurrent attacks of overwhelming anxiety that usually occur suddenly or unexpectedly recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks *increased risk of suicidality in persons with panic disorder
paraphilias
recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or partner, or (3) children or other nonconsenting persons.
Encopresis
repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally; often involuntary, but it can be intentional. Intentional encopresis is often associated with oppositional defiant disorder (ODD) or conduct disorder.
enuresis
repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally. Hereditary (75% have relatives who suffered from it)
palilalia
repeating words or sounds over and over s/s of dementia
bipolar s/s
requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem, sleeplessness, pressured speech, flight of ideas, reduced ability to filter extraneous stimuli, distractibility, increased activities with increased energy, and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments *s/s usually occur at teens, 20s, 30s
deficits in lateral hypothalamus
result in decreased eating & decreased response to sensory stimuli
stereotypic movement disorder
rhythmic, repetitive behaviors, such as hand waving, rocking, head banging, and biting, that appears to have no purpose. Self-inflicted injuries are common -Onset is prior to age 3 years
circadian rhythm sleep wake disorders
sleep-wake disorders characterized by a mismatch between the body's normal sleep-wake cycle and the demands of the environment subtypes include delayed sleep phase, jet lag, shift work, and unspecified tx: sleep hygiene, melatonin, bright light therapy
panic disorder
the nurse has read in a client's admission record that the client has been taking propranolol for psychiatric rather than medical reasons. the nurse should recognize that the client likely has a history of which mental health condition?
onset before 2.5 yrs
the nurse is couseling a family whose child has autism. when describing this condition, which would the nurse most likely include?
blood drawn for WBC
the nurse is planning discharge for a patient taking clozapine. Which of the following is essential to include? Agranulocytosis, also known as agranulosis or granulopenia, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood.
Entitlement
the nurse will assess which of the following characteristics in patient diagnosed with narcissistic personality disorder
atomoxetine
which is an antidepressant used to treat ADHD?
antidepressants (TCAs and MAOIs)
which medication classification has been found to be effective in reducing or eliminating panic attacks
fluoxetine
which medication has been found to be worthy of a trial in clients with bulemia who have OCD
Methylphenidate
which medication is effective in 70-80% of children with ADHD?
dissociation
which occurs when thinking, feeling, or behaviors occur outside a person's awareness
visual
which type of hallucination most commonly occurs in clients diagnosed with dementia
features of intellectual disability
• Onset is often in infancy, but problems show up in childhood and beyond • Various behavioral problems • Aggression, dependency, impulsivity, passivity, stubbornness, poor frustration tolerance • Gullibility and naivete - risk for exploitation by others • Many appear normal, others have obvious physical characteristics • Short stature, seizures, malformed eyes, ears, other parts of the face
bipolar assessment findings
•Disorientation •Decreased concentration, short attention span •Loose associations (loosely and poorly associated ideas) •Push of speech (rapid, forced speech) •Tangentiality of ideas and speech •Hallucinations •Delusions
nursing interventions for mania
•Provide for the client's physical safety and those around. •Set limits on the client's behavior when needed. •Remind the client to respect distances between self and others. •Use short, simple sentences to communicate. •Clarify the meaning of the client's communication. •Frequently provide finger foods that are high in calories and protein. •Promote rest and sleep. •Protect the client's dignity when inappropriate behavior occurs. •Channel the client's need for movement into socially acceptable motor activities
