NURPSYCH PRACTICE
Choice Multiple question - Select all answer choices that apply. A new client on the psychiatric unit has been diagnosed with depression and obsessive-compulsive personality disorder (OCPD). During visiting hours, her husband states to the nurse that he doesn't understand OCPD and what can be done about it. What information should the nurse share with the client and her husband? Select all that apply. a) Perfectionism and overemphasis on tasks usually interfere with friendships and leisure time. b) This disorder typically involves inflexibility and a need to be in control. c) Remind your wife that it is "OK" to be human and make mistakes. d) Medicines such as clomipramine (Anafranil) or fluoxetine (Prozac) may help. e) It will help to interrupt her tasks and tell her you are going out for the evening. f) Reinforce with her that she is not allowed to expect the whole family to be perfect too
• Perfectionism and overemphasis on tasks usually interfere with friendships and leisure time. • Medicines such as clomipramine (Anafranil) or fluoxetine (Prozac) may help. • Remind your wife that it is "OK" to be human and make mistakes. • This disorder typically involves inflexibility and a need to be in control. Inflexibility, need to be in control, perfectionism, overemphasis on work or tasks, and fear of making mistakes are common symptoms of OCPD. Anafranil and Prozac may help with the obsessive symptoms. Interrupting the client's tasks is likely to increase her anxiety even more. Telling her that she cannot expect the family to be perfect is likely to create a power struggle. (less)
Which of the following client statements indicates the need for additional teaching about benzodiazepines? a) "I can't drink alcohol while taking diazepam." b) "Diazepam will help my tight muscles feel better." c) "Diazepam can make me drowsy, so I shouldn't drive for a while." d) "I can stop taking the drug anytime I want."
- I can stop taking the drug anytime I want." Explanation: - Diazepam, like any benzodiazepine, cannot be stopped abruptly. The client must be slowly tapered off of the medication to decrease withdrawal symptoms, which would be similar to withdrawal from alcohol. - Alcohol in combination with a benzodiazepine produces an increased central nervous system depressant effect and therefore should be avoided. - Diazepam can cause drowsiness, and the client should be warned about driving until tolerance develops. - Diazepam has muscle relaxant properties and will help tight, tense muscles feel better.
In addition to teaching assertiveness and problem-solving skills when helping the client cope effectively with stress and anxiety, the nurse should also address the client's ability to: a) Use conflict resolution skills. b) Balance a checkbook. c) Suppress anger. d) Follow step-by-step directions.
In addition to teaching assertiveness and problem-solving skills when helping the client cope effectively with stress and anxiety, the nurse should also address the client's ability to: a) Use conflict resolution skills. b) Balance a checkbook. c) Suppress anger. d) Follow step-by-step directions.
Nursing implications for a client taking central nervous system (CNS) stimulants include monitoring the client for which conditions? a) Hyperpyrexia, slow pulse, and weight gain b) Tachycardia, weight loss, and mood swing c) Hypotension, weight gain, and listlessness d) Increased appetite, slowing of sensorium, and arrhythmias
Tachycardia, weight loss, and mood swings Correct Explanation: Stimulants produce mood swings, anorexia and weight loss, and tachycardia. Hyperpyrexia, slow pulse, weight gain, hypotension, listlessness, increased appetite, slowing of sensorium, and arrhythmias indicate CNS depression. (less
A 6-year-old client is diagnosed with attention deficit hyperactivity disorder (ADHD). When asking this client to complete a task, what techniques should the nurse use to communicate most effectively with him? a) Demonstrate to the client what he is to do, have him imitate the nurse's actions, and give a food reward if he completes the task. b) Explain to the client what he is to do, the consequences if he does not comply, and follow through with praise or consequences as appropriate. c) Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. d) Fully explain to the client the actions required of him, offer verbal praise and a food reward for task completion.
- Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. - Because the client with ADHD is easily distractible, it is important to obtain eye contact before explaining the task. Simple language and having him repeat what he is told are necessary because of his age. Praise encourages the client to repeat the task in the future as well as building the client's self-esteem. A full explanation with verbal praise and a food reward is inappropriate because a food reward increases the chance that he will expect a physical reward for completing tasks. In addition, a full explanation might be too confusing for someone his age. Explaining consequences focuses on punishment, rather than praise. Although demonstration and imitation is an effective teaching method, rewarding with food fosters dependence on food reward for task completion. (less)
Which action demonstrates the role of the psychiatric nurse in primary prevention? a) Providing sexual education classes for adolescents b) Conducting a postdischarge support group c) Handling crisis intervention in an outpatient setting d) Visiting a client's home to discuss medication management
- Providing sexual education classes for adolescents - The psychiatric nurse participates in primary, secondary, and tertiary prevention activities. Primary prevention includes education programs that promote mental health and prevent future psychiatric episodes such as sexual education classes for adolescents. Secondary prevention involves treatment to reduce psychiatric problems (for example, handling crisis intervention in an outpatient setting, administering and supervising medication regimens, and participating in the therapeutic milieu). Tertiary prevention involves helping clients who are recovering from psychiatric illness; activities directed toward providing aftercare and rehabilitation are part of this role. Conducting a postdischarge support group is a tertiary prevention activity. (less)
A client stalks a man she met briefly 3 years earlier. She believes he loves her and eventually will marry her and she has been sending him cards and gifts. When she violates a restraining order he has obtained, a judge orders her to undergo a 10-day psychiatric evaluation. What is the most probable psychiatric diagnosis for this client? a) Delusional disorder — jealous type b) Schizophreniform disorder c) Induced psychotic disorder d) Delusional disorder — erotomanic type
Delusional disorder — erotomanic type Explanation: - In delusional disorder of the erotomanic type, the client has an erotic delusion of being loved by another person and tries to contact the object of the delusion through such behaviors as sending gifts, calling, and stalking. The object of the undesired attention may be a complete stranger or someone the client knows, and usually is of higher status. - In a delusional disorder of the jealous type, the client has a delusion that the sexual partner is unfaithful. In a psychotic disorder, a delusion of suspicion occurs within the context of a close relationship. The individual may believe that someone has an inappropriate or sexual interest in him. - Schizophreniform disorder involves bizarre delusions and hallucinations of less than 6 months' duration
The nurse is caring for a client with a panic attack. Which nursing intervention is most helpful for this client? a) Encourage the client to learn relaxation techniques b) Encourage the client to identify what precipitated the attack c) Stay with the client and remaining calm, confident, and reassuring d) Encourage the client to verbalize any fears, feelings, or concerns
Stay with the client and remaining calm, confident, and reassuring Explanation: A panic-stricken client requires the assistance of a calm person who can provide support and direction. This approach is particularly important because the client already feels frightened and out of control. Having someone remain with the client helps prevent him from feeling isolated and deserted. Encouraging the client to verbalize any fears, feelings, or concerns or encouraging the client to identify what precipitated the attack is futile because the client's level of anxiety prevents him from focusing on precipitating factors. Also, encouraging the client to learn relaxation techniques is not possible at this time as the client is unable to learn new information when the anxiety level is at the panic level. Staying with the client is the best action for the nurse
A client taking paroxetine 40 mg P.O. every morning tells the nurse that her mouth "feels like cotton." Which of the following statements by the client necessitates further assessment by the nurse? a) "I'm using sugarless gum." b) "I'm sucking on ice chips." c) "I'm drinking 12 glasses of water every day." d) "I'm sucking on sugarless candy."
I'm drinking 12 glasses of water every day." Explanation: Dry mouth is a common, temporary side effect of paroxetine. The nurse needs to further assess the client's water intake when the client states she is drinking lots of water. Excessive intake of water could be harmful to the client and could lead to electrolyte imbalance. Dry mouth is caused by the medication, and drinking a lot of water will not eliminate it. Sucking on ice chips or using sugarless gum or candy is appropriate to ease the discomfort of dry mouth associated with paroxetine. (
A 74-year-old client receiving fluphenazine decanoate therapy develops pseudoparkinsonism, and is ordered amantadine hydrochloride. With the addition of this medication, the client reports feeling dizzy when standing. Which response by the nurse is best? a) "Do you have any slurred speech or weakness in one extremity?" b) "I will talk to your doctor about taking you off of one of these medications." c) "If this happens just after taking the medicine, consider taking the medication at bedtime." d) "When you change positions, do so slowly."
"When you change positions, do so slowly." Correct Explanation: - Both the fluphenazine decanoate and amantadine hydrochloride can have orthostatic hypotensive effects. Clients should be educated about this side effect especially in the elderly. Telling the client to change positions slowly will help ease the dizziness. If the dizziness is prolonged, the client should report those results to their practitioner. The client does not need a dose change or taken off the medication. The symptoms reported are orthostatic hypotensive effects not signs and symptoms of a stroke. The client could consider taking the medications at bedtime, but symptoms will likely persist. It would be safer to teach the client how to deal with symptoms as they occur
A nurse is developing a care plan for a client who has undergone electroconvulsive therapy (ECT). The nurse should include which intervention? a) Monitoring the client's vital signs every hour for 4 hours b) Placing the client in Trendelenburg's position c) Reorienting the client to time and place d) Encouraging early ambulation
Reorienting the client to time and place Explanation: Confusion and temporary memory loss are the most common adverse effects of ECT. A nurse should continually reorient a client to time and place as he wakes up from the procedure. Following ECT, the nurse should monitor the client's vital signs every 15 minutes for the first hour. The nurse should position the client on his side after the procedure to reduce the risk of aspiration. The client should remain on bed rest until he's fully awake and oriented
woman has become increasingly afraid to ride in elevators. While in an elevator one morning, she experiences shortness of breath, palpitations, dizziness, and trembling. A physician can find no physiological basis for these symptoms and refers her to a psychiatric clinical nurse specialist for outpatient counseling sessions. Which type of therapy is most likely to reduce the client's anxiety level? a) Systematic desensitization b) Group psychotherapy c) Referral for evaluation for electroconvulsive therap d) Psychoanalytically oriented psychotherapy
Systematic desensitization Correct Explanation: - Phobias are commonly viewed as learned responses to anxiety that can be unlearned through certain techniques such as behavior modification. - Systematic desensitization, a form of behavior modification, attempts to reduce anxiety, and thereby eradicate the phobia, through gradual exposure to anxiety-producing stimuli. - Psychoanalytically oriented therapy also may be effective in this situation, but years of treatment are required to achieve results. - Group psychotherapy could be used as an adjunct treatment to increase the client's self-esteem and reduce generalized anxiety. - Electroconvulsive therapy is reserved primarily for clients with severe depression or psychosis who respond poorly to other treatments; it's rarely indicated for phobic disorders
