Psych Exam 2

Mood Disorder Facts

- 10% of adults have a mood disorder in the U.S. - 350 million people worldwide = 17% affected - Impairment in social/ occupational functioning. - Untreated depression can lead to suicidal/homicidal ideations. **80-90% patients respond well to treatment**

Elder Abuse

- 2/3 of dependent elders are abused by their spouse or children - 1 in 10 elders in the community are mistreated - Elderly men are at higher risk abuse - Increases with added caretaker burden.

Paraphilia

- Abnormal sexual desires/ urges - Sexual behavior is atypical and extreme

Stress Hormones

- Adrenaline - Cortisol - Norepinephrine

Partner Abuse Interventions

- Advise use of shelter or safe house - Encourage to get medical Help - NO ONE DESERVES TO BE BEATEN - Emergency phone numbers - Encourage developing an emergency plan - Inform about legal protections

Extra Pyramidal Side Effects

- Akathisia: restlessness - Dystonia: muscle contraction * Torticollis : head tilts down * Tongue protrusion * Oculogyric Crisis : eyes locked upward * Opisthotonus: arching of the head, neck, and spine - Akinesia/Bradykinesia: little/slow movement - Pseudoparkinsonism: mask like face, etc. - Tardive dyskinesia: tongue movements

Somatic Symptom Disorder Interventions

- Allow a specific time period for the client to discuss physical complaints = limited behavior is better than being stopped completely. - Avoid responding with positive reinforcement about the physical complaints.

Etiology of Depression

- Altered neurotransmitters - Hereditary - Malfunction of hypothalamic-pituitary - Alteration in sleep cycles - Changes in brain anatomy

Herbal Medications

- Alternative meds: Not regulated by the FDA. - OTC meds: FDA approved. - 1:3 people in USA uses alt. therapies. - 16% of pts. on meds take herb supplements

Phobia Nursing Interventions

- Always stay with the client who is experiencing anxiety to promote safety and security. - Never force the client to have contact with the phobic object or situation.

Medications for Sexual Disorders

- Antiandrogens: dec. desires + fantasies - Depo-Provera/Lupron Depot: dec. testosterone + sex drive - SSRIs: dec. compulsive behaviors or sexual functioning Casodex Xtandi Erleada Eulexin Nilandron

Promoting a Therapeutic Relationship

- Be calm - Be consistent - Keep your promises - Be honest - Ask before touching - Orient patient to person, place, and time - Provide positive feedback - Be available and encouraging ** Do not whisper or laugh when patients are not able to hear the whole conversation** =increases paranoia

Bipolar Interventions

- Calm, matter-of-fact manner - Clear, concise directions - Set limits in a non-challenging way - Avoid arguing/debating - Distract the patient from controversial topics

Male Erectile Disorder

- Cannot obtain or maintain an erection - Affects 10% of men - Increases w/ age

Low Potency Anti-Psychotics

- Cause more intense anticholinergic effects (dry mouth, blurred vision) - Fewer EPSEs *Mellaril *Thorazine = lowest

Schizophrenia Neurobiology

- Decreased brain volume - Large ventricles - Atrophy of frontal lobe, cerebellum, hippocampus and amygdala - Decreased blood flow to frontal area and limbic system"

Emotional reactions to violent crime

- Denial, fear, anger, powerlessness - Depression, sense of failure, guilt, PTSD, suicide, weight loss/gain - Loss of trust, control, and self-esteem

Anticonvulsants for Bipolar

- Depakote: for acute mania = therapeutic level 50-115 mcg/ml - Lamictal: rash, Steven Johnson syndrome - Tegretol: faster onset than Lithium - Trileptal : similar to Tegretol but less S/Es - Gabapentin: adjunctive med (may help mood) - Topamax: weight loss, cognitive dulling

Persistent Depressive Disorder (Dysthymia)

- Depressed mood for most of the day, for more days than not (adults: 2 years + children: 1 year). - Symptoms more subtle, "I've always been this way" - Two or more symptoms

Sexual Concerns Assessment

- Difficulties w/ performance or satisfaction? - Feelings/concerns about sexuality? - How satisfied are you w/ your sex life? - Changes you'd like to make in your sex life? - Any negative sex experiences you've had?

Hoarding disorder

- Difficulty discarding or departing from possessions, regardless of value = distress when considering departing

Childhood Sexual Abuse - Child Manifestations

- Disturbed growth and development - Ambivalence, denial - Sleep/eating disturbances - Anxiety, depression, aggression - Active sexual fantasy life; masturbation, sex aggression, sexualized playing - Poor impulse control - Fear, shame, blame, self-destructive - Running away, truancy, wanting to isolate self

Lithium and Other Meds

- Diuretics/NSAIDs: increase Lithium retention - Renal disease: increases half-life of Lithium - Increased sodium: decreases Lithium levels - Decreased sodium: increases Lithium levels - Diarrhea/sweating: increases Lithium levels

Side Effects of Benzodiazepines

- Drowsiness, fatigue - Slow reflexes, confusion - Abuse potential, tolerance, withdrawal * Kava kava & Valerian root = additive effect*

Childhood Sexual Abuse - Adult Manifestations

- Dysfunctional coping - Impulsive - Self-destructive/mutilation - Suicide attempts - Prostitution, early marriage

Rumination

- Focused attention on the symptoms of one's distress. - Focus on causes and consequences - NOT focused on solutions

Which OTC drugs make psych symptoms worse?

- Ginseng/Primrose: mania is worse - Yohimbine: nervous, irritable, insomnia - Betelnut: EPSE if used w/ neuroleptics - ALL HERBALS: caution if taking TCAs or lithium

Trichotillomania

- Hair-pulling disorder - Significant distress or impairment - May relieve anxiety

Side Effects of SSRIs

- Headache - Sexual dysfunction - N/V/D = GI upset - Anticholinergic symptoms = dry

Omega-3 Fatty Acids

- Help depression symptoms - Improve cardiovascular disease - Improve schizo, mania, ADHD + borderline symptoms - Help w/ self-harm and violence

Predictors of Violence in Patients

- Hyperactive - Recent acts of violence - Stone silence - New isolation - Intoxication - Possession of weapons - Milieu: overcrowding, staff inexperience, provocative or controlling staff, poor limit setting"

Depressive Episode (Bipolar)

- Hypersomnia - Dec. in speech - Weight change - Irritability - Dec. sexual function - Increased suicidality - Sluggish thinking **Leaden paralysis: heavy feeling in arms/legs

Female Sexual Arousal Disorder

- Inhibited response to sexual stimulation - Lacking vaginal lubrication - Increases after menopause

L-Tryptophan Uses

- Insomnia - Sleep apnea - Depression/ anxiety - Facial pain - PMDD - Smoking cessation - Grinding teeth during sleep (bruxism) - ADHD - Tourette's syndrome - Improve athletic performance

Tardive Dyskinesia

- Involuntary repetitive muscle movement - Tongue movements, lip smacking, eyebrow movements, eye blinking - Stigmatizing - Early EPSEs symptoms = warning for TD * Difficult to treat/incurable * Ingrezza/ Austedo= MEDS * AIMS= screening tool"

Paxil/Paroxetine Withdrawal

- Irritability - Nausea - Vomiting - Headache ** Can last 2-4 weeks

What is Psychosis?

- Loss of contact with reality - Person's thoughts/perceptions are disturbed - Difficulty understanding what is real / not

Conversion Disorder

- Loss/change in physiological function without medical cause - Significant distress/impairment - Deficits in motor and sensory functions

Atypical Anti-Psychotics Side Effects

- Metabolic Syndrome (weight gain, DM, increased lipids) - Galactorrhea (milky nipple discharge) - Impotence (Risperidone, Haloperidol )

Sexual Dysfunction

- More common in females - More prevalent w/ age = LOW LIBIDO May be caused by: - Meds, substances - Ignorance, lack of info - Guilt, anxiety - Poor communication w/ partners

Partner Abuse

- Most common cause of injury to women. - A woman is beaten every 9 secs in the U.S. - 2 million women are injured every year. - Greater risk of injury if they threaten to/ actually leave the relationship - 1 out of 3 women have experienced rape, physical violence, or stalking by an intimate partner.

Anxiety Statistics

- Most common psych disorder (18%) - 90% comorbidity with other psych disorders - 60% comorbidity with depression - SSRIs = first line treatment - Panic attacks account for 25% of ED visits

Buspirone

- Non-sedating anxiolytic - 1 to 6 weeks for full effect - No dependence, withdrawal, or tolerance MUST BE TAKEN WITH FOOD

Somatic Symptom Disorder

- Persistent worry or complaints regarding physical illness without supportive physical findings - Anxiety is redirected into a somatic concern

Workplace Violence against Nurses

- Physical: 13%-21% of nurses - Emotional/verbal: 34%-55% of nurses ** 80% of nurse leaders endure some form of workplace violence** More workplace violence in PSYCH, ER, and STEPDOWN UNITS **Need to report and follow policies and procedures**

Milieu Interventions for Depression

- Positive feedback - Training/therapy - Support groups - Protect from suicidal intent

Body Dysmorphic Disorder

- Preoccupation with perceived flaws that are not observable by others. - Repetitive behaviors related to reassuring the flaw = mirror checking. - Significant clinical distress.

What is the role of the nurse while taking care of a child who has been abused?

- Protect and comfort the child while under the nurses' care. - Inform the physician and the Pediatric Abuse Team. - Report to Child Protective Services and authorities, such as the police.

Neuropeptides

- Protein-like molecules used by neurons to communicate with each other - Released by the hypothalamic-pituitary adrenal system

What is melatonin's effectiveness inpromoting sleep?

- Re-synchronizes the biological clock - For seasonal affective disorder (SAD) and sleep disorders - Helps with preventing ICU syndrome = delirium, psychosis caused by the stimuli in the ICU

Obsessive-Compulsive Disorder (OCD)

- Recurrent thoughts (often trivial) that cannot be dismissed = obsessive - Uncontrollable urges to perform certain acts to reduce the tension = compulsion

What is Panic Disorder?

- Recurrent, unexpected panic attacks. No stimulus is needed (random). - Often feels like a heart attack, or like they are losing their mind. Causes: - Decreased regulation of sympathetic nervous system. - Increased levels of cortisol and epinephrine.

Schiophrenia Relapse Prevention

- Reduce stress - Develop coping skills - Educate pt. about illness - Educate pt. about med adherence - Educate pt. about medication side effects - Connect pt. to community/support

Interventions for mania

- Remove hazardous objects = safety. - Assess client closely for fatigue. - Promote sleep. - Private room if possible. - Focus on 1 topic during conversation. - Distract the client from grandiose thinking. - Reduce environmental stimuli.

Hallmarks of GAD?

- Restlessness - Fatigue - Irritability - Decreased concentration - Muscle tension - Sleep disturbance - Afraid

Acute Lithium Toxicity

- Seizures - Oliguria - Circulatory failure - Coma - Death

Causes and Treatment of OCD

- Serotonin dysfunction - Basal ganglia and frontal lobe abnormalities - Genetics might play a role *SSRIs are therapeutic

Excoriation

- Skin picking = lesions - Significant distress or impairment in daily life - May relieve anxiety to pick Skin

Treating Associative Looseness

- Tell them you don't understand - Listen for themes - Summarize what they say - Reduce environmental stimuli

Serious Battering Incident

- Tension is unbearable - Victim provokes incident to get it over with - Serious battery incident occurs = beat/injury - Victim may try to cover it up or look for help

Features of MDD

- There has never been a manic or hypomanic episode.

Treating Delusions

- Trust - Empathy - Avoid arguing - Present reality - Focus on feelings

Dissociative Identity Disorder (DID)

- Two or more fully developed, distinct, and unique personalities. - Usually occurs/develops after major trauma. Host and Alters

Treating Hallucinations

- Visual cues - Present reality - Encourage competing noises (distract) - Don't dwell on hallucination - Ensure staff are present

First Generation Anti-Psychotic Side Effects

-Photophobia -Leukocytosis -Orthostatic hypotension -Anti-cholinergic effects

Selective Serotonin Reuptake Inhibitors (SSRIs)

-Prozac/Fluoxetine -Paxil/Paroxetine -Zoloft/Sertraline -Celexa/Citalopram -Lexapro/Escitalopram -Viibryd/Vilazodone -Trintellix/Vortioxetine

Which activity is the least therapeutic for a severely depressed client? a. A simple, short-term activity b. Having the client select an activity c. A monotonous, repetitive activity d. A specific activity to be followed

b. Having the client select an activity

A client who has a history of psychiatric problems, including an antisocial personality disorder, is admitted to the hospital. What typical behavior does the nurse anticipate? a. Sexual acting out b. Interpersonal difficulties c. Diminished contact with reality d. Compulsive behaviors associated with following rules.

b. Interpersonal difficulties

Monoamine Oxidase Inhibitors (MAOIs)

** Inhibit enzymes that remove norepinephrine, serotonin and dopamine from the brain MAOIs = "arrrrrrr" drugs - Marplan - Nardil - Parnate - Selegiline/Zelapar "

Hypomanic Episode

** Less severe than manic episode. - Lasts ~4 days - No hospitalization needed Bipolar II: at least one hypomanic episode and one major depressive episodes = no mania or mixed episodes

TCA Drug Interactions

** TCAs increase the effects of epinephrine Don't take with: - Epi-pen - Warfarin - NSAIDs - Barbiturates - Benzos - Alcohol

Long Acting Antipsychotics

*Abilify/ Aripiprazole= dopamine stabilizer *Haloperidol *Fluphenazine *Olanzapine *Paliperidone *Risperidone

Agranulocytosis

*Leukopenia: Decrease in total leukocyte count *Neutropenia: Decrease in neutrophil count ~1500 *Agranulocytosis: Severe neutropenia ~500 neutrophils

New Atypical Anti- Psychotics

*Paliperidone *Iloperidone *Asenapine *Lurasidone (Latuda) = for bipolar as well

Suicide Statistics

- 1/8 suicidal people attempt suicide - 5% of suicides are inpatient psychiatric patients - Females make more attempts, men are more successful - Highest rate of completed suicides: older white men - 40-50% live alone (lack support)"

Tricyclic Antidepressants (TCAs)

"AND I feel so much better on my Tricyclic" - Amitriptyline (Elavil) - Nortriptyline (Pamelor) - Desipramine (Norpramin) - Imipramine (Tofranil)

Trismus

"Lockjaw" - Reduced opening of the jaws - Caused by spasm of the muscles

Voyeuristic

"Peeping-Tom" - Sexual arousal in viewing individuals secretly - Un-robing or in engaging in sexual activities

What is Generalized Anxiety Disorder?

* Excessive anxiety and worry occurring more days than not for at least 6 months. * Significant distress or impairment in everyday life. * Hard time controlling the worry.

Gender Dysphoria

** Biological sex differs from gender identity - Uncommon - No comorbidities - Hormones may play a role - More common in males than females

Antidepressant-induced suicide

** Black box warning** - Particularly in 18-to-24 year-old patients.

Side Effects of TCAs

** Cardiovascular effects= tachy, arrhythmia, MI **Anticholinergic effects: peripheral nervous system = dry, dec. sweat, blurry vision ** GI/GU = urinary hesitancy, N/V/D/C, weight change

Lithium

** First-line treatment for BIPOLAR Narrow therapeutic range : 0.6-1.2 - Take at same time daily - Report: vomiting, severe hand tremor, sedatio, weakness, and vertigo - Toxic: T-wave depression, twitching - Check levels in the AM (8-12 hrs after dose)"

Medications for EPSEs

-Artane -Benadryl -Cogentin ** Don't help with Tardive Dyskinesia

Anticholinergic Side Effects

-Dry mouth -Dry eyes -Constipation -Blurred vision -Photosensitivity -Urinary retention

A child with attention deficit-hyperactivity disorder (ADHD) often becomes frustrated and loses control. A nurse uses a variety of techniques to manage disruptive behaviors. List the following interventions in order, from the least invasive to the most invasive.

1.Avoiding situations that usually precipitate frustration 2.Monitoring behavior for cues of rising anxiety 3.Using a signal to remind the child to use self-control 4.Refocusing the child's behavior with a specific directive 5.Placing the child in a time-out

A client who is in a manic phase of bipolar disorder threatens staff and clients on a psychiatric acute care unit. Place these interventions in priority order, from the least to the most restrictive.

1.Diversional activities 2.Limit-setting 3.Medication administration 4.Seclusion 5.Restraints

First Generation Anti-Psychotics

Traditional/conventional: - dopamine antagonists - treat positive symptoms Ex: * Thorazine (Chlorpromazine) * Mellaril (Thioridazine) * Prolixin (Fluphenazine) * Haldol (Haloperidol)

Bipolar Rapid Cycling

4 or more manic, hypomanic, or depressive episodes in 12 months.

Nicotine Dependency w/ Schizophrenia

85-90% of schizophrenics smoke - May improve cognitive and sensory deficits - Increases deficient levels of Dopamine

Mixed Episode (Bipolar)

Depressive and manic symptoms within the same episode

Which of the following assessment/treatment options are recommended for patients experiencing chronic hallucinations? Select all that apply. a. Speak to the patient using short sentences. b. Ask the patient to describe what is happening. c. Focus on the patient's emotions and not on the content being addressed. d. Assess the duration, frequency, and triggers for each event.

A, B, D ** C is WRONG because you want to focus on the content first, then the emotions.

A nurse is caring for a client with the diagnosis of somatoform disorder, conversion type. What type of affect does the nurse expect this client to exhibit? Select all that apply. a. Calm b. Cheerful c. Depressed d. Frightened e. Matter-of-fact

A, E - The client's symptoms reduce anxiety and remove the conflict = act normal

A client comes to the ambulatory surgery unit on the morning of an elective surgical procedure. The client reports shortness of breath, dizziness, and palpitations. The nurse observes profuse diaphoresis and is concerned that the client may be having either a panic attack or a myocardial infarction. Which assessments support the conclusion that the client may be experiencing a myocardial infarction? Select all that apply. a. Anxiety b. Chest pain c. Irregular pulse d. Fear of losing control e. Feelings of depersonalization

A,B,C

A client with a diagnosis of schizophrenia, undifferentiated type, is being admitted to the psychiatric unit. What clinical manifestations does the nurse expect when assessing this client? Select all that apply. a. Excited behaviors b. Loose associations c. Inappropriate affect d. Feelings of depression e. Hypervigilant behavior

A,B,C - Excited behaviors, such as aggressive hitting or biting. - Loose association is a characteristic related to thought disorders. - The affect usually is inappropriate, rather than flat.

Comorbidities associated with Schizophrenia include which of the following? Select all that apply. a. Weight gain b. Diabetes c. Metabolic syndrome d. Cardiovascular and pulmonary disease e. None of the above

A,B,C,D - Weight gain, Diabetes, Metabolic syndrome, and Cardiovascular and pulmonary disease

A client is admitted to a psychiatric unit with the diagnosis of schizophrenia, undifferentiated type. When assessing the client, the nurse identifies the presence of several characteristics related to this disorder. What may this include? Select all that apply. a. Bizarre behavior b. Extreme negativism c. Disorganized speech d. Persecutory delusions e. Auditory hallucinations

A,C,E - Bizarre behavior, disorganized speech, and auditory hallucinations are associated with undifferentiated schizophrenia.

As the nurse segregates the symptoms per category, which of the following falls under the positive symptoms? Select all that apply. a. Hallucinations b. Alogia c. Avolition d. Bizarre behavior e. Delusions f. Amotivation

A,D,E ** Positive symptoms = recognizable

A nurse should be aware of the treatment options available for client with schizophrenia. Which of the following are first generation antipsychotic medications? Select all that apply: a. Chlorpromazine (Thorazine) b. Clozapine (Clozaril) c. Risperidone (Risperdal) d. Aripiprazole (Abilify) e. Prolixin (Fluphenazine) f. Haloperidol (Haldol)

A,E,F ** First generation: Thorazine, Prolixin, Haloperidol My FIRST boyfriend Thor got the Flu, it was Hell. * Second generation: Clozaril, Risperdal, Abilify"

Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. A. Chronic obstructive pulmonary disorder B. Hyperthyroidism C. Hypertension D. Diverticulitis E. Hypoglycemia

A. Chronic obstructive pulmonary disorder B. Hyperthyroidism E. Hypoglycemia

Serotonin Syndrome

A: anxiety R: restlessness M: myoclonus S: sweating **Treat with Cyproheptadine = antihistamine** Can occur if SSRI is combined with: - MAOIs - Tryptophans - Stimulants (LSD w/ Buspirone) - Some TCAs - St. John's Wort

Third Generation Anti-Psychotics

ABC!!! - Aripiprazole (Abilify) - Brexpiprazole (Rexulti) - Cariprazine (Vraylar) * Dopamine and serotonin stabilizers * Safer, less side effects * Improves positive and negative symptoms

Assess Severity of Tardive Dyskinesias

AIMS: Abnormal Involuntary Movement Scale

The nurse knows to monitor clients who have started on antipsychotic medications for signs and symptoms of Neuroleptic Malignant Syndrome (NMS). Which of the following are signs and symptoms of NMS? Select all that apply: a. Fever b. Elevated CPK c. Autonomic instability d. Leukocytosis e. Tremors f. Rigidity

ALL OF THE ABOVE Neuroleptic Malignant Syndrome = FALTER Fever Autonomic instability Leukocytosis Tremors Elevated CBK Rigidity

Major Depressive Disorder

Intense and pervasive depression. - Hopelessness/worthlessness - Flat affect - Self-destructive thoughts - Severe psychomotor retardation - Weight loss - Sexual dysfunction - Terminal insomnia - Delusions and hallucinations

Dependent Personality Disorder

Intense lack of self-confidence, low self-esteem, and inability to function independently - difficulty making decisions

Verbal Abuse

Intimidation, ridicule, aggressive posturing, rude gestures, threats, ostracism, offensive notes/emails

Mesocortical Tract

Involved with cognitive processes: - Traditional antipsychotic blockade can intensify negative and cognitive problems

Mesolimbic Tract

Involved with emotional/sensory processes: - Traditional antipsychotic blockade normalizes these processes - Relieves or eliminates hallucinations and delusions.

Nigrostriatal Tract

Involved with movement: - Traditional antipsychotic blockade can cause EPSEs

Antisocial Personality Disorder

Irresponsible and antisocial behavior - Selfishness, inability to maintain relationships, failure to accept social norms - No shame or guilt - Self-centered - Unreliable - Superficial charm - Views others as objects to be manipulated"

Second-line anti-depressants?

Tricyclic antidepressants (TCAs)

Mild Depression

Triggered by an external event and follows the normal grief reaction (lasts ~ 2 weeks)

Negative Symptoms of Schizophrenia

Negative = taken away- too little dopamine - Absence/ dec. of normal cognition + perception - Decreased eye contact - Decline in hygiene - Social withdrawal - Poor speech

Distress

Negative Stress: - Anxiety/concerning - Short or long-term - Unpleasant - Decreased performance - Can lead to mental problems

Foods to avoid with MAOIs

Tyramine-Rich foods: - Alcohol - Dairy - Avocado, bananas, fava beans, figs - Cured meats - Caffeine - Chocolate - Licorice

Anhedonia

Unable to experience pleasure

Borderline Personality Disorder

Unstable interpersonal relationships, unstable mood and self-image = impulsive and unpredictable behavior. - Extreme mood shifts - Easily angered - Self-destructive - Manipulation - Fear of being alone - Splitting = create conflict between others

Tension-Building Stage

Abuser: edgy/explosive Victim: tense/afraid/helpless

Honeymoon stage

Abuser: loving/doting/sorry/promise to change Victim: trusting/hopeful/wants to believe promises

Depression Costs

Account for the greatest number of years lived with disability in the world: - Direct costs: medical/medications - Indirect costs: absenteeism, disability, family/medical leave, worker's comp, turnover"

Phases of Schizophrenia

Acute: severe psychotic symptoms Stabilizing: getting better Stable: some psychotic features, not as severe or disabling"

Abuse

All intentional injury or harm to an individual.

A client with bipolar disorder is aggressive and disruptive in group and social settings. How will the nurse initially work with the client to develop social skills? a. Facilitating one-on-one interactions b. Encouraging self-care with support c. Developing guidelines for behavior d. Helping the client decrease the activity level

a. Facilitating one-on-one interactions

A client comes to the mental health clinic for treatment of a phobia of large dogs. What should the nurse anticipate that this client will demonstrate? a. Fear of discussing the phobia b. Resentment toward the feared object c. Inadequate impulse control when threatened d. Distortion of reality when discussing the phobia

a. Fear of discussing the phobia

Cluster C Personality Disorders

Anxious, fearful types of personality disorders - obsessive-compulsive, avoidant, dependent

Schizophrenia symptoms are grouped into two broad categories. The nurse enumerates them as which of the following? a. Positive and Negative b. Overt and Covert c. Simple and Complex d. Internal and External

a. Positive and Negative

Atropine Psychosis

Atropine: anticholinergic used to reduce salivation and secretions -Mad as a hatter = confused -Red as a beet = fever -Dry as a bone = anticholinergic -Blind as a bat = diplopia

Second Generation Anti-Psychotics

Atypical: - block both dopamine and serotonin - treat positive and negative symptoms - more selective Ex: * Clozapine/Clozaril * Risperidone/ Risperdal * Zyprexa/Olanzapine * Geodon/Ziprasidone * Quetiapine/Seroquel

Hallucinations

Auditory: hearing voices Gustatory: tasting things Olfactory: smelling things Tactile: feeling touch sensations Visual: seeing things

Sexual Harassment

Belittling jokes, sexual advances, porn, sexual assault

Which statements regarding the use of selegiline (MAOI) to treat depression are true? Select all that apply. a. Carbamazepine lowers selegiline levels. b. Oxcarbazepine significantly raises the level of selegiline. c. Oral forms of selegiline are approved for bipolar disease. d. The most common adverse reaction of selegiline is a localized rash. e. Transdermal selegiline is the only transdermal treatment for major depression

B,D,E - Oxcarbazepine significantly raises the level of selegiline - The most common adverse reaction of selegiline is a localized rash - Transdermal selegiline is the first and only transdermal treatment for major depression

Clozaril

BEST ANTI-PSYCHOTIC MEDICATION - Expensive - Weekly labs every 6 months - Seizures, excess saliva, myocarditis

Violence

Behavior that intentionally threatens, causes, or attempts to cause physical harm to a living being

Somatic Delusion

Belief that body is diseased, distorted, or changed.

Magical Thinking

Belief that one's own thoughts, wishes, or desires can influence the external world

A client with a history of smoking is suspected of having depression. The primary healthcare provider prescribes a drug that would be beneficial in treating depression and would aid in smoking cessation. Which adverse effects would the nurse suspect in this client? Select all that apply. a. Asthenia b. Confusion c. Tachycardia d. Constipation e. Increased appetite

C,D - The nurse would suspect confusion and tachycardia in a client who is prescribed Bupropion/Wellbutrin

A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone. Which outcomes indicate that the medication has minimized these symptoms? Select all that apply. a. There is less agitation. b. There are fewer delusions. c. More interest is shown in unit activities. d. The client reports that the hallucinations have stopped. e. The client performs activities of daily living independently.

C,E - Apathy is a common negative symptom = increased interest in unit activities indicates minimized symptoms - Lack of interest is a common negative symptom = performing activities of daily living independently represents a reduction in this symptom

Nicky is a 32-year-old woman who has beenseen in the ED many times a month during this last year. She has presented with multiple system problems and high anxiety. She is concerned that she may die of some strange disease that the physician may not diagnose on time before her death. What disorder is Nicky experiencing? A. Conversion disorder B. Dissociative identity disorder C. Somatic symptom disorder D. General anxiety disorder

C. Somatic symptom disorder

The patient runs aimlessly through the lunchroom knocking over objects without apparent regard, and ignoring all outside attempts to stop or redirect her. What is this patient experiencing?

Catatonic Excitement - Purposeless motor activity and agitation

High Potency Anti-Psychotics

Cause more EPSEs and prolactin elevation - Stelazine - Prolixin - Haldol = highest

SSRIs

Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft - First line treatment for depression, bipolar, OCD - Takes 2-4 weeks - Zoloft and Paxil = more calming effect"

Grey Matter of Brain

Contains most of the brain's neuronal cell bodies - Muscle control - Sensory perception - Speech - Emotions - Memory - Decision making - Self-control

Undifferentiated Schizophrenia

DOESN'T FIT INTO ONE TYPE OF SCHIZOPHRENIA -Significant delusions, hallucinations - Disorganized speech, or disorganized/ catatonic behavior - Symptoms aren't predominantly positive, disorganized, or movement disordered.

United States pharmacopeia (USP)

Dietary supplement verification program

Obsessive-compulsive Personality Disorder

Difficulty expressing warm/tender emotions. Perfectionism, stubbornness, need to control. - Inflexible - Extremely devoted to work - Hoarding - Rituals

Schizotypal Personality Disorder

Display of abnormal or highly unusual thoughts, perceptions, speech, and behavior patterns - suspicious, paranoid, magical thinking

Mania ("DIG FAST")

Distractibility Insomnia Grandiosity Flight of ideas Activity increase Speech is fast Thoughtlessness = high risk

Schisophrenia Neurotransmitters

Dopamine: too much - hallucinations Serotonin: too little - mood control GABA: too little - anxiety Norepinephrine: too much

Cluster B Personality Disorders

Dramatic/ Emotional/ Erratic types - Histrionic, Narcissistic, Antisocial, and Borderline

Antidepressant withdrawal syndrome

Due to abrupt discontinuation of meds

Exhibitionistic

EXHIBITING one's genitals for sexual arousal. - Male

Ginkgo Biloba OTC

Effective mood booster - Enhances memory and concentration - Helps with erectile dys. d/t antidepressants Caution: - Increases effects of anticoagulants - Interacts with several drugs - May increase blood pressure

What do antidepressants do?

Elevate norepinephrine, serotonin, and/or dopamine - restore normal mood

Manic Episode

Elevated mood for at least 1 week. ** At least one manic episode in lifetime = Bipolar I ** - Dec. sleep - Talkative - Racing thoughts - Inc. self-esteem

Trauma

Emotional response to a terrible event such as an accident, rape, or natural disaster.

Fight-or-Flight Response to Stress

Epinephrine: slightly more effect on heart Norepinephrine: more effect on blood vessels **Both play a role in your body's natural fight-or-flight response to stress**

Bipolar Disorder

Episodes of mania and depression, with periods of normal mood and activity in between. Treatment: Lithium carbonate - Requires regular monitoring - Narrow therapeutic range (0.6-1.2) - Maintain sodium and water intake to avoid toxicity.

Flooding

Exposure to stimulus without relaxation until the anxiety subsides

Clomipramine

FDA approved for OCD

Munchausen by proxy

Fabricated and imposed illness on another person - usually a child

Munchausen syndrome

Fabricated and self imposed illness

Neglect

Failing to fulfill caretaking functions either knowingly or accidentally.

Person with No Ego Boundaries

Feelings of being: - Invisible - Nonexistent - Vulnerable - Empty - Wide open to the world ** Don't feel safe or protected **

Orgasm Disorder

Female: delay or absence of orgasm Male: delayed or premature ejaculation

Features of Depression

Five or more of these in the same 2-week period (one either depressed mood or anhedonia): - Depressed mood - Anhedonia (loss of interest or pleasure) - Appetite disturbance/weight change - Sleep disturbance - Psychomotor disturbance - Fatigue or loss of energy - Worthlessness/guilt - Indecision/poor concentration - Recurrent thoughts of death/suicide

Chamomile OTC

For sleep disorders

Rape

Forcible penetration without consent. - Cases reported: only 20-33% - 90% of cases: victim knows offender - 90% of cases: male predator, female victim

Systematic desensitization

Gradual exposure to trauma/anxiety/phobia

5-HTP

Helps alleviate depressive symptoms. - Produced from l-tryptophan - Converted into serotonin and melatonin - May deplete dopamine and norepinephrine if given alone

Kava Kava OTC

Helps with anxiety, relaxation and mental clarity - Interacts with parkinson drugs and benzos - Hepatotoxic , ETOH may increase toxic effects - Long-term use may cause scaly, yellow, dry skin

Valerian OTC

Helps with anxiety/depression - Negates effects of MAOIs, warfarin, and phenytoin - Potential for dependence and withdrawal

SAM-e (S-adenosylmethionine) OTC

Helps with depression - Safe to take with SSRIs - Used for patients with HIV "SAM-e = HIV"

St. John's Wort OTC

Helps with depression, anxiety, and sleep - Inc. risk for serotonin syndrome - Do not take with antivirals or warfarin - Reduces effectiveness of birth control pills

Impact Stage of Recovery

Initial disorganization/reaction Crisis intervention - Few minutes to a few days - Fear, shock, disbelief, confusion, anger, guilt, vulnerability - Disturbed eating and sleeping - Dissociate symptoms - Flashbacks, nightmares, severe anxiety

Schizoid Personality Disorder

Inability to form warm, close social relationships - social detachment

Catatonia

Inability to move normally = immobility

Dissociative Amnesia

Inability to recall important personal information because it provokes anxiety. Localized: memories from a specific time period are blocked out. Selective: only some memories can be recalled from a time period. Generalized: loss of all memory about past life.

What should a patient do if they are sweating heavily while taking Lithium for Bipolar?

Increase his intake of salt during that time.

Narcissistic Personality Disorder

Increased sense of self-importance and preoccupation with fantasies and unlimited success - needs admiration, lack of empathy

Anergia

Lack of energy

Waxy Flexibility

Limbs retain any position that they are put into

Avolition

Little or no motivation

Antidepressant apathy syndrome

Losing interest in life and events

Electroconvulsive Therapy

MOST COMMON - Most effective antidepressant remedy available - Treatments 2 to 3 times a week up to total of 6 to 12 treatments - Rapid response - Safe and effective NOT A CURE = Temporary

Schizophrenia

MOST SEVERE PSYCH DISORDER Only about 50% get treatment - Onset/relapse almost always related to stress - Psychotic features (hallucinations and delusions). - Disordered thought processes. - Disrupted interpersonal relationships.

Antidepressant loss of effectiveness

Medications stop working

What are the levels of anxiety?

Mild: nail biting, fidgeting Moderate: GI upset, headache, urinary urgency Severe: headache, nausea, dizziness, insomnia Panic: pacing, screaming, withdrawal, hallucinations, suicidal thoughts

Echopraxia

Mimic others behaviors

Tuberoinfundibular Tract

Modulates pituitary function: - Traditional antipsychotic blockade can cause elevated prolactin levels

Third-line anti-depressants?

Monoamine Oxidase Inhibitors (MAOIs)

Frotteuristic

Non-consensual touching of others - Male

Stalking

Obsessional pursuit, intimidation

Cluster A Personality Disorder

Odd disorders - Schizoid, schizotypal, and paranoid

Depersonalization/Derealization Disorder

One's own reality is temporarily lost or changed = detachment from reality .

Histrionic Personality Disorder

Overly dramatic and intensely expressive behavior = center of attention, easily bored

Dyspareunia

Pain upon intercourse (male or female)

Negativism

Patient resists all attempts to be moved, or all instructions or requests to move, without any apparent motivation

Disruptive Mood Dysregulation Disorder

Persistent irritability, frequent episodes of extreme behavioral dyscontrol temper outbursts -- BEFORE 10 YEARS OLD

Moderate Depression

Persists over time. - Helplessness/powerlessness - Intense anxiety and anger - Rumination - Difficulty concentrating

Positive Symptoms of Schizophrenia

Positive = Added- excess dopamine - Embellishment of normal cognition + perception - Hallucinations - Delusions - Disorganized speech - Bizarre behavior

Eustress

Positive Stress: - Motivates - Short-term - Exciting - Improves performance

Secondary Gain

Positive external motivations: - Patient is allowed to miss work and gets financial compensation as the result of a medical condition. - Definite evidence of falsification of symptoms for primary gain = factitious disorder - Secondary gain is malingering

Primary Gain

Positive internal motivations: - Patient feels guilty about not being able to perform a task - If there is no medical condition justifying this inability = guilt diminishes

Neuroleptic Malignant Syndrome

Possibly fatal side effect of neuroleptics = Hot, Stiff and Out of it - FEVER + RIGIDITY*** cardinal signs - Confusion - Convulsions - Death = STOP neuroleptic - emergency care

Alogia

Poverty of speech

Sydenham Chorea (SD)

SD Can cause OCD: - Neurological disorder of childhood resulting from infection via GABHS= streptococcus. - Bacteria that causes rheumatic fever - Rapid, irregular, and aimless involuntary movements

First-line anti-depressants

SSRIs

Priority for Hallucinations

Safety!! - Ensure that the client does not have an auditory command telling him or her to harm self or others

Dysphoria

Profound uneasiness/ dissatisfaction with life - Usually followed by depression, anxiety, and agitation.

Sexual Abuse of a Child

REPORTABLE IN EVERY U.S. STATE - Forced, tricked, consensual, or coerced

Reorganization Stage of Recovery

Reconstruction Long-term counseling - Months - years - Review what happened and why; blaming/justifying - Regaining sense of control/protection - Resolution of grief - Unless resolved= PTSD

Antipsychotic Blockade

Refers to the blockade of Dopamine receptors (specifically D2)

Schizoaffective Disorder

Schizophrenic symptoms are dominant. - Accompanied by major depressive or manic symptoms. **Prognosis is better than Schizophrenia, but worse when compared to other mood disorders**

Sexual Masochism

Sexual arousal by being bound, beaten or humiliated - Sex game - Underlying intent is understood

Sexual Sadism

Sexual arousal by inflicting pain. - Usually males + non-consensual

Fetishistic

Sexual focus on objects (feet/hands/clothes) - Male

Pedophilic

Sexual interest toward children - Predator must be 5 years older than victim - Abuse among boys and girls is equal

Transvestic

Sexual satisfaction by dressing in clothing of opposite gender - Males - Some eventually desire to be trans

Avoidant Personality Disorder

Social withdrawal and extreme sensitivity to potential rejection - inadequacy - poor reaction to criticism/hypersensitive - isolation - lack of support system

Vaginismus

Spasms in the vaginal wall

Recoil Stage of Recovery

Struggle to adapt Support groups and counseling - Weeks - months - Periods of ""normal"" to suppress fears, anger, sadness - Later: desire to talk about details of and feelings about trauma - Need support - Gradual awareness of full impact of event

Paranoid Personality Disorder

Suspiciousness and mistrust of others - hostile, argumentative, gradious thoughts

Cyclothymic Disorder

Swing between a hypomanic / depressive - Symptoms occurring for at least 2 years - Symptom-free lasts no longer than 2 months

Premenstrual Dysmorphic Disorder

Symptoms peak around the onset of menses, absent in the week after menses. - Mood swings, irritability, anger, fatigue, sleep issues, "out of control"

Risk Factors for Depression

Temperamental: negative, pessimistic, neuroticism Genetic: first degree family member Course modifiers: other psych or physical conditions, substance abuse, heart disease, diabetes Social/Environmental: adverse childhood experiences

What is the immediate nursing action for a client with anxiety?

To decrease stimuli in the environment and provide a calm and quiet environment

Lipo Flavonoid OTC

Used for Tinnitus

Angelica OTC

Used for sleep disorders, anxiety, and depression

Implosive therapy

Uses vivid imagery to expose pt. to trauma/anxiety/phobia.

Steven Johnson Syndrome

With Lamictal** - Rare but serious - Flu-like symptoms - Red rash that spreads w/ blisters

Benzodiazepines

Xanax, Klonopin, Ativan - Immediate effect - Risk for addiction

The registered nurse is teaching a nursing student regarding education a client who is on treatment with monoamine oxidase inhibitors (MAOIs). Which statement made by the nursing student indicates further teaching? a. "I should encourage the client to take food high in tyramine." b. "I should encourage the client to wear a medical alert necklace." c. "I should advise the client to report any problem in vision." d. "I should advise the client to report any symptoms of seizures."

a. "I should encourage the client to take food high in tyramine." - AVOID TYRAMINE CONTAINING FOODS

An anxious client who receives q4h PRN Anxiolytic medication, is in the corridor pacing. He grabs the arms of anyone who comes along and asks, When can I have medication? His voice is high-pitched and shaky. His respiratory rate is rapid. His assigned nurse should intervene by: a. Ascertaining when the client's medication is due and informing him. b. Sending him to his room to lie down for half an hour. c. Joking with him to reduce tension. d. Suggesting that he watch television."

a. Ascertaining when the client's medication is due and informing him.

What response from the nurse demonstrates an understanding of hallucinating behavior by a client? a. Asking, "What are the voices telling you to do?" b. Calmly noting that the "rat on the floor" is really a stuffed toy c. Allowing the family to bring prepackaged foods from the store d. Explaining to the family that the behavior will worsen during the night

a. Asking, "What are the voices telling you to do?"

The patient has taken Clonazepam (Klonopin) for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the ER in distress. What is the nurse's priority action? a. Begin seizure precautions b. Refer the patient for addiction counseling c. Institute a behavior modification program d. Prepare to administer Lexapro (Escitalopram)

a. Begin seizure precautions

A client is using ritualistic behaviors. Why should a nurse give the client ample time in which to perform the ritual? a. Denial of this activity may precipitate a panic level of anxiety. b. Anger turned inward on the self should be allowed to be expressed. c. Successful performance of independent activities enhances self-esteem. d. Ample time provides an opportunity to point out the inappropriate behavior.

a. Denial of this activity may precipitate a panic level of anxiety.

What are some approaches to treating stress?

a. Develop adaptive coping mechanisms. b. Use relaxation techniques. c. Provide individual therapy that addresses loss of control and/or anger issues. d. Encourage use of support groups. e. Inform the client that hypnotherapy or systematic desensitization may help.

Which of the following would the nurse expect to assess in a client diagnosed with PTSD? Select all that apply. a. Dissociative events b. Intense fear and helplessness c. Excessive attachment and dependence toward others d. Full range of affect e. Avoidance of activities that are associated with the trauma

a. Dissociative events b. Intense fear and helplessness e. Avoidance of activities that are associated with the trauma

What is the DSM-5 criteria for anxiety?

a. Excessive anxiety and worry (apprehensive expectation) occurring for at least 6 months. b. Significant impairment in daily live; difficult to control worry. "

A client who had a brain attack (cerebrovascular accident, CVA) frequently cries when family members visit, and they obviously are upset by the crying. What explanation for the client's behavior does the nurse provide the family members? a. Having difficulty controlling emotions b. Demonstrating a premorbid personality c. Mourning the loss of functional abilities d. Conveying unhappiness about the situation

a. Having difficulty controlling emotions - A common complication of a brain attack is an inability to control emotional affect.

A client with a borderline personality disorder becomes hostile and calls the nurse names. When the nurse denies privileges, the client states that the nurse is uncaring. How can the nurse be most therapeutic in this situation? a. Helping the client identify feelings b. Increasing the client's limits on privileges c. Avoiding the client until the hostility is resolved d. Advising the client how to approach people differently

a. Helping the client identify feelings

A cardinal sign of major depressive disorder is: a. Hopelessness and isolation b. Sadness and rapid thought pattern c. Lack of energy and ability to understand humor d. Isolation and experiencing tactile hallucinations

a. Hopelessness and isolation

A cardinal sign of major depressive disorder is: a. Hopelessness and isolation b. Sadness and rapid thought pattern c. Lack of energy and ability to understand humor d. Isolation and experiencing tactile hallucinations

a. Hopelessness and isolation

The nurse conducts an initial one-on-one session with a client recently admitted to the psychiatric unit, who is found to be experiencing command auditory hallucinations. What is the next important nursing intervention? a. Identifying the content of the messages in the auditory hallucinations b. Determining whether the command hallucinations are frightening to the client c. Helping the client determine whether the voices are outside or inside the client's head d. Determining the client's ability to refrain from listening to the messages from the voices

a. Identifying the content of the messages in the auditory hallucinations

A client in the mental health clinic has a phobia about closed spaces. Which desensitization method should the nurse expect to be used successfully with this client? a. Imagery b. Contracting c. Role playing d. Assertiveness training

a. Imagery

The laboratory values on a male client being treated for bipolar disorder, type 2 diabetes, and peripheral vascular disease who is currently reporting chest pain, show Lithium 2.5mEq. What is the priority nursing intervention? a. Implementing seizure precautions immediately b. Moving the crash cart outside the client's room c. Assessing the client's respiratory and circulatory status d. Performing a stat fingerstick to check the blood sugar level

a. Implementing seizure precautions immediately

Etiology of schizophrenia is associated with all of the following neurobiological factors except: a. Increased brain volume b. Dysregulation of neurotransmitters c. Decreased blood flow to the frontal cortex d. Atrophy of the frontal lobe

a. Increased brain volume **Schizophrenia DECREASES brain volume

While the schizophrenic client is in a room with the other clients in the facility, he develops active hallucinations and shouts The zombies are after me, they're going to eat my brain! Which intervention is a priority during this situation? a. Move the client to a separate, quiet room and let him do an easy activity such as drawing. b. Monitor the client for increasing fear, anxiety or agitation c. Let other people touch the client so that he understands that they are not out to get him. d. Encourage the client to express his feelings.

a. Move the client to a separate, quiet room and let him do an easy activity such as drawing. **SAFETY IS PRIORITY = decrease stimuli"

Debra has been laughing, talking rapidly, with pressured speech. She is running from one part of the unit to the other. Her interactions with the staff and patients are abrupt, and sometimes she violates the individual's personal space. What nursing intervention is appropriate? a. Offer a PRN medication b. Offer seclusion c. Offer restraints d. Offer to pace with the patient"

a. Offer a PRN medication

Debra has been laughing, talking rapidly, with pressured speech. She is running from one part of the unit to the other. Her interactions with the staff and patients are abrupt, and sometimes she violates the individual's personal space. What nursing intervention is appropriate? a. Offer a PRN medication b. Offer seclusion c. Offer restraints d. Offer to pace with the patient

a. Offer a PRN medication ** least restrictive FIRST"

"A client is noted to have a high level of non-goal directed motor activity, running from chair to chair in the solarium. He is wide-eyed and seems terror-stricken. He cries, They're coming! They're coming! He neither follows staff direction nor responds to verbal efforts to calm him. The initial nursing intervention of highest priority is to: a. Provide for client safety b. Increase environmental stimuli c. Respect client's personal space d. Encourage clarification of feelings

a. Provide for client safety

What are adolescent manifestations of childhood sexual abuse? a. Self-destructive behaviors b. Overly attached to one's family c. Developing good interpersonal relationships d. Planning to marry childhood sweetheart

a. Self-destructive behaviors

Which of the following best reflects the evidence on the sex ratio of schizophrenia? a. The disease is equally as likely to affect men and women b. The incidence of the disease is higher in women c. The incidence of the disease is higher in men

a. The disease is equally as likely to affect men and women

Following abnormal behavior in school, a 12 year-old girl is believed to be a victim of abuse. Which of the following behaviors would least likely suggest sexual abuse over other forms of abuse? a.The patient carries around a teddy. b.The patients exhibits knowledge of complex and uncommon sexual behaviors. c.The patient tries to isolate herself from her peers whenever possible. d.The patient has started construction complex fantasy scenarios that intrude daily life.

a. The patient carries around a teddy.

Antidepressants are used for: a. Treatment of depression, some anxiety disorders, and bipolar disorder b. Treatment of depression only; the other uses are off label c. Treatment of depression, abdominal pain, and bipolar disorder d. Treatment of depression and bipolar disorder only

a. Treatment of depression, some anxiety disorders, and bipolar disorder

Antidepressants are used for: a. Treatment of depression, some anxiety disorders, and bipolar disorder b. Treatment of depression only; the other uses are off label c. Treatment of depression, abdominal pain, and bipolar disorder d. Treatment of depression and bipolar disorder only

a. Treatment of depression, some anxiety disorders, and bipolar disorder

Schizophrenia Diagnostic Criteria

a. Two or more of the following, each present for a significant portion of time during a 1-month period. - Number 1, 2, or 3 must be one of the symptoms: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms b. Significant disturbance in work, achievement, interpersonal relations or self-care. c. Continuous signs of disturbance ◦ At least 6 months ◦ Must include at least 1 month of symptoms from criterion A

A hospitalized client with an obsessive-compulsive disorder tells the nurse that coworkers and roommates get upset because the client spends at least 30 minutes in the bathroom six times a day. The client says, "It keeps me from getting nervous." What is the most appropriate response by the nurse? a. "That's not a problem now, because you have your own bathroom here." b. "Tell me how spending time in the bathroom helps you avoid becoming nervous." c. "Tell me more about what you do in the bathroom during those 30-minute periods." d. "Let's start by cutting down the time you spend in the bathroom to 20 minutes three times a day."

b. "Tell me how spending time in the bathroom helps you avoid becoming nervous."

A client is admitted to the surgical unit with superficial wounds of both wrists, the result of a suicide attempt. When the nurse enters the room, the client says, "I suppose you're going to ask me about my suicide attempt." What is the best response by the nurse? a. "Do you want to talk about it?" b. "Tell me how you feel about it." c. "It's best not to dwell on it right now." d. "Why do you think I'd ask you about it?"

b. "Tell me how you feel about it." - Moves the emphasis from facts to feelings; it focuses on the client without setting the direction for communication

What is the average age of onset of schizophrenia in women? a. 15 years b. 25 years c. 35 years

b. 25 years

Roughly what proportion of people diagnosed with schizophrenia experience recurrent relapse and continued disability? a. About 90% b. About 75% c. About 50%

b. About 75%

The nurse is interviewing the family about the onset of problems in a young client with the diagnosis of schizophrenia. In what stage of development does the nurse expect that the client's difficulties with reality testing began? a. Puberty b. Adolescence c. Late childhood d. Early childhood

b. Adolescence

A client who is a regular user of cocaine is admitted to a rehabilitation facility. What are the common side effects of regular cocaine usage that the nurse should be aware of when assessing this client? a. Nausea, fatigue, and extreme hunger b. Anxiety, dysphoria, and extreme suspicion c. Seizures, hoarseness, and electrolyte imbalance d. Lethargy, sexual arousal, and hormone imbalance

b. Anxiety, dysphoria, and extreme suspicion

A client is admitted to the psychiatric unit of the hospital with a diagnosis of conversion disorder. The client is unable to move either leg. Which finding should the nurse consider consistent with this diagnosis? a. Feeling depressed b. Appearing composed c. Demonstrating free-floating anxiety d. Exhibiting tension when discussing symptoms

b. Appearing composed - The client with a conversion disorder literally converts the anxiety to the symptom = serves as a defense against the anxiety and the client is diagnostically almost anxiety-free

The teaching plan for a patient beginning Lorazepam (Ativan) should include instructions to: Select all that apply. a. Take the drug on an empty stomach b. Avoid discontinuing the drug abruptly c. Stop taking the drug if side effects occur d. Drink only moderate amounts of alcohol e. Avoid herbal preparations

b. Avoid discontinuing the drug abruptly e. Avoid herbal preparations

How can the nurse best assist a client with an obsessive-compulsive disorder to decrease the use of ritualistic behavior? a. By providing repetitive activities that require little thought b. By attempting to limit situations that will worsen the anxiety c. By getting the client involved in activities that will provide distraction d. By suggesting that the client perform menial tasks to hide feelings of guilt

b. By attempting to limit situations that will worsen the anxiety - When anxiety is reduced, the need for these obsessive-compulsive actions is reduced

A client with schizophrenia says to the nurse, "I've been here 5 days. There are five players on a basketball team. I like to play the piano." How should the nurse document this cognitive disorder? a. Word salad b. Loose association c. Thought blocking d. Delusional thinking

b. Loose association - Ideas are not well connected and there is no clear train of thought.

A delusional client verbalizes the belief that others are out to cause the client harm. A nurse notes the client's worsening pacing and agitation. What is the best nursing intervention? a. Advising the client to use a punching bag b. Moving the client to a quiet place on the unit c. Encouraging the client to sit down for a while d. Allowing the client to continue pacing with supervision

b. Moving the client to a quiet place on the unit - A client losing control feels frightened and threatened ** needs external controls ** needs a reduction in external stimuli.

What should the nurse include when planning continuing care for a moderately depressed client? a. Encouraging the client to determine leisure time activities b. Offering the client the opportunity to make some decisions c. Relieving the client of the responsibility of making any decisions d. Allowing the client time to be alone to decide in which activities to engage

b. Offering the client the opportunity to make some decisions - helps improve confidence

Amanda has benefited from the short-term hospital stay. She feels more hopeful and has begun to plan how to obtain another job. She has reconnected with her son and family members. What follow-up information must the nurse give Amanda before discharge? a. Provide a peer-to-peer counselor b. Provide suicide hotline number: 1-800-273-TALK c. Provide a support group resource d. Provide information on depression

b. Provide suicide hotline number: 1-800-273-TALK

Which intervention should the nurse use first when caring for a patient experiencing anxiety? a. Assist the patient to problem solve b. Provide support and understanding c. Reorient the patient d. Provide privacy

b. Provide support and understanding

A 54-year-old has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After the person is found disoriented and semi-naked while walking down a street, the diagnosis of dementia of the Alzheimer type is made. The client expresses fear and anxiety upon admission to a long-term care facility. What is the best nursing intervention in light of the client's diagnosis? a. Exploring the reasons for the concerns b. Reassuring the client with the frequent presence of staff members c. Providing the client with a written schedule of planned interactions d. Explaining to the client why the admission to the facility is necessary

b. Reassuring the client with the frequent presence of staff members = SUPPORT SYSTEM d/t forgetfulness

Mary is being seen in the outpt clinic for medication follow-up. She tells you that she is taking St. John's wort to help her symptoms of depression. Your response to make sure to let her primary care provider know that she is taking St. John's wort is guided by what knowledge: a. Many providers do not believe in herbal supplements. b. Talking St. John's wort along with an SSRI antidepressant may cause serotonin syndrome. c. The patient needs to increase her assertiveness with her provider. d. St. John's wort has not been shown to treat depression symptoms effectively.

b. Talking St. John's wort along with an SSRI antidepressant may cause serotonin syndrome.

Mary is being seen in the outpt clinic for medication follow-up. She tells you that she is taking St. John's wort to help her symptoms of depression. Your response to make sure to let her primary care provider know that she is taking St. John's wort is guided by what knowledge: a. Many providers do not believe in herbal supplements b. Talking St. John's wort along with an SSRI antidepressant may cause serotonin syndrome c. The patient needs to increase her assertiveness with her provider d. St. John's wort has not been shown to treat depression symptoms effectively

b. Talking St. John's wort along with an SSRI may cause serotonin syndrome

The nurse is talking with a delusional client who has been hospitalized for 2 weeks. In the middle of the conversation the client suddenly stops talking, seems preoccupied, and then states, "I hear voices." Because the nurse has already assessed the content of the hallucinations, what is the most therapeutic response? a. Asking the client, "What are the voices saying?" b. Telling the client, "I didn't hear any voices," and then focusing on the conversation c. Saying nothing, remaining observant, and later documenting the incident in the client's record d. Challenging the client by emphasizing that there is no one else there and reminding the client that there are just the two of them

b. Telling the client, "I didn't hear any voices," and then focusing on the conversation - A non-confrontational validation of reality is the most therapeutic response.

A client is admitted to the mental health hospital with the diagnosis of major depression. What is a common problem that clients experience with this diagnosis? a. Loss of faith in God b. Visual hallucinations c. Decreased social interaction d. Feelings about the future are absent

c. Decreased social interaction

Which of the following best reflects the evidence on the value of cognitive behavioral therapy (CBT) and behavioral therapy in treating schizophrenia? a. There is no evidence that behavioral therapy can help to improve rates of adherence to antipsychotic medication b. The best available evidence suggests that CBT is no better than standard care at reducing relapse rates. c. There is very good evidence that CBT is better than standard care at reducing relapse rates

b. The best available evidence suggests that CBT is no better than standard care at reducing relapse rates.

During a Peer-to-Peer meeting of NAMI, a nurse was teaching about Lithium Carbonate. Which of the following was discussed during her presentation? a. Lithium carbonate is used only as an antidepressant b. The therapeutic serum level of Lithium carbonate is between 0.6 mEq/L and 1.2 mEq/L c. Lithium carbonate decreases the seizure threshold at a therapeutic dose. d. Lithium carbonate causes sexual function disturbances.

b. The therapeutic serum level of Lithium carbonate is between 0.6 - 1.2 mEq/L

During a session, a mother disclosed to the nurse that she had decided to give valerian to her 16-year-old son to help him sleep. What information is important to share with this mother? a. Valerian is a good choice; it helps a person sleep without side effects. b. Valerian may have a potential dependence and withdrawal. c. Valerian causes significant muscle relaxation not facilitating sleep. d. Valerian improves concentration and mood and may not facilitate sleep.

b. Valerian may have a potential dependence and withdrawal.

During a session, a mother disclosed to the nurse that she had decided to give Valerian root to her 16-year-old son to help him sleep. What information is important to share with this mother? a. Valerian is a good choice; it helps a person sleep without side effects. b. Valerian may have a potential dependence and withdrawal. c. Valerian causes significant muscle relaxation not facilitating sleep. d. Valerian improves concentration and mood and may not facilitate sleep.

b. Valerian may have a potential dependence and withdrawal. **Valerian has a potential dependence and withdrawal**

Which client statement supports the diagnosis of somatic delusions? a. "I wear this coat all the time to keep them from x-raying my organs." b. "The president of France and I will be announcing our engagement soon." c. "My heart stopped beating three days ago, and now my lungs are rotting away." d. "The government has assigned a team of assassins to kill me because I know too much."

c. "My heart stopped beating three days ago, and now my lungs are rotting away."

During the first month in a nursing home, a client demonstrates numerous disorganized behaviors related to disorientation and cognitive impairment. What should the nurse's plan of care continue to take into consideration in relation to the client? a. Level of interest in unit activities b. Orientation to time, place, and person c. Ability to perform tasks without becoming frustrated d. Cognitive impairment, which will increase until adjustment to the home is accomplished

c. Ability to perform tasks without becoming frustrated

A client recently admitted to the psychiatric unit is pacing the floor and acting aloof and suspicious. The client tells the nurse that other people have all the control. What initial nursing intervention will be most helpful to the client? a. Reviewing the client's history b. Setting limits on the client's inappropriate behavior c. Accepting the client's behavior because it is not directed specifically at the nurse d. Meeting privately with family members to learn more about the client's behavior

c. Accepting the client's behavior because it is not directed specifically at the nurse

A patient is taking amitriptyline 75 mg QHS for a depression. He reports having a dry mouth, blurred vision, and constipation. What is causing these side effects? a. CNS side effects b. Antiadrenergic effects c. Anticholinergic effects d. Cardiovascular effects

c. Anticholinergic effects

A patient is taking Amitriptyline 75 mg QHS for a depression. He reports having a dry mouth, blurred vision, and constipation. What is causing these side effects? a. CNS side effects b. Antiadrenergic effects c. Anticholinergic effects d. Cardiovascular effects

c. Anticholinergic effects ** DRY

Which of the following drugs has been found consistently in clinical trials to reduce the negative symptoms of schizophrenia (de-motivation, self-neglect, and reduced emotion)? a. Chlorpromazine b. Haloperidol c. Clozapine d. None of the above

c. Clozapine **only second generation drug that targets negative symptoms as well as positive symptoms**

The only survivor of a motor vehicle collision is found to have posttraumatic stress disorder. The client verbalizes that one long-term outcome is to have a sense of control over personal feelings related to the trauma. What should the nurse include in the client's plan of care? a. Working on self-forgiveness b. Exploring specific feelings related to survivor guilt c. Discussing life situations that the client is able to manage d. Focusing on the client's inability to limit escalating anxiety

c. Discussing life situations that the client is able to manage

Which statement about violence and nursing is accurate? a.Unless working in psychiatric units, nurses are unlikely to experience patient violence. b.To date, no legislation exists that addresses workplace violence against nurses. c.Emergency, psychiatric, and step-down units have the highest rates of violence towards the staff. d.Violence primarily affects inexperienced or unskilled staff who cannot calm their patients.

c. Emergency, psychiatric, and step-down units have the highest rates of violence towards the staff.

One important sequelae of a person's life who has bipolar disorder: a. Can get a lot done when manic b. Often has high intelligence c. Experiences frequent job loss d. Loses weight from not eating

c. Experiences frequent job loss

One important sequelae (consequence) of a person's life who has bipolar disorder is: a. Can get a lot done when manic b. Often has high intelligence c. Experiences frequent job loss d. Loses weight from not eating

c. Experiences frequent job loss **work output is variable d/t manic depression

A client arrives at the mental health clinic complaining about feelings of extreme terror when attempting to ride in an elevator and feelings of uneasiness in large crowds. He reports that these fears are interfering with his concentration at work. What does the nurse identify as the source of these symptoms? a. Conflict with society, resulting in an obsession b. Depression about life events, resulting in unreasonable fears c. Generalized anxiety about conflicts, resulting in unreasonable fears d. Repression of a terrifying incident in an elevator, resulting in a phobia

c. Generalized anxiety about conflicts, resulting in unreasonable fears

A client is admitted to the psychiatric unit wearing evening clothes. During the first 24 hours the client paces continually and laughs loudly. When approached by the nurse, the client refuses to cooperate with any requests, shouting, "I'm in charge. I give the orders!" How does the nurse interpret this behavior? a. It fulfills innate desires. b. It appeases imagined isolation. c. It attempts to ward off depression. d. It controls the urge to relate to others.

c. It attempts to ward off depression. - An attempt to ward off or avoid facing feelings of depression

A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? a. Paranoid delusions and hypervigilance b. Depression and psychomotor retardation c. Loosened associations and hallucinations d. Ritualistic behavior and obsessive thinking

c. Loosened associations and hallucinations

A 32-year-old client is laughing loudly and making inappropriate comments to clients and staff on an inpatient psychiatric unit. Other clients are getting angry about the behavior and have asked the client to leave the activity room, but the client has refused to do so. The goal of the nurse in charge is to restore order and ease tension on the unit. In which situation may the nurse incur liability? a. Reporting the client's behavior to the treatment team b. Checking the client's prescriptions for an as-needed medication to help to calm the client c. Placing the client in seclusion only until the client stops verbally attacking clients and staff d. Bringing the client to a quiet area on the unit and encouraging a discussion of the thoughts and behavior

c. Placing the client in seclusion only until the client stops verbally attacking clients and staff

A client who is being treated for schizophrenia, paranoid type, arrives at the clinic demonstrating a shuffling gait and tilting the head toward one shoulder. What does the nurse conclude about these clinical manifestations? a. Expected characteristics of this illness b. Consistent with an acute exacerbation of the illness c. Possible side effects of the antipsychotic medication d. Life threatening and requiring immediate intervention

c. Possible side effects of the antipsychotic medication

A 30-year-old female client asks the nurse to change her room, stating that she hates her roommate and can't stand to be in the same room with her. Just as she finishes speaking, her roommate enters and the client tells her she missed her and has been all over the unit looking for her. What does the nurse recognize the client to be using? a. Projection b. Sublimation c. Reaction formation d. Passive aggression

c. Reaction formation - Expressed feelings are opposite the behavior

Which of the following is defined as a group of mental disorders characterized by psychotic features, disordered thought processes, and disrupted interpersonal relationships? a. Delusion b. Paranoia c. Schizophrenia d. Obsessive-compulsive personality disorder

c. Schizophrenia

Which of these agents is first-line treatment for PTSD? a. Divalproex b. Trazodone c. Sertraline d. Amitriptyline

c. Sertraline = (SSRIs)

A nurse is caring for several extremely depressed clients. What type of setting does the nurse recognize these clients do best in? a. Multiple stimuli b. Varied activities c. Simple daily routines d. Opportunities for decision-making

c. Simple daily routines

Which of the following is a possible finding of the prodromal phase of schizophrenia? a. Reduced concentration and motivation b. Deteriorating personal hygiene c. Speech that is difficult to follow d. Aggressive or agitated behavior

c. Speech that is difficult to follow **prodromal phase =strange behavior, odd ideas, suspicious, speech hard to speak

A nurse is assigned to care for a depressed client on a day when the client seems more withdrawn and depressed than usual. Which nursing intervention is most appropriate? a. Remaining visible to the client b. Involving the client in group activities c. Spending a few extra minutes with the client throughout the day d. Asking the client whether it would help if the nurse sat with the client for a while

c. Spending a few extra minutes with the client throughout the day

A client who has been hallucinating suddenly rises and shouts, "Stop saying that. Who do you think you are?" What is the most therapeutic response by the nurse? a. Telling the client that ignoring the voices will make them disappear b. Taking the client to the client's room for a quiet place to think away from other clients c. Telling the client that the voices are not heard by others, then offering to listen to music together d. Pointing out to the client the inappropriateness of the behavior in a nonthreatening, nonjudgmental manner

c. Telling the client that the voices are not heard by others, then offering to listen to music together

A 3.5-year-old child begins to scream and kick when a laboratory technician arrives to draw blood. The nurse understands that this reaction primarily is a result of the child's what? a. Fear of loss of control b. Inability to localize pain c. Terror of intrusive procedures d. Past experience with this procedure

c. Terror of intrusive procedures

You are caring for Georgia, who questions you about the safety of an herbal supplement. Which nursing response is true? a. Herbal supplements are regulated by the FDA b. Natural ingredients in herbal supplements are harmless c. Your primary care provider needs to be aware of what supplements you take d. Marketing for herbal supplements demonstrates that all supplements are safe

c. Your primary care provider needs to be aware of what supplements you take

You are caring for Georgia, who questions about the safety of an herbal supplement. Which nursing response is true? a. Herbal supplements are regulated by the FDA b. Natural ingredients in herbal supplements are harmless c. Your primary care provider needs to be aware of what supplements you take d. Marketing for herbal supplements demonstrates that all supplements are safe

c. Your primary care provider needs to be aware of what supplements you take.

The registered nurse is teaching the nursing student about the interventions to be followed while caring for a client undergoing treatment with anxiolytic drugs. Which statement made by the nursing student indicates the need for further teaching? a. "I should monitor vital signs of the client." b. "I should check the client's oral cavities for cheeking of drugs." c. "I should encourage the client to use compression stockings." d. "I should encourage the client to change positions quickly."

d. "I should encourage the client to change positions quickly." - Minimize dizziness and falls

A nurse approaches a depressed client who is sitting alone in the dayroom. What is best for the nurse to say to the client? a. "May I sit with you for a while?" b. "Just call me if you'd like to talk." c. "Do you mind if I sit and talk with you?" d. "I'll be sitting with you for a while today."

d. "I'll be sitting with you for a while today." - Removes from the client the burden of making the decision

An adolescent with the diagnosis of antisocial personality disorder is admitted to the hospital after ingesting 20 tablets of an anxiolytic. When obtaining the client's history, the nurse learns that there was an arrest for drug use and that the client is out on bail. During visiting hours the nurse discovers the client and visitors smoking marijuana in the hall. When confronted, the client responds, "I'm celebrating. Didn't you hear? I went to trial today and just got put on probation." What is the best response by the nurse? a. "You were lucky you just got probation, so don't get right back into trouble." b. "I understand your relief about the trial, but smoking pot is against the rules." c. "It's important that you and your friends join the other visitors in the dayroom." d. "If you can't follow the rules against drug use on the unit, your visiting privileges will be canceled."

d. "If you can't follow the rules against drug use on the unit, your visiting privileges will be canceled."

The nurse notes that a client has been experiencing a somatic delusion. Which statement led to this conclusion? a. "I am Jesus Christ." b. "I know I'm dead." c. "This food has been poisoned." d. "My stomach has disintegrated."

d. "My stomach has disintegrated."

During the orientation tour for three new staff members, a young, hyperactive manic client greets them by saying, "Welcome to the funny farm. I'm Jo-Jo, the head yo-yo." Which meaning can the nurse assign to the client's statement? a. Trying to fill the "life of the party" role b. Looking for attention from the new staff c. Inability to distinguish fantasy from reality d. Anxiety over the arrival of new staff members

d. Anxiety over the arrival of new staff members

A hospitalized client with borderline personality disorder consistently breaks the unit's rules. How will confronting the client about this behavior help the client? a. By controlling anger b. By reducing anxiety c. By setting realistic outcomes d. By fostering self-awareness

d. By fostering self-awareness

"From a cognitive theory perspective, which is a possible cause of panic disorder? a. Inability of the ego to intervene when conflict occurs. b. Abnormal elevations of blood lactate and increased lactate sensitivity. c. Increased involvement of the neurochemical norepinephrine. d. Distorted thinking patterns that precede maladaptive behaviors

d. Distorted thinking patterns that precede maladaptive behaviors

A schizophrenic client has been on Chlorpromazine (Thorazine) for a week already. The nurse notices the client to be constantly up and about, walking in a funny way, grimaces and make involuntary eye and body movement. She informs the attending physician immediately because the client is showing which of the following adverse effects of Thorazine? a. Anxiety b. Neuroleptic Malignant Syndrome c. ADHD d. Extrapyramidal Syndrome

d. Extrapyramidal Syndrome ** Parkinsonism, Dystonia, Akathisia and Tardive dyskinesia"

The client tells the nurse I am the president of the universe, I can do whatever I want. The nurse recognizes this as which of the following delusions? a. Jealousy b. Paranoid c. Persecution d. Grandeur

d. Grandeur ** False believe that they are powerful and an important person

A journalist who has been compiling footage of war crimes fears he may have developed PTSD. Which of these statements from the journalist would be least indicative of the condition? a. Whenever I see the footage, I feel like I'm there in the moment. b. I feel like something awful has crawled into me and it's never going to get out. c. I've started drinking more. Big surprise-that's not helping. d. I just keep pulling up the footage. I feel like I can't look away.

d. I just keep pulling up the footage. I feel like I can't look away.

A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a primary healthcare provider prescribes an antipsychotic medication for these clients? a. To improve judgment b. To promote social skills c. To eliminate neurotic tendencies d. Manage symptoms of psychosis

d. Manage symptoms of psychosis

A client is undergoing treatment for schizophrenia with antipsychotic drugs. During a client assessment, the primary healthcare provider noticed an increase in body temperature and unstable blood pressure. Which adverse effect of the antipsychotic drug caused this condition in the client? a. Akathisia b. Tardive dyskinesia c. Extrapyramidal symptoms d. Neuroleptic malignant syndrome

d. Neuroleptic malignant syndrome FEVER and RIGIDITY

A client paces back and forth across the floor, speaks incoherently, and continually talks to and verbally fights with people who are not present. What is the nurse's initial therapeutic intervention? a. Setting limits on the client's verbal aggression b. Isolating the client to decrease the aggressive behavior c. Establishing a relationship to reduce the client's loneliness d. Providing emotional support while demonstrating acceptance of the client

d. Providing emotional support while demonstrating acceptance of the client

Clients with schizophrenia are at greater risk for developing metabolic syndrome. Which of the following antipsychotic medications increases this risk? a. Chlorpromazine (Thorazine) b. Haloperidol (Haldol) c. Risperidone (Risperdal) d. Quetiapine (Seroquel)

d. Quetiapine (Seroquel) = Atypical antipsychotic

An emergency room patient was very anxious after a serious car accident. Lorazepam (Ativan) 2mg IM was administered. One hour later, which finding indicates to the nurse that the medication was effective? a. Impaired problem-solving skills b. Increased alertness and attention c. Increased verbalization and activity d. Reduced agitation and environmental scanning

d. Reduced agitation and environmental scanning

The nurse teaches an anxious client diagnosed with PTSD a breathing technique. Which client best indicates that teaching was successful? a. The client eliminates anxiety by using the breathing technique b. The client performs activities of daily living independently by discharge c. The client recognizes signs and symptoms of escalating anxiety d. The client maintains a 3/10 anxiety level without medications

d. The client maintains a 3/10 anxiety level without medications

When caring for a client with major depression, what do nurses usually have the most difficulty dealing with? a. The client's lack of energy b. Negative nonverbal responses c. The client's psychomotor retardation d. The pervasive quality of the depression

d. The pervasive quality of the depression

The nurse advises the client to refrain from skin contact of the prescribed liquid formulation. Which antipsychotic drug is prescribed to the client? a. Loxapine b. Asenapine c. Alprazolam d. Thorazine

d. Thorazine

Positive Symptoms

• Bizarre behavior • Delusions • Disorganized speech (LOA) • Hallucinations

Negative Symptoms

• Blunted affect • Inability to experience pleasure or joy (anhedonia) • Loss of motivation (avolition) • Poverty of thought (alogia )