SSRIs 1st

A nurse in a GYN clinic is completing the nursing intake on a 15-year-old girl who has lost significant weight in the last year. She received a recent diagnosis of anorexia. What question would you avoid during the assessment interview?

Any questions w/ WHY

The nurse is working with someone who has been the victim of partner abuse. Which statement by the client indicates that the nursing outcome criteria has successfully been met?

"I know that he should not slap me"

The nurse approaches a manic patient demonstrating early signs of escalation. After he complies with the request to sit and talk in an open alcove by the nurse's station, which of the following responses is the most therapeutic?

"you were loud and threatening to others. Can you think clearly right now?"

A patient addicted to synthetic marijuana tells a nurse, I can control my drug use anytime I want to; This statement is an example of the patients use of: 1. Denial 2. Repression 3. Compensation 4. Reaction formation

1. Denial

Common nursing interventions for domestic abuse survivors include which of the following? 1. Identify areas of control. 2. Remove the client from the home. 3. Support the client in the decisions they make. 4. Advise the client to pursue legal action. 5. Establish trust and rapport.

1. Identify areas of control. 3. Support the client in the decisions they make. 5. Establish trust and rapport.

You are working with a six-year-old child who has a diagnosis of autism. Which of the following characteristics would your client display? 1. Manifestation of signs and symptoms before the age of three. 2. May display repeated behavior like rocking 3. Easily makes friends. 4. Exhibits poverty of speech. 5. Displays tics at an early age

1. Manifestation of signs and symptoms before the age of three. 2. May display repeated behavior like rocking *These other ones (4 & 5) weren't on mine test. Except easily makes friends, that's a no

The patient with anorexia nervosa tells you that not eating is a way that she is able to maintain control over herself and her life. Treatment modalities for anorexia nervosa may include which of the following? 1. anti-depression medication 2. cognitive behavioral therapy 3. interpersonal skill development 4. cognitive dissonance

1. anti-depression medication 2. cognitive behavioral therapy 3. interpersonal skill development

The patient with anorexia nervosa tells you that not eating is a way that she is able to maintain control over herself and her life. Treatment modalities for anorexia nervosa may include which of the following? 1. anti-depression medication 2. cognitive behavioral therapy 3. interpersonal therapy 4. cognitive dissonance

1. anti-depression medication 2. cognitive behavioral therapy 3. interpersonal therapy

A patient is diagnosed with intermittent explosive disorder. The clinic nurse should anticipate potentially teaching about which of the following medications? 1. fluoxetine/Prozac 2. acamprosate/campra 3. disulfiram (Antabuse) 4. donepezil/Aricept

1. fluoxetine/Prozac

The nurse admitted a patient with borderline personality. The nurse is aware that the borderline client is most likely to: 1. split staff 2. exhibit intense anger 3. have life-long friends 4. experience intense relationships 5. self-mutilate

1. split staff 2. exhibit intense anger 4. experience intense relationships 5. self-mutilate

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, what do you like better, hamburgers or spaghetti? Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "I'll weigh you after your meal." 3. "Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

3. "Let's focus on your continued improvement. You ate 80% of your lunch."

A patient diagnosed with bulimia nervosa has responded well to citalopram (Celexa). Which of the following is the probable cause for this response? 1. There is an association between bulimia nervosa and dilated blood vessels and inactive alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitter dopamine. 3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. 4. There is an association between bulimia nervosa and a malfunction of the thalamus.

3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. Because citalopram (Celexa) is a selective serotonin reuptake inhibitor, it would be useful in the treatment of bulimia nervosa and responsible for a positive client response. Pt has bulimia with imbalance of serotonin

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort.

3. Vomiting, which may lead to dehydration and electrolyte imbalance.

Which statement by your 16 yr. old patient indicated a need for further assessment? 1 "I know a lot of people care about me and want me to get better." 2 "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." 3 "I don't have a good support system, but I am planning on joining a recovery group." 4 "I'm not worried. I know that things will be better soon."

4 "I'm not worried. I know that things will be better soon."

A patient diagnosed with major depressive disorder and experiencing suicidal ideation is showing signs of anxiety. Alprazolam (Xanax) is prescribed. Which assessment should be prioritized? 1. Monitor for signs and symptoms of physical and psychological with drawl. 2. Teach the client about side effects of the medication and how to handle these side effects. 3. Assess for nausea and give the medication with food if nausea occurs. 4. Ask the client to rate his or her mood on a mood scale and monitor for suicidal ideations.

4. Ask the client to rate his or her mood on a mood scale and monitor for suicidal ideations.

A patient with a history of alcohol use disorder is seen in the emergency department two days ago after a binge of excessive alcohol consumption. The nurse suspects pancreatitis. Which symptoms would support the nurse's suspicion? 1. Confusion, loss of recent memory, and confabulation. 2. Elevated creatine phosphokinase and signs and symptoms of congestive heart failure. 3. Paralysis of the ocular muscles, diplopia, and ataxia. 4. Constant, severe epigastric pain; nausea and vomiting; and abdominal distention.

4. Constant, severe epigastric pain; nausea and vomiting; and abdominal distention. Upper abdominal severe pain, N/V, loss of appetite, fast HR, weight loss

At a staff meeting a psychiatric technician states, "Miss T is a real pain. She makes suicide gestures but never really hurts herself. They should send her home instead of admitting her. The best response on the part of the nurse would be:

Any attempt at suicide should be taken seriously

patients with Cluster C (Avoidant, Dependent, Obsessive-compulsive) personality disorders typically avoid resolving issues and seek secondary gains. What type of educational content will be most helpful for these clients?

Assertive training

A nurse suspects that a patient being admitted may have a history of alcohol abuse. To further assess this issue, the nurse should consider:

Audit (The Alcohol Use Disorders Identification Test) screening tool

Your patient was prescribed the antidepressant tranylcypromine (Parnate). You know this is a monoamine oxidase inhibitor (MAOI). The nurse determines the client understands the instructions given when the client says I will:

Avoid aged cheese, over ripe fruit Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

When focusing on substance abuse relapse prevention, what is most important? Anticipating the possibility of a relapse Need to identify potential triggers Learning skills, stress management, coping Avoiding high risk situation/bad situations and habits/relapse

Avoiding high risk situation/bad situations and habits/relapse

A patient who goes to the mood disorders clinic in January tells the nurse, my mood is really low. I'm tired all the time even though I sleep for 10 or 12 hours a day. I've gained weight because I want to eat sweets all the time. It seems like it happens every fall and winter. This patient is most likely experiencing which of the following?

Seasonal Depression. Seasonal Affective DO

The adolescent client is depressed. The client's ordered medication is fluoxetine (Prozac). What is the best response by the nurse when the client says, what will this medicine do inside my brain? A. "It will help you feel less depressed." B. "It will regulate a neurotransmitter called serotonin. C. "It will raise your level of the brain hormone norepinephrine." D. "It will balance blood glucose and dopamine levels."

B. "It will regulate a neurotransmitter called serotonin. They block the reuptake of serotonin thereby making more of this neurotransmitter available.

Which thought process about relationships would be most characteristic of a patient with the diagnosis of antisocial personality disorder?

Being deceitful, manipulative for gain or hostile, lack remorse or empathy Exploiting, or violating the rights of others

A patient displaying symptoms of mania has been in constant motion for one hour. Despite attempted verbal interventions, he has run in the halls, exercised vigorously, and pushed furniture around the day area. Now, he approaches an elderly man and tells him he must do push-ups or be pushed down. The elderly patient looks fearful, but gets down on the floor. The nurse should immediately: A. Obtain an order for seclusion. B. Forbid the threatening of other patients. C. Gather several staff members to provide an escort to take the patient with mania to his room. D. Distract the patient with mania while allowing the other man to do a few push-ups.

C. Gather several staff members to provide an escort to take the patient with mania to his room.

The 16-year-old male patient has a diagnosis of anti-social behavior. You would suspect he received which diagnosis during childhood?

Conduct d/o Not: bipolar

The nurse is assessing someone with anorexia nervosa. Which of the following physical findings should be reported to the physician immediately? A. Urine output of 100 cc/hour B. Pulse rate of 98 C. Amenorrhea D. Blood pressure of 80/40mm Hg

D. Blood pressure of 80/40mm Hg

A patient is hospitalized for depression. He broods over poor financial decisions he made in the past and calls himself stupid. A strategy for limiting the amount of negative thoughts in which he engages is: A. assign client to dust and sweep unit floors B. have client write thoughts and feelings in a journal C. contract with client to focus only on positive topics D. schedule occupational therapy and unit activities for client

D. schedule occupational therapy and unit activities for client

As a well-educated BSN student from TAMUCC, you recognize the differences between delirium and dementia. Which of the following statements is true about these disorders? Delirium has an acute onset (hours-days) w/ confusion and disorganized thinking, is reversible, come with misperceptions and illusions changes in consciousness, thinking, cognition, has outburst of anger, crying or scared. Dementia has a gradual onset (months-years) with affects to short term memory, resonating and abstract thinking, is irreversible, has delusions of theft persecution and hallucinations, Sundown syndrome, with apathy (lack of interest)

Dementia has a gradual onset (months-years) with affects to short term memory,

A patient is diagnosed with anorexia nervosa. A nurse who is assessing for co-morbid psychiatric disorders should assess for signs of which common, concurrent diagnosis? a. Phobias b. Depression c. Schizophrenia d. Personality disorder

Depression

The nurse working with a patient notes that she has a poor self-worth and seems incapable of feeling secure or trusting in relationships. In planning care the nurse is cognizant of the fact, according to Erikson, that these qualities may be rooted in: (I doubt she'll list all but here they all are) Stage One - Trust vs Mistrust. ... Stage Two - Autonomy vs Shame and Doubt. ... Stage Three - Initiative vs Guilt. ... Stage Four - Industry vs Inferiority. ... Stage Five - Identity vs Role Confusion. ... Stage Six - Intimacy vs Isolation. ... Stage Eight - Ego Integrity vs Despair.

Develops in infancy

A patient with chronic severe depression, somatic delusions, and suicidal ideation has not improved after trials with SSRI medications and tricyclic antidepressants. Which treatment option can the nurse assume the psychiatrist will now consider? a. Light therapy b. Benzodiazepines c. Electroconvulsive therapy d. Antipsychotic medication

Electro convulsive therapy

In deriving nursing outcomes and goals for a patient with depression, the nurse should focus on the patient:

Expressing feelings, verbalizes suicidal ideas, refrains from suicide attempts, plans for the future

A nurse is caring for a client with bulimia who is not gaining weight. The client usually goes to the bathroom about 30 minutes after every meal. What is the best intervention for the nurse to take to improve weight gain?

Go with them to the restroom

Your patient has the diagnosis for Other-directed violence R/T lack of impulse control, rage reaction with violent outbursts and agitation. An appropriate intervention for this client is to "Set firm, reasonable expectations for patient's behavior". What is the rationale for this intervention?

Has to do with consistency and setting boundaries, have them be independent in the decisions they make and choose with knowing what the consequences will be to prevent further escalation of mania and provide safe boundaries for the patient and others.

A client arrives for her mental health appointment wearing a cocktail dress and theatrical make up. She announces loudly, dramatically, and in a flirtatious manner that she needs to be seen immediately because she is experiencing overwhelming psychological distress. The nurse should recognize these behaviors suggestive of - borderline - narcissistic - histrionic - antisocial

Histrionic Personality Disorder

Which nursing diagnosis is most appropriate for someone with Cluster A personality disorders (Paranoid, Schizoid, Schizotypal)?

Impaired social isolation r/t inadequate social skills

You are assigned to the children's unit. Your patient is an eight-year-old girl in third grade. Two weeks after her parents separated, she begins to suck her thumb, wet the bed at night and no longer interacts with her friends at school. You know that:

Loss of security causing anxiety

Your patient is taking Antabuse (disulfiram). Educations are successful when the patient states If someone takes alcohol along with the Antabuse some of the following symptoms will occur:

Nausea, vomiting, headache, sweating, Flushing, fast heartbeat, chest pain, thirst, vertigo, and low BP flushed skin, throbbing head and neck, respiratory difficulty, dizziness, nausea and vomiting, sweating, hyperventilation, tachycardia, hypotension, weakness, blurred vision, and confusion.

As a nurse you would suspect which of the following to attempt suicide?

Old white male dx w/ depression, multiple sclerosis, and lives alone Single, older men living in a rural area have the highest rates of suicide.

A patient is hospitalized for depression. The patient demonstrates dysfunctional thinking as evidenced by persistent negative thoughts and predictions of disastrous outcomes. The nurse, using cognitive behavioral therapy, will focus on: a.uncovering unconscious conflicts that affect the "here and now" behavior. b.finding an area of mutual understanding to serve as a basis for therapy. c.patient recognition and replacement of automatic negative evaluations. d.analyzing and enhancing relationships with significant others.

Patient recognition and replacement of automatic negative evaluations

The patient assigned to you has a recent history of rape. She felt her life was in danger as the masked man held a gun to her head during the ordeal. She is discussing the incident with you for the first time. She displays a flat affect with fleeting eye contact. An appropriate nursing intervention is to assure the patient she did the right thing to save her life. The rationale for this intervention is to:

Prevent feelings of shame and guilt

A charge nurse receives report at 1500. Which of the following clients would need to be assessed first? 1. A client on one-to-one status because of active suicidal ideations. 2. A client pacing the hall and experiencing irritability and flight of ideas. 3. A client diagnosed with hypomania monopolizing time in the milieu. 4. A client with a history of mania who is to be discharged in the morning.

Pt w/ clenched fist, pacing 2. A client pacing the hall and experiencing irritability and flight of ideas.

Which of the following is of highest priority when a client with borderline personality and suicidal ideation is admitted?

Safety due to impulsivity Provide clear and consistent boundaries and limits Help the client to cope and control their emotions

In a staff meeting two nurses point out that the treatment plan for a patient diagnosed with borderline personality seems too rigid. They say, the poor guy doesn't have any freedom. He's really a pleasant guy. Why is everybody so uptight with him? The rest of the treatment team maintains that this patient needs external limits and careful observation by staff. What is most likely responsible for the difference in staff opinions?

Splitting

A novice nurse asks the mentor, not all patients present with blatant suicidal ideation. How will I know when to assess for suicide risk? The best response from the mentor would be to explain that nurses working with psychiatric patients should pursue assessment of suicide risk for individuals who display which of the following behaviors?

Start giving away possessions, getting stuff in order, mood changes within a couple of days due to knowing the plan

A 55-year-old married man who has lost his job phones the mental health clinic and tells the nurse, I feel so overwhelmed that I've decided to take an overdose of sleeping medicine I bought over-the-counter at the drug store. I wish I didn't have to do it, but there's no other way. The nurse asks several questions and learns that his wife is in the next room unaware of the phone call. Which approach should the nurse take first?

Tell man to get the wife on the phone and tell her to take him to the hospital

During the admit assessment your patient stated: I just started yelling, threw the knife at my grandmother and don't even remember why I was upset. She just asked me to do the dishes. The client has a diagnosis of Conduct Disorder. When reviewing the client's prescribed medications you would expect to see which of the following medications? 1. Donepezil 2. Chlordiazepoxide 3. Phenelzine (nardil) 4. Valproate sodium

This answer was Prozac ?? donepezil is for Alzheimer chlodiazepoxide is for tremors and agitation phenelzine is a MAOI valproate sodium is an anticonvulsant; for bipolar disorder

When planning care for patients who have attempted self-injury and those who have attempted suicide, the nurse must understand that the major difference in self-injury versus suicide lies in whether the patient has: a. a need to control or a need to be controlled. b. the wish to relieve tension or the wish to die. c. been diagnosed with a developmental disorder or psychosis. d. a tendency toward indirect or direct expression of self-destructive urges.

Wants to relieve immediate tension vs. wants to die The lethality of self-injury is usually low, and patients who self-injure seek relief of tension. Suicide attempts are directed by the wish to die. Care-planning strategies will differ based on underlying patient motivation.

A nurse is planning activities for a patient who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client? 1. Writing 2. Chess 3. Bball 4. Ping-Pong

Writing Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing, walks with staff, and finger painting are activities that minimize stimuli and provide a constructive release for tension.

A patient uses the maladaptive social behavior of manipulation. Staff working to reduce this behavior therapeutically should convey the message that: a. while the patient is accepted, the behavior is rejected as inappropriate. b. if the patient cannot control the behavior, staff will establish external controls. c. manipulative behavior results in frustration and anger among staff and patients. d. manipulation of patients is no more acceptable than manipulation of unit staff.

a. while the patient is accepted, the behavior is rejected as inappropriate. Establishing the parameters of desirable and acceptable patient behavior The staff always must seek to convey acceptance of the patient because this is a building block for a therapeutic relationship. Inappropriate behaviors such as manipulation should be identified, their negative consequences to the patient should be discussed, and more adaptive behaviors should be substituted when the therapeutic relationship has been established.

Before the community meeting, an antisocial patient was overheard coaching several other patients to bring up the topic and to strongly object to the policy of the unit. What remark would be most characteristic of an antisocial individual? a. I knew theyd mess this up. Ive learned to speak for myself in the future. b. Hey, its not my fault. They object to you people running this place like a jail. c. I think the patients and staff should talk about the rules and negotiate some changes. d. Ive learned something valuable from this. Well talk about this in my therapy session.

b. Hey, its not my fault. They object to you people running this place like a jail.

A patient was admitted with major depressive disorder three weeks ago. Suicidal ideation was present and the patient has access to weapons and a plan to end his life. The patient has received sertraline (Zoloft) and says there are fewer episodes of depression. Which of the following is the most important piece of education when planning discharge care for this patient? a. There is a decreased risk for suicide as the depression lifts. b. There is an increased risk for suicide as the depression lifts. c. There is no longer a suicide risk after 3 weeks on medication. d. There is no relationship between the depth of depression and suicidal ideations.

b. There is an increased risk for suicide as the depression lifts. The pt will be at increased risk for suicide as the symptoms begin to decrease

A five-year old girl is brought to the clinic for symptoms of a urinary tract infection (UTI). The nurse's assessment reveals bruises in the child's genital and rectal areas. The mother reports that she left the little girl with her boyfriend the night before. After the assessment is complete the nurse's first priority with this client to take which action? a. Obtain a urine sample to confirm a UTI b. Teach the mother about symptoms of a UTI c. Report suspected sexual abuse to child protective services d. Assess the child for other health problems

c. Report suspected sexual abuse to child protective services

A nurse is preparing a presentation for a local community group about abuse and violence. Which of the following would the nurse most likely include? a. Abuse is primarily seen in lower socioeconomic areas where poverty is rampant. b. Children typically are around the ages of 8 to 10 years when they suffer abuse. c. Abuse indicates an underlying mental health disorder that is out of control. d. An abuser frequently uses more than one method to achieve the goal.

d. An abuser frequently uses more than one method to achieve the goal.

The nurse is talking with a patient on the unit who has been abusing alcohol. The patient tells the nurse that he has a drink or two on special occasions only. However, the nurse states: Your vitamin/mineral values indicate you are more than a social drinker. The nurse knows that:

decreased thiamine d/t alcohol abuse

As a nurse you would provide medication education to prevent complications of monoamine oxidase inhibitors (MAOIs). The potential complication associated with MAOIs is which of the following? a. gastric hemorrhage b. toxic shock c. cardiac arrest d. hypertensive crisis

hypertensive crisis

Which of the following objective data would the nurse expect to find in the client with anorexia nervosa? A. Feelings of isolation and loneliness B. Preoccupation with food C. A score of 13 on the Mini-Mental State Exam D. Osteoporosis

osteoporosis

A female patient who is severely depressed was admitted to the inpatient unit. Her psychomotor retardation and sense of worthlessness have resulted in poor personal hygiene with noticeable body odor and halitosis. After the early morning admission interview, the nurse suggests showering. The patient flatly states, "I can't." The nurse should: a. avoid forcing the issue. b. neutrally assist the patient with showering. c. Tell the patient, "You must bathe daily." d. explain that other patients will respond negatively to someone with poor hygiene.

speak a matter-of-fact and help her shower and get in clean clothes B