Unit 2 Test Mental Health.
Pica
compulsive eating of nonnutritive substances such as clay or ice
polydipsia
condition of excessive thirst
Deficits in the lateral hypothalamus result in....
decreased eating and decreased responses to sensory stimuli that are important to eating.
command hallucinations
disturbed auditory sensory perceptions demanding that the client take action, often to harm self or others, and are considered dangerous; often referred to as "voices"
low norepinephrine levels are seen in clients...
during periods of restricted food intake. Also, low epinephrine levels are related to the decreased heart rate and blood pressure seen in clients with anorexia.
The pervasive mood in borderline personality disorder is ________________, involving unhappiness, restlessness
dysphoric
ECT
electroconvulsive therapy Clients usually receive a series of six to 15 treatments scheduled three times a week. Generally, a minimum of six treatments are needed to see sustained improvement in depressive symptoms. Maximum benefit is achieved in 12 to 15 treatments.
What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting? -engaging in severe dieting -socially withdrawing -compulsively washing his or her hands -becoming sexually promiscuous
engaging in severe dieting Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy, or exerting control over oneself and the environment, may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: By continuing to lose, these clients exert control over one aspect of their lives. While the remaining options may demonstrative reactive behaviors, they are not generally associated with over-productive parenting.
Disruption of the ventromedial hypothalamus leads to.....
excessive eating, weight gain, and decreased responsiveness to the satiety effects of glucose, which are behaviors seen in bulimia.
A nurse is reviewing the medical record of a young client to determine the client's risk for suicide. Which factor would alert the nurse to an increased risk for this client? -fears of growing older -diagnosed with an acute illness -starting a new business with friends -experiencing unemployment that has lasted a year
experiencing unemployment that has lasted a year Social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among the younger population. Internal distress, low self-esteem, and interpersonal distress have long been associated with suicide. Cognitive risk factors include problem-solving deficits, impulsivity, rumination, and hopelessness. Impulsivity, anger, and reduced inhibition increase the risk of suicide. Fear of growing older is not a common concern for this population. With the likelihood of a positive outcome, acute illness is not generally viewed as being hopeless. Chronic medical illnesses increase the likelihood of chronic depression, which in turn contributes to the increased suicide rate of those older than the age of 65 years. While starting a new business may create a degree of anxiety, it is usually viewed with hopefulness and enthusiasm.
disease conviction
fear that one has a serious disease
disease phobia
fear that one will get a serious disease
Neurochemical influences of neurotransmitters (chemical messengers)
focus on serotonin and norepinephrine as the two major biogenic amines implicated in mood disorders.
Illness anxiety disorder
formerly hypochondriasis, is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions.
A client may experience a false perception of taste known as a(n)______________ hallucination.
gustatory
Clients taking MAOIs and who eat foods containing tyramine risk experiencing a(n) ___________________ crisis, which is a potentially fatal reaction.
hypertensive
Suicidal ____________ refers to having thoughts of killing oneself.
ideation
Persistent depressive (dysthymic) disorder
is a chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression.
Jikoshu-kyofu
is a condition characterized by a fear of offending others by emitting foul body odor. This was first described in Japan in the 1960s and has two subtypes, either with or without delusions
Disruptive mood dysregulation disorder
is a persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in keeping with the provocation or situation, beginning before age 10.
orthorexia nervosa
is a proposed distinct eating disorder characterized by extreme or excessive preoccupation with eating food believed to be healthy.
Qi-gong psychotic reaction
is an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic symptoms that occur after participating in the Chinese folk health-enhancing practice of qi-gong. Especially vulnerable are those who become overly involved in the practice.
Limit setting
is an effective technique that involves three steps: 1.Stating the behavioral limit (describing the unacceptable behavior) 2.Identifying the consequences if the limit is exceeded 3.Identifying the expected or desired behavior Consistent limit setting in a matter-of-fact nonjudgmental manner is crucial to success.
Confrontation
is another technique designed to manage manipulative or deceptive behavior. The nurse points out a client's problematic behavior while remaining neutral and matter-of-fact; he or she avoids accusing the client. The nurse can also use confrontation to keep clients focused on the topic and in the present. The nurse can focus on the behavior itself rather than on attempts by clients to justify it.
Passive-aggressive behavior
is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances. Their mood may fluctuate rapidly and erratically, and they may be easily upset or offended.
Depressive behavior
is characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts. It occurs more often in people with relatives who have major depressive disorders. People with depressive personality disorders often seek treatment for their distress.
cyclothymic disorder
is characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning.
Night eating syndrome
is characterized by morning anorexia, evening hyperphagia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss
Akathisia
is characterized by restless movement, pacing, inability to remain still, and the client's report of inner restlessness. Akathisia usually develops when the antipsychotic is started or when the dose is increased. Clients are typically uncomfortable with these sensations and may stop taking the antipsychotic medication to avoid these side effects. Beta-blockers such as propranolol have been most effective in treating akathisia, and benzodiazepines have provided some success as well.
Somatization
is defined as the transference of mental experiences and states into bodily symptoms.
Abnormal Involuntary Movement Scale (AIMS)
is used to screen for symptoms of movement disorders. The client is observed in several positions, and the severity of symptoms is rated from 0 to 4. The AIMS can be administered every 3 to 6 months. If the nurse detects an increased score on the AIMS, indicating increased symptoms of tardive dyskinesia, he or she should notify the physician so that the client's dosage or drug can be changed to prevent advancement of tardive dyskinesia.
An individual experiencing mania can exhibit rapidly changing emotions, also known as ____________ emotions.
labile
Enmeshment
lack of clear role boundaries between persons
Echolalia
meaningless repetition of another person's spoken words as a symptom of psychiatric disorder.
What is serotonins role in behavior?
mood, activity, aggressiveness and irritability, cognition, pain, biorhythms, and neuroendocrine processes (i.e., growth hormone, cortisol, and prolactin levels are abnormal in depression). Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid) of serotonin found in the blood or cerebrospinal fluid occur in people with depression. Positron emission tomography demonstrates reduced metabolism in the prefrontal cortex, which may promote depression.
Bipolar II disorder
ne or more major depressive episodes accompanied by at least one hypomanic episode
second-generation antipsychotics
not only diminish positive symptoms but also lessen the negative signs of lack of volition and motivation, social withdrawal, and anhedonia for many clients.
Bipolar I disorder
one or more manic or mixed episodes usually accompanied by major depressive episodes
Respiratory depression, pupillary constriction, coma, and death are possible results of ______________ overdose.
opioid.
binge eating
overeating to an extreme degree
Stilted language
overly and inappropriately artificial formal language
Perseveration
persistent repetition of the same word or idea in response to different questions
Most ___________ theories about mental disorders seem to "Blame the victim."
psychodynamic
Verbigeration
purposeless repetition of words or phrases
labile emotions
rapidly changing or fluctuating emotions
dystonic reaction
reaction characterized by muscle spasms, twitching, facial grimacing, or torticollis
hysteria
reefers to multiple physical complaints with no organic basis; the complaints are usually described dramatically
Locura
refers to a chronic psychosis experienced by Latinos in the United States and Latin America. Symptoms include incoherence, agitation, visual and auditory hallucinations, inability to follow social rules, unpredictability, and, possibly, violent behavior.
suicide precautions
removal of harmful items; increased supervision to prevent acts of self-harm
rumination
repeatedly thinking and talking about past experiences; can contribute to depression
first-generation antipsychotics
target the positive signs of schizophrenia, such as delusions, hallucinations, disturbed thinking, and other psychotic symptoms, but have no observable effect on the negative signs.
suicide
the act of intentionally taking one's own life
satiety
the state of being satisfactorily full and unable to take on more
clang associations
the stringing together of words that rhyme but have no other apparent link
suicidal ideation
thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones
ruminate
to meditate, think about at length; to chew the cud
Somatic symptom illness are more common in
woman
erratic or dramatic behaviors
-Antisocial personality disorder -Borderline personality disorder -Histrionic personality disorder -Narcissistic personality disorder
anxious or fearful behaviors
-Avoidant personality disorder -Dependent personality disorder -Obsessive personality disorder
Six antipsychotics are available as long-acting injections (LAIs), formerly called depot injections, for maintenance therapy.
-Fluphenazine (Prolixin) in decanoate and enanthate preparations -Haloperidol (Haldol) in decanoate -Risperidone (Risperdal Consta) -Paliperidone (Invega Sustenna) -Olanzapine (Zyprexa Relprevv) -Aripiprazole (Abilify Maintena)
Etiology of Schizophrenia
-Genetic vulnerability -Neurochemical factors -Structural abnormalities of the brain -The neurodevelopmental hypothesis -Expressed emotion -Precipitating stress
odd or eccentric behaviors
-Paranoid personality disorder -Schizoid personality disorder -Schizotypal personality disorder
Side Effects of Antipsychotic Medications
-dry mouth, blurry vision, photosensitivity, constipation, orthostatic hypotension, Parkinsonism, destinies, akathisia, cardiovascular disorders
Alcoholics Anonymous uses the ______________ program model for recovery.
12-step
A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long? -2 weeks -4 weeks -6 months -12 months
6 Months The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.
Alogia
A decrease in speech or speech content; a symptom of schizophrenia. Also known as poverty of speech.
Munchausen syndrome by proxy
A factitious disorder in which parents make up or produce illnesses in their children. Also known as factitious disorder by proxy.
Hypomania
A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.
Alexithymia
A person's inability to, or difficulty in, describing or being aware of emotions or mood
kindling effect
A phenomenon in the brain that produces a heightened sensitivity to repeated administrations of some drugs, such as cocaine. This heightened sensitivity is the opposite of the phenomenon of tolerance.
conversion disorder
A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.
Medical complications of eating disorders related to weight loss Neuropsychiatric
Abnormal taste sensation, apathetic depression, mild organic mental symptoms, and sleep disturbances
Schizotypal
Acute discomfort in relationships; cognitive or perceptual distortions; eccentric behavior
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to the client's history of alcohol abuse? -Pancreatitis and elevated liver enzymes -Gastritis and elevated liver enzymes -Pancreatitis, esophagitis, gastritis, and elevated liver enzymes -All the conditions are attributable to the alcohol abuse
All the conditions are attributable to the alcohol abuse. Various medical conditions may alert the nurse to the early recognition of alcohol abuse problems, including gastritis or gastric ulcers, pancreatitis, esophagitis, mild to moderate hypertension, cardiomyopathy, arrhythmias, alcoholic hepatitis, cirrhosis of the liver, decreased white blood cell production, decreased granulocyte adherence, and thrombocytopenia, or cancers of the mouth, pharynx, larynx, esophagus, pancreas, stomach, and colon.
Negative or soft symptoms of schizophrenia
Alogia Anhedonia: Apathy Asociality Blunted affect Catatonia Flat affect Avolition or lack of volition Inattention
Medical complications of eating disorders related to weight loss Reproductive
Amenorrhea and low levels of luteinizing and follicle-stimulating hormones
anorexia nervosa
An eating disorder characterized by an obstinate and willful refusal to eat, a distorted body image, and an intense fear of being fat
A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what? -The disorder occurs more frequently in women. -An individual must be at least 18 years of age to be diagnosed with the disorder. -The disorder is found primarily in Asian individuals. -Alcohol abuse disorder rarely accompanies this disorder.
An individual must be at least 18 years of age to be diagnosed with the disorder. To be diagnosed with antisocial personality disorder, the individual must be at least 18 years of age and must have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years. The disorder occurs more frequently in men and crosses all cultures and ethnicities. This personality disorder is strongly associated with alcohol and drug abuse.
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? -Antipsychotics -Stimulants -Mood stabilizers -Antidepressants
Antidepressants Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms.
A 20-year-old client was admitted to the inpatient unit following a suicide attempt. The client is disheveled, disorganized, and dehydrated. The priority for the client's care during the first 24 hours of admission will be what? -Assisting the client with activities of daily living, including a shower and clean clothing. -Assessing the client's current suicidal ideation and putting the client on suicide precautions. -Rehydrating the client by forcing fluids. -Assessing the client's recent suicide attempt and identifying factors that may have contributed to it.
Assessing the client's current suicidal ideation and putting the client on suicide precautions. The first step is to provide for the client's safety by assessing the risk for suicide. Because the client has attempted suicide, the nurse immediately places the client on suicide precautions with frequent or continuous one-to-one observation and reassessment.
A client is experiencing alcohol withdrawal symptoms. Which of the following would the nurse expect to be prescribed to assist with the withdrawal symptoms, acting as a substitute for the alcohol? -Benzodiazepines -Beta-blockers -Antiseizure agents -Phenothiazines
Benzodiazepines Several medications are used to prevent physiologic complications and provide a gradual withdrawal from alcohol. Antianxiety and sedating drugs, such as benzodiazepines, the drugs of choice, are titrated downwardly over several days as a substitution for the alcohol. Antidepressants are usually initiated to treat mood states, and sleep medication is used to promote a regular sleep pattern. Antipsychotic medications are also used if needed.
A(n) ______________ is an episode during which the individual will continue to function but does not have a conscious awareness of or will not be able to remember the events that occur during this time.
Blackout
Which personality disorder is most commonly found in clinical settings? Antisocial personality Histrionic personality Narcissistic personality Borderline personality
Borderline personality Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men.
Which is a cardiac complication of an eating disorder? -Bradycardia -Hypertension -Enlarged heart -Thrombocytopenia
Bradycardia Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.
Medical complications of eating disorders related to weight loss Cardiac
Bradycardia, hypotension, loss of cardiac muscle, small heart, cardiac arrhythmias (including atrial and ventricular premature contractions, prolonged QT interval, ventricular tachycardia), and sudden death
Anticonvulsants Used as Mood Stabilizers
Carbamazepine (Tegretol) Divalproex (Depakote) Gabapentin (Neurontin) Lamotrigine (Lamictal) Topiramate (Topamax) Oxcarbazepine (Trileptal)
A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment? -Complete blood count and differential -Evidence of injury to skin by cutting -Cardiac assessment and measurement of electrolyte levels -Psychosocial assessment and determination of coping skills
Cardiac assessment and measurement of electrolyte levels While this client would certainly receive a complete blood count and respiratory assessment, the priority assessment in this client with the client's short-term and long-term histories would be focused on electrolyte levels and cardiac abnormalities, both of which are common manifestations of the repeated vomiting that characterizes bulimia nervosa. Physical assessments would supersede psychosocial assessments and any injury to skin by intentional self-harm in the emergency setting.
The client has been diagnosed with schizophrenia and is showing the following symptoms: immobility, rigidity, and stupor. These symptoms can be further classified as which characteristic symptoms of schizophrenia? -Disorganized -Catatonic -Residual -Paranoid
Catatonic Catatonic clients show motoric immobility or stupor, rigidity, excessive motor activity, extreme negativism, stupor, and peculiarities of movement, such as posturing, echolalia and echopraxia, mutism, and waxy flexibility.
When describing somatic symptom disorder to a group of nurses, which would the nurse include as a significant obstacle in providing psychiatric care for clients with that disorder? -Clients find it difficult to go to a clinic setting. -Clients are often embarrassed about the number and extent of their physical complaints. -Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented. -There are no known successful treatments for this disorder.
Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented. Clients focus on physical symptoms as the primary problem. When physicians are unable to diagnose the cause, clients are often referred to other physicians for further physical assessment or clients seek out other providers (i.e., "provider shop").
Which cluster of disorders corresponds to symptoms of being dramatic and emotional? -Cluster A -Cluster B -Cluster C -Cluster D
Cluster B Cluster B includes individuals who appear dramatic, emotional, or erratic. Cluster C includes clients who appear anxious or fearful, such as avoidant, dependent, and obsessive-compulsive. Cluster A includes individuals whose behavior appears odd or eccentric. There is currently no Cluster D in the DSM-5.
seasonal affective disorder
Controversial disorder in which a person experiences depression during winter months and improved mood during spring. Can be treated using phototherapy, using bright light and high levels of negative ions.
Medical complications of eating disorders related to weight loss Gastrointestinal
Delayed gastric emptying, bloating, constipation, abdominal pain, gas, and diarrhea
Which is the most common disorder found in clients diagnosed with bulimia nervosa? -Depression -Anxiety -Psychosis -Substance abuse
Depression Mood disorders, anxiety disorders, and substance abuse/dependence are frequently seen in clients with eating disorders. Of those, depression and obsessive-compulsive disorder are most common.
When assessing a client with somatic symptom disorder (SSD), the nurse would be alert for which comorbidity as most common? Select all that apply. -Depression -Anxiety -Social phobia -Panic disorder -Personality disorder
Depression Anxiety Although social phobia, panic disorder, and personality disorder are other comorbidities with SSD, it frequently coexists with other psychiatric disorders, most commonly depression and anxiety.
Schizoid
Detached from social relationships; restricted affect; involved with things more than people
A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply. -Difficulty regulating moods -Overinflated self-identity -Problems with interpersonal relationships -Thinking that is based on delusions -Impulsive behavior
Difficulty regulating moods Problems with interpersonal relationships Impulsive behavior People with BPD have problems regulating their moods, developing a self-identity, maintaining interpersonal relationships, maintaining reality-based thinking, and avoiding impulsive or destructive behavior.
Antisocial
Disregard for rights of others, rules, and laws
A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? -Dopamine -Serotonin -Norepinephrine -Gamma-aminobutyric acid (GABA)
Dopamine Although research is demonstrating that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (such as serotonin, norepinephrine, or dopamine), positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by dopamine hyperactivity in the mesolimbic tract. Researchers are also hypothesizing a role for GABA but have yet to identify any specific information.
The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience? -Dopamine -Serotonin -Acetylcholine -Norepinephrine
Dopamine The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, producing pleasant feelings or a "high" that is a reinforcing, or positive, experience.
Medical complications of eating disorders related to weight loss Dermatologic
Dry, cracking skin due to dehydration, lanugo (i.e., fine, baby-like hair over body), edema, and acrocyanosis (i.e., blue hands and feet)
When a 27-year-old is admitted for treatment of anorexia nervosa, the nurse prepares the client for diagnostic testing that includes what? Select all that apply. -Electrocardiogram (ECG) -Serum glucose -Serum amylase -Serum cortisol -Serum uric acid
Electrocardiogram (ECG) Serum glucose Serum amylase Serum cortisol Anorexia nervosa affects numerous body systems. When a 27-year-old is admitted for treatment of anorexia nervosa, the nurse prepares the client for diagnostic testing that includes an electrocardiogram to check for heart arhythmia. Other tests are for serum glucose, as clients may be hypoglycemic, and serum amylase, which may be elevated due to involvement of the pancreas. Because anorexia nervosa places the body under considerable stress, cortisol levels may be elevated. While blood urea nitrogen (BUN) and its ratio to creatinine can yield important information about kidney function, serum uric acid would generally not be part of the panel.
Medical complications of eating disorders related to purging (vomiting and laxative abuse) Metabolic
Electrolyte abnormalities, particularly hypokalemia, hypochloremic alkalosis, hypomagnesemia, and elevated blood urea nitrogen
The nurse is assessing a client with schizophrenia who has a history of successfully managing the symptoms. The client has few social activities and speaks in a flat tone when interacting with others. Currently the client is experiencing acute psychosis with active hallucinations and social withdrawal. The nurse identifies improved social skills as an important therapeutic goal. How should the nurse implement this plan? -Enter the client in the ongoing social skills training program on the unit. Have the client begin on the following day. -Wait a few days to enter the client in the social skills training program. -Enter the client in a social skills training program when acute psychosis subsides. -Refer the client to a social skills training program after discharge.
Enter the client in a social skills training program when acute psychosis subsides. Although severe psychotic symptoms of schizophrenia can subside with pharmacologic treatment, many clients still have severely restricted social lives. Impaired communication, lack of motivation, inattention to self-care, and difficulty establishing and maintaining relationships leave them socially isolated. Psychosocial approaches can help clients improve social functioning and enjoy a better quality of life. These interventions usually are not implemented, however, until psychotic symptoms are controlled.
Medical complications of eating disorders related to purging (vomiting and laxative abuse) Dental
Erosion of dental enamel (perimyolysis), particularly front teeth
How often must clients receiving clozapine get white blood cell counts drawn? -Every week for the first 6 months -Every 3 months -Every 6 months -Every year
Every week for the first 6 months Clients taking clozapine must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.
Histrionic
Excessive emotionality and attention seeking
A lithium level of 1.6 mEq/L is within the therapeutic range. True or false?
False
Antidepressant medications can be discontinued quickly by the client. True or false?
False
Borderline personality disorder is more common in men than in woman. True or false?
False
Character is the biologic process of sensation, association, and motivation that underlies the integration of skills and habits based on emotions. True or False?
False
Depressed individuals can experience a lack of energy known as anhedonia. True or False?
False
Individuals with avoidant personality disorder tend to demonstrate pervasive mistrust and suspiciousness of others and perceive others' actions as potentially harmful. True or false?
False
Schizophrenia is usually diagnosed earlier in woman than in men. True or false?
False
Thought broadcasting is the false belief that someone is inserting thoughts into one's mind against one's will. True or False
False
SSRI Antidepressants
Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Vortioxetine (Trintellix)
Narcissistic
Grandiose; lack of empathy; need for admiration
A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as belonging to what class? -Hallucinogen -Hypnotic -Opioid -Sedative
Hallucinogen MDMA (3-4 methylenedioxymethamphetamine), or Ecstasy or Molly, is a hallucinogen and is known as a "designer drug" because it is used by teens and young adults as part of the nightclub, bar, and rave scenes. MDMA, similar in structure to methamphetamine, causes serotonin to be released from neurons in greater amounts than normal. Once released, this serotonin can excessively activate serotonin receptors.
psychosomatic
Having an effect on the body, but mental or emotional in origin
The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next? -Throat and esophagus -Condition of mouth and gums -Heart rate and rhythm -Patterns of activity and rest
Heart rate and rhythm Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.
The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day? -Remind them that substance dependency is a disease, not a mental disorder. -Suggest that they try to confront other issues in their lives, such as estranged relationships or financial issues. -Help them to identify appropriate diversional activities. -Ask them to make a list of all the people they harmed during their addictions.
Help them to identify appropriate diversional activities. Clients in recovery typically have devoted much time to their addiction. Substance use is integral to their existence and occupies most of their leisure time. In some cases, it also takes up work and family time. During treatment, clients may find themselves lonely, bored, idle, or conflicted about what to do with so much "free" time. They need to plan activities to minimize the temptation to revert to alcohol or drug use.
hypertensive crisis
Hypertension with Angina, Pulmonary Edema, Pregnancy or signs of cerebral edema (such as usually severe headache blurred vision/visual disturbances, nausea and vomiting, altered mental status, focal neurological sign or deficits, paresthesias, dizziness, vertigo or tinnitus >180 and/or >120
Which area of the brain has been associated with the symptoms of eating disorders? -Hypothalamus -Cerebellum -Pons -Medulla
Hypothalamus
Medical complications of eating disorders related to weight loss Metabolic
Hypothyroidism (symptoms include lack of energy, weakness, intolerance to cold, and bradycardia), hypoglycemia, and decreased insulin sensitivity
When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? -In somatic symptom disorder, clients consciously seek attention. -In factitious disorders, clients are unaware that their symptoms are not real. -In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. -Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder.
In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. Clients with somatic symptom disorder do not intentionally cause, and have no conscious or voluntary control over, their symptoms. Lack of voluntary control is in contrast to factitious disorder and malingering. In factitious disorder, clients deliberately make up or inflict symptoms.
word salad
Incoherent mixture of words, phrases, and sentences
MAOI Antidepressants
Isocarboxazid (Marplan) Phenelzine (Nardil) Tranylcypromine (Parnate) There is a 2- to 4-week lag period before MAOIs reach therapeutic levels. Because of the lag period, adequate washout periods of 5 to 6 weeks are recommended between the times that the MAOI is discontinued and another class of antidepressant is started.
___________________ is a process by which activity in the brain is initially stimulated by the cumulative effects of stress, low amounts of electric impulses, or chemicals that sensitize the neuronal pathways.
Kindling
Angeria
Lack of energy; passivity, lack of persistence at work or school
The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group? -Learning strategies to refrain from self-harm -Learning problem solving -Discussing feelings about self-harm -Expressing angry feelings
Learning strategies to refrain from self-harm Discussing feelings provides some relief, but avoiding personal harm is the highest priority for clients at risk for self-mutilation. It is helpful to learn problem-solving techniques and how to express anger, but the priority is for the client not to cause personal harm.
Medical complications of eating disorders related to weight loss Hematologic
Leukopenia, anemia, thrombocytopenia, hypercholesterolemia, and hypercarotenemia
Medical complications of eating disorders related to weight loss Musculoskeletal
Loss of muscle mass, loss of fat, osteoporosis, and pathologic fractures
Increased levels of the neurotransmitter serotonin and its precursor tryptophan have been linked with increased satiety.
Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and purge subtype of anorexia nervosa, this may explain binging behavior. The positive response of some clients with bulimia to the treatment with SSRI antidepressants supports the idea that serotonin levels at the synapse may be low in these clients.
Neologisms
Made-up words that typically have only meaning to the individual who uses them.
Which occurs when an individual intentionally produces illness symptoms to avoid work? -Malingering -Alexithymia -Conversion disorder -Illness anxiety disorder
Malingering Malingering occurs when an individual intentionally produces illness symptoms, motivated by another specific self-serving goal, such as being classified as disabled or avoiding work. Individuals with alexithymia have difficulty identifying and expressing their emotions. They have a preoccupation with external events and are described as concrete, externally oriented thinkers. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. Illness anxiety disorder occurs when an individual is fearful of developing a serious illness based on a misinterpretation of body sensations.
paranoid
Mistrust and suspicions of others; guarded, restricted affect
A client is admitted to the detoxification unit on Sunday evening. The client discloses that the client's last alcoholic drink was just before the client was admitted to the unit. When can the nurse expect that the client's alcohol withdrawal symptoms will begin? -Monday morning -Tuesday evening -Wednesday morning -Friday evening
Monday morning Symptoms of withdrawal usually begin within 12 hours after cessation or marked reduction of alcohol intake.
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? -Headache, muscle aches, and paresthesias -Confusion, giddiness, and hyperalertness -Muscular rigidity, tremors, and difficulty swallowing -Dry mouth, flushing, and urinary retention
Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.
______________ malignant syndrome is a potentially life-threatening reaction seen with clients taking antipsychotic medications
Neuroleptic
What is norepinephrine role in behavior?
Norepinephrine levels may be deficient in depression and increased in mania. This catecholamine energizes the body to mobilize during stress and inhibits kindling. Kindling is the process by which seizure activity in a specific area of the brain is initially stimulated by reaching a threshold of the cumulative effects of stress, low amounts of electric impulses, or chemicals such as cocaine that sensitize nerve cells and pathways. These highly sensitized pathways respond by no longer needing the stimulus to induce seizure activity, which now occurs spontaneously. It is theorized that kindling may underlie the cycling of mood disorders as well as addiction. Anticonvulsants inhibit kindling; this may explain their efficacy in the treatment of bipolar disorder.
Which is a true statement regarding depressive disorders? -They are more prevalent in men than women. -Depression in older adults is easier to diagnosis. -Norepinephrine, dopamine, and serotonin have been implicated. -It is the leading cause of U.S. disability in clients older than 44 years of age.
Norepinephrine, dopamine, and serotonin have been implicated. The monoamines that have been implicated in depression are norepinephrine (NE), dopamine (DA), and serotonin (5-HT). Disturbances in mood may result when absolute concentrations of NE, 5-HT, or both are deficient. Depressive disorders are more prevalent in women than in men. Depression in older adults may be difficult to diagnose because many older people have comorbid diseases. It is currently the leading cause of U.S. disability in clients 15 to 44 years of age.
A client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline? -Orthostatic hypotension -Diarrhea -Weight loss -Excessive salivation
Orthostatic hypotension Side effects of amitriptyline include orthostatic hypotension, constipation, weight gain, and dry mouth.
A nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of what? -Panic disorder -Schizophrenia -Delusional disorder -Posttraumatic stress disorder
Panic disorder The two most common comorbid conditions associated with bipolar disorder are anxiety disorders (panic disorder and social phobia are most prevalent) and substance use, most commonly alcohol and marijuana. Schizophrenia and delusional disorder are not associated comorbidities. Although posttraumatic stress disorder is an anxiety disorder, it is not as common as panic disorder and social phobia.
A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? -Paranoid thoughts -Perfectionism -Trusting behaviors -Dependency needs
Paranoid thoughts A schizotypal client would have paranoid thoughts in social situations. They experience acute discomfort in social situations and have cognitive or perceptual distortions.
__________________________ personality disorder is characterized by a negative attitude and a pervasive pattern of resistance to demands for adequate social and occupational performance.
Passive-aggressive
Borderline Personality Disorder
People with borderline personality disorder (BPD) have an extreme fear of abandonment and a history of unstable, insecure attachments. These individuals, who already are intensely emotional and have a poor sense of self, feel estranged from others and inadequate in meeting perceived social standards. The pervasive mood is dysphoric, involving unhappiness, restlessness, and malaise. Clients often report intense loneliness and feeling "empty," which causes them to rarely experience periods of satisfaction or well-being that would lead to exaggerated self-image. Clients tend to have an unstable view of themselves that shifts dramatically and suddenly, often from needy and dependent one moment to angry, hostile, and rejecting the next.
A client with delusional disorder believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what? -Erotomanic -Persecutory -Grandiose -Somatic
Persecutory The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated on, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the loved object who is usually married, of a higher economic status, or otherwise unattainable. Grandiose delusions involve the belief that the person has a great, unrecognized talent or has made an important discovery or has a special relationship with a prominent person (or of actually being a prominent person). Somatic delusions involve bodily functions or sensations, with the client believing that he or she has physical ailments.
______________________ is an ingrained enduring pattern of behaving and relating to self, others, and the environment and includes perceptions, attitudes, and emotions.
Personality
Euthymic
Pertaining to a normal mood in which the range of emotions is neither depressed nor highly elevated
_______________, or an excessive ingestion of water, can have potentially life-threatening effects on fluid and electrolyte balances.
Polydipsia
A nurse is conducting an inservice program on personality disorders. When describing obsessive-compulsive personality disorder, which characteristics would the nurse likely include? Select all that apply. -Preoccupation with control -Inability to delay rewards -Strict attention to rules -Difficulty with decision making -Relationships primarily formal and polite
Preoccupation with control Strict attention to rules Difficulty with decision making Relationships primarily formal and polite Individuals with obsessive-compulsive personality disorder demonstrate a pervasive pattern of preoccupation with orderliness, perfectionism, and control. They also have the ability to delay rewards and maintain control by careful attention to rules. Perfectionists are prone to repetition and have difficulty making decisions. They can be overly conscientious about morality and ethics and value polite, formal, and correct interpersonal relationships.
Obsessive-compulsive
Preoccupation with orderliness, perfectionism, and control
Which is the name given to a direct internal benefit that being sick provides, such as relief from anxiety? -Primary gain -Secondary gain -Malingering -La belle indifference
Primary gain Primary gains are the direct internal benefits that being sick provides. Secondary gains are the external benefits received from others because one is sick. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms. The la belle indifference is a seeming lack of concern or distress for sudden deficits in sensory or motor function, as seen in conversion disorder.
"culture-bound" syndrome
Psychotic behavior observed in countries other than the United States or among particular ethnic groups
Schizoaffective disorder
Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder.
A client is diagnosed with somatic symptom disorder. Which would the nurse expect to assess as the major clinical finding? -The client's inability to focus on emotional content -Report of symptoms with no demonstrable pathology on testing or examination -Definitive medical finding with a history of "doctor shopping" -Loss of voluntary motor or sensory functioning
Report of symptoms with no demonstrable pathology on testing or examination There are no positive lab or diagnostic tests indicating an organic cause of the physical symptom. The cause is psychological, which does not show on diagnostic testing. Although the client may "provider shop," there is no evidence or definitive finding to support the symptoms.
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? -Risk for self-mutilation -Ineffective coping -Disturbed thought process -Chronic low self-esteem
Risk for self-mutilation One of the first diagnoses to consider with this client population is risk for self-mutilation, because protection of the client from self-injury is always a priority. The other diagnoses may be appropriate for the client, but risk for self-mutilation would be the priority.
Medical complications of eating disorders related to purging (vomiting and laxative abuse) Gastrointestinal
Salivary gland and pancreas inflammation and enlargement with an increase in serum amylase, esophageal and gastric erosion or rupture, dysfunctional bowel, and superior mesenteric artery syndrome
________________ disorder describes a condition in which the client exhibits symptoms of psychosis and a mood disorder such as depression
Schizoaffective
Medical complications of eating disorders related to purging (vomiting and laxative abuse) Neuropsychiatric
Seizures (related to large fluid shifts and electrolyte disturbances), mild neuropathies, fatigue, weakness, and mild organic mental symptoms
Which drug classification has been shown to be effective in treating somatization disorders? -Selective serotonin reuptake inhibitors -Antipsychotics -Antimanics -Antianxiety medications
Selective serotonin reuptake inhibitors
In the care of a client with somatic symptom disorder, the nurse should anticipate that drug treatment will prioritize which class in order to treat the disorder? -Benzodiazepines -Selective serotonin reuptake inhibitors (SSRIs) -Monoamine oxidase inhibitors (MAOIs) -Hypnotics
Selective serotonin reuptake inhibitors (SSRIs) SSRIs are used in the treatment of somatic symptom disorder. Benzodiazepines may be occasionally indicated but are not an appropriate form of primary treatment due to the potential for dependence and difficult withdrawal. MAOIs and hypnotics are not commonly used in the treatment of the disorder.
Somatic symptom illness disorders are characterized by what? -Severe physical symptoms that cannot be explained by any organic or physical pathology -Self-inflicted injuries -Self-induced disease states or faked symptoms to garner attention -Physical symptoms coupled with extreme focus on emotional state
Severe physical symptoms that cannot be explained by any organic or physical pathology Clients with somatoform disorders experience physical symptoms despite no underlying medical explanation for them. They complain of severe symptoms with no organic or physical basis.
Avoidant
Social inhibitions; feelings of inadequacy; hypersensitive to negative evaluation
pressured speech
Speech that is increased in amount, accelerated, and difficult or impossible to interrupt. Usually it is also loud and emphatic. Frequently the person talks without any social stimulation and may continue to talk even though no one is listening.
Which occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way? -Splitting -Thought stopping -Decatastrophizing -Positive self-talk
Splitting Splitting occurs in this situation. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as, "I'm dumb, I'm stupid." Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. In positive self-talk, the client reframes negative thoughts into positive ones.
Classified as a(n) _____________, cocaine is a highly addictive drug that produces an intense and immediate feeling of euphoria.
Stimulant
Dependent
Submissive and clinging behavior; excessive need to be taken care of
Which statement most accurately describes the etiology of substance-related disorders? -Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors. -Substance-related disorders are primarily a result of the presence of an individual's inherently addictive personality. -The primary predictors of substance-related disorders are childhood trauma and parental abuse or neglect. -Substance abuse is a learned behavior.
Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors. Substance-related disorders have a complex etiology, and contributions have been noted from a combination of neurological, genetic, behavioral, and sociocultural sources.
functional somatic syndromes
Syndromes marked by the symptoms, suffering, and disability they cause rather than by demonstrable tissue abnormality.
Schizophreniformdisorder
The client exhibits an acute, reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia. If symptoms persist over 6 months, the diagnosis is changed to schizophrenia. Social or occupational functioning may or may not be impaired.
Delusional disorder
The client has one or more nonbizarre delusions—that is, the focus of the delusion is believable. The delusion may be persecutory, erotomanic, grandiose, jealous, or somatic in content. Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre.
The nurse is assessing a client who has been unable to speak after witnessing a murder. The assessment and subsequent testing reveal no physical abnormality that may cause speech impairment. What is the most likely cause of this speech impairment in the client? -The client may have vocal cord paralysis. -The client may not want to speak. -The client may be attempting to block the witnessed event to reduce anxiety. -The client may have dysfunction of the speech center of the brain.
The client may be attempting to block the witnessed event to reduce anxiety. The client is most likely experiencing conversion disorder after witnessing a violent act. In this case, the client may be trying to protect the self, either consciously or unconsciously, from the fear or anxiety from the event. The assessment and subsequent testing did not reveal any other cause of speech impairment, which indicates the client does not have vocal cord paralysis or any dysfunction related to the brain's speech center.
The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation? -The client is probably using cocaine in combination with her antidepressants to enhance the effects of the cocaine. -The client needs to address the cocaine abuse first before addressing her episodes of depression. -The client most likely has a dual diagnosis since she has both a substance dependence and depression. -The client's prognosis is very poor because discontinuing the cocaine use will exacerbate depressive symptoms.
The client most likely has a dual diagnosis since she has both a substance dependence and depression. The client has a dual diagnosis: a primary substance dependence and a mental health disorder. The client requires concurrent treatment of both disorders. Cocaine is a stimulant so it would counteract the action of the antidepressants. Prognosis is variable and dependent on the effectiveness of the treatment for both disorders.
The client's diagnosis of schizoaffective disorder is supported when the nurse documents what? -The client reports "hearing voices" for the last 3 months -The client's mother shares that "the client never missed work" even with the disorder -The client's spouse reported that the client "repeated everything I said" for 48 hours -Diagnosis testing confirmed a right parietal brain lesion
The client reports "hearing voices" for the last 3 months The client's diagnosis of schizoaffective disorder is supported when the nurse documents that the client reports "hearing voices" for the last 3 months. The documentation is objective and includes a direct quote from the actual client. What is being documented is consistent with the criteria for schizoaffective disorder.
When describing the course of illness associated with somatic symptom disorder, which would the nurse include? -The client readily discusses feelings and expresses needs verbally. -The client will often minimize the medical history. -The client will report going to many different providers without satisfaction. -The client avoids playing the sick role and resists medical attention.
The client will report going to many different providers without satisfaction. Clients living with a somatic symptom disorder usually present exaggerated, inconsistent, yet complicated medical histories. They often seek treatment from multiple health care providers when their physical complaints are not addressed to their satisfaction.
A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for the nurse to keep in mind? -Opioid analgesics are the primary mode of therapy. -The client's experience of pain is real. -Complementary therapies are usually of little benefit. -Outcomes need to reflect the biologic aspects of the pain.
The client's experience of pain is real. Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches.
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind? -Methadone is a not physiologically addictive. -The drug helps to satisfy the craving for the opioid. -Methadone is a non-opioid drug. -Methadone simulates the high of heroin.
The drug helps to satisfy the craving for the opioid Methadone maintenance is the treatment of people with opioid addiction with a daily, stabilized dose of methadone. Methadone is used because of its long half-life of 15 to 30 hours. Methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin.
A nurse was placed in charge of the pediatric care unit. Over a period of time it was discovered that most of the children on the unit experienced sudden cardiac arrest. Although the nurse went to great lengths to revive the children, most of these children died. On further investigation, it was found that the nurse had been injecting high doses of digoxin drug in the children, which caused the cardiac arrest. The nurse was arrested and found guilty. What would have been the most likely cause of the nurse's behavior? -The nurse might have conversion disorder. -The nurse might have somatic symptom disorder. -The nurse might have Munchausen's syndrome. -The nurse might have Munchausen's syndrome by proxy.
The nurse might have Munchausen's syndrome by proxy. Munchausen's syndrome by proxy is a condition in which a person inflicts illness or injury on someone else in order to gain attention from becoming a "hero" for saving the victim. In this case, the nurse tried to kill the children and then went to great lengths to revive them. This indicates that the nurse had Munchausen's syndrome by proxy. In conversion disorder, the client has sudden deficits in sensory or motor function due to an unexplained cause. In somatic symptom disorder, the client reports having one or more than one physical symptom without any underlying cause. In Munchausen's syndrome the client inflicts illness or injury on oneself in order to gain attention.
Purging
The use of vomiting, laxatives, excessive exercise, restrictive dieting, enemas, diuretics, or diet pills to compensate for food that has been eaten and that the person fears will produce weight gain
MAOI Drug Interactions
There are numerous drugs that interact with MAOIs. The following drugs cause potentially fatal interactions: -Amphetamines -Ephedrine -Fenfluramine -Isoproterenol -Meperidine -Phenylephrine -Phenylpropanolamine -Pseudoephedrine -SSRI antidepressants -Tricyclic antidepressants -Tyramine
theraputic Lithium level
There is a narrow range of safety among maintenance levels (0.5-1 mEq/L), treatment levels (0.8-1.5 mEq/L), and toxic levels (1.5 mEq/L and above). It is important to assess for signs of toxicity and to ensure that clients and their families have this information before discharge. Older adults can have symptoms of toxicity at lower serum levels. Lithium is potentially fatal in overdose.
Personality disorder is a generalized pattern of behaviors, thoughts, and emotions that begins in adolescence, remains stable over time, and causes stress or psychological damage.
They are characterized by: -Impaired personality functioning (areas of identity, self-direction, empathy, and intimacy) -Pathological personality factors (negative affectivity, detachment, antagonism, disinhibition, and psychoticism) The personality disorders included in this proposed model are antisocial, borderline, avoidant, narcissistic, obsessive-compulsive, and schizotypal.
When completing a baseline assessment of a client with depression, which diagnostic tests would the nurse anticipate? -Renal function tests -Coagulation profile -Thyroid function tests -Abdominal ultrasound
Thyroid function tests A physical examination is recommended with baseline vital signs and baseline laboratory tests, including a comprehensive blood chemistry panel, complete blood counts, liver function tests, thyroid function tests, urinalysis, and electrocardiograms. These physical examinations can help to rule out any underlying medical conditions that may be causing or exacerbating an existing depression. The other diagnostic tests indicated in the options are not related to identifying underlying medical conditions that are commonly found comorbid to depression.
latency of response
Time from onset of stimulus to onset of response
__________________, a dystonic reaction that results in muscle spasms in the neck, can be very painful for the client
Torticollis
Which statement about clients with a dual diagnosis is accurate? -Addictions and mental disorders should be treated separately. -Chances for recovery for clients with a dual diagnosis are better than average. -Traditional methods of treatment have not been very successful for these clients. -These clients represent a small percentage of hospitalized clients.
Traditional methods of treatment have not been very successful for these clients. Traditional methods of treatment for major psychiatric disorders and substance dependency (i.e., substance dependency programs) have not been successful in treating clients with dual diagnoses.
Tricyclic Antidepressant Medications
Tricyclic (and also heterocyclic) antidepressants have a lag period of 10 to 14 days before reaching a serum level that begins to alter symptoms; they take 6 weeks to reach full effect. Because they have a long serum half-life, there is a lag period of 1 to 4 weeks before steady plasma levels are reached and the client's symptoms begin to decrease. They cost less, primarily because they have been around longer and generic forms are available. Tricyclic antidepressants are contraindicated in severe impairment of liver function and in myocardial infarction
A client with schizophrenia may exhibit echolalia, an abnormal speech pattern in which he or she repeats or imitates words or phrases spoken by another individual. True or false
True
Depressed individuals who are newly taking antidepressant medication are at an increased risk for suicide. True or false?
True
Electroconvulsive therapy can be safely administered to pregnant woman. True or false?
True
In communicating with a client experiencing a delusion, it is important for the nurse to avoid confronting the false belief. True or false?
True
New prominent theories suggest that alterations in both the levels of dopamine and serotonin are involved in schizophrenia. True or False?
True
Pharmacologic treatment of personality disorders is based on the symptomatology rather than the particular subtype. True or false?
True
Tapering, or gradual decrease in the ingestion of a substance, is used to mediate withdrawal symptoms. True or False?
True
individuals who have paranoid personality disorder may experience difficulty in trusting the members of the health care team. True or false
True
Disruptions of the nuclei of the hypothalamus may produce many of the symptoms of eating disorders.
Two sets of nuclei are particularly important in many aspects of hunger and satiety (satisfaction of appetite)—the lateral hypothalamus and the ventromedial hypothalamus
Borderline
Unstable relationships, self-image, and affect; impulsivity; self-mutilation
Atypical Antidepressants
Venlafaxine (Effexor) SNRI Desvenlafaxine(Pristiq) SNRI Duloxetine (Cymbalta) SNRI Bupropion (Wellbutrin) Nefazodone (Serzone) Mirtazapine (Remeron) Vilazodone (Viibryd) Atypical antidepressants are used when the client has an inadequate response to or side effects from SSRIs.
Individuals with an addiction to alcohol are often administered _________________ to prevent or to treat Wernickle-Korsakoff syndrome.
Vitamin B1
A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what? -Waxy flexibility -Hypervigilance -Retardation -Echopraxia
Wavy flexibility Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Exchopraxia refers to the involuntary imitation of another person's movements and gestures. Hypervigilance refers to the sustained attention to external stimuli, as if expecting something important or frightening to occur. Retardation refers to slowed movements.
A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing? -Scurvy -Wernicke-Korsakoff syndrome -Alcohol dependence with memory impairment -Alcoholic dementia
Wernicke-Korsakoff syndrome Wernicke-Korsakoff syndrome is the coexistence of Wernicke's encephalopathy and Korsakoff's psychosis. Wernicke's encephalopathy is characterized by ataxia, nystagmus, ophthalmoplegia, and mental status changes. Korsakoff's psychosis involves gait disturbances, short-term memory loss, disorientation, delirium, confabulation, and neuropathy.
A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug? -white blood cells -hemoglobin -hematocrit -platelets
White blood cells Agranulocytosis can develop with the use of all antipsychotic drugs but it is most likely to develop with clozapine use. Clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated and at least weekly or twice weekly after treatment begins.
la belle indifference
a French term descriptive of the lack of concern for their (imagined) medical problem sometimes shown by people with conversion disorders
electroconvulsive therapy (ECT)
a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions
Neuroleptics
a class of antipsychotic drugs, traditionally dopamine receptor blockers
factitious disorder imposed on another
a condition in which one person induces illness symptoms in someone else
Munchausen syndrome
a condition in which the "patient" repeatedly makes up clinically convincing simulations of disease for the purpose of gaining medical attention
Anhedonia
a diminished ability to experience pleasure
Eating disorders are often linked to...
a history of sexual abuse, especially if the abuse occured before puberty.
mania
a mood disorder marked by a hyperactive, wildly optimistic state
catatonia
a pattern of extreme psychomotor symptoms, found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing
ghost sickness
a preoccupation with death and the deceased frequently observed in Native Americans. Symptoms include bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation.
psychosis
a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions
Bouffée délirante
a syndrome found in West Africa and Haiti, involves a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It is sometimes accompanied by visual and auditory hallucinations or paranoid ideation.
cyberchondria
a term used to describe people who search medical symptoms online and believe they have the worst-case scenario for their symptoms
Positive or hard symptoms of schizophrenia
ambivalence associative looseness delusions echopraxia flight of ideas hallucinations ideas of reference perseveration bizarre behavior
Tricyclic Antidepressant Medications
amitriptyline (Elavil) amoxapine (Asendin) doxepin (Sinequan) imipramine (Tofranil) desipramine (Norpramin) nortriptyline (Pamelor)
bulimia nervosa
an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise
Zar
an experience of spirits possessing a person, is seen in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. The afflicted person may laugh, shout, wail, bang his or her head on a wall, or be apathetic and withdrawn, refusing to eat or carry out daily tasks. Locally, such behavior is not considered pathologic.
psychomotor agitation
an inability to sit still, evidenced by pacing, hand wringing, or rubbing or pulling the skin, clothes, or other objects. Excessive motor and cognitive activity, usually nonproductive and in response to inner tension
______________ personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others and with the central characteristics of deceit and manipulation.
antisocial
A major depressive episode lasts...
at least 2 weeks, during which the person experiences a depressed mood or loss of pleasure in nearly all activities. Symptoms include changes in eating habits, resulting in unplanned weight gain or loss; hypersomnia or insomnia; impaired concentration, decision-making, or problem-solving abilities; inability to cope with daily life; feelings of worthlessness, hopelessness, guilt, or despair; thoughts of death and/or suicide; overwhelming fatigue; and rumination with pessimistic thinking with no hope of improvement. These symptoms result in significant distress or impairment of social, occupational, or other important areas of functioning.
