ATI Mental Health Focused Review

ADHD

inability of a person to control behaviors requiring sustained attention

Refeeding syndrome

a potentially fatal complication that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client

nursing history for eating disorder should include...

- client's perception of the issue - eating habits - hx of dieting - methods of weight control - value attached to specific weight and shape - interpersonal and social functioning - difficulty with impulsivity or compulsivity - family and interpersonal relationships

disorders that can appear during childhood and adolescence

- depressive - anxiety - trauma/stressor related - substance use - feeding and eating - disruptive, impulse control, and conduct - neurodevelopmental - bipolar and related - schizophrenia spectrum and other psychotic - non-suicidal self-harm and suicidal behaviors - impulse control disorders

risk factors for eating disorders

- occupational choices that encourage thinness such as modeling - individual history of being a "picky" eater in childhood - participation in athletics, especially at the elite level of competition or in a sport where lean body build is prized or where a specific weight is necessary

criteria for acute care treatment of a client with an eating disorder

- rapid weight loss of greater than 30% of body weight over 6 months - unsuccessful weight gain in outpatient treatment, failure to adhere to treatment contract - vital signs demonstrating HR less than 40/min, systolic BP less than 70, body temp less than 36 C - ECG changes - electrolyte disturbances - psychiatric criteria (depression, SI, family crisis, psychosis)

A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? a. "this medication increases the release of serotonin and norepinephrine." b. "i will need to monitor the client for hyponatremia while taking this medication." c. "this medication is contraindicated for clients who have an eating disorder." d. "sexual dysfunction is a common adverse effect of this medication."

A

A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat i am." C. "If i could be skinny, i know i'd be popular." D. "When i look in the mirror, I see myself as obese."

A

A nurse is caring for an adult client who has injuries resulting from intimate partner abuse. the client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A. advise the client about the location of women's shelters. B. encourage the client to participate in a support group for survivors of abuse. C. implement case management to coordinate community and social services. D. educate the client about the use of stress management techniques.

A

autism spectrum disorder

A complex neurodevelopmental disorder thought to be of genetic origin with a wide spectrum of behaviors affecting an individual's ability to communicate and interact with others. Cognitive and language development are typically delayed. Characteristic behaviors include inability to maintain eye contact, repetitive actions, and strict observance of routines

A nurse is obtaining a health history from the parents of a 12‑year‑old client who has conduct disorder. Which of the following findings should the nurse expect? (select all that apply.) a. bullying of others b. threats of suicide c. law‑breaking activities d. narcissistic behavior e. flat affect

ABC

A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse to include in the assessment? (select all that apply.) A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" C. "Would you describe your current eating habits?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?"

ACE

A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (select all that apply.) a. void just before taking the medication. B. increase the dietary intake of potassium. c. wear sunglasses when outside. d. change positions slowly when getting up. e. chew sugarless gum

ACE

Types of ADHD

ADHD predominantly inattentive ADHD predominantly hyperactive‑impulsive Combined type: Client exhibits both inattentive and hyperactive impulsive behaviors

medications for substance use disorders

Alcohol withdrawal: Diazepam, carbamazepine, clonidine, chlordiazepoxide, phenobarbital, naltrexone Alcohol abstinence: Disulfiram, naltrexone, acamprosate Opioid withdrawal: Methadone substitution, clonidine, buprenorphine, naltrexone, levo‑alpha‑acetylmethadol Nicotine withdrawal from tobacco use: Bupropion, nicotine replacement therapy (nicotine gum and nicotine patch), varenicline, bupropion Nicotine abstinence: Varenicline, rimonabant

tricyclic antidepressants

Amitriptyline Imipramine Doxepin Nortriptyline Amoxapine Trimipramine

A nurse is assessing a 4‑year‑old child for indications of autism spectrum disorder. for which of the following manifestations should the nurse assess? A. impulsive behavior B. repetitive counting C. destructiveness D. somatic problems

B

A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following? A. Refusing to pay bills for a dependent, even when funds are available, is neglect. B. Intentionally causing an older adult to fall is an example of physical violence. C. Striking an intimate partner is an example of sexual violence. D. Failure to provide a stimulating environment for normal development is emotional abuse.

B

A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? a. "while taking this medication, i'll need to stay out of the sun to avoid a skin rash." b. "i may feel drowsy for a few weeks after starting this medication." c. "i cannot eat my favorite pizza with pepperoni while taking this medication." d. "this medication will help me lose the weight that i have gained over the last year."

B

A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) a. Sunken fontanels b. Respiratory distress c. Retinal hemorrhage d. Altered level of consciousness e. Increase in head circumference

BCDE

A nurse is caring for a client who is taking phenelzine for which of the following adverse effects should the nurse monitor? (select all that apply.) a. elevated blood glucose level b. orthostatic hypotension c. priapism d. headache e. bruxism

BD

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (select all that apply.) A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face

BD

A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) a. bradycardia b. fine tremors of both hands c. hypotension d. vomiting e. restlessness

BDE

A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following manifestations should the nurse expect? (select all that apply.) A. fear of being alone B. substance use C. weight gain D. irritability E. aggressiveness

BDE

A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicate an understanding of the teaching? (Select all that apply.) a. "We need to understand that she is responsible for her disorder." b. "Eliminating any codependent behavior will promote her recovery." c. "She should participate in an al‑anon group to help her recover." d. "The primary goal of her treatment is abstinence from substance use." e. "She needs to discuss her feelings about substance use to help her recover."

BDE

A nurse working in an emergency department is assessing a preschool‑age child who reports abdominal pain. When conducting a head‑to‑toe assessment, which of the following findings should alert the nurse to possible abuse? (Select all that apply.) a. abrasions on knees b. round burn marks on forearms c. mismatched clothing d. abdominal rebound tenderness e. areas of ecchymosis on torso

BE

MAO inhibitors expected pharmacological action

Block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulses. An increased amount of those neurotransmitters at nerve endings intensifies responses and relieves depression

A nurse is caring for a client who has alcohol use disorder. the client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? a. chlordiazepoxide b. bupropion c. disulfiram d. carbamazepine

C

A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. the client tells the nurse that she is afraid she is going to gain weight. Which of the following response should the nurse make? A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."

C

A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? a. older adults require higher doses of a substance to achieve a desired effect. b. older adults commonly use rationalization to cope with a substance use disorder. c. older adults are at an increased risk for substance use following retirement. d. older adults develop substance use to mask manifestations of dementia

C

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? a. orient the client frequently to time, place, and person. b. offer fluids and nourishing diet as tolerated. c. implement seizure precautions. d. encourage participation in group therapy sessions.

C

A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? a. the client has a family history of seasonal pattern depression. b. the client currently smokes 1.5 packs of cigarettes per day. c. the client had a motor vehicle crash last year and sustained a head injury. d. the client has a BMi of 25 and has gained 10 lb over the last year.

C

A nurse is assisting the parents of a school‑age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (select all that apply.) A. allow the child to choose consequences for negative behavior. B. use role‑playing to act out unacceptable behavior. C. develop a reward system for acceptable behavior.d.encourage the child to participate in school sports. E. be consistent when addressing unacceptable behavior.

CDE

Separation anxiety disorder

Characterized by excessive anxiety when a child is separated from or anticipating separation from home or parents. Can develop into a school phobia or phobia of being left alone. Depression is also common

specific learning disorder

Client demonstrates persistent difficulty in acquiring reading, writing, or mathematical skills. Performance in one or more academic areas is significantly lower than the expected range for the client's age, level of intelligence, or educational level. Clients who have specific learning disorder benefit from an individualized education program (IEP)

Conduct disorder

Clients who have conduct disorder demonstrate a persistent pattern of behavior that violates the rights of others or rules and norms of society. Categories of conduct disorder include the following. -Aggression to people and animals -Destruction of property -Deceitfulness or theft -Serious violations of rules Childhood‑onset develops before the age of 10, with males being more prevalent. Adolescent‑onset occurs after the age of 10. The ratio of males‑to‑females is equal in the adolescent stage

A nurse in a pediatric clinic is caring for a preschool‑age child who has a new diagnosis of adHd. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD are present prior to age 3." B. "This disorder is characterized by argumentativeness." C. "Below‑average intellectual functioning is associated with adHd." D. "Because of this disorder, your child is at an increased risk for injury."

D

A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge‑eating and purging behavior. Which of the following nursing actions should the nurse include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high‑fat diet at the start of treatment. D. Implement one‑to‑one observation during meal times.

D

a charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching?a."Children older than 3 are at greater risk for abuse"B."Substance use disorder does not increase the risk for violence."C."entering an intimate relationship increases the risk for violence."d."Pregnancy increases the risk for violence toward the intimate partner."

D

MAO inhibitors therapeutic uses

Depression Bulimia nervosa First‑line treatment for atypical depression

tricyclic antidepressants therapeutic uses

Depressive disorders Neuropathic pain Fibromyalgia Anxiety disorders Insomnia Bipolar disorder

Disruptive mood dysregulation disorder

Exhibit recurrent temper outbursts that are severe and do not correlate with situation. Temper outbursts are manifested verbally and/or physically and can include aggression. Temper outbursts are not appropriate for the client's developmental level. Temper outbursts are present three or more times per week and are observable by others, such as parents, peers, and teachers, in at least two settings, such as home and school. Onset of this disorder is between the ages of 6 and 18.

economic maltreatment

Failure to provide for the needs of a vulnerable person when adequate funds are available Unpaid bills, resulting in disconnection of heat or electricity

depressive disorders - risk factors

Family history of depression Physical or sexual abuse or neglect Homelessness Disputes among parents, conflicts with peers or family, and rejection by peers or family Bullying, either as the aggressor or victim, including traditional bullying and cyberbullying behavior Engaging in high‑risk behaviors Learning disabilities Chronic illness

expected findings of depressive disorders

Feelings of sadness Loss of appetite Nonspecific complaints related to health Engaging in solitary play or work Changes in appetite, resulting in weight changes Changes in sleeping patterns Crying Loss of energy Irritability Aggression High‑risk behavior Poor school performance and/or dropping out of school Feelings of hopelessness about the future Suicidal ideation or suicide attempts

SSRI

Fluoxetine Citalopram Escitalopram Paroxetine Sertraline Vilazodone

risk factors for substance use and addictive disorders disorders

Genetics: predisposition to developing a substance use disorder due to family history Chronic stress: socioeconomic factors History of trauma: abuse, combat experience Lowered self‑esteem Lowered tolerance for pain and frustration Few meaningful personal relationships Few life successes Risk‑taking tendencies

intellectual developmental disorder

Has intellectual deficits with mental abilities such as reasoning, abstract thinking, academic learning, and learning from prior experiences. Clients demonstrate impaired ability to maintain personal independence and social responsibility, including activities of daily living, social participation, and the need for ongoing support at school. Deficits in the disorder range from mild to severe

Characteristic behaviors of ADHD

Inattention is evidenced by a difficulty in paying attention, listening, and focusing. Hyperactivity is evidenced by fidgeting, an inability to sit still, running and climbing inappropriately, difficulty with playing quietly, and talking excessively. Impulsivity is evidenced by difficulty waiting for turns, constantly interrupting others, and acting without the consideration of consequences Behaviors associated with ADHD must be present prior to age 12 and must be present in more than one setting to be diagnosed as ADHD. Behaviors associated with ADHD can receive negative attention from adults and peers

neglect

Includes the failure to provide the following: Physical care, such as feeding Emotional care, such as interacting with a child, or stimulation necessary for a child to develop normally Education, such as enrolling a young child in school Necessary health or dental care

SSRI therapeutic uses

Major depression Obsessive compulsive disorder Bulimia nervosa Premenstrual dysphoric disorders Panic disorders Posttraumatic stress disorder (PTSD) Bipolar disorder

Oppositional defiant disorder

Negativity Disobedience Hostility Defiant behaviors (especially toward authority figures) Stubbornness Argumentativeness Limit testing Unwillingness to compromise Refusal to accept responsibility for misbehavior can exhibit low self‑esteem, mood lability, and a low frustration threshold can develop into conduct disorder

Intermittent explosive disorder - clinical manifestations

Occurs in clients 18 years and older Includes verbal or physical aggression Characterized by aggressive overreaction to normal events followed by feelings of shame and regret Prevents the client's ability to have healthy relationships and/or employment. Can lead to the development of chronic disease, such as hypertension or diabetes mellitus

atypical antidepressants

buproprion - inhibits dopamine uptake

Posttraumatic stress disorder

PTSD is precipitated by experiencing, witnessing, or learning of a traumatic event. Children and adolescents who have PTSD exhibit psychological indications of anxiety, depression, phobia, or conversion reactions. If the anxiety resulting from PTSD is displayed externally, it is often manifested as irritability and aggression with family and friends, poor academic performance, somatic reports, belief that life will be short, and difficulty sleeping.

contributing factors to conduct disorder

Parental rejection and neglect Difficult infant temperament Inconsistent child‑rearing practices with harsh discipline Physical or sexual abuse Lack of supervision Early institutionalization Frequent changing of caregivers Large family size Association with delinquent peer groups Parent with a history of psychological illness

MAO inhibitors

Phenelzine Isocarboxazid Tranylcypromine Selegiline: transdermal patch

anorexia nervosa types

Restricting type - drastically restricts food intake and does not binge or purge Binge-eating/purging type - engages in binge eating or purging behaviors

anorexia nervosa

persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health

tricyclic antidepressants expected pharmacological action

These medications block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters

atypical antidepressants therapeutic uses

Treatment of depression Alternative to SSRIs for clients unable to tolerate the sexual dysfunction side effects Aid to quit smoking Prevention of seasonal pattern depression

binge eating disorder

recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa

Open-ended questions to ask for a nursing history of substance use and addiction disorders

Type of substance or addictive behavior Pattern and frequency of substance use Amount of substance used Age at onset of substance use Changes in occupational or school performance Changes in use patterns Periods of abstinence in history Previous withdrawal manifestations Date of last substance use or addictive behavior

comorbidities of eating disorders

depression, personality disorders, substance use disorder, anxiety

Intermittent explosive disorder

exhibit recurrent episodic violent and aggressive behavior with the possibility of hurting people, property, or animals

emotional violence

includes behavior that minimizes an individual's feelings of self‑worth or humiliates, threatens, or intimidates a family member

physical violence

occurs when physical pain or harm is directed toward the following. An infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants). An intimate partner, such as striking or strangling the partner. A vulnerable adult in the home, such as pushing an older adult parent and causing her to fall.

sexual violence

occurs when sexual contact takes place without consent, whether the vulnerable person is able or unable to give that consent

bulimia nervosa

recurrently eat large quantities of food over a short period of time, which can be followed by inappropriate compensatory behaviors, such as self-induced vomiting to rid the body of the excess calories

SSRI expected pharmacological action

selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin first line treatment for depression