MH Exam 2

The client has *one or more hypomanic episodes* alternating with major depressive episodes. Hypomania is a milder form of mania. Symptoms are excessive hyperactivity, but not severe enough to cause marked impairment in social or occupational functioning. J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 14

Bipolar II Disorder

ECT is good for which type of patients? J.A. prerecorded lecture ATI Ch 14

Depression/Suicidal patients - helps with anger and agitation - patients who aren't responding to medication - patients who need rapid response (catatonia, suicidal, homicidal) Manic patents - when lithium has not worked

In addition to disturbances in cognition and orientation, individuals with Alzheimer's disease may also show changes in which of the following? (Select all that apply.) a. Personality b. Vision c. Speech d. Hearing e. Mobility Ch 22 questions

a. Personality c. Speech e. Mobility

Typical nursing diagnoses for dementia J.A. prerecorded lecture

Impaired memory Self-care deficit

decreased ability to determine what is likely to be real and what is not; often contributes to hallucinations and delusions

Impaired reality testing

What are the pharmaceutical treatment options for Bipolar Disorder? J.A. prerecorded lecture

Mood Stabilizers (lithium) for the mania/depression Anticonvulsants for the mania (prevent relapses) Antipsychotics for the mania (promote sleep and decrease anxiety/agitation) Anxiolytics for the mania (decrease agitation) Antidepressants (SSRIs) for the depression

What is the criteria to diagnose Schizophrenia? Mod 5 Lesson Content

NEED AT LEAST 2 OF THE FOLLOWING, AND 1 OF THEM MUST BE ONE OF THE FIRST THREE: *1. Delusions* *2. Hallucinations* *3. Disorganized speech* 4. Grossly disorganized or catatonic behavior 5. Negative symptoms ( i.e., diminished emotional expression, lack of motivation and a sociality)

Rare but potentially fatal. Can be caused by typical or atypical antipsychotic. Side effects: muscle rigidity very high fever-hyperpyrexia tachycardia fluctuations in blood pressure diaphoresis stupor-coma Mod 5 Lesson Content

Neuroleptic Malignant Syndrome

What are some cues that someone may be contemplating suicide? J.A. prerecorded lecture

People being treated for M.D.D. start to feel better and finally have energy to maybe act on suicide. Patient has started giving away prized possessions. Patient cancelling social engagements. Patient making or changing a will. Patient have sleeping difficulties and poor appetite. Patient stating, "I'd just be better off dead." Sudden deterioration in work or school performance Feeling hopeless *Teach patients and family members to notice these cues.*

A milder form of depression that usually has an early onset (in childhood or adolescence) and lasts *at least 2 years* for adults (1 year for children). It contains *at least 3 clinical findings of depression* and can, later in life, become major depressive disorder (MDD). ex: depressed for 5/7 days a week for at least 2 years This may be a diagnosis made in children and adolescents: early onset -before age 21 late onset - 21 or older J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 13

Persistent Depressive Disorder (Dysthymia) *considered moderate depression*

Nursing Interventions: A patient states they want to stop their antipsychotics because they are feeling better (the voices are quieter, etc.) J.A. exam review

▪ Ask "have you stopped your medications before? ▪ Inform patients about the side effects of abrupt withdrawal ▪ The ONLY time we are stoping antipsychotics is if they develop NMS

s/s of Schizoaffective Disorder J.A. exam review

▪ both schizophrenia s/s and depressive or bipolar disorder s/s

What other meds besides lithium do we use for Bipolar? J.A. exam review

▪ carbamazepine (anticonvulsant) ▪ lamotrigine (anticonvulsant) ▪ valproic acid (anticonvulsant) what's the problem with prescribing those? worry about toxicity levels (? according to JA)

What does naltrexone do? J.A. exam review

▪ reduces cravings for alcohol ▪ helps prevent relapses into drug or alcohol use

s/s of Schizophreniform J.A. exam review

▪ s/s of schizophrenia but may not have social/occupational dysfunction

A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate." ATI Ch 14 Application Exercises

B. "I am here to provide care and cannot accept this from you."

A nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. Which of the following hallucinations is the priority for the nurse to address? A. Visual hallucination B. Gustatory hallucination C. Command hallucination D. Tactile hallucination Mod 5 post quiz

C. Command hallucination

Name this stage of Alzheimer's *Severe cognitive decline* - In the end stages, the individual is unable to recognize family members. He/she most commonly confined to bed and aphasic. - Problems of immobility, such as decubiti and contractures, may occur. Mod 4 Lesson Content Ch 22

Stage VII

Inability or the refusal to speak (positive symptom)

mutism

Alterations in Behavior: doing the opposite of what is requested

negativism

Which patients are at risk for developing tardive dyskinesis? J.A. exam review

patients on LONG-TERM first generation antipsychotics

A depressive disorder associated with the luteal phase (*week prior to menses*) of the menstrual cycle. Emotional manifestations include mood swings, irritability, depression, anxiety, feeling overwhelmed and difficulty concentrating. Physical manifestations include lack of energy, overeating, hyper-or insomnia, breast tenderness, aching, bloating, and weight gain. Treatment includes exercise, diet, and relaxation therapy. J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 13

premenstrual dysphoric disorder

*Name this phase of Schizophrenia:* Signs occur prior to clear evidence of an illness: - shy & withdrawn - poor peer relationships - doing poorly in school - passive - introverted *client experiences negative symptoms* Mod 5 Lesson Content

premorbid phase

rapid, frenzied, or loud, disjointed communication

pressured speech

*Name this phase of Schizophrenia:* Period between premorbid phase and the onset of psychosis (average length 2-5 years) Signs of cognitive impairment - deterioration in functioning *client experiences negative symptoms* Mod 5 Lesson Content ATI Ch 15

prodromal phase

*Name this phase of Schizophrenia:* - Psychotic symptoms are prominent *client experiences negative and positive symptoms* Mod 5 Lesson Content

psychotic phase

*Name this phase of Schizophrenia:* Usually follows the active phase of the illness, symptoms of active phase no longer prominent - flat affect - impairment in functioning *client can experience both negative and positive symptoms* Mod 5 Lesson Content

residual phase

persistent thinking and discussions of a particular subject J.A. prerecorded lecture

rumination

The symptoms meet the criteria for schizophrenia and the individual also has an uninterrupted period during which there is a major depressive, manic or mixed episode of behavior. Mod 5 Lesson Content

schizoaffective disorder

This disorder has features that are the same as Schizophrenia, but last *less than 6 months.* Mod 5 Lesson Content

schizophreniform disorder

A form of depression that occurs seasonally, usually during the winter, when there is less daylight. Light therapy is the first-lie treatment. Light therapy inhibits nocturnal secretion of melatonin. J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 13

seasonal affective disorder (SAD)

What triggers Schizophrenia? Mod 5 Lesson Content Ch 15

significant stressors like developmental (going off to college) or family stress

What are the functions of group therapy? J.A. exam review

socialization support task completion camaraderie information sharing normative influence empowerment governance

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD. J.A. exam review

sublimation (defense mechanism) *rechanneled into something healthy*

Alterations in Behavior: maintenance of posture or position over time even when it is awkward or uncomfortable

waxy flexibility

loss of pleasure and lack of interest in activities, hobbies, and sexual activity ATI Ch 14

Anhedonia

Who is at risk for suicide? J.A. prerecorded lecture ATI Ch 13

Anyone who has a history of attempt. Anyone with a family history of suicide Adolescents and older adults (>65), including terminally ill and disabled clients. Anyone who has been bullied or rejected by peers in society. Anyone who has had child maltreatment. Past psychiatric hospitalizations Substance abuser Depressed or psychotic clients

loss of language ability Ch 17

Aphasia

the inability to carry out purposeful motor activities despite intact motor function and the inability to use objects properly, may develop. Ch 17

Apraxia

unconscious *inability to concentrate on a single thought.* Can progress to flight of ideas in which the client's speech moves so rapidly from one thought to another that it is incoherent. Ideas that do not connect to each other and are expressed in garbled and illogical speech. ATI Ch 15

Associative looseness (loose association)

What is the first choice medication for Schizophrenia? J.A. prerecorded lecture vs ATI

Atypical/Second-generation antipsychotic medications *they control both positive and negative symptoms and have fewer adverse effects*

What is the most important question to ask a patient who is alcohol intoxicated? J.A. exam review

"When was your last drink?" and why do we ask this? to anticipate when they'll go through withdrawals (6 to 8 hours after last drink)

Side effects of traditional/first-generation antipsychotic medications Mod 5 Lesson Content

*Anticholinergic effects* - dry mouth - blurred vision/photosensitivity - constipation - urinary retention *Orthostatic hypotension* *Sedation* *Fatigue* *Gynecomastia (men)* *Amenorrhea (women)* *EPS symptoms* Pseudoparkinsonism Akinesia- muscular weakness Akathisia- restlessness or the urgent need for movement Dystonia- involuntary movements of the face, arms, legs and neck Oculogyric crisis- involuntary deviation and fixation of the eyeballs, usually upward

Nursing interventions for major depressive disorder (MDD) J.A. prerecorded lecture ATI Ch 13

*Nutrition* - monitor nutrition intake (I&O) - stay with them during meals and assess what they are eating and promote their eating - give Boost or Ensure, mac and cheese, eggs, soups, etc. since they don't take much energy to eat *ADLs and Self Care* - hygiene takes a significant amount of energy for them; take it slow - getting dressed takes a significant amount of energy for them; they don't care if their outfit matches, etc. They are just tired and don't care. - encourage self-care and ADLs. *Activities* - they need 1:1 activity. They don't do well in groups. - 1:1 activity should be short, so they have time to process and regroup. - gross motor activities like walking is good. - activities need to be ones they can achieve success in (don't use huge puzzles). *Self-Harm/Suicide Risk* - if there's a risk you must make sure they are safe at all costs! That is priority over anything else. - if they are expressing anger make sure it is in a therapeutic way and they aren't going to harm themselves - implement appropriate safety precautions *Communication* - make time to be with the client, even if they do not speak - make observations rather than asking direct questions. - give directions in simple, concrete sentences - give the client sufficient time to respond - do not push decision making, they can't do it. You'll only make them feel worthless. - encourage patient to express their feelings - encourage independence as much as possible - hang out with client so they feel their worth; reminisce on what made them happy.

What do we need to monitor when a patient is on clozapine (Clozaril)? Note this is a SGA. J.A. prerecorded lecture

*agranulocytosis* - CBC drawn every week to check WBC count - infection control measures (wash hands!)

Which type of antipsychotic drug class causes you to gain weight? ATI Ch 13

*second generation antipsychotics*, they have that metabolic syndrome which causes hyperlipidemia and loss of glucose control so you gain weight

List the negative symptoms of Schizophrenia *absence of things that are normally present* Mod 5 Lesson Content ATI Ch 15

- Affect - blunted or flat - Alogia - poverty of thought or speech (*mumbling*) - Anergia - lack of energy - Anhedonia - lack of pleasure or joy - Avolition - lack of motivations in activities and hygiene - Withdrawn (Asociality) - Expresses feelings of rejection/loneliness - Talks about self as bad/no good

List the positive symptoms of Schizophrenia *manifestation of things that are normally not present* Mod 5 Lesson Content ATI Ch 15

- Auditory hallucinations - Visual hallucinations - Command hallucinations - Delusions - Associative looseness - Disorganized speech - Bizarre behavior

Nursing Interventions for mania: therapeutic milieu J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 14

- Low level stimulus - Provide structured/solitary activities (assist as needed) - Provide high calorie fluids - Provide outlets for physical activity - Encourage rest periods - Redirect aggressive behavior - Store valuables until rational judgement returns - Use least restrictive measures to ensure safety - Encourage adequate diet - Finger foods may be necessary - Check for medications (make sure they didn't pocket any)

Patient education for lithium toxicity J.A. prerecorded lecture ATI Ch 23

- Teach patients about s/s of toxicity and they need to call their provider and get a blood level drawn. - Teach patients to stay hydrated and have a normal sodium diet. - Avoid NSAIDs

What are the advantages to taking second-generation antipsychotics? Mod 5 Lesson Content

- Treat both positive and negative symptoms - Decrease in affective symptoms (depression and anxiety) - Fewer or no EPS (less dopamine blockage) - Fewer anticholinergic side effects- (Except for clozapine) - Less relapse - Tolerated well

Nursing Interventions for mania: communication J.A. prerecorded lecture Mod 6 Lesson Content

- Use a firm and calm approach - Use short and concise explanations - Be consistent in approach and expectations and limit-setting - Identify expectations in simple and concrete terms with consequences - Avoid power struggles - Hear and act on legitimate complaints - Redirect energy into more appropriate behavior/actions

Treatment for NMS Mod 5 Lesson Content

- discontinue Rx - monitor vitals - antipyretics - fluids - transfer to Critical Care unit for cardiac monitoring - dantrolene (Dantrium) and bromocriptine (Parlodel)

Nursing Interventions for Opioid Withdrawal J.A. prerecorded lecture Mod 4 Lesson Content

- hydration - ventilator - Methadone (for withdrawal)/Narcan (for overdose)

Symptoms of severe lithium toxicity (> 2.5 mEq/L) J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 23

- impaired consciousness - nystagmus - seizures - coma - oliguria/anuria - arrhythmias - myocardial infarction *coma and death*

How do we treat Alzheimer's? J.A. prerecorded lecture

- medication to slow progression...does not CURE or STOP progression

Symptoms of mild lithium toxicity (1.5-2.0 mEq/L) J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 23

- mental confusion - sedations - coarse tremors - barred vision - ataxia (poor coordination) - tinnitus GI distress: - nausea and vomiting - severe diarrhea

What factors precipitate a mania relapse? ATI Ch 14

- sleep disturbance - alcohol - caffeine

What can trigger a mania relapse? ATI Ch 14

- use of substances (alcohol, cocaine, caffeine) - sleep disturbances - psychological stressors

Lithium normal range Mod 6 Lesson Content ATI Ch 23

0.6-1.2 mEg/L

A decrease in speech or speech content; Also known as poverty of speech.

Alogia

most common form of dementia Ch 22

Alzheimer's Disease

An inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. Ch 17

Amnesia

A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (SATA) A. "When did you start hearing the voices?" B. "The voices arrant real, or else we would both hear them." C. "It must be scary to hear voices" D. "Are the voices telling you to hurt yourself?" E. "Why are the voices talking only to you?" ATI Ch 15 Application Exercises

A. "When did you start hearing the voices?" C. "It must be scary to hear voices" D. "Are the voices telling you to hurt yourself?"

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.

A. Administer the next dose of lithium carbonate as scheduled.

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (SATA) A. Auditory hallucination B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect ATI Ch 15 Application Exercises

A. Auditory hallucination C. Use of clang associations D. Delusion of persecution E. Constantly waving arms

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following should the charge nurse identify as being effectively treated by conventional antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia ATI Ch 24 Application Exercises

A. Auditory hallucinations C. Delusions of grandeur D. Severe agitation

abnormal lack of energy, passivity

Anergia

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects ATI Ch 13 Application Exercises

A. Placing the client on one-to-one observation

The ______ measures involuntary movements associated with tardive dyskinesia. Mod 5 Lesson Content

Abnormal Involuntary Movement Scale (AIMS)

Schizophrenia, Depression, and Mania go through 3 phases: acute, continuation, and maintenance. What is the goal of each phase? ATI Ch 14

Acute - this is when things are BAD. Hospitalization, etc. The goal is treatment and safety. Continuation - You're in remission from those manifestations in the Acute phase. The goal is to prevent relapse of those things that happened in the acute phase. Education and therapy happen here for a few weeks or months. Maintenance - The goal is prevent future episodes (psychotic, manic, depressive) and increase the ability to function. Treatment with drugs or therapy occurs for the rest of life

A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low." ATI Ch 23 Application Exercises

B. "Regular aspirin would be a better choice than ibuprofen."

A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior. ATI Ch 15 Application Exercises

B. Ask the client, "Are you seeing something on the ceiling?"

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (SATA) A. Use caffeine in moderation to prevent relapse B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins D. Participating in psychotherapy can help prevent a relapse E. Anhedonia is a clinical manifestation of a depressive relapse. ATI Ch 14 Application Exercises

B. Difficulty sleeping can indicate a relapse. D. Participating in psychotherapy can help prevent a relapse E. Anhedonia is a clinical manifestation of a depressive relapse. avoid all caffeine!

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing ATI Ch 24 Application Exercises

B. Drooling C. Involuntary arm movements E. Continual pacing

A nurse it caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression (SATA): A. Male sex B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. Personal history of panic disorder ATI Ch 13 Application Exercises

B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. Personal history of panic disorder

A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are telling her to "kill your doctor." Which of the following actions should the nurse take first? A. Use therapeutic communication to discuss the hallucination with the client. B. Initiate one-to-one observation of the client C. Focus the client on reality D. Notify the provider of the client's statement. ATI Ch 15 Application Exercises

B. Initiate one-to-one observation of the client

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (SATA) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client concerns E. Use a firm approach with communication. ATI Ch 14 Application Exercises

B. Offer concise explanations C. Establish consistent limits E. Use a firm approach with communication.

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching (SATA)? A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus ATI Ch 23 Application Exercises

B. Polyuria D. Muscle weakness

A nurse is teaching a community education course about the physical complications related to substance use disorder. Which of the following findings should the nurse include in the discussion as a health risk of heroin use? A. Acute pancreatitis B. Slowed breathing C. Nasal septum perforation D. Permanent short-term memory loss Mod 4 post quiz

B. Slowed breathing

Most severe form of bipolar disorder. The client has *at least one episode of mania* alternating with major depressive episodes. J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 14

Bipolar I Disorder

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are most effective during the acute phase of MDD." ATI Ch 13 Application Exercises

C. "The client is at greatest risk for suicide during the first weeks of an MDD episode."

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder." ATI Ch 14 Application Exercises

C. "ECT is effective for clients who are experiencing severe mania."

A nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I should avoid exercising when I am feeling depressed." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active." ATI Ch 13 Application Exercises

C. "I am aware that my PMDD causes me to have rapid mood swings."

A nurse is caring for a client who has a history of alcohol use disorder and has been hospitalized for detoxification. The nurse enters the room and finds the client shouting in a terrified voice, "Get these bugs off of me!" Which of the following responses by the nurse is appropriate? A. "I'm sure that the bugs you see will not harm you." B. "Tell me more about the bugs that you see in your room." C. "I don't see any bugs, but you seem very frightened." D. "I do not see anything. This is part of the withdrawal process." Mod 4 post quiz

C. "I don't see any bugs, but you seem very frightened."

A nurse caring for a client who has depression observes the client comes to breakfast freshly bathed, wearing clean clothes, and with combed and styled hair. Which of the following responses by the nurse is therapeutic? A. "Everyone feels better after showering." B. "You must be getting better. You look great!" C. "I see you have done some grooming today." D. "Why are you all dressed up today? Is it a special occasion?" Mod 6 post quiz

C. "I see you have done some grooming today."

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following is the priority nursing intervention? 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. Implement seizure precautions.

A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A. Wide fluctuations in mood B. Report of a minimum of five clinical findings of depression C. Presence of manifestations for at least 2 years D. Inflated sense of self-esteem ATI Ch 13 Application Exercises

C. Presence of manifestations for at least 2 years

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? A. Chlorpromazine (Thorazine) B. Thiothixene (Navane) C. Risperidone (Risperdal) D. Haloperidol (Haldol) ATI Ch 24 Application Exercises

C. Risperidone (Risperdal) this is the prototype drug for SGAs. SGAs treat both positive and negative symptoms.

Nursing Assessment for mania J.A. prerecorded lecture

Check their speech, their behavior, their mood. Assess them for alcohol and drug use. Assess for delusions of grandeur and cognitive function with impulse control (might run out to street and get hit by a car) *focus is on safety and maintaining physical health, especially in the acute phase*

What drug do we use to control the negative side effects and EPS effects of FGAs? J.A. prerecorded lecture

Cogentin (benztropine) it's in the anticholinergic drug class this is given in conjunction with 1st generation anti-psychotics

Name the criteria to be diagnosed with major depressive disorder (MDD) J.A. prerecorded lecture ATI Ch 13

Criteria for diagnosis, need to have at least 5 of them and must occur almost every day for a minimum of 2 weeks and last most of the day: 1. Depressed/irritable mood (subjectively or objectively reported) 2. Difficulty sleeping or excessive sleeping (fatigue or loss of energy) 3. Indecisiveness 4. Decreased ability to concentrate 5. Suicidal ideation 6. Increase or decrease in motor activity (change in activity level) 7. Inability to feel pleasure or interest in activities. 8. Increase or decrease in weight of more than 5% of total body weight over 1 month or change in appetite

A nurse who works in a psychiatric unit is caring for a client who has bipolar disorder. The client comes to the nurse's station at 0300 demanding that the nurse call the provider immediately. Which of the following responses by the nurse is appropriate? A. "You are being unreasonable, and I will not call your doctor at this hour." B. "Go back to your room, and I'll try to get in touch with your doctor." C. "I can't call a doctor in the middle of the night unless it's an emergency." D. "You must be very upset about something." Mod 6 post quiz

D. "You must be very upset about something."

A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior. ATI Ch 14 Application Exercises

D. Monitor the client for escalating behavior. Monitoring for escalating behavior addresses the client's priority need for *safety*

What does diazepam do?

Diazepam is prescribed to treat the symptoms and *prevent complications of alcohol withdrawal.*

What does disulfiram do?

Disulfiram is prescribed to *deter alcohol consumption* rather than for the treatment of alcohol withdrawal drowsiness, headache, *metallic aftertaste*

What are some foods to avoid when taking MAOIs? J.A. prerecorded lecture Mod 6 Lesson Content

Figs Avocados Bananas Meats that are fermented or aged Smoked fish Cheese Foods with yeast Imported beers Chianti wine Chocolate Fava beans Caffeinated beverages

- Attempting to make excuses or formulate logical reasons to justifying unacceptable feelings or behaviors. *We see this in substance abuse disorders* EX: John tells the rehab nurse, "I drink because its the only way I can deal with my bad marriage and awful job." J.A. exam review

Rationalization (defense mechanism)

Symptoms of moderate lithium toxicity (2.0-2.5 mEq/L) J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 23

Same side effects of mild: - mental confusion - tremors - blurred vision - ataxia (poor coordination) - tinnitus Plus: - polyuria of dilute urine - giddiness - muscular irritability/jerking movements - seizures - severe hypotension - psycho motor retardation

A group of mental health problems that is characterized by psychotic features such as hallucinations and delusions, disordered thought processes and disrupted interpersonal relationships. J.A. prerecorded lecture

Schizophrenia

Name the 5 components of SMART goals J.A. exam review

Specific Measurable Attainable Realistic Timely

Name this stage of Alzheimer's *No apparent symptoms* - There is no apparent decline in memory despite changes that are beginning to occur in the brain. A positron emission tomography (PET) scan can be used to detect these changes. Mod 4 Lesson Content Ch 22

Stage I

How do lithium levels become toxic? J.A. prerecorded lecture ATI Ch 23

Taking more than the prescribed dose Anything that causes decreased sodium: - Sweating profusely - Fever - Diuresis Low sodium diet

The most common side effects of ECT Ch 19

The most common side effects of ECT are temporary memory loss and confusion.

The physician orders lithium carbonate 600 mg tid for a newly diagnosed patient with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. The therapeutic range for acute mania is: a. 0.5 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L Ch 26 questions

a. 0.5 to 1.5 mEq/L

A client on the psychiatric unit tells the nurse that the CIA is looking for him and will kill him if they find him. The client's false belief is an example of a: a. Delusion of persecution. b. Delusion of reference. c. Delusion of control or influence. d. Delusion of grandeur. Ch 24 Questions

a. Delusion of persecution.

The nurse is providing medication education to a client on lithium. Which of the following are important points to include? (Select all that apply.) a. Significant reductions in sodium intake increase the risk for lithium toxicity. b. Weight loss is a common side effect of lithium. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well. Ch 26 questions

a. Significant reductions in sodium intake increase the risk for lithium toxicity. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well.

A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select all that apply) a. Slumped posture b. Hallucinations c. Feelings of despair d. Appears to have boundless energy e. Anorexia Ch 25 questions

a. Slumped posture c. Feelings of despair e. Anorexia

A client is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself. Which of the following interventions are identified as those that will promote positive self-esteem in the client? (Select all that apply) a. Teach assertive communication skills. b. Make observations to the client when she completes a goal or task. c. Instruct the client that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend time with the client using a nonjudgmental, accepting approach. Ch 25 questions

a. Teach assertive communication skills. b. Make observations to the client when she completes a goal or task. d. Offer to spend time with the client using a nonjudgmental, accepting approach.

A client with schizophrenia has physician's orders for haloperidol (Haldol) 5 mg IM STAT and then 3 mg PO tid; 2 mg benztropine PO bid prn. Why is benztropine ordered? a. To treat extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep Ch 24 Questions

a. To treat extrapyramidal symptoms

decreased engagement in purposeful, goal-directed actions

avolition

An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?" Ch 25 questions

b. "Come with me. I will go with you to group therapy."

A client who has been taking sertraline (Zoloft) 50 mg PO bid for depression tells the nurse, "I've been on this medication for almost a week and I don't feel a bit better." What is the most appropriate response by the nurse? a. "Cheer up. You have so much to be happy about." b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. "I'll report that to the physician. Maybe he will order something different." d. "Try not to dwell on your symptoms. Why don't you join the others down in the dayroom?" Ch 25 questions

b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms."

A client who is experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by a family member. The client yells, "My family is trying to make it look like I'm insane! They just want to take all my money." This behavior is an example of: a. A delusion of grandeur b. A delusion of persecution c. A delusion of reference d. A delusion of control or influence Ch 26 questions

b. A delusion of persecution

A client has been diagnosed with schizophrenia. He has been socially isolated and is hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to: a. Give him an injection of haloperidol. b. Assess his safety toward himself and others. c. Place him in restraints. d. Order him a nutritious diet. Ch 24 Questions

b. Assess his safety toward himself and others.

Which of the following is the primary goal in working with an actively psychotic, suspicious client? a. Promote interaction with others. b. Decrease his anxiety and increase trust. c. Improve his relationship with his parents. d. Encourage participation in therapy activities. Ch 24 Questions

b. Decrease his anxiety and increase trust.

A client reports to the nurse that his foot is on fire and he thinks the demons are trying to burn off his flesh. The priority nursing intervention for this symptom is to: a. Administer prn haloperidol as ordered. b. Evaluate the client's foot to rule out physical causes for his complaint. c. Administer prn benztropine as ordered. d. Ask the client if he would like to speak with a chaplain. Ch 24 Questions

b. Evaluate the client's foot to rule out physical causes for his complaint.

A client admitted to the inpatient psychiatric unit with bipolar disorder tells the nurse, "I need to sit in on change-of-shift report because I have been appointed director of this unit." Which action by the nurse demonstrates the best clinical judgment at this point? a. Invite the client to sit in on the change-of-shift report, but do not share any confidential client information. b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available. c. Tell the client that she is delusional but that these symptoms will go away with medication. d. Place the client in seclusion for protection of self and others. Ch 26 questions

b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available

A client is brought to the emergency department by a family member who reports that the client stopped taking mood stabilizer medication a few months ago and is now agitated, pacing, demanding, and speaking very loudly. Her family member reports that she eats very little, is losing weight, and almost never sleeps. What is the priority nursing diagnosis? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression Ch 26 questions

b. Risk for injury related to hyperactivity

A nurse is educating a patient about his lithium therapy and explaining the signs and symptoms of lithium toxicity. Which of the following would she instruct the patient to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia Ch 26 questions

b. Tinnitus, severe diarrhea, ataxia

Sudden onset of at least one of the following: delusions, hallucinations, disorganized speech or catatonic behavior. The symptoms must last more than 1 day and less than 1 month. Mod 5 Lesson Content

brief psychotic disorder

A client whose husband died 6 months ago is given a diagnosis of major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b. "I can understand how you must feel." c. "Those feelings are a normal part of the grief response." d. "Just think about the good times that you had while he was alive." Ch 25 questions

c. "Those feelings are a normal part of the grief response."

A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. Delusions of reference b. Loose association c. Anosognosia d. Auditory hallucinations Ch 24 Questions

c. Anosognosia

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. Which of the following is the most appropriate follow-up assessment based on this information? a. Ask the patient if he is experiencing loose associations. b. Ask the patient if he needs more medication. c. Ask the patient if he is hearing something or someone other than the nurse's voice. d. Ask the patient if his neck is stiff. Ch 24 Questions

c. Ask the patient if he is hearing something or someone other than the nurse's voice.

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the client's pent-up tension. b. Administer a dose of prn haloperidol to keep the patient calm. c. Call for adequate help to control the situation safely. d. Convey to the client that his behavior is unacceptable and will not be permitted. Ch 24 Questions

c. Call for adequate help to control the situation safely.

One way to promote adequate nutritional intake for a client in an acute manic episode who is not eating is to: a. Sit with the client during meals to reinforce the importance of eating everything on the tray. b. Have family members bring food from home so the client will have only favorite foods. c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run." d. Restrict the client to their room until they begin to gain weight. Ch 26 questions

c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run."

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain in her room. Ch 26 questions

c. Quietly walk with her back to her room and help her change into something more appropriate.

rhyming words

clang speech

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) *teach a patient to control their negative thoughts in order to promote a different behavior* J.A. exam review

cognitive behavioral therapy *how people think significantly influences their feelings and behavior.*

Which signs/symptoms are a safety/violence risk in Schizophrenia patients?

command hallucinations paranoid delusions

In this form of bipolar disorder, the client will have symptoms of *hypomania* alternating with symptoms of *mild to moderate depression.* This individual tends to have irritable hypomanic episodes. Some experience *rapid cycling* and may have at least 4 episodes in a 12-month period. J.A. prerecorded lecture Mod 6 Lesson Content ATI Ch 14

cyclothymic disorder

A client on the psychiatric unit has been diagnosed with schizophrenia. He tells the nurse that the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That's ridiculous. No one is going to hurt you." b. "The CIA isn't interested in people like you." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, but it's really hard for me to believe." Ch 24 Questions

d. "I know you believe that, but it's really hard for me to believe."

Which of the following assessments by the nurse would convey a need for prn benztropine? a. Increased level of agitation b. Complaints of a sore throat c. A yellowish cast to the skin d. Muscle spasms Ch 24 Questions

d. Muscle spasms

The primary focus of family therapy for clients with schizophrenia and their families is: a. To discuss problem-solving and adaptive behaviors for coping with stress. b. To introduce the family to others with the same problem. c. To keep the client and family in touch with the health-care system. d. To promote family interaction and increase understanding of the illness. Ch 24 Questions

d. To promote family interaction and increase understanding of the illness.

*Delusion(s) have lasted 1 month or longer.* The general theme includes grandiose, persecutory, somatic and/or referential delusions. They are usually not severe enough to impair occupational or daily functioning. Mod 5 Lesson Content

delusional disorder

Personal Boundary Difficulties: nonspecific feeling that a person has lost her identity; self is different or unreal.

depersonalization

Personal Boundary Difficulties: perception that the environment has changed, such as the client believing that objects in their environment are shrinking

derealization

patients may feel better at a certain periods of time in the day. Ex: feeling well first thing in the morning and gets worse as the day goes on. Or vice versa. J.A. prerecorded lecture

diurnal variation

the theory there is an excess of the neurotransmitter, dopamine and too many dopamine receptors throughout the brain. It has now been determined that there is excess dopamine in the limbic system of the brain, but a decrease of dopamine in the prefrontal cortex. Mod 5 Lesson Content

dopamine theory of schizophrenia

Alterations in Behavior: purposeful imitation of movements made by others

echopraxia

symptom of mania that involves an abrupt switching in conversation from one topic to another

flight of ideas

A form of psychosocial treatment in which several clients meet together with a therapist for purposes of sharing, gaining personal insight, and improving interpersonal coping strategies. J.A. exam review

group therapy

How long does a hypomanic episode last vs a manic episode? ATI Ch 14

hypomanic - at least 4 days manic - at least 1 week

A nurse is caring for an adolescent who is experiencing indications of depression. Which of the following findings should the nurse expect? (Select all that apply.) A. Irritability B. Euphoria C. Insomnia D. Low self-esteem F. Chronic pain Mod 6 post quiz

A. Irritability C. Insomnia D. Low self-esteem F. Chronic pain

A nurse is caring for a client who is withdrawing from opioids. Which of the following medications should the nurse prepare to administer? A. Methadone B. Disulfiram C. Risperidone D. Lithium carbonate Mod 4 post quiz

A. Methadone

A nurse is teaching a newly-admitted client about the possible physical effects of alcohol withdrawal. Which of the following manifestations should the nurse include in the teaching? (Select all that apply.) A. Seizures B. Illusions C. Tremors D. Polyphagia E. Nystagmus Mod 5 post quiz

A. Seizures B. Illusions C. Tremors

Nursing interventions for a patient that continues to believe a delusion and obsesses over it J.A. prerecorded lecture

- set firm limits and firm directions ex: "We are going to talk about what it's like to be Queen for the next 15 minutes and then I don't want to hear about the queen of England for the rest of the day."

Nursing Interventions for Stimulant Withdrawal J.A. prerecorded lecture Mod 4 Lesson Content

- treated with antidepressants - suicide prevention - medical detox program

Nursing Interventions for Alcohol Withdrawal Mod 4 Lesson Content Ch 23

*Benzodiazepines* Keep environment quiet (decrease stimulus) If necessary, one to one observation (family and/or staff) Fall precautions Seizure precautions Suicidal precautions Frequently orient to reality and surroundings Monitor vital signs Follow the medication regime

What's our top nursing intervention for Alzheimer's patients? J.A. prerecorded lecture ATI Ch 17 Mod 4 Lesson Content

- Maintaining function that they have as long as we can. - Continually orient them, use large pictures and symbols, provide emotional support - Promoting client dignity: Don't feed them or wash their face if they can do it. Let them do it. - Keep the environment as safe as possible to prevent injury. - Assist the client with ambulation and ADL's. - Remain calm and undemanding and avoid pressing the client when he/she is refusing. - Dance and movement therapy has been shown to reduce anxiety and aggressiveness. - Music of the client's past has also been shown to be calming to the client. *low stimulation environment*

How do we assess for Alzheimer's? J.A. prerecorded lecture

- Mini mental status exam - plaques and tangles seen on MRI

Nursing interventions for delusions J.A. prerecorded lecture

- ask patient to describe the delusion (*paranoid delusions can result in violence/safety issue*) - focus conversation on reality - do not ever argue and try to convince people that it's wrong; try to reorient to reality and pull them back in. - validate if some of that delusion is real...Anything that the client talks about that's real - respond in reality "Look over there there's a person doing this." That person IS there but they are not doing what they think. ex: let them touch the stethoscope to show them it's not a snake

Nursing interventions for hallucinations J.A. prerecorded lecture Mod 5 Lesson Content

- ask them about the hallucinations Questions to include: What do you hear? Are you hearing a voice that is telling you to do something? Do you believe what you hear is real? - avoid reacting to the hallucination as if it's real - make it very clear you understand it's real for them, "You are seeing a spider on the wall. But I don't see it." "Present reality" and recognize the feelings observed. Example: "I understand you are frightened, but there is no one here to harm you."

Nursing interventions for significant active hallucinations J.A. prerecorded lecture

- need 1:1 observation - do not touch them - encourage them to express their feelings - do not judge or joke - make sure you attempt to engage their attention in concrete activities (get them to color or draw...anything to get them distracted and to focus on something else).

A nurse is performing a mental status examination (MSE) on a client who has a new diagnosis of dementia. Which of the following components should the nurse include? (Select all that apply.) A. Grooming B. Long-term memory C. Support systems D. Affect E. Presence of pain Mod 4 post quiz

A. Grooming B. Long-term memory D. Affect

When do alcohol withdrawal symptoms begin? ATI Ch 18

6-8 hrs after last drink. alcohol withdrawal delirium can occur 2-3 days after cessation of alcohol

A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? (Select All That Apply) A. Install childproof door locks. B. Place rugs over electrical cords. C. Mark cleaning supplies with colored tape. D. place the client's mattress on the floor. E. Install light fixtures above stairs. ATI Ch 17 Application Exercises

A. Install childproof door locks. D. place the client's mattress on the floor. E. Install light fixtures above stairs.

A nurse is caring for a client who is depressed and refuses to participate in group therapy or perform activities of daily living. Which of the following statements should the nurse make to the client? A. "I will assist you in getting out of bed and getting dressed." B. "You can remain in bed until you feel well enough to join the group." C. "The unit rules state that you may not remain in bed." D. "If you don't participate in your care, you will not get better." Mod 6 post quiz

A. "I will assist you in getting out of bed and getting dressed."

A nurse is caring for a client who has major depressive disorder and is scheduled for electroconvulsive therapy (ECT). The client's spouse asks the nurse about the possible side effects of the ECT. Which of the following responses should the nurse make? A. "The main side effects are temporary, and may include mild confusion, a headache, and short-term memory loss." B. "Most clients have no adverse effects to this treatment, but muscle cramping may result from the induced seizure." C. "Some clients have been known to have a myocardial infarction, but we will monitor your spouse closely to be certain this does not happen." D. "The most common side effects are directly related to the use of anesthesia." Mod 4 post quiz

A. "The main side effects are temporary, and may include mild confusion, a headache, and short-term memory loss."

A nurse is caring for a client who has major depressive disorder and is scheduled for electroconvulsive therapy (ECT). The client's spouse asks the nurse about the possible side effects of the ECT. Which of the following responses should the nurse make? A. "The main side effects are temporary, and may include mild confusion, a headache, and short-term memory loss." B. "Most clients have no adverse effects to this treatment, but muscle cramping may result from the induced seizure." C. "Some clients have been known to have a myocardial infarction, but we will monitor your spouse closely to be certain this does not happen." D. "The most common side effects are directly related to the use of anesthesia." Mod 5 post quiz

A. "The main side effects are temporary, and may include mild confusion, a headache, and short-term memory loss."

A nurse is caring for an adolescent client who has a new diagnosis of schizophrenia. The client's parents are tearful and express feelings of guilt. Which of the following statements should the nurse make? A. "You said that you feel guilty about your daughter's diagnosis. Let's talk about what is causing you to feel this way." B. "You should not feel guilty about your daughter's diagnosis. Schizophrenia is unpreventable." C. "I'm sure your daughter's diagnosis is very difficult to deal with, but everything will be all right once she receives the proper treatment." D. "Your provider has explained the causes of schizophrenia. Why do you feel guilty about your daughter's diagnosis?" Mod 5 post quiz

A. "You said that you feel guilty about your daughter's diagnosis. Let's talk about what is causing you to feel this way."

A nurse is admitting a client who is in the manic phase of bipolar disorder. The nurse should plan to make which of the following room assignments for the client? A. A private room in a quiet location on the unit B. A semi-private room with a roommate who has a similar diagnosis C. A private room close to the nursing station D. A seclusion room until the client's activity level becomes more subdued. Mod 6 post quiz

A. A private room in a quiet location on the unit

A nurse is performing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse identify as a negative symptom? A. Affective flattening B. Bizarre behavior C. Illogicality D. Somatic delusions Mod 5 post quiz

A. Affective flattening

A nurse is caring for a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects? A. Dysrhythmias B. Cataracts C. Pancreatitis D. Bleeding Mod 5 post quiz

A. Dysrhythmias

A nurse is caring for a client who has been hospitalized for treatment of bipolar disorder and will be discharged with a prescription for lithium. The nurse's discharge teaching should include information cautioning against which of the following factors that may cause lithium toxicity? A. Experiencing diarrhea B. Exercising moderately C. Increasing sodium intake D. Drinking green tea Mod 6 post quiz

A. Experiencing diarrhea

A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse should teach the client that which of the following factors puts her at risk for lithium toxicity? A. The client runs 4 miles outdoors every afternoon. B. The client drinks 2 liters of liquids daily. C. The client eats 2 to 3 gm of sodium-containing foods daily. D. The client eats foods high in tyramine Mod 6 post quiz

A. The client runs 4 miles outdoors every afternoon.

A nurse is assessing a client who is experiencing acute cocaine toxicity. Which of the following findings should the nurse expect? A. Tremors B. Hypothermia C. Hypotension D. Respiratory depression Mod 4 post quiz

A. Tremors

the inability to recognize familiar objects. ATI Ch 17

Agnosia

The diminished ability and eventual inability to read or write. Mod 4 Lesson Content

Agraphia

A nurse is caring for a client who has schizophrenia and tells the nurse, "They lie about me all the time and they are trying to poison my food." Which of the following statements should the nurse make? A. "You are mistaken. Nobody is lying about you or trying to poison you." B. "You seem to be having very frightening thoughts." C. "Why do you think you are being lied about and poisoned?" D. "Who is lying about you and trying to poison you?" Mod 5 post quiz

B. "You seem to be having very frightening thoughts."

A nurse in an emergency department is assessing a client for suspected cocaine intoxication. Which of the following findings should the nurse expect? A. Nystagmus B. Dilated pupils C. Hypersomnia D. Depression Mod 4 post quiz

B. Dilated pupils

A nurse is caring for a client who has major depressive disorder and was prescribed citalopram 2 weeks ago with a planned dosage increase 1 week ago. The client reports having an improved appetite, but still feels very depressed and is still having trouble sleeping. Which of the following actions should the nurse take? A. Speak to the provider about adding an MAOI to the current medication regimen. B. Explain that antidepressants often take several weeks to be fully effective. C. Tell the client that the provider will need to change citalopram to a different medication. D. Recommend a sleep study be done on the client Mod 6 post quiz

B. Explain that antidepressants often take several weeks to be fully effective.

A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following findings should the nurse expect? (Select All That Apply) A. History of gradual memory loss B. Family report of personality changes C. Hallucinations D. Unaltered level of consciousness E. Restlessness ATI Ch 17 Application Exercises

B. Family report of personality changes C. Hallucinations E. Restlessness

A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following is an expected finding? (Select all that apply.) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness ATI Ch 18 Application Exercises

B. Fine tremors of both hands D. Vomiting E. Restlessness

A nurse in an emergency department is assessing a client who has been taking haloperidol for 3 months. The client has a temperature of 39.5° C (103.4° F), blood pressure of 150/110 mm Hg, and muscle rigidity. Which of the following complications should the nurse suspect? A. Agranulocytosis B. Neuroleptic malignant syndrome C. Akathisia D. Tardive dyskinesia Mod 5 post quiz

B. Neuroleptic malignant syndrome

A nurse is collecting a health history on a client who has a diagnosis of Wernicke-Korsakoff syndrome. Which of the following is an expected finding? A. Family history of Alzheimer's disease. B. Personal history of alcohol use disorder. C. Undergoing current treatment for HIV. D. Current rehabilitation for opiate addiction Mod 4 post quiz

B. Personal history of alcohol use disorder.

A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? (Select all that apply.) A. Urinary retention and constipation B. Tongue thrusting and lip smacking C. Fine hand tremors and pill rolling D. Facial grimacing and eye blinking E. Involuntary pelvic rocking and hip thrusting movements Mod 5 post quiz

B. Tongue thrusting and lip smacking D. Facial grimacing and eye blinking E. Involuntary pelvic rocking and hip thrusting movements

A nurse is teaching about electroconvulsive therapy (ECT) with a newly licensed nurse. The nurse should identify that the newly licensed nurse understands the teaching when she states that ECT treats which of the following disorders? A. Narcotic addiction B. Vegetative depression C. Personality disorder D. Eating disorder Mod 5 post quiz

B. Vegetative depression

A nurse is planning care for a client newly admitted with major depressive disorder. Which of the following actions should the nurse plan to take? A. Ask the client to create her own schedule of daily activities. B. Teach the client to use passive communication when interacting with others. C. Determine the client's need for assistance with grooming. D. Limit the client's involvement in unit activities. Mod 6 post quiz

C. Determine the client's need for assistance with grooming.

A nurse is conducting a group therapy session for several clients. The group is laughing at a joke one of the clients told, when a client who is schizophrenic jumps up and runs out of the room yelling, "You are all making fun of me!" The nurse should identify this behavior as which of the following characteristics of schizophrenia? A. Magical thinking B. Delusions of grandeur C. Ideas of reference D. Looseness of association Mod 5 post quiz

C. Ideas of reference

A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication? A. Thyroid function tests should be performed every 6 months. B. A pretreatment electroencephalogram (EEG) will be done. C. Liver function tests must be monitored. D. High serum sodium levels can cause toxic levels of valproate. Mod 6 post quiz

C. Liver function tests must be monitored.

believes that they are all powerful and important, like a god ATI Ch 15

Delusion of grandeur

A nurse is caring for a client who has major depressive disorder and attempted suicide. The client tells the nurse, "I should have died because I am totally worthless." Which of the following responses should the nurse make? A. "You have a great deal to live for." B. "It's not unusual for depressed people to feel that way." C. "Why do you feel you are worthless?" D. "You've been feeling that your life has no meaning." Mod 6 post quiz

D. "You've been feeling that your life has no meaning."

A community health nurse is providing teaching to the family of a client who has primary dementia. Which of the following manifestations should the nurse tell the family to expect? A. Decreased auditory and visual acuity B. Decreased display of emotions C. Personality traits that are opposite of original traits D. Forgetfulness gradually progressing to disorientation Mod 4 post quiz

D. Forgetfulness gradually progressing to disorientation

A nurse in a long term care facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following statements should the nurse make? A. You have forgotten that this is your home. B. You cannot go outside without a staff member. C. Why would you want to leave? Aren't you happy with your care? D. I am your nurse. Let's walk together to your room. ATI Ch 17 Application Exercises

D. I am your nurse. Let's walk together to your room.

A nurse on a long-term care unit is creating a plan of care for a client who has Alzheimer's disease. Which of the following interventions should the nurse include in the plan? A. Rotate assignment of daily caregivers. B. Provide an activity schedule that changes from day to day. C. Limit time for the client to perform activities. D. Talk the client through tasks one step at a time. Mod 4 post quiz

D. Talk the client through tasks one step at a time.

Signs & Symptoms of Stimulant Intoxication Mod 4 Lesson Content

Elation Euphoria Sensitive, anxious, tense, hypervigilant and angry Psychotic and aggressive

Signs & Symptoms of Stimulant Withdrawal Mod 4 Lesson Content

In the initial phase, the individual feels agitated and anxious with intense cravings for the drug. Following the initial phase, the individual feels depressed and lethargic. It is often called "crashing."

Name this stage of Alzheimer's *Forgetfulness/Very Mild Changes* - Losses in short term memory are frequent. The individual begins to lose things or forget names of people. - The individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed, which in turn may worsen the symptoms. - Maintaining organization with lists and a structured routine provides some compensation. - These symptoms often are not noticed by others and do not interfere with the individual's ability to work or live independently. Mod 4 Lesson Content Ch 22

Stage II

Name this stage of Alzheimer's *Mild cognitive decline* - In this stage, there is interference with performance, and this becomes noticeable to others. There is difficulty recalling names or words. A downturn is *noticeable to family and close associates.* - The individual may get lost when driving his or her car. - Concentration may be interrupted. There is difficulty recalling names or words, which becomes noticeable to family and close associates. - A decline occurs in the ability to plan or organize. Mod 4 Lesson Content Ch 22

Stage III

At what stage of Alzheimer's can meds be stopped since they are no longer effective? J.A. prerecorded lecture

Stage IV

Name this stage of Alzheimer's *Mild to Moderate cognitive decline* - The individual may forget significant events in history, experience a declining ability to perform tasks. He/she may deny a problem exists by covering memory loss with *confabulation*. - The individual may forget major events in personal history, such as his or her child's birthday; experience declining ability to perform tasks, such as shopping and managing personal finances; or be unable to understand current news events. - Depression and social withdrawal are common. At this stage, the individual requires some assistance to maintain safety. Mod 4 Lesson Content Ch 22

Stage IV

Name this stage of Alzheimer's *Moderate cognitive decline* - At this stage, individuals *lose the ability to independently perform some ADLs*, such as hygiene, dressing, and grooming, and require some assistance to manage these tasks on an ongoing basis. - They may forget addresses, phone numbers, and names of close relatives. - They may become disoriented about place and time, but they maintain knowledge about themselves. - Frustration, withdrawal, and self-absorption are common. Mod 4 Lesson Content Ch 22

Stage V

Name this stage of Alzheimer's *Moderate to severe cognitive decline* - Disorientation to surroundings is common and may not know the day, season, or year. - The person is also *unable to manage ADLs without assistance.* Urinary and fecal incontinence are common. - Psychomotor symptoms include wandering, agitation, and aggression. Symptoms seem to worsen in late afternoon and evening (*sundowning*). - At this stage, individuals may be unable to recall the name of their spouse or may misidentify people (e.g., thinking a child is their spouse). - Delusions often become apparent, such as maintaining the belief that one must go to work even though the person is no longer employed. - Sleeping becomes a problem. - Communication becomes more difficult, with increasing loss of language skills. Institutional care is usually required at this stage. Mod 4 Lesson Content Ch 22

Stage VI

________is a form of thought disturbance which occurs as pieces of sentences flocked together J.A. exam review

fragmentation it's very similar to flight of ideas

A client comes into the emergency department stating that he is "crashing" and feels like he'd "be better off dead." Which of these nursing interventions is a priority? a. Instruct the client not to worry; these are temporary signs of withdrawal and should go away in a few days. b. Request an order for amphetamines to ease the client's withdrawal symptoms. c. Assess the client's risk for suicide. d. Instruct the physician that the client may need naloxone. Ch 23 questions

c. Assess the client's risk for suicide.

A client is brought to the emergency department unconscious by a friend who says he was injecting heroin. The client is assessed to have a weak pulse. Which of these interventions are priorities? a. Administer naloxone and rescue breathing. b. IV benzodiazepines and continuous monitoring of vital signs. c. Ask the friend how much heroin he took and confirm with a laboratory drug screen. d. Initiate cardiopulmonary resuscitation and prepare to use an external defibrillator. Ch 23 questions

a. Administer naloxone and rescue breathing.

A client is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for several years. Laboratory reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink b. 2 to 3 days after the last drink c. 4 to 5 days after the last drink d. 6 to 7 days after the last drink Ch 23 questions

a. Several hours after the last drink

A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled. Ch 23

addiction

What structural changes in the body contribute to dementia? Mod 4 Lesson Content

an overabundance of plaques and tangles that no longer allow short-term and long-term memory to occur. They also effect problem solving and behavior.

A client, who has neurocognitive disorder due to Alzheimer's disease, says to the nurse, "I have a date tonight. I always have a date on Christmas." Which of the following is the most appropriate response? a. "Don't be silly. It's not Christmas, Mrs. G." b. "Today is Tuesday, October 21, Mrs. G. We will have supper soon, and then your daughter will come to visit." c. "Who is your date with, Mrs. G.?" d. "I think you need some more medication, Mrs. G. I'll bring it to you now." Ch 22 questions

b. "Today is Tuesday, October 21, Mrs. G. We will have supper soon, and then your daughter will come to visit."

A client with neurocognitive disease due to Alzheimer's disease is admitted to the hospital. Which of the following actions by the nurse is a priority? a. Ensuring that she receives food she likes to prevent hunger b. Ensuring that the environment is safe to prevent injury c. Ensuring that she meets the other patients to prevent social isolation d. Ensuring that she takes care of her own ADLs to prevent dependence Ch 22 questions

b. Ensuring that the environment is safe to prevent injury

The night nurse finds a client with Alzheimer's disease wandering the hallway at 4 a.m. and trying to open the door to the side yard. Which of the following is the best initial response by the nurse? a. "That door leads out to the patio. It's nighttime. You don't want to go outside now." b. "You look confused. What is bothering you?" c. "This is the patio door. Are you looking for the bathroom?" d. "Are you lonely? Perhaps you'd like to go back to your room and talk for a while." Ch 22 questions

c. "This is the patio door. Are you looking for the bathroom?"

Which of the following interventions is most appropriate in helping a client with Alzheimer's disease with ADLs? (Select all that apply.) a. Perform ADLs for her while she is in the hospital. b. Provide her with a written list of activities she is expected to perform. c. Assist her with step-by-step instructions. d. Tell her that if her morning care is not completed by 9 a.m., it will be performed for her by the nurse's aide so that she can attend group therapy. e. Encourage her and give her plenty of time to perform independently as many of her ADLs as possible. Ch 22 questions

c. Assist her with step-by-step instructions. e. Encourage her and give her plenty of time to perform independently as many of her ADLs as possible.

A client who has been admitted to intensive outpatient treatment for substance use disorder arrives for group therapy and appears groggy with constricted pupils. The client denies using substances. Which of the following would be the best intervention at this time? a. Ask the client to empty his pockets. b. Smell his breath for evidence of alcohol. c. Conduct a drug screen to assess for presence of opioids. d. Discharge the client for failure to comply with treatment expectations. Ch 23 questions

c. Conduct a drug screen to assess for presence of opioids.

Symptoms of alcohol withdrawal include: a. Euphoria, hyperactivity, and insomnia. b. Depression, suicidal ideation, and hypersomnia. c. Diaphoresis, nausea and vomiting, and tremors. d. Unsteady gait, nystagmus, and profound disorientation. Ch 23 questions

c. Diaphoresis, nausea and vomiting, and tremors.

Signs & Symptoms of Alcohol Withdrawal Ch 23

coarse tremor of hands, tongue, or eyelids nausea or vomiting malaise or weakness tachycardia sweating elevated blood pressure anxiety depressed mood or irritability transient hallucinations or illusions headache insomnia

the creation of stories or answers in place of actual events to maintain self-esteem ATI Ch 15

confabulation

A client admitted to the inpatient detoxification program for alcohol withdrawal approaches the nurse complaining of nausea and feeling shaky. The nurse notices that the client has hand tremors and appears diaphoretic. Which of these nursing interventions is a priority? a. Check the client's temperature. b. Send a urine sample to the laboratory for a random drug screen. c. Ask the client if there is anything that he is particularly stressed about. d. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms. Ch 23 questions

d. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms.

A client who has NCD due to Alzheimer's disease has trouble sleeping and wanders around at night. Which of the following nursing actions would be best to promote sleep in this client? a. Ask the doctor to prescribe flurazepam (Dalmane). b. Ensure that the client gets an afternoon nap so she will not be overtired at bedtime. c. Make the client a cup of tea with honey before bedtime. d. Ensure that the client gets regular physical exercise during the day. Ch 22 questions

d. Ensure that the client gets regular physical exercise during the day.

false personal beliefs not consistent with a person's intelligence or cultural background. The individual continues to have the belief in spite of obvious proof that it is false and/or irrational Ch 24

delusion

believes that their partner is sexually involved with another individual even though there is not any factual basis for this belief ATI Ch 15

delusion of jealousy

feels singled out for harm by others (i.e. being hunted down by the FBI) ATI Ch 15

delusion of persecution

____________is a mental disorder involving a functional decline in multiple cognitive areas, including memory, along with behavioral and psychological symptoms Mod 4 Lesson Content

dementia

the client repeats words spoken to him ATI Ch 15

echoalia

A state of disturbance in cognition, perception, behavior, level of consciousness, judgment, and other functions that is directly attributable to the effects of a psychoactive drug. It may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor. Ch 23

intoxication

believes their actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes them invisible to others ATI Ch 15

magical thinking

Make-up words that have meaning only to the client ATI Ch 15

neologism

Signs & Symptoms of Opioid Intoxication Mod 4 Lesson Content

psychomotor retardation drowsiness slurred speech altered mood impaired memory and attention bradycardia hypotension hypothermia meiosis (pinpoint pupils) intense drowsiness coma "everything is LOW"

Signs & Symptoms of Opioid Withdrawal (6-8 hrs after last dose) Mod 4 Lesson Content

tachycardia rhinorrhea (runny nose) muscle spasms bone and muscle pain anxiety abdominal cramps vomiting & diarrhea hypertension hypothermia mydriasis (enlarged pupils) diaphoresis increased respiratory rate

sudden cessation of a thought in the middle of a sentence; they truly cannot finish the thought and they become extremely agitated as well as fearful J.A. prerecorded lecture

thought blocking

The need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose. Ch 23

tolerance

The physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Ch 23

withdrawal

words jumbled together with little meaning or significance to the listener ATI Ch 15

word salad