MH Exam 4

Manifestations of serotonin syndrome

Diaphoresis Shivering Diarrhea Muscle Rigidity Fever Seizures (Death if not treated) Hallucinations Agitation

Nursing interventions for children experiencing factitious disorder

Encourage visiting in groups of 2-3, never 1:1​ Interact with the client frequently during visiting hours​ Nursing interventions are aimed at protecting the victim. ​ Keep a detailed record of visitations and untoward events

812. The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on those observations, which is the nurse's immediate priority of care? 1. Provide safety for the client and other clients on the unit 2. Provide the clients on the unit with a sense of comfort and safety 3. Assist the staff in caring for the client in a controlled environment 4. Offer the client a less stimulating area in which to calm down and gain control.

1. Safety of all clients is the immediate priority

Nursing interventions and communication for clients with anxiety

Mild: Keep room dimly lit and a peaceful milieu, listen attentively to client​ Moderate: Present information again in a calm manner using simple language​ - Encourage client to share feelings and concerns. Concerns stated aloud become less overwhelming and help problem solving begin, ask clarifying questions but avoid "why" questions​ Severe: Safety, pharmacological interventions, be directive, decrease stimuli, lower the client's current anxiety before teaching alternative coping skills

Priority nursing interventions when providing care for clients exhibiting anger

Provide a safe environment for all clients and staff assess for triggers or preconditions that escalate client emotions Self assessment-self awareness

Handling aggressive behavior

Safety first​ Remain calm and therapeutic​ Avoid accusatory or threatening statements​ Have other team members available ​ Set limits

815. The nurse is caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention should the nurse include? 1. Increase socialization of the client with peers. 2. Avoid using a whisper voice in front of the client 3. Begin to educate the client about social supports in the community 4. Have the client sign a release of information to appropriate parties for assessment purposes

2. Disturbed thought process r/t paranoid personality disorder is client problem and plan of care must address it; client is distrustful and suspicious, member of healthcare team need to est. rapport and trust Incorrect: Laughing/whispering in front of client would be counterproductive; other options ask client to trust on a multitude of levels and are too intrusive

814. The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? 1. Ask direct questions to encourage talking 2. Leave the client alone so as to minimize external stimuli 3. Sit beside the client in silence with simple open-ended questions 4. Take the client into the dayroom with other clients to provide stimulation

3. Clients who are withdrawn may be immobile and mute and may require consistent, repeated approaches; communication w/ withdrawn clients requires much patience from nurse; interventions include establishment of interpersonal contact; nurse facilitates communication w/ client by sitting in silence, asking simple open-ended questions rather than direct questions, and pausing to provide opportunities for client to respond Incorrect: Overstimulation is not appropriate; no ther. value in ignoring client; client's safety is not responsibility of other clients

809. A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition? 1. Psychosis 2. Repression 3. Conversion disorder 4. Dissociative disorder

3. Conversion disorder = alteration/loss of physical fx that can't be explained by any known pathophysiological mechanism; thought to be expression of psychological need or conflict Incorrect: psychosis = state where person's mental capacity to recognize reality, communicate, and relate to others is impaired, interfering w/ person's ability to deal w/ life's demands; repression = coping mechanism where unacceptable feelings are kept out of awareness; dissociate = disturbance/alteration in normal integrative fx of identity, memory, or consciousness

805. A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? 1. Encouraging quiet reading and writing for the first few days 2. Identification of physical activity that will provide exercise 3. No socializing activities until the client asks to participate in milieu 4. A structured program of activities in which the client can participate

4. Client w/ depression is often withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. Care needs to provide successful experiences in a stimulating yet structured environment. Incorrect: Other options are too restrictive or offer little or no structure/stimulation

A nurse is assessing a client who has illness anxiety disorder. Which of the following are expected for this disorder? SATA a. Obsessive thoughts about disease b. Hx of childhood abuse c. Avoidance of HCP d. Depressive disorder e. Narcissistic personality

a, b, c, d Incorrect: e. Low self-esteem is expected finding

A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? SATA a. Hypothermia b. hallucinations c. muscular flaccidity d. diaphoresis e. agitation

b, d, e Incorrect: a. fever is indication c. muscle tremors are indication

A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? a. Narcissistic behavior b. Fear of rejection from staff c. Attempt to reduce anxiety d. Adverse effect of antidepressant medication

c. Incorrect: a. narcissism causes clients to seek admiration from others b. Fear of rejection may cause client to avoid social d. clients may take antidepressants to help control repetitive behavior

MAOIs

(Isocarboxazid/Marplan, Phenelzine/Nardil, Selegiline/Emsam and Tranylcypromine/Parnate and SSRIs (Prozac/fluoxetine, Lexapro/escitalopram, Celexa/citalopram, Zoloft/sertraline, Paxil/paroxetine)​ Cannot be given together as can result in hypertensive crisis and death​ MAOIs can cause dangerous interactions with certain foods and beverages. (tyramine = HTN crisis, explosive occipital HA)

807. A client is unwilling to go to his church because his ex-girlfriend goes there and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? 1. avoidant 2. Borderline 3. Schizotypal 4. Obsessive-compulsive

1. Avoidant personality disorder = social withdrawal and extreme sensitivity to potential rejection; person retreats to social isolation. Incorrect: borderline = unstable mood and self-image, impulsive and unpredictable behavior; schizotypal = display of abnormal thoughts, perceptions, speech, and behaviors; OCD = perfectionism, need to control others, devotion to work

806. When planning discharge of a client with chronic anxiety, which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continuing contact with a crisis counselor 4. Eliminating all anxiety from daily situations

2. recognizing situations that produce anxiety allows client to prepare to cope or avoid specific stimulus Incorrect: Counselors will not be available for all anxiety-producing situations and this option does not encourage development of internal strengths; suppressing feelings will not resolve; elimination of all anxiety is impossible

Behavioral s/s of pre-assaultive stage

Client begins to become angry Exhibits inc anxiety, tension, hyperactivity, and verbal abuse

Interventions for bruxism

Concurrent administration of buspirone Changing to a different class of antidepressant medication Use of a mouth guard

depersonalization/derealization disorder

A response to stress. Characterized by a temporary change in awareness. s/s include depersonalization, de-realization, or both.​ ​ De-realization - the feeling of being outside an event​ De-personalization - a feeling detachment where a person is observing one's self from outside their body

When teaching about the tricyclic group of ​antidepressant medications, which information should the nurse include? A. Strong or aged cheese should not be eaten while taking this group of medications.​ B. The full therapeutic potential of tricyclics may not be reached for 4 weeks.​ C. Long-term use may result in physical dependence.​ D. Tricyclics should not be given with anti-anxiety agents.

B A client needs to be advised that it may take several weeks for tricyclic medications to reach their full therapeutic effect and for relief of symptoms to be noted.

A client has been diagnosed with major ​depression. The psychiatrist prescribes Paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching? A. Do not eat chocolate while taking this medication.​ B. The medication may cause priapism.​ C. The medication should not be discontinued abruptly.​ D. The medication may cause photosensitivity.

C Antidepressants such as paroxetine must be tapered and not stopped abruptly. All classifications of antidepressants have varying potentials to cause discontinuation syndromes. Abrupt withdrawal from S S R I's, such as paroxetine, may result in dizziness, lethargy, headache, and nausea.

dissociative identity disorder (DID)

Client displays more than one distinct personality. A stressful event usually precipitates the change from one personality to another. (The stressful event is based on the perception of the client.)

Conversion disorder vs. hypochondriasis

Conversion disorder: the client's anxiety is relieved through physical symptoms​ ​ A loss of, or change, in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. Hypochondriasis: Similar to conversion disorder, but accompanied by preoccupation with thoughts about having a serious illness​ ​ Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease.

An individual experienced the death of a parent 2 years ago. This individual has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes this individual's problem? A. Post-trauma syndrome related to parent's death​ B. Anxiety (severe) related to parent's death​ C. Coping, ineffective related to parent's death​ D. Grieving, complicated related to parent's death

D The excessive reactions the individual continues to exhibit, such as daily crying, inability to return to work, and inability to look at parent's belongings after a 2-year period, are indicative of dysfunctional or complicated grieving. This individual's grieving response has arrested in the anger stage, is being turned inward on the self, and is manifested by symptoms of depression.

Physiological conditions manifesting as depression

Depressive symptoms that occur as a consequence of a non-mood disorder or as an AE of certain meds are called secondary depression; may be r/t med SE, neurological disorders, electrolyte/hormonal disturbances, nutritional deficiencies, other physiological/psychological conditions

Differentiate between dissociative amnesia and dissociative fugue

Dissociative Fugue - Usually follows a traumatic event. Client travels to a new area and is unable to remember one's own identity or at least some of one's past. Can last weeks to months. Dissociative Amnesia - Inability to recall personal information related to traumatic or stressful events. Lack of memory of name, birthday or lifetime.​ *Nursing Intervention - Use simple short sentences and keep the environment calm and protective.*

Client teaching for ECT

Explain to the client if asked that ECT is typically used to treat clients who have not responded to antidepressant therapy and that side effects may include headache and some confusion or memory loss.

etiology for clients experiencing factitious disorder by proxy.

Factitious Disorder Imposed by Another is when the client deliberately imposes harm on another.

Common characteristics of depression in adults

Hopeless outlook​ Inability to think and or concentrate​ Loss of interest in activities that use to be enjoyable​ Inability to feel pleasure​ Increased fatigue and sleep problems​ anxiety​ Irritability​ Changes in appetite and weight Uncontrollable emotions​ Looking at/thinking about death​ Behaviors last for weeks​ May have to insist they get out of bed, shower and join activities

Common behaviors exhibited by clients with anxiety

Irritability​ Muscle tension​ Easily fatigued​ Sleep disturbances​ Restless or "keyed up" feeling​ Difficulty concentrating or mind "going blank"​ Chronic, unrealistic, excessive anxiety and worry​ The client believes they have no control over their circumstances

Discharge teaching for lithium

Less salt can make lithium levels rise. More salt can cause them to fall. Less Caffeine can cause lithium levels to rise. More caffeine can cause them to fall. Alcoholic beverages can have a negative effect on lithium consumption. Avoid NSAIDS (Ibuprofen, Naproxen) as they can increase lithium levels. Regular aspirin is a better choice than Ibuprofen for clients taking lithium. Diuretics (Heart Failure clients) can cause increased lithium levels (dehydration) Clients must limit aerobic activity in HOT weather (dehydration)

Characteristics of PMDD

Pain areas: in the breast, muscles, or pelvis Mood: mood swings, sadness, anger, anxiety, hopelessness, or panic attack Sleep: excess sleepiness or insomnia Behavioral: irritability or crying Also common: appetite changes, bloating, depression, diminished interest in usual activities, economic or social dysfunction due to symptoms, fatigue, feeling overwhelmed, food craving, headache, increased sensitivity to rejection, lack of concentration, self-critical thoughts, water retention, or weight gain

SSRIs (including client teaching)

Prozac/fluoxetine, Lexapro/escitalopram, Zoloft/sertraline, Paxil/paroxetine)​ May interfere with sleep and should be taken in the morning to avoid insomnia​ Teach the client the time of administration of the medications

Tx modalities for anxiety

Response Prevention - The prevention of the client from performing compulsive behaviors​ - Modeling - Allows the client to see a demonstration of healthy behavior in stressful situations​ Cognitive Therapy - Cognitive restructuring is the intentional reframing of thoughts to match reality​ Flooding - Exposing the client to a great deal of an undesirable stimulus (Used with client who have phobias)​ Relaxation techniques - Used to control pain and minimize tension and fear (breathing, music, art, slow stretching)​ Desensitization - Exposing the client to a small amount of an undesirable stimulus (Used with client who have phobias)​ Thought Stopping - Teaches a client to say "Stop" when a negative or compulsive thought arises, and substitute it with a positive thought.

Nursing care/interventions for depressed client

Risk for suicide​: Be direct.​ Maintain close observation at irregular intervals.​ Encouraging verbalizations of honest feelings.​ Suicide risk may increase during treatment with antidepressants. As energy returns there may be in increased ability to act out self-destructive behaviors.​ If client suddenly becomes cheerful and relaxed, monitor their whereabouts at all times.​ Previous attempts = more likely to try again​ Place on suicide precautions with 15 minute observation Complicated grieving:​ Develop a trusting relationship with the client.​ Encourage the client to express emotions.​ Communicate that crying is acceptable. Powerlessness​: Encourage the client to take responsibility.​ Help the client set goals.​ Help the client identify areas of his or her life that they can and cannot control.

Discharge teaching for Haldol

Side effects requiring immediate attention include: Difficulty speaking or swallowing Inability to move the eyes Loss of balance Mask-like face Muscle spasms, especially of the neck and back Restlessness or need to keep moving Stiffness of arms and legs Trembling and shaking of fingers and hands Twisting movements of the body

Normal and abnormal lithium levels

Ther. Range: 0.6-1.2 Acute: 0.5-1.5 Toxicity can occur at 1.5 or greater; should not exceed 2.0

Common behaviors practiced by clients to relieve anxiety

Trichotillomania - hair pulling that is impulsive and preceded by anxiety ​ ​ ​ Hording Disorder - persistent difficulty discarding or parting with possessions​ ​ ​ Body Dysmorphic Disorder - the exaggerated belief that the body is deformed Repetitive behaviors may include handwashing, touching an object, like a door knob, repeatedly, counting, or repeating words silently

3.The goal of cognitive therapy with depressed clients is to: a. Identify and change dysfunctional patterns of thinking b. Resolve the symptoms and initiate or restore adaptive family functioning c. Alter the neurotransmitters that are creating the depressed mood d. Provide feedback from peers who are having similar experiences

a

7.A patient with depression asks the nurse, "Why would they be checking my thyroid fx when I clearly have depression and I'm not overweight?" Which of these is an accurate response? a. An underactive thyroid gland can manifest as depression b. Depression has been proven to be a hormonal illness c. Thyroid hormone replacement is a first-lien tx for most people with depression d. Abnormal thyroid fx predicts positive response to antidepressant medication

a

A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder? a. Death of a child 2 months ago b. Recent weight loss of 30 lb c. Retirement 1 yr ago d. Hx of migraine HA

a Acute stressor that places client at risk for conversion disorder Incorrect c. PTSD can be a risk factor d. Hx of depression can be a risk factor

6.A patient has just been admitted to the psychiatric unit with a diagnosis of MDD. Which of the following manifestations may be apparent in a patient with this diagnosis? SATA a. Slumped posture b. Delusional thinking c. feelings of despair d. feels best early in the morning and worse as the day progresses e. anorexia

a, b, c, e

10.Shondra is admitted to the hospital with MDD and repeatedly makes neg statements about herself. Which of the following interventions is identified as an approach that promotes self-esteem in the pt? SATA a. Teach assertive communication skills b. Make observations to Shondra when she completes a goal or task c. Instruct Shondra that you will not talk with her unless she stops talking neg about herself d. Offer to spend time with Shondra using a nonjudgemental, accepting approach.

a, b, d

5.A patient expresses interest in alternative tx for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the patient? SATA a. It's demonstrated effectiveness comparable to antidepressants b. Should be used regularly until season changes c. Should only be used when ECT has proven to be ineffective d. Side effects such as HA, nausea, or agitation, when they occur are usually mild and transient e. Can cause sedation so best time to use it is before bed

a, b, d

A nurse is caring for a client who takes paroxetine to tx PTSD. The client states, "I grind my teeth during the night, which causes pain in my mouth." The nurse should identify which of the following measures to manage the client's bruxism? SATA a. concurrent admin of buspirone b. admin of a different SSRI c. use of a mouth guard d. changing to a different class of antianxiety med e. inc dose of paroxetine

a, c, d Low dose buspirone, mouth guard to dec risk for oral damage Incorrect: b. other SSRIs will also have bruxism as adverse effect e. inc dose can cause adverse effect to worsen

11. Demitrius informs the nurse that his dr is considering ECT and asks for some information about the procedure. Which of the following are accurate statements that the nurse can share with this patient? SATA a. ECT is typically used to tx pts who have not responded to antidepressants b. A long-acting anesthetic agent is given the morning of the tx c. One tx is usually all that is needed to relieve depression d. Side effects may include HA and some confusion or memory loss

a, d

A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? SATA a. excessive worry for 6 months b. impulsive decision making c. delayed reflexes d. restlessness e. sleep disturbance

a, d, e Characterized by uncontrollable excessive worry for 6 m, restlessness, inability to fall asleep Incorrect: b. procrastination is common c. muscle tension is common

A nurse is caring for a client who has GAD and is experiencing severe anxiety. Which of the following statements actions should the nurse make? a. Tell me about how you are feeling right now. b. You should focus on the positive things in your life to decrease your anxiety c. Why do you beleive you are experiencing this anxiety? d. Let's discuss the meds your provider is prescribing to dec you anxiety

a. Asking open-ended question is ther. and assists in ID anxiety Incorrect: b. Offering advice = nonther. and can hinder further comm. c. Asking why is nonther. and can cause defensiveness d. postpone health teaching until acute anxiety subsides, unable to concentrate or learn

A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first? a. Assess the client's risk for self-harm b.Instill hope for positive outcomes c. Encourage the client to participate in group therapy sessions d. Assist the client to participate in treatment decisions

a. Greatest risk is self-harm or suicide Incorrect: b, c, d. Instill hope w/o positive reassurance, encourage group to address social impairments that result, encourage participation in tx but take a first

A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? a. stop screaming, and walk with me outside. b. Why are you so angry and screaming at everyone? c. You will not get your way by screaming. d. What was going through your mind when you started screaming?

a. Setting limits and use of physical activity to deescalate anger is appropriate Incorrect: b. Why questions imply criticism and can make client defensive c. close-ended, non therapeutic statement d. client is not ready to discuss this issue

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

a. greatest risk is injury due to self-harm Incorrect: These are all correct but don't address the priority

Rx meds used to treat somatic symptom disorders

antidepressants and anxiolytics

2.The physician orders sertraline (Zoloft) 50 mg PO BID for Margaret, a 60 yr old woman with MDD. After 3 days of taking the med, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a. Cheer up, Margaret. you have so much to be happy about. b. Sometimes it take 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 in the dayroom?

b

9. An acutely depressed pt isolates herself in her room and just sits and stares into space. Which of theses is the best example of an active communication approach with this pt? 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 would you stay in your room all the time?

b

A nurse is discussing the factors for somatic symptom disorder with a newly licensed nurse. Which of the following risk factors should the nurse include? SATA a. Age older than 65 yr b. anxiety disorder c. Childhood trauma D. coronary artery disease e. Obesity

b, c Incorrect: a. Age 16-25 yr is a risk factor

A nurse is 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. hx of chronic bronchitis c. recent death in client's family d. family hx of depression e. personal hx of panic disorder

b, c, d, e More common with a chronic illness; high amount of stress, family hx, hx of personality disorder or anxiety increase risk Incorrect: a. females are twice as likely

A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? SATA a. lethargy b. defensive responses to questions c. disorientation d. facial grimacing e. agitation

b, d, e Incorrect: a. lethargy is more common in depression c. disorientation more common with cognitive disorder

A nurse working in an emergency dept. is caring for a client who has benzodiazepine toxicity. Which of the following action sis the nurse's priority? a. Administer flumazenil b. ID level of orientation c. Infuse IV fluids d. Prepare client for gastric lavage

b. Always assess first Incorrect a, c, d. All correct actions but not priority; admin flumazenil to reverse effects, infuse IV fluids to maintain BP, gastric lavage will remove excess med from GI system

A nurse is caring for a client who is speaking in a loud voice with clenched fists. which of the following actions should the nurse take? a. Insist that the client stop yelling. b. Request that other staff members remain close by c. Move as close to the client as possible d. Walk away from the client

b. To assist if necessary Incorrect: a. Don't make demands of the client c. angry clients need large personal space d. never walk away from a client who is angry, it is the nurses responsibility to intervene

Risk factors for development of somatic symptom disorder

biochemical, genetic, learning theory, family dynamics, psychodynamic

1. Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be: a. imbalanced nutrition; less than body requirements b. complicated grieving c. risk for suicide d. social isolation

c

8. A patient whose husband died 6 m ago is dx with MDD. 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 star 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 process d. Just think about the good times that you had

c

A nurse is caring for a client who is to begin taking fluoxetine for tx of panic disorder. Which of the following statements indicates the client understands the use of the med? a. I will take the med at bedtime b. I will follow a low-sodium diet while taking this med c. I will need to discontinue this med slowly d. I will be at risk for weight loss with long-term use of this med

c. Client should taper med to reduce risk of withdrawal syndrome Incorrect: a. take in morning to min sleep disturbance b. at risk for hyponatremia d. at risk for weight gain

A nurse is counseling several clients. Which of the following client statements should the nurse identify as expected for factitious disorder imposed on another? a. I had to pretend I was injured in order to get disability benefits b. I know that my abdominal pain is cause by a malignant tumor. c. I needed to make my child sick so that someone else would take care of them for a while d. I became deaf when I heard that my partner was having an affaire with my best friend.

c. Client w/ factitious disorder imposed on another often consciously injures another or causes them to be sick due to a personal need for attention or relief of responsibility Incorrect a. Falsification of illness/injury for personal gain is malingering b. expected with illness anxiety disorder d. Developing a sensory impairment due to an acute stressor = conversion disorder

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

c. Incorrect: a. associated with bipolar b. associated with MDD d. decreased sense of self-esteem is associated with persistent depressive disorder

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

c. Clinical finding of PMDD is emotional lability Incorrect: a. clinical findings are present during the luteal phase of the menstrual cycle just prior to menses b. Aerobic and other exercise are effective treatments d. PMDD inc risk for weight gain due to overeating

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 6-12 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

c. at greatest risk of suicide during acute phase Incorrect: a. focus of continuation phase is relapse; tx of manifestations occurs during acute phase b. maintenance phase can last for 1 year or more d. these are used during continuation phase to prevent relapse

A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? a. Encourage the client to express feelings out loud. b. Maintain eye contact with the client c. move the client away from others d. tell the client that the behavior is not acceptable

c. this behavior indicates the client is at greatest risk for harming others Incorrect: The other options are correct but not priority

Examples of Benzos

chlordiazepoxide (Librium) clonazepam (Klonopin) diazepam (Valium) lorazepam (Ativan) alprazolam (Xanax)

Examples of SSRIs

citalopram (Celexa) escitalopram (Lexapro) fluoxetine (Prozac) sertraline (Zoloft) paroxetine (Paxil)

SSRIs safe during pregnancy

citalopram (Celexa) sertraline (Zoloft) fluoxetine (Prozac)

4.Education for the patient who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity b. Lifetime of continuous use, possible tardive dyskinesia, advantages of injection every 2-4 weeks c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of tx d. Tyramine-restricted diet, prohibitive concurrent use of OTC meds w/o physician notification

d

A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? a. encourage the client to spend time alone in their room. b. Monitor the client for self-harm once per day c. Allow the client unlimited time to discuss physical manifestations d. Discuss alternative coping strategies with the client

d. Incorrect b. continuously monitor c. Est. time limit for discussion of physical manifestations

A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? a. 3-6 wk of tx is req. to achieve ther. benefit b. combining alcohol w/ alprazolam will produce a paradoxical response c. alprazolam has a lower risk for dependence than other anti-anxiety meds d. report confusion as a potential indication of toxicity

d. Incorrect: a. buspirone req. 3-6 weeks to achieve therapeutic benefit b. combining alcohol can produce CNS/resp. depression c. preferred for short-term tx bc of inc risk of dependence

A nurse is caring for a client who is experiencing a panic attack. which of the following actions should the nurse take? a. Discuss new relation techniques b. Show the client how to change the behavior c. Distract the client with a television show d. Stay with the client and remain quiet

d. Promotes safety and reassurance w/o additional stimuli Incorrect: a, b. client is unable to concentrate on learning new info c. avoid further stimuli, can inc anxiety

A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? a. I wish you would not make me angry. b. I feel angry when you leave me. c. It makes me angry when you interrupt me. d. You'd better listen to me

d. This statement implies threat and lack of respect for another person Incorrect: a,b,c do not imply threat or lack of respect

Common characteristics of depression in teens

hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping and eating disturbances, social isolation, delusional thinking, and suicidal thoughts/actions inappropriately expressed anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, and apathy, loss of self-esteem Best indicator: behavioral change that lasts for several weeks

Dx criteria for MDD

≥5 symptoms during the same two week period that are a change from previous functioning; depressed mood and/or loss of interest/pleasure must be present: depressed mood loss of interest/pleasure weight loss/gain insomnia/hypersomnia psychomotor agitation/retardation fatigue feelings of worthlessness or excessive/inappropriate guilt dec concentration thoughts of death/suicide Must have all four of the following as well: Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning Episode not attributable to physiological effects of a substance or another medical condition Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders No history of manic or hypomanic episode